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This review examines the contributions made by anorexia, loss of taste, malabsorption and disturbances of intermediary metabolism to the cachexia of cancer. Methods of nutritional assessment are outlined and mention is made of the usefulness of nutritional support as an adjunct to anti-cancer therapies.
A nutritional survey of 350 hospital patients reveals 50 with cardiac disease who had clinically significant protein-calorie malnutrition. Assessment criteria of malnutrition (per cent normal) included triceps skin fold (52 per cent), arm muscle circumference (88 per cent), and impaired delayed hypersensitivity skin testing (i.e., deficiency in cell-mediated immunity), the latter frequently observed in patients with concurrent weight loss. The functional category of cardiac status was not precise in predictin the morbidity and mortality of 14 patients undergoing cardiac valvuloplasty. By contrast, a nutritional/metabolic profile using weight loss, triceps skin fold (35 per cent), arm muscle circumference (27 per cent), and cell-mediated immunity (29 per cent) did identify high-risk patients who could be expected to benefit by concurrent nutritional support (4/4). Further studies are indicated to determine if nutritional support for cardiac cachexia can reduce the levels of morbidity and mortality during mitral and tricuspid valve surgery.
The rapid loss of the body weight of oncological patients in the advanced stage of the carcinomatous disease is caused by numerous pathophysiological mechanisms. With the help of the modified D-xylose absorption test was investigated which value have disturbances of the enteral absorption in the complex of causes for the development of a tumour cachexia. For the patients in the stage of generalisation of the carcinomatous disease clear disturbances in the enteral food intake could be proved in contrast to patients with carcinoma without general tumour symptomatology and healthy persons. The influence of chemo- and radio-therapy on the enteral absorption of patients with carcinoma was discussed. The forced alimentation of oncological patients with unspezific tumour symptoms must be regarded as a firm constituent in the treatment of patients with carcinoma.
Zinc concentrations in autopsy material of human heart muscle, skeletal muscle, iliac crest, pancreas and liver were analyzed by atomic absorption spectrophotometry. Age dependent differences of zinc concentrations are seen in the liver. High values shows liver of premature infants, a minimum is measured in childhood which is followed by an increase in adult and senile patients. The other organs show no significant changes. Different diseases like diabetes or liver cirrhosis do not influence the zinc concentration in skeletal muscles and iliac crest. Long-term intensive care patients show a marked decrease in zinc concentration of the heart muscle. In the cirrhotic liver the zinc pool is depleted. In diabetes mellitus zinc concentration of the whole pancreas is normal, in cachexia it is critically decreased.
Host starvation is a common accompaniment to the presence of cancer. Diminished intake is a major contributor to this starvation and does not require that the oropharynx or gastrointestinal tract be the primary site. There is suggestive evidence that the normal adaptive mechanisms of the nontumor-bearing host to starvation that result in body protein conservation are not functioning in the tumor-bearing host. Cancer cachexia has some similarity to the metabolic disturbances of host metabolism that are seen in major injury or sepsis. The growing tumor shows little respect for normal constraints of host tissue growth. With the widespread availability of methods of total parenteral nutrition, the interrelationship of nutrition and host-tumor growth assumes greater importance.
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The cause of anorexia associated with neoplasia is unknown, and some investigators have suggested a central mechanism. Recent neurophysiologic studies have revealed the possible role of serotoninergic system involving tryptophan (TRP) and its indole neurotransmitter metabolites in regulating particular aspects of feeding behavior. We therefore studied plasma and brain factors affecting TRP transport through the blood-brain barrier (plasma free and total TRP, albumin, nonesterified fatty acids, plasma neutral amino acids, brain uptake index [BUI] for TRP) and central serotonin metabolism (5-HT, 5-HIAA) in young, anorexic rats bearing the Walker-256 tumor injected intramuscularly. Plasma free TRP, but not plasma total TRP, and, more important, brain TRP and brain 5-HIAA were significantly higher in tumor-bearing rats than in pair-fed control animals. The results suggest an association between altered brain TRP metabolism and feeding behavior in tumor-related anorexia.
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Rats (weight 150-200 g) bearing Walker-carcinoma showed tumour size dependent hypoglycemia, diminished mobilization of glycogen following glucagon stimulation and elevated values of the enzyme activity of glucose-6-(P)-ase. A further hormonal stimulation of this enzyme activity towards the values observed in normal rats after betamethasone stimulation was not possible. The values of the enzyme fructose-1,6-di-(P)-ase in liver of tumour bearing rats equalled those found in normal controls and did not show any rise after application of betamethasone. The serum levels of free fatty acids did not show any difference between normal controls and tumour bearing rats, and displayed an equal rise after intensive stimulation of peripheral lipolysis.
The nutritional status of 11 patients with severe mitral valve disease was investigated pre-operatively and 3 months post-operatively. It was shown that they were malnourished pre-operatively, and that this appeared to be related mainly to anorexia.
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