Assessment of Nutritional Status, Digestion and Absorption, and Quality of Life in Patients with Locally Advanced Pancreatic Cancer

Background and Aim. To provide a comprehensive quantitative assessment of nutritional status, digestion and absorption, and quality of life (QoL) in patients with locally advanced pancreatic cancer (LAPC). Methods. Sixteen patients with LAPC were prospectively assessed for weight loss (WL), body mass index (BMI), fat-free mass index (FFMI), handgrip strength (HGS), dietary macronutrient intake, serum vitamin levels, resting and total energy expenditure (REE and TEE, indirect calorimetry), intestinal absorption capacity and fecal losses (bomb calorimetry), exocrine pancreatic function (fecal elastase-1 (FE1)), and gastrointestinal quality of life (GIQLI). Results. Two patients had a low BMI, 10 patients had WL > 10%/6 months, 8 patients had a FFMI < P10, and 8 patients had a HGS < P10. Measured REE was 33% higher (P=0.002) than predicted REE. TEE was significantly higher than daily energy intake (P=0.047). Malabsorption (<85%) of energy, fat, protein, and carbohydrates was observed in, respectively, 9, 8, 12, and 10 patients. FE1 levels were low (<200 μg/g) in 13 patients. Total QoL scored 71% (ample satisfactory). Conclusion. Patients with LAPC have a severely impaired nutritional status, most likely as a result of an increased REE and malabsorption due to exocrine pancreatic insufficiency. The trial is registered with PANFIRE clinicaltrials.gov NCT01939665

The Prediction of Deterioration of Nutritional Status during Chemoradiation Therapy in Patients with Esophageal Cancer

Patients with esophageal cancer are at high risk of developing malnutrition during neoadjuvant chemoradiation therapy (CRT), which in turn is associated with postoperative morbidity. The aim of the study is to explore whether parameters of a complete pre-treatment nutritional status may predict deterioration of nutritional status during CRT in patients with esophageal cancer. In this prospective cohort study, 101 patients with esophageal cancer treated with CRT were included. Data of patient characteristics, tumor classification, performance score, %weight change, body mass index, fat (free) mass index, phase angle, handgrip strength, energy- and protein intake, and use of (additional) dietary supplements were collected. A prediction model was constructed to identify predictive parameters for deterioration in nutritional status (defined as weight loss of >5% and/or decline in fat free mass of ≥1.4 kg) during CRT. Nutritional status deteriorated in 49 patients (49%) during CRT. The only predictor for deterioration in nutritional status was fat free mass index (OR 1.21 (90% CI: 1.03–1.42)). Patients with a higher fat free mass index are at increased risk of deterioration in nutrition status during CRT. Results suggest that all patients should be carefully supervised during CRT, regardless of their nutritional status before start of CRT

The prediction of preoperative decline in nutritional status during chemo-radiation therapy in patients with esophageal cancer

Rationale: Patients with esophageal cancer are at high risk for developing malnutrition during neo-adjuvant chemo-radiation therapy (NA-CRTh), which in turn is associated with postoperative morbidity. The aim of this study was to identify which pre-treatment parameters were predictive for a decline in nutritional status during NA-CRTh. Methods: In this prospective study, 87 patients with esophageal cancer treated with NA-CRTh were included. Age, gender, % weight change, body mass index (kg/m2), fat (free) mass index (kg/m2), phase angle (°), handgrip strength (kg), energy (%EI)- and protein intake (%PI) as % of requirements, tumor classification and performance score were measured. A prediction model was constructed to analyze which of these parameters predicted a decline in nutritional status (defined as weight loss of >5% and/or decline in fat free mass of ≥1,4 kg) during NA-CRTh. Results: Nutritional status declined in 36% of the patients during NA-CRTh. Main predictors were a higher phase angle (OR 1.76 (95% CI 1.05-2.94)) and a lower %PI (OR 0.97 (95% CI 0.94- 0.99)). The prediction formula was defined as: -1.486 + 0.566∗PA-0.035∗%PI. This indicates for example a 55% chance to decline in nutritional status during NA-CRTh in a patient with a phase angle of 6 and %PI of 50%. Quality of the prediction model was tested by the Hosmer and Lemeshow test (p = 0.97). The ROC-AUC was 0.70 (95% CI 0.58-0.81). Conclusion: Results of this study suggest that patients in a good nutritional status (i.e. higher phase angle) but with a poor nutritional intake (i.e. lower %PI) are at highest risk to decline in nutritional status during NA-CRTh. This give opportunities for targeted dietetic care in patients with esophageal cancer who receive NA-CRTh