[Pathogenesis and therapy of malnutrition in oncology]

Percutaneous Endoscopic Gastrostomy for Long-Term Feeding of Patients With Oropharyngeal Tumors

Secondary malnutrition in patients with oropharyngeal tumors can be the cause of substantial morbidity. The present, prospective study examined 30 patients receiving treatment for an oropharyngeal tumor. Percutaneous endoscopic gastrostomy (PEG) was performed 1 wk prior to the start of therapy in 15 patients, and 15 patients were temporarily fed by nasogastric tube after surgery. Anthropometric and laboratory parameters were measured in both patient groups at five defined times. Based on these parameters, the nutritional status of the PEG patients was found to be substantially better. The present study was able to show that the prophylactic placement of a PEG tube greatly improves the nutritional status of the patients before and after surgery and minimizes the catabolism of the body's fat depots.

Investigations on the nutritional status of advanced breast cancer patients. The influence of long-term treatment with megestrol acetate or tamoxifen

The nutritional status of three groups of postmenopausal women (age 41-80 yrs) with advanced breast cancer was investigated with special reference to vitamin B6. The interference of hormonal treatment was studied with respect to the progestin megestrol acetate (Group MA, n = 14) and the antiestrogen tamoxifen (Group TAM, n = 15) compared with untreated patients (Group U, n = 11). Healthy postmenopausal women served as controls (Group C, n = 16). Nutritional status was judged from body mass index (BMI), vitamin and trace element status, hematology, and clinico-chemical parameters. Intake of nutrients was calculated from a food record. Hormonal status was studied by analysis of LH, FSH, and prolactin in plasma and of steroids and catecholamines and their metabolites in 24-hour urine. Compared with values for Group C, nutrient intake, hematology, clinico-chemical parameters, and 24-hour urinary excretion of catecholamines and their metabolites of patient groups (U, TAM, and MA) were not significantly different. The BMI of patients was significantly higher (by about 10%; 60% showed an overweight) than that of controls. With respect to fat-soluble vitamin status, significantly lower plasma levels of vitamin A (at least 40% lower, with deficient levels in more than 50% of the patients), D (40% lower), and E (20% lower) were found for Group U. However, water-soluble vitamin status of the four groups was fairly similar. A significantly higher excretion of xanthurenic acid in 24-hour urine, after an oral tryptophan load, was observed for Groups TAM and MA. This is most probably the result of hormonal treatment without affecting vitamin B6 status. Small, but significant, differences between groups were found for trace element status, especially with respect to lower plasma selenium of Group U (25% lower). LH, FSH, and prolactin in plasma and excretion of steroids in 24-hour urine showed levels that could be expected for controls and for untreated and hormonally treated patients. We concluded that the nutritional status of all patients is reasonably adequate. Hormonal treatment did not influence vitamin B6 status, although levels of vitamins A, D, and E and of selenium seem to be elevated.

[Imbalances of neutral plasma amino acids as a pathogenetic factor in anorexia]

Studies in anorectic tumor-bearing rats indicate that anorexia is correlated to imbalances of neutral amino acids in blood and CNS. Consequently plasma amino acids of patients with neoplastic and non-neoplastic internal diseases were studied during phases of anorexia; special regard was given to the precursors of dopamine and serotonin. Anorectic patients were compared to non-anorectic patients with neoplasia. During anorexia, plasma levels of valine and leucine and hence the ratio of the molar concentrations of Val + Leu + Ile/Phe + Tyr were significantly decreased in each anorectic patient as compared to non-anorectic patients whose ratios were always within the normal ranges. As aromatic and branched-chain amino acids compete for penetration of the blood brain barrier, the decrease of the amino acid ratio may induce a raised flux of phenylalanine and tyrosine into the CNS which results in an increased activation of dopaminergic neurons--known to cause anorexia.

[The nutritional status in malabsorption syndrome following gastrointestinal operations]

The nutritional status which includes selected biochemical, anthropometric and immunologic parameters was determined in 36 patients with malabsorption syndromes following gastrointestinal operations. The examinations revealed: Postoperative malabsorption syndromes often lead to considerable nutritional disturbances which cannot be sufficiently estimated by the sole determination of body mass. The nutritional status is a precious tool in judging deficiency symptoms, in instituting a targeted alimentary or substitutive therapy,and in evaluating the therapeutic accomplishment. Optimal long-time alimentary or substitutive therapy permits to achieve and maintain a good or sufficient nutritional status in patients with malabsorption syndromes even if the syndromes are due to extended gastrointestinal operations.