{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:39:19Z","timestamp":1790959159985,"version":"4.1.0"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of nutritional intervention for them. Study subjects were terminal cancer patients admitted for palliative care and were judged refractory cachexia in the last five years. We retrospectively examined to find useful indices for identifying such cachectic patients and for evaluating the effect of nutritional intervention. Out of 223 patients in refractory cachexia, 26 were diagnosed cachexia with starvation after symptom management. Comparing before and one week after this management, Palliative Performance Scale (PPS) and transthyretin significantly improved (p &lt; 0.0001, p = 0.0002, respectively) Then, we started nutritional intervention for these cachectic patients and divided into effective group (n = 17) and non-effective group (n = 9) using the criteria for cachexia. Comparing between the two groups, PPS significantly improved2 weeks after intervention in effective group (p = 0.006). Survival time was significantly longer in effective group (p = 0.008). PPS and transthyretin were useful for differential diagnosis of cachexia and refractory cachexia. PPS was useful for evaluating nutritional intervention for cachectic patients. Appropriate nutritional intervention improved survival.<\/jats:p>","DOI":"10.3390\/nu13030915","type":"journal-article","created":{"date-parts":[[2021,3,14]],"date-time":"2021-03-14T23:52:06Z","timestamp":1615765926000},"page":"915","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Differential Diagnosis of Cachexia and Refractory Cachexia and the Impact of Appropriate Nutritional Intervention for Cachexia on Survival in Terminal Cancer Patients"],"prefix":"10.3390","volume":"13","author":[{"given":"Nobuhisa","family":"Nakajima","sequence":"first","affiliation":[{"name":"Division of Community Medicine and International Medicine, University of the Ryukyus Hospital, Nishihara, Nakagami, Okinawa 903-0215, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.cmet.2012.06.011","article-title":"Cancer Cachexia: Mediators, Signaling, and Metabolic Pathways","volume":"16","author":"Fearon","year":"2012","journal-title":"Cell Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1002\/ijc.1332","article-title":"Dietary intake and resting energy expenditure in relation to weight loss in unse-lected cancer patients","volume":"93","author":"Bosaeus","year":"2001","journal-title":"Int. J. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.clnu.2009.07.001","article-title":"Resting energy expenditure and body composition in patients with newly detected cancer","volume":"29","author":"Cao","year":"2010","journal-title":"Clin. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1101\/gad.276733.115","article-title":"Mechanisms of metabolic dysfunction in cancer-associated cachexia","volume":"30","author":"Petruzzelli","year":"2016","journal-title":"Genes Dev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: An international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1200\/JCO.20.00611","article-title":"Management of cancer cachexia. ASCO guideline","volume":"38","author":"Roeland","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/082585979601200102","article-title":"Palliative Performance Scale (PPS): A New Tool","volume":"12","author":"Anderson","year":"1996","journal-title":"J. Palliat. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s005200050242","article-title":"The Palliative Prognostic Index: A scoring system for survival prediction of ter-minally ill cancer patients","volume":"7","author":"Morita","year":"1999","journal-title":"Support. Care Cancer"},{"key":"ref_9","first-page":"38","article-title":"CONUT: A tool for controlling nutritional status. First validation in a hos-pital population","volume":"20","author":"Ignacio","year":"2005","journal-title":"Nutr. Hosp."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.ctrv.2012.08.003","article-title":"The systemic inflammation-based Glasgow Prognostic Score: A decade of experience in patients with cancer","volume":"39","author":"McMillan","year":"2013","journal-title":"Cancer Treat. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/jnci\/dju124","article-title":"Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A system-atic review and meta-analysis","volume":"106","author":"Templeton","year":"2014","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1093\/jjco\/hyw105","article-title":"Guidelines for parenteral fluid management for terminal cancer patients","volume":"46","author":"Higashiguchi","year":"2016","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.17140\/PMHCOJ-2-117","article-title":"A Feasibility Study to Investigate the Effect of Nutritional Support for Advanced Cancer Patients in an Inpatient Hospice in Japan","volume":"2","author":"Amano","year":"2016","journal-title":"Palliat. Med. Hosp. Care Open J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E839","DOI":"10.1503\/cmaj.090449","article-title":"AGREE II: Advancing guideline development, reporting and evaluation in healthcare","volume":"182","author":"Brouwers","year":"2010","journal-title":"CMAJ"},{"key":"ref_15","unstructured":"Okumura, A., Sasaki, S., Fukuoka, T., Nakayama, T., Sugawara, H., Mori, R., and Yamaguchi, N. (2020, October 01). Trend and Quality of Japanese Clinical Guidelines on Cancer. Guidelines International Network Conference 2018, P119. Available online: https:\/\/www.g-i-n.net\/conference\/manchester-conference-2018."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_17","first-page":"23","article-title":"Identification of a transthyretin enhancer site that selectively binds the hepatocyte nu-clear factor-3 beta isoform","volume":"6","author":"Samadani","year":"1996","journal-title":"Gene Expr."},{"key":"ref_18","first-page":"169","article-title":"Measurement of visceral protein status in assessing protein and energy malnutrition: Standard of care. Prealbumin in nutri-tional care consensus group","volume":"11","author":"Bernstein","year":"1995","journal-title":"Nutrition"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4066","DOI":"10.1111\/j.1742-4658.2010.07802.x","article-title":"Hepatocyte nuclear factor-4alpha interacts with other hepatocyte nuclear factors in regulating trans-thyretin gene expression","volume":"277","author":"Wang","year":"2010","journal-title":"FEBS J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1093\/jn\/122.4.864","article-title":"Regulation of Hepatic Transthyretin Messenger RNA Levels during Moderate Protein and Food Restriction in Rats","volume":"122","author":"Gouache","year":"1992","journal-title":"J. Nutr."},{"key":"ref_21","first-page":"1575","article-title":"Prealbumin in nutrition evaluation","volume":"65","author":"Beck","year":"2002","journal-title":"Am. Fam. Physician"},{"key":"ref_22","first-page":"544","article-title":"Nutritional predictors of survival in terminally ill cancer patients","volume":"102","author":"Ho","year":"2003","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1080\/01635581.2018.1557213","article-title":"Low Transthyretin Levels Predict Poor Prognosis in Cancer Patients in Palliative Care Settings","volume":"70","author":"Miura","year":"2018","journal-title":"Nutr. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3149","DOI":"10.1007\/s00520-015-2693-x","article-title":"Glasgow prognostic score predicts prognosis for cancer patients in palliative care settings: A sub-analysis of the Japan-prognostic assessment tools validation (J-Proval) study","volume":"23","author":"Miura","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.critrevonc.2019.08.006","article-title":"Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members","volume":"143","author":"Amano","year":"2019","journal-title":"Crit. Rev. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.suc.2011.02.007","article-title":"Cachexia, Malnutrition, the Refeeding Syndrome, and Lessons from Goldilocks","volume":"91","author":"Palesty","year":"2011","journal-title":"Surg. Clin. N. Am."},{"key":"ref_27","first-page":"1410971","article-title":"Refeeding Syndrome: A Literature Review","volume":"2011","author":"Khan","year":"2010","journal-title":"Gastroenterol. Res. Pract."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/3\/915\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:34:28Z","timestamp":1760160868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/3\/915"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,12]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["nu13030915"],"URL":"https:\/\/doi.org\/10.3390\/nu13030915","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,12]]}}}