Bistrian B R
Cancer. 1986 Oct 15;58(8 Suppl):1863-6. doi: 10.1002/1097-0142(19861015)58:8+<1863::aid-cncr2820581412>3.0.co;2-p.
Two patterns of response, that due to starvation or semistarvation and that due the stress, determine whether protein-calorie malnutrition of the adult marasmus variety or hypoalbuminemic malnutrition will occur in any particular nonmalignant disease. The latter condition can have two major components, the neuroendocrine response to injury, which is in large measure mediated by hormones of the hypothalamus and adrenal gland, and the panoply of responses to interleukin-1 production and release by macrophages and monocytes upon activation, usually by phagocytosis. In some cancer patients with weight loss there are many similarities to an interleukin-1 response including increases in resting energy expenditure, whole-body protein flux and synthesis and glucose flux and recycling, hypoalbuminemia and increased albumin catabolic rates, and an adaptive low T3 state that suggest a similar injury/infection response. Separation of cancer patients with malnutrition into those with an injury/infection response and those with simple starvation may explain the heterogeneous response to nutritional support among malnourished cancer patients and suggest new feeding regimens that may uniquely benefit the stress form of cancer malnutrition.
两种反应模式，即饥饿或半饥饿引起的反应以及应激引起的反应，决定了在任何特定的非恶性疾病中是否会出现成人消瘦型蛋白质 - 热量营养不良或低蛋白血症性营养不良。后一种情况可能有两个主要成分，一是对损伤的神经内分泌反应，很大程度上由下丘脑和肾上腺的激素介导；二是巨噬细胞和单核细胞在激活（通常通过吞噬作用）后产生和释放白细胞介素 -1 所引发的一系列反应。在一些体重减轻的癌症患者中，存在许多与白细胞介素 -1 反应相似的情况，包括静息能量消耗增加、全身蛋白质通量和合成以及葡萄糖通量和再循环增加、低蛋白血症和白蛋白分解代谢率升高，以及适应性低 T3 状态，这表明存在类似的损伤 / 感染反应。将营养不良的癌症患者分为具有损伤 / 感染反应的患者和单纯饥饿的患者，可能解释了营养不良的癌症患者对营养支持的异质性反应，并提示了可能对癌症营养不良的应激形式有独特益处的新喂养方案。
