Methods and compositions for treating or preventing muscle wasting resulting from an underlying disease or disorder, such as cancer cachexia. A therapeutically effective amount of a ketogenic supplement—such as R,S 1,3 butanediol diacetoacetate, R,S 1,3-butanediol acetoacetate diester, derivatives thereof, or combinations thereof—is administered to a patient or subject in need. The ketogenic supplement may further include a medium chain triglyceride in combination with the ketone ester.