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Ernährung bei Tumorpatienten

Nutrition in tumor patients

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Der Onkologe Aims and scope

Zusammenfassung

Ernährungsstörungen treten bei Tumorpatienten oft bereits vor der Diagnosestellung auf. Folgen sind erhöhte Morbidität und Mortalität, verminderte Lebensqualität, reduzierte Tumortherapietoleranz und Prognose. Ein tumorassoziierter Gewichtsverlust ist auch für Übergewichtige ungünstig. Eine zentrale Ursache der Mangelernährung ist eine tumorassoziierte systemische Inflammationsreaktion. Eine pathophysiologisch orientierte und auch durchführbare Diagnostik sollte regelmäßig Gewicht, Appetit, Essmenge und die Akutphasenreaktion erfassen. Bei einem Gewichtsverlust ≥5% des gesunden Ausgangsgewichts sollte bei jeder Konsultation eine Ernährungsdiagnostik erfolgen. Oral kann meist mit einer auf die Wünsche und Bedürfnisse des Patienten individuell abgestimmten Vollkost ernährt werden. Bei unzureichender (Energiezufuhr <60% des errechneten Bedarfs, erwartet für mindestens 10 Tage) oder nicht möglicher [Energiezufuhr <2095 kJ/Tag (<500 kcal/Tag), erwartet für mindestens 5 Tage] oraler Ernährung ist eine künstliche Ernährung indiziert. Die Empfehlungen zur Vitamin- und Spurenelementzufuhr entsprechen den Richtlinien der Fachgesellschaften.

Abstract

Nutritional deficits are frequent in cancer patients even before tumor diagnosis, leading to increased morbidity and mortality and a reduced quality of life. These deficits increase the toxicity of cancer therapies and impair overall survival. Tumor-associated weight loss also has a negative impact in overweight individuals because of the often pronounced loss in body cell mass. An important cause of malnutrition is a tumor-associated systemic inflammatory response. The diagnostic approach should be simple and practical and follow the underlying pathophysiology; therefore, patients should be monitored regularly for weight, appetite, nutritional intake, and inflammatory response. If a patient loses 5% or more of his or her initial healthy weight, a nutritional assessment, including examination of energy uptake, should be performed at each consultation, and if necessary, medical dietary counseling should be introduced. In most cases patients can be nourished with normal meals that are individually modified based on the patient’s desires and needs. If oral feeding is insufficient (oral intake <60% of calculated needs, expected for at least 10 days) or not feasible (oral intake <500 kcal/day, expected for at least 5 days), additional artificial nutrition is indicated, primarily enteral nutrition. Vitamins and minerals should be added according to the recommended dietary allowances of specialized organizations.

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  1. Klinik für Strahlentherapie und Radioonkologie, Ruhr-Universität Bochum, Herne/Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    I.A. Adamietz

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Adamietz, I. Ernährung bei Tumorpatienten. Onkologe 16, 81–96 (2010). https://doi.org/10.1007/s00761-009-1772-3

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