Original articleAssessing clinical probability of organic disease in patients with involuntary weight loss: a simple score
Introduction
Involuntary weight loss (IWL) is a frequent complaint that causes concern to both the patient and the attending physician because of the possibility of a severe underlying disease. The best clinical approach to IWL remains unclear, especially in the absence of specific clinical clues [1]. A few studies analyzed this problem, most of them in the 1980s [2], [3], [4], [5], [6].
We undertook this study with the following objectives: (1) to evaluate the underlying clinical disorders in patients presenting with IWL; (2) to define a clinical protocol for the study of IWL; and (3) to develop a clinical prediction rule that might help in the management of these patients.
Section snippets
Setting
Fundación Hospital Alcorcón is a public general hospital in the southwest of Madrid that serves about 250 000 inhabitants. Our internal medicine department has an outpatient clinic where nearly 1400 new patients are seen every year.
Study protocol
In March 1998 we defined a diagnostic protocol for the study of involuntary weight loss (IWL) adapted from Foster [7] (Table 1, Table 2). From March 1998 to December 2000, all patients referred to our clinic with IWL as the main clinical complaint were included in
Results
Of the 91 patients with IWL seen at our internal medicine clinic, 78 (86%) were included in the study. The 13 patients who were not included because they did not have enough follow-up to achieve a diagnosis did not differ in sex or age from the patients who were included. Fifty-one percent of the patients were women, and their mean age was 59±19 years.
The primary care physician referred 85% of the patients. Eighteen patients (23%) were hospitalized for study due to a deterioration in their
Discussion
In general, weight loss occurs because of decreased caloric intake, alterations in energy metabolism, or loss of calories in the urine or feces. Different abnormalities in energy metabolism have been described and multiple factors contributing to weight loss may be present in a particular patient with cancer, AIDS, or in elderly patients [1], [9]. The precise mechanisms underlying weight loss are currently being elucidated and probably involve the action of different hormones and cytokines [1],
Acknowledgements
We thank Alejandra Perez del Real for her helpful technical assistance.
References (14)
Involuntary weight loss
Med Clin North Am
(1995)- et al.
Clinical study of 105 cases of isolated weight loss in internal medicine
Rev Med Interne
(1988) - et al.
Involuntary weight loss: diagnostic and prognostic significance
Ann Intern Med
(1981) - et al.
Unintentional weight loss: a retrospective analysis of 154 cases
Arch Intern Med
(1986) - et al.
Unexplained weight loss in the ambulatory elderly
J Am Geriatr Soc
(1991) - et al.
Involuntary weight loss as a clinical problem
Rev Invest Clin
(1989) Gain and loss in weight
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2014, Medical Clinics of North AmericaCitation Excerpt :Estimates of the incidence of involuntary weight loss vary. The yearly incidence in case series from referral centers varies between 0.6% and 7.3% per year.20,22,24,35,36 These estimates depend on the particular patient populations and referral patterns, as well as the definition of involuntary weight loss used.
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2012, FMC Formacion Medica Continuada en Atencion PrimariaEvaluating diagnostic strategy of older patients with unexplained unintentional body weight loss: A hospital-based study
2011, Archives of Gerontology and GeriatricsCitation Excerpt :In general, causes of UUWL can be classified into organic (malignancy and non-malignant diseases), neuropsychiatric and idiopathic entities. Among these underlying etiologies, cancer is always of great concerns and it accounted for 6–38% of all patients with UUWL (Marton et al., 1981; Thompson and Morris, 1991; Lankisch et al., 2001; Bilbao-Garay et al., 2002; Hernandez et al., 2003a,b; Vanderschueren et al., 2005; Chen et al., 2010). In this study, the prevalence of cancer was 16.9%, and it of benign organic diseases 33.8%, which were similar to the previous report (Lankisch et al., 2001).
Relationship Between Body Mass Index and Mortality in Adults on Maintenance Hemodialysis: A Systematic Review
2010, Journal of Renal NutritionCitation Excerpt :Participants who were overweight or obese at a young age and those who lost weight between age 21 and study entry had an increased mortality irrespective of their BMI category at a young age.79 Weight loss is a known risk factor for mortality in the elderly, and mortality rates of 9% to 38% have been observed within one to two and a half years after weight loss.80–82 Unintentional weight loss may reflect severity of underlying diseases such as CVD, cancer, or infections, all common causes of death in the studies reported in this systematic review.
Reason for consultation: Weight loss
2018, Semergen