23

Nutrition,
Cancer, and
HIV Infection

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 Cancer

• Growth of malignant tissue

• Second most common cause of death in
the United States
• Different types of cancers vary based
on:
– Characteristics
– Locations in the body
– Disease course
– Required treatments
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 Cancer (cont’d.)

Type of cancer Origination (tissues or cells)

Adenocarcinomas glandular tissues
Carcinomas epithelial tissues
Leukemias white blood cell precursors
Lymphomas lymphoid tissue
Melanomas pigmented skin cells
Myelomas plasma cells in the bone marrow
Sarcomas connective tissues

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 Cancer (cont’d.)

• How cancer develops: carcinogenesis

– Often proceeds slowly
– Continues for several decades
– Genetic mutations alter gene expression in a
single cell
• Alterations promote cellular growth, interfere with
growth restraint, or prevent cellular death
• Affected cells unable to halt cell division; produce
daughter cells with the same genetic defects

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 Cancer (cont’d.)

• How cancer develops

– Tumors: abnormal mass of cells
• Disrupts surrounding tissue function
• Metastasize: spread to other body regions
– Various reasons for cancer development
• Inherited genetic defects
• Metabolic processes
• Interactions between genes and environment
• Carcinogens

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 Cancer Development

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 Cancer Development (cont’d.)

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 Cancer: Nutrition and Cancer Risk

• How cancer develops

– Environmental factors can increase cancer
risk (Table 23-1)
• Nutrition and cancer risk
– Nutrition can influence cancer risk
(Table 23-2)
– Food components, energy balance, and
growth rate involved

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 Cancer: Nutrition and Cancer Risk
(cont’d.)
• Nutrition and increased cancer risk
– Obesity is a risk factor for a number of
different cancers
– Alcohol correlates strongly with cancers of the
head/neck, liver, colon, rectum, and breast
• Head/neck cancer risk increased with smoking
– Food preparation can produce carcinogens
• Frying or boiling meat, poultry, and fish
• Grilling meat and fish

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 Cancer: Nutrition and Cancer Risk
(cont’d.)
• Nutrition and decreased cancer risk
– Fruits and vegetables may reduce risk of
some cancers
• Nutrients and phytochemicals with antioxidant
activity
• Other phytochemical activities in the body
• Folate plays roles in DNA synthesis and
repair
• Dietary fiber may protect against colon and rectal
cancers

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 Cancer: Nutrition and Cancer Risk
(cont’d.)
• Nutrition and decreased cancer risk:
guidelines for risk reduction
– Achieve and maintain a healthy body
weight
– Be physically active as part of
everyday life
– Choose a healthy diet that emphasizes plant
sources
• Limit consumption of energy-dense foods and
sugary drinks
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 Cancer: Nutrition and Cancer Risk
(cont’d.)
• Nutrition and decreased cancer risk:
guidelines for risk reduction
– Limit consumption of foods that may increase
cancer risk
• Red meat, processed meats, salty or moldy foods
– Limit consumption of alcoholic beverages
– Aim to meet nutritional needs through the
diet
– Avoid using tobacco in any form

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 Cancer (cont’d.)

• Consequences of cancer
– Complications due to tumor’s impingement on
surrounding tissues
– Symptoms
• Nonspecific: anorexia, fatigue, unexplained weight
loss, fever, night sweats, skin lesions,
hyperpigmented skin
• Some cancers asymptomatic in early stages

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 Cancer: Consequences of Cancer
(cont’d.)
• Anorexia and reduced food intake
– Mental stress
– Chronic nausea and early satiety
– Fatigue
– Pain
– Gastrointestinal obstructions
– Effects of cancer therapies

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 Cancer: Consequences of Cancer
(cont’d.)
• Metabolic changes
– Cytokines induce an inflammatory and
catabolic state
– Increased protein turnover rate, but reduced
muscle protein synthesis
– Muscle is used for glucose production
– Triglyceride breakdown elevates serum
lipids

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 Cancer: Consequences of Cancer
(cont’d.)
• Cancer cachexia
– A wasting syndrome characterized by
anorexia, muscle wasting, weight loss, and
fatigue
– What factors play a key role in the muscle
wasting associated with cancer?

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 Cancer: Treatments for Cancer

• Treatments for cancer

– Highest likelihood of effective treatment with
early detection and intervention
– Surgery
• May remove tumors, determine the extent of
cancer, and protect nearby tissues
– Chemotherapy
• Drugs that inhibit tumor growth, shrink tumors
before surgery, prevent/suppress metastasis

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 Cancer: Treatments for Cancer (cont’d.)

• Radiation therapy
– Bombard cancer cells with X-rays, gamma
rays, or various atomic particles
– What are the advantages of radiation therapy
over surgery and chemotherapy?
– What are the nutrition-related side effects of
chemotherapy and radiation therapy?
(Table 23-5)

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 Cancer: Treatments for Cancer (cont’d.)

• Hematopoietic stem cell transplantation

– Replaces blood-forming stem cells destroyed
by high-dose chemotherapy or radiation
therapy
• Biological therapies
– Immunotherapy: biological molecules that
stimulate immune responses against cancer
cells

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 Cancer: Treatments for Cancer (cont’d.)

• Medications to combat anorexia and

wasting
– Megestrol acetate and dronabinol stimulate
appetite
– Antiemetic drugs control nausea
• Alternative therapies
– Complementary and alternative medicine
(CAM): e.g., multivitamin and herbal
supplements

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 Cancer: Nutrition Therapy

• Nutrition therapy for cancer

– What are the goals of nutrition therapy for
cancer patients?
– Protein and energy
• Protein requirements: 1.0 to 1.6 g/kg/day
• Weight loss is a problem for many cancer
patients
• Breast cancer patients often gain weight and body
fatness
• Box 23-6 discusses high-kcal, high-protein meals

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 Cancer: Nutrition Therapy for Cancer
(cont’d.)
• Managing symptoms and complications
– Dietary considerations for specific cancers
(Table 23-6)
– Tips for improving food intakes (Box 23-7)
– Responses to strategies vary, so adjustments
may be necessary
• Food safety concerns
– What are low-microbial (neutropenic) diets?

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 Cancer: Nutrition Therapy for Cancer
(cont’d.)
• Enteral and parenteral nutrition support
– Indications:
• Complications that interfere with food intake
• Long-term or permanent GI impairment
– Enteral strongly preferred over parenteral
nutrition to preserve GI function and avoid
infection

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 HIV Infection

• Acquired immune deficiency syndrome

(AIDS)
– Develops from human immunodeficiency virus
(HIV) infection
• Prevention of HIV infection
– Spread by direct contact with contaminated
body fluids
– At-risk individuals should undergo testing

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 HIV Infection (cont’d.)

• Consequences of HIV infection

– Destroys immune cells with protein called
CD4 on their surfaces
• Most affected are helper T cells (CD4+ T cells)
• Infected cells produce additional copies of the
virus
– Left untreated, HIV increases susceptibility to
opportunistic infections
– AIDS: advanced stages of HIV infection
• What diseases and complications are included in
AIDS-defining illnesses?
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 HIV Infection:
Consequences of HIV Infection (cont’d.)
• Weight loss and wasting
– Anorexia and inadequate food intake
– Nutrient malabsorption
– Altered metabolism
– Diet-drug interactions

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 HIV Infection:
Consequences of HIV Infection (cont’d.)
• Reduced food intake
– Oral infections: candidiasis, herpes simplex
virus
– Cancer: Kaposi’s sarcoma
– Medications
– Respiratory disorders: pneumonia,
tuberculosis
– Emotional distress, pain, and
fatigue

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 HIV Infection:
Consequences of HIV Infection (cont’d.)
• GI tract complications
– Attributed to opportunistic infections,
medications, or the HIV infection itself
– Advanced stages of HIV: AIDS
enteropathy
• Lipodystrophy
– Abnormalities in body fat and fat
metabolism
– Buffalo hump, lipomas
– Altered blood lipid levels
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 HIV Infection:
Consequences of HIV Infection (cont’d.)
• Neurological complications
– Clinical features: mild to severe dementia,
muscle weakness and gait disturbances, and
pain, numbness, tingling in legs and feet
• Other complications
– Anemia, skin disorders, kidney diseases, eye
disorders, and coronary heart disease

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 HIV Infection (cont’d.)

• Treatments for HIV infection

– Help to slow its progression, reduce
complications, and alleviate pain
– Standard drug treatment: combination of at
least three antiretroviral drugs (Table 23-9)
– In addition to antiviral drugs, why may adjunct
drug therapies be necessary?
– Box 23-10 lists nutrition-related drug effects

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 HIV Infection:
Treatments for HIV Infection (cont’d.)
• Control of anorexia and wasting
– Anabolic hormones, appetite stimulants, and
regular physical activity
• Reverse unintentional weight loss and increase
muscle mass
• Control of lipodystrophy
– Aerobic activity and resistance training may
help to reduce abdominal fat

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 HIV Infection:
Treatments for HIV Infection (cont’d.)
• Control of lipodystrophy
– Medications to treat abnormal blood lipid
levels and insulin resistance
• Alternative therapies
– Monitoring patients’ use of dietary
supplements is essential
• Reduces likelihood of adverse effects or diet-drug
interactions

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 HIV Infection (cont’d.)

• Nutrition therapy for HIV infection

– Initial assessment: evaluation of body weight
and body composition
– Follow-up measurements may indicate
adjustments to dietary recommendations and
drug therapies
– Weight management
• For overweight or obese patients, moderate weight
loss may be recommended

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 HIV Infection: Nutrition Therapy for HIV
Infection (cont’d.)
• Weight management
– With weight loss and wasting, a high-kcalorie,
high-protein diet may be beneficial
• Nutrient-dense snacks, bars, oral supplements
• Metabolic complications
– Insulin resistance
– Elevated triglyceride and LDL cholesterol
levels

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 HIV Infection: Nutrition Therapy for HIV
Infection (cont’d.)
• Metabolic complications
– Achieve or maintain a desirable weight
– Replace saturated fats with unsaturated fats
– Increase fiber
– Limit intakes of trans fats, cholesterol, added
sugars, and alcohol
– Regular physical activity

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 HIV Infection: Nutrition Therapy for HIV
Infection (cont’d.)
• Vitamins and minerals
– Supplements are often recommended
– Why is it important that supplement doses be
close to DRI recommendations?
• Symptom management (Box 23-7)
– Food consumption may be difficult
– Electrolyte balance affected by vomiting and
diarrhea

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 HIV Infection: Nutrition Therapy for HIV
Infection (cont’d.)
• Food safety concerns
– High susceptibility to foodborne illness
– Need detailed safe handling and preparation
instructions
– Water safety considerations
• Cryptosporidiosis

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 HIV Infection: Nutrition Therapy for HIV
Infection (cont’d.)
• Enteral and parenteral nutrition support
– Aggressive nutrition support may be needed
in later stages of illness
– Parenteral nutrition is reserved for patients
unable to tolerate enteral nutrition
– Careful measures to avoid bacterial
contamination of nutrient formulas and
feeding equipment

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 Nutrition in Practice:
Ethical Issues in Nutrition Care
• Ethical principles surrounding the decision
to withhold or withdraw nutrition support
• Life-sustaining treatments
• Legal decisions about nutrition support for
incapacitated patients
– Nancy Cruzan case
– Terri Schiavo case

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 Nutrition in Practice:
Ethical Issues in Nutrition Care (cont’d.)
• Legal documents used to declare
preferences about medical treatments
– Advance health care directive (living will)
– Durable power of attorney (health care
proxy)
• Appoints a health care agent to make
decisions
– Do-not-resuscitate (DNR) order

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