Opinion paperCachexia: A new definition
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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Affiliations for all co-authors are provided in the Appendix.