Understanding cancer patients with malnutrition and metabolic dysfunction

Cancer patients frequently experience metabolic dysfunction, leading to severe weight loss correlating with a poor prognosis. Causes for this dysfunction include malnutrition and cachexia, a systemic inflammation affecting brain mechanisms regulating satiety and hunger. Malnutrition in cancer patients may result from tumor masses in the gastrointestinal tract that obstruct nutrient absorption, or from cancer cells’ elevated metabolism, which voraciously consumes nutrients from the blood or microenvironment, depriving healthy tissue cells.

Tumor-induced chronic systemic inflammation causes endocrine dysfunction, reducing appetite (anorexia) by altering hypothalamic hunger and satiety centers, increasing protein catabolism in muscles, and lipid catabolism in adipose tissue. Anti-cancer therapies further impact nutritional status by altering endocrine metabolism or causing mucositis, which hinders food intake.

Researchers working under the guidance of oncologist Prof. Antonio Giordano, M.D., Ph.D., Founder and President of the Sbarro Health Research Organization (SHRO) at Temple University, recently examined the mechanisms by which cancer cells or anti-cancer therapies induce these metabolic alterations, leading to malnutrition and weight loss in cancer patients.

Led by Salvatore Cortellino, Ph.D., of the Responsible Research Hospital in Campobasso, Italy, with SHRO collaborators Margherita D’Angelo and Massimiliano Quintiliani, they have published a paper titled “Cancer Knocks You Out by Fasting: Cachexia as a Consequence of Metabolic Alterations in Cancer,” in the Journal of Cellular Physiology.

Their review also explores therapeutic approaches such as nutraceuticals, drug therapies, and lifestyle changes to counteract physical wasting and improve cancer patients’ quality of life and prognosis.

“Malnutrition affects 20-70% of cancer patients, worsening their living conditions and reducing their response to therapies, thereby compromising prognosis and life expectancy,” says Giordano. “Evaluating body composition and nutritional status should become standard in clinical practice to improve the psychophysical condition of cancer patients facing challenging treatments. Introducing specific programs in academic training for physicians and health professionals, along with providing appropriate technologies and hospital instrumentation, is essential for assessing these physiological parameters.”

“The tumor exploits various pathways to sustain itself, inducing systemic changes that cause the body to enter a fasting-like state due to reduced appetite and feeding difficulties,” explains Cortellino. “In this condition, the body mobilizes energy reserves by releasing fatty acids from adipose tissue and amino acids from skeletal muscle. The tumor utilizes fatty acids for energy and amino acids for synthesizing cellular components necessary for its growth or for fueling gluconeogenesis in the liver, thereby producing glucose, which cancer cells avidly consume.”

“Nutraceuticals can significantly aid cancer patients by supplying essential nutrients needed to endure debilitating treatments and potentially enhance therapeutic responses,” adds Giordano. “Given these considerations and clinical evidence, it is advisable to caution cancer patients against adopting improvised or highly publicized diets on social media, such as low-calorie diets (intermittent fasting) and ketogenic diets, as they may deteriorate the patient’s nutritional and clinical condition, thereby compromising their prognosis.”

Provided by
Sbarro Health Research Organization (SHRO)