Tags

Type your tag names separated by a space and hit enter

Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials.
Ann Oncol 2018; 29(5):1141-1153AO

Abstract

Background

Driven by reduced nutritional intakes and metabolic alterations, malnutrition in cancer patients adversely affects quality of life, treatment tolerance and survival. We examined evidence for oral nutritional interventions during chemo(radio)therapy.

Design

We carried out a systematic review of randomized controlled trials (RCT) with either dietary counseling (DC), high-energy oral nutritional supplements (ONS) aiming at improving intakes or ONS enriched with protein and n-3 polyunsaturated fatty acids (PUFA) additionally aiming for modulation of cancer-related metabolic alterations. Meta-analyses were carried out on body weight (BW) response to nutritional interventions, with subgroup analyses for DC and/or high-energy ONS or high-protein n-3 PUFA-enriched ONS.

Results

Eleven studies were identified. Meta-analysis showed overall benefit of interventions on BW during chemo(radio)therapy (+1.31 kg, 95% CI 0.24-2.38, P = 0.02, heterogeneity Q = 21.1, P = 0.007). Subgroup analysis showed no effect of DC and/or high-energy ONS (+0.80 kg, 95% CI -1.14 to 2.74, P = 0.32; Q = 10.5, P = 0.03), possibly due to limited compliance and intakes falling short of intake goals. A significant effect was observed for high-protein n-3 PUFA-enriched intervention compared with isocaloric controls (+1.89 kg, 95% CI 0.51-3.27, P = 0.02; Q = 3.1 P = 0.37). High-protein, n-3 PUFA-enriched ONS studies showed attenuation of lean body mass loss (N = 2 studies) and improvement of some quality of life domains (N = 3 studies). Overall, studies were limited in number, heterogeneous, and inadequately powered to show effects on treatment toxicity or survival.

Conclusion

This systematic review suggests an overall positive effect of nutritional interventions during chemo(radio)therapy on BW. Subgroup analyses showed effects were driven by high-protein n-3 PUFA-enriched ONS, suggesting the benefit of targeting metabolic alterations. DC and/or high-energy ONS were less effective, likely due to cumulative caloric deficits despite interventions. We highlight the need and provide recommendations for well-designed RCT to determine the effect of nutritional interventions on clinical outcomes, with specific focus on reaching nutritional goals and providing the right nutrients, as part of an integral supportive care approach.

Authors+Show Affiliations

Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam. Department of Nutrition and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.Department of Clinical Medicine, Sapienza University, Rome, Italy.Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

29788170

Citation

de van der Schueren, M A E., et al. "Systematic Review and Meta-analysis of the Evidence for Oral Nutritional Intervention On Nutritional and Clinical Outcomes During Chemo(radio)therapy: Current Evidence and Guidance for Design of Future Trials." Annals of Oncology : Official Journal of the European Society for Medical Oncology, vol. 29, no. 5, 2018, pp. 1141-1153.
de van der Schueren MAE, Laviano A, Blanchard H, et al. Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Ann Oncol. 2018;29(5):1141-1153.
de van der Schueren, M. A. E., Laviano, A., Blanchard, H., Jourdan, M., Arends, J., & Baracos, V. E. (2018). Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Annals of Oncology : Official Journal of the European Society for Medical Oncology, 29(5), pp. 1141-1153. doi:10.1093/annonc/mdy114.
de van der Schueren MAE, et al. Systematic Review and Meta-analysis of the Evidence for Oral Nutritional Intervention On Nutritional and Clinical Outcomes During Chemo(radio)therapy: Current Evidence and Guidance for Design of Future Trials. Ann Oncol. 2018 05 1;29(5):1141-1153. PubMed PMID: 29788170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. AU - de van der Schueren,M A E, AU - Laviano,A, AU - Blanchard,H, AU - Jourdan,M, AU - Arends,J, AU - Baracos,V E, PY - 2018/5/23/entrez PY - 2018/5/23/pubmed PY - 2019/10/29/medline SP - 1141 EP - 1153 JF - Annals of oncology : official journal of the European Society for Medical Oncology JO - Ann. Oncol. VL - 29 IS - 5 N2 - Background: Driven by reduced nutritional intakes and metabolic alterations, malnutrition in cancer patients adversely affects quality of life, treatment tolerance and survival. We examined evidence for oral nutritional interventions during chemo(radio)therapy. Design: We carried out a systematic review of randomized controlled trials (RCT) with either dietary counseling (DC), high-energy oral nutritional supplements (ONS) aiming at improving intakes or ONS enriched with protein and n-3 polyunsaturated fatty acids (PUFA) additionally aiming for modulation of cancer-related metabolic alterations. Meta-analyses were carried out on body weight (BW) response to nutritional interventions, with subgroup analyses for DC and/or high-energy ONS or high-protein n-3 PUFA-enriched ONS. Results: Eleven studies were identified. Meta-analysis showed overall benefit of interventions on BW during chemo(radio)therapy (+1.31 kg, 95% CI 0.24-2.38, P = 0.02, heterogeneity Q = 21.1, P = 0.007). Subgroup analysis showed no effect of DC and/or high-energy ONS (+0.80 kg, 95% CI -1.14 to 2.74, P = 0.32; Q = 10.5, P = 0.03), possibly due to limited compliance and intakes falling short of intake goals. A significant effect was observed for high-protein n-3 PUFA-enriched intervention compared with isocaloric controls (+1.89 kg, 95% CI 0.51-3.27, P = 0.02; Q = 3.1 P = 0.37). High-protein, n-3 PUFA-enriched ONS studies showed attenuation of lean body mass loss (N = 2 studies) and improvement of some quality of life domains (N = 3 studies). Overall, studies were limited in number, heterogeneous, and inadequately powered to show effects on treatment toxicity or survival. Conclusion: This systematic review suggests an overall positive effect of nutritional interventions during chemo(radio)therapy on BW. Subgroup analyses showed effects were driven by high-protein n-3 PUFA-enriched ONS, suggesting the benefit of targeting metabolic alterations. DC and/or high-energy ONS were less effective, likely due to cumulative caloric deficits despite interventions. We highlight the need and provide recommendations for well-designed RCT to determine the effect of nutritional interventions on clinical outcomes, with specific focus on reaching nutritional goals and providing the right nutrients, as part of an integral supportive care approach. SN - 1569-8041 UR - https://www.unboundmedicine.com/medline/citation/29788170/Systematic_review_and_meta_analysis_of_the_evidence_for_oral_nutritional_intervention_on_nutritional_and_clinical_outcomes_during_chemo_radio_therapy:_current_evidence_and_guidance_for_design_of_future_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0923-7534(19)34566-1 DB - PRIME DP - Unbound Medicine ER -