Nutrition Guidelines for Patients with Blood Cancers

Introduction to Nutrition Guidelines

• The American College of Nutrition and the American Cancer Society recommend a plant-based diet high in vegetables, fruits, and whole grains, while limiting saturated fats, red meats, and alcohol to improve treatment outcomes, quality of life, and overall survival for patients with blood cancers 1, 2, 3

Dietary Recommendations

• Patients with blood cancers should consume 25-30 kcal/kg/day of energy needs 3
• The recommended protein intake is 1.0-1.5 g/kg/day to maintain muscle mass 3
• The macronutrient distribution should be 45-65% carbohydrates, 20-35% fat, and 15-20% protein, emphasizing complex carbohydrates, healthy fats, and moderate protein intake 2
• Patients should consume 5-9 servings of fruits and vegetables daily, emphasizing those rich in antioxidants 1, 2, 4
• Whole grains should be the foundation of carbohydrate intake 1, 2
• Low-fat protein sources like fish, lean poultry, eggs, low-fat dairy, nuts, seeds, and legumes should be chosen 2, 4
• Sources of omega-3 fatty acids like fish and walnuts should be prioritized, and saturated fats should be limited 2
• Red and processed meats should be limited to 1-2 times/week maximum 1, 4
• Refined grains, sugary foods, and alcohol should be limited 1, 2

Lifestyle Recommendations

• Patients with blood cancers should maintain a healthy weight, with a BMI between 18.5-25 kg/m² 1, 3
• A plant-based diet pattern high in vegetables, fruits, and whole grains should be continued 1, 2
• Regular physical activity, at least 30 minutes of moderate-intensity activity 5 days/week, should be engaged in 1, 2, 3
• Weight should be monitored regularly to avoid excessive weight gain 1

Nutritional Interventions

• Nutritional interventions should be considered in context of prognosis, expected benefit on quality of life, and potential survival impact 3
• For patients with good prognosis, adequate intake of energy and protein should be ensured 3
• For patients with limited prognosis, focus should be on comfort and psychosocial support rather than aggressive nutritional intervention 3
• The American Society for Nutrition and the European Society for Clinical Nutrition and Metabolism recommend a caloric intake of 35-40 kcal/kg/day and a protein intake of 1.1-1.5 g/kg/day to promote weight gain in cancer patients, with a focus on high-quality protein sources, calorie-dense foods, and a macronutrient distribution of 50-55% complex carbohydrates, 30-35% fats, and 15-20% protein 3

Supplement Recommendations

• Vitamins and minerals should be provided in amounts approximately equal to the recommended daily allowance 3
• High-dose micronutrient supplementation should be avoided unless specific deficiencies are identified 3
• Daily multivitamin supplementation and monitoring of vitamin B12, iron, vitamin D, and calcium levels should be considered 3, 5, 6, 7

Fluid and Electrolyte Management

• Cancer patients should consume 2-2.5 liters of fluids per day, increasing during hot weather or exercise, with a focus on maintaining adequate hydration and electrolyte balance 3, 8, 6
• An oral rehydration solution should be used for high ileostomy output (>1 liter/day), consisting of:
• Patients should aim to maintain urinary sodium levels above 20 mmol/L to detect dehydration, and consider adding 0.5-1 teaspoon of extra salt daily to meals to supplement sodium, and increase potassium intake with foods like bananas, potatoes, spinach, fish, chicken, lean red meat, sweet potatoes, and avocados if serum levels are low 7, 6

Weight Management and Physical Activity

• Cancer survivors should strive to maintain a healthy weight to reduce risk of recurrence and comorbidities 1, 2
• Dietary changes should be combined with regular physical activity for optimal outcomes 1, 2, 3
• For patients with insulin resistance, the ratio of fat to carbohydrate energy may need to be adjusted to reduce glycemic load 3

Care Team and Screening

• Regular nutritional screening and assessment should be conducted throughout the cancer journey 3
• A registered dietitian should be involved as part of the multidisciplinary care team 4
• The Academy of Nutrition and Dietetics recommends avoiding restrictive diets that limit energy intake in patients at risk of malnutrition, and prolonged fasting during chemotherapy, as it can increase the risk of malnutrition, with a strength of evidence rated as high 1
• Patients with ileostomy should consume 60-80 g/day or 1.1-1.5 g/kg of ideal body weight of protein, prioritizing protein-rich foods, and follow a dietary progression from clear liquids to solid foods postoperatively, with regular evaluation of overall nutritional status, detection of recent weight loss, and monitoring of electrolyte levels 5, 9, 6
• Implement an educational program on fluid balance after discharge to reduce readmission rates for dehydration, and consider taking 1-2 tablets (2-4 mg) of loperamide 30 minutes before meals to reduce intestinal transit, and chew food well and be cautious with foods like fruit and vegetable skins, sweet corn, celery, and nuts (smooth nut butters are acceptable) 6
• The American College of Nutrition and the European Society for Clinical Nutrition and Metabolism recommend incorporating oral nutritional supplements (ONS) between meals to increase caloric and protein intake, with a focus on high-quality protein sources and calorie-dense foods, and suggest that intensive dietary counseling and oral supplements can prevent weight loss during radiotherapy and chemotherapy, with a strength of evidence rated as high 3, 10