Indirect Calorimetry in Oncology: A Case-Based Clinical Tutorial
Abstract
Background: Malnutrition is common in adult patients with cancer and is associated with increased complications, treatment toxicity, and mortality. Accurate estimation of energy requirements is essential to individualize nutrition care; however, resting energy expenditure (REE) in oncology is highly variable due to tumor characteristics, disease stage, inflammation, and treatment effects. Predictive equations and weight-based estimates may fail to capture these metabolic differences, potentially leading to inappropriate nutritional prescriptions. This case-based tutorial aims to illustrate the clinical interpretation and application of indirect calorimetry (IC) in adult oncology patients. Methods: Nine adult oncology patients were selected to represent a range of common and complex metabolic scenarios encountered in practice. Cases were obtained from ambulatory and inpatient settings across multiple tumor types and treatment stages. Clinical context, nutritional history, anthropometric measures, body composition and handgrip strength, Global Leadership Initiative on Malnutrition (GLIM) classification, and IC measurements are presented. Case discussions interpret measured REE, estimated total energy expenditure (TEE) accounting for physical activity level, and energy balance relative to intake. Results: Measured REE showed heterogeneity across clinical scenarios, including both hypermetabolic and hypometabolic states. In several cases, IC-derived energy requirements differed markedly from the guideline weight-based recommendation in oncology. Some factors associated with variability included inflammation, liver metastases, sarcopenia, and surgery. Conclusions: These clinical scenarios illustrate the marked variability in REE in oncology patients and demonstrate how IC can provide more accurate energy assessments than weight-based recommendations. This case-based tutorial highlights the role of IC in guiding individualized nutritional assessment and supporting precise energy prescription in oncology.
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BibTeX
@article{nguyen2026indirect,
title = {{Indirect Calorimetry in Oncology: A Case-Based Clinical Tutorial}},
author = {Vivian V. Nguyen and Pamela Funk-Debleds and Kate Furness and Marie Guinhut and Leah Gramlich and Amélie Rébillard and Marie-Clotilde Alves-Guerra and François Goldwasser and Diana Cardenas},
journal = {Clinical Nutrition ESPEN},
year = {2026},
month = oct,
doi = {10.1016/j.clnesp.2026.103378},
url = {https://hal.science/hal-05651896v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Indirect Calorimetry in Oncology: A Case-Based Clinical Tutorial
AU - Vivian V. Nguyen
AU - Pamela Funk-Debleds
AU - Kate Furness
AU - Marie Guinhut
AU - Leah Gramlich
AU - Amélie Rébillard
AU - Marie-Clotilde Alves-Guerra
AU - François Goldwasser
AU - Diana Cardenas
PY - 2026
DA - 2026/10/23
JO - Clinical Nutrition ESPEN
DO - 10.1016/j.clnesp.2026.103378
UR - https://hal.science/hal-05651896v1
AB - Background: Malnutrition is common in adult patients with cancer and is associated with increased complications, treatment toxicity, and mortality. Accurate estimation of energy requirements is essential to individualize nutrition care; however, resting energy expenditure (REE) in oncology is highly variable due to tumor characteristics, disease stage, inflammation, and treatment effects. Predictive equations and weight-based estimates may fail to capture these metabolic differences, potentially leading to inappropriate nutritional prescriptions. This case-based tutorial aims to illustrate the clinical interpretation and application of indirect calorimetry (IC) in adult oncology patients. Methods: Nine adult oncology patients were selected to represent a range of common and complex metabolic scenarios encountered in practice. Cases were obtained from ambulatory and inpatient settings across multiple tumor types and treatment stages. Clinical context, nutritional history, anthropometric measures, body composition and handgrip strength, Global Leadership Initiative on Malnutrition (GLIM) classification, and IC measurements are presented. Case discussions interpret measured REE, estimated total energy expenditure (TEE) accounting for physical activity level, and energy balance relative to intake. Results: Measured REE showed heterogeneity across clinical scenarios, including both hypermetabolic and hypometabolic states. In several cases, IC-derived energy requirements differed markedly from the guideline weight-based recommendation in oncology. Some factors associated with variability included inflammation, liver metastases, sarcopenia, and surgery. Conclusions: These clinical scenarios illustrate the marked variability in REE in oncology patients and demonstrate how IC can provide more accurate energy assessments than weight-based recommendations. This case-based tutorial highlights the role of IC in guiding individualized nutritional assessment and supporting precise energy prescription in oncology.
SN - 2405-4577
ER -