Derived from Greek kakhexiawhich means poor constitution, cachexia generally results in a loss of muscle mass, a more or less unexplained significant weight loss and a serious deterioration in general condition. It most often occurs following a serious chronic illness and may be responsible, as the Institut Curie reminds us, for poorer tolerance to chemotherapy treatments, physical deconditioning and decreased chance of survival (source 1). Its management is generally aimed at managing the underlying disease, improving diet, supporting weight gain and muscle mass.

The etymology of the term “cachexia” speaks for itself: cachexia designates a state of extreme weakness characterized by significant weight loss and chronic inflammation. Its most recent definition dates back to 2008. At a consensus conference on cachexia, a group of scientists and clinicians agreed on a new definition: they presented cachexia as “ a complex metabolic syndrome associated with an underlying pathology and characterized by a severe loss of muscle mass, associated or not with a loss of adipose tissue” (source 2).

Good to know: cachexia should not be confused with malnutrition, undernutrition or sarcopenia.

• There malnutrition refers to the fact that a person’s food intake does not meet their nutritional needs (due to an unbalanced diet or insufficient consumption of essential nutrients).
• There malnutritionit occurs when there is a nutrient deficiency in the diet or when the body fails to absorb and use nutrients properly.
• Finally, the sarcopenia is characterized only in case of progressive loss of muscle mass. It is generally linked to aging.

As a reminder, the body mass index (BMI) is a tool commonly used to assess one’s corpulence and adapt, if necessary, one’s lifestyle. It is impossible to set a standard, but it is known that cachectic patients often have a low, even very low BMI, less than 18.4 kg/m². However, BMI alone is not enough to make a diagnosis, because cachexia involves significant losses in weight and muscle mass which may not be fully reflected by BMI!

The underlying mechanisms of cachexia are still unknown, but according to the most recent research, it could be the result of a very complex pseudo-inflammatory reaction organization, notes the Cancer Foundation (source 3).

It is most often seen in people with serious illnesses such as:

• cancer (usually of the pancreas, stomach or lungs);
• congestive heart failure;
• chronic renal failure;
• chronic obstructive pulmonary disease (COPD);
• acquired immunodeficiency syndrome (AIDS);
• anorexia nervosa;
• Crohn’s disease;
• and various other chronic inflammatory diseases (ulcerative colitis, rheumatoid arthritis, etc.)

Symptoms of cachexia can vary from patient to patient. Most often, we note:

• a significant and unintentional weight lossgreater than 5% of body weight over a period of 6 months to 1 year;
• a decrease in muscle mass and an general weakness ;
• significant and persistent fatigueeven at rest (asthenia);
• decreased appetite which can lead to reduced food intake and aversion to food;
• A weakened immune system which increases the risk of infections and medical complications;

In fact, the overall quality of life is often considerably reduced… It is therefore important to consult a health professional if you are concerned about abnormal weight loss and your general state of health.

The diagnosis of cachexia is based primarily on theTomedical namenesis : The doctor begins by collecting the patient’s medical history, including their history of chronic illnesses, unexplained weight loss and associated symptoms.

Then comes the time to physical examination : he / she assesses your general condition, your body weight, your muscle mass, your physical strength, etc. He/she notably takes anthropometric measurements (your height, your weight, your arm and waist circumference) and evaluates your body composition using an impedance meter.

Of the medical imaging techniques, such as dual-energy X-ray absorptiometry (DXA) or magnetic resonance imaging (MRI), can also be used to get an idea of ​​bone density, for example. And if an underlying respiratory disease is suspected, pulmonary function tests may be prescribed to assess respiratory capacity and detect any abnormalities.

Finally, blood tests may be necessary to detect possible deficiencies, assess your organic functions, your inflammatory profile, etc. This may include tests such as serum albumin, pre-albumin, C-reactive protein (CRP), hemoglobin, electrolytes, etc.

The treatment of cachexia begins with the management of its cause and a gradual refeeding that helps support weight gain and muscle mass gain. It is important tobe monitored by a multidisciplinary team composed of doctors, dieticians, physiotherapists, psychologists or psychiatrists and social workers, to develop a suitable treatment plan.

First of all, it is absolutely necessary treat the disease or disorder causing the cachexia. This may involve interventions such as chemotherapy, radiation therapy, management of inflammatory disease, treatment of infections, or other approaches specific to the underlying condition.

Adequate caloric intake and proper nutrition are also essential to slow down weight loss and support the recovery of muscle mass. This may include increasing caloric intake and following a high protein diet. Food supplements can be recommended to counter any deficiencies. And in some cases, teams have to resort to artificial nutrition methods: enteral nutrition (when the digestive tract is working properly and is able to absorb nutrients) or the parenteral nutrition (in this case, the nutrients do not pass through the digestive tract, but directly reach the blood system).

In some cases, specific drugs may be prescribed to stimulate appetite, increase weight gain and promote muscle growth. These medications may include anabolic agents, hormones, or other specific medications depending on the underlying cause of the cachexia.

A progressive and adapted exercise program each person can be beneficial for maintaining and building muscle mass, improving strength and endurance, and promoting functional recovery.

Finally, patients can only benefit from psychological and social supportgiven that cachexia has a significant impact on their quality of life and psychological well-being.

Life expectancy of cachectic patients can vary considerably depending on the underlying cause of the cachexia, severity of the condition, response to treatment, and several other individual factors. But most often cachexia is associated with a poor prognosisas it is often linked to advanced illnesses and compromised general health.

In cases of advanced cancer-associated cachexia (cancer cachexia), for example, life expectancy may be reduced due to disease progression and associated complications. But cachexia itself can also contribute to a decrease in life expectancy due to deteriorating nutritional status, muscle wasting, and increased susceptibility to infection and other medical complications.

In summary, each case is unique and it is impossible to give an accurate estimate of life expectancy. The best is to refer to the medical team who takes care of each patient.