I. The purpose of tuberculosis treatment for tumor patients Malnutrition of tumor patients is a vicious circle, due to lack of appetite, reduced physical activity caused by reduced food intake, general debility, decreased digestive and absorption functions, further causing anorexia, eventually leading to weight loss, general failure and affecting prognosis, nutrition treatment for tumor patients is to break this vicious circle and achieve the following purposes Nutritional treatment for tumor patients is to break this vicious circle and achieve the following purposes: 1. to correct or improve the nutritional status of patients, improve the immune function and anti-cancer ability of the body, and achieve the purpose of supporting the righteous and eliminating the evil. 2.To improve the quality of life and avoid anxiety by adjusting the patient’s nutritional status, so that the patient is in a better state spiritually and psychologically. 3.Nutritional therapy is an indispensable part of patients’ treatment plan. Nutritional therapy can improve patients’ tolerance to surgical treatment, reduce post-surgical infection and accelerate incision healing, as well as improve patients’ ability to tolerate chemotherapy and radiotherapy and reduce toxic side effects of treatment. 4.Nutritional therapy can be divided into the following three categories according to their goals: ①Supportive nutritional therapy: for malnourished patients, the treatment can reduce the risk of surgery or improve the tolerance of radiotherapy and chemotherapy. ②Supportive nutritional therapy: It is a part of the whole treatment plan to improve the immune status of patients and increase their resistance to infection through nutritional therapy. ③Dependent nutritional therapy; it is necessary for patients to survive or maintain good nutritional status. Basic principles of nutritional therapy 1. Malnutrition is not an inevitable response of host to tumor, and the nutritional status of tumor patients can be maintained or improved through appropriate nutritional therapy means. 2.Every tumor patient should have regular nutritional evaluation in order to detect nutritional problems as early as possible. Early treatment of nutritional problems is more effective than correcting malnutrition after it occurs. 3.For patients treated with antineoplastic therapy, nutritional evaluation and nutritional therapy must be emphasized before, during and after treatment. 4. After patients are discharged from the hospital, follow-up should be continued so that the nutritional therapy program can be continued even during outpatient follow-up. 5.When the patient has good gastrointestinal function, trans-intestinal nutrition should be used as much as possible, and trans-oral feeding should be encouraged. If oral feeding is difficult or insufficient, tube feeding can be considered. If tube feeding can not meet the needs, tube feeding + intravenous nutrition should be used, and if the intestinal tract has no absorption function, total intravenous nutrition should be used. When doing intravenous nutrition, if the function of gastrointestinal tract is restored, the proportion of trans-intestinal nutrition should be gradually increased. Daily nutritional needs of tumor patients The intake of appropriate amount of basic nutrients to repair tissues and maintain body weight is one of the most important measures to help tumor patients recover their health. Basic nutrients refer to protein, fat, carbohydrates, vitamins and minerals, which all play an important role in maintaining normal physiological functions and ensuring the health of the body. Protein is necessary for the growth and repair of body tissues, carbohydrates (starch and sugar) and fats provide energy and essential fatty acids for the body, and vitamins and minerals are involved in regulating the body’s metabolism. The human body needs a variety of nutrients every day, and the amount of each nutrient required varies, so if all kinds of food can be consumed in a certain proportion when eating, the absorption and utilization rate of the body will be greatly improved. The general daily needs of patients are as follows: 1, protein, including fish, eggs, meat (pork, beef, lamb and poultry) and beans and soy products, the food is an important source of protein and B vitamins. Daily 1 egg, 100-200 grams of lean meat, 50 grams of soybeans and their products. 2, dairy products including various forms of dairy products, is the main source of protein, vitamins A, B, D and calcium, twice a day, each time the equivalent of 1 cup of milk (or yogurt) or half a cup of condensed milk. 3, vegetables and fruits mainly provide vitamins and minerals. Citrus is the main source of vitamin C, dark yellow green vegetables can provide vitamin A, 500 grams per day. 4, cereals rice, noodles, buns, cereals, etc., can provide carbohydrates . Compounds, B vitamins, 250-400 grams per day. 5, fat cooking oil 25-30 grams per day. 6.Salt 6 grams per day. IV. Nutritional support for oncology patients Correct evaluation of nutritional status is the first step to plan the implementation of nutritional therapy 1. The main parameters to evaluate the nutritional status of patients are as follows: (1) Height (cm). (2) Weight (kg): ideal weight = height one 105. (3) Percentage of actual weight equivalent to ideal weight (%) = actual weight/ideal weight x 100 (4) Weight change within a certain period of time = (original weight a real weight) / original weight x 100 (5) Percentage of actual triceps skinfold thickness equivalent to standard value. Standard value: 8.4mm for men and 15.3mm for women. (6) Actual arm muscle circumference as a percentage of the standard value: Upper arm muscle circumference (cm) = (upper arm circumference a 0.314) x triceps skinfold thickness (cm) Reference value: 25.3cm for men and 23.2cm for women. (7) Plasma albumin level is normally 35-48 g/l. Degree of albumin deficiency: mild 28~35g/l, moderate 21~27g/l, severe <20g/l. (8) Plasma transport ferritin level: normal 1.8~2.5 g/l; abnormal degree: mild 1.5~1.8 g/l, moderate 1.0~1.5 g/l, severe <1 g/l. (9) Creatinine all-in-one height index = 24-hour urinary creatinine excretion of the subject (mg)/24-hour urinary creatinine excretion of a healthy person of the same height (mg). (10) Nitrogen balance = nitrogen intake - nitrogen excretion = protein intake (g)/6.25-(urea nitrogen + 3.5 g). A value greater than zero is positive equilibrium, less than zero is negative equilibrium, and equal to zero is equilibrium. (11) Total lymphocyte count (pcs/L) = white blood cell count (pcs/L) x lymphocyte %/100 Normal (2.5~3)x109/L, mild malnutrition (1.2~2)x109/L, moderate malnutrition (0.8~1.2)x109/L, severe malnutrition less than 0.8x109/L. (12) Cellular immune function measurement. , (13) Daily basal energy expenditure. (14) Multiples of caloric intake equivalent to basal energy expenditure. (15) Dietary intake of nutrients. Human nutrition assessment standards, the above indicators 3 ~ 6 and 9, such as 80% to 90% of the normal value of mild malnutrition, 60% to 80% of moderate malnutrition, 60% or less for severe malnutrition. 2. Determine the supplied heat (1) Estimation of heat consumption 1) Basal heat consumption (BEE, kcal): BEE (male) = 66.47 + 13.75W + 5.0H - 6.76AIBEE (female) = 66.51 + 9.56W + 1.85H - 4.6A. W - weight (kg), H - height (cm), A - age (years). 2) Full-day caloric expenditure (kcal) = BEx activity coefficient x stress coefficient. Activity coefficient: bed rest 1.2; light activity 1.3; moderate activity 1.5; recovery period or intense activity 1.75 or more. Stress coefficient: minor surgical procedures 1.0-1.1, major surgical procedures 1.1-l.2. Infection or stress: mild 1.0-1.2, moderate 1.2-1.4, severe 1.4-1.8; fracture 1.2-1.35, multiple trauma 1.6, craniocerebral injury (treated with hormones) 1.6, crush injury, blunt force injury 1.15-1.35; cancer 1.1-1.45; 1.0-1.5 for burns up to 20% of body surface area, 1.85-2.00 for 20%-40% of body surface area. (2) Calculation of the patient's full-day caloric needs according to the mode of nutritional supplementation: complete parenteral nutrition (severe burns) = 2.5xBEE; complete parenteral nutrition (anabolic) = 1.75xBEE; transoral nutrition (anabolic) = 1.5xBEE; transoral Nutrition (weight maintenance) = 1.2xBEE. 3. Calorie distribution Generally, the calorie distribution for healthy adults is 60%-70% of total calories from carbohydrates, about 15% from proteins and 20%-30% from fats, with each gram of carbohydrates and proteins providing 4kcal of calories and 9kcal of fats. Calculating the nutritional requirements of individual patients can be based on the nutritional status, the patient's pathological changes and Metabolic characteristics, nutritional supplementation methods to determine the ratio of the three major substances, and regular monitoring, timely adjustment.