Nutrition support for sarcopenia in cancer patients
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1 Nutrition support for sarcopenia in cancer patients Kalliopi Anna Poulia, RD, MMedSci, PhD Clinical Nutritionist-Dietitian, Laiko General Hospital of Athens Vice President of the Hellenic Dietetic Association Member of the Board of GrESPEN
2 Multiple factors contribute to nutritional status Genetic predisposition Physiological changes Medical conditions Nutritional Status Physical disability and mental disorders Socioeconomic status
3 Malnutrition ESPEN Terminology Guidelines 2016 Malnutrition: a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease. Can be a result of: Starvation Disease Advanced ageing (e.g. >80 years), alone or in combination
4 Clinical Nutrition DOI: ( /j.clnu ) Fig. 1
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6 Diagnostic algorithm for malnutrition Clin Nutr, 2016, 15 th September.
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8 Cachexia a combination of metabolic changes and energy intake
9 Normal Pro-cachexia Cachexia Refractory cachexia Death Anorexia and metabolic changes Body weight loss 5% Weight loss >5% or ΒΜΙ<20 kg/m 2 and weight loss 2% ή sarcopenia and weight loss 2% Low dietary intake/ systematic inflamation Cachexia of multiple degrees Cancer non responsive to treatment <3 months life expectancy
10 Evans et al, Cachexia: a new definition. Clinical Nutrition 27,
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12 2018 revised European consensus on definition and diagnosis of sarcopenia (EWGSOP2) Criterion 1 Probable sarcopenia Low muscle strength Criterion 2 Diagnosis of sarcopenia Low muscle quantity/ quality Criterion 3 Severe sarcopenia Low physical performance A. J. Cruz-Jentoft et al.age and Ageing 2018; 0: 1 16
13 Sarcopenia Disability Reduced physical activity, fatigue, weakness Hospitalization Increased fall and fracture risk; frailty Loss of muscle mass and/or strength Convalescence Postoperative complications Treatment procedures Morbidity Length of stay Dependence ICU admissions Increase Hospital and health care costs non- to-home discharge mortality Norman K, Otten L, Financial impact of sarcopenia or low muscle mass e A short review, Clinical Nutrition (2018),
14 Biolo G et al. Clin Nutr 2014 Oct; FAT (central)
15 Muscle strength and the life course Environmental effects on muscle strength A. J. Cruz-Jentoft et al.age and Ageing 2018; 0: 1 16
16 Typical malnourished patient
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18 Muscle mass - variations
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21 Lieffers JR et al. Br J Cancer 2012
22 PLoS ONE 2012
23 82 patients >65 years Sarcopenia is an independent negative prognostic factor for 3-year survival (A) and survival disease free (B)
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26 Multimodal rehabilitation Multidisciplinary team work Awareness (diagnosis) Optimal oncogical management for cancer patients Early intervention Multimodal therapy Nutritional support Best supportive care Exercise Antiinflammatory therapy Anemia therapy
27 Cox S et al. BJC 2016; 115:
28 Aim of nutrition intervention Phase 1 During the treatment Prevention and treatment of nutritional deficiencies Minimize the adverse effects of therapy that are connected with nutrition Increase adherence to the treatment Maximize quality of life during treatments Phase 2: Nutrition for cancer survivors Maintain a healthy body weight Balanced nutrition Maintain habits that limit the chance of cancer reoccurrence
29 Arends J et al. ClinNutr 2017; 36:11-48
30 De Waele et al. Appetite 2015; 91:
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33 Protein Anabolic Resistance in Cancer: Does it really exist? Engelen et el. Curr Opin Clin Nutr Metab Care January ; 19(1):
34 IMPACT OF NUTRITION ON OUTCOME: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL IN PATIENTS WITH HEAD AND NECK CANCER UNDERGOING RADIOTHERAPY Paula Ravasco, Isabel Monteiro-Grillo,Pedro Marques Vidal, Maria Ermelinda Camilo G1= Intervention with normal food G2 = Intervention with ONS G3 = Control group, Nutritional intake ad libitum Energy: *G1 > G2 > G3 (p =.005) και G1 > G2 > G3 (p =.001) Protein : **G2 > G1 > G3 (p =.006) and G1> G2 > G3 (p =.001). Head & Neck 27: , 2005
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37 Nutrition Intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area Isering EA, Capra S, Bauer LD, British Journal of Cancer, 2004 ΝΙ = Nutrition intervention UC = Usual care
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40 Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review M. ELIA, M.A.E. VAN BOKHORST-DE VAN DER SCHUEREN, J. GARVEY, A. GOEDHART, K. LUNDHOLM, G. NITENBERG and R.J. STRATTON INTERNATIONAL JOURNAL OF ONCOLOGY 28: 5-23, 2006
41 Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review M. ELIA, M.A.E. VAN BOKHORST-DE VAN DER SCHUEREN, J. GARVEY, A. GOEDHART,K. LUNDHOLM, G. NITENBERG and R.J. STRATTON INTERNATIONAL JOURNAL OF ONCOLOGY 28: 5-23, 2006
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43 References T. Cederholm, R. Barazzoni, P. Austin, P. Ballmer, G. Biolo, S.C. Bischoff, C. Compher, I. Correia, and others. ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition 36 (2017) Jann Arends, Patrick Bachmann, Vickie Baracos, Nicole Barthelemy, Hartmut Bertz, Federico Bozzetti, Ken Fearon, Elisabeth Hütterer, Elizabeth Isenring, Stein Kaasa, Zeljko Krznaric, Barry Laird, Maria Larsson, Alessandro Laviano, Stefan Mühlebach, Maurizio Muscaritoli, Line Oldervoll, Paula Ravasco, Tora Solheim, Florian Strasser, Marian de van der Schueren, Jean-Charles Preise. ESPEN guidelines on nutrition in cancer patients Clinical Nutrition 36 (2017) Cederholm, T.Jensen, Gordon L.Baptista, G. et al. GLIM criteria for the diagnosis of malnutrition A consensus report from the global clinical nutrition community Clinical Nutrition, in press M. ELIA, M.A.E. VAN BOKHORST-DE VAN DER SCHUEREN, J. GARVEY, A. GOEDHART,K. LUNDHOLM, G. NITENBERG and R.J. STRATTONEnteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review INTERNATIONAL JOURNAL OF ONCOLOGY 28: 5-23, 2006 Paula Ravasco, Isabel Monteiro-Grillo,Pedro Marques Vidal, Maria Ermelinda Camilo. IMPACT OF NUTRITION ON OUTCOME: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL IN PATIENTS WITH HEAD AND NECK CANCER UNDERGOING RADIOTHERAPY Head & Neck 27: , 2005 Evans et al, Cachexia: a new definition. Clinical Nutrition 27, Biolo G et al. Clin Nutr 2014 Oct; Russell C & Elia M. Redditch, BAPEN Meijers JM et al. Br J Nutr 2009; 101(3): M. Muscaritoli et al. / Clinical Nutrition 29 (2010)
44 Thank you for your attention - Ευχαριστώ! شكرا لك على انتباهك
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