Issues

Nutrition in oncology: state of the art and future perspectives

Malnutrition is a pathological condition resulting from inadequate intake, absorption or utilization of nutrients and/or energy. It frequently arises in patients with various acute and chronic diseases, including cancer, and is associated with adverse outcomes, such as higher morbidity and mortality rates, longer hospital stays, and increased healthcare costs. Using various screening tools, malnutrition has been identified in 20-70% of cancer patients, depending on tumor site and disease stage. According to a 2019 European report, malnutrition affects approximately 50% of gastrointestinal cancer patients, over 45% of head and neck cancer patients, and over 40% of lung cancer patients. In addition, it is estimated that nearly 20% of cancer patients die because of malnutrition rather than from cancer itself.

Several metabolic abnormalities, systemic inflammation being the most prominent, are present in 30-75% of cancer patients undergoing active treatment, with prevalence reaching up to 85% in patients with advanced disease. Malnutrition and inflammation often coexist and correlate with an increased rate of infectious complications and reduced overall survival. In cancer patients malnutrition is primarily due to a reduction in dietary intake, which may be associated with impaired digestion and absorption. These problems can be a direct consequence of the underlying disease or the result of anti-cancer treatments adverse effects.

In response to stress, the local release of pro-inflammatory mediators by neoplastic and immune cells within the tumor microenvironment induces a state of chronic systemic inflammation. This, in turn, drives a series of complex metabolic alterations, including the depletion of muscle mass and fat storages, insulin and anabolic resistance, which collectively shift metabolism towards a catabolic state. The association of reduced nutritional intake, chronic inflammation, and metabolic alterations represents the pathophysiological basis of cancer cachexia and of anorexia-cachexia syndrome, both of which are characterized by weight loss and alterations in body composition. The international criteria for identifying this multifactorial condition are a weight loss exceeding 5% over the past six months, or a 2% weight loss in patients with a body mass index (BMI) below 20 kg/m² or with sarcopenia.

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Table of Content: Vol. 4 (No. 4) 2024 December

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