What dietary guidelines are recommended for patients with various blood cancers?

Dietary Guidelines for Blood Cancer Patients

For patients with blood cancers, we strongly recommend a plant-based diet high in vegetables, fruits, and whole grains, while limiting saturated fats, red meats, and alcohol to improve treatment outcomes, quality of life, and overall survival. 1

Core Nutritional Recommendations

Macronutrient Requirements

• Energy needs: 25-30 kcal/kg/day 1
• Protein intake: 1.0-1.5 g/kg/day to maintain muscle mass 1, 2
• Macronutrient distribution:
  • 45-65% carbohydrates (emphasize complex carbohydrates)
  • 20-35% fat (emphasize healthy fats)
  • 15-20% protein 1, 2

Specific Food Recommendations

• Fruits and vegetables: 5-9 servings daily, emphasizing those rich in antioxidants (β-carotene, vitamins A, E, and C) 1
• Whole grains: Make these the foundation of carbohydrate intake 1
• Protein sources: Choose low-fat options like fish, lean poultry, eggs, low-fat dairy, nuts, seeds, and legumes 1
• Fats: Prioritize sources of omega-3 fatty acids (fish, walnuts) and limit saturated fats 1
• Limit consumption of:
  • Red and processed meats (1-2 times/week maximum) 1
  • Refined grains and sugary foods 1
  • Alcohol 1

Nutritional Strategies During Different Phases

During Active Treatment

• Consume 5-6 small, high-calorie meals per day 2
• Include calorie-dense, nutrient-rich foods like nuts, dried fruits, and avocados 2
• Use healthy fats like olive oil to increase calorie intake 2
• Avoid carbonated beverages and foods with high calorie but low nutritional value 2
• Consider oral nutritional supplements between meals if needed 2

For Cancer Survivors

• Maintain a healthy weight (BMI 18.5-25 kg/m²) 1
• Continue the plant-based diet pattern high in vegetables, fruits, and whole grains 1
• Engage in regular physical activity (at least 30 minutes of moderate-intensity activity 5 days/week) 1
• Monitor weight regularly to avoid excessive weight gain 1

For Advanced Disease

• Nutritional interventions should be considered in context of prognosis, expected benefit on quality of life, and potential survival impact 1
• For patients with good prognosis (several months or years expected survival), ensure adequate intake of energy and protein 1
• For patients with limited prognosis (weeks), focus on comfort and psychosocial support rather than aggressive nutritional intervention 1

Supplementation Guidelines

• Provide vitamins and minerals in amounts approximately equal to the recommended daily allowance 1
• Avoid high-dose micronutrient supplementation unless specific deficiencies are identified 1
• Consider monitoring vitamin B12, iron, vitamin D, and calcium levels 2

Hydration Recommendations

• Consume 2-2.5 liters of fluids daily 2
• Increase intake during hot weather or exercise 2
• Monitor electrolyte balance, especially in patients with high output from treatments 2

Special Considerations

• Weight management: Cancer survivors should strive to maintain a healthy weight to reduce risk of recurrence and comorbidities 1
• Physical activity: Combine dietary changes with regular physical activity for optimal outcomes 1
• Inflammation: A diet rich in fruits, vegetables, and omega-3 fatty acids may help reduce cancer-related inflammation 3
• Metabolic concerns: For patients with insulin resistance, consider increasing the ratio of fat to carbohydrate energy to reduce glycemic load 1

Practical Implementation

• Regular nutritional screening and assessment throughout the cancer journey 1
• Adjust dietary recommendations based on treatment side effects (e.g., nausea, taste changes, mucositis)
• Educate patients on food safety practices, especially during periods of immunosuppression
• Involve a registered dietitian as part of the multidisciplinary care team 1

By following these evidence-based dietary guidelines, patients with blood cancers can potentially improve treatment outcomes, reduce risk of recurrence, manage treatment side effects, and enhance overall quality of life.