An Important Approach to Treating Geriatric Anorexia-Cachexia

Professor Baek Hyun-wook (President of the Korean Women’s Medical Association)

The older you get, the lower your activity level and the lower your muscle mass, which is necessary to reduce the amount of calories consumed, but the elderly are physiological. Malnutrition is easily accompanied by the fact that the amount of food is significantly reduced due to social factors. In addition, the need for some individual nutrients, such as vitamins and minerals, can increase with age, which can lead to nutritional imbalances.

Indeed, weight loss among the elderly is very common and is seen as a form of systemic wasting syndrome, or cachexia. In most cases, anorexia is followed by a generalized wasting syndrome, called “senile anorexia-kakexia” or “senile anorexia-generalized wasting syndrome”. Geriatric anorexia-cachexia or generalized wasting syndrome increases the morbidity and mortality of infectious diseases such as pneumonia and pressure ulcers in the elderly.

Senile systemic wasting syndrome is characterized by a reduction in the elderly’s ability to cope with external stress situations such as infection, surgery, injury and depression, which can easily progress to severe symptoms and are difficult to cure.

Weight loss associated with malnutrition is a factor that worsens cognitive decline and depression, reduces quality of life and causes increased medical costs. Unlike weight loss that accompanies simple starvation, cachexia-wasting weight loss is characterized by a very rapid loss of body protein, and most (70-80%) of weight loss involves loss of body mass lean, mostly muscle mass.

Sarcopenia refers to a decrease in muscle and lean mass and is a result of geriatric wasting syndrome or cachexia. Muscle strength, power and endurance are all reduced, leading to a decline in the function of various organs. This means loss of physical function or vitality. It goes through ‘failure to thrive’ and eventually leads to frailty.

Treatment and prevention of malnutrition in the elderly

Suppressing the chronic inflammatory response by increasing intestinal immunity together with balanced nutritional administration is an important approach for the treatment of geriatric anorexia-cachexia. Generalized wasting syndrome associated with geriatric anorexia does not cause weight gain simply by increasing caloric intake. In order to solve malnutrition, it is necessary to supply balanced nutrients including micronutrients, and in particular, to solve sarcopenia, the supply of protein is sufficient up to 1.5 times as much as normal healthy adults. As well as supplying nutrients, it is necessary to suppress the inflammatory response to reduce the body’s wasting response due to increased catabolism and promoting appetite. While catabolism is inhibited, anabolic drugs or inflammatory cytokine inhibitors can be tried, and exercise can be combined to reduce age-related weight loss.

Cyproheptadine has issues with dizziness or sedation, but is most commonly used as first line because it can down-regulate inflammatory cytokines to promote appetite and increase weight.

Megestrol acetate, used as an appetite stimulant for cancer patients, is effective in promoting appetite and preventing weight loss, so it is recommended to use it for a short period of around 2 weeks when necessary.

Omega-3 fatty acids are involved in cyclooxygenase and lipooxygenase metabolism and may contribute to promoting appetite by inhibiting inflammatory cytokine production and activity. Colostrum, which is rich in growth factors, contributes to improving immunity in the intestinal mucosa and reduces endotoxemia and bacteremia caused by intestinal bacteria, so it can be safely tested for the elderly. Glutamine is an amino acid important for immunity, protein metabolism, and maintenance of the intestinal mucosa.

In the case of acute treatment of malnutrition associated with severe illness, hospitalization and short-term intensive nutritional treatment focusing on intravenous nutrition is effective. However, oral nutritional supplementation (ONS) is a very effective method of preventing geriatric systemic wasting syndrome from occurring due to malnutrition or for elderly patients who have already developed the condition but do not require hospitalization. As a result of comparing the group that provided ONS once a day for a long period in a specific area with the group that did not provide ONS for the elderly who live everyday life without actually going to hospital, not only morbidity the disease. , but also reduced the number of hospitalizations due to the disease and the number of days in hospital. Oral nutritional supplements are packaged in small quantities with a better taste than enteral nutrition preparations. Various preparations are developed for taste, package size, calorie content, and for specific diseases. As it is based on enteral nutritional formulations, it contains the three major nutrients, such as protein, carbohydrates and fat, as well as micronutrients such as vitamins and minerals, in an appropriate ratio, making it suitable for nutritional supplementation. In principle, the intake method is to add to 150 to 200 ml 1 to 3 times a day in the form of snacks avoiding mealtimes, but depending on the individual, the amount can be adjusted or some meals can be replaced. Most commercial products are classified as food, but Encover is listed as a drug, so doctors can prescribe it and health insurance applies. It is very useful in terms of efficacy and economy for the purpose of treatment and prevention of malnutrition for cancer patients or patients of systemic wasting syndrome of old age.

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5) AGE 2015;37:81
6) Clin Nutr 2019; 38(1):10-47
7) Nutrients 2021; 13:835
8) J Frailty of Aging 2022; 11(2): 129-134

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