The role of diet, nutritional assessment and nutritional intervention in the prevention of cancer and the treatment of cancer-related malnutrition

Nutrition plays a fundamental role in both the prevention and the treatment of cancer. The aim of this thesis was to describe the prevalence of malnutrition in the Irish oncology setting using gold standard methods of body composition analysis and to explore the identification and treatment of cancer-related malnutrition, as well as the role of nutrition in cancer prevention. Malnutrition was found to be highly prevalent in a cohort of oesophageal cancer patients undergoing minimally invasive oesophagectomy (MIO) (n=47). The procedure was associated with significant nutritional decline; however the implementation of an enhanced recovery after surgery protocol incorporating intensive peri-operative feeding appeared to yield significant clinical benefits, including shorter length of hospital stay, early cessation of muscle loss and restoration of quality of life in the early post-operative period. Malnutrition was also found to be prevalent in a cohort of Irish ambulatory oncology patients receiving chemotherapy (n=725), with excessive adiposity appearing to mask the muscle wasting and under-nutrition that was present. Malnutrition screening tools did not accurately detect the cohort of nutritionally vulnerable or malnourished patients that were captured by computed tomography analysis of body composition; however the Nutritional Risk Index screening tool demonstrated potential as it had a high sensitivity for abnormal body composition phenotypes and the ability to capture patients at risk of reduced survival. Following identification of malnutrition, it is essential that a targeted, multimodal nutritional intervention is implemented. No resource existed previously, that provided patients with understandable and reliable nutritional information to help attenuate the effects of cancer-induced weight loss. A 130-page, evidence-based resource containing 52 high-protein, high-calorie recipes was created to address this deficit, with 19 000 copies of this resource published and disseminated to over 75 sites nationally. The creation of an evidence-based resource focusing on the role of nutrition in the prevention of cancer was also commenced. The research undertaken in this thesis fulfilled a previously unmet need to quantify the level of malnutrition in the Irish oncology setting and to develop evidence-based practical resource to address cancer-related malnutrition and maximise on the potential preventability of cancer through dietary and lifestyle changes