Pretreatment Dietary Patterns Are Associated with the Presence of Nutrition Impact Symptoms 1 Year after Diagnosis in Patients with Head and Neck Cancer

Abstract

Background: Dietary inflammatory potential could impact the presence and severity of chronic adverse treatment effects among patients with head and neck cancer. The objective of this study was to determine whether pretreatment dietary patterns are associated with nutrition impact symptoms (NIS) as self-reported 1 year after diagnosis. Methods: This was a longitudinal study of 336 patients with newly diagnosed head and neck cancer enrolled in the University of Michigan Head and Neck Specialized Program of Research Excellence. Principal component analysis was utilized to derive pretreatment dietary patterns from food frequency questionnaire data. Burden of seven NIS was selfreported 1 year after diagnosis. Associations between pretreatment dietary patterns and individual symptoms and a composite NIS summary score were examined with multivariable logistic regression models. Results: The two dietary patterns that emerged were prudent and Western. After adjusting for age, smoking status, body mass index, tumor site, cancer stage, calories, and human papillomavirus status, significant inverse associations were observed between the prudent pattern and difficulty chewing [OR 0.44; 95% confidence interval (CI), 0.21-0.93; P ¼ 0.03], dysphagia of liquids (OR 0.38; 95% CI, 0.18-0.79; P ¼ 0.009), dysphagia of solid foods (OR 0.46; 95% CI, 0.22-0.96; P ¼ 0.03), mucositis (OR 0.48; 95% CI, 0.24-0.96; P ¼ 0.03), and the NIS summary score (OR 0.45; 95% CI, 0.22-0.94; P ¼ 0.03). No significant associations were observed between the Western pattern and NIS. Conclusions: Consumption of a prudent diet before treatment may help reduce the risk of chronic NIS burden among head and neck cancer survivors. Impact: Dietary interventions are needed to test whether consumption of a prudent dietary pattern before and during head and neck cancer treatment results in reduced NIS burden.

Dietary Fiber, Whole Grains, and Head and Neck Cancer Prognosis: Findings from a Prospective Cohort Study

“…First, the present analysis utilized pretreatment values for the consumption of dietary fiber and whole grains, which fails to take into account the dynamic nature of dietary patterns over time. It is possible that fiber consumption may decrease during and after cancer treatment in many patients as a result of disease- and treatment-related symptoms that may negatively affect the ability or desire to consume fibrous foods [23,42]. Second, our dataset lacked information on food sources of fiber (e.g., cereal-, fruit-, or vegetable-derived).…”

Pretreatment Adherence to a Priori-Defined Dietary Patterns Is Associated with Decreased Nutrition Impact Symptom Burden in Head and Neck Cancer Survivors

“…An additional item, assessing the burning pain and discomfort that characterizes mucositis, was included and extracted from the pain domain of the questionnaire. Mucositis has been shown to impact dietary intake and thus was included in the analysis for this reason [ 9 , 26 ]. Responses to each of these individual items were dichotomized into categories “not at all bothered” and “slightly to extremely bothered”, as was previously done by members of our research team [ 27 ].…”

“…The report by Ganzer et al found that NIS, including dysphagia, xerostomia, and altered taste, persisted after three years postchemotherapy in a mixed-methods study of 10 long-term HNSCC survivors [ 8 ]. Chronic NIS may pose significant nutritional consequences, including reduced nutrient intake and impaired nutritional status, which is noteworthy, given that this population is disproportionately affected by high rates of cancer cachexia [ 9 , 10 ].…”

“…A posited etiologic mechanism for NIS involves inflammation secondary to cancer treatment and, in particular, treatment with targeted radiation [ 11 ]. While previous studies have provided that consuming a balanced and healthful diet rich in fruits and vegetables before treatment may abate inflammation and chronic NIS, research has yet to identify a generalizable dietary pattern that confers protection by mitigating inflammation after diagnosis and throughout cancer treatment [ 9 ]. Using a multivariate approach for characterizing a posteriori dietary patterns, our research team reported associations between consuming a primarily “prudent” diet, rich in fruits and vegetables, at pretreatment and reduced symptom burden at 1-year postdiagnosis [ 9 ].…”

“…While previous studies have provided that consuming a balanced and healthful diet rich in fruits and vegetables before treatment may abate inflammation and chronic NIS, research has yet to identify a generalizable dietary pattern that confers protection by mitigating inflammation after diagnosis and throughout cancer treatment [ 9 ]. Using a multivariate approach for characterizing a posteriori dietary patterns, our research team reported associations between consuming a primarily “prudent” diet, rich in fruits and vegetables, at pretreatment and reduced symptom burden at 1-year postdiagnosis [ 9 ]. Nevertheless, the purpose of the present analysis was to assess the capacity of a priori-defined diet quality indices to predict symptom burden 1-year postdiagnosis, which, for many participants, comes after the initiation and completion of treatment protocols.…”