Cachexia is a metabolic syndrome marked by severe weight loss, loss of muscle mass and/or fat, and reduced appetite. It also causes nutritional deficiencies that cannot be corrected even with proper food intake, requiring specialized treatment.
Cachexia is most common in people with chronic conditions such as cancer, HIV infection, or cardiovascular disease like heart failure, and can also develop after serious accidents.
Treatment should be guided by a team of specialists, which may include doctors, nutritionists, psychologists, and physical therapists. Management may involve individualized diets, specific exercises, and, in some cases, medications such as hormones, anti-inflammatory drugs, or steroids, depending on the severity of cachexia.
Main symptoms
The main symptoms of cachexia include:
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Significant weight loss
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Loss of appetite or feeling full quickly
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Weakness, extreme fatigue, or low energy
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Loss of muscle mass and/or body fat
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Dry mouth or changes in taste
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Vomiting or diarrhea
Cachexia can also lead to nutritional deficiencies, anemia, or a weakened immune system.
In children, cachexia may interfere with normal growth and development, potentially causing delays in both physical and cognitive milestones, depending on how severe the condition is.
It is important to seek medical care from an endocrinologist, general practitioner, nutrition specialist, or pediatrician if signs of cachexia appear so the underlying cause can be identified and treatment started promptly.
How to confirm a diagnosis
Cachexia is diagnosed by a doctor through a review of symptoms, medical history, physical examination, and lab tests.
It is identified when there is at least 5% weight loss over 12 months, or when a person has a body mass index (BMI) below 20 kg/m² along with a chronic illness.
Lab results such as blood albumin, transferrin, and C-reactive protein (CRP) levels are also considered.
Cachexia is classified according to the amount of weight lost in the past year: mild (around 5%), moderate (10%), or severe (15%). Proper evaluation by a doctor and nutritionist is essential.
Possible causes
Cachexia develops due to an increased basal metabolic rate and reduced appetite, which lower calorie and protein intake, leading to muscle loss with or without fat loss.
Loss of appetite is often linked to insulin resistance, higher levels of inflammatory substances such as cytokines, and lower levels of glucagon, cortisol, and catecholamines.
Other hormones may also be reduced, including testosterone, ghrelin, and growth hormone.
Who is at higher risk
The main risk factors for cachexia include:
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Cancer
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Cardiovascular diseases such as congestive heart failure (CHF)
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Kidney failure or liver disease
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Tuberculosis or COPD
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Chronic infections or AIDS
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Cystic fibrosis
Cachexia may also result from visceral leishmaniasis, rheumatoid arthritis, stroke, or neurological conditions such as advanced Alzheimer’s disease or dementia.
Other possible causes include poisoning and severe burns.
Types of cachexia
Cachexia can be classified as:
1. Neoplastic cachexia
Neoplastic cachexia develops in people with cancer and is often called cancer-related cachexia. It typically appears in advanced or terminal stages of the disease.
2. Cardiac cachexia
Cardiac cachexia is linked to congestive heart failure.
It may develop due to the heart condition itself, side effects of medications used for treatment, or intestinal malabsorption.
3. Senile cachexia
Senile cachexia occurs in older adults, usually as a result of chronic diseases.
Elderly individuals with cancer, respiratory disease, kidney disease, liver disease, or heart conditions are at greater risk.
Poor diet, eating disorders, or natural aging may also reduce nutrient absorption and appetite, increasing the likelihood of cachexia in older adults.
Treatment options
Treatment for cachexia should be managed by a multidisciplinary team, which may include endocrinologists, general practitioners, nutritionists, and pediatricians. The main goals are to stimulate appetite, reduce inflammation, and improve quality of life.
The main treatment approaches for cachexia are:
1. Adequate nutrition
Proper nutrition is essential and should be planned by a doctor or nutritionist.
The diet should gradually increase calorie intake, including proteins, carbohydrates, fatty acids, vitamins, and minerals needed for normal body function.
This gradual increase helps prevent refeeding syndrome, a potentially serious complication that can occur when someone who has been fasting or malnourished suddenly consumes large amounts of food.
Although diet cannot reverse the metabolic state of cachexia or fully restore muscle mass, it can help repair tissues and strengthen the immune system.
2. Nutritional supplements
In cases of severe nutritional deficiencies, supplements may be prescribed in addition to a balanced diet.
The type of supplement depends on the specific deficiency.
3. Enteral or parenteral nutrition
In severe cases, nutrition may be provided through a feeding tube (enteral nutrition) or directly into the bloodstream (parenteral nutrition).
4. Physical exercise
Exercise can help slow muscle loss caused by cachexia.
It also improves insulin sensitivity, reduces inflammation, and decreases oxidative stress.
Exercise may be combined with nutritional supplements such as branched-chain amino acids (BCAAs), under medical supervision.
5. Physical therapy
Physical therapy helps prevent excessive muscle loss and promotes mobility, which can be impaired in people with cachexia.
It also helps maintain strength, improve flexibility, and reduce complications such as immobility-related injuries and respiratory problems caused by weakened muscles.
With proper guidance, physical therapy can significantly improve quality of life.
6. Medications for cachexia
Certain medications may be prescribed to stimulate appetite in people with cachexia, such as megestrol acetate, growth hormone, or corticosteroids, depending on the medical evaluation.