Body composition and time course changes in regional distribution of fat and lean tissue in unselected cancer patients on palliative care--correlations with food intake, metabolism, exercise capacity, and hormones.
BACKGROUND
Several investigations that yielded different results in terms of net changes in body composition of weight-losing cancer patients have been reported that employed a variety of methods based on fundamentally different technology. Most of those reports were cross-sectional, whereas to the authors' knowledge there is sparse information available on longitudinal follow-up measurements in relation to other independent methods for the assessment of metabolism and performance.


METHODS
For the current report, the authors evaluated time course changes in body composition (dual-energy X-ray absorptiometry) with measurements of whole body and regional distribution of fat and lean tissue in relation to food and dietary intake, host metabolism (indirect calorimetry), maximum exercise capacity (walking test), and circulating hormones in cancer patients who were receiving palliative care during 4-62 months of follow-up. The entire cohort comprised 311 patients, ages 68 years +/- 3 years who were diagnosed with solid gastrointestinal tumors (84 colorectal tumors, 74 pancreatic tumors, 73 upper gastrointestinal tumors, 51 liver-biliary tumors, 3 breast tumors, 5 melanomas, and 21 other tumor types).


RESULTS
Decreased body weight was explained by loss of body fat, preferentially from the trunk, followed by leg tissue and arm tissue, respectively. Lean tissue (fat-free mass) was lost from arm tissue, whereas trunk and leg tissue compartments increased, all concomitant with declines in serum albumin, increased systemic inflammation (C-reactive protein, erythrocyte sedimentation rate), increased serum insulin, and elevated daily caloric intake; whereas serum insulin-like growth factor 1 (IGF-1), resting energy expenditure, and maximum exercise capacity remained unchanged in the same patients. Serum albumin levels (P < 0.001), whole body fat (P < 0.02), and caloric intake (P < 0.001) predicted survival, whereas lean tissue mass did not. Daily intake of fat and carbohydrate was more important for predicting survival than protein intake. Survival also was predicted by serum IGF-1, insulin, leptin, and ghrelin levels (P < 0.02 - P < 0.001). Serum insulin, leptin, and ghrelin (total) levels predicted body fat (P < 0.001), whereas IGF-1 and thyroid hormone levels (T3, free T3) predicted lean tissue mass (P < 0.01). Systemic inflammation primarily explained variation in lean tissue and secondarily explained loss in body fat. Depletion of lean arm tissue was related most to short survival compared with the depletion of lean leg and trunk tissue.


CONCLUSIONS
The current results demonstrated that body fat was lost more rapidly than lean tissue in progressive cancer cachexia, a phenomenon that was related highly to alterations in the levels of circulating classic hormones and food intake, including both caloric amount and diet composition. The results showed importance in the planning of efficient palliative treatment for cancer patients.
Fouladiun
Marita
M
Surgical Metabolic Research Laboratory at Lundberg Laboratory for Cancer Research, Göteborg, Sweden.
Körner
Ulla
U
Bosaeus
Ingvar
I
Daneryd
Peter
P
Hyltander
Anders
A
Lundholm
Kent G
KG
D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D001799:Blood Sedimentation; D001823:Body Composition; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004435:Eating / Q000502:physiology*; D002149:Energy Intake; D004734:Energy Metabolism; D017079:Exercise Tolerance / Q000502:physiology*; D005500:Follow-Up Studies; D054439:Ghrelin; D006728:Hormones / Q000097:blood*; D006801:Humans; D007328:Insulin / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D020738:Leptin / Q000097:blood; D008137:Longitudinal Studies; D018482:Muscle, Skeletal / Q000473:pathology*; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D036361:Peptide Hormones / Q000097:blood; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D015431:Weight Loss
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D054439:Ghrelin; D006728:Hormones; D007328:Insulin; D020738:Leptin; D036361:Peptide Hormones; D012709:Serum Albumin; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein