Basal metabolic rate in children with a solid tumour

Objective: To study the level of and changes in basal metabolic rate (BMR) in children with a solid tumour at diagnosis and during treatment in order to provide a more accurate estimate of energy requirements for nutritional support. Design: An observational study. Setting: Tertiary care at the Centre for Paediatric Oncology, University Ho spital Nijmegen. Subjects: Thirteen patients were recruited from a population of patients vi siting the University Hospital Nijmegen for treatment. All patients asked t o participate took part in and completed the study. Intervention: BMR was measured by indirect calorimetry, under stringent, st andardised conditions, for 20 min and on three different occasions in all p atients. Continuous breath gas analysis using a mouthpiece was performed. W eight, height and skinfold measurements were performed before each measurem ent. Main outcome measures: BMR was expressed as percentage of the estimated ref erence value, according to the Schofield formulas based on age, weight and sex, and in kJ (kcal) per kg of fat-free mass. Results: At diagnosis, the BMR was higher than the estimated reference BMR in all patients and 44% of the patients were considered hypermetabolic. Mea n BMR (as percentage of reference) was significantly increased (11.6% (s.d. 6.7%); P = 0.001), but decreased during treatment in 12 of the 13 patients (mean decrease 12.7% (s.d. 3.9%); P < 0.0001). Furthermore, a significant negative correlation (P = -0.67; P = 0.01) was found between the change in BMR and tumour response. Conclusions: These data suggest that the BMR of children with a solid tumou r is increased at diagnosis and possibly during the first phase of oncologi c treatment. This may be important when determining energy requirements for nutritional support.