Unifying Concepts

Diagnostic Criteria for Wasting Disease (Cachexia) in Adults

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 wasting disease. Wasting disease is distinct from starvation, age-related loss of muscle mass, primary depression, malabsorption and hyperthyroidism and is associated with increased morbidity.

Diagnostic Criteria for Wasting Disease (Cachexia) in Adults

Weight loss of at least 5%* in 12 months or less in the presence of underlying illness**, PLUS THREE of the following criteria:

  • Decreased muscle strength (lowest tertile)
  • Fatigue***
  • Anorexia****
  • Low fat-free mass index#
  • Abnormal biochemistry
    a) increased inflammatory markers CRP (>5.0 mg/l), IL-6 >4.0 pg/ml)
    b) Anemia (<12 g/dl)
    c) Low serum albumin (<3.2 g/dl)

The following needs to be excluded: starvation, malabsorption, primary depression, hyperthyroidism and age-related loss of muscle mass.
**In cases where weight loss cannot be documents a BMI <20.0 kg/m2 is sufficient.
***Fatigue is defined as physical and/or mental weariness resulting from exertion; an inability to continue exercise at the same intensity with a resultant deterioration in performance.
****Limited food intake (i.e. total caloric intake less than 20 kcal/kg body weight/d; <70% of usual food intake) or poor appetite.
#Lean tissue depletion (i.e. mid upper arm muscle circumference <10th percentile for age and gender; appendicle skeletal muscle index by DEXA (kg/m2) by DXA <5.45 in females and <7.25 in males.



  1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D, Wolfe R, Anker SD. Cachexia: a new definition. Clin Nutr. 2008 Dec;27(6):793-9. [Medline]
  2. Ni J, Zhang L. Cancer Cachexia: Definition, Staging, and Emerging Treatments. Cancer Manag Res. 2020 Jul 9;12:5597-5605. [Medline]


Created Mar 27, 2023.

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