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 (P¼ 0·03) for IDC compared with SC. Malnutrition in patients with IDC decreased over time, while malnutrition increased in patients with SC (P¼ 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.
Differential sensitivity, intensity perception, and pleasantness of sucrose-sweetness was determined with two groups of women, 13 overweight and 12 normal weight. Discriminability, psychophysical, psychohedonic, and preference functions were determined for both groups. In addition, maximally preferred sweetness intensities and the corresponding maximally preferred sucrose concentrations were calculated. The data showed that the two groups did not differ in any of these functions or measures. Individual variability in affective response behavior was larger within the overweight than within the normal weight group.
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.
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
Besides characteristic neurologic and musculoskeletal symptoms, children with mitochondrial dysfunction often present with feeding problems and failure to thrive. Substrate depletion for the respiratory chain has an effect on energy expenditure. Secondary mitochondrial dysfunction has been reported in severe chronic malnutrition. We evaluated the nutritional state, the growth parameters, and the metabolic condition in 172 children undergoing muscle biopsy for a suspected disorder of the oxidative phosphorylation system (OXPHOS). We performed dietary evaluation and initiated nutritional intervention when needed before the biopsy. Mitochondrial dysfunction was confirmed by detection of enzyme-complex deficiencies and/or by mutations in 83 children, in 14 patients no biochemical abnormalities were found. In the whole study group, and in the subgroup with enzyme-complex deficiency and/or mutation, a significant correlation was found between the mitochondrial production of adenosine triphosphate (ATP) and the age-related body mass index (BMI). Nutritional state and growth should be considered by interpreting the results of ATP-production in fresh muscle biopsy. Because of a positive correlation between the age-appropriate BMI and the ATP-production, we strongly advise optimizing the nutritional state preceding the muscle biopsy in children with a suspected OXPHOS-disorder. Dietary intervention remains although challenging because of frequent gastrointestinal problems and eating disorders. (Pediatr Res 65: 103-108, 2009) I s decreased mitochondrial energy production a consequence of severe respiratory chain dysfunction itself, or is it influenced by the actual nutritional state of the child with a severe chronic disease? This question appears frequently in the clinical practice, especially by the interpretation of the results of respiratory chain enzyme measurements in muscle. Secondary deterioration of mitochondrial function has been reported in patients with different chronic disorders, anorexia, and cancerrelated malnutrition (1-4). Therefore, one should consider that some children with severe malnutrition have only a secondary mitochondrial disease because of chronic substrate depletion (5,6). Chronic vitamin deficiency affects the mitochondrial function as well (7-9). Previously, we measured an increased mitochondrial production of adenosine triphosphate (ATP) in a few children with a second biopsy after the improvement of the nutritional condition (5). Secondary mitochondrial dysfunction was also found in several patients with variable inborn errors and insufficient nutrition (6,10). We assume that nutritional intervention with an individualized diet and optimal dietary intake in children with a mitochondrial disease improves the energy generating capacity, the clinical condition, and the quality of life in patients.We hypothesized a significant correlation between the growth and nutritional state and the energy production in children with both primary and secondary dysfunction of the oxidative phospho...
Enteral tube feeding remains an indispensible strategy to treat disease-related malnutrition. In the present study we evaluated in clinical practice whether prescribed feeding volumes correspond with administered quantities and we highlight possible causes for discrepancies. During a 4-month observation period data from all patients fully depending on tube feeding (1.5-2.5 litres/d) were collected in a Dutch 900-bed academic hospital. The range for administered feeds to be adequate was set at 100 +/- 10% of the prescribed dose. Fifty-five patients (mean age 57 (SD 30) years) were included. Tube feeding was given continuously via pump (n 37) or drip (n 3), in portions (n 14) or by combined modes (n 1). Administered tube feeding amounts were significantly lower than prescribed in 40% of all patients (P < or = 0.001). The mean ratio of administered v. prescribed energy was 87 (SD 21) % (all modes), 85 (SD 24) % (pump), 94 (SD 12) % (portions) and 88.3 (SD 18.1) % (drip), respectively. The mean energy deficit amounted to 1089 kJ/d (range -7955 to +795). Only on intensive care unit wards did feeding administration meet the set goal. Feeding interruptions because of diagnostic or therapeutic procedures were the main reason for decreased intakes. Our findings show that many patients relying on tube feeding do not meet their nutritional goals during hospital stay. This problem can be addressed by adapting feeding schedules and the use of formulations with a higher energy density.
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