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Clinical Nutrition
journal homepage: http://www.elsevier.com/locate/clnu
Opinion Paper
Department of Clinical Medicine, La Sapienza, University of Rome, Viale dellUniversita, 37, Rome 00185, Italy
Department of Cardiology, Charite Medical School, Campus Virchow-Klinikum, Berlin, Germany
c
Departament de Bioqumica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
d
Department of Geriatric Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
e
Department of Medical, Technological and Translational Sciences, Division of Internal Medicine, Molecular Medicine, AOUTS, University of Trieste, Italy
f
INRA, Centre Clermont-Ferrand-Theix, UMR 1019, Unite de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
g
Department of Clinical Nutrition, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Goteborg, Sweden
h
Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
i
Department of Experimental Medicine and Oncology, University of Turin, Turin, Italy
j
Clinical and Surgical Sciences (Surgery), The Royal Inrmary of Edinburgh, University of Edinburgh, Edinburgh, Scotland, UK
k
Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy
l
Gastroenterologie et Nutrition Clinique, INSERM U907, Universite de Nice Sophia-Antipolis, Nice, France
m
Department of Respiratory Medicine, University of Maastricht, Maastricht, The Netherlands
b
a r t i c l e i n f o
s u m m a r y
Article history:
Received 4 December 2008
Accepted 9 December 2009
Chronic diseases as well as aging are frequently associated with deterioration of nutritional status, loss
muscle mass and function (i.e. sarcopenia), impaired quality of life and increased risk for morbidity and
mortality. Although simple and effective tools for the accurate screening, diagnosis and treatment of
malnutrition have been developed during the recent years, its prevalence still remains disappointingly
high and its impact on morbidity, mortality and quality of life clinically signicant. Based on these
premises, the Special Interest Group (SIG) on cachexia-anorexia in chronic wasting diseases was created
within ESPEN with the aim of developing and spreading the knowledge on the basic and clinical aspects
of cachexia and anorexia as well as of increasing the awareness of cachexia among health professionals
and care givers. The denition, the assessment and the staging of cachexia, were identied as a priority
by the SIG. This consensus paper reports the denition of cachexia, pre-cachexia and sarcopenia as well
as the criteria for the differentiation between cachexia and other conditions associated with sarcopenia,
which have been developed in cooperation with the ESPEN SIG on nutrition in geriatrics.
2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Keywords:
Chronic diseases
Aging
Pre-cachexia
Cachexia
Anorexia
Sarcopenia
1. Introduction
The close association between chronic illnesses and the deterioration of nutritional status, impaired quality of life and increased
risk for morbidity and mortality has been long recognised.1 Indeed,
as early as in the third century B.C., the Greek physician Hippocrates
from Koos very neatly described the wasting syndrome associated
0261-5614/$ see front matter 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
doi:10.1016/j.clnu.2009.12.004
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Not
at all
A little
bit
Somewhat
Quite
a bit
Very
much
0
0
1
1
2
2
3
3
4
4
0
4
4
1
3
3
2
2
2
3
1
1
4
0
0
4
4
3
3
2
2
1
1
0
0
4
0
3
1
2
2
1
3
0
4
157
Cancer
COPD
Chronic heart failure
Chronic renal failure
Liver failure
AIDS
Rheumatoid arthritis
See ref.
70
and
71
for review.
158
11. Conclusion
A universally accepted denition of the clinical syndrome of
cachexia would represent a major achievement in clinical medicine,
allowing for early recognition, prevention and timely-appropriate
treatment of this devastating condition. Cachexia has been long
considered a late and ineluctable event complicating the natural
history of many chronic diseases such as cancer, chronic heart
failure, COPD, chronic renal failure, etc. Moreover, the negligible
response of cachexia to available pharmacological and nutritional
interventions has lead to the misconception that the complex
metabolic picture of cachexia is uniquely amenable to palliative
care. However, recent clinical and experimental evidences clearly
indicate that those mechanisms ultimately leading to the severe
wasting of cachexia are operating early during the natural history of
disease, suggesting that appropriate interventions might be effective in preventing or delaying the onset of this syndrome. Consistently with the progressive knowledge of its biochemical and
molecular mechanisms, the role of nutritional impairment in
cachexia has become increasingly clear. This underscores the need
for appropriate combined interventions (pharmacological and
nutritional) to prevent the evolution of pre-cachexia into
cachexia.69 In this respect, the staging of cachexia has major practical implications since it may help in the better denition of
screening and intervention plans. Urgent next steps are to undertake longitudinal observational studies to conrm the diagnostic
and predictive accuracy of the suggested pre-cachexia criteria, as
well as to design the targeted interventional studies.
Moreover, with this document we put forward a denition and
diagnostic criteria for age-related sarcopenia comprised by the
combined presence of muscle mass loss and reduced muscle
strength. The condition responds readily to resistance training. In
addition, new nutritional and pharmacological treatment options
are under way.
The next aim of the Special Interest Groups is to devise practical
guidelines for the prevention, diagnosis and treatment of cachexia
of chronic diseases and sarcopenia. A mission that will entirely rely
on the work performed so far.
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