Information about research into the causes, prevention and treatments of diet problems including drug therapy, food supplements and screening for malnutrition.
Researching diet problems
New treatment research
All new treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that:
- we can be sure they work
- we can be sure they work better than the treatments that are available at the moment
- they are known to be safe
Treatments are developed and tested in laboratories before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.
Tests in patients are called clinical trials.
The trials and research section has information about what trials are, including information about the 4 phases of trials.
If you are interested in taking part in a clinical trial take the information to your doctor and if it is suitable they will need to make the referral to the research team.
Research into diet problems
There is ongoing research into new approaches to diet problems and cancer.
Until studies are completed and new treatments are found to work, these treatments cannot be used to treat diet problems in people with cancer.
Over the past 20 years scientists have developed better drugs to help control sickness. However a lot of research in nutrition and cancer has been into preventing cancer through diet. There hasn’t been much research into controlling cachexia, although this is now changing.
One new trial is looking for biochemical markers in the blood that will help identify people who are likely to develop cachexia. Early treatment might then help prevent it.
Drug therapy: drugs that block cytokines
Scientists already know that natural chemicals made by cancers called cytokines are involved in causing weight loss and cachexia. This has led to research into finding drugs to help block cytokines. This research is still in very early stages of development.
Thalidomide is being used in clinical trials to help people with cachexia. This drug was responsible for birth defects in the late 1950s and early 1960s and so got a bad name. However it is only dangerous if taken in pregnancy. It seems to work in cachexia by interfering with certain cytokines. Early trial results suggest that thalidomide improves appetite and helps control sickness in people with cachexia. But there is not enough information to recommend it as a treatment at the moment.
Drug therapy: drugs that improve appetite
These drugs are called appetite stimulants and are mainly used for people with cachexia. They help some people but not others. The two most commonly used appetite stimulants are Megesterol acetate and Medroxyprogesterone acetate.
A recent review of research showed that megestrol acetate increases appetite and weight gain, but is no more effective than steroids. As both types of drugs have side effects, more research is needed to find out how much megestrol acetate improves overall quality of life.
Other appetite stimulants being tested include cannabinoids. These drugs are made from the cannabis plant, also known as marijuana. Some studies have found that smoking cannabis or eating it can help to control sickness and pain and increase appetite. But one recent phase 3 trial failed to show that cannabinoids improved appetite or quality of life. Neither does it seem to help people put on weight.
Ghrelin is an appetite regulating hormone found in the stomach lining. Anamorelin is a new drug that mimics this hormone and improves appetite.
Two large trials (ROMANA 1 and 2) have recently showed that anamorelin increased both body mass and body weight in people with advanced non small cell lung cancer and cachexia. The increase in body mass suggests an increase in muscle and strength, but this was not proven in these studies. More research is needed to see if these are lasting effects.
Steroids can help improve appetite, food intake and sense of well being in people with cachexia. But they don't tend to help you put on weight, except from fluid retention.
Non steroidal anti inflammatory drugs
Some scientists believe that malnutrition and cancer cachexia may be a response to inflammation caused by the presence of a tumour in the body. This has led to research into using non steroidal anti inflammatories (NSAIDs) to help prevent and treat malnutrition in people with cancer.
Patients with cancer who had severe malnutrition showed that an NSAID called indomethacin may help.
Omega-3 food supplements
Some food supplements may help people with cachexia. One promising nutrient is fish oil, which contains omega-3 fatty acids.
Increasing omega-3 in your diet
Omega-3 fatty acids are important chemicals that the body needs to function normally. But they are not made naturally in the body and we have to get them from our diet.
Foods rich in omega 3 fatty acids include oily fish including:
They are also in several oils, including:
Dark green vegetables also contain a little omega-3.
Taking fish oil supplements
There are 3 fatty acids that make up omega 3: Alpha linolenic acid, Eicosapentaenoic acid and Docosahexaenoic acid
These fatty acids can prevent cancer in animals and this may also be the case with humans but we have no evidence of that yet.
In early stage clinical trials, fish oil supplements have stabilised or increased the weight of people with pancreatic cancer who have cachexia. The fatty acids may decrease some of the toxins made by the cancer that are believed to cause cachexia.
The side effects of these supplements are mild to moderate and include:
- loose, fatty looking bowel motions
- fishy tasting burps
ProSure is a high protein drink with the fish oil eicosapentaenoic acid (EPA) added to it. Some people with cachexia who drank between 1.5 and 2 packs a day of ProSure did gain fat and muscle bulk. So far, ProSure is only available in a few hospitals in the UK, but it can only be prescribed by your GP if you have pancreatic cancer.
Forticare is more concentrated and claims not to have such a fishy after taste. It's also only available for people with pancreatic cancer.
A review into fish oils found that they do control some of the symptoms of cancer such as cachexia and weight loss. We need more research before we will know how these supplements work and to make sure that they are not affecting cancer treatments.
Antioxidants and cancer prevention
Some scientists believe that antioxidant vitamins and minerals may help to prevent cancer when included in a healthy, balanced diet. Early stage trials also suggest that they might help prevent cachexia in people with cancer.
In theory, antioxidants help protect body cells from damage by oxygen particles called free radicals. But antioxidants, vitamin and mineral supplements are not routinely advised for people with cancer as there is no proof that they help, especially not single nutrients or supplements that are a higher dose than the Recommended Daily Allowance (RDA).
In 2008, an overview of studies of giving antioxidants to prevent illness found that people who took antioxidants (vitamin A, beta-carotene, and vitamin E) actually had a higher risk of becoming ill or dying.
Another overview in 2004 looked at studies where antioxidants had been used to try to prevent digestive system cancers. The review found a higher risk of dying in people who took beta-carotene with vitamin A and beta-carotene and vitamin E.
A study looked into whether taking selenium and vitamin E could prevent prostate cancer. The researchers found that slightly more men who had taken the supplements developed prostate cancer. We need more research to understand why this was so and to look into what that means for people who already have cancer.
Cachexia in people with cancer is a very complex problem. Finding ways to successfully manage and control it will need a lot more research. Many scientists believe that combinations of treatments will be needed.
Exercise and cachexia
Recent studies show that exercise may help to control muscle wasting linked to cachexia.
Progressive resistance exercise training (PRT) may increase muscle mass and strength. It might also improve physical functioning and quality of life.
PRT involves a low number of muscle movements performed against increasing levels of resistance.
More research is needed to see how well this type of exercise works.
Malnutrition in hospital
Many people lose weight during their hospital stay.
Weight loss in hospital
About 4 out of 10 people are underweight when they are admitted to hospital and lose more weight during their stay. So overall, nearly 6 out of 10 people in hospital (60%) at any one time are poorly nourished (malnourished).
People who are most at risk of being malnourished are those who have:
- had treatment for cancer
- had major surgery to the digestive system - the stomach, bowel or gullet (oesophagus)
- serious bone fractures
- chronic illness (long term heart disease or lung disease for example)
The Government has recently drawn up some proposals aimed at structuring meal times on hospital wards including:
- no visitors during meal times so that patients can concentrate on eating
- no staff meal breaks during patient meal times so that there are more staff around to help
Screening people for malnutrition
Being poorly nourished is known as malnutrition. About 2 million people in Britain are malnourished and this affects their health and ability to work. Some people are more at risk than others.
To help improve things, the Malnutrition Advisory Group (MAG) of the British Association for Parenteral and Enteral Nutrition (BAPEN) have launched a programme called the ‘Malnutrition Universal Screening Tool’ (MUST). This tool is simple to use and available to GPs and other people working in health care. They should use the tool to identify adults who are at risk or already malnourished and may benefit from help with their diet.