1. Introduction
tumor, primary tumors, muscle atrophy, fatigue, Malnutrition, cancer, non-melanoma skin cancer, sarcopenia, inflammation, gastrointestinal tract, cancer deaths, Sarcopenia, cancer cachexia, reduced skeletal muscle mass, impaired muscle function, Cancer
TUMOR, PRIMARY TUMORS, MUSCLE ATROPHY, MALNUTRITION, CANCER, INFLAMMATION, SARCOPENIA, FRAGILITY, SARCOPENIA, CANCER
(1) Background: Malnutrition frequently affects patients with cancer, and it negatively impacts treatment tolerance, clinical outcomes and survival. Thus, appropriate nutritional screening and early nutrition support are extremely recommended. Currently, a significant number of oral supplements (OS) are commercially available; despite this, there is a lack of evidence for recommending specific OS, including leucine-enriched OS, for nutritional support in patients with cancer. (2) Aim: To compare the clinical evolution of patients with cancer (undergoing systemic treatment) that received standard hypercaloric, whey protein-based hyperproteic oral supplements vs. hypercaloric, hyperproteic leucine-enriched OS using a novel morphofunctional nutritional evaluation. (3) Patients and methods: This paper details an open-label, controlled clinical study in which patients were randomly assigned to receive nutritional treatment with whey protein-based hyperproteic oral supplements (control group) vs. hypercaloric, hyperproteic leucine-enriched OS (intervention group) during a twelve-week period. Forty-six patients were included; epidemiological, clinical, anthropometric, ultrasound (muscle echography of the rectus femoris muscle of the quadriceps and abdominal adipose tissue) and biochemical evaluation were performed. All patients received additional supplementation with vitamin D. (4) Results: Nutritional parameters (including bioimpedance, anthropometric, ultrasound and biochemical variables) of all included patients remained stable after the nutritional intervention. Extracellular mass tended to increase in the patients that received the leucine-enriched formula. Functionality (evaluated through the stand-up test) improved in both groups (Cancer is one of the main causes of morbidity and the second cause of mortality worldwide. It is estimated that in 2040, there will be 28.4 million cancer cases globally. According to a recent report, 19.3 million new cancer cases were reported in 2020 worldwide; among them, 18.1 million excluded non-melanoma skin cancer, and around 10.0 million cancer deaths were reported [Malnutrition and sarcopenia are frequent in patients with cancer; it occurs in 30–90% of patients, especially if it affects the gastrointestinal tract [Sarcopenia implies fatigue and decreased muscle strength due to reduced skeletal muscle mass, which is accompanied by muscle atrophy and a decreased quality of muscle tissue. Specifically, the muscle fibers are replaced by fibrotic tissue, which results in increased fragility and impaired muscle function [Recent studies suggested that tumor-derived inflammation and the resulting systemic inflammation are closely related to sarcopenia and cancer cachexia. Specifically, tumor cells release cytokines, inflammatory mediators and activated immune cells [Currently, there is no standardized treatment protocol for sarcopenia and cancer cachexia in patients undergoing systemic treatment. In most patients, it is necessary to increase energy intake; this increase alone does not correct sarcopenia and cancer cachexia due to several reasons including the inflammatory status of the patient. In this context, and when the digestive tract is functioning, the use of oral supplements (OS) is necessary. Currently, several formulas are available, but the evidence favoring one over the other is still lacking; in this context, specific strategies for nutritional supplementation should be explored, including leucine. This is a branched-chain amino acid (BCAA) that exerts downstream effects on muscle protein synthesis and promotes muscle protein anabolism [The European Society for Parenteral and Enteral Nutrition (ESPEN) recommends a protein intake of 1.0–1.5 g/kg/day in cancer patients [In this context, the aim of this study is to compare the clinical evolution of patients with cancer when receiving oral nutritional supplementation with standard hypercaloric, hyperproteic (whey protein-based) OS versus hypercaloric, hyperproteic leucine-enriched oral supplements during a twelve-week period. Patients presented with primary tumors in different locations and were receiving systemic treatment (with chemotherapy, radiotherapy or a combination of both).