A systematic review of the psychometric properties of physical performance tests for sarcopenia in community-dwelling older adults.

BACKGROUND: This review provides an overview of the psychometric properties of the short physical performance battery (SPPB), timed up and go test (TUG), 4 m gait speed test (4 m GST) and the 400 m walk test (400 m WT) in community-dwelling older adults. METHODS: A systematic search was conducted in MEDLINE, CINAHL and EMBASE, resulting in the inclusion of 50 studies with data from in total 19,266 participants (mean age 63.2-84.3). Data were extracted and properties were given a sufficient or insufficient overall rating following the COSMIN guideline for systematic reviews of patient-reported outcome measures. Quality of evidence (QoE) was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: The SPPB was evaluated in 12 studies, TUG in 30, 4 m GST in 12 and 400 m WT in 2. Reliability of the SPPB, TUG and 4 m GST was rated sufficient (moderate to good QoE). The measurement error of the SPPB was rated insufficient (low QoE). Criterion validity for the SPPB was insufficient in indicating sarcopenia (moderate QoE), while the TUG was sufficient and insufficient for determining mobility limitations (low QoE) and activities of daily living disability (low QoE), respectively. Construct validity of the SPPB, TUG, 4 m GST and 400 m WT was rated insufficient in many constructs (moderate to high QoE). Responsiveness was rated as insufficient for SPPB (high QoE) and TUG (very low QoE), while 4 m GST was rated as sufficient (high QoE). CONCLUSION: Overall, the psychometric quality of commonly used physical performance tests in community-dwelling older adults was generally rated insufficient, except for reliability. These tests are widely used in daily practice and recommended in guidelines; however, users should be cautious when drawing conclusions such as sarcopenia severity and change in physical performance due to limited psychometric quality of the recommended measurement instruments. There is a need for a disease-specific physical performance test for people with sarcopenia.This research received no specific grant from any funding agency and was registered a priori using the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022359725).

Adherence to and Efficacy of the Nutritional Intervention in Multimodal Prehabilitation in Colorectal and Esophageal Cancer Patients.

Multimodal prehabilitation programs to improve physical fitness before surgery often include nutritional interventions. This study evaluates the efficacy of and adherence to a nutritional intervention among colorectal and esophageal cancer patients undergoing the multimodal Fit4Surgery prehabilitation program. The intervention aims to achieve an intake of ≥1.5 g of protein/kg body weight (BW) per day through dietary advice and daily nutritional supplementation (30 g whey protein). This study shows 56.3% of patients met this goal after prehabilitation. Mean daily protein intake significantly increased from 1.20 ± 0.39 g/kg BW at baseline to 1.61 ± 0.41 g/kg BW after prehabilitation (p < 0.001), with the main increase during the evening snack. BW, BMI, 5-CST, and protein intake at baseline were associated with adherence to the nutritional intervention. These outcomes suggest that dietary counseling and protein supplementation can significantly improve protein intake in different patient groups undergoing a multimodal prehabilitation program.

Multimodal Prehabilitation in Patients Undergoing Complex Colorectal Surgery, Liver Resection, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Pilot Study on Feasibility and Potential Efficacy.

BACKGROUND: Surgery for complex primary and metastatic colorectal cancer (CRC), such as liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), in academic settings has led to improved survival but is associated with complications up to 75%. Prehabilitation has been shown to prevent complications in non-academic hospitals. This pilot study aimed to determine the feasibility and potential efficacy of a multimodal prehabilitation program in patients undergoing surgery in an academic hospital for complex primary and metastatic CRC. METHODS: All patients awaiting complex colorectal surgery, liver resection, or HIPEC from July 2019 until January 2020 were considered potentially eligible. Feasibility was measured by accrual rate, completion rate, adherence to the program, satisfaction, and safety. To determine potential efficacy, postoperative outcomes were compared with a historical control group. RESULTS: Sixteen out of twenty-five eligible patients (64%) commenced prehabilitation, and fourteen patients fully completed the intervention (88%). The adherence rate was 69%, as 11 patients completed >80% of prescribed supervised trainings. No adverse events occurred, and all patients expressed satisfaction with the program. The complication rate was significantly lower in the prehabilitation group (37.5%) than the control group (70.2%, p = 0.020). There was no difference in the type of complications. CONCLUSION: This pilot study illustrates that multimodal prehabilitation is feasible in the majority of patients undergoing complex colorectal cancer, liver resection, and HIPEC in an academic setting.

The effect of exercise and nutrition interventions on physical functioning in patients undergoing haematopoietic stem cell transplantation: a systematic review and meta-analysis.

PURPOSE: Haematopoietic stem cell transplantation (HSCT) is potentially lifesaving. However, it comes with negative consequences such as impaired physical functioning, fatigue and poor quality of life. The aim of this systematic review and meta-analysis is to determine the effect of exercise and nutrition interventions to counteract negative consequences of treatment and improve physical functioning in patients receiving HSCT. METHODS: This systematic review and meta-analysis included randomised controlled trials from three electronic databases between 2009 and 2020. The trials included adult patients receiving HSCT and an exercise or nutrition intervention. Study selection, bias assessment and data extraction were independently performed by two reviewers. Physical functioning outcomes were meta-analysed with a random-effects model. RESULTS: Thirteen studies were included using exercise interventions (n = 11) and nutrition interventions (n = 2); no study used a combined intervention. Meta-analysis of the trials using exercise intervention showed statistically significant effects on 6-min walking distance (standardised mean difference (SMD) 0.41, 95% CI: 0.14-0.68), lower extremity strength (SMD 0.37, 95% CI 0.12-0.62) and global quality of life (SMD 0.27, 95% CI: 0.08-0.46). CONCLUSION: Our physical functioning outcomes indicate positive effects of exercise interventions for patients receiving HSCT. Heterogeneity of the exercise interventions and absence of high-quality nutrition studies call for new studies comparing different types of exercise studies and high quality studies on nutrition in patients with HSCT.

Protein and energy intake: Comparison of two food services in patients during hemodialysis treatment.

OBJECTIVES: Radboud University Medical Center introduced a new food service (NFS) to the hemodialysis (HD) department, which contains several small protein-rich foods and adheres to the Dutch dietary HD guidelines. The objectives were to investigate whether the NFS improves protein and energy intake compared with the old food service (OFS), the number of symptomatic hypotensive events (SHEs), and patient satisfaction. METHODS: This was a prospective cohort (pilot) study of 25 adult patients with HD at the Radboud University Medical Center between August 2018 and February 2019. Differences in protein and energy intake over time by repeated measurements of the OFS and NFS were evaluated by linear mixed models with adjustments for confounders. SHEs, defined as a systolic drop >20 mmHg between two blood pressure measurements and 1) temporary or permanent stop ultrafiltration, 2) nausea, or 3) dizziness were collected. Patient satisfaction was determined by means of a self-developed questionnaire. RESULTS: Protein and energy intake for the OFS and NFS differed significantly. Mean ± standard deviation for protein intake was 26 ± 11 g and 31 ± 13 g, respectively, and for energy intake 603 ± 218 kcal and 724 ± 244 kcal, respectively. No increase in SHEs occurred between the food services (2 SHEs at OFS vs 1 SHE at NFS). OFS patient satisfaction was graded 6.7 ± 2.3 and NFS was graded 7.3 ± 1.7. CONCLUSIONS: NFS resulted in increased protein and energy intake and patient satisfaction, but no increase in SHEs was observed.

Effect of a Preoperative Home-Delivered, Protein-Rich Meal Service to Improve Protein Intake in Surgical Patients: A Randomized Controlled Trial.

BACKGROUND: The preoperative period likely provides an important opportunity to improve postoperative recovery, as suggested by the finding that low nutrition status is a predictor of increased postoperative complications and longer length of stay (LOS). It was investigated whether a home-delivered, protein-rich meal service improves protein intake relative to requirements within 3 weeks prior to surgery compared to usual care (UC). METHODS: This randomized controlled trial included adults (n = 126) with planned surgery performed at the orthopedics, urology, gynecology, or general surgery departments. The intervention group received 6 protein-rich dishes per day for 3 weeks, and the control group sustained their usual diet. Dietary intake, nutrition status, hand grip strength, physical performance, and quality of life were assessed at baseline and after 3 weeks. Patient satisfaction was reported after 3 weeks, and data on complications and LOS were reported 30 days after surgery. RESULTS: Protein intake relative to requirements significantly improved by 16%, and energy intake relative to requirements increased by 19% for the meal service, as compared with UC. The intervention group experienced significantly less stress with preparing meals and were more satisfied with the presentation of the meals than the control group. No significant effects of the intervention were detected on other secondary outcomes. CONCLUSION: The home-delivered, protein-rich meal service was successfully implemented before surgery and improved protein and energy intake relative to requirements within 3 weeks while patient satisfaction maintained. The preoperative period serves as a window of opportunity to prepare patients before hospitalization.

Protein Intake at the First Day of Full-Oral Intake During Hospitalization Is Associated With Complications and Hospital Length of Stay.

BACKGROUND: Malnutrition at admission is associated with complication-related readmission and prolonged hospital stay. This underscores the importance of an adequate intake - more particular, protein intake - to prevent further deterioration and treat malnutrition during hospitalization. Our objective was to assess whether protein intake relative to requirements at the first day of full oral intake is associated with complications and hospital length of stay (LOS) in medical and surgical patients. METHODS: This was a post hoc analysis of a prospective cohort study in patients on the wards of gastroenterology, orthopedics, urology, and gynecology. Protein intake was measured by subtracting the weight of each dish at the end of each mealtime from the weight at serving time. Complications and LOS were reported using patients' medical records. RESULTS: In total, complications were observed in 92 of 637 (14.4%) patients, with a median LOS of 5 days (3.0-7.0). An absolute increase of 10% protein intake relative to requirements reduced the relative complication risk by 10% (odds ratio, 0.900; 95% CI, 0.83-0.97; P < .05). Also, LOS was shortened by 0.23 days for each increase of 10% in protein intake relative to requirements (95% CI, -0.3 to -0.2; P < .05). CONCLUSION: Protein intake relative to requirements at the first day of full-oral intake is associated with the risk of complications and hospital LOS. This analysis bolsters the evidence for the importance of any hospital meal service that increases protein intake.

Sensitive and practical screening instrument for malnutrition in patients with chronic kidney disease.

OBJECTIVES: The aims of this study were to examine the diagnostic accuracy of the Malnutrition Universal Screening Tool (MUST) and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF) for detecting malnutrition in chronic kidney disease (CKD), study individual contributions of MUST and PG-SGA screening items to the explained variance in nutritional status (NS), and examine whether the PG-SGA-SF score, in combination with one of the items of the clinician's part of the cPG-SGA, can be used as a valid and compact nutrition assessment tool in patients with CKD. METHODS: This was a cross-sectional observational study with 123 patients with CKD who were screened for malnutrition risk by MUST and PG-SGA-SF. NS was determined by complete PG-SGA. Overall accuracy was calculated by the receiver operating curve area under the curve (ROC-AUC). Explained variance of individual screening items was assessed by Nagelkerke's R2, total explained variance was assessed by the increase of R2 after addition of items in manual stepwise forward selection. RESULTS: Of the patients, 44% were malnourished, which was detected by MUST in 24% and by PG-SGA-SF in 78%. Items "body mass index (BMI)" and "no food intake" of the MUST together explained only 3.7% of the variance in NS, whereas the item "nutrition impact symptoms" (NIS) of the PG-SGA-SF explained 57%. Total explained variance in NS by MUST and PG-SGA-SF were 15% and 74%, respectively. The PG-SGA-SF combined with the "metabolic stress" item explained most (87%) and had a sensitivity of 94% to detect malnutrition. CONCLUSIONS: Most malnourished patients with CKD failed to be identified with the MUST, whereas the PG-SGA-SF detected the majority of them with the screening item "NIS" having the highest individual contribution to the explained variance in NS. Combination of PG-SGA-SF with the item "metabolic stress" had the highest overall accuracy to detect malnutrition.

The Currently Available Literature on Inpatient Foodservices: Systematic Review and Critical Appraisal.

BACKGROUND: An adequate hospital foodservice is important to optimize protein and energy intake and to maintain or improve a patient's nutritional status. Key elements that define an optimal foodservice have yet to be identified. OBJECTIVES: To systematically describe the effects of published foodservice interventions on nutrition and clinical outcomes and determine which elements should be considered essential. Secondly, to describe the outcome measures used in these studies and evaluate their relevance and validity to guide future research. METHODS: PubMed, Embase, the Cochrane Library, and the Web of Science databases were searched. Studies that included assessment of nutrition and/or clinical outcomes of hospital foodservice up to December 2017 were eligible. The details of the subject population, the type of intervention, and the effects on reported outcomes were extracted from each study. RESULTS: In total, 33 studies that met inclusion criteria were identified, but only nine (27%) were rated as having sufficient methodologic quality. These nine studies concluded that various elements of a foodservice can be considered essential, including using volunteers to provide mealtime assistance, encouraging patients to choose protein-rich foods, adding protein-enriched items to the menu, replacing existing items with protein-enriched items, giving patients the ability to order food by telephone from a printed menu (room service concept), or a combination of these interventions. The interstudy heterogeneity was high for both outcome measures and methods. CONCLUSIONS: Various foodservice interventions have the potential to improve outcome measures. Recommendations are made to facilitate future research.

Strategies to increase protein intake at mealtimes through a novel high-frequency food service in hospitalized patients.

BACKGROUND/OBJECTIVES: Additional strategies should be applied to optimize hospital food services, in order to increase the number of patients with adequate protein intake at mealtimes. Therefore, we aim to specify the differences in protein intake per mealtime between the traditional three meals a day food service (TMS) and a novel six times a day food service containing protein-rich food items, FoodforCare (FfC). SUBJECTS/METHODS: This was a post-hoc analysis of a prospective cohort study comparing the TMS (July 2015 - May 2016; n = 326) to FfC (January 2016 - December 2016; n = 311) in adult hospitalized patients. RESULTS: Protein intake (g) was higher with FfC at all mealtimes (p < 0.05) except for dinner (median [IQR] at breakfast: 17 [6.5-25.7] vs. 10 [3.8-17]; 10:00 a.m.: 3.3 [0.3-5.3] vs. 1 [0-2.2]; lunch: 17.6 [8.4-25.8] vs. 13 [7-19.4]; 2:30 p.m.: 5.4 [0.8-7.5] vs. 0 [0-1.8]; 7:00 p.m.: 1 [0-3.5] vs. 0 [0-1.7]; 9:00 p.m.: 0 [0-0.1] vs. 0 [0-0]). At dinner, protein intake was highest for both food services (20.9 g [8.4-24.1] vs. 20.5 g [10.5-27.8]). CONCLUSIONS: Implementation of a high-frequency food service can improve protein intake at mealtimes during the day and might be a strategy to increase the number of patients with adequate protein intake.

[A novel in-hospital meal service improves protein and energy intake]. / Nieuwe maaltijdservice in ziekenhuis verbetert voedselinname.

OBJECTIVE: To investigate whether a novel meal service, FoodforCare, improves dietary intake and patient satisfaction, compared to the traditional 3-meals a day service (TMS). DESIGN: We performed a prospective cohort study at medical (Gastroenterology) and surgical (Gynecology, Urology, Orthopedics) wards. Patients were offered TMS (July 2015 - May 2016; n = 326) or FfC meal service (after stepwise introduction per ward from January 2016 - December 2016; n = 311). METHOD: Primary outcome was the mean percentage of protein and energy intake relative to requirements, between patients receiving TMS and those receiving FfC, on the first and fourth day of full oral intake. Patient satisfaction comprised rating of the experienced quality of the meals and the meal service by means of a validated questionnaire. RESULTS: Patient characteristics were similar between groups, with the exception that the FfC group contained more oncology patients (p = 0.028). FfC improved mean daily protein intake (in g/day) relative to requirements (1.2 g/kg/day) at day 1 (mean % ± SD: 79 ± 33 vs. 59 ± 28; p < 0.05) and day 4 (73 ± 38 vs. 59 ± 29; p < 0.05). Mean daily energy intake (in kcal/day) relative to requirements improved at day 1 (88 ± 34 vs. 70 ± 30; p < 0.05) and day 4 (84 ± 40 vs. 73 ± 31; p = 0.05). On a scale of 1-10, patient satisfaction remained unchanged, in terms of food quality (7.7 ± 1.5 vs. 7.4 ± 1.4; p = 0.09) and meal service (7.8 ± 1.3 vs. 7.7 ± 1.1; p = 0.29). The FfC group was more satisfied with the appearance and smell of the meals (both p < 0.05). CONCLUSION: Implementation of this novel meal service substantially improved protein and energy intake while maintaining, and to some extent, improving patient satisfaction.

A novel in-hospital meal service improves protein and energy intake.

BACKGROUND & AIMS: Improvement of hospital meal services is a strategy to optimize protein and energy intake and prevent or treat malnutrition during hospitalization. FoodforCare (FfC) is a new concept comprising 6-protein-rich meals per day, provided directly at the bedside following proactive advice from a nutritional assistant. Our aim is to investigate whether this new concept, FfC, improves dietary intake and patient satisfaction, compared to the traditional 3-meals a day service (TMS). METHODS: We performed a quasi experimental study at medical (Gastroenterology) and surgical (Gynecology, Urology, Orthopedics) wards. Patients were offered TMS (July 2015-May 2016; n = 326) or FfC meal service (after stepwise introduction per ward from January 2016-December 2016; n = 311). Primary outcome was the mean percentage of protein and energy intake relative to requirements, between patients receiving TMS and those receiving FfC, on the first and fourth day of full oral intake. Patient satisfaction comprised rating of the experienced quality of the meals and the meal service by means of a validated questionnaire. RESULTS: Patient characteristics were similar between groups, with the exception that the FfC group contained more oncology patients (p = 0.028). FfC improved mean daily protein intake (in g/day) relative to requirements (1.2 g/kg/day) at day 1 (mean % ±SD: 79 ± 33 vs. 59 ± 28; p < 0.05) and day 4 (73 ± 38 vs. 59 ± 29; p < 0.05). Mean daily energy intake (in kcal/day) relative to requirements improved at day 1 (88 ± 34 vs. 70 ± 30; p < 0.05) and day 4 (84 ± 40 vs. 73 ± 31; p = 0.05). On a scale of 1-10, patient satisfaction remained unchanged, in terms of food quality (7.7 ± 1.5 vs. 7.4 ± 1.4; p = 0.09) and meal service (7.8 ± 1.3 vs. 7.7 ± 1.1; p = 0.29). The FfC group was more satisfied with the appearance and smell of the meals (both p < 0.05). CONCLUSIONS: Implementation of this novel meal service substantially improved protein and energy intake while maintaining, and to some extent, improving patient satisfaction. REGISTRATION NO: NCT03195283.

Normalcy of food intake in patients with head and neck cancer supported by combined dietary counseling and swallowing therapy: A randomized clinical trial.

BACKGROUND: Dysphagia resulting in altered food intake is common among patients with head and neck cancer. This randomized trial investigated the effect of combined individual dietary counseling with individualized swallowing therapy (intervention) compared to individual dietary counseling (control) on normalcy of food intake (NFI). METHODS: Patients with stage II to IV head and neck cancer treated with postoperative (chemo)radiation were randomly assigned to this study. NFI, dysphagia severity, social eating, and nutritional status were measured at the start of treatment and in weeks 6, 10, 18, and 30. RESULTS: One hundred twenty patients, 60 in each group, were recruited. No overall estimated difference was detected for NFI, dysphagia severity, social eating, or nutritional status. At week 10, the intervention group slightly improved dysphagia recovery 0.6 (95% confidence interval [CI] = 0.1-1.1). This difference diminished by week 30. CONCLUSION: Adding individualized swallowing therapy to individual dietary counseling did not improve NFI but slightly accelerate swallowing recovery. © 2015 Wiley Periodicals, Inc. Head Neck 38: E198-E206, 2016.

Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study.

BACKGROUND: The aim of this study was to evaluate nutritional status, food intake, and dysphagia in long-term head and neck cancer survivors. METHODS: Thirty-two patients with stage III-IV head and neck cancer treated by chemoradiotherapy were invited to evaluate nutritional status (malnutrition, relative weight loss), food intake (food modification; quality), and dysphagia. RESULTS: At a median follow up of 44 months, 6 of 32 patients were at risk for malnutrition. Women (p = .049) and patients with high body mass index before treatment (p = .024) showed more weight loss. None of the 32 patients could eat a "full diet." Six patients used nutritional supplements/tube feeding. Low dysphagia-related quality of life scores were significantly correlated to increased food modification (r = 0.405; p = .024). CONCLUSIONS: Nutritional advice in patients with head and neck cancer is still necessary years after chemoradiation and should focus on nutritional status, food modification, and quality, in accord with recommended food groups.

Supportive care in early rehabilitation for advanced-stage radiated head and neck cancer patients.

OBJECTIVE: To investigate the health-related quality of life (HRQoL) and supportive follow-up care needs 1 month posttreatment for patients with advanced-stage (stage III or IV) radiated head and neck cancer (HNC) who were treated with curative intent. STUDY DESIGN: An exploratory, descriptive analysis of HRQoL data obtained from 3 treatment groups: conventional radiotherapy (RT, n = 21), surgery + radiotherapy (SRT, n = 10), and chemoradiation (CRT, n = 21). SETTING: The head and neck oncology center of a university hospital. SUBJECTS AND METHODS: Fifty-two patients completed the EORTC QLQ-C30 and EORTC QLQ H&N35 self-report questionnaires 1 month posttreatment. Descriptive statistics and clinically relevant differences between the groups were analyzed. RESULTS: The HRQoL outcomes between groups differed. Clinically relevant difference was observed in the RT and CRT groups with respect to dry mouth, coughing, feeling ill, use of painkillers, and the use of nutritional supplements. The RT group differed from the other groups with respect to pain and swallowing. The CRT group differed from the other groups regarding role functioning. CONCLUSION: Health-related quality of life differs between RT, SRT, and CRT patients 1 month posttreatment. The RT- and CRT-treated patients reported higher impairment than the patients who were treated with SRT. Nutritional intake and oral function emphasize the importance of providing supportive care to radiated advanced-stage HNC patients throughout the treatment trajectory and the need for continuation during the first few posttreatment months.

Weight loss in head and neck cancer patients little noticed in general practice.

INTRODUCTION: In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors. AIM: We observed patients' weight courses after specialists' care and surveyed nutrition-related documentation by general practitioners (GPs). METHODS: From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n = 24) and medical records from the year before referral (n = 45) and after HNOC care (n = 26). An impaired nutritional status was assigned to weight loss > or = 10% within six months or Body Mass Index (BMI) < 18.5 kg/m2 and 'at risk' to weight loss > or = 5% but < 10% within six months. RESULTS: Three (12%) participants were nutritionally impaired and two (8%) were deemed 'at risk'. Although GPs suspected a (pre-) malignancy in 11 cases (46%), only two (8%) documented weight loss or BMI and four (17%) nutrition-related complaints in their referral letters. Medical records more often contained information on nutrition-related complaints and tube feeding later in the disease course, as opposed to concern over weight loss or BMI. DISCUSSION: Therefore, we call for nutritional management in general practice, by urging practitioners to assess patients' nutritional status throughout the disease course and intervene if necessary. The passing on of related information in case of referral promotes continuity of care.

Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy.

Clinical research shows that nutritional intervention is necessary to prevent malnutrition in head and neck cancer patients undergoing radiotherapy. The objective of the present study was to assess the value of individually adjusted counselling by a dietitian compared to standard nutritional care (SC). A prospective study, conducted between 2005 and 2007, compared individual dietary counselling (IDC, optimal energy and protein requirement) to SC by an oncology nurse (standard nutritional counselling). Endpoints were weight loss, BMI and malnutrition (5% weight loss/month) before, during and after the treatment. Thirty-eight patients were included evenly distributed over two groups. A significant decrease in weight loss was found 2 months after the treatment (P = 0.03) for IDC compared with SC. Malnutrition in patients with IDC decreased over time, while malnutrition increased in patients with SC (P = 0.02). Therefore, early and intensive individualised dietary counselling by a dietitian produces clinically relevant effects in terms of decreasing weight loss and malnutrition compared with SC in patients with head and neck cancer undergoing radiotherapy.

Improving nutritional management within high-risk groups.

The current pitfalls and future possibilities of nutritional management are discussed by two patients with tongue cancer who have suffered from substantial weight loss. Their nutritional problems are illustrative of those among other (cancer) patient groups. The main concerns are the lack of early case finding and dietary treatment, and insufficient nutritional information transfer through referral letters. The GP as a central and longitudinal caretaker faces challenges in improving nutritional management.

A prospective study on malnutrition and quality of life in patients with head and neck cancer.

The objective of this observational prospective study in patients with squamous cell carcinoma (SCC) of the oral, oropharyngeal and hypopharyngeal cavity was to look into the relation between malnutrition (>or=10% unintended weight loss within 6 months) and specific quality of life (QoL) parameters longitudinally. Bodyweight and QoL were monitored in 47 patients with SCC at diagnosis, end of treatment and six months after treatment. EORTC QoLQ-C30 and H&N 35 questionnaires were used to assess QoL. Significantly lower scores on the global QoL during treatment (p=0.01) and revalidation (p=0.02) were found for patients who had lost >or=10% compared to patients with <10% loss of weight within 6 month. Patients with radiotherapy and a treatment modality of radiotherapy with surgery or chemotherapy kept their unintended weight loss until the end of treatment. Patients with head and neck cancer treated with radiotherapy are specifically susceptible to malnutrition during treatment with no improvement in body weight or QoL. Professional preventive nutritional support is therefore already required on diagnoses.