Nutritional therapy for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and presents together with cirrhosis in most cases. In addition to commonly recognized risk factors for HCC development, such as hepatitis B virus/hepatitis C virus infection, age and alcohol/tobacco consumption, there are nutritional risk factors also related to HCC development including high intake of saturated fats derived from red meat, type of cooking (generation of heterocyclic amines) and contamination of foods with aflatoxins. On the contrary, protective nutritional factors include diets rich in fiber, fruits and vegetables, n-3 polyunsaturated fatty acids and coffee. While the patient is being evaluated for staging and treatment of HCC, special attention should be paid to nutritional support, including proper nutritional assessment and therapy by a multidisciplinary team. It must be considered that these patients usually develop HCC on top of long-lasting cirrhosis, and therefore they could present with severe malnutrition. Cirrhosis-related complications should be properly addressed and considered for nutritional care. In addition to traditional methods, functional testing, phase angle and computed tomography scan derived skeletal muscle index-L3 are among the most useful tools for nutritional assessment. Nutritional therapy should be centered on providing enough energy and protein to manage the increased requirements of both cirrhosis and cancer. Supplementation with branched-chain amino acids is also recommended as it improves response to treatment, nutritional status and survival, and finally physical exercise must be encouraged and adapted to individual needs.

Prognostic value of combined inflammatory and nutritional biomarkers in HCC within the Milan criteria after hepatectomy

“…Down-regulation of ALB promoted migration and invasion of HCC cells by increasing uPAR, matrix metalloproteinase (MMP2), and MMP9 ( 33 ). Supplementation with branched-chain amino acids can improve outcomes after cancer therapy and inhibit early relapse after hepatectomy ( 34 ). Lymphocytes play an important role in cancer surveillance ( 35 ).…”

Practice of Multidisciplinary Collaborative Chain Management Model in Constructing Nursing Path for Acute Trauma Treatment

“…③ By clarifying the division of responsibilities of emergency nurses, performing their own duties, implementing emergency operations and responsibilities to individuals, replacing individual operations with group cooperation, and cooperating with team members, it can not only ensure the rapid progress of emergency work and improve emergency efficiency but also ensure the orderliness and pertinence in the first aid process and avoid omissions [ 18 ]. ④ Through a dedicated person to record the whole process of first aid and to appease the emotions of the patient's family in a timely manner, the patient's family can grasp the dynamics of the patient, clarify the meaning of the treatment measures, and avoid doctor-patient disputes caused by deviations and delays in information transmission [ 19 ]. ⑤ After the completion, the first aid process is reviewed to analyze the problems existing in the process, and the course of treatment is optimized, which can improve the quality of care.…”

Amino acids and cancer: potential for therapies?

“…However, they are not produced by the body, their source being protein intake. BCAAs are essential substrates for maintaining protein synthesis and play an important anabolic role, in addition to participating in protein renewal metabolism and being metabolized in skeletal muscle [19][20][21].…”