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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Virizuela JA, Camblor-Álvarez M, Luengo-Pérez LM, Grande E, Álvarez-Hernández J, Sendrós-Madroño MJ, Jiménez-Fonseca P, Cervera-Peris M, Ocón-Bretón MJ. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report. Clin Transl Oncol 2017; 20:619-629. [PMID: 29043569 DOI: 10.1007/s12094-017-1757-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/30/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. METHODS A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition convened to discuss the management of the nutritional support in cancer patients. RESULTS Of the 18 questions addressed, 9 focused on nutritional support, 5 were related to parenteral nutrition (PN) and 4 about home PN (HPN). The panel of experts recommends using nutritional screening routinely, at diagnosis and throughout the disease course, for detecting the risk of malnutrition and, if it is positive, to perform a complete nutritional assessment, to diagnose malnutrition. Currently, there are different screening tools and methods that allow us to detect nutritional risk. Based on the evidence and experience, the panel stated that PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. The nutritional needs of the cancer patients, except in those cases where individualized measures are required, should be considered similar to healthy individuals (25-30 kcal/kg/day). The panel considers that the nutritional monitoring of the cancer patient should be multidisciplinary and adapted to the characteristics of each center. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. CONCLUSIONS This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients.
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Affiliation(s)
- J A Virizuela
- Department of Medical Oncology, Virgen Macarena University Hospital, Calle Dr. Fedriani, 3, 41009, Sevilla, Spain.
| | - M Camblor-Álvarez
- Endocrinology and Nutritional Department, Gregorio Marañón University General Hospital, Madrid, Spain
| | - L M Luengo-Pérez
- Dietetic and Clinical Nutrition Unit, Endocrinology and Nutritional Department, Infanta Cristina University Hospital, Badajoz, Spain
| | - E Grande
- Department of Medical Oncology, Ramón y Cajal Hospital, Madrid, Spain
| | - J Álvarez-Hernández
- Endocrinology and Nutritional Department, Prince of Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | | | - P Jiménez-Fonseca
- Department of Medical Oncology, Asturias Central University Hospital, Oviedo, Spain
| | - M Cervera-Peris
- Pharmacy Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - M J Ocón-Bretón
- Endocrinology and Nutritional Department, Lozano Blesa Clinic University Hospital, Zaragoza, Spain
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Vidal-Casariego A, Burgos-Peláez R, Martínez-Faedo C, Calvo-Gracia F, Valero-Zanuy MÁ, Luengo-Pérez LM, Cuerda-Compés C. Metabolic effects of L-carnitine on type 2 diabetes mellitus: systematic review and meta-analysis. Exp Clin Endocrinol Diabetes 2013; 121:234-8. [PMID: 23430574 DOI: 10.1055/s-0033-1333688] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Carnitine is an endogenous metabolite and exogenous nutrient with a pivotal role in lipid metabolism. Plasma levels of carnitine are reduced in type 2 Diabetes Mellitus (T2DM). The aim was to evaluate the metabolic effects of the administration of L-carnitine in T2DM. METHOD A systematic review was performed. Relevant randomized, controlled-trials trials were searched in Pubmed, Trip Database and Cochrane Library, and selected when they had enough methodological quality assessed with the Jadad scale. Article search strategy included "Carnitine" OR "L-carnitine" AND "Diabetes -Mellitus" OR "Diabetes mellitus, type 2" OR "Noninsulindependent-diabetes mellitus". Meta-analysis was performed, and the difference of means calculated with a 95% confidence interval. Heterogeneity was evaluated with the Q statistic. RESULTS The systematic review included 4 trials with 284 patients. Oral L-carnitine lowered fasting plasma glucose [-14.3 mg/dl (CI95% - 23.2 to -5.4); p=0,002], total cholesterol [-7.8 mg/dL (95%CI -15.5 to -0.1); p=0.09], low density lipoprotein [-8.8 mg/dl (CI95% -12.2 to -8.5), p<0.0001], apolipoprotein-B100 [-7.6 mg/dl (CI95% -13.6 to -1.6); p=0.013] and apolipoprotein-A1 [-6.0 mg/dl (CI95% -10.5 a -1.5); p=0.523]. There was no significant heterogeneity. The changes in triglycerides, lipoprotein (a) or HbA(1c) were not significant. CONCLUSION The administration of L-carnitine in type 2 diabetes mellitus is associated with an improvement in glycaemia and plasma lipids.
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Affiliation(s)
- A Vidal-Casariego
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain.
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