Tailoring the nutritional regimen in the elderly cancer patient.

Our knowledge of the macronutrient requirement of elderly cancer patient is still incomplete and mainly relies on studies of elderly (healthy) people and populations of cancer patients including both adult and elderly subjects. Patients with minor nutritional deterioration do not require any specific nutritional regimen, but cachectic patients do. Total energy expenditure can be unchanged or lower in advanced weight-losing patients (when compared with matched healthy controls) because the higher resting metabolic expenditure can be offset by reduced physical activity, and it approximates to 25-28 Kcal/kg/d. Protein requirement is probably 1.5 g amino acid (AA)/kg/d or more, especially if the goal is increased lean body mass. However, the final balance depends not only on the quantity of AA but also their quality: diets including a high percentage of essential AA and especially of branched-chain ones and leucine in particular, are advocated. Total fluid load should be prudent, around 25-30 ml/kg/d.