roy2013.pdf - C CABG � Coronary Artery Bypass Graft(CABG lean body tissue replaced by fat mass with little or no resulting weight loss Cachexia occurs

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Unformatted text preview: C CABG ▶ Coronary Artery Bypass Graft (CABG) lean body tissue replaced by fat mass with little or no resulting weight loss. Cachexia occurs in 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) Cardiac Etiology The etiology of cachexia is multifactorial. Increased inflammatory processes in the form of cytokine production lead to metabolic dysregulation, such as increased resting energy expenditure, and may contribute to heightened protein degradation accompanied by decreased protein synthesis. Many patients with cachexia will also experience anorexia (i.e., a loss of appetite) and decreased nutrient absorption in the gastrointestinal tract, which accounts for concomitant weight loss. However, the overall loss of lean body tissue observed in patients with cachexia occurs independent of nutrient uptake. Cachexia is a syndrome characterized by the loss of lean body tissue, often including involuntary weight loss, accompanied by increased metabolic and proinflammatory cytokine activity. It is distinct from mere weight loss due to anorexia and from sarcopenia, which is characterized by the loss of Diagnosis The multifactorial etiology and absence of a consensus definition for cachexia presents challenges to diagnostic uniformity. Most current diagnostic systems for cachexia assess at least some of the following: (1) percentage of unintentional body weight lost in a specific time frame (e.g., the past 12 months); (2) proportion of lean body mass to fat mass; (3) body mass index; (4) the presence of clinical symptoms such as Cachexia (Wasting Syndrome) Travis Lovejoy Mental Health & Clinical Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, OR, USA Synonyms AIDS wasting; Cancer cachexia; cachexia; HIV wasting; Slim disease Definition 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 decreased muscle strength, fatigue, and decreased appetite; and (5) abnormal biochemistry such as increased inflammatory markers. Treatment Treatments for cachexia aim to restore lean body mass and improve quality of life. Pharmacological treatments have focused on (1) increasing appetite and caloric intake through the use of appetite stimulants; (2) maintaining and/or restoring lean body mass with testosterone, anabolic steroids, or human growth hormone; and (3) downregulating cytokine activity through the use of systemic antiinflammatory medications. Non-pharmacological treatments include resistance training for muscle retention, nutritional counseling and supplementation to ensure adequate macro- and micronutrient intake, and targeted amelioration of conditions that may exacerbate cachexia such as opportunistic infections in those with compromised immune systems. Psychosocial Impact of Wasting Although cachexia has a gradual onset, its clinical manifestation occurs somewhat rapidly and often during advanced disease stages. Considerable reductions in physical activity, coupled with decreased appetite and metabolic changes, have a significant impact on patients’ quality of life. Many patients with cachexia feel shame or embarrassment about their bodily changes and distance themselves from loved ones. Decreased libido may have deleterious effects on individuals’ romantic partnerships. The Role of Behavioral Medicine Behavioral medicine plays a key role in the treatment of patients with cachexia. Behavioral medicine professionals can provide patient education regarding cachexia treatment options, deliver interventions to improve medication adherence, and offer counseling and instruction for tailored nutrition and exercise programs. The provision of psychotherapy that addresses acute psychiatric conditions, adjustment to chronic illness, and couples issues pertaining to sexuality can help to improve overall quality of life for persons diagnosed with cachexia. Caffeine Cross-References ▶ Body Composition ▶ Cytokines ▶ Sarcopenia ▶ Tumor Necrosis Factor-Alpha (TNF-Alpha) References and Readings Mantovani, G., Anker, S. D., Inui, A., Morley, J. E., Fanelli, F. R., Scevola, D., et al. (2006). Cachexia and wasting: A modern approach. New York: Springer. Springer, J., von Haehling, S., & Anker, S. D. (2006). The need for a standardized definition for cachexia in chronic illness. Nature Clinical Practice Endocrinology & Metabolism, 2, 416–417. Wanke, C., Kohler, D., & HIV Wasting Collaborative Consensus Committee. (2004). Collaborative recommendations: The approach to diagnosis and treatment of HIV wasting. Journal of Acquired Immune Deficiency Syndromes, 37, S284–S288. Caffeine ▶ Coffee Drinking, Effects of Caffeine Caloric Intake Megan Roehrig1, Jennifer Duncan2 and Alyson Sularz1 1 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA 2 Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL, USA Synonyms Energy In; Energy Intake Definition Caloric intake is defined as the amount of energy consumed via food and beverage. A calorie is Cancer and Diet a unit of energy that is defined as the amount of heat energy required to raise 1 g of water by 1 C. Calories are units that measure the energy in food as well as the energy produced, stored, and utilized by living organisms. Daily caloric intake needs are determined by a variety of factors such as age, gender, height, weight, activity level, and genetics. Three welldocumented formulas are used to calculate daily caloric needs: the Harris-Benedict equation (1919), the Mifflin-St Jeor equation (1990), and the Institute of Medicine’s Dietary Reference Intake equation (2002). These equations determine the resting metabolic rate (RMR), which represents the minimum energy needed to maintain vital body functions. While the terms RMR and basal metabolic rate (BMR) are often used interchangeably, the BMR requires more stringent testing conditions and factor in calories needed based on the individual’s activity level. The HHS/USDA 2005 recommendations for daily caloric intake requirements for healthy weight maintenance and prevention of obesity according to age, gender, and activity level are available at . Caloric intake can be measured using objective and subjective methods. Common objective 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 accurate but costly to implement, while subjective measurements are less expensive but subject to greater error. In fact, subjective estimates can be off by as many as 800 kcal (Beasly, Riley, & Jean-Mary, 2004). One pound of body weight is equal to approximately 3,500 cal. When caloric intake is equal to caloric expenditure, an energy balance is achieved and body weight is maintained. Weight loss occurs when caloric expenditure is greater than caloric intake. Conversely, weight gain is the result of greater caloric intake than caloric expenditure. Caloric imbalances in either extreme have multiple health risk implications, including obesity and eating disorders and their associated medical comorbidities. 283 C Cross-References ▶ Fat, Dietary Intake References and Readings C Harris, J. A., & Benedict, F. G. (1919). A biometric study of basal metabolism in man. Washington, DC: Carnegie Institution of Washington. Mifflin, M., St Jeor, S., Hill, L., Scott, B., & Daugherty, S. (1990). A new predictive equation for resting energy expenditure in healthy individuals. The American Journal of Clinical Nutrition, 51(2), 241–247. Rolls, B., & Barnett, R. (2000). The volumetrics weightcontrol plan. New York: Harper Collins. Trumbo, P., Schlicker, S., Yates, A. A., Poos, M., & Food and Nutrition Board of the Institute of Medicine, The National Academies. (2002). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. Journal of the American Dietetic Association, 102(11), 1621–1630. U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2005). Dietary guidelines for Americans. Washington, DC: U.S. Government Printing Office. Cancer and Cigarette Smoking ▶ Cancer and Smoking Cancer and Diet Akihiro Tokoro Department of Psychosomatic Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai Osaka, Japan Synonyms Diet and cancer Definition A field in which the relationship between cancer and diet is examined from the interdisciplinary C 284 perspectives of basic medicine, clinical epidemiology, preventive medicine, and behavioral medicine. Description The relationship between diet and cancer has recently been recognized as an area of scientific interest. Dietary factors are thought to be involved in 30% of cases of cancer in developed countries and in 20% in developing countries (Marian, 2010). In 2004, the American Society of Clinical Oncology (ASCO) announced a goal of achieving prophylactic intervention for cancer prevention, with a focus placed on reduction of tobacco use, control of obesity, cancer-causing infections, and environmental carcinogens (Lippman & Bernard, 2004). A WHO report ( ) showed that 35% of adults aged 20 years old worldwide were overweight (body mass index [BMI]: 25 kg/m2) and 12% were obese (BMI: 30 kg/m2) in 2008. The rate of obesity has more than doubled since 1980. Previous studies have suggested that unhealthy eating and lack of physical activity can affect the development and prognosis of some cancers, including breast cancer, colon cancer, and prostate cancer. Research into the details of the association of diet with development of cancer is limited. However, a report by the International Agency for Research on Cancer (IARC) in 2002 showed that being overweight or obese is associated with an increased risk of cancer in both men and women (International Agency for Research on Cancer (IARC), 2002). Based on these data, the American Cancer Society (ACS) guidelines (American Cancer Society guidelines on nutrition and physical activity for cancer prevention . org/content/vol56/issue5/) recommend: 1. Maintenance of a healthy weight throughout life 2. Adoption of a physically active lifestyle Cancer and Physical Activity 3. Consumption of a healthy diet, with an emphasis on plant sources 4. Limited consumption of alcoholic beverages Further research is required to examine the relationship between single dietary factors and development or progression of cancer and between health behaviors, including dietary lifestyle, and cancer. Cross-References ▶ Cancer Prevention References and Readings American Cancer Society guidelines on nutrition and physical activity for cancer prevention. International Agency for Research on Cancer (IARC). (2002). Weight control and physical activity. In H. Vanio & F. Biaciani (Eds.), IARC handbooks of cancer preventive effects. Lyons: IARC Press. Lippman, S. M., & Bernard, L. (2004). Cancer prevention and the American Society of Clinical Oncology. Journal of Clinical Oncology, 22(19), 3848–3851. Marian, L. (2010). Diet and cancer. In Psycho-Oncology (2nd ed., pp. 22–27). New York: Oxford University Press. Cancer and Physical Activity Akihiro Tokoro Department of Psychosomatic Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai Osaka, Japan Synonyms Exercise and cancer; Physical activity and cancer Definition A field in which the relationship between cancer and physical activity is examined from the Cancer and Smoking 285 C interdisciplinary perspectives of basic medicine, clinical epidemiology, preventive medicine, rehabilitation, and behavioral medicine. physical activity may improve the prognosis and quality of life of cancer patients and survivors (National Cancer Institute fact, sheet, physical activity and cancer). Description Cross-References The relationship between physical activity and cancer has recently been recognized as an area of scientific interest. The role of physical activity in preventing cancer has been examined in several epidemiological studies and several reviews of publications. An appropriate physical activity may reduce cancer risk and improve the quality of life of cancer patients (Marian, 2010). Epidemiological evidence suggests that physical activity is associated with a reduced risk of colon and breast cancers. Some studies have also reported the link between physical activity and a reduced risk of endometrial (uterus), lung, and prostate cancers. More good news – physically active lifestyle helps you reduce your risk of heart disease, diabetes, and osteoporosis (American Cancer Society guidelines on nutrition and physical activity for cancer prevention . cancer.org/acs/groups/cid/documents/webcontent/ 002577). Based on several publications such as the American Cancer Society (ACS) guidelines (American Cancer Society guidelines on nutrition and physical activity for cancer prevention webcontent/002577), the Centers for Disease Control and Prevention (CDC) (State indicator report on physical activity, 2010) and the American Institute for Cancer Research (AICR) ( . org/reduce-your-cancer-risk/recommendations-forcancer-prevention/recommendations_02_activity. html) recommend at least 30 min of moderate to vigorous physical activity, above usual activities, 5 or more days a week, and they say 45–60 min of intentional physical activity is more beneficial. Further research is required to examine the role of physical activity in cancer survivorship and its correlation with quality of life and reduced cancer risk. The National Cancer Institute (NCI)funded studies are exploring the ways in which ▶ Cancer and Diet ▶ Cancer Prevention ▶ Exercise ▶ Physical Fitness References and Readings American Cancer Society guidelines on nutrition and physical activity for cancer prevention. http:// 002577 . html Marian, L. (2010). Exercise and cancer. In Psycho-oncology (2nd ed., pp. 28–32). New York: Oxford University Press. National Cancer Institute fact, sheet, physical activity and cancer. prevention/physicalactivity State indicator report on physical activity. (2010). PA_State_Indicator_Report_2010 Cancer and Smoking Monica Webb Hooper Department of Psychology, University of Miami, Coral Gables, FL, USA Synonyms Cancer and cigarette smoking; Cancer and tobacco smoking; Lung cancer and smoking Definition A cancer diagnosis represents a heterogeneous class of diseases characterized by uncontrolled C C 286 growth of malignant cells in the body. These cells form a tumor that starts in the epithelium, invades organs of the body and nearby tissue, has the capacity to metastasize to other sites through the bloodstream or lymph nodes, and may recur after surgical removal. The development of cancer may be influenced by hereditary and/or environmental factors. Tobacco smoking is defined as the practice of burning and inhaling tobacco. The combustion from the burning allows the nicotine, tar, and other chemicals and toxins to be absorbed through the lungs. Cigarette smoking is the most prevalent form of consuming tobacco. Most national surveys define a current smoker as having smoked at least 100 (five packs) cigarettes in their lifetime and currently smokes on at least some days. Description Over 46 years of scientific research, including 29 reports from the US Surgeon General, has led to the unequivocal conclusion that cigarette smoking causes cancer. But, Dr. John Hill, first deduced that snuff (smokeless tobacco) might be cancerous in “Cautions Against the Immoderate Use of Snuff,” written in 1761 (U.S. Department of Health and Human Services [USDHHS], 1982). The earliest scientific investigations on the positive association between smoking and cancer were published in the 1920s and 1930s (USDHHS, 1982). In 1950, four retrospective studies examining the smoking histories of lung cancer patients compared to controls were published, all indicating a positive link between smoking and cancer. The first Surgeon General’s report with sufficient evidence to declare that smoking causes lung cancer was published in 1964 (U.S. Department of Health, Education, and Welfare [USDEW], 1964). At that time, smoking was causally linked to lung cancer among men, but there was insufficient evidence among women. Early on, the most prevalent lung cancers, squamous cell and epidermoid, were specifically associated with smoking. It was also found that the frequency of oat-cell and adenocarcinoma was greater among smokers compared Cancer and Smoking to nonsmokers. In 1968, the Surgeon General’s report concluded that smoking also caused lung cancer in women (USDHEW, 1968). Lung cancer remains the most common form of cancer among men and women. Cigarette smoking is responsible for the majority of deaths due to cancer. Between 1995 and 1999, over 70% of cancer deaths among US males were attributable to smoking (USDHHS, 2004). During the same years, over 50% of cancer deaths among women were due to smoking. This corresponds to almost 1.5 million years of potential life lost among men, and almost 1 million years among women (USDHHS). Some have questioned how a causal relationship could be determined between cigarette smoking and cancer. This is largely because random assignment and a control group are necessary preconditions to conclude that a causeand-effect connection exists. However, the accumulation of robust associations over a long period of time can also be used to establish causality. The criteria used by the Surgeon General’s report included the following: (1) the consistency of association; (2) the robustness of association; (3) the specificity of association; (4) the temporal nature of association; (5) the rationality of association; and (6) experimental and clinical autopsy-based evidence (USDHEW, 1967). Using these criteria, there is no doubt that cancer is caused by smoking. Since the finding that smoking definitively causes cancer, the prevalence of cigarette smoking has declined. In 1965, the overall smoking prevalence was 42%, which decreased to 33% by 1971 (USDHEW, 1971). The rates of smoking sharply declined in the USA, although there was no change in the absolute number of smokers (53 million) over the 20-year period between 1951 and 1971. Since 2004, smoking rates have leveled off at about 20%. In 2010, 19.3% of adults (45 million) were current smokers (Centers for Disease Control and Prevention, 2011). The past decade witnessed an overall decline in the prevalence of cancer in the USA, which is directly related to declines in smoking. With each Surgeon General’s report, the evidence explicating the types of cancers caused by Cancer and Smoking 287 C Cancer and Smoking, Table 1 List of cancers caused by smoking Cancer and Smoking, Table 2 Examples of known carcinogens in cigarette smoke (humans) Lung cancer Esophageal Stomach Pancreatic Bronchial Kidney Uterine cervical Urinary bladder Category Aldehydes Aromatic amines Acute myeloid leukemia Larynx Oral cavity Pharynx Trachea Renal pelvic Nasal cavity smoking have increased. It is now well established that smoking damages almost every organ in the human body and causes at least 15 types of cancer (Table 1). There is a dose–response relationship between cancer mortality and the number of cigarettes smoked per day (USDHHS, 1982). Smoking a greater number of daily cigarettes leads to increased exposure to the 7,000 chemicals and toxins contained in each cigarette (USDHHS, 2010). Although addictive, the nicotine in cigarettes is not the source of cancer development. Rather, it likely results from the effects of the 69 carcinogens contained in cigarettes (USDHHS, 2010). There are several key chemicals in cigarettes that are known to be cancer causing in humans (Ta...
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