Nutrient and Energy Metabolism in Patients With and Without Cancer During Hyperalimentation With Fat Administered Intravenously

Abstract

Weight loss due to increased utilization of endogenous fat may be an early sign of cancer in the human host. These studies were undertaken to test the hypothesis that replacement of the calorie deficit by fat administered intravenously would prevent further deterioration of the host and demonstrate the postulated anabolic effect of caloric hyperalimentation. Four patients with neoplastic disease and three with chronic illnesses non-neoplastic in nature were given from twenty-one to thirty-six consecutive daily infusions of a 15 per cent cottonseed oil emulsion, Lipomul I.V., while consuming a constant diet, identical to that taken during control phases thirty to forty-two days in length. Balances of nitrogen, potassium, phosphorus, calcium, sodium and chloride, body weights, urinary excretions of uric acid, basal metabolic rates and respiratory quotients and a variety of blood chemical and hematologic parameters (reported elsewhere) were measured before, during and after the phase of hyperalimentation. Calorie balances were measured by the insensible water loss technic of Newburgh. Fecal lipids were measured and reported elsewhere. Albumin metabolism was measured using I¹³¹-labeled human serum albumin before, during and after hyperalimentation. Generally speaking, patients with non-neoplastic diseases responded more favorably than did those with neoplastic diseases in terms of weight gain, calorie balance and retention of protoplasmic constituents. However, one of these displayed severe reactions occurring after twenty-seven and twenty-six consecutive daily infusions, respectively, on two separate occasions. The response of patients with neoplastic disease was inversely proportional to the activity of their disease process. One patient with a rapidly progressing primary hepatoma increased his caloric expenditure, lost weight and deteriorated clinically during hyperalimentation. On the other hand, another patient with a slowly growing chondrosarcoma increased his retention of nutrients and calories and gained weight during the period of daily fat emulsion infusions. Patients in both groups showed increases in total exchangeable albumin and its turnover rate during hyperalimentation. However, in general, daily fat emulsion infusions caused greater increases in albumin synthesis in patients without cancer and in those with quiescent neoplasms than in those with active neoplastic disease. Since hyperalimentation leads to an increased calorie expenditure and an enhancement of disease activity in patients whose neoplasms are progressing rapidly, it should be withheld until other therapeutic measures have been given an opportunity to reduce the activity of the disease.