132例成年急慢性白血病患者膳食营养状况的调查

 目的　研究急、慢性白血病患者的膳食营养状况并对比分析急性和慢性白血病患者膳食营养状况的异同之处。方法　采用24 h膳食回顾和连续7 d膳食记录法获取122例急性白血病患者和10例慢性白血病患者摄入的食物种类和数量,应用SPSS 11.5统计软件对食物构成和热能、营养素摄入情况进行分析、比较。结果　白血病患者的豆类、蔬菜、乳类等食物的摄入量明显低于中国居民平衡膳食宝塔所建议的食物摄入量;能量、蛋白质、维生素A、硫胺素、核黄素、抗坏血酸、钙、锌和硒的摄入量占推荐摄入量（RNI）和（或）适宜摄入量（AI）百分比均低于80 %,其中能量、维生素A、硫胺素、核黄素、抗坏血酸、钙的摄入水平属严重缺乏状态。急性白血病患者的大部分食物种类的摄入量、能量及各种营养素的摄入量及占RNI和（或）AI百分比均有低于慢性白血病患者的趋势,其中水果、谷类、维生素A、核黄素、铁的摄入量,二者比较差异有统计学意义（P值分别为0.023、0.040、0.035、0.045、0.009）。结论　白血病患者各种营养素的摄入量普遍较低,膳食结构存在一些不合理性。急性白血病患者比慢性白血病患者的膳食营养状况普遍存在较差的趋势。     

能量摄入对头颈癌放化疗患者营养状况和生活质量的影响

目的 探讨能量摄入量对头颈癌患者放化疗期间营养状况、体成分及生活质量的影响。方法 选取符合入选标准 的头颈癌患者 90 例,分别在放化疗前和放疗结束 2 个时段对患者进行调查,调查内容包括：营养评估、膳食调查、体成分 测量以及生活质量四个部分。临床营养师通过 24 小时膳食调查获得患者的能量摄入量,包括膳食能量摄入以及 ONS,同 时采用 Harris-Benedict 公式获得患者的能量需要量,从而计算患者的能量摄入量占需要量的比例,能量摄入占比＜ 70% 为 A 组,能量摄入占比≥ 70% 为 B 组。结果 两组患者的基线资料,包括年龄、性别、BMI、治疗前的营养状况、临床分期、 诊断、放疗剂量以及治疗方式等方面差异均无统计学意义（P ＞ 0.05）,两组具有可比性。放疗结束后,A 组患者营养不 良发生率明显高于 B 组,A 组患者营养不良发生率为 100%,B 组为 84.09%,差异具有统计学意义（P ＜ 0.05）;24 小时 膳食调查发现,A 组患者每天通过膳食和 ONS 摄入的能量分别为 864kcal 和 214kcal,明显低于 B 组,差异具有统计学意义（P ＜ 0.05）。使用放疗前后体成分的变化值来表示能量摄入量对体成分的影响,发现 A 组患者 BMI、体重、肌肉、蛋白质、 骨骼肌和体脂百分比的变化均大于 B 组,两组除了蛋白质和骨骼肌的变化没有统计学意义外,其他指标差异均具有统计 学意义（P ＜ 0.05）;放疗前,两组患者生活质量评分没有明显的统计学差异;放疗结束后,A 组患者功能评分均比 B 组 偏低,而症状评分都偏高;在生活质量、认知功能、疼痛、疲倦、食欲丧失等方面两组间差异都具有统计学意义。结论 头 颈癌患者经放化疗后,营养状况、体成分及生活质量恶化,而在治疗前和治疗过程中保持能量摄入量占比≥ 70% 可以防止 进一步恶化。     

营养素与消化道肿瘤关系的研究进展

消化道肿瘤的发生与环境因素尤其是饮食因素密切相关,食物及其营养素从多方面影响着消化道肿瘤的发生与发展。能量的过多消耗及不合理的供能方式与比例,保护因子如维生素及微量元素等微量营养素、膳食纤维、n-3族多不饱和脂肪酸及多种植物化学物等的摄入不足均影响着消化道肿瘤的发生。对营养素与消化道肿瘤关系的研究,有助于指导合理膳食,从而减少消化道肿瘤的发生率与死亡率。根据目前有关此方面的国内外最新研究进展,就能量与碳水化合物、蛋白质、脂肪、膳食纤维、维生素与微量元素等营养素与消化道肿瘤发生发展的关系进行了综述。     

肿瘤内科住院患者膳食认知行为横断面多中心研究

目的  调查肿瘤内科住院患者膳食认知现状、膳食摄入量、营养状况,分析肿瘤患者膳食营养知识水平、行为习 惯及营养不良可能的发生原因,为医护人员对患者进行营养宣教及营养治疗提供依据。方法  以全国分布的18 家医院,选 择肿瘤内科住院患者进行横断面调查研究。患者以面对面调查形式自行填写膳食知识及行为问卷调查,主诊医生查房询问 患者膳食摄入情况及进行食欲评分;营养师进行营养风险筛查、膳食史回顾调查,按 ESPEN 及中国肿瘤营养指南推荐的拇 指法则计算患者的能量及蛋白质每日目标需要量。比较患者实际营养摄入量与目标摄入量是否有差别。结果  共完成 535 例 有效问卷调查：95.2% 的患者认为科学的膳食非常重要,70% 的患者对如何科学的膳食存在疑问,82.0% 的患者会遇到膳 食知识矛盾的困惑,当获取的膳食信息有矛盾时,64.2% 的患者会听取主诊医师的意见;主诊医师、网络、电视是患者了 解如何科学膳食的最主要的 3 条途径,分别占所有途径的 26.0%、18.5% 以及16.1%;99.6% 的患者存在膳食知识误区,认 为患病后不可食用某类或全部富含蛋白质的食物;90.0% 以上的患者服用灵芝孢子粉、海参、人参、冬虫夏草以及其他类 保健食品;93.0% 的患者未接受过规范的营养教育。通过营养风险筛查、膳食调查及评价发现：15.6% 的患者存在营养风 险（NRS 2002≥3分）,实际每日摄入能量为1169.20±465.97kcal,显著性低于目标需求量1797.95±375.27kcal（P＜0.01）, 仅达目标需要量的 65.3%;实际每日蛋白质摄入量为 46.55±21.40g,显著性低于目标需求量（P ＜ 0.01）,仅达目标需要量 的 74.4%。主诊医师查房询问患者膳食情况表明：69.0% 的患者认为饮食还行、挺好的、很好或者非常好。通过膳食回顾 调查发现,其中有34.0% 的患者能量摄入不足目标量60.0%。可见如果仅通过查房医生简单的询问,不足以正确的反应患 者的实际膳食摄入情况。结论  肿瘤内科住院患者对科学的膳食营养认知差,接受规范的营养教育率低。患者普遍存在膳食 摄入量低,NRS 2002 评分或查房医生的询问不足以反映肿瘤患者的实际摄入情况。因此,加强临床医生与营养师的密切合 作,有针对性的进行营养宣教将对改善患者的膳食知识及行为起到重要作用。     

均衡营养是基石，合理膳食抗肿瘤

各种饮食成分对维持健康、预防疾病相当重要。三大宏量营养素碳水化合物、蛋白质、脂肪不仅给机体供能，在肿 瘤营养代谢上也发挥重要作用。选择适量和优质的碳水化合物能降低肿瘤风险，提高优质蛋白质供给、高膳食纤维、高ω‐3多 不饱和脂肪酸的饮食，对改善肿瘤患者营养状况和预后有显著益处。不健康的膳食可使机体出现肠道菌群失调，产生有毒代 谢产物，诱导机体炎症和免疫失衡，促进肿瘤的发生。典型的西式饮食如进食较高含量的饱和脂肪酸、精制碳水化合物等会破 坏肠道屏障功能，导致肠道菌群失衡，增加肿瘤风险。以多蔬菜水果、多鱼虾水产品、经常吃奶类和大豆制品、适量的谷类和肉 禽类、烹调清淡少盐为主要特点的我国江南地区膳食模式代表东方健康膳食模式，值得倡导。遵循均衡营养、倡导合理膳食是 维持良好肠道微生态、防治肿瘤并降低全因死亡风险的关键。本文从营养素摄入和膳食模式对人体肠道微生态影响以及与肿 瘤发病及防治的角度展开论述。     

健康食品食用菌

食用菌不仅能为人体提供营养素如蛋白质、碳水化合物、维生素、矿物质、膳食纤维等,还可以供给人体一些具有特殊功效的物质。     

福建省胃癌高低发地区居民饮食习惯与营养状况的调查分析

目的:通过对福建省胃癌高低发区居民饮食习惯与营养状况的调查研究,为胃癌防治提供一定参考依据。方法:选择胃癌高低发区居民进行对照研究,通过自行设计饮食状况调查表进行入户流行病学现场调查,对饮食习惯、营养素摄入量和膳食结构等进行比较分析。结果:食用油炸食品和煎炸食品的频率(有时吃和经常吃)高发区(分别为33.3%和36.2%)高于低发区(分别为23.7%和26.1%),食用凉拌或生吃食品、盐渍食品和蒸、熬、炒食品的频率高发区则显著低于低发区;两地区居民的主要营养素来源以植物性食品为主,各种营养素从动物性食品和植物性食品中摄取的比例很接近;与膳食指南建议量作比较,高发区居民蔬菜类、豆类、蛋类和奶类食品摄入量低于参考值,低发区居民水果类、蛋类、豆类和奶类食品摄入量未达到建议摄入量,高发区居民每日蔬菜和豆类食品摄入量均低于低发区;低发区居民葱和生姜每日食用量分别是高发区的4.6倍和14.0倍。结论:高低发区居民饮食烹调方法和膳食结构存在较大差异,高发区居民的烹调方法可能是胃癌高发的危险因素,并且膳食结构不如低发区合理。低发区居民喜食葱和生姜可能是胃癌低发的重要保护因素。     

蔬菜与水果在放、化疗阶段的营养作用

放、化疗患者在饮食上应尽量做到均衡膳食。使各种营养素摄入齐全并得以充分利用。但是由于病灶本身及放疗和化疗药物的作用,会使机体出现一些毒副反应,常表现为食欲不振、恶心、呕吐等影响进食和营养素摄取。放、化疗阶段的膳食搭配应在适量谷类和优质蛋白质类食物基础上,提高蔬菜、水果类的食用比例,发挥蔬菜、水果类食品的增进食欲作用。     

博士答疑

Q我是一名刚做完手术的肿瘤患者,我想请您系统地给我一个饮食建议。A临床研究显示:肿瘤患者的营养状况直接影响手术和放疗与化疗的效果,因此合理的膳食结构,对肿瘤患者的康复极为重要。1.饮食宜少食多餐。每日膳食中蛋白质食品如鱼、肉、蛋、奶和豆制品的用量,一般以常人的1.5倍为宜;脂肪类食物     

“防癌”与“致癌”:饮食是把“双刃剑”

癌症是可以预防的。癌症的预防要从心理、环境、膳食、卫生等多方面综合入手。其中,膳食因素在癌症的预防和治疗中的作用越来越受到人们的关注。来自流行病学的研究资料表明,近40%左右的恶性肿瘤的发生和发展与膳食因素有关,其中包括食管癌、胃癌、肝癌、肠癌、乳腺癌、膀胱癌和肺癌等;而在四十多种营养素中,可能影响癌症发生的包括脂肪、维生素、蛋白质、微量元素、膳食纤维等。膳食因素对癌症的影响是一把"双刃剑":既可能起到预防或延迟癌症发生与发展的"正"性作用,也可能起导致癌症发生或加速其恶化的"负"性作用。正负之间的转向取决于以下三个方面:饮食习惯;营养素摄入的多少以及营养素之间是否平衡。     

High prevalence of malnutrition and deranged relationship between energy demands and food intake in advanced non‐small cell lung cancer

The relation between dietary intake and metabolic profile in non‐small cell lung cancer (NSCLC) was evaluated. Patients with NSCLC were recruited and their caloric requirement and resting energy expenditure (REE) were calculated using the Harris–Benedict equation and Katch–McArdle formula respectively. Hypermetabolic state was defined as REE more than 10% above the basal metabolic rate (BMR). Body composition parameters were calculated by bioelectric impedance method. The 24‐h dietary intake method and Malnutrition Universal Screening Tool assessed nutritional intake. One hundred and forty‐eight subjects were included (87% males). Of these, 46.6% subjects were hypermetabolic and 31% cachexic, with lower calorie and protein intakes than recommended, although per cent of total energy derived from protein, fat and carbohydrates were similar. Hypermetabolic patients had lower BMI, though the per cent deficit in energy and protein consumption was similar. Cachexia was associated with lower BMR but not with deficit in energy or protein consumption. No correlation was seen between dietary intake and body composition parameters. The calorie and protein intake of NSCLC patients is lower than recommended. The discordance between elevated REE and dietary intake implies that the relationship between increased energy demands and food intake may be altered.     

A randomized trial of dietary intervention for breast cancer prevention

Epidemiologic data and animal experiments suggest that dietary fat may influence risk of breast cancer. To determine whether intervention with a low-fat, high-carbohydrate diet would reduce breast cancer incidence in women at increased risk of the disease, we carried out a randomized controlled trial in Canada. We recruited 4,690 women with extensive mammographic density and randomized them to an intervention group or a comparison group. The intervention group received intensive dietary counseling to reduce fat intake to a target of 15% of calories and increase carbohydrate to 65% of calories. Dietary intakes were assessed throughout using food records. Subjects were followed for at least 7 years and for an average of 10 years. The main outcome was invasive breast cancer. Percentage of calories from fat in the intervention group decreased from 30% at baseline to 20% after randomization and remained 9% to 10% lower than the comparison group throughout. There were 118 invasive breast cancers in the intervention group and 102 in the comparison group [adjusted hazard ratio = 1.19 (95% CI: 0.91-1.55)]. Analysis of food records showed that fat intake at baseline and after randomization was not associated with total breast cancer incidence. Greater weight and lower carbohydrate intake at baseline and after randomization were associated with an increased risk of estrogen receptor (ER)-positive breast cancer. Our findings suggest that a sustained reduction in dietary fat intake did not reduce risk of breast cancer in women with extensive mammographic density. Weight and carbohydrate intakes were associated with risk of ER-positive breast cancer.     

Adult dietary fat intake and ovarian cancer risk

The association of dietary fat intake with ovarian cancer risk has been inconsistent across populations. We examined dietary fat intake, overall and by type and ovarian cancer risk in two prospective cohort studies. We assessed long-term dietary fat intake among Nurses’ Health Study (NHS) and NHSII participants using food frequency questionnaires administered every 2–4 years beginning in 1984 and 1991, respectively. We examined cumulative energy-adjusted intake of total fat, specific types of fat (animal, vegetable, saturated, monounsaturated, polyunsaturated and trans fat) and cholesterol. We identified 700 ovarian cancer cases in NHS and 196 in NHSII with dietary information. Cox proportional hazards regression was used to estimate associations between intake and ovarian cancer risk. Dietary fat intake changed over time in both cohorts and was lower in NHS than NHSII. Higher cumulative average intakes of animal fat and cholesterol were significantly positively associated with risk of ovarian cancer in NHS (relative risk [RR] comparing extreme quartiles = 1.57, 95% CI: 1.20, 2.06 and 1.35, 95% CI: 1.08, 1.69, respectively), but not in NHSII. Other dietary fat sources were not clearly associated with risk in either population. We did not observe clear associations between dietary fat and ovarian cancer risk in two large prospective cohort studies.     

Associations of mammographic density with dietary factors in Japanese women.

BACKGROUND: A high percentage of mammographic dense area has been strongly associated with a risk of beast cancer. The present cross-sectional study evaluated the relations of percent density with dietary factors, such as fats, protein, dietary fiber, and soy isoflavones. METHODS: Study subjects were 601 (348 premenopausal and 253 postmenopausal) Japanese women who were recruited from a mammographic screening center. The size of the total breast area and the dense area were measured quantitatively using an automated mammographic mass detection method. Intakes of nutrients were estimated with a validated semiquantitative food-frequency questionnaire. RESULTS: The crude means of the percent density were 39.2% and 18.9% in premenopausal and postmenopausal women, respectively. There were no significant associations of any dietary factors with the percent density in premenopausal women. In postmenopausal women, percent density was significantly positively associated with intakes of protein, total fat, and saturated fat after controlling for covariates; the increase in the means of percent density were 7.2%, 5.6%, and 9.2% in the highest versus lowest quartile of intakes for protein, total fat, and saturated fat, respectively (P for linear trend were 0.006, 0.04, and 0.01, respectively). Carbohydrate intake was inversely associated with percent density; the mean of percent density was 6.0% lower in the highest versus the lowest quartile of intake (P(trend) = 0.03). The associations of dietary factors with dense area were very similar to those with percent density. CONCLUSION: These dietary factors may have implications for the risk of breast cancer in postmenopausal women.     

Diet and risk of colon cancer in a large prospective study of older women: an analysis stratified on family history (Iowa, United States)

Objective: The purpose was to investigate whether dietary associations with risk of colon cancer in women differ by family history of the disease.Methods: Data were analyzed from a prospective cohort study of 35,216 Iowa (United States) women aged 55 to 69 years at baseline. Through 31 December 1995, 241 colon cancers were identified through record linkage with the State Health Registry. The cohort was stratified on family history of colon cancer in first-degree relatives; nutrient intakes were divided into tertiles.Results: Analyses using Cox regression revealed that the association of most dietary components with colon cancer incidence were similar for individuals with and without a family history. However, total calcium intake was associated inversely with colon cancer among women with a negative family history (relative risk [RR]=0.50 for upper cf lower tertile, P < 0.001), but was unrelated to incidence for women with a positive family history (RR=1.1 for upper cf lower tertile, P=0.69). Similarly, total vitamin E intake was associated with lower risk among women with a negative family history (RR=0.67 for upper cf lower tertile, P=0.04), but not among women with a positive family history (RR=0.87 for upper cf lower tertile, P=0.67). High intakes of fiber, fruits, and vegetables were each weakly inversely associated with risk among family-history negative women, but not among family-history positive women.Conclusions: These data, if corroborated, suggest that dietary factors typically associated with lower risk may be less effective risk-reduction interventions against colon cancer for individuals with a family history of colon cancer.     

Healthy Plant Foods Intake Could Protect Against Prostate Cancer Risk: A Case-Control Study

Background: Several studies have investigated the association between healthy plant foods intake and prostate cancer risk with inconsistent results. So this study was conducted to examine the existence of any possible association between healthy plant foods and prostate cancer risk. Materials and Methods: Sixty newly diagnosed prostate cancer cases and 60 controls engaged in a hospital-based case-control study. A validated 16o-items semi-quantitative FFQ was used to assess usual dietary intakes. Energy-adjusted amounts of healthy plant foods intake were calculated using the residual method. Logistic regression model was also used to derive beta estimates and odds ratios. Results: Cases were older and more likely to be inactive. In crude model, individuals in the highest tertile vs lowest tertile of total healthy plant foods (OR= 0.12; 95 % CI 0.04, 0.34), total fruits (OR= 0.11; 95 % CI 0.04, 0.30), total vegetables (OR= 0.08; 95 % CI 0.03, 0.24), fresh fruits (OR= 0.11; 95 % CI 0.04, 0.30), and raw vegetables (OR= 0.06; 95 % CI 0.02, 0.18) had significantly lower risk of prostate cancer. After controlling for potential confounders (age, BMI, total energy intake, job, education, smoking, physical activity, some drug usage, and also dietary intakes), just total healthy plant foods (OR= 0.12; 95 % CI 0.02, 0.55), total vegetables (OR=0.03; 95 % CI 0.00, 0.25), and raw vegetables (OR= 0.01; 95 % CI 0.00, 0.12) were associated with lower prostate cancer risk. Conclusions: The results of this study suggest that a diet rich in healthy plant foods and especially total or raw vegetable may protect against prostate cancer.     

Dietary intake of selected fatty acids,cholesterol and carotenoids and estrogen receptor status in premenopausal breast cancer patients

Although a wealth of research has focused on the influence of diet on breast cancer risk, the relationships between dietary factors and tumor characteristics of breast cancer, like estrogen receptor (ER) status, are not well characterized. In a case-case study, we evaluated self-reported dietary intake for five individual carotenoids, selected fatty acids, and cholesterol 1 year before diagnosis in 34 premenopausal breast cancer patients with ER-negative tumors and 86 premenopausal breast cancer patients with ER-positive tumors from The University of Texas M. D. Anderson Cancer Center. In multivariate logistic regression analysis adjusted for age, body mass index, and ethnicity, high intakes of linoleic acid were associated with more than a threefold greater risk of ER-negative disease than ER-positive disease (odds ratio (OR) = 3.48, 95% confidence interval (CI) = 1.42–8.54), whereas high cholesterol intake was associated with lower risk of ER-negative disease (OR = 0.35, 95% CI = 0.14–0.92). In a model evaluating carotenoids, selected fatty acids, and cholesterol together, the association with high intake of linoleic acid remained statistically significant (OR = 3.96, 95% CI = 1.53–10.25), while those for high intake of cholesterol (OR = 0.38, 95% CI = 0.14–1.03) and low intake of cryptoxanthin (OR = 0.43, 95% CI = 0.17–1.06) were of marginal significance. While no striking associations were observed for the intakes of total carotenoids, selected fatty acids, and cholesterol, our analysis revealed an association for the consumption of a specific fatty acid (i.e., linoleic acid), suggesting dietary influence of this factor on ER status in premenopausal breast cancer patients. However, larger studies are needed to clarify the role of micronutrients in ER status in breast cancer.     

Intakes of plant foods, fibre and fat and risk of breast cancer--a prospective study in the Malmö Diet and Cancer cohort

The objective of this study was to investigate prospectively the associations between intakes of plant foods, fibre and relative fat and risk of breast cancer in a subsample of 11 726 postmenopausal women in the Malm? Diet and Cancer cohort. Data were obtained by an interview-based diet history method, a structured questionnaire, anthropometrical measurements and national and regional cancer registries. During 89 602 person-years of follow-up, 342 incident cases were documented. Cox regression analysis examined breast cancer risks adjusted for potential confounders. High fibre intakes were associated with a lower risk of postmenopausal breast cancer, incidence rate ratio=0.58, 95% CI: 0.40, 0.84, for the highest quintile of fibre intake compared to the lowest quintile. The combination high fibre-low fat had the lowest risk when examining the effect in each cell of cross-classified tertiles of fibre and fat intakes. An interaction (P=0.049) was found between fibre- and fat-tertiles. There was no significant association between breast cancer risk and intakes of any of the plant food subgroups. These findings support the hypothesis that a dietary pattern characterised by high fibre and low fat intakes is associated with a lower risk of postmenopausal breast cancer.     

Diet, alcohol, tobacco and risk of cancer of the pancreas: a case-control study

In view of the increased incidence of pancreatic cancer and the possible aetiological role of certain dietary factors, a retrospective epidemiological study was undertaken to investigate the roles of tobacco, alcohol, fat, protein and carbohydrate intakes. Sixty-nine patients with pancreatic adenocarcinoma, and 199 normal subjects were interviewed. Data were obtained on life time drinking, smoking and dietary habits. Conditional logistic regression models were used to analyse the relative risk variations. It was shown that the relative risk of cancer of the pancreas increases with fat and alcohol intakes, does not vary with protein intake, and decreases with carbohydrate intake and duration of alcohol consumption. Alcohol may be not directly involved in the aetiology of cancer of the pancreas: its effect could be due to the contents of some alcoholic beverages.     

A prospective study of whole grains, fruits, vegetables and colon cancer risk

OBJECTIVE: We examined the relation between whole grains, fruit, vegetables and dietary fiber and colon cancer risk in the prospective Cancer Prevention Study II Nutrition Cohort. METHODS: In 1992-1993, 62,609 men and 70,554 women completed questionnaires on medical history, diet and lifestyle behaviors. After exclusions, we confirmed 298 cases of incident colon cancer among men and 210 among women through August 31, 1997. RESULTS: Multivariate rate ratios (RR) and 95% confidence intervals (CI) for all dietary factors were null. However, a statistically non-significant 30% reduction in risk was observed for men with the highest vegetable intakes (RR = 0.69, CI = 0.47-1.03, top versus bottom quintile, p trend = 0.10). Men with very low (lowest tertile within the lowest quintile) intakes of vegetables and dietary fiber were at increased risk compared to those in the highest four quintiles of intake (vegetables RR = 1.79, CI = 1.22-2.61, p trend = 0.04, and fiber RR = 1.96, CI = 1.24-3.10, p trend = 0.006). Women with very low intakes of fruit were also at increased risk (RR = 1.86, CI = 1.18-2.94, p trend = 0.06). CONCLUSIONS: Higher intakes of plant foods or fiber were not related to lower risk of colon cancer. However, our data suggest that very low intakes of plant foods may increase risk, and that certain phytochemical subgroups may decrease risk.