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Molfino A, Emerenziani S, Tonini G, Santini D, Gigante A, Guarino MPL, Nuglio C, Imbimbo G, La Cesa A, Cicala M, Muscaritoli M. Early impairment of food intake in patients newly diagnosed with cancer. Front Nutr 2023; 9:997813. [PMID: 36687669 PMCID: PMC9849803 DOI: 10.3389/fnut.2022.997813] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background Patients with gastrointestinal or lung cancer often suffer from a loss of appetite (anorexia), resulting in reduced food intake (hypophagia) and body weight loss. This study evaluated the prevalence of anorexia, hypophagia, pre-cachexia and cachexia in patients with cancer at time of diagnosis. Patients and methods Patients with newly diagnosed gastrointestinal or lung cancers were included. Body mass index (BMI) and weight loss over the prior 6 months were recorded. Patients were assessed for (pre-)cachexia and for anorexia using the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) and a specific anorexia questionnaire (AQ). Energy and protein intake were calculated through food diaries. Patients were considered hypophagic if intake was ≤70% of guideline-recommended levels. Results Overall, 102 patients [53 male; median age: 67 (range, 21-88) years] were enrolled. Mean BMI (± standard deviation) was 23.1 ± 3.4 kg/m2; average percentage of weight loss was 10.1 ± 7.8%. At diagnosis, 68% (69/102) of patients had cachexia, and 11% (11/102) pre-cachexia. Prevalence of anorexia was 57% (58/102) and 75% (76/102) according to FAACT and AQ, respectively. Forty-eight percent (49/102) of patients had hypophagia. Patients with anorexia had lower daily energy (p = 0.002) and protein intake (p = 0.0257), and greater percentage of weight loss (p = 0.0005). In patients with hypophagia, negative correlations were observed between percentage of weight loss and total daily calorie (r = -0.40; p = 0.01) and protein intake (r = -0.340; p = 0.018). Conclusion Anorexia, inadequate nutritional intake and cachexia are highly prevalent in patients with gastrointestinal or lung cancer at diagnosis. Negative protein and energy balance may play an important role in the pathogenesis of cachexia. Early multimodal strategies to improve food intake are urgently needed.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sara Emerenziani
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | | | | | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Chiara Nuglio
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Michele Cicala
- Gastroenterology Unit, Campus Bio-Medico University, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy,*Correspondence: Maurizio Muscaritoli,
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2
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Merchant RA, Vathsala A. Healthy aging and chronic kidney disease. Kidney Res Clin Pract 2022; 41:644-656. [PMID: 36328991 PMCID: PMC9731776 DOI: 10.23876/j.krcp.22.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/18/2022] [Accepted: 07/03/2022] [Indexed: 07/30/2023] Open
Abstract
The world population is aging and the prevalence of noncommunicable diseases such as diabetes, hypertension, and chronic kidney disease (CKD) will increase significantly. With advances in medical treatment and public health, the human lifespan continues to outpace the health span in such a way that the last decade of life is generally spent in poor health. In 2015, the World Health Organization defined healthy aging as 'the process of developing and maintaining the functional ability that enables wellbeing in older age.' CKD is increasingly being recognized as a model of accelerated aging and is associated with physical performance decline, cognitive decline, falls and fractures, poor quality of life, loss of appetite, and inflammation. Frailty and dementia are the final pathways and key determinants of disability and mortality independent of underlying disease. CKD, dementia, and frailty share a triangular relationship with synergistic actions and have common risk factors wherein CKD accelerates frailty and dementia through mechanisms such as uremic toxicity, metabolic acidosis and derangements, anorexia and malnutrition, dialysis-related hemodynamic instability, and sleep disturbance. Frailty accelerates glomerular filtration decline as well as dialysis induction in CKD and more than doubles the mortality risk. Anorexia is one of the major causes of protein-energy malnutrition, which is also prevalent in the aging population and warrants screening. Healthcare systems across the world need to have a system in place for the prevention of CKD amongst high-risk older adults, focusing on screening for poor prognostic factors amongst patients with CKD such as frailty, poor appetite, and cognitive impairment and providing necessary person-centered interventions to reverse underlying factors that may contribute to poor outcomes.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anantharaman Vathsala
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore, Singapore
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3
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Molfino A, Imbimbo G, Laviano A. Current Screening Methods for the Risk or Presence of Malnutrition in Cancer Patients. Cancer Manag Res 2022; 14:561-567. [PMID: 35210853 PMCID: PMC8857947 DOI: 10.2147/cmar.s294105] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/26/2022] [Indexed: 12/27/2022] Open
Abstract
Malnutrition is highly common among cancer patients and is associated with a poor quality of life, increased treatment toxicities and decreased survival. The screening of malnutrition should be performed in an early stage of cancer disease and should be rapid, not expensive and highly sensitive to identify the risk of developing malnutrition. Importantly, international clinical guidelines suggest to perform screening for malnutrition in all cancer patients and if the risk is present, they recommend to perform a full nutritional assessment. During the screening phase, different nutritional parameters are considered including the loss of appetite, low food intake, body weight loss and burden of the disease. These items are present in several screening tools, such as the Nutrition Risk Screening (NRS)-2002, the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment (MNA) which represent the most widely used tools to screen for an altered nutritional status in cancer patients. Recently, the Global Leadership Initiative on Malnutrition (GLIM) developed an assessment tool for the diagnosis of malnutrition taking into account the presence of i) involuntary body weight loss, ii) body mass index, iii) low muscle mass, iv) low food intake and disease burden/inflammation; in particular, body weight loss, decreased body mass index (BMI), and low muscle mass are considered as phenotypic criteria, whereas reduced food intake, disease burden and inflammation are defined as etiologic criteria. To perform the diagnosis of malnutrition, GLIM consensus considered the presence of at least one phenotypic and one etiologic criterion. The above-mentioned screening tools were validated in different clinical settings and suggesting the use of one tool vs another is challenging considering, among others, different factors including the type and stage of cancer and the setting (i.e., inpatient or outpatient care). Recent data obtained among large cohorts of cancer patients indicate that personalized nutritional therapy reduced mortality risk and ameliorated quality of life and functionality among cancer patients with high nutritional risk, supporting the urgent need for implementing screening and diagnosis of malnutrition in this context.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Correspondence: Alessandro Laviano, Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell’Università 37, Rome, 00185, Italy, Tel/Fax +39 06 49973902, Email
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4
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Li C, Chen L, He L, Zhang Y, Chen H, Liu Y, Tang S, Zheng H. Study on the relationship between sarcopenia and its components and anorexia in elderly maintenance haemodialysis patients. Nurs Open 2021; 9:1096-1104. [PMID: 34907670 PMCID: PMC8859065 DOI: 10.1002/nop2.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
AIM This study aimed to investigate the current situation of sarcopenia and anorexia of elderly maintenance haemodialysis patients and analyse the influencing factors. DESIGN A cross-sectional design was used in this study. METHODS One hundred and twelve elderly patients on MHD in 3 haemodialysis centres in Sichuan, China, were selected. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia (AWGS). Anorexia was assessed with the Functional Assessment of Anorexia Cachexia Therapy/Anorexia Cachexia Subscale (FAACT/ACS). The relationship between sarcopenia and anorexia was analysed by logistic regression. RESULTS The prevalences of sarcopenia and severe sarcopenia in elderly MHD patients were 52.7% and 39.3%, respectively, and the prevalence of anorexia was 25.9%. Severe sarcopenia was independently associated with anorexia, and weekly exercise frequency was independently associated with anorexia. The low SMI value and slow gait speed were strongly associated with anorexia. This study complied with the STROBE checklist.
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Affiliation(s)
- Chao Li
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Chen
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Li He
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yingjun Zhang
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Hui Chen
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuan Liu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Sikai Tang
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Haotian Zheng
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
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5
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Molfino A, de van der Schueren MAE, Sánchez-Lara K, Milke P, Amabile MI, Imbimbo G, Di Lazzaro L, Cavuto S, Ronzani G, Snegovoy A, Gioulbasanis I, Laviano A. Cancer-associated anorexia: Validity and performance overtime of different appetite tools among patients at their first cancer diagnosis. Clin Nutr 2021; 40:4037-4042. [PMID: 33676774 DOI: 10.1016/j.clnu.2021.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Anorexia is a frequent symptom in cancer and we aimed to assess its prevalence among patients at their first cancer diagnosis by different appetite tools and the relationship between each tool with self-reports of food intake. We also tested whether cancer anorexia influences outcomes independently of reduced food intake or body weight loss (BWL) overtime and whether BWL was associated with complications during anticancer-therapy. METHODS Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score, self-assessment of appetite, Anorexia Questionnaire (AQ) and Visual Analog Scale (VAS) were administered. Percent of food intake was used as a criterion measure of anorexia. We registered BWL and anticancer-therapy complications over 3-month-follow-up. RESULTS 438 cancer patients from 7 cancer-centers worldwide were included. The prevalence of anorexia was 39.9% by FAACT score, 40.2% by VAS, 40.6% by the self-assessment of appetite and 65.4% by AQ. Low food intake (≤50%) was reported in 28% of patients. All appetite tools correlated with food intake percent (P < 0.0001). We documented a correlation between self-assessment of appetite, FAACT score, VAS and BWL overtime (P < 0.04). The self-assessment of appetite (P = 0.0152) and the FAACT score (P = 0.043) were associated with BWL independently of anticancer therapies. Among patients with BWL, the risk to develop complications was greater with respect to those who maintained a stable or gained body weight (P = 0.03). CONCLUSIONS In our sample of cancer patients, FAACT score and self-assessment of appetite performed well when low food intake was used as a criterion measure, and revealed an association of anorexia with BWL, which was, in turn, related to the development of anticancer-therapy complications.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Marian A E de van der Schueren
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, VU Amsterdam Main Building De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands; HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Dietetics, Nijmegen, the Netherlands
| | | | - Pilar Milke
- National Institute of Health Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Maria Ida Amabile
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Luca Di Lazzaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Infrastructure Research and Statistic, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Anton Snegovoy
- N.N. Blokhin Cancer Research Centre, Moscow, Russian Federation
| | | | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy.
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6
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Molfino A, Amabile MI, Imbimbo G, Rizzo V, Pediconi F, Catalano C, Emiliani A, Belli R, Ramaccini C, Parisi C, Nigri G, Muscaritoli M. Association between Growth Differentiation Factor-15 (GDF-15) Serum Levels, Anorexia and Low Muscle Mass among Cancer Patients. Cancers (Basel) 2020; 13:cancers13010099. [PMID: 33396237 PMCID: PMC7795323 DOI: 10.3390/cancers13010099] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
Simple Summary In our study, the novel inflammatory cytokine Growth Differentiation Factor-15 (GDF-15) has been found elevated in patients with gastrointestinal and lung cancer and associated with anorexia. Patients with gastrointestinal cancer were found more anorexic (based on the FAACT score) and showed higher GDF-15 serum levels than patients with lung cancer. We also evaluated the muscularity status of the patients by CT scan. No difference was found in GDF-15 levels between cancer patients with low muscle mass vs. those with moderate/high muscularity and between patients with body weight loss vs. those with stable weight. Based on our observations, we confirm the role of GDF-15 in the pathogenesis of anorexia in cancer, although the mechanisms of action of this cytokine in cancer should be further unveiled also regarding its potential involvement in changes in muscularity. Abstract The pathophysiology of cancer anorexia is complex and serum biomarkers, including growth and differentiation factor(s) (GDF), may be modulated. We explored the association(s) between GDF-15 serum levels and anorexia and, secondarily, with low muscle mass and body weight loss in cancer patients. We considered gastrointestinal and lung cancer patients (CP) and healthy BMI-matched controls. The FAACT-questionnaire was administered to diagnose anorexia and we calculated the L3-SMI by CT scan to assess low muscularity, setting their cutoff values at the lowest tertile. GDF-15 serum levels were assessed by ELISA. We enrolled 59 CP and 30 controls; among CP, 25 were affected by gastrointestinal and 34 by lung cancer. Anorexia was present in 36% of CP. Gastrointestinal CP resulted more anorexic compared to lung CP (p = 0.0067). Low muscle mass was present in 33.9% of CP and L3-SMI was lower in gastrointestinal compared to lung CP (p = 0.049). The GDF-15 levels were higher in CP vs. controls (p = 0.00016), as well as in anorexic vs. non-anorexic CP (p = 0.005) and vs. controls (p < 0.0001). Gastrointestinal CP showed higher GDF-15 levels vs. lung CP (p = 0.0004). No difference was found in GDF-15 between CP with low muscle mass and those with moderate/high muscularity and between patients with body weight loss and those with stable weight. Our data support the involvement of GDF-15 in the pathogenesis of cancer anorexia. The mechanisms of action of GDF-15 in cancer should be further clarified also regarding the changes in muscularity.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (A.E.); (R.B.); (C.R.); (M.M.)
- Correspondence: ; Tel.: +39-064-997-2042
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (A.E.); (R.B.); (C.R.); (M.M.)
| | - Veronica Rizzo
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, 00185 Rome, Italy; (V.R.); (F.P.); (C.C.)
| | - Federica Pediconi
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, 00185 Rome, Italy; (V.R.); (F.P.); (C.C.)
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, 00185 Rome, Italy; (V.R.); (F.P.); (C.C.)
| | - Alessandra Emiliani
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (A.E.); (R.B.); (C.R.); (M.M.)
| | - Roberta Belli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (A.E.); (R.B.); (C.R.); (M.M.)
| | - Cesarina Ramaccini
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (A.E.); (R.B.); (C.R.); (M.M.)
| | - Claudia Parisi
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.P.); (G.N.)
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.P.); (G.N.)
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.I.); (A.E.); (R.B.); (C.R.); (M.M.)
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7
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de Castro GS, Correia-Lima J, Simoes E, Orsso CE, Xiao J, Gama LR, Gomes SP, Gonçalves DC, Costa RGF, Radloff K, Lenz U, Taranko AE, Bin FC, Formiga FB, de Godoy LGL, de Souza RP, Nucci LHA, Feitoza M, de Castro CC, Tokeshi F, Alcantara PSM, Otoch JP, Ramos AF, Laviano A, Coletti D, Mazurak VC, Prado CM, Seelaender M. Myokines in treatment-naïve patients with cancer-associated cachexia. Clin Nutr 2020; 40:2443-2455. [PMID: 33190987 DOI: 10.1016/j.clnu.2020.10.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/10/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
Cancer-associated cachexia is a complex metabolic syndrome characterized by weight loss and systemic inflammation. Muscle loss and fatty infiltration into muscle are associated with poor prognosis in cancer patients. Skeletal muscle secretes myokines, factors with autocrine, paracrine and/or endocrine action, which may be modified by or play a role in cachexia. This study examined myokine content in the plasma, skeletal muscle and tumor homogenates from treatment-naïve patients with gastric or colorectal stages I-IV cancer with cachexia (CC, N = 62), or not (weight stable cancer, WSC, N = 32). Myostatin, interleukin (IL) 15, follistatin-like protein 1 (FSTL-1), fatty acid binding protein 3 (FABP3), irisin and brain-derived neurotrophic factor (BDNF) protein content in samples was measured with Multiplex technology; body composition and muscle lipid infiltration were evaluated in computed tomography, and quantification of triacylglycerol (TAG) in the skeletal muscle. Cachectic patients presented lower muscle FSTL-1 expression (p = 0.047), higher FABP3 plasma content (p = 0.0301) and higher tumor tissue expression of FABP3 (p = 0.0182), IL-15 (p = 0.007) and irisin (p = 0.0110), compared to WSC. Neither muscle TAG content, nor muscle attenuation were different between weight stable and cachectic patients. Lumbar adipose tissue (AT) index, visceral AT index and subcutaneous AT index were lower in CC (p = 0.0149, p = 0.0455 and p = 0.0087, respectively), who also presented lower muscularity in the cohort (69.2% of patients; p = 0.0301), compared to WSC. The results indicate the myokine profile in skeletal muscle, plasma and tumor is impacted by cachexia. These findings show that myokines eventually affecting muscle wasting may not solely derive from the muscle itself (as the tumor also may contribute to the systemic scenario), and put forward new perspectives on cachexia treatment targeting myokines and associated receptors and pathways.
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Affiliation(s)
- Gabriela S de Castro
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil.
| | - Joanna Correia-Lima
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil
| | - Estefania Simoes
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil
| | - Camila E Orsso
- University of Alberta, Department of Agricultural, Food and Nutritional Science, Canada
| | - Jingjie Xiao
- University of Alberta, Department of Agricultural, Food and Nutritional Science, Canada; Covenant Health Palliative Institute, Edmonton, Alberta, Canada
| | - Leonardo R Gama
- Departamento de Radiologia e Oncologia & Instituto do Câncer do Estado de São Paulo, Universidade de Sao Paulo, São Paulo, Brazil
| | - Silvio P Gomes
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil; Universidade de Sao Paulo Faculdade de Medicina Veterinaria, Departamento de Cirurgia, Brazil
| | - Daniela Caetano Gonçalves
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil; Universidade Federal de Sao Paulo, Instituto de Biociencias, Santos, Brazil
| | - Raquel G F Costa
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil
| | - Katrin Radloff
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil
| | - Ulrike Lenz
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil
| | - Anna E Taranko
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil
| | - Fang Chia Bin
- Santa Casa de Misericoria de Sao Paulo, São Paulo, Brazil
| | | | | | | | - Luis H A Nucci
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, Brazil
| | - Mario Feitoza
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, Brazil
| | - Claudio C de Castro
- Universidade de Sao Paulo Faculdade de Medicina, Departamento de Radiologia, São Paulo, Brazil; Universidade de Sao Paulo Hospital Universitario, São Paulo, Brazil
| | - Flavio Tokeshi
- Universidade de Sao Paulo Hospital Universitario, São Paulo, Brazil
| | | | - Jose P Otoch
- Universidade de Sao Paulo Hospital Universitario, São Paulo, Brazil
| | - Alexandre F Ramos
- Departamento de Radiologia e Oncologia & Instituto do Câncer do Estado de São Paulo, Universidade de Sao Paulo, São Paulo, Brazil; Escola de Artes, Ciencias e Humanidades, Universidade de Sao Paulo, São Paulo, Brazil
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Dario Coletti
- Sorbonne Université, Department of Biological Adaptation and Aging, B2A, Paris, France; Department of AHFMO - Unit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Vera C Mazurak
- University of Alberta, Department of Agricultural, Food and Nutritional Science, Canada
| | - Carla M Prado
- University of Alberta, Department of Agricultural, Food and Nutritional Science, Canada
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Departamento de Biologia Celular e do Desenvolvimento and Faculdade de Medicina da Universidade de Sao Paulo, Departamento de Cirurgia, LIM 26-HC, São Paulo, Brazil
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8
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Utsumi M, Aoki H, Nagahisa S, Nishimura S, Une Y, Kimura Y, Watanabe M, Taniguchi F, Arata T, Katsuda K, Tanakaya K. Preoperative predictive factors of pancreatic fistula after pancreaticoduodenectomy: usefulness of the CONUT score. Ann Surg Treat Res 2020; 99:18-25. [PMID: 32676478 PMCID: PMC7332320 DOI: 10.4174/astr.2020.99.1.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Postoperative pancreatic fistula (POPF) is the most important factor affecting morbidity and mortality after pancreaticoduodenectomy (PD). Patients with a high controlling nutritional status (CONUT) score, which is used to assess nutritional status, are expected to have high morbidity rates. This study aimed to determine the usefulness of the CONUT score. Methods Data from 97 consecutive cases of PD performed in the Department of Surgery of Iwakuni Clinical Center, from April 2008 to May 2018, were included. Preoperative patient data, including sex, age, and hypertension, and postoperative complication data were collected to analyze pancreatic fistula occurrence. Results Of the 97 patients, 2 9 patients (29.8%) were diagnosed with POPF ≥ B, with 26 cases (26.8%) classified as grade B and 3 (3.1%) as grade C. The mortality rate was 2.1% (2 of 97). In the univariate analysis, a significant association was observed between POPF and the following factors: body mass index (BMI) ≥ 22 kg/m2, high CONUT score, nonpancreatic carcinoma, and CT attenuation values. In multivariate analysis, BMI ≥ 22 kg/m2 (odds ratio [OR], 6.16; P < 0.001), high CONUT score (OR, 3.77; P = 0.009), nonpancreatic carcinoma (OR, 5.72; P = 0.009), and CT attenuation values (late/early ratio) in the pancreas (OR, 9.07; P = 0.006) were independent risk factors for POPF. Conclusion Patients with a high CONUT score are at high risk of POPF. Further study correlating preoperative nutritional intervention with risk of POPF is necessary.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Hideki Aoki
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Seiichi Nagahisa
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Seitaro Nishimura
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yuta Une
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yuji Kimura
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Megumi Watanabe
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Fumitaka Taniguchi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Takashi Arata
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Koh Katsuda
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Kohji Tanakaya
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
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9
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Riccardi DMDR, das Neves RX, de Matos-Neto EM, Camargo RG, Lima JDCC, Radloff K, Alves MJ, Costa RGF, Tokeshi F, Otoch JP, Maximiano LF, de Alcantara PSM, Colquhoun A, Laviano A, Seelaender M. Plasma Lipid Profile and Systemic Inflammation in Patients With Cancer Cachexia. Front Nutr 2020; 7:4. [PMID: 32083092 PMCID: PMC7005065 DOI: 10.3389/fnut.2020.00004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
Cancer cachexia affects about 80% of advanced cancer patients, it is linked to poor prognosis and to date, there is no efficient treatment or cure. The syndrome leads to progressive involuntary loss of muscle and fat mass induced by systemic inflammatory processes. The role of the white adipose tissue (WAT) in the onset and manifestation of cancer cachexia gained importance during the last decade. WAT wasting is not only characterized by increased lipolysis and release of free fatty acids (FFA), but in addition, owing to its high capacity to produce a variety of inflammatory factors. The aim of this study was to characterize plasma lipid profile of cachectic patients and to correlate the FA composition with circulating inflammatory markers; finally, we sought to establish whether the fatty acids released by adipocytes trigger and/or contribute to local and systemic inflammation in cachexia. The study selected 65 patients further divided into 3 groups: control (N); weight stable cancer (WSC); and cachectic cancer (CC). The plasma FA profile was significantly different among the groups and was positively correlated with pro-inflammatory cytokines expression in the CC patients. Therefore, we propose that saturated to unsaturated FFA ratio may serve as a means of detecting cachexia.
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Affiliation(s)
| | - Rodrigo Xavier das Neves
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States
| | - Emidio Marques de Matos-Neto
- Cancer Metabolism Research Group, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil.,Department of Physical Education, Federal University of Piaui, Teresina, Brazil
| | - Rodolfo Gonzalez Camargo
- Cancer Metabolism Research Group, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil
| | | | - Katrin Radloff
- Cancer Metabolism Research Group, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil
| | - Michele Joana Alves
- Cancer Metabolism Research Group, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil
| | | | - Flávio Tokeshi
- University Hospital of the University of São Paulo, São Paulo, Brazil
| | - José Pinhata Otoch
- University Hospital of the University of São Paulo, São Paulo, Brazil.,University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Linda Ferreira Maximiano
- University Hospital of the University of São Paulo, São Paulo, Brazil.,University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | | | - Alison Colquhoun
- Department of Cell and Developmental Biology, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil.,University of São Paulo Medical School (FMUSP), São Paulo, Brazil
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10
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Costa RG, Caro PL, de Matos‐Neto EM, Lima JD, Radloff K, Alves MJ, Camargo RG, Pessoa AFM, Simoes E, Gama P, Cara DC, da Silva AS, O. Pereira W, Maximiano LF, de Alcântara PS, Otoch JP, Trinchieri G, Laviano A, Muscaritoli M, Seelaender M. Cancer cachexia induces morphological and inflammatory changes in the intestinal mucosa. J Cachexia Sarcopenia Muscle 2019; 10:1116-1127. [PMID: 31307125 PMCID: PMC6818537 DOI: 10.1002/jcsm.12449] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cachexia is a multifactorial and multiorgan syndrome associated with cancer and other chronic diseases and characterized by severe involuntary body weight loss, disrupted metabolism, inflammation, anorexia, fatigue, and diminished quality of life. This syndrome affects around 50% of patients with colon cancer and is directly responsible for the death of at least 20% of all cancer patients. Systemic inflammation has been recently proposed to underline most of cachexia-related symptoms. Nevertheless, the exact mechanisms leading to the initiation of systemic inflammation have not yet been unveiled, as patients bearing the same tumour and disease stage may or may not present cachexia. We hypothesize a role for gut barrier disruption, which may elicit persistent immune activation in the host. To address this hypothesis, we analysed the healthy colon tissue, adjacent to the tumour. METHODS Blood and rectosigmoid colon samples (20 cm distal to tumour margin) obtained during surgery, from cachectic (CC = 25) or weight stable (WSC = 20) colon cancer patients, who signed the informed consent form, were submitted to morphological (light microscopy), immunological (immunohistochemistry and flow cytometry), and molecular (quantification of inflammatory factors by Luminex® xMAP) analyses. RESULTS There was no statistical difference in gender and age between groups. The content of plasma interleukin 6 (IL-6) and IL-8 was augmented in cachectic patients relative to those with stable weight (P = 0.047 and P = 0.009, respectively). The number of lymphocytic aggregates/field in the gut mucosa was higher in CC than in WSC (P = 0.019), in addition to those of the lamina propria (LP) eosinophils (P < 0.001) and fibroblasts (P < 0.001). The area occupied by goblet cells in the colon mucosa was decreased in CC (P = 0.016). The M1M2 macrophages percentage was increased in the colon of CC, in relation to WSC (P = 0.042). Protein expression of IL-7, IL-13, and transforming growth factor beta 3 in the colon was significantly increased in CC, compared with WSC (P = 0.02, P = 0.048, and P = 0.048, respectively), and a trend towards a higher content of granulocyte-colony stimulating factor in CC was also observed (P = 0.061). The results suggest an increased recruitment of immune cells to the colonic mucosa in CC, as compared with WSC, in a fashion that resembles repair response following injury, with higher tissue content of IL-13 and transforming growth factor beta 3. CONCLUSIONS The changes in the intestinal mucosa cellularity, along with modified cytokine expression in cachexia, indicate that gut barrier alterations are associated with the syndrome.
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Affiliation(s)
- Raquel G.F. Costa
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
- Cancer and Inflammation ProgramNational Cancer Institute, National Institutes of HealthBethesdaMDUSA
| | - Paula L. Caro
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Emídio M. de Matos‐Neto
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
- Department of Physical EducationFederal University of PiauiTeresinaPIBrazil
| | - Joanna D.C.C. Lima
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Katrin Radloff
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Michele J. Alves
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Rodolfo G. Camargo
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Ana Flávia M. Pessoa
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Estefania Simoes
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Patrícia Gama
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
| | - Denise C. Cara
- Department of MorphologyFederal University of Minas GeraisBelo HorizonteMGBrazil
| | | | - Welbert O. Pereira
- School of Medicine, Faculdade Isaraelita de Ciências da Saúde Albert Einstein (FICSAE)São PauloBrazil
| | - Linda F. Maximiano
- Department of SurgeryUniversity Hospital, University of São PauloSão PauloBrazil
- Department of SurgeryUniversity of São Paulo Medical School (FMUSP)São PauloBrazil
| | | | - José P. Otoch
- Department of SurgeryUniversity Hospital, University of São PauloSão PauloBrazil
- Department of SurgeryUniversity of São Paulo Medical School (FMUSP)São PauloBrazil
| | - Giorgio Trinchieri
- Cancer and Inflammation ProgramNational Cancer Institute, National Institutes of HealthBethesdaMDUSA
| | | | | | - Marília Seelaender
- Department of Cell and Developmental Biology, Institute of Biomedical SciencesUniversity of São Paulo (USP)São PauloBrazil
- Department of SurgeryUniversity of São Paulo Medical School (FMUSP)São PauloBrazil
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11
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Lima JD, Simoes E, de Castro G, Morais MRP, de Matos‐Neto EM, Alves MJ, Pinto NI, Figueredo RG, Zorn TM, Felipe‐Silva AS, Tokeshi F, Otoch JP, Alcantara P, Cabral FJ, Ferro ES, Laviano A, Seelaender M. Tumour-derived transforming growth factor-β signalling contributes to fibrosis in patients with cancer cachexia. J Cachexia Sarcopenia Muscle 2019; 10:1045-1059. [PMID: 31273954 PMCID: PMC6818454 DOI: 10.1002/jcsm.12441] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/05/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cachexia is a paraneoplastic syndrome related with poor prognosis. The tumour micro-environment contributes to systemic inflammation and increased oxidative stress as well as to fibrosis. The aim of the present study was to characterise the inflammatory circulating factors and tumour micro-environment profile, as potentially contributing to tumour fibrosis in cachectic cancer patients. METHODS 74 patients (weight stable cancer n = 31; cachectic cancer n = 43) diagnosed with colorectal cancer were recruited, and tumour biopsies were collected during surgery. Multiplex assay was performed to study inflammatory cytokines and growth factors. Immunohistochemistry analysis was carried out to study extracellular matrix components. RESULTS Higher protein expression of inflammatory cytokines and growth factors such as epidermal growth factor, granulocyte-macrophage colony-stimulating factor, interferon-α, and interleukin (IL)-8 was observed in the tumour and serum of cachectic cancer patients in comparison with weight-stable counterparts. Also, IL-8 was positively correlated with weight loss in cachectic patients (P = 0.04; r = 0.627). Immunohistochemistry staining showed intense collagen deposition (P = 0.0006) and increased presence of α-smooth muscle actin (P < 0.0001) in tumours of cachectic cancer patients, characterizing fibrosis. In addition, higher transforming growth factor (TGF)-β1, TGF-β2, and TGF-β3 expression (P = 0.003, P = 0.05, and P = 0.047, respectively) was found in the tumour of cachectic patients, parallel to p38 mitogen-activated protein kinase alteration. Hypoxia-inducible factor-1α mRNA content was significantly increased in the tumour of cachectic patients, when compared with weight-stable group (P = 0.005). CONCLUSIONS Our results demonstrate TGF-β pathway activation in the tumour in cachexia, through the (non-canonical) mitogen-activated protein kinase pathway. The results show that during cachexia, intratumoural inflammatory response contributes to the onset of fibrosis. Tumour remodelling, probably by TGF-β-induced transdifferentiation of fibroblasts to myofibroblasts, induces unbalanced inflammatory cytokine profile, angiogenesis, and elevation of extracellular matrix components (EMC). We speculate that these changes may affect tumour aggressiveness and present consequences in peripheral organs.
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Affiliation(s)
- Joanna D.C.C. Lima
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Estefania Simoes
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Gabriela de Castro
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Mychel Raony P.T. Morais
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | | | - Michele J. Alves
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
- Department of PathologyOhio State UniversityColumbusOHUSA
| | - Nelson I. Pinto
- Department of PhysiologyFederal University of São PauloSão PauloBrazil
| | - Raquel G. Figueredo
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Telma M.T. Zorn
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | | | - Flavio Tokeshi
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | - José P. Otoch
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | - Paulo Alcantara
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | | | - Emer S. Ferro
- Department of PharmacologyUniversity of São PauloSão PauloBrazil
| | | | - Marilia Seelaender
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
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12
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de Castro GS, Simoes E, Lima JDCC, Ortiz-Silva M, Festuccia WT, Tokeshi F, Alcântara PS, Otoch JP, Coletti D, Seelaender M. Human Cachexia Induces Changes in Mitochondria, Autophagy and Apoptosis in the Skeletal Muscle. Cancers (Basel) 2019; 11:E1264. [PMID: 31466311 PMCID: PMC6770124 DOI: 10.3390/cancers11091264] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cachexia is a wasting syndrome characterized by the continuous loss of skeletal muscle mass due to imbalance between protein synthesis and degradation, which is related with poor prognosis and compromised quality of life. Dysfunctional mitochondria are associated with lower muscle strength and muscle atrophy in cancer patients, yet poorly described in human cachexia. We herein investigated mitochondrial morphology, autophagy and apoptosis in the skeletal muscle of patients with gastrointestinal cancer-associated cachexia (CC), as compared with a weight-stable cancer group (WSC). CC showed prominent weight loss and increased circulating levels of serum C-reactive protein, lower body mass index and decreased circulating hemoglobin, when compared to WSC. Electron microscopy analysis revealed an increase in intermyofibrillar mitochondrial area in CC, as compared to WSC. Relative gene expression of Fission 1, a protein related to mitochondrial fission, was increased in CC, as compared to WSC. LC3 II, autophagy-related (ATG) 5 and 7 essential proteins for autophagosome formation, presented higher content in the cachectic group. Protein levels of phosphorylated p53 (Ser46), activated caspase 8 (Asp384) and 9 (Asp315) were also increased in the skeletal muscle of CC. Overall, our results demonstrate that human cancer-associated cachexia leads to exacerbated muscle-stress response that may culminate in muscle loss, which is in part due to disruption of mitochondrial morphology, dysfunctional autophagy and increased apoptosis. To the best of our knowledge, this is the first report showing quantitative morphological alterations in skeletal muscle mitochondria in cachectic patients.
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Affiliation(s)
- Gabriela S de Castro
- Cancer Metabolism Research Group, Department of Cell and Tissue Biology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, Brazil.
| | - Estefania Simoes
- Cancer Metabolism Research Group, Department of Cell and Tissue Biology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Joanna D C C Lima
- Cancer Metabolism Research Group, Department of Cell and Tissue Biology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Milene Ortiz-Silva
- Department of Physiology & Biophysics, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, Brazil
| | - William T Festuccia
- Department of Physiology & Biophysics, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Flávio Tokeshi
- Department of Clinical Surgery, Faculty of Medicine, University of São Paulo, 01246-903 São Paulo, Brazil
| | - Paulo S Alcântara
- Department of Clinical Surgery, Faculty of Medicine, University of São Paulo, 01246-903 São Paulo, Brazil
| | - José P Otoch
- Department of Clinical Surgery, Faculty of Medicine, University of São Paulo, 01246-903 São Paulo, Brazil
| | - Dario Coletti
- Department of Biological Adaptation and Aging, B2A (CNRS UMR 8256-INSERM ERL U1164-UPMC P6), Sorbonne University, 75005 Paris, France
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Department of Cell and Tissue Biology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, Brazil
- Department of Clinical Surgery, Faculty of Medicine, University of São Paulo, 01246-903 São Paulo, Brazil
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13
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Hartley P, Costello P, Fenner R, Gibbins N, Quinn É, Kuhn I, Keevil VL, Romero-Ortuno R. Change in skeletal muscle associated with unplanned hospital admissions in adult patients: A systematic review and meta-analysis. PLoS One 2019; 14:e0210186. [PMID: 30608987 PMCID: PMC6319740 DOI: 10.1371/journal.pone.0210186] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/18/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The primary objective of the review was to describe change that occurs in skeletal muscle during periods of unplanned hospitalisation in adult patients. The secondary objective was to examine the relationship between both physical activity and inflammation with the change in skeletal muscle. A further objective was to investigate the effect of interventions on change in skeletal muscle during periods of unplanned hospitalisation. DESIGN A systematic review and meta-analyses. Embase, MEDLINE, CINAHL, AMED, PEDro and the Cochrane Library were searched for studies that included any measures of skeletal muscle (excluding pulmonary function) at two time points during unplanned hospitalisation. Studies that were set in critical care, or included patients with acute or progressive neurological illness, were excluded. RESULTS Our search returned 27,809 unique articles, of which 35 met the inclusion criteria. Meta-analyses of change between baseline and follow-up in random effects models suggested that grip strength had an average increase: standardised mean difference (SMD) = 0.10 (95% CI: 0.03; 0.16); knee extension strength had an average reduction: SMD = -0.24 (95% CI: -0.33; -0.14); and mid-arm muscle circumference had an average reduction: SMD = -0.17 (95% CI: -0.22; -0.11). Inflammation appeared to be associated with greater loss of muscle strength. There was inconclusive evidence that the level of physical activity affects change in skeletal muscle. In regard to the effect of interventions, only exercise interventions were consistently associated with improved skeletal muscle outcomes. CONCLUSIONS Adult patients who undergo an unplanned hospital admission may experience a small reduction in knee extension strength and mid-arm muscle mass. Prospective research is needed to clarify the contribution of confounding factors underlying the observations made in this review, with particular attention to levels of physical activity, and possible contributions from environmental factors and processes of hospital care.
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Affiliation(s)
- Peter Hartley
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
- * E-mail:
| | - Patricia Costello
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Rachel Fenner
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Nathalie Gibbins
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Édáin Quinn
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, United Kingdom
| | - Victoria L. Keevil
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of Medicine for the Elderly, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Roman Romero-Ortuno
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of Medicine for the Elderly, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
- Discipline of Medical Gerontology, Trinity College Dublin, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
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14
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Abstract
The vulnerability of cancer cells to nutrient deprivation and their dependency on specific metabolites are emerging hallmarks of cancer. Fasting or fasting-mimicking diets (FMDs) lead to wide alterations in growth factors and in metabolite levels, generating environments that can reduce the capability of cancer cells to adapt and survive and thus improving the effects of cancer therapies. In addition, fasting or FMDs increase resistance to chemotherapy in normal but not cancer cells and promote regeneration in normal tissues, which could help prevent detrimental and potentially life-threatening side effects of treatments. While fasting is hardly tolerated by patients, both animal and clinical studies show that cycles of low-calorie FMDs are feasible and overall safe. Several clinical trials evaluating the effect of fasting or FMDs on treatment-emergent adverse events and on efficacy outcomes are ongoing. We propose that the combination of FMDs with chemotherapy, immunotherapy or other treatments represents a potentially promising strategy to increase treatment efficacy, prevent resistance acquisition and reduce side effects.
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Affiliation(s)
- Alessio Nencioni
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Irene Caffa
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | | | - Valter D Longo
- IFOM, FIRC Institute of Molecular Oncology, Milano, Italy.
- Longevity Institute, Leonard Davis School of Gerontology and Department of Biological Sciences, University of Southern California, Los Angeles, CA, USA.
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15
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Turcott JG, Oñate-Ocaña LF, Soca-Chafre G, Ramírez-Tirado LA, Flores-Estrada D, Zatarain-Barrón ZL, Arrieta O. FAACT-Anorexia Cachexia Scale: Cutoff Value for Anorexia Diagnosis in Advanced Non-Small Cell Lung Cancer Patients. Nutr Cancer 2018; 71:409-417. [DOI: 10.1080/01635581.2018.1506488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jenny Georgina Turcott
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | - Luis F. Oñate-Ocaña
- Clinical Research Division, Surgery Division, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | - Giovanny Soca-Chafre
- Experimental Oncology Laboratory, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | | | - Diana Flores-Estrada
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute of Mexico (INCan), Mexico City, Mexico
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16
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Abstract
PURPOSE OF REVIEW Cancer anorexia is a negative prognostic factor and is broadly defined as the loss of the interest in food. However, multiple clinical domains contribute to the phenotype of cancer anorexia. The characterization of the clinical and molecular pathophysiology of cancer anorexia may enhance the efficacy of preventive and therapeutic strategies. RECENT FINDINGS Clinical trials showed that cancer anorexia should be considered as an umbrella encompassing different signs and symptoms contributing to appetite disruption in cancer patients. Loss of appetite, early satiety, changes in taste and smell are determinants of cancer anorexia, whose presence should be assessed in cancer patients. Interestingly, neuronal correlates of cancer anorexia-related symptoms have been revealed by brain imaging techniques. SUMMARY The pathophysiology of cancer anorexia is complex and involves different domains influencing eating behavior. Limiting the assessment of cancer anorexia to questions investigating changes in appetite may impede correct identification of the targets to address.
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Affiliation(s)
- Alessandro Laviano
- aDepartment of Clinical Medicine bDepartment of Clinical and Molecular Medicine, Sapienza University, Rome, Italy cCancer Metabolism Research Group, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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17
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Abstract
Purpose of Review Nutritional status in patients with cirrhosis is very frequently associated with macro- and micronutrient deficiencies. Cirrhosis itself is the cause of malnutrition and nutritional deficiencies but these conditions have to be identified and addressed properly as they can worsen the prognosis of cirrhosis. The goals of this review are to 1) identify and describe the challenges associated with nutritional assessment in cirrhosis and 2) describe recent advancements when using clinical, laboratory, and instrumental tools in the evaluation of malnourished patients with liver diseases. Recent Findings The most promising tools for nutritional assessment in cirrhosis include the evaluation of body composition with phase angle obtained by bioelectrical impedance analysis, computed tomography transverse images at the level of third lumbar vertebra. The Royal-Free Hospital global assessment algorithm appears to be helpful but needs further validation. Summary Nutritional assessment in cirrhosis is challenging as several factors, including edema, can interfere with it and because of lack of a validated gold standard. Regardless, nutritional assessment methods have been developed in recent years and should gain relevance in the clinical practice.
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18
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Van Ancum JM, Scheerman K, Jonkman NH, Smeenk HE, Kruizinga RC, Meskers CG, Maier AB. Change in muscle strength and muscle mass in older hospitalized patients: A systematic review and meta-analysis. Exp Gerontol 2017; 92:34-41. [DOI: 10.1016/j.exger.2017.03.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 12/21/2022]
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Molfino A, Iannace A, Colaiacomo MC, Farcomeni A, Emiliani A, Gualdi G, Laviano A, Rossi Fanelli F. Cancer anorexia: hypothalamic activity and its association with inflammation and appetite-regulating peptides in lung cancer. J Cachexia Sarcopenia Muscle 2017; 8:40-47. [PMID: 27897393 PMCID: PMC5326827 DOI: 10.1002/jcsm.12156] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/19/2016] [Accepted: 09/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Energy homeostasis is mediated by the hypothalamus, whose inflammation-induced functional derangements contribute to the onset of anorexia in cancer. By using functional magnetic resonance imaging (fMRI), we determined the patterns of hypothalamic activation after oral intake in anorexic (A), non-anorexic (NA) cancer patients, and in controls (C). METHODS Lung cancer patients were considered. Hypothalamic activation was recorded in A and NA patients and in C by fMRI, before (T0), immediately after (T1) the administration of an oral nutritional supplement, and after 15 min (T2). The grey of the hypothalamus and Blood Oxygen Level Dependent (BOLD) intensity were calculated and normalized for basal conditions. Interleukin (IL)-1, IL-6, tumour necrosis factor (TNF)-α, ghrelin, and leptin plasma levels were measured. A statistical parametric mapping was used. RESULTS Thirteen lung cancer patients (7 M, 6 F; 9A, 4NA) and 2 C (1 M, 1 F) were enrolled. Controls had the lowest BOLD intensity. At all-time points, anorexic patients showed lower hypothalamic activity compared with NA (P < 0.001) (T0: 585.57 ± 55.69 vs. 667.92 ± 33.18, respectively; T1: 536.50 ± 61.70 vs. 624.49 ± 55.51, respectively; T2: 556.44 ± 58.51 vs. 615.43 ± 71.50, respectively). Anorexic patients showed greater BOLD signal reduction during T0-T1 than NA (-8.5% vs. -6.80%, P < 0.001). Independently from the presence of anorexia, BOLD signals modification before and after oral challenge correlated with basal values of IL-1 and ghrelin (P < 0.001). CONCLUSIONS Hypothalamic activity in A cancer patients is reduced respect to NA and responds differently to oral challenges. This suggests a central control of appetite dysregulation during cancer anorexia, before, and after oral intake.
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Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Iannace
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Colaiacomo
- Department of Emergency, Radiology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Gianfranco Gualdi
- Department of Emergency, Radiology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Legrand R, Lucas N, Breton J, Azhar S, do Rego JC, Déchelotte P, Coëffier M, Fetissov SO. Ghrelin treatment prevents development of activity based anorexia in mice. Eur Neuropsychopharmacol 2016; 26:948-58. [PMID: 27052473 DOI: 10.1016/j.euroneuro.2016.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/12/2016] [Accepted: 03/18/2016] [Indexed: 12/30/2022]
Abstract
Stimulation of feeding is necessary for treatment of pathological conditions of chronic malnutrition due to anorexia. Ghrelin, a hunger hormone, is one of the candidate for pharmacological treatments of anorexia, but because of its instability in plasma has limited efficacy. We previously showed that plasmatic IgG protect ghrelin from degradation and that IgG from obese subjects and mice may increase ghrelin׳s orexigenic effect. In this study we tested if ghrelin alone or combined with IgG may improve feeding in chronically food-restricted mice with or without physical activity-based anorexia (ABA) induced by free access to a running wheel. Mice received a single daily intraperitoneal injection of ghrelin (1nM) together or not with total IgG (1nM) from obese ob/ob or lean mice before access to food during 8 days of 3h/day feeding time. We found that both ghrelin and ghrelin combined with IgG from obese, but not lean mice, prevented ABA, however, they were not able to diminish body weight loss. Physical activity was lower during the feeding period and was increased shortly after feeding in mice receiving ghrelin together with IgG from obese mice. In food-restricted mice without ABA, ghrelin treatments did not have significant effects on food intake. Thus, this study supports pharmacological use of ghrelin or ghrelin combined with IgG from obese animals for treatment of anorexia accompanied by elevated physical activity. The utility of combining ghrelin with protective IgG should be further determined in animal models of anorexia with unrestricted access to food.
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Affiliation(s)
- Romain Legrand
- Nutrition, Gut and Brain Laboratory, Inserm UMR1073, Rouen University, 76183 France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France
| | - Nicolas Lucas
- Nutrition, Gut and Brain Laboratory, Inserm UMR1073, Rouen University, 76183 France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France
| | - Jonathan Breton
- Nutrition, Gut and Brain Laboratory, Inserm UMR1073, Rouen University, 76183 France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France
| | - Saïda Azhar
- Nutrition, Gut and Brain Laboratory, Inserm UMR1073, Rouen University, 76183 France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France
| | - Jean-Claude do Rego
- Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France; Animal Behavioral Platform SCAC, Rouen University, Rouen 76183, France
| | - Pierre Déchelotte
- Nutrition, Gut and Brain Laboratory, Inserm UMR1073, Rouen University, 76183 France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France; Department of Nutrition, Rouen University Hospital, 76183 Rouen, France
| | - Moïse Coëffier
- Nutrition, Gut and Brain Laboratory, Inserm UMR1073, Rouen University, 76183 France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France; Department of Nutrition, Rouen University Hospital, 76183 Rouen, France
| | - Sergueï O Fetissov
- Nutrition, Gut and Brain Laboratory, Inserm UMR1073, Rouen University, 76183 France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen 76183, France.
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Molfino A, Kaysen GA, Chertow GM, Doyle J, Delgado C, Dwyer T, Laviano A, Rossi Fanelli F, Johansen KL. Validating Appetite Assessment Tools Among Patients Receiving Hemodialysis. J Ren Nutr 2016; 26:103-10. [PMID: 26522141 PMCID: PMC4796001 DOI: 10.1053/j.jrn.2015.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/10/2015] [Accepted: 09/13/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To test the performance of appetite assessment tools among patients receiving hemodialysis (HD). DESIGN Cross-sectional. SUBJECTS Two hundred twenty-one patients receiving HD enrolled in seven dialysis facilities in Northern California. INTERVENTION We assessed 5 appetite assessment tools (self-assessment of appetite, subjective assessment of appetite, visual analog scale [VAS], Functional Assessment of Anorexia/Cachexia Therapy [FAACT] score, and the Anorexia Questionnaire [AQ]). MAIN OUTCOME MEASURES Reported food intake, normalized protein catabolic rate, and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake. RESULTS Fifty-eight (26%) patients reported food intake ≤ 50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All the tools were significantly associated with food intake ≤ 50% (P < .001), except self-assessment of appetite. The FAACT score and the VAS had the strongest association with food intake ≤ 50% (C-statistic 0.80 and 0.76). Patients with food intake ≤ 50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; P = .03). Normalized protein catabolic rate was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, P = .03). Ln interleukin-6 correlated inversely with food intake (P = .03), but neither interleukin-6 nor C-reactive protein correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (P = .02), prealbumin (P = .02) and adiponectin concentrations (P = .03). CONCLUSIONS Alternative appetite assessment tools yielded widely different estimates of the prevalence of anorexia in HD. When considering self-reported food intake as the criterion standard for anorexia, the FAACT score and VAS discriminated patients reasonably well.
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Affiliation(s)
- Alessio Molfino
- Division of Nephrology, Department of Internal Medicine, University of California, Davis, California; Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
| | - George A Kaysen
- Division of Nephrology, Department of Internal Medicine, University of California, Davis, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Julie Doyle
- Division of Nephrology, University of California, San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Cynthia Delgado
- Division of Nephrology, University of California, San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Tjien Dwyer
- Division of Nephrology, Department of Internal Medicine, University of California, Davis, California
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Podfigurna-Stopa A, Czyzyk A, Katulski K, Smolarczyk R, Grymowicz M, Maciejewska-Jeske M, Meczekalski B. Eating disorders in older women. Maturitas 2015; 82:146-52. [DOI: 10.1016/j.maturitas.2015.06.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 11/26/2022]
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The assessment of anorexia in patients with cancer: cut-off values for the FAACT-A/CS and the VAS for appetite. Support Care Cancer 2015; 24:661-666. [PMID: 26160463 PMCID: PMC4689771 DOI: 10.1007/s00520-015-2826-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/16/2015] [Indexed: 11/12/2022]
Abstract
PURPOSE Anorexia is a frequently observed symptom in patients with cancer and is associated with limited food intake and decreased quality of life. Diagnostic instruments such as the Anorexia/Cachexia Subscale (A/CS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire and the visual analog scale (VAS) for appetite have been recommended in the assessment of anorexia, but validated cut-off values are lacking. This study aimed to obtain cut-off values of these instruments for the assessment of anorexia in patients with cancer. METHODS The FAACT-A/CS and the VAS for appetite were administered to patients with cancer before start of chemotherapy. As reference standard for anorexia, two external criteria were used: (1) a cut-off value of ≥2 on the anorexia symptom scale of the EORTC QLQ C-30 and (2) the question "Do you experience a decreased appetite?" (yes/no). ROC curves were used to examine the optimal cut-off values for the FAACT-A/CS and VAS. RESULTS A total of 273 patients (58 % male; 64.0 ± 10.6 years) were included. The median score on the FAACT-A/CS was 38 (IQR 32-42) points and 77 (IQR 47-93) points on the VAS. Considering both external criteria, the optimal cut-off value for the FAACT-A/CS was ≤37 (sensitivity (se) 80 %, specificity (sp) 81 %, positive predictive value (PV(+)) 79 %, negative predictive value (PV(-)) 82 %) and for the VAS was ≤70 (se 76 %, sp 83 %, PV(+) 80 %, PV(-) 79 %). CONCLUSIONS For the assessment of anorexia in patients with cancer, our study suggests cut-off values of ≤37 for the FAACT-A/CS and ≤70 for the VAS. Future studies should confirm our findings in other patient samples.
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Jeejeebhoy KN, Keller H, Gramlich L, Allard JP, Laporte M, Duerksen DR, Payette H, Bernier P, Vesnaver E, Davidson B, Teterina A, Lou W. Nutritional assessment: comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission. Am J Clin Nutr 2015; 101:956-65. [PMID: 25739926 DOI: 10.3945/ajcn.114.098665] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 02/09/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Nutritional assessment commonly includes multiple nutrition indicators (NIs). To promote efficiency, a minimum set is needed for the diagnosis of malnutrition in the acute care setting. OBJECTIVE The objective was to compare the ability of different NIs to predict outcomes of length of hospital stay and readmission to refine the detection of malnutrition in acute care. DESIGN This was a prospective cohort study of 1022 patients recruited from 18 acute care hospitals (academic and community), from 8 provinces across Canada, between 1 July 2010 and 28 February 2013. Participants were patients aged ≥18 y admitted to medical and surgical wards. NIs measured at admission were subjective global assessment (SGA; SGA A = well nourished, SGA B = mild or moderate malnutrition, and SGA C = severe malnutrition), Nutrition Risk Screening (2002), body weight, midarm and calf circumference, serum albumin, handgrip strength (HGS), and patient-self assessment of food intake. Logistic regression determined the independent effect of NIs on the outcomes of length of hospital stay (<7 d and ≥7 d) and readmission within 30 d after discharge. RESULTS In total, 733 patients had complete NI data and were available for analysis. After we controlled for age, sex, and diagnosis, only SGA C (OR: 2.19; 95% CI: 1.28, 3.75), HGS (OR: 0.98; 95% CI: 0.96, 0.99 per kg of increase), and reduced food intake during the first week of hospitalization (OR: 1.51; 95% CI: 1.08, 2.11) were independent predictors of length of stay. SGA C (OR: 2.12; 95% CI: 1.24, 3.93) and HGS (OR: 0.96; 95% CI: 0.94, 0.98) but not food intake were independent predictors of 30-d readmission. CONCLUSIONS SGA, HGS, and food intake were independent predictors of outcomes for malnutrition. Because food intake in this study was judged days after admission and HGS has a wide range of normal values, SGA is the single best predictor and should be advocated as the primary measure for diagnosis of malnutrition. This study was registered at clinicaltrials.gov as NCT02351661.
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Affiliation(s)
- Khursheed N Jeejeebhoy
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Heather Keller
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Leah Gramlich
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Johane P Allard
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Manon Laporte
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Donald R Duerksen
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Helene Payette
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Paule Bernier
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Elisabeth Vesnaver
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Bridget Davidson
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Anastasia Teterina
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
| | - Wendy Lou
- From the Department of Medicine, St Michael Hospital, University of Toronto, Toronto, Ontario, Canada (KNJ); Schlegel-UW Research Institute of Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada (HK); the Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada (LG); the Department of Medicine, University Health Network, University of Toronto, Ontario, Canada (JPA); the Clinical Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada (ML); the Department of Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (DRD); Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada (HP); Jewish General Hospital, Université de Montréal, Montréal, Québec, Canada (PB); the Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada (EV); Canadian Nutrition Society, Toronto, Ontario, Canada (BD); University Health Network, Toronto, Ontario, Canada (AT); and Dalla Lane School of Public Health, University of Toronto, Toronto, Ontario, Canada (WL)
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Molfino A, Muscaritoli M, Rossi Fanelli F. Anorexia assessment in patients with cancer: a crucial issue to improve the outcome. J Clin Oncol 2015; 33:1513. [PMID: 25753439 DOI: 10.1200/jco.2014.59.9548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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