Monitoring Energy Balance Through Clinical and Serum Biomarkers in Patients with Hmatologic Malignancies during Chemotherapy

Background: Many cancer patients experience energy imbalance due to the tumor or chemotherapy-related side effects. Chemotherapy could make significant metabolic changes leading to energy imbalance. However, the variations in energy input, metabolic rate, and physical activity are not known in detail. This study aimed to identify changes in energy balance components and serum biomarkers during chemotherapy of patients with hematologic cancer. Methods: This prospective study included 40 patients with hematologic malignancies hospitalized for chemotherapy. Energy balance components, physical function, and serum biomarkers, such as albumin, total protein, CXCL13, GDF15 and leptin, were measured weekly after chemotherapy for 3 weeks. Results: Significant body weight loss, representing negative energy balance, occurred at 2 and 3 weeks after chemotherapy. A statistically reduced oral intake was observed at week three. However, total energy intake did not show any statistical change during the study period due to parental support. Resting energy expenditure statistically decreased according to the Harris-Benedict (HB) equation, but not for the Penn State University (PSU) equation. Physical activity measured by daily steps showed no statistical difference. However, physical function according to the DEMMI score indicated a significant decrease at 3 weeks. Over half of the patients (65.0 %, n = 26) were found to have at least one of energy balance problem according to subgroup classification.Our serum biomarker analysis demonstrated significant differences in serum albumin, total protein, CXCL13, and GDF15 levels, with the exception of leptin. All three subgroups exhibited statistically significant decreases in albumin and total protein. However, only CXCL13 levels in the weight loss group and GDF level in the anorexia and impaired physical function groups were found to be significantly altered by subgroup analysis.Conclusions: The results indicated that 65 % of hematologic cancer patients suffered from energy imbalances during chemotherapy associated with weight loss and anorexia. Significant changes in albumin, total protein, CXCL13, and GDF15 were found. Additionally, subgroup analysis suggested that CXCL13 and GDF15 were associated with weight loss and appetite loss, respectively. Monitoring the energy balance of clinical and serum biomarkers together can help identify the need for nutritional intervention in patients undergoing chemotherapy.

Energy Homeostasis and the Law of Thermodynamics

With the increasing prevalence of obesity and associated morbidity, research continues to investigate the associated factors as well as approaches for effective bodyweight management. While there is consensus that obesity is characterised by an energy imbalance, the interactions between the various components of energy components and the implications of the homeostatic determinants remain controversial. This review critiques the existing theories on energy balance in relation to the law of thermodynamics and proposes the inclusion of important determinants in the energy balance equation.

You aren't what you eat, you become what you eat

Obesity (and the consequent obesity epidemic) is a complex, adaptive process, taking place over a time span of many years. Energy intake is recognized as a potentially important driver of obesity, especially in the context of an identifiable energy imbalance which, it is surmised, must lead to weight gain. Similarly, energy expenditure must play an important role. However, both show an enormous degree of individual variation. Therefore, measuring them is an exceedingly difficult task, especially in the context of large populations and long time periods. It has been argued that population-level observed weight gain can be traced back to very small daily energy imbalances while, at the same time, positing that a much larger maintenance energy gap is responsible for maintaining the energy requirements of the increased weight population. In this paper we examine the relation between BMI and energy intake as functions of age. The convexity of the BMI curves as a function of age and gender demonstrate the enhanced obesity risk apparent in young adults and women, and imply that no settling points exist at the population level. Consistent with other studies, overall weight increases are consistent with a very small daily energy imbalance, about 7 cal. Consumption as a function of age shows a small, steady, linear decrease of about 8 cal per year, and can be associated with a maximal energy excess/deficit of about 250cal for the youngest and oldest age groups. By examining weight differences between age groups as a function of age, we argue that this excess/deficit is an important motor for the observed weight differences, and argue that the apparent energy imbalance of 250 cal, due to excess consumption, leads to an effective imbalance of only 7 cal due to the existence of various physiological and behavioral mechanisms that enhance weight homeostasis and effectively reduce the energy excess from 250 cal to 7 cal. We discuss several possibilities for such mechanisms.

20th century cooling of the deep ocean contributed to delayed acceleration of Earth’s energy imbalance

The historical evolution of Earth’s energy imbalance can be quantified by changes in the global ocean heat content. However, historical reconstructions of ocean heat content often neglect a large volume of the deep ocean, due to sparse observations of ocean temperatures below 2000 m. Here, we provide a global reconstruction of historical changes in full-depth ocean heat content based on interpolated subsurface temperature data using an autoregressive artificial neural network, providing estimates of total ocean warming for the period 1946-2019. We find that cooling of the deep ocean and a small heat gain in the upper ocean led to no robust trend in global ocean heat content from 1960-1990, implying a roughly balanced Earth energy budget within −0.16 to 0.06 W m−2 over most of the latter half of the 20th century. However, the past three decades have seen a rapid acceleration in ocean warming, with the entire ocean warming from top to bottom at a rate of 0.63 ± 0.13 W m−2. These results suggest a delayed onset of a positive Earth energy imbalance relative to previous estimates, although large uncertainties remain.

Anthropogenic forcing and response yield observed positive trend in Earth’s energy imbalance

The observed trend in Earth’s energy imbalance (TEEI), a measure of the acceleration of heat uptake by the planet, is a fundamental indicator of perturbations to climate. Satellite observations (2001–2020) reveal a significant positive globally-averaged TEEI of 0.38 ± 0.24 Wm−2decade−1, but the contributing drivers have yet to be understood. Using climate model simulations, we show that it is exceptionally unlikely (<1% probability) that this trend can be explained by internal variability. Instead, TEEI is achieved only upon accounting for the increase in anthropogenic radiative forcing and the associated climate response. TEEI is driven by a large decrease in reflected solar radiation and a small increase in emitted infrared radiation. This is because recent changes in forcing and feedbacks are additive in the solar spectrum, while being nearly offset by each other in the infrared. We conclude that the satellite record provides clear evidence of a human-influenced climate system.

Dichloroacetate improves systemic energy balance and feeding behavior during sepsis

Sepsis is a life-threatening organ dysfunction by dysregulated host response to an infection. The metabolic aberrations associated with sepsis underly an acute and organism wide hyper-inflammatory response and multiple organ dysfunction; however, crosstalk between systemic metabolomic alterations and metabolic reprograming at organ levels remains unknown. We analyzed substrate utilization by the respiratory exchange ratio, energy expenditure, metabolomic screening and transcriptional profiling in a cecal ligation and puncture (CLP) model, to show that sepsis increases circulating free fatty acids and acylcarnitines but decreases levels of amino acids and carbohydrates leading to a drastic shift in systemic fuel preference. Comparative analysis of previously published metabolomics from septic liver indicates a positive correlation with hepatic and plasma metabolites during sepsis. In particular, glycine deficiency was a common abnormality of both plasma and the liver during sepsis. Interrogation of the hepatic transcriptome in septic mice suggests that the septic liver may contribute to systemic glycine deficiency by downregulating genes involved in glycine synthesis. Interestingly, intraperitoneal injection of the pyruvate dehydrogenase kinase (PDK) inhibitor dichloroacetate (DCA) reverses sepsis-induced anorexia, energy imbalance, dyslipidemia, hypoglycemia, and glycine deficiency. Collectively, our data indicate that PDK inhibition rescues systemic energy imbalance and metabolic dysfunction in sepsis partly through restoration of hepatic fuel metabolism.

Monitoring the ocean heat content change and the Earth energy imbalance from space altimetry and space gravimetry

The Earth energy imbalance (EEI) at the top of the atmosphere is responsible for the accumulation of heat in the climate system. Monitoring the EEI is therefore necessary to better understand the Earth’s warming climate. Measuring the EEI is challenging as it is a globally integrated variable whose variations are small (0.5–1 W m−2) compared to the amount of energy entering and leaving the climate system (~ 340 W m−2). Since the ocean absorbs more than 90 % of the excess energy stored by the Earth system, estimating the ocean heat content (OHC) provides an accurate proxy of the EEI. This study provides a space geodetic estimation of the OHC changes at global and regional scales based on the combination of space altimetry and space gravimetry measurements. From this estimate, the global variations in the EEI are derived with realistic estimates of its uncertainty. The mean EEI value is estimated at +0.74 ± 0.22 W m−2 (90 % confidence level) between August 2002 and August 2016. Comparisons against independent estimates based on Argo data and on CERES measurements show good agreement within the error bars of the global mean and the time variations in EEI. Further improvements are needed to reduce uncertainties and to improve the time series especially at interannual and smaller time scales. The space geodetic OHC-EEI product is freely available at https://doi.org/10.24400/527896/a01-2020.003.

Impact of Climate Change and Surface Energy (Im) Balance on North-East India Monsoonal Rainfall

In recent decades, climate change and its impact on the ecosystem has remained a concern from global to regional to local scale. Many studies performed over India have highlighted the change in precipitation associated with the Indian summer monsoon (ISM) and its linkage with changed land surface processes. Over North-East India (NEI), changed surface and atmospheric energy imbalance due to increase in wasteland, deforestation and over cultivation have made the soil barren. In addition, soil moisture of barren land has decreased, latent (sensible) heat decreased (increased) with stimulating ground heat increment. This led to lower evapotranspiration and convection leading to precipitation decrement. To analyse this in detail, the present study shows a lower increase in the near surface temperature during 1956-1985 (period I), but a higher increasing trend has been seen during 1986-2015 (period II). In the case of precipitation trends, an increase during period I and a decrease at a 95% significant level during period II are seen. The average air temperature warming rate increase of 0.09 °C/year is observed. The monsoonal precipitation has decreased significantly in recent years (1986-2015) than that in the past (1956-1985). In addition, a decrease in monsoonal precipitation at 0.35 mm/year rate during period II is seen over NEI. A prominent increment of 0.12 W/m2 is observed in surface sensible heat flux over NEI. Land use land cover change (LULCC) is continuously altering the local rate of change of thermal radiation, evapotranspiration and convection, and has also played a critical role in defining monsoonal precipitation over NEI. However, the surface net solar and thermal radiation change are in equilibrium with the surface sensible and latent heat for sustaining the surface energy budget. Hence, a small change in surface net radiation causes an imbalance of surface energetics. It is one of the most prominent causes for the precipitation pattern changes over NEI. The LULCCs and earth’ surface energy imbalance reinforce climate variability and climate change over the study region.