1
|
Soares CH, Beuren AG, Friedrich HJ, Gabrielli CP, Stefani GP, Steemburgo T. The Importance of Nutrition in Cancer Care: A Narrative Review. Curr Nutr Rep 2024:10.1007/s13668-024-00578-0. [PMID: 39278864 DOI: 10.1007/s13668-024-00578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE OF REVIEW Cancer, a complex disease affecting millions globally, presents considerable challenges for both patients and health care providers. Within the broad spectrum of cancer care, nutrition plays a key role in supporting patients throughout their journey. This narrative review examines the role of nutrition in cancer care, exploring its impact on treatment outcomes, nutritional status, current dietary recommendations, physical activity, palliative care, and finally, as a nutritional encouragement for cancer survivors. RECENT FINDINGS Evidence indicates that cancer and anticancer treatments frequently cause malnutrition and loss of muscle mass, which can exacerbate symptoms, impair immune function, and hamper recovery. Therefore, adequate nutritional support is crucial for maintaining strength, controlling symptoms, and optimizing treatment tolerance in patients with cancer. Several factors influence nutritional needs and dietary recommendations, including cancer type, treatment, and individual patient characteristics. Nutritional care aims not only to ensure sufficient energy and protein intake, but also to manage specific symptoms such as dysgeusia, nausea, and dysphagia. Registered dietitians play a crucial role in providing personalized nutritional guidance, monitoring nutritional status, and implementing interventions to address emerging challenges in cancer care. Furthermore, recent research has underscored the benefits of dietary interventions in cancer treatment. From targeted nutritional supplements to more invasive nutritional support, interest in how nutrition can affect cancer risk and treatment outcomes is increasing. Overall, this review highlights the critical role of nutritional care in comprehensive cancer treatment. By recognizing and meeting dietary demands throughout the entire cancer journey, health care professionals can improve patients' well-being, response to treatment, and long-term prognosis.
Collapse
Affiliation(s)
- Camilla Horn Soares
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Amanda Guterres Beuren
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Heloisa Jacques Friedrich
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
- Department of Nutrition, Universidade Federal Do Rio Grande Do Sul, Porto Alegre , Rio Grande Do Sul, Brazil
| | - Carolina Pagnoncelli Gabrielli
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Giovanna Potrick Stefani
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Thais Steemburgo
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil.
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil.
- Department of Nutrition, Universidade Federal Do Rio Grande Do Sul, Porto Alegre , Rio Grande Do Sul, Brazil.
| |
Collapse
|
2
|
Surov A, Wienke A, Gutzmer R, Borggrefe J. Prognostic role of the skeletal musculature in oncology: significance, coherences and clinical implications. ROFO-FORTSCHR RONTG 2024; 196:699-706. [PMID: 38134902 DOI: 10.1055/a-2213-2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
| |
Collapse
|
3
|
Chen L, Chen Y, Wang M, Lai L, Zheng L, Lu H. Ursolic acid alleviates cancer cachexia by inhibiting STAT3 signaling pathways in C2C12 myotube and CT26 tumor-bearing mouse model. Eur J Pharmacol 2024; 969:176429. [PMID: 38423241 DOI: 10.1016/j.ejphar.2024.176429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Cancer cachexia, a multi-organ disorder resulting from tumor and immune system interactions, prominently features muscle wasting and affects the survival of patients with cancer. Ursolic acid (UA) is known for its antioxidant, anti-inflammatory, and anticancer properties. However, its impact on cancer cachexia remains unexplored. This study aimed to assess the efficacy of UA in addressing muscle atrophy and organ dysfunction in cancer cachexia and reveal the mechanisms involved. UA dose-dependently ameliorated C2C12 myotube atrophy. Mechanistically, it inhibited the expression of muscle-specific RING finger containing protein 1 (MURF1) and the phosphorylation of signal transducer and activator of transcription 3 (STAT3), and upregulated the mRNA or protein levels of myogenic differentiation antigen and myogenin in cultured C2C12 myotubes treated with conditioned medium. In vivo, UA protected CT26 tumor-bearing mice against loss of body weight, as well as increased skeletal muscle and epididymal fat without affecting tumor growth. Additionally, UA increased food intake in CT26 tumor-bearing mice. The mRNA expression of tumor necrosis-α and interleukin 6 was significantly downregulated in the intestine, gastrocnemius, and heart tissues following 38 d UA administration. UA treatment reversed the levels of myocardial function indicators, including creatine kinase, creatine kinase-MB, lactate dehydrogenase, car-dial troponin T, and glutathione. Finally, UA treatment significantly inhibited the expression of MURF1, the phosphorylation of nuclear factor kappa-B p65, and STAT3 in the gastrocnemius muscle and heart tissues of cachexic mice. Our findings suggest that UA is a promising natural compound for developing dietary supplements for cancer cachexia therapy owing to its anti-catabolic effects.
Collapse
Affiliation(s)
- Li Chen
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
| | - Yan Chen
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Mengxia Wang
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Linglin Lai
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Linbo Zheng
- Department Traditional Chinese Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Huiqin Lu
- Department of Clinical Research, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| |
Collapse
|
4
|
Amano K, Koshimoto S, Arakawa S, Oyamada S, Ishiki H, Morita T, Takeuchi T, Satomi E, Mori N. Factors associated with multimodal care practices for cancer cachexia among registered dietitians. Support Care Cancer 2024; 32:213. [PMID: 38446230 DOI: 10.1007/s00520-024-08417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE This study aimed to determine factors associated with multimodal care practices for cancer cachexia among registered dietitians (RDs) working in cancer care. METHODS A secondary analysis was performed using RDs' data. Data on knowledge, skills, and confidence in multimodal care were obtained. Nine items regarding multimodal care practices were evaluated. Subjects were divided into two groups based on their answers associated with the nine items. Comparisons were obtained using the Mann-Whitney U test or chi-squared test. Multiple regression analysis was performed to identify the critical factors involved in practicing multimodal care by determining the variables with significant differences between the two groups. RESULTS Two hundred thirty-two RDs were included in this study. Significant differences were observed in their primary area of practice (p = 0.023), the number of clinical guidelines used (p < 0.001), the number of items used in cancer cachexia assessment (p = 0.002), the number of symptoms used in cancer cachexia assessment (p = 0.039), training for cancer cachexia (p < 0.001), knowledge of cancer cachexia (p < 0.001), and confidence in cancer cachexia management (p < 0.001). The number of symptoms used in cancer cachexia assessment (B = 0.42, p = 0.019), knowledge of cancer cachexia (B = 6.60, p < 0.001), and confidence in cancer cachexia management (B = 4.31, p = 0.010) were identified as critical factors according to the multiple regression analysis. CONCLUSION The RDs' knowledge and confidence in cancer cachexia management were associated with their multimodal care practices.
Collapse
Affiliation(s)
- Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan.
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan.
- Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
| | - Saori Koshimoto
- School of Health Care Sciences, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
- Faculty of Human Nutrition, Department of Human Nutrition, Tokyo Kasei Gakuin University, 22 Sanban-Cho, Chiyoda-Ku, Tokyo, 102-8341, Japan
| | - Sayaka Arakawa
- Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Shunsuke Oyamada
- Department of Biostatistics, JORTC Data Center, 2-54-6-302 Nishi-Nippori, Arakawa-Ku, Tokyo, 116-0013, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-Cho, Kita-Ku, Hamamatsu City, Shizuoka, 433-8558, Japan
| | - Takashi Takeuchi
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| |
Collapse
|
5
|
Xu H, Zhang B, Zhang Y, Yang C, Bo C, Guo Y, Cheng Y, He L. Prognostic Significance of the Cachexia Index in Patients with Non-Small-Cell Lung Cancer and Brain Metastases after Stereotactic Radiotherapy. Clin Med Insights Oncol 2024; 18:11795549231222362. [PMID: 38440045 PMCID: PMC10910881 DOI: 10.1177/11795549231222362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/04/2023] [Indexed: 03/06/2024] Open
Abstract
Background The cachexia index (CXI) has been proposed as a novel biomarker of cancer cachexia. We aimed to investigate the association between CXI and survival outcomes after stereotactic radiotherapy (SRT) in patients with non-small cell lung cancer (NSCLC) and brain metastases. Methods Data from 145 patients with NSCLC, who underwent SRT for brain metastases between April 2016 and August 2020, were retrospectively analyzed. Cachexia index was calculated as skeletal muscle index (SMI) × serum albumin level/neutrophil-to-lymphocyte ratio, whereas SMI was calculated from computed tomography images captured at the L1 level. Kaplan-Meier curves and Cox proportional hazards models were used to assess progression-free survival (PFS) and overall survival (OS). The prognostic values of CXI and other cachexia biomarkers were assessed using receiver operating characteristic (ROC) curve analysis. Results Lower pretreatment CXI (<30.8) was significantly associated with older age (P = .039), lower Karnofsky performance score (P = .009), and a high likelihood of extracranial metastases (P = .001). Patients with a lower pretreatment CXI had a significantly shorter PFS and OS than those with a higher CXI (P < .001). Multivariate analysis revealed that pretreatment CXI was an independent risk factor for both PFS, hazard ratio (HR) = 2.375; 95% confidence interval (CI) = 1.610-3.504; P < .001, and OS, HR = 2.340; 95% CI = 1.562-3.505; P < .001. Compared with other biomarkers, pretreatment CXI had the highest area under the ROC curve value for prognostic assessment, reaching 0.734. Moreover, the loss of CXI was a strong risk factor for survival independent of pretreatment CXI (P = .011). Conclusions Cachexia index may serve as a clinically useful tool for predicting survival outcomes of patients with NSCLC and brain metastases who undergo SRT.
Collapse
Affiliation(s)
- Hui Xu
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bin Zhang
- Department of Emergency, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongqian Zhang
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chunchun Yang
- Department of Digestion, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Changwen Bo
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuanyuan Guo
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Cheng
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Li He
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
6
|
Takahashi S, Matsumoto K, Ohba K, Nakano Y, Miyazawa Y, Kawaguchi T. The Incidence and Management of Cancer-Related Anorexia During Treatment with Vascular Endothelial Growth Factor Receptor-Tyrosine Kinase Inhibitors. Cancer Manag Res 2023; 15:1033-1046. [PMID: 37771675 PMCID: PMC10522463 DOI: 10.2147/cmar.s417238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
Cancer-related anorexia is a common complication and frequently occurs in cancer patients treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs). Anorexia contributes to malnutrition, body weight loss, and cachexia in affected patients. Furthermore, patients who experience anorexia have worse outcomes than those who maintain their appetite, highlighting the importance of managing anorexia and related symptoms. However, as the causes of anorexia are both diverse and interconnected, there have been challenges in evaluating and implementing effective interventions. In this review, we described the contributing factors to cancer-related anorexia and reviewed recent literature for the frequency of anorexia symptoms in patients treated with VEGFR-TKIs. Additionally, we evaluated the evidence for current interventions and the potential benefits of multimodal and multidisciplinary approaches to care. The frequency of anorexia symptoms in patients who received VEGFR-TKIs ranged from 14%-58% for all-grade anorexia and 0%-6% for grade 3 or 4 anorexia. While many of the interventions for cancer-related anorexia have minimal benefit or adverse events, recent advances in our understanding of cancer-related anorexia suggest that multimodal therapy with multidisciplinary care is a promising avenue of investigation. Several studies currently underway are anticipated to further assess the effectiveness of multimodal approaches.
Collapse
Affiliation(s)
- Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koji Matsumoto
- Department of Medical Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Kojiro Ohba
- The Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasuhiro Nakano
- Department of Pharmacy, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasushi Miyazawa
- Department of Clinical Nutrition, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| |
Collapse
|
7
|
Bibby N, Rajai A, O'Reilly DA. From prehab to rehab: Nutritional support for people undergoing pancreatic cancer surgery. J Hum Nutr Diet 2023; 36:493-503. [PMID: 35607759 DOI: 10.1111/jhn.13040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is an urgent need to identify and treat potentially modifiable factors that may improve quality of life and influence survival of people with pancreatic cancer. The present study aimed to assess nutritional status at diagnosis and in the early and later stages of postoperative recovery and to evaluate the feasibility of optimising nutritional status and symptoms in patients undergoing surgery, as part of a multidisciplinary prehabilitation intervention. METHODS Nutritional data collection and intervention took place at four time points: (1) baseline at diagnosis; (2) prior to surgery; (3) first postoperative review (within 6 weeks); and (4) at 6-12 months postoperatively. The 'Patient Generated Subjective Global Assessment' (PG-SGA) tool was used to undertake a detailed nutritional assessment and the modified 'Gastrointestinal Symptom Rating Scale' (GISRS) was completed for all patients. Handgrip strength was measured by dynamometry. RESULTS During the period between April 2016 and April 2018, 137 patients scheduled for pancreatic cancer surgery were included who had a baseline dietetic assessment and at least one further review. Baseline assessment demonstrated that malnutrition was highly prevalent, with 62.3% experiencing more than 5% and 29.2% experiencing more than 10% weight loss over the prior 6 months. With dietetic assessment and support for at least 14 days, these patients gained a mean 1.8% body weight during this period and a mean improved handgrip of 7.9%. Symptoms also improved, with absolute change in PG-SGA scores reduced by a mean of 6.19 and a 6.3 reduction of GISRS. CONCLUSIONS Dietetic assessment and intervention for all patients undergoing pancreatic resection ensures timely identification of nutritional deficiencies and correction of avoidable causes of weight loss, such as pancreatic enzyme insufficiency.
Collapse
Affiliation(s)
- Neil Bibby
- Department of Nutrition and Dietetics, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azita Rajai
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Derek A O'Reilly
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
8
|
Zarifi SH, Bagherniya M, Banach M, Johnston TP, Sahebkar A. Phytochemicals: A potential therapeutic intervention for the prevention and treatment of cachexia. Clin Nutr 2022; 41:2843-2857. [PMID: 36403384 DOI: 10.1016/j.clnu.2022.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
Cachexia, a multifactorial and often irreversible wasting syndrome, is often associated with the final phase of several chronic disorders. Although cachexia is characterized by skeletal muscle wasting and adipose tissue loss, it is a syndrome affecting different organs, which ultimately results in systemic complications and impaired quality of life. The pathogenesis and underlying molecular mechanisms of cachexia are not fully understood, and currently there are no effective standard treatments or approved drug therapies to completely reverse cachexia. Moreover, adequate nutritional interventions alone cannot significantly improve cachexia. Other approaches to ameliorate cachexia are urgently needed, and thus, the role of medicinal plants has received considerable importance in this respect due to their beneficial health properties. Increasing evidence indicates great potential of medicinal plants and their phytochemicals as an alternative and promising treatment strategy to reduce the symptoms of many diseases including cachexia. This article reviews the current status of cachexia, the molecular mechanisms of primary events driving cachexia, and state-of-the-art knowledge that reports the preventive and therapeutic activities of multiple families of phytochemical compounds and their pharmacological mode of action, which may hold promise as an alternative treatment modality for the management of cachexia. Based on our review of various in vitro and in vivo models of cachexia, we would conclude that phytochemicals may have therapeutic potential to attenuate cachexia, although clinical trials are required to unequivocally confirm this premise.
Collapse
Affiliation(s)
- Sudiyeh Hejri Zarifi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Bagherniya
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Thomas P Johnston
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
9
|
Wan Q, Yuan Q, Zhao R, Shen X, Chen Y, Li T, Song Y. Prognostic value of cachexia index in patients with colorectal cancer: A retrospective study. Front Oncol 2022; 12:984459. [PMID: 36212479 PMCID: PMC9540220 DOI: 10.3389/fonc.2022.984459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Current diagnostic criteria for cancer cachexia are inconsistent, and arguments still exist about the impact of cachexia on the survival of patients with colorectal cancer. In this study, we aim to investigate the prognostic value of a novel cachexia indicator, the cachexia index (CXI), in patients with colorectal cancer. Methods The CXI was calculated as skeletal muscle index (SMI) × serum albumin/neutrophil-lymphocyte ratio. The cut-off value of CXI was determined by the receiver operating characteristic (ROC) curves and Youden’s index. The major outcomes were major complications, overall survival (OS), and recurrence-free survival (RFS). Results A total of 379 patients (234 men and 145 women) were included. The ROC curves indicated that CXI had a significantly diagnostic capacity for the detection of major complications. Based on Youden’s index, there were 231 and 148 patients in the low and high CXI groups, respectively. Patients in the low CXI group had significantly older age, lower BMI, and a higher percentage of cachexia and TNM stage II+III. Besides, Patients in low CXI group were associated with a significantly higher rate of major complications, blood transfusion, and longer length of stay. Logistic regression analysis indicated that low CXI, cachexia, and coronary heart disease were independent risk factors for the major complications. Kaplan Meier survival curves indicated that patients with high CXI had a significantly more favorable OS than those with low CXI, while no significant difference was found in RFS between the two groups. Besides, there were no significant differences in OS or RFS between patients with and without cachexia. The univariate and multivariate Cox regression analysis indicated that older age, low CXI, and coronary heart disease instead of cachexia were associated with a decreased OS. Conclusion CXI was better than cachexia in predicting OS and could be a useful prognostic indicator in patients with colorectal cancer, and greater attention should be paid to patients with low CXI.
Collapse
Affiliation(s)
- Qianyi Wan
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Yuan
- Operating Room of Anesthesia Surgery Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoding Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yinghan Song, ; Tao Li,
| | - Yinghan Song
- Department of day surgery center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yinghan Song, ; Tao Li,
| |
Collapse
|
10
|
Gong C, Wan Q, Zhao R, Zuo X, Chen Y, Li T. Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study. Cancers (Basel) 2022; 14:cancers14184400. [PMID: 36139560 PMCID: PMC9497229 DOI: 10.3390/cancers14184400] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
The current diagnostic criteria for cancer cachexia are inconsistent, and the prognostic value of cachexia in gastric cancer (GC) is controversial. This study aimed to investigate the prognostic value of the cachexia index (CXI) in patients with GC. We calculated the CXI as skeletal muscle index (SMI) × serum albumin/neutrophil-lymphocyte ratio (NLR), and a total of 161 and 163 patients were included in the high and low CXI groups, respectively. Low CXI was significantly associated with a more advanced tumor−node−metastasis (TNM) stage, a higher level of serum C-reactive protein, serum interleukin-6, and NLR, but also a decreased level of serum prealbumin and albumin. In addition, patients in the low CXI group were more likely to have postoperative pulmonary infections (9.8% vs. 3.7%, p = 0.03). Cox proportional analyses indicated that patients with low CXI (HR 0.45, 95% CI 0.29 to 0.69; p < 0.001) or TNM stage III+IV (HR 4.38, 95% CI 2.54 to 7.55; p < 0.001) had a significantly poorer overall survival (OS). Kaplan−Meier survival curves suggested that patients with low CXI had a significantly decreased OS, which was not affected by subgroup analyses of different sex, age, cachexia, body mass index (BMI), and TNM stage. Furthermore, low CXI combined with cachexia, low BMI, or TNM stage III+IV caused the worst OS in each subgroup analysis, respectively. Our study demonstrated that CXI had a good prognostic value in GC. Greater attention should be paid to patients with low CXI, particularly those combined with cachexia, low BMI, or TNM stage III+IV.
Collapse
Affiliation(s)
- Can Gong
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610042, China
| | - Qianyi Wan
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Rui Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xinrong Zuo
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (Y.C.); (T.L.)
| | - Tao Li
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (Y.C.); (T.L.)
| |
Collapse
|
11
|
E L D, T J W, A R F, A B P, K M R, C P D, C R G, J E W, K V S, R J U, M SM. Cancer and Associated Therapies Impact the Skeletal Muscle Proteome. Front Physiol 2022; 13:879263. [PMID: 35694399 PMCID: PMC9184684 DOI: 10.3389/fphys.2022.879263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Both cancer and cancer associated therapies (CAT; including chemotherapy or concurrent chemoradiation) disrupt cellular metabolism throughout the body, including the regulation of skeletal muscle mass and function. Adjunct testosterone therapy during standard of care chemotherapy and chemoradiation modulates CAT-induced dysregulation of skeletal muscle metabolism and protects lean body mass during CAT. However, the extent to which the skeletal muscle proteome is altered under these therapeutic conditions is unknown. Objective: We probed the skeletal muscle proteome of cancer patients as an ancillary analysis following a randomized, double-blind, placebo-controlled phase II trial investigating the effect of adjunct testosterone on body composition in men and women with advanced cancers undergoing CAT. Methods: Men and women diagnosed with late stage (≥IIB) or recurrent head and neck or cervical cancer who were scheduled to receive standard of care CAT were administered an adjunct 7 weeks treatment of weekly intramuscular injections of either 100 mg testosterone (CAT+T, n = 7; 2M/5F) or placebo/saline (CAT+P, n = 6; 4M/2F). Biopsies were performed on the vastus lateralis before (PRE) and after (POST) the 7 weeks treatment. Extracted proteins were separated with 2-dimensional gel electrophoresis (2DE), and subjected to analyses of total protein abundance, phosphorylation and S-nitrosylation. Proteoforms showing significant 1.5 fold differences (t-test p ≤ 0.05) between PRE and POST timepoints were identified by mass spectroscopy (MS), and lists of altered proteins were subjected to Gene Set Enrichment Analysis (GSEA) to identify affected pathways. Results: A total of 756 distinct protein spots were identified. Of those spots, 102 were found to be altered in terms of abundance, phosphorylation, or S-nitrosylation, and identified by mass spectroscopy analysis to represent 58 unique proteins. Among the biological processes and pathways identified, CAT+P predominantly impacted metabolic processes, cell assembly, oxygen transport, and apoptotic signaling, while CAT+T impacted transcription regulation, muscle differentiation, muscle development, and contraction. Conclusion: Cancer and CAT significantly altered the skeletal muscle proteome in a manner suggestive of loss of structural integrity, reduced contractile function, and disrupted metabolism. Proteomic analysis suggests that the addition of adjunct testosterone minimized the structural and contractile influence of cancer and its associated therapies.
Collapse
Affiliation(s)
- Dillon E L
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Wright T J
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Filley A R
- Department of Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Pulliam A B
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Randolph K M
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Danesi C P
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Gilkison C R
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Wiktorowicz J E
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Soman K V
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Urban R J
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Sheffield-Moore M
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| |
Collapse
|
12
|
Surov A, Wienke A. Prevalence of sarcopenia in patients with solid tumors A meta analysis based on 81 814 patients. JPEN J Parenter Enteral Nutr 2022; 46:1761-1768. [PMID: 35633306 DOI: 10.1002/jpen.2415] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of the present meta-analysis was to analyze the prevalence of sarcopenia on staging computed tomography (CT) in patients with different malignant solid tumors and in different oncologic settings based on a large sample. METHODS MEDLINE, Cochrane, and SCOPUS databases were screened for prevalence of sarcopenia in oncologic patients up to December 2021. Overall, 280 studies met the inclusion criteria. The methodological quality of the involved studies was checked according to the QUADAS instrument. The meta-analysis was undertaken by using RevMan 5.4 software. DerSimonian and Laird random-effects models with inverse-variance weights were used. RESULTS The included 280 studies comprised 81814 patients with different tumors. The prevalence of sarcopenia over all included studies was 35.3%. A prevalence of sarcopenia over 50% was identified in esophageal cancer, urothelial cancer, cholangiocarcinoma, prostate cancer, sarcomas and thyroid cancer. In head and neck squamous cell carcinoma, pancreatic cancer, lung cancer, renal cell cancer, and ovarian cancer, the prevalence of sarcopenia varied between 35% and 50%. In colorectal cancer, gastric cancer, hepatocellular cancer, and breast cancer, the prevalence of LSMM was below 35%. In curative setting, the prevalence of sarcopenia was 39.6% and in palliative setting, it was 49.2% (p<0.001). CONCLUSIONS Sarcopenia is a frequent condition in oncology with a prevalence of 35.3%. The prevalence of sarcopenia is higher in palliative setting vs curative setting. The prevalence of sarcopenia is also different in different tumors. CLINICAL RELEVANCY STATEMENT This article is the first report regarding the prevalence of sarcopenia on staging CT in oncology based on a large sample. It provides evident data about prevalence of sarcopenia in palliative and curative settings in different malignant tumors. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany and Profile Area Clinical Studies & Biostatistics
| |
Collapse
|
13
|
Emanuel A, Krampitz J, Rosenberger F, Kind S, Rötzer I. Nutritional Interventions in Pancreatic Cancer: A Systematic Review. Cancers (Basel) 2022; 14:2212. [PMID: 35565341 PMCID: PMC9101959 DOI: 10.3390/cancers14092212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Pancreatic cancer (PaCa) is directly related to malnutrition, cachexia and weight loss. Nutritional interventions (NI) are used in addition to standard therapy. The aim of this systematic review is to provide an overview of the types of NI and their effects. (2) Methods: We included RCTs with at least one intervention group receiving an NI and compared them with a control group with no NI, placebo or alternative treatment on cachexia, malnutrition or weight loss in patients with PaCa. Any available literature until 12 August 2021 was searched in the Pubmed and Cochrane databases. RCTs were sorted according to NI (parenteral nutrition, enteral nutrition, dietary supplements and mixed or special forms). (3) Results: Finally, 26 studies with a total of 2720 patients were included. The potential for bias was mostly moderate to high. Parenteral nutrition is associated with a higher incidence of complications. Enteral nutrition is associated with shorter length of stay in hospital, lower rate and development of complications, positive effects on cytokine rates and lower weight loss. Dietary supplements enriched with omega-3 fatty acids lead to higher body weight and lean body mass. (4) Conclusions: Enteral nutrition and dietary supplements with omega-3 fatty acids should be preferred in nutritional therapy of PaCa patients.
Collapse
Affiliation(s)
- Aline Emanuel
- Division of Nutrition Sciences, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123 Saarbruecken, Germany;
| | - Julia Krampitz
- Division of Psychology and Pedagogy, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123 Saarbruecken, Germany;
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Friederike Rosenberger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Division of Health Sciences, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123 Saarbruecken, Germany;
| | - Sabine Kind
- Division of Health Sciences, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123 Saarbruecken, Germany;
| | - Ingeborg Rötzer
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Clinic for Oncology and Haemotology, Northwest Hospital, UCT-Cancer University Center, 60488 Frankfurt am Main, Germany
| |
Collapse
|
14
|
Muscaritoli M, Corsaro E, Molfino A. Awareness of Cancer-Related Malnutrition and Its Management: Analysis of the Results From a Survey Conducted Among Medical Oncologists. Front Oncol 2021; 11:682999. [PMID: 34055649 PMCID: PMC8155516 DOI: 10.3389/fonc.2021.682999] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cancer is a global major public health problem, particularly in Western countries, where it represents the second leading cause of death after cardiovascular disease. Malnutrition is common in cancer patients and differs from starvation-related malnutrition, as it results from a combination of anorexia and metabolic dysregulation, caused by the tumor itself or by its treatment, and causing cachexia. Cancer-associated malnutrition can lead to several negative consequences, including poor prognosis, reduced survival, increased therapy toxicity, reduced tolerance and compliance to treatments, and diminished response to antineoplastic drugs. Guidelines issued by the Ministry of Health in 2017, the most recent ESPEN guidelines and the PreMiO study highlighted an inadequate nutritional support in cancer patients since their first visit, and recommended an optimization of the quality of life of cancer patients in each stage of the disease, also through specific nutritional interventions by multidisciplinary teams. Based on the evidences summarized above, a survey has been carried out on a sample of 300 Italian hospital medical oncologists to evaluate their level of awareness and perception of cancer-related malnutrition and their proposals to implement effective strategies to improve nutritional care in the setting of hospital oncology departments in Italy. The survey results indicate that, despite high levels of awareness among Italian oncologists, malnutrition in cancer patients remains, at least in part, an unmet medical need, and additional efforts are necessary in terms of increased training and hiring of personnel, and of creation of organizational pathways aimed at treatment optimization based on available evidences.
Collapse
Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
15
|
Zhou X, Hu S, Zhang Y, Du G, Li Y. The mechanism by which noncoding RNAs regulate muscle wasting in cancer cachexia. PRECISION CLINICAL MEDICINE 2021; 4:136-147. [PMID: 35694153 DOI: 10.1093/pcmedi/pbab008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 02/05/2023] Open
Abstract
Abstract
Cancer cachexia (CC) is a complex metabolic syndrome that accelerates muscle wasting and affects up to 80% of patients with cancer; however, timely diagnostic methods and effective cures are lacking. Although a considerable number of studies have focused on the mechanism of CC-induced muscle atrophy, few novel therapies have been applied in the last decade. In recent years, noncoding RNAs (ncRNAs) have attracted great attention as many differentially expressed ncRNAs in cancer cachectic muscles have been reported to participate in the inhibition of myogenesis and activation of proteolysis. In addition, extracellular vesicles (EVs), which function as ncRNA carriers in intercellular communication, are closely involved in changing ncRNA expression profiles in muscle and promoting the development of muscle wasting; thus, EV-related ncRNAs may represent potential therapeutic targets. This review comprehensively describes the process of ncRNA transmission through EVs and summarizes the pathways and targets of ncRNAs that lead to CC-induced muscle atrophy.
Collapse
Affiliation(s)
- Xueer Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shoushan Hu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yunan Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Guannan Du
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yi Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| |
Collapse
|
16
|
Solsona R, Pavlin L, Bernardi H, Sanchez AMJ. Molecular Regulation of Skeletal Muscle Growth and Organelle Biosynthesis: Practical Recommendations for Exercise Training. Int J Mol Sci 2021; 22:2741. [PMID: 33800501 PMCID: PMC7962973 DOI: 10.3390/ijms22052741] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
The regulation of skeletal muscle mass and organelle homeostasis is dependent on the capacity of cells to produce proteins and to recycle cytosolic portions. In this investigation, the mechanisms involved in skeletal muscle mass regulation-especially those associated with proteosynthesis and with the production of new organelles-are presented. Thus, the critical roles of mammalian/mechanistic target of rapamycin complex 1 (mTORC1) pathway and its regulators are reviewed. In addition, the importance of ribosome biogenesis, satellite cells involvement, myonuclear accretion, and some major epigenetic modifications related to protein synthesis are discussed. Furthermore, several studies conducted on the topic of exercise training have recognized the central role of both endurance and resistance exercise to reorganize sarcomeric proteins and to improve the capacity of cells to build efficient organelles. The molecular mechanisms underlying these adaptations to exercise training are presented throughout this review and practical recommendations for exercise prescription are provided. A better understanding of the aforementioned cellular pathways is essential for both healthy and sick people to avoid inefficient prescriptions and to improve muscle function with emergent strategies (e.g., hypoxic training). Finally, current limitations in the literature and further perspectives, notably on epigenetic mechanisms, are provided to encourage additional investigations on this topic.
Collapse
Affiliation(s)
- Robert Solsona
- Laboratoire Interdisciplinaire Performance Santé Environnement de Montagne (LIPSEM), Faculty of Sports Sciences, University of Perpignan Via Domitia, UR 4640, 7 Avenue Pierre de Coubertin, 66120 Font-Romeu, France;
| | - Laura Pavlin
- DMEM, University of Montpellier, INRAE UMR866, 2 Place Pierre Viala, 34060 Montpellier, France; (L.P.); (H.B.)
| | - Henri Bernardi
- DMEM, University of Montpellier, INRAE UMR866, 2 Place Pierre Viala, 34060 Montpellier, France; (L.P.); (H.B.)
| | - Anthony MJ Sanchez
- Laboratoire Interdisciplinaire Performance Santé Environnement de Montagne (LIPSEM), Faculty of Sports Sciences, University of Perpignan Via Domitia, UR 4640, 7 Avenue Pierre de Coubertin, 66120 Font-Romeu, France;
| |
Collapse
|