General Nutrition and Dietary treatment
            Nation-wide guideline, Version: 2.0
                                      Date of approval: 01-06-2012
                                      Method: Consensus based
                                      Justification: Dutch Dieticians Oncology
                                      Group
                              Table of contents
          Introduction...................................................................................................................................................1
          Prevention......................................................................................................................................................3
              Overweight and body fat percentage.................................................................................................3
              Physical activity..................................................................................................................................3
              Sugary drinks and high-calorie food...................................................................................................4
              Plant foods.........................................................................................................................................4
              Red and processed meats.................................................................................................................4
              Alcohol................................................................................................................................................5
              Salt.....................................................................................................................................................5
              Dietary supplements...........................................................................................................................5
          Nutritional status...........................................................................................................................................6
              Nutritional status.................................................................................................................................6
              Malnutrition/ Cachexia........................................................................................................................6
                Causes.........................................................................................................................................7
                Insufficient intake of nutrition.......................................................................................................7
                Inflammation and metabolic dysregulation...................................................................................8
                Anorexia-cachexia syndrome.......................................................................................................9
              Sarcopenia/sarcopenic obesity..........................................................................................................9
              Tumour growth.................................................................................................................................10
          Screening and assessment........................................................................................................................12
              Screening.........................................................................................................................................12
              Nutritional assessment.....................................................................................................................13
              Considerations.................................................................................................................................14
              Dietary diagnosis..............................................................................................................................14
          Nutritional requirements.............................................................................................................................16
              Energy..............................................................................................................................................16
                Resting energy expenditure.......................................................................................................16
                Activity........................................................................................................................................17
              Protein..............................................................................................................................................17
              Fat and carbohydrates.....................................................................................................................18
              Dietary fibre......................................................................................................................................18
              Vitamins, minerals and antioxidants.................................................................................................18
                Vitamins.....................................................................................................................................19
                Vitamin A....................................................................................................................................19
                Beta-carotene............................................................................................................................19
                Vitamin B1..................................................................................................................................19
                Vitamin B6..................................................................................................................................20
                Folic acid....................................................................................................................................20
                Vitamin B12................................................................................................................................20
                Vitamin C...................................................................................................................................20
                Vitamin D...................................................................................................................................21
                Vitamin E....................................................................................................................................21
                Minerals.....................................................................................................................................21
                Calcium......................................................................................................................................22
                Magnesium................................................................................................................................22
                Zinc............................................................................................................................................22
                Selenium....................................................................................................................................22
                Antioxidants...............................................................................................................................23
                Combinations.............................................................................................................................23
                Recommendations.....................................................................................................................23
              Fluid intake.......................................................................................................................................24
              Disease specific formulas.................................................................................................................24
                EPA-enriched formulas..............................................................................................................24
                Immunonutrition.........................................................................................................................24
              Health products and ‘alternative’ diets...........................................................................................25
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                              Table of contents
          Nutritional interventions.............................................................................................................................27
              Dietary features................................................................................................................................27
                Healthy eating............................................................................................................................27
                Adequate diet.............................................................................................................................28
                Protein-energy enriched diet......................................................................................................28
                Protein enriched diet..................................................................................................................29
                Palliative nutritional support.......................................................................................................29
                Nutritional counselling and physical activity...............................................................................30
              Treatment.........................................................................................................................................30
                Malnutrition................................................................................................................................30
                Sarcopenia/sarcopenic obesity..................................................................................................31
                Patient queries...........................................................................................................................32
                Perioperative nutritional support................................................................................................32
          Symptoms and advice................................................................................................................................34
              Weight loss.......................................................................................................................................34
              Anorexia and early satiety................................................................................................................35
              Alterations in taste and smell...........................................................................................................36
              Nausea and vomiting........................................................................................................................38
              Dry mouth (xerostomia)....................................................................................................................39
              Difficulties in chewing and swallowing..............................................................................................40
              Mucositis..........................................................................................................................................41
                Oral mucositis............................................................................................................................41
                Intestinal mucositis.....................................................................................................................43
              Excess mucus..................................................................................................................................43
              Obstructive symptoms......................................................................................................................44
                Dysphagia..................................................................................................................................44
                Intestinal obstructions................................................................................................................45
              Endoscopic stenting.........................................................................................................................46
              Gastro-oesophageal reflux...............................................................................................................47
              Constipation.....................................................................................................................................47
              Diarrhoea..........................................................................................................................................49
              Weight gain/overweight....................................................................................................................49
              Fatigue and muscle weakness.........................................................................................................50
              Immunocompromised patients.........................................................................................................51
          Clinical nutrition..........................................................................................................................................54
              Clinical nutrition................................................................................................................................54
              Refeeding syndrome........................................................................................................................55
              Food fortification...............................................................................................................................57
              Oral nutritional supplements.............................................................................................................57
              Tube feeding....................................................................................................................................57
                Enteral formulas.........................................................................................................................58
                Tubes and access......................................................................................................................58
                Administration and advancement...............................................................................................59
                Evaluation..................................................................................................................................60
                Complications............................................................................................................................60
                Transition to oral nutrition..........................................................................................................64
              Parenteral nutrition...........................................................................................................................64
                Composition...............................................................................................................................64
                Access.......................................................................................................................................66
                Medication..................................................................................................................................68
                Evaluation..................................................................................................................................68
                Complications............................................................................................................................69
                At home......................................................................................................................................70
                Stopping.....................................................................................................................................70
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                              Table of contents
          Nutrition Care Process...............................................................................................................................71
              Nutrition Care Process.....................................................................................................................71
              Tasks and responsibilities................................................................................................................71
          Elderly patients............................................................................................................................................73
              Elderly patients.................................................................................................................................73
              Frailty................................................................................................................................................73
              Malnutrition.......................................................................................................................................74
                Functional domain......................................................................................................................74
                Psychological domain................................................................................................................74
                Social domain............................................................................................................................75
                Physical domain.........................................................................................................................75
              Nutritional care process....................................................................................................................76
                Screening...................................................................................................................................76
                Dietary requirements..................................................................................................................76
                Nutritional intervention...............................................................................................................77
          Comorbidity.................................................................................................................................................80
              Comorbidity......................................................................................................................................80
              Cardiovascular disease....................................................................................................................80
                Background and treatment.........................................................................................................80
                Nutritional status........................................................................................................................81
                Clinical nutrition..........................................................................................................................82
              Diabetes...........................................................................................................................................82
                Background and treatment.........................................................................................................83
                Nutritional status........................................................................................................................83
                Corticosteroids...........................................................................................................................84
                Clinical nutrition..........................................................................................................................85
                Nausea and vomiting.................................................................................................................86
                Hyperglycaemia following surgery.............................................................................................86
          Aftercare.......................................................................................................................................................87
              Aftercare...........................................................................................................................................87
                Malnutrition................................................................................................................................88
                Overweight.................................................................................................................................88
                Health promotion........................................................................................................................88
              Cancer rehabilitation........................................................................................................................89
              Diet and exercise..............................................................................................................................89
          Palliative care..............................................................................................................................................91
              Palliative care...................................................................................................................................91
              Nutrition............................................................................................................................................92
                Weight loss and anorexia...........................................................................................................92
                Clinical nutrition..........................................................................................................................94
                Intestinal obstruction and ileus...................................................................................................95
                Ascites.......................................................................................................................................95
                Dehydration................................................................................................................................96
                Stopping.....................................................................................................................................96
          Communication...........................................................................................................................................98
              Conversations with the patient.........................................................................................................98
              Delivering bad news.........................................................................................................................99
              Behavioural changes........................................................................................................................99
          References.................................................................................................................................................101
          Appendices................................................................................................................................................111
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