Stay away from malnutrition, cancer patients also need to manage their lives well every day

Author: Wang Qiong, Fudan University Cancer Hospital

Reviewer: Ling Yiqun, deputy chief physician, Fudan University Cancer Hospital

The incidence of malnutrition is high in cancer patients, and malnutrition can increase complications, reduce response and tolerance to treatment, reduce quality of life, and shorten survival, causing huge harm.

According to statistics, the incidence of malnutrition among malignant tumor patients in my country is high, while the rate of nutritional treatment is low [1]. Malignant tumor is a disease related to nutrition, diet and lifestyle. Nutrition is the basis of immunity, but various dietary misconceptions are also troubling and misleading the dietary behavior of cancer patients.

Figure 1 Copyright image, no permission to reprint

Many cancer patients believe that eating too well will “feed” tumor cells at the same time, which is not conducive to the treatment of the disease. The current authoritative guidelines clearly point out that nutritional support for cancer patients can effectively prevent further deterioration of their own nutritional status [2]. For patients with slower tumor progression, nutritional support can better restore their physical condition and reduce the adverse reactions caused by surgery, radiotherapy or chemotherapy, thereby achieving better long-term treatment effects. For patients with severe body consumption and tumors that have affected multiple organs, nutritional support can play a role in slowing down their own consumption.

Some cancer patients believe that after getting sick, they should eat a light diet, only eat vegetables, fruits and whole grains, and eat less staple food and red meat. Some patients believe that XX food is a super anti-cancer food, and they should eat it every day. Some patients believe that to have good nutrition, they should eat high-protein, high-calorie foods such as fish and meat every meal. So what is the truth? To understand these issues, we must first understand the relevant knowledge of nutrition.

Different foods provide different nutrients, each of which has its own physiological function and recommended intake, working together to provide different effects for the human body. Don't think that a certain type or a certain food is beneficial, and focus on this type or this food to eat, which can easily cause nutritional imbalance. For example, calcium is a mineral with a high content in the human body and is the main component of bones and teeth. According to the recommendation of the Chinese Nutrition Society, the recommended daily calcium intake for adults is 800 mg/d. Insufficient calcium intake is prone to osteoporosis, but excessive supplementation may cause kidney stones and inhibit iron absorption. If iron absorption is reduced and iron deficiency reaches a certain level, iron deficiency anemia will occur.

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Therefore, to have a good nutritional status, we need to establish a big picture of nutrition, and not just focus on a certain nutrient. Our goal is to ensure that there is enough energy and the proportion of various nutrients is appropriate. You can think of your daily eating behavior as a process of building a pagoda. To build a pagoda that is stable and good, you need to have a comprehensive and balanced diet, and on this basis, you need to have a diversified diet.

How should the nutrition pyramid be constructed? The Chinese Nutrition Society's Chinese Residents' Dietary Pagoda recommends that the recommended daily intake for an adult is:

——1500～1700 ml water

-- 200-300g of cereals (50-150g of whole grains and beans), 50-100g of potatoes

-- 300-500 grams of vegetables, 200-350 grams of fruit

- 120-200g of animal food (at least 2 servings of seafood per week and 1 egg per day)

—— 300-500 grams of milk and dairy products, 25-35 grams of soy and nuts

——Salt <5g, oil 25-30g

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It is common for cancer patients to lose a lot of weight after a serious illness. Although patients know the importance of nutrition subjectively, objectively they may not be able to eat normally for a long time due to illness, surgical trauma stress, perioperative fasting, etc., or they may not eat enough due to adverse reactions of radiotherapy and chemotherapy. In general, when the energy, protein and other nutrients provided by the diet are 50% to 75% of the target requirement, additional nutritional supplements can be made. When the gastrointestinal function is sound, enteral nutrition support should be the first choice, and the nutrition should be "eaten" directly through oral or tube feeding. If the patient's gastrointestinal function is poor and enteral nutrition cannot meet the nutritional needs, parenteral nutrition is recommended. That is, amino acids, vitamins, fat emulsions and other nutrients are given to the patient through the vein through "infusion" [3].

Cancer patients should pay attention to and pay attention to their nutritional status, eat a balanced diet, and conduct regular nutritional assessments. Once the risk of malnutrition is discovered, they should consult a professional doctor or nutritionist in a timely manner, develop a dedicated nutrition plan, and prevent and correct malnutrition in a timely manner.

References:

Song Chun, Wang Kunhua, Guo Zengqing, et al. Survey on nutritional status of patients with common malignant tumors in China[J]. Science China: Life Sciences, 2020, 50(12): 1437-1452.

Yu Kang, Tumor Nutrition Management Branch of Chinese Nutrition Society. Dietary nutrition recommendations for Chinese cancer patients[M]. Beijing: People's Medical Publishing House, 2022:16-21.

Chinese Nutrition Society Tumor Nutrition Management Branch. White Paper on Dietary Nutrition for Chinese Tumor Patients (2020-2021)[M]. Beijing: Chinese Nutrition Society, 2021:199-210.