Weight loss and low body cell mass in males with lung cancer: relationship with systemic inflammation, acute-phase response, resting energy expenditure, and catabolic and anabolic hormones

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Abstract
The aim of the present study was to investigate, in human lung cancer, the relationship between weight loss and the existence of a low body cell mass (BCM) on the one hand, and the putative presence of systemic inflammation, an increased acute-phase response, anorexia, hypermetabolism and changes in circulating levels of several anabolic and catabolic hormones on the other. In 20 male lung cancer patients, pre-stratified by weight loss of ⩾ 10% (n = 10) or of < 10% (n = 10), the following measurements were performed: BCM (by dual-energy X-ray absorptiometry/bromide dilution), circulating levels of sTNF-R55 and sTNF-R75 (soluble tumour necrosis factor receptors of molecular masses 55 and 75 kDa respectively), interleukin-6, lipopolysaccharide-binding protein, albumin, appetite (scale of 0–10), resting energy expenditure (by indirect calorimetry) and circulating levels of catabolic (cortisol) and anabolic [testosterone, insulin-like growth factor-I (IGF-I)] hormones. Compared with the patients with a weight loss of < 10%, those with a weight loss of ⩾ 10% were characterized by higher levels of sTNF-R55 (trend towards significance; P = 0.06), and lower levels of albumin (27.4 compared with 34.4 mmol/l; P = 0.02), testosterone (13.2 compared with 21.5 nmol/l; P = 0.01) and IGF-I (119 compared with 184 ng/ml; P = 0.004). In the patient group as a whole, the percentage weight loss was significantly correlated with sTNF-R55 (r = 0.59, P = 0.02), albumin (r =-0.63, P = 0.006) and IGF-I (r =-0.50, P = 0.02) levels. Height-adjusted BCM was significantly correlated with sTNF-R55 (r =-0.57, P = 0.03), sTNF-R75 (r =-0.50, P = 0.04), lipopolysaccharide-binding protein (r =-0.50, P = 0.04), albumin (r = 0.56, P = 0.02) and resting energy expenditure/BCM (r =-0.54, P = 0.03), and there was a trend towards a correlation with IGF-I concentration (r = 0.44, P = 0.06). We conclude that, in human lung cancer, weight loss and the presence of a low BCM are associated with systemic inflammation, an increased acute-phase response and decreased levels of IGF-I. In addition, a decreased BCM is associated with hypermetabolism.

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