Cachexia (extremely thin): symptoms, causes and treatment

Cachexia refers to a form of extreme thinness. The medical term ‘cachexia’ comes from the Greek words ‘kakos’ meaning ‘bad’ and ‘hexis’ meaning ‘condition’. This refers to pathological, very serious weight loss. Cachexia is a multifactorial syndrome that occurs in several chronic diseases. Many patients with chronic diseases such as cancer (50% to 80% of cancer patients suffer from cachexia at some point in their disease process), AIDS or autoimmune diseases suffer from this condition. Cachexia is a very complex and, in 2023, poorly understood syndrome that leads to uncontrollable weight loss. Decreasing fat reserves and breakdown of muscle tissue lead to weakness. Cachexia is believed to be one of the factors contributing to premature death. The usual nutritional interventions provide no relief for cachexia and ultimately lead to progressive functional limitations.

  • Definition of cachexia (extremely thin)
  • Pathophysiology
  • Symptoms of cachexia
  • Core symptoms
  • Additional complaints
  • Outward appearances
  • Causes of extreme thinness
  • Treatment of cachexia
  • Treat underlying disease
  • Nutritional treatment
  • Cachexia in the terminal phase
  • Interdisciplinary collaboration

 

Definition of cachexia (extremely thin)

Cachexia is characterized by a persistent loss of muscle mass with stable or increased fat mass, which does not respond to usual nutritional interventions that result in the patient’s intake of sufficient energy, vitamins and minerals and fluids, leading to progressive functional limitations.

Pathophysiology

What are the effects on the functioning of organs and organ systems? In the case of cachexia, there is not only a progressive loss of muscle mass, but also a general atrophy condition in which tissue or an organ becomes smaller with a gradual loss of organ function.

Symptoms of cachexia

Core symptoms

Cachexia is characterized by the following symptoms:

  • severe weight loss
  • persistent loss of muscle mass, with or without loss of fat mass (sarcopenia)
  • general weakness, characterized by:
    • physical fatigue
    • reduced ability to engage in physical activities
    • psychological exhaustion (with concentration disorders, memory loss and emotional lability)
  • progressive functional limitations
  • negative protein and energy balance due to reduced food intake and metabolic disorders
  • anemia (anemia)

In addition, there are disturbances caused by functional disturbances of vital organs. For example, atrophic heart failure may occur. With atrophy of the heart muscle, the tissue/organ becomes smaller. The bone marrow also changes in what is known as ‘gelatinous transformation of the bone marrow’ as part of a cachexia. The fat and hematopoietic cells are replaced by a gelatinous intermediate of acidic mucopolysaccharides.

Additional complaints

Other symptoms may also occur, such as:

  • taste changes
  • food passage disorders
  • rapid satiety/lack of appetite
  • nausea
  • vomit
  • constipation

 

Outward appearances

Cachexia can be recognized by the following external symptoms:

  • the bone contours become visible
  • deep-set eyes (disappearance of retrobulbar fat)
  • hollow or sunken cheeks (loss of cheek fat)
  • brown-yellow skin

 

Causes of extreme thinness

Cachexia or extreme thinness can occur in the following diseases and disorders, among others:

  • cancer (cancer cachexia), especially in lung cancer, leukemia and pancreatic cancer, where energy intake and energy consumption are out of balance and this is mainly due to inflammation in the body
  • serious infectious diseases, such as AIDS or tuberculosis (TB)
  • old age (senile cachexia)
  • COPD
  • rheumatoid arthritis (rheumatoid cachexia)
  • chronic renal failure (renal cachexia)
  • chronic heart failure (cardiac cachexia); the final stage of heart failure is often accompanied by cardiac cachexia
  • chronic lung diseases with respiratory failure (pulmonary cachexia),
  • lack of food, malnutrition (malnutrition such as kwashiorkor, a condition in children caused by a long-term lack of protein in the diet)
  • gastrointestinal causes, such as persistent diseases of the gastrointestinal tract (such as enteritis or enteritis) or the pancreas (especially chronic pancreatitis or pancreatitis), which can lead to nutrient deficiency due to insufficient breakdown in or insufficient absorption from the intestine
  • severe malabsorption or poor digestion
  • metabolic diseases
  • alcohol addiction / alcoholism
  • chronic mercury poisoning
  • diabetes mellitus type I
  • eating disorders (bulimia, anorexia nervosa)
  • terminal phase / dying phase

 

Treatment of cachexia

Treat underlying disease

The treatment of cachexia focuses on the underlying disease or disorder. If the cause of cachexia cannot be eliminated, parenteral nutrition, a means of delivering nutrients by a route other than the gastrointestinal tract, can be considered a palliative measure.

Nutritional treatment

Treatment consists of nutritional treatment (in particular artificial feeding) and removal of the triggering cause, insofar as it can be treated. Such treatment is not always necessary at the inevitable end of life. The decisive factor is the will of the patient, whether the patient is hungry at all and whether the symptoms can actually be relieved by administering nutrition.

Cachexia in the terminal phase

The primary purpose is to relieve discomfort. Continued intake of food and fluids without adapting to changing needs can place an unreasonable burden on the dying person and their family members. Artificial nutrition is not necessary at this stage. The dietary advice is aimed at improving the quality of life and preventing or alleviating suffering.

Interdisciplinary collaboration

Interdisciplinary collaboration plays an important role in cachexia. The following interdisciplinary services, among others, can be engaged in consultation with the patient:

  • nutritional advice/dietitian
  • psycho-oncologist / psycho-oncology center
  • physiotherapy
  • pastoral care from a spiritual counselor

 

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