A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia project

Abstract

We provide a systematic review to support the European Palliative Care Research Collaboration development of clinical guidelines for cancer patients suffering from cachexia. CENTRAL, MEDLINE, PsycINFO, ClinicalTrials.gov, and a selection of cancer journals have been searched up until 15 April 2016. The systematic literature research yielded 4214 publications with 21 of these included in the final evaluation. Regarding minerals, our search identified only one study examining the use of magnesium with no effect on weight loss. As far as vitamins are concerned, vitamin E in combination with omega‐3 fatty acids displayed an effect on survival in a single study, vitamin D showed improvement of muscle weakness in prostate cancer patients, and vitamin C supplementation led to an improvement of various quality of life aspects in a sample with a variety of cancer diagnoses. For proteins, a combination therapy of β‐hydroxy‐β‐methylbutyrate (HMB), arginine, and glutamine showed an increase in lean body mass after 4 weeks in a study of advanced solid tumour patients, whereas the same combination did not show a benefit on lean body mass in a large sample of advanced lung and other cancer patients after 8 weeks. L‐carnitine led to an increase of body mass index and an increase in overall survival in advanced pancreatic cancer patients. Adverse effects of food supplementation were rare and showed mild intensity. There is not enough solid evidence for the use of minerals, vitamins, proteins, or other supplements in cancer. No serious adverse effects have been reported with dietary supplementation.

Leucine‐rich diet minimises liver glycogen mobilisation and modulates liver gluconeogenesis enzyme expression in tumour‐bearing cachectic rats

“…This observation could be explained by the fact that the glycogen produced by glycogen synthase in the liver might be immediately mobilised to provide glucose to meet the growing neoplastic tissue demands. Although enhanced liver lactate dehydrogenase expression could be related to greater lactate content (observed in our previous study [14]), this fact likely suggests higher liver gluconeogenesis.…”

Skeletal muscle wasting in chronic heart failure

“…67 A recent study has identified low testosterone in men as an independent risk factor in CHF. 74 However, a recent systematic review finds not enough solid evidence for the use of minerals, vitamins, proteins, or other supplements in cancer. 69 On the other hand, supplementation of androgens such as dihydrotestosterone in mice reversed the reduction in protein synthesis and amino acid transporter expression observed in ageing animals.…”

“…68 However, testosterone deprivation therapy due to prostate cancer selectively impairs lower-limb muscle function, primarily affecting muscles that support body weight, mediate the forward movement the body during walking, and mediate balance. 74 Currently, there are only few therapy options for patients suffering from sarcopenia, which include (resistance) exercise, 75-77 nutritional approaches to increase consumption of proteins and micronutrients, 78,79 and finally, drug treatment, including testosterone, 80,81 growth hormone (GH), and IGF-1. 70 In contrast to Gielen et al, 67 a strong association between high vitamin D deficiency and an increased risk of heart failure in the elderly has been described.…”

Metabolic disorders in heart failure and cancer

“…111 Furthermore, targeting muscle ring finger 1 (MuRF1) with small molecules also resulted in attenuation of catabolic effects on both skeletal and heart muscle. 113 Since in cancer and heart failure dysregulation of the autonomic system is present, 114 the administration of the beta-blocker espindolol was tested in a randomized, placebo controlled, double blind phase II trial in end-stage non-small-cell lung and colorectal cancer patients. 113 Since in cancer and heart failure dysregulation of the autonomic system is present, 114 the administration of the beta-blocker espindolol was tested in a randomized, placebo controlled, double blind phase II trial in end-stage non-small-cell lung and colorectal cancer patients.…”