Cachexia associated with chronic disease

Specialty: General.

• severe body wear and tear
• wasting due to disease
• muscle and fat mass consumption due to systemic pathology

Why it occurs

• Advanced malignancies (tumor cachexia syndrome mediated by the massive release of cytokines such as tumor necrosis factor alpha, interleukin-6 and interferon gamma, which induce proteolysis and lipolysis)
• Terminal congestive heart failure or cardiac cachexia (intestinal hypoperfusion, malabsorption and increased basal energy expenditure due to increased respiratory and cardiac work)
• Severe chronic obstructive pulmonary disease (COPD) or lung cachexia (due to the high energy cost of chronic labored breathing and systemic inflammation)
• End-stage chronic kidney disease (uremia, nutrient loss due to dialysis, inflammation and secondary uremic anorexia)
• Long-term destructive chronic infections (progressive cavitary tuberculosis, HIV/AIDS in advanced phase without antiretroviral treatment or deep fungal infections).

Initial workup

Serum albumin and prealbumin, transferrin, C-reactive protein (as a marker of inflammation intensity), urea nitrogen, creatinine, absolute lymphocytometry, and computed tomography at the L3 level to evaluate the skeletal muscle index.

Standard management

• Megestrol acetate — 400 to 800 mg per day orally, administered to stimulate appetite and promote weight gain in patients with neoplastic cachexia, monitoring the risk of thrombosis
• Metoclopramide — 10 mg orally 30 minutes before main meals to accelerate gastric emptying and reduce early satiety
• Specialized hyperprotein and hypercaloric nutritional supplementation enriched with omega-3 fatty acids.