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Acetato de Megestrol (AM). Indicação: Tratamento da Síndrome anorexia-caquexia (SAC) em doentes crônicos em fase de cuidados paliativos. Objetivo: Avaliar a eficácia e segurança do uso do AM em doentes crônicos sob cuidados paliativos. Métodos: Foi realizada uma revisão rápida de revisões sistemáticas, com levantamento bibliográfico nas bases de dados PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web Of Science e em registros de revisões sistemáticas e ensaios clínicos. A qualidade metodológica dos estudos incluídos foi avaliada com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: A busca recuperou um total de 2.370 após exclusão das duplicatas; 1003 estudos foram triados pelo título e resumo, de acordo com os critérios de inclusão previamente estabelecidos. Dezesseis RSs foram selecionadas para leitura completa, sendo que, destas, apenas 1 RS foi classificado com alta qualidade metodológica. Após a análise dos ECR das RSs excluídas, um ECR foi incluído considerando os critérios de inclusão. Dois estudos adicionais publicados posteriormente a RS de Ruiz-Garcia et al. Conclusão: Com base nas evidências disponíveis, o AM proporciona leve ganho de peso e melhora o apetite, porém esses resultados não refletem melhoria na qualidade de vida dos pacientes, além de haver risco considerável de desenvolver fenômenos tromboembólicos
Megestrol acetate (MA). Indication: treatment of anorexia-cachexia syndrome (ACS) in chronic diseases patients, under palliative care. Objective: Evaluate the efficacy and safety of the use of Megestrol Acetate to treat ACS in patients under palliative care. Methods: Rapid review protocol of Systematic Reviews and Clinical Trials. A literature Search was performed in PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web of Science databases and in clinical trials records, following a predefined strategy. The methodological quality of the selected articles was assessed through AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2) tool. Results: the search resulted in 2,370 articles, after the duplicates exclusion. 1003 were analyzed by tittle and abstracts according the inclusion criteria. 16 were selected for full text reading, and only one considered to have high methodological quality. After the analyses of the Randomized Clinical Trials of the excluded Systematic Reviews, one RCT was included. Two additional studies published after the SR of Ruiz-Garcia et al were also included. Conclusion: based on available evidence, the MA promoted a small gain in body weight and a slight appetite improvement, although these results did not imply an enhancement in their quality of life. Moreover, there is a considerable risk of causing thromboembolic disorders
Subject(s)
Humans , Male , Female , Megestrol Acetate/adverse effects , Weight Gain/drug effectsABSTRACT
Cancer cachexia is a multifactorial syndrome characterized by the continuous loss of skeletal muscle. The pathogenic mechanism of cancer cachexia remains unknown, and the effectiveness of routine nutritional therapy is limited. The mitochondrial disorder is demonstrated to play an important role in the mechanism of tumor-induced skeletal muscle atrophy, including alterations to the mitochondrial ultrastructure, biogenesis, dynamics, mitophagy, and functions. Interventions targeting mitochondrial alterations provide a potential solution to cancer cachexia and represent a new focus in this research field.
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Cancer anorexia/cachexia syndrome (cancer anorexia cachexia syndrome, CACS) is a common complication in advanced cancer patients, which is characterized by reduced feeding, sustained weight loss, general fatigue and weakness. CACS related symptoms make patients suffer from a series of adverse psychosocial effects, such as anxiety, pain and social isolation, thus bringing serious adverse effects on patients′ individuals, families and society. This paper reviewed the symptoms associated with CACS and their psychosocial effects, as well as the interventions related to adverse psychosocial effects, in order to provide theoretical reference for alleviating psychosocial distress and improving health-related quality of life of patients with CACS.
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OBJECTIVE To investigate the improvement effects and mechanism of imperatorin on cachexia model mice. METHODS Fifteen male C57BL/6J mice were randomly divided into blank control group， model group and imperatorin group， with 5 mice in each group. Except for blank control group， the remaining mice were inoculated with LLC cell suspension subcutaneously on the dorsal surface， and the drug was administered by gavage daily from the 7th day of inoculation. The imperatorin group was gavaged with imperatorin suspension （0.5% sodium carboxymethylcellulose solution as solvent） at 60 mg/kg； blank control group and model group were given an equal volume of 0.5% sodium carboxymethylcellulose solution， for 13 d of continuous administration. During the administration period， food intake and body mass of mice were recorded daily and regularly， tumor long and short diameters were measured every two days， and tumor volume was calculated. The skeletal muscle mass and tumor mass of each group were weighed and the tumor-free body weight was calculated； the pathological changes of skeletal muscle were observed and the cross-sectional area of skeletal muscle fibers was calculated； the phosphorylation levels of signal transduction and activator of transcription 3 （STAT3） （measured as p-STAT3/STAT3 ratio）， muscle atrophy box F gene （MAFbx）， myostatin （Myog）， B-cell lymphoma-2 （Bcl-2）， Bcl-2 associated X protein （Bax）， Caspase3 protein and mRNA expression were all detected. RESULTS Compared with blank control group， body mass and skeletal muscle mass of model group were decreased significantly （P＜0.05）， and reduced food intake， loose arrangement of skeletal muscle， large cell space were observed； the cross-sectional area of skeletal muscle fiber was significantly reduced， while p-STAT3/STAT3 ratio， protein and mRNA expressions of MAFbx， Bax and Caspase3 were somo_amour@163.com increased significantly （P＜0.05）. The protein and mRNA expressions of Myog and Bcl-2 were significantly reduced （P＜ 0.05）. Compared with model group， body weight， tumor-free weight and skeletal muscle weight were increased significantly in imperatorin group （P＜0.05）； food intake increased， while the expressions of tumor weight and volume were decreased significantly （P＜0.05）； the expressions of above proteins and genes were improved significantly （P＜0.05）. CONCLUSIONS Imperatorin can improve the tumor cachexia state， the mechanism of which may be related to the regulation of ubiquitin-proteasome pathway and anti-apoptosis.
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Resumo Fundamento Problemas nutricionais são comuns em pacientes com insuficiência cardíaca (IC) e estão associados a um prognóstico ruim. É relevante mencionar que algumas populações de pacientes, como os com Doença de Chagas, são normalmente excluídas da maioria das análises. Objetivo Buscamos analisar a ocorrência de desnutrição e caquexia em pacientes com Doença de Chagas durante episódios de IC descompensada (ICD) em comparação a outras etiologias, e investigar a influência desses achados em desfechos hospitalares. Método Realizamos um estudo de série de casos consecutivos com pacientes hospitalizados com ICD. Os pacientes foram submetidos à Avaliação Nutricional Subjetiva Global (ASG), além de medidas antropométricas e laboratoriais, e foram avaliados para a ocorrência de caquexia, baixa massa muscular e força. Estudamos a ocorrência de morte e transplante cardíaco de urgência durante a internação. Resultados Ao todo, 131 pacientes foram analisados e 42 (32,1%) tinham Doença de Chagas. Pacientes com Doença de Chagas apresentavam índice de massa corporal (IMC) menor (22,4 kg/m2 [19,9-25,3] vs. 23,6 kg/m2 [20,8-27,3], p=0,03), maior frequência de desnutrição (76,2% vs 55,1%, p=0,015) e mais ocorrências de morte ou transplante (83,3% vs. 41,6%, p<0,001). Observamos que, dentre os pacientes com etiologia da Doença de Chagas, a ocorrência de morte ou transplante cardíaco esteve associada com desnutrição (3 [42,9%] pacientes com alta hospitalar vs. 29 [82,9%] pacientes que morreram ou receberam transplante cardíaco, P=0,043). Conclusões Ao todo, nossos resultados indicam que pacientes com Doença de Chagas internados com ICD costumam apresentar problemas nutricionais, principalmente desnutrição. É importante mencionar que este achado esteve associado à ocorrência de morte e transplante cardíaco durante a internação.
Abstract Background Nutritional disorders are common among patients with heart failure (HF) and associated with poor prognosis. Importantly, some populations of patients, like the ones with Chagas disease, are frequently excluded from most analyses. Objective We sought to study the occurrence of undernutrition and cachexia in patients with Chagas disease during episodes of decompensated HF (DHF) as compared to other etiologies, and to investigate the influence of these findings on hospital outcomes. Methods We performed a consecutive case series study with patients hospitalized with DHF. Patients underwent the Subjective Global Assessment of nutritional status (SGA), besides anthropometric and laboratorial measures, and were evaluated for the occurrence of cachexia, low muscle mass and strength. We studied the occurrence of death or urgent heart transplantation during hospitalization. Results Altogether, 131 patients were analyzed and 42 (32.1%) had Chagas disease. Patients with Chagas disease had lower Body Mass Index (BMI) (22.4 kg/m2[19.9-25.3] vs. 23.6 kg/m2 [20.8-27.3], p=0.03), higher frequency of undernutrition (76.2% vs 55.1%, p=0.015) and higher occurrence of death or transplant (83.3% vs. 41.6%, p<0.001). We found that, in patients with Chagas etiology, the occurrence of death or cardiac transplantation were associated with undernutrition (3 [42.9%] patients with hospital discharge vs 29 [82.9%] patients with death or heart transplant, p=0.043). Conclusions Taken together, our results indicate that patients with Chagas disease hospitalized with DHF often present with nutritional disorders, especially undernutrition; importantly, this finding was associated with the occurrence of death and heart transplant during hospitalization.
Subject(s)
Humans , Chagas Cardiomyopathy/complications , Malnutrition/complications , Heart Failure/etiology , Cachexia/etiology , HospitalsABSTRACT
ObjectiveTo explore the mechanism of Liu Junzitang in preventing and treating muscle atrophy in mice with lung cancer cachexia based on the signal transducer and activator of transcription 3（STAT3）/ubiquitin proteasome pathway in vivo. MethodForty C57BL/6 mice aged six weeks were randomly divided into a blank group， a model group， a Liu Junzitang group， an inhibitor group （stattic group），and a Liu Junzitang + inhibitor group （combination group）， with eight mice in each group. The cachectic muscle atrophy model was induced by subcutaneous inoculation of Lewis lung cancer cell line under the right anterior armpit in mice except those in the blank group. On the 8th day after subcutaneous inoculation， the mice in the corresponding groups received Liu Junzitang （9.56 g·kg-1·d-1） by gavage and intraperitoneal injection of stattic ［25 mg·kg-1·（2 d）-1］. After three weeks of drug intervention， the body weight and gastrocnemius muscle weight were recorded. Hematoxylin-eosin （HE） staining was used to observe the pathological changes and cross-sectional area of gastrocnemius muscle fibers in mice. Western blot was used to detect the expression of phosphorylated-STAT3 （p-STAT3）， STAT3， muscle atrophy F-box （MAFbx）， and muscle RING finger protein 1 （MuRF1） in the gastrocnemius muscle. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression of STAT3， MAFbx， and MuRF1 in the gastrocnemius muscle. ResultCompared with the blank group， the model group showed lightened body and the gastrocnemius muscle， reduced cross-sectional area of gastrocnemius muscle fibers， and increased protein expression of p-STAT3， STAT3， MAFbx， and MuRF1 and mRNA expression of STAT3， MuRF1， and MAFbx in the gastrocnemius muscle （P<0.05）. Compared with the model group， the Liu Junzitang group showed increased body weight， gastrocnemius muscle weight， and cross-sectional area of gastrocnemius muscle fibers （P<0.05）， and decreased protein expression of p-STAT3， STAT3， MuRF1， MAFbx， and mRNA expression of STAT3 and MAFbx in gastrocnemius muscle （P<0.05）. Compared with the model group， the inhibitor group showed increased body weight and cross-sectional area of gastrocnemius muscle fibers （P<0.05）， and reduced protein expression of p-STAT3， STAT3， MuRF1， MAFbx， and mRNA expression of STAT3 and MAFbx in gastrocnemius muscle （P<0.05）. Compared with the model group， the combination group showed increased body weight and gastrocnemius muscle weight （P<0.05），and decreased protein expression of p-STAT3， STAT3， MuRF1， and mRNA expression of STAT3 and MAFbx in the gastrocnemius muscle （P<0.05）. Compared with the Liu Junzitang group， the stattic group and the combination group showed reduced expression of p-STAT3 protein in the gastrocnemius muscle （P<0.05）. ConclusionLiu Junzitang can prevent and treat muscle atrophy in mice with lung cancer cachexia， and its mechanism may be associated with the protein and mRNA expression related to the STAT3-mediated ubiquitin proteasome pathway.
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Cachexia is a common complication in patients with lung cancer. It aggravates the toxic and side effects of chemotherapy, hinders the treatment plan, weakens the responsiveness of chemotherapy, reduces the quality of life, increases complications and mortality, and seriously endangers the physical and mental health of patients with lung cancer. The causes and pathogenesis of tumor cachexia are extremely complex, which makes its treatment difficult and complex. Controlling cachexia in lung cancer patients requires many means such as anti-tumor therapy, inhibition of inflammatory response, nutritional support, physical exercise, and relief of symptoms to exert the synergistic effect of multimodal therapy against multiple mechanisms of tumor cachexia. To date, there has been a consensus within the discipline that no single therapy can control the development of cachexia. Some therapies have made some progress, but they need to be implemented in combination with multimodal therapy after fully assessing the individual characteristics of lung cancer patients. This article reviews the application of drug therapy and nutritional support in lung cancer patients, and looks forward to the research direction of cachexia control in lung cancer patients. .
Subject(s)
Humans , Cachexia/therapy , Combined Modality Therapy , Lung Neoplasms/drug therapy , Neoplasms/complications , Nutritional Support/adverse effects , Quality of LifeABSTRACT
Abstract Background: Rheumatoid arthritis (RA) generates an inflammatory profile that predisposes to total and visceral fatty accumulation and reduced fat free mass (FFM). This metabolic disorder contributes to poor functionality, increased cardiovascular risk and higher mortality. This study aimed to address a systematic review with meta-analysis to determine the effect of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) on body composition (BC) of patients with RA. Methods: The search was conducted at the electronic databases PubMed, Cochrane Library, Embase, Lilacs and grey literature. This investigation was carried until July 2021. Outcomes of interest were total weight, body mass index (BMI), fat mass (FM) and FFM. A meta-analysis comparing these outcomes in RA patients under bDMARD treatment versus controls was performed. Results: Out of 137 studies reviewed, 18 were selected: fifteen prospective cohorts, two retrospective cohorts, and one cross-sectional study. The studies comprised 1221 patients, 778 on bDMARD treatment and 443 controls, which included RA patients under conventional synthetic DMARD (csDMARD). No study addressing BC analysis in patients using tsDMARD was found. The mean age and duration of the disease was 56.7 years and 6.77 years, respectively. Ten studies demonstrated a significant increase of total weight in 88.2% of patients and 42.3% for BMI. In studies that analyzed BC by double X-ray absorptiometry (DXA), the increase in total weight and BMI correlated positively to the increase in FFM. The meta-analysis carried out in five studies showed no significant difference of the mean difference for total weight 0.12 kg (95% CI − 5.58, 5.82), BMI 0.08 kg/m2 (95% CI − 1.76, 1.92), FM − 0.08 kg (95% IC − 5.31, 5.14), and FFM − 2.08 kg (95% CI − 7.37, 3.21). Conclusion: This systematic review suggests a possible impact of bDMARDs on BC of RA patients, even though, the meta-analysis carried out in a small part of these studies was not able to confirm significant variation in BC components. Trial registration: PROSPERO code: CRD42020206949.
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Resumen: Introducción: La caquexia es un síndrome asociado al cáncer avanzado, VIH, pacientes en quimioterapia y quienes tienen seguimiento en cuidados paliativos. La prevalencia es de 25% de los pacientes con diagnóstico de cáncer, 26% en quienes reciben quimioterapia y de 14 a 38% de pacientes con VIH. Un pilar para el manejo es el cannabis debido al efecto del delta-9-tetrahidrocanabinol (THC), del cual se derivó el dronabinol, un fármaco desarrollado para estimular apetito y ganancia de peso. El objetivo de esta revisión bibliográfica es obtener la información sobre los cannabinoides y la evidencia más sólida existente con respecto al uso del dronabinol en pacientes que han presentado pérdida de peso y apetito. Material y métodos: Revisión de la bibliografía con buscador PubMed con las palabras clave Palliative care (cuidados paliativos), Cannabinoids (cannabinoides), cachexia (caquexia), Dronabinol (dronabinol), Appetite (apetito), de 1990 a 2018, limitado a humanos, obteniendo 259 artículos, eliminando 222 por repetirse o tener poca relevancia, dejando 37 artículos para análisis. Resultados: De 37 artículos revisados, nueve fueron estudios experimentales, 10 revisiones sistematizadas, un metaanálisis y 16 artículos de recomendaciones y sugerencias de manejo. Conclusión: El manejo del apetito y pérdida de peso en pacientes en cuidados paliativos, VIH, ancianos o en quimioterapia debe ser multidisciplinario, involucrando nutriólogos, psicólogos y médicos, ajustando el manejo a las características individuales que manifiesten. El dronabinol es un fármaco de primera elección para el manejo de dichos síntomas cuando la historia natural de la enfermedad se acompaña de náusea, vómito o dolor.
Abstract: Introduction: Cachexia is a syndrome associated with advanced cancer, HIV, patients on chemotherapy and those who are followed in palliative care. The prevalence is 25% of patients diagnosed with cancer, 26% in those receiving chemotherapy and 14 to 38% of patients with HIV. A mainstay for management is cannabis, due to the effect of delta-9-tetrahydrocannabinol (THC) from which dronabinol, a drug developed to stimulate appetite and weight gain, was derived. The aim of this literature review is to obtain information on cannabinoids and the strongest existing evidence regarding the use of dronabinol in patients who have presented weight and appetite loss. Material and methods: Literature review with PubMed search engine with the keywords Palliative care, Cannabinoids, cachexia, Dronabinol, Appetite, from 1990 to 2018, limited to humans, obtaining 259 articles, eliminating 222 for repetition or low relevance, leaving 37 articles for analysis. Results: Out of 37 articles reviewed 9 were experimental studies, 10 systematized reviews, 1 meta-analysis and 16 articles of recommendations and management suggestions. Conclusion: The management of appetite and weight loss in palliative care, HIV, elderly or chemotherapy patients should be multidisciplinary, involving nutritionists, psychologists and physicians, adjusting the management to the individual characteristics manifested. Dronabinol is a drug of first choice for the management of these symptoms when the natural history of the disease is accompanied by nausea, vomiting or pain.
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Resumen La insuficiencia cardiaca (IC) representa uno de los problemas mundiales de salud pública más importantes, ya que existe un aumento en su prevalencia y se estima que 23 millones de la población mundial viven con este problema. Esta entidad se define por la presencia de anormalidades estructurales y funcionales del músculo cardiaco que conducen a un deterioro en la capacidad del llenado y eyección ventricular. Múltiples comorbilidades se han asociado a un incremento en el riesgo de desarrollo de enfermedades cardiovasculares. La hipertensión se ha reconocido como uno de los factores más importantes, sin embargo, la obesidad, el síndrome metabólico, así como la diabetes, también juegan un papel importante en la aparición de dicha enfermedad. Es frecuente encontrar en pacientes hospitalizados con IC deterioro en el estado nutricional caracterizado principalmente por la presencia de deficiencias nutricionales y sarcopenia, que, en ocasiones, puede progresar y manifestarse como caquexia. Por lo anterior, una evaluación adecuada mediante el uso correcto de herramientas para detección de riesgo nutricional es imperativa, se hace necesaria para prevenir los riesgos que esto implica. Existen múltiples parámetros antropométricos y bioquímicos para definir el estado nutricional de los pacientes hospitalizados, sin embargo, las alteraciones en el volumen sanguíneo presentes en pacientes con IC pueden alterar el resultado de dicha evaluación. Las modificaciones dietéticas en la prevención y tratamiento de diversas enfermedades cardiovasculares mediante un buen apego a patrones de alimentación tales como la dieta DASH (enfoques dietéticos para detener la hipertensión, por sus siglas en inglés) y la dieta mediterránea se han asociado inversamente con la incidencia de IC.
Abstract Heart failure (HF) is one of the most important global public health problems, as there is an increase in its prevalence and an estimated 23 million of the world's population live with this problem. HF is defined by the presence of structural and functional abnormalities of the cardiac muscle leading to an impairment of ventricular filling and ejection. Multiple comorbidities have been associated with an increased risk of developing cardiovascular diseases. Hypertension has been recognized as one of the most important factors, however, obesity, metabolic syndrome, as well as diabetes also play an important role in the onset of the disease. It is common to find in decompensated heart failure hospitalized patients an impaired nutritional status characterized mainly by the presence of nutritional deficiencies and sarcopenia, which can sometimes progress to cachexia. Therefore, an adequate evaluation through the correct use of nutritional risk tools should be the cornerstone to the prevention of risks. Multiple anthropometric and biochemical parameters are available to establish the nutritional status of hospitalized patients, however, alterations in blood volume presented in patients with HF may alter the result of such assessment. The effectiveness of dietary modifications in the prevention and treatment of different cardiovascular diseases enhanced by appropriate adherence to eating patterns such as the DASH and Mediterranean diet have been inversely associated with the incidence of HF.
Subject(s)
Humans , Cachexia , Malnutrition , Heart Failure/complications , Cardiovascular Diseases , Nutritional Status , Heart Disease Risk FactorsABSTRACT
OBJETIVO: O objetivo desse estudo foi verificar o efeito do treinamento resistido na sobrevida de camundongos C57BL/6 com caquexia associada ao melanoma cutâneo. MATERIAL E MÉTODOS: A amostra foi constituída por 64 (camundongos C57BL/6 fêmeas, com idade entre 10 e 12 semanas, com cerca de 50 ± 5 gramas de peso corporal. Os camundongos foram distribuídos aleatoriamente em quatros grupos: i. camundongos controle, com indução de tumor, inativos fisicamente (Controle, n = 16); ii. camundongos submetidos ao treinamento resistido diário somente antes da indução tumoral (Treino 1, n = 16); iii. camundongos submetidos ao treinamento resistido diário antes e após da indução tumoral (Treino 2, n = 16); iv. camundongos submetidos ao treinamento resistido diário após a indução tumoral e apresentado quadro caquético (Treino 3, n = 16). No procedimento para treinamento resistido (TR) com choque, foi utilizada uma escada com 110 cm de altura, 18 cm de largura, 2 cm entre os degraus e 80 graus de inclinação. No procedimento para TR com choque, foi utilizada uma escada 110 cm de altura, 18 cm de largura, 2 cm entre os degraus e 80 graus de inclinação. O exercício resistido baseia-se na subida dos camundongos. Na plataforma de saída, aplicava-se um choque elétrico como estímulo para subir as escadas, nesta etapa era aplicada o choque nas quatro patas do animal com uma tensão elétrica de 20 volts a uma frequência de 45 Hertz durante seis séries de oito repetições, cada uma com noventa segundos de intervalo entre as séries. Os grupos de camundongos foram submetidos a acompanhamento por no máximo 15 dias após o diagnóstico da caquexia a fim de comparar a sobrevida geral relacionada ao câncer entre os grupos de estudo. As curvas de sobrevivência de KaplanMeier foram estimadas para cada evento e as curvas dos diferentes grupos foram comparadas usando o teste de Log-rank. O tempo de sobrevida proposta foi de 25 dias após inoculação. RESULTADOS: Os resultados apresentados nesse estudo mostraram que não houve diferença significativa (p <0,05) entre as propostas de treino. CONCLUSÃO: Não houve diferença na sobrevida de animais com caquexia associada ao modelo tumoral singênico de melanoma cutâneo com intervenção de exercício resistido ou sedentários.
OBJECTIVE: The objective of this study was to verify the effect of resistance training on the survival of C57BL / 6 mice with cachexia associated with cutaneous melanoma. MATERIAL AND METHODS: The sample consisted of 64 (female C57BL/6 mice, aged between 10 and 12 weeks, with approximately 50 ± 5 grams of body weight. The mice were randomly distributed into four groups: i. control mice, with tumor induction, physically inactive (Control, n = 16); ii. mice submitted to daily resistance training only before tumor induction (Training 1, n = 16); iii. Mice submitted to daily resistance training before and after tumor induction (Training 2, n = 16); iv. Mice submitted to daily resistance training after tumor induction and presented a cachectic condition (Training 3, n = 16). In the resistance training procedure (RT) with shock, a 110 cm high, 18 cm wide, 2 cm between the steps, and 80 degrees inclination ladder was used. In the procedure for shock resistance training (TR), a ladder 110 cm high, 18 cm wide, 2 cm between the rungs, and 80 degrees of inclination was used. The resisted exercise is based on the climbing of the mice. On the exit platform, an electric shock was applied as a stimulus to climb the stairs. In this step, the shock was applied to the four legs of the animal with an electric voltage of 20 volts at a frequency of 45 Hertz during six series of eight repetitions, each with ninety-seconds intervals between the series. The mice groups underwent follow-up for no more than 15 days after diagnosis of cachexia to compare overall cancer-related survival between the study groups. Kaplan-Meier survival curves were estimated for each event, and the curves of the different groups were compared using the Log-rank test. The proposed survival time was 25 days after inoculation. RESULTS: The results presented in this study showed no significant difference (p <0.05) between the training proposals. CONCLUSION: There was no difference in animals' survival with cachexia associated with the syngeneic melanoma skin tumor model with either resistance exercise or sedentary intervention.
Subject(s)
Animals , Mice , Survival , CachexiaABSTRACT
Las enfermedades crónicas degenerativas han ganado gran interés e importancia en el ámbito de la salud debido a la alta carga mundial de morbilidad y la gran tasa de discapacidad que las mismas generan. A su vez, la prevalencia de desnutrición afecta un 40-60% de los pacientes hospitalizados, lo que supone un aumento de los costos sanitarios, mayor morbimortalidad y aumento de las tasas de discapacidad. Diversos conceptos surgen en la literatura relacionando la pérdida de masa muscular, la enfermedad y la desnutrición. El objetivo del presente artículo es definir los conceptos de desnutrición, fragilidad, caquexia y sarcopenia. Se buscó describir su prevalencia, diferenciar los mecanismos que generan cada situación y su impacto en la composición corporal(AU)
Abstract Chronic degenerative diseases have won great interest and value in the field of health due to the high global burden of morbidity and the high rate of disability that they generate. At the same time, the prevalence of malnutrition affects 40-60% of hospitalized patients, which implies an increase in health costs, greater morbi mortality and an increase in disability rates. Various concepts emerge in the literature in which the loss of muscle mass, disease and malnutrition are related. The objective of this article is to define the concepts of malnutrition, frailty, cachexia and sarcopenia. The aim was to describe its prevalence, to differentiate the mechanisms that generate each situation and its impact on body composition(AU)
Subject(s)
Muscular Atrophy , Malnutrition , Cachexia , Sarcopenia , MusclesABSTRACT
Resumo Objetivo Investigar o comprometimento do apetite em pessoas idosas hospitalizadas com câncer e sua associação com estado nutricional e presença de caquexia. Métodos Estudo transversal realizado com pessoas idosas de ambos os sexos, diagnosticadas com neoplasia maligna, de julho de 2017 a março de 2019 em um hospital universitário. A amostra final foi composta por 90 pacientes. O comprometimento do apetite foi identificado pelo Questionário de Apetite e Sintomas para Pacientes com Câncer (CASQ) e o estado nutricional pela Avaliação Subjetiva Global Produzida pelo Próprio Paciente (ASG-PPP). A presença de caquexia foi avaliada pela perda de peso >5% nos últimos 6 meses; ou índice de massa corporal (IMC) <20 kg/m2 e perda de peso >2%; ou índice de músculo esquelético apendicular consistente com sarcopenia e perda de peso >2%. Resultados Houve predomínio de indivíduos do sexo masculino (56,7%), autodeclarados não brancos (56,7%), com tumores localizados no trato gastrointestinal (75,6%) e mediana de idade de 67 anos. 75,6% dos indivíduos apresentaram comprometimento do apetite, 57,8% suspeita de desnutrição ou desnutrição de algum grau, 54,4% caquexia e 92,2% necessidade de intervenção nutricional. Houve associação entre as categorias do CASQ com estado nutricional (p=0,001) e presença de caquexia (p=0,050). Após análise de regressão logística, a desnutrição permaneceu associada ao comprometimento do apetite [OR: 4,68 (IC 95%: 1,50-14,56), p=0,008]. Conclusão A presença de desnutrição aumentou as chances de comprometimento do apetite, o que reforça a necessidade da triagem e intervenção nutricional precoces, a fim de reduzir e/ou evitar os agravos nutricionais.
Abstract Objective To investigate appetite impairment in older adults hospitalized with cancer and its association with nutritional status and cachexia. Method A cross-sectional study, conducted with older adults men and women diagnosed with malignant neoplasia from July 2017 to March 2019 at a university hospital. The final sample consisted of 90 patients. Appetite was evaluated using the Cancer Appetite and Symptom Questionnaire (CASQ) and nutritional status was determined using the Patient-Generated Subjective Global Assessment (PG-SGA). Presence of cachexia was assessed by weight loss >5% in the last 6 months; or body mass index (BMI) <20 kg/m2 and weight loss >2%; or appendicular skeletal muscle index consistent with sarcopenia and weight loss >2%. Results There was a predominance of male (56.7%) self-declared non-white individuals (56.7%), with tumors in the gastrointestinal tract (75.6%) and median age of 67.0 years. 75.6% of the individuals have impaired appetite, 57.8% suspected malnutrition or malnutrition of some degree, 54.4% cachexia and 92.2% needed nutritional intervention. There was significant association between CASQ categories with nutritional status (p= 0.001) and presence of cachexia (p=0.050). After logistic regression analysis, malnutrition remained associated with impaired appetite assessed by CASQ score [OR: 4.68 (CI 95%: 1.50-14.56), p=0.008] Conclusion The presence of malnutrition increased the chances of appetite impairment, which reinforces the need for early nutritional screening and intervention, in order to reduce and/or avoid nutritional problems.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Appetite , Cachexia/etiology , Nutritional Status , Malnutrition/etiology , Neoplasms/complications , Cross-Sectional StudiesABSTRACT
BACKGROUND: Heart failure (HF) is the leading cause of death in western countries. Cardiac dysfunction is accompanied by skeletal alterations resulting in muscle weakness and fatigue. Exercise is an accepted interventional approach correcting cardiac and skeletal dysfunction, thereby improving mortality, re-hospitalization and quality of life. Animal models are used to characterize underpinning mechanisms. Transverse aortic constriction (TAC) results in cardiac pressure overload and finally HF. Whether exercise training improves cardiac remodeling and peripheral cachexia in the TAC mouse model was not analyzed yet. In this study, 2 weeks post TAC animals were randomized into two groups either performing a moderate exercise program (five times per week at 60% VO2 max for 40 min for a total of 8 weeks) or staying sedentary. RESULTS: In both TAC groups HF characteristics reduced ejection fraction (- 15% compared to sham, p < 0.001), cardiac remodeling (+ 22.5% cardiomyocyte cross sectional area compared to sham; p < 0.001) and coronary artery congestion (+ 34% diameter compared to sham; p = 0.008) were observed. Unexpectedly, peripheral cachexia was not detected. Furthermore, compared to sedentary group animals from the exercise group showed aggravated HF symptoms [heart area + 9% (p = 0.026), heart circumference + 7% (p = 0.002), right ventricular wall thickness - 30% (p = 0.003)] while muscle parameters were unchanged [Musculus soleus fiber diameter (p = 0.55), Musculus extensor digitorum longus contraction force (p = 0.90)]. CONCLUSION: The severe TAC model is inappropriate to study moderate exercise effects in HF with respect to cardiac and skeletal muscle improvements. Further, the phenotype induced by different TAC procedures should be well documented and taken into account when planning experiments.
Subject(s)
Animals , Mice , Quality of Life , Heart Failure , Muscle, Skeletal , Disease Models, Animal , Heart Ventricles , Mice, Inbred C57BLABSTRACT
Objective:The incidence rate of cancer cachexia is high in late stage of cancer， which is characterized by skeletal muscle atrophy and rapid reduction of adipose tissue and systemic inflammation. Cachexia is highly related to a variety of tumors， and causes a large proportion of cancer deaths. Cancer cachexia can lead to serious complications in patients with cancer， then， the quality of life of patients decreases， the psychological state becomes negative， and the state of illness is further worsened. At present， there is no effective intervention means to completely reverse cachexia. The combined use of multiple targets and effective components of traditional Chinese medicine（TCM）， as well as the treatment based on syndrome differentiation and the theory of TCM play an important role in the prevention and treatment of cancer cachexia. Therefore， exploring the pathogenesis of cancer cachexia and prevention and treatment with TCM is helpful for basic study and clinical application. Method:In this paper， cancer cachexia and TCM in China national knowledge infrastructure （CNKI） and Public Medline （PubMed） databases were retrieved， and 98 Chinese and English literatures were included through summarization to elaborate the pathogenesis of cancer cachexia and the prevention and treatment of TCM. Result:Emphasis was given to the important role of inflammatory reaction， skeletal muscle atrophy， energy metabolism abnormality and multiple signal joint regulation in occurrence of cancer cachexia， and the unique advantages and significant role of TCM in treatment of cancer cachexia under different treatment principles. Conclusion:Inflammatory reaction， skeletal muscle atrophy， abnormal energy metabolism make the pathogenesis of cancer cachexia complex and diverse. TCM prescriptions， Chinese herbal medicine and their effective ingredients have the natural advantages of targeting multiple pathways， controlling multiple signal pathways and inhibiting various inflammatory factors in the prevention and treatment of cancer cachexia， and are safe and effective in improving diet， prolonging the survival period of patients and keeping weight.
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Cancer cachexia is a complex metabolic syndrome characterized by muscle wasting, fat decomposition, unplanned weight loss, anorexia and immune dysfunction. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity on cancer patients. It increases the symptom burden in patients, affects the quality of their life, ultimately shortens patients' survival. Lucubrating the pathogenesis of cachexia is of great significance to provide rationale treatment guidance. Here we reviewed the research progress on pathogenesis of cancer cachexia, including inflammatory response mediated by TNF-α, IL-1, IL-6 and STAT-3 and abnormal nutrition metabolism, as well as mitochondrial dysfunction.
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Food and eating are of great significance to humans, as we are the only creatures that establish relationships and sustain a social network through food and eating. Recent studies revealed that patients with advanced cancer and their family members often experience complicated eating-related distress due to tumors themselves, side effects of cancer treatments, and negative impacts of cancer cachexia. Therefore, we suggested the importance of the integration of palliative, supportive, and nutritional care to alleviate eating-related distress among patients and family members, and the significance of the development of tools to measure their distress in supportive and palliative care settings. No care strategies for eating-related distress experienced by patients and family members have been established, and the development of an interdisciplinary psychosocial approach and integrative care is required. As such, we are planning to start a nutritional support and cancer cachexia clinic in the National Cancer Center, and disseminate a newly developed care program across Japan.
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Objective:To investigate the clinical features of preoperative gastric cancer cachexia patients, with the focus on changes of abdominal fat distribution and serum inflammatory factors.Methods:128 gastric cancer patients admitted to General Surgery Department of Zhongshan Hospital, Fudan University from January 2018 to December 2018 were included. Relevant clinical information was collected, including age, gender, height, weight, hematological test results and blood lipid profiles (including free fatty acids ,FFA). Concurrent serum IL-6 and TNF-α levels were examined using enzyme-linked immunosorbent assay. Areas of subcutaneous and visceral fat were both measured at umbilical level on CT. Data mentioned above were compared between gastric cancer patients with cachexia and pre-cachexia.Results:The 128 patients were divided into stable pre-cachexia group (97 patients) and cachexia group (31 patients). Compared with pre-cachexia group, patients in the cachexia group showed significant decline in BMIs (23.4±0.3 vs 21.9±0.6, t=2.359, P=0.019), apparent elevation in serum IL-6 levels [(3.73±0.32) ng/L vs(5.26±0.77) ng/L, t=2.214, P=0.036], significant decrease in lymphocyte counts [(1.67±0.05)×10 9/L vs (1.42±0.12)×10 9/L, t=2.251, P=0.026], as well as predominant decrease in total protein levels, [(64.9 ± 0.8) g/L vs (61.5±1.1) g/L, t=2.208, P=0.029], total cholesterol levels [(4.09±0.09) mmol/L vs (3.74±0.15) mmol/L, t=2.393, P=0.046] and pre-albumin levels [(0.22±0.01) g/L vs (0.19±0.01) g/L, t=1.987, P=0.049]. Additionally, there was a noticeable decrease in subcutaneous fat area [(151.6±8.73) cm 2vs (112.4±15.9) cm 2, t=2.192, P=0.042]. The other markers displayed no remarkable differences. Conclusion:Based on our investigation, it's highly suspected that IL-6 plays a more important role than TNF-α in the fat loss of gastric cancer cachexia patients, and these patients have increased lipid catabolism predominated by subcutaneous fat loss.