Effects of oral meal feeding on whole body protein breakdown and protein synthesis in cachectic pancreatic cancer patients (original) (raw)
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Effect of Total Parenteral Nutrition on the Protein Kinetics of Patients with Cancer Cachexia
Tumori Journal, 2000
Aims and background The question of whether TPN is able to reverse lean body mass depletion in cachectic cancer patients and, in particular, its effect on protein kinetics is a matter of some controversy. This study investigates the impact of TPN on protein kinetics in patients with gastric cancer. Methods The study involved three patients with 14–30% weight loss. They were administered a TPN regimen including 33–40 kcal/kg/day and 1.4–1.7 g amino acid/kg/day. The protein metabolism was studied before and during TPN using a stable amino acid isotope. Results Whole body protein turnover and breakdown did not change during TPN, whereas whole body protein synthesis increased from 3.39 ± 1.04 to 6.05 ± 0.48 g/kg/day (P = 0.03). However, the net balance, which was slightly negative prior to TPN, became positive during nutritional support. In the skeletal muscle compartment the synthesis improved with TPN (from 9.38 ± 2.6 nmol/100 mL/min to 35.95 ± 3.4 nmol/100 mL/min; P = 0.0143), wherea...
European Journal of Cancer …, 1991
Cancer and non-cancer patients received total parenteral nutrition (TPN) corresponding to either 120% or 200% non-protein energy resting energy expenditure. Whole-body tyrosine flux and leg exchange of various metabolites were measured in the fasted and fed state. Feeding with the moderate TPN rate did not stimulate whole-body protein synthesis in either group, but the high rate did. Both TPN rates switched an efflux of branched-chain aminoacids from the leg to an uptake in both groups, but this did not apply to tyrosine or phenylalanine. Only the high TPN rate stimulated glucose uptake across the leg in both groups. The leg exchanges of lactate, glycerol and free fatty acids were not significantly influenced by moderate or high TPN rates in either group, although changes in arterial concentrations indicated significant exchanges in compartments other than leg tissues. Thus standard TPN is insufficient to stimulate overall protein synthesis in both malnourished cancer and non-cancer patients, which may explain why previous studies have demonstrated insignificant functional effects with nutritional support to cancer patients.
Clinical Science, 2004
The acute-phase protein response is associated with accelerated weight loss and shortened survival in cancer. This may be due to hepatic protein synthesis increasing demand for amino acids. An n-3 fatty-acid-enriched nutritional supplement will moderate aspects of cachexia in cancer patients. The present study examined the effect of such a supplement on hepatic synthesis of albumin and fibrinogen. Albumin and fibrinogen synthesis were measured in the fed and fasting state in eight weight-losing patients with pancreatic cancer by an intravenous flooding dose technique. Tracer incorporation into proteins was measured by GC/MS. Patients were restudied after 3 weeks of oral supplement enriched with fish oil (providing 2510 kJ/day and 2 g of eicosapentaenoic acid/day). At baseline, all patients were losing weight (median, 2.4 kg/month). After 3 weeks of consumption of the fish-oil-enriched nutritional supplement, patients′ weight stabilized (median change, +1 kg; P=0.01). At baseline, al...
Food intake and body composition in cancer cachexia
Nutrition, 1996
As a complex syndrome, cachexia has different clinical manifestations; anorexia appears to be one of the most frequent findings, together with weight loss. Anorexia is the cause and partly the consequence of metabolic changes and of progressive undernourishment. In cancer cachexia, weight loss is associated with a marked decrease of food intake and severe alteration of body composition. Malnourished cancer patients show a marked loss of adipose tissue and protein mass with BIA evidence of decreased body cell mass and expansion of extracellular water. The mechanisms of anorexia and cachexia are still a matter of debate, but the possible involvement of cytokines in the pathogenesis of this syndrome has opened up new possibilities for its understanding and treatment. As a result of the multifactorial etiology of cancer caehexia/anorexia, therapies that stimulate appetite and promote greater food intake, coupled with factors that influence metabolism and cytokine production may be an optimal therapeutic strategy. Of particular interest appears to be the possible role played by fish oil in antagonizing the negative effects of cytokines. Future research in this field will help clinicians develop new methods to treat patients who have diseaseinduced starvation and wasting.
Cancer, Malnutrition and Cachexia: We Must Break the Triad
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 2015
Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments causing malabsorption. The cachexiaanorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, anorexia, early satiety, fatigue and weakness due to shifts in metabolism caused by tumour by-products and cytokines. Cachexia is a distressing and debilitating condition, affecting significant numbers of patients with advanced disease and is the primary cause of death in about 20% of all patients with cancer. Though cachexia is most commonly associated with particular tumours, such as head and neck, gastrointestinal tract, pancreas, central nervous system and lung, it may affect any patient with any tumour at any site; no patient and no tumour are excluded. Current treatment for principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. A careful decision based on good clinical judgement is necessary before deciding to start either enteral or parenteral nutrition, to avoid a useless, costly and difficult treatment. Treatment should be directed toward improvement in the quality of life of the patient and should often include nutritional counseling. It should take into consideration both disease and treatment related factors as well as the cachexia syndrome itself.