The role of physical activity and nutritional intake on nutritional status in patients with head and neck cancer

Malnutrition is a frequent problem in patients with head and neck cancer. Prevention or timely treatment of malnutrition is of great importance because deteriorated nutritional status can have a negative effect on clinical outcome in head and neck cancer patients. Malnutrition is a multidimensional problem, in which a nutritional disbalance causes loss of weight and muscle mass, either or not accompanied by inflammatory activity, resulting in functional decline. Thus far, little is known about the role of physical activity in both the development and treatment of malnutrition in cancer patients. Although positive effects of exercise on fatigue and quality of life have been reported, the relationship between physical activity and prevention and treatment of malnutrition needs to be further elucidated. In this presentation, current insights and hypotheses on the relationship between physical activity and nutritional status in patients with cancer will be discussed

Assessment of malnutrition in patients with head and neck cancer: a multidimensional approach

Patients with head and neck cancer often have problems with food intake that can result in a disturbed nutritional balance and malnutrition. The disease itself, the localization of the tumor, and the side effects of the treatment, that is often aggressive, may result in not fulfilling nutritional needs. Malnutrition in its turn can delay recovery and negatively influence treatment tolerance. In this thesis the general aim was threefold. Firstly, to describe diagnostic value of malnutrition assessment methods. Secondly, to adapt an instrument to assess nutritional status for Dutch practice. Finally, to explore psychological mechanisms that may influence physical activity behavior in patients with head and neck cancer. This study has led to the conclusion that it is still a challenge to find the most suitable and effective method to treat malnutrition in patients with head and neck cancer. However, the Patient-Generated Subjective Global Assessment is now available and appears to be a suitable and available instrument for screening and assessment of malnutrition (risk) and provides information for tailored interventions. Patients with head and neck cancer may not always be interested in increasing their level of physical activity, because they may overestimate their actual level of physical activity. Since malnutrition is a highly complicated problem, a multidimensional approach is needed, with attention for nutritional balance, body composition and function, possible influence of inflammatory factors, and a sufficient level of physical activity

Association between lean body mass and muscle thickness with frailty in community dwelling dutch older adults

Rationale: Lean body mass, including muscle, is known to decrease with age, which may contribute to loss of physical function, an indicator of frailty. Moreover, low muscle thickness is considered an indicator of frailty in critically ill patients. However, little is known about the relationship between muscle thickness and frailty in community dwelling adults. Therefore, we studied the association between frailty and whole body lean body mass index (LBMi) and muscle thickness of the rectus femoris (RF) in community dwelling older adults. Methods: In older adults aged ≥55y, who participated in the Hanze Health and Ageing Study, frailty status was assessed with a multidimensional instrument, measuring frailty on a cognitive, psychosocial en physical level, i.e., the Groningen Frailty Indicator (GFI), using ≥4 as cut-off score for frailty. LBMi (kg/m2) was estimated with BIA (Quadscan 4000©, Bodystat), using the build-in equation. Muscle thickness (mm) of the RF was measured with ultrasound, using the Bodymetrix© (Intelametrix). Univariate and multivariate binary logistic regression analyses were performed for LBMi and for RF thickness. Multivariate analysis corrected for age, sex, body mass index (kg/m2), and handgrip strength (handgrip dynamometer; kg). A p-level of <0.05 was considered significant and Odds Ratios (OR; [95% CI]) were presented. Results: 93 participants (age 65.2±7.7 years; male 46 %; LBMi 17.2±2.6 kg/m2; RF 14.6±4.4 mm; median GFI =1 (interquartile range=0-3; frail: n=18) were included in the analysis. In both the univariate and multivariate analysis, LBMi (p=0.082, OR=0.82 [0.66-1.03]; p=0.077, OR=0.55 [0.28-1.07] respectively) and muscle thickness of RF (p=0.436, OR=0.95 [0.84-1.08]; p=0.796, OR= 1.02 [0.88-1.18] respectively) were not significantly associated with frailty. None of the co-variables were significantly associated with frailty either. Conclusion: In this sample of older adults aged ≥55 years, LBMi and RF thickness are not associated with frailty. However, frail participants scored at cut-off or just above, and measurements in a population with higher scores for frailty may provide further insight in the association between lean body mass and muscle thickness and frailty