Reply - Letter to the editor: “Energy and protein intake may have an impact on survival in patients with advanced cancer”

Published:November 24, 2021DOI:https://doi.org/10.1016/j.clnu.2021.11.025
      We thank Dr. Arends for his thoughtful comments on our retrospective study enrolling cancer outpatients [
      • Pimentel G.D.
      • Pichard C.
      • Laviano A.
      • Fernandes R.C.
      High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer.
      ]. Initially, the manuscript was submitted as a short communication due to the preliminary nature of the results, but then we resubmit it as an original article as suggested during the review process. Dr. Arends’ comments are well taken, since it should be noted that the Brazilian Sistema Único de Saúde does not implement a timely screening of patients, which yields to delayed start of therapies. As a consequence, many patients with cancer lose body weight, even those with an early tumour stage. We also agree that 24 h food recall may not represent a robust tool to assess volitional food intake. Moreover, food intake was assessed only once, at study enrollment, which may correspond to different time points in the clinical journey of the patients with cancer studied. At enrollment as outpatients in our study, oral nutrition supplements or food fortification were prescribed to increase food intake and meet nutritional targets as per international guidelines. As a clinical outcome, we investigated survival and we apologize for the mistyping in the original publication, which we have already corrected in an Erratum [
      • Pimentel G.D.
      • Pichard C.
      • Laviano A.
      • Fernandes R.C.
      Corrigendum to "High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer" [Clin Nutr] 40/3 (2021) 1376-1380.
      ]. Despite the above mentioned limitations, we feel that our study can be of help to healthcare professionals dealing with patients with cancer, by showing that proactive nutritional approach is key to increase energy and protein intake, which may translate in improved clinical outcomes as recently demonstrated [
      • Bargetzi L.
      • Brack C.
      • Herrmann J.
      • Bargetzi A.
      • Hersberger L.
      • Bargetzi M.
      • et al.
      Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial.
      ]. Nevertheless, we fully agree with Dr. Arends in that large clinical studies with a robust design are needed to precisely identify the nutritional targets to be met during cancer trajectory, i.e., during catabolic crisis and follow-up, and to investigate the cause-effect relationship.

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      References

        • Pimentel G.D.
        • Pichard C.
        • Laviano A.
        • Fernandes R.C.
        High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer.
        Clin Nutr. 2021; 40: 1376-1380
        • Pimentel G.D.
        • Pichard C.
        • Laviano A.
        • Fernandes R.C.
        Corrigendum to "High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer" [Clin Nutr] 40/3 (2021) 1376-1380.
        Clin Nutr. 2021 Apr; 40 (Erratum for: Clin Nutr. 2021 Mar;40(3):1376-1380): 1441
        • Bargetzi L.
        • Brack C.
        • Herrmann J.
        • Bargetzi A.
        • Hersberger L.
        • Bargetzi M.
        • et al.
        Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial.
        Ann Oncol. 2021; 32: 1025-1033

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