energy and protein enriched Nutrion

You are receiving this brochure because a doctor or nurse has identified you as being at increased risk of malnutrition. This risk is determined based on your weight changes over the past three months, your appetite, and any use of nutritional supplements or tube feeding in the past month. In this brochure, you will learn more about what you can do yourself to prevent or treat malnutrition.

Causes and consequences of malnutrition

In malnutrition, your body lacks essential nutrients. In cancer, there are two causes of malnutrition. On one hand, your metabolism becomes disrupted by the tumor, leading to increased nutritional needs for your body. On the other hand, you may eat less nutrients due to the location of the tumor and any resulting treatment-related symptoms.

Unintentional weight loss is often an indicator of (impending) malnutrition. Even if you are overweight, you can still become malnourished. When you lose weight unintentionally, you not only lose fat tissue but also muscle tissue, which is detrimental to your overall condition and physical functioning. When malnourished, you are at an increased risk of infections, wounds heal more slowly, you are more prone to treatment complications, and your recovery is slower.

Nutrition and exercise play a crucial role in maintaining or building your weight and therefore require special attention. Below, you will find more information on these topics.

Preventing and/or treating malnutrition (during hospitalization and at home)

Adopt a diet rich in energy and protein

To prevent or treat malnutrition, you need a diet that is rich in energy and protein. With a so-called "energy- and protein-rich diet", the aim is to prevent further weight loss. Weight gain is generally undesirable because it usually involves an increase in fat mass, which offers little or no benefits for most patients. However, if weight gain is desired, it will require more time.

Energy is a fuel necessary for everything we do. Even when you are not moving or barely moving, your body still requires energy. The amount of energy in a food is expressed in kilocalories (kcal).

Protein is a building block necessary for the construction, maintenance, and repair of body tissues such as muscles and organs. It is crucial that your diet contains enough protein to prevent the loss of muscle mass.

Proteins are mainly found in:

• Dairy and dairy products;
• Soy yogurt and soy milk;
• Meat (including processed meats), fish, chicken;
• Meat substitutes (soy, Quorn, tofu, tempeh);
• Beans (legumes: white/brown beans, lentils, chickpeas);
• Eggs;
• (Spreadable) cheese;
• Nuts.

1.1 General Tips and Tricks most of the time:

• Try to eat something every two to three hours. Typically, six to eight smaller meals are better tolerated than three large meals;
• Try to stick to regular meal times;
• Rest a little before meals to prevent fatigue from hindering your ability to eat;
• Use full-fat variants and products such as whole milk, full-fat yogurt, or cheese with a fat content of 48+. Avoid lean or light products;
• Use products that are rich in protein (as listed under point 1);
• Spread margarine or butter on your bread instead of low-fat spreads. Diet margarine contains as much energy as butter and twice as much energy as low-fat spreads;
• Choose savory toppings for your bread such as (foreign) cheese, cold cuts, eggs, hummus, nut butter, crab salad, tuna salad, or meat salad. Avoid sweet spreads because they provide energy but not a lot of protein;
• Use double toppings on your bread;
• If you don't feel like eating bread, you can make porridge that is made from whole milk. Add an extra spoonful of sugar or a knob of butter for more energy;
• When drinking, preferably choose full-fat dairy products (which contain both protein and energy), or alternatively, fruit juice or lemonade (which provide energy but no protein);
• If you enjoy soup, choose creamy soups that contain meat, fish, chicken, legumes and/or cream. Broth provides only water and salt but hardly any energy or protein;
• Have snacks between main meals, such as: 
  • Dairy products (buttermilk, milk, yogurt drinks, chocolate milk, milkshakes, custard, cream yogurt, quark, pudding)
  • Candybar
  • Pudding pastry
  • Pancake 
  • Cream-based soup
  • Cheese (french cheeses, spreadable cheese)
  • Deli meat 
  • Crackers with pâté
  • Egg salad 
  • Battered fish (herring, eel, mackerel, crab salad, tuna salad)
  • Savory pastries (sausage rolls, cheese rolls, nuts, chips) 
  • Cheese soufflé
  • Croquettes
  • Hamburger 
  • Spring roll 
  • Satay
    
• Avoid large amounts of raw vegetables as they quickly make you feel full and provide little energy or protein;
• Even if you have diabetes, overweight, or cardiovascular diseases, it is advised to temporarily opt for full-fat and energy-rich products. Extra glucose monitoring for diabetes is recommended. Consult with your diabetes nurse if necessary.

1.2 Tips and Tricks for Decreased Appetite

A reduced appetite can have various causes. One cause is that the tumor secretes certain substances that disrupt metabolism and often reduce appetite. Additionally, you may not feel well due to treatment, or anxiety, pain, and fatigue may decrease your desire to eat. The location of the tumor can also play a role, causing you to feel full and eat less. The most important advice for a decreased appetite is that when you do eat, choose foods that are rich in calories and protein.

• Serve the main meal on a smaller plate if a full-sized dinner plate is unappealing;
• During the main meal, focus on the main protein source (meat, fish, chicken, or meat substitute) and dessert. Take a generous portion of these items. You can opt to leave out vegetables, potatoes, rice, and pasta if necessary;
• Use generous amounts of gravy or sauce;
• Add margarine, butter, cream, or crème fraîche to vegetables;
• Prepare mashed potatoes with margarine, butter, or crème fraîche. Alternatively, otherwise you can choose roasted potatoes or fries;
• Preferably choose dairy or ice cream for dessert;
• Consider having dessert an hour after the main meal if you feel full after eating;
• Liquid products are often easier to consume than solid foods; Opt for foods that are easy to chew such as minced meat, tartare, fish, or liquid foods like soups, porridge, and pudding;
• Try to eat with others. Eating together creates a relaxed atmosphere and is more enjoyable, which can help you eat better;
• Choose foods that are easy to prepare, such as ready-to-eat vegetables (frozen or pre-packaged from the supermarket or butcher), meats with short cooking times, one-pot meals, and pre-packaged desserts. Ready-to-eat meals delivered to your home can be ordered through services like Apetito, Alle Smaken, Uitgekookt/Tafeltje dekje, or local delivery services;
• If the smells bother you: Cooking meals in the microwave reduces odor spread or have someone else cook for you.

1.3 Alternatives for When a Warm Meal Is Not Possible:

• If the smells bother you: Then you can cook meals in the microwave that  reduces the smell, or have someone else cook for you.
• Alternatives to a warm meal:
  • Salad with plenty of cheese, feta, mozzarella, nuts, cold meats, fish, and/or chicken;
• Cold potato/pasta/couscous salad with extra fish/chicken/meat, cheese, and/or nuts. Bacon bits (fried or pre-cooked) can also be added cold (pre-cooked bacon bits are available);
• Bread meal with double toppings, dessert, and a dairy drink;
• Dishes like macaroni and fried rice are suitable for being eaten cold the next day or incorporated into a salad;
• If meat is not working out, perhaps try fish, chicken, or vegetarian burgers (nut burgers, bean burgers, beetroot burgers, cheeseburgers);
• Pancake with cheese, feta, or mozzarella, or a cold hot dog, can also be eaten cold. Otherwise, if you prefer sweet, spread the pancake with quark or a neutral cream cheese and top with fruit.

2. Exercise for 30 minutes moderately to intensely every day

In addition to nutrition, exercise is necessary to build or maintain muscle tissue. The recommendation is to engage in moderate to intense exercise for 30 minutes every day. "Moderate to intense" means that you should feel warm, your heart rate should increase, and you should breathe slightly faster due to the exertion. You don't have to exercise for a continuous 30 minutes; you can, for example, opt for two sessions of 15 minutes or three sessions of 10 minutes. If you have difficulty getting out of bed or a chair, it's useful to do exercises from a seated or lying position. A physiotherapist can provide guidance on this.

Especially resting when you're fatigued can lead to further deterioration of your condition and increased fatigue.

3. Weigh yourself once a week

Your body weight is a good measure to see if you are getting enough energy from your diet. A stable or increasing weight indicates that you are getting sufficient energy. Therefore, it is advisable to weigh yourself once a week. Try to do this under similar conditions: on the same scale, at a fixed time of day, with approximately the same clothing or without clothing. It's important to note that if you retain fluid or take diuretic medication, your weight (progression) may be unreliable.

Record the measurements to track your progress. Fluctuations in weight of one to two kilograms in a week are normal. If you continue to lose weight for two weeks, notify your doctor or specialist.

Dietary Products

Despite following the advice in this brochure, you may still find it challenging to consume sufficient energy and protein through regular foods. There is a wide range of medical dietary products available that you can use both in the hospital and at home. An example of this is nutritional supplements, available in various types and flavors. The dietitian (or doctor, depending on your insurance) can prescribe these products for you, provide advice on their use, and issue an authorization for reimbursement of the costs of using these products from your health insurance.

Extra Vitamins and Minerals

Vitamin and mineral supplements may be beneficial if you are struggling to eat enough or eat a sufficiently varied diet. However, these supplements cannot replace a healthy dietary pattern. A multivitamin that provides up to 100% of the recommendeddaily requirement (RDA) can be used without risk. If you are using higher doses or other supplements, inform your specialist and/or dietitian.

Dietitian Guidance

You can ask your nurse or specialist whether you qualify for guidance from the hospital dietitians. If not, you can contact the dietitians that you can find in the verwijsgidskanker (www.verwijsgidskanker.nl). There you can find a dietitian close to where you live. Another option to find a dietitian is through the website of the Dutch Association of Dietitians (www.nvdietist.nl). Here, you can search for a dietitian by postal code. It is advisable to inquire whether the chosen dietitian has experience in treating malnutrition in illness before making an appointment. On the website malnucare (www.malnucare.nl) you can also find a dietitian that is close to where you live and can help you with malnutrition. These are a few options to find a dietitian that is close to home and can help you after the treatment, if it is necessary.  

Additional Tips and Advice

• The list with “energie en eiwitrijke producten”, contains information about the number of calories and the amount of protein that certain food contains.
• The brochure “Eat well during Cancer" by the World Cancer Research Fund contains information on preventing or combatting malnutrition in cancer;
• The World Cancer Research Fund also has a website with useful information: www.wcrf-uk.org.

Practical information

Contact

Phone number: 020 512 9111.

Our telephone operators will be happy to connect you to the correct department.

For urgent matters outside office hours, you can ask for the Weekend, Evening of Night head. For other questions, please wait until the next business day.

Patient information center

Would you like more information because you or a loved one is dealing with cancer? Out employees are happy to think along with you. You can call or walk in without an appointment.

More information: www.avl.nl/cpi

Center for Quality of Life

Do you need professional support during and after your treatment? Then you can make an appointment at our center through your practitioner.

More information: www.avl.nl/ckvl

Information on the Internet

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Visiting address

Antoni van Leeuwenhoek

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1066 CX Amsterdam

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mei 2024