Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients

Abstract

BackgroundWhereas there are numerous studies on unintentional weight loss (UWL), these have been limited by small sample sizes, short or variable follow‐up, and focus on older patients. Although some case series have revealed that malignancies escaping early detection and uncovered subsequently are exceptional, reported follow-ups have been too short or unspecified and necropsies seldom made. Our objective was to examine the etiologies, characteristics, and long-term outcome of UWL in a large cohort of outpatients.MethodsWe prospectively enrolled patients referred to an outpatient diagnosis unit for evaluation of UWL as a dominant or isolated feature of disease. Eligible patients underwent a standard baseline evaluation with laboratory tests and chest X-ray. Patients without identifiable causes 6 months after presentation underwent a systematic follow-up lasting for 60 further months. Subjects aged ≥65 years without initially recognizable causes underwent an oral cavity examination, a videofluoroscopy or swallowing study, and a depression and cognitive assessment.ResultsOverall, 2677 patients (mean age, 64.4 [14.7] years; 51% males) were included. Predominant etiologies were digestive organic disorders (nonmalignant in 17% and malignant in 16%). Psychosocial disorders explained 16% of cases. Oral disorders were second to nonhematologic malignancies as cause of UWL in patients aged ≥65 years. Although 375 (14%) patients were initially diagnosed with unexplained UWL, malignancies were detected in only 19 (5%) within the first 28 months after referral. Diagnosis was established at autopsy in 14 cases.ConclusionThis investigation provides new information on the relevance of follow-up in the long-term clinical outcome of patients with unexplained UWL and on the role of age on this entity. Although unexplained UWL seldom constitutes a short-term medical alert, malignancies may be undetectable until death. Therefore, these patients should be followed up regularly (eg yearly visits) for longer than reported periods, and autopsies pursued when facing unsolved deaths.

Prognostic significance of unintentional body weight loss in colon cancer patients

“…The patients were classified according to their age into 3 groups: <50 years (young), 50–75 years (middle-age) and >75 years (old). Unintentional BWL was defined numerically as weight loss of at least 5 kg (or >5% of body weight) within the recent 6–12 months ( 5 ), or defined subjectively based on the following: Evidence of change in clothing size and corroboration of the reported weight loss by a family member or friend ( 6 ). BWL data were recorded for patients who were able to provide it.…”

Metabolomic correlates of central adiposity and earlier-life body mass index

“…Self-reported information on use of statin, diabetes diagnosis and unintentional weight loss was therefore collected. Unintentional weight loss, which may represent pre-clinical chronic disease (25), was defined as losing weight more than 10 lbs unintentionally in the past year.…”

Eating disturbances in the elderly: A geriatric-psychiatric perspective

“…In a prospective observational study involving 1419 older adults aged 65 years and above, Bosch et al found 2/3 of unintentional weight loss cases were attributed to malignant and non-malignant organic disorders. 50 % of non-malignant organic disorders were digestive disorders such as gastric and duodenal ulcer, colitis, in addition to swallowing and dental problems [44]. Patients with malignancies were predominantly older men, with more pronounced weight loss.…”

“…Patients with malignancies were predominantly older men, with more pronounced weight loss. Therefore, it is important to differentiate malignant disorders in patients with red flag signs [44].…”