# Association between nutritional targets and muscle index changes in patients with terminal cancer under palliative care

## TL;DR

Meeting nutritional goals helps preserve muscle mass in terminal cancer patients, and ultrasound is a useful tool to monitor this.

## Contribution

The study identifies the importance of early caloric and protein intake in preventing muscle loss and validates the use of ultrasound for monitoring.

## Key findings

- Patients who failed to meet caloric goals showed greater muscle loss.
- Protein intake ≥1.5 g/kg/day was linked to reduced muscle loss.
- Rectus femoris muscle was most sensitive to nutritional changes.

## Abstract

Malnutrition and muscle wasting are common in terminal cancer patients and adversely affect prognosis. Bedside muscle ultrasonography (US) has emerged as a practical tool to assess nutritional status and monitor therapy. This study evaluated the relationship between achieving individualized nutritional targets and changes in muscle indices measured by US in terminal cancer patients receiving palliative care.

Subcutaneous fat tissue thickness (SFTT), muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii (BB) muscles were assessed by US over 10 days and normalized to height squared (m2). A total of 95 patients with complete retrospective data were included; 74.7% achieved their caloric targets, while 25.3% did not.

Patients who failed to meet caloric goals exhibited significantly greater reductions across all muscle parameters. Among those who achieved caloric targets, protein intake ≥1.5 g/kg/day was associated with reduced muscle loss compared to lower intake. The RF muscle was particularly sensitive to nutritional status, exhibiting more pronounced changes in response to both caloric and protein adequacy. No significant differences were observed between feeding routes, although patients receiving parenteral nutrition tended to exhibit greater decline. Correlation analyses demonstrated a significant negative association between time to achieve caloric targets and muscle preservation, underscoring the importance of early intervention. Linear regression further identified delayed caloric achievement as an independent predictor of accelerated muscle loss.

Achieving caloric and high-protein targets is critical for preserving muscle mass in terminal cancer patients. US, particularly of the RF muscle, provides a reliable, noninvasive, and practical tool for monitoring the effects of nutritional interventions in this vulnerable population.