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dc.contributor.authorWallengren, Ola
dc.date.accessioned2012-10-25T11:13:10Z
dc.date.available2012-10-25T11:13:10Z
dc.date.issued2012-10-25
dc.identifier.isbn978-91-628-8528-1
dc.identifier.urihttp://hdl.handle.net/2077/29709
dc.description.abstractBackground & Aims: Cachexia is frequent in advanced cancer and is associated with adverse outcomes; however, definite diagnostic criteria for cachexia are not established. Diet energy density (ED) may affect energy intake (EI) and energy balance. Patient characteristics may also influence such associations. This potentially hampers cachexia treatment and dietary treatment in clinical practice. The aim was to study associations between ED and EI in palliative cancer patients and whether ED or EI predict energy balance, and the influence of systemic inflammation and survival time. The prevalence of reduced quality of life (QoL), function and survival, in patients classified by different cachexia criteria were compared. Methods: Dietary intake and ED was assessed by food records (n=251-322). Energy balance was calculated from the change in body energy content by repeated DXA scans in 107 patients for a total of 164 4-month periods. Linear regression and linear mixed model were used to investigate relationships between ED and EI with patient characteristics as covariates. In energy balance analysis systemic inflammation and survival were covariates. Quality of life (QoL) was assessed by questionnaire, physical function by treadmill test. Results: Diet ED was associated with EI, explaining approximately 16-22 % of the variation in EI. Age, BMI, fatigue and survival were negatively associated and hypermetabolism was positively associated with EI. After covariate adjustment, ED was still positively associated with EI. In unadjusted models, the ED of solid food and EI were both positive predictors of energy balance (P<0.03). Survival was positively and systemic inflammation negatively associated with energy balance (P<0.005). After adjustment for inflammation, only EI remained a significant predictor. Adverse QoL, function and symptoms were associated with weight loss >2%, BMI <20, fatigue and CRP >10mg/L (P<0.05). Short walking distance was associated with fatigue, low grip strength and inflammation (P<0.05). Short survival was associated with weight loss, fatigue, inflammation and S-albumin < 32g/L (P<0.05). The prevalence of cachexia diagnosis varied from 12 to 85 % using different definitions. Conclusions: Diet energy density and energy intake are positively associated. Age, BMI, fatigue, survival and hypermetabolism are associated with EI, but do not substantially influence the association between ED and EI. Diet EI and ED of solid food are positively associated with energy balance in patients with advanced cancer. Relations between EI, ED and energy balance are affected by systemic inflammation. Thus, targeting systemic inflammation may be important in nutritional interventions in this patient group. Weight loss, fatigue and markers of systemic inflammation were consistently associated with adverse QoL, reduced function, more symptoms and shorter survival. The prevalence of cachexia using different definitions varied widely; indicating a need to further explore and validate diagnostic criteria for cancer cachexia.sv
dc.language.isoengsv
dc.relation.haspartI. Wallengren O, Lundholm K, Bosaeus I. Diet energy density and energy intake in palliative care cancer patients. Clin Nutr. 2005;24(2):266-73. ::PMID::15784488sv
dc.relation.haspartII. Wallengren O, Bosaeus I, Lundholm K. Dietary energy density is associated with energy intake in palliative care cancer patients. Support Care Cancer. 2012:20(11):2851-2857. ::PMID::22350645sv
dc.relation.haspartIII. Wallengren O, Bosaeus I, Lundholm K. Dietary energy density, inflammation and energy balance in palliative care cancer patients. Clin Nutr. 2012. Epub 2012/06/26. ::PMID::22727547sv
dc.relation.haspartIV. Wallengren O, Lundholm K, Bosaeus IV. Diagnostic criteria of cancer cachexia: Relation to quality of life, exercise capacity and survival in patients with advanced cancer. Submittedsv
dc.subjectCancersv
dc.subjectcachexiasv
dc.subjectdiagnostic criteriasv
dc.subjectquality of lifesv
dc.subjectnutritional supportsv
dc.subjectenergy intakesv
dc.subjectenergy balancesv
dc.subjectdietary energy densitysv
dc.titleDietary energy density and energy intake in cancer patientssv
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailola.wallengren@vgregion.sesv
dc.type.degreeDoctor of Philosophy (Medicine)sv
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academysv
dc.gup.departmentInst of Medicine. Department of Internal Medicine and Clinical Nutritionsv
dc.gup.defenceplaceTorsdagen den 15 november 2012, kl. 9.00, Hörsal Ivan Östholm, Läkemedels och Nutritionscentrum, Medicinaregatan 13, Göteborgsv
dc.gup.defencedate2012-11-15
dc.gup.dissdb-fakultetSA


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