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 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.

One positive quality RCT evaluated treatment with a formula containing HMB, L-glutamine and L-arginine in Stage IV cancer patients.  At 4 weeks, weight changes were not significant in the treatment group. At 12 weeks, weight gain of the treatment group from baseline (2.27+1.17 kg) was significant (p<.05).  Intent to treat analysis at 24 weeks, at which point only 9 patients completed the protocol, showed a trend toward a significant increase in FFM and weight.  More research is needed.  

• 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.