Diagnosis and treatment of starvation, cachexia and sarcopenia

• Starvation, cachexia and sarcopenia are three interrelated medical conditions frequently seen in medical settings (1). They have nutrition as a common component both as an underlying cause but also as part of treatment. However, the aetiology and thereby adequate therapy differ between these three conditions. Starvation means lack of food leading to deficiency of energy and nutrients. During pure starvation (without disease) the body reacts by decreased basal metabolic rate and loss of energy stores (body weight) mainly fat mass. Therapy aims to provide the body with adequate amounts of energy and nutrients to restore the losses. Cachexia (disease related malnutrition) is a condition caused by underlying disease and generally mediated by inflammation. The body responds by increased basal metabolic rate, loss of body weight mainly muscle mass and appetite. Adequate energy and nutrition, especially protein, supply is an important part of therapy but pharmacological actions are also needed treat the inflammation and other mediating factors. Sarcopenia means loss of muscle mass, function and strength (2). It is caused by a combination of several factors associated with normal ageing e.g. decreased level of anabolic hormones and changed body composition leading to impaired anabolic response to above all protein intake, decreased physical activity and impaired motor neuron function. Loss of body weight might be a part of the problem, but not necessarily (3). Sarcopenic obesity means a high proportion of body fat but low proportion of muscle mass combined by loss of muscle function and strength. Adequate energy and nutrition, especially protein, supply is an important part of therapy but also physical exercise, especially resistance training, is important for optimal effect (3, 4). It is important for dietitians to have knowledge of and be able to distinguish between these three nutrition related conditions to provide patients with optimal nutrition treatment. References 1. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. Clinical nutrition (Edinburgh, Scotland). 2015;34(3):335-40. Epub 2015/03/24. 2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and ageing. 2010;39(4):412-23. Epub 2010/04/16. 3. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clinical nutrition (Edinburgh, Scotland). 2014;33(6):929-36. Epub 2014/05/13. 4. Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542-59. Epub 2013/07/23.

Ämnesord

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Nutrition and Dietetics (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper -- Näringslära (hsv//swe)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

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Nutrition

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