nutrition_ORL

Effectiveness of an evidence-based swallowing facilitation strategy for patients undergoing radiotherapy for head and neck cancer: A study protocol for a randomised controlled trial

Sat, 02 Mar 2024 08:26:22 +0000

Author Names: Zhang Y.,Zhu Y.,Wan H.

Database Source: Embase Weekly Updates

Journal Title: BMJ Open,BMJ Open

Article Title: Effectiveness of an evidence-based swallowing facilitation strategy for patients undergoing radiotherapy for head and neck cancer: A study protocol for a randomised controlled trial

Year: 2024

Issue: 1

Volume: 14

Abstract: Introduction Dysphagia emerges as a frequent, persistent and enduring aftermath in individuals undergoing radiotherapy for head and neck cancer (HNC). Timely intervention becomes imperative to ameliorate prolonged dysphagia and curtail related complications. Among the evidence-grounded tactics, preventive swallowing training and proficient feeding management stand out as pivotal measures for precluding and mitigating dysphagia. However, past inquiries that amalgamated these dual interventions exhibited heterogeneous quality due to their restricted participant cohorts and a dearth of uniform, systematic and practicable procedural benchmarks. Method/design This randomised, parallel-controlled study enrols 94 patients diagnosed with HNC, who are undergoing radiotherapy either with or without concurrent chemotherapy. The patients will be randomly assigned to either the intervention group, which will receive a facilitation strategy to enhance swallowing function in conjunction with standard care, or the control group, which will receive typical radiotherapy care. Patient assessments will be conducted at three distinct time points: at the onset of radiotherapy (baseline), at the conclusion of radiotherapy and 3 months postradiotherapy. The primary outcome will revolve around measuring swallowing function, while secondary outcomes will encompass swallowing-related quality of life and nutritional status. Ethics and dissemination This research initiative received endorsement from the Shanghai Proton Heavy Ion Hospital Ethics Committee on 2 December 2 (Approval Number 2210-59-01). Throughout the recruitment process, patients will be acquainted with the primary aims and scope of the study. Their participation will be a voluntary choice, demonstrated by their informed consent form signatures. The outcomes of this study will be disseminated through publication in a peer-reviewed journal. Trial registration number Clinical Trials.gov, ChiCTR2300067550, registered 11 January 2023.<br/>Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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

Provincial Dietary Intake Study (PDIS): Micronutrient Intakes of Children in a Representative/Random Sample of 1- to <10-Year-Old Children in Two Economically Active and Urbanized Provinces in South Africa.

Fri, 11 Dec 2020 08:58:08 +0000

Author Names: Senekal M,Nel J,Malczyk S,Drummond L,Steyn NP

Database Source: Ovid MEDLINE(R) <January Week 4 2019 to December Week 1 2020>

Journal Title: International Journal of Environmental Research & Public Health [Electronic Resource]

Article Title: Provincial Dietary Intake Study (PDIS): Micronutrient Intakes of Children in a Representative/Random Sample of 1- to <10-Year-Old Children in Two Economically Active and Urbanized Provinces in South Africa.

Year: 2020

Issue: 16

Volume: 17

Abstract: In 1999, the National Food Consumption Survey found serious risk of dietary deficiency for a number of micronutrients in 1- to 9-year-old children in South Africa. To address these shortfalls, fortification with vitamin A, thiamine, riboflavin, niacin, vitamin B6, folic acid, iron and zinc of maize meal and bread flour was made mandatory in 2003. The aim of this study was to examine micronutrient intakes of 1- to <10-year-old children after nearly 20 years of fortification in two of the most urbanized and economically active provinces, Gauteng (GTG) and the Western Cape (WC). A multistage stratified cluster random sampling design and methodology was used. Households were visited by fieldworkers who interviewed caregivers and obtained dietary intake data by means of a multiple-pass 24-h recall. Two additional 24-h recalls were completed among a nested sample of 146 participants to adjust the single 24-h recall data of the total sample using the National Cancer Institute Method. Results show that median intake of all the fortification nutrients were above the estimated average requirement (EAR), with the only concern being folate in the WC. Between a quarter and a third of children in the WC, where maize porridge intake was significantly lower than in GTG, had a folate intake below the EAR. Nutrients that are not included in the fortification mix that remain a serious concern are calcium and vitamin D, with intake of dairy and vitamin D sources being very limited in both provinces. The improvement in micronutrient intakes of children is encouraging, however the outstanding nutrient deficiency risks need attention.

Comparison of Various Methods to Determine Added Sugars Intake to Assess the Association of Added Sugars Intake and Micronutrient Adequacy.

Tue, 01 Sep 2020 04:00:00 +0000

Nutrients; 09/01/2020
(AN 146686663); ISSN: 20726643
CINAHL Complete

Provincial Dietary Intake Study (PDIS): Micronutrient Intakes of Children in a Representative/Random Sample of 1- to <10-Year-Old Children in Two Economically Active and Urbanized Provinces in South Africa

Sun, 23 Aug 2020 00:00:00 +0000

Int J Environ Res Public Health. 2020 Aug 14;17(16):5924. doi: 10.3390/ijerph17165924.

ABSTRACT

In 1999, the National Food Consumption Survey found serious risk of dietary deficiency for a number of micronutrients in 1- to 9-year-old children in South Africa. To address these shortfalls, fortification with vitamin A, thiamine, riboflavin, niacin, vitamin B6, folic acid, iron and zinc of maize meal and bread flour was made mandatory in 2003. The aim of this study was to examine micronutrient intakes of 1- to <10-year-old children after nearly 20 years of fortification in two of the most urbanized and economically active provinces, Gauteng (GTG) and the Western Cape (WC). A multistage stratified cluster random sampling design and methodology was used. Households were visited by fieldworkers who interviewed caregivers and obtained dietary intake data by means of a multiple-pass 24-h recall. Two additional 24-h recalls were completed among a nested sample of 146 participants to adjust the single 24-h recall data of the total sample using the National Cancer Institute Method. Results show that median intake of all the fortification nutrients were above the estimated average requirement (EAR), with the only concern being folate in the WC. Between a quarter and a third of children in the WC, where maize porridge intake was significantly lower than in GTG, had a folate intake below the EAR. Nutrients that are not included in the fortification mix that remain a serious concern are calcium and vitamin D, with intake of dairy and vitamin D sources being very limited in both provinces. The improvement in micronutrient intakes of children is encouraging, however the outstanding nutrient deficiency risks need attention.

PMID:32824083 | PMC:PMC7460187 | DOI:10.3390/ijerph17165924

A comparative study of three nutritional risk screening tools in surgical inpatients with laryngeal cancer

Fri, 17 Jul 2020 00:00:00 +0000

Asia Pac J Clin Nutr. 2020;29(2):227-233. doi: 10.6133/apjcn.202007_29(2).0003.

ABSTRACT

BACKGROUND AND OBJECTIVES: Nutritional screening has been recommended for hospitalized patients. The goal of this study was to compare the screening value of Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Malnutrition Screening Tool (MST) in inpatients with laryngeal cancer, and to identify which is the most accurate.

METHODS AND STUDY DESIGN: An observational cross-sectional study of 197 laryngeal cancer patients admitted for surgery was conducted using continuous sampling. NRS-2002, MUST, and MST were used to screen the nutritional risk of patients after admission and before discharge. Diagnostic information and the length-of-hospital stay (LOS) data were extracted from the hospital HIS system.

RESULTS: The detection rates of NRS-2002, MUST, and MST in admission or discharge patients were 14.7%/27.9%, 22.3%/26.9%, and 4.6%/11.2%, respectively. Using NRS-2002 as the reference, high sensitivity (82.8%) and a Kappa coefficient (k=0.584) were achieved using MUST in admission patients, while MST presented the lowest sensitivity (17.3%) and Kappa coefficient (k=0.208). MST maintained low sensitivity (25.5%) and Kappa coefficient (k=0.243) in discharge patients. NRS-2002 ≥3 was an independent risk factor for longer LOS in patients with laryngeal cancer (odds ratio (OR)=5.59, 95% confidence interval (CI)=1.86-16.81, p=0.002). The MUST and MST scores did not predict long LOS.

CONCLUSIONS: Compared with NRS-2002, MUST is superior to MST in sensitivity, specificity, and Kappa coefficient. NRS-2002 better identified patients at risk for longer LOS, but a consistent conclusion was not reached with MUST and MST. Further validation in larger samples is needed.

PMID:32674228 | DOI:10.6133/apjcn.202007_29(2).0003

Swallowing functional outcomes and nutritional status in head and neck cancer radiotherapy: longitudinal study

Fri, 15 May 2020 00:00:00 +0000

BMJ Support Palliat Care. 2020 Dec;10(4):452-461. doi: 10.1136/bmjspcare-2020-002216. Epub 2020 May 13.

ABSTRACT

OBJECTIVE: To explore the relationships between swallowing functional outcomes and nutritional status in patients with head and neck cancer undergoing radiotherapy (RT).

METHODS: This longitudinal study included 122 patients. Data were collected at three time points: baseline (T₁), the third week of RT (T₂) and the completion of RT (T₃). The Common Terminology Criteria for Adverse Events was used to assess the symptom of dysphagia and other toxicities; the MD Anderson Dysphagia Inventory (MDADI) was used to assess the patient-perceived swallowing functional outcomes; the nutritional status was evaluated by the weight ratio and the Patient-Generated Subjective Global Assessment (PG-SGA). The generalised estimating equation (GEE) was used to measure the correlation of MDADI with the weight ratio or PG-SGA and also to analyse the influential factors of swallowing functional outcomes.

RESULTS: The participants' acute dysphagia rates were 5.7% at T₁, 69.7% at T₂ and 77.9% at T₃. The swallowing functional outcomes worsen over RT (p<0.001) and were associated with weight ratio (β=0.032, p=0.008) and PG-SGA (β=-0.115, p<0.001). GEE models showed that patients with cancer of the pharynx region, advanced stage, chemoradiotherapy and high RT dose perceived worse swallowing functional outcomes. Oral mucositis, pharynx mucositis and salivary gland inflammation were positively correlated with swallowing functional outcomes, and the pharynx mucositis presented the highest absolute value of β.

CONCLUSION: The swallowing functional outcomes were negatively correlated with nutritional status. Healthcare professionals should identify early on the population at higher risk and focus on multiple toxicities, especially the management of pharynx mucositis, to improve nutritional status.

PMID:32404303 | DOI:10.1136/bmjspcare-2020-002216

Taste-Specific Eating Recommendation for Head and Neck Treatment Survivors: A Randomized Controlled Trial.

Fri, 01 May 2020 04:00:00 +0000

MEDSURG Nursing; 05/01/2020
(AN 143616913); ISSN: 10920811
CINAHL Complete

Meta-analysis of the association between dietary inflammatory index (DII) and upper aerodigestive tract cancer risk

Sun, 26 Apr 2020 00:00:00 +0000

Medicine (Baltimore). 2020 Apr;99(17):e19879. doi: 10.1097/MD.0000000000019879.

ABSTRACT

BACKGROUND: Epidemiological studies have reported an inconsistent relationship between dietary inflammatory index (DII) and upper aerodigestive tract (UADT) cancer risk. However, no systematic review or meta-analysis has been reported up to now. To quantify the association between DII and UADT cancer risk, we performed this meta-analysis.

METHODS: The PubMed, EMBASE, Web of Science and Cochrane Library database were searched for relevant studies from inception December 2018. All case-control studies investigating the association between DII and UADT cancer risk were selected.

RESULTS: A total of 9 case-control studies were identified, involving 13,714 participants. The adjusted pooled OR of UADT cancer for the highest (the most pro-inflammatory diet) vs lowest (the most anti-inflammatory diet) DII categories were 2.27 (95% CI: 1.89-2.73). Subgroup analysis showed that individuals with the highest category of DII score were independently associated with esophagus cancer (OR = 2.53, 95% CI: 1.74-3.68), oral cavity cancer (OR = 2.23, 95% CI: 1.73-2.86), pharyngeal cancer (OR = 2.02, 95% CI: 1.54-2.64), and laryngeal cancer (OR = 2.05, 95% CI: 0.85-4.93).

CONCLUSION: This meta-analysis suggested that the most pro-inflammatory diets (the highest DII scores) are associated with increased UADT cancer risk. However, the association between DII and laryngeal cancer risk need to be further investigated.

PMID:32332658 | PMC:PMC7220683 | DOI:10.1097/MD.0000000000019879

The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Head and Neck Cancer

Sat, 22 Feb 2020 00:00:00 +0000

Laryngoscope. 2021 Jan;131(1):E151-E156. doi: 10.1002/lary.28587. Epub 2020 Feb 21.

ABSTRACT

OBJECTIVE: The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool and is a significant prognostic factor in various cancers. However, the role of the GNRI in predicting clinical outcomes in patients with advanced head and neck cancer (AHNC) has not been investigated. The aim of the present study was to examine the association between the GNRI and prognosis in patients with AHNC.

STUDY DESIGN: Retrospective cohort study.

METHODS: Data collected between 2002 and 2013 from Tsukuba University Hospital were reviewed. The GNRI was calculated according to the equation, 1.489 × serum albumin (g/l) + 41.7 × (body weight/ideal body weight). Characteristics and prognosis were compared among three risk groups: high (GNRI <82); intermediate (GNRI 82-98); and normal (GNRI >98). The primary endpoint was overall survival.

RESULTS: A total of 248 AHNC patients were enrolled, among whom 134 (54%) exhibited no nutritional risk, 53 (21%) had an intermediate risk for malnutrition, and 61 (25%) exhibited a high risk for malnutrition. Three-year survival rates according to the three-group GNRI scores for normal, intermediate, and high risk were 76.6%, 56.3%, and 19.5%, respectively. As the three-group GNRI score increased, the risk for mortality significantly increased (adjusted hazard ratio [HR] for intermediate to normal, 1.73 [95% CI, 1.02-2.92]; adjusted HR for high to normal, 4.31 [95% CI, 2.71-6.84]).

CONCLUSIONS: The GNRI could be considered a useful prognostic factor in patients with AHNC.

LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E151-E156, 2021.

PMID:32083731 | DOI:10.1002/lary.28587

The association between the Nutrition-Related index and morbidity following head and neck microsurgery.

Sat, 01 Feb 2020 05:00:00 +0000

Laryngoscope; 02/01/2020
(AN 141315126); ISSN: 0023852X
CINAHL Complete

Comparison of Dietary Micronutrient Intakes by Body Weight Status among Mexican-American and Non-Hispanic Black Women Aged 19-39 Years: An Analysis of NHANES 2003-2014

Sun, 24 Nov 2019 00:00:00 +0000

Nutrients. 2019 Nov 20;11(12):2846. doi: 10.3390/nu11122846.

ABSTRACT

The objective of the current study was to examine micronutrient intake from foods in women of childbearing age and to better understand potential nutritional problems varied by body weight status in minority women. A sample of women aged 19-39 years from the National Health and Nutrition Examination Surveys (NHANES) 2003-2014 was analyzed. Dietary intakes of 13 micronutrients were estimated using the National Cancer Institute method. Mexican-American and non-Hispanic Black women were categorized into normal/under-weight, overweight, or obese groups according to their body mass index (BMI). Mexican-American and non-Hispanic Black women had lower dietary intakes for vitamins A, B₂, B₆, B₁₂, and D, folate, calcium, and magnesium than non-Hispanic Whites. Among Mexican-Americans, obese women had the lowest dietary intake of vitamins A, B₂, C and D. Obese non-Hispanic Black women had significantly lower dietary intakes of iron and zinc than their normal/under-weight counterparts. Comparable percentages (>30%) of Mexican-American and non-Hispanic Black women had dietary intake less than the Estimated Average Requirements (EARs) for several key nutrients including vitamin A, C and D, folate, calcium and magnesium, and the percentages varied by body weight status. These results indicate micronutrient inadequacies persist among and within racial/ethnic and body weight groups.

PMID:31757075 | PMC:PMC6950012 | DOI:10.3390/nu11122846

Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

Tue, 13 Aug 2019 00:00:00 +0000

Head Neck. 2019 Nov;41(11):3850-3857. doi: 10.1002/hed.25909. Epub 2019 Aug 12.

ABSTRACT

BACKGROUND: Physician practice patterns regarding diagnosis and management of malnutrition in the head and neck cancer patient population are not well studied.

METHODS: A 17-question survey was distributed to 1392 members of the American Head and Neck Society (AHNS). The impact of hospital type, fellowship training, experience, and specialty was assessed.

RESULTS: Among AHNS members, there were 124 total respondents (9% response rate), including both otolaryngologists and radiation oncologists. Respondents strongly agreed (90%) that malnutrition negatively impacts patient outcomes. The majority (63%) felt comfortable screening for malnutrition, but 13% reported no routine assessment of malnutrition; 57% were unfamiliar with relevant guidelines. Barriers to screening included lack of familiarity with screening tools/guidelines, lack of time, and lack of access to dietitian.

CONCLUSION: Although there was a strong consensus among respondents that the identification and management of malnutrition among head and neck cancer patients is critical, familiarity with relevant guidelines was poor.

PMID:31403751 | DOI:10.1002/hed.25909

Toxicity of docetaxel, platine, 5-fluorouracil-based induction chemotherapy for locally advanced head and neck cancer: The importance of nutritional status

Thu, 30 May 2019 00:00:00 +0000

Cancer Radiother. 2019 Jul;23(4):273-280. doi: 10.1016/j.canrad.2018.08.003. Epub 2019 May 25.

ABSTRACT

PURPOSE: The objective of this study was to identify predictive factors of toxicity of docetaxel, platin, 5-fluorouracil (TPF) induction chemotherapy for locally advanced head and neck cancers.

PATIENTS AND METHODS: From July 2009 to March 2015, 57 patients treated consecutively with TPF were included retrospectively. There were 47 males (83%), the median age was 56 years [40-71 years]. Thirty-eight patients (67%) were treated for inoperable cancer (highly symptomatic and/or high tumor burden) and 19 (33%) were treated for laryngeal preservation. There were 47% stage IVa, 32% stage III and 21% stage IVb. At diagnosis, there were 53% stable weight, 28% grade 1 weight loss, 17% grade 2 weight loss and 2% grade 3 weight loss.

RESULTS: Forty-seven percent of patients were in partial response after TPF, 28% in complete response, 7% stable, 2% progressing and 2% discordant response. The possibility of oral feeding without a feeding tube was predictive of a better response (P=0.02). Thirty-nine percent of patients increased weight during TPF, 35% were stable, 18% in grade 1 weight loss, 6% in grade 2 and 2% in grade 3. Six of the patients (10.5%) died during chemotherapy: four from febrile neutropenia, one from pneumopathy and one of unknown cause. Age 57years and older was associated with a higher risk of grade≥3 anemia and thrombocytopenia. There was a higher risk of grade≥3 infection for weight loss at diagnosis (P=0.04) and feeding tube (P=0.05). There was a higher risk of grade≥3 neutropenia for weight loss during TPF (P=0.03).

CONCLUSION: Induction chemotherapy by TPF has an strong anti-tumor efficacy (75.5% objective response) but an important morbidity with 10% toxic deaths in our very symptomatic population with a very important tumor burden. Age and nutritional status are important factors to consider.

PMID:31138520 | DOI:10.1016/j.canrad.2018.08.003

The association between the Nutrition-Related index and morbidity following head and neck microsurgery

Thu, 07 Mar 2019 00:00:00 +0000

Laryngoscope. 2020 Feb;130(2):375-380. doi: 10.1002/lary.27912. Epub 2019 Mar 6.

ABSTRACT

OBJECTIVES/HYPOTHESIS: Despite consensus that preoperative nutritional assessment is of importance in the head and neck surgical oncology population, it remains unclear how exactly malnutrition is associated with perioperative morbidity especially among those undergoing microvascular surgery. We aimed to study this association to help inform preoperative risk stratification, guide the use of nutritional interventions, and ultimately help prevent malnutrition related morbidity.

STUDY DESIGN: Database analysis.

METHODS: Retrospective, linked analysis of the 2011 to 2016 National Surgical Quality Improvement Program. After identifying eligible patients and stratifying according to the Nutrition-Related Index, a univariate screen of preoperative demographic and clinical covariates was performed. Subsequently, propensity score matching was utilized to control for differences in baseline covariates. Perioperative complications and mortality were then analyzed using the propensity score-matched cohorts.

RESULTS: Among 977 identified patients, 276 (28.2%) were malnourished. Malnourished patients had higher rates of comorbidity, were more likely to actively smoke, and were more likely to have primaries in the oropharynx or hypopharynx/larynx. After propensity score matching to control for confounders, malnourished patients had higher rates of pulmonary complications (21.5% vs. 11.6%, P < .01), higher rates of bleeding or need for transfusion (56.6% vs. 43.0%, P < .01), higher rates of venous thromboembolism (3.7% vs. 0.8%, P = .03), and a higher 30-day mortality rates (3.7% vs. 0.0%, P < .01).

CONCLUSIONS: This nationwide analysis finds that 28.2% of patients undergoing surgery for head and neck cancers with free flap reconstruction are malnourished. Malnourishment was found to be independently associated with postoperative pulmonary complications, bleeding or need for transfusion, and 30-day mortality.

LEVEL OF EVIDENCE: NA Laryngoscope, 130:375-380, 2020.

PMID:30840321 | DOI:10.1002/lary.27912

Evaluation of nutritional status and analysis of body composition in cancer patients admitted to the department of otolaryngology for radical treatment...European Society for Clinical Nutrition and Metabolism (ESPEN) 40th Congress, September 1-4, 2018, Ma

Sun, 02 Sep 2018 04:00:00 +0000

Clinical Nutrition; 09/02/2018
(AN 139327358); ISSN: 02615614
CINAHL Complete

Vitamin D intake and survival and recurrence in head and neck cancer patients

Tue, 15 May 2018 00:00:00 +0000

Laryngoscope. 2018 Nov;128(11):E371-E376. doi: 10.1002/lary.27256. Epub 2018 May 14.

ABSTRACT

OBJECTIVES/HYPOTHESIS: With an unacceptably low 5-year survival rate and few identified modifiable factors that affect head and neck cancer (HNC) outcomes, HNC survival remains an important public health problem. Vitamin D has been shown to be associated with immune reactivity and improved outcomes for some cancer sites, but findings are mixed, and few studies have examined vitamin D in relation to HNC. This study aimed to assess the association between vitamin D intake and survival outcomes in HNC patients.

STUDY DESIGN: Prospective cohort study.

METHODS: This study utilized data on 434 HNC patients with valid pretreatment food frequency questionnaire data who participated in the University of Michigan Head and Neck Specialized Program of Research Excellence epidemiology project. Cox proportional hazard models were used to estimate the associations between total, dietary, and supplemental vitamin D intake and HNC outcomes, while adjusting for other known prognostic factors.

RESULTS: After multivariable adjustment, we found a statistically significant inverse trend between total vitamin D intake and recurrence (Q4 vs. Q1 hazard ratio: 0.47, 95% confidence interval: 0.20-1.10, P trend = .048). We observed no association with dietary or supplemental intake separately, and no association was observed with all-cause or HNC-specific mortality.

CONCLUSIONS: These findings suggest that HNC patients with lower levels of vitamin D intake are at higher risk of recurrence. If borne out in future studies, our results suggest that increased vitamin D intake through dietary intervention or the use of supplements may be a feasible intervention for prevention of recurrence in HNC patients.

LEVEL OF EVIDENCE: 2b. Laryngoscope, E371-E376, 2018.

PMID:29756240 | PMC:PMC6235739 | DOI:10.1002/lary.27256

Poor oral intake causes enteral nutrition dependency after concomitant chemoradiotherapy for pharyngeal cancers

Wed, 04 Apr 2018 00:00:00 +0000

Eur Arch Otorhinolaryngol. 2018 Jun;275(6):1607-1611. doi: 10.1007/s00405-018-4963-y. Epub 2018 Apr 2.

ABSTRACT

PURPOSE: To identify precipitating factors responsible for enteral nutrition (EN) dependency after concomitant chemoradiotherapy (CCRT) of head and neck cancers and to examine their statistical correlations.

METHODS: Factors related to feeding condition, nutritional status, disease, and treatment of 26 oropharyngeal and hypopharyngeal cancer patients who received definitive CCRT were retrospectively investigated by examining their medical records. The days of no oral intake (NOI) during hospitalization and the months using enteral nutrition after CCRT were counted as representing the feeding condition, and the changes in body weight (BW) were examined as reflecting nutritional status. The factors related to EN dependency after CCRT were analyzed.

RESULTS: Long duration of total NOI (≥ 30 days) and maximum NOI ≥ 14 days were significant predictors of EN dependency. Decreased BW (≥ 7.5 kg) was the next predictor identified, but it was not significant. Multivariate analysis showed that the total duration of NOI was more correlated with EN dependency than changes in BW.

CONCLUSIONS: A long duration of NOI was more strongly related to EN dependency than nutritional factors.

PMID:29610959 | DOI:10.1007/s00405-018-4963-y