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Dietary patterns in patients with advanced cancer: implications for anorexia-cachexia therapy^1,2,3,4

¹ From the Departments of Agricultural, Food & Nutritional Science (JLH, LM, CJF, and WVW) and of Oncology (SMW and VEB), University of Alberta, Edmonton, Canada, and the MD Anderson Cancer Center, Houston, TX (EDB)

Background: Severe malnutrition and wasting are considered hallmarks of advanced malignant disease, and clinical research into anorexia-cachexia therapy and nutritional support for cancer patients is ongoing. However, information on typical dietary intakes and food choices for this population is notably lacking; proposed therapies for anorexia and wasting are not framed within the context of current intake.

Objective: The objective of the study was to characterize the food intake patterns of patients with advanced cancer.

Design: Patients with advanced cancer (n = 151) recruited from a regional cancer center and palliative-care program completed a 3-d dietary record a mean (±SD) 8 ± 7 mo before death. Food items were categorized according to macronutrient content and dietary use and subsequently entered into cluster analysis.

Results: Wide variations in intakes of energy (range: 4–53 kcal · kg body wt^–1 · d^–1; ± SD: 25.1 ± 10.0 kcal · kg body wt^–1 · d^–1) and protein (range: 0.2–2.7 g · kg body wt^–1 · d^–1; ± SD: 1.0 ± 0.4 g · kg body wt^–1 · d^–1) were observed. Even the subjects with the highest intakes had a recent history of weight loss, which suggests that the diets of those persons were consistently inadequate for weight maintenance. Cluster analysis found 3 dietary patterns that differed in food choice and caloric intake. Low intakes and a high risk of weight loss were associated with decreased frequency of eating and dietary profiles with little variety and unusually high proportions of liquids.

Conclusion: These data provide a glimpse into dietary habits toward the end of life. Unique dietary patterns were found in this nutritionally vulnerable patient population.

Key Words: Malnutrition • advanced cancer • dietary assessment • dietary patterns • cachexia • cluster analysis

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