Energy expenditure and loss of muscle and fat mass in patients with walled-off pancreatic necrosis: A prospective study

Abstract Objective Ensuring adequate nutritional support in patients with walled-off pancreatic necrosis (WON) is challenging and weight loss is often considerable. We evaluated resting energy expenditure (REE) and body composition in patients with WON. Methods We prospectively included 18 patients (67% men; median age 63 years; 44% gallstones; 39% alcohol) with WON undergoing endoscopic transgastric drainage and necrosectomy (ETDN). Patients were followed for four weeks after admission. We assessed hand grip strength (HGS), REE using indirect calorimetry, and body composition with dual-energy x-ray absorptiometry (DXA) to assess the %change in muscle mass (MM) and fat mass (FM). Data are summarised using medians (range). Results At baseline, the median BMI was 27.9 kg/m2 (17.7 to 35.6). Fifteen patients (83%) had infected WON. Eight patients (44%) received total or supplemental parenteral nutrition. The median %loss in MM was 0.31% and FM was 6.2%. The median REE was 6870 kilojoules (3255 to 8870) at baseline. Compared with the predicted REE, the measured REE was 1049 kilojoules higher (-3065 to 2126) at baseline and -951 kilojoules lower (-2600 to 3202) at four weeks. The difference between the predicted and measured REE at baseline was correlated with the percentage loss in MM (P= 0.043) and FM (P=0.026). In addition, patients with infected WON had significantly higher REE (P=0.003). Conclusion In patients with WON, an increased REE appears to predict increased muscle and fat loss. Additional studies are necessary to evaluate if REE may be used to improve nutritional support.