Contribution of anorexia and hypermetabolism to weight loss in anicteric patients with pancreatic cancer

Pancreatic cancer is frequently associated viith cachexia, although the mechanisms of weight loss are unclear. Weight loss is generally associated with a negative energy balance, which can result from a rise in energy expenditure, a fall in energy intake or a combination of the two. Both sides of the energy balance equation can be influenced by activation of the proinflammatory cytokine network. Excess production of proinflammatory cytokines has been shown to result in weight loss in animal models of cancer cachexia(1). The authors have previously demonstrated increased energy expenditure in weight-losing patients with pancreatic cancer(2). Moreover, energy expenditure was greatest in patients with evidence of another cytokine-mediated metabolic event, an acute-phase protein response (APPR). The aim of the present study was to determine whether there is a similar association between the presence of an acute-phase response and reduced food intake.