The significance of learned food aversions in the aetiology of anorexia associated with cancer

Cachexia in experimental models

Cachexia refers to a state of severe malnutrition characterized by anorexia, weight loss, and muscle wasting. Although it is most commonly considered in the context of cancer, it may occur as a consequence of a variety of chronic diseases. Cachexia appears to differ from "semistarvation" in that there is evidence of metabolic changes that are different from the normal response to reduce food intake. Animal models are useful in the study of cachexia because they allow homogeneous groups of subjects, free from confounding influences, to be studied. Accurate control of diet is possible, and pair-fed controls can be used to allow specific investigation of the metabolic component. However, the model must show features that are appropriate for the disease being studied. In the case of cancer this means using a model in which cachexia occurs without too high a tumor burden or growth rate or too severe a reduction in food intake. Studies in the author's laboratory have used a transplantable Leydig cell tumor in Fischer rats. Food intake decreases by 20-40% and energy expenditure is greater than that of pair-fed controls. One mechanism that may be responsible for this relates to the postprandial metabolism of carbohydrate, since after a test meal there appears to be a greater rate of hepatic glycogen synthesis via the indirect pathway in tumor-bearing rats than in controls. The indirect pathway involves gluconeogenic enzymes, and studies using a variety of different tracers and enzyme inhibitors suggest that amino acids are important precursors. An increased rate of hepatic glycogen synthesis also appears to be maintained for a longer time after the meal in tumor-bearing rats, and this may act to delay the onset of the next meal, thereby explaining the decreased meal frequency that has been observed.

The effect of meal size on postprandial carbohydrate metabolism in normal and tumor-bearing rats

Doubling the size of a meal causes less than a two-fold increase in the thermic effect of feeding. One possible reason for this is that larger meals may be associated with a change in the pathway of postprandial hepatic glycogen synthesis from the indirect pathway, involving gluconeogenesis, to the more energetically efficient direct pathway. We have therefore investigated the effect of meal size on the relative contributions of those two pathways both in normal rats and in tumor-bearing rats, which have previously been shown to utilize the indirect pathway to a greater extent. Rats bearing a transplantable Leydig cell tumor and freely fed controls were fasted overnight and given a test meal amounting to 12 or 24 kJ of their normal diet. They were then injected with 3H2O and 14C-glycerol and killed one hour later. The total amount of 3H incorporated into liver glycogen was not affected by meal size, although it was greater in tumor-bearing rats than controls. Analysis of the 3H labelling at different positions in the glycogen glucose residues showed that the proportion of glycogen synthesized via pyruvate, which tended to be greater in tumor-bearing rats, was significantly reduced by increasing the size of the meal. Glycogen synthesis from glycerol was not affected by either meal size or tumor growth. Increasing the size of the meal increased the rate of fatty acid synthesis in both the liver and the epididymal fat pad, but not the tumor. Thus increasing the size of the meal appeared to increase the proportion of glycogen synthesized by the direct pathway from glucose in both tumor-bearing and control animals.

Effect of acute acipimox administration on the rates of lipid and glycogen synthesis in cachectic tumor-bearing rats

Increased energy expenditure in cancer cachexia may be associated with increased postprandial glycogen synthesis via an indirect pathway involving gluconeogenesis. The possible beneficial effect of acipimox, a nicotinic acid analogue that suppresses lipolysis and may also inhibit gluconeogenesis, were therefore examined. Rats bearing a transplantable Leydig cell tumor and freely fed controls were fasted overnight, then given a test meal with or without 10 mg of acipimox. The meal included 200 mg of [1-13C]glucose, and the rats were injected simultaneously with 7 mCi of 3H2O and 1 microCi of [14C]glycerol. The rats were killed one hour later. The rate of incorporation of 3H2O into hepatic glycogen was increased in the tumor-bearing rats and suppressed by acipimox. Positional analysis of the tritium incorporated into glycogen indicated that a greater proportion of the glycogen was synthesized via pyruvate in the tumor-bearing rats. Acipimox tended to reduce this proportion, although the effect was not statistically significant. Neither tumor growth nor acipimox significantly affected the proportion of 13C incorporated into different positions in the glycogen glucose. Glycogen synthesis from glycerol tended to decrease when lipolysis was suppressed by acipimox, although the statistical significance of this effect was marginal. Fatty acid synthesis in liver and adipose tissue was reduced in tumor-bearing rats, but acipimox had no effect. It is concluded that acipimox does suppress gluconeogenesis and glycogenesis in the postprandial state, but it does not normalize all the metabolic abnormalities observed in cancer cachexia.

Alterations in postprandial glycogen and lipid synthesis in cachectic tumor-bearing rats

Alterations in the postprandial metabolism of glucose were investigated in groups of tumor-bearing rats and freely fed controls and in groups of normal rats whose food intake had been restricted to match that of the tumor-bearing rats. A standard mixed meal was administered by gavage, and the rate of incorporation of 3H from 3H2O into hepatic glycogen and into saponifiable lipids in the liver and adipose tissue was measured at intervals up to three hours after the meal. In tumor-bearing rats, the rate of glycogen synthesis rose by more than twice as much as normal after the meal, while the normal rise in rates of fatty acid synthesis was suppressed. In contrast, in the rats whose food intake had been restricted, the postprandial rise in hepatic glycogenesis was suppressed and the rates of postprandial lipogenesis in liver and adipose tissue were increased. Thus the changes that were observed in the tumor-bearing animals did not represent a normal response to reduced food intake. Increased postprandial glycogenesis in tumor-bearing rats is likely to be associated with increased gluconeogenesis, thereby increasing energy expenditure. The prolonged high rate of hepatic glycogen synthesis may also delay the initiation of the next meal and thus contribute to the decrease in food intake in cancer cachexia.

Lipid metabolism in cachectic tumor-bearing rats at different stages of tumor growth

Rates of lipogenesis and lipoprotein lipase (LPL) activity were measured in liver, adipose tissue, heart, and tumor at several stages during 10 days of palpable growth of a transplantable Leydig cell tumor in rats. This model showed the same characteristics as human cancer cachexia, including anorexia, weight loss, and muscle wasting. Comparison with pair-fed controls showed that the rate of loss of body fat was greater than could be explained by anorexia alone. The rate of lipogenesis tended to decrease during the later stages of tumor growth, particularly in the liver, where there was a statistically significant reduction on Days 5 and 10. This may be largely attributable to decreased availability of substrates caused by decreasing food intake and increasing glucose uptake by the tumor. There was a significant decrease in plasma glucose concentration by Day 10. In contrast, LPL activity in adipose tissue was depressed from the earliest stage of tumor growth, and this is likely to be a major cause of lipid depletion in cancer. There was no difference in adipose tissue LPL activity between the fed and postabsorptive states in the tumor-bearing rats, indicating that the normal response to nutrient intake was impaired. Thus, treatment of cancer cachexia should concentrate on normalizing the metabolic response to nutrient ingestion.