Ernährung bei Tumorpatienten

I.A. Adamietz1
1Klinik für Strahlentherapie und Radioonkologie, Ruhr-Universität Bochum, Herne/Bochum, Herne, Deutschland

Tóm tắt

Ernährungsstörungen treten bei Tumorpatienten oft bereits vor der Diagnosestellung auf. Folgen sind erhöhte Morbidität und Mortalität, verminderte Lebensqualität, reduzierte Tumortherapietoleranz und Prognose. Ein tumorassoziierter Gewichtsverlust ist auch für Übergewichtige ungünstig. Eine zentrale Ursache der Mangelernährung ist eine tumorassoziierte systemische Inflammationsreaktion. Eine pathophysiologisch orientierte und auch durchführbare Diagnostik sollte regelmäßig Gewicht, Appetit, Essmenge und die Akutphasenreaktion erfassen. Bei einem Gewichtsverlust ≥5% des gesunden Ausgangsgewichts sollte bei jeder Konsultation eine Ernährungsdiagnostik erfolgen. Oral kann meist mit einer auf die Wünsche und Bedürfnisse des Patienten individuell abgestimmten Vollkost ernährt werden. Bei unzureichender (Energiezufuhr <60% des errechneten Bedarfs, erwartet für mindestens 10 Tage) oder nicht möglicher [Energiezufuhr <2095 kJ/Tag (<500 kcal/Tag), erwartet für mindestens 5 Tage] oraler Ernährung ist eine künstliche Ernährung indiziert. Die Empfehlungen zur Vitamin- und Spurenelementzufuhr entsprechen den Richtlinien der Fachgesellschaften.

Từ khóa


Tài liệu tham khảo

Algara M, Rodríquez N, Viñals P et al (2007) Prevention of radiotherapy-induced esophagitis with glutamine: results of a pilot study. Int J Radiat Oncol Biol Phys 69:342–349 Allison SP (1992) The uses and limitations of nutritional support. Clin Nutr 11:319–330 Andreyev HJN, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34:503–509 Anthony HM, Schorah CJ (1982) Severe hypovitaminosis C in lung-cancer patients: the utilization of vitamin C in surgical repair and lymphocyte-related host resistance. Br J Cancer 46:354–367 Arends J (2008) Mangelernährung bei Tumorpatienten. Onkologe 14:9–14 Arends J, Bodoky G, Bozzetti F et al (2006) ESPEN guidelines on enteral nutrition in non-chirurgical oncology. Clin Nutr 25:245–259 Arends J, Zürcher G, Fietkau R et al (2007) DGEM-Leitlinie Parenterale Ernährung – nicht-chirurgische Onkologie. Aktuelle Ernahrungsmed [Suppl 1] 32:S124–S133 Biesalski H-K (2008) Mikronährstoffsupplemente bei onkologischen Patienten. Rationale für die Empfehlung. Onkologe 14:45–57 Bishop CW, Bowen PE, Ritchey SJ (1981) Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 34:2530–2539 Bokhorst-de van der Schuer MA van, Leeuwen PA van, Kuik DJ et al (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527 Bosaeus I, Daneryd P, Svanberg E et al (2001) Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients. Int J Cancer 93:380–383 Breitkreutz R, Tesdal K, Jentschura D et al (2005) Effects of a high-fat diet on body composition in cancer patients receiving chemotherapy: a randomized controlled study. Wien Klin Wochenschr 117:685–692 Cahill GF Jr (2006) Fuel metabolism in starvation. Annu Rev Nutr 26:1–22 Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638 Cerchietti L, Navigante A, Lutteral MA et al (2006) Double-blinded, placebo-controlled trial on intra-venous L-alanyl-L-glutamine in the incidence of oral mucositis following chemoradio-therapy in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 65:1330–1337 Cockerham MB, Weinberger BB, Lerchie SB et al (2000) Oral glutamin for the prevention of oral mucositis associated with high-dose paclitaxel and melphalan for autologus bone marrow transplantation. Ann Pharmacother 34:300–303 Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420:860–867 Darwin C (1859) The origin of species by means of natural selection. Murray, London Davis MP, Dreicer R, Walsh D et al (2004) Appetite and cancer-associated anorexia. A review. J Clin Oncol 22:1510–1517 Dawkins R (1976) The selfish gene. Oxford University Press, Oxford Deans C, Wigmore SJ (2005) Systemic inflammation, cachexia and prognosis in patients with cancer. Curr Opin Clin Nutr Metab Care 8:265–269 Detsky AS, McLaughlin JR, Baker JP et al (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13 Deutsche Gesellschaft für Ernährung (DGE) (2000) Referenzwerte für die Nährstoffzufuhr, 1. Aufl. Umschau, Frankfurt am Main Deutsche Gesellschaft für Ernährungsmedizin (DGEM) (2007) DGEM-Leitlinien enterale und parenterale Ernährung: nichtchirurgische Onkologie. Thieme, Stuttgart DeWys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 69:491–497 Fearon KCH, Barber MD, Falconer JS et al (1999) Pancreatic cancer as a model: inflammatory mediators, acute-phase response and cancer cachexia. World J Surg 23:584–588 Fiaschi AI, Cozzolino A, Ruggiero G, Giorgi G (2005) Glutathione, ascorbic acid and antioxidant enzymes in the tumor tissue and blood of patients with oral squamous cell carcinoma. Eur Rev Med Pharmacol Sci 9:361–367 Gianotti L, Braga M, Fortis C et al (2002) A randomized controlled trial of preoperative oral supplementation with a spezialised diet in patients with gastrointestinal cancer. Gastroenterology 122:1763–1770 Gramignano G, Lusso MR, Madeddu C et al (2006) Efficacy of L-carnitine administration on fatigue, nutritional status, oxidative stress and related quality of live in 12 advanced cancer patients undergoing anticancer therapy. Nutrition 22:136–145 Graziano F, Bisonni R, Catalano V et al (2002) Potential role of levocarnitine supplementation for the treatment of chemotherapy-induced fatigue in non-anaemic cancer patients. Br J Cancer 86:1854–1857 Hutton J, Martin L, Field CJ et al (2006) Dietary patterns in patients with advanced cancer: implications for anorexia-cachexia therapy. Am J Clin Nutr 84:1163–1170 Isenring EA, Capra S, Bauer JD et al (2004) Nutrition intervention is beneficial in oncology out patients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91:447–452 Khalid U, Spiro A, Baldwin C et al (2006) Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation. Support Care Cancer 15:39–46 Kondrup J, Rasmussen HH, Hamberg O et al (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336 Kotler DP (2000) Cachexia. Ann Intern Med 133:622–634 Kotler DP, Wang J, Pierson RN (1985) Body composition studies in patients with the acquired immunodeficiency syndrome. Am J Clin Nutr 42:1255–1265 Krasner N, Dymock IW (1974) Ascorbic acid deficiency in malignant diseases: a clinical and biochemical study. Br J Cancer 30:142–145 López A, Figuls R, Urrutia Cuchi G et al (2004) Systematic review of megestrol acetate in the treatment of anorexia-cachexia-syndrome. J Pain Symptom Manage 27:360–369 Lundholm K, Daneryd P, Bosaeus I et al (2004) Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: effects on survival, metabolism and function. Cancer 100:1967–1977 Maltoni M, Nanni O, Scarpi E et al (2001) High dose progestins for the treatment of cancer anorexia-cachexia syndrome: a systematic review of randomized clinical trials. Ann Oncol 12:226–232 Moses AW, Slater C, Preston T et al (2004) Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90:996–1002 Orrevall Y, Tishelman C, Permert J et al (2004) The path from oral nutrition to home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families. Clin Nutr 23:1280–1287 Orrevall Y, Tishelman C, Permert J et al (2005) Home parenteral nutrition: a qualitative interview study of the experience of advanced cancer patients and their families. Clin Nutr 26:961–970 Peterson DE, Jones JB, Petit RG et al (2007) Randomized, placebo-controlled trial for saforis for prevention and treatment of oral mucositis in breast cancer patients receiving anthracycline-based chemotherapy. Cancer 109:322–331 PotterJ, Langhorne P, Roberts M et al (1998) Routine protein energy supplementation in adults: systematic review. BMJ 317:495–501 Ravasco P, Monteiro-Grillo I, Vidal PM et al (2004) Cancer: disease and nutrition are key determinants of patients‘ quality of life. Support Care Cancer 12:246–252 Ravasco P, Monteiro-Grillo I, Vidal PM et al (2005) Impact of nutrition on outcome: a prospective, randomized, controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668 Ravasco P, Vidal PM, Monteiro-Grillo I et al (2005) Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 23:1431–1438 Ross PJ, Ashley S, Norton A et al (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancer? Br J Cancer 90:1905–1911 Schütz T, Valentini L, Plauth M (2005) Screening auf Mangelernährung nach den ESPEN-Leitlinien 2002. Aktuelle Ernahrungsmed 30:99–103 Schütz T, Valentini L, Herbst B et al (2006) ESPEN-Leitlinien Enterale Ernährung – Zusammenfassung. Aktuelle Ernahrungsmed 31:196–210 Shang E, Weiss C, Kaehler G et al (2006) The influence of early supplementation of parenteral nutrition on quality of life and body composition in patients with advanced cancer. JPEN J Parenter Enteral Nutr 30:222–230 Springer J, Haehling S von, Anker SD (2006) The need for a standardized definition for cachexia in chronic illness. Nat Clin Pract Endocrinol Metab 2:416–417 Stratton RJ, King CL, Stroud MA et al (2006) Malnutrition universal screening tool predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 95:325–330 Wang WS, Lin JK, Lin TC et al (2007) Oral glutamine is effectiv for preventing oxaliplatin-induced neuropathy in colorectal cancer patients. Oncologist 12:312–319 Weimann A, Braga M, Harsanyi L et al (2006) ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 25:224–244 Weimann A, Ebener C, Hausser L et al (2007) DGEM-Leitlinie Parenterale Ernährung: Chirurgie und Transplantation. Aktuelle Ernahrungsmed [Suppl 1] 32:S114–S124 Zürcher G (2006) Ernährung bei konsumierenden Erkrankungen. Med Welt 4:134–140 Zürcher G (2008) Wann und wie sollen Patienten ernährt werden? Onkologe 14:15–21