Display omitted
Cancer remains a public health challenge in the identification and development of ideal pharmacological therapies and dietary strategies. The use of whey protein as a dietary strategy ...is widespread in the field of oncology. The two types of whey protein, sweet or acid, result from several processing techniques and possess distinct protein subfraction compositions. Mechanistically, whey protein subfractions have specific anti-cancer effects. Alpha-lactalbumin, human α-lactalbumin made lethal to tumor cell, bovine α-lactalbumin made lethal to tumor cell, bovine serum albumin, and lactoferrin are whey protein subfractions with potential to hinder tumor pathways. Such effects, however, are principally supported by studies performed in vitro and/or in vivo. In clinical practice, whey protein intake-induced anti-cancer effects are indiscernible. However, whey protein supplementation represents a practical, feasible, and cost-effective approach to mitigate cancer cachexia syndrome. The usefulness of whey protein is evidenced by a greater leucine content and the potential to modulate IGF-1 concentrations, representing important factors towards musculoskeletal hypertrophy. Further clinical trials are warranted and needed to establish the effects of whey protein supplementation as an adjuvant to cancer therapy.
Obesity and type 2 diabetes mellitus (DM) have grown in prevalence around the world, and recently, related diseases have been considered epidemic. Given the high cost of treatment of ...obesity/DM-associated diseases, strategies such as dietary manipulation have been widely studied; among them, the whey protein diet has reached popularity because it has been suggested as a strategy for the prevention and treatment of obesity and DM in both humans and animals. Among its main actions, the following activities stand out: reduction of serum glucose in healthy individuals, impaired glucose tolerance in DM and obese patients; reduction in body weight; maintenance of muscle mass; increases in the release of anorectic hormones such as cholecystokinin, leptin, and glucagon like-peptide 1 (GLP-1); and a decrease in the orexigenic hormone ghrelin. Furthermore, studies have shown that whey protein can also lead to reductions in blood pressure, inflammation, and oxidative stress.
High protein diet (HDP) promotes improvement of lean body mass in elderly without cancer; but the impact of high protein intake on muscle strength and mortality in cancer patients remains to be ...elucidated. This study evaluates the association between HPD on handgrip strength (HGS) and survival in older adults outpatients with advanced gastrointestinal cancer.
Ninety-one patients with advanced gastrointestinal cancer (>65% tumor stage III-IV) undergoing radiotherapy, chemotherapy or surgery were enrolled. Upon first oncological visit, tumor stage was assessed by a physician. Then, a nutritionist or a dietitian measured the body mass index (BMI), HGS by means of a dynamometer, and dietary food intake by using 24h food recall. Patients were stratified in HPD (i.e, ≥1.5 g/kg/d) or low protein diet (LPD: <1.5 g/kg/d). Kaplan-Meier curve was used to assess the survival since the cancer diagnosis.
HPD was reported by approximately 30% of patients. Protein intake was significantly higher in HPD vs LPD patients (2.2 ± 0.8 vs. 0.8 ± 0.4 g/kg/d, respectively; p < 0.0001). No significant association was found between HPD and HGS, even after adjustment for physical activity, alcohol intake, smoking, sex, age, tumor stage, oncologic treatment and BMI (OR: 0.97 95%CI: 0.88-1.08, p = 0.64), or for energy intake kcal/kg/day, leucine g/d and lipids g/d (OR: 0.93 95%CI: 0.85-1.03, p = 0.19. In addition, HPD group showed higher overall survival than LPD group (HPD: 14.7 vs. LPD: 7.3 months, p = 0.04).
HPD is not associated with better muscle function as measured by HGS, but with overall survival in older adults outpatients with advanced gastrointestinal cancer. HPD may represent a strategy to mitigate the cancer-induced mortality and should be further explored.
Systemic inflammation has been reported as a new predictor for cancer outcomes. This study aimed i) to identify the neutrophil to lymphocytes ratio (NLR) cut-off point that best predicts sarcopenia ...and ii) to verify the association between NLR and sarcopenia risk in hospitalized cancer patients.
A cross-sectional study enrolled a total of 123 hospitalized cancer patients receiving chemotherapy and/or undergoing surgery. Systemic inflammation was assessed as revealed by circulating levels of C-reactive protein, neutrophils, platelet, and by calculating platelet-lymphocytes ratio (PLR) and NLR. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F; score≥4 identifies sarcopenia risk). ROC curve were used to identify the best NLR cut-off value which predicts sarcopenia risk. Differences between groups were tested using the T Student, Mann–Whitney, or Chi–Square tests. Logistic regression analyses were done to assess the association between NLR and sarcopenia risk.
ROC curve revealed that the best cut-off point to predict sarcopenia risk was NLR ≥6.5 (sensitivity of 45% and specificity of 81%). Those with NLR ≥6.5 presented higher C-reactive protein, neutrophils, platelet-lymphocytes ratio (PLR), and SARC-F than NLR <6.5 group. A negative correlation was found between NLR and gait speed (r = −0.48, p = 0.0001), handgrip strength (r = −0.29, p = 0.002), arm circumference (r = −0.29, p = 0.002) and calf circumference (r = −0.28, p = 0.003). Those with increased NLR values were associated with high sarcopenia risk in crude model, as well as if adjusted by smoking, alcohol intake, and sex (OR:1.19 95%CI:1.03–1.37, p = 0.013) or by BMI (OR:1.20 95%CI:1.05–1.38, p = 0.006).
In hospitalized cancer patients, systemic inflammation measured by NLR was associated with increased sarcopenia risk.
Hemodialysis has a detrimental effect on fat-free mass (FFM) and muscle strength over time. Thus, we aimed to evaluate the effect of creatine supplementation on the body composition and ...Malnutrition-Inflammation Score (MIS) in patients with chronic kidney disease (CKD) undergoing hemodialysis. An exploratory 1-year balanced, placebo-controlled, and double-blind design was conducted with hemodialysis patients (≥18 years). The creatine group (CG) received 5 g of creatine monohydrate and 5 g of maltodextrin per day and the placebo group (PG) received 10 g of maltodextrin per day. MIS and body composition were analyzed at three time points: pre, intermediate (after 6 months), and post (after 12 months). After 6 months, 60% of patients on creatine experienced an increase in FFM compared to a 36.8% increase for those on placebo. Moreover, 65% of patients on creatine increased their skeletal muscle mass index (SMMI) compared to only 15.8% for those on placebo. Creatine increased intracellular water (ICW) in 60% of patients. MIS did not change after the intervention. In the CG, there was an increase in body weight (
= 0.018), FFM (
= 0.010), SMMI (
= 0.022). CG also increased total body water (pre 35.4 L, post 36.1 L;
= 0.008), mainly due to ICW (pre 20.2 L, intermediate 20.7 L, post 21.0 L;
= 0.016). Long-term creatine supplementation in hemodialysis patients did not attenuate the MIS, but enhanced FFM and SMMI, which was likely triggered by an increase in ICW.
To evaluate the association of inflammation (C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels) with muscle strength in older adults. We also aimed to evaluate whether these ...associations are sex-specific. A cross-sectional study was performed with data from the National Health and Nutrition Examination Survey (NHANES) 1999–2000 and 2001–2002. A total of 2387 individuals over 50 years of both sexes were evaluated, according to the eligibility criteria for the strength test. Muscle strength was measured by Kinetic Communicator isokinetic dynamometer; while the NLR was obtained by the ratio of the total neutrophil for lymphocyte count and CRP was quantified by latex nephelometry. Linear regression analyses, crude and adjusted for confounders, were used to estimate the coefficients and 95 % confidence intervals for peak strength (muscle strength) by tertiles of NLR and CRP. There was no association between NLR and peak strength for both sexes. CRP levels were inversely associated with peak force in men 2nd tertile β = −3.33 (−15.92; 9.25); 3rd tertile β = −24.69 (−41.18; −8.20), p for trend = 0.005, but not in women 2nd tertile β = −3.22 (−15.00; 8.56); 3rd tertile β = −9.23 (−28.40; −9.94), p for trend = 0.332. In conclusion, NLR levels were not associated with muscle strength in both sexes. CRP levels were inversely associated with muscle strength in older men, but not in women, suggesting that the association between inflammation and muscle strength in older adults can be sex-specific.
•There was no association between NLR and peak strength for both sexes.•CRP levels were inversely associated with peak force in older adult men, but not in women.•The association between inflammation and muscle strength in older adults can be sex-specific.
Sarcopenia promotes worsening of nutritional status and an increase in comorbidities. Likewise, use of validated instruments to assess nutritional and comorbidity factors are warranted. Thus, the ...objectives were to assess the prevalence of risk for sarcopenia and to determine whether there is an association between sarcopenia and nutritional status and comorbidities in hospitalized patients with cancer.
This was a cross-sectional study with 77 patients with different types of cancer. Both men and women were enrolled. The risk for sarcopenia was assessed by the Strength, Assistance With Walking, Rise From a Chair, Climb Stairs, and Falls (SARC-F) questionnaire. Patients were divided into two groups: risk for sarcopenia (SARC-F score ≥4) and no risk for sarcopenia (SARC-F score <4). The presence of comorbidities and nutritional risks were analyzed using Charlson Comorbidity Index (CCI) and Nutrition Risk Screening 2002 (NRS-2002), respectively. Logistic and multiple regression analyses were used to verify the association and predictive factors of SARC-F.
Of the 77 patients, 40.2% (n = 31; 63.48 ± 10.59 y of age) were classified as having a risk for sarcopenia and 59.7% (n = 46; 51.20 ± 12.81 y of age) without risk. We found an association between the risk for sarcopenia and CCI and NRS-2002 in crude model and after adjustment for age. Additionally, SARC-F is a good predictor of the increase of CCI (β = 0.357, R² = 0.29, P = 0.003) and NRS-2002 (β = 0.519, R² = 0.49, P < 0.001).
In the present study, ∼40% of patients with cancer had a risk for sarcopenia and a greater prediction for nutritional risk (49%) and comorbidities (29%).
•Of hospitalized patients with cancer, 40% were at risk of sarcopenia.•Sarcopenia predicts poor nutritional status in hospitalized patients with cancer.•SARC-F, Charlson Comorbidity Index, and Nutrition Risk Screening 2002 are good, fast, and useful approaches for screening in a hospital clinical routine.•Screening of sarcopenia should be evaluated in hospitalized patients with cancer.
Abstract
Cancer patients possess metabolic and pathophysiological changes and an inflammatory environment that leads to malnutrition. This study aimed to (i) determine whether there is an association ...between neutrophil-to-lymphocyte ratio (NLR) and nutritional risk, and (ii) identify the cut-off value of NLR that best predicts malnutrition by screening for nutritional risk (NRS 2002). This cross-sectional study included 119 patients with unselected cancer undergoing chemotherapy and/or surgery. The NRS 2002 was applied within 24 h of hospitalisation to determine the nutritional risk. Systemic inflammation was assessed by blood collection, and data on C-reactive protein (CRP), neutrophils, and lymphocytes were collected for later calculation of NLR. A receiver operating characteristic (ROC) curve was used to identify the best cut-point for NLR value that predicted nutritional risk. Differences between the groups were tested using the Student’s t-, Mann–Whitney U and Chi-Square tests. Logistic regression analyses were performed to assess the association between NLR and nutritional risk. The ROC curve showed the best cut-point for predicting nutritional risk was NLR > 5.0 (sensitivity, 60.9%; specificity, 76.4%). The NLR ≥ 5.0 group had a higher prevalence of nutritional risk than the NLR < 5.0 group (NLR ≥ 5.0: 73.6% vs. NLR < 5.0: 37.9%,
p
= 0.001). The NLR group ≥ 5.0 showed higher values of CRP and NLR than the NLR < 5.0 group. In addition, patients with NLR ≥ 5.0 also had higher NRS 2002 values when compared to the NLR < 5.0 group (NLR ≥ 5.0: 3.0 ± 1.1 vs. NLR < 5.0: 2.3 ± 1.2,
p
= 0.0004). Logistic regression revealed an association between NRS and NLR values. In hospitalised unselected cancer patients, systemic inflammation measured by NLR was associated with nutritional risk. Therefore, we highlight the importance of measuring the NLR in clinical practice, with the aim to detect nutritional risk.
Cancer and its morbidities, such as cancer cachexia, constitute a major public health problem. Although cancer cachexia has afflicted humanity for centuries, its underlying multifactorial and complex ...physiopathology has hindered the understanding of its mechanism. During the last few decades we have witnessed a dramatic increase in the understanding of cancer cachexia pathophysiology. Anorexia and muscle and adipose tissue wasting are the main features of cancer cachexia. These apparently independent symptoms have humoral factors secreted by the tumor as a common cause. Importantly, the hypothalamus has emerged as an organ that senses the peripheral signals emanating from the tumoral environment, and not only elicits anorexia but also contributes to the development of muscle and adipose tissue loss. Herein, we review the roles of factors secreted by the tumor and its effects on the hypothalamus, muscle and adipose tissue, as well as highlighting the key targets that are being exploited for cancer cachexia treatment.
PDF
