Malnutrition & altered body composition in oncology: prevalence, aetiology, consequences & potential therapies

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Sullivan, Erin S.
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University College Cork
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Malnutrition is common across all cancer sites and stages and its aetiology is multifactorial and complex. It is associated with poorer quality of life, increased morbidity and mortality and is often considered an inevitable consequence of cancer and its treatments. However, we lack efficacious treatments for cancer-related malnutrition. The aim of this thesis was to describe the epidemiology of malnutrition in cancer, examine the causes and consequences of the condition and explore potential treatment strategies. This thesis begins by estimating that across Ireland and the UK, 34% of cancer patients (128,892) are affected by clinically significant weight loss annually and there are 133,707 annual cases of cancer-related sarcopenia (35% patients affected). This thesis shows using computed tomography scans (the gold standard in body composition analysis) that abnormalities of body composition, including loss of fat without loss of muscle, are predictive of poor survival in advanced cancer. Furthermore, cachexia (a syndrome of disease-related appetite loss and wasting) was shown to be more prevalent in those with inflammation and poor performance status and the obesity paradox in colorectal cancer was confirmed (obesity is a risk factor for the disease, but is associated with improved survival). The nutritional experience of patients with cancer is described, namely that nutrition is a high priority for patients, who experience many dietary issues throughout their journey, but that information available to patients is lacking and referral to dietitians is very inconsistent. Finally, a placebo controlled trial of 2 novel dairy-derived, ghrelinergic peptides showed that one of the peptides investigated increased protein intake in healthy males by 23 g per day. Prompt identification of patients with cancer-related malnutrition must be optimised and development of an effective, evidence-based treatment strategy is of the utmost importance as it stands to improve longevity and quality of life for cancer survivors.
Malnutrition , Cancer , Cachexia , Sarcopenia , Nutrition , Dietetics , Appetite , Clinical trial , Epidemiology , Radiology , Oncology
Sullivan, E. S. 2020. Malnutrition & altered body composition in oncology: prevalence, aetiology, consequences & potential therapies. PhD Thesis, University College Cork.
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