Imbalance of catabolic and anabolic pathways in chronic heart failure

Cardiac Cachexia: Unaddressed Aspect in Cancer Patients

Tumor-derived cachectic factors such as proinflammatory cytokines and neuromodulators not only affect skeletal muscle but also affect other organs, including the heart, in the form of cardiac muscle atrophy, fibrosis, and eventual cardiac dysfunction, resulting in poor quality of life and reduced survival. This article reviews the holistic approaches of existing diagnostic, pathophysiological, and multimodal therapeutic interventions targeting the molecular mechanisms that are responsible for cancer-induced cardiac cachexia. The major drivers of cardiac muscle wasting in cancer patients are autophagy activation by the cytokine-NFkB, TGF β-SMAD³, and angiotensin II-SOCE-STIM-Ca²⁺ pathways. A lack of diagnostic markers and standard treatment protocols hinder the early diagnosis of cardiac dysfunction and the initiation of preventive measures. However, some novel therapeutic strategies, including the use of Withaferin A, have shown promising results in experimental models, but Withaferin A’s effectiveness in human remains to be verified. The combined efforts of cardiologists and oncologists would help to identify cost effective and feasible solutions to restore cardiac function and to increase the survival potential of cancer patients.

Nutritional assessment of older adults with diabetes mellitus

AIMS

We aimed to screen the nutritional status of older adults with diabetes mellitus, seeking to outline the needs of this population group considering their socioeconomic status.

METHODS

Cross-sectional study of 246 diabetic people aged 65-94 years in Northeastern Brazil. Semi-structured questionnaires were used to collect sociodemographic, general health and lifestyle data. The Mini Nutritional Assessment was used to screen nutritional status.

RESULTS

Participants' mean age was 73 ± 6.4 years, and there was a predominance of women (56.5%). The mean duration of diabetes was 14.1 years (±9.6 years). Patients aged 80 years or older presented a 3.7-fold higher risk of malnutrition (p < 0.001), and those who were uneducated exhibited a 5.8-fold higher risk of malnutrition (p = 0.040). Patients with BMI of 18.6-24.9 km/m² presented a 2.2-fold higher risk of malnutrition than overweight or obese patients (p < 0.001). Nutritional status was significantly associated with coronary artery disease (p = 0.010) and stroke (p < 0.001). Malnourished patients exhibited a 2.2-fold higher occurrence of infection in the past 6 months (p = 0.017) and 2-fold higher occurrence of foot injuries (p = 0.028) than their well-nourished peers.

CONCLUSION

Malnutrition in older diabetic patients exacerbates underlying diseases and contributes to unfavorable prognosis, particularly in the oldest old and in individuals with low levels of education.

Molecular mechanism of sarcopenia and cachexia: recent research advances

Skeletal muscle provides a fundamental basis for human function, enabling locomotion and respiration. Muscle loss occurs as a consequence of several chronic diseases (cachexia) and normal aging (sarcopenia). Although many negative regulators (atrogin-1, muscle ring finger-1, nuclear factor-kappaB (NF-κB), myostatin, etc.) have been proposed to enhance protein degradation during both sarcopenia and cachexia, the adaptation of these mediators markedly differs within both conditions. Sarcopenia and cachectic muscles have been demonstrated to be abundant in myostatin-linked molecules. The ubiquitin-proteasome system (UPS) is activated during rapid atrophy model (cancer cachexia), but few mediators of the UPS change during sarcopenia. NF-κB signaling is activated in cachectic, but not in sarcopenic, muscle. Recent studies have indicated the age-related defect of autophagy signaling in skeletal muscle, whereas autophagic activation occurs in cachectic muscle. This review provides recent research advances dealing with molecular mediators modulating muscle mass in both sarcopenia and cachexia.

Malnutrition and associated factors among heart failure patients on follow up at Jimma university specialized hospital, Ethiopia

Background

Malnutrition and cachexia are serious consequences of numerous chronic diseases. Severe heart failure patients could be related with marked weight loss. Malnutrition is associated with poor prognosis among heart failure patients. Despite its implication, factors associated with malnutrition among heart failure patients in Africa and Ethiopia was not addressed. Hence, in this study we tried to determine factors associated with malnutrition among heart failure patients on follow up at Jimma University specialized hospital, Ethiopia.

Methods

A cross-sectional study was done on 284 randomly selected heart failure patients. The nutritional status of the patients was assessed based on their serum albumin level (normal value 4–5 mg/dl) and triceps skin fold thickness. The data was analyzed using SPSS version 20.0. Multivariable logistic regression was used to identify factors associated with malnutrition among heart failure patients using SPSS 20.0.

Results

Based on serum albumin and triceps skin fold thickness, 77.8 % of patients were malnourished. Mean age of the patients was 48.3 ± 15.9 years. The commonest cause of heart failure was ischemic heart disease (34.9 %). Hypertension (36 %) was the commonest co morbid disease. Forty four percent of patients had New York heart association functional class II heart failure. Serum hemoglobin (AOR = 0.77, 95 % CI: 0.67–0.92) was found to be significantly associated with nutritional status of heart failure patients. As serum hemoglobin increases by 1gm/dl, the risk of malnutrition decreased by 15 % (P value = 0.03).

Conclusions

The majority of patients were malnourished. A higher hemoglobin concentration was associated with reduced odds of being malnourished.

IL-10, IL-6, and TNF-alpha: central factors in the altered cytokine network of uremia--the good, the bad, and the ugly

It has been increasingly apparent that wasting and cardiovascular disease (CVD) is associated with a persistent systemic inflammatory response in end-stage renal disease (ESRD) patients. The reasons for the increased risk of inflammation in ESRD patients appear to be complex, including non-dialysis as well as dialysis-related factors. The combination of an impaired immune response coupled with persistent immune stimulation may have a role in the low-grade systemic inflammation and altered cytokine balance that characterizes the uremic state and which may translate into increased risk for vascular disease. The accelerated atherosclerotic process of ESRD may involve several interrelated processes, such as oxidative stress, endothelial dysfunction, and vascular calcification, in a milieu of constant low-grade inflammation with impaired function of neutrophils and T cells, as well as a dysregulated cytokine network. Although a large number of pro- and anti-inflammatory cytokines are of importance, available data suggest that the anti-inflammatory cytokine interleukin (IL)-10 and the mainly proinflammatory cytokines IL-6 and tumor necrosis factor-alpha (TNF-alpha) may play important roles in the development of Th imbalance, CVD and wasting in the uremic milieu. Given the strong association between proinflammatory cytokines and complications common in ESRD, such as vascular calcification and wasting, the potential role of both general and targeted anticytokine treatment strategies in ESRD patients needs further evaluation.

POOR NUTRITIONAL STATUS AND INFLAMMATION: Novel Approaches in an Integrated Therapy of Inflammatory-Associated Wasting in End-Stage Renal Disease

It is increasingly apparent that end-stage renal disease (ESRD) patients carry an inflammatory burden, which may play a pivotal role in the evolution of not only wasting, but also the massive increase in the relative risk of cardiovascular disease (CVD). Thus wasting is strongly associated with a persistent systemic inflammatory response, CVD, and impaired patient survival in end-stage renal disease (ESRD), as well as in other chronic diseases. Evidence suggests that a facilitative interaction between inflammatory cytokines and other factors such as poor appetite, comorbidity, acidosis, anemia, and hormonal derangements may cause wasting in this patient group. Clearly, isolated interventions in the form of nutritional energy and protein supplementation have seldom proven to be very effective in improving nutritional status and outcome in ESRD patients, presumably because of the need to attack other causative factors. Therefore, new treatment strategies must be evaluated. Strategies such as multiple appetite stimulants, various "anti-inflammatory diets," and new potentially useful anti-inflammatory pharmacologic agents may be tested alone, or in combination, to evaluate if these new therapeutic modalities can improve the outcome of ESRD patients. As the etiology of wasting in ESRD is multifactorial, we propose that its treatment must include not one, but a number of concomitant measures to provide an integrated therapy against this devastating complication.