Search

This opinion paper presents a short review of the potential impact of protein on muscle anabolism in cancer, which is associated with better patient outcomes. Protein source is a topic of interest for patients and clinicians, partly due to recent emphasis on the supposed non-beneficial effect of proteins; therefore, misconceptions involving animal-based (e.g., meat, fish, dairy) and plant-based (e.g., legumes) proteins in cancer are acknowledged and addressed. Although the optimal dietary amino acid composition to support muscle health in cancer is yet to be established, animal-based proteins have a composition that offers superior anabolic potential, compared to plant-derived proteins. Thus, animal-based foods should represent the majority (i.e., ?65%) of protein intake during active cancer treatment. A diet rich in plant-derived proteins may support muscle anabolism in cancer, albeit requiring a larger quantity of protein to fulfill the optimal amino acid intake. We caution that translating dietary recommendations for cancer prevention to cancer treatment may be inadequate to support the pro-inflammatory and catabolic nature of the disease. We further caution against initiating an exclusively plant-based (i.e., vegan) diet upon a diagnosis of cancer, given the presence of elevated protein requirements and risk of inadequate protein intake to support muscle anabolism. Amino acid combination and the long-term sustainability of a dietary pattern void of animal-based foods requires careful and laborious management of protein intake for patients with cancer. Ultimately, a dietary amino acid composition that promotes muscle anabolism is optimally obtained through combination of animal- and plant-based protein sources.

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021, Rationale: Cancer is associated with muscle wasting. However, optimal protein intake has not been determined, limiting the efficacy of nutritional interventions. This systematic review aims to assess the effect of protein intake on muscle mass of patients with cancer types with high prevalence of sarcopenia during treatment, in longitudinal studies. Methods: MEDLINE, CINAHL, and Scopus databases were searched following PRISMA guidelines. Longitudinal studies written in English, including adults with high sarcopenia prevalence cancer diagnosis, submitted to (chemo)radiotherapy, with assessment of protein intake and muscle changes during treatment, published until 4 October 2020 were included. Studies including supplementation with substances, such as n-3 fatty acids, specific amino acids, or proteins, were excluded. Study appraisal was independently conducted by two reviewers, and a qualitative research synthesis was performed. Results: Overall, 575 records were identified, of which, eight studies were included (one randomized clinical trial and seven uncontrolled before and after studies). Patients with head and neck (n = 5), lung (n = 2), and esophageal cancer (n = 1) were included, comprising a total of 554 participants. The studies presented heterogeneous methodologies, objectives, and methods to assess body composition. Overall, participant groups with a mean protein intake below 1.2 g/kg presented muscle wasting, with one exception, while those reporting a mean intake above 1.4 g/kg, maintained muscle during treatment. Conclusions: Our findings show that protein intakes below 1.2 g/kg, even when within the recommendations, have been associated with muscle wasting during treatment. Only intakes above 1.4 g/kg have been associated with muscle maintenance. High-quality research is needed to establish an optimal dose response.

Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using “OR” as a Boolean function and the results of the four components were combined by utilizing the “AND” Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1−2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019 Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2020-04-22T10:24:03Z No. of bitstreams: 1 InesMSilva.pdf: 696597 bytes, checksum: 24442d1f4ce0c75493ec421c201c1315 (MD5) Made available in DSpace on 2020-04-22T12:36:00Z (GMT). No. of bitstreams: 1 InesMSilva.pdf: 696597 bytes, checksum: 24442d1f4ce0c75493ec421c201c1315 (MD5) Previous issue date: 2019

O cancro colo-retal é uma das principais causas de morte na população portuguesa e grande parte das mortes que causa não se deve diretamente aos sintomas e complicações causados pela doença, mas sim à desnutrição que, muitas vezes, resulta deste tipo de tumor. Por esta razão é importante considerar o acompanhamento nutricional individualizado dos pacientes, garantindo o seu aconselhamento durante todo o processo de tratamento da doença e assegurando o melhoramento dos sintomas que causam a falta de apetite e intolerância a certos alimentos. O objetivo deste trabalho residiu na observação da evolução e melhoria dos doentes, aquando acompanhados por consultas de nutrição durante o tratamento radioterapêutico realizado em doentes com cancro colo-retal. Esta análise é fundamental não só para compreender a importância da nutrição na área da oncologia, como também para confirmar que uma alimentação equilibrada e variada poderá favorecer o estado de saúde dos doentes. Durante seis meses, acompanharam-se 50 doentes com cancro colo-retal que se encontravam a fazer tratamentos de radioterapia e que realizaram consultas de nutrição clínica no serviço de Radioterapia do Hospital de Santa Maria. O estado nutricional destes doentes foi avaliado antes e no final dos tratamentos através de diferentes metodologias: estudo da perda de peso médio percentual, avaliação do Índice de Massa Corporal (IMC) e avaliação através do método Patient Generated Subjective Global Assessment (PG-SGA). Foram ainda avaliados parâmetros antropométricos e dados obtidos com base nas características do tumor diagnosticado (histologia, estadio, sintomas). Através de todas as metodologias utilizadas foi possível observar que a intervenção nutricional realizada contribuiu para a melhoria do estado nutricional dos doentes. O acompanhamento efetuado permitiu concluir que as consultas de nutrição não só ajudaram a que os doentes se tornassem fisicamente mais capazes de enfrentar os tratamentos, como foi possível observar um aumento do ânimo psíquico dos mesmos em relação à doença.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2018-01-30T11:43:18Z No. of bitstreams: 1 DarynaLavriv.pdf: 543137 bytes, checksum: f816f255a6d83dc862e404dcc467d5d2 (MD5) Made available in DSpace on 2018-01-30T16:17:15Z (GMT). No. of bitstreams: 1 DarynaLavriv.pdf: 543137 bytes, checksum: f816f255a6d83dc862e404dcc467d5d2 (MD5) Previous issue date: 2017

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2018-01-30T13:26:11Z No. of bitstreams: 1 DuarteAFerreira.pdf: 1330536 bytes, checksum: 2f9443827813df2ef8989d27407ca4f2 (MD5) Made available in DSpace on 2018-01-30T16:31:54Z (GMT). No. of bitstreams: 1 DuarteAFerreira.pdf: 1330536 bytes, checksum: 2f9443827813df2ef8989d27407ca4f2 (MD5) Previous issue date: 2017

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2018-02-02T13:40:56Z No. of bitstreams: 1 GoncaloRSousa.pdf: 955752 bytes, checksum: 514b26f7da5b025e3a97d78bc6ff8c80 (MD5) Made available in DSpace on 2018-02-02T15:59:35Z (GMT). No. of bitstreams: 1 GoncaloRSousa.pdf: 955752 bytes, checksum: 514b26f7da5b025e3a97d78bc6ff8c80 (MD5) Previous issue date: 2017

Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2017 Submitted by Fernando João Machado (fjmachado@fm.ul.pt) on 2018-05-08T13:20:53Z No. of bitstreams: 1 11374_Tese.pdf: 1119787 bytes, checksum: c27847a492b4c0dd9e3b660556fc61cc (MD5) Made available in DSpace on 2018-05-08T13:21:05Z (GMT). No. of bitstreams: 1 11374_Tese.pdf: 1119787 bytes, checksum: c27847a492b4c0dd9e3b660556fc61cc (MD5) Previous issue date: 2017

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2018-03-28T12:39:57Z No. of bitstreams: 1 MauroFernandes.pdf: 702633 bytes, checksum: 3d75622fcd8de5eb560492492c3be3bd (MD5) Made available in DSpace on 2018-04-05T11:25:23Z (GMT). No. of bitstreams: 1 MauroFernandes.pdf: 702633 bytes, checksum: 3d75622fcd8de5eb560492492c3be3bd (MD5) Previous issue date: 2017

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-04-11T13:13:20Z No. of bitstreams: 1 JoanaOMiranda.pdf: 888380 bytes, checksum: 583c1a6b80e1406b1aa4a71a9fd10336 (MD5) Made available in DSpace on 2017-04-11T15:11:11Z (GMT). No. of bitstreams: 1 JoanaOMiranda.pdf: 888380 bytes, checksum: 583c1a6b80e1406b1aa4a71a9fd10336 (MD5) Previous issue date: 2016

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-04-10T13:53:34Z No. of bitstreams: 1 JessicaEVChaves.pdf: 425290 bytes, checksum: 9006358681185f9f6ba49a69ebc2b124 (MD5) Made available in DSpace on 2017-04-10T15:53:21Z (GMT). No. of bitstreams: 1 JessicaEVChaves.pdf: 425290 bytes, checksum: 9006358681185f9f6ba49a69ebc2b124 (MD5) Previous issue date: 2016

Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2016 Submitted by Lucília Mateus (luciliamateus@fm.ul.pt) on 2016-11-09T15:51:59Z No. of bitstreams: 2 11110_Tese.pdf: 878385 bytes, checksum: df59cb81abb408098ec51095a45eae0b (MD5) 11110-Errata.pdf: 57617 bytes, checksum: f1962e78d950978f6191f08e0e7a12fd (MD5) Made available in DSpace on 2016-11-17T11:52:01Z (GMT). No. of bitstreams: 2 11110_Tese.pdf: 878385 bytes, checksum: df59cb81abb408098ec51095a45eae0b (MD5) 11110-Errata.pdf: 57617 bytes, checksum: f1962e78d950978f6191f08e0e7a12fd (MD5) Previous issue date: 2016