PD1042 - THE ENERGY GAP: INDIRECT CALORIMETRY VS ESPEN TARGETS IN HEAD AND NECK CANCER SURGERY

PD1042

THE ENERGY GAP: INDIRECT CALORIMETRY VS ESPEN TARGETS IN HEAD AND NECK CANCER SURGERY

E. Haruoch^1,2,*, A. Buch^2,3, A. Warshavsky⁴, S. Maymon⁴, D. Zecharia¹, R. Anbar¹

¹Tel Aviv Sourasky Medical Center, Nutrition and Dietetic Departmen, Tel -aviv , ²Ariel University, Department of Nutrition Sciences, School of Health Sciences, Ariel, ³Tel Aviv Sourasky Medical Center, Institute of Endocrinology, Metabolism and Hypertension, ⁴Tel Aviv Sourasky Medical Center, Otolaryngology and Head and Neck Surgery, Tel -aviv , Israel

Rationale: Patients undergoing oncologic resection with free-flap reconstruction for Head and Neck Cancer (HNC) experience metabolic stress, and guideline-based calorie targets may not  reflect actual energy expenditure. This study aimed to evaluate perioperative changes in Resting Energy Expenditure (REE) and compare measured REE with ESPEN recommendations (25–30 kcal/kg/day).

Methods: This prospective study at Tel Aviv Sourasky Medical Center included adults undergoing oncologic resection for HNC. Nutritional status was assessed using the Subjective Global Assessment (SGA), and demographic data were collected. REE was measured by indirect calorimetry (IC) with canopy  method (Q-NRG, Cosmed, Italy) at four perioperative time points, and compared with a predictive value of 25 kcal/kg/day. Statistical analysis included one-sample t-tests and repeated-measures ANOVA (Greenhouse–Geisser correction) to assess changes over time. Significance was set at p<0.05.

Results: Eleven patients were included (median age 69 [IQR 56–73] years; 73% male; BMI 27±3 kg/m²). By SGA, 82% were well nourished and 18% malnourished. Mean measured REE was 1570±321 kcal/day preoperatively, 1837±458  kcal/day on postoperative day (POD) 4-5, 1760±471 kcal/day on POD 12-14, and 1543±386  kcal/day one month postoperatively. Measured REE ranged 19-22 kcal/kg/day and remained below 25 kcal/kg/day at all time points (p<0.05).Weight-normalized REE differed significantly across perioperative time points  (η²=0.34, p=0.048).

Conclusion: To our knowledge, this is the first study to assess perioperative REE using repeated IC in this population. Preliminary results showed dynamic changes across four time points. Measured REE remained below ESPEN recommendations and showed changes over time, suggesting that estimated REE may not fully reflect energy requirements and could be associated with overfeeding. A larger sample is required to confirm these findings

Disclosure of Interest: None declared