title: The energy balance in cancer cachexia revisited.
abstract: OBJECTIVE
  To review new putative mechanisms involved in the pathophysiology of a disturbed energy balance in cancer cachexia, which can lead to novel targets for clinical cachexia management. In the context of rapid developments in tumour treatment with potential systemic consequences, this article reviews recent data on energy requirements. Furthermore, we focus on new insights in brown adipose tissue (BAT) activity and reward processing in the brain in relation to the cachexia process.
  
  
  RESULTS
  Nearly no new data have been published on energy requirements of cancer patients in the light of comprehensive new therapies in oncology. New developments, such as the introduction of staging with 18F-fluorodeoxyglucose PET-computed tomography scanning, led to the observation that BAT activation may contribute to impaired energy balance in cancer cachexia. Animal and human data to date provide an indication that BAT activation indeed occurs, but its quantitative impact on the degree of cachexia is controversial. The peripheral and central nervous system is known to influence satiation, with a possible role for impaired food reward processing in the brain. To date, there are limited confirmatory data, but this is an interesting new area to explore for better understanding and treating cancer-induced anorexia.
  
  
  CONCLUSIONS
  The multimodal approach to counteract cancer cachexia should expand its targets to BAT and food reward processing in the brain.
authors.affiliation: aDepartment of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands bDepartment of Surgery, University of Edinburgh, Edinburgh, United Kingdom cDepartment of Respiratory Medicine, NUTRIM School of Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: de Vos-Geelen
authors.forename: Kenneth C H
authors.initials: KC
authors.lastname: Fearon
authors.forename: Annemie M W
authors.initials: AM
authors.lastname: Schols
mesh_terms: D002001:Adipose Tissue, Brown / Q000502:physiology*; D000818:Animals; D001921:Brain / Q000502:physiology; D002100:Cachexia / Q000503:physiopathology*; D004195:Disease Models, Animal; D004734:Energy Metabolism; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000503:physiopathology*; D009751:Nutritional Requirements; D049268:Positron-Emission Tomography