Cancer cachexia, weight loss with altered body composition, is a multifactorial syndrome propagated by symptoms that impair caloric intake, tumor byproducts, chronic inflammation, altered metabolism, and hormonal abnormalities. Cachexia is associated with reduced performance status, decreased tolerance to chemotherapy, and increased mortality in cancer patients. Insulin resistance as a consequence of tumor byproducts, chronic inflammation, and endocrine dysfunction has been associated with weight loss in cancer patients. Insulin resistance in cancer patients is characterized by increased hepatic glucose production and gluconeogenesis, and unlike type 2 diabetes, normal fasting glucose with high, normal or low levels of insulin. Cancer cachexia results in altered body composition with the loss of lean muscle mass with or without the loss of adipose tissue. Alteration in visceral adiposity, accumulation of intramuscular adipose tissue, and secretion of adipocytokines from adipose cells may play a role in promoting the metabolic derangements associated with cachexia including a proinflammatory environment and insulin resistance. Increased production of ghrelin, testosterone deficiency, and low vitamin D levels may also contribute to altered metabolism of glucose. Cancer cachexia cannot be easily reversed by standard nutritional interventions and identifying and treating cachexia at the earliest stage of development is advocated. Experts advocate for multimodal therapy to address symptoms that impact caloric intake, reduce chronic inflammation, and treat metabolic and endocrine derangements, which propagate the loss of weight. Treatment of insulin resistance may be a critical component of multimodal therapy for cancer cachexia and more research is needed.

中文翻译：

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癌症患者的胰岛素抵抗和身体成分。

癌症恶病质（体重减轻且身体成分改变）是一种多因素综合症，症状由热量摄入不足，肿瘤副产物，慢性炎症，新陈代谢改变和荷尔蒙异常引起。恶病质与癌症患者的体力状态降低，对化疗的耐受性降低以及死亡率增加相关。由肿瘤副产物，慢性炎症和内分泌功能障碍引起的胰岛素抵抗与癌症患者的体重减轻有关。癌症患者的胰岛素抵抗以肝葡萄糖生成增加和糖异生为特征，与2型糖尿病不同，正常的空腹血糖具有高，正常或低水平的胰岛素。癌症恶病质导致身体组成发生变化，同时伴有或不伴有脂肪组织损失的瘦肌肉减少。内脏脂肪的改变，肌内脂肪组织的积累以及脂肪细胞分泌脂肪细胞因子可能在促进与恶病质相关的代谢紊乱中发挥作用，包括促炎性环境和胰岛素抵抗。ghrelin的产生增加，睾丸激素缺乏和低维生素D水平也可能导致葡萄糖代谢改变。标准的营养干预措施不能轻易逆转癌症恶病质，因此提倡在发展的最早阶段识别和治疗恶病质。专家主张采用多式联运疗法，以解决影响热量摄入，减轻慢性炎症的症状，并治疗新陈代谢和内分泌失调，这些失调会加剧体重减轻。胰岛素抵抗的治疗可能是癌症恶病质多峰疗法的关键组成部分，需要更多的研究。