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Prior-Sánchez I, Herrera-Martínez AD, Zarco-Martín MT, Fernández-Jiménez R, Gonzalo-Marín M, Muñoz-Garach A, Vilchez-López FJ, Cayón-Blanco M, Villarrubia-Pozo A, Muñoz-Jiménez C, Zarco-Rodríguez FP, Rabat-Restrepo JM, Luengo-Pérez LM, Boughanem H, Martínez-Ramírez MJ, García-Almeida JM. Prognostic value of bioelectrical impedance analysis in head and neck cancer patients undergoing radiotherapy: a VALOR® study. Front Nutr 2024; 11:1335052. [PMID: 38463940 PMCID: PMC10921554 DOI: 10.3389/fnut.2024.1335052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Bioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy. Methods A multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed. Results Significant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m2 was the most significant predictor for predicting survival within the overall HNC population. The PA values of <5.1° in male and <4.8° in female patients showed the best predictive potential for mortality. Increased PA (as a continuous variable) demonstrated a significantly reduced risk for mortality (OR, 0.64; 95% CI, 0.43-0.94; p < 0.05) and a decreased likelihood of hospital admission (OR, 0.75; 95% CI, 0.52-1.07; p < 0.05). Higher BCM correlated with a lower risk of mortality (OR, 0.88; 95% CI, 0.80-0.96; p < 0.01) and a diminished probability of hospital admission (OR, 0.91; 95% CI, 0.83-0.99; p < 0.05). Conclusion BIA is a crucial tool in the nutritional assessment of HNC patients. BCM and PA are the main bioelectrical parameters used to predict clinical outcomes in this population. Future studies are needed to validate BIA variables in a large cohort to ensure whether early intensification of nutritional treatment would improve survival.
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Affiliation(s)
| | - Aura Dulcinea Herrera-Martínez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Cordoba, Spain
| | - María Teresa Zarco-Martín
- Department of Endocrinology and Nutrition, San Cecilio University Hospital, Granada, Spain
- Granada Biosanitary Research Institute (Ibs. Granada), Granada, Spain
| | - Rocío Fernández-Jiménez
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Malaga Hospital, Malaga, Spain
- Department of Medicine and Dermatology, Malaga University, Malaga, Spain
| | - Montserrat Gonzalo-Marín
- Endocrinology and Nutrition Department, Malaga Regional University Hospital, Malaga, Spain
- Malaga Biomedical Research Institute and BIONAND Platform, Malaga, Spain
| | - Araceli Muñoz-Garach
- Granada Biosanitary Research Institute (Ibs. Granada), Granada, Spain
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, Granada, Spain
- Network Biomedical Research Center Physiopathology of Obesity and Nutrition (CiberOBN), Carlos III Health Institute, Madrid, Spain
| | - Francisco Javier Vilchez-López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz, Cadiz, Spain
| | - Manuel Cayón-Blanco
- Biomedical Research and Innovation Institute of Cadiz, Cadiz, Spain
- Endocrinology and Nutrition Department, Hospital Universitario de Jerez de la Frontera, Cadiz, Spain
| | - Ana Villarrubia-Pozo
- Department of Endocrinology and Nutrition, Seville Institute of Biomedicine (IBIS), Virgen del Rocio University Hospital, Seville, Spain
| | - Concepción Muñoz-Jiménez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Cordoba, Spain
| | | | | | - Luis Miguel Luengo-Pérez
- Department of Endocrinology and Nutrition, Badajoz University Hospital, Seville, Spain
- Department of Biomedical Sciences, Universidad de Extremadura, Badajoz, Spain
| | - Hatim Boughanem
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute, Madrid, Spain
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Cordoba, Spain
| | | | - Jose Manuel García-Almeida
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Malaga Hospital, Malaga, Spain
- Department of Medicine and Dermatology, Malaga University, Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute, Madrid, Spain
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Pelc Z, Sędłak K, Mlak R, Chawrylak K, Mielniczek K, Leśniewska M, Skórzewska M, Kwietniewska M, Paśnik I, Gęca K, van der Sluis P, Banasiewicz T, Pędziwiatr M, Polkowski WP, Pawlik TM, Małecka-Massalska T, Rawicz-Pruszyński K. MalnutritiOn assessment with biOelectrical impedaNce analysis in gastRic cancer patIentS undergoing multimodaltrEatment (MOONRISE)-Study protocol for a single-arm multicenter cross-sectional longitudinal study. PLoS One 2024; 19:e0297583. [PMID: 38319910 PMCID: PMC10846730 DOI: 10.1371/journal.pone.0297583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
European data suggests that over 30% of gastric cancer (GC) patients are diagnosed with sarcopenia before surgery, while unintentional weight loss occurs in approximately 30% of patients following gastrectomy. Preoperative sarcopenia significantly increases the risk of major postoperative complications, and preoperative body weight loss remains a superior predictor of outcome and an independent prognostic factor for overall survival (OS) in patients with GC. A standardized approach of nutritional risk screening of GC patients is yet to be established. Therefore, the MOONRISE study aims to prospectively analyze the changes in nutritional status and body composition at each stage of multimodal treatment among GC patients from five Western expert centers. Specifically, we seek to assess the association between nutritional status and body composition on tumor response following neoadjuvant chemotherapy (NAC). Secondary outcomes of the study are treatment toxicity, postoperative complications, quality of life (QoL), and OS. Patients with locally advanced gastric adenocarcinoma scheduled for multimodal treatment will be included in the study. Four consecutive nutritional status assessments will be performed throughout the treatment. The following study was registered in ClinicalTrials.gov (Identifier: NCT05723718) and will be conducted in accordance with the STROBE statement. The anticipated duration of the study is 12-24 months, depending on the recruitment status. Results of this study will reveal whether nutritional status and body composition assessment based on BIA will become a validated and objective tool to support clinical decisions in GC patients undergoing multimodal treatment.
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Affiliation(s)
- Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Chawrylak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | | | | | | | - Iwona Paśnik
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Pieter van der Sluis
- Upper Gastrointestinal Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Tomasz Banasiewicz
- Department of General, Endocrynological Surgery and Gastrointestinal Oncology, Institute of Surgery, Poznan University of Medical Sciences, Poznań, Polska
| | - Michał Pędziwiatr
- 2nd Department of Surgery, Jagiellonian University Medical College, Kraków, Polska
| | | | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio, United States of America
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Victoria-Montesinos D, García-Muñoz AM, Navarro-Marroco J, Lucas-Abellán C, Mercader-Ros MT, Serrano-Martínez A, Abellán-Aynés O, Barcina-Pérez P, Hernández-Sánchez P. Phase Angle, Handgrip Strength, and Other Indicators of Nutritional Status in Cancer Patients Undergoing Different Nutritional Strategies: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15071790. [PMID: 37049629 PMCID: PMC10097099 DOI: 10.3390/nu15071790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023] Open
Abstract
Malnutrition in cancer patients is one of the most influential factors in the evolution and mortality of such patients. To reduce the incidence of malnutrition, it is necessary to establish a correct nutritional intervention. For this purpose, precise tools and indicators must be developed to determine the patient’s condition. The main objective of this systematic review and meta-analysis was to analyze the relationship between different nutritional strategies, phase angle (PA), and handgrip strength in patients with cancer, with the secondary objectives being the modification of other indicators of nutritional status, such as weight and body mass index (BMI). A systematic review of randomized clinical trials was carried out in March 2023 in the databases PubMed, Web of Science, Cochrane, and Scopus. As a risk-of-bias tool, RoB 2.0 was utilized. A total of 8 studies with a total of 606 participants were included in the analysis. A significant increase in PA was observed after the different nutritional strategies (SMD: 0.43; 95% CI: 0.10 to 0.77; p = 0.01; I2 = 65.63%), also detecting a significant increase in handgrip strength (SMD: 0.27, 95% CI: 0.08 to 0.47; p = 0.01; I2 = 30.70%). A significant increase in PA and handgrip were observed in cancer patients subjected to different nutritional strategies. These results suggest that these indicators could be used in the nutritional and functional assessment of the patients.
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Affiliation(s)
| | - Ana María García-Muñoz
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Julia Navarro-Marroco
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Carmen Lucas-Abellán
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - María Teresa Mercader-Ros
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Ana Serrano-Martínez
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | | | - Pablo Barcina-Pérez
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Pilar Hernández-Sánchez
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
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Detopoulou P, Tsiouda T, Pilikidou M, Palyvou F, Mantzorou M, Perzirkianidou P, Kyrka K, Methenitis S, Kondyli FS, Voulgaridou G, Zarogoulidis P, Matthaios D, Oikonomidou R, Romanidou M, Giannakidis D, Papadopoulou SK. Dietary Habits Are Related to Phase Angle in Male Patients with Non-Small-Cell Lung Cancer. Curr Oncol 2022; 29:8074-8083. [PMID: 36354697 PMCID: PMC9689548 DOI: 10.3390/curroncol29110637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Lung cancer constitutes the most common cause of cancer death. Phase angle (PhA) has been related to lung cancer prognosis, which implies that the identification of dietary or other factors that could predict or modify PhA may have beneficial effects. Νutritional interventions have been linked with positive changes in PhA in certain types of cancer. Aim: The present study aimed to investigate the relationships between dietary habits/nutrition and PhA in NSCLC patients. Methods: The sample consisted of 82 male patients with non-small-cell lung cancer (NSCLC; stage IV) from the 'Theageneio' Cancer Hospital (Thessaloniki, Greece). Several parameters were assessed, such as body mass index (BMI), lean mass, PhA, Mediterranean diet score (MedDietScore), dietary patterns, smoking, resting metabolic rate, resting oxygen consumption (VO2), ventilation rate, and physical activity. Results: According to our results, a dietary pattern rich in potatoes and animal proteins (meat and poultry) was a significant determinant of PhA (B ± SE, p: 0.165 ± 0.08, p = 0.05) in multiple linear regression models after adjusting for age, smoking, lean tissue, and MedDietScore. Conclusion: In conclusion, dietary patterns may affect PhA, suggesting the crucial role of protein in cancer management and the prevention of sarcopenia.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, 11526 Athens, Greece
- Department of Nutritional Sciences and Dietetics, University of the Peloponnese, 24100 Kalamata, Greece
| | - Theodora Tsiouda
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 54007 Thessaloniki, Greece
| | - Maria Pilikidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Foteini Palyvou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, University of Aegean, 81400 Lemnos, Greece
| | | | - Krystallia Kyrka
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 54007 Thessaloniki, Greece
| | - Spyridon Methenitis
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
- Sports Performance Laboratory, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 15772 Athens, Greece
- Theseus, Physical Medicine and Rehabilitation Center, 17671 Athens, Greece
| | - Foivi S. Kondyli
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department, General Clinic Euromedica Private Hospital, 54645 Thessaloniki, Greece
- 3rd Surgery Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence:
| | | | | | - Maria Romanidou
- Dietitian, Adult Eating Disorders Service, Essex Partnership University NHS Foundation Trust, Wickford SS11 7XX, UK
| | - Dimitrios Giannakidis
- 1st Department of Surgery, Attica General Hospital “Sismanogleio—Amalia Fleming”, 15126 Athens, Greece
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
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Nett H, Steegmann J, Tollkühn-Prott B, Hölzle F, Modabber A. A prospective randomized comparative trial evaluating postoperative nutritional intervention in patients with oral cancer. Sci Rep 2022; 12:14213. [PMID: 35987809 PMCID: PMC9392772 DOI: 10.1038/s41598-022-18292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
Extensive surgical treatment of oral cancer results in significant deterioration of nutritional status with concomitant increased nutrient requirements. The consequences are an elevated risk of postoperative complaints as well as morbidity and mortality. The aim of this study was to investigate an additional postoperative nutritional intervention through professional nutritional advice and nutritional supplementation in patients with oral cancer for at least six months. 62 patients with oral cancer in the department of oral and maxillofacial surgery were randomized into two groups. The intervention group received nutritional supplements, protein-rich, high-fiber diet and care by a professional nutritionist in addition to the standard treatment. The control group received only the standard treatment. Statistical analysis includes the evaluation of means and standard deviations as well as the calculation of p values with a significance level of 0.05. A deficiency of protein, albumin, vitamin D, zinc and iron was noticed in both groups immediately after surgery. Patients in the intervention group recorded significantly less weight loss (pT2 = 0.0031, pT4 = 0.0424), a more stable BMI (pT2 = 0.0496), better values for albumin (pT2 = 0.0265), vitamin A (pT3 = 0.0248, pT4 = 0.0007) and calcium (pT3 = 0.0362) during the follow-ups. The patients in the intervention group showed significantly fewer digestive problems (p = 0.0062) and muscular complaints (p = 0.0448). They showed better eating habits (p = 0.0348) and were capable of more physical activity (p = 0.0045) than patients in the control group. Patients with oral cancer can have a benefit from postoperative nutritional intervention. Early screening, appropriate care by a nutritionist and supplementation with vitamin D, zinc, calcium and protein-rich food are recommended.
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Kowshik V, Velkumary S, Sethi P, Feula JM, Subhashri S, Abirami M. Association of handgrip strength and endurance with body composition in head and neck cancer patients. J Family Med Prim Care 2021; 10:910-916. [PMID: 34041097 PMCID: PMC8138385 DOI: 10.4103/jfmpc.jfmpc_1695_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 12/16/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Assessment of skeletal muscle function (SMF) is of clinical relevance in the prediction of treatment outcome and to decide on optimal management of head & neck cancer (HNC) patients. Handgrip strength (HGS) & handgrip endurance (HGE) are considered as surrogate marker for whole-body skeletal muscle function. Further, SMF depends substantially on the body composition (BC). Hence in this study, we compared BC, HGS and HGE between HNC patients and healthy controls and also analysed the association of HGS, HGE with body composition in HNC patients. Methods: A cross-sectional study, conducted in 44 subjects in the age between 18 to 60 years. Twenty-two were histologically proven HNC patients prior to cancer-specific treatment and twenty-two age and gender-matched healthy volunteers. The parameters recorded were Height, weight, waist circumference, hip circumference, HGS, HGE and BC. Hand-held dynamometer was used to measure HGS and HGE measured using a stopwatch. BC was estimated by whole-body bioelectrical Impedance analysis method using Bodystat Quad scan 4000 device. Result: Comparison of data between HNC patient & healthy control was done by Student's t test. HGS, HGE, lean body mass (LBM), fat-free mass index (FFMI), Phase angle (PA), body cell mass (BCM) and body cell mass index (BCMI) were found to be reduced significantly in HNC patients when compared to healthy subjects. Further, Pearson correlation analysis revealed a significant positive correlation of HGS & HGE with LBM, FFMI, PA, BCM & BCMI, whereas body fat mass index showed a negative correlation with HGS & HGE in HNC patients. Conclusion: Our findings revealed, a significant reduction in HGS, HGE in patient with HNC which denotes decreased skeletal muscle function and it is linearly associated with low muscle mass, body cell mass and phase angle.
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Affiliation(s)
- Vengadesan Kowshik
- 3rd Year MBBS, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subramanian Velkumary
- Additional Professor, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pooja Sethi
- Assistant Professor, Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jothi Marie Feula
- Assitant Professor, Department of Physiology, Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - Soundirarajan Subhashri
- Assistant Professor, Department of Physiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India
| | - Manikandan Abirami
- III Year Post Graduate, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Nutritional Deficiencies in Radiotherapy-Treated Head and Neck Cancer Patients. J Clin Med 2021; 10:jcm10040574. [PMID: 33546506 PMCID: PMC7913750 DOI: 10.3390/jcm10040574] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
Nutritional deficiencies (malnutrition, cachexia, sarcopenia, and unfavorable changes in the body composition) developing as a side effect of radiotherapy (RT) currently represents a significant but still inaccurately studied clinical problem in cancer patients. The incidence of malnutrition observed in head and neck cancer (HNC) patients in oncological radiology departments can reach 80%. The presence of malnutrition, sarcopenia, and cachexia is associated with an unfavorable prognosis of the disease, higher mortality, and deterioration of the quality of life. Therefore, it is necessary to identify patients with a high risk of both metabolic syndromes. However, the number of studies investigating potential predictive markers for the mentioned purposes is still significantly limited. This literature review summarizes the incidence of nutritional deficiencies in HNC patients prior to therapy and after the commencement of RT, and presents recent perspectives for the prediction of unfavorable nutritional changes developing as a result of applied RT.
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Valentino NP, Gomes TLN, Barreto CS, Borges TC, Soares JDP, Pichard C, Laviano A, Pimentel GD. Low phase angle is associated with the risk for sarcopenia in unselected patients with cancer: Effects of hydration. Nutrition 2021; 84:111122. [PMID: 33477000 DOI: 10.1016/j.nut.2020.111122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Individuals with cancer are affected by a loss of cell membrane integrity due to electrolyte imbalance between the intra- and extracellular fluids. Cell membrane integrity and hydration status can be assessed according to the phase angle (PhA) and the risk for sarcopenia, by using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire. To our knowledge, this approach has not been validated in patients with cancer. The aims of this study were to verify the prevalence of the risk for sarcopenia, and to analyze the association between PhA and the risk for sarcopenia with and without adjustment for extracellular water content. METHODS This was a cross-sectional study conducted with 124 male and female cancer patients (77.4% men). PhA and hydration status were assessed using bioelectrical impedance analysis (BIA), and the risk for sarcopenia (cutoff ≥4) was assessed using the SARC-F questionnaire. RESULTS Of the 124 patients, 28 (22.5%) were at risk for sarcopenia (SARC-F ≥4). There was no association between PhA and the risk for sarcopenia in the crude model, nor in the model adjusted for age, sex, smoking, alcohol consumption, and physical activity, nor after adjusting for use of supplements, body mass index, treatment type, performance status, and type and stage of cancer. However, we found an association between lower PhA values and a higher risk for sarcopenia after adjusting for hydration abnormalities (odds ratio, 1.74; 95% confidence interval, 1.03-2.93; P < 0.035). CONCLUSION We found that 22.5% of patients with cancer presented with a risk for sarcopenia. Additionally, an association between lower PhA values and enhanced risk for sarcopenia highlighted the importance of adequate hydration and evaluation of fluid status via BIA as a new recommendation to prevent sarcopenia.
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Affiliation(s)
- Nathalia P Valentino
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Tatyanne L N Gomes
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Cleidiana S Barreto
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Thaís C Borges
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Jéssika D P Soares
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Claude Pichard
- Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Gustavo D Pimentel
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil.
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de Almeida C, Penna PM, Pereira SS, Rosa CDOB, Franceschini SDCC. Relationship between Phase Angle and Objective and Subjective Indicators of Nutritional Status in Cancer Patients: A Systematic Review. Nutr Cancer 2020; 73:2201-2210. [PMID: 33251872 DOI: 10.1080/01635581.2020.1850815] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To investigate the relationship between phase angle (PA) and objective and subjective indicators of nutritional status in cancer patients, as well as to identify cutoff points for PA, to detect malnutrition in these patients. The study was a systematic review, carried out following the guidelines of the Preferred Reporting Items for Systematic Reviews and meta-analyses (PRISMA). Literature search was performed for two authors, in indexed databases, including the National Library of Medicine, Bethesda, MD (PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), and Scopus (Elsevier). We used the checklist from the Joanna Briggs Institute for assessing the risk of bias. The review was registered with the Systematic Review Registration (PROSPERO), number CRD42020134324. In total, nine papers were eligible. PA was correlated with several objective and subjective indicators of nutritional status in most cases. Cutoff point values for the PA, capable of detecting malnutrition, varied from 4.73° to 6°, despite the modest diagnostic accuracy. We assume that PA may be considered an indicator of nutritional status, when complementing additional data and assisting health practitioners in evaluating individuals with malignant neoplasms. However, a single cutoff point with fair and concomitant sensitivity and specificity was not identified.
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Affiliation(s)
- Carolina de Almeida
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Paula Moreira Penna
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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