NUTRITIONAL AND ZINC STATUS OF HEAD AND NECK-CANCER PATIENTS - AN INTERPRETIVE REVIEW

In this review, we provide evidence based on our studies, for zinc def iciency and cell mediated immune disorders, and the effects of protein and zinc status on clinical morbidities in patients with head and nec k cancer. We investigated subjects with newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx. Pat ients with metastatic disease and with severe co-morbidity were exclud ed. Nutritional assessment included dietary history. body composition, and prognostic nutritional index (PNI) determination. Zinc status was determined by zinc assay in plasma, lymphocytes, and granulocytes. Pr etreatment zinc status and nutritional status were correlated with cli nical outcomes in 47 patients. Assessment of immune functions included production of TH1 and TH2 cytokines, T cell subpopulations and cutane ous delayed hypersensitivity reaction to common antigens. At baseline approximately 50% of our subjects were zinc-deficient based on cellula r zinc criteria and had decreased production of TH1 cytokines but not TH2 cytokines, decreased NK cell lytic activity and decreased proporti on of CD4+ CD45RA+ cells in the peripheral blood. The tumor size and o verall stage of the disease correlated with baseline zinc status but n ot with PNI, alcohol intake, or smoking. Zinc deficiency was associate d with increased unplanned hospitalizations. The disease-free interval was highest for the group which had both zinc sufficient and nutritio n sufficient status. Zinc deficiency and cell mediated immune dysfunct ions were frequently present in patients with head and neck cancer whe n seen initially. Zinc deficiency resulted in an imbalance of TH1 and TH2 functions. Zinc deficiency was associated with increased tumor siz e, overall stage of the cancer and increased unplanned hospitalization s. These observations have broad implications in the management of pat ients with head and neck cancer.