Cachexia: Know symptoms, causes, and treatment

There are certain diseases that can severely impact your weight and muscle mass, leading to significant health challenges. One such condition is cachexia, a complex metabolic syndrome that often accompanies chronic illnesses like cancer, heart failure, and chronic obstructive pulmonary disease (COPD). It causes extreme muscle and weight loss, regardless of how much food you eat or nutrient intake. This can leave the patient malnourished and severely weak. This happens because the body breaks down muscle and fat tissue faster than it can rebuild them, driven by inflammation and metabolic changes.

It is estimated that 50–80 percent of cancer patients experience cachexia, and it is linked to higher mortality rates, as per a study published in the Journal of Cachexia, Sarcopenia and Muscle. Since there is no cure for cachexia, it is essential to recognise the signs and symptoms of this disorder at an early age.

What is cachexia?

Cachexia is a metabolic syndrome characterised by significant weight loss, muscle wasting (loss of muscle tissue), and weakness, commonly seen in people with chronic illnesses such as cancer or heart failure. Unlike typical weight loss, cachexia is not just about not eating enough. Instead, it results from complex changes in the body, including inflammation, increased metabolism, and hormonal imbalances. These factors contribute to the breakdown of muscle and fat, making it challenging for patients to maintain strength and fitness despite eating a proper diet and getting enough nutrition.

How does cachexia lead to weight loss?

Often associated with chronic diseases such as cancer, heart failure, and chronic kidney disease, cachexia may cause significant weight loss and muscle wasting. It causes weight loss by making the body break down both fat and muscle, even if you are following a healthy diet. This happens because chronic illnesses like cancer trigger inflammation and changes in how the body uses energy.

Unlike normal weight loss, where fat is primarily lost, this disorder leads to muscle wasting too. It also causes changes in metabolism, making it hard to stop the weight loss, leading to severe and rapid drop in your weight. As per a study published in the Diagnostics, weight loss in cachexia can be severe, with patients losing more than 5 percent of their body weight in just 6 months, reducing the quality of life.

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What are the symptoms of cachexia?

This disorder presents itself in a range of debilitating symptoms, each contributing to the overall decline in the health of the patient:

1. Unintended weight loss: This is a hallmark symptom, where patients lose significant body weight without even trying, primarily due to muscle and fat loss.
2. Muscle wasting: This is another common symptom of cachexia in which muscle mass diminishes rapidly, leading to noticeable weakness. However, not all people with this disorder appear malnourished.

3. Loss of appetite (Anorexia): Patients often experience a reduced desire to eat, exacerbating the weight loss and nutritional deficits.
4. Swelling or edema: Low protein levels in blood may lead to fluid retention that occurs, particularly in the legs and ankles.
5. Reduced functional ability: Due to muscle wasting and weakness, patients may struggle with mobility and performing daily tasks, leading to reduced quality of life.
6. Fatigue and weakness: This condition can make you feel exhausted and too tired, causing persistent tiredness and a lack of strength, even after minimal exertion.
7. Anemia: Low red blood cell counts are common, which can contribute to further fatigue, weakness, and reduced oxygen delivery to tissues.
8. High level of inflammation: Chronic inflammation is a key cause of cachexia, contributing to muscle breakdown and weight loss.
9. Low levels of albumin: Albumin, a vital blood protein, often drops, reflecting poor nutritional status and worsening prognosis, as it is crucial for maintaining fluid balance and transporting nutrients.

Each of these symptoms interacts with each other, creating a vicious cycle that may severely impact the health and quality of life of the patient.

What causes cachexia?

Cachexia is a complex metabolic syndrome that can be caused by:

• Increased breakdown of muscle
• High metabolic rate and energy expenditure
• Reduced nutrient intake or availability
• Prevention of muscle growth
• Metabolic abnormalities

There are various reasons why metabolism might increase, and particularly with cancer, one key factor is the release of cytokines by the immune system into the bloodstream. These chemicals are believed to speed up your metabolism and contribute to inflammation throughout the body. This process can lead to fat and muscle loss, which are characteristic of cachexia, according to the National Cancer Institute.

Risk factors of cachexia

Cachexia occurs when there is a disconnect between energy demand (your metabolism) and energy supply (food intake). This imbalance frequently happens in the later stages of severe health conditions such as:

These conditions increase or put you at risk of developing cachexia.

Stages of cachexia

There are 3 main stages of cachexia you should know:

1. Pre-cachexia

This is an early stage where the patient experiences mild weight loss (less than 5 percent of your body weight) in 6 to 12 months. Other symptoms include reduced appetite and metabolic changes. It is the phase where medical interventions can help manage the condition.

2. Cachexia

In this stage of cachexia, significant weight loss (over 5 percent of body weight) in the 6 to 12 months occurs. Other symptoms include muscle wasting, reduced appetite, and severe metabolic changes. Patients experience reduced functional ability, fatigue, and inflammation as well.

3. Refractory cachexia

This advanced stage causes more than 20 percent of your usual weight loss. It may also cause severe muscle wasting, minimal response to nutrition, and a poor prognosis, often with limited life expectancy.

Complications of cachexia

Cachexia can lead to several serious complications. The most noticeable is severe weight loss, including muscle wasting, which weakens the body and reduces strength. Others are:

1. Increased fatigue: The loss of muscle mass and overall weakness can cause persistent fatigue, impacting daily functioning and overall quality of life.
2. Heart complications: The condition can also impair heart function, potentially leading to heart failure due to the additional strain on the cardiovascular system.
3. Weakened immune system: Cachexia compromises the immune system, making you susceptible to common infections and illnesses.
4. Delayed recovery: The loss of muscle and fat also increases the risk of pressure sores and makes it harder for the body to recover from surgery or illness.

Due to these complications, cachexia significantly worsens the overall prognosis and can lead to a decreased quality of life and a shorter lifespan.

Diagnosis of cachexia

Diagnosing cachexia is more than just observing symptoms like muscle mass loss or weight loss. Cachexia typically involves a 5 percent or greater weight loss over six months in someone with a chronic illness, alongside muscle wasting and reduced appetite. In addition to a physical examination, your doctor will review your medical history, particularly if you are undergoing treatment for a chronic disease known to cause cachexia.

The doctor may also perform tests to assess your overall health, including blood tests such as a comprehensive metabolic panel (CMP) and a computed tomography (CT) scan.

Treatment of cachexia

First, understand that there is no specific treatment or way to reverse the condition. The goal of treatment is to improve symptoms and quality of life. Here’s how it can be managed:

• Appetite stimulants: Medications like megestrol acetate (Megace) can help boost appetite.
• Antiemetics and mood enhancers: Drugs such as dronabinol (Marinol) can address nausea, improve appetite, and elevate mood.
• Anti-inflammatory medications: These can help reduce inflammation, which is a key factor in cachexia.
• Dietary interventions: It involves focusing on high-calorie, high-protein diets, and sometimes supplements to combat weight loss and muscle wasting.
• Exercise: Exercise can help maintain muscle mass and overall fitness.

Importantly, treatment focuses on addressing the underlying disease causing cachexia, whether it is cancer, heart failure, or another chronic condition.