Nutrition in Oncology

Maintaining good nutritional habits before, during, and after receiving cancer treatment is vital towards the management of this disease. Individuals with cancer may experience rapid weight loss and tumor-associated malnutrition even before treatment begins, especially if the cancer is in the throat or gastrointestinal tract [1]. Malnutrition may occur due to a number of different factors related to the disease, including metabolic changes.

Metabolic Changes in Cancer

A number of genes and enzymes that contribute to the development of cancer are key regulators of metabolism. In some cases, mutations of metabolic enzymes or genes are all it takes to initiate the formation of tumors. Accordingly, cancer cells differ primarily from healthy cells due to their limitless division potential and the altered metabolism of cancer cells appears to promote their rapid growth and duplication [2].

In order to accommodate their rapid metabolism, cancer cells subsequently begin to dominate the uptake and incorporation of nutrients in order to facilitate new cancer cell growth. This includes amino acids that are essential for protein synthesis, nucleic acids for healthy DNA, and lipids (fats) for healthy cell membranes [2]. All of these factors may lead to malnutrition and a condition known as cachexia.

Cachexia and Malnutrition

There are various factors that contribute to tumor-associated malnutrition, which include but are not limited to:

  • Abnormal hunger-satiation feelings
  • Impaired nutrient digestion
  • Psychological changes (e.g. depression, loss of appetite)

These health issues may cause reduced nutrient intake and decreased nutrient absorption. Impaired nutrient digestion and absorption in combination with the metabolic changes in cancer cells may result in the development of cancer-induced cachexia, which is characterized by the dramatic loss of weight and body mass (wasting away) as well as inflammation [3]. Both tumor-associated malnutrition and cachexia may diminish the body’s response to cancer therapy and even augment the side effects of therapy [4, 5]. These factors emphasize the need for optimal nutrition support during cancer treatment.

Nutrition Support in Cancer Management

Many cancer patients have multiple nutrient deficiencies and regular food intake does not usually meet the nutrient requirements or replenish the nutrient sites that cancer cells continuously deplete [1]. Some patients with cancer also experience food aversion, which only worsens this problem [6, 7]. Therefore, micronutrient supplementation is typically recommended [1], and clinical studies show that cancer patients who take vitamin and mineral supplements often experience improved nutritional status [8, 9]. Furthermore, research has also demonstrated the importance of consuming a high protein diet.

Role of High Protein Oral Nutrition Supplements

High protein supplements can add nutrient density to food, are a rich source of essential amino acids, are highly digestible, and quickly absorbed by the gut, which is beneficial for cancer patients who may be experiencing gastrointestinal problems [10, 11]. Protein supplements also target decreases in weight and body mass by promoting increased lean muscle mass as well as the maintenance of muscle growth [12-14]. In addition, protein supplementation promotes healthier levels of inflammation [15]; all of which can help improve malnutrition and cachexia.

References

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  2. Wu W, Zhao S. Metabolic changes in cancer: beyond the Warburg effect. Acta Biochim Biophys Sin (Shanghai). 2013;45(1):18-26.
  3. Fearon KC, Voss AC, Hustead DS, Cancer Cachexia Study Group. Definition of cancer cachexia: Effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006;83:1345-1350.
  4. Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34:2132-2133.
  5. Ross PJ, Ashley S, Norton A, Priest K. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer. 2004; 90:1905-1911.
  6. Khalid U, Spiro A, Baldwin C, Sharma B, et al. Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation. Support Care Cancer. 2007;15:39-46.
  7. Hutton JL, Martin L, Field CJ, Wismer WV, Bruera ED, Watanabe SM and Baracos VE: Dietary patterns in patients with advanced cancer: implications for anorexia-cachexia therapy. Am J Clin Nutr. 2006;84:1163-1170.
  8. Elango N, Samuel S, Chinnakkannu P. Enzymatic and nonenzymatic antioxidant status in stage (III) human oral squamous cell carcinoma and treated with radical radiotherapy: Influence of selenium supplementation. Clin Chim Acta. 2006;373:92-98.
  9. Federico A, Iodice P, Federico P, et al. Effects of selenium and zinc supplementation on nutritional status in patients with cancer of digestive tract. Eur J Clin Nutr. 2001;55:293-297.
  10. Boirie Y, Dangin M, Gachon P, et al. Slow and fast dietary proteins differently modulate postprandial protein accretion. Proc Natl Acad Sci U S A. 1997;94(26):14930-5.
  11. Frid AH, Nilsson M, Holst JJ, Björck IM. Effect of whey on blood glucose and insulin responses to composite breakfast and lunch meals in type 2 diabetic subjects. Am J Clin Nutr. 2005;82(1):69-75.
  12. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 2009;12(1):86-90.
  13. Tang JE, Moore DR, et al. Ingestion of whey hydrolysate, casein, or soy protein isolate: effects on mixed muscle protein synthesis at rest and following resistance exercise in young men. J Appl Physiol (1985). 2009;107(3):987-92.
  14. Pennings B, Boirie Y, et al. Whey protein stimulates postprandial muscle protein accretion more effectively than do casein and casein hydrolysate in older men. Am J Clin Nutr. 2011;93(5):997-1005.
  15. Zhou LM, Xu JY, Rao CP, et al. Effect of whey supplementation on circulating C-reactive protein: a meta-analysis of randomized controlled trials. Nutrients. 2015;7(2):1131-43.