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Shorter E, Engman V, Lanner JT. Cancer-associated muscle weakness - From triggers to molecular mechanisms. Mol Aspects Med 2024; 97:101260. [PMID: 38457901 DOI: 10.1016/j.mam.2024.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
Skeletal muscle weakness is a debilitating consequence of many malignancies. Muscle weakness has a negative impact on both patient wellbeing and outcome in a range of cancer types and can be the result of loss of muscle mass (i.e. muscle atrophy, cachexia) and occur independently of muscle atrophy or cachexia. There are multiple cancer specific triggers that can initiate the progression of muscle weakness, including the malignancy itself and the tumour environment, as well as chemotherapy, radiotherapy and malnutrition. This can induce weakness via different routes: 1) impaired intrinsic capacity (i.e., contractile dysfunction and intramuscular impairments in excitation-contraction coupling or crossbridge cycling), 2) neuromuscular disconnection and/or 3) muscle atrophy. The mechanisms that underlie these pathways are a complex interplay of inflammation, autophagy, disrupted protein synthesis/degradation, and mitochondrial dysfunction. The current lack of therapies to treat cancer-associated muscle weakness highlight the critical need for novel interventions (both pharmacological and non-pharmacological) and mechanistic insight. Moreover, most research in the field has placed emphasis on directly improving muscle mass to improve muscle strength. However, accumulating evidence suggests that loss of muscle function precedes atrophy. This review primarily focuses on cancer-associated muscle weakness, independent of cachexia, and provides a solid background on the underlying mechanisms, methodology, current interventions, gaps in knowledge, and limitations of research in the field. Moreover, we have performed a mini-systematic review of recent research into the mechanisms behind muscle weakness in specific cancer types, along with the main pathways implicated.
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Affiliation(s)
- Emily Shorter
- Karolinska Institutet, Department of Physiology and Pharmacology, Molecular Muscle Physiology and Pathophysiology, Biomedicum, Stockholm, Sweden
| | - Viktor Engman
- Karolinska Institutet, Department of Physiology and Pharmacology, Molecular Muscle Physiology and Pathophysiology, Biomedicum, Stockholm, Sweden
| | - Johanna T Lanner
- Karolinska Institutet, Department of Physiology and Pharmacology, Molecular Muscle Physiology and Pathophysiology, Biomedicum, Stockholm, Sweden.
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2
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Patel I, Winer A. Assessing Frailty in Gastrointestinal Cancer: Two Diseases in One? Curr Oncol Rep 2024; 26:90-102. [PMID: 38180691 DOI: 10.1007/s11912-023-01483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
PURPOSEOF REVIEW This review examines the challenges of treating gastrointestinal cancer in the aging population, focusing on the importance of frailty assessment. Emphasized are the rise in gastrointestinal cancer incidence in older adults, advances in frailty assessments for patients with gastrointestinal cancer, the development of novel frailty markers, and a summary of recent trials. RECENT FINDINGS Increasing evidence suggests that the use of a Comprehensive Geriatric Assessment (CGA) to identify frail older adults and individualize cancer care leads to lower toxicity and improved quality of life outcomes. However, the adoption of a full CGA prior to chemotherapy initiation in older cancer patients remains low. Recently, new frailty screening tools have emerged, including assessments designed to specifically predict chemotherapy-related adverse events. Additionally, frailty biomarkers have been developed, such as blood tests like IL-6 and performance tracking through physical activity monitors. The relevance of nutrition and muscle mass is discussed. Highlights from recent trials suggest the feasibility of successfully identifying patients most at risk of serious adverse events. There have been promising developments in identifying novel frailty markers and methods to screen for frailty in the older adult population. Further prospective trials that focus on and address the needs of the geriatric population for early identification of frailty in cancer care, facilitating a more tailored treatment approach. Practicing oncologists should select a frailty assessment to implement into their routine practice and adjust treatment accordingly.
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Affiliation(s)
- Ishan Patel
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA.
| | - Arthur Winer
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA
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3
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Zhang FM, Wu HF, Shi HP, Yu Z, Zhuang CL. Sarcopenia and malignancies: epidemiology, clinical classification and implications. Ageing Res Rev 2023; 91:102057. [PMID: 37666432 DOI: 10.1016/j.arr.2023.102057] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
Sarcopenia is a progressive systemic skeletal muscle disorder characterized by a pathological decline in muscle strength, quantity, and quality, which frequently affects the elderly population. The majority of cancer patients are of advanced age. Patients may already have sarcopenia prior to cancer development, and those with cancer are prone to developing sarcopenia due to hypercatabolism, inflammation, reduced physical fitness, anorexia, adverse effects, and stress associated with anticancer therapy. Based on the timing, sarcopenia in patients with cancer can be categorized into three: pre-existing sarcopenia before the onset of cancer, sarcopenia related to cancer, and sarcopenia related to cancer treatment. Sarcopenia not only changes the body composition of patients with cancer but also increases the incidence of postoperative complications, reduces therapeutic efficacy, impairs quality of life, and results in shortened survival. Different therapeutic strategies are required to match the cancer status and physical condition of patients with different etiologies and stages of sarcopenia. Here, we present a comprehensive review of the epidemiology and diagnosis of sarcopenia in patients with cancer, elucidate the complex interactions between cancer and sarcopenia, and provide evidence-based strategies for sarcopenia management in these patients.
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Affiliation(s)
- Feng-Min Zhang
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hao-Fan Wu
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University/ Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Zhen Yu
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Cheng-Le Zhuang
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
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4
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Ford KL, Orsso CE, Kiss N, Johnson SB, Purcell SA, Gagnon A, Laviano A, Prado CM. Dietary choices following a cancer diagnosis: a narrative review. Nutrition 2022; 103-104:111838. [DOI: 10.1016/j.nut.2022.111838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/21/2022] [Indexed: 11/29/2022]
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5
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Khalid W, Arshad MS, Aslam N, Majid Noor M, Siddeeg A, Abdul Rahim M, Zubair Khalid M, Ali A, Maqbool Z. Meat myofibril: Chemical composition, sources and its potential for cardiac layers and strong skeleton muscle. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2022. [DOI: 10.1080/10942912.2022.2044847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Waseem Khalid
- Department of Food Science, Government College University, Faisalabad, Pakistan
| | | | - Noman Aslam
- Department of Food Science, Government College University, Faisalabad, Pakistan
| | - Muhammad Majid Noor
- Department of Food Science, Government College University, Faisalabad, Pakistan
| | - Azhari Siddeeg
- Department of Food Engineering and Technology, Faculty of Engineering and Technology, University of Gezira, Wad Medani, Sudan
| | | | | | - Anwar Ali
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, HN, China
| | - Zahra Maqbool
- Department of Food Science, Government College University, Faisalabad, Pakistan
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6
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Ford KL, Arends J, Atherton PJ, Engelen MPKJ, Gonçalves TJM, Laviano A, Lobo DN, Phillips SM, Ravasco P, Deutz NEP, Prado CM. The importance of protein sources to support muscle anabolism in cancer: An expert group opinion. Clin Nutr 2022; 41:192-201. [PMID: 34891022 DOI: 10.1016/j.clnu.2021.11.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022]
Abstract
This opinion paper presents a short review of the potential impact of protein on muscle anabolism in cancer, which is associated with better patient outcomes. Protein source is a topic of interest for patients and clinicians, partly due to recent emphasis on the supposed non-beneficial effect of proteins; therefore, misconceptions involving animal-based (e.g., meat, fish, dairy) and plant-based (e.g., legumes) proteins in cancer are acknowledged and addressed. Although the optimal dietary amino acid composition to support muscle health in cancer is yet to be established, animal-based proteins have a composition that offers superior anabolic potential, compared to plant-derived proteins. Thus, animal-based foods should represent the majority (i.e., ≥65%) of protein intake during active cancer treatment. A diet rich in plant-derived proteins may support muscle anabolism in cancer, albeit requiring a larger quantity of protein to fulfill the optimal amino acid intake. We caution that translating dietary recommendations for cancer prevention to cancer treatment may be inadequate to support the pro-inflammatory and catabolic nature of the disease. We further caution against initiating an exclusively plant-based (i.e., vegan) diet upon a diagnosis of cancer, given the presence of elevated protein requirements and risk of inadequate protein intake to support muscle anabolism. Amino acid combination and the long-term sustainability of a dietary pattern void of animal-based foods requires careful and laborious management of protein intake for patients with cancer. Ultimately, a dietary amino acid composition that promotes muscle anabolism is optimally obtained through combination of animal- and plant-based protein sources.
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Affiliation(s)
- Katherine L Ford
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Jann Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Philip J Atherton
- MRC Versus Arthritis Centre of Excellence for Musculoskeletal Ageing Research, Centre of Metabolism & Physiology (COMAP), University of Nottingham, Derby, UK
| | - Mariëlle P K J Engelen
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Thiago J M Gonçalves
- Department of Nutrology and Clinical Nutrition, Sancta Maggiore Hospital, Prevent Senior Institute, São Paulo, Brazil
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | | - Paula Ravasco
- Catolica Medical School and Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal; Centre for Interdisciplinary Research Egas Moniz (CiiEM), Egas Moniz Cooperativa de Ensino Superior, CRL, Almada, Portugal
| | - Nicolaas E P Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA.
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada.
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Impact of β-hydroxy-β-methylbutyrate (HMB) on muscle loss and protein metabolism in critically ill patients: A RCT. Clin Nutr 2021; 40:4878-4887. [PMID: 34358832 DOI: 10.1016/j.clnu.2021.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Muscle wasting deteriorates life quality after critical illness and increases mortality. Wasting starts upon admission to intensive care unit (ICU). We aimed to determine whether β-hydroxy-β-methylbutyrate (HMB), a metabolite of leucine, can attenuate this process. METHODS Prospective randomized, placebo-controlled double blind trial. INCLUSION CRITERIA ICU patients depending on mechanical ventilation on day 3 having a functional gastrointestinal tract. They were randomized to HMB (3 g/day) or placebo (maltodextrin) from day 4 on for 30 days. PRIMARY OUTCOME magnitude of loss of skeletal muscle area (SMA) of the quadriceps femoris measured by ultrasound at days 4 and 15. SECONDARY OUTCOMES body composition, change in protein metabolism assessed by amino acids tracer pulse, and global health at 60 days. Data are mean [95% CI]. Statistics by ANCOVA with correction for confounders sex, age and/or BMI. RESULTS Thirty patients completed the trial, aged 65 [59, 71] years, SAPS2 score 48 [43, 52] and SOFA 8.5 [7.4, 9.7]. The loss of total SMA was 11% between days 4 and 15 (p < 0.001), but not different between the groups (p = 0.86). In the HMB group, net protein breakdown (Δ Estimate HMB-Placebo: -153 [-242, -63]; p = 0.0021) and production of several amino acid was significantly reduced, while phase angle increased more (0.66 [0.09, 1.24]; p = 0.0247), and SF-12 global health improved more (Δ Estimate HMB-Placebo: 27.39 [1.594, 53.19], p = 0.04). CONCLUSION HMB treatment did not significantly reduce muscle wasting over 10 days of observation (primary endpoint), but resulted in significantly improved amino acid metabolism, reduced net protein breakdown, a higher phase angle and better global health. CLINICALTRIALS. GOV IDENTIFIER NCT03628365.
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8
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Qin L, Tian Q, Zhu W, Wu B. The Validity of the GLIM Criteria for Malnutrition in Hospitalized Patients with Gastric Cancer. Nutr Cancer 2020; 73:2732-2739. [PMID: 33305620 DOI: 10.1080/01635581.2020.1856894] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) has recently proposed a consensus on the criteria to diagnose malnutrition. The validity of the new criteria to detect malnutrition is still being explored. Therefore, this study aimed to verify the validity of the GLIM criteria for malnutrition in hospitalized patients with gastric cancer (GC) using the Patient-Generated Subjective Global Assessment (PG-SGA) as a comparator. METHODS This is a cross-sectional study involving 217 GC inpatients. Nutrition assessment was performed during their hospitalization with both the GLIM criteria and the PG-SGA. Consistency of the assessment results and their correlation with the quality of life in patients were evaluated. RESULTS A moderate concordance (K = 0.483, P < 0.001) was founded between the two methods for malnutrition diagnosis. Spearman correlation analysis confirmed the significant association (P < 0.05) between most aspects of the quality of life and nutrition status regarding either the GLIM criteria or the PG-SGA. In multivariate linear regression, adjusted for confounding variables, the quality of life was significantly associated with nutrition status by the GLIM criteria (B = 5.63, 95% CI: 0.09-11.16, P = 0.046), and by the PG-SGA (B = 13.53, 95% CI: 7.78-19.27, P < 0.001). CONCLUSIONS This study provides a new understanding of the validity of the GLIM criteria in hospitalized GC patients. In the study, we have found that the new GLIM criteria are of concurrent and clinical validity in GC inpatients, suggested by the comparison with the PG-SGA and its correlation with the quality of life.
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Affiliation(s)
- Liyuan Qin
- Nursing College, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Nursing Department, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Qiuju Tian
- Nursing College, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Nursing Department, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Weiyi Zhu
- Nursing Department, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Beiwen Wu
- Nursing Department, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
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9
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Liu Y, Li D, Wei Y, Ma Y, Wang Y, Huang L, Wang Y. Hydrolyzed peptides from purple perilla (Perilla frutescens L. Britt.) seeds improve muscle synthesis and exercise performance in mice. J Food Biochem 2020; 44:e13461. [PMID: 32984958 DOI: 10.1111/jfbc.13461] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 01/04/2023]
Abstract
The purple perilla (Perilla frutescens L. Britt.) seed peptides (PPSP) were obtained and their improvement of muscle synthesis and exercise performance was investigated in this work. Results showed that the weight-average molecular weight of the PPSP was 869 Dalton. The PPSP were rich in branched-chain amino acids (18.82 g/100 g) and anti-fatigue amino acids, including glutamate (Glu), aspartic acid (Asp), and arginine (Arg). After the administration of PPSP at 1.2 g kg-1 day-1 for 4 weeks, the muscle coefficient and muscle fiber thickness in mice displayed a distinct (p < .05) increase via the upregulation of myogenic differentiation (MyoD) and myogenin (MyoG). The improved muscle strength and exercise tolerance were also observed. Simultaneously, the levels of the biochemical blood markers associated with fatigue and the glycogen degradation in liver and muscle were significantly (p < .05) suppressed. These results suggested that PPSP could effectively promote muscle synthesis and ameliorate exercise fatigue. PRACTICAL APPLICATIONS: Purple perilla is an annual herbal plant and widely grown in Asian countries as an important crop and food. It is believed that the protein content of purple perilla seeds can reach 23.7%, and the protein is rich in essential amino acids. However, the information about the beneficial effects of their proteins or peptides on muscle synthesis and anti-exercise fatigue were still limited. The present results discovered that the PPSP can effectively promote the growth of muscle tissue and improve exercise tolerance. It is indicated that PPSP may have a potential application value in partly or completely replacing animal proteins such as whey protein.
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Affiliation(s)
- Yixiang Liu
- College of Food and Biological Engineering, Jimei University, Xiamen, People's Republic of China
| | - Donghui Li
- College of Food and Biological Engineering, Jimei University, Xiamen, People's Republic of China
| | - Ying Wei
- The Department of Food Engineering, China National Research Institute of Food & Fermentation Industries Corporation Limited, Beijing, People's Republic of China
| | - Yu Ma
- College of Food and Biological Engineering, Jimei University, Xiamen, People's Republic of China
| | - Yuchen Wang
- The Department of Food Engineering, China National Research Institute of Food & Fermentation Industries Corporation Limited, Beijing, People's Republic of China
| | - Ling Huang
- College of Food and Biological Engineering, Jimei University, Xiamen, People's Republic of China
| | - Yanbo Wang
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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10
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van der Meij BS, Deutz NEP, Rodriguez RE, Engelen MPKJ. Early Signs of Impaired Gut Function Affect Daily Functioning in Patients With Advanced Cancer Undergoing Chemotherapy. JPEN J Parenter Enteral Nutr 2020; 45:752-760. [PMID: 32511767 DOI: 10.1002/jpen.1941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gastrointestinal symptoms are common during chemotherapy, but underlying disturbances in gut function and their impact on daily life are unclear. This study investigates gut function in a heterogenous group of cancer patients with gastrointestinal symptoms during chemotherapy and its relation to anabolic response, muscle health, and daily functioning. METHODS In 16 patients with solid tumors (mostly stage III+IV) undergoing chemotherapy (T) and 16 healthy (H) matched controls, small-intestinal membrane integrity was measured by urine sugar tests. Protein digestion, absorption, and anabolic response to a conventional protein supplement were analyzed by stable-tracer methods. Muscle mass and strength and daily functioning were assessed. RESULTS Eighty-one percent of T patients reported gastrointestinal symptoms. Small-intestinal membrane permeability was similar, but active glucose transport was lower in the T group (T, 35.5% ± 3.4% vs H, 48.4% ± 4.7%; P = .03). Protein digestion and absorption tended to be lower in the T group (0.67 ± 0.02 vs 0.80 ± 0.04; P = .08). Net protein anabolic response to feeding was comparable, although lower in cancer patients with recent weight loss. Gut permeability negatively correlated to hand grip strength, global health, and physical functioning, and active-transport capacity positively correlated to global health in the T group. CONCLUSION Advanced cancer patients with gastrointestinal symptoms during chemotherapy, particularly those with recent weight loss, show signs of impaired gut function negatively affecting muscle health, daily functioning, and anabolic response to feeding.
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Affiliation(s)
- Barbara S van der Meij
- Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA.,Faculty of Health Sciences and Medicine, Bond University, Bond University Nutrition and Dietetics Research Group, Gold Coast, Queensland, Australia.,Department of Dietetics and Food Services, Mater Health, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Nicolaas E P Deutz
- Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Ramon E Rodriguez
- Division of Hematology and Medical Oncology, Baylor Scott and White Medical Center, College Station, Texas, USA
| | - Mariëlle P K J Engelen
- Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
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11
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Brook MS, Wilkinson DJ. Contemporary stable isotope tracer approaches: Insights into skeletal muscle metabolism in health and disease. Exp Physiol 2020; 105:1081-1089. [PMID: 32362047 DOI: 10.1113/ep087492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review discusses the application of new stable isotope tracer techniques in understanding the control of skeletal muscle mass. What advances does it highlight? This review highlights current advances in stable isotope tracer techniques through their combination with high-throughput proteomics technologies. ABSTRACT Beyond its primary locomotory and key structural functions, skeletal muscle provides additional vital roles for maintenance of metabolic health, acting as a storage point for glucose and intramuscular lipids for energy production, alongside being the largest reservoir for amino acids in the body. Therefore, maintenance of muscle mass is key to the promotion of health and well-being across the lifespan and in several disease states. As such, when skeletal muscle is lost, in either clinical (cancer, organ failure etc.) or non-clinical (ageing, inactivity) situations, there are potentially devastating consequences attached, with robust links existing between muscle mass loss and mortality. Great efforts are being made to reverse or slow muscle mass declines in health and disease, through combinations of lifestyle changes and nutritional and/or pharmaceutical intervention. However, despite this comprehensive research effort, the underlying metabolic and molecular mechanisms have yet to be defined properly. However, with the rapid acceleration of analytical developments over recent years, the application of stable isotope tracers to the study of human muscle metabolism is providing unique insights into the mechanisms controlling skeletal muscle loss and allowing more targeted therapeutic strategies to be developed. The aim of this review is to highlight the technical breakthroughs in our understanding of muscle wasting in health and disease and how future directions and developments incorporating 'omics' with stable isotope tracers will allow for a more personalized and stratified therapeutic approach.
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Affiliation(s)
- Matthew S Brook
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,School of Life Science, Queen's Medical Centre, Nottingham, UK
| | - Daniel J Wilkinson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,Division of Health Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital Centre, Derby, UK
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12
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Brook MS, Wilkinson DJ, Atherton PJ. An update on nutrient modulation in the management of disease-induced muscle wasting: evidence from human studies. Curr Opin Clin Nutr Metab Care 2020; 23:174-180. [PMID: 32175954 DOI: 10.1097/mco.0000000000000652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Skeletal muscle has many essential roles in maintaining human health, not only being crucial for locomotion, but further as a metabolically important organ. Muscle wasting in disease (cachexia) is highly prevalent, associated with poor clinical outcomes and is not fully reversible with nutritional interventions. Understanding proteostasis in diseased states is of great importance to design novel, effective nutritional/nutraceutical strategies aimed at alleviating muscle wasting. In this review, we will provide an update on muscle kinetics in disease and the effects of nutritional interventions. RECENT FINDINGS Whole body and skeletal muscle kinetics are commonly shown to be imbalanced in disease, promoting overall catabolism that underlies the development of cachexia. However, recent advancements in defining the effectiveness of nutritional interventions on muscle anabolism are clouded by heterogenous patient populations and a lack of direct incorporation stable isotope techniques. Current recommendations are focused on combating malnutrition, with increased protein intake (high in EAA) demonstrating promise. SUMMARY Recent progress in understanding catabolic states in cachexia across disease is minimal. Further, studies investigating muscle-specific protein turnover along with nutritional interventions are scarce. As such, there is a significant requirement for strong RCT's investigating both acute and chronic nutritional interventions and their impact on skeletal muscle in individual disease states.
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Affiliation(s)
- Matthew S Brook
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital Centre, Derby
- Queens Medical Centre, Nottingham, UK
| | - Daniel J Wilkinson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital Centre, Derby
| | - Philip J Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital Centre, Derby
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13
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Cereda E, Turri A, Klersy C, Cappello S, Ferrari A, Filippi AR, Brugnatelli S, Caraccia M, Chiellino S, Borioli V, Monaco T, Stella GM, Arcaini L, Benazzo M, Grugnetti G, Pedrazzoli P, Caccialanza R. Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy. Cancer Med 2019; 8:6923-6932. [PMID: 31568698 PMCID: PMC6853834 DOI: 10.1002/cam4.2517] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022] Open
Abstract
In recent years, whey proteins (WP) have attracted increasing attention in health and disease for their bioactive functions. The aim of this study was to evaluate the benefit of WP isolate (WPI) supplementation in addition to nutritional counseling in malnourished advanced cancer patients undergoing chemotherapy (CT). In a single‐center, randomized, pragmatic, and parallel‐group controlled trial (http://www.ClinicalTrials.gov: NCT02065726), 166 malnourished advanced cancer patients with mixed tumor entities candidate to or undergoing CT were randomly assigned to receive nutritional counseling with (N = 82) or without (N = 84) WPI supplementation (20 g/d) for 3 months. The primary endpoint was the change in phase angle (PhA). Secondary endpoints included changes in standardized PhA (SPA), fat‐free mass index (FFMI), body weight, muscle strength, and CT toxicity (CTCAE 4.0 events). In patients with the primary endpoint assessed (modified intention‐to‐treat population), counseling plus WPI (N = 66) resulted in improved PhA compared to nutritional counseling alone (N = 69): mean difference, 0.48° (95% CI, 0.05 to 0.90) (P = .027). WPI supplementation also resulted in improved SPA (P = .021), FFMI (P = .041), body weight (P = .023), muscle strength (P < .001), and in a reduced risk of CT toxicity (risk difference, −9.8% [95% CI, −16.9 to −2.6]; P = .009), particularly of severe (grade ≥ 3) events (risk difference, −30.4% [95% CI, −44.4 to −16.5]; P = .001). In malnourished advanced cancer patients undergoing CT, receiving nutritional counseling, a 3‐month supplementation with WPI resulted in improved body composition, muscle strength, body weight, and reduced CT toxicity. Further trials, aimed at verifying the efficacy of this nutritional intervention on mid‐ and long‐term primary clinical endpoints in newly diagnosed specific cancer types, are warranted.
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Affiliation(s)
- Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turri
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Cappello
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Silvia Brugnatelli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marilisa Caraccia
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Chiellino
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Borioli
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Monaco
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Maria Stella
- Unit of Respiratory System Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Marco Benazzo
- Department of Otolaryngology, University of Pavia, Pavia, Italy.,Head Neck Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppina Grugnetti
- Nursing Technical and Rehabilitation Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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