Comparative Protein Repletion in Cancer and Non-Cancer Cachexia

Abstract

Based on the depleted body weight, initial plasma volume in cachexia is high without a corresponding change in red cell volume. The individual variations were great but no greater than those found by others. During repletion (hyperalimentation) gain in weight and in total circulating albumin and hemoglobin was most pronounced in non-cancer cachexia as long as a high caloric and protein intake was provided with a uniform feeding mixture as the sole nutritional intake. On subsequent ad libitum hospital or out-patient diets, repletion was less evident for periods up to one month. In four advanced cases of cancer cachexia, weight gain was consistent but there was a striking failure in regeneration of plasma albumin and hemoglobin. In non-cancer cachexia in the absence of hemorrhage, the manufacture of plasma albumin and hemoglobin tends to proceed at the same rate as weight gain, or even more rapidly. Plasma globulin varied widely and is of little significance as a measure of the nutritional state or of repletion. Overall gains in circulating plasma albumin plus hemoglobin for 27 to 106 days accounted for only a small amount (not greater than 8.7 per cent) of the total nitrogen retained during repletion. The maximum gain in albumin was 1.89 per cent of the total nitrogen retained. Despite great and inevitable individual variations during hyperalimentation in non-cancer cachexia, positive nitrogen balance was consistently greater than can be accounted for by observed gain in body weight and total circulating hemoglobin and plasma protein. A shift in body water from the extracellular to the intracellular space could account for this discrepancy.