Among the sources of lack of nutrition in this group are factors pertaining to the individual, the lump itself, as well as therapies.
Regarding the factors connected to the patient, the patient may endure an incredible mental affectation consequently of the cancer medical diagnosis and the misery before the different treatments to which he is going to go through. Depression, anxiety, stress and anxiety, and concern are often experienced emotions that can contribute to anorexia or loss of the wish to eat 1.
On the other hand, there are alterations caused by the tumor itself (both locally, depending on its location and also metabolic degree) that will modify the nutritional status of cancer people 1,2.
Mechanical or practical alterations
The location of the tumor at any factor in the gastrointestinal system can induce mechanical as well as functional alterations that will impact the feeding of the individual.
- – Esophageal lumps: dysphagia.
- – Head as well as neck lumps: change in chewing, drool, or swallowing as well as connected discomfort.
- – Stomach lumps: anorexia nervosa, very early satiation, or blockage of transportation at the stomach level.
- – Intestinal growths: occlusive or sub-occlusive images, maldigestion, and also malabsorption.
There are a series of metabolic as well as endocrinological adjustments that generate a catabolic state in which lipolysis, as well as proteolysis, are caused, causing a loss of lean mass, fat, and insulin resistance.
- – Growth aspects ( generated by the growth itself): proteolysis generating element (PIF) or lipid mobilization factor.
- – Humoral factors ( produced by the host in reaction to the existence of the lump): cytokines (TNF-α, IL-1 and 6 as well as IFN-γ), neuropeptides (neuropeptide Y, serotonin and also melanocortins) and also hormones (insulin and glucagon).
Finally, it must be borne in mind that the surgical, chemotherapy, as well as radiation therapies, made use of in cancer individuals, can have adverse effects that damage dietary standing 3:
can produce mechanical or physiological barriers relying on the intervened location.
- – Head and also Neck: Trouble talking, chewing, drooling, swallowing, smelling, or tasting.
- – Digestive system: gastric paresis, food digestion disruptions, nutrient malabsorption, anastomotic leakages, fluid and also electrolyte inequalities, or minerals and vitamin shortages, among others.
It can create anorexia, taste disorders, early satiety, queasiness, vomiting, looseness of the bowels, as well as constipation.
Negative effects rely on the irradiated location, dose, fractionation, duration, as well as irradiated quantity. A lot of are severe, beginning around the 2nd or 3rd week of treatment and disappearing 2-3 weeks after the conclusion.
- – Head and also neck: preference disorders, odynophagia, xerostomia, mucositis, dysphagia, or stenosis in the top esophagus.
- – Thoracic location: esophagitis, dysphagia, or esophageal reflux.
- – Pelvic or stomach location: nausea or vomiting, vomiting, looseness of the bowels, enteritis, and malabsorption.
As already pointed out, lack of nutrition connected with cancer has low consumption, and also metabolic conditions stemmed from the inflammatory action. Nutritional support can partially reverse this scenario and has been linked to an enhancement in the client’s body weight, useful status, and lifestyle. Although it has actually disappointing results in terms of survival, some researches suggest better resistance to therapy 4-6.
Nutritional assistance is indicated in malnourished individuals or those in danger of lack of nutrition, and also in those in whom the growth of anorexia or stomach problems due to treatment toxicity is anticipated. It can be categorized, according to its complexity and also invasiveness, right into the adhering to categories5:
– Nutritional suggestions or dietary recommendations. When the client is able to ingest greater than 75% of their dietary needs with the oral diet plan and also it is not anticipated to accomplish danger therapy in the near future. The primary goal of these dietary referrals is to regulate the signs and symptoms brought on by the tumor itself or the therapies, with adjustments in eating routines as well as oral supplements.
- – Dental enteral nutrition or supplements. If the individual is only able to ingest between 50 and 75% of their requirements with the usual diet regimen for greater than 5 consecutive days or is a little malnourished. It is recommended to start supplementation with typical formulas carried out outside meal times.
- – Enteral tube nutrition. If the individual ingests less than 50% of their requirements for greater than 5 days or has moderate-severe malnutrition. Enteral tube nourishment is indicated, especially if there is dysphagia or extreme mucositis is anticipated to show up. It can be carried out by gastroenteric tubes or ostomy.
- – Parenteral nutrition. When enteral nutrition is contraindicated or stops working to meet nutritional demands.
This post concentrates on the initial line of nutritional support, that is, individualized dietary advice, consisting of recommendations on dietary supplements, which can be performed in the context of a neighborhood pharmacy. It is not the goal of this write-up to talk about man-made nutrition.
Macro as well as trace element demands
The energy requirements of cancer patients ought to be thought about equal to or slightly higher than that of a healthy person if they can not be measured individually. The guidelines of the European Society for Enteral and Parenteral Nutrition (ESPEN), published in 2016, generally recommend a total caloric intake of between 25 and 30 kcal/kg/ day in cancer patients 6.
Some studies suggest some variability in resting energy expenditure between different tumors: it remains normal in patients with tumors of gastric and colorectal origin, and increases in pancreatic and lung cancers. However, the evidence is not enough to make a recommendation in this regard. 7
The macronutrient recommendations in the cancer patient are mainly based on the metabolic disorders already mentioned. A minimum protein intake of 1 g/ kg/day, and up to 2 g/ kg/day if possible, is recommended to promote protein anabolism and curb the loss of lean mass. On the other hand, the optimal energy ratio between carbohydrates and fats has not been determined. However, due to the insulin resistance present in these patients (as well as the risk of infection associated with hyperglycemia and the positive water balance it causes), it seems reasonable to recommend an increase in the energy intake from fats and a decrease in carbohydrates 6.7.
The electrolyte, vitamin, and mineral requirements must be adjusted to the needs of the patient. In the absence of a specific deficit, a standard contribution based on the recommended daily amounts is recommended. 6 Taking into account the low intake in the cachectic patient, the use of a multivitamin-multimineral oral supplement in physiological doses would be a useful and safe option 8.
Dietary recommendations for
symptom control The dietary advice for symptom control is a first-line treatment that must accompany any other nutritional therapy necessary for the patient. As an accessible and patient-friendly healthcare professional, the pharmacist plays a key role and can offer dietary advice. Table 1 summarizes the recommendations based on symptoms 5,9-12.
Food supplements in oncology
As previously mentioned, food supplements in the oncology patient can be useful as an instrument that allows providing the recommended daily amount of vitamins and minerals in patients with a low intake. 8
This article, however, focuses mainly on the use of food supplements in two settings in which much literature has been published in recent years: supplements as primary prevention of oncological diseases, and supplements as treatment of side effects. of antineoplastic therapy.
Food supplements as primary prevention
The use of vitamins and minerals in cancer prevention is, even today, a topic of interest to researchers. In the last 40 years, a multitude of studies has been carried out with the aim of evaluating the usefulness of vitamin and mineral supplementation as primary prevention of oncological diseases.
Free radicals are highly reactive chemical compounds that naturally form in the body and play an important role in many normal cell processes. However, in high concentrations, they can damage cellular components such as DNA, proteins, or cell membranes. When natural defense mechanisms are not sufficient to counteract the production of free radicals, a state of oxidative stress is generated, which has been related to various pathologies, such as cancer 13,14.
Antioxidants are chemical compounds that interact with and neutralize free radicals. The body produces some of these compounds (endogenous antioxidants), but it also depends on external sources (exogenous antioxidants) 13,14. The latter constitute a very large and diverse group of molecules (in terms of a chemical structure and biological properties) that can be divided into three subgroups: polyphenols (flavonoids and phenolic acids), vitamins (vitamins C, E, K, beta-carotene, and lycopene) and minerals (selenium and zinc). They mainly come from foods of plant origin (fruits, vegetables, and cereals) 14, and some exogenous antioxidants are also available as food supplements.
Several in vitro and animal studies have shown that the presence of higher concentrations of exogenous antioxidants prevents the damage caused by free radicals that have been associated with the presence of cancer 13,14. For this reason, researchers have studied whether the use of dietary antioxidant supplements can help reduce the risk of cancer in humans. To date, in addition to numerous observational studies, several randomized controlled trials (RCTs) have been published that have provided variable results.
Antioxidant supplementation for lung cancer prevention is one of the most controversial issues after the publication of two epidemiological trials that documented worse results with the use of antioxidant vitamins and minerals: the α-Tocopherol and β-Carotene Trial (ATBC), carried out in Finland, and the Carotene and Retinol Efficacy Trial (CARET), carried out in the United States.
The ATBC trial included more than 29,000 male smokers, ages 50-69, who were randomized to receive 20 mg of β-carotene and 50 mg of α-tocopherol (alone, in combination, or placebo) for 5-8 years. The initial results of the study showed an increase in the incidence of lung cancer among the participants who had received beta-carotene supplements, while there was no difference in the incidence of lung cancer in the patients who took α-tocopherol.
The CARET study included more than 18,000 participants at high risk for lung cancer due to a history of smoking or exposure to asbestos. The study ended 2 years earlier than planned because preliminary results showed that taking daily supplements with 15 mg of β-carotene and 25,000 IU of retinol was associated with more cases of death from lung cancer and increased mortality from any cause. 13.
A systematic review was published in late 2012 to determine whether vitamin and/or mineral supplementation reduced the incidence and mortality from lung cancer in healthy people. Nine randomized controlled trials (including ATBC and CARET), with almost 190,000 participants, comparing vitamin and/or mineral supplementation versus placebo in healthy people, with the aim of preventing lung cancer, were included. In conclusion, the review indicated that there is no evidence to recommend supplements of vitamins A, C, E, or selenium, either alone or in different combinations, for the prevention of lung cancer or to reduce mortality from lung cancer in healthy people. Further,15.
In the case of gastrointestinal cancer, another systematic review published in 2010, which included 20 randomized controlled trials (with more than 210,000 participants) studying antioxidant supplements for the prevention of this disease, also found no evidence of its benefit. However, they identified a possible beneficial effect of selenium in cancer prevention 16.
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