What should patients eat when suffering from chronic disease?
Early identification and treatment of poor nutrition in chronic disease is fundamental.
13 November 2019
Nutrition matters in managing chronic illness
Chronic diseases such as cardiovascular disease, diabetes and cancer take a huge toll on individuals and contribute heavily to hospital admissions, outpatient care, and the total healthcare burden. The World Health Organisation has indicated that 60% of all deaths are attributable to chronic diseases .
Nutrition and health science, alongside government campaigns have advanced in the past decade to provide nutrition and lifestyle guidelines that prevent cancer-related deaths, but the disease is still prevalent as shown by data from GLOBACAN .
Nutrition can have a substantial impact in the co-treatment of chronic disease, with malnutrition (insufficient intake of nutrients) continuing to gain traction inpatient care literature.
Survival rates are better with optimised nutrition
Significant differences have been noted in cancer survival rates between malnourished patients and peers with healthy body weights. More detailed data show that loss of muscle mass is predictive of poor outcomes.
The decline in muscle mass associated with ageing is described as sarcopenia, which together with loss of muscle strength and fatigue leads to lower survival rates in cancer patients . Sarcopenia is apparent in clearly underweight patients but is also common in those with normal weight or obesity.
In these patients, it remains difficult for physicians and caretakers to identify sarcopenia which contributes to the risk of delayed diagnosis and treatment. Therefore, timely recognition and treatment of reduced muscle mass are essential in the management of chronic diseases.
Illness impacts ability to meet protein guidelines
Protein guidelines have been developed worldwide, which in general recommend increasing protein intake in malnourished elderly where sarcopenia occurs more frequently.
ESPEN guidelines recommend nutritional screening of patients, including the development of weight goals but also measuring both qualitative and quantitative parameters such as anorexia, muscle mass and function and inflammatory blood markers .
To both prevent and treat sarcopenia, gentle exercise is suggested alongside an increase dietary protein intake from the standard 0.8-1.0 grams per kilogram of body weight per day, to the level of 1.2-1.5 grams per kilogram of body weight per day, which results in 84-105g for a person weighing 75kg. With one egg containing only six grams of protein, these targets can be difficult to reach when suffering from a low appetite.
Many great options for improving dietary intake
Malnutrition in cancer is multifactorial. There may be treatment complications and disease-related symptoms such as reduced appetite, difficulty with swallowing, early satiety and nausea .
Therefore, it is recommended to work together with a specialized dietitian that understands the drivers of these issues and can support the patient to manage them to meet nutritional needs. Adapting the normal diet by incorporating high protein foods is the first step. Fortifying the diet by adding protein powders or protein liquids to foods that are familiar and enjoyed by patients is also a simple strategy to increase protein levels without impacting too much on the patients’ quality of life.
Compact solutions key to nutrition with impact
If eating becomes a high burden due to complete loss of appetite, pain or fatigue, there is the opportunity to provide oral nutrition supplements. These beverages are liquid and therefore easy to consume. Furthermore, they are fortified with micronutrients to provide patients with all of the micronutrient nutrition they need to fuel their bodies through periods of illness. It has been shown that high-protein, high-energy solutions possibly help encourage patients to meet their dietary goals by allowing them to consume consuming less product, due to the concentrated solution .
Authored by Jacqueline van Schaik, MSc Human Nutrition
Global Lead Nutritionist, NZMP Medical Nutrition
1. The world health report 2002: Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
2. Bray et al, Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
3. Sarcopenia Supersedes Subjective Global Assessment as a Predictor of Survival in Colorectal Cancer. Vashi et al, ASPEN 2018
4. ESPEN expert group recommendations for action against cancer related Malnutrition, Clinical Nutrition; Volume 36, Issue 5, October 2017, Pages 1187-1196
5. Walsh et al, Malnutrition in Cancer Care: Time to Address the Elephant in the Room, Journal of Oncology Practice, 2019
6. Hubbard et al, Clin Nutr. 2012 Jun;31(3):293-312
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