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Frailty, Sarcopenia and Cachexia

Frailty

What is it?

It is an age-dependent biological state characterised by reduced resistance to stress, secondary to the cumulative decline of several physiological systems and related to comorbidity, disability, risk of institutionalisation and mortality.

Causes

Recognising the biological characteristics of age-related frailty and understanding its pathophysiological determinants has been the focus of gerontological research in recent years; in particular, research has concentrated on identifying biological markers that allow screening for frailty at an early stage when the possibilities for prevention and intervention are most likely to succeed.

The condition of frailty from the clinical point of view is one that is characterised by:

  • high susceptibility to developing acute illnesses expressed in atypical clinical pictures (mental confusion, postural instability and falls);
  • reduced motor capacity to the point of immobility due to severe asthenia and adynamia not fully justified by the pathologies present;
  • rapid fluctuations in health status also with a marked tendency to develop complications (decompensation cascade);
  • high risk of adverse events;
  • slow recovery, almost always partial;
  • Continued need for medical intervention, frequent and repeated hospitalisation, need for ongoing care;
  • high risk of institutionalisation and mortality.

Stress, acute and chronic, depression, decreased protein and micronutrient intake in the diet can trigger and accelerate frailty.

Diagnosis

To diagnose frailty in the elderly, specific parameters can be determined, such as:

  • Weight loss (4.5 kg in the last year);
  • Fatigue (self-reported) (fatigue on at least 3 days/week);
  • Reduction in muscle strength (hand-grip measured with a dynamometer);
  • Reduced physical activity (assessed by the PASE – Physical Activity Scale for the Elderly);
  • Reduction in walking speed (known path: more than 7 seconds to cover 4.57 metres).

Fragility is observed when at least 3 of the 5 items are present. When 1 or 2 items are present it can be considered pre-frail.

Sarcopenia

What is it?

Sarcopenia is considered to be the main element of frailty. It is the most important multidimensional functional clinical complication of malnutrition in the geriatric age; it is a syndrome characterised by the progressive and generalised loss of skeletal muscle mass and strength, resulting in a situation of individual fragility. It is a powerful risk factor for the development of adverse health-related events in the elderly, such as the risk of falls and fractures, inability to perform daily activities, disability and poor quality of life.

Causes

Several mechanisms may be involved in a subject with sarcopenia. By recognising these and their underlying causes, it is easy to envisage the design of intervention studies aimed at counteracting the progress of this disease.

Several endogenous and exogenous factors can influence the body’s ability to maintain protein homeostasis:

  • Physical inactivity and allurement;
  • Non-muscular factors such as loss of motor neurons, alteration of the neuromuscular plate or imbalance between denervation and reinnervation (muscular atrophy);
  • Inflammation and oxidative stressare the main regulators of cell apoptosis and protein metabolism, and are two of the main factors contributing to the decline of skeletal muscle with ageing;
  • The frequent reduction of food intake in the elderly, hence the risk of malnutrition (micro- and macronutrients) related to endogenous (e.g. malabsorption) or external (e.g. lack of social support, disability) causes;
  • Mitochondrial dysfunction;
  • Hormonal changes (e.g. insulin resistance, decrease in testosterone and oestrogen, decrease in growth hormone (GH) and insulin-like growth factor 1 [IGF-1], decrease in vitamin D and corticosteroids).
Treatment

On the basis of the clinical and instrumental assessment, a treatment plan is set up consisting of:

  • Branched-chain amino acids (BCAAs) and essential amino acids for reducing catabolism and improving insulin sensitivity, thus stimulating protein synthesis;
  • Leucine metabolites such as hydroxymethylbutyrate (HMB) for increasing strength and lean mass;
  • Molecules with antioxidant capacity (e.g. Zinc and Vitamin C) can counteract oxidative damage and inflammation to prevent the onset of age-related adverse conditions;
  • Vitamin D, for bone health, improved physical function and proper functioning of the immune system;
  • Long-chain omega-3 polyunsaturated fatty acids for their anti-inflammatory properties.

Fragility is observed when at least 3 of the 5 items are present. When 1 or 2 items are present it can be considered pre-frail.

Foodar Solutions

FoodAR product for the frail elderly and their diseases: MIOAMIN SILVER, Special Medical Purpose Food based on amino acids and vitamins.

Thanks to its specific composition of amino acids, with a high concentration of branched amino acids, and the addition of arginine, vitamins (B1, B6, C, D), zinc and HMB, it is suitable for the dietary management of malnourished subjects or those at risk of malnutrition; it increases lean mass, enhances muscle strength and reduces the healing time of surgical wounds and pressure ulcers.

Cachexia
What is it?

Cachexia is a degenerative disease that involves the loss of both adipose tissue and skeletal muscle mass, leading to anorexia, weight loss, fatigue, impaired neurological and motor function, and reduced survival time.

Causes

Cachexia can be an expression of several conditions:

  • Cachexia due to malnutrition, often accompanied by oedema, hypocholesterolemia, hypothermia and arterial hypotension.
  • Endocrine cachexia: caused by serious diseases of the endocrine system (responsible for hormone production); example: hyposecretion – pituitary hormone pathology (Simmonds’ disease or pituitary cachexia).
  • Infection-related cachexia: caused by particularly debilitating infectious diseases, such as malaria, tuberculosis and AIDS.
  • Dementia kachexia or anorexia nervosa: caused by the almost total loss of appetite due to a complex mental illness typical of the adolescent period.
  • Cachexia from autoimmune diseases.
  • Drug addiction cachexia.
  • Neoplastic cachexia: cancer cachexia is common and affects about 50% of all cancer patients, and up to 85% have gastric and pancreatic neoplasms.

The aetiology of cancer cachexia is complex and involves not only reduced nutrient intake, but also tumour-induced metabolic changes, including increased resting energy expenditure; loss of muscle mass, resulting from increased proteolysis and reduced protein synthesis; loss of fat mass due to increased lipolysis; reduced intake of energy substrates in the diet, as a result of symptoms such as anorexia, nausea and vomiting; difficulty in using newly formed glucose due to hypoinsulinemia and/or peripheral insulin resistance; oxidative stress, resulting in DNA damage to membrane lipoproteins and central enzymes and coenzymes that regulate the main cellular metabolic pathways. Translated with www.DeepL.com/Translator (free version)

There are secondary causes, such as alterations in the integrity and function of the gastro-intestinal tract, intestinal malabsorption from post-surgical syndromes, toxicity of chemotherapy treatments, uncontrolled pain and depression.

The characteristic features of neoplastic cachexia are commonly weight loss (especially of muscle mass) and inflammation. They are associated with the symptoms of the cachectic patient such as asthenia, anorexia, anaemia, fatigue, which contribute to the complex clinical picture and to the impairment of the patient’s quality of life.

Treatment

The treatment of cachexia must take into account the patient’s prognosis and the presence of uncontrolled symptoms (nausea, vomiting, constipation, pain, etc.). The type of approach and objectives vary depending on the degree of severity of cachexia. Attention to nutritional aspects is of considerable importance for the prevention of weight loss and cachexia, and should therefore be implemented as early as possible. Treatment of pre-cachexia is based on: dietary counselling; control of concomitant symptoms; possible administration of nutritional supplements (supplements of minerals, vitamins, but also omega-3 fatty acids and amino acids) with anti-inflammatory active ingredients (anti-inflammatory and antioxidant activity counteracts the metabolic changes that characterise cachexia and the associated weight loss). Translated with www.DeepL.com/Translator (free version) In cachexia, treatment should be aimed at recovering body weight and muscle mass or, subordinately, at avoiding further deterioration. A state of pre-cachexia may complicate surgery or make it impossible to maintain adequate preoperative medical treatment.

Foodar Solutions

Mioamin Effe is a new proposal and new composition (formulation) in the world of Supportive Care for immunocompromised patients, in chronic degenerative diseases and in oncology to combat the fatigue (Cancer Related Fatigue) of neopastic patients undergoing major surgery and cycles of chemo-radiotherapy that sometimes have to be interrupted or repeated because of the inevitable and disabling side effects.

It consists of a unique and innovative blend of ingredients that work synergistically – with optimal treatment compliance – to increase body weight, lean mass and muscle strength to improve the quality of life of neoplastic, immunocompromised and chronically degenerative patients.

It is therefore not a simple supplement, but more correctly a ‘physiological modulator’ notified and approved for ‘the dietary treatment of malnourished subjects with severe anabolic and protein deficiency’.