Bosaeus I, Daneryd P, Svanberg E, Lundholm K
Department of Clinical Nutrition, Sahlgrenska University Hospital, Göteborg, Sweden.
Int J Cancer. 2001 Aug 1;93(3):380-3. doi: 10.1002/ijc.1332.
Weight loss and anorexia are frequent findings in advanced cancer. The progressive wasting could be attributed to changes in dietary intake and/or energy expenditure mediated by metabolic alterations. In this study, we analyzed dietary intake in generalized malignant disease of solid tumor type in relation to resting energy expenditure (REE) and reported weight loss. In a group of 297 unselected cancer patients from a university hospital outpatient clinic, dietary intake of energy and macronutrients from a 4-day food record, REE by indirect calorimetry, height, weight and weight loss were recorded. Protein intake was validated against 24 hr urine nitrogen in a subgroup (n = 53), and no indication of systematic misreporting was found. Mean daily dietary intake was below maintenance requirements, 26 +/- 10 kcal/kg. Weight loss of more than 10% was present in 43% of patients and elevated REE (>110% of predicted) in 48%. Dietary intake did not differ between normo- and hypermetabolic patients, nor was tumour type or gender related to energy and protein intake. Weight loss could not be accounted for by diminished dietary intake since energy intake in absolute amounts was not different and intake per kilogram body weight was higher in weight-losing patients compared to weight-stable patients. Dietary macronutrient composition did not differ from the general population. Dietary intake of energy and protein was decreased, but dietary macronutrient composition did not appear to be changed. Weight loss and hypermetabolism were frequent and not compensated for by an increase in spontaneous food intake. Our results indicate that an expected up-regulation of dietary intake in response to elevated energy expenditure is frequently lost in cancer patients. This may be the explanation behind cancer cachexia rather than a primary decrease in appetite.
体重减轻和厌食是晚期癌症的常见症状。进行性消瘦可能归因于饮食摄入量的变化和/或由代谢改变介导的能量消耗。在本研究中，我们分析了实体瘤类型的全身性恶性疾病患者的饮食摄入量与静息能量消耗（REE）及报告的体重减轻之间的关系。在一组来自大学医院门诊的297例未经选择的癌症患者中，记录了通过4天食物记录得出的能量和常量营养素的饮食摄入量、通过间接测热法测得的REE、身高、体重和体重减轻情况。在一个亚组（n = 53）中，根据24小时尿氮对蛋白质摄入量进行了验证，未发现系统性误报的迹象。平均每日饮食摄入量低于维持需求，为26 +/- 10千卡/千克。43%的患者体重减轻超过10%，48%的患者REE升高（>预测值的110%）。正常代谢和高代谢患者的饮食摄入量没有差异，肿瘤类型或性别与能量和蛋白质摄入量也无关。体重减轻不能用饮食摄入量减少来解释，因为绝对能量摄入量没有差异，而且与体重稳定患者相比，体重减轻患者每千克体重的摄入量更高。饮食中常量营养素组成与一般人群没有差异。能量和蛋白质的饮食摄入量减少，但饮食中常量营养素组成似乎没有改变。体重减轻和高代谢很常见，且自发食物摄入量的增加无法弥补。我们的结果表明，癌症患者常常无法实现因能量消耗增加而预期的饮食摄入量上调。这可能是癌症恶病质背后的原因，而非食欲的原发性下降。
