1. Cancer induced malnutritionCause of cachexiaNutrient substrate requirementManaging side effects during treatmentFAQ and Myths

2. The prevalence of malnutrition in cancerPancrease 8085%Gastric 6585%Head and Neck 6575%Esophagus 6080%Lung4560%Colon 3060%1. StrattonRetal.Prevalenceofdiseaserelatedmalnutrition.In:StrattonRJ,GreenCJ,Elia M(Eds),Diseaserelated malnutrition:AnEvidencebasedApproachtoTreatment.CABIPublishing,Wallingford,Oxon,UK,2003;3592.2. Muscaritoli Metal.Preventionandtreatmentofcancercachaxia:Newinsightintoanoldproblem.Europ JCancer 2006;24:3141 Cachexia: A new definition. Clinical Nutrition V.27(6), 2008 3. Metabolic derangement- - - , - ( )-, 4. Metabolic derangement- Hypo-albuminemia-Depletion of lipid storesLipoprotein lipase, 5. The pathophysiologic role of cytokines inthe production of cachexia AJCN 2006 83: 923-924 Side effects and nutrition impact during treatmentOral ulcers Dry mouthTaste changesNauseaConstipation / Vomiting /DiarrheaDifficulty in swallowing AnorexiaAbsorptionWeight loss 6. Infections & Medications Mouth soresDiarrheaDecreased appetite Too tiredEat less to eat CYCLE OF Lose weightToo tiredMALNUTRITIONto cookTire out quickly Lose strengthCancer deaths: Up to half are malnourished and 20% die from malnutrition rather than cancer1. Capra S, Bauer J, Davidson W, Ash S: Nutritional therapy for cancer-induced weight loss. Nutr ClinPract 2002;17(4):210-213.2. Ottery FD: Cancer cachexia: Prevention, early diagnosis, and management. Cancer Pract1994;2:123-131. 7. Feel better Keep up your strength and energy Maintain your weight and your bodys store of nutrients Better tolerate treatment-related side effects Lower your risk of infection Heal and recover faster 8. Goals of nutrition therapy for cancerpatients in treatment and recovery Prevent or treat nutrition problems, including preventing muscle and bone loss. Decrease side effects of cancer treatment and problems that affect nutrition. Keep up the patients strength and energy Help the immune system fight infection Help the body recover and heal Keep up or improve the patients quality of life AvoidCancerrelatedcachexia 9. () 10. BMI (Body Mass Index)?- BMI 35 ()-80x 0.7= () 10%()-70x 0.6= () 10% BMI()= 22 x ()2 10% 11. 1 > 1-2% 1 > 5% 3 > 7.5% 6 10% 1-6 5-10% 6 5-10%= (- )/ x 100% Harris-Benedict EquationMBEE66.4713.75W5H6.76A FBEE6559.56W1.85H4.68ATERBEE Activity Factor Stress FactorActivity Factor : 1.2, 1.3, 1.4Stress Factor:1.2, 1.2-1.4, 1.3,1.4, 1 1.13WWeight(kg)HHeight(cm)AAge(y)(kg)x 30~35kcal/kg 12. 16~ 20% of Total Energy1.2~ 2.0 g/BW(kg)/day50%~70% 13. ( 7) ()()() 5 2 = 1 ()8 812 150240cc () 8 412 120 ()8 +12 80(:1/4) 215 70 ()7355(:1, 1.5) ()7575()7 10120 (:)1525 (:)15 (:1/3)5 45 14. 170cm, 65Kg 4.54.5 1 41 6-74-5 3-44-5 3-4 2 + 22 + 3 : http://mi9.com/wallpaper/3d-human-figure_233/ 1-2 28 15. :29 30 16. 200CC31 () 32 17. B/ 33(chemotherapy- induced peripheral neuropathy, CIPN) 10~ 40% Vit B12Vit E() Glutamine() 18. resveratrol(ACE) 19. - Reviewed by Liz Butler et.al.(2010) 20. / 21. - L-Glutamine () 5-10 20-30g/- L-Arginine () - L-Alanine (: , ) - BCAA ( 22. - -3 ( ) 23. The Claim:Sugar feeds cancer ?The Facts:All cells (including cancer cells) in our body use sugar (glucose) from thebloodstream for fuel. But that blood sugar comes from all carbohydrate foods,including healthful vegetables, fruits, whole grains and low fat dairy sources; someglucose is even produced within our bodies from protein.While avoiding sugar completely will not slow cancer growth, eating a lot of highsugar foods may mean excess calories in your diet which leads to excess weight andbody fat. And excess body fat is linked to greater risk of several types of cancers.