The Clarification of Cachexia

By: Nikki Nies

Overconsumption of food is emphasized as the leading cause of obesity in the U.S.  However, the other end of the spectrum  of nutrition related problems, such as starvation and/or cancer cachexia are not equally advertised in the media.

How many people know what cachexia is? Truthfully?It’s understandable why the two terms could be confused.  Starvation is defined as the suffering caused by hunger.  Cachexia, aka paraneoplastic syndrome, is the progressive and extreme weight loss associated with certain chronic diseases (i.e. multiple sclerosis, type 1 diabetes, failure to thrive syndrome, heart failure, emphysema,cancer and/or HIV/AIDS).

Cachexia is caused by “tumor factors”, which are produced and secreted by the tumor.  It is dominated by catabolic metabolism, which is the breakdown of normal bodily processes.


  • Anorexia
  • Early satiety
  • Progressive and severe weight loss with >10%  in 6 months
  • Generalized wasting and weakness
  • Impaired immune function
  • Poor physical performance.

 It is present in more than 50% of those with advanced cancer and thought to contribute to 20% of cancer deaths.   Although diagnosis of cancer cachexia often comes after some time with cancer, it commonly leads to muscle wasting in the early stages of cancer.  Cancer cachexia is more common in those with stomach, lung or pancreatic cancer.

Cancer cachexic patients may have a harder time handling treatments, such as chemotherapy due to additional side effects and have a poorer prognosis.

The metabolic difference between starvation and cachexia are important to note and provide better insight into why the terms cachexia and starvation can not and should not be used interchangeably.

Starvation Cachexia
Mobilizes fat, spares skeletal muscle Mobilizes fat and skeletal muscle
Decreased Basal Metabolic Rate (BMR) Normal or increased BMR
Decreased liver size Increased liver size
Normal lipoprotein lipase (LPL) Decreased LPL activity
Decreased glucose turnover Normal or increased glucose turnover
Decreased protein breakdown Increased protein breakdown
Increased Cori Cycle activity
Increased synthesis of positive acute phase proteins

LPL is responsible for the cleavage of triacylglyercols into fatty acids and glycerol.

The evaluation of cachexia can be found by measuring one’s lean body mass, food intake diaries, BMI and blood tests that include (WBC count, serum albumin, uric acid and C-reactive protein).

The nutritional goal when treating cancer cachexia is the recommendation of nutrient through a variety of foods daily.  The goal is to preserve lean body mass, minimize nutrition related side effects and/or deficiencies and maximize quality of life.It is difficult to reverse cachexia,  but that doesn’t mean there’s no cause of concern.  The aim is to “stimulate” anabolic processes, which is muscle building while inhibiting catabolic processes, which are the actions that result in the breakdown of muscle.

It’s been found that the addition of supplements in the diet is not found to be effective, but the gradual increase of nutrients can benefit.  Some studies have found using fish oil or EPA, one of three fatty acids may decrease inflammatory markers.  In addition, endurance training exercise may decrease the decline of muscle mass and there are medications available (i.e. megace, thalidomide).


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