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Sarcopenia, malnutrition and cachexia: what are their similarities and differences?

These three disorders characterize the patient's nutritional status, i.e. when nutritional needs (macro and/or micronutrients) are not met. They generally lead to a loss of lean mass. But even with these similarities, they have important differences that must be identified by health professionals. There are still many questions about these disorders, especially from those professionals who are not so used to nutritional therapy and who are trying to get up to speed on the correct nomenclature so that they can offer the right therapy to their patients.

To get a better understanding of the three terminologies, we spoke to PhD Marilia Seelaender, a biochemist at the Institute of Biomedical Sciences - ICB/USP, with an emphasis on Metabolism and Bioenergetics, working mainly on the following topics: cancer-related cachexia, adipose tissue, exercise, nutritional supplementation and lipid metabolism.

Prodiet - What are the similarities and differences between sarcopenia, malnutrition and cachexia?
Dr. Marilia Seelaender -
All three conditions lead to loss of lean mass, but they have different depths, mechanisms and dynamics. Simple malnutrition occurs as a result of a low intake of nutrients, especially proteins, and first results in a loss of fat mass, followed, if the process is prolonged, by a gradual, progressive reduction in lean mass. Sarcopenia may not depend on nutritional status, but on other factors, especially ageing. The loss is also progressive and occurs slowly, but is accompanied by a gain (and not a loss, as in malnutrition) in fat mass. In cachexia there is a loss of lean and fat mass at the same time, both quite rapidly (months). All three conditions have an important inflammatory component, but in the first two the degree of systemic and chronic inflammation is quite low, whereas in cachexia, systemic inflammation is more forceful and rapid in onset. Finally, cachexia, unlike sarcopenia, is associated with the presence of diseases that induce it, such as cancer, chronic obstructive pulmonary disease (COPD), among others.

Prodiet - What are the risks for patients suffering from these diseases?
Dr. Marilia Seelaender -
Profound malnutrition, and cachexia can lead to death. All three disorders can compromise patients' functionality and quality of life. When associated with other diseases, the prognosis worsens and the effectiveness of treatment decreases.

Prodiet - Do the three definitions apply to the same patient?
Dr. Marilia Seelaender -
In some cases, yes, such as an elderly patient (sarcopenic) who has chronic malnutrition (due to social conditions, etc.) or who becomes malnourished (anorexia associated with diseases, such as cancer).

Prodiet - What are the symptoms of each of these diseases?
Dr. Marilia Seelaender
The symptoms vary greatly, so I can't generalize. They have to be assessed individually. However, non-voluntary weight loss, loss of muscle function and systemic inflammation (low for malnutrition and sarcopenia, high for cachexia) are indicators.

Prodiet - What are the treatment options?
Dr. Marilia Seelaender -
Simple malnutrition can be treated with the careful and programmed introduction of adequate nutrition. In sarcopenia, greater protein intake and exercise should be associated. In cachexia, intake of specific nutrients (e.g. HMB) and physical exercise.

Prodiet - Who are the people most likely to have these diseases?
Dr. Marilia Seelaender
In the case of malnutrition, it varies greatly, from socioeconomic problems to anorexia nervosa and behavioral patterns. Sarcopenia affects more elderly people, sedentary people and a combination of factors. Cachexia is more common in patients with cancer, COPD, AIDS, sepsis, burns and rheumatoid arthritis, among others.

Prodiet - What are the implications of cachexia in cancer?
Dr. Marilia Seelaender -
It reduces survival, quality of life and the effect of treatment. It is also directly associated with death in 20-40% of cancer patients.

Prodiet - What is the most important information that health professionals need to know in order to give patients the right advice?
Dr. Marilia Seelaender
Professionals should know how to distinguish between the three disorders, taking into account the time the weight loss occurred, the compartment of the loss (fat or muscle) and the presence of underlying diseases.

Prodiet When should a patient see a specialist?
Dr. Marilia Seelaender -
I believe that people should go to a health professional if there is unintentional weight loss, reduced functionality and reduced appetite.

Prodiet What can you do to prevent these disorders?
Dr. Marilia Seelaender -
Keeping active and consuming adequate amounts of macro and micronutrients for your gender and age.AF_PR000516C_Infogra?fico_Fevereiro_Dia19_01-02

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