【原】营养饮食学会（美国营养师协会）成人肿瘤循证营养实践指南（一）

　　2016年7月16日，营养饮食学会官方期刊《营养饮食学会杂志》在线发表阿巴拉契亚州立大学、玛丽·格里利医学中心、墨西哥总医院（墨西哥城综合医院）、戴尔儿童血液与癌症中心、营养饮食学会起草的《成人肿瘤循证营养实践指南》，全文共61页。

　　2012年，成立于1917年的美国营养师协会（American Dietitian Association，ADA）正式更名为营养饮食学会（Academy of Nutrition and Dietetics）, 新名称的缩写为：A.N.D.（请记得在字母之间加点，而不要写成：AND）。官方网站地址仍为：www.eatright.org

　　该学会下属的饮食教育认证委员会（Commission on Accreditation for Dietetics Education，CADE）是营养专业教育项目的认证机构，主要负责注册营养师（Registered Dietitian，RD）和注册饮食技师（Dietetic Technician Registered，DTR）的认证。2011年更名为营养饮食教育认证委员会（Accreditation Council for Education in Nutrition and Dietetics，ACEND），主要负责注册饮食营养师（Registered Dietitian Nutritionist，RDN）和注册营养饮食技师（Nutrition and Dietetic Technician Registered，NDTR）的认证。该委员会受美国教育部认可，且是专业与职业认证委员会的一员，凡通过该机构认证的营养学项目均为正规项目。

　　此外，美国还有：成立于1959年的美国营养学院（American College of Nutrition，ACN），2005年由美国临床营养学会（American Society for Clinical Nutrition）美国营养科学学会（American Society for Nutritional Sciences）国际营养学会（Society for International Nutrition）合并而成的美国营养学会（American Society for Nutrition，ASN），成立于1975年的美国肠外肠内营养学会（American Society for Parenteral and Enteral Nutrition，ASPEN），需要注意区别。

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　　癌症是用于描述一组100多种多因素疾病的术语，其中的异常细胞不受控制地增殖，而且能够转移到机体其他部位并侵袭健康组织【1】。癌症死亡数量自20世纪90年代逐渐下降，癌症幸存者数量上升【2】。据美国国家癌症研究所（NCI）估计，2016年将有168.521万例新诊断病例和59.569万例死亡。基因和环境之间复杂的相互作用促进了癌症的发生【3】。尽管营养状况影响癌症的许多具体途径仍不清楚【4】，但是人们已认识到营养在癌症预防和治疗中起重要作用【4-8】。

　　2007年，营养饮食学会在证据分析库（EAL）上发布了针对特定类型癌症及其治疗的营养干预相关指南建议。2010年，新的证据分析工作组建立，对原指南进行补充，2013年11月发布于EAL。当前的指南主要关注成人肿瘤患者广泛的肿瘤营养实践。虽然这些建议是为注册饮食营养师（RDN）而写，但是其他人可能发现有帮助。

　　由工作组制定的指南，首先根据EAL相关系统回顾作出建议，然后概述本学会以外组织的指南作出的建议【9-11】。后者被列入以进一步拓展循证建议的范围。最后，对基于共识建议的简要回顾，将进一步指导在该领域中营养研究较少或研究难以阐明的RDN。

　　结论声明和建议的制定

　　整个项目遵循本学会的5步系统回顾流程【12】。肿瘤工作组主要针对成人肿瘤营养有足够营养状况和营养干预相关证据的4个领域：

• 营养不良筛查和营养评定工具的有效性；

• 营养状况与发病率和死亡率的相关性；

• 医学营养疗法（MNT）对化疗（CT）和放疗（RT）患者的影响【13】；

• 癌症恶病质、包含鱼油（特别是二十碳五烯酸[EPA]）的医学食品补充剂（MFS）和饮食补充剂对体重和瘦体重（LBM）的影响。

参考文献（一）

1. National Cancer Institute. What is cancer? http://www./cancertopics/cancerlibrary/what-is-cancer. Updated February 9, 2015. Accessed February 15, 2016.

2. National Cancer Institute. Cancer statistics. http://www./about-cancer/what-is-cancer/statistics. Updated March 14, 2016. Accessed June 13, 2016.

3. American Cancer Society. Genes in cancer. http://www./cancer/cancercauses/geneticsandcancer/genesandcancer/genes-and-cancer-gene-changes. Reviewed June 25, 2014. Accessed February 15, 2016.

4. National Cancer Institute. Nutrition in cancer care-health professional version (PDQ): Overview. http://www./cancertopics/pdq/supportivecare/nutrition/HealthProfessional. Updated January 8, 2016. Accessed February 15, 2016.

5. Reeves, GK, Pirie, K, Beral, V, Green, J, Spencer, E, Bull, D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: Cohort study. BMJ. 2007;335:1134.

6. Lelièvre, SA, Weaver, CM. Global nutrition research: Nutrition and breast cancer prevention as a model. Nutr Rev. 2013;71:742-752.

7. Key, TJ, Allen, NE, Spencer, EA, Travis, RC. The effect of diet on risk of cancer. Lancet. 2002;360:861-868.

8. Key, T. Cancer prevention and treatment. World Rev Nutr Diet. 2014;111:123-129.

9. American Society of Parenteral and Enteral Nutrition. Clinical guidelines. http://www./Guidelines_and_Clinical_Resources/Clinical_Guidelines/. Accessed February 15, 2016.

10. Clinical Oncological Society of Australia, Cancer Council Australia. Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. http://wiki..au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines/Introduction. Accessed February 15, 2016.

11. Oncology Nursing Society. PEP rating system overview. https://www./practice-resources/pep. Accessed February 15, 2016.

12. Handu, D, Moloney, L, Wolfram, T, Ziegler, P, Acosta, A, Steiber, A. Academy of Nutrition and Dietetics methodology for conducting systematic reviews for the Evidence Analysis Library. J Acad Nutr Diet. 2016;116:311-318.

13. Definition of terms list. Academy of Nutrition and Dietetics. Definition and Terms Workgroup and the Quality Management Committee. January 2016. http://www./~/media/eatrightpro%20files/practice/patient%20care/scope%20of%20practice/definition_of_terms_policy.ashx Accessed May 9, 2016.

翻译：肖慧娟（天津市第三中心医院）

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J Acad Nutr Diet. 2016 Jul 16. [Epub ahead of print]

Oncology Evidence-Based Nutrition Practice Guideline for Adults.

Thompson KL, Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T.

Appalachian State University, Boone, NC; Mary Greeley Medical Center, Ames, IA; Hospital General de México, Mexico City, Mexico; Dell Children's Blood and Cancer Center, Austin, TX; Palm Bay, FL; Academy of Nutrition and Dietetics, St Petersburg, FL.

Cancer is a term used to describe a group of more than 100 multifactorial diseases in which abnormal cells reproduce in an uncontrolled manner and are able to spread to other parts of the body and invade healthy tissues.【1】Numbers of cancer-related deaths have fallen steadily since the 1990s, and the number of cancer survivors has increased.【2】The National Cancer Institute has estimated that 1,685,210 new cases will be diagnosed and 595,690 deaths will occur in 2016.2 Cancers develop from complex interactions between genes and the environment.【3】Although many of the specific pathways by which nutritional status can impact cancer remain poorly understood,【4】it is well recognized that nutrition plays important roles in cancer prevention and treatment.【4-8】

In 2007, the Academy of Nutrition and Dietetics (Academy) published guideline recommendations on the Evidence Analysis Library (EAL) related to nutrition interventions for specific types of cancer and cancer treatments. In 2010, a new evidence analysis workgroup was formed to supplement the original guideline, which was subsequently published on the EAL during November 2013. The current guideline focuses on comprehensive oncology nutrition practice for the care of adult patients with cancer. Although the recommendations are written for registered dietitian nutritionists (RDNs), others may find them helpful.

The guideline developed by the workgroup will be reviewed, beginning with the recommendations that are based on the related EAL systematic review, followed by a brief review of recommendations based on organization guidelines outside of the Academy.【9-11】The latter were included to further expand the scope of the evidence-based recommendations. Finally, a brief review of the consensus-based recommendations will be provided to further guide the RDN, where there is less nutrition research or the research is difficult to elucidate.

Development of Conclusion Statements and Recommendations

The Academy's 5-step systematic review process【12】was followed throughout the project. The Oncology Workgroup chose to principally target four areas of oncology nutrition in adults where there was an adequate pool of evidence related to nutritional status and nutrition interventions:

• validity of malnutrition screening and nutrition assessment tools;

• the association among nutritional status and morbidity and mortality outcomes;

• the effect of medical nutrition therapy (MNT)【13】on patients undergoing chemotherapy (CT) and radiation treatment (RT); and

• cancer cachexia and the effect of dietary supplements and medical food supplements (MFS) containing fish oil (specifically eicosapentaenoic acid [EPA]), on body weight and lean body mass (LBM).

PMID: 27436529

PII: S2212-2672(16)30265-9

DOI: 10.1016/j.jand.2016.05.010