Risk of Malnutrition

Malnutrition occurs when a person does not eat or absorb enough calories of key nutrients needed for healthy body function. Cancer patients who are malnourished are at greater risk for health complications, hospitalization, infections, loss of muscle strength and poor quality of life. Malnourished patients may need to delay, change or stop cancer treatment.

To decrease the risk of malnutrition, try to avoid losing weight during treatment unless you are advised to lose weight by your healthcare team.

Tell your healthcare team about about any weight loss, decreased appetite or side effects that make it difficult for you to eat. 

It is common for changes in appetite to occur during cancer treatment. Loss of appetite may be caused by the cancer itself, the type of treatment received (chemotherapy and/or radiation), other medications, emotions, pain, fatigue, as well as other conditions or problems that may interfere with digestion. Good nutrition is a necessity before, during, and after treatment. The following are some tips to optimize nutrition while dealing with appetite loss:

Manage any other nutrition-related side effects that may contribute to appetite loss.

  • Nausea, vomiting, diarrhea, constipation, dry mouth, sore mouth, swallowing difficulty, and heartburn may lead to loss of appetite.
  • Talk to a registered dietitian and your healthcare team for assistance with any of these side effects. It is important to get help managing any of these side effects to increase appetite.

Take note of when your appetite is best.

  • For some people this is in the morning and appetite diminishes throughout the day. For other people it may be the opposite.
  • When you feel well, eat as much nutritious food as possible in case you do not feel well later.
  • Do not limit or restrict food intake when appetite is good.

Eat 5-6 small meals per day and snack anytime.

  • Small amounts of food are typically easier to digest and are easier on the stomach. It is often easier to better meet nutrition needs while battling appetite loss with smaller amounts of food more frequently.

Keep healthy snacks around, and do not go more than three hours without eating.

  • Pack a cooler or insulated lunch bag to take on longer trips or to appointments when the wait time is variable.
  • Keep small containers of fruit, dried fruit, trail mix, small bottles of juice, yogurt, cheese, whole grain crackers, cereal, granola bars, and other portable food items that are easy to eat and require little to no preparation.
  • Always keep snacks visible and available as a reminder that it is important to eat to get the body the nutrients it needs.

If food is not appealing, have a nutritious beverage instead.

  • A high-protein shake or smoothie can have as many calories as a small meal or large snack.
  • Have a ready-to-drink liquid nutrition supplement when food is not appealing.
  • Milkshakes, smoothies, or protein shakes can be made with yogurt, milk, ice cream, protein powder, fruit, and other ingredients using a blender. Have these ingredients available for times when a drink sounds better than a meal.

Drink liquids between meals.

  • Sometimes drinking liquids with meals causes the stomach to get full faster. This prevents eating enough and maximizing nutrition from food sources.
  • If an early feeling of fullness is a problem, try waiting to drink any liquids until after a meal and do not drink any liquids for at least 30 minutes before a meal.

Add calories and protein to foods to give their nutrient content a boost.

  • There are ways to add protein and calories to foods that are already eaten regularly.
  • Add a scoop of protein powder to a shake or smoothie.
  • Add healthy fat such as olive oil, nuts, or nut butter to recipes and other dishes to boost the calorie content.
  • Ask a registered dietitian for other suggestions on how to increase the protein and calorie content of foods.

Exercise or do some physical activity at least an hour before a meal.

  • Regular exercise may help increase appetite.
  • Ask your healthcare team before beginning any exercise program.
  • Go for a 20-minute walk before sitting down to a meal.

Get in the habit of having a bedtime snack.

  • An easy-to-digest snack such as yogurt and fruit, cheese and crackers, or peanut butter and crackers is an easy way to get some additional nutrition and will not impact appetite for the next meal.
  • If reflux or heartburn is an issue, have this snack at least one hour before lying down.

Emotions are often related to appetite. Talk to your healthcare team about managing your emotional well-being.

  • Depression, anxiety, fear, and stress can all affect appetite.
  • Trained health professionals such as social workers and psychologists can assist in managing these emotions.
  • Support groups are another resource that may help in processing these emotions.

Download or order The Leukemia & Lymphoma Society’s free handout Side-Effect Management: Managing Low Appetite and Weight Loss for more information.