Mitchell Toni, Clarke Lewis, Goldberg Alexandra, Bishop Karen S
School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand.
Department of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand.
Healthcare (Basel). 2019 Jul 9;7(3):89. doi: 10.3390/healthcare7030089.
Pancreatic cancer is a cancer with one of the highest mortality rates and many pancreatic cancer patients present with cachexia at diagnosis. The definition of cancer cachexia is not consistently applied in the clinic or across studies. In general, it is "defined as a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass with or without loss of fat mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment." Many regard cancer cachexia as being resistant to dietary interventions. Cachexia is associated with a negative impact on survival and quality of life. In this article, we outline some of the mechanisms of pancreatic cancer cachexia and discuss nutritional interventions to support the management of pancreatic cancer cachexia. Cachexia is driven by a combination of reduced appetite leading to reduced calorie intake, increased metabolism, and systemic inflammation driven by a combination of host cytokines and tumour derived factors. The ketogenic diet showed promising results, but these are yet to be confirmed in human clinical trials over the long-term. L-carnitine supplementation showed improved quality of life and an increase in lean body mass. As a first step towards preventing and managing pancreatic cancer cachexia, nutritional support should be provided through counselling and the provision of oral nutritional supplements to prevent and minimise loss of lean body mass.
胰腺癌是死亡率最高的癌症之一，许多胰腺癌患者在确诊时就已出现恶病质。癌症恶病质的定义在临床或各项研究中并未得到一致应用。一般来说，它“被定义为一种多因素综合征，其特征是骨骼肌质量持续丧失，伴有或不伴有脂肪量的减少，且无法通过传统营养支持完全逆转，并导致进行性功能损害”。许多人认为癌症恶病质对饮食干预有抗性。恶病质对生存和生活质量有负面影响。在本文中，我们概述了胰腺癌恶病质的一些机制，并讨论了支持胰腺癌恶病质管理的营养干预措施。恶病质是由食欲减退导致热量摄入减少、代谢增加以及宿主细胞因子和肿瘤衍生因子共同驱动的全身炎症所引起的。生酮饮食显示出有前景的结果，但这些结果尚未在长期人体临床试验中得到证实。补充左旋肉碱显示出生活质量得到改善，瘦体重增加。作为预防和管理胰腺癌恶病质的第一步，应通过咨询和提供口服营养补充剂来提供营养支持，以预防和尽量减少瘦体重的损失。
