Extreme exhaustion, fraught with systemic metabolic syndrome in the form of muscle tissue volume minimization with or without loss of lipid layer, is called cachexia. The pathology is formed under the influence of exo- or endogenous causes. The former include a lack of nutrients in the body, the latter include severe somatic and psychogenic disorders. You will learn about the symptoms of cachexia, its diagnosis and treatment in this article.
- General information.
- Classification and symptoms.
- Prognosis and prevention.
Cachexia (hypotrophy, nutritional or protein-energy deficiency) is said to occur when body weight is reduced by one third or more of the optimal weight for a patient of a given age, height or BMI below 17 kg/m2. It is a multidisciplinary pathology that occurs as a complication of a variety of diseases and aggravates them. Cachexia increases mortality by 50%. There is no gender, endemicity, seasonality, or age pattern to the disease.
Exhaustion is primary when it occurs as a result of a nutritional deficiency, or secondary when it is a symptom of a somatic or mental illness. The primary form is associated with forced or deliberate starvation, severe vitamin deficiency, minimal caloric intake by vegetarians or fasting believers.
Other exofactors of this type of exhaustion are as follows:
- heavy physical work, especially in the heat or in conditions of minimum caloric intake;
- prolonged psycho-emotional stress with loss of appetite against the background of anxiety;
- alcohol, drugs, intoxication.
The triggers of secondary cachexia are diverse; metabolic disorders are a consequence of any acute or chronic disease, more often neglected and untreated. The progression of the pathology correlates with the underlying cause, the patient’s constitution and initial body weight.
The causes of endocachexia are divided into the following groups:
- Infections: from worm infestation to lues and HIV.
- Malignant neoplasms: when the digestive system is affected, emaciation is observed in 80% of cases, bronchopulmonary in 60%, breast in about 40%.
- Problems with the gastrointestinal tract due to inability to enter food on the background of the structure of the esophagus, esophagitis, pylorostenosis. Malabsorption and maldigestion syndrome, provoked by chronic enterocolitis, hepatitis, pancreatitis are often diagnosed. Less commonly, Crohn’s disease, nonspecific ulcerative colitis, Whipple’s disease.
- Hormonal fluctuations, diseases of the endocrine glands.
- Somatic pathologies.
- Psychogenic factors.
There are several key points in the development of cachexia that complicate the course of the pathology. In addition to exonutrient deficiency, their deficiency can be provoked by disorders of food digestion, hypercatabolism, and high energy expenditure. Activation of proinflammatory cytokines and humoral imbalance that stimulates catecholamines, glucocorticoids, and glucagon play the main role in weight loss. They in turn inhibit protein synthesis, provoke steroid myopathy, and change glucose tolerance. The adipose tissue hormone leptin also contributes. High concentration of cytokines aggravates catabolism.
As a result, all energy resources are mobilized from fat depots and muscle tissue, gluconeogenesis, lipolysis and oxidation at the expense of free radicals are activated. Against the background of neuropeptide Y level minimization, plastic processes are blocked, resources are redistributed in favor of leptin- and insulin-independent tissues: cerebral structures, eyeballs, cerebral adrenal gland layer.
In addition, features of cachexia in primary somatic pathology are noted: cardiovascular problems, venous stasis in the intestine, imbalance of catabolism and anabolism, digitalis intoxication. Metabolic problems are considered the main cause of cachexia in oncological problems, and uremia in renal damage.
Classification and symptoms
To be diagnosed with cachexia, you need a weight loss of more than 5% of your baseline over a year. This is accompanied by decreased muscle strength, chronic fatigue, and lack of appetite. According to the triggers, cachexia is divided into cardiac, pituitary, alimentary, and medication.
Cancer cachexia and its three stages are distinguished in a separate group:
- Pre-cachexia with weight loss of more than 5% for six months on the condition of anorexia and negative metabolism.
- Cachexia proper with similar weight loss or with BMI less than 20 kg/m2 and weight loss >2%, or with sarcopenia and weight loss >2% with a background of inflammation.
- Refractory cachexia with critical weight loss and marked catabolism, with no effect of antitumor treatment.
A sign worthy of special attention is considered to be a weight loss of 5% of the initial value for no apparent reason. In cachexia, the face is skinned, the features are pointed, the clavicles and ribs, and the pelvic bones may serve as an anatomical exhibit. The skin is dry, wrinkled, jaundiced gray, pigmented.
Nutrient deficiency provokes alopecia, stratification and deformation of nail plates, their slow growth. Subcutaneous fat is rapidly lost, muscles melt, and body volume is minimized. Patients develop chronic fatigue syndrome, rapid fatigue, dizziness, somnolence, fainting spells. There appear disturbances of sensitivity in the extremities, hypersensitivity to low temperatures, hypothermia.
The exhaustion is characterized by abnormalities of the digestive tube, joints, retrosternal discomfort, hypotension. The symptomatology is correlated with the underlying cause of cachexia. For example, a sharp loss of pounds against a background of relative well-being is typical for endocrine pathology, and a slow decrease in weight is typical for somatics. In primary cachexia there may be an increase in body weight against the background of fluid retention in the body – kwashiorkor.
Cachexia is an unfavorable diagnostic sign that increases the risk of mortality. A weight loss of 45-50% of normal body weight is fatal. Internal organ weight is minimized due to dystrophy, visceral fat disappears, mineral imbalance is diagnosed, osteoporosis and osteomalacia are formed. Interstitial edema develops due to impaired contractility of the heart. Depression of immunity, neurological symptoms, disorders of pelvic organs functions are also dangerous. In adults – cognitive disorders, in children – delayed psychophysical development.
The diagnosis can be made visually, the examination is performed by a specialized specialist, taking into account the underlying pathology. Collection of anamnesis, finding out the nature of nutrition, physical examination are mandatory.
At the first stage they use:
- Anthropometry with determination of BMI and thickness of subcutaneous fatty fold, assessing body weight and percentage of fat tissue (normal is 23% of total weight).
- Laboratory tests to determine hormone profile and general body screening.
In the second stage, they look for the underlying cause of exhaustion by ultrasound of the abdominal and pelvic organs, ECG, cardiac ultrasound, CT and MRI scans, EFGDS, colonoscopy and laparoscopy. A psychiatrist and neurologist are involved in the examination.
The therapy is complex and includes:
- Replenishment of nutrients by means of nutritional correction – basic, topical and auxiliary therapy. The goal is to provide the body with macro- and micronutrients, saturation with nutrient mixes to normalize nutritional status, and elimination of avitaminosis. And all by means of enteral nutrition.
- Drugs – to correct the underlying cause: etiotropic drugs, anabolics, appetite stimulators, cytokine and ACE inhibitors.
Prognosis and prevention
Nutritional support for malnutrition is temporarily effective and improves quality of life. Primary cachexia with timely therapy is fully corrected, with the secondary form the prognosis is correlated with the degree of severity of the underlying pathology. Prevention of cachexia involves treatment of somatic pathologies and proper diagnosis.