Cancer and its treatments can impact nutrition in several ways. Common issues include decreased appetite, nausea, taste changes, and digestive issues like diarrhea or constipation. Appropriate diet interventions include small, frequent meals and calorie-dense supplements to address appetite and weight loss. Soft, bland foods are recommended for mouth pain while high-fiber foods may help constipation and low-residue foods can relieve diarrhea. Nutrition therapy should meet calorie and protein needs based on weight and activity level. Maintaining proper hydration and micronutrient intake through diet and supplements also supports health during cancer.

1. Appropriate Diet Interventions
During Cancer
Department of Food Science and Nutrition
Hajee Mohammad Danesh Science and Technology University
Dinajpur-5200, Bangladesh

2. Cancer
 Cancer is a group of diseases involving abnormal cell growth with the
potential to spread to other parts of the body. These contrast with tumors.
 Possible signs and symptoms include a lump, sore, abnormal bleeding,
prolonged cough, unexplained weight loss and a change in bowel movements.
 Over 100 types of cancers affect humans.
 Common environmental factors that contribute to cancer death include
 Tobacco (25–30%),
 Diet and obesity (30–35%),
 Infections (15–20%),
 Radiation (both ionizing and non-ionizing, up to 10%),
 Stress, lack of physical activity and pollution (up to 10%).

3. Body’s response to Cancer
 The specific type of cancer, and the disease process itself, has profound
effects on the entire body system and cause primary nutritional deficiencies.
 Cancers occurring in the gastrointestinal tract or adjacent tissue cause
difficulty in ingestion and use of nutrients.
 Cancer of the bone, or breast cancer with metastasis to the bone, also lead
to hypokalemia.
 Cancer within the thyroid gland will result in hormonal imbalances.
 Pancreatic cancer and resulting pancreatectomy lead to the loss of
digestive enzymes and diabetes mellitus.
 Vomiting and diarrhea result in loss of water-soluble vitamins.

4. Body’s response to Cancer
 Abdominal tumors may cause fistulas to develop, leading to bypass of the
small intestine and consequent malabsorption. General malabsorption also
contributes to fluid and electrolyte imbalance.
 Malabsorption interferes with digestion of fats and fat-soluble vitamins,
especially vitamin D, which in turn leads to decreased metabolism and
absorption of calcium, causing osteomalacia.
 Increased hemolysis, fistulas, and malabsorption of nutrients needed for
hemoglobin formation (iron, protein, vit-B, and vit-C) lead to severe anemia.
 Anorexia, the most common symptom, is related to altered metabolism,
type of treatment, or emotional distress.

5. Body’s response to Medical Therapy
Current cancer therapy takes three major forms:
1) Chemical Therapy or Chemotherapy,
2) Radiation Therapy or Radiotherapy,
3) Surgical Therapy or Surgery.
Treatment 1: Chemotherapy
 Interference with production of both white blood cells and red blood cells.
 Nausea, vomiting, stomatitis, anorexia, ulcers, and diarrhea; response of the GI
system similar to those that occur in radiotherapy.
 Body fluid and electrolyte disturbances.
 Hair follicle loss.

6. Body’s response to Medical Therapy
Treatment 2: Radiotherapy
 Anorexia and nausea.
 Reduced food intake.
 Difficulty swallowing.
 Tooth decay and gum disease.
 Sensitivity to texture and temperature of food.
 Decreased salivary secretions, impaired taste acuity and taste sensations.
 Inflamed oral mucosa and inflammation in abdomen.
 Loss of intestinal villi and absorbing surfaces.
 Vascular changes, abdominal obstructions, strictures and fistulas.
 Malabsorption and Diarrhea.

7. Body’s response to Medical Therapy
Treatment 3: Surgery
 Impaired food ingestion.
 Malabsorption.
 Potential dumping syndrome.
 Possible low blood glucose following gastric resection.
 Insulin deficiency from resection of the pancreas (diabetes mellitus).
 Fluid and electrolyte imbalances.
 Head and neck surgery or resection poses special feeding problems: different
feeding methods (enteral or parenteral) and feeding intervals, and modifications in
oral food preparation.

8. World Cancer Research Fund/American Institute of Cancer Research
recommendations on cancer prevention.
Recommendation 1: Body Fatness
 Avoid weight gain and increases in waist circumference throughout adulthood
Recommendation 2: Physical Activity
 As fitness improves, increase to 60 minutes or more of moderate or to 30
minutes or more of vigorous physical activity/day.
Recommendation 3: Foods and drinks that promote weight gain
 Limit consumption of energy-dense foods (energy content >225-275 kcal/100 g).
 Average energy density of diets should be lowered towards 125 kcal/100 g.
 Avoid sugary drinks (mostly those with added sugars; however, fruit juices should
be also limited).

9. World Cancer Research Fund/American Institute of Cancer Research
recommendations on cancer prevention.
Recommendation 4: Plant foods
 Individuals should consume at least five portions/servings (i.e. 400 g) of a variety
of non-starchy vegetables and fruits per day.
 Eat relatively unprocessed cereals (grains) and/or pulses (legumes) with every
meal. Limit refined cereals.
Recommendation 5: Animal foods
 Limit intake of red meat (beef, pork, lamb and goat) and avoid processed meat
(preserved by smoking, curing or salting or addition of chemical preservatives).
 Goal for the individual is consumption of less than 500 g per week of red
meat and very little if any to be processed.

10. World Cancer Research Fund/American Institute of Cancer Research
recommendations on cancer prevention.
Recommendation 6: Alcoholic drinks
 Limit alcoholic drinks consumption to no more than two drinks/day for men and
one drink a day for women (one drink = 10 to 15 g of ethanol).
 Children and pregnant women should not consume alcoholic drinks.
Recommendation 7: Preservation, Processing and Preparation
 On an individual basis salt consumption should be limited to less than 6 g (2.4 g
of sodium) per day.
 Avoid mouldy cereals or pulses to avoid aflatoxin contamination risk. Use
methods of preservation that do not use salt include refrigeration, freezing, drying,
bottling, canning and fermentation.

11. World Cancer Research Fund/American Institute of Cancer Research
recommendations on cancer prevention.
Recommendation 8: Dietary supplements
 Aim to meet nutritional needs through diet alone. In some cases of illness or
dietary inadequacy, supplements may be valuable. Dietary supplements are not
recommended for cancer prevention.
Special recommendation 1: Breastfeeding
 Mothers to breastfeed; children to be breastfed.
 Aim to breastfeed infants exclusively up to six months and continue with
complementary feeding thereafter.
Special recommendation 2: Cancer Survivors
 These recommendations are also applied for the Cancer Survivors.

12. General Guidelines for Nutrition Therapy
Alterations
Pain, anorexia, decreased appetite
Appropriate Interventions
 Calorie-dense supplements that provide 100% of all required nutrients.
 Small, frequent high-caloric, high-protein meals with snacks between meals and
at bedtime.
 Milkshakes and custards are good snack foods. Avoid milk products if lactose
deficiency or diarrhea is present.
 Increase foods with high liquid content, such as sauces, gravy, or broth if dry
mouth is a problem.
 Use appetite stimulants or pain medications as needed.

13. General Guidelines for Nutrition Therapy
Alterations
Nausea, vomiting
Appropriate Interventions
 Clear, cold and carbonated beverages with added polycose; sipping beverage
slowly with a straw.
 Offer foods cold or room temperature and soft, salty foods as tolerated.
 No greasy, spicy, or rich foods.
 Separate intake of liquids from solids by at least 30 to 60 minutes.
 Offer crackers or dry toast before arising.
 Offer high-protein, high-calorie milkshake supplements.
 Use antinausea medications or antiemetics before meals.

14. General Guidelines for Nutrition Therapy
Alterations
Diminished taste, unpleasant taste in mouth, food aversions
Appropriate Interventions
 Increase taste sensations: add spices, flavorings such as herbs, lemon and sugar.
 Fluids with meals and throughout the day. Eliminate any unpleasant odors.
 Remove adverse foods and substitute foods of equal nutrient value.
 Plastic eating utensils may be substituted if client has a metallic taste in mouth.
 Use temperature extremes (hot/cold) to stimulate taste buds.
 Frequent rinsing of mouth, brushing helps.
 Foods served in attractive environment.
 Zinc deficiencies sometimes present; supplement may be necessary.

15. General Guidelines for Nutrition Therapy
Alterations
Stomatitis, esophagitis, sore mouth
Appropriate Interventions
 Offer frequent small meals and snacks with soft texture, bland, cool to cold.
 Avoid acidic foods and juices, very hot or very cold foods, and spices.
 Avoid hard or irritating foods.
 Use chilled foods and fluids, cooled oral supplements.
 Brush with a soft toothbrush 2 to 3 times daily.
 Use topical analgesics before meals to decrease pain.
 Sprays, mouthwash, baking soda, or salt rinses used to patient tolerance.

16. General Guidelines for Nutrition Therapy
Alterations
Dysphagia
Appropriate Interventions
 Offer small, frequent, high-protein, high-calorie meals, supplemented with
calorie-dense high-protein puddings.
 Modify consistency as liquids may be difficult to swallow; soft foods are better
tolerated. Liquids can be thickened to semisolid consistency.
 Wait one or two minutes between bites.
 Cool foods are better tolerated.
 Avoid spicy, acidic, or irritating foods.

17. General Guidelines for Nutrition Therapy
Alterations
Diarrhea, malabsorption
Appropriate Interventions
 Provide a low-residue diet and supplements.
 Offer small frequent feedings at room temperature.
 Provide foods high in soluble fiber (applesauce, oatmeal, cream of wheat etc.).
 Avoid gas-forming, fatty, or high-lactose foods; citrus fruits; alcohol; caffeine and
caffeine-containing beverages.
 Provide foods high in sodium and potassium (bananas, potatoes etc.).
 Use soy supplement formulas and multivitamin supplements.
 Administer antidiarrheal medications and 8 c fluid if tolerated.

18. General Guidelines for Nutrition Therapy
Alterations
Constipation
Appropriate Interventions
 Offer high-fiber foods, including fresh fruits and vegetables.
 Offer extra fluids.
 Provide stool softeners when needed.
Alterations
Fever
Appropriate Interventions
 Increase fluid volume.
 Use refrigerated foods.

19. Energy Requirements for Cancer Patients
Cancer does not have a consistent effect on resting energy expenditure (REE).
 REE for Male: (10 x Weight + 6.25 x Height + 5 x Age – 5) x 1.5 Kcal/day
 REE for Female: (10 x Weight + 6.25 x Height – 5 x Age – 161) x 1.6 Kcal/day
If REE cannot be measured in individual cases then assumption of total
energy expenditure (TEE) calculated from equations is acceptable.
 Ambulant patients: 30–35 kcal/kg body weight/day
 Bedridden patients: 20–25 kcal/kg body weight/day
With regard to protein needs, the optimal nitrogen supply for cancer patients
cannot be easily determined.
 Recommendations range of protein supply: 1.2–2 g/kg body weight/day.

20. References
Meropi Kontogianni. 2010. “Neoplastic Diseases”. Clinical Nutrition in
Practice, Blackwell Publishing Ltd, UK. ISBN 978-1-4051-8084-9 . Chapter
13, pp 163-170
Peggy S. Stanfield and Y. H. Hui. 2010. “Nutrition and Diet Therapy for
Cancer Patients and Patients with HIV Infection”. Nutrition and diet therapy
: self-instructional approaches. Jones and Bartlett Publishers, Canada. ISBN-
13: 978-0-7637-6137-0. Chapter 21, pp 319-333
The Author
A. B. M. Said Bin Saifullah
https://www.linkedin.com/in/sbsriyad/