Unintentional weight loss: what radiologists need to know and what clinicians want to know

Rao, Subramanyeshwar; Kikano, Elias; Smith, Daniel A.; Güler, Ezgi; Tirumani, Sree Harsha; Ramaiya, Nikhil H.

doi:10.1007/s00261-020-02908-6

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…The most common causes of UWL in clinical practice revealed by the current study were poor appetite [ 6 ], dementia with BPSD [ 65 ] and medications. Unlike preceding reports, the three most common causes of UWL were gastrointestinal disorders, followed by malignant diseases and psychological problems [ 34 , 66 , 67 ]. Self-reported reduced appetite was significantly more frequent in older patients with UWL in the studies by Sorbye et al and Mowé et al [ 6 , 68 ].…”

Section: Discussionmentioning

confidence: 80%

Factors associated with unintentional weight loss among older adults in a geriatric outpatient clinic of university hospital

et al. 2021

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Background Unintentional weight loss (UWL) is defined as unintentional reduction of more than 5% of baseline body weight over 6 to 12 months. UWL is a common problem in the older adults, resulting in increased rate of morbidity and mortality. With specific reference to Thailand, no information on factors associated with UWL in older adults could be traced. The aims of this research were to identify the factors associated with UWL and to assess the common causes of UWL among older adults in the geriatric outpatient clinic of university hospital. Methods A case-control study was conducted from June 1st, 2020 to December 31st, 2020. Eighty older adults aged 60 years or older were enrolled in the UWL group while the non-UWL group consisted of 160 participants. Data collection was performed by structural questionnaire including baseline characteristics, psychosocial factors, health information, lifestyle behaviors, and medications. The factors associated with UWL were analyzed by using univariate and multivariate logistic regression analysis. Causes of UWL were recorded from electronic medical records. Results The mean age of the 240 participants was 79.6 years (SD 7.4). Most patients were female (79.2%) and had fewer than 12 years of education (62.6%). The three common causes of UWL were reduced appetite (20.1%), dementia and behavioral and psychological symptoms of dementia (13.7%) and medications (11.0%). Multivariate logistic regression analysis showed that a Charlson Comorbidity Index (CCI) score of >1 (OR 2.55, 95% CI 1.37–4.73; P = 0.003), vitamin D deficiency (OR 4.01, 95% CI 1.62–9.97; P = 0.003), and hemoglobin level of <12 g/dL (OR 2.47, 95% CI 1.32–4.63; P = 0.005) were factors significantly associated with UWL. Conclusions Factors associated with UWL were CCI score >1, vitamin D deficiency, and hemoglobin level of <12 g/dl. The early detection of these associated factors, reduced appetite, dementia and polypharmacy may be important in UWL prevention in older adults.

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Section: Discussionmentioning

confidence: 80%

Factors associated with unintentional weight loss among older adults in a geriatric outpatient clinic of university hospital

et al. 2021

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“…Recent reviews have estimated that the probability of malignancy in patients presenting with UWL ranges from 6% to 38%, non‐malignant gastrointestinal disorders from 6% to 19%, cardiopulmonary disorders from 9% to 14%, endocrine disorders from 2% to 11%, and psychiatric disorders from 8% to 33%. 2 , 5 , 6 , 7 , 8 , 9 Many of the studies contributing to these risk estimates have however been based on hospital inpatients or patients referred to secondary care, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 therefore limiting generalizability to the primary care population where prevalence of serious disease is relatively low. The wide ranges of these published estimates also indicate that even within a secondary care/referred population, there remains broad variation in risk estimates across studies.…”

Section: Introductionmentioning

confidence: 99%

Serious disease risk among patients with unexpected weight loss: a matched cohort of over 70 000 primary care presentations

Withrow

Oke

Smith

et al. 2022

J cachexia sarcopenia muscle

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Background Unexpected weight loss (UWL) in patients consulting in primary care presents dilemmas for management because of the broad differential diagnoses associated with UWL. Research on the risks of serious disease among patients with UWL to date has largely taken place in secondary care, limiting generalizability to primary care patients. In this study, we use a large matched cohort study to estimate the risks of 12 serious diseases among patients presenting to primary care with UWL where this was recorded, stratified by age and sex, in order to inform a rational clinical approach to patients presenting with UWL. Methods This was a retrospective matched cohort study using electronic health records (EHRs) from the UK Clinical Practice Research Datalink (CPRD). Each patient with UWL (ascertained from EHR coding) was matched to five patients without UWL and followed until the earliest of a diagnosis of the serious disease, date of death, exit from the CPRD database, or end of the study. Observed absolute risks of the 12 serious diseases were estimated as probabilities, and hazard ratios (HRs) were estimated with Cox proportional hazards models. Results Between 2000 and 2012, 70 193 patients in CPRD had at least one record of UWL and were matched with 295 579 patients without UWL. Patients with UWL had significantly higher risk of nearly all serious diseases examined compared with patients without. HRs ranged from 1.43 for congestive heart failure [95% confidence interval (CI): 1.27-1.62] to 9.70 for malabsorption (95% CI: 6.81-13.82). The absolute risks of any given serious disease were relatively low (<6% after 1 year). The magnitude and rank order of absolute risks varied by age and sex. Depression was the most common diagnosis among women aged <80 with UWL (3.74% of women aged <60 and 2.46% of women aged 60-79), whereas diabetes was the most common in men <60 with UWL (2.96%) and cancer was the most common in men aged 60 and over with UWL (3.79% of men aged 60-70 and 5.28% of men aged ≥80). Conclusions This analysis provides new evidence to patients and clinicians about the risks of serious disease among patients presenting with UWL in primary care. Depending on age and sex, the results suggest that workup for UWL should include screening for diabetes, thyroid dysfunction, depression, and dementia. If performed in a timely manner, this workup could be used to triage patients eligible for cancer pathway referral.

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Een 54-jarige man met onverklaard gewichtsverlies

Mutebi¹,

Kharagjitsing²

2023

Tijdschr Geneesk

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A 54-year-old male patient with unexplained weight loss Unfortunately, a common form of autoimmune diabetes in adults remains ill-recognized in daily clinical practice. This articles describes a case of a 54-year-old male patient with a recent diagnosis of type 2 diabetes mellitus, who was referred to the internal medicine service with unexplained weight loss. Thorough analysis led to the diagnosis of latent autoimmune diabetes in adults (LADA). Remarkably, unexplained weight loss and a moderate response to the initial treatment were the only clinical manifestations of this autoimmune form of diabetes. First, the article briefly describes the analysis of unexplained weight loss and then discusses this still poorly recognized form of diabetes. Taking into account the worldwide acknowledgment of the heterogeneity of both type 1 and 2, an exact diabetes classification is becoming increasingly compelling, considering its (therapeutic) consequences. Furthermore, in the context of unexplained weight loss and regardless of a pre-existing diagnosis of diabetes, this form of autoimmune diabetes should be considered.

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Unintentional weight loss: what radiologists need to know and what clinicians want to know

Cited by 3 publications

References 38 publications

Factors associated with unintentional weight loss among older adults in a geriatric outpatient clinic of university hospital

Factors associated with unintentional weight loss among older adults in a geriatric outpatient clinic of university hospital

Serious disease risk among patients with unexpected weight loss: a matched cohort of over 70 000 primary care presentations

Een 54-jarige man met onverklaard gewichtsverlies

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