5: Nutrition Needs in Adults with Cancer Flashcards
Explain the effects of systemic inflammation on macronutrient metabolism
Protein metabolism: changes in protein synthesis and degradation, loss of fat and muscle mass, and an increase in the production of acute-phase protein, such as C-reactive protein
Carb metabolism: increased insulin resistance and impaired glucose tolerance
Lipid metabolism: maintained or increased lipid oxidation, particularly in the presence of weight loss
DRI for Protein in Adult with Cancer, cancer cahexia, and hematopoietic stem cell transplant (HSCT)
g/kg/d (actual body weight unless otherwise specified)
Cancer: 1-1.5
Cachexia: 1.5-2.5
HSCT: 1.5
Which cancers are typically seen as hypermetabolic?
pancreatic, gastric, bile duct, kidney, adrenal, non-small cell lung, and head & neck
Which cancers are typically seen as normometabolic or not statistically significantly different from the control group?
breast, colorectal, and bladdar
Why is underhydration usually a problem for cancer patients?
Usually having decreased fluid intake (difficulty obtaining and consuming fluids) and excessive fluid losses (volume depletion due to vomiting and diarrhea)
Also noted impaired thirst mechanisms and access issues due to mobility issues in older oncology patients
What are the three methods for calculating fluid needs?
Weight (Holliday-Segar), BSA method, or RDA (energy) method
none are validated
What micronutrients are decreased with inflammation?
Selenium, copper, iron, and zinc
What micronutrients are usually not impacted by inflammation? (Low=likely true deficiency issue)
Thiamine, riboflavin, B12, and folate
Micronutrient level changes: Alcoholic liver
decrease in folate, thiamine, pyridoxine, and vit A
Micronutrient level changes: Renal failure
decrease in pyridoxine, folate and vit C
Micronutrient level changes: GI fistulas and diarrhea
Decrease in all vitamin and multiple trace minerals, particularly zinc and selenium
Micronutrient level changes: Loss of bile
decrease in fat-soluble vitamins
Micronutrient level changes: pancreatitis
decrease in absorption of B12
Micronutrient level changes: chyle leas and fistulas
decrease in micronutrients
Micronutrient level changes: Gastrectomy or terminal ileum resection
decrease in iron and B12
Micronutrient level changes: bariatric surgery
Decrease in fat-soluble vitamins, water-soluble vitamins, and minerals such as iron and zinc
Micronutrient level changes: critical illness
decrease in Vit C despite supplementation
Micronutrient level changes: syndrome of inappropriate antidiuretic hormone (SIADH)
decrease in sodium
Micronutrient level changes: Cisplatin
Decrease in magnesium
What factors should be considered when deciding on energy need requirements for cancer patients?
Medical (cancer) diagnosis
presence and extent of comorbidities
intent of treatment (cure, control, palliative)
anticancer treatment modalities
presence and extent of malnutrition
stress factors (fever, infection)
presence of advance directives, if appropriate
What are the recommendations for cancer patients using weight (kcal/kg)?
Cancer-wt gain:
Cancer- maintain/non-stress
Cancer- hypermetabolic
sepsis-
HSCT-
Cancer - weight gain: 30-35
Cancer - maintain/non stressed: 25-30
Cancer - hypermetabolic: 35
Sepsis: 25-30
HSCT: 30-35
What is a hallmark of refeeding syndrome?
Hypophosohatemia - usually within 3 days of starting intervention
Common conditions for refeeding syndrome to occur in?
long-standing alcohol abuse with or without cirrhosis
prolonged undernutrition
morbid obesity with substantial weight loss
How do you address/prevent refeeding syndrome?
for at risk patients, start with 25% of needs and slowly advance over next 3-5 days, watching electrolytes for signs. Can add thiamine to help with glucose levels
DRI of Calcium
19–50 years 1,000 mg (M) 1,000 mg (F)
51–70 years 1,000 mg (M) 1,200 mg (F)
DRI of Vitamin E
15 mg (22 IU)
DRI of B-carotene
75 to 180 mg of beta-carotene
(the equivalent of 125,000 to 300,000 Units of vitamin A activity)
