From the Guidelines
Cachexia and poor oral intake are associated with multiple nutritional deficiencies, primarily protein-calorie malnutrition, which leads to muscle wasting and weight loss, and it is crucial to address these deficiencies to improve quality of life, functional status, and potentially treatment outcomes. The most common nutritional deficiencies associated with cachexia include vitamins B1 (thiamine), B12, D, zinc, iron, magnesium, and selenium, as well as inadequate levels of essential amino acids and fatty acids 1. These deficiencies occur because cachexia involves inflammatory processes that increase metabolic demands while simultaneously reducing appetite and food intake, creating a dangerous cycle of declining nutritional status and worsening health. For patients with cachexia and poor oral intake, a comprehensive nutritional assessment and intervention plan is recommended, including high-calorie, high-protein oral supplements like Ensure Plus or Boost Plus (1-2 servings daily), along with a multivitamin containing minerals 1. Specific supplementation may include vitamin D3 (1000-2000 IU daily), vitamin B12 (1000 mcg daily if deficient), and thiamine (100 mg daily, especially in alcoholic patients) 1. Early nutritional intervention is crucial, and parenteral nutrition may be considered in patients who cannot be fed orally or enterally, with a standard nutritional regimen recommended for short-term parenteral nutrition, and a high fat-to-glucose ratio may be advised for cachectic patients receiving intravenous feeding for several weeks 1. Key considerations for nutritional intervention in cachexia include:
- Comprehensive nutritional assessment and intervention plan
- High-calorie, high-protein oral supplements
- Multivitamin containing minerals
- Specific supplementation (e.g. vitamin D3, vitamin B12, thiamine)
- Parenteral nutrition for patients who cannot be fed orally or enterally
- Monitoring and adjustment of nutritional intervention based on patient response and needs.
From the Research
Nutritional Deficiencies in Cachexia
- Cachexia is often associated with malnutrition, and nutritional intervention is a widely accepted strategy 2
- The condition is characterized by a negative prognostic factor in cancer patients, with a variable combination of reduced food intake and metabolic changes 3
- Anorexia and weight loss are associated with increased mortality in cachectic patients, highlighting the need for caloric supplementation 4
Key Nutritional Deficiencies
- Protein catabolism and anti-inflammation are most pronounced benefits of n-3 fatty acid supplementation 2
- Omega-3 fatty acids, particularly eicosapentaenoic acid and docosahexaenoic acid, may enhance the efficacy of nutritional support in cancer patients with high-inflammatory response 3
- Vitamin D deficiency may also be a concern, with targeted medical nutrition containing high-dose vitamin D showing positive effects on blood pressure and blood lipids 5
Dietary Interventions
- A balanced essential amino acid supplement given at least twice a day may improve outcomes in malnourished patients 4
- Caloric supplementation rich in protein and with adequate vitamin D should be given between meals to all patients with cachexia 4
- Targeted medical nutrition containing high-dose omega-3 fatty acids, vitamin D, and high-quality protein may be clinically beneficial in the nutritional and metabolic support of pre-cachectic and cachectic patients with chronic obstructive pulmonary disease (COPD) 5