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Staxen CS, Andersen SE, Pedersen LM, Poulsen CB, Andersen JR. Nutrition and Lifestyle-Related Factors as Predictors of Muscle Atrophy in Hematological Cancer Patients. Nutrients 2024; 16:283. [PMID: 38257176 PMCID: PMC10819894 DOI: 10.3390/nu16020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cancer and side effects from cytostatic treatment commonly affect nutritional status manifested as a decrease in muscle mass. We aimed to investigate the impact of nutrition and lifestyle-related factors on muscle mass in patients with hematological cancer. METHODS Dietary intake, food preferences, quality of life (QoL), and physical activity level (PAL) were monitored during 1-2 cytostatic treatment series. Body composition was estimated using bioelectrical impedance analysis (BIA). RESULTS 61 patients were included. Weight loss and loss of muscle mass were detected in 64% and 59% of the patients, respectively. Muscle mass was significantly positively correlated to increasing PAL (p = 0.003), while negatively correlated to increasing age (p = 0.03), physical QoL (p = 0.007), functional QoL (p = 0.05), self-perceived health (p = 0.004), and self-perceived QoL (p = 0.007). Weight was significantly positively correlated to increased intake of soft drinks (p = 0.02) as well as the favoring of bitter grain and cereal products (p = 0.03), while negatively correlated to increasing age (p = 0.03) and increasing meat intake (p = 0.009) Conclusions: Several nutritional and lifestyle-related factors affected change in body composition. The clinical significance of these changes should be investigated in controlled, interventional studies.
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Affiliation(s)
- Christiane S. Staxen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Sara E. Andersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Lars M. Pedersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christian B. Poulsen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens R. Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
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Dingemans AM, van Walree N, Schramel F, Soud MYE, Baltruškevičienė E, Lybaert W, Veldhorst M, van den Berg CA, Kaasa S. High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study. Nutrients 2023; 15:5030. [PMID: 38140289 PMCID: PMC10745925 DOI: 10.3390/nu15245030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
ESPEN guidelines recommend a minimum protein intake of 1.0 g/kg body weight (BW) per day to maintain or restore lean body mass in patients with cancer. During anti-cancer treatment, optimal protein intake is difficult to achieve. We investigated whether a high-protein, low-volume oral nutritional supplement (ONS) supports patients in meeting recommendations. A multi-centre, randomised, controlled, open-label, parallel-group study was carried out in nine hospitals (five countries) between January 2019 and July 2021 in colorectal and lung cancer patients undergoing first-line systemic treatment with chemo(radio-) or immunotherapy. Subjects were randomised (2:1) to receive Fortimel Compact Protein® or standard care. Protein intake was assessed with a 3-day food diary (primary outcome). BW was a secondary outcome. Due to challenges in recruitment, the study was terminated prematurely with 42 patients randomised (intervention group (IG) 28; control group (CG) 14). At T1 and T2, protein intake was statistically significantly higher in the IG compared to the CG (1.40 vs. 1.07 g/kg/day at T1, p = 0.008; 1.32 vs. 0.94 g/kg/day at T2, p = 0.002). At baseline, only 65% (IG) and 45% (CG) of patients met ESPEN minimum protein intake recommendations. However, at T1 and T2 in the IG, a higher proportion of patients met recommendations than in the CG (88% vs. 55% and 40%). No statistically significant difference between study groups was observed for BW. Mean compliance to the ONS was 73.4%. A high-protein, low-volume ONS consumed twice daily enables the majority of patients to reach minimal ESPEN protein recommendations.
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Affiliation(s)
- Anne-Marie Dingemans
- Department of Pulmonology, Erasmus Medical Center Cancer Institute, 3015 CN Rotterdam, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Franz Schramel
- Department of Pulmonary Diseases, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | | | | | - Willem Lybaert
- Department of Medical Oncology, VITAZ, 9100 Sint-Niklaas, Belgium;
| | - Margriet Veldhorst
- Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.V.); (C.A.v.d.B.)
| | | | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, 0379 Oslo, Norway;
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Zhuang B, Zhang L, Wang Y, Cao Y, Shih Y, Jin S, Li H, Gong L, Wang Y, Jin S, Lu Q. Body composition and dietary intake in patients with head and neck cancer during radiotherapy: a longitudinal study. BMJ Support Palliat Care 2023; 13:445-452. [PMID: 32917650 DOI: 10.1136/bmjspcare-2020-002359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/14/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the body composition and dietary intake in the patients with head and neck cancer (HNC) during radiotherapy (RT), and explore the relationship between them. METHODS This was a prospective, longitudinal observational study. Adult patients with HNC undergoing RT between March 2017 and August 2018 were recruited. Patients' body compositions were evaluated by bioelectrical impedance analysis, and dietary intake was recorded by 24-hour dietary recall at three time points, including baseline (T1), mid-treatment (T2) and post-treatment (T3). Patients were divided into low, middle and high energy intake groups based on the average daily energy intake (DEI). Changes in body weight (BW), fat mass (FM), fat-free mass (FFM) and skeletal muscle mass (SMM) among these three groups were compared. RESULTS From T1 to T3, the median loss of patients' BW, FM, FFM and SMM was 4.60, 1.90, 2.60 and 1.50 kg, respectively. The loss of BW was more dramatic from T2 to T3 than that from T1 to T2. BW loss was mainly contributed by SMM loss from T1 to T2 and by FM loss from T2 to T3. Meanwhile, patients' dietary intake reduced during treatment. High DEI group had a significantly attenuated loss of patients' BW, FFM, SMM and FM compared with the low DEI group. CONCLUSION Patients' BW, FM, FFM and SMM all significantly reduced, especially from T2 to T3, with decreased DEI during RT, which stresses the importance of nutrition intervention during the whole course of RT.
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Affiliation(s)
- Bing Zhuang
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
| | - Lichuan Zhang
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
| | - Yujie Wang
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
| | - Yiwei Cao
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
| | - Yian Shih
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
| | - Sanli Jin
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
| | - Hongmei Li
- Division of Surgical Nursing, Shanxi Hospital of Integrated Traditional and Western Medicine, Taiyuan, China
| | - Liqing Gong
- Division of Clinical Nutrition, Beijing Cancer Hospital, Beijing, China
| | - Yanli Wang
- Division of Clinical Nutrition, Beijing Cancer Hospital, Beijing, China
| | - Shuai Jin
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
| | - Qian Lu
- Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
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Gliwska E, Głąbska D, Zaczek Z, Sobocki J, Guzek D. Influence of Enteral Nutrition on Quality of Life in Head and Neck Cancer and Upper Gastrointestinal Tract Cancer Patients within a Pair-Matched Sample. Nutrients 2023; 15:4698. [PMID: 37960351 PMCID: PMC10647548 DOI: 10.3390/nu15214698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Patients with cancers of the head and neck and upper gastrointestinal tract are particularly susceptible to malnutrition, which worsens both their prognosis and quality of life and may result in the need for enteral or parenteral nutrition. The aim of this study was to investigate the impact of enteral nutrition on the quality of life in a paired sample. This study included 50 patients with cancer in two paired subgroups: with enteral nutrition (studied group) and without enteral nutrition (matched group). This study was based on self-reports collected with the EORTC QLQ C30 questionnaire and retrospective analysis of medical records. The analysis revealed that weight loss, group type, and age were the primary factors influencing patients' quality of life. Compared with all cancer patients and the general Polish population, the scores of patients in both groups were below reference values for functional scales and exceeded reference values or were similar for fatigue and vomiting/nausea. Patients who received enteral nutrition more frequently scored lower on the functional scales and higher on the symptomatic scales than the control group. These findings emphasize the complex relationship between cancer, nutritional status, and quality of life.
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Affiliation(s)
- Elwira Gliwska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Cancer Epidemiology and Primary Prevention Department, Maria Sklodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, 02-034 Warsaw, Poland
| | - Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
| | - Zuzanna Zaczek
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education in Warsaw, 231 Czerniakowska Street, 00-416 Warsaw, Poland; (Z.Z.); (J.S.)
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 27 Erazma Ciolka Street, 01-445 Warsaw, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education in Warsaw, 231 Czerniakowska Street, 00-416 Warsaw, Poland; (Z.Z.); (J.S.)
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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Kipouros M, Vamvakari K, Kalafati IP, Evangelou I, Kasti AN, Kosti RI, Androutsos O. The Level of Adherence to the ESPEN Guidelines for Energy and Protein Intake Prospectively Influences Weight Loss and Nutritional Status in Patients with Cancer. Nutrients 2023; 15:4232. [PMID: 37836516 PMCID: PMC10574131 DOI: 10.3390/nu15194232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Nutrition therapy aims to prevent weight loss and its health consequences in patients with cancer. The aim of this study was to assess Greek patients' adherence to the ESPEN guidelines for oncology patients and its prospective effect on their body weight (BW) and nutritional status. In total, 152 patients with cancer were recruited from the Attikon University Hospital, Greece, and provided data in 2019 (baseline) and 2020 (follow-up) (drop-out rate = 28.3%). Nutritional status was assessed with the PG-SGA questionnaire. Patients were categorized based on whether they adhered at least to the minimum ESPEN-recommended intakes of energy (≥25 kcal/kg/day) or protein (≥1.0 g/kg/day) or not. On average, patients did not adhere to ESPEN guidelines for energy and protein intake. Most patients meeting the minimum recommendations had an improvement of their nutritional status at follow-up and increased their BW compared to those not meeting them. All patients with head, neck, and spinal cancer who met the minimum recommendations for energy intake improved their nutritional status at follow-up. This study showed that consuming at least the minimum amounts of protein and energy recommended by ESPEN may prevent from weight loss and improve nutritional status; however, the exact amounts need to be personalized.
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Affiliation(s)
- Michail Kipouros
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition-Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece; (M.K.); (K.V.); (I.P.K.); (I.E.); (R.I.K.)
| | - Konstantina Vamvakari
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition-Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece; (M.K.); (K.V.); (I.P.K.); (I.E.); (R.I.K.)
| | - Ioanna Panagiota Kalafati
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition-Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece; (M.K.); (K.V.); (I.P.K.); (I.E.); (R.I.K.)
- Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, 17676 Kallithea, Greece
| | - Iliana Evangelou
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition-Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece; (M.K.); (K.V.); (I.P.K.); (I.E.); (R.I.K.)
| | - Arezina N. Kasti
- Department of Nutrition & Dietetics, Attikon University General Hospital, 12462 Athens, Greece;
| | - Rena I. Kosti
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition-Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece; (M.K.); (K.V.); (I.P.K.); (I.E.); (R.I.K.)
| | - Odysseas Androutsos
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition-Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece; (M.K.); (K.V.); (I.P.K.); (I.E.); (R.I.K.)
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Starska-Kowarska K. Role of Vitamin D in Head and Neck Cancer-Immune Function, Anti-Tumour Effect, and Its Impact on Patient Prognosis. Nutrients 2023; 15:nu15112592. [PMID: 37299554 DOI: 10.3390/nu15112592] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) describes a heterogeneous group of human neoplasms of the head and neck with high rates of morbidity and mortality, constituting about 3% of all cancers and ~1.5% of all cancer deaths. HNSCC constituted the seventh most prevalent human malignancy and the most common human cancer in the world in 2020, according to multi-population observations conducted by the GLOBOCAN group. Since approximately 60-70% of patients present with stage III/IV neoplastic disease, HNSCC is still one of the leading causes of death in cancer patients worldwide, with an overall survival rate that is too low, not exceeding 40-60% of these patients. Despite the application of newer surgical techniques and the implementation of modern combined oncological treatment, the disease often follows a fatal course due to frequent nodal metastases and local neoplastic recurrences. The role of micronutrients in the initiation, development, and progression of HNSCC has been the subject of considerable research. Of particular interest has been vitamin D, the pleiotropic biologically active fat-soluble family of secosteroids (vitamin-D-like steroids), which constitutes a key regulator of bone, calcium, and phosphate homeostasis, as well as carcinogenesis and the further development of various neoplasms. Considerable evidence suggests that vitamin D plays a key role in cellular proliferation, angiogenesis, immunity, and cellular metabolism. A number of basic science, clinical, and epidemiological studies indicate that vitamin D has multidirectional biological effects and influences anti-cancer intracellular mechanisms and cancer risk, and that vitamin D dietary supplements have various prophylactic benefits. In the 20th century, it was reported that vitamin D may play various roles in the protection and regulation of normal cellular phenotypes and in cancer prevention and adjunctive therapy in various human neoplasms, including HNSCC, by regulating a number of intracellular mechanisms, including control of tumour cell expansion and differentiation, apoptosis, intercellular interactions, angio- and lymphogenesis, immune function, and tumour invasion. These regulatory properties mainly occur indirectly via epigenetic and transcriptional changes regulating the function of transcription factors, chromatin modifiers, non-coding RNA (ncRNAs), and microRNAs (miRs) through protein-protein interactions and signalling pathways. In this way, calcitriol enhances intercellular communication in cancer biology, restores the connection with the extracellular matrix, and promotes the epithelial phenotype; it thus counteracts the tumour-associated detachment from the extracellular matrix and inhibits the formation of metastases. Furthermore, the confirmation that the vitamin D receptor (VDR) is present in many human tissues confirmed the physiopathological significance of vitamin D in various human tumours. Recent studies indicate quantitative associations between exposure to vitamin D and the incidence of HNC, i.e., cancer risk assessment included circulating calcidiol plasma/serum concentrations, vitamin D intake, the presence of the VDR gene polymorphism, and genes involved in the vitamin D metabolism pathway. Moreover, the chemopreventive efficacy of vitamin D in precancerous lesions of the head and neck and their role as predictors of mortality, survival, and recurrence of head and neck cancer are also widely discussed. As such, it may be considered a promising potential anti-cancer agent for developing innovative methods of targeted therapy. The proposed review discusses in detail the mechanisms regulating the relationship between vitamin D and HNSCC. It also provides an overview of the current literature, including key opinion-forming systematic reviews as well as epidemiological, prospective, longitudinal, cross-sectional, and interventional studies based on in vitro and animal models of HNSCC, all of which are accessible via the PubMed/Medline/EMBASE/Cochrane Library databases. This article presents the data in line with increasing clinical credibility.
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Affiliation(s)
- Katarzyna Starska-Kowarska
- Department of Physiology, Pathophysiology and Clinical Immunology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland
- Department of Clinical Physiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland
- Department of Otorhinolaryngology, EnelMed Center Expert, Lodz, Drewnowska 58, 91-001 Lodz, Poland
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7
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Chen LL, Xia LY, Zhang JP, Wang Y, Chen JY, Guo C, Xu WH. Saikosaponin D alleviates cancer cachexia by directly inhibiting STAT3. Phytother Res 2023; 37:809-819. [PMID: 36447385 DOI: 10.1002/ptr.7676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
Cancer cachexia is a metabolic syndrome that is characterized by progressive loss of skeletal muscle mass, and effective therapeutics have yet to be developed. Saikosaponin D (SSD), a major bioactive component of Radix Bupleuri, exhibits antiinflammatory, anti-tumor, anti-oxidant, anti-viral, and hepatoprotective effects. In this study, we demonstrated that SSD is a promising agent for the treatment of cancer cachexia. SSD could alleviate TCM-induced myotube atrophy and inhibit the expression of E3 ubiquitin ligases muscle RING-finger containing protein-1 (MuRF1) and muscle atrophy Fbox protein (Atrogin-1/MAFbx) in vitro. Moreover, SSD suppressed the progression of cancer cachexia, with significant improvements in the loss of body weight, gastrocnemius muscle, and tibialis anterior muscle mass in vivo. Mechanism investigations demonstrated that SSD could directly bind to STAT3 and specifically inhibit its phosphorylation as well as its transcriptional activity. Overexpression of STAT3 partially abolished the inhibitory effect of SSD on myotube atrophy, indicating that the therapeutic effect of SSD was attributed to STAT3 inhibition. These findings provide novel strategies for treatment of cancer cachexia by targeting STAT3, and SSD may be a promising drug candidate for cancer cachexia.
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Affiliation(s)
- Lin-Lin Chen
- School of Pharmacy, Naval Medical University, Shanghai, China.,Department of Critical Care Medicine, School of Anesthesiology, Naval Medical University, Shanghai, China
| | - Liu-Yuan Xia
- School of Pharmacy, Naval Medical University, Shanghai, China
| | - Jun-Ping Zhang
- College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yan Wang
- School of Pharmacy, Naval Medical University, Shanghai, China
| | - Jian-Yu Chen
- College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Cheng Guo
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei-Heng Xu
- School of Pharmacy, Naval Medical University, Shanghai, China
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8
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Smith LO, Olieman JF, Berk KA, Ligthart-Melis GC, Earthman CP. Clinical applications of body composition and functional status tools for nutrition assessment of hospitalized adults: A systematic review. JPEN J Parenter Enteral Nutr 2023; 47:11-29. [PMID: 36036239 DOI: 10.1002/jpen.2444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND No global consensus exists on diagnostic criteria for malnutrition. Muscular deficits and functional impairments are major components of available malnutrition diagnostic frameworks because these facets of nutrition status significantly impact outcomes. The purpose of this review is to explore which body composition assessment (BCA) and functional status assessment (FSA) tools are being used for nutrition assessment (NA) and monitoring the response to nutrition interventions (RNIs) in adult inpatients. METHODS A literature search of Embase, Medline (Ovid), Web of Science, and Cochrane Central was performed to identify studies that used BCA and/or FSA tools for NA (along with an accepted NA diagnostic framework) and/or for monitoring RNI in adult inpatients. RESULTS The search yielded 3667 articles; 94 were included in the review. The number of studies using BCA and/or FSA tools for NA was 47 and also 47 for monitoring RNI. Seventy-nine percent of studies used bioimpedance for BCA, and 97% that included FSA utilized handgrip strength. When compared against sets of diagnostic criteria, many of the BCA and FSA tools showed promising associations with nutrition status. CONCLUSION Bioimpedance methods are the most widely used bedside BCA tools, and handgrip strength is the most widely used FSA tool; however, these methods are being used with a variety of protocols, algorithms, and interpretation practices in heterogeneous populations. To create a standardized nutrition status assessment process there is a need for validation studies on bedside methods and the development of globally standardized assessment protocols in clinical inpatient settings.
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Affiliation(s)
- Luke O Smith
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Joanne F Olieman
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kirsten A Berk
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gerdien C Ligthart-Melis
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
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9
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A Multi-Site, International Audit of Malnutrition Risk and Energy and Protein Intakes in Patients Undergoing Treatment for Head Neck and Esophageal Cancer: Results from INFORM. Nutrients 2022; 14:nu14245272. [PMID: 36558428 PMCID: PMC9785112 DOI: 10.3390/nu14245272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with foregut tumors are at high risk of malnutrition. Nutrition care focuses on identifying individuals at risk of malnutrition and optimizing nutrient intake to promote the maintenance of body weight and lean body mass. This multi-center prospective, longitudinal study audited nutrition care practices related to screening for risk of malnutrition (Patient-Generated Subjective Global Assessment Short Form; PG-SGA SF), and nutrition interventions prescribed (route; adequacy of energy and protein intakes). Audits occurred at four time periods: baseline (before treatment) and at 2, 4, and 6 months after starting cancer treatment; 170 patients (esophageal (ESO; n = 51); head and neck (HN; n = 119)) were enrolled. Nutrition risk (PG-SGA SF score ≥ 4) was prevalent at every time period: HN (baseline: 60%; 6 months 66%) and ESO (77%; 72%). Both groups had significant (p < 0.001) weight losses over the 6 month audit period (HN = 13.2% ESO = 11.4%). Enteral nutrition (EN) was most likely to be prescribed at 2 months for HN and at 4 and 6 months for ESO. Target prescribed energy and protein intakes were not met with any nutrition intervention; although adequacy was highest for those receiving EN. Nutrition care practices differed for HN and ESO cancers and there may be time points when additional nutrition support is needed.
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10
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Amino Acids in Cancer and Cachexia: An Integrated View. Cancers (Basel) 2022; 14:cancers14225691. [PMID: 36428783 PMCID: PMC9688864 DOI: 10.3390/cancers14225691] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Rapid tumor growth requires elevated biosynthetic activity, supported by metabolic rewiring occurring both intrinsically in cancer cells and extrinsically in the cancer host. The Warburg effect is one such example, burning glucose to produce a continuous flux of biomass substrates in cancer cells at the cost of energy wasting metabolic cycles in the host to maintain stable glycemia. Amino acid (AA) metabolism is profoundly altered in cancer cells, which use AAs for energy production and for supporting cell proliferation. The peculiarities in cancer AA metabolism allow the identification of specific vulnerabilities as targets of anti-cancer treatments. In the current review, specific approaches targeting AAs in terms of either deprivation or supplementation are discussed. Although based on opposed strategies, both show, in vitro and in vivo, positive effects. Any AA-targeted intervention will inevitably impact the cancer host, who frequently already has cachexia. Cancer cachexia is a wasting syndrome, also due to malnutrition, that compromises the effectiveness of anti-cancer drugs and eventually causes the patient's death. AA deprivation may exacerbate malnutrition and cachexia, while AA supplementation may improve the nutritional status, counteract cachexia, and predispose the patient to a more effective anti-cancer treatment. Here is provided an attempt to describe the AA-based therapeutic approaches that integrate currently distant points of view on cancer-centered and host-centered research, providing a glimpse of several potential investigations that approach cachexia as a unique cancer disease.
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11
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Mäkitie AA, Alabi RO, Orell H, Youssef O, Almangush A, Homma A, Takes RP, López F, de Bree R, Rodrigo JP, Ferlito A. Managing Cachexia in Head and Neck Cancer: a Systematic Scoping Review. Adv Ther 2022; 39:1502-1523. [PMID: 35224702 PMCID: PMC8989808 DOI: 10.1007/s12325-022-02074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients with head and neck cancer (HNC) are usually confronted with functional changes due to the malignancy itself or its treatment. These factors typically affect important structures involved in speech, breathing, chewing, swallowing, and saliva production. Consequently, the intake of food will be limited, which further contributes to loss of body weight and muscle mass, anorexia, malnutrition, fatigue, and anemia. This multifactorial condition can ultimately lead to cancer cachexia syndrome. This study aims to examine the treatment of cachexia in HNC patients. METHODS We systematically searched OvidMedline, PubMed, Scopus, and Web of Science for articles examining the treatment of cachexia in HNC. RESULTS A total of nine studies were found, and these suggested interventions including nutritional, pharmacologic, therapeutic exercise, and multimodal approaches. The nutritional intervention includes essential components such as dietary counseling, oral nutritional supplements, and medical nutritional support. Individualized nutritional interventions include oral, enteral (feeding tubes i.e., percutaneous endoscopic gastrostomy [PEG], nasogastric tube [NGT]) and parenteral nutrition. The pharmacologic interventions aim at increasing the appetite and weight of cachectic patients. Therapeutic exercise and increased physical activity can help to enhance the synthesis of muscle protein, reducing inflammation and the catabolic effects of cachexia syndrome. CONCLUSION Owing to the multifactorial nature of this syndrome, it is expected that the management approach should be multi-interventional. Early implementation of these interventions may help to improve survival and quality of health and life of cachectic HNC patients.
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Affiliation(s)
- Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
| | - Rasheed Omobolaji Alabi
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Helena Orell
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Omar Youssef
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Alhadi Almangush
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fernando López
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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12
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Muralidharan S, Acharya A, Mallaiah P, Babu BA. A systematic review on the guidelines for nutritional assessment for head and neck cancer patients managed by surgery. J Oral Maxillofac Pathol 2021; 25:370. [PMID: 34703139 PMCID: PMC8491340 DOI: 10.4103/0973-029x.325255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
There are a number of guidelines to assess the nutrition status of cancer cases. None of these guidelines are specifically head and neck cancer related; except for the European guidelines. This article reviews the different guidelines in nutrition for cancer cases and also their drawbacks.
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Affiliation(s)
| | - Arunkumar Acharya
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Pramila Mallaiah
- Department of Public Health Dentistry, MR Ambedkar Dental College and Hospital, Karnataka, India
| | - B Anil Babu
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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13
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Findlay M, Bauer JD, Dhaliwal R, de van der Schueren M, Laviano A, Widaman A, Martin L, Day AG, Gramlich LM. Translating Evidence-Based Guidelines into Practice-Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM). Nutrients 2020; 12:E3808. [PMID: 33322627 PMCID: PMC7763837 DOI: 10.3390/nu12123808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is highly prevalent in patients with foregut tumors comprising head and neck (HNC) and esophageal (EC) cancers, negatively impacting outcomes. International evidence-based guidelines (EBGs) for nutrition care exist; however, translation of research evidence into practice commonly presents considerable challenges and consequently lags. This study aimed to describe and evaluate current international nutrition care practices compared with the best-available evidence for patients with foregut tumors who are at high risk of malnutrition. A multi-centre prospective cohort study enrolled 170 patients commencing treatment of curative intent for HNC (n = 119) or EC (n = 51) in 11 cancer care settings in North America, Europe and Australia between 2016 and 2018. Adherence criteria were derived from relevant EBG recommendations with pooled results for participating centres reported according to the Nutrition Care Model at either system or patient levels. Adherence to EBG recommendations was: good (≥80%) for performing baseline nutrition screening and assessment, perioperative nutrition assessment and nutrition prescription for energy and protein targets; moderate (≥60 to 80%) for utilizing validated screening and assessment tools and pre-radiotherapy dietitian consultation; and poor (60%) for initiating post-operative nutrition support within 24 h and also dietetic consultation weekly during radiotherapy and fortnightly for 6 weeks post-radiotherapy. In conclusion, gaps in evidence-based cancer nutrition care remain; however, this may be improved by filling known evidence gaps through high-quality research with a concurrent evolution of EBGs to also encompass practical implementation guidance. These should aim to support multidisciplinary cancer clinicians to close evidence-practice gaps throughout the patient care trajectory with clearly defined roles and responsibilities that also address patient-reported concerns.
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Affiliation(s)
- Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Judith D. Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD 4072, Australia;
| | | | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands;
- Department of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy;
| | - Adrianne Widaman
- Department of Nutrition, Food Science and Packaging, San Jose State University, San Jose, CA 95192, USA;
- University of California Davis Medical Center, Sacramento, CA 94558-5004, USA
| | - Lisa Martin
- Department of Medicine, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
| | - Andrew G. Day
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 2V7, Canada;
| | - Leah M. Gramlich
- Royal Alexandra Hospital, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB T5H 3V9, Canada;
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14
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Neoh MK, Abu Zaid Z, Mat Daud ZA, Md. Yusop NB, Ibrahim Z, Abdul Rahman Z, Jamhuri N. Changes in Nutrition Impact Symptoms, Nutritional and Functional Status during Head and Neck Cancer Treatment. Nutrients 2020; 12:nu12051225. [PMID: 32357529 PMCID: PMC7282002 DOI: 10.3390/nu12051225] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background: The purpose of this study is to evaluate changes in nutrition impact symptoms (NIS) and nutritional and functional status that occur throughout radiotherapy in head and neck cancer (HNC) patients. Methods: A prospective observational study of HNC inpatients who underwent radiotherapy with or without chemotherapy were recruited to participate. Fifty patients were followed for the periods before, in the middle and at the end of radiotherapy. Nutritional parameters were collected throughout radiotherapy. Results: According to Patient-Generated Subjective Global Assessment (PG-SGA), there was an increase from a baseline of 56% malnourished HNC patients to 100% malnourished with mean weight loss of 4.53 ± 0.41kg (7.39%) at the end of radiotherapy. Nutritional parameters such as muscle mass, fat mass, body mass index, dietary energy and protein intake decrease significantly (p < 0.0001) while NIS score, energy and protein intake from oral nutritional supplements (ONS) increased significantly (p < 0.0001). Hand grip strength did not differ significantly. All HNC patients experienced taste changes and dry mouth that required ONS at the end of treatment. ONS compliance affected the percentage of weight loss (p = 0.013). Conclusions: The intensive nutritional care time point was the middle of RT. The PG-SGA and NIS checklist are useful for monitoring nutrition for HNC patients.
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Affiliation(s)
- May Kay Neoh
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (M.K.N.); (Z.A.M.D.); (N.B.M.Y.); (Z.I.); (N.J.)
- Department of Dietetic and Food Service, National Cancer Institute, Ministry of Health, 4, Jalan P7, Presint 7, Putrajaya 62250, Malaysia;
| | - Zalina Abu Zaid
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (M.K.N.); (Z.A.M.D.); (N.B.M.Y.); (Z.I.); (N.J.)
- Correspondence: ; Tel.: +603-9769-2961
| | - Zulfitri Azuan Mat Daud
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (M.K.N.); (Z.A.M.D.); (N.B.M.Y.); (Z.I.); (N.J.)
| | - Nor Baizura Md. Yusop
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (M.K.N.); (Z.A.M.D.); (N.B.M.Y.); (Z.I.); (N.J.)
| | - Zuriati Ibrahim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (M.K.N.); (Z.A.M.D.); (N.B.M.Y.); (Z.I.); (N.J.)
| | - Zuwariah Abdul Rahman
- Department of Dietetic and Food Service, National Cancer Institute, Ministry of Health, 4, Jalan P7, Presint 7, Putrajaya 62250, Malaysia;
| | - Norshariza Jamhuri
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (M.K.N.); (Z.A.M.D.); (N.B.M.Y.); (Z.I.); (N.J.)
- Department of Dietetic and Food Service, National Cancer Institute, Ministry of Health, 4, Jalan P7, Presint 7, Putrajaya 62250, Malaysia;
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