Cachexia is defined as condition in which the loss of body mass cannot be reversed nutritionally. It is also known as wasting syndrome. Cachexia can be seen in different chronic diseases, mercury poisoning and hormonal imbalances. As a part of its pathology, cachexia includes sarcopenia, the loss of skeletal muscle mass.
System wise: Clinically, cachexia manifests as asthenia, anorexia, nausea, taste change, loss of subcutaneous fat, body fat and muscle, hormonal aberration, and anemia. The skin is atrophic, shiny, and has loose folds. On the face, zygomatic protuberances are prominent, eyes may bulge. The ribs are prominent, sternum and xyphoid visible. The abdomen is scaphoid or protuberant, there is often ascites because of proteinemia (sacral/ankle edema as well). Because of the weakness they feel, these patients are often immobilized, and decubitus ulcerations are often seen.
Systemic/general: Most people with cachexia have problems with fatigue, weakness, and different difficulties in daily living.
It is often very difficult to address early signs of cachexia until it reaches the point, the efficacy of intervention aimed at improving body composition is considerably reduced. That is the reason why the specific guidelines on the recognition of (pre)cachexia were made. It may be assessed by:
Terms of setting diagnose are underlying chronic disease, unintentional weight loss ≤5% usual body weight in 6 months, systemic inflammatory response (chronic or recurrent) and anorexia .
One of the strategies in treatment is to use appetite stimulants to improve the intake of nutrients. Not long ago, thalidomide has been demonstrated as drug that blocks production of some cytokines, but recent data showed that it is not so successful in fighting cachexia. Maybe the best way to treat cachexia is to combine high protein supplementation with antioxidants, anticyclooxygenase-2 drugs, appetite stimulants and physical activity .
With the proper conventional treatment for the underlying cause (such as cancer, HIV/AIDS, respiratory or kidney failure), cachexia is often resolved. Children are most vulnerable, and approximately 50% of the 10 million deaths each year in developing countries occur because of malnutrition in children younger than 5 years .
Cachexia is almost always sign of various underlying disorders, such as cancer, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, reductions in level of testosterone, chronic inflammation, HIV/AIDS, etc. . It can be also seen in the eating disorder anorexia nervosa .
The significant increase in obesity of the general population confounds such simple estimates of the true prevalence of cachexia. Because of its wide spectrum of clinical presentation and lack of comprehensive definition, it is hard to determine true prevalence of cachexia. Recent data shows that there is a relatively high prevalence of cachexia in patients with chronic diseases. More than 80% of patients with advanced noncancerous illnesses develop cachexia, 10%-15% of patients with advanced congestive heart failure develop severe weight loss, and two thirds develop muscle wasting .
Pathophysiology of cachexia is poorly understood, but it is known that some particular cytokines are involved in its pathogenesis. One of them is tumor necrosis factor alpha (TNF-α), that has a direct catabolic effect on skeletal muscle and adipose tissue. The other included cytokines are interleukin 6, interferon-gamma, etc. .
Early recognition and treatment of cachexia is very important, and can be achieved by adequate lifestyle, nutritional and pharmacological innovative interventions. Consumption of adequate calories dailies coupled with physical exercises is paramount for maintaining healthy body mass and muscle function.
Malnutrition is deficiency in one or more nutrients that must be ingested to satisfy the energetic needs of the organism. Cachexia, also called wasting syndrome, is an even more serious health condition and includes symptoms such as loss of weight, muscle atrophy, loss of appetite, fatigue, weakness and collapse of the immune system . During starvation first of all the body uses glycogen, then fats, and proteins at the end. In cachexia, the person is not starving, but yet losing all component nutrients, including proteins. Body mass index (BMI) is always very low, and this condition can be for many reasons life-threatening.