nutrition_ORL

Factors Associated With the Presence and Severity of Nutritional Impact Symptoms in Individuals With Head and Neck Cancer Before Treatment

Sat, 19 Apr 2025 08:25:47 +0000

Author Names: do Rosario T.C.,Soares F.L.P.,Soares L.V.O.,Gallavotti J.S.N.,Rodrigues I.S.,do Prado C.B.,de Podesta O.P.G.,Viana K.C.G.,Rocha R.M.,Lenzi J.,de Podesta J.R.V.,de Souza E.D.,Haraguchi F.K.,Petarli G.B.,Leopoldo A.S.,Salaroli L.B.

Database Source: Embase Weekly Updates

Journal Title: International journal of surgical oncology

Article Title: Factors Associated With the Presence and Severity of Nutritional Impact Symptoms in Individuals With Head and Neck Cancer Before Treatment

Year: 2024

Issue:

Volume: 2024

Abstract: Background: As head and neck cancer (HNC) affects regions directly related to the digestive tract, it is consistently associated with nutritional impact symptoms (NISs), which further reduce food intake and affect nutritional status. Early identification of patients with NIS can assist therapy. <br/>Method(s): This is a cross-sectional study with HNC patients from a cancer reference hospital. Sociodemographic, lifestyle, clinical, and anthropometric data were collected, along with information on nutritional risk screening and screening for NIS. <br/>Result(s): Cancer in the larynx (p=0.031) showed a 6.67 lower NIS score than that in the oral cavity. Ex-smokers (p=0.019) showed a 5.87 lower NIS score and nutritional risk (p=0.009) increased NIS scores by 6.15 points. <br/>Conclusion(s): Tumor location, smoking, and the presence of nutritional risk influence the quantity and severity of NIS.<br/>Copyright © 2024 Thaina C. do Rosario et al.

Sensorineural hearing loss after concurrent chemoradiotherapy with high-dose cisplatin in head and neck cancer patients: Roles of nutrition and trace elements

Thu, 06 Feb 2025 00:00:00 +0000

Auris Nasus Larynx. 2025 Apr;52(2):141-145. doi: 10.1016/j.anl.2025.01.013. Epub 2025 Feb 5.

ABSTRACT

OBJECTIVE: Sensorineural hearing loss (SNHL) is one of the most important adverse events of concurrent chemoradiotherapy (CCRT) with high-dose cisplatin for locally advanced head and neck squamous cell carcinoma (HNSCC). This retrospective study aimed to elucidate the effects of nutritional status and trace elements on the development of SNHL.

METHODS: A retrospective review of 211 ears from 109 patients with HNSCC who underwent CCRT with high-dose cisplatin was performed. SNHL of each ear was classified according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and possible contributing factors were evaluated by univariate and multivariate analyses. Age, sex, primary site, clinical stage, treatment intent, smoking and drinking habits, history of hypertension, diabetes mellitus, body mass index, serum albumin, trace elements (Fe, Zn, Cu, Se), pretreatment average hearing level at 2-8 kHz, weight loss rate, cumulative cisplatin dose, and inner ear radiation dose were the variables evaluated.

RESULTS: Ordinal logistic regression analysis showed that increased age, better pretreatment average hearing level at 2-8 kHz, and cumulative cisplatin dose were independent factors associated with the development of SNHL.

CONCLUSION: Nutritional status and trace elements were not associated with the development of SNHL caused by CCRT with high-dose cisplatin.

PMID:39914173 | DOI:10.1016/j.anl.2025.01.013

Individualized symptom experience and predictors in cancer patients after oesophagectomy: A latent profile analysis.

Sat, 01 Feb 2025 05:00:00 +0000

European Journal of Oncology Nursing; 02/01/2025
(AN 182871907); ISSN: 14623889
CINAHL Complete

Preoperative Nutritional Status Influences Enteral Nutrition Weaning 6 Months Post-Surgery in Patients with Esophageal Cancer

Tue, 28 Jan 2025 00:00:00 +0000

Asian Pac J Cancer Prev. 2025 Jan 1;26(1):263-267. doi: 10.31557/APJCP.2025.26.1.263.

ABSTRACT

OBJECTIVE: This study aimed to clarify whether nutritional status at admission affects enteral nutrition weaning 6 months after surgery in patients with esophageal cancer.

METHODS: This was a retrospective study of 81 patients who underwent subtotal esophageal cancer resection between April 2014 and February 2016. The survey items were as follows: 1) sex, 2) age, 3) presence or absence of family members living together, 4) clinical stage, 5) surgical procedure, 6) reconstructed organs, 7) nutritional status at admission, 8) presence or absence of postoperative complications (anastomotic leakage, chylothorax, and recurrent laryngeal nerve paralysis), and 9) presence or absence of treatment other than surgery (chemo- or radiotherapy).

RESULTS: The enteral nutrition withdrawal rate after 6 months was 15.5% in the malnutrition group and 84.5% in the normal nutrition group (p = 0.007). In a comparison between groups with and without enteral nutrition after 6 months, a significant association was observed with surgical procedure, nutritional status at admission, and postoperative complications (p < 0.05). Logistic regression analysis showed that the odds of discontinuing enteral nutrition 6 months later were 5.692 (hazard ratio: 1.545-20.962) for malnutrition on admission and 11.921 (hazard ratio: 3.449-41.207) for complications.

CONCLUSION: Regardless of the presence or absence of treatment other than surgery, preoperative nutritional improvement is beneficial for increasing postoperative oral intake.

PMID:39874009 | DOI:10.31557/APJCP.2025.26.1.263

Effectiveness of a nurse-led coaching in self-care intervention for elderly undergoing total laryngectomy: a randomised controlled trial

Tue, 14 Jan 2025 00:00:00 +0000

BMJ Open. 2024 Dec 20;14(12):e078948. doi: 10.1136/bmjopen-2023-078948.

ABSTRACT

OBJECTIVES: To evaluate the effectiveness of nurse-led coaching in self-care (SC) interventions for elderly patients undergoing total laryngectomy (TL) using multidimensional parameters.

DESIGN: This was a double-arm randomised, single-centre trial that met the requirements of the CONSORT statement.

SETTING: Head and neck department in a tertiary A-level hospital.

INTERVENTION: Elderly patients scheduled for TL were randomly allocated to either the control group (n=24) or the intervention group (n=23). Patients in the control group received routine nursing care during hospitalisation and, subsequently, at home after discharge, received conventional family care without the regular supervision of nurses. Patients in the intervention group received a series of SC interventions led by nurses during hospitalisation and discharge and implemented SC practice using the home SC manual (SC knowledge and SC diary), nurses regularly supervised and evaluated the SC effect. The primary outcome was the SC ability. Secondary outcomes were self- efficacy, quality of life (QoL) and nutritional status.

RESULTS: The SC intervention improved the SC ability, self-efficacy, QoL and nutritional status scores of patients in the intervention group compared with that of patients in the control group (p<0.01). The outcomes showed that the intervention had a significant effect on SC ability, self-efficacy and QoL scores, with both the main effects of time and intervention, as well as their interaction being significant (p<0.05). Nutritional status, as assessed using the PG-SGA, was better in the intervention group than in the control group (p<0.001). No adverse events (AEs) were observed in either group.

CONCLUSION: Nurse-led SC intervention for elderly patients with TL is an effective strategy that can bring multidimensional benefits, including higher self-efficacy, stronger SC ability to actively solve health problems, better QoL and nutritional status, as well as shorter hospital stays.

TRIAL REGISTRATION NUMBER: ChiCTR2100043731.

PMID:39806609 | PMC:PMC11667481 | DOI:10.1136/bmjopen-2023-078948

Predicting complications in elderly patients undergoing oral cancer resection with free flap reconstruction in China: a retrospective cohort study using the modified Frailty Index and Prognostic Nutritional Index

Fri, 27 Dec 2024 00:00:00 +0000

BMJ Open. 2024 Dec 26;14(12):e085985. doi: 10.1136/bmjopen-2024-085985.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the predictive abilities of the 5-item modified Frailty Index (5-mFI), Prognostic Nutrition Index (PNI), and their combination in older adult patients undergoing oral cancer resection and free flap reconstruction.

DESIGN: Retrospective cohort study.

SETTING: Secondary care involving multiple centres treating older adult patients for oral cancer.

PARTICIPANTS: This study included a total of 1197 patients aged ≥60 years who underwent oral cancer resection with free flap reconstruction between January 2014 and December 2022. The study included patients aged ≥60 years with malignant tumours who underwent selective radical surgery, such as mandibulectomy, maxillectomy, glossectomy or laryngectomy, followed by free flap reconstruction under general anaesthesia. Exclusion criteria included the presence of any inflammatory disease affecting blood test results, incomplete clinical records or missing data for any of the five items in the 5-mFI. Patients were categorised into four groups based on PNI and 5-mFI values: (1) 'Control' (neither frail nor malnourished), (2) 'Frailty' (frail only), (3) 'Malnutrition' (malnourished only) and (4) 'Frailty+Malnutrition' (both frail and malnourished).

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the rate of complications within 30 days after surgery. Secondary outcomes included unplanned reoperation rates, length of postoperative hospital stay and the predictive performance of PNI, 5-mFI and their combination.

RESULTS: The overall complication rate within 30 days post-surgery was 34.6%. The Frailty+Malnutrition group exhibited the highest risk of complications, longer postoperative hospital stays and increased rates of unplanned reoperation compared with the Control, Frailty and Malnutrition groups. The combined PNI and 5-mFI model significantly improved the predictive value for postoperative complications compared with either PNI or 5-mFI alone.

CONCLUSIONS: Older adult patients undergoing oral cancer resection with free flap reconstruction face considerable risk from frailty and malnutrition. Although both 5-mFI and PNI independently demonstrated good predictive abilities for postoperative complications, the combined model provided the best prediction. These findings could help optimise preoperative management in this high-risk population.

PMID:39730151 | PMC:PMC11683887 | DOI:10.1136/bmjopen-2024-085985

Preserving Laryngo-Esophageal Function in Patients With Hypopharyngeal Cancer Treated With Radiotherapy: Predictive Factors and Long-Term Outcomes

Sat, 02 Nov 2024 00:00:00 +0000

Cancer Med. 2024 Nov;13(21):e70374. doi: 10.1002/cam4.70374.

ABSTRACT

BACKGROUND: Functional outcomes after hypopharyngeal cancer (HPC) treatment have a significant effect on patients' quality of life and prognosis. This study aimed to identify the predictive factors associated with laryngo-esophageal dysfunction in patients with HPC who received definitive radiotherapy.

METHODS: Patients with HPC treated with definitive intensity-modulated radiotherapy between 2007 and 2019 at our institution were retrospectively evaluated. Laryngo-esophageal dysfunction-free survival (LDFS) events were defined as local recurrence, laryngo-esophageal dysfunction (defined as tracheostomy or feeding tube dependence), or death from any cause.

RESULTS: The median follow-up period was 61 months for the 80 patients included in the study. The 5-year LDFS rate was 47%. A clinical T4 stage and lower pretreatment prognostic nutritional index (PNI) were independently associated with a lower LDFS.

CONCLUSION: A clinical T4 stage and lower pretreatment PNI were identified as predictors of a lower LDFS after definitive radiotherapy for HPC.

PMID:39487662 | PMC:PMC11530706 | DOI:10.1002/cam4.70374

Prognostic value of serum 25-hydroxyvitamin D levels and malnutrition status on postoperative complications in patients following laryngectomy with neck dissection

Tue, 22 Oct 2024 00:00:00 +0000

Eur Arch Otorhinolaryngol. 2025 Jan;282(1):341-349. doi: 10.1007/s00405-024-09046-5. Epub 2024 Oct 22.

ABSTRACT

BACKGROUND: Postoperative complications (PCs) following total laryngectomy remain a significant challenge, with recent investigations directed toward the impact of nutrition status and vitamin D deficiency.

OBJECTIVES: To elucidate the association between preoperative vitamin D level status, malnutrition risk score, and surgical and survival outcomes in patients with advanced laryngeal cancer following total laryngectomy.

STUDY DESIGN: Prospective cohort study.

METHODS: Sixty-four patients with advanced laryngeal carcinoma treated with total laryngectomy were included in the study. Serum levels of 25(OH) D₃ were measured employing a commercial chemiluminescent immunoassay kit, while nutrition status was evaluated using the nutrition risk index (NRI) and Malnutrition universal screening tool (MUST).

RESULTS: The mean serum 25(OH) D level was 37.1 ± 19.4 nmol/L (range 11.0-100.6 nmol/L), with 47% of patients exhibiting vitamin D deficiency and 31% displaying insufficiency. Medium/high MUST score had 53% of patients, and moderate/severe NRI was verified in 48% of patients. Univariate logistic regression analysis identified MUST score, GPS score, neutrophil-to-lymphocyte ratio, and circulating 25(OH) D levels as predictive for the occurrence of PCs. In multivariate analysis, MUST score and circulating 25(OH) D levels remained significantly associated with PCs. Patients with high nutrition risk had significantly lower two-year OS rates compared to the medium and low nutrition risk groups, respectively (30% vs. 62% and 83%, p = 0.010).

CONCLUSION: Early identification of malnourished or patients with vitamin D deficiency and those who would benefit from specific nutritional support could be beneficial for minimizing the risk of development of surgical complications and help improve our clinical outcomes.

PMID:39438295 | DOI:10.1007/s00405-024-09046-5

Association between provegetarian food patterns and micronutrient adequacy in preschoolers: the SENDO project

Mon, 07 Oct 2024 00:00:00 +0000

Eur J Pediatr. 2024 Dec;183(12):5267-5278. doi: 10.1007/s00431-024-05808-9. Epub 2024 Oct 7.

ABSTRACT

This study aims to examine the association between different versions of a provegetarian food pattern and micronutrient adequacy in a population of children from the SENDO Project. Children aged 4-5 years old were recruited and baseline information on diet, lifestyle and socio-demographic characteristics was collected through self-administered online questionnaires completed by their parents. Scores were calculated for overall, healthful, and unhealthful provegetarian food patterns (FP) using an a priori approach. Participants were categorized into tertiles according to their scores. Micronutrient adequacy was assessed using the Estimated Average Requirement (EAR) cut-off point. Multivariate analyses were performed to evaluate the relationship between tertiles of each provegetarian FP and the risk of inadequate micronutrient intake (failing to meet ≥ 3 requirements). Despite lower intakes of certain micronutrients, children with higher scores in the healthful provegetarian FP did not exhibit a higher prevalence of inadequacy. Children in the highest tertile of this index had 0.47-fold lower odds (95%CI 0.23-0.95) of having ≥ 3 inadequate micronutrient intakes than their peers in the lowest tertile, after adjusting for potential confounders. In contrast, children in the highest tertile of the unhealthful provegetarian FP had 20.06-fold higher odds (95%CI 9.19-43.79) of having ≥ 3 inadequate micronutrient intakes compared to children in the lowest tertile.

CONCLUSIONS: Adherence to a healthful provegetarian food pattern is associated with improved nutritional adequacy in preschoolers, while following an unhealthful pattern is detrimental to micronutrient adequacy. These results suggest that moderate reductions in animal food consumption within a healthy diet may not compromise micronutrient adequacy in young children. Further research is needed to explore the impact of diets reduced in animal food intake on the health of children.

WHAT IS KNOWN: • There's a notable trend towards plant-based diets due to health and sustainability concerns. • Research links plant-based diets in adults with lower risks of obesity, cardiovascular disease, and cancer.

WHAT IS NEW: • A new study examines how different versions of a provegetarian food pattern affect micronutrient adequacy in children, using a moderate and stepwise approach. • Following a healthful provegetarian food pattern enhances nutritional adequacy in preschoolers, whereas an unhealthful pattern negatively impacts micronutrient adequacy.

PMID:39373794 | PMC:PMC11527897 | DOI:10.1007/s00431-024-05808-9

How enteral nutrition modes influence nasopharyngeal carcinoma survivors with late dysphagia after radiotherapy: a randomized controlled study

Fri, 04 Oct 2024 00:00:00 +0000

Support Care Cancer. 2024 Oct 5;32(10):702. doi: 10.1007/s00520-024-08912-6.

ABSTRACT

BACKGROUND: Palliation to late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC) continues to be a challenge. Intermittent oro-esophageal tube feeding (IOE) is an emerging enteral nutrition mode that can address nutrition and quality of life issues related to nasogastric tube feeding (NGT).

OBJECTIVES: This study aims to investigate the effect of IOE versus NGT in late dysphagia after radiotherapy for NPC.

METHODS: This randomized controlled study included 82 NPC survivors with late dysphagia after radiotherapy. The subjects were randomized divided into the IOE and NGT groups (n1 = n2 = 41). Both groups received standard-of-care rehabilitation. Enteral nutrition supports were administered through IOE or NGT accordingly. This study lasted 2 weeks for each participant. The primary outcome was nutritional status including albumin, hemoglobin, total serum protein, and body mass index. The secondary outcomes were (i) the functional oral intake scale (FOIS), (ii) the penetration-aspiration scale (PAS), (iii) oral transit time (OTT), (iv) hyoid pause time (HPT), (v) pharyngeal transport time (PTT), and (vi) swallowing-quality of life (SWAL-QoL).

RESULTS: Three cases quitted the study halfway and there were no significant baseline differences between the IOE (n = 40) and NGT (n = 39) groups. Both time and group effects were significant in all nutritional indicators. The time effect was significant in the FOIS levels, OTT and PTT, while the group effect was not. Either time or group effect were insignificant in the PAS levels and HPT. Both group and time effects were significant in the SWAL-QoL total scores (z_Group = 5.080, P < 0.001; z_Time = 18.005, P < 0.001). The significance of time and group effects varied across different dimensions of the SWAL-QoL.

CONCLUSIONS: Rehabilitation interventions can improve swallowing function among NPC survivors with late dysphagia after radiotherapy. In this population who received standard-of-care rehabilitation, IOE is more conducive to the improvement of nutritional status, and swallowing-related quality of life.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06301763.

PMID:39367230 | DOI:10.1007/s00520-024-08912-6

Analysis of the effects of postoperative cluster nursing care on the incidence rate of postoperative complications and nutritional indicators in patients with primary laryngeal cancer

Sun, 25 Aug 2024 00:00:00 +0000

Clin Transl Oncol. 2025 Mar;27(3):1334-1339. doi: 10.1007/s12094-024-03673-4. Epub 2024 Aug 26.

ABSTRACT

OBJECTIVE: In this study, we investigated the effects of cluster nursing care on postoperative infection risk and nutritional indicators in patients with primary laryngeal cancer.

METHODS: This study comprised 50 patients with primary laryngeal cancer diagnosed between March 2020 and December 2022. They were randomly divided into the test and control groups, with each group comprising 25 patients. The test group received cluster nursing care, while the control group received standard nursing care. Indicators for quantitative scoring, such as Patient Generated Subjective Global Assessment (PG-SGA), Zubrod Performance Status (ZPS), Karnofsky score, and Nutrition Risk Screening 2002 (NRS-2002), measurement indicators such as body mass index (BMI), body mass, hip circumference, calf circumference, grip strength, weight loss, and laboratory indicators, such as hemoglobin, albumin, and transaminase levels, were used to analyze change.

RESULTS: Improvements were observed in the scores of PG-SGA, ZPS, and NRS-2002 in the test group following the implementation of nursing care for the test and control groups for 1 week, which were statistically significantly different from those at baseline (P < 0.05), and compared to the control group (P < 0.05). No statistically significant differences were observed in other indicators (P > 0.05). There was a statistically significant difference (P < 0.05) between the incidence rate of infections and complications in the test and control groups, which were 20.00% and 48.00%.

CONCLUSION: The postoperative nutritional status of patients with primary laryngeal cancer improved in phases through specialized nursing care. It is also a factor closely related to postoperative complications.

PMID:39183246 | DOI:10.1007/s12094-024-03673-4

Prognostic nutritional index (PNI) correlates with survival in head and neck cancer patients more precisely than other nutritional markers - real world data

Tue, 06 Aug 2024 00:00:00 +0000

Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6599-6611. doi: 10.1007/s00405-024-08865-w. Epub 2024 Aug 6.

ABSTRACT

PURPOSE: The survival benefit with higher body mass index (BMI) of patients suffering from head and neck squamous cell carcinoma (HNSCC) is documented as BMI paradox. As the early re-nourishment of high-risk patients determine survival, we searched for a nutritional status marker suitable for everyday screening. Grouping patients based on the 8th Edition of TNM Classification, we investigated for the first time the candidate nutritional status markers among TNM8 subgroups, including the newly introduced p16 positive oropharyngeal squamous cell cancer (OPSCC) patients.

METHODS: We conducted a retrospective cohort study enrolling 661 patients and collecting anthropometric indices, laboratory parameters, clinical scores, nutritional risk scores. To discover the best one for screening survival analyses and correlation tests were executed.

RESULTS: By performing univariate Cox regression, we found three nutritional markers significantly correlating with overall survival (OS) and cancer specific survival (CSS): BMI at diagnosis, percent of weight loss over six months and prognostic nutritional index (PNI). The latter proved to be independent of tumor stage. p16 negative OPSCC patient's OS and CSS did not correlate with BMI, but it did correlate with PNI and percent of weight loss. BMI was the only marker correlating with OS, only in stage 4 hypopharyngeal cancer patients. All three markers significantly correlated with survival among p16 positive oropharyngeal and glottic cancer patients.

CONCLUSION: We found BMI, percent of weight loss and PNI good candidate markers for malnutrition. PNI proved to be superior in every aspect, enabling the treating physicians to discover high-risk patients in need of aggressive re-nourishment. The survival of supraglottic laryngeal squamous cancer patients seemed to be independent of these nutritional status markers, which observation should be a subject of further investigations.

PMID:39107550 | PMC:PMC11564356 | DOI:10.1007/s00405-024-08865-w

The Relationship between miR-5682 and Nutritional Status of Radiotherapy-Treated Male Laryngeal Cancer Patients

Sat, 25 May 2024 00:00:00 +0000

Genes (Basel). 2024 Apr 27;15(5):556. doi: 10.3390/genes15050556.

ABSTRACT

BACKGROUND: Nutritional deficiencies are frequently observed in patients with head and neck cancer (HNC) undergoing radiation therapy. microRNAs (miRNAs) were found to play an important role in the development of metabolic disorders throughout regulation of genes involved in inflammatory responses. This study aimed to explore the correlation between pre-treatment miR-5682 expression and parameters reflecting nutritional deficits in laryngeal cancer (LC) patients subjected to radiotherapy (RT).

METHODS: Expression of miR-5682 was analyzed in plasma samples of 56 male LC individuals. Nutritional status of LC patients was assessed using anthropometric and laboratory parameters, bioelectrical impedance analysis (BIA) and clinical questionnaires.

RESULTS: A high expression of miR-5682 was associated with significantly lower values of BMI, fat mass, fat-free mass and plasma albumin at selected periods of RT course. miR-5682 allowed us to distinguish between patients classified with both SGA-C and low albumin level from other LC patients with 100% sensitivity and 69.6% specificity (AUC = 0.820; p < 0.0001). Higher expression of studied miRNA was significantly associated with shorter median overall survival (OS) in LC patients (HR = 2.26; p = 0.008).

CONCLUSIONS: analysis of miR-5682 expression demonstrates a potential clinical utility in selection of LC patients suffering from nutritional deficiencies developing as a consequence of RT-based therapy.

PMID:38790185 | PMC:PMC11120884 | DOI:10.3390/genes15050556

Taste alteration and its relationship with nutritional status among cancer patients receiving chemotherapy, cross-sectional study

Thu, 09 May 2024 00:00:00 +0000

PLoS One. 2024 May 9;19(5):e0302990. doi: 10.1371/journal.pone.0302990. eCollection 2024.

ABSTRACT

The aim of this study is to determine the prevalence of taste alterations (TAs) during chemotherapy and their association with nutritional status and malnutrition. In addition to the associated factors with TA, including sociodemographic health-related factors and clinical status, and to investigate coping strategies to manage TA. A multicenter cross-sectional design study was conducted on 120 cancer patients aged at least 18 who had been undergoing at least one round of chemotherapy. TAs were evaluated using the chemotherapy-induced taste alteration scale (CiTAS), the malnutrition universal screening tool (MUST) was used for nutritional screening, the antineoplastic side effects scale (ASES) was used for subjective assessment of chemotherapy side effects, and the Charlson comorbidity index (CCI) was used for comorbidity assessment. SPSS21 software was used to analyze the data, and the independent T-test and one-way ANOVA test were used to determine the association between TAs and a variety of related variables. The prevalence of TAs was 98.3%. Among participants, 48.3% were at low risk of malnutrition, 20% at medium risk, and 31.7% at high risk. Malnutrition risk was associated with taste disorders (p<0.05). Patients' age, gender, educational level, and physical status were associated with TAs (p<0.05). Type of cancer, chemotherapy regimen, and number of chemotherapy cycles were also associated with TAs (p<0.05). A variety of antineoplastic side effects were associated with TAs (p<0.05), including nausea, vomiting, dry mouth, sore mouth and throat, excessive thirst, swallowing difficulty, appetite changes, weight loss, dizziness, lack of energy, disturbed sleep, anxiety, and difficulty concentrating. TAs were associated with an increased number of comorbidities, and individuals with diabetes, pulmonary diseases, and hypertension were associated with TAs (P<0.05). Patients in this study rarely practice self-management strategies to cope with TAs. A high prevalence (98.3%) of TAs in cancer patients receiving chemotherapy was found, and it was linked to a variety of negative outcomes. Chemotherapy-induced TAs are an underestimated side effect that requires more attention from patients and health care providers.

PMID:38723006 | PMC:PMC11081316 | DOI:10.1371/journal.pone.0302990

Analyzing HALP and PNI scores as prognostic factors in metastatic head and neck cancers

Sat, 04 May 2024 00:00:00 +0000

Asian J Surg. 2024 Dec;47(12):5101-5105. doi: 10.1016/j.asjsur.2024.04.093. Epub 2024 May 3.

ABSTRACT

OBJECTIVE: This study investigates the prognostic significance of Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score and Prognostic Nutritional Index (PNI) in metastatic head and neck cancers.

METHODS: Retrospective analysis was conducted on data obtained from January 2014 to June 2022 for 68 patients using rigorous statistical methods. HALP and PNI scores, derived from routine laboratory parameters, were categorized into low and high groups using respective median values. Prognostic significance was determined through Kaplan-Meier survival analyses and Cox proportional hazards regression using IBM SPSS Statistics.

RESULTS: Of the 68 patients (80.9% male, median age 57), 39 (57.4%) had laryngeal cancer. When stratified by low and high HALP scores, the median overall survival (OS) was 5.9 and 16.4 months, respectively (P < 0.001), while the median progression-free survival (PFS) was 5.7 months and 8.2 months, respectively (P: 0.016). In the low and high PNI score groups, the median OS was 7 and 13.2 months (P < 0.001), with median PFS of 5.6 months and 8.2 months (P: 0.002), respectively. In the multivariate analysis, while the HALP score did not reach statistical significance in terms of PFS, the PNI score and age groups were found to be statistically significant. In terms of OS, higher HALP score and PNI scores were significantly associated with longer OS.

CONCLUSION: In this study, the HALP score and PNI score were found to be a prognostic factor in patients with metastatic head and neck cancer.

PMID:38704268 | DOI:10.1016/j.asjsur.2024.04.093

Association of perioperative oral swallowing function with post-esophagectomy outcomes and nutritional statuses in patients with esophageal cancer

Thu, 25 Apr 2024 00:00:00 +0000

Dis Esophagus. 2024 Jul 31;37(8):doae032. doi: 10.1093/dote/doae032.

ABSTRACT

Dysphagia after esophagectomy is a serious complication; however, no method has been established to accurately assess swallowing function. We evaluated the association of swallowing function tests with patients' post-esophagectomy complications and nutritional statuses. We retrospectively reviewed the data of 95 patients with esophageal cancer who underwent esophagectomy between 2016 and 2021. We performed perioperative swallowing function tests, including the repetitive saliva swallowing test (RSST), maximum phonation time (MPT), and laryngeal elevation (LE). Patients with recurrent laryngeal nerve palsy (RLNP) and respiratory complications (RC) had significantly lower postoperative RSST scores than patients without them; the scores in patients with or without anastomotic leakage (AL) were similar. Postoperative MPT in patients with RLNP was shorter than that in patients without RLNP; however, it was similar to that in patients with or without AL and RC. LE was not associated with any complications. Patients with an RSST score ≤2 at 2 weeks post-esophagectomy had significant weight loss at 1, 6, and 12 months postoperatively compared with patients with an RSST score ≥3. The proportion of patients with severe weight loss (≥20% weight loss) within 1 year of esophagectomy was significantly greater in patients with RSST scores ≤2 than in those with RSST scores ≥3. Multivariate analysis showed that an RSST score ≤2 was the only predictor of severe post-esophagectomy weight loss. RSST scoring is a simple tool for evaluating post-esophagectomy swallowing function. A lower RSST score is associated with postoperative RLNP, RC, and poor nutritional status.

PMID:38661378 | DOI:10.1093/dote/doae032

Contribution of Beef to Key Nutrient Intakes and Nutrient Adequacy in Pregnant and Lactating Women: NHANES 2011–2018 Analysis.

Mon, 01 Apr 2024 04:00:00 +0000

Nutrients; 04/01/2024
(AN 176592694); ISSN: 20726643
CINAHL Complete

Correlation between plasma lycopene levels in patients with laryngeal carcinoma and postoperative adverse complications of chemoradiotherapy and nutritional risks

Wed, 27 Dec 2023 00:00:00 +0000

Eur Arch Otorhinolaryngol. 2024 Mar;281(3):1417-1424. doi: 10.1007/s00405-023-08399-7. Epub 2023 Dec 27.

ABSTRACT

OBJECTIVE: In this study, we analyzed the correlation between the preoperative plasma lycopene levels, postoperative adverse complications of chemoradiotherapy, and nutritional risk scores in patients with laryngeal carcinoma.

METHODS: A total of 114 patients with laryngeal carcinoma and 114 healthy respondents were enrolled in this study. The patients with laryngeal carcinoma were divided into two groups: 62 patients with laryngeal carcinoma, with an NRS2002 score higher than 3 points and whose diet contained lycopene, were enrolled in the observation group, and 52 patients with laryngeal carcinoma during the corresponding time period, whose diet did not contain lycopene, were enrolled in the reference group. The immune indexes (CD4 + , CD8 + , IGA, IGM, IGG), nutritional indexes (albumin, prealbumin, transferrin), and postoperative adverse complications of chemo-radiotherapy in the two groups were recorded.

RESULTS: The lycopene levels were lower in patients with advanced tumor stage (III and IV). The diagnosis threshold of the plasma lycopene level for laryngeal carcinoma was 0.503 μmol/L. The area under the curve for plasma lycopene levels in cancer diagnosis was 0.96, with a clinical specificity of 0.943 and a sensitivity of 0.859. There was a significant negative correlation between the plasma lycopene levels and Nutrition Risk Screening (NRS) 2002 score (R² = - 0.523, P < 0.001), which was related to the increase in NRS-2002 scores and nutritional hazards in patients with laryngeal carcinoma. The observation group showed a significant increase in nutritional and immune indices, as compared to the reference group, as well as a lower incidence of severe and serious adverse reactions to chemo-radiotherapy. Lycopene supplementation, tumor stage, NRS-2002 scores, nutritional and immune indices were all significant predictors of postoperative severe and serious adverse complications of chemoradiotherapy.

CONCLUSION: Progression of laryngeal carcinoma and severity of the side effects of the adverse complications of chemo-radiotherapy are related to the levels of lycopene.

PMID:38150023 | DOI:10.1007/s00405-023-08399-7

Comparison of three nutritional assessment methods associated with the prognostic impact of laryngeal cancer

Wed, 06 Dec 2023 00:00:00 +0000

Support Care Cancer. 2023 Dec 2;31(12):737. doi: 10.1007/s00520-023-08148-w.

ABSTRACT

BACKGROUND: Several studies have found that the prognostic nutritional index (PNI), controlling nutritional status (CONUT), and Glasgow Prognostic Score (GPS) of patients with laryngeal cancer accurately predict their prognosis. However, there is no consensus regarding the best assessment tool. Therefore, this study aimed to confirm the predictive value of the three nutritional scoring systems for the prognosis of patients with laryngeal cancer.

METHODS: This study analyzed a cohort of 427 patients with laryngeal cancer who visited our hospital. PNI, CONUT, and GPS were calculated, and the relationship between these indicators and prognosis was examined.

RESULTS: The optimal cut-off levels for overall survival (OS) of laryngeal cancer patients determined by PNI, CONUT, and GPS were 45, 3, and 0, respectively. When patients were stratified based on these thresholds, OS and disease-free survival (DFS) were significantly decreased in the malnutrition group (all three, p < 0.05). The OS rates of patients with laryngeal cancer were significantly affected by the three scores according to multivariate analysis.

CONCLUSIONS: The three scoring methods had a high predictive value for the prognosis of patients with laryngeal cancer, with GPS having the strongest correlation with the prognosis of laryngeal cancer patients.

PMID:38055054 | DOI:10.1007/s00520-023-08148-w

Beef Intake Is Associated with Higher Nutrient Intake and Nutrient Adequacy in U.S. Adolescents, NHANES 2001–2018.

Fri, 01 Dec 2023 05:00:00 +0000

Nutrients; 12/01/2023
(AN 174112225); ISSN: 20726643
CINAHL Complete

May Nutritional Status Positively Affect Disease Progression and Prognosis in Patients with Esophageal and Pharyngeal Cancers? A Scoping Review of the Current Clinical Studies

Tue, 24 Oct 2023 00:00:00 +0000

Med Sci (Basel). 2023 Oct 2;11(4):64. doi: 10.3390/medsci11040064.

ABSTRACT

BACKGROUND: Malnutrition in esophageal and pharyngeal cancer patients constitutes a common and serious concern, which significantly reduces patients' prognoses. Cancers of the esophagus and the pharynx can considerably impair feeding in patients, resulting in severe undernutrition. This is a scoping review that intends to critically analyze the most well-designed clinical studies investigating the potential beneficial impact of diverse nutritional assessment tools on the prognosis of patients with esophageal and pharyngeal cancers.

METHODS: The most accurate and remarkable scientific databases were comprehensively explored utilizing relative keywords to detect clinical studies that investigate whether nutritional status may affect disease prognosis.

RESULTS: Several assessment tools have evaluated and highlighted the potential beneficial impact of nutritional status on disease progression and patients' prognosis in both esophageal and pharyngeal cancers. Regarding esophageal cancer, CONUT, PNI, PG-SGA, and NRS-2002 are more commonly used, while albumin is also frequently evaluated. Regarding pharyngeal cancers, fewer studies are currently available. PNI has been evaluated, and its significance as a factor for shorter survival' times has been highlighted. The Comprehensive Nutritional Index has also been evaluated with positive results, as well as NRS 2002, GPS, and body-weight status. However, there is currently a lack of studies with an adequate number of women with cancer. An international literature gap was identified concerning follow-up studies with adequate methodology.

CONCLUSIONS: Nutritional status may significantly affect disease progression and patients' survival, highlighting the significance of a great nutritional status in individuals with esophageal and pharyngeal cancers. Further large-scale and well-designed prospective surveys should be performed to verify the potential beneficial effects of adequate nourishment in people suffering from cancer of the esophagus and pharynx.

PMID:37873749 | PMC:PMC10594480 | DOI:10.3390/medsci11040064

Predicting the need for prophylactic gastrostomy in major head and neck cancer surgery: The PEG score

Wed, 04 Oct 2023 00:00:00 +0000

Head Neck. 2023 Dec;45(12):3042-3052. doi: 10.1002/hed.27532. Epub 2023 Oct 3.

ABSTRACT

BACKGROUND: To elaborate a preoperative score to predict the necessity of enteral nutrition at 28 days postoperatively in patients undergoing head and neck surgery.

METHODS: A total of 424 patients with oral cavity, oropharyngeal, laryngeal, and hypopharyngeal carcinoma were retrospectively enrolled and analyzed to identify preoperative predictors of prolonged postsurgical enteral feeding which were used to create a prediction model with an easy-to-use nomogram.

RESULTS: Five preoperative variables (body mass index, previous radiotherapy, preoperative dysphagia, type of surgery, flap reconstruction) were found to be independent predictive factors and were used to create a prediction model named PEG score together with the related nomogram. Accuracy, F1, and the area under the curve (AUC) were 0.74, 0.83, and 0.74. Different decision thresholds can be used to vary the sensitivity and specificity.

CONCLUSIONS: The PEG score showed high prediction performances for modeling the need for enteral nutrition at 28 days postoperatively. Prospective studies are needed to define a personalized nutrition protocol.

PMID:37789705 | DOI:10.1002/hed.27532

Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer

Thu, 03 Aug 2023 00:00:00 +0000

Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5531-5538. doi: 10.1007/s00405-023-08139-x. Epub 2023 Aug 3.

ABSTRACT

PURPOSE: Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer.

METHODS: Patients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications.

RESULTS: Pre-operative malnutrition incidence was 40%. Malnourished patients had higher incidences of any type of complication (57% vs 44%, p = 0.013) and pressure injury (86% vs 14%, p = 0.011) compared to well-nourished patients. Well-nourished patients had a clinically important shorter median length of stay compared to malnourished patients (17.5 vs 20 days).

CONCLUSION: Early identification and management of malnutrition is essential to minimize risk of post-operative complications and reduce length of stay and should be considered a key component of prehabilitation programs.

PMID:37535080 | PMC:PMC10620302 | DOI:10.1007/s00405-023-08139-x

Iodine Intake From Diet and Supplements and Urinary Iodine Concentration in a Cohort of Pregnant Women in the United States

Wed, 05 Jul 2023 00:00:00 +0000

Am J Clin Nutr. 2023 Jul;118(1):283-289. doi: 10.1016/j.ajcnut.2023.04.005. Epub 2023 May 26.

ABSTRACT

BACKGROUND: The DRI Estimated Average Requirement (EAR) in pregnancy for Iodine (I), an essential nutrient for fetal neurodevelopment, is 160 μg/d. Supplementation with 150 μg/d I/day is recommended during pregnancy, however, neither dietary intake or the combination of diet and supplement intake has been reported in US pregnant women.

OBJECTIVE: Determine iodine intake from diet and supplements and iodine status in pregnancy by urinary iodine concentration in a large cohort of pregnant women.

DESIGN: Pregnant women (n=750) completed the Diet History Questionnaire 2.0 from the National Institute of Cancer or multiple 24-hour recalls at baseline and identified their prenatal supplement(s). Dietary iodine intake was estimated using the USDA, FDA and ODS-NIH Database for the Iodine Content of Common Foods at enrollment, supplemental iodine intake throughout the study using content databases, and urinary iodine concentration (UIC) by the modified Sandell-Kolthoff reaction in samples collected between 14-20 weeks gestation (n=966).

RESULTS: The median intake of iodine from diet was 108.8 μg/d, and 63% (473/750) were below the Estimated Average Requirement (EAR). Furthermore, 65% (529/818) took a supplement containing iodine, however, only 32% (259/818) took ≥150 μg/d. Median intake increased to 188.5 μg/d with the inclusion of I from supplements, however , 41% (380/925) remained below the EAR even after supplementation suggesting inadequate intake in nearly half of the cohort. A similar 48% (467/966) had UIC ≤150 μg/L.

CONCLUSIONS: Assessment of iodine status by UIC and intake of iodine from diet and supplements support a high prevalence of iodine insufficiency during pregnancy in this large cohort of US women.

PMID:37407165 | PMC:PMC10493429 | DOI:10.1016/j.ajcnut.2023.04.005

Folate and vitamin B12 usual intake and biomarker status by intake source in United States adults aged ≥19 y: NHANES 2007-2018

Fri, 12 May 2023 00:00:00 +0000

Am J Clin Nutr. 2023 Jul;118(1):241-254. doi: 10.1016/j.ajcnut.2023.05.016. Epub 2023 May 11.

ABSTRACT

BACKGROUND: Folate and vitamin B12 are important biomarkers of nutritional status of populations.

OBJECTIVES: This study aims to estimate folate and vitamin B12 usual intakes among United States adults and examine folate and vitamin B12 biomarker status by intake source.

METHODS: We analyzed data for United States adults aged ≥19 y from National Health and Nutrition Examination Survey 2007-2018 (n = 31,128), during which time voluntary corn masa flour (CMF) fortification was started. Usual intake was estimated using the National Cancer Institute method. Folate intake included folate from natural foods and folic acid from 4 sources: enriched cereal grain products (ECGPs), CMF, ready-to-eat cereals (RTEs), and folic acid-containing supplements (SUP). Vitamin B12 intake was mainly from food and supplements.

RESULTS: The median natural food folate intake (222 μg dietary folate equivalents (DFE)/d) was below the estimated average requirement (EAR) of 320 μg DFE/d. The proportions of those who consumed folic acid from ECGP/CMF only, ECGP/CMF + RTE, ECGP/CMF + SUP, and ECGP/CMF + RTE + SUP were 50%, 18%, 22%, and 10%, respectively. Median usual folic acid intakes (μg/d) were 236 (IQR: 152, 439) overall and 134, 313, 496, and 695 in the ECGP/CMF only, ECGP/CMF + RTE, ECGP/CMF + SUP, and ECGP/CMF + RTE + SUP folic acid consumption groups, respectively. Overall, 2.0% (95% CI: 1.7%, 2.3%) of adults, all of whom used folic acid supplements, consumed greater than the tolerable upper intake level (UL) of 1000 μg/d folic acid. The median usual vitamin B12 intake (μg/d) was 5.2 for vitamin B12 supplement nonusers and 21.8 for users. Consumption of RTE and/or supplements with folic acid was associated with higher serum and red blood cell folate concentrations. Vitamin B12 supplement users had significantly higher serum vitamin B12 concentrations.

CONCLUSIONS: Folic acid fortification plays a critical role in helping United States adults meet the folate EAR. At current fortification levels, United States adults who do not consume supplements do not have the usual folic acid intake exceeding the UL.

PMID:37172826 | PMC:PMC10926004 | DOI:10.1016/j.ajcnut.2023.05.016

Malnutrition, Cancer Stage and Gastrostomy Timing as Markers of Poor Outcomes in Gastrostomy-Fed Head and Neck Cancer Patients

Sat, 11 Feb 2023 00:00:00 +0000

Nutrients. 2023 Jan 28;15(3):662. doi: 10.3390/nu15030662.

ABSTRACT

For percutaneous endoscopic gastrostomy (PEG)-fed head and neck cancer (HNC) patients, risk markers of poor outcomes may identify those needing more intensive support. This retrospective study aimed to evaluate markers of poor outcomes using TNM-defined stages, initial anthropometry [body mass index (BMI), mid-upper arm circumference (MUAC), tricipital skinfold (TSF), mid-arm muscle circumference (MAMC)] and laboratory data (albumin, transferrin, cholesterol), with 138 patients, 42-94 years old, enrolled. The patients had cancer, most frequently in the larynx (n = 52), predominantly stage IV (n = 109). Stage IVc presented a four times greater death risk than stage I (OR 3.998). Most patients presented low parameters: low BMI (n = 76), MUAC (n = 114), TSF (n = 58), MAMC (n = 81), albumin (n = 47), transferrin (n = 93), and cholesterol (n = 53). In stages I, III, IVa, and IVb, MAMC and PEG-timing were major survival determinants. Each MAMC unit increase resulted in 16% death risk decrease. Additional 10 PEG-feeding days resulted in 1% mortality decrease. Comparing IVa/IVb vs. IVc, albumin and transferrin presented significant differences (p = 0.042; p = 0.008). All parameters decreased as severity of stages increased. HNC patients were malnourished before PEG, with advanced cancer stages, and poor outcomes. Initial MAMC, reflecting lean tissue, significantly increases survival time, highlighting the importance of preserving muscle mass. PEG duration correlated positively with increased survival, lowering death risk by 1% for every additional 10 PEG-feeding days, signaling the need for early gastrostomy.

PMID:36771369 | PMC:PMC9919312 | DOI:10.3390/nu15030662

Changes in Body Mass Index Are Associated with Squamous Cell Carcinomas of Oral Cavity, Oropharynx and Larynx: A Case-Control Study in Brazil.

Wed, 01 Feb 2023 05:00:00 +0000

Nutrition & Cancer; 02/01/2023
(AN 162055478); ISSN: 01635581
CINAHL Complete

Malnutrition, Cancer Stage and Gastrostomy Timing as Markers of Poor Outcomes in Gastrostomy-Fed Head and Neck Cancer Patients.

Wed, 01 Feb 2023 05:00:00 +0000

Nutrients; 02/01/2023
(AN 161871159); ISSN: 20726643
CINAHL Complete

Prognostic Value of Controlling Nutritional Status Score in Advanced Hypopharyngeal Cancer

Wed, 18 Jan 2023 00:00:00 +0000

Laryngoscope. 2023 Oct;133(10):2613-2620. doi: 10.1002/lary.30568. Epub 2023 Jan 18.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the prognostic significance of the preoperative controlling nutritional status (CONUT) score in patients with resectable advanced hypopharyngeal cancer.

METHODS: This retrospective study included 113 advanced hypopharyngeal cancer patients who underwent curative resection in our hospital from 2013 to 2017. The association between the CONUT score and clinicopathological variables was evaluated. The association between CONUT score and survival was analyzed using Kaplan-Meier survival curves and Cox regression. The efficacy of the CONUT score and other immune-nutritional markers to predict prognosis was compared using a time-dependent receiver operating characteristic (ROC).

RESULTS: Patients were divided into the high-CONUT score group (≥3) and the low-CONUT score group (≤2) according to ROC analysis. The CONUT score was associated with body mass index (p = 0.047), monocyte (p = 0.021), pharyngocutaneous fistula (p = 0.045), flap repairment (p = 0.034), tumor (T) classification (p = 0.034), node (N) classification (p = 0.036), subsite of tumor (p = 0.035), and negative pathologic factors (p < 0.001). Tumor, node, metastasis (TNM) stage, negative pathologic factors, adjuvant radiotherapy, postoperative chemoradiotherapy, and CONUT score were independent prognostic factors for survival. Patients with a higher CONUT score had worse overall survival (OS) (hazard ratio: 2.76, 95% confidence interval [CI]: 1.44-5.29, p = 0.002) and disease-free survival (hazard ratio: 2.51, 95% CI: 1.28-4.91, p = 0.007). The area under the curve of the CONUT score (0.799) to predict 5-year OS was greater than those of Preoperative Nutritional Index (0.769), platelet-to-lymphocyte ratio (0.643), neutrophil-to-lymphocyte ratio (0.565), and lymphocyte-to-monocyte ratio (0.577).

CONCLUSION: The CONUT score is a prognostic marker for patients with resectable advanced hypopharyngeal cancer.

LEVEL OF EVIDENCE: 3 Laryngoscope, 133:2613-2620, 2023.

PMID:36651579 | DOI:10.1002/lary.30568

Controlling Nutritional Status (CONUT) score is a prognostic marker for laryngeal cancer patients with curative resection

Wed, 28 Sep 2022 00:00:00 +0000

Head Neck. 2022 Dec;44(12):2834-2841. doi: 10.1002/hed.27206. Epub 2022 Sep 28.

ABSTRACT

BACKGROUND: To investigate the prognostic value of pre-treatment Controlling Nutritional Status (CONUT) score in laryngeal cancer.

METHODS: Preoperative CONUT score was retrospectively calculated in 154 laryngeal cancer patients who underwent curative resection in our hospital from 2013 to 2016. The associations of CONUT with clinicopathological factors and survival were evaluated. The efficacy of CONUT score to predict prognosis was evaluated.

RESULTS: The CONUT score was associated with body mass index (p = 0.033), neutrophil (p = 0.011), tumor size (p = 0.017), pTNM stage (p = 0.001), adjuvant radiotherapy (p < 0.001), negative pathologic factors (p < 0.001), and larynx preservation (p < 0.001). Patients with a higher CONUT score had worse overall survival (hazard ratio: 1.94, 95% confidence interval [CI]: 1.13-3.72, p = 0.039) and disease-free survival (hazard ratio: 2.16, 95% CI: 1.19-3.90, p = 0.011). The area under the curve of CONUT score (0.728) was higher than Preoperative Nutritional Index (0.72), platelet-to-lymphocyte ratio (0.675), and neutrophil-to-lymphocyte ratio (0.687).

CONCLUSION: The CONUT score can be useful for predicting survival in laryngeal cancer patients after curative resection.

PMID:36169119 | DOI:10.1002/hed.27206

Case study: nutritional considerations in the head and neck cancer patient.

Wed, 01 Jun 2022 04:00:00 +0000

South African Journal of Clinical Nutrition; 06/01/2022
(AN 157382901); ISSN: 16070658
CINAHL Complete

Efficacy of the pretreatment geriatric nutritional risk index for predicting severe adverse events in patients with head and neck cancer treated with chemoradiotherapy.

Fri, 01 Apr 2022 04:00:00 +0000

Auris Nasus Larynx; 04/01/2022
(AN 155723747); ISSN: 03858146
CINAHL Complete

Effect of swallowing training combined with nutritional intervention on the nutritional status and quality of life of laryngeal cancer patients with dysphagia after operation and radiotherapy

Wed, 30 Mar 2022 00:00:00 +0000

J Oral Rehabil. 2022 Jul;49(7):729-733. doi: 10.1111/joor.13328. Epub 2022 Apr 18.

ABSTRACT

BACKGROUND: Dysphagia is a common complication in patients with laryngeal cancer after surgery and radiotherapy.

OBJECTIVES: To explore the effect of swallowing training administered in combination with nutritional intervention on the nutritional status and quality of life of laryngeal cancer patients with dysphagia after surgery and radiotherapy.

METHODS: Sixty-six patients with laryngeal cancer who developed dysphagia were randomly divided into control group and intervention group (n = 33 in each group). Patients in both groups received total laryngectomy and prophylactic radiotherapy and were provided routine health counseling and swallowing training. Patients in the intervention group were additionally provided with nutritional intervention. All patients were evaluated using video fluoroscopic swallowing examination (VFSE), Patient-Generated Subjective Global Assessment on nutritional status (PG-SGA) score, and Quality of Life Questionnaire-core 30 (QLQ-c30) score immediately after radiotherapy and 3 months later.

RESULTS: Prior to swallowing training, there was no significant between-group difference with respect to VFSE evaluation, PG-SGA score, or QLQ-c30 score. Both groups showed improvement in these measures at 3 months after radiotherapy; however, the improvement in the intervention group was significantly better than that in the control group.

CONCLUSIONS: Swallowing training combined with nutritional intervention can improve swallowing function, nutritional status and the quality of life of laryngeal cancer patients with dysphagia after operation and radiotherapy.

PMID:35352383 | DOI:10.1111/joor.13328

Nutritional status at diagnosis is prognostic for pharyngeal cancer patients: a retrospective study

Tue, 25 Jan 2022 00:00:00 +0000

Eur Arch Otorhinolaryngol. 2022 Jul;279(7):3671-3678. doi: 10.1007/s00405-021-07222-5. Epub 2022 Jan 25.

ABSTRACT

BACKGROUND: Malnutrition in head and neck cancer (HNC) patients is associated with increased morbidity and mortality. Several nutrition indicators have been reported to be related to the prognosis of HNC. However, the prognostic effect of these multiple nutrition factors in HNC is not well elucidated. The aim of this study was to evaluate the prognostic effect of these factors, including the novel hemoglobin, albumin, lymphocyte, and platelet (HALP) score, for pharyngeal cancers.

MATERIAL AND METHODS: From 2008 to 2019, a total of 319 pharyngeal cancer patients were recruited. We collected adult patients with a diagnosis of nasopharyngeal carcinoma, oropharyngeal carcinoma and hypopharyngeal carcinoma. Patients who completed definite staging workup and treatment were selected for analysis. We traced nutritional and hematological parameters, including body mass index (BMI), albumin, and complete blood count, for survival analysis.

RESULTS: We found that multiple nutritional markers, including BMI, hemoglobin, albumin, prognostic nutritional index (PNI), nutritional risk index (NRI) and HALP score, were important predictors for pharyngeal cancers in univariate Cox regression analysis. In multivariate analysis, we found that the HALP score was still an independent factor (HR: 1.62, 1.13-2.32 for overall survival [OS]) after adjusting of gender, age, cancer site, clinical stage, and BMI. The PNI was the most important independent factor for OS (HR: 3.12, 2.18-4.47) and cancer-specific survival (HR: 2.88, 1.88-4.41) in multivariate analysis.

CONCLUSION: We found that multiple nutrition markers, including BMI, hemoglobin, albumin, PNI, NRI and HALP score, are important predictors for pharyngeal cancers. This is the first report confirming the prognostic effect of the HALP score for HNCs. Nutritional status at diagnosis should be given more attention in pharyngeal cancer patients.

PMID:35076744 | DOI:10.1007/s00405-021-07222-5

Inadvertent placement of a nasogastric tube following traumatic nasal tube intubation

Fri, 31 Dec 2021 00:00:00 +0000

BMJ Case Rep. 2021 Dec 30;14(12):e247696. doi: 10.1136/bcr-2021-247696.

ABSTRACT

Adequate nutrition is necessary in head and neck surgery. Enteral feeding via a nasogastric tube is often required due to the altered anatomy and to allow sufficient intraoral healing. Insertion of a nasogastric tube is commonly performed without complication and confirmation of its position by a number of different methods. Incorrect positioning can cause significant morbidity with associated mortality. This case report describes the inadvertent placement of a nasogastric tube in a patient with a mandibular squamous cell carcinoma, into the abdominal cavity following a failed traumatic nasal tube intubation. Chest radiography and auscultation failed to identify the abnormal position with subsequent commencement of feeds for a number of days. Following a laporotomy and insertion of abdominal drains, the patient recovered and was discharged from hospital. To prevent recurrence, it is suggested that direct laryngoscopy or direct visualisation of the upper aspect be performed.

PMID:34969812 | PMC:PMC8719158 | DOI:10.1136/bcr-2021-247696

Iodine Status of Canadian Children, Adolescents, and Women of Childbearing Age.

Wed, 01 Dec 2021 05:00:00 +0000

Journal of Nutrition; 12/01/2021
(AN 153995243); ISSN: 00223166
CINAHL Complete

Decrement of prognostic nutrition index in laryngeal diseases: from precancerous lesion to squamous cell carcinoma

Fri, 26 Nov 2021 00:00:00 +0000

Acta Otolaryngol. 2021 Dec;141(12):1070-1074. doi: 10.1080/00016489.2019.1634836. Epub 2021 Nov 26.

ABSTRACT

BACKGROUND: Malnutrition and systemic inflammatory response have been confirmed to be important risk factors for various cancers.

OBJECTIVE: To compare pretreatment prognostic nutrition index (PNI) among patients with laryngeal squamous cell carcinoma (LSCC), laryngeal precancerous lesion (LPL) and laryngeal benign lesion (LBL).

METHODS: A total of 253 male patients with laryngeal lesions were divided into LBL, LPL with low risk (LPL (l)), LPL with high risk (LPL(h)), LSCC (i), LSCC (ii) and LSCC (iii) groups according to their histopathological findings and the TNM staging system. PNI and other clinical parameters were calculated. Kruskal-Wallis, Mann-Whitney U or Chi-square or Fisher's exact test were used for comparison of different parameters among groups. Logistic regression was performed to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI).

RESULTS: The PNI in the LSCC group was significantly lower than those of the LBL and LPL groups (p = .013 and p = .004, respectively), and decreased from LPL(l) to LSCC (iii) (from 53.97 ± 3.69 to 50.02 ± 4.75). LPL patients with lower PNI values had a higher risk of LSCC, the OR was 0.91 (95% CI: 0.84, 0.97) for a one-unit decrease.

CONCLUSIONS: PNI could be a simple and reproducible marker for predicting the severity of laryngeal diseases.

PMID:34823427 | DOI:10.1080/00016489.2019.1634836

Swallowing, nutritional status, and salivary flow in patients after head and neck cancer treatment, a pilot study

Wed, 13 Oct 2021 00:00:00 +0000

Sci Rep. 2021 Oct 12;11(1):20233. doi: 10.1038/s41598-021-99208-w.

ABSTRACT

Determine the relationship between swallowing function, nutritional status, and salivary flow in patients after head and neck cancer treatment. This pilot study included 17 patients. Swallowing was assessed through videofluoroscopy and surface electromyography (sEMG), nutritional status through anthropometry and dietary assessment, and salivary flow both with and without mechanical stimulation. Test analysis showed that 66.7% of patients had functional limitations in swallowing in 58.3%, 66.7%, and 58.3% residue scale with an average of a line of barium on a structure for pudding, honey, and liquid consistencies, respectively. Laryngeal penetration was found in 8.3% during the swallowing of liquid. Surface electromyography (sEMG) showed above normal values for muscle activity time during the swallowing of pudding. Anthropometric assessment and muscle and adipose tissue indicated eutrophy. Salivary flow test with mechanical stimulus showed that 82.3% of patients' salivary production was well below the appropriate level. There was a significant correlation between muscle tissue reserve and muscle activity time during swallowing in the studied muscles (left masseter p = 0.003, right masseter p = 0.001, suprahyoid p = 0.001, orbicularis oris = 0.020), all in pudding consistency. This pilot study confirmed the relationship between swallowing and nutritional status for its participants, showing that appropriate protein intake influences muscle activity during swallowing in head and neck cancer survivors.

PMID:34642369 | PMC:PMC8511146 | DOI:10.1038/s41598-021-99208-w

Efficacy of the pretreatment geriatric nutritional risk index for predicting severe adverse events in patients with head and neck cancer treated with chemoradiotherapy

Sun, 12 Sep 2021 00:00:00 +0000

Auris Nasus Larynx. 2022 Apr;49(2):279-285. doi: 10.1016/j.anl.2021.08.009. Epub 2021 Sep 9.

ABSTRACT

OBJECTIVE: The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool. Although concurrent chemoradiotherapy (CCRT), particularly cisplatin-based CCRT, is a standard treatment for locoregional advanced head and neck squamous cell carcinoma (HNSCC), the predictive factors of adverse events related to CCRT remain to be elucidated. The present study aimed to determine the association between GNRI and CCRT-related adverse events in patients of all ages with head and neck cancer (HNC) who underwent CCRT.

METHODS: We retrospectively analyzed and compared the clinical characteristics and adverse events of 82 patients with HNC treated with CCRT according to their GNRI at the Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba Hospital, between May 2014 and November 2019. The GNRI was calculated according to the equation: 1.489 × serum albumin (g/L) + 41.7 × (body weight/ideal body weight). We compared two groups: low GNRI (GNRI < 98) and normal GNRI (GNRI ≥ 98) groups.

RESULTS: Eighty-two patients were enrolled in this study. There were 61 (76%) and 21 (26%) patients in the normal GNRI group and low GNRI group, respectively. There were significant differences in the incidence of grade ≥ 3 radiation mucositis, radiation dermatitis, and leukopenia between the low GNRI group and the normal GNRI groups.

CONCLUSIONS: Patients with low GNRI scores were more likely to have severe adverse events. Pretreatment GNRI predicted severe CCRT-related adverse events in patients of all ages with HNC undergoing CCRT.

PMID:34509306 | DOI:10.1016/j.anl.2021.08.009

Objective evaluation of nutritional status using the prognostic nutritional index during and after chemoradiotherapy in Japanese patients with head and neck cancer: a retrospective study

Tue, 24 Aug 2021 00:00:00 +0000

Eur J Hosp Pharm. 2021 Sep;28(5):266-270. doi: 10.1136/ejhpharm-2019-001979. Epub 2019 Aug 17.

ABSTRACT

OBJECTIVES: The incidence of severe mucosal damage due to low nutritional status is high in patients receiving concurrent chemoradiotherapy (CCRT) for head and neck cancer. Objective assessments do not exist for discharge criteria after completion of CCRT. Although the prognostic nutritional index (PNI) is an objective indicator of postoperative outcomes in patients undergoing cancer surgery, the prognostic impact of the PNI in patients with head and neck cancer receiving CCRT is unexplored. We investigated whether the PNI could be an objective criterion for nutritional status and a discharge criterion after completion of CCRT.

METHODS: We assessed the medical records of 23 patients with head and neck cancer who received triweekly cisplatin +radiotherapy (2 Gy ×35 fractions). We evaluated whether the PNI could be a useful evaluation indicator in patients with head and neck cancer receiving CCRT and determined the cut-off PNI value by receiver operating characteristic (ROC) curve analysis as a criterion for hospital discharge.

RESULTS: The PNI pre-treatment and post-treatment values were 51.0 and 38.0, respectively (p<0.05). The median length of hospitalisation after therapy was 5 days in patients with grades 1 and 2 and 10 days in patients with grade 3 oral and pharyngeal mucositis (p<0.05). The optimal cut-off PNI value as a criterion for hospital discharge was found to be 40.4 (grades 1 and 2 mucositis) and 38.6 (grade 3 mucositis) by the ROC analysis.

CONCLUSIONS: The PNI is a simple, objective and temporal indicator which is useful in assessing the nutritional status of patients with head and neck cancer. The PNI could be used as an objective indicator to determine the time of discharge after CCRT completion.

PMID:34426479 | PMC:PMC8403783 | DOI:10.1136/ejhpharm-2019-001979

Malnutrition screening in head and neck cancer patients with oropharyngeal dysphagia

Sat, 31 Jul 2021 00:00:00 +0000

Clin Nutr ESPEN. 2021 Aug;44:348-355. doi: 10.1016/j.clnesp.2021.05.019. Epub 2021 May 31.

ABSTRACT

BACKGROUND & AIMS: Malnutrition in head and neck cancer (HNC) patients is associated with increased morbidity and mortality. The purpose of this study is two-fold: to identify the risk of malnutrition in patients with oropharyngeal dysphagia (OD) secondary to HNC, and to determine the relationship between the risk of malnutrition versus tumor characteristics, treatment modality, time interval (between the end of oncological treatment and swallowing assessment date), level of oral intake, body mass index (BMI), aspiration, pharyngeal pooling, and OD-related quality of life (QoL).

METHODS: The Short Nutritional Assessment Questionnaire (SNAQ) was used to screen patients for the risk of malnutrition. Patients underwent a standardized swallowing examination protocol including an endoscopic evaluation of swallowing.

RESULTS: Seventy-five dysphagic HNC patients were included. Forty-eight percent of the patients presented a high risk of malnutrition using SNAQ. The majority of the patients (81.3%) was on a total oral diet. Moreover, BMI did not appear to be a reliable measure to screen for malnutrition as a normal BMI was often associated with an increased risk of malnutrition on the SNAQ. In contrast, patients who were underweight or overweight did not show an association with a high risk of malnutrition. With the exception of BMI, no other patient and tumor characteristics were found to be associated with the risk of malnutrition.

CONCLUSIONS: This study emphasizes the importance of early nutritional screening in dysphagic HNC patients, as almost half of these patients presented a high risk of malnutrition. Malnutrition screening using SNAQ can identify HNC patients with OD who are at risk of malnutrition and subsequently need to be referred to a dietician for additional nutritional assessment, diagnosis of malnutrition, and nutritional support, even when their BMI is within normal range.

PMID:34330489 | DOI:10.1016/j.clnesp.2021.05.019

Iodine Status of Canadian Children, Adolescents, and Women of Childbearing Age

Tue, 27 Jul 2021 00:00:00 +0000

J Nutr. 2021 Dec 3;151(12):3710-3717. doi: 10.1093/jn/nxab268.

ABSTRACT

BACKGROUND: Adequate iodine intake is important for children and women of childbearing age because iodine is vital for fetal brain development and early life.

OBJECTIVE: Iodine status of children (n = 1875), adolescents (n = 557), and women of childbearing age (n = 567) was assessed using urinary iodine concentrations (UIC) from duplicate spot samples collected in the Canadian Health Measures Survey, cycle 5 (2016-2017).

METHODS: Daily iodine intakes were estimated from urinary iodine and creatinine concentrations using a formula based on iodine absorption and predicted 24-h creatinine excretion. Usual UIC and iodine intakes, adjusted for within-person variation, were estimated using the National Cancer Institute method. Iodine status was assessed by 1) comparing median UIC with WHO/UNICEF/ICCIDD reference ranges and 2) estimating the prevalence of inadequate and excessive intakes using the estimated average requirement (EAR) and tolerable upper intake level (UL) cut-point method, respectively.

RESULTS: Median UIC for males and females 6-11 or 12-19 y old were ≥100 μg/L, the lower cutoff for adequate intakes. For women 20-39 y old, the median UIC of an unadjusted sample was 81 μg/L (95% CI: 67, 95) and for the usual UIC was 108 μg/L (95% CI: 84, 131). The percentage of children 3 y old with iodine intake ≥EAR was 82% (95% CI: 75, 89). The corresponding estimates for males 4-8, 9-13, and 14-18 y old were 93% (95% CI: 88, 97), 91% (95% CI: 87, 96), and 84% (95% CI: 76, 91), respectively. Estimates for females 4-8, 9-13, 14-18, and 19-39 y old were 86% (95% CI: 83, 89), 87% (95% CI: 80, 95), 68% (95% CI: 55, 80), and 68% (95% CI: 59, 76), respectively. For all sex-age groups, 91-100% had iodine intakes ≤UL.

CONCLUSIONS: Iodine intakes may be insufficient for some women of childbearing age. Public health policies and programs should continue to recommend that all women who could become pregnant, or women who are pregnant or breastfeeding, take a daily multivitamin-mineral supplement containing iodine.

PMID:34313736 | DOI:10.1093/jn/nxab268

Impact of Nutritional Status on Survival in Head and Neck Cancer Patients After Total Laryngectomy

Mon, 19 Jul 2021 00:00:00 +0000

Nutr Cancer. 2022;74(4):1252-1260. doi: 10.1080/01635581.2021.1952446. Epub 2021 Jul 19.

ABSTRACT

Malnutrition is an important prognostic indicator of laryngeal squamous cell carcinoma. Retrospective study with head and neck cancer patients who underwent total laryngectomy. 243 patients of both sex were evaluated. The univariate analyses demonstrated an increased risk of death for the patients with greater weight loss, hypoalbuminemia, radiotherapy as an initial treatment, salvage surgery, and radical neck dissection. In a Multivariate Cox regression, older age (p = 0.03, 95% confidence interval [CI] 1.003-1.06, hazard ratio [HR] 1.029), Nutritional Risk Index ≤100 (p = 0.008, 95% CI 1.18-3.12, HR 1.921) and adjuvant radiotherapy (p = 0.029, 95% CI 0.31-3.12, HR 0.544) demonstrated prognostic significance in survival. Nutritional status is a modifiable variable and these findings highlight the need to adoption of simple nutritional assessment methods routinely during the treatment of head and neck cancer patients, in order to help improve prognosis after surgery.

PMID:34278898 | DOI:10.1080/01635581.2021.1952446

Micronutrient dietary intakes and their food sources in adults: the Hellenic National Nutrition and Health Survey (HNNHS).

Tue, 01 Jun 2021 04:00:00 +0000

Journal of Human Nutrition & Dietetics; 06/01/2021
(AN 150672337); ISSN: 09523871
CINAHL Complete

Evaluation and revision of core postoperative nursing outcomes for laryngeal carcinoma in China.

Tue, 23 Mar 2021 04:00:00 +0000

BMC Nursing; 03/23/2021
(AN 149433236); ISSN: 14726955
CINAHL Complete

Micronutrient dietary intakes and their food sources in adults: the Hellenic National Nutrition and Health Survey (HNNHS)

Tue, 26 Jan 2021 00:00:00 +0000

J Hum Nutr Diet. 2021 Jun;34(3):616-628. doi: 10.1111/jhn.12840. Epub 2021 Jan 26.

ABSTRACT

BACKGROUND: The present study aimed to assess micronutrient intake among Greek adults and to identify the main food sources that contribute to it.

METHODS: Food consumption data from 2389 participants in the Hellenic National Nutrition and Health Survey (HNNHS), collected with 24-h recalls, was used to calculate micronutrient intakes. Usual nutrient intake was estimated according to the National Cancer Institute method. Nutrient adequacy was estimated using the estimated average requirement (EAR) cut-point method, when available, or adequate intake otherwise. The probability approach was used to determine iron intake adequacy in females of reproductive age. Food group contribution for each nutrient assessed was derived to identify their main food sources.

RESULTS: Almost all individuals had vitamin D intake below EAR, whereas vitamins A, E, K and C, as well as potassium intake, were also insufficient in a considerable percentage of the population (>70% in most age groups). Calcium intake was substantially below the EAR for females aged >50 years and males >70 years; the same for magnesium in males >70 years. Furthermore, 50% of females, including those of reproductive age, had intake of folate below EAR. More than 50% of the population (to 79%) exceeded the upper tolerable limit for sodium (2300 mg day^-1 ). Food contribution analysis revealed that most vitamins were derived from low-quality foods (i.e. fast-food).

CONCLUSIONS: A significant proportion of adults residing in Greece have low nutrient intake and poor food selections. These results provide guidance to public health policy makers for developing strategies to improve the dietary quality in Greece.

PMID:33497494 | DOI:10.1111/jhn.12840

Enteral tube feeding of head and neck cancer patients undergoing definitive chemoradiotherapy in the Nordic Countries: Survey of the Scandinavian Society for Head and Neck Oncology

Sun, 03 Jan 2021 00:00:00 +0000

Eur Arch Otorhinolaryngol. 2021 Sep;278(9):3489-3496. doi: 10.1007/s00405-020-06545-z. Epub 2021 Jan 2.

ABSTRACT

PURPOSE: We assessed current policies and perceptions of enteral tube feeding in head and neck cancer (HNC) patients undergoing chemoradiotherapy (CRT). A web-based survey was used to compare the timing and method of tube feeding within and between the five Nordic countries, covering a population of 27 million.

METHODS: From each of the 21 Nordic university hospitals, one oncologist and one otorhinolaryngology-head and neck (ORL-HN) surgeon responded to a survey. The respondents were asked whether tube insertion before the onset of CRT, or during CRT as required (prophylactic vs. reactive) was preferred. The use of a pretreatment nutritional screening tool and the choice of feeding route (nasogastric vs. gastrostomy tube) were assessed. In total, we analyzed responses from 21 oncologists and 21 ORL-HN surgeons.

RESULTS: A tendency was observed towards decreasing the use of a PEG tube. Of the 21 university hospitals, only 2 (10%) reported using a prophylactic PEG tube in over half of HNC patients undergoing definitive CRT. The preferred method for reactive tube feeding was by a NG tube in 14 of 21 (67%), and by a PEG in 7 of 21 (33%). In general, both oncologists and ORL-HN surgeons were content with their current policy.

CONCLUSIONS: The practices for enteral tube feeding in HNC management vary within and between the Nordic countries. We suggest that unified protocols for tube feeding should be developed for this patient population.

PMID:33389006 | DOI:10.1007/s00405-020-06545-z

The effect of consuming voluntarily fortified food and beverages on usual nutrient intakes in the Canadian population.

Fri, 01 Jan 2021 05:00:00 +0000

Food & Nutrition Research; 01/01/2021
(AN 154640187); ISSN: 16546628
CINAHL Complete

Effect of Breast Cancer Treatment on Dietary Vitamin Intake Levels

Wed, 30 Dec 2020 00:00:00 +0000

Int J Environ Res Public Health. 2020 Dec 22;18(1):19. doi: 10.3390/ijerph18010019.

ABSTRACT

Breast cancer is the most common tumor among women, representing the second cause of cancer deaths in women. Treatment with chemotherapy negatively interferes with nutritional status. The intake of vitamins before, during and after treatment in a pilot cohort of women with non-invasive breast cancer (type I, II) treated at the Valencian Institute of Oncology (IVO) is evaluated. A 3-day anthropometric and nutritional assessment was performed using the DIAL program. Nutritional intake is compared with the values of Estimated Average Requirements (EAR) and Dietary Reference Intake (DRI) provided by the United States Department of Agriculture (USDA) and the European Food Safety Authority (EFSA). There is an overall decrease in vitamin intake during treatment which worsens at the end of said treatment. The decrease is significant in the case of vitamins B₂ (p = 0.006), B₃ (p = 0.042), B₅ (p = 0.001), and B₈ (p = 0.021). The relative risk during and after treatment increases with respect to the reference timeframe, before treatment. Deficit risks are statistically significant in the case of vitamins B₅ (p = 0.001), B₈ (p = 0.001) and B₁₂ (p = 0.001). Decreased vitamin intake during treatment suggests a negative change in the patients' dietary behaviors during this time. Nutritional intervention and support may be beneficial to optimize overall dietary intake and maintain compliance with EAR and DRI for patients during a time in which adequate nutrition is important.

PMID:33375141 | PMC:PMC7792964 | DOI:10.3390/ijerph18010019

Loss status of fat - free mass in patients with head and neck cancer during perioperative period and its influencing factors.

Tue, 15 Dec 2020 05:00:00 +0000

Chinese Nursing Research; 12/15/2020
(AN 148070882); ISSN: 10096493
CINAHL Complete