悪液質レクチャー：ESPEN2011

2011年のESPENで行われたがん悪液質のレクチャーをまとめた論文を紹介します。

Fearon KC. The 2011 ESPEN Arvid Wretlind lecture: Cancer cachexia: The potential impact of translational research on patient-focused outcomes. Clin Nutr. 2012 Jul 21. [Epub ahead of print]

がん悪液質に対する介入のアウトカムとして、筋肉量もよいですがより患者中心のアウトカムとして身体活動（1日歩数など）が適切ではないかと提案しています。すべての患者に対する基本的な管理（栄養、運動、抗炎症治療）を確立する臨床研究が重要です。

Anorexia + Meabolic changes = Cachexiaですので、食事摂取量の増加＋代謝調整で悪液質を改善できる可能性があると図3にあります。それには栄養療法単独ではなく、やはり多方面からの包括的アプローチが重要です。今後、悪液質に対するリハ栄養研究が増えると嬉しいですね。

Abstract

Cancer cachexia is a multifactorial syndrome characterised by loss of skeletal muscle that cannot be fully reversed by conventional nutritional support. Uncertainty continues as to its precise mediators and mechanisms. The pathophysiology is characterised by a variable combination of reduced food intake and abnormal metabolism. Recent evidence has suggested that there may be a genetic component to cachexia with emphasis on genes linked to systemic inflammation. Loss of skeletal muscle mass and function is a major contributor to the excess frailty, disability and increased mortality in cancer cachexia. Whilst muscle mass per se has been considered a key outcome measure in treating cachexia, it might be more rationale to choose a patient-centred outcome such as physical activity. Beyond good medical management, it is important that trials establish basic management for all patients (nutrition, exercise and anti-inflammatory treatment). Specific therapies for cachexia should focus on the key issues of reduced food intake and abnormal metabolism. Whilst combination regimens to treat these issues continue to be explored, there is also interest in biological therapies that target conserved molecular mechanisms of muscle growth/atrophy. The combination of approaches promises a new era for the management of cachexia in the context of supportive oncology.