by Jenna Koroly, MS, RD, CSOWM, CDN
As November approaches, we recognize “Pancreatic Cancer Awareness Month.”
Recent research on pancreatic cancer offers insight into dietary patterns associated with pancreatic cancer risk, as well as the metabolic and peri-operative nutritional influences that pancreatic cancer has on the body. With this understanding, patients can make changes to their eating patterns and the healthcare team can anticipate nutritional needs before, during, and after their operation in order to achieve better outcomes.
This article will provide take home advice based on the latest research, for both the patient and the healthcare team.
Study 1
Dietary Patterns and Pancreatic Cancer Risk: A Meta-Analysis
Journal: Nutrients
High intake of certain foods are linked to cancer risk. A nutritious eating pattern with light to moderate alcohol intake may decrease the risk of pancreatic cancer.
The authors conducted a meta-analysis of 32 studies to investigate how eating patterns and alcohol intake relates to pancreatic cancer risk. All studies used Food Frequency Questionnaires (FFQ) or another form of questionnaire to obtain diet patterns. The following important terms were defined:
- Healthy diet consists of high intake of fruits, vegetables, whole grains, fish, poultry, soy, low-fat dairy, and olive oil.
- Western-type diet consists of high intake of red or processed meat, refined grains, high-fat dairy, potatoes and gravy, butter, sweets, and low intake of fruits and vegetables.
- Alcohol intake levels: low alcohol intake is 1 drink/day for men, 0.5 drink/day for women; high alcohol intake is 4 drinks/day for men, 2 drinks/day for women; and light-moderate intake is anything in between low or high intake.
So what did the authors find as a result of the investigation? Here are their main findings:
There is:
- An inverse relationship between healthy eating patterns and pancreatic cancer risk
- An inverse relationship between light-moderate alcohol intake and pancreatic cancer risk
- A direct relationship between western-type eating patterns and pancreatic cancer risk
- A direct relationship between high alcohol intake and pancreatic cancer risk
For the Patient and Caregiver
Reduce the risk of pancreatic cancer by kicking red meat and refined grains aside and bringing vegetables, fruits, and whole grains to center stage. If you do consume alcohol, do so in moderation. Try the Mediterranean type diet, consisting of healthy oils like olive oil, plenty of fruits and vegetables, whole grains like oats, whole wheat bread and ancient grains like farro and bulgur, and fatty fish like salmon and mackerel. Enjoy small portions of animal meats and sweets in moderation. Save for special occasions.
Study 2
Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection.
Journal: Nutrients
Armed with the knowledge of how pancreatic resection surgery influences the body, patients, caregivers, and healthcare professionals can be better prepared to implement nutritional interventions.
The study, published in March, investigates the metabolic and peri-operative nutritional influence of pancreatic cancer through a review of 51 articles. Here is a quick summary of what the investigators found:
Metabolically, pancreatic cancer impacts enzymes needed for digestion and the production of insulin and glucagon, which regulate blood sugar and are secreted by the pancreas. In turn, pancreatic insufficiency can lead to weight loss, malabsorption of fat and other micronutrients, and may lead to diabetes.
After removal of the pancreas and part of the small intestine, patients may continue to experience nutritional deficiencies of fat-soluble vitamins, B12 and zinc even after serum markers and body weight return to normal. The use of enzyme replacement therapy, omega-3 supplementation, and enteral nutrition support for the patient may be warranted after surgery to maintain strength, fight infection and keep the patient healthy.
Based on their findings, the authors of the study outline peri-operative nutrition guidelines for the pancreatic cancer patient as follows, which can be translated by both the patient and the healthcare team after blood work is completed:
- Before Surgery:
- If albumin < 2.5 mg/dL or weight loss of >10%
- Postpone Surgery
- Begin aggressive nutrition supplementation.
- Place feeding tube when surgery is conducted.
- If albumin < 3.0 mg/dL or weight loss of 5-10%
- Begin nutrition supplementation pre-surgery.
- Place feeding tube during surgery.
- If albumin < 2.5 mg/dL or weight loss of >10%
- After Surgery:
- Monitor blood sugar via a hemoglobin A1c or an oral glucose tolerance test.
- Measure and monitor albumin, fecal elastase, fecal fat, zinc, iron, vitamins B12, A, D, E.
- Supplement nutrients as needed.
For the Patient and Caregiver
Becoming familiar with which nutritional supplements are necessary after surgery will ease the transition for the body and mind. Remember the important ones: Vitamin B12, A, D, and E, zinc and iron. Ask your dietitian and healthcare team to explain the findings and communicate the needs to you, but have a critical ear and ask questions. Working with a Registered Dietitian is critical to ensure best care when it comes to nutritional needs.
For the Healthcare Team
By pairing the findings on dietary pattern and pancreatic cancer risk with the perioperative nutrition recommendations for the patient undergoing a pancreatic resection, you may be better informed on how to best counsel individuals and nutritionally monitor and treat your patients before, during, and after surgery. It also empowers individuals and their families to be well-informed with any necessary dietary modifications, and well-prepared as they go through surgery. Knowledge is power.