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A 46-year-old man with no co-morbidity was diagnosed with Right supraglottic squamous cell carcinoma in November 2016. He has no family history of malignancy.
Patient was admitted to ward due to right neck swelling with pus discharge; increasing trend of White Blood Cell (WBC) and persistent wound infection prior chemotherapy despite on various antibiotics. During the first visit, the patient’s weight was 60.5kg, BMI 22kg/m2 and Subjective Global Assessment (SGA) score B. Patient was on Percutaneous Endoscopic Gastrostomy (PEG) tube feeding with standard enteral product added WPC which provide 26Kcal/kg energy and 1.1g/kg protein. Estimated intake was 71% from energy and protein requirement.
Patient’s compliance was the main issue upon admission, nutrition diagnosis was inadequate enteral nutrition infusion related to infusion volume not reached as evidence by inadequate energy intake compared to requirement. Subsequently, it turned to increase nutrient needs related to increased protein demand as evidence by delayed wound healing.
Due to wound infection and weight loss of 2.5%, the initiate main goal was to preserve body weight and improve nutritional status with high protein. However, patient has persistent reducing trend of albumin despite on 1.9g/kg protein for 4 weeks, therefore quality of protein has been changed from WPC to WPI with same strength of 1.9g/kg protein for another 4 weeks.
Patient’s weight gains and albumin increased from 28g/L to 35g/L after compliance to PEG feeding of 37Kcal/kg energy and 1.9g/kg protein consist 31% of WPI. Good improvement of wound and completed 3 cycles of chemotherapy. The isolated whey protein separates whey from lactose, ash, fats and carbs which provide 92% protein while WPC only provide 79% of protein for same serving size.
Higher content of whey protein in WPI appear to modulate immune function effectively by boosting glutathione (GSH) production in various tissue especially in wound healing.
WPI is effective in improving albumin as well as immune system. This case has result the importance of quality of protein for wound healing. Further study with more subjects is recommended