がん低栄養の経口栄養介入：メタ分析

がんの低栄養患者に対する経口栄養介入の系統的レビューの論文を紹介します。

Christine Baldwin; Ayelet Spiro; Roger Ahern; Peter W. Emery: Oral Nutritional Interventions in Malnourished Patients With Cancer. A Systematic Review and Meta-analysis. Journal of the National Cancer Institute. 2012;104(5):371-385

13研究、1414人の参加者が含まれています。経口栄養介入によって有意な体重増加（1.86 kg, 95% CI = 0.25 to 3.47）とエネルギー摂取量増加（432 kcal/d, 95% CI = 172 to 693）を認めました。ただし、統計学的に不均一を除外すると有意差は認めませんでした。
QOLのいくつかの側面は有意に改善しましたが、死亡率には有意差を認めませんでした。以上より、がんの低栄養もしくは低栄養のAt risk患者に対する経口栄養介入は、エネルギー摂取量増加とQOLのいくつかの側面の改善に効果的と結論付けています。

メタ分析でがんの低栄養患者に対する経口栄養介入の有用性が示されたことは意味があります。悪液質に対して栄養介入単独では無効という報告が少なくありませんが、少なくともエネルギー摂取量増加までは得られそうな印象です。栄養改善といえるかは微妙ですが。

Abstract

Background
International guidelines on the nutritional management of patients with cancer recommend intervention with dietary advice and/or oral nutritional supplements in patients who are malnourished or those judged to be at nutritional risk, but the evidence base for these recommendations is lacking. We examined the effect of oral nutritional interventions in this population on nutritional and clinical outcomes and quality of life (QOL).

Methods
Electronic searches of several databases including MEDLINE, EMBASE, and CINAHL (from the first record to February 2010) were searched to identify randomized controlled trials of patients with cancer who were malnourished or considered to be at risk of malnutrition and receiving oral nutritional support compared with routine care. We performed a meta-analysis using a fixed effect model, or random effects models when statistically significant heterogeneity was present, to calculate relative risk (mortality) or mean difference (weight, energy intake, and QOL) with 95% confidence intervals (CIs). Heterogeneity was determined by using the χ2 test and the I2 statistic. All statistical tests were two-sided.

Results
Thirteen studies were identified and included 1414 participants. The quality of the studies varied, and there was considerable clinical and statistical heterogeneity. Nutritional intervention was associated with statistically significant improvements in weight and energy intake compared with routine care (mean difference in weight = 1.86 kg, 95% CI = 0.25 to 3.47, P = .02; and mean difference in energy intake = 432 kcal/d, 95% CI = 172 to 693, P = .001). However, after removing the main sources of heterogeneity, there was no statistically significant difference in weight gain or energy intake. Nutritional intervention had a beneficial effect on some aspects of QOL (emotional functioning, dyspnea, loss of appetite, and global QOL) but had no effect on mortality (relative risk = 1.06, 95% CI = 0.92 to 1.22, P = .43; I2 = 0%; Pheterogeneity = .56).

Conclusion
Oral nutritional interventions are effective at increasing nutritional intake and improving some aspects of QOL in patients with cancer who are malnourished or are at nutritional risk but do not appear to improve mortality