Ketogenic diet has been used for more than 80 years as a successful dietary regimen for epilepsy. Recently, dietary modulation by carbohydrate depletion via ketogenic diet has been suggested as an important therapeutic strategy to selectively kill cancer cells and as adjuvant therapy for cancer treatment. However, some researchers insist ketogenic diet to be highly undesirable as ketogenic diet may trigger and/or exacerbate cachexia development and usually result in significant weight loss. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possibility of the use of ketogenic diet for oncology patients. Article search was performed from 1985 through 2017 and finally 10 articles were analyzed. The review focused on the results of human trials for cancer patients and checked the feasibility of using ketogenic diet for cancer patients as adjuvant therapy. The main outcomes showed improvement of body weight changes, anthropometric changes, serum blood profiles, and reduction in novel marker for tumor progression, TKTL1, and increase of ketone body. Lactate concentration was reduced, and no significant changes were reported in the measurements of quality of life. Ketogenic diet may be efficacious in certain cancer subtypes whose outcomes appear to correlate with metabolic status, but the results are not yet supportive and inconsistent. Therefore, it warrants further studies.
Body Weight Changes ; Cachexia ; Diet, High-Fat ; Epilepsy ; Humans ; Ketogenic Diet* ; Ketosis ; Lactic Acid ; Quality of Life ; Weight Loss

Diabetic neuropathic cachexia (DNC) is one of the rarest presentations of diabetic neuropathy associated with profound weight loss. A 50-year-old Korean woman with poorly controlled type 2 diabetes complained of intractable pain in the trunk and lower extremities, and total body weight loss of 17% over a 6 month period. The patient's symptoms persisted after glucose control and various medications for neuropathic pain. A diagnosis of DNC was made based on the rapid onset of severe pain, polyneuropathy, and marked weight loss without evidence of end organ disease other than mild retinopathy, and the exclusion of other possible causes. Spontaneous improvement of the patient's neuropathic pain and gradual weight gain occurred after 6 months of supportive care. Since the original report of DNC, 31 cases have been published in the English-language literature; however, ours is the first reported case in Korea. Clinicians must be aware of this debilitating complication of diabetes because of its severity and rapid progression.
Body Weight ; Cachexia* ; Diabetic Neuropathies ; Diagnosis ; Female ; Glucose ; Humans ; Korea ; Lower Extremity ; Middle Aged* ; Neuralgia ; Pain, Intractable ; Polyneuropathies ; Weight Gain ; Weight Loss

Profound weight loss with painful symmetrical peripheral neuropathy in diabetic patients was first described as diabetic neuropathic cachexia more than 4 decades ago. It is a distinct type of diabetic peripheral neuropathy that occurs in the absence of other microvascular and autonomic complications of diabetes. The mechanism and precipitating cause are unknown. It was reported to have good prognosis with spontaneous recovery within months to 2 years. However, it was frequently missed by clinicians because the profound weight loss is the most outstanding complaint, rather than the pain, numbness, or weakness. This often leads to extensive investigation to exclude more sinister causes of weight loss, particularly malignancy. We report a case of a young woman with well-controlled diabetes who presented with profound unintentional weight loss (26 kg), symmetrical debilitating thigh pain, and clinical signs of peripheral neuropathy. As the disease entity may mimic an inflammatory demyelinating cause of neuropathy, she was treated with a trial of intravenous immunoglobulin, which failed to give any significant benefit. However, she recovered after 6 months without any specific treatment, other than an antidepressant for the neuropathic pain and ongoing rehabilitation.
Cachexia ; Diabetic Neuropathies ; Female ; Humans ; Hypesthesia ; Immunoglobulins ; Neuralgia ; Peripheral Nervous System Diseases ; Prognosis ; Rehabilitation ; Thigh ; Weight Loss

Cancer is a catabolic inflammatory disease that causes patients to often experience weight loss, or even cachexia in severe cases. Undernourishment in patients with cancer impairs the quality of life and therapeutic response, further leading to poor prognosis. Active and frequent nutritional screening and assessment using valid tools are important for fast and appropriate nutritional intervention. Additionally, a suitable individualized nutritional intervention strategy should be established based on the nutritional assessment result. In general, nutritional intervention begins with nutritional counseling of patients diagnosed with cancer, and a well-planned nutritional counseling improves the treatment adherence and nutritional status. When planning nutritional supplementation for cancer patients, specific nutrients, including amino acids and fatty acids, should be considered. However, there has been no consistent result showing that any particular nutrient significantly improves the prognosis of cancer patients. Hence, continuous attention from clinical physicians is needed to plan nutritional improvement in patients with cancer.
Amino Acids ; Cachexia ; Counseling ; Fatty Acids ; Humans ; Mass Screening ; Nutrition Assessment ; Nutrition Therapy ; Nutritional Status ; Prognosis ; Quality of Life ; Weight Loss

BACKGROUND: A recent animal study showed that parathyroid hormone-related peptide (PTHrP) is associated with cancer cachexia by promoting adipose tissue browning, and we previously demonstrated that PTHrP predicts weight loss (WL) in patients with cancer. In this study, we investigated whether prediction of WL by PTHrP is influenced by clinical factors such as serum albumin, corrected calcium levels, cancer stage, and performance status (PS). METHODS: A cohort of 219 patients with cancer whose PTHrP level was measured was enrolled and followed for body weight (BW) changes. Subjects were divided into two groups by serum albumin (cutoff value, 3.7 g/dL), corrected calcium (cutoff value, 10.5 mg/dL), cancer stage (stage 1 to 3 or 4), or PS (Eastern Cooperative Oncology Group 0 to 1 or 2 to 4), respectively. Clinically significant WL was defined as either percent of BW change (% BW) <−5% or % BW <−2% plus body mass index (BMI) < 20 kg/m². RESULTS: After a median follow-up of 327 days, 74 patients (33.8%) experienced clinically significant WL. A positive PTHrP level was associated with a 2-fold increased risk of WL after adjusting for age, baseline BMI, serum albumin, corrected calcium level, cancer stage, and PS. The effect of PTHrP on WL remained significant in patients with low serum albumin, stage 4 cancer, and good PS. Regardless of calcium level, the effect of PTHrP on WL was maintained, although there was an additive effect of higher calcium and PTHrP levels. CONCLUSION: Early recognition of patients with advanced cancer who are PTHrP positive with hypercalcemia or hypoalbuminemia is needed for their clinical management.
Adipose Tissue ; Animals ; Body Mass Index ; Body Weight ; Cachexia ; Calcium* ; Cohort Studies ; Follow-Up Studies ; Humans ; Hypercalcemia ; Hypoalbuminemia ; Parathyroid Hormone-Related Protein* ; Serum Albumin* ; Weight Loss*

No abstract available.
Dietary Supplements* ; Weight Loss*

No abstract available.
Humans ; Weight Loss*

No abstract available.
Stomach Neoplasms* ; Weight Loss*

Background: The weight loss benefit of semaglutide in patients with diabetes is well-documented, but its clinical utility in treating obesity among patients without diabetes is less described. We therefore assessed the efficacy and safety of subcutaneous semaglutide as treatment for obesity in patients without diabetes. Methodology: A comprehensive search of PubMed/MEDLINE, Cochrane and Google scholar was performed to identify trials on the efficacy and safety of subcutaneous semaglutide on patients with obesity without diabetes. Primary outcome was expressed as percent mean weight difference. Secondary outcomes including risk for gastrointestinal adverse events, discontinuation of treatment and serious adverse events were expressed as risk ratios. These were calculated using the random effects model. Results: The study included 4 randomized controlled trials having a total of 3,613 individuals with obesity without diabetes. The mean difference for weight reduction was -11.85%, favoring semaglutide [95% confidence interval (CI) (-12.81,-10.90), p<0.00001]. Secondary outcomes showed that the risk of developing gastrointestinal adverse events was 1.59 times more likely with semaglutide (RR 1.59, 95%CI [1.34, 1.88], p<0.00001). Risk for discontinuation due to adverse events was twice as likely in the semaglutide group (RR 2.19, 95%CI [1.36,3.55], p=0.001) and the risk for serious adverse events was 1.6 times more likely for semaglutide (RR1.60, 95%CI [1.24, 2.07], p=0.0003). Serious events were mostly of gastrointestinal and hepatobiliary disorders such as acute pancreatitis and cholelithiasis. Conclusion Among individuals with obesity without type 2 diabetes, subcutaneous semaglutide is effective for weight loss with an 11.85% reduction from baseline compared to placebo. This supports the use of semaglutide for weight management in obesity. However, risk of gastrointestinal adverse events, discontinuation of treatment and serious adverse events were higher in the semaglutide group versus placebo.
Obesity ; Weight Loss

Introduction: With the rising number of patients with diabetes, an increased trend of people having pre-diabetic state also increases. Interventions that promote weight reduction and improved physical activity decrease the risk of diabetes and even normalize blood sugar levels among pre-diabetic individuals. Promising evidence showed that the use of digital health technologies, focusing on weight loss, has significant effects on preventing diabetes. Objective: To synthesize available evidence on the effectiveness of digital health technology in achieving weight loss among pre-diabetic adults. Methods: A meta-analysis of randomized and non-randomized controlled trials among pre-diabetic adults was conducted.. A database search using The Cochrane Library, PubMed®, Google Scholar, and ProQuest was done by the investigators. Separate forest plots were developed for each outcome. Pooled estimates of mean differences for each outcome were computed. Results: Eleven trials were included. The pooled estimate demonstrated significantly higher weight loss (MD=1.77, 95%CI=0.82 to 2.73, p-value=0.0003), higher BMI reduction (MD=0.81, 95%CI=0.64 to 0.97, p-value<0.00001) and higher percent weight loss (MD=2.60, 95%CI=2.12 to 3.07, p-value<0.00001) among patients who received digital health technology interventions than controls. However, these results had high heterogeneity. Subgroup analysis by type of intervention significantly decreased the heterogeneity, with mixed interventions (combination of web pages, mobile applications, wearable technologies etc.) showing significant improvement in BMI and percent weight loss Conclusions/Recommendations The current meta-analysis demonstrated that use of digital health technology in achieving weight loss among pre-diabetic adults is more effective than usual care alone, particularly when delivered through mixed digital health technologies. Providing health education, reminders, counseling, and motivation through the web, emails, and mobile phones are recommended to achieve weight loss and BMI reduction among pre-diabetics. Further studies are recommended to evaluate the cost-effectiveness and sustainability of these interventions and whether these interventions offer long-term benefits.
Telemedicine ; Weight Loss