Unintentional weight loss

Unintentional weight loss
Unintentional weight loss
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Unintentional weight loss

Unintentional weight loss
Unintentional weight loss

Unintentional weight loss usually develops over weeks or months. It may be a sign of a significant physical or mental impairment and is associated with an increased risk of mortality.

The cause may be obvious (eg, chronic diarrhea due to malabsorption syndrome) or unknown (eg, undiagnosed cancer).

This discussion concerns patients who experience weight loss, not those who lose weight due to a more or less expected consequence of a known chronic disease (eg, metastatic cancer, end-stage chronic obstructive pulmonary disease [COPD]).

Weight loss is generally considered clinically important if it exceeds 5% of body weight or 5 kg within 6 months. However, this traditional definition does not distinguish between the loss of both lean body mass and body fat, which can lead to different results.

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In addition, edema (eg, in heart failure or chronic kidney disease) may mask the clinically significant loss of lean body mass.

In addition to weight loss, patients may have other symptoms such as anorexia, fever, or night sweats due to an underlying medical condition.

Depending on the cause and severity, symptoms and signs of a nutritional deficiency may also be present (see Overview of Vitamins).

The overall incidence of significant involuntary weight loss in the US is about 5% per year. However, the incidence increases with age, often reaching 50% among patients in nursing care centers.

Pathophysiology of involuntary weight loss

Weight loss results are caused by more calories expended than calories gained (ingested and consumed). Diseases that increase consumption or decrease absorption tend to cause an increase in appetite.

More often, insufficient caloric intake is the mechanism for weight loss, and these patients tend to have decreased appetite. Sometimes multiple mechanisms are involved.

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For example, cancer leads to decreased appetite but also increases basal calorie expenditure through cytokinin mechanisms.

Etiology of involuntary weight loss-Unintentional weight loss

Unintentional weight loss
Unintentional weight loss

Many diseases cause involuntary weight loss, including almost any chronic disease of sufficient severity. However, many of these are clinically evident and are usually diagnosed at the time of the observed weight loss.

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Other disorders are more likely to present as involuntary weight loss (see table Some Causes of Primary Symptoms of Involuntary Weight Loss).

Increased appetite is associated with the most common causes of involuntary weight loss of unknown etiology, such as

  1. Hyperthyroidism
  2. Uncompensated diabetes mellitus
  3. Diseases that cause malabsorption

The most common causes of involuntary weight loss of unknown etiology are associated with decreased appetite, such as

  1. Psychiatric disorders (eg depression)
  2. Crayfish
  3. Side effects of drugs
  4. Drug Abuse

Some Causes of Primary Symptoms of Involuntary Weight Loss

Medicines and herbal products that can cause weight loss

In some diseases that cause involuntary weight loss, other symptoms are more noticeable, so weight loss is usually not the main complaint. Examples include the following:

Some malabsorptive diseases: gastrointestinal surgery and cystic fibrosis

Chronic inflammatory diseases: severe rheumatoid arthritis

Gastrointestinal diseases: achalasia, celiac disease, Crohn’s disease, chronic pancreatitis, obstructive esophageal disease, ischemic colitis, diabetic enteropathy, peptic ulcer, progressive systemic sclerosis, ulcerative colitis (end stage)

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Severe chronic diseases of the lungs and heart: chronic obstructive pulmonary disease (COPD), heart failure (stage III or IV), pulmonary fibrosis

Mental illnesses (known and poorly controlled): anxiety, bipolar disorder, depression, schizophrenia

Neurological diseases: amyotrophic lateral sclerosis, dementia, multiple sclerosis, myasthenia gravis, Parkinson’s disease, stroke

Social problems: poverty, social exclusion-Unintentional weight loss

In chronic kidney disease and heart failure, swelling can mask the loss of lean body mass.

Assessment of involuntary weight loss

The examination should focus on identifying other unknown causes of the disease. Because these reasons are numerous, the examination should be comprehensive.

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Anamnesis-Unintentional weight loss

History of the present illness includes questions about quantitative weight loss and its dynamics. The weight loss report may not be accurate.

Thus, corroborating evidence should be sought, for example, from weight measurements in old medical records, changes in clothing size, or confirmation from family members.

Appetite, the process of eating and swallowing, and images of the intestines should be described. At follow-up examinations, patients should keep a food diary because memories of meals are often inaccurate.

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Non-specific symptoms of possible causes are noted, such as feeling tired, malaise, fever, and night sweats.

The systems review should be complete, with symptoms for all major organ systems considered.

The medical history may reveal diseases that can cause weight loss. The need to use prescription drugs, over-the-counter drugs, soft drugs, and herbal remedies is also being considered.

Social history may reveal changes in life situations that could explain why food intake is declining (eg, loss of a loved one, loss of independence or job, loss of normal eating habits).

Objective examination-Unintentional weight loss

Vital signs are checked for fever, tachycardia, tachypnea, and hypotension. Weight is measured and Body Mass Index (BMI) is calculated.

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Triceps skinfold thickness and mid-arm circumference can be measured to assess muscle mass. BMI and lean body mass assessment are mainly useful for detecting changes at follow-up visits.

General examination should be particularly complete, including examination of the heart, lungs, abdominal organs, head and neck, breasts, nervous system, rectum (including prostate examination and occult blood test), genitals, liver, spleen, lymph nodes, joints, skin, mood, and emotional reactions.

Anxiety symptoms-Unintentional weight loss

Fever, night sweats, generalized lymphadenopathy

Pain in the bones

Shortness of breath, cough, hemoptysis

Misplaced fear of weight gain in teenage girls or young women

Polydipsia and polyuria

Headache, chronic mandibular dislocation, and/or visual disturbances in the elderly

Roth’s spots, Janeway’s ulcers, Osler’s nodes, hemorrhages at the base of the nails, retinal artery embolisms

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Interpretation of results-Unintentional weight loss

Interpretations of some results are shown in the table Interpretation of individual results in involuntary weight loss. Abnormal results suggest the cause of weight loss in about half or more of patients, including patients who were eventually diagnosed with cancer.

Although many chronic diseases can lead to weight loss, the doctor should not be quick to assume that existing diseases are the cause.

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Although an existing disease is a likely cause of weight loss in patients whose condition remains poorly controlled or worsens, stable patients who suddenly begin to lose weight without worsening the disease may be diagnosed with new diseases (for example, patients with stable ulcerative colitis may begin to lose weight because they developed colon cancer).

Common sense and caution

If this chronic condition has been stable, do not assume that it is the cause of acute weight loss.

Interpretation of Individual Findings in Involuntary Weight Loss

Survey-Unintentional weight loss

Age-appropriate cancer screening tests (eg, colonoscopy, mammography) are indicated if not previously done. Another test is performed in the treatment of diseases suspected based on abnormal findings in history or on examination.

There is no generally accepted recommendation for another type of examination of patients without such focal pathological findings. According to one of the proposed approaches, it is necessary to do the following tests:

Chest x-ray

General urine analysis

Complete blood count (CBC) with the determination of the leukocyte formula

Erythrocyte sedimentation rate (ESR) or C-reactive protein

HIV testing

Biochemical analysis (serum electrolyte and calcium levels, liver and kidney function test)

The level of thyrestimulating hormone (TSH) in the blood serum

As shown, the pathological findings of these studies follow from additional analyses. If all test results are within normal limits and clinical findings are normal, then further comprehensive investigation (eg, CT, MRI) is not recommended. Such testing is very ineffective and can be misleading and harmful in showing cases.

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