Cancer No known dietary intervention to prevent cancers, only general guidelines Mostly based on healthy weight and consumption of balanced diet high in vegetables Only limitations are intake of processed or over- cooked meat and excessive alcohol intake Charred meats form (HCA) heterocyclic aromatic acids, believed to increase risk of colorectal CA

Cancer Alcohol has known risk for esophageal and hepatic cancers, likely due cell necrosis Prevention, mostly based on 5 servings of vegetables daily, and physical activity One type of vegetable or fruit not effective but rather a mix of beneficial phytochemcals Lycopene in tomato, folate rich spinach, antioxidant in berries

Cancer Survival is >5yrs, with now 70% known mostly breast and prostate CA Major nutritional problem, malnutrition with >10% wt loss and <75% of estimated KCAL needs Hypermetabolism, surgery, chemotherapy, radiation, and fatigue all effect nutrition status Taste changes, thrush, loss of appetite, nausea, depression and pain contribute to malnutrition Anorexia, small frequent meals, kcal dense foods, supplements and protein powders, liberalize

Cancer Taste changes, oral hygiene, glass utensils, cool and soft foods, creative spices, sauces and gravies Stomatitis, drink with straw, liquids at meals, avoids acids, sucking candies, lemon flavor Nausea, bland foods, low-fat, microwave, small portions, bed positioning >45d Cachexia, protein intake, appetite stimulant, registered dietitian, nutrition support

End of Life Comfort measures with family wishes and liberalized dietary restrictions Aspiration precautions with and equate hydration and oral hygiene, respiratory considerations Prevent dry mouth with ice chips, mouthwash, IVFs, with regular blood work Dementia, eating in groups, regular schedule, assistance, soft texture

End of Life Ethical considerations and quality of life can often relate to nutritional status, PEG Typical nutrition related issues that affect elderly can be addressed with simple modification Anemia, risk of GI bleed, poor diet, need to increase red meat, supplements Anorexia, need for encouragement, assist at meals, textures, flavors, and KCAL density

End of Life GI disorders, keep NPO, clear liquids with bowel rest, small frequent meals, low fat and fiber Constipation, hydration, high fiber, check medications, consider bowel regimen Diarrhea, omit hyperosmotic beverages, high soluble fiber, high K foods, small frequent meals GERD, avoid acidic and high fat foods, eat upright, limit spices, dairy as tolerated

End of Life Nausea, bland diet, eat slowly, limit fluids at meals, small meals, no strong odors, KCAL dense soups Xerostomia, mouth wash, oral hydration, sucking candies, soft cold foods, supplements, no acids Always know code status and family wishes with nutritional plan or feeding with aspiration risk Liberalized diet at end of life without restriction, except for texture pending SLP evaluation