• Intervention
    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 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 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 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