Malnutrition, Sarkopenie und Kachexie im Alter - Von der Pathophysiologie zur Therapie

Zusammenfassung

Malnutrition, Sarkopenie und Kachexie sind drei Syndrome, die für Funktionalität, Morbidität und Mortalität älterer Menschen große Bedeutung besitzen. Der Begriff der Malnutrition beschreibt eine defizitäre Versorgung mit Makro- und Mikronährstoffen. Bei der Sarkopenie handelt es sich um einen altersassoziierten Verlust von Muskelkraft und Muskelmasse. Die Kachexie ist durch einen Gewichtsverlust mit übermäßigem Abbau von Muskelmasse bei akuter oder chronischer Inflammation charakterisiert. Für alle drei Entitäten ist das Zusammenwirken eines weiten Spektrums möglicher Kausalfaktoren typisch. Hierbei sind für Sarkopenie und Kachexie neben inflammatorischen Prozessen auch Veränderungen der hormonellen Regulation von wesentlicher Bedeutung. Die Diagnose von Malnutrition, Sarkopenie und Kachexie erfordert neben einer diesbezüglichen Sensibilität des Arztes die Kenntnis der unterschiedlichen pathophysiologischen Grundlagen sowie den Einsatz spezieller diagnostischer Methoden. Aufgrund der demographischen Entwicklung ist durch den steigenden Betreuungsaufwand der betroffenen Patienten eine zunehmende Belastung des öffentlichen Gesundheitswesens zu erwarten. Daher sind weitere Studien erforderlich, die insbesondere für Sarkopenie und Kachexie die Entwicklung neuer Therapieoptionen auf der Basis der pathophysiologischen Kenntnisse ermöglichen.

Summary

Malnutrition, sarcopenia and cachexia are three syndromes that are highly relevant for capacity, morbidity and mortality of the elderly. The term malnutrition denotes a deficit of macro- und micronutrients, while sarcopenia describes an age-associated loss of muscle mass and strength. In cachexia weight loss und changes in body composition are closely related to acute and chronic inflammatory co-morbidities. A wide array of possible causal factors is typical for all three entities. Inflammatory processes and changes in hormonal regulation are of prominent importance for sarcopenia and cachexia.

The diagnosis of malnutrition, sarcopenia and cachexia requires, in addition to a special interest of the treating physician, a thorough knowledge of pathophysiology as well as the use of specific diagnostic methods. A better understanding of the causes of malnutrition, sarcopenia and cachexia will make it possible to use specific modes of treatment.

Because of the demographic shift an increasing financial burden has to be faced by the public health system resulting from the growing expenditure needed for the care of affected patients. Additional studies are, therefore, necessary to develop new therapeutic options based on the pathophysiology of these three entities. This is especially important with regard to sarcopenia and cachexia.

Malnutrition - Sarkopenie - Kachexie - Alter - Pathophysiologie

malnutrition - sarcopenia - cachexia - elderly - pathophysiology

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