Nutritional assessment of selected patients with cancer

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Background. It is recognised that both nutritional status and an improper diet have significant effects on weakening the RXWFRPHVRIWUHDWPHQWLQFDQFHUSDWLHQWV$VDUHVXOWDORZHUHGUHVSRQVHWRWKHUDS\DQGDQLQFUHDVHLQXQWRZDUGVLGHHIIHFWV is often observed leading to a deteriorating quality of life. The role of an adequately balanced diet is thus regarded as being vital in supporting recovery.

Objective. 7RDVVHVVWKHGLHWDU\FRQVXPSWLRQRIFDORULHVPDFURHOHPHQWVDQGVHOHFWHGYLWDPLQVDQGPLQHUDOVIRUVXEMHFWV GLDJQRVHGZLWKFDQFHUVRIWKHEUHDVWOXQJVDQGERQHVRUVRIWWLVVXH

Material and Methods. $VXUYH\ZDVSHUIRUPHGRQVXEMHFWVGLDJQRVHGZLWKYDULRXVWXPRXUVEHWZHHQWKH6HSWHPEHU DQG'HFHPEHUPRQWKVRIFRQVLVWLQJRIZLWKEUHDVWFDQFHUOXQJFDQFHUDQGZLWKERQHRUVRIWWLVVXHFDQFHU 7KHTXHVWLRQQDLUHZDVGHYLVHGLQKRXVHZKLFKLQFOXGHGDWKUHHGD\GLHWDU\UHFRUG Results. 7KHDYHUDJHGDLO\FDORULILFLQWDNHZDVIRXQGWREHLQDGHTXDWHDWNFDO,QDGGLWLRQDEQRUPDOSURSRUWLRQVRI HQHUJ\GHULYHGIURPPDFURHOHPHQWVZDVVHHQZKHUHWKHFRQWULEXWLRQVPDGHE\IDWVDQGSURWHLQVZHUHVRPHZKDWKLJK DWUHVSHFWLYHO\DQGEXWWRRORZLQWKHFDVHRIFDUERK\GUDWHVDW8SWRVXEMHFWVKDGLQVXIILFLHQW SURWHLQLQWDNHVVKRZHGGHILFLHQFLHVLQFRQVXPLQJFDUERK\GUDWHVDVZHUHIRUILEUHYLWDPLQ&FDOFLXP PDJQHVLXPDQGIRULURQ

Conclusions. Many dietary shortcomings were observed in the studied subjects. There is therefore a need to educate per-sons suffering from cancer to adopt an adequate and balanced diet as means of providing vital support for treatment to be more effective. Key words:FDQFHUQXWULWLRQDODVVHVVPHQW 675(6=&=(1,( :SURZDG]HQLH1LHSUDZLGáRZ\VSRVyEĪ\ZLHQLDRUD]VWDQRGĪ\ZLHQLDRVyE]FKRUREąQRZRWZRURZąZSá\ZDQDVáDEV]ą RGSRZLHGĨQDOHF]HQLHSU]HFLZQRZRWZRURZHPRĪHQDVLODüMHJRREMDZ\XERF]QHRUD]ZSá\ZDüQDMDNRĞüĪ\FLD3UDZLGáRZR ]ELODQVRZDQDGLHWDSHáQLZVSRPDJDMąFąUROĊZSRZURFLHGR]GURZLD

Cel pracy. &HOHPEDGDĔE\áDRFHQDVSRĪ\FLDHQHUJLLPDNURVNáDGQLNyZRUD]Z\EUDQ\FKZLWDPLQLVNáDGQLNyZPLQHUDOQ\FK XRVyE]GLDJQR]RZDQąFKRUREąQRZRWZRURZąSLHUVLSáXFRUD]NRĞFLLWNDQHNPLĊNNLFK 0DWHULDáLPHWRG\%DGDQLHSU]HSURZDG]RQRZRNUHVLHRGZU]HĞQLDGRJUXGQLDURNX%DGDQąJUXSĊVWDQRZLáR RVyE]H]GLDJQR]RZDQąFKRUREąQRZRWZRURZąRVRE\]QRZRWZRUHPSLHUVLRVRE\]QRZRWZRUHPSáXFLRVRE\ ]QRZRWZRUHPNRĞFLLWNDQHNPLĊNNLFK%DGDQLDSU]HSURZDG]RQRSU]\XĪ\FLXDXWRUVNLHMDQNLHW\RUD]PHWRG\GQLRZHJR ELHĪąFHJRQRWRZDQLD :\QLNL6SRĪ\FLHHQHUJLLSU]H]RVRE\]FKRUREąQRZRWZRURZąE\áRQLHZ\VWDUF]DMąFHLĞUHGQLRZ\QRVLáRNFDOG]LHĔ 3URFHQWRZ\XG]LDáSRV]F]HJyOQ\FKPDNURVNáDGQLNyZZGRVWDUF]DQLXHQHUJLLE\áQLHSUDZLGáRZ\ZSU]\SDGNXWáXV]F]X LELDáNDE\á]E\WZ\VRNLRGSRZLHGQLRRUD]DZSU]\SDGNXZĊJORZRGDQyZ]E\WQLVNL$Ī EDGDQ\FKQLHUHDOL]RZDáRQRUP\QDELDáNRZSU]\SDGNXZĊJORZRGDQyZZDUWRĞüWDZ\QRVLáDDGODEáRQQLND 6SRĪ\FLHZLWDPLQ\&E\áR]E\WQLVNLHXEDGDQ\FKZDSQLDXPDJQH]XXDĪHOD]DXEDGDQ\FK :QLRVNL:RFHQLDQ\FKUDFMDFKSRNDUPRZ\FKSDFMHQWyZREVHUZRZDQROLF]QHQLHSUDZLGáRZRĞFL,VWQLHMHSRWU]HED edukacji RVyE]FKRUREąQRZRWZRURZąZ]DNUHVLH]DVDGSUDZLGáRZHJRĪ\ZLHQLDL]QDF]HQLDELODQVRZDQLDGLHW\ 6áRZDNOXF]RZHFKRUREDQRZRWZRURZDVSRVyEĪ\ZLHQLD

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(SLGHPLRORJLFDOVWXGLHVGHPRQVWUDWHWKDWDIWHUFDU-GLRYDVFXODUGLVHDVHFDQFHULVWKHVHFRQGPRVWFRPPRQ disease contributing to mortality rates in Poland. This has constituted a serious problem for the elderly but QRZPRUHZRUU\LQJO\IRUWKRVHDJHGXQGHU\HDUV 0RUWDOLW\UDWHVVKRZWKDWLQGHDWKVIURPFDQFHU DPRXQWHGWRPDOHVDQGIHPDOHV>@$VKDV EHHQ ZHOO UHFRJQLVHG IRU PDQ\ \HDUV WKH FDXVHV RI malignant tumours are many and varied. It is estimated WKDW  ±  RI VXFK WXPRXUV DULVH IURP DFTXLULQJ negative lifestyle behaviours that include smoking ci-JDUHWWHVLQDSSURSULDWHGLHWUHGXFHGSK\VLFDODFWLYLW\ viral infection or long-term exposure to harmful factors IURPWKHHQYLURQPHQWDODQGRUZRUNSODFH>@ $WWKHSUHVHQWWLPHVRPHFDQFHUVFDQEHVXFFHVV-IXOO\WUHDWHGKRZHYHULQ3RODQGWKLVDPRXQWVWREDUHO\ FRPSDUHGWRUDWHVLQ:HVWHUQ(XURSHDQG WKH86$(VVHQWLDOO\FRQWHPSRUDU\PHGLFLQHRIIHUV W\SHVRIWUHDWPHQWVXUJLFDOLQWHUYHQWLRQFKHPRWKHUDS\ UDGLRWKHUDS\DQGLPPXQRWKHUDS\>@

Most cancer patients suffer from inadequate nu-trition when the condition is diagnosed. One of the GHILQLQJV\PSWRPVRIGHYHORSLQJPDOLJQDQWWXPRXUV IUHTXHQWO\REVHUYHGLVDORVVRIERG\PDVV'HSHQGLQJ RQWKHW\SHRIWXPRXULWVORFDWLRQDQGVWDJHRIGHYHORS- PHQWWKHERG\PDVVORVVLQFDQFHUSDWLHQWVUDQJHVEH-WZHHQ$FFRPSDQ\LQJV\PSWRPVDUHRIWHQ VHHQZKLFKLQFOXGHERG\ZDVWLQJWKHFDQFHUDQRUH[LD-FDFKH[LDV\QGURPHDQDYHUVLRQWRHDWGLVWXUEDQFHVLQ ERG\PDVVFRPSRVLWLRQDQGDQDEQRUPDOPHWDEROLVP FRXSOHGZLWKDV\VWHPLFLQIODPPDWRU\UHVSRQVH,QGHHG the aforementioned syndrome is regarded as being one of the main factors that cause death in such cases. The abnormal nutritional status found in cancer patients is both a consequence of disease development as well as WKHUDSHXWLFLQWHUYHQWLRQVVRDGPLQLVWHUHGWKXVOHDGLQJ to a weaker response when anti-cancer treatment is XVHGPRUHXQWRZDUGVLGHHIIHFWVGXULQJWKHUDS\DQG a deteriorating quality of life that includes depression DQGGHFUHDVHGSK\VLFDODFWLYLW\>@

To gain a further understanding of how the nutritional FRPSRQHQWFDQDIIHFWFDQFHUWUHDWPHQWWKHVWXG\DLPLV to assess nutrition in patients suffering from this disease.

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Study was conducted from September to December  RQ  KRVSLWDOLVHG SDWLHQW VXEMHFWV GLDJQRVHG with cancer which were divided into 3 groups according WRW\SH7DEOH7KHVHFRQVLVWHGRISDWLHQWVZLWK EUHDVWFDQFHUZLWKOXQJFDQFHUDQGZLWKERQHDQG Table 1. Characteristic of subjects

Factor

Subjects

p***

Total type of cancer

breast lung bone and soft tissue

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Nutritional assessment of patients with cancer  Nr 3 VRIWWLVVXHFDQFHU*HQHUDOLQIRUPDWLRQRQJHQGHUDJH KHLJKWZHLJKWSODFHRIUHVLGHQFHDQGOHYHORIHGXFDWLRQ ZHUHREWDLQHGE\TXHVWLRQQDLUH7KH%RG\0DVV,QGH[ in kg/m%0,ZDVWKXVFDOFXODWHG7KHSDWLHQWVZHUH DOVRJUDGHGDFFRUGLQJWR%0,JURXSLQJVXVLQJSURSRVHG :+2UHFRPPHQGDWLRQV$%0,ZDVWDNHQDV XQGHUZHLJKW±DVQRUPDODQG!DVRYHU-ZHLJKW>@([SHQGLWXUHVRIFDORULHVPDFURHOHPHQWV and selected vitamins and minerals were obtained on WKH GD\ RI SDWLHQW DGPLVVLRQ WR KRVSLWDO DV SDUW RI continuing treatment using a 3 day current reporting procedure. In order to determine food portion sizes and PHQXV FRQVXPHG D FXVWRP PDGH SKRWRJUDSK DOEXP RIIRRGVWXIIVDQGGLVKHV>@ZDVSURYLGHGIRUSDWLHQWV so that appropriate selections could be made. The data so obtained was assessed by a computer programme

WDLORUHGIRUWKLVSXUSRVH>@µ)RRGVWXIIFRPSRVLWLRQ and nutritional value’ from which individual estimates could be made for each of the aforementioned factors. Results were adjusted for technical and cooking (heat WUHDWPHQWORVVHV>@7KHERG\¶VGDLO\FDORULILFUHTX-irement was set at 35 kcal/kg body weight from which WKHSURSRUWLRQVRIHQHUJ\REWDLQHGIURPSURWHLQIDWDQG FDUERK\GUDWHZHUHWDNHQDVDQG>@ The levels had been established as being the nutritional UHTXLUHPHQWVIRUQRUPDOKHDOWK\SHUVRQV>@WDNLQJ LQWRDFFRXQWLQGLYLGXDOSDWLHQW¶V5'$5HFRPPHQGHG 'DLO\$OORZDQFHDQGLQWKHFDVHRIYLWDPLQVDQGPLQH-rals the AI (Adequate Intake). These were used because of the large risk of nutritional deficiencies occurring in cancer patients and also due to recommendations FRQFHUQLQJILEUHDQGFKROHVWHUROLQWDNH>@

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Intake

Subjects

total type of cancer

p*

breast lung bone and soft tissue

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recommendation Q     NS Carbohydrate >JGD\@ “ 76.1 - 389.1  “a 76.1 - 333.5 181.8 “ab 91.1 - 389.1  “b 138.9 - 351.3   ** Carbohydrate intake below norm

Q     NS Fibre >JGD\@ “  15.7 “  15.1 “  17.1 “  15.7 NS Fibre intake below

recommendation Q

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Energy intake 

Subjects

total type of cancer

p*

breast lung bone and soft tissue

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Nutritional assessment of patients with cancer 

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sive anti-cancer therapy may both cause and deepen malnutrition but paradoxically lead to increased body weight. However patients suffering from cancer univer-sally demonstrate a loss in body weight which is linked with a poor response to therapy and increased mortality risk. Such patients demonstrate both a loss of body fat DQGPXVFOH>@$VWXG\E\$PDUDOHWDO>@VKRZHG FDQFHUSDWLHQWVWREHXQGHUZHLJKWZLWKD FRUUHFWZHLJKWDQGWREHRYHUZHLJKWRUREHVH 7KRVH XQGHUZHLJKW RQFRORJ\ SDWLHQWV PD\ EH HLWKHU due to the development of disease or a side-effect of WKHUDSHXWLFWUHDWPHQWLHFKHPRWKHUDS\UDGLRWKHUDS\RU surgical intervention. Patients undergoing general treat-PHQWH[KLELWV\PSWRPVRIQDXVHDYRPLWLQJGLDUUKRHD FRQVWLSDWLRQ DSSHWLWH ORVV DQ DYHUVLRQ WR SDUWLFXODU IRRGVWXIIVRHVRSKDJHDOLQIODPPDWLRQDQGG\VSKDJLD

Patients also suffer from chronic stress and depression. It is not surprising that these symptoms may therefore lead to an insufficient dietary intake of calories and nu-trients. .DZDLHWDO>@GHPRQVWUDWHGWKDWDORZ%0,LQ women with breast cancer is positively correlated with PRUWDOLW\ULVNLQFRQWUDVWWRVXFKZRPHQWKDWKDYHD QRUPDO%0,$VWXG\E\.XEUDNHWDO>@REVHUYHGWKDW WKHGHFUHDVHRI%0,LQSDWLHQWVZLWKFDQFHUVLQWKHKHDG and neck was due the radiotherapy and chemotherapy treatment as well as increased CRP levels thus reflecting progressing states of inflammation and/or acute phase UHVSRQVH7KHGHFUHDVHLQ%0,FRXSOHGZLWKPDOQXWUL-tion has been shown by 6DQFKH]/DUDHWDO>@LQOXQJ cancer patients to be associated with decreased levels RI+54/+HDOWK5HODWHG4XDOLW\RI/LIHZKLFKLVDQ independent prognostic indicator of lung cancer. 7DEOH 'DLO\LQWDNHRIVHOHFWHGYLWDPLQV

Intake

Subjects

total type of cancer

p*

breast lung bone and soft tissue

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An excess of body weight in cancer patients may EHWKHUHVXOWRIGHFUHDVHGSK\VLFDODFWLYLW\DGLHWRYHU-ULFKLQFDORULHVFKDQJHVLQPHWDEROLVPDQGHQGRFULQH function together with the effects of treatment. A very commonly seen side-effect of treating breast cancer is LQFUHDVHGERG\ZHLJKWIRULQVWDQFHZKHQFRPELQDWLRQ WKHUDS\LVDGRSWHG$KLJK%0,DWWKHWLPHRIGLDJQRVLQJ EUHDVWFDQFHUDVZHOODVWKHLQFUHDVHLQERG\PDVVGX-ring treatment are positively correlated with a worsening SURJQRVLVDQGPRUWDOLW\ULVN)XUWKHUPRUHWKHUHLVDQ increasing amount of evidence demonstrating the link EHWZHHQUHFXUUHQFHRIEUHDVWFDQFHUZLWKRYHUZHLJKW> @&RPSDUHGWRZRPHQZLWKD%0,LQFUHDVH WKRVHLQZKRPWKH%0,URVHE\%0,XQLWVKDG DJUHDWHUFKDQFHRIUHFXUUHQFHZKLFKLQFUHDVHG WRLQWKRVHVKRZLQJULVHVDERYH%0,XQLWV>@ A prospective USA study by &DOOH HW DO >@ VKRZHG an increase in mortality risk due to cancer linked with body mass. The relationship between an excess dietary intake of calories and cancer has been extensively de-monstrated in many animal models studied (eg. rats and PLFHZKHUHLQFUHDVLQJHQHUJ\FRQVXPSWLRQLVWKRXJKW to stimulate the development of breast tumours. A study by 3KRHQL[HWDO>@VXJJHVWVWKDWKLJKFDORULHGLHWV can promote tumour development and the expression

of the pro-inflammatory adipokinins leptin and resistin. However the link between a diet containing too many calories and the incidence of cancer is as yet not fully understood. It is suggested that leptin protein derived from fat tissue may exert a carcinogenic effect through stimulating angiogenesis and tumour cell proliferation. A diet with lowered calories may however decrease WKHERG\¶VOHSWLQOHYHOV>@$QRWKHUFDUFLQRJHQLF factor is high levels of blood glucose for which it is FRQVLGHUHGWKDWWXPRXUVUHTXLUHKLJKJOXFRVHFRQFHQ-WUDWLRQVIRUWKHLUSUROLIHUDWLRQ>@$VWXG\E\:D\QH et DO>@GHPRQVWUDWHGDGDLO\FDORULILFFRQVXPSWLRQRI NFDODVWXG\E\+HEHUWHWDONFDOGD\>@ and %HDVOH\HWDO>@VKRZHGDUDQJHEHWZHHQWR NFDOGD\GHSHQGLQJRQWKHVXEJURXSLQYHVWLJDWHG /XQJFDQFHUSDWLHQWVVKRZHGYDOXHVRINFDOGD\ according to %DXHUHWDO>@ 5HGXFLQJWKHDPRXQWRIGLHWDU\IDWLVWKRXJKWQRW RQO\WRLQFUHDVHPRUWDOLW\EXWDOVRGHFUHDVHWKHULVNRI cancers recurring. Animal studies have shown increases in tumour mass when the proportion of dietary fat is also LQFUHDVHGWKDWFRQVWLWXWHVDERYHRIWKHFDORULILF YDOXHRIDJLYHQGLHW>@$µ:RPHQ¶V,QWHUYHQWLRQ1XWUL-tion Study’ indicated that those women limiting dietary IDWEHORZDOHYHOWKDWVXSSOLHVRIDGLHWVFDORULHV Table 5. Daily intake of selected minerals

Intake

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total type of cancer

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breast lung bone and soft tissue

Q  Q  Q  Q  Calcium >PJGD\@ “1  3 “   “   “   NS &DOFLXPLQWDNHEHORZQRUPQ     NS Potassium >PJGD\@ “   “   “   “   NS 3RWDVVLXPLQWDNHEHORZQRUPQ     NS Magnesium >PJGD\@ “   “   “   “   NS Magnesium intake below norm n

     NS Copper >PJGD\@ “   “   “   “   NS &RSSHULQWDNHEHORZQRUP     NS Iron >PJGD\@ “  8.6 8.8 ± 3.1  8.9 “  8.5 “  8.6 NS ,URQLQWDNHEHORZQRUPQ     NS Zinc >PJGD\@ “  7.7 “  7.5 “  7.8 “ 5.1 - 15.5 7.6 NS =LQFLQWDNHEHORZQRUPQ     NS

1_{PHDQ“VWDQGDUGGHYLDWLRQ}_UDQJH3_{PHGLDQ YDOXHIRU$129$ test or FKL}2_{WHVW GLIIHUHQFHVVWDWLVWLFDOO\VLJQL¿FDQWS”PDUNHG}

Nutritional assessment of patients with cancer 

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results in the risk of recurring tumours being reduced by ,WLVVXJJHVWHGWKDWWKLVHIIHFWPLJKWEHKLJKHULQ ZRPHQWKDWODFNRHVWURJHQUHFHSWRUV>@7RJHWKHUZLWK RWKHUDXWKRUVWKHSUHVHQWHGVWXG\VKRZVWKDWZRPHQ with breast cancer consume too many dietary calories derived from fat as demonstrated by :D\QHHWDO>@

%HDVOH\HWDO>@DQG+HEHUWDHWDO>@ZLWKUHVSHFWLYH

OHYHOVRIDQG$QREVHUYDWLRQDOVR made on these breast cancer women showed a link be-tween a diet rich in saturated and trans-saturated fat with DGHFUHDVHLQPRUWDOLW\ZKHUHDFDORULILFGLHWDU\ OHYHOGHULYHGIURPVDWXUDWHGIDWVGHPRQVWUDWHGD LQFUHDVHLQPRUWDOLW\ULVNRYHUWKRVHZLWKOHYHOVRI )XUWKHUPRUHLQWKLVVDPHVWXG\ZRPHQZKRFRQVXPHG WZLFHPRUHHQHUJ\GHULYHGIURPWUDQVIDWVKDGD higher risk of mortality than women consuming half less >@,WLVLPSRUWDQWWKDWDQDSSURSULDWHUDWLRRIGLHWDU\

RPHJD6 to RPHJD-3 fats be observed. Some current

studies suggest that the RPHJD-3 fats may beneficially effect persons suffering from cancer. They not only act as anti-inflammatories and immune function modulators but they apparently inhibit tumour growth and angioge-QHVLVDPHOLRUDWHFDFKH[LDLPSURYHWKHTXDOLW\RIOLIH DQGHQKDQFHWKHHIIHFWVRIWUHDWPHQW>@

An adequate protein intake is vital during treatment as well as afterwards. The adaptive mechanism that enables protein metabolism to slowly rise together with the protection afforded against breakdown of non-fat ERG\PDVVVHHQLQIDVWLQJVXEMHFWVLVDEVHQWLQFDQFHU SDWLHQWV WKXV OHDGLQJ WR SURWHLQ UHVHUYHV EHFRPLQJ depleted and in some cases to muscular atrophy. The current study showed that protein intake in those suffe-ring from breast and lung cancer were slightly less than IRXQGLQRWKHUVWXGLHV>@,WZDVDOVRREVHUYHGWKDW the cancer patients consumed somewhat lowered levels RIFDUERK\GUDWHZKLFKZDVVLPLODUO\VHHQLQDVWXG\E\

:D\QHHWDO>@7KH%HDVOH\ et al. study demonstrated

that the proportion of dietary energy derived from carbo-K\GUDWHVLQZRPHQZLWKFDQFHUZDV+RZHYHU the +HEHUWHWDOVWXG\>@UHYHDOHGDQHYHQVPDOOHU FRQVXPSWLRQDW±JGD\7KHPDLQVRXUFHRI GLHWDU\FDUERK\GUDWHVVKRXOGEHYHJHWDEOHVIUXLWDQG ZKROHJUDLQSURGXFWVWKDWDUHULFKLQQXWULHQWVSK\WR-chemicals and fibre. It is found that these components can all reduce the risk of developing cancer and halt LWVSURJUHVVLRQ>@/RZILEUHLQWDNHVKDYHKRZHYHU EHHQQRWHGLQWKLVDQGRWKHUVWXGLHV±JGD\

+HEHUWHWDO>@LQEUHDVWFDQFHUSDWLHQWVDQGJ

GD\LQWKRVHZLWKOXQJFDQFHU%DXHUHWDO>@'LHWDU\ ILEUH LV NQRZQ WR VXSSRUW JDVWURLQWHVWLQDO IXQFWLRQ decreases blood cholesterol some authors claim that it can also reduce the risk of developing certain tumours. This paper also indicates a deficiency of vitamin C consumption in the cancer patients. Study by 1LVVHQ et DO>@DQG6DTXLEHWDO>@JDYHGDLO\LQWDNHVRI

PJDQGPJ7KHYLWDPLQ$OHYHOVIRXQGDJUHHG with a study by /DQJH and 3\]DOVND>@KRZHYHUERWK ZHUHOHVVWKDQWKRVHUHFRUGHGLQRWKHUZRUNV>@,Q DOOVWXG\JURXSVYLWDPLQ(FRQVXPSWLRQZHUHFORVH to recommended values as well as to the results obta-ined by 1LVVDQHWDO>@DQG6DTXLEHWDO>@ZKHUH women with breast cancer daily consumed respectively PJDQGPJ

It is the authors suggestion that women suffering from breast cancer who consume larger amounts of ȕFDURWHQHDQGYLWDPLQ&KDYHGHFUHDVHGPRUWDOLW\ULVN compared to those with lower intakes of these vitamins. Many authors recognise that an adequate consumption RIWKHDQWLR[LGDQWYLWDPLQVVXFKDV$&RU(PD\EH beneficial to persons suffering from cancer. Each of these 3 vitamins protect DNA against oxidative damage and strengthen the immune system. Vitamins A and E VWLPXODWHVXSSUHVVRUJHQHVGHUHJXODWHRQFRJHQHVDQG inhibit tumour angiogenesis. Retinol regulates cellular GLIIHUHQWLDWLRQDQGVWLPXODWHVDSRSWRVLVWKHUHE\LWFDQ halt carcinogenesis. Experiments have demonstrated WKDWĮWRFRSKHUROLQKLELWVWKHQLWURVDWLRQRIDPLQHVERWK

LQYLYR and LQYLWUR in a fat soluble environment (just

OLNHYLWDPLQ&GRHVXQGHUZDWHUVROXEOHFRQGLWLRQV it inhibits the development of skin cancer induced by UV radiation and it inhibits tumour growth induced E\ SRO\F\FOLF DURPDWLF K\GURFDUERQV ,Q DGGLWLRQ LW is considered that vitamin E can potentiate selenium LQKLELWLRQRIFDUFLQRJHQHVLV>@

7KHFXUUHQWVWXG\IXUWKHUPRUHDOVRVKRZVWKDWLQ-takes of calcium and magnesium in all 3 study groups ZHUHLQVXIILFLHQW/LNHZLVHVLPLODUGHILFLHQFLHVZHUH also observed by 6DTXLEHWDO>@,WLVFRQVLGHUHGWKDW high intakes of these minerals can afford protection against breast and large bowel cancer whilst conver-VHO\ORZGLHWDU\LQWDNHVDUHOLQNHGZLWKDQLQFUHDVHG risk of morality due to breast cancer. Intakes of copper in the presented study are in line with recommended YDOXHVKRZHYHUWKH6DTXLEHWDOVWXG\>@QRWHGD twice higher intake of this trace element. Copper forms part of the superoxide dismutase complex which takes part in the first line of defence against cancer develop-PHQWE\DPRQJVWRWKHUWKLQJVIDFLOLWDWLQJWKHUHDFWLRQ between free oxygen radicals and various ‘mopping up’ biological compounds. Dietary iron intakes were found to be inadequate especially for women with EUHDVWFDQFHUKRZHYHU6DTXLEHWDO>@VKRZHGWKDW their subject women with breast cancer had adequate LQWDNHV,WLVVHHQWKDWKLJKLURQFRQVXPSWLRQOHDGLQJ WRKLJKIUHHLURQLQWKHERG\PD\SRWHQWLDWHWKHHIIHFW RI RHVWUDGLRO HWKDQRO DQG LRQLVLQJ UDGLDWLRQ  ZKLFK are 3 independent factors that cause breast cancer. In FRQWUDVW GHILFLHQFLHV LQ LURQ LQWDNH FDQ FRPSURPLVH immune function and increase the risk of upper dige-stive tract tumours occurring. The 6DTXLE et al. study

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>@UHSRUWHGWKDWPJ]LQFZDVFRQVXPHGGDLO\E\ breast cancer patients. It is considered that zinc intakes in cancer patients is important as it also forms part of the antioxidant superoxide dismutase complex. Zinc deficiencies can lead to decreased immune function and low blood levels are linked to increase risks for GHYHORSLQJWXPRXUVRIWKHEUHDVWOXQJEODGGHUEXFFDO FDYLW\DQGRYDULHV>@

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1. The intake of dietary calories was found to be ina-GHTXDWHLQDOOSDWLHQWJURXSVLHWKRVHZLWKFDQFHU RI WKH EUHDVW OXQJ DQG ERQHV RU VRIW WLVVXH 7KH proportions of energy derived from dietary fat and SURWHLQZHUHVRPHZKDWUDLVHGZKHUHDVIRUFDUER-hydrates this was low. Subjects with breast cancer derived significantly more calories from dietary protein compared to those with cancers of the lung and bones or soft tissue.

7KHJUHDWHVWGLIILFXOWLHVWKDWVXEMHFWVVKRZHGZHUH LQNHHSLQJWRGLHWDU\LQWDNHJXLGHOLQHVIRUSURWHLQ FDUERK\GUDWHV ILEUH9LWDPLQ & FDOFLXP PDJQH-sium and iron.

3. Due to the increased mortality of patients suffering IURPPDOLJQDQWFDQFHUVLWLVLPSRUWDQWWKDWQXWULWLRQ is monitored and that such further studies are con-ducted.

Conflict of interest

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