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Cancer-associated malnutrition

European Journal of Clinical Nutrition volume 72, pages 1255–1259 (2018)Cite this article

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We know the susceptibility of patients with different cancers to malnutrition, albeit that there are not widespread demographics. While cancer statistics are reported in most jurisdictions, malnutrition statistics on a population basis are not. However, we do know that 50% of all cancer deaths on a worldwide basis (~8.9 million people per year) are attributed to the cancers most commonly associated with malnutrition [1]. These include pancreatic, esophageal, gastric, lung, hepatic, and colorectal cancers [2]. In recent decades, the prevalence of cancer-associated malnutrition in inevitably framed in the context of epidemic obesity. One-third of cancer diagnoses are attributed to behavioral and nutritional risks that lead to excess body weight [3]. Overweight and obesity are now prevalent in patients with cancer and the upward shift in body weight makes it more challenging to define malnutrition based on criteria for clinically significant weight loss.

Recent years have seen an emerging consensus regarding the definition of and the specific criteria to adequately describe disease-associated malnutrition [4, 5]. This has been motivated by the perception that multiple discordant definitions used in the literature are an impediment to clinical practice and research [4, 6]. Cancer-associated malnutrition, like other forms of disease-associated malnutrition, is generally acknowledged to differ from deficiency of nutrients in the absence of underlying disease (i.e., starvation, anorexia nervosa). Metabolic changes in the patients with cancer caused by the tumor or by the cancer therapy alter the ability to utilize nutrients. These metabolic changes include inflammation, excess catabolism, futile cycling, and anabolic resistance [4, 7]. Cancer-associated malnutrition is thus partially, but not completely reversible by conventional nutrition therapy [4, 8]. Another key concept is that the detrimental outcomes associated with cancer-associated malnutrition are driven substantially by the depletion of skeletal muscle [4, 7]; state-of-the-art approaches based on diagnostic imaging are available to quantify this depletion [9, 10].

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References

  1. WHO. Cancer Fact sheet [online], http://www.who.int/mediacentre/factsheets/fs297/en/ (2017).

  2. Hébuterne X, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr. 2014;38:196–204.

    Article  Google Scholar 

  3. WHO. Obesity and overweight fact sheet [online], http://www.who.int/mediacentre/factsheets/fs311/en/ (2016).

  4. Fearon K, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95.

    Article  Google Scholar 

  5. Jensen GL, et al. International Consensus Guideline Committee. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr. 2010;34:156–9.

    Article  Google Scholar 

  6. Dechaphunkul T, et al. Malnutrition assessment in patients with cancers of the head and neck: a call to action and consensus. Crit Rev Oncol Hematol. 2013;88:459–76.

    Article  Google Scholar 

  7. Baracos VE, et al. Cancer-associated cachexia. Nat Rev Dis Prim. 2018;4:17105.

    Article  Google Scholar 

  8. de van der Schueren MAE, et al. Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Ann Oncol. 2018;29:1141–53.

    Article  Google Scholar 

  9. Mourtzakis M, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33:997–1006.

    Article  Google Scholar 

  10. Kazemi-Bajestani SMR, et al. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes. Semin Cell Dev Biol. 2016;54:2–10.

    Article  Google Scholar 

  11. Arends J, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36:11–48.

    Article  Google Scholar 

  12. Bozzetti F, et al. The prognosis of incurable cachectic cancer patients on home parenteral nutrition: a multi-centre observational study with prospective follow-up of 414 patients. Ann Oncol. 2014;25:487–93.

    Article  CAS  Google Scholar 

  13. Bozzetti F, et al. Development and validation of a nomogram to predict survival in incurable cachectic cancer patients on home parenteral nutrition. Ann Oncol. 2015;26:2335–40.

    Article  CAS  Google Scholar 

  14. Crowder SL, et al. Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review. J Cancer Surviv. 2018. https://doi.org/10.1007/s11764-018-0687-7.

    Article  Google Scholar 

  15. Scott D, et al. Health care professionals’ experience, understanding and perception of need of advanced cancer patients with cachexia and their families: the benefits of a dedicated clinic. BMC Palliat Care. 2016;15:100.

    Article  Google Scholar 

  16. Dev R, et al. Hypermetabolism and symptom burden in advanced cancer patients evaluated in a cachexia clinic. J Cachex- Sarcopenia Muscle. 2015;6:95–98.

    Article  Google Scholar 

  17. Vigano A, et al. The Cachexia Clinic: from staging to managing nutritional and functional problems in advanced cancer patients. Crit Rev Oncog. 2012;17:293–304.

    Article  Google Scholar 

  18. Cederholm T, et al. To create a consensus on malnutrition diagnostic criteria. JPEN J Parenter Enteral Nutr. 2017;41:311–4.

    Article  Google Scholar 

  19. Martin L, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33:90–9.

    Article  Google Scholar 

  20. Schiessel DL, et al. Barriers to cancer nutrition therapy: excess catabolism of muscle and adipose tissues induced by tumour products and chemotherapy. Proc Nutr Soc. 2018;30:1–9.

    Google Scholar 

  21. Loomans HA, et al. Intertwining of activin a and TGFβ signaling: dual roles in cancer progression and cancer cell invasion. Cancers. 2014;7:70–91.

    Article  Google Scholar 

  22. Agustsson T, et al. Mechanism of increased lipolysis in cancer cachexia. Cancer Res. 2007;67:5531–7.

    Article  CAS  Google Scholar 

  23. Xue Y, et al. Zinc-α-2-glycoprotein: a candidate biomarker for colon cancer diagnosis in chinese population. Int J Mol Sci. 2015;16:691–703.

    Article  Google Scholar 

  24. Cabassi A, et al. Zinc-α2-glycoprotein as a marker of fat catabolism in humans. Curr Opin Clin Nutr Metab Care. 2013;16:267–71.

    Article  CAS  Google Scholar 

  25. Adegoke OAJ, et al. mTORC1 and the regulation of skeletal muscle anabolism and mass. Appl Physiol Nutr Metab. 2012;37:395–406.

    Article  CAS  Google Scholar 

  26. Egerman MA, et al. Signaling pathways controlling skeletal muscle mass. Crit Rev Biochem Mol Biol. 2014;49:59–68.

    Article  CAS  Google Scholar 

  27. Martin L, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31:1539–47.

    Article  Google Scholar 

  28. Blauwhoff-Buskermolen S, et al. Loss of muscle mass during chemotherapy is predictive for poor survival of patients with metastatic colorectal cancer. J Clin Oncol. 2016;34:1339–44.

    Article  CAS  Google Scholar 

  29. Ní Bhuachalla ÉB, et al. Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?. J Cachex- Sarcopenia Muscle. 2018;9:295–305.3.

    Article  Google Scholar 

  30. Purcell SA, et al. Key determinants of energy expenditure in cancer and implications for clinical practice. Eur J Clin Nutr. 2016;70:1230–8.

    Article  CAS  Google Scholar 

  31. Mitchell CJ, et al. The effects of dietary protein intake on appendicular lean mass and muscle function in elderly men: a 10-wk randomized controlled trial. Am J Clin Nutr. 2017;106:1375–83.

    Article  CAS  Google Scholar 

  32. Weyermann P, et al. Orally available selective melanocortin-4 receptor antagonists stimulate food intake and reduce cancer-induced cachexia in mice. PLoS ONE. 2009;4:e4774.

    Article  Google Scholar 

  33. Breit SN, et al. Targeting obesity and cachexia: identification of the GFRAL receptor-MIC-1/GDF15 pathway. Trends Mol Med. 2017;3:1065–7.

    Article  Google Scholar 

  34. Temel JS, et al. Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials. Lancet Oncol. 2016;17:519–31.

    Article  CAS  Google Scholar 

  35. Prado CMM, et al. Skeletal muscle anabolism is a side effect of therapy with the MEK inhibitor: selumetinib in patients with cholangiocarcinoma. Br J Cancer. 2012;106:1583–6.

    Article  CAS  Google Scholar 

  36. Pappalardo G, et al. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism. Nutrition. 2015;31:549–55.

    Article  CAS  Google Scholar 

  37. Di Girolamo FG, et al. Omega-3 fatty acids and protein metabolism: enhancement of anabolic interventions for sarcopenia. Curr Opin Clin Nutr Metab Care. 2014;17:145–50.

    Article  Google Scholar 

  38. Xue H, et al. Nutrition modulation of gastrointestinal toxicity related to cancer chemotherapy: from preclinical findings to clinical strategy. JPEN J Parenter Enteral Nutr. 2011;35:74–90.

    Article  CAS  Google Scholar 

  39. Fridman WH, et al. The immune contexture in cancer prognosis and treatment. Nat Rev Clin Oncol. 2017;14:717–34.

    Article  CAS  Google Scholar 

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Acknowledgements

The author receives funding from the Canadian Institutes of Health Research and the Alberta Cancer Foundation.

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  1. Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue Edmonton, Alberta, Canada, T6G1Z2

    Vickie E. Baracos

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Correspondence to Vickie E. Baracos.

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Baracos, V.E. Cancer-associated malnutrition. Eur J Clin Nutr 72, 1255–1259 (2018). https://doi.org/10.1038/s41430-018-0245-4

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