Cachectic

An overview of cachexia, a complex metabolic syndrome associated with underlying illness.

Cachexia is a complex metabolic syndrome characterized by severe body weight, fat, and muscle loss and increased protein catabolism due to underlying disease(s). It is often associated with chronic illnesses such as cancer, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and congestive heart failure. Cachexia is distinct from starvation, malnutrition, and age-related muscle loss (sarcopenia) as it involves an inflammatory response and is not fully reversible by conventional nutritional support.

Pathophysiology

Cachexia involves a multifactorial pathophysiological process that includes systemic inflammation, negative protein and energy balance, and abnormal metabolism. The inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 (IL-1) play a significant role in the development of cachexia. These cytokines contribute to increased muscle protein breakdown and decreased muscle protein synthesis, leading to muscle wasting.

Clinical Features

Patients with cachexia often present with significant weight loss, muscle atrophy, fatigue, weakness, and loss of appetite. Unlike simple starvation, cachexia is characterized by a disproportionate loss of lean body mass compared to fat mass. The condition can severely impact the quality of life and is associated with poor prognosis in patients with chronic diseases.

Diagnosis

The diagnosis of cachexia is primarily clinical and involves the identification of weight loss greater than 5% over 12 months or less, in the presence of underlying illness and at least three of the following criteria:

• Decreased muscle strength
• Fatigue
• Anorexia
• Low fat-free mass index
• Abnormal biochemistry (e.g., increased inflammatory markers, anemia, low serum albumin)

Management

Management of cachexia involves a multidisciplinary approach aimed at treating the underlying disease, nutritional support, and pharmacological interventions. Nutritional interventions may include high-calorie, high-protein diets, and the use of appetite stimulants. Pharmacological treatments may involve the use of anti-inflammatory agents, anabolic steroids, and other medications aimed at reducing muscle wasting.

Prognosis

The prognosis of cachexia is generally poor, as it is often associated with advanced stages of chronic diseases. Effective management of the underlying condition and early intervention can help improve outcomes and quality of life for affected individuals.

Also see

• Sarcopenia
• Malnutrition
• Anorexia (symptom)
• Inflammation
• Muscle atrophy