Several components of the cachexia definition were also present in patients with other syndromes, e. Besides the necessary criterion loss of weight, the most prevalent features in cachectic patients were increased CRP values and anorexia in more than three quarters of patients Table 3. Since its publication in , the ESPEN definition was used in a number of studies [ 5 , 44 , 45 , 46 ] providing a good basis for comparison of our own results.
This may be explained by the close relation of the MNA to functionality and level of dependence [ 47 ] and the low level of dependence in our patient group Table 1. Interestingly, malnutrition according to MNA was significantly more prevalent not only in patients with malnutrition according to ESPEN but also in all other syndromes Table 3.
This might also be due to the functional nature of the MNA. This is again explainable by the fact that functional aspects are included in the MNA whereas the ESPEN definition is restricted to weight loss and reduced body mass or fat-free mass.
Despite this lacking significance in the association between malnutrition and frailty, malnutrition according to ESPEN showed the largest overlap with the other syndromes Table 4 , Fig. All malnourished patients except one were also cachectic, which may be due to the fact that two of the three malnutrition criteria — weight loss and low fat-free mass — are also components of the cachexia definition.
Interestingly, all malnourished patients had a low SMI, probably as a consequence of the experienced weight loss. Thus, the large overlap of malnutrition with the other syndromes is probably caused by the fact that malnutrition is mainly characterized by wasting which is a central symptom also of the other syndromes. Even though every other patient experienced weight loss, more than one quarter of the patients was obese, and obesity did not preclude the presence of sarcopenia, frailty or cachexia.
In these patients, tissue loss is hidden behind high body fat mass and may easily be overlooked if no special attention is paid. Obese patients with one or more of the four syndromes might have higher risks for cardio-metabolic diseases and physical disability compared to patients with normal BMI and these syndromes [ 48 ] and thus deserve special attention. In order to identify these patients, body composition needs to be measured.
The major strength of the present study is the application of consensus definitions and complete information on all four syndromes in the same patients. Moreover, all measurements were highly standardized. One limitation of the study is the rather small sample size, which is however, comparable to previous studies investigating the overlap of tissue loss syndromes in hospital settings [ 5 , 14 ].
Due to hospital equipment, we were forced to select patients who were able to stand which limits the generalizability of our results. As these patients did not consent to any data collection, it is unfortunately not possible to describe potential differences between these patients and the study sample. It may be assumed that a selective participation of less severely impaired patients also contributed to the high physical and mental performance of the study sample.
This might have led to a slight underestimation of the malnutrition prevalence. Furthermore, the accuracy of BIA measurements is limited in case of changes in the amount and distribution of body water. In the present cross-sectional study, the tissue loss syndromes sarcopenia, frailty, cachexia and malnutrition and their constituting components were widespread among older medical inpatients, even though patients were physically and mentally rather unimpaired.
The syndromes occurred concurrently and were interrelated. In the light of well-known serious health consequences of each syndrome, in clinical routine attention should be paid to the presence of each syndrome, also in obese patients. In addition, each component of the syndromes needs particular attention as weight loss, reduced muscle mass, reduced physical performance and inflammation are treatable by nutritional support, physical exercise or anti-inflammatory treatment.
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Malnutrition, cachexia and nutritional intervention: when much becomes too much. Abstract Disease-associated malnutrition, also defined as cachexia, is a complex syndrome characterised by the progressive deterioration of nutritional status resulting from the combined effects of reduced appetite and food intake, and profound changes in host metabolism.
Keywords Malnutrition; Cachexia; Enteral nutrition; Complications; Refeeding syndrome; Oral nutritional supplements; Monitoring program.
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Oncology Malnutrition and cachexia. Published on ; The most clinically significant feature of cancer cachexia is muscle loss sarcopenia , as this relates to fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Published on ;75 2 Malnutrition and cachexia-related weight loss in cancer patients is thought to be caused by a combination of undernutrition, inflammation, and cancer-induced catabolism. Published on Causes of nutrient deficiencies in cancer 6 Grober U, et al.
Published on ;8 3 International guidelines on nutritional intervention have been recently updated and published. Published on ;8 3 1. Published on ;75 2 2 Fearon K, et al. Published on ; 4 Fearon KC. Published on ; 5 Arends J, et al.
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