Akbulut Gamze
Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey.
Exp Ther Med. 2011 Jul;2(4):675-684. doi: 10.3892/etm.2011.247. Epub 2011 Apr 1.
Cancer and its treatment result in severe biochemical and physiological alterations associated with a deterioration of quality of life (QoL). Cancer-related malnutrition may evolve into cancer cachexia due to complex interactions between pro-inflammatory cytokines and the host metabolism. Depending on the type of cancer treatment (either curative or palliative), the clinical condition of the patient and nutritional status, adequate and patient-tailored nutritional intervention should be prescribed (diet counseling, oral supplementation, enteral or total parenteral nutrition). Nutritional support has been widely advocated as adjunctive therapy for a variety of underlying illnesses, including surgery and medical oncotherapy (radiation or chemotherapy for cancer). Glutamine, n-3 fatty acids and probiotics/prebiotics are therapeutic factors that potentially modulate gastrointestinal toxicity related to cancer treatments. Enteral and parenteral nutrition may help improve patient survival, functional status and QoL, yet the benefits appear to be primarily limited to patients with good functional status and with gastrointestinal disease affecting nutritional intake. Parenteral nutrition offers the possibility of increased or maintenance of the nutrient intake in patients for whom normal food intake is inadequate and for whom enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. This article reviews evidence on issues relevant to enteral and parenteral nutrition in patients with cancer.
癌症及其治疗会导致严重的生化和生理改变，并伴有生活质量（QoL）的下降。由于促炎细胞因子与宿主代谢之间的复杂相互作用，癌症相关营养不良可能会发展为癌症恶病质。根据癌症治疗的类型（治愈性或姑息性）、患者的临床状况和营养状况，应制定适当且针对患者个体的营养干预措施（饮食咨询、口服补充剂、肠内营养或全胃肠外营养）。营养支持已被广泛提倡作为包括手术和肿瘤内科治疗（癌症放疗或化疗）在内的各种基础疾病的辅助治疗方法。谷氨酰胺、n-3脂肪酸和益生菌/益生元是可能调节与癌症治疗相关的胃肠道毒性的治疗因素。肠内营养和胃肠外营养可能有助于提高患者的生存率、功能状态和生活质量，但这些益处似乎主要限于功能状态良好且患有影响营养摄入的胃肠道疾病的患者。胃肠外营养为正常食物摄入量不足且肠内营养不可行、禁忌或不被患者接受的患者提供了增加或维持营养摄入的可能性。本文综述了与癌症患者肠内营养和胃肠外营养相关问题的证据。
