In the frail elderly, it may be difficult to distinguish relative starvation due to decreased or inadequate caloric intake from cachexia, which is due to an inflammatory response with elevated cytokines.
Appetite: Appetite is decreased early in cases of cachexia but remains normal in the early stages of starvation.
Albumin: Likewise, albumin decreases early in cases of cachexia and later in starvation.
Cachexia is resistant to refeeding because it is due to the inflammatory changes, not from lack of nutrients.