scholarly journals Nutritional Approach to Cancer Cachexia: A Proposal for Dietitians

Nutrients ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 345
Author(s):  
Kotone Tanaka ◽  
Sho Nakamura ◽  
Hiroto Narimatsu
Keyword(s):  
Skeletal Muscle ◽  
Nutritional Support ◽  
Skeletal Muscle Mass ◽  
Cancer Cachexia ◽  
The Body ◽  
Current Evidence ◽  
Muscle Loss ◽  
Related Factors ◽  
Skeletal Muscle Loss

Cachexia is one of the most common, related factors of malnutrition in cancer patients. Cancer cachexia is a multifactorial syndrome characterized by persistent loss of skeletal muscle mass and fat mass, resulting in irreversible and progressive functional impairment. The skeletal muscle loss cannot be reversed by conventional nutritional support, and a combination of anti-inflammatory agents and other nutrients is recommended. In this review, we reviewed the effects of nutrients that are expected to combat muscle loss caused by cancer cachexia (eicosapentaenoic acid, β-hydroxy-β-methylbutyrate, creatine, and carnitine) to propose nutritional approaches that can be taken at present. Current evidence is based on the intake of nutrients as supplements; however, the long-term and continuous intake of nutrients as food has the potential to be useful for the body. Therefore, in addition to conventional nutritional support, we believe that it is important for the dietitian to work with the clinical team to first fully assess the patient’s condition and then to safely incorporate nutrients that are expected to have specific functions for cancer cachexia from foods and supplements.

scholarly journals Impact of preoperative nutritional support on patients with skeletal muscle loss undergoing pancreatoduodenectomy

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S284
Author(s):  
M. Tsukagoshi ◽  
N. Harimoto ◽  
K. Araki ◽  
N. Kubo ◽  
A. Watanabe ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Nutritional Support ◽  
Muscle Loss ◽  
Skeletal Muscle Loss

Inclusion criteria for cancer cachexia clinical trials: CT-defined skeletal muscle loss versus body weight loss.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 67-67
Author(s):  
Eric Roeland ◽  
Sandahl H Nelson ◽  
Ashleigh Campillo ◽  
Sean Heavey ◽  
Joseph D. Ma ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Weight Loss ◽  
Cancer Cachexia ◽  
Ct Scans ◽  
Muscle Loss ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Skeletal Muscle Loss ◽  
Visceral Adipose ◽  
Over Time

67 Background: Cancer cachexia is defined by skeletal muscle loss, with or without fat loss (Fearon et al 2011); however, inclusion criteria for cachexia clinical trials requires a defined weight loss over time rather than muscle loss. We hypothesized that cross sectional imaging may reveal the presence of cachexia otherwise obscured by fat mass changes. Methods: A retrospective analysis of longitudinal CT scans was performed in metastatic colorectal cancer (mCRC) patients screened for a cancer cachexia trial, which required ≥5% weight loss in the prior 6 mos. De-identified CT images were analyzed for total muscle, subcutaneous, and visceral fat cross-sectional areas (cm2) at the 3rd lumbar vertebra at baseline and up to 12 mos prior (Lieffers et al 2009). Logistic regression was used to test differences between patients with <5% vs ≥5% weight loss. Random intercept regression was used to evaluate significant trends in CT measures over time. Results: 42 mCRC patients were screened and 3(7%) enrolled. Patients were excluded for comorbidity/contraindication 14 (33%), excessive [>20%] weight loss 4 (9.5%), and insufficient [<5%] weight loss 19 (45%). For the <5% weight loss subset, there was a mean of 6.7 CT scans (SD=2.67) and of 9% (SD=5.4, min=0%, 25th percentile=4.9%) mean max muscle loss. Notably this group was simultaneously losing muscle (p=0.002) and gaining visceral adipose (p=0.007). For the ≥5% weight loss subset, there was a mean of 7.5 CT scans (SD=4.5) and 20% (SD=10.0, min=5.2%, 25th percentile =10.6) mean max muscle loss. Greater max muscle loss increased the odds of being in the ≥5% weight loss subset (OR=1.19, 95% CI: 1.06,1.33). This group also had a significant decrease in visceral adipose over time (p<0.001). Redefined inclusion criteria of ≥5% muscle loss would have included 14 of the 19 patients excluded because of <5% weight loss. Conclusions: Defining cancer cachexia as weight loss over time may be limited as it does not capture body composition changes and hinders trial accrual. Cross-sectional CT body composition analysis may improve early detection of muscle loss and improve trial accrual.

scholarly journals Skeletal Muscle Loss during Multikinase Inhibitors Therapy: Molecular Pathways, Clinical Implications, and Nutritional Challenges

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3101
Author(s):  
Emanuele Rinninella ◽  
Marco Cintoni ◽  
Pauline Raoul ◽  
Carmelo Pozzo ◽  
Antonia Strippoli ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Muscle Mass ◽  
Nutritional Support ◽  
Muscle Wasting ◽  
Early Recognition ◽  
Clinical Implications ◽  
Molecular Pathways ◽  
Muscle Loss ◽  
Skeletal Muscle Loss ◽  
The Impact

In cancer patients, loss of muscle mass is significantly associated with low tolerability of chemotherapy and poor survival. Despite the great strides in the treatment of cancer, targeted therapies such as tyrosine kinase inhibitors (TKIs) could exacerbate muscle wasting. Over recent years, the impact of skeletal muscle loss during TKI therapy on clinical outcomes has been in the spotlight. In this review, we focus on the different molecular pathways of TKIs potentially involved in muscle wasting. Then, we report the results of the studies assessing the effects of different TKI therapies—such as sorafenib, regorafenib, sunitinib, and lenvatinib—on muscle mass, and highlight their potential clinical implications. Finally, we discuss an integrative nutritional approach to be adopted during TKI treatment. The assessment of muscle mass from computerized tomography imaging could be helpful in predicting toxicity and prognosis in patients treated with TKI such as sorafenib. Early recognition of low muscle mass and effective personalized nutritional support could prevent or attenuate muscle mass wasting. However, the role of nutrition is still overlooked, and future clinical trials are needed to find the optimal nutritional support to countermeasure muscle mass depletion during TKI therapy.

Association of skeletal muscle loss with the long-term outcomes of esophageal cancer patients treated with neoadjuvant chemotherapy

Surgery Today ◽  
2019 ◽  
Vol 49 (12) ◽  
pp. 1022-1028 ◽  
Author(s):  
Naoki Kamitani ◽  
Kazuhiro Migita ◽  
Sohei Matsumoto ◽  
Kohei Wakatsuki ◽  
Tomohiro Kunishige ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Muscle Loss ◽  
Long Term Outcomes ◽  
Skeletal Muscle Loss

scholarly journals Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

2020 ◽  
Author(s):  
Naoaki Maeda ◽  
Yasuhiro Shirakawa ◽  
Shunsuke Tanabe ◽  
Kazufumi Sakurama ◽  
Kazuhiro Noma ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Survival Rate ◽  
Acute Phase ◽  
Reduction Rate ◽  
Lumbar Vertebra ◽  
Muscle Loss ◽  
Psoas Major Muscle ◽  
Skeletal Muscle Loss ◽  
Long Term Prognosis

Abstract Background: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.Methods: The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and June 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and three days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model.Results: There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The three-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group.Conclusion: skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 168-168
Author(s):  
Kazumasa Fujitani ◽  
Yusuke Yamaoka ◽  
Toshimasa Tsujinaka ◽  
Kazuyoshi Yamamoto ◽  
Motohiro Hirao ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Adjuvant Chemotherapy ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Significant Loss ◽  
Muscle Loss ◽  
Clinical Factors ◽  
Improved Outcomes ◽  
Skeletal Muscle Loss

168 Background: Skeletal muscle loss is associated with physical disability, nosocomial infections, postoperative complications, and decreased survival. Preventing the loss of skeletal muscle mass after gastrectomy may lead to improved outcomes. The aims of this study were to assess changes in skeletal muscle mass after total gastrectomy (TG) and to clarify the clinical factors affecting significant loss of skeletal muscle after TG. Methods: One hundred and two patients undergoing TG for primary gastric cancer underwent abdominal computed tomography (CT) before and 1 year after TG to precisely quantify postoperative changes in skeletal muscle and adipose tissue. Univariate and multivariate logistic regression analyses identified clinical factors contributing to significant loss of skeletal muscle after TG. Results: At 1 year after TG, the mass of both skeletal muscle and adipose tissue was reduced by 6.20±6.80% and 65.8±36.1% of the preoperative values, respectively, and 26 patients (25.5%) showed a significant loss of skeletal muscle of more than 10%. Adjuvant chemotherapy with S-1 for ≥6 months (hazard ratio 26.75, 95% confidence interval 3.511 to 203.9) was identified as the single independent risk factor for a significant loss of skeletal muscle. Conclusions: Skeletal muscle loss was exacerbated by extended adjuvant chemotherapy after TG. Further research should identify appropriate nutritional interventions for maintaining skeletal muscle mass and leading to improved outcomes.

scholarly journals Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

2020 ◽  
Author(s):  
Naoaki Maeda ◽  
Yasuhiro Shirakawa ◽  
Shunsuke Tanabe ◽  
Kazufumi Sakurama ◽  
Kazuhiro Noma ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Survival Rate ◽  
Acute Phase ◽  
Psoas Muscle ◽  
Muscle Loss ◽  
Psoas Major Muscle ◽  
Significant Difference ◽  
Skeletal Muscle Loss ◽  
Long Term Prognosis

Abstract Background: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss (SML) in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.Methods: The following items were retrospectively investigated. First, whether SML occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in SML in the postoperative acute phase of ESCC were investigated. Then, whether SML in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC were retrospectively reviewed; 72 cases were eligible for this study.Results: There was already a significant difference between the total psoas major muscle mass index (TPI) of the acute phase up to 3 days after surgery and the preoperative baseline TPI. The psoas muscle loss index (PMLI) was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The three-year overall survival rate was significantly different between the PMLI severe group and the PMLI mild group.Conclusion: SML occurred even in the postoperative acute phase. Furthermore, it is very significant that SML in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

scholarly journals Skeletal muscle loss was associated with the risk of diabetes in non non-alcoholic fatty liver disease Chinese male middle-aged and elderly population, the Shanghai Changfeng Study

2021 ◽  
Author(s):  
Lingyan Chen ◽  
Mingfeng Xia ◽  
Li Wu ◽  
Qian Li ◽  
Yu Hu ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Logistic Regression ◽  
Liver Disease ◽  
Muscle Mass ◽  
Fatty Liver Disease ◽  
Skeletal Muscle Mass ◽  
Muscle Loss ◽  
Alcoholic Fatty Liver ◽  
Skeletal Muscle Loss ◽  
Alcoholic Fatty Liver Disease

Abstract Background Previous studies have presented skeletal muscle loss was associated with diabetes mellitus (DM) and non-alcoholic fatty liver disease (NAFLD). However, whether the presence of NAFLD could influence the association between skeletal muscle mass and DM was still unknown. The aim of the present study was to investigate the relationship of skeletal muscle mass with diabetes in Chinese middle-aged and older community population, and whether the association could be effected by NAFLD. Methods A cross-sectional study of 5,626 residents aged 45 and above in Changfeng community in Shanghai were conducted. Skeletal muscle mass (SMM) was detected by dual-energy X ray absorption (DXA) and calculated as ASM% [appendicular skeletal muscle mass (ASM) (kg) /body weight*100%]. Liver fat content (LFC) was measured using a quantitative ultrasound method. Multivariate logistic regression analyses were conducted to investigate the association between ASM% quartiles with DM. Results With ASM% decreasing, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hBG) and Homeostasis model assessment for insulin resistance (HOMA-IR) as well as LFC increased in both genders, and the prevalence of diabetes and NAFLD also increased. Spearman analysis showed ASM% was negatively correlated with FBG, 2hBG and LFC. Stepwise logistic regression analysis showed after multiple adjustments, ASM% quartile was negatively associated with the risk of diabetes only in male, but not in female. Subgroup analysis found the ASM% quartiles remained negatively correlated with the risk of diabetes in male non-NAFLD population, but not in NAFLD population. When stratified by LFC quartiles, the results was similar. After multivariate adjustments, low ASM% was negatively correlated with the risk of diabetes only in the first and second LFC quartile in male, and the association remained insignificant in each LFC quartile in female. Conclusions Skeletal muscle mass was negatively associated with the risk of diabetes in male population but not in female. The presence of NAFLD weakened this association. The results suggested stratified management of diabetes should be considered according to skeletal muscle mass and the presence of NAFLD.

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