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Introduction

Malnutrition is a dietary deficiency that results from various environmental and medical conditions, such as mental health problems, social problems, GI disorders, and alcoholism among others. This is defined as weight loss greater than 5% to 10% of ideal body weight, with preferential loss of adipose tissue over muscle. The resting energy expenditure is reduced. Improved caloric intake of nutritious food or nutritional supplements will often reverse malnutrition and starvation. Malnutrition can occur in specific scenarios; however, cachexia is a pathology commonly observed in patients with head and neck cancer. Cachexia is a multifactorial metabolic syndrome characterized by systemic sarcopenia, with or without loss of fat mass that accompanies a chronic disease (usually malignant), whereas malnutrition is a lack of adequate nourishment. While all cachectic patients suffer from malnutrition, cachexia is not always present in malnourished patients. Loss of adipose tissue in cachexia is a result of increased lipolysis by tumor or host products. Sarcopenia is mainly due to diminished synthesis of muscle protein and increased degradation of proteins; these amino acids are shunted into acute phase response proteins in the liver resulting in liver hypertrophy.

At presentation, up to 50% of patients with head and neck cancer are already malnourished and it can be as high as 80% during radiotherapy or concurrent chemoradiation.1,2

  • It appears to be associated with disease-mediated metabolic disorders, inflammatory responses (interleukin [IL]-1α, IL-1β, IL-6, and tumor necrosis factor [TNF]), and insulin resistance.3,4

  • Patients may experience either early satiety or food aversion.

  • In addition, there could be other physical factors contributing to patients losing appetite in cachexia. They are as follows:

    • Mechanical obstruction

    • Dysphagia or odynophagia

    • Anorexia, fatigue, mouth ulcers, nausea, and gastrointestinal disturbance.

Cachexia is diagnosed as weight loss of more than 5% over past 6 months or a body mass index (BMI) of less than 20 kg/m2. Although no single marker can comprehensively measure the nutritional status, albumin, pre-albumin, and transferrin to assess nutritional status.

The importance of diagnosing and treating both malnutrition and cancer cachexia is evident in the increased perioperative morbidity when untreated. Poor wound healing, increased rates of sepsis, and increased rates of wound infections are seen with malnutrition. Increased complications from surgery, radiation, and chemotherapy are seen in patients with cancer cachexia. There is mounting evidence that cancer cachexia profoundly affects cardiac structure and function, causing significant impairment in patients who previously had no history of cardiac dysfunction. The implications of this for patients undergoing major surgical ablation may be profound, especially in the perioperative period. During therapy, weight loss is an independent poor prognostic sign. Morbidly obese patients can still be profoundly malnourished and weight loss during treatment is not necessarily healthy for them. This form of sarcopenic obesity may be difficult to diagnose and treat.

Nutritional assessment and counseling by a certified nutritionist is a critical part ...

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