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Saroul N, Tardif N, Pereira B, Dissard A, Montrieul L, Sanchez P, Salles J, Petersen JE, Jakobson T, Gilain L, Mom T, Boirie Y, Rooyakers O, Walrand S. Conditioned Media from Head and Neck Cancer Cell Lines and Serum Samples from Head and Neck Cancer Patients Drive Catabolic Pathways in Cultured Muscle Cells. Cancers (Basel) 2023; 15:cancers15061843. [PMID: 36980729 PMCID: PMC10047086 DOI: 10.3390/cancers15061843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The role of secreted factors from the tumor cells in driving cancer cachexia and especially muscle loss is unknown. We wanted to study both the action of secreted factors from head and neck cancer (HNC) cell lines and circulating factors in HNC patients on skeletal muscle protein catabolism. METHODS Conditioned media (CM) made from head and neck cancer cell lines and mix of sera from head and neck cancer (HNC) patients were incubated for 48 h with human myotubes. The atrophy and the catabolic pathway were monitored in myotubes. The patients were classified regarding their skeletal muscle loss observed at the outset of management. RESULTS Tumor CM (TCM) was able to produce atrophy on myotubes as compared with control CM (CCM). However, a mix of sera from HNC patients was not able to produce atrophy in myotubes. Despite this discrepancy on atrophy, we observed a similar regulation of the catabolic pathways by the tumor-conditioned media and mix of sera from cancer patients. The catabolic response after incubation with the mix of sera seemed to depend on the muscle loss seen in patients. CONCLUSION This study found evidence that the atrophy observed in HNC patients cannot be solely explained by a deficit in food intake.
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Affiliation(s)
- Nicolas Saroul
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
- Biostatistics Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
| | - Nicolas Tardif
- Anesthesiology and Intensive Care, Department of Clinical Science Intervention and Technology, CLINTEC, Karolinska Institutet, 141 86 Huddinge, Sweden
- Division of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 77 Huddinge, Sweden
| | - Bruno Pereira
- Biostatistics Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
| | - Alexis Dissard
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
| | - Laura Montrieul
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
| | - Phelipe Sanchez
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
| | - Jérôme Salles
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
| | - Jens Erik Petersen
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
| | - Towe Jakobson
- Anesthesiology and Intensive Care, Department of Clinical Science Intervention and Technology, CLINTEC, Karolinska Institutet, 141 86 Huddinge, Sweden
| | - Laurent Gilain
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
| | - Thierry Mom
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
| | - Yves Boirie
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
- Clinical Nutrition Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
| | - Olav Rooyakers
- Anesthesiology and Intensive Care, Department of Clinical Science Intervention and Technology, CLINTEC, Karolinska Institutet, 141 86 Huddinge, Sweden
- Division of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 77 Huddinge, Sweden
| | - Stéphane Walrand
- Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, 63000 Clermont-Ferrand, France
- Clinical Nutrition Department, CHU de Clermont-Ferrand France, 63000 Clermont-Ferrand, France
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Xu J, Zheng B, Zhang S, Zeng T, Chen H, Zheng W, Chen C. Effects of preoperative sarcopenia on postoperative complications of minimally invasive oesophagectomy for oesophageal squamous cell carcinoma. J Thorac Dis 2019; 11:2535-2545. [PMID: 31372290 DOI: 10.21037/jtd.2019.05.55] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Sarcopenia is closely associated with surgical complications in patients with certain cancers. In this study we assessed the relationship between sarcopenia and postoperative complications in patients with oesophageal squamous cell carcinoma. Methods We retrospectively analysed of patients who underwent thoracoscopic combined with laparoscopic radical resection of oesophageal cancer. Preoperative computed tomography to evaluate skeletal muscle mass to diagnose sarcopenia and to evaluate associations with age, body mass index (BMI), lung function and postoperative complications. Results Among 141 patients, 73 presented with sarcopenia (sarcopenia group) and 68 did not (non-sarcopenia group). The mean skeletal muscle index in all patients was 49.5±9.0 cm2/m2; median, 49.3 cm2/m2. The sarcopenia group included a higher proportion of men (P=0.039) and had a lower BMI than the non-sarcopenia group (P=0.001). There were no significant differences in any other clinical and pathological features. The incidences of postoperative complications in the sarcopenia and non-sarcopenia groups were 63.0% and 36.8%, respectively (P=0.002). The incidences of pulmonary infections and postoperative pleural effusions were 28.8% vs. 11.8% (P=0.011) and 38.4% vs. 20.6% (P=0.020) in the sarcopenia and non-sarcopenia groups, respectively. The incidences of other complications were not significantly different between the two groups. Univariate and multivariate analyses of pulmonary infection-related clinical factors revealed that sarcopenia and forced expiratory volume in the first second as a percent of forced vital capacity (FEV1.0%) were independent risk factors for pulmonary infection after minimally invasive surgery. Conclusions Preoperative sarcopenia is an independent risk factor for pulmonary infection after minimally invasive oesophagectomy (MIE). Evaluation of preoperative sarcopenia will thus help to prevent postoperative complications.
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Affiliation(s)
- Jinxin Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Shuliang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Taidui Zeng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Hao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Wei Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
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Khan S, Shahzadi A. Clinical pharmacokinetics of drugs in cardiopulmonary associated cachexia without hepatorenal pathology: a systematic review. Drug Metab Rev 2018; 51:1-11. [PMID: 30449195 DOI: 10.1080/03602532.2018.1508226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cachexia not only has a dramatically harmful impact on a patient's life, but also a poor response to therapeutic agents. The purpose of the present review is to provide updated information concerning the pharmacokinetic aspects of drugs used to treat cardiopulmonary cachexia in patients with no signs of hepatic or renal pathology. A systematic search of PubMed, the Cochrane Central Register of Control Trials, Science Direct, and Clinical Trials Registry (ClinicalTrials.gov), encompassing the period between 2000 and 2017, was conducted in accordance to PRISMA guidelines. Seven studies were identified. Collectively, these studies included a total of 196 individuals (19 healthy subjects and 177 diseased patients). This data review found no differences in bisoprolol and prothionamide absorption in cachectic patients with chronic heart failure and tuberculosis, but higher absorption of oflaxocin in the same set of patients was observed. The distribution of bisoprolol, prothionmaide, ceftazidime, and cefipirome was reduced in cardiopulmonary cachexia patients. Hepatic clearance of rifampin was equivalent in cachectic and non-cachectic patients that had normal hepatic function. Similarly in cardiopulmonary cachexia patients, renal clearance of ceftazidime was reduced by 19% but no significant differences in bisorpolol and prothionamide clearance were observed. In the case of cefipirome, both renal clearance and creatinine clearance were higher in cachectic patients with cystic fibrosis. From the limited evidence available, the main drug pharmacokinetic changes seen in cardiopulmonary cachexia patients were a reduction in the volume of distribution and impairment of clearance.
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Affiliation(s)
- Safeer Khan
- a Al-Taaluf National Group of Polyclinics , Alqunfdha , Makkah , Kingdom of Saudi Arabia
| | - Anum Shahzadi
- b Department of Pharmacy , COMSATS Institute of Information Technology (CIIT) , Khyber Pakhtun Khwa , Abbottabad , Pakistan
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Liu Z, Martin JH. Gaps in predicting clinical doses for cannabinoids therapy: Overview of issues for pharmacokinetics and pharmacodynamics modelling. Br J Clin Pharmacol 2018; 84:2483-2487. [PMID: 29766540 PMCID: PMC6177720 DOI: 10.1111/bcp.13635] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 01/14/2023] Open
Abstract
Model-based prediction on clinical doses for cannabinoids therapy is beneficial in the clinical setting, especially for seriously ill patients with both altered pharmacokinetics and pharmacodynamic responses. The objective of this article is to review the currently available PK and/or PD models of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) and to highlight the major issues for modelling this complex therapeutic area. A systematic search was conducted in the electronic databases PubMed and EMBASE using the key words 'cannabis', 'cannabinoid', 'tetrahydrocannabinol', 'THC', 'cannabidiol', 'CBD', 'pharmacokinetic model', 'pharmacodynamics model' and their combinations. Twelve empirical PK and/or PD models for THC for humans were identified. Among them, ten were developed from data of healthy participants and two were from ill patients. Models for CBD were not found. Model-based prediction on appropriate doses for cannabinoids therapy for ill patients is currently limited due to insufficiency of relevant PK and PD data. High-quality PK and PD data of cannabinoids for patients with different illnesses is needed for model development. Mechanism-based PK and PD models are promising for improved predictive dosing performance for ill and comorbid patients.
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Affiliation(s)
- Zheng Liu
- School of Medicine and Public HealthUniversity of Newcastle, Hunter Medical Research Institute, Kookaburra CircuitNSW2305Australia
- The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE)New Lambton HeightsNSW2305Australia
- Clinical Pharmacology, Department of MedicineThe Royal Children's Hospital MelbourneAustralia
| | - Jennifer H. Martin
- School of Medicine and Public HealthUniversity of Newcastle, Hunter Medical Research Institute, Kookaburra CircuitNSW2305Australia
- The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE)New Lambton HeightsNSW2305Australia
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Severe Sarcopenia and Increased Fat Stores in Pediatric Patients With Liver, Kidney, or Intestine Failure. J Pediatr Gastroenterol Nutr 2017; 65:579-583. [PMID: 28604513 DOI: 10.1097/mpg.0000000000001651] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Malnutrition and wasting predict clinical outcomes in children with severe chronic illness. Objectively calculated malnutrition in children with end-stage organ failure has not been well studied. This analysis compares children with kidney, liver or intestine failure to healthy controls to quantitate the disparity in muscle and fat stores. METHODS Children younger than 19 years with end-stage liver, kidney, or intestine failure and with pretransplant computed tomography (CT) imaging were selected from the transplant database. Age- and sex-matched healthy controls were selected from the trauma database. Measures of nutrition status included a scaled scoring of core muscle mass, and visceral and subcutaneous fat stores. Analysis was conducted using the pooled and individually matched subject-control differences. RESULTS There were 81 subjects included in the final analysis (liver [n = 35], kidney [n = 20], and intestine [n = 26]). Children with end-stage liver disease had a 23% reduction in muscle mass, a 69% increase in visceral fat, and a 29% increase in subcutaneous fat. End-stage renal disease patients had a 19% reduction in muscle mass and a 258% increase in subcutaneous fat. Intestine failure patients had a 24% reduction in muscle mass, a 30% increase in visceral fat, and a 46% increase in subcutaneous fat. CONCLUSIONS These results demonstrate significant sarcopenia and increased fat stores in end-stage organ failure patients, which supports the idea of an active physiologic mechanism to store fat while losing muscle mass. Sarcopenia may be related to total protein loss from a catabolic state, or from decreased synthesis (liver), wasting (kidney), or malabsorption (intestine).
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Harada K, Ida S, Baba Y, Ishimoto T, Kosumi K, Tokunaga R, Izumi D, Ohuchi M, Nakamura K, Kiyozumi Y, Imamura Y, Iwatsuki M, Iwagami S, Miyamoto Y, Sakamoto Y, Yoshida N, Watanabe M, Baba H. Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma. Dis Esophagus 2016; 29:627-33. [PMID: 26123787 DOI: 10.1111/dote.12381] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recently, depletion of skeletal muscle mass (sarcopenia) has been linked to poor prognosis in several types of cancers, but has not been investigated in esophageal squamous cell carcinoma (ESCC). This retrospective study investigates the relationship between sarcopenia and clinical outcome in ESCC patients treated by surgical resection or definitive chemoradiation therapy (dCRT). The study was retrospectively conducted in a single academic hospital in Kumamoto, Japan, and involved 325 ESCC patients (256 surgical cases and 69 dCRT cases) treated between April 2005 and April 2011. Skeletal muscle mass was quantified by radiologic measures using standard computed tomography scans. The skeletal muscle tissue in the 325 ESCC patients was distributed as follows: mean: 47.10; median: 46.88; standard deviation (SD): 7.39; range: 31.48-71.11; interquartile range, 46.29-47.90. Skeletal muscle tissue was greater in male patients than in female patients (P < 0.0001), but was independent of other clinical and tumor features. Sarcopenia was not significantly associated with overall survival (log rank P = 0.54). Lymph node involvement significantly altered the relationship between sarcopenia and survival rate (P for interaction = 0.026). Sarcopenia significantly reduced the overall survival of patients without lymph node involvement (log rank P = 0.035), but was uncorrelated with overall survival in patients with lymph involvement (log rank, P = 0.31). The anastomosis leakage rate was significantly higher in the sarcopenia group than in the non-sarcopenia group (P = 0.032), but other surgical complications did not significantly differ between the two groups. Sarcopenia in ESCC patients without lymph node involvement is associated with poor prognosis, indicating sarcopenia as a potential biomarker for identifying patients likely to experience an inferior outcome. Moreover, sarcopenia was associated with anastomosis leakage but no other short-term surgical outcome.
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Affiliation(s)
- K Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - S Ida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.,Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - T Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - K Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - R Tokunaga
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - D Izumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - M Ohuchi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - K Nakamura
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Y Kiyozumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Y Imamura
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - M Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - S Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Y Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Y Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - N Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - M Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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Franken LG, de Winter BCM, van Esch HJ, van Zuylen L, Baar FPM, Tibboel D, Mathôt RAA, van Gelder T, Koch BCP. Pharmacokinetic considerations and recommendations in palliative care, with focus on morphine, midazolam and haloperidol. Expert Opin Drug Metab Toxicol 2016; 12:669-80. [PMID: 27081769 DOI: 10.1080/17425255.2016.1179281] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION A variety of medications are used for symptom control in palliative care, such as morphine, midazolam and haloperidol. The pharmacokinetics of these drugs may be altered in these patients as a result of physiological changes that occur at the end stage of life. AREAS COVERED This review gives an overview of how the pharmacokinetics in terminally ill patients may differ from the average population and discusses the effect of terminal illness on each of the four pharmacokinetic processes absorption, distribution, metabolism, and elimination. Specific considerations are also given for three commonly prescribed drugs in palliative care: morphine, midazolam and haloperidol). EXPERT OPINION The pharmacokinetics of drugs in terminally ill patients can be complex and limited evidence exists on guided drug use in this population. To improve the quality of life of these patients, more knowledge and more pharmacokinetic/pharmacodynamics studies in terminally ill patients are needed to develop individualised dosing guidelines. Until then knowledge of pharmacokinetics and the physiological changes that occur in the final days of life can provide a base for dosing adjustments that will improve the quality of life of terminally ill patients. As the interaction of drugs with the physiology of dying is complex, pharmacological treatment is probably best assessed in a multi-disciplinary setting and the advice of a pharmacist, or clinical pharmacologist, is highly recommended.
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Affiliation(s)
- L G Franken
- a Department of Hospital Pharmacy , Erasmus Medical Centre , Rotterdam , the Netherlands
| | - B C M de Winter
- a Department of Hospital Pharmacy , Erasmus Medical Centre , Rotterdam , the Netherlands
| | - H J van Esch
- b Palliative Care Centre , Laurens Cadenza , Rotterdam , the Netherlands
| | - L van Zuylen
- c Department of Medical Oncology , Erasmus MC Cancer Institute , Rotterdam , the Netherlands
| | - F P M Baar
- b Palliative Care Centre , Laurens Cadenza , Rotterdam , the Netherlands
| | - D Tibboel
- d Intensive Care, Department of Paediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.,e Pain Expertise Centre , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands
| | - R A A Mathôt
- f Hospital Pharmacy - Clinical Pharmacology , Academic Medical Centre , Amsterdam , the Netherlands
| | - T van Gelder
- a Department of Hospital Pharmacy , Erasmus Medical Centre , Rotterdam , the Netherlands
| | - B C P Koch
- a Department of Hospital Pharmacy , Erasmus Medical Centre , Rotterdam , the Netherlands
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Reuter SE, Martin JH. Pharmacokinetics of Cannabis in Cancer Cachexia-Anorexia Syndrome. Clin Pharmacokinet 2016; 55:807-812. [DOI: 10.1007/s40262-015-0363-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Trobec K, Kerec Kos M, von Haehling S, Springer J, Anker SD, Lainscak M. Pharmacokinetics of drugs in cachectic patients: a systematic review. PLoS One 2013; 8:e79603. [PMID: 24282510 PMCID: PMC3835942 DOI: 10.1371/journal.pone.0079603] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 09/25/2013] [Indexed: 12/27/2022] Open
Abstract
Cachexia is a weight-loss process caused by an underlying chronic disease such as cancer, chronic heart failure, chronic obstructive pulmonary disease, or rheumatoid arthritis. It leads to changes in body structure and function that may influence the pharmacokinetics of drugs. Changes in gut function and decreased subcutaneous tissue may influence the absorption of orally and transdermally applied drugs. Altered body composition and plasma protein concentration may affect drug distribution. Changes in the expression and function of metabolic enzymes could influence the metabolism of drugs, and their renal excretion could be affected by possible reduction in kidney function. Because no general guidelines exist for drug dose adjustments in cachectic patients, we conducted a systematic search to identify articles that investigated the pharmacokinetics of drugs in cachectic patients.
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Affiliation(s)
- Katja Trobec
- Pharmacy Department, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Mojca Kerec Kos
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Center for Cardiovascular Research, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Jochen Springer
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Center for Cardiovascular Research, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stefan D. Anker
- Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
| | - Mitja Lainscak
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Division of Cardiology, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- * E-mail:
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10
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Afzal A, Oriqat G, Akram Khan M, Jose J, Afzal M. Chemistry and Biochemistry of Terpenoids fromCurcumaand Related Species. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/22311866.2013.782757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Rothney MP, Martin FP, Xia Y, Beaumont M, Davis C, Ergun D, Fay L, Ginty F, Kochhar S, Wacker W, Rezzi S. Precision of GE Lunar iDXA for the measurement of total and regional body composition in nonobese adults. J Clin Densitom 2012; 15:399-404. [PMID: 22542222 DOI: 10.1016/j.jocd.2012.02.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 02/11/2012] [Accepted: 02/21/2012] [Indexed: 11/15/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) is a well-accepted technique for measuring body composition. Knowledge of measurement precision is critical for monitoring of changes in bone mineral content (BMC), and fat and lean masses. The purpose of this study was to characterize in vivo precision of total body and regional body composition parameters using the GE Lunar iDXA (GE Healthcare Lunar, Madison, WI) system in a sample of nonobese subjects. We also evaluated the difference between expert and automatic region-of-interest (ROI) analysis on body composition precision. To this end, 2 total body scans were performed on each subject with repositioning between scans. Total body precision for BMC, fat and lean mass were 0.5%, 1.0%, and 0.5% coefficient of variation (CV), respectively. Regional body composition precision error was less than 2.5% CV for all regions except arms. Precision error was higher for the arms (CV: BMC 1.5%; fat mass 2.8%; lean mass 1.6%), likely owing to the placement of arms relative to torso leading to differences in ROI. There was a significant correlation between auto ROI and expert ROI (r>0.99). Small, but statistically significant differences were found between auto and manual ROI. Differences were small in total body, leg, trunk, and android and gynoid regions (0.004-2.8%), but larger in arm region (3.0-6.3%). Total body and regional precision for iDXA are small and it is suggested that iDXA may be useful for monitoring changes in body composition during longitudinal trials.
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Affiliation(s)
- Megan P Rothney
- Computational Biology and Biostatistics Laboratory, GE Global Research Center, Niskayuna, NY, USA.
| | | | - Yi Xia
- GE Healthcare, Madison, WI, USA
| | | | - Cynthia Davis
- Computational Biology and Biostatistics Laboratory, GE Global Research Center, Niskayuna, NY, USA
| | | | - Laurent Fay
- Nestec Ltd., Nestle Research Center, Lausanne, Switzerland
| | - Fiona Ginty
- Computational Biology and Biostatistics Laboratory, GE Global Research Center, Niskayuna, NY, USA
| | - Sunil Kochhar
- Nestec Ltd., Nestle Research Center, Lausanne, Switzerland
| | | | - Serge Rezzi
- Nestec Ltd., Nestle Research Center, Lausanne, Switzerland
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12
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Jacquelin-Ravel N, Pichard C. Clinical nutrition, body composition and oncology: A critical literature review of the synergies. Crit Rev Oncol Hematol 2012; 84:37-46. [DOI: 10.1016/j.critrevonc.2012.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 01/26/2012] [Accepted: 02/01/2012] [Indexed: 12/21/2022] Open
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Thibault R, Pichard C. The evaluation of body composition: a useful tool for clinical practice. ANNALS OF NUTRITION AND METABOLISM 2011; 60:6-16. [PMID: 22179189 DOI: 10.1159/000334879] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/07/2011] [Indexed: 12/22/2022]
Abstract
Undernutrition is insufficiently detected in in- and outpatients, and this is likely to worsen during the next decades. The increased prevalence of obesity together with chronic illnesses associated with fat-free mass (FFM) loss will result in an increased prevalence of sarcopenic obesity. In patients with sarcopenic obesity, weight loss and the body mass index lack accuracy to detect FFM loss. FFM loss is related to increasing mortality, worse clinical outcomes, and impaired quality of life. In sarcopenic obesity and chronic diseases, body composition measurement with dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or computerized tomography quantifies the loss of FFM. It allows tailored nutritional support and disease-specific therapy and reduces the risk of drug toxicity. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up of nutritional status. It could allow objective, systematic, and early screening of undernutrition and promote the rational and early initiation of optimal nutritional support, thereby contributing to reducing malnutrition-induced morbidity, mortality, worsening of the quality of life, and global health care costs.
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Affiliation(s)
- Ronan Thibault
- Centre de Recherche en Nutrition Humaine Auvergne, UMR 1019 Nutrition Humaine, INRA, Clermont Université, Service de Nutrition Clinique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Benedik B, Farkas J, Kosnik M, Kadivec S, Lainscak M. Mini nutritional assessment, body composition, and hospitalisations in patients with chronic obstructive pulmonary disease. Respir Med 2011; 105 Suppl 1:S38-43. [DOI: 10.1016/s0954-6111(11)70009-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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15
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Anorexia nervosa and nutritional assessment: contribution of body composition measurements. Nutr Res Rev 2011; 24:39-45. [DOI: 10.1017/s0954422410000284] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The psychiatric condition of patients suffering from anorexia nervosa (AN) is affected by their nutritional status. An optimal assessment of the nutritional status of patients is fundamental in understanding the relationship between malnutrition and the psychological symptoms. The present review evaluates some of the available methods for measuring body composition in patients with AN. We searched literature in Medline using several key terms relevant to the present review in order to identify papers. Only articles in English or French were reviewed. A brief description is provided for each body composition technique, with its applicability in AN as well as its limitation. All methods of measuring body composition are not yet validated and/or feasible in patients with AN. The present review article proposes a practical approach for selecting the most appropriate methods depending on the setting, (i.e. clinical v. research) and the goal of the assessment (initial v. follow-up) in order to have a more personalised treatment for patients suffering from AN.
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Chen YM, Chen HH, Hsieh CW, Hsieh TY, Lan JL, Chen DY. A close association of body cell mass loss with disease activity and disability in Chinese patients with rheumatoid arthritis. Clinics (Sao Paulo) 2011; 66:1217-22. [PMID: 21876977 PMCID: PMC3148467 DOI: 10.1590/s1807-59322011000700016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 04/12/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To investigate the association of body cell mass loss with disease activity and disability in rheumatoid arthritis patients. INTRODUCTION Rheumatoid cachexia, defined as the loss of body cell mass, is important but under-recognized and contributes to morbidity and mortality in patients with rheumatoid arthritis. METHODS One hundred forty-nine rheumatoid arthritis patients and 53 healthy, non-rheumatoid arthritis control subjects underwent anthropometric measurements of body mass index and waist and hip circumferences. Bioelectrical impedance analysis was used to determine the subjects' body compositions, including fat mass, skeletal lean mass, and body cell mass. The disease activity of rheumatoid arthritis was assessed using C-reactive protein serum, the erythrocyte sedimentation rate and the 28-joint disease activity score, while disability was evaluated using a health assessment questionnaire. RESULTS Rheumatoid arthritis patients had lower waist-to-hip ratio (0.86 ± 0.07 vs. 0.95 ± 0.06; p<0.001) and lower skeletal lean mass indexes (14.44 ± 1.52 vs. 15.18 ± 1.35; p = 0.002) than those in the healthy control group. Compared with rheumatoid arthritis patients with higher body cell masses, those with body cell masses lower than median had higher erythrocyte sedimentation rates (40.10 ± 27.33 vs. 25.09 ± 14.85; p<0.001), higher disease activity scores (5.36 ± 3.79 vs. 4.23 ± 1.21; p = 0.022) and greater disability as measured by health assessment questionnaire scores (1.26 ± 0.79 vs. 0.87 ± 0.79; p = 0.004). CONCLUSIONS The loss of body cell mass is associated with higher disease activity and greater disability in rheumatoid arthritis patients. Body composition determined by bioelectrical impedance analysis can provide valuable information for a rheumatologist to more rapidly recognize rheumatoid cachexia in rheumatoid arthritis patients.
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Affiliation(s)
- Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung City, Taiwan.
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17
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Baracos VE, Reiman T, Mourtzakis M, Gioulbasanis I, Antoun S. Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Am J Clin Nutr 2010; 91:1133S-1137S. [PMID: 20164322 DOI: 10.3945/ajcn.2010.28608c] [Citation(s) in RCA: 326] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss; however, in recognition of the potential for divergent behavior of muscle and adipose tissue, cachexia was recently defined as loss of muscle with or without loss of fat mass. Detailed assessments are required to verify body composition in patients with cancer cachexia. DESIGN We adopted a population-based approach to study body composition in patients with cancer, with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up. A prospective cohort of 441 patients with non-small cell lung cancer, who were referred consecutively to a regional medical oncology service in Alberta, Canada, was evaluated. RESULTS At referral (median time to death: 265 d), mean body mass index (BMI; in kg/m(2)) was 24.9, with 47.4% of patients being overweight or obese. Only 7.5% overall were underweight as conventionally understood (BMI < 18.5). Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI. The overall prevalence of severe muscle depletion (sarcopenia) was 46.8% and was present in patients in all BMI categories. A much higher proportion of men (61%) than women (31%) met the criteria for sarcopenia. CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer, despite normal or heavy body weights. The significance of muscle wasting in normal-weight, overweight, and obese patients as a nutritional risk factor, as a prognostic factor, and as a predictor of cancer treatment toxicity is discussed in this article.
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Affiliation(s)
- Vickie E Baracos
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, Canada.
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Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, Boirie Y, Bosaeus I, Cederholm T, Costelli P, Fearon KC, Laviano A, Maggio M, Rossi Fanelli F, Schneider SM, Schols A, Sieber CC. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics". Clin Nutr 2010; 29:154-9. [PMID: 20060626 DOI: 10.1016/j.clnu.2009.12.004] [Citation(s) in RCA: 1103] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 10/22/2009] [Accepted: 12/09/2009] [Indexed: 12/13/2022]
Abstract
Chronic diseases as well as aging are frequently associated with deterioration of nutritional status, loss muscle mass and function (i.e. sarcopenia), impaired quality of life and increased risk for morbidity and mortality. Although simple and effective tools for the accurate screening, diagnosis and treatment of malnutrition have been developed during the recent years, its prevalence still remains disappointingly high and its impact on morbidity, mortality and quality of life clinically significant. Based on these premises, the Special Interest Group (SIG) on cachexia-anorexia in chronic wasting diseases was created within ESPEN with the aim of developing and spreading the knowledge on the basic and clinical aspects of cachexia and anorexia as well as of increasing the awareness of cachexia among health professionals and care givers. The definition, the assessment and the staging of cachexia, were identified as a priority by the SIG. This consensus paper reports the definition of cachexia, pre-cachexia and sarcopenia as well as the criteria for the differentiation between cachexia and other conditions associated with sarcopenia, which have been developed in cooperation with the ESPEN SIG on nutrition in geriatrics.
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Affiliation(s)
- M Muscaritoli
- Department of Clinical Medicine, La Sapienza, University of Rome, Viale dell'Universita, 37, Rome 00185, Italy.
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19
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Differentiating between body fat and lean mass--how should we measure obesity? ACTA ACUST UNITED AC 2009; 4:E1; author reply E2. [PMID: 18946485 DOI: 10.1038/ncpendmet0999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Trutschnigg B, Kilgour RD, Reinglas J, Rosenthall L, Hornby L, Morais JA, Vigano A. Precision and reliability of strength (Jamar vs. Biodex handgrip) and body composition (dual-energy X-ray absorptiometry vs. bioimpedance analysis) measurements in advanced cancer patients. Appl Physiol Nutr Metab 2008; 33:1232-9. [DOI: 10.1139/h08-122] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Important deteriorations in body composition and strength occur and need to be accurately measured in advanced cancer patients (ACPs). The aim of this study was to establish the relationship between a single-frequency bioimpedance analyzer (BIA) and the dual-energy X-ray absorptiometer (DXA), as well as the Jamar handgrip dynometer and the Biodex handgrip attachment, and to determine the precision of each of these instruments in ACPs. Eighty-one ACPs with non-small-cell lung cancer and gastrointestinal cancer were recruited from the McGill University Health Centre (Montreal, Que.). Consecutive paired measurements, with repositioning between measurements, were obtained for total-body DXA, BIA, Biodex handgrip, and BIA plus Jamar handgrip. The total-body percent coefficient of variation (%CV) for the BIA and DXA were 1.34 and 1.56 for fat mass (FM), respectively, and 0.42 and 0.72 for fat free mass (FFM), respectively. The %CV for the Jamar and Biodex handgrips were 6.3 and 16.7, respectively. Bland–Altman plots were used to characterize the limits of agreement between DXA and BIA for FM (4.60 ± 7.80 (–3.19 to 12.39) kg) and FFM (–1.87 ± 7.16 (–9.03 to 5.29) kg). Both DXA and BIA demonstrate good short-term precision in ACPs. However, given its poor accuracy, it remains to be determined if BIA can be used to monitor ACPs for changes in total-body tissue composition as a function of time, whether for observation or response to treatment. Furthermore, because of wide limits of agreement, the DXA and BIA cannot be used interchangeably in research or clinical settings. The Jamar handgrip dynamometer shows more consistency than the Biodex handgrip attachment in ACPs, and should therefore be the preferred measure of changes in strength over time.
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Affiliation(s)
- Barbara Trutschnigg
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Exercise Science, Concordia University, Montreal, QC H4B 1R6, Canada
- Department of Radiology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Geriatrics, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - Robert D. Kilgour
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Exercise Science, Concordia University, Montreal, QC H4B 1R6, Canada
- Department of Radiology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Geriatrics, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - Jason Reinglas
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Exercise Science, Concordia University, Montreal, QC H4B 1R6, Canada
- Department of Radiology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Geriatrics, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - Leonard Rosenthall
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Exercise Science, Concordia University, Montreal, QC H4B 1R6, Canada
- Department of Radiology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Geriatrics, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - Laura Hornby
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Exercise Science, Concordia University, Montreal, QC H4B 1R6, Canada
- Department of Radiology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Geriatrics, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - José A. Morais
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Exercise Science, Concordia University, Montreal, QC H4B 1R6, Canada
- Department of Radiology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Geriatrics, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Exercise Science, Concordia University, Montreal, QC H4B 1R6, Canada
- Department of Radiology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Geriatrics, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
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Summers GD, Deighton CM, Rennie MJ, Booth AH. Rheumatoid cachexia: a clinical perspective. Rheumatology (Oxford) 2008; 47:1124-31. [PMID: 18448480 DOI: 10.1093/rheumatology/ken146] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Rheumatoid cachexia is under-recognized in clinical practice. The loss of lean body tissue, which characterizes cachexia, is often compensated for by gain in body fat-so called 'cachectic obesity'-so that 85% or more RA patients have a normal BMI. Severe cachexia with loss of weight leads to increased morbidity and premature mortality but loss of muscle bulk with a normal BMI also associates with poor clinical outcomes. Increasing BMI, even into the obese range, is associated with less joint damage and reduced mortality. Measurement of body composition using DXA and other techniques is feasible but the results must be interpreted with care. Newer techniques such as whole-body MRI will help define with more confidence the mass and distribution of fat and muscle and help elucidate the relationships between body composition and outcomes. Cachexia shows little response to diet alone but progressive resistance training and anti-TNF therapies show promise in tackling this potentially disabling extra-articular feature of RA.
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Affiliation(s)
- G D Summers
- Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derbyshire Royal Infirmary, London Road, Derby DE1 2QY, UK.
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Lai V, George J, Richey L, Kim HJ, Cannon T, Shores C, Couch M. Results of a pilot study of the effects of celecoxib on cancer cachexia in patients with cancer of the head, neck, and gastrointestinal tract. Head Neck 2008; 30:67-74. [PMID: 17615567 DOI: 10.1002/hed.20662] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Animal models suggest that cyclooxygenase-2 (COX-2) inhibitors may be beneficial in suppressing cancer cachexia. We investigated the effect of short-course celecoxib on body composition, inflammation, and quality of life (QOL) in patients with cancer cachexia in a phase II clinical pilot trial. METHODS Eleven cachectic patients with head and neck or gastrointestinal cancer were randomly assigned to receive placebo or celecoxib for 21 days while awaiting the initiation of cancer therapy. Body composition, resting energy expenditure, QOL, physical function, and inflammatory markers were measured on days 1 and 21. RESULTS Patients receiving celecoxib experienced statistically significant increases in weight and body mass index (BMI), while patients receiving placebo experienced weight loss and a decline in BMI. Patients receiving celecoxib also had increases in QOL scores. CONCLUSIONS Cachectic patients receiving celecoxib gained weight, experienced increased BMI, and demonstrated improved QOL scores. Compliance was good and no adverse events were seen.
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Affiliation(s)
- Victor Lai
- Doris Duke Clinical Research Fellowship, The Verne S. Caviness General Clinical Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Prestwich WV, McNeill FE, Waker AJ. Monte Carlo simulation of neutron irradiation facility developed for accelerator based in vivo neutron activation measurements in human hand bones. Appl Radiat Isot 2006; 64:63-84. [PMID: 16122932 DOI: 10.1016/j.apradiso.2005.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2003] [Accepted: 06/24/2005] [Indexed: 11/29/2022]
Abstract
The neutron irradiation facility developed at the McMaster University 3 MV Van de Graaff accelerator was employed to assess in vivo elemental content of aluminum and manganese in human hands. These measurements were carried out to monitor the long-term exposure of these potentially toxic trace elements through hand bone levels. The dose equivalent delivered to a patient during irradiation procedure is the limiting factor for IVNAA measurements. This article describes a method to estimate the average radiation dose equivalent delivered to the patient's hand during irradiation. The computational method described in this work augments the dose measurements carried out earlier [Arnold et al., 2002. Med. Phys. 29(11), 2718-2724]. This method employs the Monte Carlo simulation of hand irradiation facility using MCNP4B. Based on the estimated dose equivalents received by the patient hand, the proposed irradiation procedure for the IVNAA measurement of manganese in human hands [Arnold et al., 2002. Med. Phys. 29(11), 2718-2724] with normal (1 ppm) and elevated manganese content can be carried out with a reasonably low dose of 31 mSv to the hand. Sixty-three percent of the total dose equivalent is delivered by non-useful fast group (> 10 keV); the filtration of this neutron group from the beam will further decrease the dose equivalent to the patient's hand.
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de Campos JRM, Wolosker N, Takeda FR, Kauffman P, Kuzniec S, Jatene FB, de Oliveira SA. The body mass index and level of resection: predictive factors for compensatory sweating after sympathectomy. Clin Auton Res 2005; 15:116-20. [PMID: 15834768 DOI: 10.1007/s10286-005-0259-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 12/22/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Compensatory sweating (CS) is the most common adverse event and the main cause of dissatisfaction among patients undergoing a VATS sympathectomy for the treatment of primary hyperhidrosis. It has been described that obese individuals experience more sweating than thinner ones. The aim of this study is to identify the Body Mass Index (BMI) and the level of resection as predictive factors for CS and its relation to levels of patient satisfaction following the procedure. METHODS From October 1998 to June 2003, 102 patients undergoing VATS sympathectomies (51 for palmar hyperhidrosis, PH, and 51 for axillary hyperhidrosis, AH) were prospectively surveyed. They were divided into three groups according to their BMI: Group I was composed of 19 patients with BMI<20 (9 patients with PH and 10 with AH); Group II was composed of 52 patients with 20 < or =BMI<25 (25 with PH and 27 with AH); and Group III was composed of 31 patients with BMI > or =25 (17 with PH and 14 with AH). Each procedure was simultaneously and bilaterally performed under general anesthesia using two 5.5 mm trocars and a 30 degrees optic system. RESULTS Patients treated for PH (resection of T2-T3) had more severe CS than those with AH (resection of T3-T4) (p=0.007) and the greater the BMI, the greater the severity of the CS (p<0.001). No statistically significant difference was found between the BMI bands in relation to the degree of satisfaction (p=0.644), nor when we compared the degree of satisfaction to the degree of CS (p=0.316). CONCLUSIONS The greater the BMI, the more severe the CS, but this did not correlate with the patients' level of satisfaction. Avoiding the resection of T2 sympathetic ganglia is also important in reducing the intensity of CS.
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Affiliation(s)
- José Ribas Milanez de Campos
- Dept. of Thoracic Surgery, Hospital das Clínicas Heart Institute-Incor University of São Paulo Medical School, São Paulo, Brazil
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Pison C, Cano N, Chérion C, Roth H, Pichard C. IRAD2 : Insuffisant respiratoire à domicile 2 (2e étude) effets d’une réhabilitation à domicile chez l’insuffisant respiratoire chronique dénutri. Rev Mal Respir 2004; 21:573-82. [PMID: 15292850 DOI: 10.1016/s0761-8425(04)71362-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
STATE OF THE ART The IRAD2 trial is evaluating a 3-month home intervention which includes education, oral supplements, exercise and androgenic steroids in undernourished patients with chronic respiratory failure. The main objective is to increase the six-minute walking distance by more than 50 m with an improvement in health-related quality-of-life. Secondary end-points include a reduction in exacerbation rates by 25%, a reduction in health-related costs and an increase in survival during the year following intervention. MATERIAL AND METHODS This interventional, multi-centre, prospective, two-armed parallel, controlled trial is being conducted in 200 patients. In both groups, "Control" and "Rehabilitation", 7 home visits are scheduled during the 3-month intervention for education purpose. In the "Rehabilitation" group, patients will receive 160 mg/d of oral testosterone undecanoate in men, 80 mg/d in women, oral dietary supplements (563 kcal/d) and exercises on an ergometric bicycle 3 to 5 times a week. EXPECTED RESULTS In the event of significant responses to intervention, this trial would validate a comprehensive and global home-care for undernourished patients with chronic respiratory failure combining therapeutic education, oral supplements, androgenic substitution and physical activity.
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Affiliation(s)
- C Pison
- Département de Médecine Aiguë Spécialisée, Hôpital Michallon, CHU Grenoble, Université Joseph Fourier, France.
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Abstract
Declining physical, emotional, and social function as a result of anorexia and cachexia are considerable contributors to discomfort for cancer patients and their families, and they impair the patient's ability to express optimal physical and psychosocial potential as long as possible. This decline no longer has to be accepted as an indispensable sequel to advanced cancer, just as pain is no longer considered to be unavoidable. A routine screening for anorexia and cachexia and associated symptoms is necessary, as is a careful, comprehensive assessment, because the condition is not always obvious. Decisions about anorexia and cachexia treatment are guided by prioritizing the different, concurrent physical, psychosocial, and existential problems and by considering the natural course of the cancer and the effects of antineoplastic therapies. Reversible causes for anorexia and cachexia need to be identified and treated, if appropriate. Nutritional interventions are often indicated; patients with a predominant starvation component and without inflammation may profit the most. New pharmacologic therapies for primary anorexia and cachexia syndrome are expected to enter clinical practice soon; however, until then, treatment with corticosteroids, progestins, or prokinetics may be indicated for some patients. To understand a multicausal syndrome, multimodal and interdisciplinary therapy is required. Specialist palliative care services can be helpful to provide, hand-in-hand with the disease specialists [172], assessment and management of psychophysical symptoms and sociospiritual needs of patients during the course of the illness and at the end of life [173]. Research efforts aim to better characterize subgroups of patients suffering from secondary causes of anorexia and cachexia and to elucidate the mechanisms involved in the primary anorexia and cachexia syndrome. Increasingly individualized treatments are expected with combination treatments that involve different mechanisms including nutrition.
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Affiliation(s)
- Florian Strasser
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 0008, Houston, TX 77030, USA
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Abstract
Anorexia and cachexia accompany advancing cancer to a greater extent than any other symptom. Cachexia alone causes 22% of cancer deaths. The pathophysiology of cachexia is distinctly different from that of starvation. Resting energy expenditures are elevated, and abnormal intermediary metabolism, proteolysis, and lipolysis occur independently of caloric intake. A facilatative interaction between catecholamines, prostaglandins, and inflammatory cytokines is responsible for cachexia. Successful treatment requires reduction of energy expenditures, reversal of anorexia, and correction of abnormal intermediary metabolism, lipolysis, and proteolysis. Multiple appetite stimulants can be used in combination. Several new potentially useful biologic agents have been tested in animal tumor models. Several of the anticachectic agents have demonstrated in vivo or in vitro antitumor activity. The biologic and clinical activity of each drug is reviewed herein, and potentially useful combinations are listed.
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Affiliation(s)
- Mellar P Davis
- The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Center, The Cleveland Clinic Foundation, R35, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Kyle UG, Genton L, Slosman DO, Pichard C. Fat-free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years. Nutrition 2001; 17:534-41. [PMID: 11448570 DOI: 10.1016/s0899-9007(01)00555-x] [Citation(s) in RCA: 259] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fat-free mass (FFM) and fat mass (FM) are important in the evaluation of nutritional status. Bioelectrical impedance analysis (BIA) is a simple, reproducible method used to determine FFM and FM. Because normal values for FFM and FM have not yet been established in adults aged 15 to 98 y, its use is limited in the evaluation of nutritional status. The aims of this study were to determine reference values for FFM, FM, and percentage of FM by BIA in a white population of healthy adults, observe their differences with age, and develop percentile distributions for these parameters between ages 15 and 98 y. METHODS Whole-body resistance and reactance of 2735 healthy white men and 2490 healthy white women, aged 15 to 98 y, was determined by 50-kHz BIA, with four skin electrodes on the right hand and foot. FFM and FM were calculated by a previously validated, single BIA formula and analyzed for age decades. RESULTS Mean FFM peaked in 35- to 44-y-old men and 45- to 54-y-old women and declined thereafter. Mean FFM was 8.9 kg or 14.8% lower in men older than 85 y than in men 35 to 44 y old and 6.2 kg or 14.3% lower in women older than 85 y than in women 45 to 54 y old. Mean FM and percentage of FM increased progressively in men and women between ages 15 and 98 y. The results suggested that the greater weight noted in older subjects is due to larger FM. CONCLUSIONS The percentile data presented serve as reference to evaluate deviations from normal values of FFM and FM in healthy adult men and women at a given age.
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Affiliation(s)
- U G Kyle
- Department of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
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Pichard C, Kyle UG, Bracco D, Slosman DO, Morabia A, Schutz Y. Reference values of fat-free and fat masses by bioelectrical impedance analysis in 3393 healthy subjects. Nutrition 2000; 16:245-54. [PMID: 10758358 DOI: 10.1016/s0899-9007(00)00256-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Determination of fat-free mass (FFM) and fat mass (FM) is of considerable interest in the evaluation of nutritional status. In recent years, bioelectrical impedance analysis (BIA) has emerged as a simple, reproducible method used for the evaluation of FFM and FM, but the lack of reference values reduces its utility to evaluate nutritional status. The aim of this study was to determine reference values for FFM, FM, and %FM by BIA in a white population of healthy subjects, to observe the changes in these values with age, and to develop percentile distributions for these parameters. Whole-body resistance of 1838 healthy white men and 1555 women, aged 15-64 y, was determined by using four skin electrodes on the right hand and foot. FFM and FM were calculated according to formulas validated for the subject groups and analyzed for age decades. This is the first study to present BIA-determined age- and sex-specific percentiles for FFM, FM, and %FM for healthy subjects, aged 15-64 y. Mean FM and %FM increased progressively in men and after age 45 y in women. The results suggest that any weight gain noted with age is due to a gain in FM. In conclusion, the data presented as percentiles can serve as reference to evaluate the normality of body composition of healthy and ill subject groups at a given age.
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Affiliation(s)
- C Pichard
- Division of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland.
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