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Cachexia is a syndrome of metabolic dysfunction secondary to an underlying disease in which there is depleted skeletal muscle (sarcopenia) which may or may not be accompanied by an absolute loss of body fat.
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Cancer cachexia is specifically used to refer to the cachexia associated with malignant disease. Similarly, cardiac cachexia is used for those with chronic heart disease who are cachectic.
Cachexia is common with several chronic disease states including :
- cancer: commonest
- chronic cardiac failure
- chronic renal failure
- autoimmune diseases e.g. AIDS
In adults, cachexia is usually diagnosed when there is unequivocal loss of weight, whilst in children there is usually an impairment of normal growth 1. A loss of appetite (anorexia), insulin resistance and sarcopenia are often also present 1.
Cachexia is an entity which is distinct from other conditions such as starvation, malnutrition, malabsorptive states, hyperthyroidism, depression and loss of muscle bulk due to aging 1,3.
Historically, it was thought that the cachexia associated with cancer was primarily due to a combination of anorexia and an elevated basal energy utilization 1. This is now deemed to be far too simplistic, not least because optimal dietetic interventions do not reverse the condition. The development of cachexia is complex and characterized by an interplay of metabolic, immunological and neurological factors 1.
CT and MRI have been used to diagnose cachexia mainly by assessing for a depletion of absolute skeletal muscle mass, i.e. sarcopenia. The techniques are now highly accurate, and most measurements are felt to be within 1.5% of the true value 6.
History and etymology
Cachexia is derived from the Greek words κακος (kakos) meaning "bad" and εξις (hexis), a "bodily condition" or "state" 4,5.
- 1. Nishikawa H, Goto M, Fukunishi S, Asai A, Nishiguchi S, Higuchi K. Cancer Cachexia: Its Mechanism and Clinical Significance. Int J Mol Sci. 2021;22(16):8491. doi:10.3390/ijms22168491 - Pubmed
- 2. Muscaritoli M, Anker S, Argilés J et al. Consensus Definition of Sarcopenia, Cachexia and Pre-Cachexia: Joint Document Elaborated by Special Interest Groups (SIG) "Cachexia-Anorexia in Chronic Wasting Diseases" and "Nutrition in Geriatrics". Clin Nutr. 2010;29(2):154-9. doi:10.1016/j.clnu.2009.12.004 - Pubmed
- 3. Meza-Valderrama D, Marco E, Dávalos-Yerovi V et al. Sarcopenia, Malnutrition, and Cachexia: Adapting Definitions and Terminology of Nutritional Disorders in Older People with Cancer. Nutrients. 2021;13(3):761. doi:10.3390/nu13030761 - Pubmed
- 4. William Alexander Newman Dorland. Dorland's Illustrated Medical Dictionary. (2007) ISBN: 9781416023647 - Google Books
- 5. James Morwood, John Taylor. Pocket Oxford Classical Greek Dictionary. (2002) ISBN: 9780198605126
- 6. Baracos V, Mazurak V, Bhullar A. Cancer Cachexia is Defined by an Ongoing Loss of Skeletal Muscle Mass. Ann Palliat Med. 2019;8(1):3-12. doi:10.21037/apm.2018.12.01 - Pubmed