Cachexia in cancer

Cancer cachexia is a multifactorial syndrome (wasting syndrome), mainly characterized by weight loss anorexia, asthenia, and anemia. These factors demonstrate variable extent in the initial phases. It is considered the most common representation of the advanced form of malignant disease, causing death. It is the most destructive disease affecting other body systems such as skeletal muscle and adipose tissue while causing numbness due to lack of nutrition ^​1​. Hence, the nutritional status within the body is estimated to show direct linkage towards tumor-induced alterations during the metabolism. Cachexia suppresses the patient’s immunity to fight against any infection and withstanding any treatment of chemotherapy and radiotherapy. It results in decreasing the efficiency of the body. 

Cancer cachexia affects the fat cells and leads to wasting and weakness of muscle mass. It is mainly associated with abnormal energy and byproduct metabolism that cannot be reversed by conventional nutritional support. It shows a higher prevalence of advanced types of cancers. One of the most common screening criteria for cancer cachexia includes losing body weight with more than 5% of the patient’s original body weight. 

Risk factors and causes of Cachexia cancer

Several factors are responsible for the cause of cachexia while decreasing the level of essential substances within the body. Multiple mechanisms are involved in the development of cachexia. An inflammatory reaction to tumor, anorexia (loss of appetite), decreased physical activity, decreased secretion of host anabolic hormones, altered metabolic response in the body with abnormalities in protein, lipid, and carbohydrate metabolism are the common factors responsible for the cause of cachexia. These factors make the liver incapable of responding to insulin, leading to insulin resistance. The body loses its ability to utilize blood glucose for energy, and the body becomes weak. 

Symptoms

The primary symptoms of cachexia involve muscle and fat loss, making the individual look malnourished. The other common cachexia symptoms include fatigue, reduced muscle strength and muscle wasting, loss of appetite, decreased albumin protein level, anaemia, high inflammation level, low fat-free mass index, and oedema swelling. 

Prevention of cachexia cancer

Cachexia cancer can be prevented by consuming a healthy diet and exercising regularly. It helps in improving muscle strength and its function. Hence, cardiovascular fitness is maintained, and fatigue is reduced. It eventually enhances the quality of life and is considered an effective strategy in managing cancer-related cachexia.

Nutritional diet for cachexia cancer prevention

The nutritional support to the patients of cancer cachexia helps counter negative energy balance and the mechanism of protein breakdown without stimulating tumor growth or the negative influence of anti-tumor therapy ^​2​. Therefore, positive protein balance is required with supplementation of specific nutrients for mitigating the catabolic and stimulating anabolic signals among patients of cachexia cancer. Some of the common nutrients for cachexia cancer are illustrated below:

• Dietary protein helps maintain a positive balance by increasing skeletal muscle mass, elevating the plasma levels of essential amino acids, and maintaining plasma protein values. The dietary protein intake is evaluated at 1.3–1.5 g/kg/day. It consists of branched-chain amino acids (BCAAs) showing therapeutic effects and is considered to build up the integral part of skeletal muscles. It further decreases protein breakdown and stimulates protein synthesis. Leucine is the most potent branched-chain amino acid in the dietary protein, which aims for improving protein synthesis, increase plasma amino acid concentration, and reduce the loss of skeletal muscle mass induced by cancer cachexia. Leucine is mainly found in chickpea, soybean, and nuts. 

Glutamine is another primary metabolic fuel for gastrointestinal cells that helps maintain the intestinal mucosa’s normal integrity. It is a precursor amino acid of glutathione, a major antioxidant. The glutamine content in dietary protein evolves the mechanism for preventing cachexia which is associated with a decrease in intracellular glutathione concentration in the muscle. It is mainly present in Tofu, Lentils, beans, and peas.

Glycine is also found in dietary protein showing anti-inflammatory, immunomodulatory and cytoprotective properties. It aims to inhibit inflammatory cell activation, decrease the formation of free radicals and other toxic compounds, inhibit the growth of certain types of tumor, reduce tumor growth, and weaken cancer-induced cachexia. It is mainly found in soy, peanuts, sesame seeds, lentils etc. are good sources of glycine. 

Arginine is BCCA which is essential for cell growth survival and protein synthesis. It is the type of precursor of nitric oxide needed for stimulating the release of certain hormones, such as insulin and growth hormone, regulating blood flow, tissue oxygenation, and improving immune function. It further enhances T cell natural killer cell activity and inhibits tumor growth. It is found in the food items of nuts such as almond, peanuts, brazil nuts, cashew nuts, pumpkin, sesame, sunflower seeds and whole grains like buckwheat, oats, brown rice.

• Dietary Fat: It is essential for providing energy to the body. It is considered the structural component of the cell membrane and carries fat-soluble vitamins. It majorly contains Omega 3 fatty acids. Omega 3 fatty acids constitute Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which aim for reducing inflammation in the human body. Its mechanism evolves the blocking of muscle proteolysis (breakdown of proteins). Muscle health tends to improve when the omega three fatty acid supply is maintained in the body. Supplementation with omega three effectively stabilizes weight loss, reduces lean tissue wasting, and increases survival in patients with advanced cancer. Chia seeds, hemp seeds, almonds, walnuts, and flax seeds are good plant-based Omega 3 fatty acids sources.
• Other nutrients include L carnitine and magnesium. L carnitine is considered essential for the metabolism of fatty acids, and its 95 % content is present in muscles ^​3​. It has antioxidant and anti-inflammatory properties. The decreased carnitine levels lead to fatigue, muscle weakness, and reduced tolerance to metabolic stress. Patients suffering from cachexia have low L carnitine levels; improving these levels decreases fatigue and enhances the quality of life. Muscles and heart muscles rely on carnitine as a source of energy. The damage of carnitine due to chemotherapy and deficiency may cause fatigue.

Magnesium is considered the traditional chemotherapeutic agent that causes hypomagnesemia and can persist for months to years after cessation of chemotherapy. Its deficiency can lead to anorexia, nausea, and fatigue. It mainly develops in patients with cancer, and patients hospitalized or critically ill are at enhanced risk. Nuts (almonds), green vegetables, cereal and millets are good sources. Magnesium deficiency can cause muscle weakness, leading to a lack of exercise, which may lead to loss of lean muscle mass.

• Foods: Garlic is considered an essential food source. Ajoene, a Sulphur compound found in crushed garlic, exhibits protective effects against muscle atrophy ^​4​. The extract of Ajoene is prepared from garlic bulbs through crushing and heat treatment. It is one of the most powerful chemopreventive and anti-cancer foods. It is effective in suppressing inflammatory responses and muscle wasting. It improves myofiber formation via stimulation of muscle protein synthesis. It is muscle protein synthesis.

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