Clinical evaluation for cancer in patients with involuntary weight loss without specific symptoms

Background Numerous studies on involuntary weight loss (IWL) have been published since the 1980s, although most of them have included small samples of patients with specific symptoms. The aim of the present study was to determine the causes, demographic and clinical characteristics and mortality at 12 months in patients attended at a rapid diagnostic unit (RDU) for isolated IWL. Methods A single-center retrospective observational study including all patients presenting to the RDU for isolated IWL between 2005 and 2013. The following data were recorded: demographic and clinical variables, results of complementary tests (blood tests, x-rays, computed tomography scan and digestive endoscopy), main diagnosis and vital status at 12 months. Results Seven hundred and ninety-one patients met the criteria for IWL. Mean age was 67.9 years (SD 4.7), 50.4% were male and mean weight loss was 8.3 kg (SD 4.7). The cause for IWL was malignant disease in 23.6% of patients, non-malignant organic disease in 44.5%, psychiatric disorder in 29.0% and unknown in 3.2%. Overall mortality at 12 months was 18.6% (95%CI: 16.1–21.6). The mortality rate was highest in the group with malignancy (61.1%; 95%CI: 54.2–68.2). Conclusions Almost a quarter of all patients attended at the RDU for IWL were diagnosed with cancer. Mortality at 12 months was higher in this group than in the other three. Malignancy should therefore be ruled out during the first visit for patients attended for IWL.

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Involuntary weight loss without specific symptoms: a clinical prediction score for malignant neoplasm

QJM ◽

10.1093/qjmed/hcg107 ◽

2003 ◽

Vol 96 (9) ◽

pp. 649-655 ◽

Cited By ~ 21

Author(s):

J.L. Hernandez ◽

P. Matorras ◽

J.A. Riancho ◽

J. Gonzalez-Macias

Keyword(s):

Weight Loss ◽

Malignant Neoplasm ◽

Prediction Score ◽

Clinical Prediction ◽

Specific Symptoms ◽

Involuntary Weight Loss

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Alterations In Macronutrient Metabolism In Starvation And Disease

10.2310/im.9006 ◽

2018 ◽

Author(s):

L John Hoffer

Keyword(s):

Weight Loss ◽

Muscle Atrophy ◽

Systemic Inflammation ◽

Protein Energy Malnutrition ◽

Metabolic Adaptation ◽

Clinical Approach ◽

Protein Energy ◽

Key Words Adaptation ◽

Disuse Muscle Atrophy ◽

Involuntary Weight Loss

This review explains starvation as both a physiologic process and a disease. It includes a detailed explanation of the modifying effects of metabolic adaptation and systemic inflammation, as interpreted in a clinical context. It navigates the reader through the difficult shoals of vague and conflicting terminology that burden this topic and provides current definitions and nuanced explanations of the important but frequently misunderstood terms related to starvation and its modifiers and consequences. It provides a succinct explanation of the physiology of total fasting and its clinical correlates. Finally, it explains the interactions among starvation, sarcopenia, frailty, involuntary weight loss, systemic inflammation, cachexia, and disuse muscle atrophy. The multiple and interacting causes of generalized muscle atrophy are pointed out. Inadequate appreciation of these interactions can result in failure to diagnose and treat starvation-induced diseases. A clinical approach to involuntary weight loss is outlined. This review contains 6 figures, 2 tables and 56 references Key words: adaptation, cachexia, frailty, hypoalbuminemia, inflammation, ketosis, kwashiorkor, malnutrition, marasmus, muscle atrophy, protein-energy malnutrition, sarcopenia, starvation, systemic inflammation, weight loss

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