McGill Cancer Nutrition Rehabilitation Program, Segal Cancer Centre, Jewish General Hospital, Montreal, Canada; Peter Brojde Lung Cancer Centre, Segal Cancer Centre, Jewish General Hospital, Montreal, Canada.
McGill Cancer Nutrition Rehabilitation Program, Segal Cancer Centre, Jewish General Hospital, Montreal, Canada.
Clin Nutr. 2018 Feb;37(1):235-241. doi: 10.1016/j.clnu.2016.12.012. Epub 2016 Dec 21.
BACKGROUND & AIMS: Weight loss is a cardinal feature of cachexia and is frequently associated with reduced food intake and anorexia. It is still unclear how much reduced food intake contributes to cancer-related weight loss and how effective increasing dietary energy and protein is in combating this weight loss. The relationship between weight change and both diet and change in dietary intake, was examined in patients with advanced stage cancer referred to a multidisciplinary clinic for management of cancer cachexia.
A retrospective study of data for each of the first three clinic visits for patients seen between 2009 and 2015. Data on weight change, dietary intake and change in dietary intake were compared. Regression analysis was used to determine independent explanatory factors for weight change, including the impact of appetite level and a marker of systemic inflammation.
Of 405 eligible patients, 320 had data on dietary intake available. Dietary intake varied widely at baseline: 26.9% reported very poor diet and only 17% were consuming recommended levels of energy and protein. A highly significant positive correlation was found between dietary energy or protein intake and weight change, both before and after being seen in the clinic. Anorexia was also significantly correlated with weight loss at each clinic visit. However, there was no similar overall correlation between change in dietary intake and change in weight.
Many patients with advanced cancer and weight loss are consuming diets that would likely be insufficient to maintain weight even in healthy individuals. Higher consumption of protein and energy correlates with greater weight gain, but it is impossible to predict the response to increased nutritional intake when patients are first assessed. There is a pressing need to improve understanding of factors that modulate metabolic responses to dietary intake in patients with cancer cachexia.
体重减轻是恶病质的一个主要特征，常与食物摄入减少和厌食有关。目前尚不清楚减少的食物摄入量对癌症相关体重减轻的影响有多大，以及增加饮食能量和蛋白质对对抗这种体重减轻的效果如何。本研究旨在探讨晚期癌症患者体重变化与饮食和饮食摄入量变化之间的关系，这些患者被转诊至多学科诊所接受癌症恶病质的治疗。
对 2009 年至 2015 年间就诊的前三次就诊的每位患者的数据进行回顾性研究。比较体重变化、饮食摄入量和饮食摄入量变化的数据。回归分析用于确定体重变化的独立解释因素，包括食欲水平和全身炎症标志物的影响。
在 405 名符合条件的患者中，有 320 名患者有饮食摄入数据。基线时饮食摄入差异很大：26.9%的患者报告饮食非常差，只有 17%的患者摄入推荐水平的能量和蛋白质。在就诊前和就诊后，饮食能量或蛋白质摄入量与体重变化之间均存在高度显著的正相关。厌食症在每次就诊时与体重减轻也显著相关。然而，饮食摄入量的变化与体重的变化之间没有总体相关性。
许多晚期癌症和体重减轻的患者摄入的饮食量可能不足以维持健康个体的体重。较高的蛋白质和能量摄入与体重增加相关，但当患者首次评估时，无法预测增加营养摄入的反应。迫切需要提高对癌症恶病质患者饮食摄入代谢反应调节因素的理解。
