Wasting Syndrome

What is Wasting Syndrome?

There are individuals who actively lose weight without intending to. This condition is called wasting syndrome and it is usually associated with other pre-existing medical conditions. It currently affects millions of people and contributes to the mortality of these patients ^{[1, 2]}.

The official definition of wasting syndrome or cachexia is unintentional weight loss. Wasting syndrome can be life-threatening because it can’t be reversed by nutritional means. The lost in weight is primarily due to muscle atrophy of the skeletal muscles. The atrophy is caused by increased rate of muscle catabolism or muscle breakdown. Patients who experience this syndrome becomes very weak and it affects their response to their respective treatment. If the physical deterioration combines with the poor response to their treatment, the possibility of recovering from their illnesses becomes smaller ^{[2, 3, 4].}

Figure 1- A Person with Wasting Syndrome

Etiology

Wasting syndrome is associated with several serious conditions. It is commonly seen in cancer patients especially in those who are receiving palliative care. This syndrome more frequently occurs in patients with malignancy of the stomach, pancreas, colon, rectum and esophagus ^{[1, 3]}.

Other conditions where wasting syndrome can be seen are Acquired Immune Deficiency Syndrome (AIDS), tuberculosis, congestive heart failure, Crohn’s disease, rheumatoid arthritis, cystic fibrosis and Chronic Obstructive Pulmonary Disease. Not only that this syndrome affects the response to treatment but it also increases the possibility of post-operative complications if a patient would undergo a surgical procedure as a part of the management ^{[3, 5]}.

Signs and Symptoms

The main symptom of this syndrome is unintentional or involuntary weight loss. The lost in weight is defined as involuntary if the individual still loses weight despite adequate food intake. Anorexia may occur alongside wasting syndrome and it can amplify the weight loss ^{[1, 2, 5]}.

Another defining characteristic is the wasting of the skeletal wasting. It is important to note that for overweight patients, the muscle wasting may not be evident to their appearance. Decreased muscle mass secondary to wasting syndrome lowers the quality of life of the person. It makes activities of daily living like walking and eating difficult ^{[1, 2, 5]}.

Diagnosis

Health history and physical examination

A patient with a pre-existing illness may present with weight loss. The physician may have to monitor the condition of the patient before a diagnosis of wasting syndrome is established. Other possible cause of weight loss may have to ruled out. A food diary may be requested by the physician to ensure the look into the food intake of the patient ^{[1, 5]}.

Wasting syndrome evaluation

The weight of the patient will be evaluated by the physician using parameters such as the Body Mass Index (BMI) and body composition. The BMI will show if the patient is still within the range of healthy weight. The value is calculated based on the height and weight of the patient. The body composition compares the ratio of body fat and muscle mass. The result of this may aid in establishing the diagnosis ^{[1, 5]}.

Blood tests

The levels of white blood cells, transferrin levels, albumin and inflammatory markers are useful in the evaluation of the condition ^{[1, 5]}.

Treatment

The goal of the management for wasting syndrome is to stimulate the muscle building process or anabolism of the individual. There are several approaches to achieve this ^{[1, 3, 5]}.

Diet

Diet modification can be advised even if will not reverse the effect of this syndrome. Increasing the caloric intake should not be done rapidly because it may lead to “overfeeding syndrome.” The food intake must be increased gradually and if the patient could not tolerate oral intake, a feeding tube may be necessary ^{[1, 3, 5]}.

Medications

There are drugs that are used to attempt to aid in the treatment of wasting syndrome. Examples of these drugs include celecoxib, allopurinol, L-carnitine, testosterone and medical marijuana. These drugs have limited success in this realm ^{[1, 3, 5]}.

Food supplements

Ideally, the nutrients should come from food but supplements can help especially if the patient has decreased appetite. The use of supplements such as fish oil and omega-3 fatty acids have been linked to fewer complications ^{[1, 3, 5]}.

Increased activity or exercise

Increasing the physical activity of the patient may assist in slowing down the effect of wasting syndrome to the body. The activities should be done under the supervision of a professional to avoid any injuries ^{[1, 3, 5]}

References

1. Morley, J. E., Thomas, D. R., & Wilson, M.-M. G. (2006). Cachexia: pathophysiology and clinical relevance. The American Journal of Clinical Nutrition , 735-743.
2. MedicaLook. (2016). Cachexia. MedicaLook: http://www.medicalook.com/Weight_loss/Cachexia.html
3. Willacy, H. (2016). Cachexia. Patient: http://patient.info/doctor/cachexia
4. WebMD. (2014, March 12). Cardiac Cachexia. WebMD: http://www.webmd.com/heart-disease/heart-failure/tc/cardiac-cachexia-topic-overview
5. Eldridge, L. (2016, June 20). Cachexia. Very Well: https://www.verywell.com/understanding-cachexia-symptoms-causes-and-treatments-2249008