Approach to Patients with Unintentional Weight Loss

Perera, Liyanage Ashanthi Menaka; Chopra, Aparna; Shaw, Amy L

doi:10.1016/j.mcna.2020.08.019

Cited by 20 publications

(21 citation statements)

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“…In Thailand, approximately 70% of older adults in outpatient clinics experience to polypharmacy [ 43 ]. According to recent studies [ 2 – 4 , 44 , 45 ], polypharmacy was associated with UWL, which contradicts the findings of our current study. Amongst UWL patients, the most common prescribed medications were statins, calcium channel blockers and calcium, which were prescribed for treatment of common co-morbidities including dyslipidemia and hypertension.…”

Section: Discussioncontrasting

confidence: 99%

“…Worldwide, the number of people 60 years or older in 2017 was estimated at 926 million and is projected to reach 2.1 billion by 2050 [ 1 ]. Unintentional weight loss (UWL) is defined as unintentional reduction of more than 5% of baseline body weight within 6 months to a year [ 2 – 4 ]. The population 60 years or older in Thailand has risen markedly from 12 million in 2020 and is predicted to reach 20 million by 2040 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Pre-diagnostic weight loss is a well-known phenomenon for many cancers, and weight loss may in fact trigger cancer diagnoses in many instances [ 14 , 15 ]. Therefore, participants with preclinical undiagnosed cancer at baseline are expected to be overrepresented in the normal-weight group and underrepresented in the obese group of the VITAL study.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Advanced Cancer by Vitamin D3 Supplementation: Interaction by Body Mass Index Revisited

et al. 2021

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Meta-analyses of randomized controlled trials (RCTs) have demonstrated a protective effect of vitamin D3 (cholecalciferol) supplementation against cancer mortality. In the VITAL study, a RCT including 25,871 men ≥ 50 years and women ≥ 55 years, protective effects of vitamin D3 supplementation (2000 IU/day over a median of 5.3 years) with respect to incidence of any cancer and of advanced cancer (metastatic cancer or cancer death) were seen for normal-weight participants but not for overweight or obese participants. We aimed to explore potential reasons for this apparent variation of vitamin D effects by body mass index. We conducted complementary analyses of published data from the VITAL study on the association of body weight with cancer outcomes, stratified by vitamin D3 supplementation. Significantly increased risks of any cancer and of advanced cancer were seen among normal-weight participants compared to obese participants in the control group (relative risk (RR), 1.27; 95% confidence interval (CI), 1.07–1.52, and RR, 1.44; 95% CI, 1.04–1.97, respectively). No such patterns were seen in the intervention group. Among those with incident cancer, vitamin D3 supplementation was associated with a significantly reduced risk of advanced cancer (RR, 0.86; 95% CI, 0.74–0.99). The observed patterns point to pre-diagnostic weight loss of cancer patients and preventive effects of vitamin D3 supplementation from cancer progression as plausible explanations for the body mass index (BMI)—intervention interactions. Further research, including RCTs more comprehensively exploring the potential of adjuvant vitamin D therapy for cancer patients, should be pursued with priority.

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“… 14 , 15 As most patients presenting to primary care with UWL will not have cancer, diagnostic strategies that avoid the harms of unnecessary invasive and costly investigation are required. 13 , 16 , 17 , 18 , 19 …”

Section: Introductionmentioning

confidence: 99%

“…UWL may go undetected or may be misattributed due to diurnal fluctuations in weight, expected weight changes with age, diet or exercise, obesity, and variation in weight measurement frequency 14,15 . As most patients presenting to primary care with UWL will not have cancer, diagnostic strategies that avoid the harms of unnecessary invasive and costly investigation are required 13,16–19 …”

Section: Introductionmentioning

confidence: 99%

Measured weight loss as a precursor to cancer diagnosis: retrospective cohort analysis of 43 302 primary care patients

Nicholson

Thompson

Hobbs

et al. 2022

J cachexia sarcopenia muscle

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Background Unexpected weight loss is a presenting feature of cancer in primary care. Data from primary care are lacking to quantify how much weight loss over what period should trigger further investigation for cancer. This research aimed to quantify cancer diagnosis rates associated with measured weight change in people attending primary care. Methods Retrospective cohort study of primary care electronic health records data linked to the Surveillance, Epidemiology, and End Results cancer registry (Integrated healthcare delivery system in Washington State, United States). Multivariable Cox regression incorporating time varying covariates using splines to model non-linear associations (age, percentage weight change, and weight change interval). Fifty thousand randomly selected patients aged 40 years and over followed for up to 9 years (1 January 2006 to 31 December 2014). Outcome measures are hazard ratios (95% confidence intervals) to quantify the association between percentage weight change and cancer diagnosis for all cancers combined, individual cancer sites and stages; percentage risk of cancer diagnosis within 6 months of the end of each weight change episode; and the positive predictive value for cancer diagnosis. Results There were 43 302 included in the analysis after exclusions. Over 287 858 patient-years of follow-up, including 24 272 (56.1%) females, 23 980 (55.4%) aged 40 to 59 years, 15 113 (34.9%) 60 to 79 years, and 4209 (9.7%) aged 80 years and over. Adjusted hazard ratios (95% confidence interval) for cancer diagnosis in a 60 years old ranged from 1.04 (1.02 to 1.05, P < 0.001) for 1% weight loss to 1.44 (1.23 to 1.68, P < 0.001) for 10%. An independent linear association was observed between percentage weight loss and increasing cancer risk. The absolute risk of cancer diagnosis increased with increasing age (up to 85 years) and as the weight change measurement interval decreased (<1 year). The positive predictive value for a cancer diagnosis within 1 year of ≥5% measured weight loss in a 60 to 69 years old was 3.41% (1.57% to 6.37%) in men and 3.47% (1.68% to 6.29%) in women. The risk of cancer diagnosis was significantly increased for pancreatic, myeloma, gastro-oesophageal, colorectal, breast, stage II and IV cancers. Conclusions Weight loss is a sign of undiagnosed cancer regardless of the interval over which it occurs. Guidelines should resist giving an arbitrary cut-off for the interval of weight loss and focus on the percentage of weight loss and the patient's age. Future studies should focus on the association between diagnostic evaluation of weight change and risk of cancer mortality.

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Approach to Patients with Unintentional Weight Loss

Cited by 20 publications

References 54 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

Prevention of Advanced Cancer by Vitamin D3 Supplementation: Interaction by Body Mass Index Revisited

Measured weight loss as a precursor to cancer diagnosis: retrospective cohort analysis of 43 302 primary care patients

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