Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland.
Cancer Epidemiology and Primary Prevention Department, The Maria Sklodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, 02-034 Warsaw, Poland.
Nutrients. 2021 Dec 19;13(12):4551. doi: 10.3390/nu13124551.
Most studies confirm the beneficial effects of enteral nutrition on the quality of life, but some studies indicate an inverse association and its detrimental impacts. However, there are insufficient data on the effects of enteral nutrition on the quality of life of cancer patients. This systematic review aimed to describe the influence of applied enteral nutrition on the quality of life of cancer patients, based on the results of randomized controlled trials. It was registered in the PROSPERO database (CRD42021261226) and conducted based on the PRISMA guidelines. The searching procedure was conducted using the PubMed and Web of Science databases, as well as Cochrane Library, and it included studies published until June 2021. It was conducted to select randomized controlled trials assessing the influence of enteral nutrition (compared with the other model of nutrition) on the quality of life of cancer patients. A general number of 761 records were screened and a final number of 16 studies were included in the systematic review. The studies were included and assessed by two independent researchers, while the risk of bias was analyzed using the Newcastle-Ottawa Scale (NOS). Studies compared patients treated with and without enteral nutrition, patients treated with various methods of enteral nutrition or with enteral diets of various content, as well as patients treated with enteral and parenteral nutrition. Within the included studies, the majority were conducted in patients with cancers located in various parts of the body, or diverse areas within the gastrointestinal system, while some studies were conducted in specific populations of patients with a defined cancer location-esophagus, stomach, or ovary. The duration of applied enteral nutrition within the included studies was diversified-from two weeks or less to half a year or even more. The vast majority of studies used well-known and validated tools to assess the quality of life, either developed for a specific group of head/neck, esophagus/stomach, and ovary cancer patients or developed for more general patient populations. Most studies concerning patients treated with and without enteral nutrition supported applying enteral nutrition, which was concluded in seven studies out of ten (including four studies with a low risk of bias). The other important observations to be emphasized-formulated based on the studies with a low risk of bias-presented the role of oral supportive nutrition guided by a dietitian, as well as the beneficial role of enteral and parenteral nutrition, combined. In spite of a relatively low number of randomized controlled trials assessing the influence of enteral nutrition on the quality of life of cancer patients, which should be considered as a limitation, the results were promising. Most studies supported the positive influence of enteral nutrition on the quality of life, either assessed based on the psychological measures of the quality of life or by considering the other potential determinants (e.g., malnutrition, complications, etc.). Taking this into account, enteral nutrition should be applied whenever possible, both to prevent and treat malnutrition in cancer patients. However, considering the limited number of studies conducted so far, further research conducted in homogenic populations of patients is necessary.
大多数研究证实了肠内营养对生活质量的有益影响，但一些研究表明存在相反的关联及其不利影响。然而，关于肠内营养对癌症患者生活质量影响的数据还不够充分。本系统评价旨在根据随机对照试验的结果，描述应用肠内营养对癌症患者生活质量的影响。该研究已在 PROSPERO 数据库（CRD42021261226）中进行了注册，并按照 PRISMA 指南进行了操作。检索过程使用了 PubMed 和 Web of Science 数据库以及 Cochrane Library，并纳入了截至 2021 年 6 月发表的研究。该研究旨在选择评估肠内营养（与其他营养模式相比）对癌症患者生活质量影响的随机对照试验。共筛选了 761 条记录，最终有 16 项研究纳入了系统评价。这些研究由两名独立的研究人员进行了纳入和评估，同时使用纽卡斯尔-渥太华量表（NOS）分析了偏倚风险。研究比较了接受肠内营养和不接受肠内营养的患者、接受不同肠内营养方法或不同内容肠内饮食的患者，以及接受肠内和肠外营养的患者。在纳入的研究中，大多数研究的对象是患有身体各部位或胃肠道不同部位癌症的患者，而一些研究的对象是特定部位癌症（食管、胃或卵巢）的患者。纳入研究中应用肠内营养的时间长短不一——从两周或更短到半年甚至更长时间。绝大多数研究使用了众所周知的和经过验证的工具来评估生活质量，这些工具是为特定的头/颈、食管/胃和卵巢癌症患者群体开发的，或者是为更一般的患者群体开发的。大多数关于接受和不接受肠内营养的患者的研究都支持应用肠内营养，其中 10 项研究中有 7 项（包括 4 项低偏倚风险研究）得出了这一结论。另一个需要强调的重要观察结果——基于低偏倚风险的研究提出了在营养师指导下进行口服支持性营养的作用，以及肠内和肠外营养联合应用的有益作用。尽管评估肠内营养对癌症患者生活质量影响的随机对照试验数量相对较少，这应该被认为是一个局限性，但结果还是很有希望的。大多数研究支持肠内营养对生活质量的积极影响，无论是基于生活质量的心理测量指标评估，还是考虑其他潜在的决定因素（例如，营养不良、并发症等）。考虑到这一点，无论在预防还是治疗癌症患者的营养不良方面，都应尽可能地应用肠内营养。然而，考虑到迄今为止进行的研究数量有限，还需要在同质的患者群体中进行进一步的研究。
