Energy in the body is stored mainly in body fat, which is depleted during the wasting process. This process is normally increased during fasting without tumor or injury. When the patient has a tumor, there is a metabolic response to the injury that also promotes lipid mobilization. Several authors have implicated a lipid mobilization factor as being responsible for this process, which is believed to occur in both infection and cancer. Data suggest that this factor may also be responsible for the depletion of liver glycogen in cancer cachexia. This factor(s) increases lipolysis and plasma triglyceride concentrations. The former effect may be due to an increase in the hormone-sensitive lipase and the latter effect due to inhibition of lipoprotein lipase activity. However, the exact factor(s) that is responsible for these effects is not known.
Cancer patients with weight loss have an increase in whole body lipid turnover measured by radio-actively labeled fatty acids. However, when weight loss is prevented, there is no increase in the rate of lipolysis. Similarly, the rates of lipid oxidation are normal in cancer patients compared to weight-matched controls. In more severe injury, as seen in sepsis, the rate of lipolysis is increased.
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