Nutritional status and cytokine-related protein breakdown in elderly patients with gastrointestinal malignancies.
BACKGROUND
Age-related factors affecting cytokine-related whole-body protein breakdown and their relation to clinical outcomes in cancer patients were investigated.


METHODS
For assessment of protein-calorie malnutrition and protein breakdown, the creatinine height index (CHI) and daily urinary excretion of 3-methylhistidine (3-MH) were measured in 70 patients with gastrointestinal malignancies. Perioperative cytokine profile was evaluated to assess its relation to perioperative protein catabolism.


RESULTS
In elderly patients, daily 3-MH excretion during the stable preoperative period decreased with the increase of tumor interleukin (IL)-6 production, suggestive of the activation of a metabolic compensation mechanism. However, these patients showed significant increases in postoperative 3-MH excretion in accord with perioperative systemic IL-6 response, and this deterioration of the compensating mechanism seemed to be associated with poor clinical outcome. An increase in 3-MH excretion under surgical stress was positively correlated with postoperative consumption of IL-6 soluble receptor (sR) in elderly patients with nutritional depletion.


CONCLUSIONS
In elderly cancer patients with protein-calorie malnutrition, metabolic compliance against intrinsic IL-6 may be compensated for in the preoperative stable period, but deteriorate from surgical insults. This mechanism might involve increased affinity of IL-6 with IL-6sR under surgical stress.
Inoue
Yasuhiro
Y
The Second Department of Surgery, Mie University School of Medicine, Tsu, Japan.
Miki
Chikao
C
Kusunoki
Masato
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000378:metabolism / Q000601:surgery; D003404:Creatinine / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000378:metabolism* / Q000601:surgery; D006801:Humans; D015850:Interleukin-6 / Q000096:biosynthesis; D008297:Male; D008762:Methylhistidines / Q000652:urine; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011379:Prognosis; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000378:metabolism*; D019947:Receptors, Interleukin-6 / Q000378:metabolism; D012737:Sex Factors
D016207:Cytokines; D015850:Interleukin-6; D008762:Methylhistidines; D019947:Receptors, Interleukin-6; D003404:Creatinine; C028118:3-methylhistidine