Nutrition
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Meta Analysis
Fuel utilization in neoplastic disease: implications for the use of nutritional support in cancer patients.
Tumor cell metabolism and the whole-body response to tumor metabolic activity produces a complex derangement, including alterations in carbohydrate oxidation with futile cycling and changes in gluconeogenesis and lipid utilization. An interplay between circulating hormones, lymphocyte-mediated cytokines, and tumor growth factors complicates fuel metabolism in these individuals. ⋯ Therefore, it is impossible to determine the validity of the results. Furthermore, it is possible that some of the detrimental effects of TPN observed in earlier studies were secondary to the inappropriate use of large glucose loads in cancer patients.
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Despite numerous controlled clinical trials, the indications for parenteral nutritional support of cancer patients undergoing chemotherapy remain controversial. The results of the published trials have therefore been subjected to meta-analysis. ⋯ In summary, for the patients in trials to date, TPN was associated with net harm. Routine use of TPN in patients undergoing chemotherapy should be strongly discouraged, and trials involving specific groups of patients or modifications in TPN should be undertaken with caution.