Nutritional Therapy Based on ESPEN Guidelines in a Patient with Ascending Colon Non-Hodgkin Lymphoma Undergoing Chemotherapy with Decreased Oral Intake and Infectious Complications: A Case Report
DOI:
https://doi.org/10.71341/bmwj.v3i2.65Keywords:
non-Hodgkin lymphoma, chemotherapyAbstract
Background: Malnutrition is a frequent complication in patients with cancer undergoing chemotherapy due to increased metabolic requirements, treatment-related adverse effects, and infectious complications. Gastrointestinal disturbances such as nausea, dysphagia, and opportunistic infections may worsen food intake and increase the risk of malnutrition.
Case Description: A 66-year-old woman with ascending colon non-Hodgkin lymphoma undergoing the fourth cycle of R-CHOP chemotherapy was hospitalized with pneumonia, oroesophageal candidiasis, suspected pneumonitis, electrolyte disturbances (Na 129 mmol/L; K 3.2 mmol/L), and mild anemia (Hb 9.8 g/dL). Nutritional assessment showed a body mass index of 19.2 kg/m2 with approximately 10.6% weight loss during the chemotherapy period, indicating a risk of malnutrition. Nutritional therapy was provided gradually as a high-energy, high-protein diet with targets of 2100 kcal and 70 g protein/day, in the form of blenderized meals three times daily, together with peptide-based enteral formula supplementation, additional virgin coconut oil, and zinc and vitamin C supplementation.
Discussion: Texture modification was intended to improve oral tolerance and minimize discomfort during swallowing, whereas the peptide-based formula was selected because it may be more easily absorbed when gastrointestinal function is impaired. The addition of virgin coconut oil as a source of medium-chain triglycerides provided energy that is rapidly metabolized without complex emulsification. Zinc and vitamin C supplementation was expected to support immune response, reduce oxidative stress, and accelerate the healing of mucosa inflamed due to infection and chemotherapy-related effects.
Conclusion: A combination of food texture modification, peptide-based formula, and rapidly absorbed energy sources is a rational strategy to maintain nutritional adequacy and prevent worsening nutritional status during chemotherapy.
Keywords: non-Hodgkin lymphoma, chemotherapy, malnutrition, ESPEN
References
Arends, J. (2024). Malnutrition in cancer patients: Causes, consequences and treatment options. European Journal of Surgical Oncology, 50(5). https://doi.org/10.1016/j.ejso.2023.107074
Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A., Crivelli, A., Evans, D. C., Gramlich, L., Fuchs-Tarlovsky, V., Keller, H., Llido, L., Malone, A., Mogensen, K. M., Morley, J. E., & Fuchs, V. (2019). GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clinical Nutrition, 38(1), 1-9. https://doi.org/10.1016/j.clnu.2018.08.002
Chaundry, S., & Ehtesham, Z. (2022). Swallowing dysfunction and its impact on patients undergoing oncological treatment. Asian Pacific Journal of Cancer Care, 7(4), 691-694. https://doi.org/10.31557/APJCC.2022.7.4.691
Delsoglio, M., Capener, R., Smith, T. R., Donald, M., Hubbard, G. P., & Stratton, R. J. (2025). High-protein oral nutritional supplement use in patients with cancer reduces complications and length of hospital stay: A systematic review and meta-analysis. Frontiers in Nutrition, 12. https://doi.org/10.3389/fnut.2025.1654637
Dingemans, A. M., van Walree, N., Schramel, F., Soud, M. Y. El, Baltruskevicienė, E., Lybaert, W., Veldhorst, M., van den Berg, C. A., & Kaasa, S. (2023). High protein oral nutritional supplements enable the majority of cancer patients to meet protein intake recommendations during systemic anti-cancer treatment: A randomised controlled parallel-group study. Nutrients, 15(24). https://doi.org/10.3390/nu15245030
Directo, D., & Lee, S. R. (2023). Cancer cachexia: Underlying mechanisms and potential therapeutic interventions. Metabolites, 13(9). https://doi.org/10.3390/metabo13091024
Hosseini, S. M., Salari, N., Darvishi, N., Siahkamari, Z., Rahmani, A., Shohaimi, S., Faghihi, S. H., & Mohammadi, M. (2025). Prevalence of severe malnutrition in cancer patients: A systematic review and meta-analysis. Journal of Health, Population and Nutrition, 44(1). https://doi.org/10.1186/s41043-025-01006-x
Inciong, J. F. B., Chaudhary, A., Hsu, H. S., Joshi, R., Seo, J. M., Trung, L. V., Ungpinitpong, W., & Usman, N. (2020). Hospital malnutrition in northeast and southeast Asia: A systematic literature review. Clinical Nutrition ESPEN, 39, 30-45. https://doi.org/10.1016/j.clnesp.2020.06.001
Kaegi-Braun, N., Schuetz, P., Mueller, B., & Kutz, A. (2021). Association of nutritional support with clinical outcomes in malnourished cancer patients: A population-based matched cohort study. Frontiers in Nutrition, 7. https://doi.org/10.3389/fnut.2020.603370
Ministry of Health of the Republic of Indonesia. (2019). Decree of the Minister of Health of the Republic of Indonesia concerning National Guidelines for Medical Services for the Management of Adult Malnutrition (Kepmenkes No. HK.01.07/MENKES/393/2019).
Kondrup, J., Allison, S. P., Elia, M., Vellas, B., & Plauth, M. (2003). ESPEN guidelines for nutrition screening 2002. Clinical Nutrition, 22(4), 415-421. https://doi.org/10.1016/S0261-5614(03)00098-0
Kühn, T., Kalotai, N., Amini, A. M., Haardt, J., Lehmann, A., Schmidt, A., Buyken, A. E., Egert, S., Ellinger, S., Kroke, A., Lorkowski, S., Louis, S., Schulze, M. B., Schwingshackl, L., Siener, R., Stangl, G. I., Watzl, B., Zittermann, A., & Nimptsch, K. (2024). Protein intake and cancer: An umbrella review of systematic reviews for the evidence-based guideline of the German Nutrition Society. European Journal of Nutrition, 63(5), 1471-1486. https://doi.org/10.1007/s00394-024-03380-4
Martin-Gonzalez, C., Gonzalez-Gimeno, M. J., De-Frutos-Hernan, B., & Valor-Garcia, C. (2023). Oropharyngeal dysphagia in head and neck cancer: How to reduce aspiration pneumonia. Journal of Laryngology and Otology, 137(7), 820-825. https://doi.org/10.1017/S0022215122002638
Muscaritoli, M., Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Hütterer, E., Isenring, E., Kaasa, S., Krznaric, Z., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Oldervoll, L., Ravasco, P., Solheim, T. S., Strasser, F., & Bischoff, S. C. (2021). ESPEN practical guideline: Clinical nutrition in cancer. Clinical Nutrition, 40(5), 2898-2913. https://doi.org/10.1016/j.clnu.2021.02.005
Ravasco, P. (2019). Nutrition in cancer patients. Journal of Clinical Medicine, 8(8). https://doi.org/10.3390/jcm8081211
Schönfeld, P., & Wojtczak, L. (2016). Short- and medium-chain fatty acids in energy metabolism: The cellular perspective. Journal of Lipid Research, 57(6), 943-954. https://doi.org/10.1194/jlr.R067629
Vella, R., Pizzocaro, E., Bannone, E., Gualtieri, P., Frank, G., Giardino, A., Frigerio, I., Pastorelli, D., Gruttadauria, S., Mazzali, G., di Renzo, L., & Butturini, G. (2024). Nutritional intervention for the elderly during chemotherapy: A systematic review. Cancers, 16(16). https://doi.org/10.3390/cancers16162809
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