Gastrointestinal Cancer Patient Nutritional Management: From Specific Needs to Novel Epigenetic Dietary Approaches

Abstract

Nutritional habits impinge on the health of the gastrointestinal (GI) tract, contributing to GI disorder progression. GI cancer is a widespread and aggressive tumor sensitive to nutritional changes. Indeed, specific nutritional expedients can be adopted to prevent GI cancer onset and to slow down disease activity. Moreover, the patient’s nutritional status impacts prognosis, quality of life, and chemotherapy tolerance. These patients encounter the highest frequency of malnourishment risk, a condition that can progressively evolve into cachexia. Clinical studies dealing with this topic stressed the importance of nutritional counseling and put under the spotlight nutrient delivery, the type of nutrient supplementation, and timing for the start of nutritional management. A medical practitioner well-prepared on the topic of nutrition and cancer should operate in the clinical team dedicated to these oncological patients. This specific expertise needs to be implemented as soon as possible to adopt nutritional interventions and establish a proper patient-tailored dietary regimen. The nutritional gap closure should be prompt during anticancer treatment to stabilize weight loss, improve treatment tolerability, and ameliorate survival rate. Recently, novel nutritional approaches were investigated to target the bidirectional link between epigenetics and metabolism, whose alteration supports the onset, progression, and therapeutic response of GI cancer patients.

Benefícios promovidos pela utilização de um nutracêutico produzido por fermentação altamente biodisponível, rico em β-glucanas e aminoácidos, para pacientes oncológicos tratados com quimioterapias e radioterapias

“…Dados da literatura demonstram que a desnutrição em pacientes oncológicos está relacionada a diversos parâmetros como, por exemplo, a localização do tumor, o estágio da doença e o tipo de tratamento adotado. Estudos mostram que pacientes com cânceres que afetam o trato gastrintestinal como, por exemplo, 60% dos pacientes com câncer de esôfago e de 85% a 90% dos pacientes com câncer gástrico e pâncreas apresentam importantes quadros de desnutrição (Tartari et al, 2010;Cencioni et al, 2022), que estão associados com o aumento do risco de infecção, diminuição da tolerância ao tratamento e, consequentemente, redução na qualidade de vida (Prado & Campos, 2015).…”

A meta-analysis of randomized controlled trials comparing enteral immunonutrition (EIN) and standard enteral nutrition regarding biochemical, immunological, and clinical outcomes in gastrectomy patients with gastric cancer and investigating evidence networks for EIN formulae.

“…Malnutrition commonly results in diminished cellular and humoral immune function, modifications in the inflammatory response, and a potential impediment or inability to properly heal wounds [ 37 , 38 ]. Hence, in the context of patients undergoing postoperative care, the implementation of dietary aid measures has gained significant importance and prevalence [ 39 , 40 ]. Both EN and EIN are components of nutritional treatment.…”

Serum Ketone Levels May Correspond with Preoperative Body Weight Loss in Patients Undergoing Elective Surgery: A Single-Center, Prospective, Observational Feasibility Study

“…In the case of NRS, almost half of the points are counted based on reported preoperative weight loss, thus the statistical significance of this result is self-explanatory. The higher representation of oncological patients in reported body weight loss could be associated with impaired digestion and absorption due to the malignant process [ 13 ]. A combination of multiple malnutrition detecting tools should be investigated in the future to determine the approach with the highest specificity and sensitivity of results.…”