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Cook-Medley Hostility Scale 495 C C CABG lean body tissue replaced by fat mass with little or no resulting weight loss. Cachexia occurs in ▶ Coronary Artery Bypass Graft (CABG) patients with chronic illnesses such as cancer, HIV/AIDS, chronic kidney disease, chronic heart failure, and chronic obstructive pulmonary disease. Cachectin Description ▶ Tumor Necrosis Factor-Alpha (TNF-Alpha) Etiology The etiology of cachexia is multifactorial. Increased inflammatory processes in the form Cachexia (Wasting Syndrome) of cytokine production lead to metabolic dysregulation, such as increased resting energy Travis Lovejoy expenditure, and may contribute to heightened Mental Health & Clinical Neurosciences protein degradation accompanied by decreased Division, Portland Veterans Affairs Medical protein synthesis. Many patients with cachexia Center, Portland, OR, USA will also experience anorexia (i.e., a loss of appe- tite) and decreased nutrient absorption in the gastrointestinal tract, which accounts for con- Synonyms comitant weight loss. However, the overall loss of lean body tissue observed in patients with AIDS wasting; Cancer cachexia; Cardiac cachexia occurs independent of nutrient uptake. cachexia; HIV wasting; Slim disease Diagnosis The multifactorial etiology and absence of Definition a consensus definition for cachexia presents challenges to diagnostic uniformity. Most current Cachexia is a syndrome characterized by the loss of diagnostic systems for cachexia assess at least lean body tissue, often including involuntary some of the following: (1) percentage of weight loss, accompanied by increased metabolic unintentional body weight lost in a specific time and proinflammatory cytokine activity. It is distinct frame (e.g., the past 12 months); (2) proportion of from mere weight loss due to anorexia and from lean body mass to fat mass; (3) body mass index; sarcopenia, which is characterized by the loss of (4) the presence of clinical symptoms such as M.D. Gellman & J.R. Turner (eds.), Encyclopedia of Behavioral Medicine, DOI 10.1007/978-1-4419-1005-9, # Springer Science+Business Media New York 2013 C 282 Caffeine decreased muscle strength, fatigue, and Cross-References decreased appetite; and (5) abnormal biochemis- try such as increased inflammatory markers. ▶ Body Composition ▶ Cytokines Treatment ▶ Sarcopenia Treatments for cachexia aim to restore lean body ▶ Tumor Necrosis Factor-Alpha (TNF-Alpha) mass and improve quality of life. Pharmacological treatments have focused on (1) increasing appetite References and Readings and caloric intake through the use of appetite stimulants; (2) maintaining and/or restoring lean Mantovani, G., Anker, S. D., Inui, A., Morley, J. E., body mass with testosterone, anabolic steroids, or Fanelli, F. R., Scevola, D., et al. (2006). Cachexia human growth hormone; and (3) downregulating and wasting: A modern approach. New York: cytokine activity through the use of systemic anti- Springer. Springer, J., von Haehling, S., & Anker, S. D. (2006). The inflammatory medications. Non-pharmacological need for a standardized definition for cachexia in treatments include resistance training for muscle chronic illness. Nature Clinical Practice Endocrinol- retention, nutritional counseling and supplementa- ogy & Metabolism, 2, 416–417. tion to ensure adequate macro- and micronutrient Wanke, C., Kohler, D., & HIV Wasting Collaborative Consensus Committee. (2004). Collaborative recom- intake, and targeted amelioration of conditions mendations: The approach to diagnosis and treatment that may exacerbate cachexia such as opportunis- of HIV wasting. Journal of Acquired Immune tic infections in those with compromised immune Deficiency Syndromes, 37, S284–S288. systems. Psychosocial Impact of Wasting Caffeine Although cachexia has a gradual onset, its clinical manifestation occurs somewhat rapidly ▶ Coffee Drinking, Effects of Caffeine and often during advanced disease stages. Considerable reductions in physical activity, coupled with decreased appetite and metabolic changes, have a significant impact on patients’ Caloric Intake quality of life. Many patients with cachexia feel shame or embarrassment about their bodily Megan Roehrig1, Jennifer Duncan2 and changes and distance themselves from loved Alyson Sularz1 ones. Decreased libido may have deleterious 1Department of Preventive Medicine, Feinberg effects on individuals’ romantic partnerships. School of Medicine, Northwestern University, Chicago, IL, USA The Role of Behavioral Medicine 2Department of Preventive Medicine, Feinberg Behavioral medicine plays a key role in the treat- School of Medicine Northwestern University, ment of patients with cachexia. Behavioral med- Chicago, IL, USA icine professionals can provide patient education regarding cachexia treatment options, deliver Synonyms interventions to improve medication adherence, and offer counseling and instruction for tailored Energy In; Energy Intake nutrition and exercise programs. The provision of psychotherapy that addresses acute psychiatric conditions, adjustment to chronic illness, and Definition couples issues pertaining to sexuality can help to improve overall quality of life for persons Caloric intake is defined as the amount of energy diagnosed with cachexia. consumed via food and beverage. A calorie is Cancer and Diet 283 C a unit of energy that is defined as the amount of Cross-References heat energy required to raise 1 g of water by 1C. Calories are units that measure the energy in food ▶ Fat, Dietary Intake as well as the energy produced, stored, and uti- lized by living organisms. Daily caloric intake needs are determined by References and Readings a variety of factors such as age, gender, height, C weight, activity level, and genetics. Three well- Harris, J. A., & Benedict, F. G. (1919). A biometric documented formulas are used to calculate daily study of basal metabolism in man. Washington, DC: Carnegie Institution of Washington. caloric needs: the Harris-Benedict equation Mifflin, M., St Jeor, S., Hill, L., Scott, B., & Daugherty, S. (1919), the Mifflin-St Jeor equation (1990), and (1990). A new predictive equation for resting energy the Institute of Medicine’s Dietary Reference expenditure in healthy individuals. The American Intake equation (2002). These equations deter- Journal of Clinical Nutrition, 51(2), 241–247. Rolls, B., & Barnett, R. (2000). The volumetrics weight- mine the resting metabolic rate (RMR), which control plan. New York: Harper Collins. represents the minimum energy needed to Trumbo, P., Schlicker, S., Yates, A. A., Poos, M., & Food maintain vital body functions. While the terms and Nutrition Board of the Institute of Medicine, The RMR and basal metabolic rate (BMR) are often National Academies. (2002). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, choles- used interchangeably, the BMR requires more terol, protein and amino acids. Journal of the American stringent testing conditions and factor in calories Dietetic Association, 102(11), 1621–1630. needed based on the individual’s activity level. U.S. Department of Health and Human Services and U.S. The HHS/USDA 2005 recommendations for Department of Agriculture. (2005). Dietary guidelines for Americans. Washington, DC: U.S. Government daily caloric intake requirements for healthy Printing Office. weight maintenance and prevention of obesity according to age, gender, and activity level are available at http://www.nhlbi.nih.gov/health/pub- lic/heart/obesity/wecan/downloads/calreqtips.pdf. Cancer and Cigarette Smoking Caloric intake can be measured using objec- tive and subjective methods. Common objective ▶ Cancer and Smoking methods are calorimetry and the doubly labeled water technique, while common subjective methods are 24-h dietary recall interviews and food diaries. Objective measurements are highly Cancer and Diet accurate but costly to implement, while subjec- tive measurements are less expensive but subject Akihiro Tokoro to greater error. In fact, subjective estimates can Department of Psychosomatic Medicine, be off by as many as 800 kcal (Beasly, Riley, & National Hospital Organization, Kinki-Chuo Jean-Mary, 2004). Chest Medical Center, Sakai Osaka, Japan One pound of body weight is equal to approx- imately 3,500 cal. When caloric intake is equal to caloric expenditure, an energy balance is Synonyms achieved and body weight is maintained. Weight loss occurs when caloric expenditure is greater Diet and cancer than caloric intake. Conversely, weight gain is the result of greater caloric intake than caloric expenditure. Caloric imbalances in either Definition extreme have multiple health risk implications, including obesity and eating disorders and their A field in which the relationship between cancer associated medical comorbidities. and diet is examined from the interdisciplinary C 284 Cancer and Physical Activity perspectives of basic medicine, clinical epidemi- 3. Consumption of a healthy diet, with an empha- ology, preventive medicine, and behavioral sis on plant sources medicine. 4. Limited consumption of alcoholic beverages Further research is required to examine the relationship between single dietary factors Description and development or progression of cancer and between health behaviors, including dietary life- The relationship between diet and cancer has style, and cancer. recently been recognized as an area of scientific interest. Dietary factors are thought to be involved in 30% of cases of cancer in developed Cross-References countries and in 20% in developing countries ▶ (Marian, 2010). Cancer Prevention In
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