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Cachexia: Causes, Symptoms and Treatment

Cachexia is a severe wasting syndrome characterized by unintentional weight loss, muscle wasting, and fatigue, commonly associated with chronic or serious illnesses.

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Things worth knowing about "Cachexia"

Cachexia is a severe wasting syndrome characterized by unintentional weight loss, muscle wasting, and fatigue, commonly associated with chronic or serious illnesses.

What is Cachexia?

Cachexia is a complex metabolic syndrome defined by progressive, involuntary weight loss, significant loss of muscle mass (sarcopenia), fatigue, loss of appetite, and systemic inflammation. It occurs as a consequence of serious underlying diseases and cannot be fully reversed by standard nutritional support alone. Cachexia severely impairs quality of life and is associated with increased mortality.

Causes

Cachexia results from a complex interaction of increased energy expenditure, reduced food intake, and chronic inflammatory processes. Common underlying conditions that can lead to cachexia include:

Cancer (the most frequent cause, often referred to as cancer cachexia)
Chronic heart failure
Chronic obstructive pulmonary disease (COPD)
Chronic kidney disease
HIV/AIDS
Inflammatory bowel disease (e.g., Crohn's disease)
Rheumatoid arthritis
Sepsis and other severe infections

At the molecular level, pro-inflammatory signaling molecules (cytokines) such as TNF-alpha, interleukin-1, and interleukin-6 play a central role. These cytokines drive the breakdown of muscle and fat tissue while simultaneously suppressing appetite.

Symptoms

The symptoms of cachexia affect the entire body and can include:

Unintentional weight loss of more than 5% of body weight within 12 months
Significant loss of muscle mass and muscle weakness
Chronic fatigue
Loss of appetite (anorexia)
Reduction in body fat
Decreased physical performance and endurance
Anemia
Weakened immune function
Depression and psychological distress

Diagnosis

The diagnosis of cachexia is based on established clinical criteria. According to the international consensus definition, cachexia is present when:

weight loss exceeds 5% over 12 months, or
body mass index (BMI) is below 20 kg/m² with a weight loss of more than 2%, or
weight loss of more than 2% is accompanied by low muscle mass (sarcopenia).

Additional diagnostic tools include:

Blood tests (inflammatory markers such as CRP, albumin, and hemoglobin levels)
Body composition analysis (e.g., DEXA scan or bioelectrical impedance analysis)
Nutritional assessments and quality-of-life questionnaires
Evaluation and monitoring of the underlying disease

Treatment

Treatment of cachexia is multimodal and focuses primarily on addressing the underlying condition, improving nutritional status, and maintaining physical function.

Nutritional Therapy

A high-calorie, high-protein diet tailored to the individual patient is a cornerstone of treatment. If oral intake is insufficient, oral nutritional supplements or enteral nutrition (tube feeding) may be used. In severe cases, parenteral nutrition (intravenous nutrient delivery) may be required.

Physical Exercise

Targeted resistance and endurance training, adapted to the patient's condition, can help slow muscle loss and improve physical capacity and overall well-being.

Drug Therapy

Depending on the underlying disease and severity, the following medications may be considered:

Appetite stimulants (e.g., megestrol acetate, corticosteroids)
Anti-inflammatory agents (e.g., omega-3 fatty acids, NSAIDs in specific contexts)
Anabolic agents (e.g., testosterone, and in clinical trials, selective androgen receptor modulators)

Psychosocial Support

Since cachexia brings significant psychological burden, psychosocial support from nutritionists, psychologists, and palliative care specialists is an essential part of comprehensive management.

Prognosis

The prognosis in cachexia largely depends on the nature and stage of the underlying disease, as well as how early the condition is identified and treated. Early intervention can positively influence the course of the condition. In advanced stages, particularly in oncological diseases, so-called refractory cachexia can no longer be reversed and requires palliative care with a focus on maintaining quality of life.

References

Fearon K et al. - Definition and classification of cancer cachexia: an international consensus. Lancet Oncology. 2011;12(5):489-495. PubMed.
Evans WJ et al. - Cachexia: a new definition. Clinical Nutrition. 2008;27(6):793-799. PubMed.
Muscaritoli M et al. - Consensus definition of sarcopenia, cachexia and pre-cachexia: Joint document elaborated by Special Interest Groups of the Society on Sarcopenia, Cachexia and Wasting Disorders. Clinical Nutrition. 2010;29(2):154-159. PubMed.

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