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 risk for malnutrition increases with age and presence of cancer, and it is particularly common in older cancer patients. A range of simple and validated nutrition screening tools can be used to identify malnutrition risk in cancer patients (e.g., Malnutrition Screening Tool, Mini Nutritional Assessment Short Form Revised, Nutrition Risk Screening, and the Malnutrition Universal Screening Tool). ⋯ Nutritional assessment is a comprehensive assessment of dietary intake, anthropometrics, and physical examination often conducted by dietitians or geriatricians after simple screening has identified at-risk patients. The result of nutritional screening, assessment and the associated care plans should be documented, and communicated, within and between care settings for best patient outcomes.
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The combination of age-related muscle loss (sarcopenia) and the diagnosis of cancer (and the onset of cachexia) is likely a metabolic challenge that skeletal muscle of older cancer patients is not prepared to handle. Albeit to a smaller extent than healthy older controls, the skeletal muscle of older cancer patients is still acutely anabolic to the provision of amino acids. To provide an anabolic stimulus to skeletal muscle during a time when it is susceptible to an advanced rate of breakdown due to cancer- and tumor-related factors, enhanced intake of protein and amino acid sources might be necessary and should likely be higher than the current US recommended daily intake of 0.8 g protein/kg body weight/day. Future studies should investigate whether the acute effects of amino acids on muscle protein anabolism can be sustained over a longer period of time in the presence of cancer cachexia in older patients.
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To assess the energy expenditure of women with breast cancer and the effectiveness of available predictive equations (PEs) for the estimation of energy requirements in these subjects. ⋯ The REE of women with breast cancer was similar to that of healthy women. The energy requirements of these patients may be calculated based on the quick formula of 25 kcal/kg of BW. Nonetheless, this estimation should be used cautiously as it results in wide variations when used alone.