Poor Vitamin Status is Associated with Skeletal Muscle Loss and Mucositis in Head and Neck Cancer Patients

Abstract

Mucositis and muscle wasting are two common toxicity effects of cancer treatment in head and neck cancer (HNC). There is limited data evaluating cancer treatment toxicities in relation to vitamin status. This study aimed to assess changes in vitamin status during HNC treatment in relation to body composition, inflammation and mucositis. In this prospective cohort study, dietary intakes (3-day food record), plasma levels of vitamins and C-reactive protein (CRP) were assessed at baseline (at diagnosis) and post-treatment (after 6–8 weeks of radiation therapy with or without chemotherapy). Computed tomography images were used to quantify body composition. Mucositis information was collected from health records of patients. Twenty-eight HNC patients (age 60 ± 10 years) completed both study time points. Patients who developed mucositis had significantly lower dietary intake of vitamins and plasma 25-hydroxy vitamin D (25-OHD) and all-trans retinol levels (p < 0.02). Patients lost a considerable amount of muscle mass (3.4 kg) and fat mass (3.6 kg) over the course of treatment. There was a trend toward greater muscle loss in patients with 25-OHD < 50 nmol/L compared to patients with 25-OHD ≥ 50 nmol/L (p = 0.07). A significant negative correlation was found between plasma all-trans retinol and CRP level at the end of treatment (p = 0.03). Poor vitamin status could be a contributing factor in developing treatment-induced toxicities.

Body Composition Evaluation in Head and Neck Cancer Patients: A Review

“…A total of 41 studies were included in this review, with different methodologies: one systematic review (16), one consensus paper (17), one data descriptor (18), nine randomized trials (6, 11, 19–25), 12 cohort studies (3, 7–9, 15, 26–32), three randomized controlled trials (4, 5, 33), three cross-sectional studies (34–36), two prospective non-randomized trials (37, 38), eight retrospective studies (10, 12–14, 39–42), and one case-control study (43).…”

Oral Nutritional Supplementation Affects the Dietary Intake and Body Weight of Head and Neck Cancer Patients during (Chemo) Radiotherapy

“…In addition, magnesium participates in energy metabolism, protein synthesis, and plays an important physiological role in organs such as the brain and heart [43]. In relation to low micronutrient intake, there is a high prevalence of vitamin D deficiency among HNC patients [44]. This deficiency has been linked to an increased risk of postoperative hypocalcemia in patients undergoing total thyroidectomy [45].…”

“…This deficiency has been linked to an increased risk of postoperative hypocalcemia in patients undergoing total thyroidectomy [45]. Low levels of calcium, vitamin E, and folate intake were also found in patients with HNC [10,44]. So, while adequate levels of some micronutrients can be obtained from a healthy diet, inadequate dietary intake of others can lead to negative health consequences.…”

Therapeutic effects of Vitamin D and IL-22 on methotrexate-induced mucositis in mice

“…These results are consistent with previous findings that Vit D deficiency is associated with more severe mucositis both in adults and pediatrics. 9,21 Nejatinamini et al reported that lower intake of vitamins and plasma 25-hydroxy Vit D (25-OHD) was associated with mucositis in head and neck cancers treatments. 21 The patients included both radiation and chemotherapy or combined therapy groups (22% radiotherapy, 71% chemotherapy, 7% both).…”

“…9,21 Nejatinamini et al reported that lower intake of vitamins and plasma 25-hydroxy Vit D (25-OHD) was associated with mucositis in head and neck cancers treatments. 21 The patients included both radiation and chemotherapy or combined therapy groups (22% radiotherapy, 71% chemotherapy, 7% both). Similar observations were made in acute lymphoblastic leukemia in children.…”