{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:26:55Z","timestamp":1790015215732,"version":"4.0.1"},"reference-count":82,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:00:00Z","timestamp":1642118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kanagawa University of Human Services","award":["111"],"award-info":[{"award-number":["111"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Cachexia is one of the most common, related factors of malnutrition in cancer patients. Cancer cachexia is a multifactorial syndrome characterized by persistent loss of skeletal muscle mass and fat mass, resulting in irreversible and progressive functional impairment. The skeletal muscle loss cannot be reversed by conventional nutritional support, and a combination of anti-inflammatory agents and other nutrients is recommended. In this review, we reviewed the effects of nutrients that are expected to combat muscle loss caused by cancer cachexia (eicosapentaenoic acid, \u03b2-hydroxy-\u03b2-methylbutyrate, creatine, and carnitine) to propose nutritional approaches that can be taken at present. Current evidence is based on the intake of nutrients as supplements; however, the long-term and continuous intake of nutrients as food has the potential to be useful for the body. Therefore, in addition to conventional nutritional support, we believe that it is important for the dietitian to work with the clinical team to first fully assess the patient\u2019s condition and then to safely incorporate nutrients that are expected to have specific functions for cancer cachexia from foods and supplements.<\/jats:p>","DOI":"10.3390\/nu14020345","type":"journal-article","created":{"date-parts":[[2022,1,16]],"date-time":"2022-01-16T20:45:21Z","timestamp":1642365921000},"page":"345","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Nutritional Approach to Cancer Cachexia: A Proposal for Dietitians"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5274-7462","authenticated-orcid":false,"given":"Kotone","family":"Tanaka","sequence":"first","affiliation":[{"name":"School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services 1-10-1 Heiseicho, Yokosuka-shi 238-0013, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5378-9477","authenticated-orcid":false,"given":"Sho","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan"},{"name":"Graduate School of Health Innovation, Kanagawa University of Human Services, 3-25-10 Research Gate Building 2-A, Tonomachi, Kawasaki-ku, Kawasaki 210-0821, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0383-4911","authenticated-orcid":false,"given":"Hiroto","family":"Narimatsu","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan"},{"name":"Graduate School of Health Innovation, Kanagawa University of Human Services, 3-25-10 Research Gate Building 2-A, Tonomachi, Kawasaki-ku, Kawasaki 210-0821, Japan"},{"name":"Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.clnu.2016.09.004","article-title":"ESPEN guidelines on definitions and terminology of clinical nutrition","volume":"36","author":"Cederholm","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_2","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_3","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.clnu.2017.06.017","article-title":"ESPEN expert group recommendations for action against cancer-related malnutrition","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.tipsro.2020.10.001","article-title":"Sarcopenia in cancer: Risking more than muscle loss","volume":"16","author":"Anjanappa","year":"2020","journal-title":"Tech. Innov. Patient Support Radiat. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8075","DOI":"10.7314\/APJCP.2015.16.18.8075","article-title":"Sarcopenia in Cancer Patients","volume":"16","author":"Chindapasirt","year":"2015","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Fukushima, H., Takemura, K., Suzuki, H., and Koga, F. (2018). Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer. Int. J. Mol. Sci., 19.","DOI":"10.20944\/preprints201808.0077.v1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1002\/jcsm.12525","article-title":"Nutrition interventions to treat low muscle mass in cancer","volume":"11","author":"Prado","year":"2020","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.appet.2017.03.020","article-title":"Appetite disorders in cancer patients: Impact on nutritional status and quality of life","volume":"114","year":"2017","journal-title":"Appetite"},{"key":"ref_9","first-page":"Cd011056","article-title":"Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain","volume":"2014","author":"Wiffen","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","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":"Medicine","year":"2016","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/hed.20447","article-title":"Cancer cachexia syndrome in head and neck cancer patients: Part I. Diagnosis, impact on quality of life and survival, and treatment","volume":"29","author":"Couch","year":"2007","journal-title":"Head Neck"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"601329","DOI":"10.3389\/fnut.2020.601329","article-title":"Nutritional Interventions in Cancer Cachexia: Evidence and Perspectives From Experimental Models","volume":"7","author":"Schols","year":"2020","journal-title":"Front. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/jnci\/djr556","article-title":"Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis","volume":"104","author":"Baldwin","year":"2012","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.critrevonc.2014.02.005","article-title":"Dietary treatment of weight loss in patients with advanced cancer and cachexia: A systematic literature review","volume":"91","author":"Balstad","year":"2014","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Bourdel-Marchasson, I., Blanc-Bisson, C., Doussau, A., Germain, C., Blanc, J.F., Dauba, J., Lahmar, C., Terrebonne, E., Lecaille, C., and Ceccaldi, J. (2014). Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: A two-year randomized controlled trial. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0108687"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1188\/02.ONF.517-532","article-title":"A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia","volume":"29","author":"Brown","year":"2002","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1016\/j.clnu.2017.05.027","article-title":"Effects of nutrition and physical exercise intervention in palliative cancer patients: A randomized controlled trial","volume":"37","author":"Uster","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1002\/cncr.20160","article-title":"Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: Effects on survival, metabolism, and function","volume":"100","author":"Lundholm","year":"2004","journal-title":"Cancer"},{"key":"ref_19","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_20","doi-asserted-by":"crossref","first-page":"100092","DOI":"10.1016\/j.esmoop.2021.100092","article-title":"Cancer cachexia in adult patients: ESMO Clinical Practice Guideline","volume":"6","author":"Arends","year":"2021","journal-title":"ESMO Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3389\/fnut.2020.00101","article-title":"Bioavailability of Micronutrients From Nutrient-Dense Whole Foods: Zooming in on Dairy, Vegetables, and Fruits","volume":"7","year":"2020","journal-title":"Front. Nutr."},{"key":"ref_22","unstructured":"(2020). Dietary Reference Intakes for Japanese, Ministry of Health, Labour and Welfare. (In Japanese)."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/000313480306900107","article-title":"Omega-3 fatty acids: Implications for the treatment of tumor-associated inflammation","volume":"69","author":"Jho","year":"2003","journal-title":"Am. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1080\/07315724.2002.10719248","article-title":"Omega-3 fatty acids in inflammation and autoimmune diseases","volume":"21","author":"Simopoulos","year":"2002","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.foodchem.2014.02.135","article-title":"Optimisation of the microencapsulation of tuna oil in gelatin-sodium hexametaphosphate using complex coacervation","volume":"158","author":"Wang","year":"2014","journal-title":"Food Chem."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/S0140-6736(07)60527-3","article-title":"Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): A randomised open-label, blinded endpoint analysis","volume":"369","author":"Yokoyama","year":"2007","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1136\/gut.52.10.1479","article-title":"Effect of a protein and energy dense n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: A randomised double blind trial","volume":"52","author":"Fearon","year":"2003","journal-title":"Gut"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1207\/S15327914NC3602_6","article-title":"Effect of oral eicosapentaenoic acid on weight loss in patients with pancreatic cancer","volume":"36","author":"Wigmore","year":"2000","journal-title":"Nutr. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1002\/cncr.25709","article-title":"Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy","volume":"117","author":"Murphy","year":"2011","journal-title":"Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1200\/JCO.2003.01.101","article-title":"Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia\/cachexia: A double-blind, placebo-controlled study","volume":"21","author":"Bruera","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.clnesp.2018.02.006","article-title":"Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia?","volume":"25","author":"Lavriv","year":"2018","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/0269216311418709","article-title":"A systematic review on the role of fish oil for the treatment of cachexia in advanced cancer: An EPCRC cachexia guidelines project","volume":"26","author":"Ries","year":"2012","journal-title":"Palliat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"C1899","DOI":"10.1111\/1750-3841.13367","article-title":"Mechanisms of Docosahexaenoic and Eicosapentaenoic Acid Loss from Pacific Saury and Comparison of Their Retention Rates after Various Cooking Methods","volume":"81","author":"Cheung","year":"2016","journal-title":"J. Food Sci."},{"key":"ref_34","first-page":"E27","article-title":"Oxidation of leucine and alpha-ketoisocaproate to beta-hydroxy-beta-methylbutyrate in vivo","volume":"262","author":"Nissen","year":"1992","journal-title":"Am. J. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.2174\/18715206113139990321","article-title":"\u03b2-Hydroxy-\u03b2-methylbutyrate as a countermeasure for cancer cachexia: A cellular and molecular rationale","volume":"13","author":"Kim","year":"2013","journal-title":"Anticancer Agents Med. Chem."},{"key":"ref_36","first-page":"597","article-title":"\u03b2-hydroxy-\u03b2-methylbutyrate as a dietary supplement (II): Cell and molecular mechanism of action","volume":"31","year":"2014","journal-title":"Nutr. Hosp."},{"key":"ref_37","first-page":"590","article-title":"\u03b2-hydroxy-\u03b2-methylbutyrate as a dietary supplement (I): Metabolism and toxicity","volume":"31","year":"2014","journal-title":"Nutr. Hosp."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1097\/00005768-200012000-00022","article-title":"Beta-hydroxy-beta-methylbutyrate ingestion, Part I: Effects on strength and fat free mass","volume":"32","author":"Gallagher","year":"2000","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1016\/j.clnu.2017.09.024","article-title":"Impact of the calcium form of \u03b2-hydroxy-\u03b2-methylbutyrate upon human skeletal muscle protein metabolism","volume":"37","author":"Wilkinson","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_40","first-page":"200","article-title":"Effect of beta-hydroxy-beta-methylbutyrate on protein metabolism in bed-ridden elderly receiving tube feeding","volume":"19","author":"Hsieh","year":"2010","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"8731","DOI":"10.1158\/0008-5472.CAN-04-1760","article-title":"Mechanism of the attenuation of proteolysis-inducing factor stimulated protein degradation in muscle by beta-hydroxy-beta-methylbutyrate","volume":"64","author":"Smith","year":"2004","journal-title":"Cancer Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/S0002-9610(02)00823-1","article-title":"Reversal of cancer-related wasting using oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine","volume":"183","author":"May","year":"2002","journal-title":"Am. J. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1007\/s00520-008-0403-7","article-title":"A randomized, double-blind, placebo-controlled trial of a beta-hydroxyl beta-methyl butyrate, glutamine, and arginine mixture for the treatment of cancer cachexia (RTOG 0122)","volume":"16","author":"Berk","year":"2008","journal-title":"Support Care Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"970","DOI":"10.2174\/1381612826666200218100420","article-title":"Dietary Amino Acids and Immunonutrition Supplementation in Cancer-Induced Skeletal Muscle Mass Depletion: A Mini-Review","volume":"26","author":"Soares","year":"2020","journal-title":"Curr. Pharm. Des."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1002\/jcsm.12208","article-title":"Beta-hydroxy-beta-methylbutyrate supplementation and skeletal muscle in healthy and muscle-wasting conditions","volume":"8","year":"2017","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_46","unstructured":"(2020). Standard Tables of Food Composition in Japan, Ministry of Education, Sports, Science and Technology. (In Japanese)."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12970-017-0173-z","article-title":"International Society of Sports Nutrition position stand: Safety and efficacy of creatine supplementation in exercise, sport, and medicine","volume":"14","author":"Kreider","year":"2017","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Mills, S., Candow, D.G., Forbes, S.C., Neary, J.P., Ormsbee, M.J., and Antonio, J. (2020). Effects of Creatine Supplementation during Resistance Training Sessions in Physically Active Young Adults. Nutrients, 12.","DOI":"10.3390\/nu12061880"},{"key":"ref_49","first-page":"822","article-title":"Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance","volume":"17","author":"Rawson","year":"2003","journal-title":"J. Strength Cond. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"B11","DOI":"10.1093\/gerona\/58.1.B11","article-title":"Creatine Supplementation Enhances Isometric Strength and Body Composition Improvements Following Strength Exercise Training in Older Adults","volume":"58","author":"Brose","year":"2003","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Candow, D.G., Forbes, S.C., Kirk, B., and Duque, G. (2021). Current Evidence and Possible Future Applications of Creatine Supplementation for Older Adults. Nutrients, 13.","DOI":"10.3390\/nu13030745"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"107","DOI":"10.2165\/00007256-200535020-00002","article-title":"Creatine supplementation and exercise performance: Recent findings","volume":"35","author":"Bemben","year":"2005","journal-title":"Sports Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1152\/jappl.1996.81.1.232","article-title":"Muscle creatine loading in men","volume":"81","author":"Hultman","year":"1996","journal-title":"J. Appl. Physiol."},{"key":"ref_54","first-page":"503","article-title":"The anti-wasting effects of L-carnitine supplementation on cancer: Experimental data and clinical studies","volume":"27","author":"Esfahani","year":"2018","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.2174\/1389203718666170606105108","article-title":"Creatine Supplementation and Skeletal Muscle Metabolism for Building Muscle Mass-Review of the Potential Mechanisms of Action","volume":"18","author":"Farshidfar","year":"2017","journal-title":"Curr. Protein Pept. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/MCO.0b013e328331de63","article-title":"Can the use of creatine supplementation attenuate muscle loss in cachexia and wasting?","volume":"12","author":"Sakkas","year":"2009","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.clnu.2006.01.014","article-title":"Effects of creatine supplementation on nutritional status, muscle function and quality of life in patients with colorectal cancer\u2014A double blind randomised controlled trial","volume":"25","author":"Norman","year":"2006","journal-title":"Clin. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1093\/annonc\/mdx232","article-title":"A double-blind, placebo-controlled randomized trial of creatine for the cancer anorexia\/weight loss syndrome (N02C4): An Alliance trial","volume":"28","author":"Jatoi","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1248\/bpb.b16-00638","article-title":"Effects of Combined Treatment with Branched-Chain Amino Acids, Citric Acid, L-Carnitine, Coenzyme Q10, Zinc, and Various Vitamins in Tumor-Bearing Mice","volume":"40","author":"Awa","year":"2017","journal-title":"Biol. Pharm. Bull."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00394-019-01933-6","article-title":"Creatine supplementation in Walker-256 tumor-bearing rats prevents skeletal muscle atrophy by attenuating systemic inflammation and protein degradation signaling","volume":"59","author":"Cella","year":"2020","journal-title":"Eur. J. Nutr."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1053\/j.jrn.2019.05.004","article-title":"Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis","volume":"29","author":"Pertille","year":"2019","journal-title":"J. Ren. Nutr."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4085\/1062-6050-44.2.215","article-title":"Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses","volume":"44","author":"Lopez","year":"2009","journal-title":"J. Athl. Train."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1200\/JCO.2004.06.024","article-title":"An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: A North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort","volume":"22","author":"Jatoi","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"268","DOI":"10.2165\/00007256-199418040-00005","article-title":"Creatine in humans with special reference to creatine supplementation","volume":"18","author":"Balsom","year":"1994","journal-title":"Sports Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/0149-2918(95)80017-4","article-title":"Pharmacokinetic considerations for the therapeutic use of carnitine in hemodialysis patients","volume":"17","author":"Brass","year":"1995","journal-title":"Clin. Ther."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1113\/jphysiol.2006.125799","article-title":"New insights concerning the role of carnitine in the regulation of fuel metabolism in skeletal muscle","volume":"581","author":"Stephens","year":"2007","journal-title":"J. Physiol."},{"key":"ref_67","unstructured":"(1989). Recommended Dietary Allowances, National Academy Press. [10th ed.]."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/07315724.1989.10720288","article-title":"Alterations of serum and urinary carnitine profiles in cancer patients: Hypothesis of possible significance","volume":"8","author":"Dodson","year":"1989","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1001\/archpedi.1987.04460060076039","article-title":"Plasma carnitine deficiency. Clinical observations in 51 pediatric patients","volume":"141","author":"Winter","year":"1987","journal-title":"Am. J. Dis. Child."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.ejim.2005.02.014","article-title":"Serum carnitine levels in patients with tumoral cachexia","volume":"16","author":"Vinci","year":"2005","journal-title":"Eur. J. Intern. Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1038\/sj.bjc.6600413","article-title":"Potential role of levocarnitine supplementation for the treatment of chemotherapy-induced fatigue in non-anaemic cancer patients","volume":"86","author":"Graziano","year":"2002","journal-title":"Br. J. Cancer"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"4541","DOI":"10.3748\/wjg.v12.i28.4541","article-title":"Decrease of serum carnitine levels in patients with or without gastrointestinal cancer cachexia","volume":"12","author":"Malaguarnera","year":"2006","journal-title":"World J. Gastroenterol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.nut.2005.06.003","article-title":"Efficacy of l-carnitine administration on fatigue, nutritional status, oxidative stress, and related quality of life in 12 advanced cancer patients undergoing anticancer therapy","volume":"22","author":"Gramignano","year":"2006","journal-title":"Nutrition"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"125","DOI":"10.4161\/cbt.12.2.15717","article-title":"L-carnitine ameliorates cancer cachexia in mice by regulating the expression and activity of carnitine palmityl transferase","volume":"12","author":"Liu","year":"2011","journal-title":"Cancer Biol. Ther."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1475-2891-11-52","article-title":"L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN)\u2014A randomized multicentre trial","volume":"11","author":"Kraft","year":"2012","journal-title":"Nutr. J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.jpainsymman.2006.09.001","article-title":"Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: A phase I\/II study","volume":"32","author":"Cruciani","year":"2006","journal-title":"J. Pain Symptom Manag."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1053\/gast.2001.28031","article-title":"AGA technical review on parenteral nutrition","volume":"121","author":"Koretz","year":"2001","journal-title":"Gastroenterology"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"3864","DOI":"10.1200\/JCO.2011.40.2180","article-title":"L-carnitine supplementation for the management of fatigue in patients with cancer: An eastern cooperative oncology group phase III, randomized, double-blind, placebo-controlled trial","volume":"30","author":"Cruciani","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/1743-7075-7-30","article-title":"Role of carnitine in disease","volume":"7","author":"Flanagan","year":"2010","journal-title":"Nutr. Metab."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1038\/sj.bjc.6601981","article-title":"Effect of eicosapentaenoic acid, protein and amino acids on protein synthesis and degradation in skeletal muscle of cachectic mice","volume":"91","author":"Smith","year":"2004","journal-title":"Br. J. Cancer"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1038\/sj.bjc.6604905","article-title":"Dietary supplementation with a specific combination of high protein, leucine, and fish oil improves muscle function and daily activity in tumour-bearing cachectic mice","volume":"100","author":"Kegler","year":"2009","journal-title":"Br. J. Cancer"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"989","DOI":"10.6004\/jnccn.2017.0132","article-title":"NCCN Guidelines Insights: Palliative Care, Version 2.2017","volume":"15","author":"Dans","year":"2017","journal-title":"J. Natl. Compr. Cancer Netw."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/2\/345\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:27:23Z","timestamp":1760362043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/2\/345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,14]]},"references-count":82,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["nu14020345"],"URL":"https:\/\/doi.org\/10.3390\/nu14020345","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,14]]}}}