Nutritional Interventions to Improve Cachexia Outcomes in Cancer—A Systematic Review

Abstract

Background and Objectives: The prevalence of cachexia has increased across all of the cancer types and accounts for up to 20% of cancer-related deaths. This paper is a systematic review of nutritional interventions aiming to improve cachexia outcomes in cancer, focusing on weight gain. Materials and Methods: A search in Medline and Elsevier databases for articles up until the 23 January 2022, was conducted. Results: Out of 5732 screened records, 26 publications were included in the final analysis. Four randomized clinical trials showed a significant body weight (BW) increase in patients treated with eicosapentaenoic acid (EPA), β-hydroxy-beta-methyl butyrate (β-HMB), arginine, and glutamine or marine phospholipids (MPL). An upward BW trend was observed in patients treated with L-carnitine, an Ethanwell/Ethanzyme (EE) regimen enriched with ω-3 fatty acids, micronutrients, probiotics, fish oil, a leucine-rich supplement, or total parental nutrition (TPN) with a high dose of a branched-chain amino acid (BCAA). Conclusions: Although clinical trials relating to large numbers of nutritional supplements present promising data, many trials provided negative results. Further studies investigating the underlying mechanisms of action of these nutritional supplements in cancer cachexia are needed. Early screening for cancer cachexia risk and nutritional intervention in cancer patients before aggravating weight loss may stabilize their weight, preventing cachexia syndrome. According to the GRADE methodology, no positive recommendation for these nutritional supplements may be expressed.

The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery

“…Although supplementation with specific nutrients, such as branched chain amino acids, HMB, omega 3-fatty acids, arginine, and leucine, has shown some benefit in traumatic and elective surgical patients, there are mixed results in oncology, and no recommendations have been made for their use in cachexia management 181 . Glutamine supplementation has, however, been found to attenuate muscle catabolism in animals and protect immune and gut-barrier function during radiochemotherapy in humans 182 .…”

Malnutrition in solid organ transplant patients: A review of the literature

“…2 Patients with either cardiac disease or cancer exhibit marked wasting and are often found to have cachexia which is associated with progressive dysfunction, high morbidity and mortality risk, decreased quality of life, and increased complications from surgery. 28 Insufficient nutrient provision is a primary cause of malnutrition, however it is not always present in the setting of sarcopenia or cachexia. For example, cachexia may be present with weight, muscle, and fat loss while the individual is meeting their nutrition needs, and muscle wasting in sarcopenia may occur with age, independent of energy intake.…”

“…Cachexia is defined as muscle wasting as a result of underlying illness with chronic inflammation and increased breakdown of muscle proteins that may or may not be associated with loss of fat mass 2 . Patients with either cardiac disease or cancer exhibit marked wasting and are often found to have cachexia which is associated with progressive dysfunction, high morbidity and mortality risk, decreased quality of life, and increased complications from surgery 28 . Insufficient nutrient provision is a primary cause of malnutrition, however it is not always present in the setting of sarcopenia or cachexia.…”

Treatment of Cachexia in Gastric Cancer: Exploring the Use of Anti-Inflammatory Natural Products and Their Derivatives

“…Cancer cachexia was traditionally thought to be due to malnutrition but is now known to be largely due to the metabolic stress of systemic inflammation, which increases calorie consumption to a level not reversible with increased nutritional intake and results in loss of lean body mass [ 6 , 7 , 8 ]. This is further compounded in many patients by reduced calorie intake due to symptoms such as nausea and anorexia, which may be associated with the underlying disease process and/or with adverse effects of treatments including chemotherapy [ 11 ]. This combination of abnormally high metabolism combined with reduced food intake results in negative nitrogen and energy balance, which leads to the catabolism of lean tissue and adipose tissue to preserve energy supply to the vital organs, driving cancer cachexia [ 8 ].…”