Monitoring Energy Balance Through Clinical and Serum Biomarkers in Patients with Hmatologic Malignancies during Chemotherapy

Abstract Background: Many cancer patients experience energy imbalance due to the tumor or chemotherapy-related side effects. Chemotherapy could make significant metabolic changes leading to energy imbalance. However, the variations in energy input, metabolic rate, and physical activity are not known in detail. This study aimed to identify changes in energy balance components and serum biomarkers during chemotherapy of patients with hematologic cancer. Methods: This prospective study included 40 patients with hematologic malignancies hospitalized for chemotherapy. Energy balance components, physical function, and serum biomarkers, such as albumin, total protein, CXCL13, GDF15 and leptin, were measured weekly after chemotherapy for 3 weeks. Results: Significant body weight loss, representing negative energy balance, occurred at 2 and 3 weeks after chemotherapy. A statistically reduced oral intake was observed at week three. However, total energy intake did not show any statistical change during the study period due to parental support. Resting energy expenditure statistically decreased according to the Harris-Benedict (HB) equation, but not for the Penn State University (PSU) equation. Physical activity measured by daily steps showed no statistical difference. However, physical function according to the DEMMI score indicated a significant decrease at 3 weeks. Over half of the patients (65.0 %, n = 26) were found to have at least one of energy balance problem according to subgroup classification.Our serum biomarker analysis demonstrated significant differences in serum albumin, total protein, CXCL13, and GDF15 levels, with the exception of leptin. All three subgroups exhibited statistically significant decreases in albumin and total protein. However, only CXCL13 levels in the weight loss group and GDF level in the anorexia and impaired physical function groups were found to be significantly altered by subgroup analysis.Conclusions: The results indicated that 65 % of hematologic cancer patients suffered from energy imbalances during chemotherapy associated with weight loss and anorexia. Significant changes in albumin, total protein, CXCL13, and GDF15 were found. Additionally, subgroup analysis suggested that CXCL13 and GDF15 were associated with weight loss and appetite loss, respectively. Monitoring the energy balance of clinical and serum biomarkers together can help identify the need for nutritional intervention in patients undergoing chemotherapy.