欧洲肠外肠内营养学会专家组推荐意见：癌症相关营养不良行动建议
前情提要
癌症患者发生营养不良的风险特别高，因为该疾病及其治疗都会威胁到患者的营养状况。然而癌症相关营养风险有时被临床医生、患者及其家属忽视或治疗不足。
最近，欧洲临床营养代谢学会（欧洲肠外肠内营养学会）发布了癌症患者营养诊疗循证指南。为了进一步支持这些指南，欧洲临床营养代谢学会（欧洲肠外肠内营养学会）肿瘤学专家组于2016年10月24、25日在柏林举行了一次癌症与营养研讨会。该专家组分析了癌症相关营养不良的原因和后果，回顾了目前可用的治疗方法，并确立了参与癌症患者诊疗的临床医生采取行动促进营养支持的依据和动力。
2017年6月23日，欧洲临床营养代谢学会（欧洲肠外肠内营养学会）官方期刊《临床营养》在线发表德国弗莱堡大学、慕尼黑大学、不来梅中心医院、柏林伊丽莎白基督新教医院、慕尼黑技术大学、莱比锡圣乔治医院、加拿大阿尔伯塔大学、意大利米兰大学、罗马大学、英国南安普敦大学、索尔福德大学、诺丁汉大学、格拉斯哥大学、美国德克萨斯农工大学、瑞士圣加仑州立医院、荷兰阿姆斯特丹自由大学、汉恩应用科学大学、比利时布鲁塞尔自由大学的欧洲临床营养代谢学会（欧洲肠外肠内营养学会）专家组推荐意见：癌症相关营养不良行动建议。
该推荐意见立场文件的内容基于柏林会议的报告和讨论。专家组强调了更新癌症患者营养诊疗的3个关键步骤：
营养筛查：无论体重指数和体重史如何，在所有癌症患者诊疗过程早期，对营养风险进行筛查；
营养评定：扩大营养相关评定实践，包括厌食、身体组成、炎性生物标志、静息能量消耗、身体功能的衡量；
营养干预：使用经过个体化规划的多种方式营养干预，其中包括注意增加营养摄入量、减轻炎症和高代谢应激、增加体力活动。
Clin Nutr. 2017 Jun 23. [Epub ahead of print]
ESPEN expert group recommendations for action against cancer-related malnutrition.
Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, Erickson N, Laviano A, Lisanti M, Lobo DN, McMillan D, Muscaritoli M, Ockenga J, Pirlich M, Strasser F, de van der Schueren M, Van Gossum A, Vaupel P, Weimann A.
University of Freiburg, Freiburg, Germany; University of Alberta, Edmonton, Canada; University of Milan, Milan, Italy; University of Southampton, Southampton, UK; Texas A&M University, College Station, TX, USA; Ludwig-Maximilian-University Hospital, Munich, Germany; Sapienza University, Rome, Italy; University of Salford, Salford, UK; University of Nottingham, Nottingham, UK; University of Glasgow, Glasgow, UK; Klinikum Bremen Mitte, Bremen, Germany; Elisabeth Protestant Hospital, Berlin, Germany; Cantonal Hospital St Gallen, St Gallen, Switzerland; VU University Medical Center, Amsterdam, Netherlands; HAN University of Applied Sciences, Nijmegen, the Netherlands; Hospital Erasme, Brussels, Belgium; Technical University, Munich, Germany; Hospital St Georg, Leipzig, Germany.
Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity.
KEYWORDS: Cancer; malnutrition; sarcopenia; cachexia; anorexia; nutritional intervention
PII: S0261-5614(17)30228-5
DOI: 10.1016/j.clnu.2017.06.017
