This study analyzed the nutritional status of cancer patients in relation to type and site of origin of the tumor, stage of disease, and previous chemical or radiation therapy. The analysis was performed on 321 patients (280 with cancer and 41 controls). The nutritional parameters included per cent of weight loss, anthropometric indices (arm circumference, triceps skinfold, arm muscle circumference), creatinine-height index, serum protein, albumin, total iron binding capacity and cholinesterase, C3 and C4 components of complement, total peripheral lymphocytes, and skin tests. The statistical comparison between patients with different tumors and controls, between patients with different stages of the same tumor, and between patients treated with or without previous chemical or radiation therapy led to the following conclusions: 1) malnutrition is mainly related to the type and site of origin of the tumor and, in the early stages of disease, is more pronounced in patients with cancer of the esophagus and stomach; 2) except in patients with breast and cervix cancer, malnutrition gets more severe as the disease becomes advanced; 3) chemical or radiation therapy has a variable impact on the nutritional status, but in selected patients it causes a drop in body weight, arm circumference, arm muscle circumference, and peripheral lymphocytes; 4) body weight, cutaneous delayed hypersensitivity and serum albumin are the most commonly altered parameters.

Impact of Cancer, Type, Site, Stage and Treatment on the Nutritional Status of Patients

A review of the literature reveals that unfavourable surgical outcome, including problems with wound infection and dehiscence, sepsis, and longer lengths of stay, correlates well with the determination of perioperative malnutrition as measured by a variety of indices. Increased malnutrition and more severe surgeries are individually predictive of poorer outcome. There is evidence that particular deficiencies of nutrients are likely to cause wound healing problems. Particularly important nutrients include amino acids (notably glycine, proline, and arginine) carbohydrates, fatty acids (especially linoleic and linolenic), vitamins (particularly C and A), minerals and the elements (particularly magnesium, copper, phosphorous and selenium). The postoperative feeding of seemingly large amounts of amino acids is correlated with positive nitrogen balance and shorter hospital stays. The enteral route is preferred unless there is disturbed absorption or other complications. Total parenteral nutrition (TPN) formulations should include all of the essential nutrients, especially trace elements which were formerly overlooked. Introduction With surgery, as with trauma and sepsis, there is an increase in the requirement for calories, amino acids, vitamins, minerals, water and oxygen. This paper reviews the possible relationship between certain nutrients and wound healing, evidence pointing to a connection between perioperative nutritional status and surgical outcome (including wound healing), and information concerning route of administration and prevention of deficiencies of certain nutrients. 1. Princeton Associates for Total Health, 100 102 Tamarack Circle, Skillman, NJ 08558. 2. Columbia University School of Medicine. Nutrients Which May Affect Wound Healing \"Wound healing is a biochemical process and that nutrition itself is really a clinical biochemistry, and an obvious relationship between these two areas exists... Nutrition has to be thought of by all clinicians as the specific nutrient substrates that are being delivered to the specific cells and tissues at a given time. This is where nutrition really occurs, at the cell mem brane and in the cell, and it is only when we realize this and practice surgery with this in the proper context that we will then achieve optimal wound healing to correlate with the technical and other aspects of wound healing in which we engage as surgeons.\" H. Polk Protein and Amino Acid Balance Surgery, trauma and sepsis introduce a protein catabolic state. Wound healing is in part dependent on the ability of the body to provide adequate amounts of amino acids. Animal studies conducted by Harvey and Gibson showed that simultaneous supplementation with glycine, proline and arginine produced an increase of as much as 60-70% in nitrogen retained. This effect may be reversed if glycine alone is used. Arginine, which can be converted to proline, is associated with more rapid wound healing and greater collagen synthesis in animal models and may even inhibit post-trauma weight loss. 6 Furthermore, arginine-deficient rats rapidly lost collagen. Glycine accounts for approximately one-third of all amino acids found in most collagen alpha chains. Glycine and arginine are shown to be necessary for the synthesis of creatinine and for optimal growth in experimental animals. Furthermore, arginine detoxifies ammonia and detoxifies benzoic acid. Glycine may play a part in the repair of muscle fibers. Arginine converts to orni-

Nutrition and wound healing.

The different uses of nutritional assessment are briefly reviewed. The parameters of nutritional assessment should be determined according to the use for which they are intended, such as nutritional epidemiology, preoperative assessment of nutritional risk, or nutritional monitoring during parenteral or enteral feeding. The roles of some nutritional variables that are used to identify and monitor high-risk patients during nutritional repletion are examined. The main questions that confront the clinician are as follows: (1) are the nutritional indicators of surgical risk altered by poor intake of nutrients? (2) can these indicators be normalized with adequate feeding or are they abnormal as a result of the metabolic impact of the disease? (3) are these variables simple indicators of surgical risk or are they directly involved in the host-defense mechanism? The importance is stressed of an integrated assessment of the patient's status when nutritional support is considered. This involves not only the static evaluation of the nutritional support according to standard parameters, but also a prospective and dynamic evaluation of nutrient requirements, length of hospital stay, and the curability of the basic disease.

Nutritional assessment from the perspective of a clinician.

Nutritional assessment is a technique by which malnutrition can be identified. The importance of identifying malnourished patients has greatly increased in the recent past because of our increased ability to alter the nutritional state. Significant malnutrition remains a term which is difficult to define because it implies that nutritional intervention is mandated to improve clinical outcome.

Nutritional assessment of the hospitalized patient.

Current status of nutritional support in Latin America.

Malnutrition in general medical and surgical patients: an anthropometric survey in Niteroi, Brazil.

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Malnutrition in general medical and surgical patients: an anthropometric survey in Niteroi, Brazil.