Cachexia (Wasting Syndrome), Loss of Appetite and Anorexia

Cachexia, or wasting syndrome, is a serious complication of chronic illness. Symptoms include weight loss, loss of appetite and muscle wasting. Cachexia commonly affects individuals with cancer, heart failure and COPD. Treatment options — including nutrition support, physical therapy and medications — can help to improve appetite and quality of life.

What is Cachexia?

Cachexia, also known as wasting syndrome, is a metabolic disorder associated with substantial weight loss. It is a multifactorial syndrome related to underlying illness and characterized by:

• Sarcopenia, with or without fat mass loss
• Anorexia (loss of appetite, not to be confused with anorexia nervosa)
• System-wide inflammation
• Increased protein turnover

Cachexia is divided into three stages:¹

• Pre-cachexia: weight loss >1kg but <5%
• Cachexia: weight loss >5% or when weight loss is >2% with BMI <20kg/m²
• Refractory cachexia: when weight loss is >15% with body mass index BMI <23kg/m² or when weight loss is >20% with BMI <27 kg/m²

What Causes Cachexia?

Gastrointestinal issues

Different conditions and infections – as well as medications and treatments for them – can cause a variety of gastrointestinal issues that can contribute to loss of appetite, including:¹

• Dysgeusia (altered or distorted taste)
• Nausea
• Dysphagia (difficulty swallowing)
• Mucositis
• Constipation

Tumor-mediated factors

Many health conditions, including cancer, are linked to the secretion of pro-inflammatory cytokines, such as tumor necrosis factor and many others.¹ These cytokines have various inflammatory effects in the body, including increased muscle breakdown and disruption of metabolic processes, which further contribute to muscle wasting.

Hormonal anabolic mediators

These pro-inflammatory cytokines can further disrupt various anabolic hormones such as growth hormone and testosterone, which also contribute to muscle breakdown and wasting.¹

Conditions Associated with Cachexia

Cachexia is a common yet often overlooked complication of many chronic illnesses. Medical conditions linked to cachexia include:

• Cancer
• HIV/AIDS
• Chronic obstructive pulmonary disorder (COPD)
• Congestive heart failure
• Chronic kidney disease
• Cystic fibrosis
• Rheumatoid arthritis and other autoimmune diseases
• Celiac disease
• Crohn’s disease
• Mycobacterium avium complex (MAC) infection
• Many others

Anorexia & Cachexia

Loss of appetite, medically known as anorexia, can lead to weight loss, fatigue and weakness. If left untreated, it can be life-threatening. Cancer, chronic illnesses, aging and certain mental health issues can all contribute to anorexia.^1-6

What’s the Difference Between Anorexia & Anorexia Nervosa?

"It’s important to distinguish between anorexia and anorexia nervosa," explains Leah Puckett, MD, MPH, hospitalist at ACUTE, "Anorexia is not the same as the eating disorder, as there are not intentional efforts to lose weight or body dysmorphia."

Anorexia nervosa is an eating disorder characterized by restricted food intake leading to significantly low body weight, an intense fear of gaining weight and a distorted perception of body shape or size.⁷

Anorexia nervosa includes two subtypes:

• Restricting subtype: where weight loss is achieved primarily through dieting, fasting or excessive exercise
• Binge eating and purging subtype: where an individual regularly engages in episodes of binge eating or purging behaviors

What Contributes to Cachexia & Anorexia?

Changes in taste or smell

Changes in taste or smell are common with many types of cancer and zinc deficiency and more severe changes in taste and smell are linked to poorer dietary intake and cachexia-related quality of life.^8,9

Anti-hypertensive drugs used in patients with heart disease can also affect smell and taste. Catopril is known for causing a bitter or salty taste in the mouth as well as a reduced sense of taste. Other cardiac drugs have the potential to alter taste include:¹⁰

• Statins (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin)
• Clopidogrel
• Losartan
• Propranolol
• Calcium-channel blockers (diltiazem, nifedipine)
• Antiarrhythmic medications (amiodarone, flecainide, procainamide, propafenone, sotalol)

There are also various other medications that may cause taste or smell dysfunction as a side effect, including:

• Antibiotics (amoxicillin, azithromycin, ciprofloxacin)
• Prednisone
• Levothyroxine
• Albuterol
• Psychiatric medication (amitriptyline, bupropion, trazodone, diazepam)

Anxiety & depression

Psychiatric conditions such as depression and anxiety can lead to anorexia. About 50% of patients with major depression experience a decrease in appetite, and roughly one-third of these patients have depression-related weight loss.¹

Anxiety causes appetite suppression through a few different mechanisms. First, stress triggers the release of certain hormones (adrenaline, corticotropin-releasing hormones) that can reduce appetite. The gastrointestinal system can also be affected by the development of disorders of gut-brain interaction, such as functional dyspepsia.

Dietary changes

A strict dietary regimen is a common part of managing and treating diet-related chronic health conditions like cystic fibrosis, Celiac’s disease and Crohn’s disease. Following these diets can make eating challenging or lead to a distorted relationship with food.

Cachexia & mortality

Cachexia is not solely caused by inadequate nutritional intake but is often linked to long-standing or end-stage conditions. It is typically associated with a reduced quality of life and has a high mortality rate. Cachexia accounts for up to 20% of cancer deaths, usually occurring when weight loss exceeds 30%.¹¹ While most cancer patients do not die directly from cachexia, up to 50% die with it.¹²

Every year, an estimated 25% of those with COPD, 40% of those with chronic heart failure, and 20% of those with end-stage kidney disease with cachexia die as a result of their cachexia.¹³

Cachexia Treatment & Management

Nutritional rehabilitation

Although refeeding can help patients with cachexia, unlike those with malnutrition, cachexia is less responsive to nutritional interventions alone. It is crucial to treat cachexia carefully to avoid refeeding syndrome.

Learn how to prevent refeeding syndrome.

Physical therapy & exercise

Physical therapy and exercise, both aerobic and anaerobic, may help reduce the effects of cachexia. Exercise increases protein synthesis and decreases protein degradation, altering muscle metabolism.¹² Exercise can also improve insulin sensitivity, reduce oxidative stress, and diminish the response to inflammation.¹²

Pharmacological Interventions

Megestrol acetate

The most effective treatment for anorexia is megestrol acetate.¹⁴Around 30% of patients experience increased appetite and an increased body mass index, primarily through increased fat, when given megestrol acetate.¹⁴ Some patients report quality of life improvement as well.

Other medications

Other medications can be useful in increasing appetite:

• Antiemetics, such as dronabinol (cannabinoid) and olanzapine (antipsychotic) may be beneficial, depending on the underlying cause of the cachexia¹⁵
• Corticosteroids may be useful at improving appetite short term, but metabolic effects limit their long-term use¹⁶
• Cyproheptadine, a histamine antagonist, may be beneficial in some patients to help boost appetite¹⁷

Find Help for Cachexia

If you are living with cachexia and anorexia, medical stabilization and tailored nutritional support are essential to address both conditions while managing your chronic illness. Because cachexia can be especially resistant to weight gain, working with a team experienced in comprehensive approaches for cachexia and anorexia is key to supporting your recovery.

Start with a free assessment.

References

1. Maxwell, M. A., & Cole, D. A. (2009). Weight change and appetite disturbance as symptoms of adolescent depression: Toward an integrative biopsychosocial model. Clinical Psychology Review, 29(3), 260–273. https://doi.org/10.1016/j.cpr.2009.01.007
2. Landi, F., Calvani, R., Tosato, M., Martone, A., Ortolani, E., Savera, G., Sisto, A., & Marzetti, E. (2016). Anorexia of aging: risk factors, consequences, and potential treatments. Nutrients, 8(2), 69. https://doi.org/10.3390/nu8020069
3. Walsh, D., Donnelly, S., & Rybicki, L. (2000). The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Supportive Care in Cancer, 8(3), 175–179. https://doi.org/10.1007/s005200050281
4. Koehler, F., Doehner, W., Hoernig, S., Witt, C., Anker, S. D., & John, M. (2006). Anorexia in chronic obstructive pulmonary disease — Association to cachexia and hormonal derangement. International Journal of Cardiology, 119(1), 83–89. https://doi.org/10.1016/j.ijcard.2006.07.088
5. Saitoh, M., Santos, M. R. D., Emami, A., Ishida, J., Ebner, N., Valentova, M., Bekfani, T., Sandek, A., Lainscak, M., Doehner, W., Anker, S. D., & Von Haehling, S. (2017). Anorexia, functional capacity, and clinical outcome in patients with chronic heart failure: results from the Studies Investigating Co‐morbidities Aggravating Heart Failure (SICA‐HF). ESC Heart Failure, 4(4), 448–457. https://doi.org/10.1002/ehf2.12209
6. Sung, C., Liao, M., & Chao, C. (2021). Independent Determinants of Appetite Impairment among Patients with Stage 3 or Higher Chronic Kidney Disease: A Prospective Study. Nutrients, 13(8), 2863. https://doi.org/10.3390/nu13082863
7. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: APA.
8. Otani, N. H., Amano, K., Morita, T., Miura, T., Mori, N., Tatara, R., Kessoku, T., Matsuda, Y., Tagami, K., Mori, M., Taniyama, T., Nakajima, N., Nakanishi, E., Kako, J., Shirado, A. N., Yokomichi, N., & Miyashita, M. (2023). Impact of taste/smell disturbances on dietary intakes and cachexia-related quality of life in patients with advanced cancer. Supportive Care in Cancer, 31(2). https://doi.org/10.1007/s00520-023-07598-6
9. Hannon, M., Shaw, A., Connolly, M., & Davies, A. (2023). Taste disturbance in patients with advanced cancer: a scoping review of clinical features and complications. Supportive Care in Cancer, 31(10). https://doi.org/10.1007/s00520-023-08012-x
10. Harvard Medical School. (2019, August 26). Ask the doctor: Is my blood pressure medicine changing my ability to taste? Harvard Health Publishing. https://www.health.harvard.edu/newsletter_article/ask_the_doctor_is_my_blood_pressure_medicine_changing_my_ability_to_taste
11. Argilés, J. M., López-Soriano, F. J., Stemmler, B., & Busquets, S. (2023). Cancer-associated cachexia — understanding the tumour macroenvironment and microenvironment to improve management. Nature Reviews Clinical Oncology, 20(4), 250–264. https://doi.org/10.1038/s41571-023-00734-5
12. Von Haehling, S., & Anker, S. D. (2010). Cachexia as a major underestimated and unmet medical need: facts and numbers. Journal of Cachexia Sarcopenia and Muscle, 1(1), 1–5. https://doi.org/10.1007/s13539-010-0002-6
13. Von Haehling, S., & Anker, S. D. (2014). Prevalence, incidence and clinical impact of cachexia: facts and numbers—update 2014. Journal of Cachexia Sarcopenia and Muscle, 5(4), 261–263. https://doi.org/10.1007/s13539-014-0164-8
14. Baker Rogers, J., Syed, K., & Minteer, J. (2025). Cachexia [Digital Book]. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470208/
15. Ispoglou, T., McCullough, D., Windle, A., Nair, S., Cox, N., White, H., Burke, D., Kanatas, A., & Prokopidis, K. (2024). Addressing cancer anorexia-cachexia in older patients: Potential therapeutic strategies and molecular pathways. Clinical Nutrition, 43(2), 552–566. https://doi.org/10.1016/j.clnu.2024.01.009
16. Oneda, E., Manno, A., Noventa, S., Libertini, M., Cherri, S., & Zaniboni, A. (2025). Role of diet, physical activity and new drugs in the primary management of cancer cachexia in gastrointestinal tumors – a comprehensive review. Frontiers in Oncology, 15. https://doi.org/10.3389/fonc.2025.1600425
17. Harrison, M. E., Norris, M. L., Robinson, A., Spettigue, W., Morrissey, M., & Isserlin, L. (2019). Use of cyproheptadine to stimulate appetite and body weight gain: A systematic review. Appetite, 137, 62–72. https://doi.org/10.1016/j.appet.2019.02.012