HEALTH OF WOMAN. 2020.3(149): 15-22; doi 10.15574/HW.2020.149.15
Татарчук Т.Ф., Манжалий Э. Г., Поминчук Д. В., Шевчук Т. С.
МЦ «Verum Expert Clinic», г. Киев

В статье рассмотрена важность нутритивной поддержки для онкологических больных. Высокая частота недостаточности питания и нарушения процессов всасывания макро- и микронутриентов у онкологических пациентов, которые в своем максимальном проявлении приводят к синдрому анорексии-кахексии. Это является непосредственной причиной смерти пациента.
Прогрессирование опухолевого процесса всегда сопровождается нарушением нутритивного статуса, что проявляется в изменении массы тела, слабости, уменьшении физической активности, нарушениях со стороны пищеварительной системы. Считается, что около половины связанных с раком смертей можно предотвратить, многие из которых – благодаря диете и образу жизни. Диетические факторы могут участвовать в инициации роста опухоли (канцерогены) или обладать протективной активностью вследствие развития рака. Поэтому нутритивная поддержка – это одна из важных составляющих мультидисциплинарного подхода в лечении онкопатологии.
На основе проведенного анализа литературы для практического врача определены основные задачи нутритивной поддержки, показания к применению, методы и критерии эффективности лечебного питания. Также представлен краткий обзор диет, которые используются онкологическими пациентами, и составлен список антиканцерогенных продуктов.
Ключевые слова: антиканцерогенные продукты, диета, нутритивная поддержка, онкологический больной, профилактика рака, питание.

ЛИТЕРАТУРА

1. Ravdin, P. M., K. A. Cronin, N. Howlader, et al. «“The Decrease in Breast-Cancer Incidence in 2003 in the United States,” New England Journal of Medicine 356, no. 16 (2007): 1670-74. https://doi.org/10.1056/NEJMsr070105; PMid:17442911

2. Richard Bйliveau, Denis Gingras Foods That Fight Cancer: Preventing Cancer Through Diet (New York: Random House, 2006).

3. Fidler, I. J. “Angiogenic Heterogeneity: Regulation of Neoplastic Angiogenesis by the Organ Microenvironment,” Journal of the National Cancer Institute 93, no. 14 (2001): 1040-41. https://doi.org/10.1093/jnci/93.14.1040; PMid:11459857

4. Demeule, M., B. Annabi, J. Michaud-Levesque, et al. “Dietary Prevention of Cancer: Anticancer and Antiangiogenic Properties of Green Tea Polyphenols,” Medicinal Chemistry Reviews-Online 2 (2005): 49-58. https://doi.org/10.2174/1567203052997095

5. Joan Gandy. “Manual of dietetic practice” 2014 by The British Dietetic Association.

6. Alessandro Laviano, Luca Di Lazzaro and Angela Koverech “Nutrition support and clinical outcome in advanced cancer patients” 2018. https://doi.org/10.1017/S0029665118000459; PMid:30001763

7. Bozzetti, Federico. (2008). Bozzetti FScreening the nutritional status in oncology: a preliminary report on 1000 outpatients. SCRINIO Working Group. Support Care Cancer 17: 279-284. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 17. 279-84. https://doi.org/10.1007/s00520-008-0476-3; PMid:18581148.

8. R. Doll et all “The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today”Cancer Inst. 1981 Jun; 66(6): 1191–1308. https://doi.org/10.1023/B:CACO.0000016566.30377.4e; PMid:14970729

9. James R. Cerhan, Dawn M. Grabrick, Robert A. Vierkant, Carol A. Janney, Celine M. Vachon, Janet E. Olson, Larry H. Kushi, Thomas A. Sellers “Interaction of adolescent anthropometric characteristics and family history on breast cancer risk in a Historical Cohort Study of 426 families (USA)”. https://doi.org/10.1023/B:CACO.0000016566.30377.4e; PMid:14970729

Cancer Causes Control. 2004 Feb; 15(1): 1–9. doi: 10.1023/B:CACO.0000016566.30377.4e

10. Wiseman, Martin & Cannon, Geoffrey & Butrum, Ritva & Martin, Greg & Higginbotham, Susan & Heggie, Steven & Jones, Chris & Fletcher, Mark. (2007). Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Summary.

11. Cassileth, Barrie & Lusk, Edward & Guerry, DuPont & Blake, Alicia & Walsh, William & Kascius, Lauren & Schultz, Delray. (1991). Survival and Quality of Life among Patients Receiving Unproven as Compared with Conventional Cancer Therapy. The New England journal of medicine. 324. 1180-5. https://doi.org/10.1056/NEJM199104253241706; PMid:2011162.

12. Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D. Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer. 2004;90(2):408–413. https://doi.org/10.1038/sj.bjc.6601560; PMid:14735185 PMCid:PMC2410154

 13. Knoops, K. T. B., et al. “Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women—The HALE Project,” JAMA 292 (2004): 1433-39. https://doi.org/10.1001/jama.292.12.1433; PMid:15383513

 14. Oldways Trust Mediterranean Diet Foundation US, “Mediterranean Diet: The Scientific Evidence” (2009). (Accessed March 15, 2009, at http://www.oldwayspt.org/.)

 15. Sofi, F., “Adherence to Mediterranean Diet and Health Status: Meta-Analysis,” British Medical Journal (2008).

 16. Aggarwal, B. B., H. Ichikawa, P. Garodia, et al. “From Traditional Ayurvedic Medicine to Modern Medicine: Identification of Therapeutic Targets for Suppression of Inflammation and Cancer,” Expert Opinion on Therapeutic Targets 10, no. 1 (2006): 87-118. https://doi.org/10.1517/14728222.10.1.87; PMid:16441231

 17. Ferlay, J., F. Bray, P. Piesci, et al., eds., WHO International Agency for Research on Cancer (IARC), IARC Cancer Epidemiology Database, Globocan 2000, Cancer Incidence, Mortality and Prevalence Worldwide (Lyon, France: IARC Press, 2000).

 18. Doris Lippmann, Carsten Lehmann, Simone Florian, Gitte Barknowitz, Michael Haack, Inga Mewis, Melanie Wiesner, Monika Schreiner, Hansruedi Glatt, Regina Brigelius-Flohй, et al. “Glucosinolates from pak choi and broccoli induce enzymes and inhibit inflammation and colon cancer differently”.Food Funct. 2014 Jun; 5(6): 1073–1081. Published online 2014 Apr 9. https://doi.org/10.1039/C3FO60676G; PMid:24714741

19. Adriana Conzatti, Fernanda Carolina Telles da Silva Frуes, Ingrid Dalira Schweigert Perry, Carolina Guerini de Souza. “Clinical and molecular evidence of the consumption of broccoli, glucoraphanin and sulforaphane in humans.” Nutr Hosp. 2015; 31(2): 559–569. Published online 2014 Nov 30. doi: 10.3305/nh.2015.31.2.7685

20. Canene-Adams, K., et al., “Combinations of Tomato and Broccoli Enhance Antitumor Activity in Dunning r3327-h Prostate Adenocarcinomas,” Cancer Research 67, no. 2 (2007): 836-43. https://doi.org/10.1158/0008-5472.CAN-06-3462; PMid:17213256

21. Baglietto, L., et al. “Does Dietary Folate Intake Modify Effect of Alcohol Consumption on Breast Cancer Risk? Prospective Cohort Study,” BMJ 331, no. 7520 (2005): 80. https://doi.org/10.1136/bmj.38551.446470.06; PMid:16087654 PMCid:PMC1246078

22. Thorand, B., et al. “Intake of Fruits, Vegetables, Folic Acid and Related Nutrients and Risk of Breast Cancer in Postmenopausal Women,” Public Health Nutrition 1, no. 3 (1998): 147-56. https://doi.org/10.1079/PHN19980024; PMid:10933412

23. Tjonneland, A., et al., “Folate Intake, Alcohol and Risk of Breast Cancer Among Postmenopausal Women in Denmark,” European Journal of Clinical Nutrition, 60, no. 2 (2006): 280-86. https://doi.org/10.1038/sj.ejcn.1602313; PMid:16234832

24. Lajous M., Lazcano–Ponce E., Hernandez–Avila M., et al. Folate, vitamin B(6), and vitamin B(12) intake and the risk of breast cancer among Mexican women. // Cancer Epidemiol Biomarkers Prev. – 2006; Mar;15(3): – P. 443–448. https://doi.org/10.1158/1055-9965.EPI-05-0532; PMid:16537699

25. Seeram, N., L. Adams, Y. Zhang, et al. “Blackberry, Black Raspberry, Blueberry, Cranberry, Red Raspberry, and Strawberry Extracts Inhibit Growth and Stimulate Apoptosis of Human Cancer Cells in Vitro,” Journal of Agricultural and Food Chemistry 54 (2006): 9329-39. https://doi.org/10.1021/jf061750g; PMid:17147415

26. Labrecque, L., S. Lamy, A. Chapus, et al. “Combined Inhibition of PDGF and VEGF Receptors by Ellagic Acid, a Dietary-Derived Phenolic Compound,” Carcinogenesis 26, no. 4 (2005): 821-26. https://doi.org/10.1093/carcin/bgi024; PMid:15661805

27. Mei-Ling Tsai, Ching-Shu Lai, Yen-Hui Chang, Wei-Jen Chen, Chi-Tang Ho, Min-Hsiung Pan. “Pterostilbene, a natural analogue of resveratrol, potently inhibits 7,12-dimethylbenz[a]anthracene (DMBA)/12-O-tetradecanoylphorbol-13-acetate (TPA)-induced mouse skin carcinogenesis” Food Funct. 2012 Nov; 3(11): 1185–1194. https://doi.org/10.1039/c2fo30105a; PMid:22842666

28. Lamy, S., et al. “The Dietary Flavonols Apigenin and Luteolin Inhibit PDGF-Dependent Vascular Smooth Muscle Cell Migration,” Cancer Research , in submission.

29. Khaw, K.-T., et al. “Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study,” PLoS Medicine 5, no. 1 (2008): e12. https://doi.org/10.1371/journal.pmed.0050012; PMid:18184033 PMCid:PMC2174962

30. Hsing, A. W., A. P. Chokkalingam, Y.-T. Gao, et al. “Allium Vegetable and Risk of Prostate Cancer: A Population-Based Study,” Journal of the National Cancer Institute 94, no. 21 (2002): 1648 51. https://doi.org/10.1093/jnci/94.21.1648; PMid:12419792;

Thomson, M., and M. Ali, “Garlic [Allium sativum]: A Review of Its Potential Use as an Anti-Cancer Agent.” Current Cancer Drug Targets 3, no. 15 (2003): 67-81. https://doi.org/10.2174/1568009033333736; PMid:12570662

 31. Owen, R. W., Haubner, R., Wurtele, G., Hull, E., Spiegelhalder, B., Bartsch, H. “Olives and Olive Oil in Cancer Prevention,” European Journal of Cancer Prevention 13 (2004): 319-26. https://doi.org/10.1097/01.cej.0000130221.19480.7e; PMid:15554560

 32. Martin-Moreno, J. M., et al. “Dietary Fat, Olive Oil Intake and Breast Cancer Risk,” International Journal of Cancer 58, no. 6 (1994): 774-80. https://doi.org/10.1002/ijc.2910580604; PMid:7927867

 33. Stoneham, M., et al. “Olive Oil, Diet and Colorectal Cancer: An Ecological Study and a Hypothesis,” Journal of Epidemiology & Community Health 54, no. 10 (2000): 756-60. https://doi.org/10.1136/jech.54.10.756; PMid:10990479 PMCid:PMC1731571

 34. Lipworth, L., et al. “Olive Oil and Human Cancer: An Assessment of the Evidence,” Preventive Medicine 26, no. 2 (1997): 181-90. https://doi.org/10.1006/pmed.1996.9977; PMid:9085386

 35. Menendez, J. A., et al. “Oleic Acid, the Main Monounsaturated Fatty Acid of Olive Oil, Suppresses Her-2/neu (erbB-2) Expression and Synergistically Enhances the Growth Inhibitory Effects of Trastuzumab (Herceptin) in Breast Cancer Cells with Her-2/neu Oncogene Amplification,” Annals of Oncology 16, no. 3 (2005): 359-71. https://doi.org/10.1093/annonc/mdi090; PMid:15642702

 36. Menendez, J. A., et al. “Analyzing Effects of Extra-Virgin Olive Oil Polyphenols on Breast Cancer-Associated Fatty Acid Synthase Protein Expression Using Reverse-Phase Protein Microarrays,” International Journal of Molecular Medicine 22, no. 4 (2008): 433-39. https://doi.org/10.3892/ijmm_00000039

37. Onuma, Kunishige, et al. “Fermented Brown Rice and Rice Bran with Aspergillus oryzae (FBRA) Prevents Inflammation-Related Carcinogenesis in Mice, through Inhibition of Inflammatory Cell Infiltration.” Nutrients vol. 7,12 10237-50. 8 Dec. 2015, https://doi.org/10.3390/nu7125531; PMid:26670250 PMCid:PMC4690083

38. Wollowski, I., G. Rechkemmer, and B. L. Pool-Zobel. “Protective Role of Probiotics and Prebiotics in Colon Cancer,” American Journal of Clinical Nutrition 73, no. 2 (2001): 451S-55. https://doi.org/10.1093/ajcn/73.2.451s; PMid:11157356

39.Norat, T., S. Bingham, P. Ferrari, et al. “Meat, Fish, and Colorectal Cancer Risk: The European Prospective Investigation into Cancer and Nutrition,” Journal of the National Cancer Institute 97, no. 12 (2005): 906-16. https://doi.org/10.1093/jnci/dji164; PMid:15956652 PMCid:PMC1913932

40. Hedelin, M. “Association of Frequent Consumption of Fatty Fish with Prostate Cancer Risk Is Modified by COX-2 Polymorphism,” Internation Journal of Cancer 120, no. 2 (2006): 398-405. https://doi.org/10.1002/ijc.22319; PMid:17066444

 41. Terry, P., A. Wolk, H. Vainio, et al. “Fatty Fish Consumption Lowers the Risk of Endometrial Cancer: A Nationwide Case-Control Study in Sweden,” Cancer Epidemiology, Biomarkers & Prevention 11, no. 1 (2002): 143-45. https://doi.org/10.1207/S15327914NC421_4; PMid:12235647

 42. Terry, P., P. Lichtenstein, M. Feychting, et al. “Fatty Fish Consumption and Risk of Prostate Cancer,” Lancet 357, no. 9270 (2001): 1764-66. https://doi.org/10.1016/S0140-6736(00)04889-3

43. Ma, Jia-Yi et al. “Increased expression and possible role of chitinase 3-like-1 in a colitis-associated carcinoma model.” World journal of gastroenterology vol. 20,42 (2014): 15736-44. https://doi.org/10.3748/wjg.v20.i42.15736; PMid:25400457 PMCid:PMC4229538.

44. Zhang, M., et al. “Dietary Intakes of Mushrooms and Green Tea Combine to Reduce the Risk of Breast Cancer in Chinese Women,” International Journal of Cancer 15 (2009): 1404-8. https://doi.org/10.1002/ijc.24047; PMid:19048616

45. Mehta, K., P. Pantazis, T. McQueen, et al. “Antiproliferative Effect of Curcumin (Diferuloylmethane) Against Human Breast Tumor Cell Lines,” Anti-Cancer Drugs 8, no. 5 (1997): 470-81. https://doi.org/10.1097/00001813-199706000-00010; PMid:9215611

 46. Aggarwal, B. B., S. Shishodia, Y. Takada, et al. “Curcumin Suppresses the Paclitaxel-Induced Nuclear Factor-kappaB Pathway in Breast Cancer Cells and Inhibits Lung Metastasis of Human Breast Cancer in Nude Mice,” Clinical Cancer Research 11, no. 20 (2005): 7490-98. https://doi.org/10.1158/1078-0432.CCR-05-1192; PMid:16243823

 47. Carter, A. “Curry Compound Fights Cancer in the Clinic,” Journal of the National Cancer Institute (2008). p. djn141. https://doi.org/10.1093/jnci/djn141; PMid:18445813

48. Cheng, A. L., C. H. Hsu, J. K. Lin, et al. “Phase I Clinical Trial of Curcumin, a Chemopreventive Agent, in Patients with High-Risk or Pre-malignant Lesions,” Anticancer Research 21, no. 4B (2001): 2895-900.

49. Shoba, G., D. Joy, T. Joseph, et al. “Influence of Piperine on the Pharmacokinet ics of Curcumin in Animals and Human Volunteers.” Planta Medica 64, no. 4 (1998): 353-56. https://doi.org/10.1055/s-2006-957450; PMid:9619120

 50. Gao, X., D. Deeb, H. Jiang, et al. “Curcumin Differentially Sensitizes Malignant Glioma Cells to TRAIL/Apo2L-Mediated Apoptosis Through Activation of Pro caspases and Release of Cytochrome c from Mitochondria,” Journal of Experimental Therapeutics & Oncology 5, no. 1 (2005): 39-48.

 51. Maruyama, H., H. Tamauchi, M. Hashimoto, et al. “Antitumor Activity and Immune Response of Mekabu Fucoidan Extracted from Sporophyll of Undaria pinnatifida, ” Vivo 17, no. 3 (2003): 245-49.

 52. Shimizu, J. “Proportion of Murine Cytotoxic T Cells Is Increased by High Molecular-Weight Fucoidan Extracted from Okinawa Mozuku (Cladosiphon okamuranus ),” Journal of Health Sciences 51 (2005): 394-97. https://doi.org/10.1248/jhs.51.394

 53. Toshiya Kuno, Yuichiro Hatano, Hiroyuki Tomita, Akira Hara, Yoshinobu Hirose, Akihiro Hirata, Hideki Mori, Masaru Terasaki, Sonoko Masuda, Takuji Tanaka. “Organomagnesium suppresses inflammation-associated colon carcinogenesis in male Crj: CD-1 mice.” Carcinogenesis. 2013 Feb; 34(2): 361–369. Published online 2012 Nov 3. https://doi.org/10.1093/carcin/bgs348; PMid:23125223

54. Lappe, J. M., K. Travers-Gustafson, K. M. Davies, “Vitamin D and Calcium Supplementation Reduces Cancer Risk: Results of a Randomized Trial,” American Journal of Clinical Nutrition 85 (2007): 1586-91. https://doi.org/10.1093/ajcn/85.6.1586; PMid:17556697

55. Woo, T. C. S., et al. “Pilot Study: Potential Role of Vitamin D (Cholecalciferol) in Patients with PSA Relapse After Definitive Therapy,” Nutrition & Cancer 51, no. 1 (2005): 32-36. https://doi.org/10.1207/s15327914nc5101_5; PMid:15749627

56. Cannell, J. J. and B. W. Hollis. “Use of Vitamin D in Clinical Practice,” Alternative Medicine Review, 13 (2003).