title: An exploration of factors predicting malnutrition in patients with advanced head and neck cancer.
abstract: OBJECTIVE
  Malnutrition is common among head and neck cancer patients and negatively impacts on survival and quality of life. This study aimed to identify predictors of malnutrition at time of diagnosis in order to identify patients at risk and enable early nutritional support and prevent malnutrition.
  
  
  METHODS
  A total of 134 patients with advanced oral and pharyngeal cancer were included in the study. Weight, body mass index (BMI), fat free mass (FFM), dysphagia, and quality of life were measured at diagnosis and after 6 months. Two definitions for malnutrition were applied: >10% weight loss and BMI <20 after 6 months.
  
  
  RESULTS
  Six months after diagnosis, 66% of the patients were malnourished as per the >10% weight loss definition, and 26% of the patients were malnourished as per the BMI < 20 weight loss definition. In multivariate analysis, low BMI followed by low FFM and dysphagia were the strongest predictors for malnutrition using BMI <20. Chemotherapy and high BMI at diagnosis were the strongest predictors of malnutrition using the 10% weight loss definition. For patients treated with chemotherapy, the risk for malnutrition was very high both for patients with normal BMI (67%) and for patients with BMI 30 (89%).
  
  
  CONCLUSIONS
  Unintended weight loss more than 10% seems to be the most reasonable definition of malnutrition for identifying predictors of this in head and neck cancer patients. The weight loss correlated significantly to a loss of FFM. Treatment with chemotherapy was a strong predictor, as was a high BMI at time of diagnosis. This is an important finding since overweight patients might not be considered at high risk for developing malnutrition, and consequently nutritional support for them might be delayed.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Sweden.
authors.forename: Ewa
authors.initials: E
authors.lastname: Silander
authors.forename: Jan
authors.initials: J
authors.lastname: Nyman
authors.forename: Eva
authors.initials: E
authors.lastname: Hammerlid
mesh_terms: D015992:Body Mass Index; D059248:Chemoradiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications; D015596:Nutrition Assessment; D018529:Nutritional Support; D010610:Pharyngeal Neoplasms / Q000150:complications; D012307:Risk Factors; D014062:Tongue Neoplasms / Q000150:complications; D014067:Tonsillar Neoplasms / Q000150:complications; D015431:Weight Loss
keywords: Advanced head and neck cancer; BMI; malnutrition; predictor; weight loss