INS and neoplasm: Cancer-related cachexia is thought to be caused by changes in the systemic metabolic environment due to elevated inflammatory cytokines such as IL-6 and TNF27,28 in adipose tissue29,30, tumour cells31, and hepatocytes32; changes in protein synthesis and degradation in skeletal muscle; and insulin resistance33, which together lead to weight loss, anorexia, decreased systemic function, and increased adiposity34.