Anorexia, cachexia and nutrition

Anorexia, cachexia and malnutrition occur in many chronic disease states including cancer, chronic obstructive pulmonary disease, chronic heart failure, chronic renal failure, chronic liver failure, rheumatoid arthritis and AIDS. Despite the relative frequency of such symptoms and signs, they are often overlooked or managed inadequately. Cachexia is characterized by a negative nitrogen and energy balance, with loss of both lean body mass and adipose tissue. It is due to a combination of reduced food intake and metabolic change triggered by pro-inflammatory cytokines and the neuroendocrine stress response. Clinical management needs to focus on stabilizing the primary condition whilst treating any reversible factors that might contribute to ongoing weight loss. In the past, cachexia was seen to be an irreversible and terminal event. However, advancements over the last couple of decades have meant that in a substantial proportion of patients, therapy can reverse, or at least halt, the progression of wasting with subsequent improvement in quality, if not quantity, of life.