Preventing malnutrition in people with blood cancer

Malnutrition is a common but difficult to manage complication for people with cancer, especially those treated with intensive chemotherapy. Now new research from the University of Adelaide has delivered new insights into the way nutrients are provided for people with blood cancer to ensure they maintain adequate nutrition during treatment.

The study compared enteral (tube) feeding with parenteral (intravenous) feeding methods to see which one was better for patient nutrition and had less complications for gut microbiota – bacteria found in your intestines that help break down food and prevent illness.

“The disruption of gut microbiome is a common consequence of high dose chemotherapy, and this is linked to detrimental treatment outcomes such as sepsis,” said University of Adelaide Associate Professor Hannah Wardill, who was the lead author of the study.

“Parenteral feeding is generally the most common method used to prevent malnutrition in these patients however we wanted to see if there was a better way to prevent these side effects which increase infection and can lead to an earlier death.”

People with blood cancer receiving treatment in the Netherlands were selected for the randomised study, with researchers monitoring faecal samples as well as changes in body weight and upper arm circumference.

“We discovered that enteral was poorly tolerated by patients, with most not able to cope with the tube for more than five days,” said Associate Professor Wardill.

“There was no benefit in terms of weight management or gut health. This is despite evidence from preclinical studies indicating that it is better for maintaining gut microbiota, which we know are severely damaged during chemotherapy.”

The study also looked at factors responsible for gut disruption in the trial participants.

“Contrary to popular belief, antibiotics had minimal effects on the gut microbiota, reiterating the benefits of the highly restricted antibiotic protocols mandated in the Netherlands. Instead, it was mucosal damage – or damage to the protective lining of the gastrointestinal tract – that was the main offender,” said Associate Professor Wardill.

“Interestingly, we discovered that we could predict these changes to the gut microbiota by monitoring citrulline levels. Citrulline is a naturally occurring amino acid and is a reliable indicator of how damaged the intestinal lining is.

“This confirms preclinical data from a previous study and, with further research, could help us to identify and manage complications associated with the gut microbiota, like infection, sooner”

The results of the study have been published in Springer Nature publication, Supportive Care in Cancer.