Role of micronutrients in cancer patients

Malnutrition, the result of a poor nutritional status, has a well-documented negative effect on treatment outcome in cancer patients. The malnutrition of many cancer patients is not limited to macronutrients, but the supply of various vitamins and minerals is also often inadequate. In all forms of malnutrition there is a risk of micronutrient deficiency, especially, but not limited to, water soluble vitamins. Therefore, in cancer patients, adequate nutritional intervention is needed.

Recent studies have shown that the use of micronutrients can improve appetite, increase the tolerance and response to the oncology treatment, reduce or prevent the side effects of the therapy, and improve quality of life.

Malnutrition, primarily characterized by a rapid weight loss, is a typical finding in patients suffering from cancer. Numerous factors are involved in development of malnutrition and micronutrient deficiencies. In addition to the immediate consumptive effect of the tumor, the most important include anorexia (e.g. lack of appetite, premature satiation, food aversions, taste disorders), side effects of cancer therapy (e.g. nausea, vomiting), hormone and metabolic disorders. Nutritional deficiencies weaken the immune status, reduce tolerance to treatment and interfere with several organic and metabolic functions.

Even at the time of diagnosis and before there are clinically-relevant changes in the nutritional status, but certainly after the start of treatment, the supply of various vitamins (e.g., vitamin D, vitamin C, and B-group vitamins) and trace elements (e.g., selenium, zinc) is worse in patients with cancer than in healthy people.

According to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on enteral nutrition, it can be assumed that all patients with cancer who consume less than 60% of their daily energy requirements for more than 7–10 days have an inadequate supply of micronutrients. This especially applies if, under chemo and radiation therapy, they rapidly lose micronutrients due to vomiting and diarrhea. Chemotherapy- and radiation-induced damage of the mucous membranes (e.g. radiation colitis and diarrhea) adversely affects micronutrient absorption (e.g. folic acid, vitamin B12) and can cause major loss of micronutrients. In addition to chemotherapy and radiotherapy, surgical procedures on the gastrointestinal tract can also trigger malfunctions of absorption and utilization of micronutrients.

Micronutrients exert anti-cancer action by the following underlying molecular mechanisms: antioxidant effects, apoptosis targeting, anti-proliferative mechanisms, and anti-angiogenic effects.

In view of the restricted dietary pattern of tumor patients, the use of a multivitamin-multimineral supplement in physiological doses, i.e. nutrient amounts that approximately equal the recommended daily allowance, is a useful and safe measure. This also applies to cancer patients during chemo- and radiation therapy.

The importance of antioxidant micronutrients as an adjunct to nutritional therapy is substantiated by results from several studies which have shown that consuming multivitamin and mineral preparations can enhance both the quality of life and the prognosis for cancer patients.

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