Determining Energy Needs in Colorectal Cancer
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Observational

Summary: 
      This is an observational study to assess the determinants of energy expenditure in cancer,
      and how those change throughout the disease trajectory. The investigators hypothesize that
      skeletal muscle will be the primary determinant of energy expenditure throughout the disease
      trajectory.
    

Detailed description: 
      Proper nutrition is a hallmark of successful cancer treatment. Adequate energy intake helps
      to maintain body weight and composition, improving outcomes such as response to therapy,
      quality of life, and survival. Unfortunately, little is known about energy needs in cancer,
      as few studies have assessed energy expenditure (the amount of calories used/day).
      Furthermore, individuals with cancer often experience muscle loss (sarcopenia), changes in
      physical activity, and undergo treatment, all of which might substantially alter energy
      needs. Equations to estimate energy REE (and thus dietary requirements) were created from
      cohorts of healthy individuals, and no tools that can be easily used in clinical settings are
      validated to assess REE.

      The overarching aim of this study is to evaluate the largest component of energy needs -
      resting energy expenditure (REE) in relation to body composition (skeletal muscle, adipose
      tissue) and physical activity in a cohort of patients with colorectal cancer. Other aims will
      explore the changes in energy expenditure and determine the accuracy of a portable indirect
      calorimeter for measuring REE.

      Newly-diagnosed individuals with stage II-IV colorectal cancer will undergo indirect
      calorimetry to assess REE. Body composition will be measured by CT scans, with sarcopenia
      status based on previously published cut-points. Nutritional status and inflammation
      (C-reactive protein, neutrophil:lymphocyte) will be assessed as confounding variables.

      Total energy expenditure will be measured near treatment start in a sub-sample of 20
      participants with colorectal cancer using doubly labeled water and accelerometers.
      Participants will wear accelerometers (ActiCal) for 14 days to provide detailed physical
      activity data.These assessments will also be preformed in a sub-sample of 20 participants
      after treatment end.

      An additional part of this study will assess the validity of a portable indirect calorimeter
      for measuring REE. To address this, a sub-group of patients will be invited to undergo an
      additional test of REE using a portable indirect calorimeter, the FitMate (COSMED). Results
      will be compared using Pearson's correlation, dependent samples t-test, and Bland-Altman
      analysis to assess agreement between the FitMate and validated indirect calorimeters (VMax
      metabolic cart and whole body calorimtery unit). Exploratory outcomes include phase angle by
      bioelectrical impedance analysis, handgrip strength, calf circumference, and nutrition status
      by patient generated subjective global assessment (PG-SGA).

      The results from this project will provide a basis of better energy recommendations to
      sustain body weight and composition, thereby improving prognosis in cancer.
    

Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Patients with colorectal cancer (stage II-IV) at the Cross Cancer Institute (Edmonton,
        Alberta, Canada)
      
Keywords: Energy expenditure; Nutrition; Colorectal cancer; Dietary needs