Protein anabolic resistance in cancer

Abstract

Purpose of review Preventing unintentional weight and muscle loss is of crucial importance to maintain the condition and well-being of patients with cancer, improve treatment response and tolerance, and prolong survival. Anabolic resistance might explain why some cancer patients do not respond to nutritional intervention but does recent evidence actually support this? We will discuss recent literature that cast doubt on attenuated anabolic potential in cancer. Recent findings Although anabolic resistance was observed in the past, more recent studies have shown that advanced cancer patients have an anabolic potential after intake of high-quality proteins. Furthermore a consistent linear relationship is observed in cancer between (essential) amino acid availability from the diet and net protein gain. The studied cancer patients however were often characterized by a normal or obese body weight, following the trend in the general population, and mild systemic inflammation. Factors like recent chemotherapy, surgery or cachexia do not seem to attenuate the anabolic potential to feeding. Summary Cancer patients have a normal anabolic potential which relates to the amount of essential amino acids in the meal. It remains to be determined if this is also the case in weak cancer patients with a short life expectancy and high systemic inflammation.

Nutrition Support for Persistent Inflammation, Immunosuppression, and Catabolism Syndrome

“…Therefore, what works in cancer cachexia should be applicable to PICS. Recent studies have shown a linear relationship between dietary amino acid intake and net protein anabolism in patients with advanced cancer (including non–small cell lung cancer and pancreatic cancer) similar to that observed in healthy controls 21 . These data support the recent guideline recommendation that cancer patients should consume at least 1.2–2.0 g/kg/d of protein 22 .…”

High Serum Essential Amino Acids as a Predictor of Skeletal Muscle Depletion in Patients With Cachexia and Advanced Gastrointestinal Cancers

“…Previous studies have shown that a lower ΔPMI (likely, patients with sarcopenia or cachexia) results in poor prognosis for patients with solid cancer 13 , 14 . In other words, cancer and inflammation due to cancer cachexia must be considered nutrition risk factors.…”

Pre‐operative nutrition and the elective surgical patient: why, how and what?

“…A stable isotope investigation estimated that, in pancreatic cancer, patients experiencing an ongoing inflammatory response, 2.6 g of muscle protein would need to be catabolised to synthesise 1 g of the positive acute phase reactant fibrinogen, if food was not consumed . In addition, older patients and patients with advanced cancer might suffer from anabolic resistance. That is, although their anabolic capacity is intact, a larger, sufficient dose of amino acids is required to achieve a typical anabolic response .…”