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A 50-years-old man with underlying disease of morbid obesity BMI 57kg/m2, hypertension, hyperlipidemia, Obstructive Sleep Apnea(OSA) and Chronic Kidney Disease(CKD) stage III was diagnosed with Buccal mucosa carcinoma in March 2015. He has no family history of malignancy.
During first visit, patient’s weight was 173.6kg, BMI 57kg/m2, 50.9% fat and Subjective Global Assessment(SGA) score A.
Nutrition diagnosis was excessive energy intake related to food and nutrition knowledge deficit as evidenced by dietary history and morbid obesity BMI 57kg/m2 prior radiotherapy Weight maintenance is important during radiotherapy, it turns to increase energy expenditure related to increase nutrient needs due to catabolic condition as evidenced by ongoing radiotherapy
Due to morbid obesity and OSA, patient was referred to dietitian for weight loss prior radiotherapy about healthy food choices and eating behaviour. The main goal during radiotherapy was to preserve body weight and maintain nutritional status. Long-term post treatment goal was to achieve ideal body weight with gradual weight loss of 0.5kg to 1kg per week.
Bioelectrical impedance analysis(BIA) was used to analyse body composition. Patient has reduced weight to 167kg prior radiotherapy. Patient’s weight was 154.8kg and BMI 51.1kg/m2 after completed radiotherapy. BIA results revealed total weight loss was 10.5% with fat mass loss 8.3% while muscle mass loss 2.2%. This indicated that patient has higher fat mass loss rather than muscle mass. Nutrition support preserves muscle mass eventhough weight loss occurs. Patient’s hemoglobin, albumin and renal function remain normal and weight recorded after 9 months post radiotherapy was 121.3kg with BMI 40.3kg/m2.
Regular nutrition intervention is necessary to improve a patient’s nutritional status before, during and after radiotherapy. For radiotherapy patients, especially those who are obese, body composition assessment is recommended for monitoring rather than BMI. Early and intensive nutrition support appears to minimize the loss of weight and fat-free mass