Nutritional challenges in head and neck cancer.

In head and neck cancer patients malnutrition impacts on quality of life, complications of therapy and also prognosis, in part via altered immunity. Dysphagia assessment is extremely valuable but more work is needed to optimize the rehabilitation of the incompetent swallow in this particular patient group. Proper nutritional assessment is mandatory pre-/peri-/post-treatment. The range and palatability of nutritional supplements has greatly increased over the past few years. Many of the early problems of percutaneous gastrostomy feeding have been addressed but complication rates still remain high. As accelerated radiotherapy and chemoradiation techniques become more widely advocated, nutrition is likely to become increasingly important. The authorship includes two otolaryngologists, a nutritionist and a speech and language therapist with an interest in head and neck dysphagia, thereby aiming to provide a broad perspective of these issues. However, there appears to be a lack of prospective evaluation of many aspects of dysphagia/nutrition in head and neck cancer, which needs to be addressed.

Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group.

AIMS: The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity. METHODS: We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lost > or = 10% of their body weight, had a Body Mass Index <20, or had a Body Mass Index <20 with one anthropometric measurement <15th centile were considered malnourished. RESULTS: Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished. CONCLUSIONS: One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity.

Four methods to recruit renal functional reserve.

The acute changes in creatinine clearance (Ccr) in response to intravenous amino acid infusion and to oral meat and milk protein meals were studied in seven healthy control subjects (Acute study). Para-aminohippurate clearance (CPAH), Ccr, inulin clearance (Cin), and plasma renin activity (PRA) were measured in seven different healthy control subjects following 1 week of low-protein diet, 0.7 g/kg per day, and again after one week of high-protein diet, 2.0 g/kg per day (Chronic study). In the acute study Ccr increased to a similar extent with each of the three stimuli, 20.1 +/- 6.2% (SD), 12.6 +/- 6.2% (SD) and 19 +/- 6.2% (SD) with amino acid infusion, 80-g meat protein and 80-g milk protein meals respectively. In the chronic study Ccr was 21%, Cin 26%, CPAH 8%, and filtration factor (FF) 14% greater during the high-protein diet than the low-protein diet, while PRA was increased by 43% on the high-protein diet. We conclude that an 80-g protein oral meal is probably sufficient to elicit the maximum acute increase in Ccr, since all three acute responses were similar, and similar in degree, to those previously reported, and may therefore be of value in measuring maximal filtration capacity. In contrast to one previous report, meat and milk proteins induced similar changes in Ccr. Thus milk protein cannot be regarded as a dietary substitute for meat in any diet designed to reduce glomerular hyperfiltration. Renin may play a part in the increase in glomerular filtration rate through the action of angiotensin II on the efferent arteriole, increasing filtration fraction.