Tuesday, July 10, 2012

Nutritional Intervention in Cancer Cachexia

     Cancer Cachexia is a wasting syndrome that over half of cancer patients will experience.   Some of the symptoms of cancer cachexia include weight loss, loss of appetite, early satiety, changes in taste, ascites, and dry mouth.  There are two forms of this syndrome, primary anorexia cachexia and secondary anorexia cachexia.   Primary anorexia cachexia is directly related to the disease process while the latter version is a consequence  of other factors not directly associated with the disease such as chronic infection, inadequate food intake, and impaired absorption of nutrients among other things.  Treatment measures are mainly to improve quality of life and reverse the condition through early detection, nutrition counseling, exercise, medications and treating the secondary causes as well as taking care of their emotional well being. 

     Patients have been shown to benefit from dietary counseling in treating cancer cachexia.  When assessing the patient it is important to review the patient’s medical history, medications/supplements taken, weight changes, dietary intake, labs, bioimpedance analysis, skin fold thickness, mid arm circumference, and DEXA scan.  Pertinent labs in the nutritional assessment of the patient include transferrin, retinol binding protein, albumin and prealbumin.  Patients should be encouraged to consume nutrient and energy dense foods.   High calorie nutrition supplements are also beneficial in treating this condition.   Exercise can help build lean body mass in these patients.  For patients with very poor appetites, appetite stimulants like megace, medroxyprogesterone, and prednisolone can be effective in improving oral intake of food.   Nutrition support may be warranted in situations where oral intake is not adequately meeting the patient’s nutritional needs. Enteral tube feedings, as always is the preferred method of administering nutrition support if the patient is agreeable to such methods of nutrition support and if the patient’s condition exhibits no contraindications for enteral tube feeds.  In cases where enteral tube feeds are contraindicated (ex. bowel obstruction, malabsorption, etc.) parenteral nutrition is preferred.    

     There is some evidence that omega-3 fatty acid supplements may improve appetite and hinder growth of tumors.  Additionally, growth hormones, testosterone, melatonin, cannabinoids and thalidomides have shown that they may be beneficial in combatting symptoms such as weight loss and lack of appetite but these benefits have also not been established. 

Granda-Cameron, Clara. "Cancer Cachexia." A Guide to Oncology Symptom Management. Ed. Mary P. Lynch. Pittsburgh: Oncology Nursing Society, 2010. 65-89. Print.

Sunday, July 8, 2012

Summary of the, "American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention"

     According to nutrition research scientists and the American Cancer Society, a substantial percentage of newly diagnosed cancer cases could have been prevented with proper attention to food choices and living a more physically active lifestyle.  Guidelines set forth by the American Cancer Society for cancer prevention encourage maintaining a healthy weight, consuming 2.5 cups of fruits and vegetables a day, limiting intake of alcohol, tobacco products, red meat, processed meats, and refined grains should considerably reduce an individual’s risk of becoming a cancer victim.  The information presented in this blog will discuss some of the American Cancer Society’s recommendations. 

     The predisposition of overweight and obese individuals to cancer is due to alterations in metabolism that effect hormones, immune functioning and inflammation.   Levels of obesity have stabilized in women and youth but are on the rise for adult men.  Increasing physical activity and limiting caloric intake are encouraged to help with weight loss efforts and chronic disease prevention, including cancer.  For adults, it is recommended that they partake in 150 minutes of moderate activity (examples given are: mowing the lawn, walking, dancing)  or 75 minutes of intense activity (examples include jogging, martial arts, soccer)  a week.  Children are encouraged to partake in at least 1 hour of activity each day.  Three days out of the week should be allocated for more intense physical activity for these youth.  Exceeding these recommendations for all groups could be even more beneficial to health and well being.  A 50 to 100 calorie a day reduction of intake from foods should prevent weight gain according the American Cancer Society.  

     Decreasing caloric intake and making an emphasis to eat more plant based foods can help reduce risk of cancer.   High fat and sugary foods/beverages  should be minimized.   Consumers should be aware that just because a food product is labeled as, “nonfat” or “low in fat,” does not assure that the item is low in calories.  Increasing fiber through consumption of whole grain bread, pasta and cereal products is encouraged.  Additionally, red meat and processed meat products should be limited because of their association with mutagens and carcinogens.  In preparing meat, poultry, and fish meals cooking methods such as frying and charbroiling should be avoided.  Instead, it is advised that you bake, broil or poach these food products to limit exposure to mutagens and carcinogens like nitrosamines and heterocyclic amines.  Processed meats have a stronger correlation to disease risk.  These meats are preserved in using nitrates which can lead to disease causing mutations.  There is an established link between alcohol and certain cancers and therefore it is advised that men drink no more than 2 drinks a day and women drink no more than 1 drink a day to minimize the risk.   If you do not already drink, it is advised that continue to abstain.  One alcoholic beverage serving is equivalent to 12oz. of beer, 5oz. of wine or 1.5 oz. of 80 proof distilled spirits. 

     Food contaminants can unintentionally affect our food supply that can indirectly or directly make metabolic alterations that may result in cancer.   Some of these include antibiotics or hormones injected into animals, bisphenol A or phthalates that are found in packaging, heavy metals and a fungal toxin called aflatoxin produced by Aspergillus flavus.  It is also unclear whether or not organic foods are effective in decreasing cancer risk.   For now, the American Cancer Society feels that the evidence is inconclusive and that food recommendations are effective if followed using either organic or conventional food products.