Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit

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.

Nutritional Assessment in Gastrointestinal Tumors: News from the 2020 ASCO and ESMO World GI Meetings

Nutritional risk screening and assessment of general nutritional status are of primary importance in the management of gastrointestinal cancers (GIC). Indeed, a major problem in these patients is the involuntary weight loss leading eventually to cachexia. With our review, we aimed at collecting the most recent advances in nutritional assessment of patients with GIC. All the abstracts presented both at the 2020 ASCO and ESMO World GI meetings were considered and a total number of 12 abstracts were selected, reporting colorectal, gastric, esophageal, and pancreatic cancer (PC) series. In some of the analyzed series, pathological conditions such as cachexia and sarcopenia had prognostic significance on clinical outcomes. One abstract reported the results of a phase I trial with the use of a novel interleukin-1-alpha antagonist, bermekimab. Its association with standard chemotherapy in advanced PC brought an improved patients’ performance during treatment. Insufficient attention is paid to the nutritional status of patients with GIC both at screening and during specific cancer treatment. The use of antropometric measurements, together with nutritional assessment tools, may facilitate the clinical evaluation of these patients. Large randomized trials are warranted in order to clarify the real impact of nutritional interventions on clinical outcomes.

Involuntary Weight Loss and Late-Life Depression in Korean Older Adults

Background: To investigate the association between involuntary weight loss (IWL) and late-life depression (LLD) in a population-based cohort study. Methods: Data (N=6945) obtained from the 2008 baseline and 2011 follow-up assessments of the Living Profiles of Older People Survey in Korea were used. Changed body weight between the 2008 and 2011 was classified into stable weight (<-5% ~ <+5%), lightweight loss (≥-5% ~ <-10%), moderate weight loss (≥-10%), lightweight gain (+≥5 ~ <+10%), and moderate weight gain (≥+10%). Results: Compared to the stable weight group, the moderate weight loss group had a higher risk of LLD (odds ratio=1.99, 95% confidence interval=1.61-2.46, P<0.001) even after adjustments for covariates, including age, BMI, education, income, life of solitude, smoking, physical activity, dependent aging, comorbidity, and cognitive function. Conclusion: IWL is significantly associated with LLD in Korean older adults, implying the prognostic importance of IWL for presenting mental health issues later in life.

Electrical and Hormonal Biomarkers in Cachectic Elderly Women with Chronic Heart Failure

Background: Cachexia is an unfavorable metabolic syndrome causing involuntary weight loss followed by muscle wasting, which can lead to the exacerbation of chronic heart failure (CHF), and considerably increases mortality rate among CHF patients. Unfortunately, until now it has not been possible to determine factors that could improve clinical options for cachexia management or enable the identification of patients at risk of its development. We assessed how cachexia conditions in CHF reflect cardiac and laboratory parameters in comparison with non-cachectic patients. Methods: 66 women were enrolled to the study group and underwent meticulous screening, according to recent clinical guidelines, in order to enable CHF and cachexia detection. Body composition was evaluated by bioelectrical impedance analysis (BIA) and laboratory tests were supplemented by analysis of plasma circulating irisin. Results: A negative correlation between irisin concentration and both CRP and TNF-α was recorded (R = −0.362 and R = −0.243; p < 0.05). Irisin concentration positively correlated with EF% (R = 0.253; p = 0.046) and negatively with LVESd, LVEDd and NT-proBNP (R = −0.326, −0.272, and −0.320; p < 0.05). Both low levels of circulating irisin and Capacitance of membrane (Cm) were selected as unfavorable factors affecting cachexia in CHF patients (OR = 1.39 and 34.49; p < 0.05). Combination of Cm, irisin, CRP and albumin demonstrated sensitivity of 93.3% and specificity of 85.3% (AUC = 0.949) for distinguishing between cachectic and non-cachectic CHF patients. Conclusions: Selected parameters reliably reflect cachectic conditions in CHF, and the proposed approach for cachexia based on the combined analysis of at least a few non-invasive markers could offer new opportunities for improving clinical outcomes in CHF patients.

DYSPNOEA AS THE FIRST SYMPTOM OF COLON CANCER

Introduction: Colorectal cancer is one of the most frequently diagnosed cancer worldwide. Abdominal pain, alteration of chronic bowel habits, changes in bowel movements and involuntary weight loss belong to typical symptoms. It is important to diagnose the disease in early stage to improve effectiveness of treatment. The aim: To present a case report of exertional dyspnoea in patient with newly diagnosed colorectal cancer without any symptoms and abnormalities in physical examination suggesting malignant process of digestive tract. Case report: We present a 71-year-old male who has been admitted to the Department of Internal Medicine, Angiology and Physical Medicine under emergency care, where was aimed at by general practitioner to diagnose exertional dyspnoea ongoing last few weeks, which appearing after two hundred meters walk on flat surface. In the course of the diagnostic process, it turned out that the cause of dyspnoea was colorectal cancer. Conclusions: This case report shows that initial symptoms of cancer may be nonspecific and it confirms how important it is for doctors to remain vigilant in the diagnostic process.

Hypercalcaemia, adrenal insufficiency and bilateral adrenal histoplasmosis in a middle-aged man: a diagnostic dilemma

A 45-year-old man presented with a 3-month history of involuntary weight loss, anorexia, postural dizziness and intermittent fever. On investigation, he was found to have parathyroid hormone (PTH)-independent hypercalcaemia, with negative workup for 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D excess, thyrotoxicosis, multiple myeloma and bony metastases. On further evaluation, he was detected to have primary hypoadrenalism with bilateral adrenal enlargement, secondary to adrenal histoplasmosis. Hypercalcaemia improved with hydration and physiological steroid replacement even before initiation of antifungal therapy, confirming adrenal insufficiency as the cause for hypercalcaemia. Hypercalcaemia resulting from hypoadrenalism secondary to adrenal histoplasmosis is rare and should be suspected whenever evaluating a patient with PTH-independent hypercalcaemia.

Sodium Oxybate: A Cause of Extreme Involuntary Weight Loss in a Young Lady

We present a case of a young lady with extreme involuntary weight loss and alarming constitutional symptoms found ultimately to be all due to a single medication’s side effects. The objective of this case report is to alert physicians, especially in a primary care setting, that the side effects of a medication used mostly in a highly specialized field of neurology, sodium oxybate (SXB), can cause extreme involuntary weight loss in addition to chronic night sweats and symptoms of clinical depression.