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Importance of Nutrition in Oncology Patients
<ul><li>Cancer and its oncological treatment cause symptoms which increase the patients risk to suffer from  MALNUTRITION ...
<ul><li>MALNUTRITION  is a common problem in cancer patients that has been recognized as an important component of adverse...
Malnutrition and Cancer <ul><li>Diminished Tolerance Of Therapy </li></ul><ul><li>Lower Survival Rates </li></ul><ul><li>D...
<ul><li>Good nutrition practices can help cancer patients  </li></ul><ul><li>MAINTAIN WEIGHT </li></ul><ul><li>The body's ...
<ul><li>Nutritional intervention should be considered as a supportive measure within the  GLOBAL ONCOLOGY STRATEGY .  </li...
<ul><li>In curative oncology care, it contributes to </li></ul><ul><li>Reduced  Postoperative Infection Rate </li></ul><ul...
<ul><li>In palliative care, the nutritional intervention focuses on controlling symptoms, thus improving  Quality of Life ...
<ul><li>Systemic Effects of Cancer on Nutrition </li></ul><ul><li>Guidelines for Nutritional Support </li></ul>Nutritional...
Cancer-related Defects in Carbohydrate Metabolism <ul><li>Glucose intolerance </li></ul><ul><li>Insulin resistance </li></...
Cancer-related Defects in  Fat Metabolism <ul><li>Excess body fat depletion relative to protein loss </li></ul><ul><li>Dec...
Cancer-related Defects in Protein Metabolism <ul><li>Increased whole-body  PROTEIN TURNOVER </li></ul><ul><li>Persistent m...
<ul><li>Guidelines for Nutritional Support </li></ul>
<ul><li>Step 1 - Assessment </li></ul><ul><ul><li>History </li></ul></ul><ul><ul><li>Labs </li></ul></ul><ul><li>Step 2 - ...
Assess - Ask! <ul><li>Ask about: </li></ul><ul><li>APPETITE  - good/poor </li></ul><ul><li>GRAZING  or snacking </li></ul>...
Assess - Ask! <ul><li>Beware of: </li></ul><ul><li>Living arrangements </li></ul><ul><ul><li>Alone? </li></ul></ul><ul><ul...
Assess - Look for signs! <ul><li>HAIR  - dull, brittle, dry or falls out easily </li></ul><ul><li>SWOLLEN GLANDS  in the n...
Assess - Regular weighing! < 20 = malnutrition possible < 18 = malnutrition likely Weight (kg)/height(m) 2 BMI (Body Mass ...
Assess - Know lab results! <ul><li>Albumin (3.5-5 g/dL) </li></ul><ul><ul><li>Mild depletion (2.8-3.4 g/dL) </li></ul></ul...
Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Calories per day  </li></ul><ul><li>Norma...
Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Protein per day   </li></ul><ul><li>0.8 g...
Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Protein required per day based on albumin...
Symptom Management <ul><li>Strategies for Patients   </li></ul><ul><ul><li>Patient teaching </li></ul></ul><ul><li>Pharmac...
Evaluation <ul><li>Cardinal principle:  </li></ul><ul><ul><li>Individualize to needs of patient </li></ul></ul><ul><li>Sho...
<ul><li>SLIMFIT  Provides   </li></ul><ul><li>AMINO FUEL 900 </li></ul>
<ul><li>High Energy Hydrolysed Starches </li></ul>AMINO FUEL 900  contains
<ul><li>High Biological Value Proteins   </li></ul><ul><li>  </li></ul>AMINO FUEL 900  contains
<ul><li>Mono-unsaturated Fatty Acids & Poly-unsaturated Fatty Acids   </li></ul><ul><li>  </li></ul>AMINO FUEL 900  contains
<ul><li>High in Calorie </li></ul>AMINO FUEL 900  contains
<ul><li>Malnourished cancer patients commonly have increased whole body protein turnover and subsequent body nitrogen loss...
Nutrient Information   * With milk Nutrient Content 40 gms 100 gms Units Carbohydrate Protein Fats Saturated MUFA PUFA Cho...
Amino Fuel 900 Ensure Protein  per Dose Gm. Protein Comparison
Amino Fuel 900 Ensure Price  per Dose Rs. Price Comparison
<ul><li>Vanilla </li></ul><ul><li>Chocolate </li></ul><ul><li>Raspberry </li></ul><ul><li>Mango </li></ul><ul><li>Pineappl...
ONCE  or  TWICE   Daily or as needed 4 SCOOPS  (40 gm)  in 200 ml of Water or  Milk Dose
Let  Food  Be Your  Medicine  And  Medicine  Be Your  Food - Hippocrates,  337 BC
<ul><li>THANK YOU </li></ul>
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Importance Of Nutrition In Cancer Patients

Importance of Nutrition In Cancer Patients

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Importance Of Nutrition In Cancer Patients

  1. 1. Importance of Nutrition in Oncology Patients
  2. 2. <ul><li>Cancer and its oncological treatment cause symptoms which increase the patients risk to suffer from MALNUTRITION . </li></ul><ul><li>This affects the patients health status negatively by </li></ul><ul><li>Increasing the Number of Complications </li></ul><ul><li>Reducing the TOLERANCE to the oncology treatment </li></ul><ul><li>Decrease of the patients Quality of Life </li></ul>2008 Sep-Oct;23(5):458-68.
  3. 3. <ul><li>MALNUTRITION is a common problem in cancer patients that has been recognized as an important component of adverse outcomes, including </li></ul><ul><li>Increased MORBIDITY and MORTALITY and </li></ul><ul><li>Decreased Quality of Life. </li></ul>Supplement 6: 20-7, 1998
  4. 4. Malnutrition and Cancer <ul><li>Diminished Tolerance Of Therapy </li></ul><ul><li>Lower Survival Rates </li></ul><ul><li>Diminished Quality Of Life </li></ul><ul><li>Longer Hospitalizations </li></ul>
  5. 5. <ul><li>Good nutrition practices can help cancer patients </li></ul><ul><li>MAINTAIN WEIGHT </li></ul><ul><li>The body's NUTRITION STORES </li></ul><ul><li>Improving QUALITY OF LIFE </li></ul>
  6. 6. <ul><li>Nutritional intervention should be considered as a supportive measure within the GLOBAL ONCOLOGY STRATEGY . </li></ul>2007 Jul;10(4):480-7
  7. 7. <ul><li>In curative oncology care, it contributes to </li></ul><ul><li>Reduced Postoperative Infection Rate </li></ul><ul><li>Better Control of Cancer-related Symptoms </li></ul><ul><li>Shortened Length of Hospital Stay and </li></ul><ul><li>Improved Tolerance to Treatment </li></ul>2007 Jul;10(4):480-7
  8. 8. <ul><li>In palliative care, the nutritional intervention focuses on controlling symptoms, thus improving Quality of Life . </li></ul>2007 Jul;10(4):480-7
  9. 9. <ul><li>Systemic Effects of Cancer on Nutrition </li></ul><ul><li>Guidelines for Nutritional Support </li></ul>Nutritional Issues in Cancer
  10. 10. Cancer-related Defects in Carbohydrate Metabolism <ul><li>Glucose intolerance </li></ul><ul><li>Insulin resistance </li></ul><ul><li>Abnormal insulin secretion </li></ul><ul><li>Delayed glucose clearance </li></ul><ul><li>Increased glucose production </li></ul><ul><li>Variably increased Cori cycle activity </li></ul>
  11. 11. Cancer-related Defects in Fat Metabolism <ul><li>Excess body fat depletion relative to protein loss </li></ul><ul><li>Decreased free fatty acids, and glycerol turnover </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Decreased serum lipoprotein lipase activity </li></ul>
  12. 12. Cancer-related Defects in Protein Metabolism <ul><li>Increased whole-body PROTEIN TURNOVER </li></ul><ul><li>Persistent muscle protein breakdown </li></ul><ul><li>Decreased plasma branched-chain amino acids </li></ul>
  13. 13. <ul><li>Guidelines for Nutritional Support </li></ul>
  14. 14. <ul><li>Step 1 - Assessment </li></ul><ul><ul><li>History </li></ul></ul><ul><ul><li>Labs </li></ul></ul><ul><li>Step 2 - Planning </li></ul><ul><ul><li> Nutritional requirements </li></ul></ul><ul><ul><li> Setting achievable goals </li></ul></ul><ul><li> Step 3 - Intervention </li></ul><ul><ul><li>Symptom Management </li></ul></ul><ul><ul><li>Nourishment </li></ul></ul><ul><li>Step 4 - Evaluation </li></ul>
  15. 15. Assess - Ask! <ul><li>Ask about: </li></ul><ul><li>APPETITE - good/poor </li></ul><ul><li>GRAZING or snacking </li></ul><ul><li>SPECIAL DIETS / practices </li></ul><ul><li>FOOD likes/dislikes </li></ul><ul><li>QUANTITY - calories in </li></ul><ul><li>SYMPTOMS - mouth pain or difficulties with chewing or swallowing </li></ul><ul><li>VITAMIN /herb use </li></ul>
  16. 16. Assess - Ask! <ul><li>Beware of: </li></ul><ul><li>Living arrangements </li></ul><ul><ul><li>Alone? </li></ul></ul><ul><ul><li>Housebound? </li></ul></ul><ul><ul><li>Vigor? </li></ul></ul><ul><li>Income level </li></ul><ul><li>Alcohol use </li></ul><ul><li>Mental status </li></ul>
  17. 17. Assess - Look for signs! <ul><li>HAIR - dull, brittle, dry or falls out easily </li></ul><ul><li>SWOLLEN GLANDS in the neck </li></ul><ul><li>SKIN - dry, rough, spotty, or sandpapery feel </li></ul><ul><li>SORES and delayed wound healing </li></ul><ul><li>MUSCLE WASTING (decreased size & strength) </li></ul><ul><li>EDEMA of the lower extremities </li></ul><ul><li>ABNORMAL HEART RATE , rhythm, & blood pressure </li></ul><ul><li>ENLARGED LIVER or spleen </li></ul><ul><li>LOSS OF BALANCE or coordination </li></ul>
  18. 18. Assess - Regular weighing! < 20 = malnutrition possible < 18 = malnutrition likely Weight (kg)/height(m) 2 BMI (Body Mass Index) Significant weight loss is greater than: 1% - 2% in 1 week 5% in 1 month 7.5% in 3 months 10% in 6 months Amount of weight change divided by usual weight x 100 Percent Weight Change >120 % IBW is obese 110% - 120% IBW is over weight 90% - 110% IBW is normal range 80% - 90% IBW is mildly underweight <80% IBW is moderately underweight Ideal Body Weight (BMI) Men: 106 lbs. For the first 5' of height plus 6 lbs. For each additional inch. Women : 100 lbs. For the first 5' of height plus 5 lbs. For each additional inch. Weight Interpretation Standard Criteria
  19. 19. Assess - Know lab results! <ul><li>Albumin (3.5-5 g/dL) </li></ul><ul><ul><li>Mild depletion (2.8-3.4 g/dL) </li></ul></ul><ul><ul><li>Moderate depletion (2.1-2.7 g/dL) </li></ul></ul><ul><ul><li>Severe depletion (<2.1g/dL) </li></ul></ul><ul><li>Total lymphocyte count (2500 mm 3) </li></ul><ul><ul><li>TLC (mm 3 ) = WBC (mm 3 ) x % lymphocytes </li></ul></ul><ul><ul><li>Mild depletion (<1500 mm 3 ) </li></ul></ul><ul><ul><li>Moderate depletion (<1200 mm 3 ) </li></ul></ul><ul><ul><li>Severe depletion (<800 mm 3 ) </li></ul></ul>
  20. 20. Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Calories per day </li></ul><ul><li>Normal: 30 cal/kg (for adults) - average activity levels </li></ul><ul><li>28 cal/kg in starvation - due to slowed metabolism & decreased calorie needs </li></ul><ul><li>32 cal/kg in elective surgery - mildly increased needs   </li></ul><ul><li>40 cal/kg in polytrauma; significantly increased needs </li></ul><ul><li>50 cal/kg in sepsis or severe stress; highly increased needs </li></ul>
  21. 21. Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Protein per day </li></ul><ul><li>0.8 g/kg (for adults Normal) - average activity levels </li></ul><ul><li>1.5 - 2 g/kg with fever, fracture, infection, wound healing </li></ul><ul><li>1.5 - 2 g/kg for protein repletion </li></ul><ul><li>1.5 - 3 g/kg for Cachexia or burns </li></ul>
  22. 22. Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Protein required per day based on albumin level </li></ul><ul><li>If albumin is 3.5 g/dL, protein requirement is 0.8 g/kg </li></ul><ul><li>If albumin is 2.8 - 3.5 g/dL, protein requirement is 1 - 1.2 g/kg </li></ul><ul><li>If albumin is 2.1 - 2.7 g/dL, protein requirement is 1.2 -1.5 g/kg </li></ul><ul><li>If albumin is <2.1g/dL, protein requirement is 1.5 - 2 g/kg </li></ul>
  23. 23. Symptom Management <ul><li>Strategies for Patients </li></ul><ul><ul><li>Patient teaching </li></ul></ul><ul><li>Pharmacological Interventions </li></ul><ul><li>SUPPLEMENTS </li></ul><ul><li>Coping Strategies </li></ul><ul><ul><li>Spiritual </li></ul></ul><ul><ul><li>Support Groups </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><li>Total Parenteral Nutrition (TPN) </li></ul>
  24. 24. Evaluation <ul><li>Cardinal principle: </li></ul><ul><ul><li>Individualize to needs of patient </li></ul></ul><ul><li>Short-term goal: </li></ul><ul><ul><li>Improve Nutritional Status </li></ul></ul><ul><li>Long-term goal: </li></ul><ul><ul><li>Normalize Nutrient Intake </li></ul></ul><ul><ul><li>Alleviate disease symptoms </li></ul></ul><ul><li>Outcomes??? </li></ul><ul><ul><li>Better Quality of life / Vigor </li></ul></ul><ul><ul><li>Fewer Crisis / Improved Treatment Response </li></ul></ul>
  25. 25. <ul><li>SLIMFIT Provides </li></ul><ul><li>AMINO FUEL 900 </li></ul>
  26. 26. <ul><li>High Energy Hydrolysed Starches </li></ul>AMINO FUEL 900 contains
  27. 27. <ul><li>High Biological Value Proteins </li></ul><ul><li>  </li></ul>AMINO FUEL 900 contains
  28. 28. <ul><li>Mono-unsaturated Fatty Acids & Poly-unsaturated Fatty Acids </li></ul><ul><li>  </li></ul>AMINO FUEL 900 contains
  29. 29. <ul><li>High in Calorie </li></ul>AMINO FUEL 900 contains
  30. 30. <ul><li>Malnourished cancer patients commonly have increased whole body protein turnover and subsequent body nitrogen loss </li></ul>1998;48:69-80
  31. 31. Nutrient Information * With milk Nutrient Content 40 gms 100 gms Units Carbohydrate Protein Fats Saturated MUFA PUFA Cholesterol Fiber Energy Moisture 19.63 12.86 7.34 3.82 2.57 0.95 1.19 240 200 (400)* 49.08 32.16 18.34 9.54 6.42 2.38 2.97 600 500 (1000)* gms gms gms         mg k/cals 3 - 4 %
  32. 32. Amino Fuel 900 Ensure Protein per Dose Gm. Protein Comparison
  33. 33. Amino Fuel 900 Ensure Price per Dose Rs. Price Comparison
  34. 34. <ul><li>Vanilla </li></ul><ul><li>Chocolate </li></ul><ul><li>Raspberry </li></ul><ul><li>Mango </li></ul><ul><li>Pineapple </li></ul><ul><li>Lemon </li></ul>Flavours
  35. 35. ONCE or TWICE Daily or as needed 4 SCOOPS (40 gm) in 200 ml of Water or Milk Dose
  36. 36. Let Food Be Your Medicine And Medicine Be Your Food - Hippocrates, 337 BC
  37. 37. <ul><li>THANK YOU </li></ul>

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