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TAILORED NUTRITIONAL SUPPORT AS A PREDICTIVE FACTOR FOR SURVIVAL IN HEAD AND NECK CANCER PATIENTS UNDERGOING TREATMENTS
SINPE conference abstracts / Nutrition 65 (2019) 110580
evaluated the rate of weight loss (WL) compared to self-reported usual weight (UW) and at 6 and 1 months before the visit, performed by an expert physician and a certified dietitian. We explored the association of WL10% with inflammation biomarkers, total protein, albumin, diagnosis and nutritional intervention through chi-squared or Kruskal-Wallis test, as statistically appropriate (Tab.2). Patients’ characteristics were summarized through descriptive analysis (Tab.1). Noteworthy 48% of CP was 65 years old, 20% had BMI<18.49; 21% had BMI25, 51% of them had a WL10%. About 63%, 44% and 13% of patients had a WL10% from UW, at 6 months and at 1 month, respectively. Moreover, 57% received oral supplementation after nutritional counseling. Conversely, 31% received artificial nutrition. Interestingly, WL10% from UW was associated with neutrophils-to-lymphocytes ratio (P=0.049) (Fig.1), cholesterol level (P=0.016) (Fig.2) and cancer type both from UW (P=0.003) (Fig.3) and at 6 months (P=0.007) before evaluation. A trend was observed with artificial nutrition (P=0.067). Prevention and treatment of cachexia still remain a critical need in CP. Therefore, integrating nutritional supportive care to oncologic treatments is crucial.
3
Fig. 2. Association of Total Cholesterol and %WL from UW.
Table 1 Patients' characteristics.
Fig. 3. Association of Diagnosis and %WL from UW.
Table 2 Association with %WL UW.
TAILORED NUTRITIONAL SUPPORT AS A PREDICTIVE FACTOR FOR SURVIVAL IN HEAD AND NECK CANCER PATIENTS UNDERGOING TREATMENTS I. Trestini *,1, L. Carbognin 2,3, I. Sperduti 4, C. Bonaiuto 1, L. Tondulli 1, S. Pilotto 1, G. Tortora 5, M. Milella 1, E. Bria 5 1 Department of Oncology, University of Verona Hospital, Verona, Italy 2 University of Verona, Verona, Italy 3 Division of Gynecologic Oncology, Department of Woman and Child Cattolica del Sacro Cuore, Fondazione Policlinico Health, Universita Universitario A. Gemelli IRCCS, Roma, Italy 4 Biostatistics, Regina Elena National Cancer Institute, Roma, Italy 5 Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Cattolica del Sacro Cuore, Roma, Italy IRCCS, Universita
Fig. 1. Association of NLR with %WL from UW.
The purpose of the present study was to explore the prognostic relevance of tailored nutritional intervention in patients affected by head and neck (HNC) undergoing chemotherapy and/or radiotherapy. We retrospectively analysed data from patients affected by HNC (stage II-IV), diagnosed between April 2010 and August 2016 at the AOUI of Verona and undergoing chemotherapy and/or radiotherapy. Descriptive statistics was adopted. Clinical, pathological and nutritional data were correlated with Overall Survival (OS) using a Cox model. Overall data from 87 patients were gathered. Forty-one patients (47.1%) received an individualized nutritional intervention, including tailored nutritional counselling by a skilled dietitian, in addition to oral nutritional supplements, addressing the patients’ needs, and 46 patients (52.9%) did not receive that, without significant differences for baseline clinical and pathological characteristics. At the multivariate analysis, the independent significant predictors of OS were the response or stable disease after the first line treatment (HR 4.62,p<0.0001), the Performance Status (ECOG)<1 (HR 2.06, p=0.037), the nutritional intervention (HR 3.72, p<0.0001), and the BMI 25 at baseline (HR 2.85, p=0.006). Particularly, the 3-year OS
4
SINPE conference abstracts / Nutrition 65 (2019) 110580
was 59.0% in patients receiving the nutritional support and 34.9% in patients who did not receive that (p=0.007). Among patients with unplanned hospital admissions 32 (37 pts [42.5%]), the nutritional support significantly discriminated the OS (61.5% vs. 25.5%, p=0.006). These data support the prognostic relevance of the tailored nutritional management into cancer care of HNC patients undergoing chemotherapy and/or radiotherapy.
RESTING ENERGY EXPENDITURE IN BOYS WITH DUCHENNE MUSCULAR DISTROPHY: WHICH IS THE BEST PREDICTIVE FORMULA? M. Bassano *,1, G. Baranello 2, A. Battezzati 3, S. Bertoli 3, R. De Amicis 3, A. Foppiani 3, A. Leone 2, T. Mami 1, E. Giaquinto 1 1 Cesena, Ospedale Bufalini - AUSL Romagna - sede Cesena, Italy 2 Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy 3 International Center for the Assessment of Nutritional Status, degli studi di Milano, Milano, Italy DeFENS Universita Duchenne muscular dystrophy (DMD) is the most prevalent dystrophy. A range of nutritional status derangements, varying from over nutrition to under nutrition, occurs with disease progression. The estimation of resting energy expenditure (REE) is the first step towards a personalized nutritional intervention, but indirect calorimetry (IC), the reference method, is available only in advanced clinical centers, and prediction formulas (PFs) are used in clinical practice. For this purpose, we compared the existing PFs for REE to identify the most accurate in DMD patients. We performed IC on 26 DMD patients (mean age 10.38§5.06) with an open-circuit ventilated-hood system (Sensor Medics 29, Anaheim, CA, USA). Patients were fasted for at least 6h. Data collection time was at least 20 min, with a 5 min run-in time for stabilization. Than we compared the results of IC with the PFs. Differences between IC vs PFs are shown on Table 1. The most accurate of PFs is Muller et Al. which has a delta <10% for 70% of the sample. Further studies are needed to elaborate a REE formula specifically for DMD patients.
MULTIDISCIPLINARY MANAGEMENT OF A CASE OF INTESTINAL FAILURE DUE TO SHORT BOWEL SYNDROME IN GARDNER SYNDROME O. Colombo *,1, E. Capitanio 1, M. Colledan 3, F. Cortinovis 1, S. Fagiuoli 2, C. Iegri 2, B. Mologni 1, L. Pasulo 2, E. Rodeschini 1 1 UOSD Dietetics and Clinical Nutrition, Papa Giovanni XXIII Hospital, Bergamo, Italy 2 UOC Gastroentherology 1, Papa Giovanni XXIII Hospital, Bergamo, Italy 3 UOC General Surgery 3, Papa Giovanni XXIII Hospital, Bergamo, Italy Objective: There still is little attention about both nutritional/metabolic consequences and multi-organ involvement after intestinal surgery. Our multidisciplinary team aimed to an integrated approach to short bowel syndrome (SBS). Research Methods & Procedures: A 37-years-old man affected by Gardner Syndrome, who previously underwent colectomy and several small bowel resections elsewhere without receiving appropriate nutritional prescriptions, was admitted into our hospital to be evaluated for intestinal transplant: biochemistry showed acute renal failure and multiple critical dysionias and the patient referred habitual copious liquid output, also containing undigested food, from ileostomy; he had lost 30 kg (-40% usual body weight, BW) in the last month. He promptly underwent nutritional assessment and, consequently, nutritional treatment: firstly we corrected dysionias and immediately started thiamin supplementation, thereafter we prescribed a personalized semielemental low-fiber diet per os, parceled out on 5-6 meals, and we started a personalized admixture parenteral nutrition support (PN). Regardless of appropriate evidences, the patient finally refused to give his consent to intestinal transplant, he was then discharged in PN and personalized diet per os.
Results: Despite severe dehydration and malnutrition, we early achieved and maintained hydro-electrolytic balance, thus recovering renal enhancement; besides, Refeeding Syndrome was adequately prevented and, beyond rehydration, the patient also started regaining BW. Conclusions: SBS can result in both intestinal and renal failure. It needs a multidisciplinary approach, including early and appropriate nutritional assessment and treatment. When intestinal transplant is not possible, even if recommended, PN remains the main therapeutic strategy.
BODY COMPOSITION AND METABOLIC CHANGES IN VLCKD: AN UPDATE G. Corbelli *,2, L. Valeriani 2, F. Anzolin 2, G. Tommesani 1, M. Fornari 1, M.G. Benassi 1, B. Corradini 1, L. Morisi 1, L. Zoni 2 1 UA DIETETICA AUSL BOLOGNA, Bologna, Italy 2 UO NUTRIZIONE CLINICA AUSL BOLOGNA, Bologna, Italy VLCKD is becoming an elective choice to promote weight loss, especially in the case of severe obesity and its metabolic complications. Some authors have assumed that VLCKD can better pre-serve lean body mass during weight loss, saving from diet-induced sarcopenia. BIA evaluation is a simple method to estimate body compostion. At the Maggiore Hospital in Bologna in 2017-2018 we conducted a dietary intervention with a VLCKD ranging from 700 to 800 kcal-die for 1 month in 52 female patients (mean age 48 years), to estimate the effectiveness on body composition. Biochemical indices exploring metabolic and nutritional condition and BIA evaluation was performed before and after VLCKD Before and after VLCKD the average of weight (108,6 vs 104,6), BMI (41,3 vs 39,6) and FM (50,5 vs 47,7 kg) was significantly different, meanwhile no signficant differences was found in Phase angle (6,5 vs 6,35), Body cell mass (BCM: 31,4 vs 30,5 kg) and Muscle Mass (MM: 38,6 vs 37,6). Significantly different were instead the value of basal insulin (12.9 vs 9.1) and the HOMA index (3,2 vs 2), but no differences was found for basal glycemia (94 vs 89), creatinine (0,7 vs 0,7) and serum electrolytes. Our study showed that a VLCKD was highly effective in terms of body weight reduction without to induce body cell mass loss, preventing the risk of sarcopenia. It was also able to reduce the basal insulin level without modify glycemia level and not to change kydney function and electrolytes level
WEIGHT LOSS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE MULTIDISCIPLINARY APPROACH OF MAGGIORE DELLA CARITA’ AOU, NOVARA E. Cava *, F. Butera, A. Collo, G. D"Aloisio, S. Gentilli, , G. Ziliotto S. Passera, S. Riso, M.T. Sama , Novara, Italy AOU Maggiore della Carita Bariatric surgery is currently considered the most effective treatment to obtain a substantial weight loss sustained on the long term in morbid obesity. We present data regarding the recent bariatric experience of candidates enrolled between July 2016 and 2018 at “Maggiore Della Carita” Novara hospital. According to international and national guidelines1-2, surgery inclusion criteria were: age 8-65 years old; BMI 40 kg/m2 or 35 kg/m2 with at least one obesity-related comorbidity; multi-disciplinary team pre-surgical evaluation of the medical and psychological conditions that could interfere with health, weight loss outcome, or follow-up compliance 3. Among 98 candidates, 40 (41%) subjects underwent a bariatric procedure; 90% (36) underwent laparoscopic sleeve gastrectomy (LSG). No serious adverse events (SAE) were observed after surgery up to 12 months. The mean baseline BMI was 44.4 kg/m2 (§5.2), with a decrease of 9.7 kg/m2 (§3.5) and 13.3 kg/m2 (§5.5) at 6 and 12 months, respectively. The Percent Excess Weight Loss (%EWL) and Percent Total Body Weight Loss (%TBWL) were 47.8 (§17.7), 61.2 (§27.6) and 21.9 (§7.5), 27.6 (§10) at 6 and 12 months, respectively. Moreover, mean serum glucose levels reduced from 110.6 (§35.5) mg/dL at baseline to 90.4 mg/dL (§14.8) and
evaluated the rate of weight loss (WL) compared to self-reported usual weight (UW) and at 6 and 1 months before the visit, performed by an expert physician and a certified dietitian. We explored the association of WL10% with inflammation biomarkers, total protein, albumin, diagnosis and nutritional intervention through chi-squared or Kruskal-Wallis test, as statistically appropriate (Tab.2). Patients’ characteristics were summarized through descriptive analysis (Tab.1). Noteworthy 48% of CP was 65 years old, 20% had BMI<18.49; 21% had BMI25, 51% of them had a WL10%. About 63%, 44% and 13% of patients had a WL10% from UW, at 6 months and at 1 month, respectively. Moreover, 57% received oral supplementation after nutritional counseling. Conversely, 31% received artificial nutrition. Interestingly, WL10% from UW was associated with neutrophils-to-lymphocytes ratio (P=0.049) (Fig.1), cholesterol level (P=0.016) (Fig.2) and cancer type both from UW (P=0.003) (Fig.3) and at 6 months (P=0.007) before evaluation. A trend was observed with artificial nutrition (P=0.067). Prevention and treatment of cachexia still remain a critical need in CP. Therefore, integrating nutritional supportive care to oncologic treatments is crucial.
3
Fig. 2. Association of Total Cholesterol and %WL from UW.
Table 1 Patients' characteristics.
Fig. 3. Association of Diagnosis and %WL from UW.
Table 2 Association with %WL UW.
TAILORED NUTRITIONAL SUPPORT AS A PREDICTIVE FACTOR FOR SURVIVAL IN HEAD AND NECK CANCER PATIENTS UNDERGOING TREATMENTS I. Trestini *,1, L. Carbognin 2,3, I. Sperduti 4, C. Bonaiuto 1, L. Tondulli 1, S. Pilotto 1, G. Tortora 5, M. Milella 1, E. Bria 5 1 Department of Oncology, University of Verona Hospital, Verona, Italy 2 University of Verona, Verona, Italy 3 Division of Gynecologic Oncology, Department of Woman and Child Cattolica del Sacro Cuore, Fondazione Policlinico Health, Universita Universitario A. Gemelli IRCCS, Roma, Italy 4 Biostatistics, Regina Elena National Cancer Institute, Roma, Italy 5 Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Cattolica del Sacro Cuore, Roma, Italy IRCCS, Universita
Fig. 1. Association of NLR with %WL from UW.
The purpose of the present study was to explore the prognostic relevance of tailored nutritional intervention in patients affected by head and neck (HNC) undergoing chemotherapy and/or radiotherapy. We retrospectively analysed data from patients affected by HNC (stage II-IV), diagnosed between April 2010 and August 2016 at the AOUI of Verona and undergoing chemotherapy and/or radiotherapy. Descriptive statistics was adopted. Clinical, pathological and nutritional data were correlated with Overall Survival (OS) using a Cox model. Overall data from 87 patients were gathered. Forty-one patients (47.1%) received an individualized nutritional intervention, including tailored nutritional counselling by a skilled dietitian, in addition to oral nutritional supplements, addressing the patients’ needs, and 46 patients (52.9%) did not receive that, without significant differences for baseline clinical and pathological characteristics. At the multivariate analysis, the independent significant predictors of OS were the response or stable disease after the first line treatment (HR 4.62,p<0.0001), the Performance Status (ECOG)<1 (HR 2.06, p=0.037), the nutritional intervention (HR 3.72, p<0.0001), and the BMI 25 at baseline (HR 2.85, p=0.006). Particularly, the 3-year OS
4
SINPE conference abstracts / Nutrition 65 (2019) 110580
was 59.0% in patients receiving the nutritional support and 34.9% in patients who did not receive that (p=0.007). Among patients with unplanned hospital admissions 32 (37 pts [42.5%]), the nutritional support significantly discriminated the OS (61.5% vs. 25.5%, p=0.006). These data support the prognostic relevance of the tailored nutritional management into cancer care of HNC patients undergoing chemotherapy and/or radiotherapy.
RESTING ENERGY EXPENDITURE IN BOYS WITH DUCHENNE MUSCULAR DISTROPHY: WHICH IS THE BEST PREDICTIVE FORMULA? M. Bassano *,1, G. Baranello 2, A. Battezzati 3, S. Bertoli 3, R. De Amicis 3, A. Foppiani 3, A. Leone 2, T. Mami 1, E. Giaquinto 1 1 Cesena, Ospedale Bufalini - AUSL Romagna - sede Cesena, Italy 2 Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy 3 International Center for the Assessment of Nutritional Status, degli studi di Milano, Milano, Italy DeFENS Universita Duchenne muscular dystrophy (DMD) is the most prevalent dystrophy. A range of nutritional status derangements, varying from over nutrition to under nutrition, occurs with disease progression. The estimation of resting energy expenditure (REE) is the first step towards a personalized nutritional intervention, but indirect calorimetry (IC), the reference method, is available only in advanced clinical centers, and prediction formulas (PFs) are used in clinical practice. For this purpose, we compared the existing PFs for REE to identify the most accurate in DMD patients. We performed IC on 26 DMD patients (mean age 10.38§5.06) with an open-circuit ventilated-hood system (Sensor Medics 29, Anaheim, CA, USA). Patients were fasted for at least 6h. Data collection time was at least 20 min, with a 5 min run-in time for stabilization. Than we compared the results of IC with the PFs. Differences between IC vs PFs are shown on Table 1. The most accurate of PFs is Muller et Al. which has a delta <10% for 70% of the sample. Further studies are needed to elaborate a REE formula specifically for DMD patients.
MULTIDISCIPLINARY MANAGEMENT OF A CASE OF INTESTINAL FAILURE DUE TO SHORT BOWEL SYNDROME IN GARDNER SYNDROME O. Colombo *,1, E. Capitanio 1, M. Colledan 3, F. Cortinovis 1, S. Fagiuoli 2, C. Iegri 2, B. Mologni 1, L. Pasulo 2, E. Rodeschini 1 1 UOSD Dietetics and Clinical Nutrition, Papa Giovanni XXIII Hospital, Bergamo, Italy 2 UOC Gastroentherology 1, Papa Giovanni XXIII Hospital, Bergamo, Italy 3 UOC General Surgery 3, Papa Giovanni XXIII Hospital, Bergamo, Italy Objective: There still is little attention about both nutritional/metabolic consequences and multi-organ involvement after intestinal surgery. Our multidisciplinary team aimed to an integrated approach to short bowel syndrome (SBS). Research Methods & Procedures: A 37-years-old man affected by Gardner Syndrome, who previously underwent colectomy and several small bowel resections elsewhere without receiving appropriate nutritional prescriptions, was admitted into our hospital to be evaluated for intestinal transplant: biochemistry showed acute renal failure and multiple critical dysionias and the patient referred habitual copious liquid output, also containing undigested food, from ileostomy; he had lost 30 kg (-40% usual body weight, BW) in the last month. He promptly underwent nutritional assessment and, consequently, nutritional treatment: firstly we corrected dysionias and immediately started thiamin supplementation, thereafter we prescribed a personalized semielemental low-fiber diet per os, parceled out on 5-6 meals, and we started a personalized admixture parenteral nutrition support (PN). Regardless of appropriate evidences, the patient finally refused to give his consent to intestinal transplant, he was then discharged in PN and personalized diet per os.
Results: Despite severe dehydration and malnutrition, we early achieved and maintained hydro-electrolytic balance, thus recovering renal enhancement; besides, Refeeding Syndrome was adequately prevented and, beyond rehydration, the patient also started regaining BW. Conclusions: SBS can result in both intestinal and renal failure. It needs a multidisciplinary approach, including early and appropriate nutritional assessment and treatment. When intestinal transplant is not possible, even if recommended, PN remains the main therapeutic strategy.
BODY COMPOSITION AND METABOLIC CHANGES IN VLCKD: AN UPDATE G. Corbelli *,2, L. Valeriani 2, F. Anzolin 2, G. Tommesani 1, M. Fornari 1, M.G. Benassi 1, B. Corradini 1, L. Morisi 1, L. Zoni 2 1 UA DIETETICA AUSL BOLOGNA, Bologna, Italy 2 UO NUTRIZIONE CLINICA AUSL BOLOGNA, Bologna, Italy VLCKD is becoming an elective choice to promote weight loss, especially in the case of severe obesity and its metabolic complications. Some authors have assumed that VLCKD can better pre-serve lean body mass during weight loss, saving from diet-induced sarcopenia. BIA evaluation is a simple method to estimate body compostion. At the Maggiore Hospital in Bologna in 2017-2018 we conducted a dietary intervention with a VLCKD ranging from 700 to 800 kcal-die for 1 month in 52 female patients (mean age 48 years), to estimate the effectiveness on body composition. Biochemical indices exploring metabolic and nutritional condition and BIA evaluation was performed before and after VLCKD Before and after VLCKD the average of weight (108,6 vs 104,6), BMI (41,3 vs 39,6) and FM (50,5 vs 47,7 kg) was significantly different, meanwhile no signficant differences was found in Phase angle (6,5 vs 6,35), Body cell mass (BCM: 31,4 vs 30,5 kg) and Muscle Mass (MM: 38,6 vs 37,6). Significantly different were instead the value of basal insulin (12.9 vs 9.1) and the HOMA index (3,2 vs 2), but no differences was found for basal glycemia (94 vs 89), creatinine (0,7 vs 0,7) and serum electrolytes. Our study showed that a VLCKD was highly effective in terms of body weight reduction without to induce body cell mass loss, preventing the risk of sarcopenia. It was also able to reduce the basal insulin level without modify glycemia level and not to change kydney function and electrolytes level
WEIGHT LOSS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE MULTIDISCIPLINARY APPROACH OF MAGGIORE DELLA CARITA’ AOU, NOVARA E. Cava *, F. Butera, A. Collo, G. D"Aloisio, S. Gentilli, , G. Ziliotto S. Passera, S. Riso, M.T. Sama , Novara, Italy AOU Maggiore della Carita Bariatric surgery is currently considered the most effective treatment to obtain a substantial weight loss sustained on the long term in morbid obesity. We present data regarding the recent bariatric experience of candidates enrolled between July 2016 and 2018 at “Maggiore Della Carita” Novara hospital. According to international and national guidelines1-2, surgery inclusion criteria were: age 8-65 years old; BMI 40 kg/m2 or 35 kg/m2 with at least one obesity-related comorbidity; multi-disciplinary team pre-surgical evaluation of the medical and psychological conditions that could interfere with health, weight loss outcome, or follow-up compliance 3. Among 98 candidates, 40 (41%) subjects underwent a bariatric procedure; 90% (36) underwent laparoscopic sleeve gastrectomy (LSG). No serious adverse events (SAE) were observed after surgery up to 12 months. The mean baseline BMI was 44.4 kg/m2 (§5.2), with a decrease of 9.7 kg/m2 (§3.5) and 13.3 kg/m2 (§5.5) at 6 and 12 months, respectively. The Percent Excess Weight Loss (%EWL) and Percent Total Body Weight Loss (%TBWL) were 47.8 (§17.7), 61.2 (§27.6) and 21.9 (§7.5), 27.6 (§10) at 6 and 12 months, respectively. Moreover, mean serum glucose levels reduced from 110.6 (§35.5) mg/dL at baseline to 90.4 mg/dL (§14.8) and