We investigated whether age at menopause is associated with subsequent mortality from colorectal cancer along with the possible modification of this association by body mass index. Our data are from the Diagnostisch Onderzoek Mammacarcinoom cohort of 10,671 postmenopausal women in the Netherlands, enrolled between 1974 and 1977, with a median follow-up of 18 years. During this follow-up, 95 women died of colorectal cancer. Women 49 years of age or older at menopause showed a lower risk of colorectal cancer mortality compared with women younger than 49 at menopause. This protective effect, however, was found only among nonoverweight women (< or =24 kg/m2), for whom the hazard ratio was 0.46 (95% confidence interval = 0.21-1.03). In larger women, the hazard ratio was 1.17 (95% confidence interval = 0.68-2.00).

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 =10% within six months or Body Mass Index (BMI) <18.5 kg/m2 and ‘at risk’ to weight loss =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. KEYWORDS: Humans; follow-up studies; weight loss; cachexia; family practice; head and neck neoplasms

Obese patients present more common illnesses to their GP, such as common cold (without fever), myalgia of the upper girdle, dermatophytosis and bruise (contusion, haematoma). This is in addition to their higher co-morbidity of chronic medical conditions.

Objective: Nutritional deficiency is an independent risk factor for mortality. Despite its clinical relevance, the prevalence in a primary care setting is poorly documented. We performed a systematic review of reported prevalence and clinical assessment of nutritional deficiency in general practice. Methods: From MEDLINE, Current Contents and EMBASE, we derived articles and checked the initially included ones for references on prevalence data. Of the eligible articles, we assessed the quality of research and results. Results: We finally included eight studies. The prevalence ranged from 0 to 13%. However, the study populations were heterogeneous and all studies contained methodological flaws, especially selection bias. In addition, the clinical assessment differed between studies. Conclusion: Literature on the prevalence of nutritional deficiency within general practice is rare and provides disputable prevalence assessments.

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Objective: To explore incidence and prevalence rates of nutritional deficiency in adults in general practice.

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.

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