Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
Department of Nutrition and Dietetics, Mater Hospital, South Brisbane, QLD, Australia.
J Hum Nutr Diet. 2021 Feb;34(1):243-254. doi: 10.1111/jhn.12811. Epub 2020 Oct 10.
Cancer cachexia (CC) is a multifactorial syndrome characterised by ongoing skeletal muscle loss that leads to progressive functional impairment driven by reduced food intake and abnormal metabolism. Despite the traditional use of non-volitional weight loss as the primary marker of CC, there is no consensus on how to diagnose and manage CC.
The aim of this narrative review was to describe and discuss diagnostic criteria and therapeutic approaches for the accredited practicing dietitian with respect to identifying and managing CC.
Available diagnostic criteria for cachexia include the cancer-specific (Fearon and Cachexia Score) and general criteria (Evans and Global Leadership Initiative on Malnutrition). These include phenotypic criteria [weight loss, body mass index, (objective) muscle mass assessments, quality of life] and aetiological criteria (disease burden, inflammation, energy expenditure, anorexia and inadequate food intake) and can be incorporated into the nutrition care process (NCP). This informs the nutrition diagnosis of 'chronic disease- or condition-related malnutrition (undernutrition) as related to increased nutrient needs, anorexia or diminished intake due to CC'. Optimal nutrition care and management of CC is multidisciplinary, corrects for increased energy expenditure (via immunonutrition/eicosapentaenoic acid), suboptimal protein/energy intake and poor nutrition quality of life, and includes a physical exercise intervention. Monitoring of intervention efficacy should focus on maintaining or slowing the loss of muscle mass, with weight change as an alternative gross indicator.
Dietitians and the NCP can play an essential role with respect to identifying and managing CC, focusing on aspects of nutrition screening, assessment and intervention.
癌症恶病质（CC）是一种多因素综合征，其特征为持续的骨骼肌丢失，导致进行性功能障碍，其原因是食物摄入减少和代谢异常。尽管非自愿性体重减轻一直被用作 CC 的主要标志物，但在如何诊断和管理 CC 方面尚未达成共识。
本叙述性综述的目的是描述和讨论经过认证的执业营养师在识别和管理 CC 方面的诊断标准和治疗方法。
现有的恶病质诊断标准包括癌症特异性（Fearon 和恶病质评分）和一般标准（Evans 和全球营养不良领导倡议）。这些标准包括表型标准[体重减轻、体重指数、（客观）肌肉质量评估、生活质量]和病因标准（疾病负担、炎症、能量消耗、厌食和摄入不足），并可纳入营养护理过程（NCP）。这为“与疾病相关的营养不良（营养不足），由于 CC 导致营养需求增加、厌食或摄入不足”提供了营养诊断。CC 的最佳营养护理和管理是多学科的，纠正了能量消耗增加（通过免疫营养/二十碳五烯酸）、蛋白质/能量摄入不足和营养质量差，并包括身体运动干预。干预效果的监测应侧重于维持或减缓肌肉量的损失，体重变化是替代的总指标。
营养师和 NCP 可以在识别和管理 CC 方面发挥重要作用，重点关注营养筛查、评估和干预的方面。
