Malnutrition, cachexia and nutritional intervention: when much becomes too much

Serena Rianda, Filippo Rossi Fanelli, Alessandro Laviano

DOI: https://doi.org/10.7175/cmi.v7i2.647

Abstract

Disease-associated malnutrition, also defined as cachexia, is a complex syndrome characterised by the progressive deterioration of nutritional status resulting from the combined effects of reduced appetite and food intake, and profound changes in host metabolism. Cachexia has been repeatedly demonstrated to represent a negative prognostic factor for patients suffering from acute and chronic diseases, including cancer. In oncology patients, early diagnosis of cachexia and timely nutritional intervention have been demonstrated not only to prevent further deterioration of nutritional status, but also to increase quality of life and survival when integrated in a multiprofessional and multidisciplinary approach. However, nutritional therapy is associated to the possible development of complications, which may be fatal. Therefore, nutritional therapy in severely malnourished patients should be cautiously prescribed by experts in the field, who should develop a monitoring program to early detect complications and to maximise the clinical efficacy.

Here we describe a cancer patient affected by refeeding syndrome, who was fortunately early diagnosed and properly treated.

Keywords

Malnutrition; Cachexia; Enteral nutrition; Complications; Refeeding syndrome; Oral nutritional supplements; Monitoring program

Full Text

HTML PDF

References

  • Linee guida SINPE per la Nutrizione Artificiale Ospedaliera 2002. Rivista Italiana di Nutrizione Parenterale ed Enterale 2002; 20: S5-S8
  • Laviano A, Meguid MM, Inui A, et al. Therapy insight: cancer anorexia-cachexia syndrome – when all you can eat is yourself. Nat Clin Pract Oncol 2005; 2: 158-65. http://dx.doi.org/10.1038/ncponc0112
  • DeWys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980; 69: 491-7. http://dx.doi.org/10.1016/S0149-2918(05)80001-3
  • Laviano A, Rianda S, Molfino A, et al. Omega-3 fatty acids in cancer. Curr Opin Clin Nutr Metab Care 2013; 16: 156-61. http://dx.doi.org/10.1097/MCO.0b013e32835d2d99
  • Laviano A, Inui A, Marks DL, et al. Am J Physiol Endocrinol Metab 2008; 295: E1000-8. http://dx.doi.org/10.1152/ajpendo.90252.2008
  • Cleeland CS, Allen JD, Roberts SA, et al. Reducing the toxicity of cancer therapy: recognizing needs, taking action. Nat Rev Clin Oncol 2012; 9: 471-8. http://dx.doi.org/10.1038/nrclinonc.2012.99
  • Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011; 12: 489-95. http://dx.doi.org/10.1016/S1470-2045(10)70218-7
  • Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol 1997; 50: 693-703. http://dx.doi.org/10.1016/S0895-4356(97)00015-2
  • Stanga Z, Sobotka L. Refeeding syndrome. In: Sobotka L, Allison S, Forbes A, et al (eds.). Basics in Clinical Nutrition. 4th edition. Prague: Publishing House Galen, 2011; pp. 427-432
  • Fearon KC, Von Meyenfeldt MF, Moses AG, et al. Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut 2003; 52: 1479-86. http://dx.doi.org/10.1136/gut.52.10.1479
  • van der Meij BS, Langius JA, Spreeuwenberg MD, et al. Oral nutritional supplements containing n-3 polyunsaturated fatty acids affect quality of life and functional status in lung cancer patients during multimodality treatment: an RCT. Eur J Clin Nutr 2012; 66: 399-404. http://dx.doi.org/10.1038/ejcn.2011.214
  • Murphy RA, Mourtzakis M, Chu QS, et al. Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer. Cancer 2011; 117: 3774-80. http://dx.doi.org/10.1002/cncr.25933
  • van der Meij BS, van Bokhorst-de van der Schueren MA, Langius JA, et al. n-3 PUFAs in cancer, surgery, and critical care: a systematic review on clinical effects, incorporation, and washout of oral or enteral compared with parenteral supplementation. Am J Clin Nutr 2011; 94: 1248-1265. http://dx.doi.org/10.3945/ajcn.110.007377
  • Ries A, Trottenberg P, Elsner F, et al. A systematic review on the role of fish oil for the treatment of cachexia in advanced cancer: an EPCRC cachexia guidelines project. Palliat Med 2012; 26: 294-304. http://dx.doi.org/10.1177/0269216311418709
  • Espen. Oral Nutritional Supplements to Tackle Malnutrition. Disponibile online su: http://www.espen.org/ons-to-tackle-malnutrition (ultimo accesso: giugno 2013)

Statistics

Abstract: 1687 views
HTML: 906 views
PDF: 233 views

Refbacks

  • There are currently no refbacks.




© SEEd srl