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Nutrients Apr 2019Omega-3 polyunsaturated fatty acids (PUFAs) are considered immunonutrients and are commonly used in the nutritional therapy of cancer patients due to their ample... (Review)
Review
Omega-3 polyunsaturated fatty acids (PUFAs) are considered immunonutrients and are commonly used in the nutritional therapy of cancer patients due to their ample biological effects. Omega-3 PUFAs play essential roles in cell signaling and in the cell structure and fluidity of membranes. They participate in the resolution of inflammation and have anti-inflammatory and antinociceptive effects. Additionally, they can act as agonists of G protein-coupled receptors, namely, GPR40/FFA1 and GPR120/FFA4. Cancer patients undergo complications, such as anorexia-cachexia syndrome, pain, depression, and paraneoplastic syndromes. Interestingly, the 2017 European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines for cancer patients only discuss the use of omega-3 PUFAs for cancer-cachexia treatment, leaving aside other cancer-related complications that could potentially be managed by omega-3 PUFA supplementation. This critical review aimed to discuss the effects and the possible underlying mechanisms of omega-3 PUFA supplementation in cancer-related complications. Data compilation in this critical review indicates that further investigation is still required to assess the factual benefits of omega-3 PUFA supplementation in cancer-associated illnesses. Nevertheless, preclinical evidence reveals that omega-3 PUFAs and their metabolites might modulate pivotal pathways underlying complications secondary to cancer, indicating that this is a promising field of knowledge to be explored.
Topics: Anorexia; Depressive Disorder, Major; Fatty Acids, Omega-3; Humans; Neoplasms; Pain; Paraneoplastic Syndromes
PubMed: 31035457
DOI: 10.3390/nu11050945 -
Journal of Advanced Research Apr 2024Cancer-associated cachexia is a multi-organ disorder associated with progressive weight loss due to a variable combination of anorexia, systemic inflammation and... (Review)
Review
BACKGROUND
Cancer-associated cachexia is a multi-organ disorder associated with progressive weight loss due to a variable combination of anorexia, systemic inflammation and excessive energy wasting. Considering the importance of immunoregulation in cachexia, it still lacks a complete understanding of the immunological mechanisms in cachectic progression.
AIM OF REVIEW
Our aim here is to describe the complex immunoregulatory system in cachexia. We summarize the effects and translational potential of the immune system on the development of cancer-associated cachexia and we attempt to conclude with thoughts on precise and integrated therapeutic strategies under the complex immunological context of cachexia.
KEY SCIENTIFIC CONCEPTS OF REVIEW
This review is focused on three main key concepts. First, we highlight the inflammatory factors and additional mediators that have been identified to modulate this syndrome. Second, we decipher the potential role of immune checkpoints in tissue wasting. Third, we discuss the multilayered insights in cachexia through the immunometabolic axis, immune-gut axis and immune-nerve axis.
Topics: Humans; Cachexia; Neoplasms; Weight Loss; Anorexia; Inflammation
PubMed: 37150253
DOI: 10.1016/j.jare.2023.04.018 -
Current Opinion in Supportive and... Dec 2017In spite of its relevance, treatments for the cancer anorexia and cachexia syndrome (CACS) are not available. One of the agents that recently reached phase III clinical... (Review)
Review
PURPOSE OF REVIEW
In spite of its relevance, treatments for the cancer anorexia and cachexia syndrome (CACS) are not available. One of the agents that recently reached phase III clinical trials is anamorelin. Its development, along with that of other agents for this indication, will be reviewed here, with a focus on the gaps in the current knowledge and future directions.
RECENT FINDINGS
In spite of several targets showing promising results in early development, their difficulties obtaining regulatory approval underscore the need to reconsider the current strategies in drug development and the challenges in the field of CACS.
SUMMARY
Further research is needed in order to meet the challenges of developing treatments for CACS. Preclinical studies should expand our understanding about key regulators of appetite, muscle, and energy metabolism in this setting using models that can be translated reliably to humans. Clinical research efforts should focus on validating the entry criteria, endpoints, outcomes, and the potential synergistic effects and interaction between different targets, nutrition, and exercise interventions. Clinical meaningfulness and significance should be taken into account in the design of clinical trials. It is essential that all key stakeholders are included in the design of future strategies.
Topics: Anorexia; Biomarkers; Cachexia; Drug Approval; Humans; Hydrazines; Neoplasms; Oligopeptides; Quality of Life; Randomized Controlled Trials as Topic; Receptors, Ghrelin; Research Design
PubMed: 28957883
DOI: 10.1097/SPC.0000000000000299 -
JAMA Oncology Sep 2017Early palliative care integration for cancer patients is now touted as the optimal care model, yet significant barriers often prevent its implementation. A perceived...
IMPORTANCE
Early palliative care integration for cancer patients is now touted as the optimal care model, yet significant barriers often prevent its implementation. A perceived barrier, especially for pediatric oncology patients, is the notion that patients and their families may not need or want palliative care involvement early in the disease trajectory.
OBJECTIVE
To determine the perception of symptom burden early in treatment and assess attitudes toward early integration of palliative care in pediatric oncology patient-parent pairs.
DESIGN, SETTING, AND PARTICIPANTS
Novel but pretested survey tools were administered to 129 patient-parent dyads of hospital-based pediatric oncology ambulatory clinics and inpatient units between September 2011 and January 2015. All patient participants were aged between 10 and 17 years and were diagnosed as having an oncologic condition 1 month to 1 year before enrollment. Both the patient and the parent in the dyad spoke English, and all participating parents provided written informed consent. A convenience sample was used for selection, with participants screened when otherwise presenting at a participating site. A total of 280 eligible participants were approached for study inclusion, 258 of whom were enrolled in the study (92.1% positive response-rate).
MAIN OUTCOMES AND MEASURES
Degree of perceived suffering from early symptom-related causes, attitudes toward early palliative care integration, and patient-parent concordance. Statistical analysis included descriptive statistics, calculation of concordance, McNemar test results, and Cochran-Armitage trend test results.
RESULTS
Of the 129 patients in the dyads, 68 were boys, and 61 girls; of the 129 parents, 15 were men, and 114 women. Patients reported the following symptoms in the first month of cancer therapy: nausea (n = 109; 84.5%), loss of appetite (n = 97; 75.2%), pain (n = 96; 74.4%), anxiety (n = 77; 59.7%), constipation (n = 69; 53.5%), depression (n = 64; 49.6%), and diarrhea (n = 52; 40.3%). A large proportion of those reporting suffering indicated substantial suffering severity from specific symptoms (ie, a great deal or a lot) including nausea, 52.3% (57 of 109), loss of appetite, 50.5% (49 of 97), constipation 30.4% (21 of 69), pain 30.2% (29 of 96), anxiety 28.6% (22 of 77), depression 28.1% (18 of 64), and diarrhea 23.1% (12 of 52). Few children and parents expressed opposition to early palliative care involvement (2 [1.6%] and 8 [6.2%]) or perceived any detrimental effects on their relationship with their oncologist (6 [4.7%] and 5 [3.9%]), loss of hope (3 [2.3%] and 10 [7.8%]), or therapy interference (3 [2.3%] and 2 [1.6%], respectively). Intradyad concordance was low overall: 26% to 29% for exact concordance and 40% to 69% for agreement within 1 response category. Significant differences in patient-parent attitudes toward aspects of early palliative care included child participants being more likely than their parents (40.3% [n = 52] vs 17.8% [n = 23]) to indicate that palliative care would have been helpful for treating their symptoms (P < .001).
CONCLUSIONS AND RELEVANCE
Pediatric oncology patients experience a high degree of symptom-related suffering early in cancer therapy, and very few patients or parents in this study expressed negative attitudes toward early palliative care. Our findings suggest that pediatric oncology patients and families might benefit from, and are not a barrier to, early palliative care integration in oncology.
Topics: Adolescent; Adult; Aged; Anorexia; Anxiety; Attitude; Cancer Pain; Child; Constipation; Depression; Diarrhea; Female; Humans; Male; Medical Oncology; Middle Aged; Nausea; Neoplasms; Palliative Care; Parents; Patient Acceptance of Health Care; Pediatrics; Perception; Surveys and Questionnaires; Symptom Assessment
PubMed: 28278329
DOI: 10.1001/jamaoncol.2017.0368 -
CNS Neuroscience & Therapeutics Dec 2022Immunological dysfunctions in eating disorders have recently gained increasing scientific attention. Furthermore, the reciprocal association between anorexia and... (Review)
Review
Immunological dysfunctions in eating disorders have recently gained increasing scientific attention. Furthermore, the reciprocal association between anorexia and autoimmune diseases is of particular interest and suggests a role of autoimmunity in the pathogenesis of eating disorders. Anorexia nervosa (AN) and autoimmune diseases are linked by a bidirectional relationship based on common immunopathological mechanisms. In this review, in addition to reporting the numerous cases described in which autoimmune disorders are associated with anorexia or vice versa, we summarize the many aspects of this relationship between the immune system (IS) and AN. We describe how the microbiota affects the IS, disrupts gut-brain communication, and possibly triggers eating disorders. We also describe the shared immunological pathways of autoimmune and eating disorders and in particular the occurrence of disrupted T cell tolerance and autoantibodies in AN. The described observations represent the starting point for possible, future research directions.
Topics: Humans; Anorexia Nervosa; Anorexia; Feeding and Eating Disorders; Comorbidity; Autoimmune Diseases
PubMed: 36114699
DOI: 10.1111/cns.13953 -
Nutrients Jun 2023Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while... (Review)
Review
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
Topics: Humans; Anorexia Nervosa; Anorexia; Family Therapy
PubMed: 37299557
DOI: 10.3390/nu15112594 -
The Journal of Nutrition, Health & Aging 2023
Topics: Humans; Anorexia; Aging
PubMed: 36973923
DOI: 10.1007/s12603-023-1899-1 -
Experimental & Molecular Medicine Apr 2022Cancer cachexia syndrome is a major cause of morbidity and mortality in cancer patients in the advanced stage. It is a devastating disorder characterized by nutritional... (Review)
Review
Cancer cachexia syndrome is a major cause of morbidity and mortality in cancer patients in the advanced stage. It is a devastating disorder characterized by nutritional impairment, weakness, and wasting, and it affects treatment success and quality of life. Two major symptoms of cancer cachexia are anorexia and weight loss. Weight loss in cachexia is not reversed through increased food intake, suggesting that anorexia and weight loss in cancer patients are regulated by independent molecular mechanisms. Although the wasting phenotype mostly occurs in skeletal muscle and adipose tissue, other organs, such as the brain, liver, pancreas, heart, and gut, are also involved in cachexia. Thus, cachexia is a multiorgan syndrome. Although the molecular basis of cancer cachexia-induced weight loss is known, the mechanism underlying anorexia is poorly understood. Here, we highlight our recent discovery of a new anorexia mechanism by which a tumor-derived humoral factor induces cancer anorexia by regulating feeding-related neuropeptide hormones in the brain. Furthermore, we elucidated the process through which anorexia precedes tissue wasting in cachexia. This review article aims to provide an overview of the key molecular mechanisms of anorexia and tissue wasting caused by cancer cachexia.
Topics: Adipose Tissue; Anorexia; Cachexia; Humans; Neoplasms; Quality of Life
PubMed: 35388147
DOI: 10.1038/s12276-022-00752-w -
Journal of Cachexia, Sarcopenia and... Apr 2019Cachexia is a complex metabolic process that is associated with several end-stage organ diseases. It is known to be also associated with advanced dementia, although the... (Review)
Review
Cachexia is a complex metabolic process that is associated with several end-stage organ diseases. It is known to be also associated with advanced dementia, although the pathophysiologic mechanisms are still largely unknown. The present narrative review is aimed at presenting recent insights concerning the pathophysiology of weight loss and wasting syndrome in dementia, the putative mechanisms involved in the dysregulation of energy balance, and the interplay among the chronic clinical conditions of sarcopenia, malnutrition, and frailty in the elderly. We discuss the clinical implications of these new insights, with particular attention to the challenging question of nutritional needs in advanced dementia and the utility of tube feeding in order to optimize the management of end-stage dementia.
Topics: Aging; Anorexia; Cachexia; Dementia; Disease Susceptibility; Frailty; Humans; Sarcopenia; Translational Research, Biomedical
PubMed: 30794350
DOI: 10.1002/jcsm.12380 -
Journal of Cachexia, Sarcopenia and... Oct 2018Anorexia of ageing may be a precursor to various geriatric syndromes. We elucidated whether anorexia of ageing had a significant impact on incident disability and...
BACKGROUND
Anorexia of ageing may be a precursor to various geriatric syndromes. We elucidated whether anorexia of ageing had a significant impact on incident disability and investigated whether anorexia of ageing had a direct association with future disability or an indirect association with disability via frailty.
METHODS
This study employed an observational, longitudinal, cohort design in a community setting. Participants were 4393 older adults (75.9 ± 4.3 years). Anorexia of ageing was assessed by a simplified nutritional appetite questionnaire. Frailty was operationalized as slowness, weakness, exhaustion, low physical activity, and weight loss. Participants who had none of these characteristics were considered robust, those with one or two characteristics were considered pre-frail, and those with three or more characteristics were considered frail. We examined sociodemographic variables (age, sex, and education), medical history (medication and chronic disease history), lifestyle factors (smoking and drinking habits and living arrangement), body mass index, blood nutrition data, depressive symptoms, physical functioning, and cognitive functioning.
RESULTS
The prevalence of anorexia of ageing was 10.7% (n = 468). The proportion of physical frailty, pre-frailty, and robustness were 8.4, 52.0, and 39.6%, respectively, in the without anorexia of ageing group, and 20.3, 57.7, and 22.0%, respectively, in the anorexia of ageing group (P < 0.001). During a 2-year follow-up, the prevalence proportion of disability was 5.6% in the without anorexia of ageing group and 10.7% in the anorexia of ageing group (P < 0.001). Adjusted for covariates (except for frailty status), the participants with anorexia of ageing had an independently associated higher risk of incident disability compared with those without anorexia of ageing (hazard ratio: 1.43, 95% confidence interval: 1.04-1.95, P = 0.03). However, adjusted for covariates (including frailty status), anorexia of ageing was not significantly associated with incident disability (P = 0.09). Structural equation models revealed that anorexia of ageing had no direct effect on disability; however, anorexia of ageing was associated with frailty.
CONCLUSIONS
Older adults with anorexia of ageing had a higher proportion of frailty and a higher prevalence proportion of disability compared with those without anorexia of ageing. Although anorexia of ageing may not have a direct effect on incident disability, the structural equation model suggests an indirect relationship between anorexia of ageing and incident disability via frailty status.
Topics: Aged; Aged, 80 and over; Aging; Anorexia; Comorbidity; Disabled Persons; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Male; Prevalence; Socioeconomic Factors
PubMed: 30109778
DOI: 10.1002/jcsm.12330