Ohmae Nao, Yasui-Yamada Sonoko, Furumoto Taiki, Wada Kyoko, Hayashi Haruka, Kitao Midori, Yamanaka Ayaka, Kubo Miyu, Matsuoka Momoyo, Kamimura Seiichiro, Shimada Aki, Sato Nori, Kitamura Yoshiaki, Katoh Shinsuke, Takeda Noriaki, Hamada Yasuhiro
Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan.
Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan.
Clin Nutr ESPEN. 2023 Feb;53:113-119. doi: 10.1016/j.clnesp.2022.12.006. Epub 2022 Dec 9.
BACKGROUND & AIMS: Cancer cachexia is commonly associated with poor prognosis in patients with head and neck cancer (HNC). However, its pathophysiology and treatment are not well established. The current study aimed to assess the muscle mass/quality/strength, physical function and activity, resting energy expenditure (REE), and respiratory quotient (RQ) in cachectic patients with HNC.
This prospective cross-sectional study analyzed 64 patients with HNC. Body composition was measured via direct segmental multifrequency bioelectrical impedance analysis, and muscle quality was assessed using echo intensity on ultrasonography images. Muscle strength was investigated utilizing handgrip strength and isometric knee extension force (IKEF). Physical function was evaluated using the 10-m walking speed test and the five times sit-to-stand (5-STS) test. Physical activity was examined using a wearable triaxial accelerometer. REE and RQ were measured via indirect calorimetry. These parameters were compared between the cachectic and noncachectic groups.
In total, 23 (36%) patients were diagnosed with cachexia. The cachectic group had a significantly lower muscle mass than the noncachectic group. Nevertheless, there was no significant difference in terms of fat between the two groups. The cachectic group had a higher quadriceps echo intensity and a lower handgrip strength and IKEF than the noncachectic group. Moreover, they had a significantly slower normal and maximum walking speed and 5-STS speed. The number of steps, total activity time, and time of activity (<3 Mets) did not significantly differ between the two groups. The cachectic group had a shorter time of activity (≥3 Mets) than the noncachectic group. Furthermore, the cachectic group had a significantly higher REE/body weight and REE/fat free mass and a significantly lower RQ than the noncachectic group.
The cachectic group had a lower muscle mass/quality/strength and physical function and activity and a higher REE than the noncachectic group. Thus, REE and physical activity should be evaluated to determine energy requirements. The RQ was lower in the cachectic group than that in the noncachectic group, indicating changes in energy substrate. Further studies must be conducted to examine effective nutritional and exercise interventions for patients with cancer cachexia.
癌症恶病质通常与头颈癌（HNC）患者的不良预后相关。然而，其病理生理学和治疗方法尚未完全明确。本研究旨在评估HNC恶病质患者的肌肉质量/质量/力量、身体功能和活动能力、静息能量消耗（REE）以及呼吸商（RQ）。
这项前瞻性横断面研究分析了64例HNC患者。通过直接节段多频生物电阻抗分析测量身体成分，并使用超声图像上的回声强度评估肌肉质量。利用握力和等长膝关节伸展力（IKEF）研究肌肉力量。使用10米步行速度测试和五次坐立试验（5-STS）评估身体功能。使用可穿戴三轴加速度计检查身体活动。通过间接测热法测量REE和RQ。比较恶病质组和非恶病质组之间的这些参数。
共有23例（36%）患者被诊断为恶病质。恶病质组的肌肉质量明显低于非恶病质组。然而，两组之间的脂肪量没有显著差异。恶病质组的股四头肌回声强度高于非恶病质组，握力和IKEF低于非恶病质组。此外，他们的正常和最大步行速度以及5-STS速度明显较慢。两组之间的步数、总活动时间和活动时间（<3梅脱）没有显著差异。恶病质组的活动时间（≥3梅脱）比非恶病质组短。此外，恶病质组的REE/体重和REE/去脂体重明显高于非恶病质组，RQ明显低于非恶病质组。
恶病质组的肌肉质量/质量/力量、身体功能和活动能力低于非恶病质组，REE高于非恶病质组。因此，应评估REE和身体活动以确定能量需求。恶病质组的RQ低于非恶病质组，表明能量底物发生了变化。必须进行进一步研究，以检查针对癌症恶病质患者的有效营养和运动干预措施。
