Q14. What is the nutrition prescription to meet these goals? - Post treatment
One level II positive quality study measured mean intakes of energy and protein for up to 3 months post radiotherapy treatment , and found that patients in the intervention group maintained higher intakes of protein and energy post treatment resulting in weight maintenance. One level III-1 neutral quality study , provided dietetic counselling to achieve energy intakes of >125kJ/kg/day (30kcal/kg/day) and protein intakes of 1-1.5g/kg/day for up to 10 weeks post treatment, resulting in weight stabilisation/weight gain of 1%.
There is one level III-2 neutral quality study , one level IV positive quality study  and two level IV neutral quality studies , however evidence is not consistent and there is lack of longitudinal studies with sufficient sample size. The level III-2 study looked at patients for two weeks post treatment, and found energy intakes of 105kJ/kg/day (25kcal/kg/day) using indirect calorimetry, which were elevated compared to the measurements taken during radiotherapy.
The level IV positive quality study  found that patients whose intake was above 145kJ/kg/day and 1.5g protein/kg/day were able to gain weight and lean body mass, compared to patients whose intake was below this, who were not able to gain weight. The first level IV neutral quality study  reported aiming for energy intakes of 125-170kJ/kg/day (30-40kcal/kg/day); however energy intake only reached 80kJ/kg/day (19kcal/kg/day) during chemoradiotherapy resulting in weight loss. Despite increases in energy intake post treatment, weight loss continued post treatment, indicating elevated requirements in this phase. The second level IV neutral quality study  reported the following energy intakes at one year post treatment to be associated with the following outcomes to achieve optimal Body Mass Index (BMI): 145kJ/kg/day (35kcal/kg/day) for weight maintenance, 185kJ/kg/day (44kcal/kg/day) for weight gain and 115kJ/kg/day (28kcal/kg/day) for weight loss.
|Energy and protein requirements remain elevated post treatment and weight should continue to be monitored and intervention adjusted as appropriate.||C|
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