Severely impaired nutritional status in patients with locally advanced pancreatic cancer

Abstract

Rationale: Although malnutrition is frequently described in patients with locally advanced pancreatic cancer (LAPC), little quantitative data is available on the nutritional status and gastrointestinal functioning of these patients. Method(s): Patients with LAPC included for experimental treatment by Irreversible Electroporation (IRE) were included. Weight loss in the past 6 months (kg), body mass index (BMI), nutritional intake (4-d diary), fat free mass index (FFMI), handgrip strength, resting energy expenditure by indirect calorimetry (REE) and gastro intestinal functioning measured by intestinal absorption capacity of energy and macronutrients (3-d faeces collection and bomb calorimetry) and exocrine pancreatic function by faecal elastase-1 (FE1) were measured before IRE. Result(s): Sixteen patients (50% male; mean age 60.3+/-9.5 y) were included. Median weight loss over the past 6 months amounted 10.1 kg [IQR 4.8-14.3], mean BMI was 23.9+/-2.5 kg/m2. Energy and protein intake were 27+/-10 kcal/kg and 1.1 g/kg [IQR 0.8-1.5] respectively. In 7 patients the FFMI and in 8 patients the handgrip strength was Median REE as % of predicted REE by the Harris & Benedict equation was 132% [IQR 114-142]. Malabsorption (<85%) of energy, fat and protein was observed in respectively 9 (range 21-96%), 8 (range 7-97%) and 12 (range 16-100%) patients. Median energy loss was 336 [IQR 205-1153] kcal/day. Exocrine pancreatic function was severely impaired (FE1 <100 mg/g) in 11 patients. Conclusion(s): Despite an apparently sufficient nutritional intake, patients with LAPC have a severely impaired nutritional status, most likely as a result of an increased resting energy expenditure and decreased absorption capacity of energy and macronutrients.