Cachexia in Chronic Kidney Disease

Many reports indicate that in patients with advanced chronic kidney disease (CKD) and those on dialysis there is a high prevalence of PEM, up to 40 or more, and a strong association between malnutrition and greater morbidity and mortality 25 . CKD patients not only have a high prevalence of malnutrition, but also a higher occurrence rate of inflammatory processes. Many conditions leading to malnutrition and wasting may also cause inflammation. Oxidative stress may be a major underlying cause...

References

Zigman JM, Elmquist JK (2003) Minireview from anorexia to obesity - the yin and yang of body weight control. Endocrinology 144 3749-3756 2. Asakawa A, Inui A, Kaga T et al (2003) Antagonism of ghrelin receptor reduces food intake and body weight gain in mice. Gut 52 947-952 3. Kojima M, Hosoda H, Date Y et al (1999) Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 402 656-660 4. Mondal MS, Date Y, Yamaguchi H et al (2005) Identification of ghrelin and its receptor in...

Body Mass Index

Body mass index (BMI) is an anthropometric standard measure defining the body composition of men and women. Initially it was used to measure obesity in developed countries, but it is now applied to underweight and overweight adults throughout the world. BMI provides a simple, convenient and relatively inexpensive indicator for assessing whether a person is taking in too little or too much energy. However, BMI is a crude measure of nutritional status, and additional information is needed to...

Depression

Disturbances in appetite are reported by 77-90 of all depressed patients. Among depressed patients with symptoms of appetite disturbance, about four out of five will have a decrease in appetite and one out of five an increase, a relationship that appears to be constant across cultures. In particular, patients with melancholic features are characterised by significant anorexia or weight loss and those with atypical features by significant weight gain or increase in appetite 6 . Several scales...

Leptin and Satiety

Satiety is a condition defined by a feeling of fullness and disappearance of appetite after a meal. In humans, leptin is not considered a primary satiety factor because changes in food intake do not induce short-term changes in blood leptin concentration 64 . On the other hand, leptin may play a permissive effect on satiety, by sufficiently inhibiting the central nervous system orexigenic neurons and allowing satiety signals from gut hormones and baroreceptors to affect eating behaviour 65 ....

Transthyretin or Prealbumin

The transthyretin (TTR) prealbumin molecule is a stable tetramer, composed of four identical sub-units, with a total molecular weight (MW) of 55 KDa. Each prealbumin subunit contains 127 amino acid residues 22 . The TTR monomer contains eight antiparallel beta-pleated sheet domains. The molecular structure has been determined by X-ray analysis 23 . TTR was formerly called prealbumin because it migrates anodally to albumin on serum protein electrophoresis, but this name is misleading because TTR...

Acquired Generalised Lipodystrophy Lipoatrophic Diabetes or Lawrence Syndrome

Acquired generalised lipodystrophy (AGLD) is a rare, juvenile-onset lipodystrophy, first fully described by Lawrence in 1946 1 , who reported on a young female subject with 'lipodystrophy, and hepatomegaly with diabetes, lipaemia and other metabolic disturbances.' To date, approximately 80 patients with AGLD have been reported 2 . Like others LDs, AGLD is prevalent in females. Lipoatrophy develops over a number of years, in childhood or in adolescence, so that the onset of the condition is...

Immunological Parameters of Nutrition

3.6 Functional Parameters of Nutrition Max Dahele, Kenneth C.H. Fearon 125 4. THE DIFFERENT FEATURES OF WASTING IN HUMANS Alessandro Laviano, Michael M. Meguid, Filippo Rossi 139 4.2 Starvation Social,Voluntary, and Involuntary Causes of Weight Loss Daniele Scevola,Angela Di Matteo,Omar Giglio,Filippo Uberti 149 4.3 Cachexia Related to Multiple Causes 4.4 Non-AIDS Lipodistrophy Syndrome Giuliano Enzi, Luca Busetto, Giuseppe Sergi, Sabrina Pigozzo 163 5. PATHOPHYSIOLOGY OF WASTING CACHEXIA 5.1...

Strategies To Fight Cachexia Based on Cytokines and Transcriptional Factors

Since both anorexia and metabolic disturbances are involved in cancer cachexia, the development of different therapeutic strategies has focused on these two factors. Unfortunately, counteracting anorexia either pharmacologically or nutritionally has led to rather disappointing results in the treatment of cancer cachexia. It is basically for this reason that the strategies mentioned below rely on neutralising the metabolic changes induced by the tumour, which are ultimately responsible for the...

Conclusions

Infectious diseases and drugs, with separate mechanisms, induce fat loss in people infected with HIV. The natural course of HIV infection finally leads to cachexia (slim disease). The combined actions of HIV, opportunistic infections, and HAART (including NRTIs, NNRTIs, and PIs) result in the redistribution of fat throughout the body (lipodys-trophy), with simultaneous fat gain and fat loss in peripheral and central sites (lipohypertrophy and lipoatrophy). This clinical condition, therefore...

Desacyl Ghrelin A New Peptide

In 1999, acyl ghrelin was discovered in the stomach as an appetite stimulatory signal from the periphery with structural resemblance to motilin 2 . Ghrelin molecules exist in two major molecular forms acylated ghrelin, which has n-octanoy-lated serine in position 3, and des-acyl ghrelin, which is the major circulating isoform 3 . A recent study has shown that both the molecular forms are localised to the hypothalamic arcuate nucleus of rodents 4 , as seen in the stomach 5 . The glucoprivic...

High Constitutive Signalling of the Ghrelin Receptor

Although obtained only in vitro, the recent results of Holst et al. convincingly demonstrated that the transfected ghrelin GHS receptor Type 1a in HEK or COS cells has a constitutively high signalling rate 24 . This property of the receptor was shown to be due to an inherent high on-rate of the receptor alone, even when devoid of any ligand. The authors theorised that the molecular mechanism of this constitutive activation was due to the tilting or the direct approximation of the receptor TM 3...

Cytokines and Hypermetabolism

Hypermetabolism, i.e. an increase in resting energy expenditure, occurs in many cachectic diseases 46 . Several cytokines, including TNF-a, IL-1 p and IL-6 47-49 , have been shown to stimulate energy expenditure and to induce fever as part of their effects on CNS mechanisms of defence and or energy balance control. Similar to the cytokine anorectic effects see above , cytokine-induced hypermetabolism appears to result from synergistic and sequential interactions 50 and to involve the same...

Malnutrition Inflammation Complex Syndrome

The foregoing discussion, which is summarised in Tables 1-3, indicates that there is a major overlap among both possible aetiologic factors and the assessment tools for protein-energy malnutrition and inflammation in CKD patients. The link between protein-energy malnutrition and inflammation in CKD population may be an explanation for malnutrition-associated mortality 22, 23, 91 . Indeed, several investigators suggest that protein-energy malnutrition and subsequent wasting syndrome and cachexia...

Chronic Inflammation as a Cause of Cachexia in CKD Patients

Inflammation is defined as a localised adaptive response elicited by injury or destruction of tissues that serves to destroy, dilute, or sequester both the injurious agent and the injured tissue 30, 31 . The acute-phase response or reaction is a major pathophysiological phenomenon that accompanies inflammation and is associated with increased activity of pro-inflammatory cytokines 32 . With this reaction, normal homeostatic mechanisms are replaced by new set points that presumably contribute to...

Diagnosis and Management of MICS and Wasting Syndrome in CKD

Since various markers of nutritional state and inflammation may independently predict outcome and assess different aspects of nutritional status, several researchers have tried to develop composite scores to identify the wasting syndrome and MICS in CKD. Ideally, such a scoring system would not only reflect the overall nutritional and inflammatory status of a chronic dialysis patient but would predict outcome. Wolfson et al. 81 introduced a composite score based on body weight, mid-arm muscle...

Energy Expenditure in Diabetes Mellitus

Urinary glucose loss may be a more important cause of negative energy balance and weight loss in diabetic patients. However, the basal metabolic rate BMR of diabetic patients without glycosuria is higher than that of normal subjects. Increased resting energy expenditure may be another mechanism contributing to weight loss in diabetic subjects, in addition to caloric losses due to glyco-suria. The basal energy expenditure of type 1 diabetic patients 2042 Kcal 24 h was found to be significantly...

Acromegaly

Though GH exerts a lipolytic effect, patients affected by acromegaly generally do not show significant weight loss. However, a decreased fat mass has been reported 39 . The most common somatic findings include acral growth gigantism if acromegaly has a prepubertal onset , facial changes, voice reduction, arthralgias, excessive sweating, weakness, and malocclusion. Hypertension, reduced glucose tolerance or diabetes mellitus, and dyslipidaemia hyper-trygliceridaemia commonly occur. Although GH...