Department of Otorhinolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Sweden.
Laryngoscope. 2013 Oct;123(10):2428-34. doi: 10.1002/lary.23877. Epub 2013 Aug 5.
OBJECTIVES/HYPOTHESIS: Malnutrition is common among head and neck cancer patients and negatively impacts on survival and quality of life. This study aimed to identify predictors of malnutrition at time of diagnosis in order to identify patients at risk and enable early nutritional support and prevent malnutrition.
A total of 134 patients with advanced oral and pharyngeal cancer were included in the study. Weight, body mass index (BMI), fat free mass (FFM), dysphagia, and quality of life were measured at diagnosis and after 6 months. Two definitions for malnutrition were applied: >10% weight loss and BMI <20 after 6 months.
Six months after diagnosis, 66% of the patients were malnourished as per the >10% weight loss definition, and 26% of the patients were malnourished as per the BMI < 20 weight loss definition. In multivariate analysis, low BMI followed by low FFM and dysphagia were the strongest predictors for malnutrition using BMI <20. Chemotherapy and high BMI at diagnosis were the strongest predictors of malnutrition using the 10% weight loss definition. For patients treated with chemotherapy, the risk for malnutrition was very high both for patients with normal BMI (67%) and for patients with BMI 30 (89%).
Unintended weight loss more than 10% seems to be the most reasonable definition of malnutrition for identifying predictors of this in head and neck cancer patients. The weight loss correlated significantly to a loss of FFM. Treatment with chemotherapy was a strong predictor, as was a high BMI at time of diagnosis. This is an important finding since overweight patients might not be considered at high risk for developing malnutrition, and consequently nutritional support for them might be delayed.
目的/假设：营养不良在头颈部癌症患者中很常见，会对生存和生活质量产生负面影响。本研究旨在确定诊断时营养不良的预测因素，以便识别高危患者，从而尽早提供营养支持，预防营养不良。
共纳入 134 例晚期口腔和咽癌患者。在诊断时和 6 个月后测量体重、体重指数（BMI）、去脂体重（FFM）、吞咽困难和生活质量。采用两种营养不良定义：6 个月后体重下降>10%和 BMI<20。
诊断后 6 个月，66%的患者根据体重下降>10%的定义存在营养不良，26%的患者根据 BMI<20 的定义存在营养不良。多变量分析显示，低 BMI 其次是低 FFM 和吞咽困难是 BMI<20 营养不良的最强预测因素。诊断时接受化疗和高 BMI 是体重下降 10%定义下营养不良的最强预测因素。对于接受化疗的患者，BMI 正常（67%）和 BMI 30（89%）的患者营养不良风险非常高。
体重下降>10%似乎是头颈部癌症患者识别营养不良预测因素的最合理定义。体重下降与 FFM 丢失显著相关。化疗是一个强有力的预测因素，诊断时的高 BMI 也是如此。这是一个重要的发现，因为超重患者可能不会被认为存在发展为营养不良的高风险，因此可能会延迟对他们的营养支持。
