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Cachexia: Diagnosis and Treatment

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Book cover Handbook of Clinical Nutrition and Aging

Part of the book series: Nutrition and Health ((NH))

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Key Points

  • Three primary categories of loss of body weight include starvation (including undernutrition), sarcopenia, and cachexia.

  • Cachexia is the cytokine-associated wasting of protein and energy stores due to the effects of disease; there is a progressive, severe loss of skeletal muscle with relative preservation of visceral protein reserves.

  • Cachexia is directly related to inflammatory states, such as cancer or acquired immunodeficiency syndrome, and also occurs in rheumatoid arthritis, chronic renal insufficiency, chronic obstructive pulmonary disease, ischemic cardiomyopathy, and infectious diseases.

  • In developing appropriate interventions for weight loss, it is important to recognize the distinction between cachexia and starvation.

  • While starvation due to protein-energy undernutrition is widely regarded as the primary cause of loss of fat and fat-free mass in older persons, a failure to improve with nutritional replacement should trigger a consideration of other causes.

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REFERENCES

  1. Thomas DR. Distinguishing starvation from cachexia. Geriatric Clinics of North America 2002;18:883–92.

    Google Scholar 

  2. Rosenberg IH. Summary comments. Am J Clin Nutr 1989;50:1231–33.

    Google Scholar 

  3. Morley JE, Thomas D. Cachexia: New Advances in the Management of Wasting Diseases. J Am Med Dir Assoc 2008;9(4):205–10.

    Article  PubMed  Google Scholar 

  4. Thomas DR. Weight loss in older adults. Rev Endocr Metab 2005; 6:129–36.

    Article  Google Scholar 

  5. Haddad RY, Thomas DR. Enteral nutrition and tube feeding: A review of the evidence. Geriatr Clin North Am 2002;18:867–82.

    Google Scholar 

  6. Thomas DR. A prospective, randomized clinical study of adjunctive peripheral parenteral nutrition in adult subacute care patients. J Nutr Health Aging 2005;9:321–5.

    PubMed  Google Scholar 

  7. Morley JE. Thomas DR. Wilson MM. Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr 2006;83(4):735–43.

    PubMed  CAS  Google Scholar 

  8. Friedman FJ, Campbell AJ, Caradoc-Davies. Hypoalbuminemia in the elderly is due to disease not malnutrition. Clin Exp Gerontol 1985;7:191–203.

    Google Scholar 

  9. Rosenthal AJ, Sanders KM, McMurtry CT, Jacobs MA, Thompson DD, Gheorghiu D, Little KL, Adler RA. Is malnutrition overdiagnosed in older hospitalized patients? Association between the soluble interleukin-2 receptor and serum markers of malnutrition. J Gerontol. Series A, Biological Sciences & Medical Sciences 1998;53:M81–6.

    Article  CAS  Google Scholar 

  10. Thomas DR. Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr, 2007;26(4):389–99

    Google Scholar 

  11. Baracos VE. Management of muscle wasting in cancer-associated cachexia: understanding gained from experimental studies. Cancer 2001;92(6 Suppl):1669–77.

    Article  PubMed  CAS  Google Scholar 

  12. Westerblad, H, Allen DG. Recent advances in the understanding of skeletal muscle fatigue. Curr Opin Rheumatol 2002;14(6):648–52.

    Article  PubMed  CAS  Google Scholar 

  13. Ikeda U, Yamamoto K, Akazawa H, et al. Plasma cytokine levels in cardiac chambers of patients with mitral stenosis with congestive heart failure. Cardiology 1996;87:476–8.

    Article  PubMed  CAS  Google Scholar 

  14. Jagoe RT, Redfern CP, Roberts RG, Gibson GJ, Goodship TH. Skeletal muscle mRNA levels for cathepsin B, but not components of the ubiquitin-proteasome pathway, are increased in patients with lung cancer referred for thoracotomy. Clin Sci 2002;102:353–61.

    Article  PubMed  CAS  Google Scholar 

  15. Gordon JN, Green SR, Goggin PM. Cancer cachexia. Q J Med 2005;98(11):779–88.

    Article  CAS  Google Scholar 

  16. Frost RA, Lang CH. Skeletal muscle cytokines: regulation by pathogen-associated molecules and catabolic hormones. Curr Opin Clin Nutr Metabolic Care 2005;8(3):255–63.

    Article  CAS  Google Scholar 

  17. Murray S, Schell K, McCarthy DO, Albertini MR. Tumor growth, weight loss and cytokines in SCID mice. Cancer Lett 1997;111:111–15.

    Article  PubMed  CAS  Google Scholar 

  18. Haddad F, Zaldivar FP, Cooper DM, Adams GR. IL-6 induced skeletal muscle atrophy. J Appl Physiol 2005;98(3):911–7.

    Article  PubMed  CAS  Google Scholar 

  19. Espat NJ, Moldawer LL, Copeland EM 3rd. Cytokine-mediated alterations in host metabolism prevent nutritional repletion in cachectic cancer patients. J Surg Oncol 1995;58:77–82.

    Article  PubMed  CAS  Google Scholar 

  20. Rote NS. Inflammation. In: Pathophysiology: The biological basis for disease in adults and children. McCance KL, Huether SE, eds. St. Louis: Mosby, 1998:205–36.

    Google Scholar 

  21. Visser M, Pahor M, Taaffe DR, Goodpaster BH, Simonsick EM, Newman AB, Nevitt M, Harris TB. Relationship of interleukin-6 and tumor necrosis factor-alpha with muscle mass and muscle strength in elderly men and women: the Health ABC Study. J Gerontol Ser A-Biol Sci Med Sci 2002;57(5):M326–32.

    Article  Google Scholar 

  22. Schols AM, Buurman WA, Staal van den Brekel AJ, Dentener MA, Wouters EF. Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax 1996;51:819–24.

    Article  PubMed  CAS  Google Scholar 

  23. Anker SD, Ponikowski PP, Clark AL, et al. Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure. Eur Heart J 1999;20: 683–93.

    Article  PubMed  CAS  Google Scholar 

  24. Ferrucci L, Penninx BW, Volpato S, Harris TB, Bandeen-Roche K, Balfour J, Leveille SG, Fried LP, Md JM. Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. J Am Geriatr Soc 2002;50(12):1947–54.

    Article  PubMed  Google Scholar 

  25. Cesari M, Kritchevsky SB, Baumgartner RN, Atkinson HH, Penninx BWHJ, Lenchik L, Palla SL, Ambrosius WT, Tracy RP, Pahor M. Sarcopenia, obesity, and inflammation—results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. Am J Clin N 2005;82:428–34.

    CAS  Google Scholar 

  26. Ferrucci L, Harris TB, Guralnik JM, Tracy RP, Corti MC, Cohen HJ, Penninx B, Pahor M, Wallace R, Havlik RJ. Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc 1999;47(6):639–46.

    PubMed  CAS  Google Scholar 

  27. Cohen HJ, Pieper CF, Harris T, Rao KM, Currie MS. The association of plasma IL-6 levels with functional disability in community-dwelling elderly. J Gerontol Ser A-Biol Sci Med Sci 1997;52(4):M201–8.

    Article  CAS  Google Scholar 

  28. Baggio G, Donazzan S, Monti D, Mari D, Martini S, Gabelli C, Dalla Vestra M, Previato L, Guido M, Pigozzo S, Cortella I, Crepaldi G, Franceschi C. Lipoprotein(a) and lipoprotein profile in healthy centenarians: a reappraisal of vascular risk factors. FASEB J 1998;12(6):433–7.

    PubMed  CAS  Google Scholar 

  29. Liso Z, Tu JH, Small CB, Schnipper SM, Rosenstreich DL. Increased urine IL-1 levels in aging. Gerontology 1993;39:19–27.

    Article  Google Scholar 

  30. Cederholm T, Whetline B, Hollstrom K, et al. Enhanced generation of Interleukin 1β and 6 may contribute to the cachexia of chronic disease. Am J Clin Nutr 1997;65:876–82.

    PubMed  CAS  Google Scholar 

  31. Gardner EM, Murasko DM. Age-related changes in Type 1 and Type 2 cytokine production in humans. Biogerontology 2002;3(5):271–90.

    Article  PubMed  CAS  Google Scholar 

  32. Straub RH, Miller LE, Scholmerich J, Zietz B. Cytokines and hormones as possible links between endocrinosenescence and immunosenescence. J Neuroimmunol 2000;109(1):10–50.

    Article  PubMed  CAS  Google Scholar 

  33. Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V. Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link? Atherosclerosis 2000;148(2):209–14.

    Article  PubMed  CAS  Google Scholar 

  34. Crossley KB, Peterson PK. Infections in the elderly. Clin Infect Dis 1996;22(2):209–15.

    Article  PubMed  CAS  Google Scholar 

  35. American Society of Parenteral and Enteral Nutrition. The clinical guidelines task force, guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr 2002:26:S1-? Single supplement issue.

    Google Scholar 

  36. Wilson MM. Thomas DR. Rubenstein LZ. Chibnall JT. Anderson S. Baxi A. Diebold MR. Morley JE. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 2005;82(5):1074–81.

    PubMed  CAS  Google Scholar 

  37. Thomas DR. Guidelines for the use of orexigenic drugs in long-term care. Nutr Clin Pract 2006;21(1):82–7.

    Article  PubMed  Google Scholar 

  38. Deans C, Wigmore SJ. Systemic inflammation, cachexia and prognosis in patients with cancer. Curr Opin Clin Nutr Metabolic Care 2005;8:265–9.

    Article  CAS  Google Scholar 

  39. Gordon JN, Trebble TM, Ellis RD, Duncan HD, Johns T, Goggin PM. Thalidomide in the treatment of cancer cachexia: a randomised placebo controlled trial. Gut 2005; 54:540–5.

    Article  PubMed  CAS  Google Scholar 

  40. Fearon KC, Von Meyenfeldt MF, Moses AG, Van Geenen R, Roy A, Gouma DJ, Giacosa A, Van Gossum A, Bauer J, Barber MD, Aaronson NK, Voss AC, Tisdale MJ. Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut 2003;52:1479.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of IM-Geriatric Medicine, Saint Louis University Health Sciences Center, St. Louis, MO

    David R. Thomas

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  1. David R. Thomas
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Editor information

Editors and Affiliations

  1. Center for the Study of Aging &, Human Development, Duke University Medical Center, Durham, 27710, USA

    Connie W. Bales

  2. Div. Gerontology, Geriatrics &, Palliative Medicine, University of Alabama, Birmingham, 19th Street South 933, Birmingham, 35294, USA

    Christine S. Ritchie

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© 2009 Humana Press, a part of Springer Science+Business Media, LLC

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Thomas, D.R. (2009). Cachexia: Diagnosis and Treatment. In: Bales, C., Ritchie, C. (eds) Handbook of Clinical Nutrition and Aging. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-385-5_11

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  • DOI: https://doi.org/10.1007/978-1-60327-385-5_11

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-384-8

  • Online ISBN: 978-1-60327-385-5

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