TY - JOUR

T1 - Energy expenditure and loss of muscle and fat mass in patients with walled-off pancreatic necrosis

T2 - A prospective study

AU - Naver, Astrid Vinsand

AU - Grandt, Juliana Josephine Vivian

AU - Rysgaard, Sisse

AU - Schmidt, Palle Nordblad

AU - Nøjgaard, Camilla

AU - Møller, Søren

AU - Novovic, Srdan

AU - Gluud, Lise Lotte

PY - 2020/1

Y1 - 2020/1

N2 - Objective: Ensuring adequate nutritional support in patients with walled-off pancreatic necrosis (WON) is challenging and weight loss is often considerable. The aim of this study was to evaluate resting energy expenditure (REE) and body composition in patients with WON. Methods: We prospectively included 18 patients (67% men; median age 63 y; 44% gallstones; 39% alcohol) with WON undergoing endoscopic transgastric drainage and necrosectomy. Patients were followed for 4 wk after admission. We assessed hand-grip strength, REE using indirect calorimetry, and body composition with dual-energy x-ray absorptiometry to assess the percentage change in muscle mass (MM) and fat mass (FM). Data are summarized using medians (range). Results: At baseline, the median body mass index was 27.9 kg/m2 (17.7–35.6 kg/m2). Fifteen patients (83%) had infected WON. Eight patients (44%) received total or supplemental parenteral nutrition. The median percentage loss in MM was 0.31% and FM was 6.2%. The median REE was 6870 kJ (3255–8870 kJ) at baseline. Compared with the predicted REE, the measured REE was 1049 kJ higher (–3065 to 2126 kJ) at baseline and –951 kJ lower (–2600 to 3202 kJ) at 4 wk. The difference between the predicted and measured REE at baseline was correlated with the percentage loss in MM (P = 0.043) and FM (P = 0.026). Additionally, patients with infected WON had significantly higher REE (P = 0.003). Conclusion: In patients with WON, an increased REE appears to predict increased muscle and fat loss. Additional studies are necessary to evaluate if REE may be used to improve nutritional support.

AB - Objective: Ensuring adequate nutritional support in patients with walled-off pancreatic necrosis (WON) is challenging and weight loss is often considerable. The aim of this study was to evaluate resting energy expenditure (REE) and body composition in patients with WON. Methods: We prospectively included 18 patients (67% men; median age 63 y; 44% gallstones; 39% alcohol) with WON undergoing endoscopic transgastric drainage and necrosectomy. Patients were followed for 4 wk after admission. We assessed hand-grip strength, REE using indirect calorimetry, and body composition with dual-energy x-ray absorptiometry to assess the percentage change in muscle mass (MM) and fat mass (FM). Data are summarized using medians (range). Results: At baseline, the median body mass index was 27.9 kg/m2 (17.7–35.6 kg/m2). Fifteen patients (83%) had infected WON. Eight patients (44%) received total or supplemental parenteral nutrition. The median percentage loss in MM was 0.31% and FM was 6.2%. The median REE was 6870 kJ (3255–8870 kJ) at baseline. Compared with the predicted REE, the measured REE was 1049 kJ higher (–3065 to 2126 kJ) at baseline and –951 kJ lower (–2600 to 3202 kJ) at 4 wk. The difference between the predicted and measured REE at baseline was correlated with the percentage loss in MM (P = 0.043) and FM (P = 0.026). Additionally, patients with infected WON had significantly higher REE (P = 0.003). Conclusion: In patients with WON, an increased REE appears to predict increased muscle and fat loss. Additional studies are necessary to evaluate if REE may be used to improve nutritional support.

KW - Absorptiometry

KW - Acute necrotizing pancreatitis

KW - Dual-energy x-ray

KW - Endoscopic surgical procedure

KW - Hand-grip strength

KW - Indirect calorimetry

KW - Muscular atrophy

KW - Walled-off pancreatic necrosis

UR - http://www.scopus.com/inward/record.url?scp=85072753950&partnerID=8YFLogxK

U2 - 10.1016/j.nut.2019.110574

DO - 10.1016/j.nut.2019.110574

M3 - Journal article

C2 - 31586481

AN - SCOPUS:85072753950

VL - 69

JO - Nutrition

JF - Nutrition

SN - 0899-9007

M1 - 110574

ER -