Starvation and cachexia

It is essential that you understand the difference between Starvation and Cachexia. 

Cachexia manifests with extreme weight loss, usually with disproportionate muscle wasting. Being able to differentiate this from other syndromes of weight loss is vital to prompt recognition and effective management of Cachexia. Weight loss resulting from starvation occurs as a direct result of caloric deprivation.

In starvation, the body tries to conserve energy and nutrients through mostly using fat stores to produce energy, in an attempt to preserve protein and muscle. In Cachexia the body uses mostly protein/muscle stores to produce energy.

Cachexia is defined as involuntary weight loss (more than 5% of baseline) with a bigger loss of muscle than fat. Cachexia is common in severe End of Life illnesses, including advanced cancer.

Starvation is the result of a severe or total lack of nutrients needed for the maintenance of life.

What causes Cachexia?

The body’s inflammatory reaction and tumours produce proteins that decrease motility of the stomach and intestines as well as increased muscle breakdown. This results in reduced intake of food and nutrients and an accelerated weight loss.

Why do you need to know?

Cachexia can occur in different stages dependant on how the person is clinically and their circumstances: pre-cachexia, cachexia and refractory cachexia. At all stages an impeccable assessment needs to be carried out to determine functional or anatomical barriers within the gastro-intestinal tract, or symptoms such as breathlessness or incident pain affecting the person’s ability to eat (Radbruch et al 2010). All patients, regardless of setting, should have equal access to appropriate assessment and management of cachexia.

Refractory cachexia is where reversal of weight loss seems no longer possible due to advanced progressive disease and here the burden and risks of artificial nutrition are likely to be greater than the benefits. It is here that care needs to have emphasis on alleviation of the suffering linked with cachexia, such as good symptom management with appetite stimulation, where appropriate, and treatment of nausea and vomiting (Radbruch et al, 2010).

It is important that time and support are given to relieve any eating-related distress of patients and their families. Research has shown that with cachexia the accompanying symptom of anorexia can cause distress, tension and arguments among patients and their family carers, the latter who have a desire to promote food for the person’s survival without understanding the futility (Reid et al, 2009).