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The tumor that has the most impact on nutrition! Nutrition therapy for patients at different stages of treatment should pay attention!

 Last Update: 2023-01-05
 Source: Internet
 Author: User

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▎WuXi AppTec content team editor

Gastric cancer refers to malignant tumors of epithelial origin that originate in the stomach
.
According to the latest data from China in 2020, the incidence and mortality of gastric cancer ranked 3rd
among various malignant tumors.
China accounts for about 40%
of the approximately 1.
2 million new cases of gastric cancer worldwide each year.
The occurrence and development of gastric cancer seriously threatens people's lives and health
.

The 2015 Guidelines for Nutritional Treatment of Patients with Gastric Cancer pointed out that gastric cancer is the tumor with the most serious nutritional impact of all tumors
.
Nutritional therapy for gastric cancer patients is part of comprehensive treatment, which should start from the diagnosis of the disease and run through the whole process
of anti-tumor treatment.

In this article, we elaborate on gastric cancer risk factors, causes and mechanisms of malnutrition, nutritional risk screening and nutritional assessment, clinical diagnostic criteria for malnutrition and nutritional therapy, etc.
, for your reference
.

Image source: 123RF

5 types of risk factors for the occurrence of gastric cancer

The occurrence of gastric cancer is a complex process of multi-factor participation and multi-step evolution, and is the comprehensive result of the interaction of
genetic and environmental factors.
Risk factors for gastric cancer include Helicobacter pylori infection, poor diet, smoking, heavy alcohol consumption, and family history of gastric cancer in first-degree relatives
.

Helicobacter pylori infection is an important risk factor for the occurrence of gastric cancer, and its long-term presence in the stomach can cause chronic gastritis, and plays an important role
in the atrophy of the gastric mucosa and the occurrence and development of intestinal metaplasia.
Poor eating habits are also one of the important factors in the occurrence of stomach cancer, including regular intake of pickled and smoked fried foods
.
Smoking can increase the risk of stomach cancer, and the larger the amount of smoking and the longer the smoking period, the higher the
risk of stomach cancer.
Heavy alcohol consumption increases the risk
of stomach cancer.
The risk of gastric cancer in first-degree relatives was significantly increased (OR=2.
85, 95% CI: 1.
83~4.
46).

Causes and mechanisms of malnutrition in gastric cancer patients

The causes and mechanisms of malnutrition in gastric cancer patients are complex, which are related
to the characteristics of the tumor itself and the impact of anti-tumor therapy on the body.

Malignant tumors lead to dysfunction of the feeding regulation center, and pain, nausea and vomiting, anxiety and depression caused by anti-tumor treatments such as surgery, radiotherapy and chemotherapy can cause anorexia and early satiety, affecting the intake
of nutrients.

At the same time, the nutrient metabolism characteristics of tumor patients are different from those of non-tumor patients, and abnormal carbohydrate metabolism, increased protein conversion rate, increased lipolysis, decreased fat storage, muscle and visceral protein consumption, decreased lean body mass, disturbance of water-electrolyte balance, and changes in energy consumption will induce and aggravate malnutrition
.

In addition, patients with gastric cancer may also face local factors such as gastrointestinal obstruction, delayed gastric emptying, and digestive absorption disorders caused by gastrectomy and digestive tract reconstruction, resulting in further reduction
in nutrient intake.

Nutritional risk screening and nutritional assessment of gastric cancer patients

After the diagnosis of gastric cancer patients is confirmed, nutritional risk screening
should be carried out as soon as possible.
The Nutritional Risk Screening Scale 2002 (NRS-2002) is recommended as a nutritional risk screening tool for scoring
.
NRS-2002 score< 3 points without nutritional risk; Those with a score of 3 in NRS-2002 ≥ have nutritional risks and should be evaluated<b20> for nutrition.

Relevant nutritional assessment indicators include weight loss, body mass index (BMI), fat body mass index (FFMI), blood biochemical indicators (such as albumin), etc.
, and the patient's subjective overall assessment scale (PG-SGA) can be used for nutritional assessment
when possible.

Image source: 123RF

Clinical diagnostic criteria for malnutrition in patients with gastric cancer

For the clinical diagnosis of malnutrition in gastric cancer patients, it is recommended to refer to the Consensus on Malnutrition Assessment (Diagnosis) Standards (GLIM) initiated by the Global (Nutrition)
Leadership Initiative.

The GLIM consensus states that malnutrition can be diagnosed by identifying nutritional risks through effective screening tools (e.
g.
, NRS-2002), and at least one phenotypic index and one etiotypic index
.

Phenotypic indicators include: (1) (Asia) BMI <18.
5 (< 70 years) or BMI < 20 (> 70 years).

(2) Involuntary weight loss: weight loss of >5% within 6 months, or weight loss of >10%
in more than 6 months.
(3) Reduction in muscle mass (fat body mass index, grip strength, etc.
) determined by effective body composition detection technology
.
Etiologic indicators include: (1) a reduction in energy intake ≤ 50% (> 1 week), or any proportion of a decrease in energy intake (> 2 weeks), or chronic gastrointestinal symptoms
that lead to malabsorption or malabsorption in the patient.
(2) Acute illness, injury, or inflammation associated with chronic disease
.

Nutritional therapy for patients with gastric cancer

When performing nutritional interventions for patients with malnutrition with gastric cancer, a 5-step treatment model should be followed:

Tier 1, diet + nutrition education;
Tier 2, diet + oral nutritional supplements;
Tier 3, complete enteral nutrition (oral and/or tube feeding);
Tier 4, partial enteral nutrition + partial parenteral nutrition;
Tier 5, complete parenteral nutrition
.

Nutrition education is preferred, enteral and parenteral nutrition is secondary; enteral nutrition is preferred, followed by parenteral nutrition; Oral administration is preferred, followed by tube feeding
.
First choose nutrition education, then move up to oral nutritional supplements, complete enteral nutrition, partial parenteral nutrition, and complete parenteral nutrition
.
When the next ladder cannot meet 60% of the target energy requirement for 3~5 days, the previous ladder
should be selected.

Image source: 123RF
gastric cancer patients after nutritional risk screening and assessment, if the preoperative nutritional status is good, nutritional therapy is not required; If the patient is moderately to severely malnourished and requires major surgery, nutritional therapy for 7 to 14 days before surgery is recommended to reduce the postoperative morbidity and mortality
.

Oral nutritional supplements or enteral nutrition therapy is preferred for perioperative nutrition therapy in patients with gastric cancer, and parenteral nutrition therapy should be supplemented or selected if enteral nutrition therapy is not available or does not provide sufficient energy and protein
.
In addition, a reasonable ratio of carbohydrate and fat should be maintained to increase energy density; Pay attention to supplement the physiological needs of vitamins and trace elements, such as iron, vitamin B12, vitamin D, etc
.

Patients with gastric cancer resumed oral eating, oral nutritional supplements or enteral nutrition therapy
in the early postoperative period (24 h~48 h).

Patients with gastric cancer are advised to undergo reasonable nutritional therapy
as needed during chemoradiotherapy.
Patients with normal swallowing and gastrointestinal function are recommended to choose oral nutritional supplements
.
Tube feeding
is an option for those with eating disorders but normal or tolerated gastrointestinal function.
When enteral dysfunction, enteral nutrition is not available, or energy and protein requirements are not met, supplemental parenteral nutrition or complete parenteral nutrition
should be chosen.