• E-ISSN: 2348-1064
  • Follow us

Journal of Nutrition Research
An official journal of IAPEN India association


Journal of Nutrition Research

Year: 2023, Volume: 11, Issue: 1, Pages: 6-19

Review Article

IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

Received Date:27 December 2022, Accepted Date:22 January 2023, Published Date:30 January 2023


Nutritional support is an integral component in the treatment of head and neck cancers (HNC). Studies indicate 90% of HNC patients are at high risk of developing malnutrition. Chemo-radiation and surgery, the three common treatments used to treat HNC are highly susceptible to toxic side effects. Dysphagia is often underestimated in HNC patients. A prolonged impaired swallowing process can lead to severe morbidities like malnutrition, dehydration, aspiration, pneumonia, and even death. These complications have adverse effects on patients' QoL (Quality of Life) and mental health. These adverse reactions further complicate the nutritional status of the patients and the final treatment outcome, increasing morbidity and mortality. The consensus statements try to address nutritional issues and provide practical recommendations for practicing dieticians and clinicians.


Keywords: Head and neck cancer guidelines, Nutrition in head and neck cancers, Consensus statements in nutrition in Head and neck cancers, IAPEN head and neck cancer guidelines


  1. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutritionClinical Nutrition2017;36(5):11871196. Available from: https://doi.org/10.1016/j.clnu.2017.06.017
  2. Wagner C. Nutritional management during treatment for head and neck cancermemo - Magazine of European Medical Oncology2020;13(4):405408. Available from: https://doi.org/10.1007/s12254-020-00613-0
  3. Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional Risk Screening and AssessmentJournal of Clinical Medicine2019;8(7):119. Available from: https://doi.org/10.3390/jcm8071065
  4. Sandmæl JA, Sand K, Bye A, Solheim TS, Oldervoll L, Helvik AS. Nutritional experiences in head and neck cancer patientsEuropean Journal of Cancer Care2019;28(6). Available from: https://doi.org/10.1111/ecc.13168
  5. Kreymann KG, Berger MM, Deutz NEP, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN Guidelines on Enteral Nutrition: Intensive careClinical Nutrition2006;25(2):210223. Available from: https://doi.org/10.1016/j.clnu.2006.01.021
  6. Prado CM, Elliott SA, Mota JF. Advanced imaging techniques for assessment of undernutritionAdvanced Nutrition and Dietetics in Nutrition Support2018;p. 91105. Available from: https://doi.org/10.1002/9781118993880.ch2.7
  7. Wang JR, Habbous S, Espin-Garcia O, Chen D, Huang SH, Simpson C, et al. Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinomaHead & Neck2016;38(5):736742. Available from: https://doi.org/10.1002/hed.23947
  8. Corrêa GTB, Bandeira GA, Cavalcanti BG, Santos FBG, Neto JFR, Guimarães ALS, et al. Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survivalSupportive Care in Cancer2012;20(11):26792685. Available from: https://doi.org/10.1007/s00520-012-1386-y
  9. García-Peris P, Parón L, Velasco C, Cuerda CDL, Camblor M, Bretón I, et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of lifeClinical Nutrition2007;26(6):710717. Available from: https://doi.org/10.1016/j.clnu.2007.08.006
  10. Christianen MEMC, Schilstra C, Beetz I, Muijs CT, Chouvalova O, Burlage FR, et al. Predictive modelling for swallowing dysfunction after primary (chemo)radiation: Results of a prospective observational studyRadiotherapy and Oncology2012;105(1):107114. Available from: https://doi.org/10.1016/j.radonc.2011.08.009
  11. Eisbruch A, Kim HM, Feng FY, Lyden TH, Haxer MJ, Feng MY, et al. Chemo-IMRT of Oropharyngeal Cancer Aiming to Reduce Dysphagia: Swallowing Organs Late Complication Probabilities and Dosimetric CorrelatesInternational Journal of Radiation Oncology*Biology*Physics2011;81(3):e93e99. Available from: https://doi.org/10.1016/j.ijrobp.2010.12.067
  12. Denaro N, Merlano MC, Russi EG. Dysphagia in Head and Neck Cancer Patients: Pretreatment Evaluation, Predictive Factors, and Assessment during Radio-Chemotherapy, RecommendationsClinical and Experimental Otorhinolaryngology2013;6(3):117126. Available from: https://doi.org/10.3342/ceo.2013.6.3.117
  13. Clarke P, Radford K, Coffey M, Stewart M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary GuidelinesThe Journal of Laryngology & Otology2016;130(S2):S176S180. Available from: https://doi.org/10.1017/s0022215116000608
  14. Larsson M, Hedelin B, Johansson I, Athlin E. Eating Problems and Weight Loss for Patients With Head and Neck CancerCancer Nursing2005;28(6):425435. Available from: https://doi.org/10.1097/00002820-200511000-00004
  15. Langius JAE, Zandbergen MC, Eerenstein SEJ, Tulder MWV, Leemans CR, Kramer MHH, et al. Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic reviewClinical Nutrition2013;32(5):671678. Available from: https://doi.org/10.1016/j.clnu.2013.06.012
  16. Bhattacharjee A, Bahar I, Saikia A. Nutritional assessment of patients with head and neck cancer in North-East India and dietary interventionIndian Journal of Palliative Care2015;21(3):289. Available from: https://doi.org/10.4103/0973-1075.164889
  17. Ackerman D, Laszlo M, Provisor A, Yu A. Nutrition Management for the Head and Neck Cancer PatientCancer Treat Res2018;174:187208. Available from: https://doi.org/10.1007/978-3-319-65421-8_11
  18. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancerClinical Nutrition2021;40(5):28982913. Available from: https://doi.org/10.1016/j.clnu.2021.02.005
  19. Avancini A, Pala V, Trestini I, Tregnago D, Mariani L, Sieri S, et al. Exercise Levels and Preferences in Cancer Patients: A Cross-Sectional StudyInternational Journal of Environmental Research and Public Health2020;17(15):5351. Available from: https://doi.org/10.3390/ijerph17155351
  20. Gibney E, Elia M, Jebb S, Murgatroyd P, Jennings G. Total energy expenditure in patients with small-cell lung cancer: Results of a validated study using the bicarbonate-urea methodMetabolism1997;46(12):9014090142. Available from: https://doi.org/10.1016/s0026-0495(97)90140-2
  21. Peñas RDL, Majem M, Perez-Altozano J, Virizuela JA, Cancer E, Diz P, et al. SEOM clinical guidelines on nutrition in cancer patients (2018) Clinical and Translational Oncology2019;21(1):8793. Available from: https://doi.org/10.1007/s12094-018-02009-3
  22. Ravasco P. Nutrition in Cancer PatientsJournal of Clinical Medicine2019;8(8):1211. Available from: https://doi.org/10.3390/jcm8081211
  23. Macdonald AJ, Johns N, Stephens N, Greig C, Ross JA, Small AC, et al. Habitual Myofibrillar Protein Synthesis Is Normal in Patients with Upper GI Cancer CachexiaClinical Cancer Research2015;21(7):17341740. Available from: https://doi.org/10.1158/1078-0432.ccr-14-2004
  24. Nesemeier R, Dunlap N, Mcclave SA, Tennant P. Evidence-Based Support for Nutrition Therapy in Head and Neck CancerCurrent Surgery Reports2017;5(8):18. Available from: https://doi.org/10.1007/s40137-017-0179-0
  25. Talwar B, Donnelly R, Skelly R, Donaldson M. Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary GuidelinesThe Journal of Laryngology & Otology2016;130(S2):S32S40. Available from: https://doi.org/10.1017/s0022215116000402
  26. Burns CP, Halabi S, Clamon G, Kaplan E, Hohl RJ, Atkins JN, et al. Phase II study of high-dose fish oil capsules for patients with cancer-related cachexiaCancer2004;101(2):370378. Available from: https://doi.org/10.1002/cncr.20362
  27. Tobberup R, Carus A, Rasmussen HH, Falkmer UG, Jorgensen MG, Schmidt EB, et al. Feasibility of a multimodal intervention on malnutrition in patients with lung cancer during primary anti-neoplastic treatmentClinical Nutrition2021;40(2):525533. Available from: https://doi.org/10.1016/j.clnu.2020.05.050
  28. Patursson P, Møller G, Muhic A, Andersen JR. N-3 fatty acid EPA supplementation in cancer patients receiving abdominal radiotherapy - A randomised controlled trialClinical Nutrition ESPEN2021;43:130136. Available from: https://doi.org/10.1016/j.clnesp.2021.03.001
  29. Cereda E, Cappello S, Colombo S, Klersy C, Imarisio I, Turri A, et al. Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapyRadiotherapy and Oncology2018;126(1):8188. Available from: https://doi.org/10.1016/j.radonc.2017.10.015
  30. Sánchez-Lara K, Turcott JG, Juárez-Hernández E, Nuñez-Valencia C, Villanueva G, Guevara P, et al. Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: Randomised trialClinical Nutrition2014;33(6):10171023. Available from: https://doi.org/10.1016/j.clnu.2014.03.006
  31. Ghoreishi Z, Esfahani A, Djazayeri A, Djalali M, Golestan B, Ayromlou H, et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: A randomized double-blind placebo controlled trialBMC Cancer2012;12(1):12. Available from: https://doi.org/10.1186/1471-2407-12-355
  32. Lyra MDMF, Meira JECD, Guedes GDS, Bueno NB. Immunonutrition in head and neck cancer: Systematic review and metanalysis of its clinical and nutritional effectsClinical Nutrition ESPEN2021;41:3041. Available from: https://doi.org/10.1016/j.clnesp.2020.12.014
  33. Machon C, Thezenas S, Dupuy AMM, Assenat E, Michel F, Mas E, et al. Immunonutrition before and during radiochemotherapy: improvement of inflammatory parameters in head and neck cancer patientsSupportive Care in Cancer2012;20(12):31293135. Available from: https://doi.org/10.1007/s00520-012-1444-5
  34. Boisselier P, Kaminsky MCC, Thézenas S, Gallocher O, Lavau-Denes S, Garcia-Ramirez M, et al. A double-blind phase III trial of immunomodulating nutritional formula during adjuvant chemoradiotherapy in head and neck cancer patients: IMPATOXThe American Journal of Clinical Nutrition2020;112(6):15231531. Available from: https://doi.org/10.1093/ajcn/nqaa227
  35. Uno H, Furukawa K, Suzuki D, Shimizu H, Ohtsuka M, Kato A, et al. Immunonutrition suppresses acute inflammatory responses through modulation of resolvin E1 in patients undergoing major hepatobiliary resectionSurgery2016;160(1):228236. Available from: https://doi.org/10.1016/j.surg.2016.01.019
  36. Boisselier P, Kaminsky MCC, Thézenas S, Gallocher O, Lavau-Denes S, Garcia-Ramirez M, et al. A double-blind phase III trial of immunomodulating nutritional formula during adjuvant chemoradiotherapy in head and neck cancer patients: IMPATOXThe American Journal of Clinical Nutrition2020;112(6):15231531. Available from: https://doi.org/10.1093/ajcn/nqaa227
  37. Wei L, Wu Z, Chen YQ. Multi-targeted therapy of cancer by omega-3 fatty acids-an updateCancer Letters2022;526:193204. Available from: https://doi.org/10.1016/j.canlet.2021.11.023
  38. Wang CCC, Hwang TZZ, Yang CCC, Lien CF, Wang CCC, Shih YC, et al. Impact of Parenteral Glutamine Supplement on Oncologic Outcomes in Patients with Nasopharyngeal Cancer Treated with Concurrent ChemoradiotherapyNutrients2022;14(5):997. Available from: https://doi.org/10.3390%2Fnu14050997
  39. Howes N, Atkinson C, ST, Lewis SJ. Immunonutrition for patients undergoing surgery for head and neck cancerCochrane Database Syst Rev2018;8(8):CD010954. Available from: https://doi.org/10.1002/14651858.cd010954.pub2
  40. Mueller SA, Mayer C, Bojaxhiu B, Aeberhard C, Schuetz P, Stanga Z, et al. Effect of preoperative immunonutrition on complications after salvage surgery in head and neck cancerJ Otolaryngol Head Neck Surg2019;48(1). Available from: https://doi.org/10.1186/s40463-019-0345-8
  41. Aeberhard C, Mayer C, Meyer S, Mueller SA, Schuetz P, Stanga Z, et al. Effect of preoperative immunonutrition on postoperative short-term outcomes of patients with head and neck squamous cell carcinomaHead Neck2018;40(5):10571067. Available from: https://doi.org/10.1002/hed.25072
  42. Chitapanarux I, Traisathit P, Chitapanarux T, Jiratrachu R, Chottaweesak P, Chakrabandhu S, et al. Arginine, glutamine, and fish oil supplementation in cancer patients treated with concurrent chemoradiotherapy: A randomized control studyCurrent Problems in Cancer2020;44(1):100482. Available from: https://doi.org/10.1016/j.currproblcancer.2019.05.005
  43. Dechaphunkul T, Arundon T, Raungkhajon P, Jiratrachu R, Geater SL, Dechaphunkul A. Benefits of immunonutrition in patients with head and neck cancer receiving chemoradiation: A phase II randomized, double-blind studyClinical Nutrition2022;41(2):433440. Available from: https://doi.org/10.1016/j.clnu.2021.12.035
  44. Barajas-Galindo DE, Vidal-Casariego A, Maza BPDL, Fernández-Martínez P, Ramos-Martínez T, García-Arias S, et al. Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomesEndocrinol Diabetes Nutr (Engl Ed)2019;67(1):1319. Available from: https://doi.org/10.1016/j.endinu.2019.05.006
  45. Vidal-Casariego A, Calleja-Fernández A, Villar-Taibo R, Kyriakos G, Ballesteros-Pomar MD. Efficacy of arginine-enriched enteral formulas in the reduction of surgical complications in head and neck cancer: A systematic review and meta-analysisClinical Nutrition2014;33(6):951957. Available from: https://doi.org/10.1016/j.clnu.2014.04.020
  46. Schueren MAVBDVD, Quak JJ, Flier BMEVBVD, Kuik DJ, Langendoen SI, Snow GB, et al. Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patientsThe American Journal of Clinical Nutrition2001;73(2):323332. Available from: https://doi.org/10.1093/ajcn/73.2.323
  47. MochamatCuhls H, Marinova M, Kaasa S, Stieber C, Conrad R, et al. A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia projectJournal of Cachexia, Sarcopenia and Muscle2017;8(1):2539. Available from: https://doi.org/10.1002/jcsm.12127
  48. Gröber U, Holzhauer P, Kisters K, Holick MF, Adamietz IA. Micronutrients in Oncological InterventionNutrients2016;8(3):163. Available from: https://doi.org/10.3390/nu8030163
  49. Pu Y, Zhu G, Xu Y, Zheng S, Tang B, Huang H, et al. Association Between Vitamin D Exposure and Head and Neck Cancer: A Systematic Review With Meta-AnalysisFrontiers in Immunology2021;12.
  50. Yokosawa EB, Arthur AE, Rentschler KM, Wolf GT, Rozek LS, Mondul AM. Vitamin D intake and survival and recurrence in head and neck cancer patientsThe Laryngoscope2018;128(11):371376. Available from: https://doi.org/10.1002/lary.27256
  51. Izreig S, Hajek M, Edwards HA, Mehra S, Sasaki C, Bl J, et al. The role of vitamin D in head and neck cancerLaryngoscope Investig Otolaryngol2020;5(6):10791088. Available from: https://doi.org/10.1002%2Flio2.469
  52. Bochen F, Balensiefer B, Körner S, Bittenbring JT, Neumann F, Koch A, et al. Vitamin D deficiency in head and neck cancer patients - prevalence, prognostic value and impact on immune functionOncoimmunology2017;7(9). Available from: https://doi.org/10.1080%2F2162402X.2018.1476817
  53. Maturana-Ramírez A, Aitken-Saavedra J, Guevara-Benítez AL, Espinoza-Santander I. Hypovitaminosis D, oral potentially malignant disorders, and oral squamous cell carcinoma: a systematic reviewMedicina Oral Patología Oral y Cirugia Bucal2022;27(2):e135e141. Available from: https://doi.org/10.4317/medoral.25049
  54. Khamis A, Gül D, Wandrey M, Lu Q, Knauer SK, Reinhardt C, et al. The Vitamin D Receptor–BIM Axis Overcomes Cisplatin Resistance in Head and Neck CancerCancers1920;14(20):5131. Available from: https://doi.org/10.3390/cancers14205131
  55. Afzal S, Bojesen SE, Nordestgaard BG. Low Plasma 25-Hydroxyvitamin D and Risk of Tobacco-Related CancerClinical Chemistry2013;59(5):771780. Available from: https://doi.org/10.1373/clinchem.2012.201939
  56. Fanidi A, Muller DC, Midttun Ø, Ueland PM, Vollset SE, Relton C, et al. Circulating vitamin D in relation to cancer incidence and survival of the head and neck and oesophagus in the EPIC cohortScientific Reports2016;6(1):111. Available from: https://doi.org/10.1038/srep36017
  57. Giovannucci E, Liu Y, Rimm EB, Hollis BW, Fuchs CS, Stampfer MJ, et al. Prospective Study of Predictors of Vitamin D Status and Cancer Incidence and Mortality in MenJNCI: Journal of the National Cancer Institute2006;98(7):451459. Available from: https://doi.org/10.1093/jnci/djj101
  58. Lipworth L, Rossi M, Mclaughlin JK, Negri E, Talamini R, Levi F, et al. Dietary vitamin D and cancers of the oral cavity and esophagusAnnals of Oncology2009;20(9):15761581. Available from: https://doi.org/10.1093/annonc/mdp036
  59. Gugatschka M, Kiesler K, Obermayer-Pietsch B, Groselj-Strele A, Griesbacher A, Friedrich G. Vitamin D status is associated with disease-free survival and overall survival time in patients with squamous cell carcinoma of the upper aerodigestive tractEuropean Archives of Oto-Rhino-Laryngology2011;268(8):12011204. Available from: https://doi.org/10.1007/s00405-010-1481-y
  60. Gnagnarella P, Muzio V, Caini S, Raimondi S, Martinoli C, Chiocca S, et al. Vitamin D Supplementation and Cancer Mortality: Narrative Review of Observational Studies and Clinical TrialsNutrients2021;13(9):3285. Available from: https://doi.org/10.3390/nu13093285
  61. Meyer F, Liu G, Douville P, Samson É, Xu W, Adjei A, et al. Dietary vitamin D intake and serum 25-hydroxyvitamin D level in relation to disease outcomes in head and neck cancer patientsInternational Journal of Cancer2011;128(7):17411746. Available from: https://doi.org/10.1002/ijc.25496
  62. Akutsu T, Kitamura H, Himeiwa S, Kitada S, Akasu T, Urashima M. Vitamin D and Cancer Survival: Does Vitamin D Supplementation Improve the Survival of Patients with Cancer? Current Oncology Reports2020;22(6):62. Available from: https://doi.org/10.1007/s11912-020-00929-4
  63. Nejatinamini S, Kubrak C, Álvarez-Camacho M, Baracos VE, Ghosh S, Wismer WV, et al. Head and Neck Cancer Patients Do Not Meet Recommended Intakes of Micronutrients without Consuming Fortified ProductsNutr Cancer2018;70(3):474482. Available from: https://doi.org/10.1080/01635581.2018.1445767
  64. Munter LD, Maasland DH, Brandt PAVD, Kremer B, Schouten LJ. Vitamin and carotenoid intake and risk of head-neck cancer subtypes in the Netherlands Cohort StudyThe American Journal of Clinical Nutrition2015;102(2):420432. Available from: https://doi.org/10.3945/ajcn.114.106096
  65. Nett H, Steegmann J, Tollkühn-Prott B, Hölzle F, Modabber A. A prospective randomized comparative trial evaluating postoperative nutritional intervention in patients with oral cancerScientific Reports2022;12(1). Available from: https://doi.org/10.1038/s41598-022-18292-8
  66. Melo ADS, Dantas JBDL, Medrado ARAP, Lima HR, Martins GB, Carrera M. Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary reviewClinical Nutrition ESPEN2021;43:3138. Available from: https://doi.org/10.1016/j.clnesp.2021.03.030
  67. Rao S, Kalekhan F, Hegde SK, Rao P, Suresh S, Baliga MS. Serum zinc status and the development of mucositis and dermatitis in head-and-neck cancer patients undergoing curative radiotherapy: A pilot studyJournal of Cancer Research and Therapeutics2022;18(1):4248. Available from: https://doi.org/10.4103/jcrt.jcrt_344_20
  68. Hoppe C, Kutschan S, Dörfler J, Büntzel J, Büntzel J, Huebner J. Zinc as a complementary treatment for cancer patients: a systematic reviewClinical and Experimental Medicine2021;21(2):297313. Available from: https://doi.org/10.1007/s10238-020-00677-6
  69. Nascimento RB, Leite ÉGDS, Dantas JBDL, Costa TF, Martins GB, Carrera M, et al. Zinc supplementation in the management of oral mucositis in head and neck cancer patients: narrative literature review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology2022;134(3):E234. Available from: https://doi.org/10.1016/j.oooo.2022.01.750
  70. Shuai T, Yi LJJ, Tian X, Chen WQQ, Chen HQ, Li NE. Prophylaxis with oral zinc sulfate against radiation-induced oropharyngeal mucositis in patients with head and neck cancerMedicine2018;97(48):e13310. Available from: https://doi.org/10.1097/md.0000000000013310
  71. Menêses AG, Normando AGC, Toledo IPD, Reis PED, Guerra ENS. Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta‐analysis of randomized clinical trialsJournal of Oral Pathology & Medicine2020;49(2):117125. Available from: https://doi.org/10.1111/jop.12901
  72. Torgersen Z, Balters M. Perioperative NutritionSurgical Clinics of North America2015;95(2):255267. Available from: https://doi.org/10.1016/j.suc.2014.10.003
  73. Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, González-Navarro I, Remón-Ruíz PJ, Pereira-Cunill JL, et al. Perioperative Nutritional Support: A Review of Current LiteratureNutrients2022;14(8):1601. Available from: https://doi.org/10.3390/nu14081601
  74. Moore C, Pegues J, Narisetty V, Spankovich C, Jackson L, Jefferson GD. Enhanced Recovery After Surgery Nutrition Protocol for Major Head and Neck Cancer SurgeryOTO Open2021;5(2). Available from: https://doi.org/10.1177/2473974x211021100
  75. Ljungqvist O. ERAS--enhanced recovery after surgery: moving evidence-based perioperative care to practiceJPEN J Parenter Enteral Nutr2014;38(5):559566. Available from: https://doi.org/10.1177/0148607114523451
  76. Coyle MJ, Main B, Hughes C, Craven R, Alexander R, Porter GR, et al. Enhanced recovery after surgery (ERAS) for head and neck oncology patientsClinical Otolaryngology2016;41(2):118126. Available from: https://doi.org/10.1111/coa.12482
  77. Bertazzoni G, Testa G, Tomasoni M, Mattavelli D, Bon D, Montalto F, et al. The Enhanced Recovery After Surgery (ERAS) protocol in head and neck cancer: a matched-pair analysisActa Otorhinolaryngol Ital2022;42(4):325333. Available from: https://doi.org/10.14639/0392-100x-n2072
  78. Prasad A, Chorath K, Barrette LX, Go B, Deng J, Moreira A, et al. Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients: Considerations and best practicesWorld J Otorhinolaryngol Head Neck Surg2022;8(2):9195. Available from: https://doi.org/10.1002/wjo2.20
  79. Martindale RG, Mcclave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape? JPEN J Parenter Enteral Nutr2013;37(5S):520. Available from: https://doi.org/10.1177/0148607113496821
  80. Nesemeier R, Dunlap N, Mcclave SA, Tennant P. Evidence-Based Support for Nutrition Therapy in Head and Neck CancerCurrent Surgery Reports2017;5(8):18. Available from: https://doi.org/10.1007/s40137-017-0179-0
  81. Rowan NR, Johnson JT, Fratangelo CE, Smith BK, Kemerer PA, Ferris RL. Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patientsOral Oncology2016;54:4246. Available from: https://doi.org/10.1016/j.oraloncology.2016.01.006
  82. Pogatschnik C, Steiger E. Review of Preoperative Carbohydrate LoadingNutrition in Clinical Practice2015;30(5):660664. Available from: https://doi.org/10.1177/0884533615594013
  83. Mörbe UM, Jørgensen PB, Fenton TM, Burg NV, Riis LB, Spencer J, et al. Human gut-associated lymphoid tissues (GALT); diversity, structure, and functionMucosal Immunology2021;14(4):793802. Available from: https://doi.org/10.1038/s41385-021-00389-4
  84. Stahl MG, Belkind-Gerson J. 1 - Development of the Gastrointestinal TractPediatric Gastrointestinal and Liver Disease (Sixth Edition)2021;p. 210.e2. Available from: https://doi.org/10.1016/b978-0-323-67293-1.00001-3
  85. Szefel J, Kruszewski WJ, Buczek T. Enteral feeding and its impact on the gut immune system and intestinal mucosal barrierGastroenterology Review2015;2(2):7177. Available from: https://doi.org/10.5114/pg.2015.48997
  86. Delaney SW, Shi H, Shokrani A, Sinha UK. Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment StrategiesInternational Journal of Otolaryngology2017;2017:112. Available from: https://doi.org/10.1155/2017/8362874
  87. Kawasaki N, Suzuki Y, Nakayoshi T, Hanyu N, Nakao M, Takeda A, et al. Early postoperative enteral nutrition is useful for recovering gastrointestinal motility and maintaining the nutritional statusSurgery Today2009;39(3):225230. Available from: https://doi.org/10.1007/s00595-008-3861-0
  88. Crumley RL, Smith JD. Postoperative chylous fistula prevention and managementThe Laryngoscope1976;86(6):804813. Available from: https://doi.org/10.1288/00005537-197606000-00008
  89. Ilczyszyn A, Ridha H, Durrani AJ. Management of chyle leak post neck dissection: A case report and literature reviewJournal of Plastic, Reconstructive & Aesthetic Surgery2011;64(9):e223e230. Available from: https://doi.org/10.1016/j.bjps.2010.12.018
  90. Jiang H, Deng XF, Duan CM, Chen C, Xiang JL, Lu YL, et al. Somatostatin receptors SSTR2 and SSTR5 are expressed in the human thoracic ductLymphology2011;44(1):2128. Available from: https://pubmed.ncbi.nlm.nih.gov/21667819/
  91. 2nd BG, Janis JE, Attinger CE. The basic science of wound healingPlast Reconstr Surg2006;117(7):12S34S. Available from: https://doi.org/10.1097/01.prs.0000225430.42531.c2
  92. Berbée C, Marx JP, Voelker MT, Schotte D, Bercker S. Parenteral nutrition in palliative care: single-centre observational studyBMJ Supportive & Palliative Care2022. Available from: https://doi.org/10.1136/bmjspcare-2022-003581
  93. Murai M, Higashiguchi T, Ohara H, Katsura N, Futamura A, Nakayama N. Multicentric prospective study of effect of dietary intake on quality of life for patients with end-stage cancersFujita Med J2020;6(1):16. Available from: https://doi.org/10.20407/fmj.2018-023
  94. Sánchez-Sánchez E, Ruano-Álvarez MA, Díaz-Jiménez J, Díaz AJ, Ordonez FJ. Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic ReviewNutrients2021;13(5):1562. Available from: https://doi.org/10.3390/nu13051562
  95. Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, et al. ESPEN guideline on ethical aspects of artificial nutrition and hydrationClinical Nutrition2016;35(3):545556. Available from: https://doi.org/10.1016/j.clnu.2016.02.006
  96. Tagliaferri S, Lauretani F, Pelá G, Meschi T, Maggio M. The risk of dysphagia is associated with malnutrition and poor functional outcomes in a large population of outpatient older individualsClinical Nutrition2019;38(6):26842689. Available from: https://doi.org/10.1016/j.clnu.2018.11.022
  97. Reber E, Gomes F, Dähn IA, Vasiloglou MF, Stanga Z. Management of Dehydration in Patients Suffering Swallowing DifficultiesJ Clin Med2019;8(11):1923. Available from: https://doi.org/10.3390/jcm8111923


© This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Published By India Association for Parenteral and Enteral Nutrition (IAPEN)


Subscribe now for latest articles and news.