The Effect of Immunotherapy on Macro-Micronutrient Intake and Its Relationship with Anthropometric Measurements in Patients with Non-Small Cell Lung Cancer

Year 2025, Volume: 15 Issue: 3, 695 - 704, 30.09.2025

Dilek Doğan , S. Mine Yurttagül , Timuçin Çil

https://doi.org/10.33808/clinexphealthsci.1754549

Abstract

Objective: This study aims to investigate the effect of immunotherapy on macro- micronutrient intake and its relationship with anthropometric measurements in patients with non-small cell lung cancer (NSCLC).
Methods: The 24-hour dietary recall and anthropometric measurements were obtained from patients diagnosed with primary NSCLC receiving immunotherapy treatment at three time points (initial, 2 months, and 6 months) at Adana City Training and Research Hospital. Statistical analyses of the data were performed using SPSS v27.
Results: The study included 47 individuals (M:43, F:4) with a mean age of 64.55±8.19 years; however, the data of 30 individuals (M: 28, F: 2) (due to death/progression) who were able to complete immunotherapy treatment were evaluated. As a result of immunotherapy treatment, the median values of Water (g), Carbohydrate (g), Vitamins (A, B1, B2, C, B12), Folate, Zinc, and the mean values of Energy (kcal), Protein (g), Fat (g), Fat (%), Fiber (g), Vitamin E, Potassium, Calcium, Magnesium, Phosphorus, Iron, in the interim and final measurements were found to be higher (p<.05) than the initial measurement values. The mean Protein (%) at the interim measurement was found to be statistically higher than the mean of the final and initial measurements (p<.05). The mean of the final BMI (kg/m2), Body Fat Percentage (%) and Lean Body Mass (kg) measurements was found to be statistically higher than the mean of the interim and initial measurements (p<.05).
Conclusion: During the immunotherapy treatment process, macro and micronutrient intake and anthropometric measurements increased in individuals diagnosed with NSCLC.

Keywords

ımmunotherapy , nutritional status , anthropometric measurements , non-small cell lung cancer

Ethical Statement

This study was approved by Ethics Committee of Adana City and Research Hospital, Clinical Research Ethics Committee (Approval date: 18.01.2024; Decision number: 3112)

Supporting Institution

The authors received no financial support for the research.

Thanks

The authors would like to thank all participants

References

• Oliver AL. Lung Cancer: Epidemiology and Screening. The Surgical clinics of North America.2022; 102(3), 335–344. https://doi.org/10.1016/j.suc.2021.12.001
• Malhotra J, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. The European respiratory journal. 2016; 48(3), 889–902. https://doi.org/10.1183/13993003.00359-2016
• Collins LG, Haines C, Perkel R, Enck RE. Lung cancer: diagnosis and management. American family physician. 2007; 75(1), 56–63.
• Alexander M, Kim SY, Cheng H. Update 2020: Management of Non-Small Cell Lung Cancer. Lung. 2020; 198(6), 897–907. https://doi.org/10.1007/s00408-020-00407-5
• Batra U, Munshi A, Kabra V, Momi G. Relevance of multi-disciplinary team approach in diagnosis and management of Stage III NSCLC. Indian journal of cancer. 2022; 59(Supplement), S46–S55. https://doi.org/10.4103/ijc.IJC_51_21
• Smyth MJ, Teng MW. 2018 Nobel Prize in physiology or medicine. Clinical & translational immunology. 2018; 7(10), e1041. https://doi.org/10.1002/cti2.1041
• Mielgo-Rubio X, Montemuiño S, Jiménez U, Luna J, Cardeña A, Mezquita L, Martín M, Couñago F. Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy. Cancers. 2021; 13(19), 4811. https://doi.org/10.3390/cancers13194811
• Nigro E, Perrotta F, Scialò F, D'Agnano V, Mallardo M, Bianco A, Daniele A. Food, Nutrition, Physical Activity and Microbiota: Which Impact on Lung Cancer. International journal of environmental research and public health. 2021; 18(5), 2399. https://doi.org/10.3390/ijerph18052399
• Polański J, Dudek K, Mazur G, Chabowski M. Effect of nutritional status on psychological functioning and coping in patients with lung cancer. Nutrition. 2023;109, 111970. https://doi.org/10.1016/j.nut.2022.111970
• Pilikidou M, Palyvou F, Papadopoulou SK, Tsiouda T, Tsekitsidi E, Arvaniti K, Miziou A, Tsingerlioti Z, Apostolidis G, Ntiloudis R, Boniou, K, Tsioudas AA, Cheva A, Petridis D, Zarogoulidis P. Lung cancer, treatment and nutritional status. Molecular and clinical oncology. 2021; 15(6), 248. https://doi.org/10.3892/mco.2021.2410
• Borchardt I, Augusto C, Vieira E, Chek S, Farias G, Moreira GF, Dias FC, Taveira FT, Montella TC, Melo AC, Peres W, Ferreira CGM. Dietary patterns and clinical outcomes in patients with lung cancer: What needs to change Annals of Oncology. 2023; 34 (suppl_2): S1080-S1134. 10.1016/S0923-7534(23)01268-
• Higuera-Pulgar I, Ribed A, Carrascal-Fabian ML, Romero-Jiménez RM, Velasco-Gimeno C, Bretón-Lesmes I, Camblor-Álvarez M, Cuerda-Compes C, García-Peris P. Evolution of nutritional status and survival in patients with cancer on tyrosine kinase inhibitors treatment. Evolución nutricional y de la supervivencia en un grupo de pacientes oncológicos en tratamiento con inhibidores de tirosina quinasa. Endocrinologia, diabetes nutricion. 2019; 66(8), 472–479. https://doi.org/10.1016/j.endinu.2019.03.017
• Fassier P, Zelek L, Lécuyer L, Bachmann P, Touillaud M, Druesne-Pecollo N, Galan, P, Cohen P, Hoarau H, Latino-Martel P, Kesse-Guyot E. Baudry J, Hercberg S, Deschasaux M, Touvier M. Modifications in dietary and alcohol intakes between before and after cancer diagnosis: Results from the prospective population-based NutriNet-Santé cohort. International journal of cancer. 2017;141(3), 457–470. https://doi.org/10.1002/ijc.30704
• Branco MG, Mateus C, Capelas ML, Pimenta N, Santos T, Mäkitie A, Ganhão-Arranhado S, Trabulo C, Ravasco P. Bioelectrical Impedance Analysis (BIA) for the Assessment of Body Composition in Oncology: A Scoping Review. Nutrients. 2023; 15(22), 4792. https://doi.org/10.3390/nu15224792
• Detopoulou P, Tsiouda T, Pilikidou M, Palyvou F, Tsekitsidi E, Mantzorou M, Pezirkianidou P, Kyrka K, Methenitis S, Voulgaridou G, Zarogoulidis P, Oikonomidou R, Matthaios D, Porpodis Κ, Giannakidis D, Papadopoulou SK. Changes in Body Weight, Body Composition, Phase Angle, and Resting Metabolic Rate in Male Patients with Stage IV Non-Small-Cell Lung Cancer Undergoing Therapy. Medicina. 2022; 58(12), 1779. https://doi.org/10.3390/medicina58121779
• 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. European journal of clinical nutrition. 2015; 69(12), 1290–1297. https://doi.org/10.1038/ejcn.2015.126.
• Baysal A, Aksoy M, Besler HT. Diet Handbook. Ankara: Hatiboğlu Press; 2005.
• Nutrition Information System - BeBiS, Version 9; 2021, Istanbul.
• Choi J, Peters, M., Mueller, RHO. Correlational analysis of ordinal data: from Pearson’sr to Bayesian polychoric correlation. Asia Pacific Educ. Rev. 2010; 11(4), 459-466. https://doi.org/10.1007/s12564-010-9096-y
• Chewaskulyong B, Malairungsakul H, Buranapin S, Jesadaporn P, Ketpueak T, Suksombooncharoen T, Charoentum C. Dietary Counseling Outcomes in Patients with Lung Cancer in an Upper-Middle-Income Country: An Open-Label Randomized Controlled Trial. Journal of Clinical Medicine.2024; 13(17), 5236. https://doi.org/10.3390/jcm13175236
• Trestini I, Sperduti I, Sposito M, Kadrija D, Drudi A, Avancini A, Tregnago D, Carbognin L, Bovo C, Santo A, Lanza M, D'Onofrio M, Tortora G, Bria E, Milella M, Pilotto S. Evaluation of nutritional status in non-small-cell lung cancer: screening, assessment and correlation with treatment outcome. ESMO open.2020; 5(3), e000689. https://doi.org/10.1136/esmoopen-2020-000689
• Lahiri A, Maji A, Potdar PD, Singh N, Parikh P, Bisht B, Mukherjee A, Paul MK. Lung cancer immunotherapy: progress, pitfalls, and promises. Mol Cancer. 2023; 21, 22(1), 40.
• Lehto RH. Symptom burden in lung cancer: management updates. Lung Cancer Manag. 2016; 5(2), 61-78.
• Madeddu C, Busquets S, Donisi C, Lai E, Pretta A, López-Soriano FJ, Argilés JM, Scartozzi M, Macciò, A. Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer. Cancers. 2023; 15(4), 1076. https://doi.org/10.3390/cancers15041076
• Ford KL, Arends J, Atherton, PJ, Engelen MPKJ, Gonçalves TJM, Laviano A, Lobo DN, Phillips SM, Ravasco P, Deutz, NEP, Prado CM. The importance of protein sources to support muscle anabolism in cancer: An expert group opinion. Clinical nutrition. 2022; 41(1), 192–201. https://doi.org/10.1016/j.clnu.2021.11.032
• Kristoffersen A E, Stub T, Nilsen JV, Nordberg JH, Broderstad AR, Wider B, Bjelland, M. Exploring dietary changes and supplement use among cancer patients in Norway: prevalence, motivations, disclosure, information, and perceived risks and benefits: a cross sectional study. BMC nutrition. 2024; 10(1), 65. https://doi.org/10.1186/s40795-024-00872-8
• Kichenadasse G, Miners JO, Mangoni AA, Rowland A, Hopkins AM, Sorich MJ. Association Between Body Mass Index and Overall Survival With Immune Checkpoint Inhibitor Therapy for Advanced Non-Small Cell Lung Cancer. JAMA oncology. 2020; 6(4), 512–518. https://doi.org/10.1001/jamaoncol.2019.5241
• Shijubou N, Sumi T, Yamada Y, Nakata H, Mori Y, Chiba H. Immunological and nutritional predictive factors in patients receiving pembrolizumab for the first-line treatment of non-small cell lung cancer. Journal of Cancer Research and Clinical Oncology. 2022; 148(8), 1893-1901.
• Detopoulou P, Tsiouda T, Pilikidou M, Palyvou F, Tsekitsidi E, Mantzorou M, Pezirkianidou P, Kyrka K, Methenitis S, Voulgaridou G, Zarogoulidis P, Oikonomidou R, Matthaios D, Porpodis Κ, Giannakidis, D, Papadopoulou SK. Changes in Body Weight, Body Composition, Phase Angle, and Resting Metabolic Rate in Male Patients with Stage IV Non-Small-Cell Lung Cancer Undergoing Therapy. Medicina. 2022; 58(12), 1779. https://doi.org/10.3390/medicina58121779
• Madeddu C, Busquets S, Donisi C, Lai E, Pretta A, López-Soriano FJ, Argilés JM, Scartozzi M, Macciò A. Effect of Cancer-Related Cachexia and Associated Changes in Nutritional Status, Inflammatory Status, and Muscle Mass on Immunotherapy Efficacy and Survival in Patients with Advanced Non-Small Cell Lung Cancer. Cancers. 2023; 15(4), 1076. https://doi.org/10.3390/cancers15041076.
• Kaur P, Yadav AK, Pal A, Jassal RS, Shafiq N, Sahni N, Kumar V, Jha, V. Estimation of dietary intake of sodium, potassium, phosphorus and protein in healthy Indian population and patients with chronic kidney disease. Frontiers in nutrition. 2024; 11, 1312581. https://doi.org/10.3389/fnut.2024.1312581