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Purcell SA, Oliveira CLP, Mackenzie M, Robson P, Lewis JD, Prado CM. Body Composition and Prostate Cancer Risk: A Systematic Review of Observational Studies. Adv Nutr 2022; 13:1118-1130. [PMID: 34918023 PMCID: PMC9340980 DOI: 10.1093/advances/nmab153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/13/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Body composition parameters are not captured by measures of body mass, which may explain inconsistent associations between body weight and prostate cancer (PC) risk. The objective of this systematic review was to characterize the association between fat mass (FM) and fat-free mass (FFM) parameters and PC risk. A search of PubMed, Embase, and Web of Science identified case-control and cohort studies that measured body composition in relation to PC risk. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Thirteen observational studies were included, of which 8 were case-control studies (n = 1572 cases, n = 1937 controls) and 5 were prospective cohort studies (n = 7854 incident cases with PC). The NOS score was 5.9 ± 1.1 for case-control studies and 8.4 ± 1.3 for cohort studies. The most common body composition technique was bioelectrical impedance analysis (n = 9 studies), followed by DXA (n = 2), computed tomography (n = 2), air displacement plethysmography (n = 1), and MRI (n = 1). No case-control studies reported differences in %FM between PC cases and controls and no consistent differences in FM or FFM (in kilograms) were observed. Two out of 5 cohort studies reported that higher %FM was associated with lower PC risk. Conversely, 3 cohort studies reported a greater risk of being diagnosed with advanced/aggressive PC with higher FM (expressed in kilograms, %FM, or fat distribution). Two out of 4 studies (both case-control and cohort) found that higher abdominal adipose tissue was associated with increased PC risk. In conclusion, although results were inconsistent, there is some evidence that FM may be negatively associated with total PC risk but positively associated with the risk of advanced/aggressive PC; modest evidence suggests that abdominal adipose tissue may increase the risk of PC. Future work should elucidate unique patterns of FM distribution and PC risk to triage men at risk for developing PC. This study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database as CRD42019133388.
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Affiliation(s)
- Sarah A Purcell
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Camila L P Oliveira
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Mackenzie
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Paula Robson
- Cancer Care Alberta and the Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - John D Lewis
- Department of Experimental Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Carla M Prado
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Association of Energy Expenditure and Efficacy in Metastatic Renal Cell Carcinoma Patients Treated with Nivolumab. Cancers (Basel) 2022; 14:cancers14133214. [PMID: 35804986 PMCID: PMC9264847 DOI: 10.3390/cancers14133214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Nivolumab improved patients’ survival in metastatic renal cell carcinoma (mRCC). We aimed to evaluate resting energy expenditure (REE) (i.e., patients’ basal metabolism) to predict efficacy. Methods: We conducted a monocentric, observational study of mRCC patients receiving nivolumab between October 2015 and May 2020. REE was measured prior to initiating immunotherapy using indirect calorimetry to determine hypo, normo and hypermetabolism. Primary endpoint was 6-month, progression-free survival (PFS), and secondary endpoints were response rate, PFS and overall survival (OS). Results: Of the 51 consecutive patients, 15 (29%) were hypermetabolic, 24 (47%) normometabolic, and 12 (24%) hypometabolic. The 6-month PFS was 15% for hypermetabolic patients and 65% for non-hypermetabolic patients (p < 0.01). In the multivariate analysis, hypermetabolism was the only baseline factor predicting 6-month PFS (OR 9.91, 95%CI [1.62−60.55], p = 0.01). Disease progression was noted as the best response in 73% of hypermetabolic patients and 26% of non-hypermetabolic patients (p = 0.02). Median PFS was 2.8 and 8.7 months (p < 0.01), and median OS was 20.2 and 35.1 months (p = 0.13) in the hypermetabolic and non-hypermetabolic groups, respectively. Conclusions: Our study identifies an association between mRCC patients’ energy expenditure and nivolumab efficacy. The measurement of REE by indirect calorimetry in routine practice could help identify patients at risk of nivolumab failure.
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Bulmuş Tüccar T, Acar Tek N. Determining the factors affecting energy metabolism and energy requirement in cancer patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:124. [PMID: 35126587 PMCID: PMC8772515 DOI: 10.4103/jrms.jrms_844_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/26/2020] [Accepted: 07/15/2021] [Indexed: 11/04/2022]
Abstract
Cancer is the second most common cause of death worldwide. It is a generic name for a large group of diseases that can affect any part of the body. Cancer affects both energy intake through the diet and the total energy expenditure (TEE) through the changes in energy metabolism, resulting in negative or positive energy balance. Determining daily energy requirement is very important in the regulation of the nutrition therapy in a cancer patients. Due to the difficulty in directly measuring the TEE, resting energy expenditure, which is the largest component of the TEE, is often used in the determination of the energy requirement. In this study, the effects of disease-specific factors such as tumor burden, inflammation, weight loss and cachexia on energy metabolism in cancer patients were investigated.
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Affiliation(s)
- Tuğçe Bulmuş Tüccar
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Yüksek İhtisas University, Ankara, Turkey
| | - Nilüfer Acar Tek
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Biswas AK, Acharyya S. The Etiology and Impact of Muscle Wasting in Metastatic Cancer. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a037416. [PMID: 31615873 DOI: 10.1101/cshperspect.a037416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Metastasis arises when cancer cells disseminate from their site of origin and invade distant organs. While cancer cells rarely colonize muscle, they often induce a debilitating muscle-wasting condition known as cachexia that compromises feeding, breathing, and cardiac function in metastatic cancer patients. In fact, nearly 80% of metastatic cancer patients experience a spectrum of muscle-wasting states, which deteriorates the quality of life and overall survival of cancer patients. Muscle wasting in cancer results from increased muscle catabolism induced by circulating tumor factors and a systemic metabolic dysfunction. In addition, muscle loss can be exacerbated by the exposure to antineoplastic therapies and the process of aging. With no approved therapies to alleviate cachexia, muscle health, therefore, becomes a key determinant of prognosis, treatment response, and survival in metastatic cancer patients. This review will discuss the current understanding of cancer-associated cachexia and highlight promising therapeutic strategies to treat muscle wasting in the context of metastatic cancers.
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Affiliation(s)
- Anup K Biswas
- Department of Pathology and Cell Biology, Institute for Cancer Genetics, Columbia University, New York, New York 10032, USA
| | - Swarnali Acharyya
- Department of Pathology and Cell Biology, Institute for Cancer Genetics, Columbia University, New York, New York 10032, USA.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York 10032, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York 10032, USA
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Oshima T, Berger MM, De Waele E, Guttormsen AB, Heidegger CP, Hiesmayr M, Singer P, Wernerman J, Pichard C. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clin Nutr 2016; 36:651-662. [PMID: 27373497 DOI: 10.1016/j.clnu.2016.06.010] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS This review aims to clarify the use of indirect calorimetry (IC) in nutritional therapy for critically ill and other patient populations. It features a comprehensive overview of the technical concepts, the practical application and current developments of IC. METHODS Pubmed-referenced publications were analyzed to generate an overview about the basic knowledge of IC, to describe advantages and disadvantages of the current technology, to clarify technical issues and provide pragmatic solutions for clinical practice and metabolic research. The International Multicentric Study Group for Indirect Calorimetry (ICALIC) has generated this position paper. RESULTS IC can be performed in in- and out-patients, including those in the intensive care unit, to measure energy expenditure (EE). Optimal nutritional therapy, defined as energy prescription based on measured EE by IC has been associated with better clinical outcome. Equations based on simple anthropometric measurements to predict EE are inaccurate when applied to individual patients. An ongoing international academic initiative to develop a new indirect calorimeter aims at providing innovative and affordable technical solutions for many of the current limitations of IC. CONCLUSION Indirect calorimetry is a tool of paramount importance, necessary to optimize the nutrition therapy of patients with various pathologies and conditions. Recent technical developments allow broader use of IC for in- and out-patients.
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Affiliation(s)
- Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuou-ku, Chiba City, Chiba 260-8677, Japan.
| | - Mette M Berger
- Adult Intensive Care, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Elisabeth De Waele
- Department of Intensive Care, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Anne Berit Guttormsen
- Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway; Department of Clinical Medicine University of Bergen, Bergen, Norway; Haukeland Universitetssykehus Laboratoriebygget, 7. etg. Heis øst, Norway.
| | - Claudia-Paula Heidegger
- Service of Intensive Care, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Michael Hiesmayr
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, University Hospital of Vienna, Waehrihger Guertel 18-20, 1090 Vienna, Austria.
| | - Pierre Singer
- Critical Care Medicine, Institute for Nutrition Research, Rabin Medical Center, Beilison Hospital, Petah Tikva 49100, Israel.
| | - Jan Wernerman
- Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital Huddinge, Sweden.
| | - Claude Pichard
- Nutrition Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
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Purcell SA, Elliott SA, Baracos VE, Chu QSC, Prado CM. Key determinants of energy expenditure in cancer and implications for clinical practice. Eur J Clin Nutr 2016; 70:1230-1238. [DOI: 10.1038/ejcn.2016.96] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/06/2016] [Indexed: 12/17/2022]
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Nguyen TYV, Batterham MJ, Edwards C. Comparison of Resting Energy Expenditure Between Cancer Subjects and Healthy Controls: A Meta-Analysis. Nutr Cancer 2016; 68:374-87. [DOI: 10.1080/01635581.2016.1153667] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Friesen DE, Baracos VE, Tuszynski JA. Modeling the energetic cost of cancer as a result of altered energy metabolism: implications for cachexia. Theor Biol Med Model 2015; 12:17. [PMID: 26370269 PMCID: PMC4570294 DOI: 10.1186/s12976-015-0015-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/01/2015] [Indexed: 01/06/2023] Open
Abstract
Background Cachexia affects most patients with incurable cancer. We hypothesize that in metastatic cancer the mass of the tumor as well as its level of anaerobic energy metabolism play a critical role in describing its energetic cost, which results in elevated resting energy expenditure and glucose utilization, leading to cachexia. Prior models of cancer cachexia may have underestimated the specific energetic cost of cancer as they have not taken the range of tumor mass and anaerobic energy metabolism fully into account. Methods We therefore modelled the energetic cost of cancer as a function of the percentage of energy the cancer produces anaerobically, based on resting energy expenditure, glucose turnover, glucose recycling, and oxygen consumption in cancer patients found in previous studies. Results Data from two clinical studies where tumor burden was estimated and resting energy expenditure or oxygen consumption were measured lead to a broad range of estimates of tumor cost from 190 to 470 kcal/kg tumor/day. These values will vary based of the percentage of energy the cancer produces anaerobically (from 0 to 100 %), which in and of itself can alter the cost over a 2 to 3-fold range. In addition to the tumor cost/kg and the degree of anaerobic metabolism, the impact on a given individual patient will depend on tumor burden, which can exceed 1 kg in advanced metastatic disease. Considering these dimensions of tumor cost we are able to produce a 2-dimensional map of potential values, with an overall range of 100–1400 kcal/day. Conclusions Quantifying the energetic cost of cancer may benefit an understanding of the tumor’s causation of cachexia. Our estimates of the range of tumor cost include values that are higher than prior estimates and suggest that in metastatic disease the tumor cost could be expected to eclipse attempts to stabilize energy balance through nutrition support or by drug therapies. Tumor mass and the percentage of anaerobic metabolism in the tumor contribute to the cost of the tumor on the body and potentially lead directly to negative energy balance and increased muscle wasting. Electronic supplementary material The online version of this article (doi:10.1186/s12976-015-0015-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Douglas E Friesen
- Department of Oncology, University of Alberta, Edmonton, AB, T6G 1Z2, Canada.
| | - Vickie E Baracos
- Department of Oncology, University of Alberta, Edmonton, AB, T6G 1Z2, Canada.
| | - Jack A Tuszynski
- Department of Oncology, University of Alberta, Edmonton, AB, T6G 1Z2, Canada. .,Department of Physics, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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Dev R, Hui D, Chisholm G, Delgado-Guay M, Dalal S, Del Fabbro E, Bruera E. Hypermetabolism and symptom burden in advanced cancer patients evaluated in a cachexia clinic. J Cachexia Sarcopenia Muscle 2015; 6:95-8. [PMID: 26136416 PMCID: PMC4435101 DOI: 10.1002/jcsm.12014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/15/2014] [Accepted: 10/31/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Elevated resting energy expenditure (REE) may contribute to weight loss and symptom burden in cancer patients. AIMS The aim of this study was to compare the velocity of weight loss, symptom burden (fatigue, insomnia, anxiety, and anorexia-combined score as measured by the Edmonton Symptom Assessment Score), high-sensitivity C-reactive protein, and survival among cancer patients referred to a cachexia clinic with hypermetabolism, elevated REE > 110% of predicted, with normal REE. METHODS A retrospective analysis of 60 advanced cancer patients evaluated in a cachexia clinic for either >5% weight loss or anorexia who underwent indirect calorimetry to measure REE. Patients were dichotomized to either elevated or normal REE. Descriptive statistics were generated, and a two-sample Student's t-tests were used to compare the outcomes between the groups. Kaplan-Meier and Cox regression methodology were used to examine the survival times between groups. RESULTS Thirty-seven patients (62%) were men, 41 (68%) were White, 59 (98%) solid tumours, predominantly 23 gastrointestinal cancers (38%), with a median age of 60 (95% confidence interval 57.0-62.9). Thirty-five patients (58%) were hypermetabolic. Non-Caucasian patients were more likely to have high REE [odds ratio = 6.17 (1.56, 24.8), P = 0.01]. No statistical difference regarding age, cancer type, gender, active treatment with chemotherapy, and/or radiation between hypermetabolic and normal REE was noted. The velocity of weight loss over a 3 month period (-8.5 kg vs. -7.2 kg, P = 0.68), C-reactive protein (37.3 vs. 55.6 mg/L, P = 0.70), symptom burden (4.2 vs. 4.5, P = 0.54), and survival (288 vs. 276 days, P = 0.68) was not significantly different between high vs. normal REE, respectively. CONCLUSION Hypermetabolism is common in cancer patients with weight loss and noted to be more frequent in non-Caucasian patients. No association among velocity of weight loss, symptom burden, C-reactive protein, and survival was noted in advanced cancer patients with elevated REE.
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Affiliation(s)
- Rony Dev
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Chisholm
- Department of Biostatisitics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marvin Delgado-Guay
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Egidio Del Fabbro
- Division of Hematology/Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ceolin Alves AL, Zuconi CP, Correia MI. Energy Expenditure in Patients With Esophageal, Gastric, and Colorectal Cancer. JPEN J Parenter Enteral Nutr 2015; 40:499-506. [DOI: 10.1177/0148607114567336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/06/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Ana Lígia Ceolin Alves
- Food Science Postgraduate Program, Pharmacy School, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Carolina Pereira Zuconi
- Food Science Postgraduate Program, Pharmacy School, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Maria Isabel Correia
- Alfa Institute of Gastroenterology, Hospital of Clinics, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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