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Cancer has an increasingly significant impact on society, being a highly destabilizing factor in the life of any patient. The disease as well as anti-neoplastic treatments can profoundly alter biological functions and, remarkably, the patients' nutritional status. Thus, Nutrition is a key factor in oncology, by influencing the development of the disease, cancer related symptoms, the response to, and recovery from treatment(s), and therefore determining the patients' Quality of Life and probably prognosis. Therefore, the assessment of Quality of Life in any clinical study is essential because it values physical, psychological and social factors, which often depend on or are related with Nutrition. The aim of this review work, was to explore extent to which individualized nutrition intervention improves nutritional parameters (nutritional status and intake), Quality of Life, and ultimately the prognosis of the disease. Based on clinical research studies conducted until now, early nutritional intervention via individualized nutritional counseling, does significantly improve nutritional parameters and Quality of Life. It was also found that appropriate and individualized nutritional intervention, improves symptoms, reduces morbidity and may have the potential to improve the prognosis of the disease. According to the reviewed data and guidelines, nutritional therapy should be central and adjuvant to any treatment, and should be included in the multidisciplinary approach mandatory in oncology. This will allow for more adequate and efficient results these patients. Multidisciplinary follow-up, with early nutritional intervention, is of major importance in oncology, thus being a key factor for successful treatment and recovery of these patients.

In the past few years, there has been a growing interest on body composition changes of cancer patients. Muscle mass and fat mass are pointed out as the most important compartments from a physiological point of view, as their changes are the ones with the most impact on disease. The excess of fat mass is related with increased risk of incidence and recurrence of some types of cancer, and some studies identify it as a major contributing factor for increased morbidity and mortality in cancer patients. Weight loss in cancer is frequent and is associated with symptoms, circulating pro-cachectic substances produced by the tumour, and/or hypermetabolism states, not compensated with adequate intake. Muscle mass depletion is the most worrying, and has been associated with decreased functional capacity, increased toxicity of anti-neoplastic treatments, longer length of stay and higher risk of nosocomial infections. In end stage disease, some patients may develop cancer cachexia, an irreversible condition highly associated with mortality. Of note that, lean body mass depletion may occur with excess fat mass (sarcopenic obesity), a condition that combines the health risks of obesity and those of sarcopenia. The high prevalence of malnutrition in cancer patients justifies its relevance. Many patients point it as a cause for the reduction of physical, cognitive, emotional and social functions, as well as anorexia, fatigue, dyspnoea, insomnia, gastrointestinal symptoms and worse Quality of Life. Additionally, body composition may be affected by nutrition, lifestyles and physical activity; therefore, any approach to the patient should include all these dimensions, with special emphasis on individualised nutritional intervention. Therefore, nutritional therapy should be adjuvant to any treatment, as it is essential in all stages of the disease: for its development, during the treatment(s) and in the follow-up period. The aim of nutritional intervention is to promote changes in body composition, by maintaining or increasing lean body mass and keeping fat mass in healthy levels, which may have a positive impact on Quality of Life, response to treatment(s), prognosis and reduced health care costs.

Background: Cancer aetiology is multifactorial and risk factors include: obesity, central adiposity, sedentarism, excessive or deficient intake of foods and/or nutrients with pro-carcinogenic effects vs protective ones., Objectives: To evaluate the pattern of nutritional status, life styles, physical activity and diet in a cohort of cancer patients., Methods: This pilot cross-sectional study was conducted in 64 patients referred for radiotherapy at the Radiotherapy Department of the University Hospital of Santa Maria (CHLN). Evaluations were: waist circumference associated with potential cardio-metabolic risk, body composition by Tetrapolar Bioimpedance Analysis (XITRON®), Body Mass Index, dietary intake pattern with a short food frequency questionnaire, physical activity with Jackson questionnaire., Results: The most frequent diagnosis were breast and colorectal cancers; 53% of patients were overweight/obese, and there was a significant correlation between this nutritional pattern and weight gain in comparison with usual weight (p<0.005). There were 78% of patients with a waist circumference above the maximum cut-off limit, indicating moderate/ high cardio-metabolic risk, and most were female patients (87%). The great majority of patients (61%) had excessive fat mass highly above the maximum recommended cut-off value, especially male patients (74%). The dietary pattern was poor in vegetables (55%) and excessive in meat and simple carbohydrates (78%); physical activity was low with a high prevalence of sedentarism., Conclusions: This population presented excessive body weight, excessive fat mass, high cardio-metabolic risk, sedentarism and an unbalanced diet poor in protective foods/nutrients. This population's life styles and nutritional pattern, may be considered of risk in oncology disease. The elevated and growing incidence of cancer in Portugal, reinforces the need for further research in order to identify nutritional factors involved in the etiology/evolution and probably prognosis of cancer.

Each individual is unique, with genetic factors that interact with a particular environment. Therefore, the daily energy requirements should be calculated individually and have to consider the several factors which influence them: basal metabolic rate, diet-induced thermogenesis, physical activity, specific diseases, among other factors. Food provides macronutrients: carbohydrates, proteins and lipids, as well as micronutrients: vitamins, minerals and oligoelements, which should be eaten daily in the recommended amounts during the life cycle, e.g. pregnancy, childhood, adolescence, adulthood and aging. Health professionals can use the "Roda dos Alimentos Portuguesa" to teach and guide the population on how to eat, whether they are healthy or ill individuals, in order to meet their nutritional needs. Through this tool it is possible for everyone to understand and to practice a diet that is: 1) complete (eating foods from all groups), 2) balanced (to respect the proportions of each food group, adjusting the recommended portions/amounts for each individual), and 3) diversified (to choose different foods within each group). Some studies show that food marketing and advertising influence the consumers' choices since childhood. There is already some Regulation in this field, especially about nutrition and health claims. However, a permanent supervision of food marketing is necessary, to ensure compliance with the European Regulation from EFSA. It is crucial to teach and to encourage people to carefully read the food labels before purchasing. Health professionals should also be aware, academically and professionally, about the basics principles of Food and Health Promotion. The unique and essential role of the Professionals of Nutrition needs to be valued and recognized, and these professionals have to be integrated in sufficient number, in the multidisciplinary teams of the National Health Service, whether in Hospitals or Health Care Centers for the ambulatory population. These are the interventions and attitudes that make a difference and that are actually effective in preventing and/or treating many chronic diseases. Hence it is possible to improve health and quality of health services provided to the population (public health scope) and that of patients (clinical practice scope) as well as to optimize costs in health.

Introduction: In oncology, early and individualized nutritional intervention for each patient is essential to improve nutritional intake and status, to reduce morbidity during treatment, enhance tolerance to treatment and improve Quality of Life., Objectives: For medical students to evaluate nutritional risk and status, analyse the prevalence of undernutrition in a population of patients with diverse types of tumours. We aimed to identify difficulties regarding the use of the MUST tool (Malnutrition Universal Screening Tool) for nutritional risk by the students., Methods: This study included 35 cancer patients consecutively referenced for Radiotherapy (RT) in the Radiotherapy Department of the University Hospital of Santa Maria. Nutritional risk was evaluated by MUST; nutritional status by Patient Generated-Subjective Global Assessment (PG-SGA) validated and specific for oncology., Results: Students identified 13 patients (36%) at moderate/high risk of undernutrition. According to PG-SGA, 31,5% (11/35) of patients presented moderate or severe undernutrition, of which 77% of patients needed individualized nutritional counselling. Students successfully detected undernourished patients using these specific methods., Conclusion: Risk of undernutrition and undernutrition are common in oncology, therefore indicating the critical need to educate all health professionals for risk screening and for the relevance of nutritional intervention in the multidisciplinary context. MUST is a simple and quick tool, that demonstrated to be adequate when applied by medical students, well accepted by these health professionals and effectively used. Nutritional risk evaluation can and must be performed by health professionals such as the medical team, as long as they are involved in patient's treatment. Our methodology may be used as a model allowing for early guidance to individualized intervention, human resources' optimization and education for the importance of nutrition care.

Introduction: Nutrition and Quality of Life (QoL) are key issues., Aims: 1) to evaluate Quality of Life (QoL), nutritional status and dietary intake, taking into account the stage of disease and therapeutic interventions, 2) to determine potential inter-relations, 3) to quantify the relative contributions of cancer/nutrition/treatments on QoL., Methods: In 184 oesophagus, stomach and colon/rectum cancer patients, the following were evaluated: QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), nutritional status (% weight loss over the previous 6 months), usual diet (diet history), current diet (24 hr recall) and a range of clinical variables., Results: Stage III/IV patients showed a significant reduction from their usual energy/protein intake (p=0.001), worse in oesophagus (p=0.02), while current intakes were lower than in stage I/II patients (p=0.0002). Weight loss was greater in stage III/IV (p=0.001). Different diagnoses and cancer stages presented different patterns of QoL function scales (p=0,03), significantly and independently associated with nutritional factors (p=0,05). Patients in stage III/IV had increased symptomatology (p=0,003); symptom scales and single items were strongly associated with stage III/IV (p=0,04). Patients with stomach cancer presented the worst global QoL not significantly different from oesophagus, vs colon/rectum, p=0,02., Conclusions: In oesophageal, stomach and colon/rectum cancer, nutritional deterioration depends of diet intake, the latter is mainly determined by cancer location and stage. Patients' QoL was determined by cancer or nutrition-related factors with distinct relative weights. Due to this multidimensional construct, in which nutrition plays a major role, nutritional therapy must be integrated in early stages of the overall treatment.