What Is Cachexia?

Cachexia is a wasting syndrome, which is a process that causes fat tissues and muscle to waste away. This disorder causes involuntary weight loss, which often affects people with late-stage chronic diseases, such as cancer, renal disease, HIV or AIDS, and congestive heart failure.

People with cachexia usually lose weight due to various reasons. Their metabolism also changes causing their body too much muscle breakdown. Loss of appetite is due to inflammation and tumor substances, which cause the body to rapidly burn more calories.

According to experts, cachexia is one of the body’s responses to combat diseases. The body breaks down fat and muscle to obtain more energy, especially when the body is low in nutritional stores. However, getting more calories and nutrition are not sufficient to reverse cachexia. People with this wasting syndrome do not just lose weight. They often become frail and too weak making them more susceptible to developing infections. Their symptoms also include a lower quality of life. At least 50 percent of people with progressive or terminal cancer have cachexia.

Cachexia Categories

Cachexia is divided into three categories: precachexia, cachexia, and refractory cachexia.

• Precachexia: A person with precachexia experiences loss of appetite, changes in metabolism, and inflammation. This category involves the loss of up to 5 percent of body weight while being affected by a known disease.

• Cachexia: People with known diseases experience unintentional weight loss of more than 5 percent of their body weight up to one year. Other criteria in this category include fatigue, reduced or poor appetite, muscle weakness, and inflammation.

• Refractory Cachexia: This category involves people who have cancer. It is characterized by muscle loss, unintentional weight loss, and resistance to cancer treatment.

Symptoms

Although most people with cachexia look malnourished due to extreme loss of weight and muscle mass, some people seem to appear with a normal weight. According to research, this wasting disorder usually begins even before weight loss occurs, which means that people with cachexia may not initially exhibit any signs or symptoms of the disorder.

To confirm cachexia, a person with a known disease must have lost a minimum of 5 percent of body weight within a year or less than a year including any three of the following signs and symptoms:

• Fatigue
• Anorexia
• Anemia
• Low albumin levels
• Decreased muscle strength
• High inflammation level confirmed by certain blood tests
• A low fat-free mass index (FFMI)

The symptoms of reduced functional ability, such as abnormally low energy levels and fatigue can make it difficult for people with cachexia to do basic and daily activities, such as taking a bath, brushing their teeth, and getting dressed.

Edema or swelling may also occur due to low protein levels in the blood because fluid moves into the leg tissues of people who can still manage to stand or sit.

Causes

Cachexia may be due to substances that are produced by tumors or by the host response, which is simply the body’s reaction or response to tumors. Other causes of cachexia including how the immune system reacts to cancer are being studied to further understand the disorder.

Catabolic metabolism is a characteristic feature of cachexia, which involves losing body mass, both fat and muscle.

Risk Factors

Cachexia is usually seen with cancer as well as other diseases, such as emphysema, heart failure, HIV or AIDS, and chronic renal failure. When it comes to cancer, cachexia is mostly seen with pancreatic cancer, lung cancer, stomach cancer, and other types of advanced cancer.

Other conditions linked to cachexia include:

• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis
• Crohn’s disease
• Rheumatoid arthritis

Diagnosis

The process of muscle wasting often begins quite early upon cancer diagnosis. However, the signs and symptoms of cachexia are usually observed in the late stages of cancer. Before any weight loss occurs, cachexia has already begun.

The following measures can be used to evaluate cachexia:

• Blood Tests: These tests include inflammatory markers (C-reactive protein or CRP), WBC count, serum albumin, uric acid, and transferrin levels.

• Body Mass Index (BMI): Your weight and height are needed to calculate your BMI. Your BMI can provide more information about relative body weight and healthy body weight.

• Record of Daily Food Intake: Keeping track of your food intake can help you cope or prevent cachexia. It is important to note that malnutrition in cachexia can develop in spite of consuming enough calories.
• Lean Muscle Mass: There are tests used to determine body composition from lean muscle mass to body fat, and they include bioimpedance and skin folds.

Treatment

Cachexia does not have a specific treatment. There is no way to reverse it, so its treatment mainly focuses on how to improve a patient’s symptoms and quality of life. Another goal of treatment is to enable anabolic processes while disabling catabolic processes, which result in muscle breakdown.

Although treating cachexia is both challenging and fairly disappointing, the following treatments may help:

1. Medications

Despite limited success, the following medications and supplements have been used for the treatment of cachexia:

• Testosterone
• Medroxyprogesterone
• Thalidomide
• Celebrex (celecoxib)
• Zyloprim (allopurinol)
• Medical marijuana

• Megace (megestrol acetate)
• L-Carnitine
• Marinol (dronabinol)

2. Dietary Intake

It is very important for people with cancer and other cachexia-related conditions to consume a healthy diet. There should be a gradual increase in the food intake of people who have not been eating for a certain period of time to avoid experiencing the overfeeding syndrome. Doctors may recommend a feeding tube if patients cannot orally consume their food.

3. Supplements

The use of eicosapentaenoic acid (EPA) supplements is linked to improved levels of inflammatory markers in people with cachexia. According to studies, fish oil has the ability to treat cachexia due to its omega-3 fatty acid content.

The use of EPA supplements is also linked to fewer complications and infections, including shorter hospital stays.

4. Exercise

Although it may seem the other way around, exercise may actually help people with cachexia. The benefits of exercise include an increase in appetite and slow progression of declining muscle mass, especially in endurance training.

Complications and Outlook

Cachexia can lower a person’s response to treatment, which can become very serious. People who are undergoing chemotherapy may not be able to tolerate its side effects and may become too weak to survive. Because of these complications, individuals with cachexia tend to have a worse survival outlook.

References

Tackling the Conundrum of Cachexia in Cancer. (2011). National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/research/cachexia

Morley, J., Thomas, D., & Wilson, M. (2006). Cachexia: pathophysiology and clinical relevance. The American Journal Of Clinical Nutrition, 83(4), 735-743.

Argilés, J., López-Soriano, F., Toledo, M., Betancourt, A., Serpe, R., & Busquets, S. (2011). The cachexia score (CASCO): a new tool for staging cachectic cancer patients. Journal Of Cachexia, Sarcopenia And Muscle, 2(2), 87-93. doi:10.1007/s13539-011-0027-5

Cancer Cachexia. (n.d.). The James - OSUCCC. https://cancer.osu.edu/research-and-education/clinical-research/cancer-cachexia