Nutritional condition in oral squamous cell carcinoma patient – an observation study

Nutritional condition in oral squamous cell carcinoma patient – an observation study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nutritional condition in oral squamous cell carcinoma patient – an observation study Caroline Wurche, Julia Wirth, Johannes Kleinheinz, Lauren Bohner, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8144821/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Mar, 2026 Read the published version in Head & Face Medicine → Version 1 posted 12 You are reading this latest preprint version Abstract Background Cancer related malnutrition is an often-disregarded problem with a lack of knowledge and standards concerning diagnosis and therapy. Especially patients with oral squamous cell cancer can suffer not only from metabolic factors but also from aggravated oral food intake. This study examines the problem of malnutrition in patients with oral squamous cell carcinoma (OSCC) before diagnosis and under treatment. Methods The nutritional status of 30 patients with OSCC was registered before and after surgical treatment, with a time interval of 16 weeks. The methods applied were body mass index (BMI), subjective global assessment (SGA) and bioelectrical impedance analysis (BIA). The control group consisted of 30 patients planned for orthognathic surgery. Equal for both groups were comparable nutrition via nasogastric tube. Data were analysed and tested for significance with a level of p = 0.05. Results The control group showed a moderate malnutrition status during hospital stay according to SGA. This improved in the course of therapy to a good status in nearly all cases. In contrast, only 6% of OSCC patients start with a good nutritional status, but this group enhances nearly up to 50% during therapy, although two patients ended up with severe malnutrition. The cellular share of the control group increased over time from 46.3 to 49.7%, while body fat decreased constantly from 20.8 to 18.0 kg (p < 0.05). Conclusion Malnutrition is a relevant problem in patients with OSCC due to the high prevalence in this population, which was confirmed in these data. Appropriate diagnostic tools and an adapted treatment concept in terms of application form and ingredients as well as supplements should be an integral part of the treatment concept for these patients. malnutrition OSCC nutritional status observation study nutrition treatment cancer-related cachexia Figures Figure 1 Background The treatment of cancer patients usually includes multimodal concepts, with the implementation of various disciplines in interdisciplinary teams. Even if the prevalence and consequences of cancer-related cachexia are well known, the problem of malnutrition is often disregarded by all involved participants. Hence, patients are left alone and may seek questionable so-called cancer diets via the internet. At the time of diagnosis already 54% of all cancer patients notice a loss of weight and over 25% of all cancer patients die only due to the malnutrition [ 1 – 3 ]. There is a lack of knowledge and standards in the diagnosis of malnutrition and clinical nutrition in all professions. This issue is just considered to be facultative instead of a mandatory part of the therapy with no concrete assignment of responsibility to any profession [ 3 – 6 ]. The causal of this issue is, especially in the case of oral squamous cancer (OSCC), the aggravated oral food intake. However, in addition, for all oncological diseases, cancer related multifactorial changes can be summarized as cancer related cachexia. This term includes the metabolic shift due to the cancer related inflammation with the loss of fat and muscle tissue and the reduced food intake because of physical and mental stress. Further, the term includes hypercatabolism with insulin resistance, hyperglycaemia, protein loss, anaemia, fatigue, and infection susceptibility [ 2 , 7 , 8 ]. This creates a vicious circle of reduced mobility, reduced power, and lethargy with a loss of life quality, complication, and, ultimately, morbidity and mortality [ 2 , 9 – 13 ]. In the treatment of the OSCC, malnutrition is mentioned in the current German guidelines. On the one hand, patients should receive a professional nutrition therapy in early stage. Otherwise, there are no tools or standards recommended how to diagnose or conduct this nutrition therapy [ 8 , 13 – 15 ]. Nevertheless, there are different definitions and measuring methods published to diagnose a cancer-related malnutrition. One method for describing the nutritional status of patients is to determine body weight and, for easy adjustment, to calculate the body mass index (BMI) as the ratio of body weight to height squared. The BMI, or generally weight control, as a simple and easy workable technique, is a good part for monitoring the nutritional status. For further adjustments, there are tables with age, sex or different classifications of the nutritional status like underweight, healthy, overweight or obesity. Underweight, according to the World Health Organization (WHO) is defined as having a BMI below 18.5 kg/m² [ 16 ]. This should be extended to include the aetiology. A classification is provided by guidelines of The European Society for Clinical Nutrition and Metabolism (ESPEN), in which the term of cancer cachexia is found, subsumed in the category of disease-related malnutrition. The definition of Fearon is used here, which has been expanded to include the following criteria: with weight loss > 5% over the past 6 months or BMI below 20 kg/m² and any degree of weight loss > 2%; or appendicular skeletal muscle index consistent with sarcopenia (males < 7-·26 kg/m²; females 2%[ 8 ]. The American Society of Parenteral and Enteral Nutrition (ASPEN) in turn uses 6 diagnostic criteria such as low-energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, and hand grip strength [ 17 ]. But there are other frequently used diagnostic methods with additional measuring methods. To enhance the unidimensional parameter of BMI and include more anamnesis and clinical examination other assessments have been developed and are recommended [ 13 ]. An established, often used and therefore comparable example is the subjective global assessment (SGA) by Detsky [ 18 ]. The SGA is separated into three sections: the medical history, the physical examination with a focus on malnutrition-specific changes, such as measurement of subcutaneous adipose tissue, muscle atrophy or oedema in defined areas of the body, and the subjective assessment of the nutritional status by a qualified examiner, finally. The focus lies on weight loss, dietary intake change, loss of subcutaneous fat tissue, and muscle atrophy. This results in a three-level categorization of good (category A), moderately malnourished (B) or severe malnourished (C) [ 18 ]. Another tool for determining nutritional status with the advantage of providing objective and comparable data is the bioelectrical impedance analysis (BIA). The BIA measures the different electrical conductivity of tissues and therefore shows the change of the body compartments with the possibility for further description of malnutrition. It is the standard procedure to determine the individual body compartments based on the three components total body water, body fat, and lean body mass (LBM). The lean body mass is subdivided into body cell mass (BCM) and extracellular mass (ECM). This method is based on the different electrical conductivity of different tissues. With the loss of skeletal muscles and body fat, the BCM decreases while ECM increases, the LBM remains constant. Especially, the loss of muscle causes a shift of intracellular body water to extracellular, which strongly distinguishes tumour related cachexia from starvation metabolism [ 19 – 21 ]. Patients were categorized as malnourished if at least two of the three decisive parameters such as phase angle ( 1), % cell ratio (< 35% for men, < 30% for women) deviated from the norm due to malnutrition according to manufacture protocols. There are various values discussed in the literature for the constellation of the relevant parameters and their cut-off values; we decided in favour of the standard values specified by the manufacturer [ 21 , 22 ].The aim of this study is to assess the extent of the problem of malnutrition in patients with OSCC. By comparing the BMI, the SGA score and the BIA measurement method, the best instrument for initial diagnosis and follow-up should be determined. In addition, the course of the nutritional status peri-operatively should be recorded and compared with a healthy collective who have received a comparable nasogastric diet. Methods Study design and ethics approval In the obtaining study, the nutritional status of 30 patients with histological verified primary OSCC was determined during the cancer treatment and afterwards with a time interval of 4 months. All patients were first treated surgically and, if necessary, received adjuvant radio(chemo)therapy in accordance with the interdisciplinary tumour conference decision. As a control group, 30 patients undergoing orthognathic surgery were included. Equal for all groups was a standardized nutrition via nasogastric tube. Inclusion and exclusion criteria were determined in general: Included: age over 18 years, agreement to the study protocol, participation in examinations and completed follow-up over 4 months. Excluded were patients with any other oncological diagnosis or relapse, also patients with gastrointestinal diseases such as chronic inflammatory bowel disease or gluten-related disorders. Further pregnant women, person with a pacemaker, or an implanted cardioverter-defibrillator, or likewise devices. The study was designed according to the “Declaration of Helsinki” and approved by the Ethics Committee of the Faculty of Medicine, University of Muenster (#2018-642-f-S). A written informed consent was obtained from all patients. Body-Mass-Index (BMI) The BMI was estimated with an electrical column scale (type 769, SECA, Hamburg, Germany). During measurement, the patient stands lightly dressed upright and flat on the scale. Patients were included in BMI categories, according to the World Health Organization (WHO): mild thinness ( 40 kg/m 2 ) [ 16 ]. Subjective Global Assessment (SGA) The SGA was performed according to Detsky [ 18 ]. A well-trained examiner performed the examination steps. The SGA was separated into three parts: the anamnesis, a physical examination, and afterwards the subjective assessment about the nutritional status. The patients were grouped as A) well nutritional status, B) moderate malnourished, and C) severe malnourished[ 18 , 23 ][ 18 , 23 ][ 17 , 21 ] 17,21 . For grouping, no weighted scoring system was used. Patients were classified as moderately malnourished, when patients lost 5% of body weight without any earlier recognized stabilizations nor weight gain and in addition, a loss in food supply and a mild subcutaneous tissue loss. Patients were included in a severe malnutrition status, when patients lost at least 10% of body weight, a severe loss of subcutaneous fat and muscle mass, and the occurrence of oedema. Bioelectrical impedance analysis (BIA) The BIA was performed by a well-trained examiner according to manufacture protocols with the Bioelectrical Impedance Analyzation Nutribox with electrodes (BIANOSTOC AT, Data Input GmbH, Pöcking, Germany). Before examination, patients remained fasting for at least four hours without being physically active for at least 12 hours. The bladder was emptied before measurement. No alcohol was consumed for at least 24 hours. For measurement, the patients lay flat and horizontal in the supine position on a non-conductive surface at complete physical rest. Electrodes were placed, according to manufacture protocols, on hand and foot of the dominant side of the body. Hand and foot were unclothed and free of compressive bandages. To ensure that the patient's blood volume and body water were distributed evenly throughout the body the patient remained nearly 10 min in this position before measurements starts according to manufacture protocols. Statistical Analysis Statistical analysis was performed with the software SPSS Version 29 (IBM). Changes in nutritional status of tumour patients 4 months after the surgical procedure were assessed and compared with the baseline (pre-operative measurements). All tests were performed considering a statistical significance level of p = 0.05. The variables dielectric phase angle, BMI, weight, and body fat were assessed as dependent variables. Time was set as an independent variable. Results The study was performed during 2019 and 2020 in our department. In both groups, 30 patients each were included. The median age was 25 years in the control group and 64 years in the OSCC groups. The prevalence of men was in both groups higher, 63% in the control group and 77% in the OSCC group. The mean nutrition time via nasogastric tube was 16 days, with a hospital stay of 18.9 days in the OSCC group. In addition, 2.9 days with a hospital stay of 7.6 days in the control group. In contrast, the control group received nutrition via nasogastric tube for 2.9 days, with a hospital stay of 7.6 days in the control group. In the OSCC group, complications were reported in 12 cases. In six cases, wound healing impairments occurred. Two patients suffered from dysphagia. In other cases, patients underwent a re-resection, a radial flap revision, atrial fibrillation and optic nerve ischaemia, respectively. In the control group, a total of three patients showed a complication, with the development of a perimandibular abscess in two cases and paraesthesia in one case. In table 1, a comparative overview between the control group and the OSCC group is shown. Based on the comparative analysis from the SGA, patients from the control group showed a moderate malnutrition status during hospital time. Nutritional status raised to a good status in nearly all cases. In contrast, only 6% of OSCC patients starts with a good nutritional status. During treatment time and afterwards, the ratio rose to nearly 50% of OSCC patients. However, two patients ended up with severe malnutrition (table 1). In figure 1, results from BIA and BMI are summarised. Except for the BIA parameter body water (p=0.12), observed differences of measurable data from BMI and BIA measurements were statistically significant with a p<0.05. In the OSCC group, BMI fell by 2 points over time. The BMI ranged between 24 and 26. In the control group, the BMI remained constantly within a variation of 1.5 points (figure 1). In the control group, two patients with obese category II and III were included and one patient with a mild thinness (table 1). The BMI of all three patients altered during examination time, but there were no changes in category observable. The amount of body water sunk in both groups during the first days. Afterwards, the amount of body water increased in the OSCC group (figure 1). In the control group, the cellular share levels between 54.7 and 55.5%. Therefore, in the OSCC group, it increased from 46.3 to 49.7% continuously. The amount of body fat levels between 17.7 and 18.4 kg in the control group and decreased constantly during the observation time from 20.8 to 18.0 kg in the OSCC group (figure 1). In the OSCC group, the BCM decreased during the first weeks and increased afterwards continuously. On the other hand, the ECM decreased in this group constantly. The BCM/ECM index decreased to an end value of nearly one, accordingly (figure 1). In the control group, the BCM decreased over time and the ECM remained constant. The BCM/ECM index levels between the values of 0.8 for the whole examination period. For the dielectric phase angle, there was a comparable shift. In the control group, the value levels between 6.78 and 6.6° during the examination period. In the OSCC group, the angle increased from 4.9 to 5.5° continuously. Discussion In this study, we monitored changes in the nutritional status of OSCC patient before and after surgical treatment, with a time interval of 4 months. The study again showed, how important a controlling group is, also in an observation study. With this control group, a punctuation of observed results is possible. A scientific correct and comparable control group against a tumour group is all but impossible and ethical questionable. At the first glance, both groups are incommensurable. Nevertheless, on closer examination, both groups got the same standardized non-individualised dietetic treatment by a nutrition tube. The control group received the tube feeding just for 1–5 days and the OSCC group for 7–28 days. Knowing the disparity, we focused our study mainly on the OSCC group, but there were also unexpected results from the control group. In this study, the BMI shows no case of malnutrition. Unlike the SGA and the BIA, which showed prevalence’s of malnutrition in the study population with OSCC of 80% and 60%, respectively. Concerning malnutrition, BMI as a standalone parameter is far from sufficient according to this data because essential factors are not recognised. These data therefore underline the need for specialised assessments such as SGA or BIA [ 3 ]. The definition of a gold standard would be desirable to enable good comparability of the data, as different assessments are currently being made in different studies and there are no detailed data available with the criteria selected by Fearon for cancer cachexia [ 8 ]. In this study we were able to demonstrate that SGA and BIA, in contrast to BMI, exhibited a similar tendency and detected patients at risk more frequently. This was also seen in the control group. Orthognatic control group is expected to be younger due to higher incidence of dysgnathia in younger age, which is proved in our data with a median age of 25 years comparable to 64 years in OSCC group. OSCC group is expected having more comorbidities caused by different factors like nicotine, alcohol abuses and increasing diseases in higher age, which was not subject of his study. Pre-operative, no patient showed signs of malnutrition according to the SGA. Within the first 4 weeks postoperatively, however, nearly 50% switched to category B, i.e. were moderately malnourished. At the end of the observation period after 4 months, 83.3% of the patients had recovered to category A. Awareness of malnutrition in the context of such interventions seems to be limited to a few studies, often focusing only on weight, but showing similar tendencies [ 24 – 26 ]. For the OSCC group, this study observed that already about 6 months before treatment, 87% of OSCC patients reported a weight loss. This number seems to be very high compared to reported prevalence rates of weight loss with 54% over all oncology patients 6 months before diagnosis [ 1 – 3 ]. The possible cause in OSCC patients could be impaired food intake due to local mechanical restrictions. A more pronounced inflammation with increased catabolism or comorbidities resulting from the risk factors are also conceivable causes [ 2 , 7 , 8 ]. This underlines the usefulness of the definition of Fearon and ESPEN to consider the anamnestic weight loss. With this study, we could demonstrate that this unspecific dietetic treatment influenced strongly the nutritional status and alleviate malnutrition in OSCC patients. The nutritional status, as assessed by SGA and BIA, showed significant reductions under simple, non-individualised nutritional therapy utilising standardized nutrition via tube during post-operative hospitalisation. At the beginning of the study, 20% of OSCC patients showed an SGA category A and raised up to 50% of OSCC patients at the end. However, a small proportion of 13% of the OSCC collective (n = 4) also deteriorated during therapy and fell into the worst category C of the SGA, severe malnutrition, suspected caused by the exhausting oncological therapy, psychological factors or morbidities due to surgery and possibly adjuvant radiotherapy. The data from the BIA gave the most reliable information about shifts in nutrition’s status. In the OSCC group, this angle raised continuity to 5.5° during time. Further, the amount of body fat sank, and the amount of muscle mass raised simultaneously in this group. The BCM/ECM ratio sank to a value of nearly one, deductively. In the control group, the BCM/ECM ration levels at 0.8 during time. Caped all BIA values, a regeneration from malnutrition to a better nutritional status was observable in the OSCC group. The early changes in nutritional status could be explained by the surgery and circumstances itself comparable to the control group. These similar results and developments in SGA and BIA mean that both methods can be regarded as suitable based on this data, whereas the cut- offs of the BIA should be reviewed. There is a certain range in the literature, which could be a reason for Barbosa-Silva to conclude that the two methods are less similar in their significance [ 27 ]. This study showed how important diagnosis, monitoring, and therapy of malnutrition for patient’s outcome is. Not only concerning oncological patients, but also patients like the control group with orthognathic surgery or potentially with any kind of head and neck surgery. In particular, change in oral food intake due to local restrictions and intermaxillary fixation should be considered. Furthermore, this simple, non- individualized standardised nutrition therapy could change hospital stay and nutritional status of oncological and orthognathic surgery patients. It can even be assumed that this should also be important for other indication groups in the head and neck surgery. This study provides the comparative data for further studies to investigate the effect of different nutritional therapies and the effect on various parameters such as BMI, SGA, BIA and in perspective blood parameters concerning nutrition (e.g. albumin, LDL, HDL etc.), hospitalisation, prognosis, morbidity, mortality, quality of life and patient reported outcome. Observational studies with professional individualized nutrition therapy should follow to verify these data. In a relevant proportion of OSCC patients over 80 years, data should also be collected with various groups of age to distinguish tumour-associated cachexia from frailty in the elderly. The requirement is to use assessments to diagnose malnutrition early and establish a standardized follow-up to prevent its multiple consequences. This is already stipulated in the German guideline of OSCC, but concrete recommendations for implementing an assessment or nutritional concepts have yet to be established. Especially in the field of head and neck surgery, not only the form of application but also the composition should be taken into focus of all participants. This requires the awareness, cross-sectoral and interdisciplinary cooperation at all points of time from prehabilitation to follow- up. Conclusion Malnutrition is a relevant problem in patients with OSCC, as the prevalence in this population group is very high. This was confirmed by our results. Appropriate valid diagnostic tools and an adapted individualized treatment concept should be an integral part of the treatment concept for these patients. Professional dietary treatment is necessary and should be provided from the time of diagnosis until aftercare. Patients must not be left alone with this problem. Especially in relation to some of the dubious so-called cancer diets on the Internet. We call for an individualized concept about the form of application and ingredients as well as supplements for each patient. Abbreviations OSCC oral squamous cell carcinoma BMI body mass index SGA subjective global assessment BIA bioelectrical impedance analysis WHO World Health Organization ESPEN The European Society for Clinical Nutrition and Metabolism ASPEN The American Society of Parenteral and Enteral Nutrition LBM lean body mass BCM body cell mass ECM extracellular mass LDL Low density lipoprotein HDL High density lipoprotein Declarations Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the Faculty of Medicine, University of Muenster (#2018-642-f-S). A written informed consent was obtained from each patient. Consent for publication: Not applicable. Availability of data and materials: The datasets analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare no conflict of interest. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions: Study concepts: C.W. and J.W.; study design: C.W., J.W. and J.K; data acquisition: J.W.; quality control and interpretation: C.W. and L.B.; data analysing and interpretation: C.W. and S.S.; statistical analysis: L.B.; manuscript preparation: C.W. and S.S.; manuscript editing: C.W. and S.S.; manuscript review: J.K. All authors have read and agreed to the published version of the manuscript. Acknowledgements: We thank Sebastian Igelbrink for academically advice. We thank Nancy Thielscher (physician assistant) for helping in data acquisition. We acknowledge support from the Open Access Publication Fund of the University of Muenster. References Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7. doi:10.1016/s0149-2918(05)80001-3. Arends J. Ernährung von Tumorpatienten. Aktuel Ernahrungsmed. 2012;37:91–106. doi:10.1055/s-0031-1277005. Löser C, Fruehauf S, Müller M, Brück P, Hahn L, Lange O, et al. Moderne Ernährungstherapie bei onkologischen Patienten – ein Positionspapier. Aktuel Ernahrungsmed. 2014;39:127–31. doi:10.1055/s-0034-1369885. Spiro A, Baldwin C, Patterson A, Thomas J, Andreyev HJN. The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br J Cancer. 2006;95:431–4. doi:10.1038/sj.bjc.6603280. Kopelman P, Lennard-Jones J. Nutrition and patients: a doctor's responsibility. Clin Med (Lond). 2002;2:391–4. doi:10.7861/clinmedicine.2-5-391. Löser C. Nutrition in Modern Oncology. 1st ed. Bremen: UNI-MED Verlag; 2013. Lucia S, Esposito M, Rossi Fanelli F, Muscaritoli M. Cancer cachexia: from molecular mechanisms to patient's care. Crit Rev Oncog. 2012;17:315–21. doi:10.1615/critrevoncog.v17.i3.90. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95. doi:10.1016/S1470-2045(10)70218-7. Caburet C, Farigon N, Mulliez A, Mom T, Boirie Y, Gilain L, Saroul N. Impact of nutritional status at the outset of assessment on postoperative complications in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137:393–8. doi:10.1016/j.anorl.2019.12.005. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5–15. doi:10.1016/j.clnu.2007.10.007. Fearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol. 2013;10:90–9. doi:10.1038/nrclinonc.2012.209. Kang MC, Kim JH, Ryu SW, Moon JY, Park JH, Park JK, et al. Prevalence of Malnutrition in Hospitalized Patients: a Multicenter Cross-sectional Study. J Korean Med Sci. 2018;33:e10. doi:10.3346/jkms.2018.33.e10. Löser C. Malnutrition in hospital: the clinical and economic implications. Dtsch Arztebl Int. 2010;107:911–7. doi:10.3238/arztebl.2010.0911. Pirlich M, Schwenk A, Müller MJ. DGEM-Leitlinie Enterale Ernährung: Ernährungsstatus. Aktuelle Ernährungsmedizin. 2003;28:10–25. doi:10.1055/s-2003-36934. Wolff. S3-Leitlinie Mundhöhlenkarzinom: Leitlinienprogramm Onkologie (Deutsche Krebsgesell-schaft, Deutsche Krebshilfe, AWMF) (2021): S3-Leitlinie Diagnostik und Therapie des Mundhöhlen-karzinoms, Langversion 3.0, 2021, AWMF-Registernummer: 007/100OL, https://www.leitlinien-programm-onkologie.de/leitlinien/mundhoehlenkarzinom/ (zuletzt aufgerufen am: 22.08.2021). 2021. Weir CB, Jan A. StatPearls: BMI Classification Percentile and Cut Off Points. Treasure Island (FL); 2024. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36:49–64. doi:10.1016/j.clnu.2016.09.004. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987;11:8–13. doi:10.1177/014860718701100108. Kyle UG, Bosaeus I, Lorenzo AD de, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis--part I: review of principles and methods. Clin Nutr. 2004;23:1226–43. doi:10.1016/j.clnu.2004.06.004. Grundmann O, Yoon SL, Williams JJ. The value of bioelectrical impedance analysis and phase angle in the evaluation of malnutrition and quality of life in cancer patients--a comprehensive review. Eur J Clin Nutr. 2015;69:1290–7. doi:10.1038/ejcn.2015.126. Małecka-Massalska T, Smoleń A, Morshed K. Extracellular-to-body cell mass ratio and subjective global assessment in head-and-neck cancers. Curr Oncol. 2014;21:e62-6. doi:10.3747/co.21.1671. Büntzel J, Krauß T, Büntzel H, Küttner K, Fröhlich D, Oehler W, et al. Nutritional parameters for patients with head and neck cancer. Anticancer Res. 2012;32:2119–23. Schütz T, Plauth M. Subjective Global Assessment - A Method for the Assessment of Nutritional State. Akt Ernähr Med. 2005;30:43–8. doi:10.1055/s-2004-834559. Irgebay Z, Beiriger JC, Beiriger JW, Matinrazm S, Natali M, Yi C, et al. Review of Diet Protocols Following Orthognathic Surgery and Analysis of Postoperative Weight Loss. Cleft Palate Craniofac J. 2023;60:1411–8. doi:10.1177/10556656221113998. Ooi K, Inoue N, Matsushita K, Yamaguchi H, Mikoya T, Kawashiri S, Tei K. Body Weight Loss After Orthognathic Surgery: Comparison Between Postoperative Intermaxillary Fixation with Metal Wire and Elastic Traction, Factors Related to Body Weight Loss. J Maxillofac Oral Surg. 2021;20:95–9. doi:10.1007/s12663-019-01318-6. Inaba Y, Hasebe D, Hashizume K, Suda D, Saito N, Saito D, et al. Changes in nutritional status of patients with jaw deformities due to orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2023;135:347–54. doi:10.1016/j.oooo.2022.07.007. Barbosa-Silva MCG, Barros AJD, Post CLA, Waitzberg DL, Heymsfield SB. Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment? Nutrition. 2003;19:422–6. doi:10.1016/s0899-9007(02)00932-2. Table Table 1 is available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Published Journal Publication published 07 Mar, 2026 Read the published version in Head & Face Medicine → Version 1 posted Editorial decision: Revision requested 03 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviews received at journal 24 Nov, 2025 Reviewers agreed at journal 23 Nov, 2025 Reviews received at journal 21 Nov, 2025 Reviewers agreed at journal 21 Nov, 2025 Reviewers agreed at journal 21 Nov, 2025 Reviewers agreed at journal 21 Nov, 2025 Reviewers invited by journal 21 Nov, 2025 Editor assigned by journal 19 Nov, 2025 Submission checks completed at journal 19 Nov, 2025 First submitted to journal 18 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8144821","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":550182301,"identity":"991c5765-e855-4156-b236-05df2f5e0d27","order_by":0,"name":"Caroline Wurche","email":"","orcid":"","institution":"University Hospital Muenster","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Wurche","suffix":""},{"id":550182302,"identity":"9674bb92-573f-4319-b10e-1941e1772b37","order_by":1,"name":"Julia Wirth","email":"","orcid":"","institution":"University Hospital Muenster","correspondingAuthor":false,"prefix":"","firstName":"Julia","middleName":"","lastName":"Wirth","suffix":""},{"id":550182303,"identity":"efbb41e3-9011-450d-9c18-86367746ad3c","order_by":2,"name":"Johannes Kleinheinz","email":"","orcid":"","institution":"University Hospital Muenster","correspondingAuthor":false,"prefix":"","firstName":"Johannes","middleName":"","lastName":"Kleinheinz","suffix":""},{"id":550182304,"identity":"f1f34eb3-debd-4158-8cce-0faabaa92034","order_by":3,"name":"Lauren Bohner","email":"","orcid":"","institution":"Universidade Federal de Santa Catarina","correspondingAuthor":false,"prefix":"","firstName":"Lauren","middleName":"","lastName":"Bohner","suffix":""},{"id":550182305,"identity":"800ba3cf-0fe2-4471-b704-ef6c2c6afe98","order_by":4,"name":"Sonja 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07:05:40","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92476,"visible":true,"origin":"","legend":"","description":"","filename":"22d4dfc34d244d2b82a22cc795b63e891structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8144821/v1/10cde1637eff0f3445576409.xml"},{"id":97141507,"identity":"48bfda65-8421-4c7e-b82a-8c4d3f62598d","added_by":"auto","created_at":"2025-12-01 10:06:46","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":104498,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8144821/v1/595176cc2b21165d900ffefa.html"},{"id":97115724,"identity":"f432ee56-3f6b-45a2-a7ff-89af6d483eb4","added_by":"auto","created_at":"2025-12-01 07:05:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":142761,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of results received from BMI and from BIA examination. Shown is the median. For clear arrangement, examination “pre surgery day” was set as time point zero and error bars with one-site direction (circles= control group, triangle = OSCC group; trend lines = sliding average, dotted for control group and dashed for OSCC group).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8144821/v1/23d2f1a6c4ca5611b8977879.png"},{"id":104250814,"identity":"adedf962-c253-433e-947d-03ad9aae377c","added_by":"auto","created_at":"2026-03-09 16:09:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":490251,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8144821/v1/daf4f519-0df3-4148-bbed-572b490303c8.pdf"},{"id":97115693,"identity":"af36f619-9bd1-4125-8760-662638fa651b","added_by":"auto","created_at":"2025-12-01 07:05:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18144,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8144821/v1/0fc81d528d08a1803db6f617.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nutritional condition in oral squamous cell carcinoma patient – an observation study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe treatment of cancer patients usually includes multimodal concepts, with the implementation of various disciplines in interdisciplinary teams. Even if the prevalence and consequences of cancer-related cachexia are well known, the problem of malnutrition is often disregarded by all involved participants. Hence, patients are left alone and may seek questionable so-called cancer diets via the internet.\u003c/p\u003e\u003cp\u003eAt the time of diagnosis already 54% of all cancer patients notice a loss of weight and over 25% of all cancer patients die only due to the malnutrition [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. There is a lack of knowledge and standards in the diagnosis of malnutrition and clinical nutrition in all professions. This issue is just considered to be facultative instead of a mandatory part of the therapy with no concrete assignment of responsibility to any profession [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe causal of this issue is, especially in the case of oral squamous cancer (OSCC), the aggravated oral food intake. However, in addition, for all oncological diseases, cancer related multifactorial changes can be summarized as cancer related cachexia. This term includes the metabolic shift due to the cancer related inflammation with the loss of fat and muscle tissue and the reduced food intake because of physical and mental stress. Further, the term includes hypercatabolism with insulin resistance, hyperglycaemia, protein loss, anaemia, fatigue, and infection susceptibility [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This creates a vicious circle of reduced mobility, reduced power, and lethargy with a loss of life quality, complication, and, ultimately, morbidity and mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In the treatment of the OSCC, malnutrition is mentioned in the current German guidelines. On the one hand, patients should receive a professional nutrition therapy in early stage. Otherwise, there are no tools or standards recommended how to diagnose or conduct this nutrition therapy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, there are different definitions and measuring methods published to diagnose a cancer-related malnutrition. One method for describing the nutritional status of patients is to determine body weight and, for easy adjustment, to calculate the body mass index (BMI) as the ratio of body weight to height squared. The BMI, or generally weight control, as a simple and easy workable technique, is a good part for monitoring the nutritional status. For further adjustments, there are tables with age, sex or different classifications of the nutritional status like underweight, healthy, overweight or obesity. Underweight, according to the World Health Organization (WHO) is defined as having a BMI below 18.5 kg/m\u0026sup2; [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis should be extended to include the aetiology. A classification is provided by guidelines of The European Society for Clinical Nutrition and Metabolism (ESPEN), in which the term of cancer cachexia is found, subsumed in the category of disease-related malnutrition. The definition of Fearon is used here, which has been expanded to include the following criteria: with weight loss\u0026thinsp;\u0026gt;\u0026thinsp;5% over the past 6 months or BMI below 20 kg/m\u0026sup2; and any degree of weight loss\u0026thinsp;\u0026gt;\u0026thinsp;2%; or appendicular skeletal muscle index consistent with sarcopenia (males\u0026thinsp;\u0026lt;\u0026thinsp;7-\u0026middot;26 kg/m\u0026sup2;; females\u0026thinsp;\u0026lt;\u0026thinsp;5-\u0026middot;45 kg/m\u0026sup2;) and any degree of weight loss\u0026thinsp;\u0026gt;\u0026thinsp;2%[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The American Society of Parenteral and Enteral Nutrition (ASPEN) in turn uses 6 diagnostic criteria such as low-energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, and hand grip strength [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBut there are other frequently used diagnostic methods with additional measuring methods. To enhance the unidimensional parameter of BMI and include more anamnesis and clinical examination other assessments have been developed and are recommended [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. An established, often used and therefore comparable example is the subjective global assessment (SGA) by Detsky [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The SGA is separated into three sections: the medical history, the physical examination with a focus on malnutrition-specific changes, such as measurement of subcutaneous adipose tissue, muscle atrophy or oedema in defined areas of the body, and the subjective assessment of the nutritional status by a qualified examiner, finally. The focus lies on weight loss, dietary intake change, loss of subcutaneous fat tissue, and muscle atrophy. This results in a three-level categorization of good (category A), moderately malnourished (B) or severe malnourished (C) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnother tool for determining nutritional status with the advantage of providing objective and comparable data is the bioelectrical impedance analysis (BIA). The BIA measures the different electrical conductivity of tissues and therefore shows the change of the body compartments with the possibility for further description of malnutrition. It is the standard procedure to determine the individual body compartments based on the three components total body water, body fat, and lean body mass (LBM). The lean body mass is subdivided into body cell mass (BCM) and extracellular mass (ECM). This method is based on the different electrical conductivity of different tissues. With the loss of skeletal muscles and body fat, the BCM decreases while ECM increases, the LBM remains constant. Especially, the loss of muscle causes a shift of intracellular body water to extracellular, which strongly distinguishes tumour related cachexia from starvation metabolism [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePatients were categorized as malnourished if at least two of the three decisive parameters such as phase angle (\u0026lt;\u0026thinsp;4\u0026deg;), ECM/BCM index (\u0026gt;\u0026thinsp;1), % cell ratio (\u0026lt;\u0026thinsp;35% for men, \u0026lt;\u0026thinsp;30% for women) deviated from the norm due to malnutrition according to manufacture protocols. There are various values discussed in the literature for the constellation of the relevant parameters and their cut-off values; we decided in favour of the standard values specified by the manufacturer [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].The aim of this study is to assess the extent of the problem of malnutrition in patients with OSCC. By comparing the BMI, the SGA score and the BIA measurement method, the best instrument for initial diagnosis and follow-up should be determined. In addition, the course of the nutritional status peri-operatively should be recorded and compared with a healthy collective who have received a comparable nasogastric diet.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design and ethics approval\u003c/p\u003e\u003cp\u003eIn the obtaining study, the nutritional status of 30 patients with histological verified primary OSCC was determined during the cancer treatment and afterwards with a time interval of 4 months. All patients were first treated surgically and, if necessary, received adjuvant radio(chemo)therapy in accordance with the interdisciplinary tumour conference decision. As a control group, 30 patients undergoing orthognathic surgery were included. Equal for all groups was a standardized nutrition via nasogastric tube. Inclusion and exclusion criteria were determined in general: Included: age over 18 years, agreement to the study protocol, participation in examinations and completed follow-up over 4 months. Excluded were patients with any other oncological diagnosis or relapse, also patients with gastrointestinal diseases such as chronic inflammatory bowel disease or gluten-related disorders. Further pregnant women, person with a pacemaker, or an implanted cardioverter-defibrillator, or likewise devices. The study was designed according to the \u0026ldquo;Declaration of Helsinki\u0026rdquo; and approved by the Ethics Committee of the Faculty of Medicine, University of Muenster (#2018-642-f-S). A written informed consent was obtained from all patients.\u003c/p\u003e\u003cp\u003eBody-Mass-Index (BMI)\u003c/p\u003e\u003cp\u003eThe BMI was estimated with an electrical column scale (type 769, SECA, Hamburg, Germany). During measurement, the patient stands lightly dressed upright and flat on the scale. Patients were included in BMI categories, according to the World Health Organization (WHO): mild thinness (\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), normal range (18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e), overweight (25.0-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e), obese I (30.0-34.9 kg/m\u003csup\u003e2\u003c/sup\u003e), obese II (35.0-39.9 kg/m\u003csup\u003e2\u003c/sup\u003e), and obese III (\u0026gt;\u0026thinsp;40 kg/m\u003csup\u003e2\u003c/sup\u003e) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSubjective Global Assessment (SGA)\u003c/p\u003e\u003cp\u003eThe SGA was performed according to Detsky [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A well-trained examiner performed the examination steps. The SGA was separated into three parts: the anamnesis, a physical examination, and afterwards the subjective assessment about the nutritional status. The patients were grouped as A) well nutritional status, B) moderate malnourished, and C) severe malnourished[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003csup\u003e17,21\u003c/sup\u003e. For grouping, no weighted scoring system was used. Patients were classified as moderately malnourished, when patients lost 5% of body weight without any earlier recognized stabilizations nor weight gain and in addition, a loss in food supply and a mild subcutaneous tissue loss. Patients were included in a severe malnutrition status, when patients lost at least 10% of body weight, a severe loss of subcutaneous fat and muscle mass, and the occurrence of oedema.\u003c/p\u003e\u003cp\u003eBioelectrical impedance analysis (BIA)\u003c/p\u003e\u003cp\u003eThe BIA was performed by a well-trained examiner according to manufacture protocols with the Bioelectrical Impedance Analyzation Nutribox with electrodes (BIANOSTOC AT, Data Input GmbH, P\u0026ouml;cking, Germany). Before examination, patients remained fasting for at least four hours without being physically active for at least 12 hours. The bladder was emptied before measurement. No alcohol was consumed for at least 24 hours. For measurement, the patients lay flat and horizontal in the supine position on a non-conductive surface at complete physical rest. Electrodes were placed, according to manufacture protocols, on hand and foot of the dominant side of the body. Hand and foot were unclothed and free of compressive bandages. To ensure that the patient's blood volume and body water were distributed evenly throughout the body the patient remained nearly 10 min in this position before measurements starts according to manufacture protocols.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was performed with the software SPSS Version 29 (IBM). Changes in nutritional status of tumour patients 4 months after the surgical procedure were assessed and compared with the baseline (pre-operative measurements). All tests were performed considering a statistical significance level of p\u0026thinsp;=\u0026thinsp;0.05. The variables dielectric phase angle, BMI, weight, and body fat were assessed as dependent variables. Time was set as an independent variable.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study was performed during 2019 and 2020 in our department. In both groups, 30 patients each were included. The median age was 25 years in the control group and 64 years in the OSCC groups. The prevalence of men was in both groups higher, 63% in the control group and 77% in the OSCC group. The mean nutrition time via nasogastric tube was 16 days, with a hospital stay of 18.9 days in the OSCC group. In addition, 2.9 days with a hospital stay of 7.6 days in the control group. In contrast, the control group received nutrition via nasogastric tube for 2.9 days, with a hospital stay of 7.6 days in the control group.\u003c/p\u003e\n\u003cp\u003eIn the OSCC group,\u0026nbsp;complications were reported in 12 cases. In six cases, wound healing impairments occurred. Two patients suffered from dysphagia. In other cases, patients underwent a re-resection, a radial flap revision, atrial fibrillation and optic nerve ischaemia, respectively.\u0026nbsp;In the control group,\u0026nbsp;a total of three patients showed a complication, with the development of a perimandibular abscess in two cases and paraesthesia in one case.\u003c/p\u003e\n\u003cp\u003eIn table 1, a comparative overview between the control group and the OSCC group is shown. Based on the comparative analysis from the SGA, patients from the control group showed a moderate malnutrition status during hospital time. Nutritional status raised to a good status in nearly all cases. In contrast, only 6% of OSCC patients starts with a good nutritional status. During treatment time and afterwards, the ratio rose to nearly 50% of OSCC patients. However, two patients ended up with severe malnutrition (table 1).\u003c/p\u003e\n\u003cp\u003eIn figure 1, results from BIA and BMI are summarised. Except for the BIA parameter body water (p=0.12), observed differences of measurable data from BMI and BIA measurements were statistically significant with a p\u0026lt;0.05. In the OSCC group, BMI fell by 2 points over time. The BMI ranged between 24 and 26. In the control group, the BMI remained constantly within a variation of 1.5 points (figure 1). In the control group, two patients with obese category II and III were included and one patient with a mild thinness (table 1). The BMI of all three patients altered during examination time, but there were no changes in category observable. The amount of body water sunk in both groups during the first days. Afterwards, the amount of body water increased in the OSCC group (figure 1). In the control group, the cellular share levels between 54.7 and 55.5%. Therefore, in the OSCC group, it increased from 46.3 to 49.7% continuously. The amount of body fat levels between 17.7 and 18.4 kg in the control group and decreased constantly during the observation time from 20.8 to 18.0 kg in the OSCC group (figure 1). In the OSCC group, the BCM decreased during the first weeks and increased afterwards continuously. On the other hand, the ECM decreased in this group constantly. The BCM/ECM index decreased to an end value of nearly one, accordingly (figure 1). In the control group, the BCM decreased over time and the ECM remained constant. The BCM/ECM index levels between the values of 0.8 for the whole examination period. For the dielectric phase angle, there was a comparable shift. In the control group, the value levels between 6.78 and 6.6° during the examination period. In the OSCC group, the angle increased from 4.9 to 5.5° continuously.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we monitored changes in the nutritional status of OSCC patient before and after surgical treatment, with a time interval of 4 months. The study again showed, how important a controlling group is, also in an observation study. With this control group, a punctuation of observed results is possible. A scientific correct and comparable control group against a tumour group is all but impossible and ethical questionable. At the first glance, both groups are incommensurable. Nevertheless, on closer examination, both groups got the same standardized non-individualised dietetic treatment by a nutrition tube. The control group received the tube feeding just for 1\u0026ndash;5 days and the OSCC group for 7\u0026ndash;28 days. Knowing the disparity, we focused our study mainly on the OSCC group, but there were also unexpected results from the control group.\u003c/p\u003e\u003cp\u003eIn this study, the BMI shows no case of malnutrition. Unlike the SGA and the BIA, which showed prevalence\u0026rsquo;s of malnutrition in the study population with OSCC of 80% and 60%, respectively. Concerning malnutrition, BMI as a standalone parameter is far from sufficient according to this data because essential factors are not recognised. These data therefore underline the need for specialised assessments such as SGA or BIA [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The definition of a gold standard would be desirable to enable good comparability of the data, as different assessments are currently being made in different studies and there are no detailed data available with the criteria selected by Fearon for cancer cachexia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this study we were able to demonstrate that SGA and BIA, in contrast to BMI, exhibited a similar tendency and detected patients at risk more frequently.\u003c/p\u003e\u003cp\u003eThis was also seen in the control group. Orthognatic control group is expected to be younger due to higher incidence of dysgnathia in younger age, which is proved in our data with a median age of 25 years comparable to 64 years in OSCC group. OSCC group is expected having more comorbidities caused by different factors like nicotine, alcohol abuses and increasing diseases in higher age, which was not subject of his study. Pre-operative, no patient showed signs of malnutrition according to the SGA. Within the first 4 weeks postoperatively, however, nearly 50% switched to category B, i.e. were moderately malnourished. At the end of the observation period after 4 months, 83.3% of the patients had recovered to category A. Awareness of malnutrition in the context of such interventions seems to be limited to a few studies, often focusing only on weight, but showing similar tendencies [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor the OSCC group, this study observed that already about 6 months before treatment, 87% of OSCC patients reported a weight loss. This number seems to be very high compared to reported prevalence rates of weight loss with 54% over all oncology patients 6 months before diagnosis [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The possible cause in OSCC patients could be impaired food intake due to local mechanical restrictions. A more pronounced inflammation with increased catabolism or comorbidities resulting from the risk factors are also conceivable causes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This underlines the usefulness of the definition of Fearon and ESPEN to consider the anamnestic weight loss.\u003c/p\u003e\u003cp\u003eWith this study, we could demonstrate that this unspecific dietetic treatment influenced strongly the nutritional status and alleviate malnutrition in OSCC patients. The nutritional status, as assessed by SGA and BIA, showed significant reductions under simple, non-individualised nutritional therapy utilising standardized nutrition via tube during post-operative hospitalisation. At the beginning of the study, 20% of OSCC patients showed an SGA category A and raised up to 50% of OSCC patients at the end. However, a small proportion of 13% of the OSCC collective (n\u0026thinsp;=\u0026thinsp;4) also deteriorated during therapy and fell into the worst category C of the SGA, severe malnutrition, suspected caused by the exhausting oncological therapy, psychological factors or morbidities due to surgery and possibly adjuvant radiotherapy.\u003c/p\u003e\u003cp\u003eThe data from the BIA gave the most reliable information about shifts in nutrition\u0026rsquo;s status. In the OSCC group, this angle raised continuity to 5.5\u0026deg; during time. Further, the amount of body fat sank, and the amount of muscle mass raised simultaneously in this group. The BCM/ECM ratio sank to a value of nearly one, deductively. In the control group, the BCM/ECM ration levels at 0.8 during time. Caped all BIA values, a regeneration from malnutrition to a better nutritional status was observable in the OSCC group. The early changes in nutritional status could be explained by the surgery and circumstances itself comparable to the control group.\u003c/p\u003e\u003cp\u003eThese similar results and developments in SGA and BIA mean that both methods can be regarded as suitable based on this data, whereas the cut- offs of the BIA should be reviewed. There is a certain range in the literature, which could be a reason for Barbosa-Silva to conclude that the two methods are less similar in their significance [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study showed how important diagnosis, monitoring, and therapy of malnutrition for patient\u0026rsquo;s outcome is. Not only concerning oncological patients, but also patients like the control group with orthognathic surgery or potentially with any kind of head and neck surgery. In particular, change in oral food intake due to local restrictions and intermaxillary fixation should be considered. Furthermore, this simple, non- individualized standardised nutrition therapy could change hospital stay and nutritional status of oncological and orthognathic surgery patients. It can even be assumed that this should also be important for other indication groups in the head and neck surgery.\u003c/p\u003e\u003cp\u003eThis study provides the comparative data for further studies to investigate the effect of different nutritional therapies and the effect on various parameters such as BMI, SGA, BIA and in perspective blood parameters concerning nutrition (e.g. albumin, LDL, HDL etc.), hospitalisation, prognosis, morbidity, mortality, quality of life and patient reported outcome. Observational studies with professional individualized nutrition therapy should follow to verify these data. In a relevant proportion of OSCC patients over 80 years, data should also be collected with various groups of age to distinguish tumour-associated cachexia from frailty in the elderly.\u003c/p\u003e\u003cp\u003eThe requirement is to use assessments to diagnose malnutrition early and establish a standardized follow-up to prevent its multiple consequences. This is already stipulated in the German guideline of OSCC, but concrete recommendations for implementing an assessment or nutritional concepts have yet to be established. Especially in the field of head and neck surgery, not only the form of application but also the composition should be taken into focus of all participants. This requires the awareness, cross-sectoral and interdisciplinary cooperation at all points of time from prehabilitation to follow- up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMalnutrition is a relevant problem in patients with OSCC, as the prevalence in this population group is very high. This was confirmed by our results. Appropriate valid diagnostic tools and an adapted individualized treatment concept should be an integral part of the treatment concept for these patients. Professional dietary treatment is necessary and should be provided from the time of diagnosis until aftercare. Patients must not be left alone with this problem. Especially in relation to some of the dubious so-called cancer diets on the Internet. We call for an individualized concept about the form of application and ingredients as well as supplements for each patient.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOSCC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eoral squamous cell carcinoma\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSGA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esubjective global assessment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBIA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebioelectrical impedance analysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eESPEN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThe European Society for Clinical Nutrition and Metabolism\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASPEN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThe American Society of Parenteral and Enteral Nutrition\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLBM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elean body mass\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBCM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebody cell mass\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eECM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eextracellular mass\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLDL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow density lipoprotein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHDL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHigh density lipoprotein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the Faculty of Medicine, University of Muenster (#2018-642-f-S). A written informed consent was obtained from each patient.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003eFunding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy concepts: C.W. and J.W.; study design: C.W., J.W. and J.K; data acquisition: J.W.; quality control and interpretation: C.W. and L.B.; data analysing and interpretation: C.W. and S.S.; statistical analysis: L.B.; manuscript preparation: C.W. and S.S.; manuscript editing: C.W. and S.S.; manuscript review: J.K.\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe thank Sebastian Igelbrink for academically advice. We thank Nancy Thielscher (physician assistant) for helping in data acquisition. We acknowledge support from the Open Access Publication Fund of the University of Muenster.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491\u0026ndash;7. doi:10.1016/s0149-2918(05)80001-3.\u003c/li\u003e\n \u003cli\u003eArends J. Ern\u0026auml;hrung von Tumorpatienten. Aktuel Ernahrungsmed. 2012;37:91\u0026ndash;106. doi:10.1055/s-0031-1277005.\u003c/li\u003e\n \u003cli\u003eL\u0026ouml;ser C, Fruehauf S, M\u0026uuml;ller M, Br\u0026uuml;ck P, Hahn L, Lange O, et al. Moderne Ern\u0026auml;hrungstherapie bei onkologischen Patienten \u0026ndash; ein Positionspapier. Aktuel Ernahrungsmed. 2014;39:127\u0026ndash;31. doi:10.1055/s-0034-1369885.\u003c/li\u003e\n \u003cli\u003eSpiro A, Baldwin C, Patterson A, Thomas J, Andreyev HJN. The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br J Cancer. 2006;95:431\u0026ndash;4. doi:10.1038/sj.bjc.6603280.\u003c/li\u003e\n \u003cli\u003eKopelman P, Lennard-Jones J. Nutrition and patients: a doctor\u0026apos;s responsibility. Clin Med (Lond). 2002;2:391\u0026ndash;4. doi:10.7861/clinmedicine.2-5-391.\u003c/li\u003e\n \u003cli\u003eL\u0026ouml;ser C. Nutrition in Modern Oncology. 1st ed. Bremen: UNI-MED Verlag; 2013.\u003c/li\u003e\n \u003cli\u003eLucia S, Esposito M, Rossi Fanelli F, Muscaritoli M. Cancer cachexia: from molecular mechanisms to patient\u0026apos;s care. Crit Rev Oncog. 2012;17:315\u0026ndash;21. doi:10.1615/critrevoncog.v17.i3.90.\u003c/li\u003e\n \u003cli\u003eFearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489\u0026ndash;95. doi:10.1016/S1470-2045(10)70218-7.\u003c/li\u003e\n \u003cli\u003eCaburet C, Farigon N, Mulliez A, Mom T, Boirie Y, Gilain L, Saroul N. Impact of nutritional status at the outset of assessment on postoperative complications in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137:393\u0026ndash;8. doi:10.1016/j.anorl.2019.12.005.\u003c/li\u003e\n \u003cli\u003eNorman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5\u0026ndash;15. doi:10.1016/j.clnu.2007.10.007.\u003c/li\u003e\n \u003cli\u003eFearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol. 2013;10:90\u0026ndash;9. doi:10.1038/nrclinonc.2012.209.\u003c/li\u003e\n \u003cli\u003eKang MC, Kim JH, Ryu SW, Moon JY, Park JH, Park JK, et al. Prevalence of Malnutrition in Hospitalized Patients: a Multicenter Cross-sectional Study. J Korean Med Sci. 2018;33:e10. doi:10.3346/jkms.2018.33.e10.\u003c/li\u003e\n \u003cli\u003eL\u0026ouml;ser C. Malnutrition in hospital: the clinical and economic implications. Dtsch Arztebl Int. 2010;107:911\u0026ndash;7. doi:10.3238/arztebl.2010.0911.\u003c/li\u003e\n \u003cli\u003ePirlich M, Schwenk A, M\u0026uuml;ller MJ. DGEM-Leitlinie Enterale Ern\u0026auml;hrung: Ern\u0026auml;hrungsstatus. Aktuelle Ern\u0026auml;hrungsmedizin. 2003;28:10\u0026ndash;25. doi:10.1055/s-2003-36934.\u003c/li\u003e\n \u003cli\u003eWolff. S3-Leitlinie Mundh\u0026ouml;hlenkarzinom: Leitlinienprogramm Onkologie (Deutsche Krebsgesell-schaft, Deutsche Krebshilfe, AWMF) (2021): S3-Leitlinie Diagnostik und Therapie des Mundh\u0026ouml;hlen-karzinoms, Langversion 3.0, 2021, AWMF-Registernummer: 007/100OL, https://www.leitlinien-programm-onkologie.de/leitlinien/mundhoehlenkarzinom/ (zuletzt aufgerufen am: 22.08.2021). 2021.\u003c/li\u003e\n \u003cli\u003eWeir CB, Jan A. StatPearls: BMI Classification Percentile and Cut Off Points. Treasure Island (FL); 2024.\u003c/li\u003e\n \u003cli\u003eCederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36:49\u0026ndash;64. doi:10.1016/j.clnu.2016.09.004.\u003c/li\u003e\n \u003cli\u003eDetsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987;11:8\u0026ndash;13. doi:10.1177/014860718701100108.\u003c/li\u003e\n \u003cli\u003eKyle UG, Bosaeus I, Lorenzo AD de, Deurenberg P, Elia M, G\u0026oacute;mez JM, et al. Bioelectrical impedance analysis--part I: review of principles and methods. Clin Nutr. 2004;23:1226\u0026ndash;43. doi:10.1016/j.clnu.2004.06.004.\u003c/li\u003e\n \u003cli\u003eGrundmann O, Yoon SL, Williams JJ. The value of bioelectrical impedance analysis and phase angle in the evaluation of malnutrition and quality of life in cancer patients--a comprehensive review. Eur J Clin Nutr. 2015;69:1290\u0026ndash;7. doi:10.1038/ejcn.2015.126.\u003c/li\u003e\n \u003cli\u003eMałecka-Massalska T, Smoleń A, Morshed K. Extracellular-to-body cell mass ratio and subjective global assessment in head-and-neck cancers. Curr Oncol. 2014;21:e62-6. doi:10.3747/co.21.1671.\u003c/li\u003e\n \u003cli\u003eB\u0026uuml;ntzel J, Krau\u0026szlig; T, B\u0026uuml;ntzel H, K\u0026uuml;ttner K, Fr\u0026ouml;hlich D, Oehler W, et al. Nutritional parameters for patients with head and neck cancer. Anticancer Res. 2012;32:2119\u0026ndash;23.\u003c/li\u003e\n \u003cli\u003eSch\u0026uuml;tz T, Plauth M. Subjective Global Assessment - A Method for the Assessment of Nutritional State. Akt Ern\u0026auml;hr Med. 2005;30:43\u0026ndash;8. doi:10.1055/s-2004-834559.\u003c/li\u003e\n \u003cli\u003eIrgebay Z, Beiriger JC, Beiriger JW, Matinrazm S, Natali M, Yi C, et al. Review of Diet Protocols Following Orthognathic Surgery and Analysis of Postoperative Weight Loss. Cleft Palate Craniofac J. 2023;60:1411\u0026ndash;8. doi:10.1177/10556656221113998.\u003c/li\u003e\n \u003cli\u003eOoi K, Inoue N, Matsushita K, Yamaguchi H, Mikoya T, Kawashiri S, Tei K. Body Weight Loss After Orthognathic Surgery: Comparison Between Postoperative Intermaxillary Fixation with Metal Wire and Elastic Traction, Factors Related to Body Weight Loss. J Maxillofac Oral Surg. 2021;20:95\u0026ndash;9. doi:10.1007/s12663-019-01318-6.\u003c/li\u003e\n \u003cli\u003eInaba Y, Hasebe D, Hashizume K, Suda D, Saito N, Saito D, et al. Changes in nutritional status of patients with jaw deformities due to orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2023;135:347\u0026ndash;54. doi:10.1016/j.oooo.2022.07.007.\u003c/li\u003e\n \u003cli\u003eBarbosa-Silva MCG, Barros AJD, Post CLA, Waitzberg DL, Heymsfield SB. Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment? Nutrition. 2003;19:422\u0026ndash;6. doi:10.1016/s0899-9007(02)00932-2.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"head-and-face-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hafm","sideBox":"Learn more about [Head \u0026 Face Medicine](http://head-face-med.biomedcentral.com)","snPcode":"13005","submissionUrl":"https://submission.nature.com/new-submission/13005/3","title":"Head \u0026 Face Medicine","twitterHandle":"@HeadNeckMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"malnutrition, OSCC, nutritional status, observation study, nutrition treatment, cancer-related cachexia","lastPublishedDoi":"10.21203/rs.3.rs-8144821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8144821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCancer related malnutrition is an often-disregarded problem with a lack of knowledge and standards concerning diagnosis and therapy. Especially patients with oral squamous cell cancer can suffer not only from metabolic factors but also from aggravated oral food intake. This study examines the problem of malnutrition in patients with oral squamous cell carcinoma (OSCC) before diagnosis and under treatment.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe nutritional status of 30 patients with OSCC was registered before and after surgical treatment, with a time interval of 16 weeks. The methods applied were body mass index (BMI), subjective global assessment (SGA) and bioelectrical impedance analysis (BIA). The control group consisted of 30 patients planned for orthognathic surgery. Equal for both groups were comparable nutrition via nasogastric tube. Data were analysed and tested for significance with a level of p\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe control group showed a moderate malnutrition status during hospital stay according to SGA. This improved in the course of therapy to a good status in nearly all cases. In contrast, only 6% of OSCC patients start with a good nutritional status, but this group enhances nearly up to 50% during therapy, although two patients ended up with severe malnutrition. The cellular share of the control group increased over time from 46.3 to 49.7%, while body fat decreased constantly from 20.8 to 18.0 kg (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMalnutrition is a relevant problem in patients with OSCC due to the high prevalence in this population, which was confirmed in these data. Appropriate diagnostic tools and an adapted treatment concept in terms of application form and ingredients as well as supplements should be an integral part of the treatment concept for these patients.\u003c/p\u003e","manuscriptTitle":"Nutritional condition in oral squamous cell carcinoma patient – an observation study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 07:05:34","doi":"10.21203/rs.3.rs-8144821/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-03T14:07:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T14:17:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T21:23:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47489625721481316064718490325557996203","date":"2025-11-23T08:30:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-21T14:11:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234679991362921159952156366255467315146","date":"2025-11-21T13:51:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36222406110177287675437324437935284960","date":"2025-11-21T10:01:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150523219951301168172383571187878522506","date":"2025-11-21T08:22:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-21T08:14:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-19T07:35:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-19T07:31:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Head \u0026 Face Medicine","date":"2025-11-18T11:26:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"head-and-face-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hafm","sideBox":"Learn more about [Head \u0026 Face Medicine](http://head-face-med.biomedcentral.com)","snPcode":"13005","submissionUrl":"https://submission.nature.com/new-submission/13005/3","title":"Head \u0026 Face Medicine","twitterHandle":"@HeadNeckMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b3addba8-54da-409f-98a7-003ac85a2be8","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:04:49+00:00","versionOfRecord":{"articleIdentity":"rs-8144821","link":"https://doi.org/10.1186/s13005-026-00604-2","journal":{"identity":"head-and-face-medicine","isVorOnly":false,"title":"Head \u0026 Face Medicine"},"publishedOn":"2026-03-07 15:57:28","publishedOnDateReadable":"March 7th, 2026"},"versionCreatedAt":"2025-12-01 07:05:34","video":"","vorDoi":"10.1186/s13005-026-00604-2","vorDoiUrl":"https://doi.org/10.1186/s13005-026-00604-2","workflowStages":[]},"version":"v1","identity":"rs-8144821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8144821","identity":"rs-8144821","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}