Cachexia is a pathological weight loss that can occur in the context of severe diseases. In addition to the body’s fat deposits, this phenomenon also affects the body fat in the organs. One possible treatment measure is artificial nutrition.
What is cachexia?
The term cachexia refers to weight loss with disease significance. In tumor diseases, for example, pronounced weight loss presents itself in the form of tumor cachexia. In cachexia, the body mass index falls below a value of 18, and the body fat percentage decreases by at least five percent within five months. Overall weight loss is more than two percent during this period. Severe cachexia is often interpreted as an announcement of imminent death. Refractory cachexia is present as soon as the pathological weight loss can no longer be influenced therapeutically, for example in the terminal stage of tumor diseases. Life expectancy in refractory cachexia is only a few months. Inanition, which is understood as emaciation, is to be distinguished from cachexia. This is referred to as long as the vital building fat of the body is not affected by the weight loss. Accordingly, in cachexia, not only the fat deposits of the body are affected, but also the muscles and organs.
Causes
The causes of cachexia are usually diseases or a certain age. In particular, chronic wasting diseases such as cancer, type 1 diabetes, African sleeping sickness, or rheumatoid arthritis are associated with cachexia. The same applies to persistent diseases of the gastrointestinal tract, such as enteritis or pancreatitis. In the context of these diseases, nutrient absorption in the gastrointestinal tract can no longer take place to the usual extent. Just as often, chronic heart failure, kidney failure or lung diseases trigger cachexia and thus weaken the organism. We are then talking about cardiac, renal or pulmonary cachexia. Cachexia may also be caused by malnutrition or even an eating disorder such as bulimia. Senile cachexia, on the other hand, is a symptom of old age, often associated with the terminal dying phase. Sometimes cachexias are also associated with intoxications. Alcoholism, drug addictions, and chronic mercury poisoning can trigger the phenomena in this way, for example.
Symptoms, complaints, and signs
The first signs of cachexia are already given by the appearance of the affected person. The contours of the bones become visible piece by piece. The eyes lie low and the cheeks deform into hollow cheeks. These appearances are related to the breakdown of the retrobulbar fat depots and the structurally provided cheek fat body. Soon, organic disorders appear. For example, late in the course, atrophic cardiac insufficiencies are common. The bone marrow transforms into gelatinous marrow. In this process, the fatty components of the anatomical structure are replaced with a serous fluid and take on a grayish color. The affected person becomes visibly weaker. In the late course, the weakness may turn into lethargy, i.e. sleepiness with an increase in the stimulus threshold. Since muscles also shrink in the course of cachexia, the heart muscle may be attacked in the final course. The damage to organs is irreversible and death may occur.
Diagnosis and disease progression
The physician makes the diagnosis of cachexia during visual diagnosis and BMI measurement. To assess the extent of pathologic weight loss, the medical history helps. However, the organs and spinal cord may also be examined for involvement to complete the picture. The course of the disease in this presentation is highly dependent on the underlying cause and the time of diagnosis. If cachexia has already attacked the organs at the time of diagnosis, this means a rather poor prognosis. As long as there is no organic damage yet and the cause of cachexia can theoretically be eliminated, a full recovery is possible. Thus, the prognosis in this case is favorable. Often, the patient’s self-will, hunger, and cooperation are also considered prognostically favorable factors.
Complications
Cachexia causes very severe weight loss in the patient.Underweight is a very unhealthy condition for the body, which must be avoided or corrected at all costs. This can also damage the internal organs, resulting in irreversible consequential damage to the patient. The external appearance is also severely restricted by cachexia, so that most patients do not feel comfortable with their body and are ashamed of it. This can lead to inferiority complexes or lowered self-esteem. Muscles also shrink, so there is a reduction in the patient’s ability to bear weight. Those affected appear tired and exhausted. If vital organs are irreversibly damaged, the patient may die if no treatment is initiated. The heart can also be affected, resulting in cardiac death. As a rule, causal treatment of cachexia must take place in any case. However, it is not possible to predict in general whether the course of the disease will be positive. If necessary, life expectancy is reduced.
When should one go to the doctor?
Unusual weight loss should be investigated by a physician. Individuals who notice weight loss that may be associated with an eating disorder or other medical condition are best to speak with the appropriate physician. At the latest, when other warning signs such as an increasing lack of strength and fatigue are added, medical advice is required. The affected person should also visit a doctor’s office if psychological complaints are added or are a possible trigger for the complaints. If the weight loss causes physical or mental deficiency symptoms, a doctor must be consulted the same day. If there is an acute risk of falling or complaints of the cardiovascular system, the relatives should call the emergency physician. Cachexia occurs mainly in chronic diseases such as cancer, type one diabetes or rheumatoid arthritis also. Chronic renal failure, heart failure and lung disease are also possible risk factors. Affected patients should see a doctor immediately. In addition to the family doctor, an internist or eating disorder therapist is the right person to contact. Children should be presented to a pediatrician or a child psychologist.
Treatment and therapy
When cachexia is present, treatment usually takes place according to cause. To cure cachexia, the physician must ultimately eliminate the cause. For diseases, this means a cure of the causative disease. This goal is approached through the disease-specific therapy steps. Thus, in the case of serious diseases such as cancer or heart failure, the treatment of cachexia also turns out to be rather difficult. For cachexia due to malnutrition, treatment includes dietary changes and slow approximation of healthy food intake. Self-induced cachexia due to eating disorders or alcoholism may require treatment by a psychotherapist. On the other hand, if oral food intake is not possible or there is an absorption disorder in the gastrointestinal tract, the doctor initiates parenteral forms of nutrition. In this case, the patient is given a small-molecule solution of nutrients into the bloodstream via an infusion. In this way, the gastrointestinal tract can be bypassed and the vital nutrients are once again available to the organism. In refractory cachexia or cachexia in the terminal dying phase, the patient’s symptoms can no longer be alleviated by measures such as artificial nutrition. Thus, no meaningful treatment can take place at this stage.
Outlook and prognosis
Because cachexias are merely symptoms of underlying diseases, they do not have a prognosis in themselves. However, they sometimes have a significant impact on the prognosis of the diseases that cause them. For example, so-called tumor cachexia says a lot about whether a cancer patient’s prognosis looks good or rather poor. Often occurring during the course of cancer treatment using chemotherapy, this type of cachexia worsens the prognosis by robbing the affected patient of important energy resources needed to better cope with the consequences of their therapy. Cachexia can also occur rapidly in eating disorders, especially anorexia and bulimia. These disorders are not initially life-threatening, but can quickly become so if cachexia has already occurred in the affected patient.If he does not get professional help now, then the internal organs take damage. This damage can be permanent or, in the worst case, fatal. Most other forms of cachexia also do not mean anything positive for a person’s health. Old-age cachexia, for example, is often an indication of dwindling strength in an aging person. Cachexias in third-world countries that occur because of famine also indicate dangerous health conditions that can quickly lead to life-threatening problems.
Prevention
Self-induced cachexia in the context of eating disorders or substance abuse can be prevented. Cachexia in the context of serious illness, on the other hand, cannot be directly prevented.
Follow-up
In cachexia, follow-up care consists primarily of achieving and maintaining a healthy body weight. Because the therapy for cachexia is also to correct the emaciated nutritional state, follow-up should be directly linked to ensuring that body weight remains stable and does not drop again in the interim. During aftercare, it is important to continue to consume sufficient food. High-calorie food is best suited here; in some cases, high-calorie drinkable food can also be consumed as a supplement or substitute. In any case, the goal should be to provide optimal nutrients and to achieve and maintain a normal weight. Since cachexia often occurs as a consequence of another underlying disease and rarely in isolation, it is important to diagnose and treat this underlying disease. Therefore, a thorough medical examination for all possible causes is required. Furthermore, follow-up should consist of regular weight monitoring and blood testing for deficiencies. Since cachexia also causes a decrease in muscle mass, it may be useful to slowly build up muscle again with the help of exercise. Last but not least, it should also be thought of possibly considering psychological counseling, because often cachexia patients also suffer psychologically from their external appearance. The severely emaciated body can be stressful and even lead to depression.
What you can do yourself
The disorder is life-threatening and must be treated by a doctor without fail. In most cases, cachexia is due to a serious underlying disease such as cancer, which is in a very advanced stage. In these cases, the patient himself can do little to improve his condition. Very often, artificial nutrition is then required. There is room for self-help measures, however, where the cachexia is due to malnutrition or malnutrition. People suffering from anorexia or bulimia are particularly at risk. Since the affected persons themselves usually have a severely disturbed self-image due to the illness and are unable or unwilling to recognize the external signs of cachexia, it is up to the social environment to take the necessary self-help measures. Affected persons suffering from an eating disorder often try to conceal this. Severe weight loss is then explained by supposedly healthy activities such as a lot of sport or fasting. The families of those affected should become alert in the event of persistent severe weight loss and insist sensitively but consistently that the person concerned seek medical treatment. For parents of anorexic children and adolescents suffering from bulimia nervosa, there are special counseling centers that educate family members and help them take the steps indicated when a severe eating disorder is suspected.
