NUTRICIÓN Y METABOLISMO EN EL PACIENTE ONCOLÓGICO

  • Patricia Savino Lloreda Academia Nacional de Medicina de Colombia
Palabras clave: cancer, estado nutricional, terapia médica nutricional, tumor, caquexia, fortificación, nutrición entérica, nutrición parenteral

Resumen

El cáncer afecta seriamente el estado nutricional del paciente. La pérdida de peso, y principalmente de masa libre de grasa, puede ser de gran magnitud, como sucede cuando afecta órganos sólidos. Asimismo, se producen anormalidades metabólicas que impiden la adecuada utilización de los nutrientes, por lo cual es necesario ajustar, en forma individual, el plan de alimentación. Los efectos secundarios generados por los medicamentos anticancerosos dificultan aún más una alimentación adecuada. Un pobre estado nutricional limita el tratamiento, sea de quimioterapia o de radioterapia, pues aumenta la intolerancia, lo cual impide la administración de las dosis usuales o su aumento en magnitud o frecuencia. También el estado de desnutrición significa un mayor reconocido riesgo cuando se emprende un tratamiento quirúrgico. La implementación del tratamiento médico nutricional (evaluación, diagnóstico, intervención, vigilancia y seguimiento) es fundamental para el manejo multimodal que requieren estos pacientes. La selección del tipo de soporte nutricional debe ser personalizada y su principal objetivo también debe estar encaminado a mejorar la calidad de vida. En muchos casos la fortificación de los alimentos, especialmente con proteína de alto valor biológico, logra mejorar el estado nutricional. Cuando esta no es suficiente, o sea aquella que cubre menos del 60% del requisito proteico-calórico diario, se deben considerar alternativas, como la nutrición entérica por sonda o la parenteral suplementaria. Cuando el pronóstico de supervivencia es mayor de tres meses o cuando la localización del tumor o las alteraciones gastrointestinales impiden el empleo de la vía entérica, se sugiere la nutrición parenteral total, la cual, idealmente, debería ser ambulatoria. Hoy en día se considera que la nutrición y el ejercicio son factores fundamentales en el manejo de estos pacientes, y que no hay bases para considerar que alimentar al individuo es alimentar el tumor.

Biografía del autor/a

Patricia Savino Lloreda, Academia Nacional de Medicina de Colombia
ND, MBA. Miembro Asociado Academia Nacional de Medicina, Bogotá, D.C. Colombia

Citas

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Publicado
2018-06-29
Sección
Artículos de Revisión