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Correct Answer: cachexia
cachexia is a complex 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 frequently associated with cachexia. cachexia is seen in patients with cancer, chronic heart failure, chronic kidney disease, chronic obstructive pulmonary disease, and rheumatoid arthritis, and is a serious clinical and public health issue due to its association with poor quality of life and increased mortality.
the pathophysiology of cachexia is multifactorial and complex. it involves an imbalance between protein and energy metabolism driven by a variable combination of reduced food intake and abnormal metabolism. unlike simple starvation, where weight loss can largely be reversed by nutritional repletion, cachexia includes an ongoing loss of skeletal muscle mass that is not entirely reversible with nutritional support. cytokines and metabolic alterations play significant roles in this process, with tumor necrosis factor-alpha (tnf-alpha), interleukin-1 (il-1), interleukin-6 (il-6), and interferon-gamma (ifn-gamma) being key mediators that drive the cachectic process.
clinically, cachexia is recognized by the loss of body mass that cannot be reversed nutritionally. even if caloric intake is adequate, muscle wasting continues to occur. this muscle wasting leads to weakness and functional impairments. symptoms of cachexia include severe weight loss, muscle atrophy, fatigue, weakness, and a significant loss of appetite. treatment of cachexia is challenging and focuses on the underlying condition as well as nutritional support and medications that might include appetite stimulants and agents that decrease inflammation and promote muscle growth.
in conclusion, cachexia is a severe form of malnutrition and body wasting that arises as a consequence of chronic disease. it leads to significant clinical consequences including increased susceptibility to infections, poor recovery from surgery, and increased mortality. understanding and managing cachexia is crucial for improving the quality of life and outcomes in patients with chronic diseases. effective management requires a multidisciplinary approach that addresses both the underlying disease and the metabolic abnormalities contributing to muscle loss and malnutrition.
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