ONCOLOGY cer patients have a tolerance range for dietary intake of various nutrients e . g . lactate 1 , this homeostatic reservoir is narrower than for healthy patients .
Essentially , malignancy causes alterations in the major nutritional axes as follows :
• PROTEINS – patients have skeletal muscle loss due to increased activity of proteolytic ( catabolic ) pathways and processes , even though liver protein synthesis increases . This causes protein metabolism to be shifted toward the tumour ( s ), and not replacing the muscle loss ( sarcopenia ). The altered liver metabolism is typical of the “ acute phase protein response ” seen in many inflammatory diseases . οο
Clinical consequence – if protein intake does not match requirements , poor wound healing and immunity and altered GIT function result .
• FATS / LIPIDS – the cachexia seen with malignancy is also due to reduce fat synthesis with concurrent lipolysis , driven by various cytokines and chemicals . Insulin resistance caused by various cytokines and tumour-derived factors may be an important driver of this altered lipid state . 2 In addition , the finding that some tumour cells have only a limited ability to utilise fats for gluconeogenesis ( the generation of glucose from non-carbohydrate sources ) leads some to believe a higher fat diet is physiologically appropriate to cancer patients . In fact , dogs allowed to self-select foods according to the satisfaction of energy intake , will tend to select a diet that is 30 % protein , 63 % fat and only 7 % carbohydrate . 3 In addition , the type of fat eaten seems to be important , with diets higher than 5 % in ω3 fatty acids advised by veterinary nutritionists . 4 οο
Clinical consequence – patients with inadequate lipid intake may experience alterations in energy status , increased usage of muscle amino acids to drive gluconeogenesis ( further sarcopaenia ), altered lipid-soluble vitamin homeostasis ( Vit A , D , E and K ) and greater susceptibility to oxidative damage of other organs .
• CARBOHYDRATES – at the centre of many arguments about cancer metabolism are carbohydrates ( CHO ). In this respect we are not discussing fibre , which is discussed below . Carbohydrate is an energy source used by all cells , but less effectively in cancer , due to insulin resistance at the cell membrane . This is aggravated by a relative or absolute hyperlactataemia which may be worsened by administration of Ringer ’ s Lactated intravenous solutions 1 , 5 Malignancy sufferers express embryonic versions of certain enzymes and have
Protein , Fat & Carbohydrate Percentage Dry Matter Contents of Various Diets Recommended Values from Roudebush et al ( 2004 )
FATS 25 - 40 % |
33 |
23 |
34 |
31 |
26 |
36 |
40 |
25 |
20 |
42 |
22 |
21 |
42 |
20 |
23 |
Eukanuba Working & Endurance |
Hill ’ s Science Plan Performance |
Acana Heritage Grain Free Sport & Agility |
ORIJEN - Whole Prey Puppy |
ORIJEN - Whole Prey Puppy 6 Fish Adult |
|
|
71 |
|
|
|
44 |
|
|
Cat protein 40-50 % |
38 |
|
|
38 |
|
33 |
20 |
30 |
15 |
15 10 |
36 |
Dog protein 35-45 %
Carbohydrates < 25 %
0
|
Hill ’ s Prescription n / d |
Hill ’ s Prescription a / d |
Weruva Chicken |
ORIJEN Freeze dry |
|
|
|
Adult |
■ Protein DMB
■
Fat DMB ■
Carbohydrate DMB
|
Issue 03 | JUNE 2016 | 13
ONCOLOGY
cer patients have a tolerance range for dietary intake
of various nutrients e.g. lactate1, this homeostatic reservoir is narrower than for healthy patients.
drate sources) leads some to believe a higher fat
diet is physiologically appropriate to cancer patients. In fact, dogs allowed to self-select foods
according to the satisfaction of energy intake, will
tend to select a diet that is 30% protein, 63% fat
and only 7% carbohydrate.3 In addition, the type
of fat eaten seems to be important, with diets
higher than 5% in ω3 fatty acids advised by veterinary nutritionists.4
οο Clinical consequence – patients with inadequate lipid intake may experience alterations
in energy status, increased usage of muscle amino acids to drive gluconeogenesis
(further sarcopaenia), altered lipid-soluble
vitamin homeostasis (Vit A, D, E and K) and
greater susceptibility to oxidative damage of
other organs.
Essentially, malignancy causes alterations in the major
nutritional axes as follows:
• PROTEINS – patients have skeletal muscle loss
due to increased activity of proteolytic (catabolic)
pathways and processes, even though liver protein synthesis increases. This causes protein metabolism to be shifted toward the tumour(s), and
not replacing the muscle loss (sarcopenia). The
altered liver metabolism is typical of the “acute
phase protein response” seen in many inflammatory diseases.
οο Clinical consequence – if protein intake does
not match requirements, poor wound healing and immunity and altered GIT function
result.
•
•
CARBOHYDRATES – at the centre of many arguments about cancer metabolism are carbohyFATS/LIPIDS – the cachexia seen with malignancy
drates (CHO). In this respect we are not discussis also due to reduce fat synthesis with concuring fibre, which is discussed below. Carbohydrate
rent lipolysis, driven by various cytokines and
is an energy source used by all cells, but less efchemicals. Insulin resistance caused by various
fectively in cancer, due to insulin resistance at the
cytokines and tumour-derived factors may be an
cell membrane. This is aggravated by a relative or
important driver of this altered lipid state.2 In addiabsolute hyperlactataemia which may be worstion, the finding that some tumour cells have only
ened by administration of Ringer’s Lactated intraRecommended
Values from Roudebush
et al1, 5(2004)
a limited ability to utilise
fats for gluconeogenesis
venous solutions
Malignancy sufferers express
Recommended
Values from Roudebush
et al (2004)
(the generation of glucose
from non-carbohyembryonic versions
of certain enzymes and have
Protein, Fat & Carbohydrate Percentage Dry
Protein, Fat & Carbohydrate Percentage Dry
Matter Contents of Various Diets
Matter Contents of Various Diets
■ Protein DMB ■ Fat DMB ■ Carbohydrate DMB
■ Protein DMB
■ Fat DMB
Carbohydrate
DMB of Various Diets
Protein, Fat & Carbohydrate
Percentage
Dry■ Matter
Contents
FATS 25 - 40%
FATS 25 - 40%
Recommended Values from Roudebush et al (2004)
33
33
34
34
36
36
31
31
26
26
23
23
Eukanuba Working &
Eukanuba
Working &
Endurance
Endurance
42
42
40
40
25
25
Hill’s Science Plan
Hill’s
Science Plan
Performance
Performance
20
20
Acana Heritage Grain
Acana
Heritage
Grain
Free
Sport
& Agility
Free Sport & Agility
42
42
22
22
23
23
21
21
ORIJEN - Whole Prey
ORIJENPuppy
- Whole Prey
Puppy
20
20
ORIJEN - Whole Prey
ORIJEN
Prey
Puppy -6Whole
Fish Adult
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