International Journal Publishing

INFLUENCE: International Journal of Science Review

Volume 4 No. 2, 2022
https://influence-journal.com/index.php/influence/index

Research Article
Cancer Patient with Malnutrition
Nani Eduardo
Universidad Nacional Autonoma de Honduras, Honduras
A correspondência deve ser endereçada: [email protected]

Editor Acadêmico: Nguyen Ngoc Anh

Copyright © 2022 Nani Eduardo. Este é um artigo de acesso aberto distribuído sob a Licença de Atribuição Creative Commons,
que permite o uso irrestrito, distribuição e reprodução em qualquer meio, desde que o trabalho original seja devidamente citado

Abstract. Nutrition is an important part on the implementation of cancer, both in patients who are
undergoing therapy, restoration of the therapy, in a State of remission or to prevent a recurrence.
Nutritional status in cancer patients is known to correlate with response therapy, prognosis and quality
of life. More or less 30-87% of cancer patients experiencing malnutrition before undergoing therapy. The
incidence of malnutrition vary depending on the origin of cancer, for example in patients with pancreatic
cancer and gaster are experiencing malnutrition to 85%, 66% in lung cancer, and 35% in breast cancer.
One of the problems of nutrients that need attention in cancer patients is the kaheksia. The malnutrition
common in advance because the nutrition component of the intake not as recommended.

Keywords: Nutrition, Malnutrition, Cancer

A. INTRODUCTION
Nutrition is an important part of the implementation of cancer, whether in patients who
are undergoing therapy, recovering from therapy, in a state of remission or to prevent
recurrence. Nutritional status in cancer patients is known to be associated with therapeutic
response, prognosis and quality of life. Malnutrition and cachexia often occur in cancer patients
(24% at an early stage and > 80% at an advanced stage). The incidence of malnutrition varies
depending on the origin of the cancer, for example in patients with pancreatic and gastric cancer
who are malnourished up to 85%, 66% in lung cancer, and 35% in breast cancer.
One of the nutritional problems that need attention in cancer patients is cachexia.
Cachexia is also closely related to malnutrition.1 Cachexia is defined as muscle loss, or no
lipolysis, which cannot be reversed with conventional nutritional support.
Various cancer malnutrition factors known as cachexia have been reported for a long
time, but it has not been confirmed and it is suspected that the causes are multifactorial, namely
decreased nutritional intake and changes in metabolism in the body. Decreased nutritional
intake occurs due to decreased oral food intake (due to anorexia, nausea and vomiting, changes
in taste and smell perception), local effects of tumors (odynophagy, dysphagi, gastric/intestinal
obstruction, malabsorption, early satiety, psychological factors (depression, anxiety), and side
effects of therapy.
Cancer can cause an effect severe detrimental to nutritional status. Not only cancer cells
take up nutrients of the patient's body, but treatment and consequences physiology of cancer
can interfere with maintaining adequate nutrition. Some of the potential effects of cancer on
nutrition: Weight loss due to:
1. Reduced food intake, possibly induced by changes in the levels of neotransmitters
(serotonin) in the central nervous system; increased levels of lactic acid produced by
anaerobic metabolism, the preferred method of metabolism for tumors; psychological
stress, dysguesia (changes in taste); and dislike of certain foods. About 70% of
individuals with cancer experience an aversion or dislike of certain foods, due to
changes in taste thresholds for some components of smell and taste.

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INFLUENCE: International Journal of Science Review
Volume 4 No. 2, 2022
https://influence-journal.com/index.php/influence/index

2. Increased basal metabolic rate.

3. Increased gluconeogenesis (production of glucose with the breakdown of body
glycogen, fat and protein) caused by the dependence of tumors on anaerobic
metabolism.
4. Decreased body protein synthesis "Cancer cachexia" is a form of severe malnutrition
characterized by anorexia, rapid satiety, weight loss, anemia, weakness, and muscle
loss. Although adequate nutritional support can help prevent muscle loss and weight
loss, only successful cancer therapy can repair / restore this cancer cachexia syndrome.4

B. METHOD
This study used a qualitative approach by collecting data with a literature study on
malnutrition in cancer patients. the data is then analyzed and analyzed to produce a research
framework.

C. RESULT AND DISCUSSION

1. Causes of Malnutrition in Cancer Patients
a. Anorexia
Anorexia is common in cancer patients, with an incidence of 15% -40% at the time of
diagnosis.13 Anorexia is a major cause of cachexia in cancer patients. Causes and mechanisms
of anorexia in patients cancer is not known until now clear. Cancer metabolite products can
also causes anorexia. Cancer metabolism too may cause changes in the taste of soy sauce.
Psychological stress that occurs in cancer patients plays an important role in its occurrence
anorexia. Mechanical obstruction on gastrointestinal tract, pain, depression, constipation,
malabsorption, side effects treatment such as opiates, radiotherapy and chemotherapy can
decrease intake food. Treatment with anti-cancer too the most common cause of malnutrition.
Chemotherapy can cause nausea, vomiting, stomach cramps and bloating, mucositis and ileus
paralytic. Some antineoplastics such as fluorouracil, adriamysin, methotrexate and cisplatin
induces complications gastrointestinal weight.
b. Changes in Metabolism
Metabolism is closely related metabolism of carbohydrates, protein, and fat. In cancer
patients the metabolism of these substances changes and has an effect on the occurrence of
weight loss. Hypermetabolism often occurs in cancer patients, the increase in metabolism is up
to 50% higher than in non-cancer patients. But this increase in metabolism does not occur in
all cancer patients. Several studies have reported this increase in metabolism is associated with
decreased nutritional status and tumor type and size. In normal people the metabolic rate
decreases during starvation as a normal adaptation process but in cancer patients this process
does not occur. The difference between metabolic disorders due to starvation and cancer
cachexia can be seen in Table 1.
Table 1. Difference between metabolic disorders due to starvation and cancer cachexia
Starvation Cachexia Cancer
Basal Metabolism N/ N/ /
Role of mediator - +++
Liver Uragenesis + +++
Nitrogen Balance Negative + +++
gluconeogenesis + +++
Proteolysis + +++
liver protein synthesis + +++

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Protein Metabolism In starvation conditions, use energy for the brain by glucose is
replaced by objects ketones which are the result of breaking down fat. Muscle protein and
visceral protein are used as a precursor to gluconeogenesis thus there is a decrease in protein
catabolism and decreased gluconeogenesis of amino acids in heart. In cancer patients, amino
acids are not stored so that there is a depletion of the mass muscle and in some patients there
is muscle atrophy severe.16 Loss of muscle mass is a result of increased protein degradation
and decreased protein synthesis due to use for the formation of acute phase proteins and
gluconeogenesis. Several studies states that branched chain amino acids (BCAA) can regulate
protein synthesis directly by modulating mRNA translation. 6

2. Lipid Metabolism
In cancer patients there are changes lipid mobilization in the form, decreased
lipogenesis, decreased lipoprotein lipase (LPL) activity and increased lipolysis. Increased
lipolysis caused by an increase in hormones epinephrine, glucagon, adrenocorticotropic
hormone (ACTH) which is cyclic mediated adenosine monophosphate (c-AMP). c-AMP will
activate hormone sensitive lipase (HSL) which will then convert one triglyceride molecules
into three acid molecules free fat and one glycerol molecule. The decrease in LPL activity is
caused by cytokines pro inflammatory TNF-α, INF-γ and IL-1β prevent storage of fatty acids
on adipose tissue and causes increased levels of free fatty acids and glycerol in circulation.5

3. Diet Therapy for Cancer Patients

Weight loss that occurs continuously in cancer patients caused by a decrease in intake
energy or increased expenditure energy. Production of insulin in cancer patients will decrease,
low insulin production the body can further cause increased blood glucose levels. High blood
glucose levels can further causing a decrease in the patient's appetite. Therefore, breakfast is
the time eating right versus meal times others because in the morning levels blood glucose is
the lowest. Tolerance glucose levels affect function gastrointestinal, due to blood glucose levels
high ones can slow down movement peristalsis in the stomach. This can then be causing cancer
patients to feel fast full and no appetite. 7
Increased breakdown of muscle protein in cancer patients can cause losing the body's
amino acids, and so on causing tuhuh to be weak. For support the success of cancer treatment
the need for optimal nutritional support by paying attention to nutritional needs and the purpose
of nutrition for cancer patients. The goal of giving cancer patients a diet among others are:
a. Prevent weight loss(short-term).
b. Achieve and maintain body weight normal (long term).
c. Replacing nutrients lost due to treatment effect.
d. Meet the needs of calories, protein, Carbohydrates, Vitamins and Minerals balanced to
prevent the occurrence of nutrition.
e. Prevent infection and further complications.
f. Meet the needs of micronutrients.
g. Maintain a balance of blood glucose levels:

4. Recommended diet
a. high protein: 1.5 - 2.0 g / kg BW to compensate for weight loss,
b. high in calories: 25 - 35 kcal / kg BW, and 40 -50 kcal / kg BW to replace savings in
the body when the patient is under-weight less. If there is infection it needs additional
calories according to the state of infection.

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c. fat: 30-50% of total calorie requirements.more food should be givena lot in the morning.
Serves are given small and frequent. Sonde formula food can be provided in accordance
with the conditions patient. When you lose weight more than 20% can given.
d. Total Parenteral Nutrition (TPN), as appropriate with the patient's condition:
e. supplement if necessary vitamin B complex (vitamin 86, pantothenic acid 1 folic acid,
etc.) vitamin A, and vitamin C
f. special dietary therapy requirements varies according to the patient's condition and
accompanying diseases.
g. is also recommended to fulfill the amino acid requirement of Leucine and Methionine.
Glutamine is necessary for postoperative or radiation patients on abdomen.9,10

5. Micronutrious Needs
Micronutrient deficiencies that occur in cancer patients, has the meaning to be causing
impaired immune function as a result deficiency of zinc, selenium, vitamin C, vitamin A,
vitamin B6, folic acid. Supplementation vitamins and minerals in cancer patients are if found
the patient's condition cannot meet these needs through intake daily or have an effect side of
therapy that affects intake patient.
According to the American Institute for Cancer Research (AICR) on cancer patients
undergoing radiation therapy and chemotherapy should not consume supplementation vitamins
and minerals that act as antioxidants in amounts that exceed the upper of safe intake, namely
vitamin C 2000 mg/day, vitamin E 250 mg / day, and selenium 400ug/day. Recommended
consumption of potassium, sodium and chloride 45 - 145 meq/day each, calcium 60 meq/day,
magnesium 35 meq/day, and phosphate 23 mmol. 11

6. Route of Nutrition
The first option is through nutrition oral route. Oral nutrition is a first choice after
surgery. If inadequate intake can be given orally nutritional supplementation to intake optimal.
If 10-14 days intake is less than 60% of need, then an indication of giving enteral. Short-term
enteral administration (<4-6 week) can use a nasogastric tube (NGT). Long-term enteral
administration (> 4-6 weeks) using endoscopic percutaneous gastrostomy (PEG). Use of a
nasogastric tube has no effect on tumor response nor any negative effects related to
chemotherapy. Installation of a nasogastric tube is not must be done routinely, unless there is
one the threat of ileus or insufficient nutritional intake adequate.12
Parenteral nutrition is used whenoral and enteral nutrition are not fulfillingthe patient's
nutritional needs, or if the gastrointestinal tract not functioning normally eg bleeding massive
gastrointestinal tract, severe diarrhea, intestinal obstruction total or mechanical, severe
malabsorption. Providing nutrition education can improve quality of life and slow down
toxicity radiation in colorectal cancer patients versus the usual diet with or without nutritional
supplements.13.14

D. CONCLUSION
If not handled properly, malnutrition can develop into cachexia. Cachexia defined as
loss of muscle mass, with or without lipolysis, which cannot restored with conventional
nutritional support. Judging from the symptoms, cachexia is a a syndrome characterized by no
appetite (anorexia), feeling full quickly, and general body weakness.

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