Ravasco Paula
University Hospital of Santa Maria, 1649-035 Lisbon, Portugal.
University of Lisbon, 1649-028 Lisbon, Portugal.
J Clin Med. 2019 Aug 14;8(8):1211. doi: 10.3390/jcm8081211.
Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using "OR" as a Boolean function and the results of the four components were combined by utilizing the "AND" Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1-2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.
尽管人们认识到营养干预至关重要，但并非所有患者都能广泛获得营养支持。鉴于营养风险和营养消耗的发生率，以及由于恶病质管理在临床实践中仍然是一项挑战，采用多学科方法并进行有针对性的营养治疗对于提高肿瘤学护理质量至关重要。在PubMed和Cochrane图书馆进行了从创刊到3月26日的文献检索。检索词包括：癌症、营养、营养治疗、营养不良、恶病质、肌肉减少症、生存、营养素和指南。关键词使用“OR”作为布尔函数进行链接，四个部分的结果通过使用“AND”布尔函数进行合并。选择用英文撰写的指南、临床试验和观察性研究。本文酌情引用了开创性论文。本文讨论了相关文章。近期文献支持将营养筛查/评估纳入癌症护理。建议身体成分评估对干预措施、治疗和结果起决定性作用。营养干预作为任何治疗的辅助手段是必不可少的，因为它可以改善营养参数、身体成分、症状、生活质量，并最终提高生存率。营养咨询是首选，可使用或不使用口服营养补充剂（ONS）。升级营养措施的标准包括：（1）摄入量占需求量的50%以上且持续1-2周以上；（2）如果预计营养不良患者将长期无法进食和/或吸收营养；（3）如果肿瘤本身影响口服摄入。n-3脂肪酸是有前景的营养素，但临床上缺乏针对同质人群的试验来阐明已确定的临床益处。蛋白质摄入不足是癌症的一个关键特征；近期指南建议提高蛋白质摄入量范围，因为这可能对治疗耐受性和疗效产生有益影响。用于对抗肌肉消耗的氨基酸需要进一步研究。建议维生素/矿物质的剂量接近推荐膳食摄入量，避免使用更高剂量。维生素D缺乏可能与癌症相关，并且有人认为需要维生素D来优化蛋白质补充剂的效果。对癌症中发生的临床改变进行积极评估对于选择适当的营养干预措施至关重要，这对营养状况、身体成分、治疗效果以及最终减少并发症、提高生存率和生活质量具有最佳影响。
