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  • Intervention
    Can the catabolic process that occurs in head and neck cancer patients be altered by amino acids?
    • Conclusion

      Evidence from 3 RCTs (two positive and one neutral quality) suggests that the catabolic process that occurs in head and neck cancer patients is not altered by arginine.  Two studies provided EN enhanced with arginine (.625 g/100 ml) to head and neck cancer patients for an average of 21 and 22 days.  Changes in weight from baseline were not significant in both the arginine and control groups.  The third study provided 1.2 g arginine/100 ml for 90 days to head and neck cancer patients. Changes in weight, FFM, FM, TSF, and AC were not significant. 

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Catabolic Process: Amino Acids 2006
       
    Does the intake of an arginine-enhanced medical food supplement improve plasma protein levels in post-surgical patients with head and neck cancer?
    • Conclusion

      One positive quality RCT used an arginine-enhanced MFS vs. an omega-3 enhanced MFS daily for 3 months in post-surgical ambulatory patients with head and neck cancers. There was no control group. All patients received dietary education. There were no significant differences in calories or protein between the two groups in amount of MFS consumed. The arginine group showed an increase in plasma protein levels, but this was not significant when compared with the omega-3 group. There was no significant difference in FFM post-intervention or weight gain between the two groups.  More research is needed.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Arginine and Symptoms/Complications 2005
       
    Is there a relationship between an oral and laryngeal cancer patient's postoperative intake of EPA-containing nutritional supplement to improve tolerance and support recovery from surgery, and the reduction of complications associated with surgery?
    • Conclusion

      One positive quality RCT studied post-operative oral and laryngeal cancer patients who had not experienced weight loss in the 3 months before surgery to see if an EPA-enhanced MFS (2 cans for 2.2 g EPA/day) versus an arginine-enhanced MFS for 12 weeks post-operatively would support post-operative recovery. Results for the EPA group included increased weight and increased fat mass and triceps skinfold. No differences were noted for fat-free mass, arm circumference, or rate of infectious complications between groups.  This study was not placebo controlled, and patients were instructed to eat 30 kcal/kg/day, 1.1 g protein/kg/day and exercise which are potentially confounding to the study results. Therefore, further studies are needed to clarify the relationship between EPA's relationship with cancer cachexia and treatment.

       

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: EPA/Omega 3 Fatty Acids and Symptoms/Complications 2005
       
    Is there a relationship between post-operative arginine-enhanced enteral nutrition and post-operative wound complication rates by patients with oral or laryngeal cancer?
    • Conclusion

      Three RCTs (two positive quality, one neutral quality) studied the effect of post-operative arginine-enhanced EN on patients with oral or laryngeal cancer and the decrease in post-operative wound complications, including fistulas. One positive quality study showed a decrease in the incidence of post-operative fistulas in the arginine-enhanced group (P < 0.05). In the neutral quality study, development of post-operative fistulas were lower in the study group (0% vs. 20.8%, p < 0.05). This study, however, was confounded; both groups used an arginine-enhanced EN formula containing fiber. In the positive quality study, malnourished patients (> 10% weight loss/past 6 months) who received post-operative arginine-enhanced EN, experienced a decrease in post-operative wound complication rate compared to the well-nourished group (P < 0.05).  More research is needed.

       

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Arginine and Symptoms/Complications 2005
       
    Is there a relationship between the use of postoperative arginine-enhanced enteral nutrition and treatment-related diarrhea by patients with oral or laryngeal cancer?
    • Conclusion

      Two (2) RCTs (one positive quality, one neutral quality) studied the effects of post-operative arginine-enhanced EN on patients with oral or laryngeal cancer. The positive quality RCT arginine group experienced a significant increase in diarrhea (P<.05) The neutral quality study was confounded with the use of an arginine-enhanced EN formula with fiber used by all groups.  More research is needed.

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Arginine and Symptoms/Complications 2005
       
    Is there a relationship between use of a preoperative arginine-enhanced enteral nutrition formula and reduction in post-operative complications by patients with oral or laryngeal cancer?
    • Conclusion

      One RCT of positive quality on malnourished (loss of >10% body weight per 6 months) patients with oral or laryngeal cancer received 7-10 days of preoperative home arginine-enhanced EN (energy goal 1.5 x estimated BEE, 12.5 g arginine/L in arginine-supplemented group). There was no improvement in clinical outcomes, nutritional status, or reduction in surgery-induced immune suppression compared to the oral food intake ad lib control group.  Further research is needed.

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Arginine and Symptoms/Complications 2005
       
    Is there a relationship between use of an arginine-enhanced medical food supplement and post-operative complications in patients with oral or laryngeal cancer?
    • Conclusion

      One RCT of positive quality on patients with oral or laryngeal cancer (surgery only) used either Group 1) an arginine-enhanced MFS daily for 3 months, or Group 2) EPA-enhanced MFS. This study did not have a control group. All patients received dietary education. The arginine group did not experience a significant improvement in weight, body composition indices, or plasma levels of albumin or prealbumin, compared to the EPA group. Plasma protein status of both groups improved (difference = NS). There was no significant increase in weight in the arginine group.

      More research is needed.

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Arginine and Symptoms/Complications 2005
       
    Is there a relationship between use of an arginine-enhanced enteral nutrition and plasma protein levels and immune function with postoperative patients with head and neck cancer?
    • Conclusion

      Three positive quality RCTs and one neutral quality RCT on postoperative patients with head and neck cancer compared an arginine-enhanced EN formula with an isocaloric, isonitrogenous EN formula.  Improvements in plasma proteins (albumin, prealbumin and transferrin) were found in the arginine-enhanced groups, but the difference was not statistically significant.  While immune parameters improved, the difference was only statistically significant among the malnourished patient group in one positive quality study.  The same study showed a significant decrease in both postoperative complications and LOS compared to the control group (p<0.05).  Postoperative patients receiving enteral formula containing arginine experienced an increase in diarrhea that was statistically different in one positive quality study, but not in the neutral quality study.  More research is needed.

       

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Arginine and Symptoms/Complications 2005