Nutrition
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Epidemiologic studies show that malnutrition frequently afflicts elderly cancer patients. Malnutrition, (expressed as weight loss, or depletion of some body compartments or alteration of nutritional clinical or biochemical scores) is associated with higher morbidity/mortality, poor quality of life, reduced tolerance to oncologic therapy and poor efficacy of chemotherapy. Recently, sarcopenia, regardless of the presence of weight loss, has been identified as an independent risk factor for chemotherapy toxicity.
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The objective of this review article is to present the most recent intervention studies with EPA on nutritional outcomes in cancer patients, e.g. nutritional status, weight & lean body mass. ⋯ Indeed, cancer-related sarcopenia/cachexia is a multifactorial syndrome characterized by inflammation, anorexia, weight loss, and muscle/adipose tissue loss mediated by proinflammatory cytokines, e.g. TNF-α and IL-6, resulting in increased chemotherapy toxicity, costs, morbidity and mortality. With this review we found that EPA can reduce inflammation and has the potential to modulate nutritional status/body composition. In view of the modest survival benefits of chemotherapy/radiotherapy in some cancers, important issues for physicians are to optimize well-being, Quality of Life via nutritional status and adequate body composition. Thus, improvement in nutritional status is a central outcome.
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The aim of this study was to determine the effects of some polyunsaturated fatty acids plus phytomelatonin from walnuts in the development of mammary gland adenocarcinoma. ⋯ This study shows that melatonin, along with polyunsaturated fatty acids, exerts a selective inhibition of some COX and LOX activities and has a synergistic anti-tumor effect on a mammary gland adenocarcinoma model.
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Although the nutritional approach, especially when delivered through a gastric or jejunal tube or in a central vein, is handled by the nutritional support team or a specialist in nutrition, it is the responsibility of the oncologist, who knows the natural history of the disease and the impact of the oncologic therapy, to identify the potential candidates for the nutritional support, to recommend the nutritional strategy and to integrate it within the oncologic program. If gastrointestinal function is preserved, the initial nutritional approach should be through oral supplementation, followed by tube feeding if previous attempts are unsuccessful or upper gastrointestinal tract is not accessible. Parenteral nutrition is the obligatory resort when patients are (sub)obstructed but it may also be a practical way to integrate an insufficient oral nutrient intake (so called "supplemental" parenteral nutrition). Depending on the patient's condition and the disease's stage, artificial nutrition may have a "permissive" role in patients receiving aggressive oncologic therapy or represent just a supportive treatment in patients likely to succumb from starvation sooner than from tumor progression.
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Our knowledge of the macronutrient requirement of elderly cancer patient is still incomplete and mainly relies on studies of elderly (healthy) people and populations of cancer patients including both adult and elderly subjects. Patients with minor nutritional deterioration do not require any specific nutritional regimen, but cachectic patients do. ⋯ However, the final balance depends not only on the quantity of AA but also their quality: diets including a high percentage of essential AA and especially of branched-chain ones and leucine in particular, are advocated. Total fluid load should be prudent, around 25-30 ml/kg/d.