Cachexia: Diagnosis and Treatment

Abstract

Three primary categories of loss of body weight include starvation (including undernutrition), sarcopenia, and cachexia. Cachexia is the cytokine-associated wasting of protein and energy stores due to the effects of disease; there is a progressive, severe loss of skeletal Muscle with relative preservation of visceral protein reserves. Cachexia is directly related to inflammatory states, such as cancer or acquired immunodeficiency syndrome, and also occurs in rheumatoid arthritis, chronic renal insufficiency, chronic obstructive pulmonary disease, ischemic cardiomyopathy, and infectious diseases. In developing appropriate interventions for weight loss, it is important to recognize the distinction between cachexia and starvation. While starvation due to protein-energy undernutrition is widely regarded as the primary cause of loss of fat and fat-free mass in older persons, a failure to improve with nutritional replacement should trigger a consideration of other causes.