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Mulasi U, Vock DM, Jager-Wittenaar H, Teigen L, Kuchnia AJ, Jha G, Fujioka N, Rudrapatna V, Patel MR, Earthman CP. Nutrition Status and Health-Related Quality of Life Among Outpatients With Advanced Head and Neck Cancer. Nutr Clin Pract 2020; 35:1129-1137. [PMID: 32141121 DOI: 10.1002/ncp.10476] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This pilot study evaluated nutrition status and health-related quality of life (HRQOL) outcomes among outpatients with head and neck cancer (HNC). Data were collected from 19 patients (18 males, 1 female) during 3 time points: once before chemoradiotherapy (CRT) initiation and 1 and 3 months after CRT. Nutrition status was evaluated using the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Malnutrition was defined as PG-SGA stage B (moderate/suspected malnutrition) or stage C (severely malnourished). HRQOL was assessed through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its HNC-specific module (QLQ-H&N35). We found that well-nourished patients reported having fewer issues with pain, fatigue, appetite loss, chewing, sticky saliva, coughing, and social eating than those categorized as malnourished (P < .05). The association between the global quality-of-life score and PG-SGA score was statistically significant but weak in strength (r = -0.37, P = .012). Although PG-SGA identified 70% as either moderately or severely malnourished before treatment initiation, the mean body mass index was in the overweight category (29 ± 5 kg/m2 ). Compared with pretreatment, patients reported more severe problems with chewing, swallowing, sticky saliva, dry mouth, speech, social eating, and taste and smell sensations at 1-month follow-up, although issues with dry mouth persisted 3 months post treatment (P = .003). In conclusion, malnourished patients reported having worse HRQOL symptoms compared with well-nourished patients. Routine nutrition and psychosocial assessment through PG-SGA and EORTC tools might help identify patients in need of nutrition and psychosocial care.
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Affiliation(s)
- Urvashi Mulasi
- Department of Family & Consumer Sciences (Nutrition and Food/Dietetics), California State University, Sacramento, California, USA
| | - David M Vock
- School of Public Health, Division of Biostatistics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.,Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Adam J Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gautam Jha
- Division of Hematology, Oncology and Transplantation, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Naomi Fujioka
- Division of Hematology, Oncology and Transplantation, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | | | - Manish R Patel
- Division of Hematology, Oncology and Transplantation, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
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Mulasi U, Vock DM, Kuchnia AJ, Jha G, Fujioka N, Rudrapatna V, Patel MR, Teigen L, Earthman CP. Malnutrition Identified by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Consensus Criteria and Other Bedside Tools Is Highly Prevalent in a Sample of Individuals Undergoing Treatment for Head and Neck Cancer. JPEN J Parenter Enteral Nutr 2018. [PMID: 29505143 DOI: 10.1177/0148607116672264.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) Consensus malnutrition definition, we estimated malnutrition prevalence in a sample of individuals with head and neck cancer (HNC) and compared it with the Patient-Generated Subjective Global Assessment (PG-SGA). We also investigated the utility of the 50-kHz phase angle (PA) and 200-kHz/5-kHz impedance ratio (IR) to identify malnutrition. MATERIALS AND METHODS Nineteen individuals (18 males, 1 female) scheduled to undergo chemoradiotherapy were seen at 5 time points during and up to 3 months after treatment completion. Multiple-frequency bioelectrical impedance analysis, PG-SGA, nutrition-focused physical examination, anthropometry, dietary intake, and handgrip strength data were collected. RESULTS Using the Consensus, 67% were found to be malnourished before treatment initiation; these criteria diagnosed malnutrition with overall good sensitivity (94%) and moderate specificity (43%) compared with PG-SGA. Over all pooled observations, "malnourished" (by Consensus but not PG-SGA category) had a lower mean PA (5.2 vs 5.9; P = .03) and higher IR (0.82 vs 0.79; P = .03) than "well-nourished" categorizations, although the clinical relevance of these findings is unclear. PA and IR were correlated with higher PG-SGA score (r = -0.35, r = 0.36; P < .01) and handgrip strength (r = 0.48, r = -0.47; P < .01). CONCLUSION The Academy/ASPEN Consensus and the PG-SGA were in good agreement. It is unclear whether PA and IR can be used as surrogate markers of nutrition status or muscle loss.
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Affiliation(s)
- Urvashi Mulasi
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - David M Vock
- School of Public Health, Division of Biostatistics, University of Minnesota, Twin Cities, Minnesota, USA
| | - Adam J Kuchnia
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Gautam Jha
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Naomi Fujioka
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Manish R Patel
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
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Kuchnia AJ, Teigen L, Nagel E, Ligthart-Melis G, Mulasi U, Weijs P, Earthman CP. Protein in the Hospital: Gaining Perspective and Moving Forward. JPEN J Parenter Enteral Nutr 2018; 42:270-278. [PMID: 29356030 DOI: 10.1002/jpen.1068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/14/2017] [Indexed: 12/15/2022]
Abstract
Provision of adequate protein is crucial for optimizing outcomes in hospitalized patients. However, the methodologies upon which current recommendations are based have limitations, and little is known about true requirements in any clinical population. In this tutorial, we aim to give clinicians an understanding of how current protein recommendations were developed, an appreciation for the limitations of these recommendations, and an overview of more sophisticated approaches that can be applied to better define protein requirements. A broader perspective of the challenges and opportunities in determining clinical protein requirements can help clinicians think critically about the individualized nutrition care they provide to their patients with the goal of administering adequate protein to optimize outcomes.
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Affiliation(s)
- Adam J Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Emily Nagel
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Gerdien Ligthart-Melis
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Urvashi Mulasi
- Department of Family and Consumer Sciences, California State University, Sacramento, California, USA
| | - Peter Weijs
- Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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Mulasi U, Vock DM, Kuchnia AJ, Jha G, Fujioka N, Rudrapatna V, Patel MR, Teigen L, Earthman CP. Malnutrition Identified by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Consensus Criteria and Other Bedside Tools Is Highly Prevalent in a Sample of Individuals Undergoing Treatment for Head and Neck Cancer. JPEN J Parenter Enteral Nutr 2018; 42:139-147. [PMID: 29505143 DOI: 10.1177/0148607116672264] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/31/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) Consensus malnutrition definition, we estimated malnutrition prevalence in a sample of individuals with head and neck cancer (HNC) and compared it with the Patient-Generated Subjective Global Assessment (PG-SGA). We also investigated the utility of the 50-kHz phase angle (PA) and 200-kHz/5-kHz impedance ratio (IR) to identify malnutrition. MATERIALS AND METHODS Nineteen individuals (18 males, 1 female) scheduled to undergo chemoradiotherapy were seen at 5 time points during and up to 3 months after treatment completion. Multiple-frequency bioelectrical impedance analysis, PG-SGA, nutrition-focused physical examination, anthropometry, dietary intake, and handgrip strength data were collected. RESULTS Using the Consensus, 67% were found to be malnourished before treatment initiation; these criteria diagnosed malnutrition with overall good sensitivity (94%) and moderate specificity (43%) compared with PG-SGA. Over all pooled observations, "malnourished" (by Consensus but not PG-SGA category) had a lower mean PA (5.2 vs 5.9; P = .03) and higher IR (0.82 vs 0.79; P = .03) than "well-nourished" categorizations, although the clinical relevance of these findings is unclear. PA and IR were correlated with higher PG-SGA score (r = -0.35, r = 0.36; P < .01) and handgrip strength (r = 0.48, r = -0.47; P < .01). CONCLUSION The Academy/ASPEN Consensus and the PG-SGA were in good agreement. It is unclear whether PA and IR can be used as surrogate markers of nutrition status or muscle loss.
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Affiliation(s)
- Urvashi Mulasi
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - David M Vock
- School of Public Health, Division of Biostatistics, University of Minnesota, Twin Cities, Minnesota, USA
| | - Adam J Kuchnia
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Gautam Jha
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Naomi Fujioka
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Manish R Patel
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
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Teigen LM, Kuchnia AJ, Nagel E, Deuth C, Vock DM, Mulasi U, Earthman CP. Impact of Software Selection and ImageJ Tutorial Corrigendum on Skeletal Muscle Measures at the Third Lumbar Vertebra on Computed Tomography Scans in Clinical Populations. JPEN J Parenter Enteral Nutr 2017; 42:933-941. [DOI: 10.1002/jpen.1036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Levi M. Teigen
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Adam J. Kuchnia
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Emily Nagel
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Christopher Deuth
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - David M. Vock
- Division of Biostatistics; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Urvashi Mulasi
- Department of Family and Consumer Sciences (Nutrition and Food/Dietetics); California State University; Sacramento California USA
| | - Carrie P. Earthman
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
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Johnson AJ, Matthie JR, Kuchnia A, Teigen LM, Beckman LM, Mager JR, Nicklay SA, Mulasi U, Sibley SD, Nagel E, Earthman CP. Evaluation of Advanced Bioimpedance Spectroscopy Models for Measuring Body Composition in Healthy Adults (NHANES 1999-2004) and Those Undergoing Massive Weight Loss Following Roux-en-Y Gastric Bypass Surgery. BRASPEN J 2017; 32:193-202. [PMID: 31396584 PMCID: PMC6687078] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Bioimpedance spectroscopy (BIS) devices utilize biophysical modeling to generate body composition data. The addition of body mass index (BMI) to modified Xitron-Hanai-based mixture equations improved BIS estimates of intracellular water (ICW), particularly at the extremes of BMI. A 3-compartment model for distinguishing excess fluid (ExF) from normally hydrated lean (NHLT) and adipose tissue may further improve BIS estimates. OBJECTIVE We aimed to validate a BIS approach based on the Chamney model for determining fat mass (FM) in healthy individuals (NHANES) and for measuring FM changes in individuals undergoing massive weight loss. METHODS Using adult NHANES 1999-2004 (2821 female, 3063 male) and longitudinal pre-to-post-RYGB (15F) data, we compared dual-energy-X-ray absorptiometry (DXA) and BIS for FM. We applied BIS adiposity-corrected values to Chamney equations for normally hydrated lean and adipose tissue (NHLT, NHAT) and FM. Method agreement was evaluated by correlations, paired t-tests, root mean square error (RMSE), Bland-Altman (B-A) analysis, and concordance correlation coefficients (CCC). RESULTS Method agreement between BIS and DXAFM was good in healthy adults (r=0.96, CCC=0.93, p<.0001), and pre-to-post-RYGB (r=0.93-0.98, CCC=0.81-0.86, p<.001). Although cross-sectional FM measures differed, FM change measures post-RYGB did not (35.6±8.9 vs. 35.2±9.2 kg, BIS vs. DXA) and agreed well (r=0.84, p<.0001). The 15 subjects with follow-up measurements at 1 year lost 11.5±9.8 kg FFM by DXA, but only 1.3±2.5 kg of NHLT by BIS, suggesting that the FFM loss may have been mostly adipose tissue water. CONCLUSIONS Incorporation of the Chamney model into BIS algorithms is a major conceptual advancement for assessing and monitoring body composition. Its ability to differentiate ICW and extracellular water (ECW) in NHLT and NHAT, as well as excess ECW is promising, and would facilitate lean tissue monitoring in obesity and acute/chronic disease.
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Affiliation(s)
- Abigail J. Johnson
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | | | - Adam Kuchnia
- MS, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Levi M. Teigen
- RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Lauren M. Beckman
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Jennifer R. Mager
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Sarah A. Nicklay
- MS, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Urvashi Mulasi
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Shalamar D. Sibley
- MD, MPH. University of Minnesota-Twin Cities, Department of Medicine, Minneapolis, MN, USA
| | - Emily Nagel
- MS, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Carrie P. Earthman
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
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Kuchnia AJ, Teigen LM, Cole AJ, Mulasi U, Gonzalez MC, Heymsfield SB, Vock DM, Earthman CP. Phase Angle and Impedance Ratio: Reference Cut-Points From the United States National Health and Nutrition Examination Survey 1999-2004 From Bioimpedance Spectroscopy Data. JPEN J Parenter Enteral Nutr 2016; 41:1310-1315. [PMID: 27670250 DOI: 10.1177/0148607116670378] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Raw bioimpedance parameters (eg, 50-kHz phase angle [PA] and 200-kHz/5-kHz impedance ratio [IR]) have been investigated as predictors of nutrition status and/or clinical outcomes. However, their validity as prognostic measures depends on the availability of appropriate reference data. Using a large and ethnically diverse data set, we aimed to determine if ethnicity influences these measures and provide expanded bioimpedance reference data for the U.S. POPULATION METHODS The National Health and Nutrition Examination Survey (NHANES) is an ongoing compilation of studies conducted by the U.S. Centers for Disease Control and Prevention designed to monitor nutrition status of the U.S. POPULATION The NHANES data sets analyzed were from the years 1999-2000, 2001-2002, and 2003-2004. RESULTS Multivariate analysis showed that PA and IR differed by body mass index (BMI), age, sex, and ethnicity (n = 6237; R2 = 41.2%, P < .0001). Suggested reference cut-points for PA stratified by age decade, ethnicity, and sex are provided. CONCLUSION Ethnicity is an important variable that should be accounted for when determining population reference values for PA and IR. We have provided sex-, ethnicity-, and age decade-specific reference values from PA for use by future studies in U.S. POPULATIONS Interdevice differences are likely to be important contributors to variability across published population-specific reference data and, where possible, should be evaluated in future research. Ultimately, further validation with physiologically relevant reference measures (eg, dual-energy x-ray absorptiometry) is necessary to determine if PA/IR are appropriate bedside tools for the assessment of nutrition status in a clinical population.
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Affiliation(s)
- Adam J Kuchnia
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - Levi M Teigen
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - Abigail J Cole
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - Urvashi Mulasi
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - M Cristina Gonzalez
- 2 Post-graduate Program on Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Steven B Heymsfield
- 3 Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - David M Vock
- 4 School of Public Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Carrie P Earthman
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
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Affiliation(s)
- Urvashi Mulasi
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Adam J. Kuchnia
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Abigail J. Cole
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Carrie P. Earthman
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
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