What is the impact of a diagnosis of malnutrition at baseline on a patient’s treatment outcomes?
There are four level III-2 Ø studies  ), three level III-3 Ø studies (Salas 2008, Guo 1996, Linn 1988), and fourteen level IV studies (2 + and 12 Ø) addressing this question. From the level III-2 studies, malnourished patients have an increased risk of developing non thyroidal illness post surgery (Siroen 2006), have a reduced survival if they have had more weight loss at baseline (Van-Bokhorst-de van der schueren 2000), have a lower HLA-DR expression on monocytes which may explain increased risk of infections (Van-Bokhorst-de van der Schueren 1998), and reduced immune function, increased surgical complications, increased length of stay (Linn 1988a).
From the level III-3 studies, C-reactive protein and albumin levels impact on survival and response to treatment (Salas 2008), increased complications and length of stay (Guo 1996), increased length of stay and readmissions (Linn 1988b).
The other level IV studies showed malnourished patients had reduced quality of life (Van den berg 2008, Capuano 2010, Ravasco 2004), reduced survival (Capuano 2008, Mick 1991, Brookes 1985, Goodwin 1984), increased length of stay (Shirodkar 2005, Guo 1994), and increased complications including infections, admissions and treatment interruptions (Capuano 2008, Guo 2007, Shirodkar 2005, Ravasco 2004, Van-Bokhorst-de van der schueren 1997, Guo 1994, Goodwin 1984). One paper found that patients who were well nourished with an adequate zinc status had improved disease free survival, and those with impaired zinc status had increased morbidity, unplanned admissions and treatment delays (Doerr 1998). Only 2 papers (+ and Ø) found that malnutrition at baseline had no impact on survival outcomes (Van Bokhorst-de van der Schueren 1999, Matthews 1995).
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- Siroen MP, van Bokhorst-de van der Schueren MA, Richir MC, Sauerwein HP, Leemans CR, Quak JJ, et al. The prognostic value of severe malnutrition in the development of nonthyroidal illness in head and neck cancer patients. JPEN J Parenter Enteral Nutr 2006;30(5):415-20 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16931610.
- Van Bokhorst-de Van der Schuer MA, Langendoen SI, Vondeling H, Kuik DJ, Quak JJ, Van Leeuwen PA. Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial. Clin Nutr 2000 Dec;19(6):437-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11104595.
- van Bokhorst-De van der Schuer MA, von Blomberg-van der Flier BM, Riezebos RK, Scholten PE, Quak JJ, Snow GB, et al. Differences in immune status between well-nourished and malnourished head and neck cancer patients. Clin Nutr 1998 Jun;17(3):107-11 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10205326.
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