Hematologic studies of severe undernutrition of infancy. I. The anemia of prolonged caloric deprivation in the pig

Nutritional Support in Patients with Cancer of the Esophagus: Impact on Nutritional Status, Patient Compliance to Therapy, and Survival

AIMS AND BACKGROUND

The multimodal approach to patients with esophageal squamous cell carcinoma often includes polychemotherapy combined with radiation therapy. Cancer dysphagia and drug-related anorexia, mucositis and vomiting can all lead to malnutrition. The aim of this study was to analyze the impact of the administration of enteral nutrition (EN) on the patient's nutritional status, tolerance of chemotherapy and radiotherapy, and final oncological outcome.

METHODS

Fifty esophageal cancer patients who were to be submitted to chemotherapy (days 1-4 5-fluorouracil (FU) 1 g/m2/day and cisplatin (CDDP) 100 mg/m2/day 1) for two cycles plus radiotherapy (31 Gy) were referred to the Nutrition Support Unit prior to any therapy due to their malnourished status. Twenty-nine dysphagic patients received nutrition via tube (37 kcal/kg/day + 2.0 g proteins/kg/day for 34 days), while 21 others who were not dysphagic were given a standard oral diet (SD). The patients who received EN had a more severe weight loss than the SD patients (16.8% vs 12.8%, P <0.02).

RESULTS

The dose of administered EN represented 86% of the planned support, and 70% of the nutritional therapy was administered in the home setting. Administration of EN support resulted in stable body weight and unchanged levels of visceral proteins, while SD patients had a decrease in body weight, total proteins and serum albumin (P <0.01). There was no difference between the two groups in terms of tolerance and response to cancer therapy, suitability for radical resection and median survival (9.5 months).

CONCLUSIONS

EN in patients with cancer of the esophagus undergoing chemotherapy and radiotherapy is well tolerated, feasible even in the home setting, prevents further nutritional deterioration and achieves the same oncological results in dysphagic patients as those achieved in non-dysphagic patients.

The regulation of erythropoiesis in protein-energy-malnutrition

The erythropoietin (ESF) content of plasma and urine has been studied in children with protein-energy-malnutrition (PEM) living in the Kivu province at an altitude of 1467--2000 m. On admission, packed cell volume (PCV) was moderately reduced; after 2 months of refeeding PCV had increased but was still lower than in the controls. Plasma ESF was increased on admission and in patients refed for 2 months. The expected positive correlation between serum and urine ESF levels was found after refeeding but not on admission; the last finding could not be explained by the presence of erythropoiesis inhibiting factor(s) in the urine. In spite of the normal 2,3-DPG and P50 previously described in PEM in Kivu, the anaemia associated with this disease is not merely an adaptation to lowered oxygen consumption and there must be some disturbances in the responsiveness of bone marrow to ESF. The high ESF values observed after 2 months of refeeding confirm that the restoration of the red cell volume proceeds slowly.

Gelatinous transformation of bone marrow in prolonged self-induced starvation

In bone marrow from 3 patients with prolonged, severe self-induced starvation, fat atrophy, hypoplasia of haemopoietic cells and characteristic gelatinous transformation of marrow were noted. The gelatinous substance appeared amorphous and stained pink with the Wright-Giemsa stains. Histochemical and ultrasturctural studies indicated that it consisted of acid mucopolysaccharides and was extracellular in nature. Similar marrow abnormalities were produced in rabbits by limitating their food intake for 4 months. These marrow abnormalities in the experimental animals could be reverted to normal by restoring their nutritional status. It is proposed that the gelatinous transformation of marrow is caused by excessive production of mucopolysacchrides of the ground substance to compensate for the mobilization of marrow fat which occurs to meet the energy requirement. It is further postulated that excessive production of acid mucopolysaccharides may provide a microenvironment unsuitable for haemopoietic proliferation. The relevance of these findings to other conditions associated with marrow aplasia, is discussed.