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Hyperalimentation of the Cancer Patient with Protein-Calorie Undernutrition¹

Departments of Medicine [D. W. N., D. H. L., M. S., S. H., R. C., T. H. C., D. R.], Surgery [J. A.], and Biometry [M. K.], the Winship Memorial Clinic for Neoplastic Disease and the Clinical Research Facility, Emory University School of Medicine, Atlanta, Georgia 30322

Because protein-calorie undernutrition is common in patients with neoplastic disease, nutritional support is often recommended. It is uncertain, however, that methods of supplemental alimentation successful in noncancerous subjects are suitable in cancer patients. We measured elemental balances, serum proteins, anthropometrics (triceps skinfold and mid-arm muscle area), and creatinine/height ratio in 15 undernourished patients with advanced cancer and in 10 noncancer undernourished controls during central venous or enteral hyperalimentation and found the following. (a) During central venous hyperalimentation, cancer patients showed significantly less improvement than the noncancerous controls in body weight (median increment, 5 kg in cancer patients and 8.5 kg in noncancerous), albumin (0.1 g/dl in cancer patients and 0.5 g/dl in noncancerous patients), creatinine/height ratio (4% of standard in cancer and 10% of standard in noncancer), and mid-arm muscle area (4% of standard in cancer and 11% of standard in noncancer). During enteral hyperalimentation, gains in body weight and albumin by cancer patients were significantly inferior to those in noncancerous subjects. Triceps skinfold increments, in contrast, were similar during both central venous and enteral hyperalimentation for cancer and noncancerous patients. (b) While nitrogen retention was similar in cancer and noncancer patients, the cancer group retained significantly less magnesium and phosphorus (Mg in cancer patients, 3.2 mEq/day central, -2.7 mEq/day enteral; Mg in noncancer patients, 11.9 mEq/day central, 10.1 mEq/day enteral; P in cancer patients, 0.13 g/day central, 0.07 g/day enteral; P in noncancer patients, 0.27 g/day central, 0.33 g/day enteral). The poorer balances of cancer patients were caused by increased urinary, not fecal, loss.

These findings indicate a partial block in repletion of lean body mass or abnormal composition of newly deposited lean body mass when undernourished patients with advanced cancer receive hyperalimentation.

¹ Supported by NIH Grants R01 CA 20997, 16255, and RR 39; NIH Contract N01-CP-65802; the American Legion Gioia Osborne Cancer Research Fund; the State of Georgia Nutrition-Cancer Contract; and the Emory University Cancer Center. Presented in part to the American Society of Clinical Nutrition, Washington, D. C., (Nixon, D. W., Rudman, D., Heymsfield, S. B., Ansley, J., and Kutner, M. Abnormal response of cancer patients to hyperalimentation. Am. J. Clin. Nutr. 32: 935, 1979.) and the American Association for Cancer Research, New Orleans, 1979 (49).

² To whom requests for reprints should be addressed, at Winship Memorial Clinic, 1365 Clifton Road, Atlanta, Ga. 30322.

Received 12/26/79. Accepted 2/17/81.

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