Cachexia in cancer patients

04/05/2023

Cachexia has a negative impact on the patient’s ability to fight infection and to withstand chemotherapy or radiation treatments, thereby increasing the mortality rate. To prevent cachexia, patients need early nutritional intervention with a rational diet.

What is cachexia?

Cancer cachexia (also known as cachexia) is defined as a syndrome defined by persistent loss of skeletal muscle mass (with or without loss of fat mass) that is not completely reversible by normal nutritional support, thereby leading to functional decline of body organs. Cachexia is characterized by a negative energy and protein balance, meaning that less energy and protein is consumed than is expended1.

The severity of cachexia can be classified according to the degree of depletion of body energy and protein stores (Body mass index – BMI), combined with the degree of persistent weight loss. This syndrome can develop gradually through different stages, divided into 3 milestones as follows:

Stages of cancer cachexia

Evaluation for clinical classification and management of cachexia may include factors such as anorexia or decreased food intake, catabolism, muscle mass, strength, and decline in physical and psychosocial functions.

Cachexia is a consequence of both reduced dietary intake and abnormal metabolism in advanced stages of cancer. Tumor development changes the metabolism and absorption of protein, carbohydrate, and lipid, as well as increasing the need for energy2. Meanwhile, many cancer patients experience loss of appetite due to the side effects of radiotherapy and chemotherapy, which change the sense of taste, smell, nausea and vomiting, causing an early feeling of fullness3. Even just being depressed or worrying too much about the condition can make the patient no longer interested in eating4. Loss of appetite will cause the body’s nutritional intake to be insufficient to meet the body’s needs, causing malnutrition and accelerating the cachexia process2.

Cachexia has a negative impact on the patient’s ability to fight infection and to withstand chemotherapy or radiation treatments, thereby increasing the mortality rate. Therefore, this condition needs to be detected early and have treatment and prevention plans and a rattional nutritional regimen from an early stage.

Prevent cachexia with proper nutrional regimen

An inadequate diet leads to chronic malnutrition, causing weight loss, sarcopenia and a precursor to cachexia. To prevent cachexia, patients need early nutritional intervention with a rational diet.

Proper nutrition helps prevent cachexia in cancer (Ảnh: Freepik)

Proper nutrition helps prevent cachexia in cancer (Ảnh: Freepik)

Meets energy level: 25 – 30 kcal/kg body weight:

According to the recommendations of the European Society of Clinical Nutrition and Metabolism5, patients need to be provided with 25–30 kcal/kg body weight/day. To maintain a stable nutritional status, the diet must meet the patient’s energy needs, balanced with total energy expenditure during rest, physical activity, and thermogenesis. However, with the appearance of side effects during treatment, it will be difficult for patients to eat large amounts of food like normal people , so some advice has been applied to many cancer patients is to divide meals into smaller portions and eat many times a day, limiting drinking water while eating and eating favorite foods.

In addition, patients can also supplement medical nutritional foods with high energy density to compensate for the lack of energy needs. Liquid products with high energy density (100kcal/100ml) are suitable for patients with problems with swallowing, fatigue, and loss of appetite, because only a small amount of solution is enough to provide energy which is equivalent to a much larger amount of food but with low energy density.

Meet protein intake: 1 – 1.5g/kg body weight/day

Cancer patients need to provide enough protein to maintain and regenerate lean muscle mass. A meta-analysis has shown that adding protein-rich supplements improves energy and protein requirements, helping to reduce complications of the disease. Therefore, patients can choose protein-rich foods to supplement their daily diet. According to FAO’s definition, protein-rich foods are foods that meet: 9g protein/100g solid food; or 4.5g protein/100ml liquid food; or 4.5g protein/100kcal of energy the product provides; or 9g protein/serving.

Protein supplementation also needs to be focused not only on quantity but also on quality, which is understood as the content of essential amino acids important for muscle mass such as branched chain amino acids BCAA (branched chain amino acid). BCAAs include 3 essential amino acids: valine, leucine and iso-leucine. Cancer patients often lack a relative amount of BCAA compared to the body’s needs due to the high level of BCAA metabolism in tumors, leading to a BCAA deficiency in the body6. Therefore, patients need to supplement BCAAs to prevent and fight cachexia caused by cancer7. Many clinical studies have been conducted on BCAA supplementation in cancer patients, especially liver cancer patients. Studies report that supplementation with BCAAs leads to higher survival rates, as well as fewer complications in liver cancer patients8.

Supplement lipid which is suitable for cancer patients

For patients lacking energy, supplementing fat, especially easily absorbed fats such as MCT (Medium Chain Triglycerides) fat, will help the body replenish energy quickly. If the energy in 1g of sugar or 1g of protein is 4kcal, the energy in 1g of fat is 9kcal. Especially when using MCT fats, the body will absorb this lipid faster than long-chain lipid. This characteristic is due to the rapid absorption mechanism from the intestines into the liver and does not need to wait for bile to be cut into small pieces like long-chain lipid, but can go straight into the blood, from which MCT can be used as an energy source right away9,10.

In addition, unsaturated fats such as omega 3 have been shown to help support immunity and improve taste, body weight, survival rate after surgery and increase quality of life in cancer patients having weight loss11,12. There is even research showing the protective ability of fish oil, a rich source of omega 3, against toxins released by chemotherapy13,14.

Supplement enough vitamins and minerals

Although vitamins and minerals only contain very small amounts, they play a very important role in the physiology of the body of both healthy people and cancer patients. Some vitamins and minerals have a particularly important role such as Vitamins A, C, D, E and minerals such as Zinc, Copper, Iron, Selenium that need to be focused on because they participate in the functioning of immune reactions. Supplementing vitamins and minerals directly from food is the best option, however, in some cases where the patient cannot eat enough food to provide enough vitamins and minerals, caregivers may consider to give patients vitamin and mineral supplements from other synthetic sources or foods fortified with vitamins and minerals.

Rational nutrition contributes to increased treatment efficiency (Photo: Freepik)

Rational nutrition contributes to increased treatment efficiency (Photo: Freepik)

Leanmax Hope – Medical Nutrition helps gain weight and muscle for cancer patients

Leanmax Hope is a specialized Medical Nutrition product for cancer patients, clinically proven to be included in the diet for cancer patients at Hanoi Medical University Hospital.

Experimental results show that supplementing 2 glasses of Leanmax Hope milk every day will help cancer patients gain weight (average 1.4kg) and muscle (average 1.2kg) after 8 weeks. At the same time, the patient’s quality of life is also significantly improved: Fatigue and pain are reduced; Increase mobility; Improve quality of life.

Leanmax Hope products contain high energy (474 kcal/ 100g powder) with nutritional ingredients such as BCAA, whey protein, easily absorbed MCT fats to support weight recovery and increase muscle mass; Soluble fiber FOS/Inulin, B vitamins and lactose-free: Increase appetite, improves digestion; Omega 3,6 with Antioxidant (vitamins A, C, E and Selenium): Helps increase resistance, reduce fatigue; Nano Curcumin, Arginine, Vitamin C: Supports reducing inflammation and healing surgical wounds quickly.

In 2018, the Leanmax product variation, including Nutricare’s Leanmax Hope, was recognized as a National Medical Nutrition Brand. Leanmax Hope is currently widely distributed in hospitals nationwide, especially the two leading hospitals in the country in treating pediatric cancer patients including National Pediatrics Hospital (Hanoi) and Pediatrics II Hospital (Ho Chi Minh City), to supplement nutrition for pediatric cancer patients being treated here.

Cachexia in cancer leads to impaired organ function and cancer treatment. Supplementing Leanmax Hope and a nutritional regimen consistent with the doctor’s treatment regimen helps promote anabolism, increase lean body mass, reduce the risk of weight loss, and increase the effectiveness of treatments.

References

  1. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011 May;12(5):489-95. doi: 10.1016/S1470-2045(10)70218-7. Epub 2011 Feb 4. PMID: 21296615.
  2. Gambardella A, Tortoriello R, Tagliamonte MR, et al.: Metabolic changes in elderly cancer patients after glucose ingestion. The role of tumor necrosis factor-alpha. Cancer 79 (1): 177-84, 1997.
  3. Rivadeneira DE, Evoy D, Fahey TJ, et al.: Nutritional support of the cancer patient. CA Cancer J Clin 48 (2): 69-80, 1998 Mar-Apr.
  4. Bruera E: ABC of palliative care. Anorexia, cachexia, and nutrition. BMJ 315 (7117): 1219-22, 1997
  5.  V.E. Baracos, M.L. Mackenzie Investigations of branched-chain amino acids and their metabolites in animal models of cancer J. Nutr., 136 (2006), pp. 10-1093 (237–242)
  6.  ESPEN. 2021. ESPEN practical guideline: Clinical Nutrition in cancer
  7. J. Soares, S.L. Howell, F.J. Teixeira, G.D. Pimentel Dietary amino acids and immunonutrition supplementation in cancer-induced skeletal muscle mass depletion: a mini-review Curr. Pharm. Des., 26 (2020), pp. 970-97
  8. S. Nojiri, K. Fujiwara, N. Shinkai, E. Iio, T. Joh Effects of branched-chain amino acid supplementation after radiofrequency ablation for hepatocellular carcinoma: a randomized trial Nutrition, 33 (2017), pp. 20-27
  9. Schönfeld P, Wojtczak L. Short- and medium-chain fatty acids in energy metabolism: the cellular perspective. J Lipid Res. 2016 Jun;57(6):943-54. doi: 10.1194/jlr.R067629. Epub 2016 Apr 14.
  10. Shah, N. (2017). The Use of Medium-Chain Triglycerides in Gastrointestinal Disorders.
  11. Colomer R, Moreno-Nogueira JM, García-Luna PP, García-Peris P, García-de Lorenzo A, Zarazaga A, et al. N-3 fatty acids, cancer and cachexia: a systematic review of the literature. Br J Nutr 2007;97:823e31
  12. de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clin Nutr (Edinb) 2015;34:359e66.
  13. Ghoreishi Z, Esfahani A, Djazayeri A, Djalali M, Golestan B, Ayromlou H, et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial. BMC Canc 2012;12:355.
  14. S anchez-Lara K, Turcott JG, Juarez-Hernandez E, Nunez-Valencia C, Villanueva G, Guevara P, et al. Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomised trial. Clin Nutr (Edinb) 2014;33:1017e23
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