Malnutrition cachexia

Human growth hormone, used as a human pharmaceutical, is approved for only one indication in the United States, treatment of growth failure owing to hGH deficiency, a condition known as pituitary dwarfism. However, clinical trials are under way to test its efficacy in Turner s syndrome, bums, wound healing, cachexia, osteoporosis, constitutional growth delay, aging, malnutrition, and obesity. 

Cachexia is more difficult to treat, although it may resolve following treatment of the underlying malignancy. Nutritional consultation may be of aid, although cachexia is thought to be more attributable to internal pathophysiologic processes than malnutrition. 

Malnutrition, and its ultimate form cachexia, are encountered every day in cancer and haematology wards. Malnutrition results from the parasitic metabolism of the tumour at the expense of the host, from the impact of the tumour on the metabolism of the host... The major consequence is an increased risk of complications and death during the course of chemotherapy, radiation therapy and major surgery. It is thus important to offer nutritional support, in order to stop or reverse the process of malnutrition. Nutritional intervention should be founded on the abundant literature devoted to cancer cachexia, including the pathophysiology of the disease. .. 

TNF-a is identical to cachetin, a protein that suppresses completely the lipoprotein lipase of adipose tissue and is believed to be responsible for cachexia, a condition of general ill health, malnutrition, weight loss, and wasting of muscle that accompanies cancer and other chronic diseases. Nevertheless, TNF-a may be overproduced in obesity as well. It has been suggested that abnormal production of TNF-a may induce cachexia while abnormal action of the cytokine may cause obesity.233 Some TNF receptors have "death domains" and trigger apoptosis, while other receptors promote proliferation and differentiation via transcription factor NF-kB.242... 

Cachexia is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite. It is seen in patients with cancer, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease and congestive heart failure. Underlying causes are poorly understood, but there is an involvement of inflammatory cytokines, such as TNF-a, IFN-y, IL-6 and tumour-secreted proteolysis-inducing factor. Related syndromes are kwashiorkor and marasmus, although these are most often symptomatic of severe malnutrition. 

Cancer results in anorexia (lack of interest in eating), malnutrition, and weight loss. Although weight loss may be due to loss of muscle and organ tissue (lean body mass), as well as of fat, the loss of fat is a minimal concern in cancer and other wasting diseases. Cachexia is a term that is often used to n fer to the wasting of muscle and other tissues that occurs with various diseases. 

Improved nutrition stains enhances snrvival and improves treatment tolerance in many but not all children. Mahmtrition in cancer patients due to simple starvation, characterized by normal metabolism but inadequate nutrient intake or malabsorption, appears to be responsive to nutrition intervention. However, malnutrition due to cancer cachexia, characterized by altered nutrient use despite adequate supply, does not. " ... 

The intent of EN and PN should be to prevent or reverse protein-calorie malnutrition, and treatment of malnutrition due to cancer cachexia is controversial. Some clinicians believe nutrition support is warranted in terminally ill children if an improved quality of life can be attained. 

For the above retisons, and probably others yet unknown, cancer patients often exhibit cachexia—a general lack of nutrition. Hence, steps should be taken to correct the malnutrition and fluid and electrolyte imbalances in order for other therapeutic measures to proceed—and succeed. 

Malnutrition, acidosis, electrolyte disturbances, cachexia, infection, fatigue, and muscle dysfunction, aU exacerbate ventilatory insufficiency. Narcotics, sedatives, and supplemental oxygen reduce ventilatory drive and exacerbate alveolar hypoventilaticm. 

---