Changes in Intestinal Permeability and Nutritional Status After Cytotoxic Therapy in Patients with Cancer

Abstract

Damage to intestinal mucosa may impair nutritional status and increase the demand for nutrients involved in intestinal cell proliferation (retinol and folate). It is still unclear if cytotoxic therapy affects serum concentrations of these nutrients in patients with cancer and if this would be associated with disturbances of intestinal mucosa. Intestinal permeability, serum folate, and retinol and nutritional status of 22 patients with hematologic malignancies and 17 healthy volunteers [control group (CG)] were assessed before (T0) and after cytotoxic therapy (T1). Ingestion of lactulose and mannitol was used to assess intestinal permeability. Anthropometric, body composition, phase angle (PA), and biochemical analysis (albumin, retinol, and folate) were also performed. Lactulose/mannitol ratio (0.026 ± 0.014 vs. 0.052 ± 0.037) and lactulose excretion (0.27 ± 0.18% vs. 0.53 ± 0.6%) increased at T1. PA decreased (7.2 ± 1.9° vs. 6.2 ± 0.9°). Serum folate and albumin (20.7 ± 9.5 nmol/L, 37.7 ± 5.5 g/L) were lower than CG (39.2 ± 16.4 nmol/L, 42.9 ± 5.2 g/L) but did not change at T1 (17.5 ± 7.0 nmol/L, 35.9 ± 4.5 g/L). Serum retinol did not differ from CG and did not change at T1 (1.83 ± 0.30 μmol/L vs. 1.69 ± 0.3 μmol/L; CG: 1.86 ± 0.20 μmol/L). Abnormal intestinal permeability, low serum folate levels, and its possible relationship with intestinal alterations, and reduced PA, may be associated with poor nutritional status in cancer patients.

Nutrition in Cancer Patients

“…If the intestinal functions are preserved, EN should be preferred in order to maintain gut integrity and reduce bacterial translocation [45], as well as to reduce infectious complications [19,20,21,23,26]. A standard polymeric feeding formula should be preferred.…”

Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review

“…At the same time, such damage may increase the need for nutrients such as retinol and folate involved in intestinal cell proliferation. 22 The adverse effects of cancer treatment depend on different characteristics related to the chemotherapy itself (ie, the agent used, the dose administered, and individual susceptibility) and tumor proliferative capacity (chemotherapy sensitivity). The intestinal mucosa is inevitably damaged, resulting in mucositis, ulceration, and bleeding, especially when the patient receives different chemotherapeutic regimens administered during HM (ie, accumulated toxicity).…”

“…Various chemotherapy regimens, radiotherapy, and even hematopoietic stem cell transplantation (HSCT) adjunctive therapy (ie, conditioning regimens) can affect healthy cells with a high replication rate, such as intestinal epithelial cells, leading to mucosal damage and alterations in permeability. At the same time, such damage may increase the need for nutrients such as retinol and folate involved in intestinal cell proliferation 22 . The adverse effects of cancer treatment depend on different characteristics related to the chemotherapy itself (ie, the agent used, the dose administered, and individual susceptibility) and tumor proliferative capacity (chemotherapy sensitivity).…”

A Panel Discussion in Nutritional Management in Cancer Care

“…• EN should be preferred in patients with preserved GI functions in order to maintain gut integrity, reduce bacterial translocation and to reduce infectious complications. (16,17,(19)(20)(21)28) EN is recommended in severely undernourished patients with compromised volitional intake or inadequate food intake is anticipated. (16,20,22,29,30) Routine use of artificial nutrition during chemotherapy is not recommended.…”