Assessment of Nutritional Status, Digestion and Absorption, and Quality of Life in Patients with Locally Advanced Pancreatic Cancer

Background and Aim. To provide a comprehensive quantitative assessment of nutritional status, digestion and absorption, and quality of life (QoL) in patients with locally advanced pancreatic cancer (LAPC). Methods. Sixteen patients with LAPC were prospectively assessed for weight loss (WL), body mass index (BMI), fat-free mass index (FFMI), handgrip strength (HGS), dietary macronutrient intake, serum vitamin levels, resting and total energy expenditure (REE and TEE, indirect calorimetry), intestinal absorption capacity and fecal losses (bomb calorimetry), exocrine pancreatic function (fecal elastase-1 (FE1)), and gastrointestinal quality of life (GIQLI). Results. Two patients had a low BMI, 10 patients had WL > 10%/6 months, 8 patients had a FFMI < P10, and 8 patients had a HGS < P10. Measured REE was 33% higher (P=0.002) than predicted REE. TEE was significantly higher than daily energy intake (P=0.047). Malabsorption (<85%) of energy, fat, protein, and carbohydrates was observed in, respectively, 9, 8, 12, and 10 patients. FE1 levels were low (<200 μg/g) in 13 patients. Total QoL scored 71% (ample satisfactory). Conclusion. Patients with LAPC have a severely impaired nutritional status, most likely as a result of an increased REE and malabsorption due to exocrine pancreatic insufficiency. The trial is registered with PANFIRE clinicaltrials.gov NCT01939665

Severely impaired nutritional status in patients with locally advanced pancreatic cancer

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. Methods: 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. Results: 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