Meeting Minimum ESPEN Energy Recommendations Is Not Enough to Maintain Muscle Mass in Head and Neck Cancer Patients

Nutrients. 2019 Nov 12;11(11):2743. doi: 10.3390/nu11112743.


The relationship between dietary intake and body composition changes during cancer treatment has not been well characterized. The aim of this study was to compare dietary intake at diagnosis and end of treatment in relation to changes in muscle mass and adiposity in head and neck cancer (HNC) patients. Dietary intakes (three-day food record) and body composition using computed tomography (CT) were assessed at diagnosis (baseline) and after treatment completion (post-treatment). Skeletal muscle (SM) loss was explored as a consequence of energy and protein intake in relation to the minimum and maximum European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines. Higher energy intakes (kcal/kg/day) and increases in energy intake (%) from baseline to post-treatment were correlated with attenuated muscle loss (r = 0.62, p < 0.01; r = 0.47, p = 0.04, respectively). Post-treatment protein intake demonstrated a weak positive correlation (r = 0.44, p = 0.05) with muscle loss, which did not persist when controlling for covariates. Meeting minimum ESPEN energy guidelines (25 kcal/kg/day) did not attenuate SM loss, whereas intakes >30 kcal/kg/day resulted in fewer participants losing muscle. Greater baseline adiposity correlated with greater SM loss (p < 0.001). Energy intakes of 30 kcal/kg/day may be required to protect against SM loss during treatment in HNC patients. The influence of adiposity on SM loss requires further exploration.

Keywords: body composition; cachexia; computed tomography; dietary intake; head and neck cancer; skeletal muscle loss.

MeSH terms

  • Adiposity
  • Adult
  • Aged
  • Aged, 80 and over
  • Body Composition*
  • Cachexia / diagnostic imaging
  • Cachexia / physiopathology
  • Cachexia / prevention & control*
  • Diet Records
  • Dietary Proteins / administration & dosage
  • Energy Intake*
  • Female
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / physiopathology
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Muscle, Skeletal / diagnostic imaging
  • Muscle, Skeletal / physiopathology*
  • Nutritional Status*
  • Risk Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Weight Loss*


  • Dietary Proteins