Elsevier

Neurologic Clinics

Volume 18, Issue 1, 1 February 2000, Pages 245-262
Neurologic Clinics

TISSUE WASTING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE, THE ACQUIRED IMMUNE DEFICIENCY SYNDROME, AND CONGESTIVE HEART FAILURE

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THE WASTING SYNDROME IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Malnutrition is common among hypoxemic patients with chronic obstructive pulmonary disease (COPD): 40%–50% weigh less than 90% of ideal body weight.24, 68, 99 Although increased mortality and morbidity have been associated with weight loss, 24, 68, 97, 99, 109, 115 the pathophysiology of malnutrition remains unclear.5 The primary postulated mechanism is hypermetabolism resulting in elevated total caloric expenditure, which arises from a number of perturbations. When contrasted with normally

THE AIDS WASTING SYNDROME

The tissue-wasting syndrome associated with AIDS is a significant public health problem in the United States because it ultimately affects most patients with AIDS. Insights into its pathogenesis are important because the loss of lean tissue mass, one of the hallmarks of the syndrome, is associated with increased mortality and morbidity.18, 62 The cause of lean tissue-wasting in AIDS is poorly understood, but the operative mechanisms may include inadequate nutrient intake (including

THE CONGESTIVE HEART FAILURE WASTING SYNDROME

The state of undernutrition that often accompanies chronic congestive heart failure (CHF) has long been recognized as a significant clinical problem; it was first characterized by Hippocrates as a disorder in which the flesh is consumed and the feet and ankles swell93 and was recognized later by Withering in the late 18th century as a malady in which significant amounts of fat and skeletal muscle are lost.116 This tissue wasting syndrome, which has been termed cardiac cachexia, may be present

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      In dystrophic muscle, elevated levels of TNF-α inhibit the regenerative potential of satellite cells by epigenetically silencing Notch 1 [164]. TNF-α has been attributed to a number of inflammatory diseases like COPD and is associated with loss of muscle mass in COPD patients [165]. The cytokine tumor necrosis factor like weak inducer of apoptosis (TWEAK) is a member of the TNF superfamily.

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      Cachexia is a process of muscle and fat tissue wasting and subsequent weight loss that occurs in several different chronic disorders and is also part of the process of aging, being almost always associated with a very poor prognosis [1–4].

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      There is limited information regarding nutritional status and metabolic abnormalities in these conditions. The causes of cachexia in COPD are thought to be multifactorial, and include tissue hypoxia, ageing, physical inactivity, increased resting metabolic rate, chronic inflammatory processes,38 and certain drugs, resulting in net catabolism and muscle wasting.39,40 Endogenous protective anabolic mechanisms are insufficiently effective, due possibly to hormonal resistance syndromes.41

    • Cachexia: Pathophysiology and clinical relevance

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    Address reprint requests to Mark O. Farber, MD, Veterans Affairs Medical Center, 1481 W Tenth Street, Indianapolis, IN 46202

    Partial support provided by The AIDS Clinical Trials Group at Indiana University School of Medicine, NIH grant #AI 25859.

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