Anorexia-cachexia Flashcards
What is anorexia-cachexia?
A multi-factorial syndrome (of involuntary weight loss) defined by an **ongoing loss of skeletal muscle mass **(with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support. It leads to progressive functional impairment. .
What is the pathophysiology of anorexia-cachexia?
Its pathophysiology is characterizedby a negative protein and energy balance** driven by a variable combination of reduced food intake and abnormal metabolism**
Tumor interactions with the immune system elicits a panoply of what type of molecules?
Pro-inflammatory molecules
What are examples of anorexia-cachexia symptoms/signs?
1) Weight loss
2) Anorexia
3) Fatigue
4) Depression
5) Early satiety
6) Reducted function
What biological features may you see in a patient with anorexia-cachexia?
1) Markers of chronic inflammation
Raised CRP; Elevated neutrophil : lymphocyte ratio
2) Immune cell activation
3) Low albumin
4) Low testosterone (men)
5) Tumour and immune cell production of catabolic effector molecules
In anorexia-cachexia syndrome what signals are amplified within the CNS that generates inflammation?
Cytokine signals
Cytokine signals are amplified within the CNS, generating** inflammation** that, in turn, initiates and sustains alterations in the activity of neuronal populations that regulate appetite, metabolism and body weight.
List 5 potentially reversible psychological factors that contribute to anorexia-cachexia.
1) Anxiety
2) Depression
3) Family distress
4) Spirtual distress
5) Social isolation
What oral issues may contribute to anorexia-cachexia?
1) disturbed taste or smell
2) dentures
3) mouth sores
4) thrush
5) dry mouth
What gi issues may contribue to anorexia-cachexia?
1) gastric reflux
2) early satiety
3) nausea and vomiting
4) obstruction
5) constipation
6) diarrhea
7) malabsorption (pancreas, fistula)
What 5 metabolic issues may contribute to anorexia-cachexia?
1) Diabetes
2) adrenal insufficiency
3) hypogonadism
4) thyroid insuffficiency
5) low testosterone
What cancers are more likely to cause cachexia?
1) Pancreas
2) Lung
3) Upper gastrointestinal tumours
Name 3 assessment tools for anorexia-cachexia
1) The Functional Assessment of Anorexia Cachexia Therapy (FAACT)
2) QLQ-CAX24 (Cancer cachexia specific questionnaire)
3) Patient-Generated Subjective Global Assessment (PG-SGA)- scores pt-reported food intake, wt loss and sx impacting on food intake with pt estimation of function
What 2 biological markers show an inflammatory state?
1) CRP
2) inc in neutrophils & dec in lymphocytes
What biological marker strongly correlates with severity of cachexia and bodes a poor prognosis?
Elevated CRP
What are some strategies around meals for patients with anorexia-cachexia?
If pts find odours problematic, cook elsewhere/serve cold dishes
Serve small portions
More frequent meals
Sparkling water prior to eating may help reduce bitter or metallic taste
Are there specific dietary ;supplements which can be used in anorexia-cachexia syndrome?
Omega-3 fatty acids MAY stabilize or improve appetite, food intake, lean body mass and body weight.
The specific elements are DHA and EPA.
OMega-3 fatty acids reduce formation of inflammatory eicosanoids.
TRUE or FALSE
To date, no approved agents improve muscle mass or function.
TRUE
Appetite stimulants
What is the main disadvantage to using corticosterois as an appetite stimulant?
1) Increase muscle breakdown
Dexamethasone is a potent inducer of muscle catabolism
What progestational agent is most commonly used to boost appetite?
Megestrol acetate
What causes the wt gain when a patient takes mestrole acetate for appetite stimulation?
Fat accumulation
What is the difference between starvation and anorexia- cachexia?
Starvation is characterized by a slowing down of metabolism in response to reduced food intake.
In cachexia syndrome, weight loss and protein and lipid breakdown proceed rapidly even if caloric intake is optimal.
Name 4 inflammatory cytokines
1 Tumor Necrosis factor (TNF),
2 interleukin-1
3 interleukin-6
4 protein cachexia factor
What could you consider prescribing for early satiety?
metoclopramide
When may artificial nutrition be appropriate?
Cachetic patients with therapy responsive tumor
Swallowing problem due to obstructing but potentially resectable or treatable tumor (localized head and neck cancer in which weight loss is due to decreased oral intake and no cachexia syndrome)
Pre-operative treatment of malnutrition in surgcally resectable tumor
Malabsorption syndrome in a patient with controllable or localized disease
