Controversies in NEN: an ENETS position statement on nutritional support in neuroendocrine neoplasms

Neuroendocrine neoplasms (NEN) themselves and also their treatment may cause malnutrition, inducing changes in physiological behaviour and eventually leading to increased rates of morbidity and mortality. Malnutrition is a common, under-recognised and under-treated condition in patients with NEN, and there are limited data available on the role of optimising nutrition in this setting. There are no formal evidence-based European Neuroendocrine Tumor Society (ENETS) guidelines on nutrition evaluation and management in patients with NEN to date. This manuscript was initiated during the 2024 ENETS Advisory Board meeting by using an expert panel consensus methodology and specific structured questions, which were identified and addressed through a structured review of the literature. The manuscript aims to identify the presence of specific nutrient deficits and define unmet needs and controversies regarding nutrition and NEN in a succinct manner, to promote collaborative and multidisciplinary research in the field, and to offer practical guidance in terms of how to assess malnutrition and dietary interventions by means of formulating a structured questionnaire.