Written by Rachel Nall, RN, BSN, CCRNReviewed by Suzanne Falck, MD, FACP
Cachexia is a condition that causes extreme weight loss as well as muscle wasting. The name comes from two Greek words: kakos, meaning “bad,” and hexis, meaning “condition.”
The condition is a symptom or side effect of chronic conditions, such as cancer, type 1 diabetes, HIV, and multiple sclerosis. Older individuals with “failure to thrive” syndrome may also develop cachexia. According to one study, an estimated 5 million Americans have the condition.
There are other conditions that cause a person to lose weight, but cachexia is different in that a person loses weight even if they are still eating. Usually a person who does not eat enough will lose fat, but a person with cachexia will lose both fat and muscle mass.
Causes of cachexia
People with cachexia have incorrect levels of certain substances in their body. It is these imbalances that cause the weight loss and muscle wastage.
People with cachexia may also have decreased levels of testosterone in their body.
The substances that prevent muscle growth and contribute to the muscle wasting include elevated levels of insulin-like growth factor I (IFG-I), increased levels of the hormone myostatin, and high levels of glucocorticoids, which are hormones made by the kidneys.
The weight loss is caused by increased levels of cytokines, which are inflammatory substances that can contribute to weight loss. The increased levels of cytokines in the blood can develop as a result of having one of a number of long-term health conditions that are related to cachexia.
The conditions linked to cachexia may also cause reduced appetite or inability to eat without feeling nauseated.
Researchers are still studying the many links and other potential causes that can lead to cachexia.
There are certain chronic conditions that have been linked with cachexia. If a person has one of these conditions, they should talk to their doctor about steps they can take to prevent cachexia from developing and to live well.
Examples of these conditions include:
- Chronic obstructive pulmonary disease (COPD)
- Chronic renal failure– according to one study, an estimated quarter of all people with chronic renal failure are malnourished
- Congestiveheart failure
- Crohn’s disease
- Cystic fibrosis
- Rheumatoid arthritis
Symptoms of cachexia
Not all people with cachexia may look as if they are malnourished. It is possible that a person with cachexia was overweight before they developed a chronic illness. While they may look like they are of average size, it is possible that they could actually have lost a significant amount of weight.
Because cachexia is sometimes difficult to recognize, doctors use a variety of criteria to diagnose it.
To diagnose a person with cachexia, the person must have experienced the following:
- Unintentionally losing more than 5 percent of theirbody weight.
- Having a body mass index (BMI) of less than 20 in a person less than 65 years old, or a BMI of less than 22 in a person older than 65 years.
- Having less than 10 percent body fat.
- Having increased levels of cytokines in the blood is a marker ofinflammation in the body. When cytokine levels are elevated in the blood, they activate a compound that reduces the creation of new muscle in the body. They also activate a process in the body that stimulates the breakdown of muscles known as hypercatabolism. The results of these processes can cause symptoms like malaise, fatigue, and poor energy levels.
- Having an albumin level of less than 35 grams per liter. Albumin is a protein made in the liver that helps maintain fluid balance in the body. The loss of albumin that is associated with cachexia can also result inedema or swelling. Because the body can’t balance fluid levels properly, a person can experience swelling, often in the ankles.
The fat and muscle wasting associated with cachexia is very serious and can potentially lead to death. According to the book, Cachexia and Wasting: A Modern Approach, losing an estimated 66 percent of a person’s body weight is a predictor of death, regardless of the cause of the weight loss.
Some of the complications of cachexia include:
- Diminished quality of life
- Impaired response to treatments such as anticancer treatments
- Lowered immunity
- Worsened symptoms of the underlying chronic condition
A person who experiences severe weight loss and lacks muscle and fat can develop a number of unwanted complications and symptoms, including fatigue, malaise, and swelling.
All people rely on nutrients from food and glucose to survive. Fat and muscle are two of the places where the body stores these nutrients. When the body no longer has anywhere to store the nutrients, a person’s life will be severely impacted. Ultimately, cachexia can cause a person’s body systems to shut down, resulting in death.
Treatments for cachexia can include medications to reduce the cytokines in the body, stimulate appetite, or block hormones associated with causing cachexia.
Examples of appetite stimulants include dronabinol and megesterol acetate. Corticosteroids, such as dexamethasone, methylprednisolone, and prednisolone, also stimulate appetite.
However, dietary changes are rarely enough to reverse the incidences of the muscle wasting associated with cachexia. Muscle mass can be built up through exercise. If physically able, a person may try resistance training by lifting weights, using resistance bands, or using a person’s bodyweight.
Sometimes, doctors will prescribe growth hormone, such as Serostim or Norditropin FlexPro.
Can cachexia be prevented?
Because cachexia is usually a side effect of an underlying medical condition, the focus should instead be on preventing these conditions whenever possible. Some conditions such as COPD or AIDS may be preventable for some people. However, other conditions such as cancer, rheumatoid arthritis, or Crohn’s disease are largely unavoidable.
What is cancer anorexia cachexia syndrome?
Cancer-related anorexia/cachexia syndrome (CACS) is a condition seen in cancer patients that results in muscle and fat loss associated with cachexia.
According to one study, an estimated 15 to 40 percent of patients with cancer experience significant weight loss associated with cachexia. Unfortunately, weight loss due to excessive cytokines is associated with a poor outlook and early death.
Symptoms of CACS include:
- Affected quality of life
- Mental fatigue
- Physical deterioration
- Significant weight loss
When a person has cancer, the tumor cells may release cytokines that reduce a person’s appetite. Treatments for cancer, such as chemotherapy and radiation, can also affect appetite. When a person doesn’t eat enough and also has inflammatory compounds present, fat and muscle start to waste away. As a result, the cancer cells start to use up a person’s energy.
Treatments for CACS are similar to those of cachexia treatments for other conditions. Intervening as soon as possible to reduce the effects of cachexia can help to reduce the serious effects it has on people with cancer.
Sometimes, when a person is in the advanced stages of cancer, a doctor may recommend palliative care. Palliative care is a shift from trying to treat or cure the disease and instead focuses on making a person comfortable and enhancing their quality of life.
Although the decision to switch to a palliative care mindset can be a difficult one, it can often provide peace and additional support to a person in the final stages of their life.
According to the Ohio State University, an estimated 80 percent of patients with advanced cancer have CACS. The condition is estimated to be the cause of anywhere from 20 to 40 percent of all cancer deaths.