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What Is Cachexia?

Medically Reviewed by Dan Brennan, MD on June 01, 2021

Cachexia is a condition that causes the body muscles to waste away. It comes with extreme weight loss and can include loss of body fat. It's one of the symptoms that appear when you have a chronic condition, including:

Several independent conditions can cause you to lose weight, but cachexia affects you regardless of how much you eat. Under normal circumstances, if you don't eat enough food, you'll only lose fat. Cachexia makes you lose both fat and muscle.

One notable difference between cachexia and regular weight loss is that it happens involuntarily. In this case, you don’t lose weight because you want to, but because of factors beyond your control. At the same time, your metabolism changes, causing the body to break down too much muscle. Inflammation affects your appetite and makes your body burn more calories than it should.

Researchers say that the condition is one of the body's responses to fighting disease. When your nutritional stores get low, the body synthesizes muscle and fat to get more energy to fuel the brain. You get so weak, which increases your vulnerability to more infections. Consuming more nutrients or calories usually doesn't help reverse the condition.

Causes and Risk Factors of Cachexia

Cachexia occurs from a variety of factors. When you have the condition, your body contains abnormal levels of certain substances. This imbalance is what leads to weight loss and wasting of muscles.

Several factors contribute to cachexia, one of them being the levels of these substances in the body. Other factors are the reaction they cause and the reason they’re in your body in the first place. When they interact with each other, they worsen the condition in several pathways by:

  • Causing inflammation
  • Increasing the rate of metabolism
  • Preventing muscle growth
  • Increasing muscle breakdown

The condition also makes the liver unable to respond well to insulin, leading to insulin resistance. This means that your body loses its ability to use blood glucose for energy.

While research is still underway to establish why this happens and the other potential causes of cachexia, experts have been able to link cachexia to cancer.

Cancer is a disease that causes your immune system to release certain chemicals called cytokines into your bloodstream. These chemicals cause inflammation that contributes to muscle and fat loss. Cytokines also speed up your metabolism, making you lose calories faster.

Cachexia has also been linked to:

Symptoms of Cachexia

When you have cachexia, the first symptom is muscle and fat loss, making you look malnourished. While some people may appear to have standard weight, they may show signs of:

  • Fatigue, which makes it hard for you to enjoy the things you love
  • Reduced muscle strength and muscle wasting
  • Appetite loss
  • Low levels of the albumin protein
  • Anemia
  • High levels of inflammation as identified through tests
  • Low fat-free mass index
  • Swelling or edema as low protein levels in the blood cause fluid to remain in body tissues

Categories of Cachexia

Cachexia falls into three main categories:

  • Precachexia. This is where you lose approximately 5% of your body weight due to a known disease. The category is also accompanied by loss of appetite, changes in metabolism, and inflammation.
  • Cachexia. You lose more than 5% of your body weight in 12 months or less without trying to lose weight. Other symptoms include decreased appetite, inflammation, fatigue, and loss of muscle strength.
  • Refractory cachexia. This happens when you have cancer and lose weight, muscle, function, and lack of response to cancer treatment. Approximately 80% of people with cancer in its late stages have cachexia and a third of them die from the condition.

Treatment of Cachexia

Research has not established a single treatment plan or medicine that can cure cachexia. This is partly because of the many factors that contribute to its cause. The best approach would be to incorporate several types of therapy, as changing your diet alone won’t work. You might also want to consider the following.

  • Incorporate the social aspects of eating. There is pleasure in sitting together with friends and family to share a meal. Emphasizing social eating instead of the amount of food you eat can help reposition your emotional, social, and psychological relationship to eating. It will also make you look forward to family mealtimes and feel less isolated for the sake of your mental health.
  • Use appetite stimulants. Medications like megestrol and dronabinol can enhance your appetite, but remember, eating more may not stop muscle wasting or stop the symptoms from progressing.
  • Eat small, frequent meals. If your body can tolerate it, eat high-calorie meals in small portions throughout the day. Choose drinks with nutritional supplements between meals to increase caloric intake.
  • Emotional support. Let your family or caregivers know how you feel and why you may not want to eat sometimes. When your family understands what you’re going through, they won’t force you to eat or do anything that might hurt you unknowingly.
WebMD Medical Reference

Sources

SOURCES:

The American Journal of Clinical Nutrition: “Cachexia: pathophysiology and clinical relevance.”

Cancer Management and Research: “Cancer Cachexia: Definition, Staging, and Emerging Treatments.”

Cancer Medicine: “Manifestations of Cachexia.”

Cancer Network: “The Evolving Approach to Management of Cancer Cachexia.”

Cancer Research UK: “Cachexia (wasting syndrome).”

Current Opinion in Supportive and Palliative Care: “Psychosocial, educational, and communicative interventions for patients with cachexia and their family carers.”

Frontiers in Physiology: “The Impact of Immune Cells on the Skeletal Muscle Microenvironment During Cancer Cachexia.”

International Journal of Science: “Cachexia: The Last Illness.”

Journal of B.U.O.N.: Official Journal of the Balkan Union of Oncology: “Cancer cachexia and immunomodulation.”

Journal of Cachexia,Sarcopenia, and Muscle: "Cachexia as a common characteristic in multiple chronic diseases," “Psychological impact of cancer cachexia.”

National Cancer Institute: “Tackling the Conundrum of Cachexia in Cancer.”

Nutrition in clinical practice: official publication of the American Society for Parenteral and Enteral Nutrition: “Treatment of unintentional weight loss in patients with cancer.”

Rogers, J., Syed, K., Minteer, J. Cachexia. StatPearls Publishing, 2020.

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