2016年7月16日，營(yíng)養(yǎng)飲食學(xué)會(huì)官方期刊《營(yíng)養(yǎng)飲食學(xué)會(huì)雜志》在線發(fā)表阿巴拉契亞州立大學(xué)、瑪麗·格里利醫(yī)學(xué)中心、墨西哥總醫(yī)院（墨西哥城綜合醫(yī)院）、戴爾兒童血液與癌癥中心、營(yíng)養(yǎng)飲食學(xué)會(huì)起草的《成人腫瘤循證營(yíng)養(yǎng)實(shí)踐指南》，全文共61頁(yè)。

　　2012年，成立于1917年的美國(guó)營(yíng)養(yǎng)師協(xié)會(huì)（American Dietitian Association，ADA）正式更名為營(yíng)養(yǎng)飲食學(xué)會(huì)（Academy of Nutrition and Dietetics）, 新名稱的縮寫為：A.N.D.（請(qǐng)記得在字母之間加點(diǎn)，而不要寫成：AND）。官方網(wǎng)站地址仍為：www.eatright.org

　　該學(xué)會(huì)下屬的飲食教育認(rèn)證委員會(huì)（Commission on Accreditation for Dietetics Education，CADE）是營(yíng)養(yǎng)專業(yè)教育項(xiàng)目的認(rèn)證機(jī)構(gòu)，主要負(fù)責(zé)注冊(cè)營(yíng)養(yǎng)師（Registered Dietitian，RD）和注冊(cè)飲食技師（Dietetic Technician Registered，DTR）的認(rèn)證。2011年更名為營(yíng)養(yǎng)飲食教育認(rèn)證委員會(huì)（Accreditation Council for Education in Nutrition and Dietetics，ACEND），主要負(fù)責(zé)注冊(cè)飲食營(yíng)養(yǎng)師（Registered Dietitian Nutritionist，RDN）和注冊(cè)營(yíng)養(yǎng)飲食技師（Nutrition and Dietetic Technician Registered，NDTR）的認(rèn)證。該委員會(huì)受美國(guó)教育部認(rèn)可，且是專業(yè)與職業(yè)認(rèn)證委員會(huì)的一員，凡通過(guò)該機(jī)構(gòu)認(rèn)證的營(yíng)養(yǎng)學(xué)項(xiàng)目均為正規(guī)項(xiàng)目。

　　此外，美國(guó)還有：成立于1959年的美國(guó)營(yíng)養(yǎng)學(xué)院（American College of Nutrition，ACN），2005年由美國(guó)臨床營(yíng)養(yǎng)學(xué)會(huì)（American Society for Clinical Nutrition）美國(guó)營(yíng)養(yǎng)科學(xué)學(xué)會(huì)（American Society for Nutritional Sciences）國(guó)際營(yíng)養(yǎng)學(xué)會(huì)（Society for International Nutrition）合并而成的美國(guó)營(yíng)養(yǎng)學(xué)會(huì)（American Society for Nutrition，ASN），成立于1975年的美國(guó)腸外腸內(nèi)營(yíng)養(yǎng)學(xué)會(huì)（American Society for Parenteral and Enteral Nutrition，ASPEN），需要注意區(qū)別。

　　癌癥是用于描述一組100多種多因素疾病的術(shù)語(yǔ)，其中的異常細(xì)胞不受控制地增殖，而且能夠轉(zhuǎn)移到機(jī)體其他部位并侵襲健康組織【1】。癌癥死亡數(shù)量自20世紀(jì)90年代逐漸下降，癌癥幸存者數(shù)量上升【2】。據(jù)美國(guó)國(guó)家癌癥研究所（NCI）估計(jì)，2016年將有168.521萬(wàn)例新診斷病例和59.569萬(wàn)例死亡。基因和環(huán)境之間復(fù)雜的相互作用促進(jìn)了癌癥的發(fā)生【3】。盡管營(yíng)養(yǎng)狀況影響癌癥的許多具體途徑仍不清楚【4】，但是人們已認(rèn)識(shí)到營(yíng)養(yǎng)在癌癥預(yù)防和治療中起重要作用【4-8】。

　　2007年，營(yíng)養(yǎng)飲食學(xué)會(huì)在證據(jù)分析庫(kù)（EAL）上發(fā)布了針對(duì)特定類型癌癥及其治療的營(yíng)養(yǎng)干預(yù)相關(guān)指南建議。2010年，新的證據(jù)分析工作組建立，對(duì)原指南進(jìn)行補(bǔ)充，2013年11月發(fā)布于EAL。當(dāng)前的指南主要關(guān)注成人腫瘤患者廣泛的腫瘤營(yíng)養(yǎng)實(shí)踐。雖然這些建議是為注冊(cè)飲食營(yíng)養(yǎng)師（RDN）而寫，但是其他人可能發(fā)現(xiàn)有幫助。

　　由工作組制定的指南，首先根據(jù)EAL相關(guān)系統(tǒng)回顧作出建議，然后概述本學(xué)會(huì)以外組織的指南作出的建議【9-11】。后者被列入以進(jìn)一步拓展循證建議的范圍。最后，對(duì)基于共識(shí)建議的簡(jiǎn)要回顧，將進(jìn)一步指導(dǎo)在該領(lǐng)域中營(yíng)養(yǎng)研究較少或研究難以闡明的RDN。

　　結(jié)論聲明和建議的制定

　　整個(gè)項(xiàng)目遵循本學(xué)會(huì)的5步系統(tǒng)回顧流程【12】。腫瘤工作組主要針對(duì)成人腫瘤營(yíng)養(yǎng)有足夠營(yíng)養(yǎng)狀況和營(yíng)養(yǎng)干預(yù)相關(guān)證據(jù)的4個(gè)領(lǐng)域：

• 營(yíng)養(yǎng)不良篩查和營(yíng)養(yǎng)評(píng)定工具的有效性；

• 營(yíng)養(yǎng)狀況與發(fā)病率和死亡率的相關(guān)性；

• 醫(yī)學(xué)營(yíng)養(yǎng)療法（MNT）對(duì)化療（CT）和放療（RT）患者的影響【13】；

• 癌癥惡病質(zhì)、包含魚油（特別是二十碳五烯酸[EPA]）的醫(yī)學(xué)食品補(bǔ)充劑（MFS）和飲食補(bǔ)充劑對(duì)體重和瘦體重（LBM）的影響。

參考文獻(xiàn)（一）

1. National Cancer Institute. What is cancer? http://www./cancertopics/cancerlibrary/what-is-cancer. Updated February 9, 2015. Accessed February 15, 2016.

2. National Cancer Institute. Cancer statistics. http://www./about-cancer/what-is-cancer/statistics. Updated March 14, 2016. Accessed June 13, 2016.

3. American Cancer Society. Genes in cancer. http://www./cancer/cancercauses/geneticsandcancer/genesandcancer/genes-and-cancer-gene-changes. Reviewed June 25, 2014. Accessed February 15, 2016.

4. National Cancer Institute. Nutrition in cancer care-health professional version (PDQ): Overview. http://www./cancertopics/pdq/supportivecare/nutrition/HealthProfessional. Updated January 8, 2016. Accessed February 15, 2016.

5. Reeves, GK, Pirie, K, Beral, V, Green, J, Spencer, E, Bull, D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: Cohort study. BMJ. 2007;335:1134.

6. Lelièvre, SA, Weaver, CM. Global nutrition research: Nutrition and breast cancer prevention as a model. Nutr Rev. 2013;71:742-752.

7. Key, TJ, Allen, NE, Spencer, EA, Travis, RC. The effect of diet on risk of cancer. Lancet. 2002;360:861-868.

8. Key, T. Cancer prevention and treatment. World Rev Nutr Diet. 2014;111:123-129.

9. American Society of Parenteral and Enteral Nutrition. Clinical guidelines. http://www./Guidelines_and_Clinical_Resources/Clinical_Guidelines/. Accessed February 15, 2016.

10. Clinical Oncological Society of Australia, Cancer Council Australia. Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. http://wiki..au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines/Introduction. Accessed February 15, 2016.

11. Oncology Nursing Society. PEP rating system overview. https://www./practice-resources/pep. Accessed February 15, 2016.

12. Handu, D, Moloney, L, Wolfram, T, Ziegler, P, Acosta, A, Steiber, A. Academy of Nutrition and Dietetics methodology for conducting systematic reviews for the Evidence Analysis Library. J Acad Nutr Diet. 2016;116:311-318.

13. Definition of terms list. Academy of Nutrition and Dietetics. Definition and Terms Workgroup and the Quality Management Committee. January 2016. http://www./~/media/eatrightpro%20files/practice/patient%20care/scope%20of%20practice/definition_of_terms_policy.ashx Accessed May 9, 2016.

翻譯：肖慧娟（天津市第三中心醫(yī)院）

相關(guān)閱讀

• 腫瘤患者特殊醫(yī)學(xué)用途配方食品應(yīng)用專家共識(shí)
  

• 口服營(yíng)養(yǎng)補(bǔ)充指南
  

• 腫瘤惡液質(zhì)營(yíng)養(yǎng)療法指南
  

• 肌肉減少癥營(yíng)養(yǎng)療法指南
  

• 食管癌放療患者腸內(nèi)營(yíng)養(yǎng)專家共識(shí)
  

• 肺癌營(yíng)養(yǎng)指南
  

J Acad Nutr Diet. 2016 Jul 16. [Epub ahead of print]

Oncology Evidence-Based Nutrition Practice Guideline for Adults.

Thompson KL, Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T.

Appalachian State University, Boone, NC; Mary Greeley Medical Center, Ames, IA; Hospital General de México, Mexico City, Mexico; Dell Children's Blood and Cancer Center, Austin, TX; Palm Bay, FL; Academy of Nutrition and Dietetics, St Petersburg, FL.

Cancer is a term used to describe a group of more than 100 multifactorial diseases in which abnormal cells reproduce in an uncontrolled manner and are able to spread to other parts of the body and invade healthy tissues.【1】Numbers of cancer-related deaths have fallen steadily since the 1990s, and the number of cancer survivors has increased.【2】The National Cancer Institute has estimated that 1,685,210 new cases will be diagnosed and 595,690 deaths will occur in 2016.2 Cancers develop from complex interactions between genes and the environment.【3】Although many of the specific pathways by which nutritional status can impact cancer remain poorly understood,【4】it is well recognized that nutrition plays important roles in cancer prevention and treatment.【4-8】

In 2007, the Academy of Nutrition and Dietetics (Academy) published guideline recommendations on the Evidence Analysis Library (EAL) related to nutrition interventions for specific types of cancer and cancer treatments. In 2010, a new evidence analysis workgroup was formed to supplement the original guideline, which was subsequently published on the EAL during November 2013. The current guideline focuses on comprehensive oncology nutrition practice for the care of adult patients with cancer. Although the recommendations are written for registered dietitian nutritionists (RDNs), others may find them helpful.

The guideline developed by the workgroup will be reviewed, beginning with the recommendations that are based on the related EAL systematic review, followed by a brief review of recommendations based on organization guidelines outside of the Academy.【9-11】The latter were included to further expand the scope of the evidence-based recommendations. Finally, a brief review of the consensus-based recommendations will be provided to further guide the RDN, where there is less nutrition research or the research is difficult to elucidate.

Development of Conclusion Statements and Recommendations

The Academy's 5-step systematic review process【12】was followed throughout the project. The Oncology Workgroup chose to principally target four areas of oncology nutrition in adults where there was an adequate pool of evidence related to nutritional status and nutrition interventions:

• validity of malnutrition screening and nutrition assessment tools;

• the association among nutritional status and morbidity and mortality outcomes;

• the effect of medical nutrition therapy (MNT)【13】on patients undergoing chemotherapy (CT) and radiation treatment (RT); and

• cancer cachexia and the effect of dietary supplements and medical food supplements (MFS) containing fish oil (specifically eicosapentaenoic acid [EPA]), on body weight and lean body mass (LBM).

PMID: 27436529

PII: S2212-2672(16)30265-9

DOI: 10.1016/j.jand.2016.05.010