Clinical nutrition (Edinburgh, Scotland) · 2025
Cachexia phenotype in community-dwelling, middle-aged and older adults and its impacts on intrinsic capacity and mortality: A pooled analysis of three cohorts.
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Chen Liang-Kung, Wu Chi-Yun, Lee Wei-Ju, Peng Li-Ning, Hsu Pi-Shan, Hsiao Fei-Yuan
Аннотация
BACKGROUND AND AIMS: Cachexia, which is a complex metabolic disorder that is characterized by weight loss, muscle atrophy, and inflammation, is commonly associated with chronic diseases. However, the occurrence of cachexia among community-dwelling, middle-aged and older adults remains underexplored. This study aimed to assess the associations among cachexia, intrinsic capacity (IC) impairment, and mortality in adults aged 50 years and older.
METHODS: We pooled data from three longitudinal cohort studies, which included 3112 individuals aged 50 years and older. The cachexia phenotype was defined using two algorithms suggested by the Asian Working Group for Cachexia (AWGC), even in the absence of specific index diseases. For Algorithm 1, patients were identified as having cachexia when they presented with weight loss or low body mass index (BMI) combined with one of the following: anorexia, decreased grip strength, or elevated C-reactive protein (CRP) levels. For Algorithm 2, the identification of cachexia required elevated CRP levels, along with weight loss or low BMI, combined with either anorexia or decreased grip strength. Importantly, the presence of a specific index disease was not necessary to define the cachexia phenotype using these criteria. Instead, we screened for the following index diseases as comorbid conditions: malignancy, congestive heart failure, chronic pulmonary disease, chronic kidney disease, severe liver disease, rheumatic or immune diseases, and acquired immunodeficiency syndrome (AIDS). IC was evaluated using the World Health Organization's ICOPE framework (Step 1 screening; Step 2 in-depth assessment), which includes six domains: locomotor, vitality, vision, hearing, cognition, and psychological capacity. Logistic regression was used to assess the association between cachexia and IC impairment, and Cox proportional hazard models were used to examine the effect of cachexia on all-cause mortality.
RESULTS: Among 3112 participants (median age 68.8 years, 43.7 % male) in the three cohorts, 5.4 % of participants were identified as having the cachexia phenotype using Algorithm 1, whereas only 0.4 % met the criteria for Algorithm 2. Notably, only 22 % of the participants with the cachexia phenotype (Algorithm 1) had at least one of the screened index diseases compared with 12 % in the non-cachexia group (p < 0.001). These findings demonstrate that the cachexia phenotype can be identified even in the absence of specific index diseases. The cachexia phenotype was significantly associated with impairments in multiple IC domains, including vitality (Step 1: aOR 8.44 [95 % CI 5.15-13.83], p < 0.001; Step 2: aOR 15.89 [10.72-23.56], p < 0.001), cognition (Step 1: aOR 1.75 [1.17-2.62], p = 0.007), and psychological capacity (Step 2: aOR 2.56 [1.39-4.73], p = 0.003). Individuals with the cachexia phenotype had a significantly higher risk of mortality than those in the non-cachexia group (aHR 1.77 [95 % CI 1.15-2.73], p = 0.010) after adjustment for confounders.
CONCLUSION: The cachexia phenotype, even in the absence of specific index diseases, is associated with impairments in IC and increased mortality among middle-aged and older adults. Early identification and targeted interventions are crucial to mitigate functional decline and improve survival in patients with the cachexia phenotype.
METHODS: We pooled data from three longitudinal cohort studies, which included 3112 individuals aged 50 years and older. The cachexia phenotype was defined using two algorithms suggested by the Asian Working Group for Cachexia (AWGC), even in the absence of specific index diseases. For Algorithm 1, patients were identified as having cachexia when they presented with weight loss or low body mass index (BMI) combined with one of the following: anorexia, decreased grip strength, or elevated C-reactive protein (CRP) levels. For Algorithm 2, the identification of cachexia required elevated CRP levels, along with weight loss or low BMI, combined with either anorexia or decreased grip strength. Importantly, the presence of a specific index disease was not necessary to define the cachexia phenotype using these criteria. Instead, we screened for the following index diseases as comorbid conditions: malignancy, congestive heart failure, chronic pulmonary disease, chronic kidney disease, severe liver disease, rheumatic or immune diseases, and acquired immunodeficiency syndrome (AIDS). IC was evaluated using the World Health Organization's ICOPE framework (Step 1 screening; Step 2 in-depth assessment), which includes six domains: locomotor, vitality, vision, hearing, cognition, and psychological capacity. Logistic regression was used to assess the association between cachexia and IC impairment, and Cox proportional hazard models were used to examine the effect of cachexia on all-cause mortality.
RESULTS: Among 3112 participants (median age 68.8 years, 43.7 % male) in the three cohorts, 5.4 % of participants were identified as having the cachexia phenotype using Algorithm 1, whereas only 0.4 % met the criteria for Algorithm 2. Notably, only 22 % of the participants with the cachexia phenotype (Algorithm 1) had at least one of the screened index diseases compared with 12 % in the non-cachexia group (p < 0.001). These findings demonstrate that the cachexia phenotype can be identified even in the absence of specific index diseases. The cachexia phenotype was significantly associated with impairments in multiple IC domains, including vitality (Step 1: aOR 8.44 [95 % CI 5.15-13.83], p < 0.001; Step 2: aOR 15.89 [10.72-23.56], p < 0.001), cognition (Step 1: aOR 1.75 [1.17-2.62], p = 0.007), and psychological capacity (Step 2: aOR 2.56 [1.39-4.73], p = 0.003). Individuals with the cachexia phenotype had a significantly higher risk of mortality than those in the non-cachexia group (aHR 1.77 [95 % CI 1.15-2.73], p = 0.010) after adjustment for confounders.
CONCLUSION: The cachexia phenotype, even in the absence of specific index diseases, is associated with impairments in IC and increased mortality among middle-aged and older adults. Early identification and targeted interventions are crucial to mitigate functional decline and improve survival in patients with the cachexia phenotype.