29 Nov 2021

Cachexia: What it Is and How to Help Manage It

Perhaps you’ve seen a loved one or friend lose weight – a lot of weight, in fact, and in a short amount of time. If this friend or loved one is sick to begin with, this likely isn’t healthy weight loss.


This might be cachexia, or “wasting syndrome."


What is Cachexia?


Cachexia is known as wasting syndrome because with progressive loss of weight and muscle mass, the body is wasting away. It doesn’t just suddenly happen – it is associated with an underlying illness.


As many as 50-80 percent of people with cancer suffer from cachexia, although not all cancer diagnoses are associated with wasting syndrome. It’s most common among cancer of the pancreas, esophagus, stomach and lungs.


People with HIV/AIDS, COPD (chronic obstructive pulmonary disease), congestive heart failure (CHF), chronic kidney and liver diseases, and rheumatoid arthritis are also susceptible to this complex syndrome.


What Are Signs and Stages of Cachexia?


Man with Cachexia Who is Not Hungry


The main signs of this wasting syndrome are weakness and fatigue, and severe weight loss, including loss of muscle mass.


Because people with cachexia don’t feel like eating, their nutrition status also suffers. That might lead to an electrolyte imbalance, a decrease in the ability to fight infections, and anemia (low red blood cell counts).


These effects can be diagnosed with results from doctor-ordered bloodwork, but a diagnosis of cachexia mainly hinges on a person’s weight loss.


There are three stages of cachexia that doctors and dietitians monitor for. The rate that someone will progress through these stages can vary quite a bit, and some people won’t progress at all beyond a certain stage.


  • Precachexia is when someone has weight loss of 5% or less within 6 months.
  • Cachexia is weight loss of more than 5%, or a weight loss of more than 2% when body mass index (BMI) is less than 20.
  • Refractory cachexia is weight loss of more than 15% when BMI is less than 23 or weight loss of greater than 20% when BMI is less than 27. This stage is also seen in people with cancer whose treatments are no longer working.


How To Manage Cachexia


When you lose weight on purpose, such as to reduce obesity, you are preserving muscle and mostly shedding excess fat that your body doesn’t really need in the first place.


For people that have experienced a loss of muscle mass and function, that might be sarcopenia, the medical term for muscle loss often associated with aging. (You can help overcome sarcopenia with increased physical activity and by increasing your protein intake.)


Cachexia, on the other hand, is progressive weight loss as the body breaks down muscle (and possibly fat, too). The body becomes so frail and weak that even walking can become a chore.


If you or your loved one is at risk for cachexia, you need to contact your healthcare provider.


Managing cachexia depends on each person’s individual circumstances. Cachexia may not be avoidable or reversed completely, but it is treatable with the help of your care team.


Getting adequate nutrition, including sufficient calories and protein, are important.


You should aim for at least 1.5 grams of protein per kilogram of body weight to help combat wasting syndrome. For a 150-pound person, that would be about 100 grams of protein per day.


Supplemental nutrition with high-protein shakes is an easy way to get in more protein and calories, especially if eating is challenging. Milkshakes or protein powders added to soups and smoothies are other smart options.


Talk with a dietitian for any questions or concerns and to determine the nutrition options that are best for you. 


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