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NUTRITIONAL STRATEGIES TO TACKLE LOSS OF
MUSCLE MASS AND IMPROVE PATIENT OUTCOMES
ACROSS THE HEALTHCARE CONTINUUM
40TH ESPEN CONGRESSABBOTT NUTRITION HEALTH INSTITUTE SYMPOSIUM
WHY MUSCLE MATTERS:
MEETING NUTRITIONAL
NEEDS THROUGHOUT THE
CANCER JOURNEY
Alessandro Laviano, MD
Sapienza University, Rome, Italy
Disclosures
• Consulting Fees: Abbott, Baxter, BASF, Nestlè Health Science, Nutricia Advanced Medical Nutrition, Nutrileads, Smartfish
• Grants: Fresenius-Kabi (INFORM trial)
• Independent lectures at industry-organized symposia: Abbott, BBraun, Fresenius-Kabi, Nestlè Health Science, Nutricia Advanced Medical Nutrition, Smartfish
Objectives
1. Provide an overview of the importance of muscle mass, consequences of musclemass loss, and prevalence of muscle mass loss in cancer patients.
2. Describe the changing nutritional needs of cancer patients from diagnosis totreatment, including current expert guidelines and recommendations.
3. Highlight research and evidence to support the role of nutrition intervention andspecific nutrients in improving muscle mass and patient outcomes.
4. Share practical ways clinicians can assess muscle mass and better meet thenutritional needs of cancer patients to protect muscle mass.
adapted from Laviano A et al. Proc Nutr Soc 2018
chronic intervention:- preserve body weight- diet quality- physical activity
acute intervention:- preserve body weight- patient tailored- counselling- ONS- EN- PN
17
ESPEN Guidelines (Arends J et al. Clin Nutr 2017) recommend:a. 25-30 Kcal/KgBW/day (strength: STRONG; level: low)b. 1-1.5 g/KgBW/day (strength: STRONG; level: moderate)
Shen W-Q et al. Cancer Treat Rev 2018
J Clin Oncol 2017; 35:96-112
«For newly diagnosed patients with advanced cancer, theExpert Panel suggests early palliative involvement within 8weeks of diagnosis (type: informal consensus, benefitsoutweigh harms, evidence quality: intermediate; strength ofrecommendation: moderate)»
• Check regularly your patients’ muscle mass:
- CT scan at L3
- CT scan at C3
- DEXA scan
- BIA
- Muscle function (i.e., strength)
- Anthropometry (i.e., calf circumference
• Check your patients’ appetite and food intake:
- Energy and protein adequacy
- Diet quality
- Adapt intervention to patients’ needs
- Consider to use specific nutrients
• Cancer is a systemic disease requiring multiprofessional and multidisciplinary approach.
• Body composition changes (↓ muscle mass) are early and reversible negative prognosticfactors.
• Muscle mass should be monitored during the clinical journey.
• Long-term nutrition intervention ameliorates survival and should be patient-tailored tominimize weight loss during catabolic crisis and to maximize anabolism during recovery.
• Specific nutrients (i.e., N-3 fatty acids, HMB, vitamin D, etc.) have been preliminarilyshown to improve muscle mass and function.
• Nutrition intervention should be part of an early and comprehensive multimodalapproach.
Conclusions