La Nutricion

CE: Madhur; MCO/200787; Total nos of Pages: 7;

MCO 200787

REVIEW
CURRENT
OPINION

Malnutrition, fatigue, frailty, vulnerability,
sarcopenia and cachexia: overlap of clinical
features
Khursheed N. Jeejeebhoy

Purpose of review
Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia all phenotypically present with the
same features because they are subject to theoperation of similar mechanistic factors. However, the
conditions referred to above differ by which mechanism dominates the cause of the clinical condition.
This review discusses the overlap and differences, which distinguish as well as unite these different
conditions and allow a rationale for treatment.
Recent findings
In the continuum of malnutrition, cachexia, sarcopenia and frailty therecent activities focus on two areas.
The first is a better understanding of the mechanisms of cachexia and sarcopenia and frailty. In particular,
the differential effects of cytokines on muscle and on the hypothalamic system. The effects of inactivity
promoting the loss of body mass in cachexia and sarcopenia as well as the positive effects of exercise.
The second is the development of asynthesis of available literature to develop consensus documents about
the definition, causes, diagnosis and treatment of cachexia, sarcopenia and frailty.
Summary
Loss of body tissues resulting in wasting is a common phenotype for several different conditions which can
be caused by a combination of reduced food intake, excessive requirements, altered metabolism, sepsis,
trauma, ageing andinactivity. They have been referred to loosely as malnutrition but in not all will respond
to simply providing nutrients. In this review the common features and the differences as they relate to cause
and response to treatment are discussed.
Keywords
ageing, cachexia, cancer, malnutrition, sarcopenia, sepsis, trauma

INTRODUCTION
Loss of weight caused by loss of the body tissues
is associated with anumber of conditions which
range from deliberate desire to lose body fat [1 ] to
disease-induced inexorable and unwanted weight
loss progressing to extreme weakness and death.
The latter is called cachexia but despite a myriad
of expert opinions and even a recent consensus
conference, the understanding remains elusive as
shown by the rather broad definition proposed [2]
‘cachexia, is acomplex metabolic syndrome associated with underlying illness and characterized by
loss of muscle with or without loss of fat mass. The
prominent clinical feature of cachexia is weight loss
in adults (corrected for fluid retention) or growth
failure in children (excluding endocrine disorders).
Anorexia, inflammation, insulin resistance and
increased muscle protein breakdown are frequentlyassociated with cachexia [3 ]. Cachexia is distinct
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from starvation, age-related loss of muscle mass,
primary depression, malabsorption and hyperthyroidism and is associated with increased morbidity’. Unfortunately, the mechanism as discussed
below overlaps between ‘cachexia’ and many of
the conditions from which it is supposed to
be distinguished [4]. Another condition of tissueloss is age-related muscle loss that has been referred
to as ‘sarcopenia’ [5 ,6 ], a term coined by Irwin
Rosenberg [7,8]. It is a predominant loss of muscle
without loss of fat much like that in cachexia.
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University of Toronto and St. Michael’s Hospital, Toronto, Ontario,
Canada
Correspondence to Dr Khursheed N. Jeejeebhoy, 69 Boulton Drive,
Toronto, ON M4 V 2V5, Canada. Tel: +1416 822 1576; e-mail:
Khushjeejeebhoy@compuserve.com
Curr Opin Clin Nutr Metab Care 2012, 15:000–000
DOI:10.1097/MCO.0b013e328352694f

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