|
现有的乳腺癌患者饮食指南对于可能改善患者营养状况的宏量和微量营养素合理饮食摄入尚不明确。 2017年7月14日，美国营养学会《营养学进展》正式发表墨西哥食品研发中心和索诺拉大学的系统回顾：乳腺癌患者饮食指南。 该系统回顾包括了近15年来PubMed和生物医学中心（BioMed Central）数据库关于乳腺癌患者饮食指南的信息，以及个体化、营养素特异性饮食对抗肿瘤治疗期间和之后患者营养状况的潜在影响。 结果表明，乳腺癌患者应在诊断后立即接受营养评定。 此外，应该鼓励她们追求并保持健康的体重（体重指数，即体重除以身高平方：20～24.9kg/m²），保持瘦体重（非脂肪体重），避免脂肪组织增加。 因此，在营养状况诊断后，可以适时考虑饮食干预的保守能量限制为每天500～1000kcal。 根据回顾信息，作者建议在抗肿瘤治疗期间和之后对乳腺癌患者进行个体化营养干预。 营养疗法实施应该根据患者的营养状况、饮食习惯、日常安排、体力活动、文化偏好。 乳腺癌患者日常能量摄入应该分配如下：每天＜30%为脂肪（主要为单和多不饱和脂肪酸）、约55%为碳水化合物（主要为燕麦、糙米、水果等天然食品）、蛋白质1.2～1.5g/kg，以避免肌肉减少性肥胖。 应该鼓励每天摄入5～9份的水果（每份约150g）和蔬菜（每份约75g）。 大蒜和十字花科蔬菜也应作为营养疗法之一。 从富含维生素A、E、C和β-胡萝卜素的食品摄入足够宏量和微量营养素，可以预防乳腺癌患者营养状况恶化，并改善其整体健康和预后。 相关阅读 Adv Nutr. 2017 Jul 14;8(4):613-623. Dietary Guidelines for Breast Cancer Patients: A Critical Review. Limon-Miro AT, Lopez-Teros V, Astiazaran-Garcia H. Research Center for Food and Development, Hermosillo, Sonora, Mexico; University of Sonora, Hermosillo, Sonora, Mexico. Current dietary guidelines for breast cancer patients (BCPs) fail to address adequate dietary intakes of macro- and micronutrients that may improve patients' nutritional status. This review includes information from the PubMed and Biomed Central databases over the last 15 y concerning dietary guidelines for BCPs and the potential impact of a personalized, nutrient-specific diet on patients' nutritional status during and after antineoplastic treatment. Results indicated that BCPs should receive a nutritional assessment immediately after diagnosis. In addition, they should be encouraged to pursue and maintain a healthy body weight [body mass index (BMI; in kg/m2) 20-24.9], preserving their lean mass and avoiding an increase in fat mass. Therefore, after nutritional status diagnosis, a conservative energy restriction of 500-1000 kcal/d could be considered in the dietary intervention when appropriate. Based on the reviewed information, we propose a personalized nutrition intervention for BCPs during and after antineoplastic treatment. Specifications in the nutritional therapy should be based on the patients' nutritional status, dietary habits, schedule, activities, and cultural preferences. BCPs' daily energy intake should be distributed as follows: <30% fat/d (mainly monounsaturated and polyunsaturated fatty acids), ~55% carbohydrates (primarily whole foods such as oats, brown rice, and fruits), and 1.2-1.5 g protein/kg/d to avoid sarcopenic obesity. Findings suggest that 5-9 servings/d of fruits (~150 g/serving) and vegetables (~75 g/serving) should be encouraged. Garlic and cruciferous vegetables must also be part of the nutrition therapy. Adequate dietary intakes of food-based macro- and micronutrients rich in β-carotene and vitamins A, E, and C can both prevent deterioration in BCPs' nutritional status and improve their overall health and prognosis. KEYWORDS: dietary assessment; drug-nutrient interaction; food-based intervention; macronutrients and micronutrients in breast cancer; personalized diet PMID: 28710147 DOI: 10.3945/an.116.014423
|
|
|
