Advertisement

Anorexia

  • Alessandro Laviano
  • Michael M. Meguid
  • Filippo Rossi Fanelli

Abstract

In medicine, specific combinations of symptoms and signs contribute to establishing a diagnosis. However, symptoms or constellations of symptoms (i.e., syndromes) per se may not be specific for a single disease; rather, they are observed during the clinical course of a number of acute and chronic diseases. Among them, anorexia is a highly prevalent syndrome that heavily impacts on the prognosis of patients suffering from acute (i.e. sepsis) and chronic (i.e. cancer, liver cirrhosis, chronic renal failure, chronic obstructive pulmonary [COPD]) diseases.

Keywords

Energy Intake Arcuate Nucleus Reduce Food Intake Chronic Renal Failure Patient Peripheral Signal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Murray MJ, Murray AB (1979) Anorexia of infection as a mechanism of host defense. Am J Clin Nutr 32:593–596PubMedGoogle Scholar
  2. 2.
    Stubbs RJ, Hughes DA, Johnstone AM et al (2000) The use of visual analogue scales to assess motivation to eat in human subjects: a review of their reliability and validity with an evaluation of new handheld computerized systems for temporal tracking of appetite ratings. Br J Nutr 84:405–415PubMedGoogle Scholar
  3. 3.
    Rossi Fanelli F, Cangiano C, Ceci F et al (1986) Plasma tryptophan and anorexia in human cancer. Eur J Cancer Clin Oncol 22:89–95PubMedCrossRefGoogle Scholar
  4. 4.
    Geels P, Eisenhauer E, Bezjak A et al (2000) Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol 18:2395–2405PubMedGoogle Scholar
  5. 5.
    DeWys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am JMed 69:491–497Google Scholar
  6. 6.
    Sutton LM, Demark-Wahnefried W, Clipp EC (2003) Management of terminal cancer in elderly patients. Lancet Oncol 4:149–157PubMedCrossRefGoogle Scholar
  7. 7.
    Pirovano M, Maltoni M, Nanni O et al (1999) A new palliative score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage 17:231–239PubMedCrossRefGoogle Scholar
  8. 8.
    Maltoni M, Nanni O, Pirovano M et al (1999) Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care. J Pain Symptom Manage 17:240–247PubMedCrossRefGoogle Scholar
  9. 9.
    Daly JM, Redmond HP, Gallagher H (1992) Perioperative nutrition in cancer patients. JPEN 16(Suppl 6):100S–105SGoogle Scholar
  10. 10.
    Marchesini G, Bianchi G, Merli M et al for the Italian BCAA Study Group (2003) Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 124:1792–1801PubMedCrossRefGoogle Scholar
  11. 11.
    Hiroshige K, Sonta T, Suda T et al (2001) Oral supplementation of branched-chain amino acid improves nutritional status in elderly patients on chronic haemodialysis. Nephrol Dial Transplant 16:1856–1862PubMedCrossRefGoogle Scholar
  12. 12.
    Edmonds P, Karlsen S, Khan S, Addington-Hall J (2001) A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer. Palliat Med 15:287–295PubMedCrossRefGoogle Scholar
  13. 13.
    Nordgren L, Sorensen S (2003) Symptoms experienced in the last six months of life in patients with end-stage heart failure. Eur J Cardiovasc Nurs 2:213–217PubMedCrossRefGoogle Scholar
  14. 14.
    Lynn J, Teno JM, Phillips RS et al (1997) Perceptions by family members of the dying experience of older and seriously ill patients. SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Int Med 126:97–106PubMedGoogle Scholar
  15. 15.
    Gibbs JS, McCoy AS, Gibbs LM et al (2002) Living with and dying from heart failure: the role of palliative care. Heart 88(Suppl 2):ii36–ii39PubMedGoogle Scholar
  16. 16.
    Rossi Fanelli F, Muscaritoli M, Cangiano C et al (1999) The basis for a rational nutritional approach to patients with cancer. In: Abraham NG, Tabilio A, Martelli M et al (eds) Molecular biology of hematopoiesis. Kluwer Academic/Plenum Publishers, New York, pp 229–234Google Scholar
  17. 17.
    Tisdale MJ (2002) Cachexia in cancer patients. Nat Rev Cancer 2:862–871PubMedCrossRefGoogle Scholar
  18. 18.
    Maltoni M, Pirovano M, Scarpi E et al (1995) Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study. Cancer 75:2613–2622PubMedCrossRefGoogle Scholar
  19. 19.
    Apolone G, De Carli G, Brunetti M, Garattini S (2001) Health-related quality of life (HR-QOL) and regulatory issues. An assessment of the European Agency for the Evaluation of Medicinal Products (EMEA) recommendations on the use of HR-QOL measures in drug approval. Pharmacoeconomics 19:1727–1729CrossRefGoogle Scholar
  20. 20.
    Schwartz MW, Woods SC, Porte DJr et al (2000) Central nervous system control of food intake. Nature 404:661–671PubMedGoogle Scholar
  21. 21.
    Janik JE, Curti BD, Considine RV et al (1997) Interleukin-1 alpha increases serum leptin concentrations in humans. J Clin Endocrinol Metab 82:3084–3086PubMedCrossRefGoogle Scholar
  22. 22.
    Chance WT, Sheriff S, Moore J et al (1998) Reciprocal changes in hypothalamic receptor binding and circulating leptin in anorectic tumor-bearing rats. Brain Res 803:27–33PubMedCrossRefGoogle Scholar
  23. 23.
    Simons JP, Schols AM, Campfield LA et al (1997) Plasma concentration of total leptin and human lung-cancer-associated cachexia. Clin Sci 93:273–277PubMedGoogle Scholar
  24. 24.
    Bing C, Taylor S, Tisdale MJ, Williams G (2001) Cachexia in MAC 16 adenocarcinoma: suppression of hunger despite normal regulation of leptin, insulin and hypothalamic neuropeptide Y. J Neurochem 79:1004–1012PubMedCrossRefGoogle Scholar
  25. 25.
    Mantovani G, Macciò A, Mura L et al (2000) Serum levels of leptin and proinflammatory cytokines in patients with advanced-stage cancer at different sites. J Mol Med 78:554–561PubMedCrossRefGoogle Scholar
  26. 26.
    Stenvinkel P, Lindholm B, Lonnqvist F et al (2000) Increases in serum leptin levels during peritoneal dialysis are associated with inflammation and a decrease in lean body mass. J Am Soc Nephrol 11:1303–1309PubMedGoogle Scholar
  27. 27.
    Ben-Ari Z, Schafer Z, Sulkes J et al (2002) Alterations in serum leptin in chronic liver disease. Dig Dis Sci 47:183–189PubMedCrossRefGoogle Scholar
  28. 28.
    Kahler A, Zimmermann M, Langhans W (1999) Suppression of hepatic fatty acid oxidation and food intake in men. Nutrition 15:819–828PubMedCrossRefGoogle Scholar
  29. 29.
    Loftus TM, Jaworsky DE, Frehywot GL et al (2000) Reduced food intake and body weight in mice treated with fatty acid synthase inhibitors. Science 288:2379–2381PubMedCrossRefGoogle Scholar
  30. 30.
    Rasmussen BB, Holmback UC, Volpi E et al (2002) Malonyl coenzyme A and the regulation of functional carnitine palmitoyltransferase-1 activity and fat oxidation in human skeletal muscle. J Clin Invest 110:1687–1693PubMedCrossRefGoogle Scholar
  31. 31.
    Peluso G, Nicolai R, Reda E et al (2000) Cancer and anticancer therapy-induced modification on metabolism mediated by carnitine system. J Cell Physiol 182:339–350PubMedCrossRefGoogle Scholar
  32. 32.
    Laviano A, Meguid MM, Renvyle T et al (1996) Carnitine supplementation accelerates normalization of food intake depressed during TPN. Physiol Behav 60:317–320PubMedCrossRefGoogle Scholar
  33. 33.
    Li JL, Zheng FL, Tan HB et al (2003) Orexin A and neuropeptide Y in plasma and hypothalamus of rats with chronic renal failure. Zhonghua Yi Xue Za Zhi 83:992–995PubMedGoogle Scholar
  34. 34.
    Rossi Fanelli F, Cangiano C (1991) Increased availability of tryptophan in brain as common pathogenic mechanism for anorexia associated with different diseases. Nutrition 7:364–367PubMedGoogle Scholar
  35. 35.
    Laviano A, Meguid MM, Yang Z-J et al (1996) Cracking the riddle of cancer anorexia. Nutrition 12:706–710PubMedGoogle Scholar
  36. 36.
    Chance WT, Balasubramaniam A, Fischer JE (1995) Neuropeptide Y and the development of cancer anorexia. Ann Surg 221:579–587PubMedCrossRefGoogle Scholar
  37. 37.
    Chance WT, Sheriff S, Kasckow JW et al (1998) NPY messenger RNA is increased in medial hypothalamus of anorectic tumor-bearing rats. Regul Pept 75–76:347–353PubMedCrossRefGoogle Scholar
  38. 38.
    Plata-Salaman CR, Ilyin SE, Gayle D (1998) Brain cytokine mRNAs in anorectic rats bearing prostate adenocarcinoma tumor cells. Am J Physiol 275:R566–R573PubMedGoogle Scholar
  39. 39.
    Jatoi A, Loprinzi CL, Sloan JA et al (2001) Neuropeptide Y, leptin, and cholecystokinin 8 in patients with advanced cancer and anorexia: a North Central Treatment Group exploratory investigation. Cancer 92:629–633PubMedCrossRefGoogle Scholar
  40. 40.
    Meguid MM, Ramos EJ, Laviano A et al (2004) Tumor anorexia: effects on neuropeptide Y and monoamines in paraventricular nucleus. Peptides 25:261–266PubMedCrossRefGoogle Scholar
  41. 41.
    Makarenko IG, Meguid MM, Gatto L et al (2003) Decreased NPY innervation of the hypothalamic nuclei in rats with cancer anorexia. Brain Res 961:100–108PubMedCrossRefGoogle Scholar
  42. 42.
    Aguilera A, Codoceo R, Selgas R et al (1998) Anorexigen (TNF-alpha, cholecystokinin) and orexigen (neuropeptide Y) plasma levels in peritoneal dialysis (PD) patients: their relationship with nutritional parameters. Nephrol Dial Transplant 13:1476–1483PubMedCrossRefGoogle Scholar
  43. 43.
    Marks DL, Ling N, Cone RD (2001) Role of central melanocortin system in cachexia. Cancer Res 61:1432–1438PubMedGoogle Scholar
  44. 44.
    Wisse BE, Frayo RS, Schwartz MW, Cummings DE (2001) Reversal of cancer anorexia by blockade of central melanocortin receptors in rats. Endocrinology 142:3292–3301PubMedCrossRefGoogle Scholar
  45. 45.
    Plata-Salaman CR (1996) Anorexia during acute and chronic disease. Nutrition 12:69–78PubMedCrossRefGoogle Scholar
  46. 46.
    Aguilera A, Selgas R, Codoceo R, Bajo A (2000) Uremic anorexia: a consequence of persistently high brain serotonin levels? The tryptophan/serotonin disorder hypothesis. Perit Dial Int 20:810–816PubMedGoogle Scholar
  47. 47.
    Opara El, Laviano A, Meguid MM, Yang Z-J (1995) Correlation between food intake and CSF IL-la in anorectic tumor bearing rats. Neuroreport 6:750–752PubMedCrossRefGoogle Scholar
  48. 48.
    Laviano A, Gleason JR, Meguid MM et al (2000) Effects of intra-VMN mianserin and IL-Ira on meal number in anorectic tumor-bearing rats. J Investig Med 48:40–48PubMedGoogle Scholar
  49. 49.
    Pereira BJ, Shapiro L, King AJ et al (1994) Plasma levels of IL-1 beta, TNF-alpha and their specific inhibitors in undialyzed chronic renal failure, CAPD and hemodialysis patients. Kidney Int 45:890–896PubMedCrossRefGoogle Scholar
  50. 50.
    Cangiano C, Testa U, Muscaritoli M et al (1994) Cytokines, tryptophan and anorexia in cancer patients before and after surgical tumor ablation. Anticancer Res 14:1451–1456PubMedGoogle Scholar
  51. 51.
    Wang W, Lonnroth C, Svanberg E, Lundholm K (2001) Cytokine and cyclooxigenase-2 protein in brain areas of tumor-bearing mice with prostanoidrelated anorexia. Cancer Res 61:4707–4715PubMedGoogle Scholar
  52. 52.
    Wang W, Danielsson A, Svanberg E, Lundholm K (2003) Lack of effects by tricyclic antidepressant and serotonin inhibitors on anorexia in MCG 101 tumor bearing mice with eicosanoid-related anorexia. Nutrition 19:47–53PubMedCrossRefGoogle Scholar
  53. 53.
    Inui A (1999) Cancer anorexia-cachexia syndrome: are neuropeptides the key? Cancer Res 59:4493–4501PubMedGoogle Scholar
  54. 54.
    Heisler LK, Cowley MA, Tecott LH et al (2002) Activation of central melanocortin pathways by fenfluramine. Science 297:609–611PubMedCrossRefGoogle Scholar
  55. 55.
    Shintani F, Kanba S, Nakaki T et al (1993) Interleukin-lbeta augments release of norepinephrine, dopamine and serotonin in the rat anterior hypothalamus. J Neurosci 13:3574–3581PubMedGoogle Scholar
  56. 56.
    Blaha V, Yang ZJ, Meguid MM et al (1998) Ventromedial nucleus of hypothalamus is related to the development of cancer-induced anorexia: in vivo microdialysis study. Acta Medica (Hradec Kralove) 41:3–11Google Scholar
  57. 57.
    Diksic M, Young SN (2001) Study of the brain serotonergic system with labelled a-methyl-L-tryptophan. J Neurochem 78:1185–1200PubMedCrossRefGoogle Scholar
  58. 58.
    Cangiano C, Cascino A, Ceci F et al (1990) Plasma and CSF tryptophan in cancer anorexia. J Neural Transm (Gen Sect) 81:225–233CrossRefGoogle Scholar
  59. 59.
    Laviano A, Cangiano C, Preziosa I et al (1997) Plasma tryptophan and anorexia in liver cirrhosis. Int J Eating Disord 21:181–186CrossRefGoogle Scholar
  60. 60.
    Chance WT, von Meyenfeldt M, Fischer JE (1983) Serotonin depletion by 5,7-dihydroxytryptamine or para-chloroamphetamine does not affect cancer anorexia. Pharmacol Biochem Behav 18:115–121PubMedCrossRefGoogle Scholar
  61. 61.
    Laviano A, Rossi Fanelli F (2003) Pathogenesis of cancer anorexia. Still doubts after all these years? Nutrition 19:67–68PubMedCrossRefGoogle Scholar
  62. 62.
    Torelli GF, Meguid MM, Moldawer LL et al (1999) Use of recombinant human soluble TNF receptor in anorectic tumor-bearing rats. Am J Physiol 277:R850–R855PubMedGoogle Scholar
  63. 63.
    Inui A (2002) Cancer anorexia-cachexia syndrome: current issues in research and management. CA Cancer J Clin 52:72–91PubMedCrossRefGoogle Scholar
  64. 64.
    Mantovani G, Macciò A, Bianchi A et al (1995) Megestrol acetate in neoplastic anorexia/cachexia: clinical evaluation and comparison with cytokine levels in patients with head and neck carcinoma treated with neoadjuvant chemotherapy. Int J Clin Lab Res 25:135–141PubMedCrossRefGoogle Scholar
  65. 65.
    Mantovani G, Macciö A, Esu S et al (1997) Medroxyprogesterone acetate reduces the in vitro production of cytokines and serotonin involved in anorexia/cachexia and emesis by peripheral blood mononuclear cells of cancer patients. Eur J Cancer 33:602–607PubMedCrossRefGoogle Scholar
  66. 66.
    Jatoi A, Windschitl HE, Loprinzi CL et al (2002) Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer treatment Group study. J Clin Oncol 20:567–573PubMedCrossRefGoogle Scholar
  67. 67.
    Loprinzi CL, Kugler JW, Sloan JA et al (1999) Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol 17:3299–3306PubMedGoogle Scholar
  68. 68.
    Calder PC (2002) Dietary modifications of inflammation with lipids. Proc Nutr Soc 61:345–358PubMedCrossRefGoogle Scholar
  69. 69.
    Bruera E, Strasser F, Palmer JL et al (2003) Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. J Clin Oncol 21:129–134PubMedCrossRefGoogle Scholar
  70. 70.
    Cahlin C, Gelin J, Delbro D et al (2000) Effect of cyclooxigenase and nitric oxide synthase inhibitors on tumor growth in mouse tumor models with and without cachexia related to prostanoids. Cancer Res 60:1742–1749PubMedGoogle Scholar
  71. 71.
    Lundholm K, Gelin J, Hyltander A et al (1994) Antiinflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors. Cancer Res 54:5602–5606PubMedGoogle Scholar
  72. 72.
    Squadrito F, Calapai G, Altavilla D et al (1994) Central serotoninergic system involvement in the anorexia induced by NG-nitro-L-arginine, an inhibitor of nitric oxide synthase. Eur J Pharmacol 255:51–55PubMedCrossRefGoogle Scholar
  73. 73.
    Lugarini F, Hrupka BJ, Schwartz GJ et al (2002) A role for cyclooxygenase-2 in lipopolysaccharideinduced anorexia in rats. Am J Physiol Regul Integr Comp Physiol 283:R862–R868PubMedGoogle Scholar
  74. 74.
    Nakamura K, Li YQ, Kaneko T et al (2001) Prostaglandin E3 receptor protein in serotonin and catecholamine cell groups: a double immunofluorescence study in the rat brain. Neuroscience 103:763–775PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Alessandro Laviano
    • 1
  • Michael M. Meguid
    • 2
  • Filippo Rossi Fanelli
    • 1
  1. 1.Department of Clinical MedicineUniversity of Rome La SapienzaRomeItaly
  2. 2.Department of SurgerySurgical Metabolism and Nutrition Laboratory, Neuroscience Programs,University Hospital, Upstate Medical UniversitySyracuseUSA

Personalised recommendations