HYPERALIMENTATION OF THE CANCER-PATIENT WITH PROTEIN-CALORIE UNDERNUTRITION

  • 1 January 1981
    • journal article
    • research article
    • Vol. 41  (6) , 2038-2045
Abstract
Because protein-calorie undernutrition is common in patients with neoplastic disease, nutritional support is often recommended. It is uncertain that methods of supplemental alimentation successful in noncancerous subjects are suitable in cancer patients. Elemental balances, serum proteins, anthropometrics (triceps skinfold and mid-arm muscle area), and creatinine/height ratio were measured in 15 undernourished patients with advanced cancer and in 10 noncancer undernourished controls during central venous or enteral hyperalimentation. During central venous hyperalimentation, cancer patients showed significantly less improvement than the noncancerous controls in body weight (median increment, 5 kg in cancer patients and 8.5 kg in noncancerous), albumin (0.1 g/dl in cancer patients and 0.5 g/dl in noncancerous patients), creatinine/height ratio (4% of standard in cancer and 10% of standard in noncancer), and mid-arm muscle area (4% of standard in cancer and 11% of standard in noncancer). During enteral hyperalimentation, gains in body weight and albumin by cancer patients were significantly inferior to those in noncancerous subjects. Triceps skinfold increments were similar during both central venous and enteral hyperalimentation for cancer and noncancerous patients. While N retention was similar in cancer and noncancer patients, the cancer group retained significantly less Mg and P (.DELTA.Mg in cancer patients, 3.2 meq/day central, -2.7 meq/day enteral; .DELTA.Mg in noncancer patients, 11.9 meq/day central, 10.1 meq/day enteral; .DELTA.P in cancer patients, 0.13 g/day central, 0.07 g/day enteral; .DELTA.P in noncancer patients, 0.27 g/day central, 0.33 g/day enteral). The poorer balances of cancer patients were caused by increased urinary, not fecal, loss. These findings indicate a partial block in repletion of lean body mass or abnormal composition of newly deposited lean body mass when undernourished patients with advanced cancer receive hyperalimentation.