Energy- & Protein-Modified Diets

for Cancer & HIV Infection

Chapter 25

Nutrition & Diet Therapy, 7th edition

 Cancer Malignant: cancerous
cell or tumor which
can injure healthy
tissue & spread
cancer to other parts
of the body
• Growth of malignant tissue
• Many different kinds of malignant
growth
– Differ in characteristics
– Occur in different locations in the body
– Take different courses
– Require different treatments
• Advanced cancers, especially those
of GI tract, can seriously impair
nutrition status

Nutrition & Diet Therapy, 7th edition

 Cancer
• Cancer development (carcinogenesis)
– Arises from mutations in genes that control cell
division
– Abnormal mass of cells (tumor) develops own
blood supply to deliver oxygen & nutrients, &
otherwise support tumor growth
– Tumor causes disruption of functioning of
surrounding tissues
– May spread to another region of body (metastasis)
– Reasons for development varied, including
exposure to cancer-causing agents (carcinogens)
in environment

Nutrition & Diet Therapy, 7th edition

Nutrition & Diet Therapy, 7th edition
Nutrition & Diet Therapy, 7th edition
 Cancer

• Nutrition & cancer risk

– Diet & lifestyle have strong influence on
cancer risk
• Damage to DNA
• Alteration of metabolism of carcinogens
• Inhibition of formation of carcinogens
– Energy balance & growth rates affect
rate of cell division, therefore
influencing rate of tumor growth

Nutrition & Diet Therapy, 7th edition

 Influence of Nutrition on
Cancer Risk
Increased Risk
• Obesity
• Total fat intake
• Red meat, processed
meats
• Calcium (over 1500
mg/day)
• Salted & salt-preserved
foods
• Low physical activity level
• Food preparation methods
Nutrition & Diet Therapy, 7th edition
Decreased Risk
• Fruits & vegetables
• Tomato products
• Cruciferous vegetables
(broccoli, cauliflower,
Brussels sprouts)
• Allium vegetables (onion,
garlic)
• Citrus fruits
• Folate-containing foods &
supplements
• Calcium (up to 1000
mg/day)
• High level of physical activity
 Cancer
• Consequences of
cancer
– Depends on location of
tumor, severity &
treatment
– Complications often due
to tumor’s impingement
on surrounding tissues
– Effectiveness of
treatment is greatest
with early detection &
intervention
Nutrition & Diet Therapy, 7th edition
Frequent consequences
– Cancer cachexia: wasting
syndrome characterized by
anorexia, muscle wasting,
weight loss & fatigue
– Metabolic changes
– Anorexia & reduced food
intake related to…
• Chronic nausea & early
satiety
• Fatigue
• Pain
• Mental stress
• Effects of cancer
therapies
• Obstructions
 Cancer
• Treatments for cancer
– Main goals of treatment are to remove cancer cells,
prevent further tumor growth & alleviate symptoms
– Primary treatment involves surgery, chemotherapy,
radiation therapy, or combination of the three
– Surgery
• Purpose
– Tumor removal
– Determination of extent of involvement
– Discern involvement of surrounding tissues
• Acute metabolic stress caused by surgery increases energy
& protein needs; may exacerbate wasting
• Other effects can reduce food intake, contributing to
nutrient losses & malnutrition

Nutrition & Diet Therapy, 7th edition

 Cancer
• Treatments for cancer (con’t)
– Chemotherapy
• Relies on use of drugs to inhibit tumor growth
• Most drugs are toxic to healthy cells as well as cancerous ones
• Associated with variety of nutrition-related side effects
– Radiation therapy
• Treatment of cancer cells by damaging DNA (& causing cell death)
with x-rays, gamma rays, other atomic particles
• Focused directly on tumors with minimal damage to surrounding
tissues
– Bone marrow transplant
• Replacement of bone marrow that has been destroyed by
chemotherapy or radiation therapy
• Used as one of primary treatments for leukemia
• Immunosuppressant drugs necessary when separate donor used
• Major impact on food intake & nutrition status

Nutrition & Diet Therapy, 7th edition

Nutrition & Diet Therapy, 7th edition
 Cancer
• Nutrition therapy for cancer
– Goals of nutrition therapy
• Minimize loss of weight & muscle tissue
• Correct nutrient deficiencies
• Provide diet that can be tolerated & enjoyed despite
complications of disease
– Nutrition needs among cancer patients vary
widely
– Appropriate nutrition helps patients preserve
strength & improve recovery
– Initial screening & follow-up assessment for
malnutrition necessary during treatment &
recovery periods

Nutrition & Diet Therapy, 7th edition

 Cancer
• Nutrition therapy for cancer (con’t)
– Protein & energy intake recommendations
• Recommendation ranges vary depending on patient
condition
• Energy needs may be 25-35 kcalories/kg, depending
on patient’s current weight, activity level, degree of
metabolic stress, energy needs for tissue repair &
weight regain
• Protein requirements depend on level of metabolic
stress, treatment stage & cachexia
• Regular monitoring of weight changes, nutrition
status & adjustments of diet necessary
• Supplementation may be necessary

Nutrition & Diet Therapy, 7th edition

Nutrition & Diet Therapy, 7th edition
 Cancer
• Nutrition therapy for cancer (con’t)
– Managing symptoms & complications
• Thorough nutritional assessment
• Patient’s response to strategies varies
considerably
– Enteral & parenteral nutrition support
• Necessary for patients with long-term or
permanent GI impairment or severe
complications interfering with food intake
• Enteral nutrition preferred unless
contraindicated

Nutrition & Diet Therapy, 7th edition

Nutrition & Diet Therapy, 7th edition
 HIV Infection
• Human immunodeficiency (HIV) virus
attacks immune system, disabling
defenses against infection & some
cancers
• Often leads to acquired immune
deficiency syndrome (AIDS)
• Diagnosis devastating to patient
– Can expect ever-worsening course of illness,
possibly death
– Recent treatment options have expanded,
offering benefits to patients & improvements
in quality of life

Nutrition & Diet Therapy, 7th edition

 HIV Infection
• World-wide epidemic
– Although no cure, progress
in treatment has been made
– Best course of treatment is
prevention
– Death rate in U.S. begin to
decline during 1990s
– Progression from HIV to
AIDS has also slowed
• Transmission
– Sexual transmission
– Direct contact with
contaminated body fluids,
including blood, semen,
vaginal secretions, breast
milk
Nutrition & Diet Therapy, 7th edition
• Risk factors
– Many individuals remain
asymptomatic during early
stages—unknowingly
passing infection to others
– Individuals at risk should
be tested
– Testing can detect HIV
antibodies within several
months after exposure,
sometimes sooner
– Estimated 25% of infected
individuals in U.S. are
unaware of infection
 HIV Infection
• Consequences of HIV Infection
– Destruction of immune cells—
most affected are helper T cells
(CD4+ T cells) Opportunistic Infection
– Nonspecific early symptoms Infection that results from
• Fever, sore throat, malaise, skin microorganisms that do
rashes, nausea, muscle & joint not cause disease in
pain, diarrhea healthy individuals, but
are damaging to those
• After initial symptoms, may with compromised
remain asymptomatic for 5-10 immune system
years or more
• Untreated, depletion of T cells
eventually increases susceptibility
to opportunistic infections

Nutrition & Diet Therapy, 7th edition

 HIV Infection
• Consequences of HIV Infection
(con’t)
– Weight loss & wasting (AIDS- Anorexia & reduced food
related wasting syndrome) intake
• 10% weight loss within 6 • Key factor in
months development of wasting
• Diarrhea or fever for more than • Results from many
30 days with no known cause
associated problems
• Linked to disease progression,
reduced strength & fatigue – Emotional distress, pain
& fatigue
• Severe in later stages;
– Oral infections
increases risk of death
• Causes – Respiratory disorders
– Anorexia & reduced food – Cancer
intake – Medications
– Altered metabolism &
malabsorption
– Chronic diarrhea
– Diet-drug interactions
Nutrition & Diet Therapy, 7th edition
 HIV Infection
• Consequences of HIV Infection (con’t)
– GI tract complications
• May result from opportunistic infections, medications
or HIV infection itself
• High risk of malnutrition related to…
– Infections in stomach & intestines
– Nausea, vomiting & diarrhea from medications
– Bacterial overgrowth resulting from antiviral, antibiotic
& antifungal medications
• Treatment
– No cure, but treatment can slow progression,
reduce complications & alleviate pain

Nutrition & Diet Therapy, 7th edition

 HIV Infection
• Treatment
– Highly active antiretroviral therapy (HAART)
• Combination of 3 or more antiretroviral agents
• Improved lifespan & quality of life for many patients
• Multiple adverse effects from drugs
– GI effects; diet-drug interactions
– Skin rashes
– Headache
– Anemia
– Tingling & numbness
– Hepatitis
– Pancreatitis
– Kidney stones

Nutrition & Diet Therapy, 7th edition

 HIV Infection
• Treatment (con’t)
– Control of anorexia &
wasting
• Appetite stimulants
• Physical activity

Nutrition & Diet Therapy, 7th edition

 HIV Infection
• Medical nutrition therapy
– Initial nutrition assessment to provide baseline
– Weight maintenance
• Primary objective: maintain weight & muscle tissue
• Determine dietary & lifestyle factors that may
interfere with food intake, appetite & physical activity
• Provide suggestions to prevent future weight
problems
• Small, frequent feedings may be better tolerated
than large meals
• Addition of nutrient-dense snacks, protein or energy
bars, oral supplements may help

Nutrition & Diet Therapy, 7th edition

 HIV Infection
• Medical nutrition therapy (con’t)
– Vitamins & minerals
• Needs are variable
• Multivitamin-mineral supplements often recommended to
reduce risk of deficiencies associated with reduced food
intake, malabsorption, diet-drug interactions & nutrient losses
– Metabolic complications
• Dietary adjustments for treatment of insulin resistance &
elevated triglyceride & LDL levels should be tried before
medication treatment
– Achieve & maintain desirable weight
– Replace saturated fats with monounsaturated & polyunsaturated
fats
– Limit intake of trans fats & cholesterol
– Replace sugar intake with complex carbohydrates
• Maintain regular physical activity

Nutrition & Diet Therapy, 7th edition

 HIV Infection
• Medical nutrition therapy (con’t)
– Symptom management
– Food safety
– Enteral & parenteral nutrition support
• Patients may need aggressive nutrition
support during later stages
• Tube feeding preferred if GI tract is
functional
• Parenteral nutrition reserved for patients
who cannot tolerate enteral nutrition

Nutrition & Diet Therapy, 7th edition