Développement professionnel continu Nutrition et cancer : pourquoi intervenir avant 5 % de perte de poids ? Nutrition and cancer: Why take care of before 5% weight loss?

The prevalence of malnutrition is high in cancer and is on average around 40%. These data are obtained with the usual criteria that refer in particular to a weight loss of 10% or more. However, if we consider that a patient with a 5% weight loss is already at nutritional risk, the prevalence of protein-energy malnutrition is above 55%. Finally, only 15% of cancer patients have not lost any weight. The analysis of medical literature suggests that in medical oncology, a weight loss of 5% is associated with an alteration of the patient’s prognosis (increased morbidity and mortality). Many studies show that, during radiotherapy and chemo-radiotherapy, dietetic counselling, associated or not with the use of oral nutritional supplements, can improve the prognosis of patients. During chemotherapy, data are less convincing but most studies have proposed insufficient support in already malnourished patients and more studies are needed. During radio-chemotherapy for cancers of the upper aerodigestive tract, prophylactic placement of a gastrostomy, before any nutritional intervention, is associated with a better prognosis for the patient and is recommended. In surgery, the nutritional preoperative load is recommended in malnourished and non-malnourished patients before major surgery and early postoperative oral or enteral nutrition is associated with a reduction in infectious complications and mortality. © 2015 Elsevier Masson SAS. All rights reserved.