Malnutrition as a Risk Factor in the Development of Oral Cancer: A Systematic Literature Review and Meta-Analyses
Abstract
:1. Introduction
- Primary malnutrition, linked to the availability and intake of food;
- Secondary malnutrition, resulting from specific physiological (e.g., pregnancy, lactation, febrile states) and pathological conditions that impair digestion and nutrient absorption [6].
2. Materials and Methods
2.1. Study Objective and PECOS Model
- P. Population/problem/patient: adult patients not affected by any systemic disease;
- E. Exposure: patients exposed to primary or secondary malnutrition due to different causes;
- C. Comparison: the incidence of oral cancer in healthy subjects and in patients not affected by primary or secondary malnutrition;
- O. Outcome: development of oral carcinoma;
- S. Study design: cohort studies, case–control studies, cross-sectional studies, and randomized clinical trials (RCTs) with no fewer than 10 patients.
2.1.1. Inclusion Criteria
2.1.2. Exclusion Criteria
Electronic Search
Manual Search
Unpublished Articles
2.2. Study Selection
2.2.1. Data Extraction
2.2.2. Quality Assessment
2.2.3. Heterogeneity Assessment
- 0−40%: negligible;
- 30−60%: moderate;
- 50−90%: substantial;
- 75−100%: considerable [14].
2.3. Data Analysis
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Risk of Bias Assessment
3.4. Results of the Meta-Analyses
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors–Year | Place of Publication | Study Design | Number of Patients | Analyzed Micronutrient | Patients with SCC | Study Objective | Years of Follow-Up | Results |
---|---|---|---|---|---|---|---|---|
Barone (1992) [16] | USA | R | 870 | Vitamin C and E | 290 | Use of vitamin supplements and the risk of oral and esophageal carcinogenesis | 0 | It was noted that the intake of vitamin C and E acts as a protective factor in the onset of oral and esophageal cancer. |
Skaaby (2001) [17] | Denmark | P | 12,204 | Vitamin D | 1248 | Correlation between blood vitamin D concentration and generalized risk of carcinogenesis | 11.3 | There was no observed increase in the risk of a specific tumor, but a generalized risk of the development of neoplasms. |
Pelucchi (2003) [18] | Italy and French Switzerland | R | 2521 | Folic acid | 749 | To assess whether daily intake of folic acid is considered a protective factor for SCC | 5 | Low intake of folic acid and alcohol consumption increase the risk of SCC. |
Shanmugham (2010) [19] | USA | P | 87,621 | Folic acid | 147 | Quantifying folate intake as a risk factor for the development of SCC | 26 | Patients who consume >30 g/day of alcohol and <350 μg/day of folate have a 20% increased risk of developing SCC. |
Arem (2011) [20] | Finland | P | 29,133 | Vitamin D | 348 | Assessing serum vitamin D concentrations as a risk factor for the development of HN tumors | 20 | No correlation was found between low serum levels and an increased incidence of HNC. |
Aune (2011) [21] | Uruguay | R | 5571 | Folic acid | 3539 | Folic acid as a protective factor against 11 types of cancer | 8 | There is a significant reduction in the incidence of oral and pharyngeal SCC in patients with adequate folate intake. |
Fanidi (2016) [22] | Europe | P | 385,747 | Vitamin D | 497 | Correlation between circulating vitamin D and the incidence and survival of SCC | 8 | Reduced levels of circulating vitamin D are correlated with an increase in the incidence of laryngeal, hypopharyngeal, and oral cancer. |
Quality Assessment Outcome: Oral Cancer Incidence in Patients with Malnutrition | ||||||
---|---|---|---|---|---|---|
Question: Does malnutrition have an influence on oral cancer incidence? | ||||||
Number of studies according to meta-analysis | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias |
Meta-analysis on folate effects (3 studies) | cohort and case–control studies | medium | serious (a) | serious (b) | not serious | N/A |
Meta-analysis on vitamin C effects (1 study) | case–control study | medium | N/A | serious (b) | not serious | N/A |
Meta-analysis on vitamin D effects (3 studies) | cohort and case–control studies | medium | not serious | serious (b) | not serious | N/A |
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Patini, R.; Favetti Giaquinto, E.; Gioco, G.; Castagnola, R.; Perrotti, V.; Rupe, C.; Di Gennaro, L.; Nocca, G.; Lajolo, C. Malnutrition as a Risk Factor in the Development of Oral Cancer: A Systematic Literature Review and Meta-Analyses. Nutrients 2024, 16, 360. https://doi.org/10.3390/nu16030360
Patini R, Favetti Giaquinto E, Gioco G, Castagnola R, Perrotti V, Rupe C, Di Gennaro L, Nocca G, Lajolo C. Malnutrition as a Risk Factor in the Development of Oral Cancer: A Systematic Literature Review and Meta-Analyses. Nutrients. 2024; 16(3):360. https://doi.org/10.3390/nu16030360
Chicago/Turabian StylePatini, Romeo, Eleonora Favetti Giaquinto, Gioele Gioco, Raffaella Castagnola, Vittoria Perrotti, Cosimo Rupe, Leonardo Di Gennaro, Giuseppina Nocca, and Carlo Lajolo. 2024. "Malnutrition as a Risk Factor in the Development of Oral Cancer: A Systematic Literature Review and Meta-Analyses" Nutrients 16, no. 3: 360. https://doi.org/10.3390/nu16030360