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Cachexia and Sarcopenia 140.e1

Cachexia and Sarcopenia
VetBooks.ir Diseases and Disorders

may have anabolic effects to help maintain
BASIC INFORMATION
DIAGNOSIS
lean body mass.
Definition Diagnostic Overview • Nutritional management is key to the
Muscle loss (and often weight loss) is com- It is important to identify muscle loss at an effective chronic treatment of cachexia (see
monly associated with various diseases, such early stage when intervention is more likely below).
as congestive heart failure (CHF) (cardiac to be successful.
cachexia), cancer (cancer cachexia), chronic Nutrition/Diet
kidney disease (CKD), and acute illness or Differential Diagnosis • Anorexia (complete absence of food intake),
injury. Sarcopenia is muscle loss associated Because medical conditions are more common hyporexia (decreased food intake), and dys-
with aging in the absence of disease. as animals age, cachexia and sarcopenia can rexia (changes in food preferences or patterns)
occur concurrently in older dogs and cats. are common in animals with many acute or
Epidemiology chronic diseases and during aging.
SPECIES, AGE, SEX Initial Database • Ensuring adequate calorie intake
Cachexia can occur in dogs and cats of any • A nutritional assessment should be per- ○ Ensure optimal management of underlying
age in association with a variety of diseases. formed on all animals at every visit. This disease.
Sarcopenia occurs gradually during the aging includes body weight, BCS, MCS, and diet ○ Provide multiple options of diets with
process and is most common in older dogs history. appropriate nutritional properties for the
and cats. • The diet history includes the specific brand, individual patient’s underlying disease,
product, flavor, and amount of pet food clinical signs, laboratory values, and
RISK FACTORS (or recipe and amounts for home-prepared preferences (animal’s and owner’s).
• Acute illness/injury, chronic disease, aging diets), treats, table foods, rawhides and other ○ Try multiple forms (e.g., dry vs. canned)
• Inadequate calorie and/or protein intake chew toys, dental products, dietary supple- or different brands or flavors.
are confounding factors, but cachexia and ments, and foods used for administering ○ Balanced homemade diet formulated by
sarcopenia can occur even in the face of medications. board-certified veterinary nutritionist
adequate nutritional intake. • Evaluation for potential causes of reduced ○ Smaller, more frequent meals
food intake (e.g., progression of the underly- ○ Vary temperature; animals may prefer
Clinical Presentation ing disease; dental disease, environmental foods at room temperature, warmed,
DISEASE FORMS/SUBTYPES factors, medication side effects, dietary refrigerated, or even frozen.
Severity ranges from subtle muscle loss to severe, properties) ○ Feed from a different bowl/plate or feed
end-stage muscle wasting. • Evaluation for underlying diseases that cause in a different area of the home.
cachexia (e.g., cancer, CHF, CKD). ○ Palatability enhancers: appropriate addi-
HISTORY, CHIEF COMPLAINT tions depend on the underlying disease
Heart failure (p. 409), cancer, CKD (p. 169), TREATMENT (e.g., low-sodium, cooked meat or fish or
acute critical illness/injury, aging/geriatrics homemade, no-sodium broth for animals
Treatment Overview with CHF; avoid meat/fish as palatability
PHYSICAL EXAM FINDINGS The goals of treatment are to 1) optimally enhancers in animals with CKD).
• Muscle condition score (MCS) assessed by manage any underlying disease, 2) ensure ○ Fish oil supplementation (see “Modulate
visualization and palpation of the spine, adequate calorie and protein intake, and 3) cytokine production” below)
scapulae, skull, and wings of the ilia. Palpa- reduce inflammation (i.e., modulate cytokine ○ Consider placing a feeding tube if oral
tion is especially important when muscle production). intake is inadequate to maintain body
loss is mild, when the haircoat is thick, and weight and muscle mass.
when animals are overweight. Acute General Treatment • Ensure adequate protein intake
• Muscle loss typically is first noted in the • In newly diagnosed illness or acute exac- ○ Avoid protein-restriction (<4.5 g/100 kcal
epaxial muscles. Muscle loss at other sites erbations, avoid major diet changes until protein [dogs] or < 6.5 g/100 kcal protein
(e.g., gluteal, scapular, temporal muscles) the patient is home and stabilized on [cats]) unless advanced CKD is present.
can vary more. medications. Higher protein intake than these mini-
• The MCS and body condition score (BCS), • To avoid food aversions, introduce new diets mums may be warranted in some patients,
which assesses the animal’s fat stores, should gradually. but very high protein intake is unlikely to
be assessed on every animal at every visit. • Appetite stimulants (e.g., mirtazapine for be beneficial to prevent or treat cachexia
Animals can have significant muscle loss cats, capromorelin for dogs [also under or sarcopenia. Be cautious of senior diets
even if they are overweight (BCS > 5/9), investigation for cats]) can help improve because the energy density and nutritional
and animals that are thin (BCS < 4/9) can food consumption; calorie intake must be profile is highly variable.
have normal muscle mass. monitored to ensure adequacy. ○ Because protein restriction does not
slow progression of CKD, avoid severe
Etiology and Pathophysiology Chronic Treatment protein restriction unless advanced disease
• Cachexia and sarcopenia reduce strength, • Ensure optimal medical therapy for any (International Renal Interest Society [IRIS]
immune function, wound healing, and underlying disease. stage 3-4) or proteinuria are present.
survival. • Appetite stimulants (e.g., mirtazapine for • Modulate cytokine production
• Tumor necrosis factor (TNF), interleukin-1 cats, capromorelin for dogs [also under ○ Omega-3 fatty acids in fish oil can reduce
(IL-1), and other inflammatory mediators investigation for cats]) can help improve cytokines. The author uses a dose of
contribute to reduced food intake, increased food consumption; calorie intake must be 40 mg/kg body weight eicosapentaenoic
energy requirements, and loss of lean body monitored to ensure adequacy. Ghrelin acid (EPA) and 25 mg/kg body weight
mass. receptor agonists (e.g., capromorelin) also docosahexaenoic acid (DHA). One 1-gram

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