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.

Baracos VE et al. Nat Rev Dis Primer 2018; 4:17105

JM Argiles et al. Nat Rev Cancer 2014; 14:754-762

Martin L et al. Ann Surg Oncol 2018

Martin L et al. Ann Surg Oncol 2018

Grossberg AJ et al. JAMA Oncol 2018

Chang K-V et al. Liver Cancer 2018

Caan BJ et al. JAMA Oncol 2018

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Lundberg M et al. Acta Otolaryngol 2017

Real GG et al. JPEN 2018

Baracos VE et al. Nat Rev Dis Primer 2018; 4:17105

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

Fearon K et al. Lancet Oncol 2011; 12:489-495

Trestini I et al. Eur J Clin Nutr 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)»

de van der Schueren MAE et al. Ann Oncol 2018

Shirai Y et al. Sci Rep 2017; 7:4826

Ryan ZC et al. Biochem Biophys Res Commun 2018

Kim J-S et al. Anticancer Agents Med Chem 2013

Eubanks P et al. Am J Surg 2002

• 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