Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes

Barajas-Galindo, David E.; Vidal-Casariego, Alfonso; Maza, Begoña Pintor-de la; Fernández-Martínez, P.; Ramos-Martínez, Tania; García-Arias, Sara; Hernández-Moreno, A.; Urioste-Fondo, Ana; Cano-Rodríguez, Isidoro; Ballesteros-Pomar, María D.

doi:10.1016/j.endinu.2019.05.006

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…(103) Similar results were observed in a retrospective study in patients who received immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean Length of Stay (LOS) [28.25 (SD 16.11) Vs 35.50 (SD 25.73) days; p=0.030]. (57) In a systemic review of 19 RCTs (1099 patients) the authors found no evidence of a difference in the LOS (mean difference -2.5 days, 95% confidence interval (CI) -5.11 to 0.12). Similarly, the effect of immunonutrition on wound infection was found to be poor (risk ratio (RR) 0.94, 95% CI 0.70 to 1.26) However, there was reduced fistula formation with immunonu-trition group; the absolute risks were 11.3% and 5.4% in the standard care and immunonutrition groups, with a RR of 0.48 (95% CI 0.27 to 0.85).…”

Section: Moderate Consensussupporting

confidence: 67%

“…However, the advantages seemed to be statistically insignificant after adjusting for age, tumor stage, or aggressiveness of the surgery. (57) Similarly, in a meta-analysis, 397 patients from six studies receiving arginine as a single substance with other nutrition saw a reduction in fistulas (OR 1 4 0.36, 95% CI: 0.14 to 0.95, p 1 4 0.039), and LOS (mean difference: 6.8 d, 95% CI: 12.6 to 0.9 d, p 1 4 0.023). But, there was no benefit observed in wound infections or other infections (58) Another RCT showed that enteral arginine supplementation had no advantage in postoperative nutritional status, surgeryinduced immune suppression, or clinical outcome in severely malnourished HNC patients.…”

Section: Moderate Consensusmentioning

confidence: 96%

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IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

Timmanpyati¹,

Meenakshi²,

Canday³

et al. 2023

JNUTRES

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Nutritional support is an integral component in the treatment of head and neck cancers (HNC). Studies indicate 90% of HNC patients are at high risk of developing malnutrition. Chemo-radiation and surgery, the three common treatments used to treat HNC are highly susceptible to toxic side effects. Dysphagia is often underestimated in HNC patients. A prolonged impaired swallowing process can lead to severe morbidities like malnutrition, dehydration, aspiration, pneumonia, and even death. These complications have adverse effects on patients' QoL (Quality of Life) and mental health. These adverse reactions further complicate the nutritional status of the patients and the final treatment outcome, increasing morbidity and mortality. The consensus statements try to address nutritional issues and provide practical recommendations for practicing dieticians and clinicians. Keywords: Head and neck cancer guidelines, Nutrition in head and neck cancers, Consensus statements in nutrition in Head and neck cancers, IAPEN head and neck cancer guidelines

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Section: Moderate Consensussupporting

confidence: 67%

Section: Moderate Consensusmentioning

confidence: 96%

IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

Timmanpyati¹,

Meenakshi²,

Canday³

et al. 2023

JNUTRES

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“…In clinical nutrition, some nutritional formulas are recommended in specific situations; for example, immunonutrition is currently a standard of care in fast-track abdominal surgery programs, or after surgery in patients with head and neck cancer [ 18 , 34 , 35 ]. Based on the results of this study (significant decrease in ferritin and C-RP in the intervention group), it would be interesting to evaluate the effect of specific immunomodulatory OSs in patients with HF.…”

Section: Discussionmentioning

confidence: 99%

Mediterranean Diet, Vitamin D, and Hypercaloric, Hyperproteic Oral Supplements for Treating Sarcopenia in Patients with Heart Failure—A Randomized Clinical Trial

Herrera-Martínez,

Muñoz Jiménez,

López Aguilera

et al. 2023

Nutrients

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Background: Malnutrition and sarcopenia frequently affect patients with heart failure (HF), in which clinical outcomes and survival is decreased. Thus, appropriate nutritional screening and early nutrition support are highly recommended. Currently, nutritional support is not a standard of care in patients with HF, and the use of commercially available oral supplements (OSs) could provide an additional benefit to medical treatment in these patients. Aim: To compare the effect of the Mediterranean diet in combination with hypercaloric, hyperproteic OS in patients with HF. Patients and methods: An open label, controlled clinical study in which patients were randomly assigned to receive a Mediterranean diet (control group) vs. hypercaloric, hyperproteic OS (intervention group) for twenty-four weeks. Thirty-eight patients were included; epidemiological, clinical, anthropometric, ultrasound (muscle echography of the rectus femoris muscle of the quadriceps and abdominal adipose tissue), and biochemical evaluations were performed. All patients received additional supplementation with vitamin D. Results: Baseline malnutrition according to the GLIM criteria was observed in 30% of patients, while 65.8% presented with sarcopenia. Body cell mass, lean mass, and body mass increased in the intervention group (absolute increase of 0.5, p = 0.03, 1.2 kg, p = 0.03, and 0.1 kg, p = 0.03 respectively). In contrast, fat mass increased in the control group (4.5 kg, p = 0.05). According to the RF ultrasound, adipose tissue, muscle area, and circumference tended to decrease in the intervention group; it is probable that 24 weeks was too short a period of time for evaluating changes in muscle area or circumference, as previously observed in another group of patients. In contrast, functionality, determined by the up-and-go test, significantly improved in all patients (difference 12.6 s, p < 0.001), including the control (10 s improvement, p < 0.001) and the intervention group (improvement of 8.9 s, p < 0.001). Self-reported QoL significantly increased in all groups, from 68.7 ± 22.2 at baseline to 77.7 ± 18.7 (p = 0.01). When heart functionality was evaluated, LVEF increased in the whole cohort (38.7 ± 16.6 vs. 42.2 ± 8.9, p < 0.01); this increase was higher in the intervention group (34.2 ± 16.1 at baseline vs. 45.0% ± 17.0 after 24 weeks, p < 0.05). Serum values of NT-proBNP also significantly decreased in the whole cohort (p < 0.01), especially in the intervention group (p = 0.02). After adjusting by age and sex, nutritional support, baseline LVEF, NT-proBNP, and body composition parameters of functionality tests were not associated with mortality or new hospital admissions in this cohort. Conclusion: Nutritional support with hypercaloric, hyperproteic OS, Mediterranean diet, and vitamin D supplementation were associated with decreased NT-proBNP and improvements in LVEF, functionality, and quality of life in patients with HF, despite a significant decrease in hospital admissions.

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“…Currently, several specific nutritional formulas are available, and their use in precise clinical scenarios is recommended; for example, the use of immunonutrition as a part of abdominal surgery programs or even after surgery in patients with head–neck cancer is recommended [ 21 , 22 ]. Despite this, there is no specific recommendation for the use of specific OS in cancer patients undergoing systemic treatment.…”

Section: Discussionmentioning

confidence: 99%

Standard Hypercaloric, Hyperproteic vs. Leucine-Enriched Oral Supplements in Patients with Cancer-Induced Sarcopenia, a Randomized Clinical Trial

Herrera-Martínez,

León Idougourram,

Muñoz Jiménez

et al. 2023

Nutrients

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(1) Background: Malnutrition frequently affects patients with cancer, and it negatively impacts treatment tolerance, clinical outcomes and survival. Thus, appropriate nutritional screening and early nutrition support are extremely recommended. Currently, a significant number of oral supplements (OS) are commercially available; despite this, there is a lack of evidence for recommending specific OS, including leucine-enriched OS, for nutritional support in patients with cancer. (2) Aim: To compare the clinical evolution of patients with cancer (undergoing systemic treatment) that received standard hypercaloric, whey protein-based hyperproteic oral supplements vs. hypercaloric, hyperproteic leucine-enriched OS using a novel morphofunctional nutritional evaluation. (3) Patients and methods: This paper details an open-label, controlled clinical study in which patients were randomly assigned to receive nutritional treatment with whey protein-based hyperproteic oral supplements (control group) vs. hypercaloric, hyperproteic leucine-enriched OS (intervention group) during a twelve-week period. Forty-six patients were included; epidemiological, clinical, anthropometric, ultrasound (muscle echography of the rectus femoris muscle of the quadriceps and abdominal adipose tissue) and biochemical evaluation were performed. All patients received additional supplementation with vitamin D. (4) Results: Nutritional parameters (including bioimpedance, anthropometric, ultrasound and biochemical variables) of all included patients remained stable after the nutritional intervention. Extracellular mass tended to increase in the patients that received the leucine-enriched formula. Functionality (evaluated through the stand-up test) improved in both groups (p < 0.001). Prealbumin, transferrin levels and superficial adipose tissue increased in the control group (p < 0.05), while self-reported quality of life improved in all the evaluated patients (p < 0.001). (5) Conclusions: Nutritional support with hypercaloric, hyperproteic (with whey protein) OS and vitamin D supplementation were associated with the maintenance of body composition and improvements in functionality and in quality of life in the patients with cancer undergoing systemic treatment. No significant benefits were observed when a leucine-enriched formula was used.

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Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes

Cited by 7 publications

References 17 publications

IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

Mediterranean Diet, Vitamin D, and Hypercaloric, Hyperproteic Oral Supplements for Treating Sarcopenia in Patients with Heart Failure—A Randomized Clinical Trial

Standard Hypercaloric, Hyperproteic vs. Leucine-Enriched Oral Supplements in Patients with Cancer-Induced Sarcopenia, a Randomized Clinical Trial

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