Elsevier

Clinical Nutrition

Volume 27, Issue 6, December 2008, Pages 793-799
Clinical Nutrition

Opinion paper
Cachexia: A new definition

https://doi.org/10.1016/j.clnu.2008.06.013Get rights and content

Summary

On December 13th and 14th a group of scientists and clinicians met in Washington, DC, for the cachexia consensus conference. At the present time, there is no widely agreed upon operational definition of cachexia. The lack of a definition accepted by clinician and researchers has limited identification and treatment of cachectic patient as well as the development and approval of potential therapeutic agents. The definition that emerged is: “cachexia, is a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention) or growth failure in children (excluding endocrine disorders). Anorexia, inflammation, insulin resistance and increased muscle protein breakdown are frequently associated with cachexia. Cachexia is distinct from starvation, age-related loss of muscle mass, primary depression, malabsorption and hyperthyroidism and is associated with increased morbidity. While this definition has not been tested in epidemiological or intervention studies, a consensus operational definition provides an opportunity for increased research.

Section snippets

Definition

Cachexia has long been recognized as a syndrome associated with many illnesses. However, the underlying mechanisms causing cachexia are not well understood and there is no universally agreed upon definition. It is essential to have a specific definition so clinicians can recognize the problem and institute corrective measures to treat cachexia.1 On December 13th and 14th, 2006, scientists and clinicians met in Washington, DC, to reach a consensus on the definition of the constellation of

Weight loss

Weight loss is a powerful independent variable that predicts mortality in patients with cancer.7, 8 Anker9 has demonstrated that cardiac cachexia is associated with a poor prognosis, independently of functional severity, age, and exercise capacity and cardiac function. Weight loss is associated with increased mortality among elderly people discharged from a hospital10; in elderly nursing home patients a 5% or greater weight loss in a month is associated with a 10-fold increase risk of death.11

Skeletal muscle

As noted, muscle wasting is important in the pathophysiology of cachexia and a major cause of fatigue18 in patients. Accelerated or exaggerated loss of skeletal muscle mass distinguishes cachexia from the weight loss due solely to reduced energy intake. Several groups of investigators have suggested that actomyosin, actin and myosin are selectively targeted for degradation in clinical conditions associated with cachexia.19, 20, 21 Selective targeting of skeletal muscle is at least in part due

Nutritional factors

It is important to distinguish cachexia from starvation, malabsorption, hyperthyroidism, dehydration or sarcopenia (though these conditions may represent a pre-cachectic state) and from subcutaneous fat loss (lipoatrophy), which can occur as a side effect of some antiretroviral therapies in HIV. Sarcopenia is defined as the age-associated decrease in skeletal muscle mass23 resulting from a variety of causes including decreased physical activity and/or decreased production of anabolic hormones.

Treatment options and conclusions

The treatment options for cachexia are limited. Unfortunately, refeeding a patient with cachexia does not correct the underlying problem. Even with total parenteral nutrition, weight stabilization does not prevent the continuing loss of skeletal muscle mass or correct the underlying abnormality in the metabolic state. Potential strategies for treating cachexia target skeletal muscle wasting in the presence of adequate nutrition.32 Some potential pharmacological agents include androgens,

Conflict of interest statement

None declared.

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