Malnutrition in patients with gastrointestinal malignancy. Significance and management

Malnutrition is a common accompaniment of gastrointestinal malignancy. The etiology of such malnutrition is multifactorial, but, when present, is a poor prognostic sign. Simple causes of decreased intake such as obstruction are readily overcome by distal enteral or parenteral feeding. Metabolic abnormalities that limit the efficacy of parenteral nutrition in such patients have been identified and, although not uniform, give further insight into the manner in which the host and the tumor partition energy and substrate. Widespread use of adjunctive parenteral nutrition in patients undergoing chemotherapy or radiation therapy for gastrointestinal malignancy has not improved tolerance or efficacy of such treatment. Nutritional support of the malnourished patient with a gastrointestinal cancer, prior to a major operation, has been shown to decrease perioperative morbidity and mortality.