Protein-energy and carnitine status in patients with upper aerodigestive tract cancer

Malnutrition is a common problem in patients with cancer. Its presence may lead to an increase in morbidity and mortality following cancer treatment. Therefore, a prospective study on the nutritional status of 51 patients with cancer of the upper aerodigestive tract (UAT) was undertaken. Nutritional status was evaluated by dietary, anthropométrie and biochemical methods including the détermination of camitine and selected vitamins. The protein-energy status was monitored by serum transport proteins: serum albumin, transferrin and retinol binding protein (RBP) and by anthropometrie indices. During cancer treatment, the patients' nutritional status was evaluated 3 times in those receiving only one treatment and 5 to 7 times in those receiving a set of combined treatments. After termination of treatment, all of the patients were evaluated 3 times with 2 to 3 months intervals. The results of nutritional assessment were evaluated according to tumour localization and tumour stage as well as to their response to treatment. At the time of diagnosis, some patients already developed protein-energy malnutrition, alteration of carnitine status and an inadequate ascorbic acid status. We also observed an effect of tumour localization and tumour stage on the protein-energy status of the patients. Patients with pharyngeal cancer tended to have lower serum RBP concentration than those with laryngeal and oral cavity cancer. As the tumour stage advanced, serum transport proteins (RBP and transferrin) tended to decrease. There was a tendency towards lower serum ascorbic acid concentration in patients at an advanced tumour stage as compared to those at an early tumour stage. A change in the serum carnitine status was shown in these patients by a shift in the relative amount of serum acylcarnitine and free carnitine especially in those at an advanced tumour stage. During cancer treatment, patients with UAT cancer at an advanced stage were more likely to be at risk for malnutrition during treatment than those at an early tumour stage. There was a significant change in nutritional status as indicated by a significant weight loss, especially in patients receiving a combined set of cancer treatments. The serum carnitine status was also affected during cancer treatment in a complex manner, the serum total and free carnitine were significantly decreased during cancer treatment. An acute effect of chemotherapy was also observed by a significant increase in serum total and free carnitine 12 hours after the administration of chemotherapy. Results from this study showed that the carnitine status of the UAT cancer patients was already compromised from cancer alone and can be further affected by the local and systemic effects of cancer treatment. The UAT cancer patients were also at risk of vitamin deficiency by demonstrating a significantly decrease intake of dietary carotene by the end of treatment and during follow-up period. The intake of dietary ascorbic acid tended to decrease during cancer treatment as well as during follow-up period. Using multivariate regression analyses, we found that the average value of serum B- carotene and dietary carotene intake during cancer treatment were associated with the response to treatment. However, none of the nutritional indicators would enable us to predict the outcome of treatment. Thus, findings from this study suggest the need for further research aimed at: 1) understanding the effect of cancer and its treatment on carnitine balance, 2) establishing the nutritional and clinical indices that can identify patients at risk of therapy-related complications and early death, 3) examining the effect of nutrition on recurrence rate and survival of the UAT cancer patients.

Name thesis:degree_name

Ph. D.

Level thesis:degree_level

Doctorat

Discipline thesis:degree_discipline

Sciences cliniques

Grantor dc:publisher

Université de Sherbrooke

Year dc:date.issued

1991

Author dc:creator

• Pattamakom, Vongsvat

Advisor dc:contributor.advisor

• Vobecky, Jitka S.

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/11143/12722

OAI identifier oai:identifier

oai:usherbrooke.scholaris.ca:11143/12722