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Importance of Protein intake in Cancer
By - Danone Nutricia Academy

Cancer continues to be a major health problem worldwide despite advances in medical technology for its diagnosis and treatment. Cancers are the leading causes of mortality and morbidity, with the increase in rates expected to further increase in the coming decades 1. As per India’s first cancer atlas developed by Indian Council of Medical Research shows parts of India have the world's highest incidence of cancers of the gall bladder, mouth, and lower pharynx 2.

Malnutrition is highly prevalent amongst cancer patients with close to 40-80% cancer patients being malnourished during the course of disease. Malnutrition further worsens the treatment outcomes by causing problems like wound healing, muscle loss and increased post-operative complications risk 3.

Malnutrition results in muscle protein depletion which is a hallmark of cancer cachexia severely impacting quality of life and negatively impacting the physical function and tolerance to treatment. Proper nutrition can alleviate symptom burden, improve health across the cancer continuum, support cancer survivorship and is a hallmark of successful cancer treatment 4.

One of the important nutrients that need to be supplemented in the diets of cancer patients is protein. ESPEN guidelines strongly recommend the intake of protein should be above 1g/kg/day and if possible upto 1.5g/kg/d 5. Metabolic investigations have shown that elevated protein intake promoted muscle protein anabolism in patients with cancer 6.

For chronically ill older subjects, evidence-based recommendation call for protein supplementation between 1.2-1.5g/kg body weight/day, since most of these patients have anabolic resistance i.e. decreased responsiveness of protein synthesis to anabolic stimuli. In case of patients have normal kidney function protein dosage upto 2g/kg/d is considered safe whereas for patients with acute or chronic renal failure, protein intake should be in the range of 1-1.2g/kg/day 5.

A scoping review was performed by searching Pubmed and Scopus databases to examine the available evidence on the effects of proteins, amino acids and their derivatives on muscle strength in adult cancer patients. The results from the studies revealed administration of both energy and proteins in the presence of reduced oral intakes resulted in more robust effects on both muscle strength and mass 7.

However, research shows many patients with cancer do not meet the recommended intake (1.2–1.5 g/kg/day) of protein, and not even the one for healthy individuals (0.8 g/kg/day) 8. Limited protein and other nutrients intake ensues mainly from nutrition impact symptoms that affect dietary intake, such as nausea, vomiting, difficulty in swallowing, mucositis-related decrease in food intake, loss of appetite 9. Furthermore, it has been found that cancer treatments and the disease process of cancer itself makes people more susceptible to many types of infections10 due to an impaired immune system.

Hence, oral nutritional supplements may be necessary, as a means to compensate for lower food intake and to try to prevent nutritional deterioration during the course of treatments 3. Several studies have shown the beneficial effect of nutritional interventions in the form of dietary advice and/or oral nutritional supplements (ONS) as being effective at increasing nutritional intake and causing improvement in quality of life of patients with cancer who are malnourished 11. In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and was associated with better anti-cancer treatment tolerance 12.

Choosing an appropriate oral nutritional supplement could be crucial in nutritional management of cancer. Supplement providing both quality and quantity protein, energy and immuno nutrients could be chosen, to promote muscle protein synthesis, limit weight loss and support immunity in cancer patients.

Timely nutritional intervention has the potential to improve body composition and treatment efficacy and thereby improve disease prognosis 3.

References:-

  1. Krishnaswamy K, Polasa K. Diet, nutrition & cancer--the Indian scenario. The Indian journal of medical research. 1995 Nov 1;102:200-9.
  2. Mudur G. India has some of the highest cancer rates in the world. BMJ. 2005 Jan 29; 330(7485): 215
  3. Ravasco P. Nutrition in cancer patients. Journal of clinical medicine. 2019 Aug;8(8):1211.
  4. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Cancer: disease and nutrition are key determinants of patients’ quality of life. Supportive Care in Cancer. 2004 Apr;12(4):246-52.
  5. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z. ESPEN guidelines on nutrition in cancer patients. Clinical nutrition. 2017 Feb 1;36(1):11-48.
  6. Baracos VE. Skeletal muscle anabolism in patients with advanced cancer. The Lancet. Oncology. 2014 Dec 16;16(1):13-4.
  7. Zanetti M, GortanCappellari G, Barazzoni R, Sanson G. The Impact of Protein Supplementation Targeted at Improving Muscle Mass on Strength in Cancer Patients: A Scoping Review. Nutrients. 2020 Jul;12(7):2099.
  8. Deutz NE, Safar A, Schutzler S, Memelink R, Ferrando A, Spencer H, van Helvoort A, Wolfe RR. Muscle protein synthesis in cancer patients can be stimulated with a specially formulated medical food. Clinical nutrition. 2011 Dec 1;30(6):759-68.
  9. Kapucu S. Nutritional issues and self-care measures adopted by cancer patients attending a University Hospital in Turkey. Asia-Pacific journal of oncology nursing. 2016 Oct;3(4):390.
  10. 10https://www.foodsafety.gov/people-at-risk/people-with-weakened-immune-systems, An Official website of the United States Government.
  11. 11Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. Journal of the National Cancer Institute. 2012 Mar 7;104(5):371-85.
  12. 12Cereda E, Cappello S, Caccialanza R. The use of oral nutritional supplements in patients with head and neck cancer receiving (chemo) radiotherapy. Clinical Nutrition. 2014 Apr 1;33(2):370.

CVM Code - 1612414225095