Unintentional weight loss: what radiologists need to know and what clinicians want to know

Serious disease risk among patients with unexpected weight loss: a matched cohort of over 70 000 primary care presentations

BACKGROUND

Unexpected weight loss (UWL) in patients consulting in primary care presents dilemmas for management because of the broad differential diagnoses associated with UWL. Research on the risks of serious disease among patients with UWL to date has largely taken place in secondary care, limiting generalizability to primary care patients. In this study, we use a large matched cohort study to estimate the risks of 12 serious diseases among patients presenting to primary care with UWL where this was recorded, stratified by age and sex, in order to inform a rational clinical approach to patients presenting with UWL.

METHODS

This was a retrospective matched cohort study using electronic health records (EHRs) from the UK Clinical Practice Research Datalink (CPRD). Each patient with UWL (ascertained from EHR coding) was matched to five patients without UWL and followed until the earliest of a diagnosis of the serious disease, date of death, exit from the CPRD database, or end of the study. Observed absolute risks of the 12 serious diseases were estimated as probabilities, and hazard ratios (HRs) were estimated with Cox proportional hazards models.

RESULTS

Between 2000 and 2012, 70 193 patients in CPRD had at least one record of UWL and were matched with 295 579 patients without UWL. Patients with UWL had significantly higher risk of nearly all serious diseases examined compared with patients without. HRs ranged from 1.43 for congestive heart failure [95% confidence interval (CI): 1.27-1.62] to 9.70 for malabsorption (95% CI: 6.81-13.82). The absolute risks of any given serious disease were relatively low (<6% after 1 year). The magnitude and rank order of absolute risks varied by age and sex. Depression was the most common diagnosis among women aged <80 with UWL (3.74% of women aged <60 and 2.46% of women aged 60-79), whereas diabetes was the most common in men <60 with UWL (2.96%) and cancer was the most common in men aged 60 and over with UWL (3.79% of men aged 60-70 and 5.28% of men aged ≥80).

CONCLUSIONS

This analysis provides new evidence to patients and clinicians about the risks of serious disease among patients presenting with UWL in primary care. Depending on age and sex, the results suggest that workup for UWL should include screening for diabetes, thyroid dysfunction, depression, and dementia. If performed in a timely manner, this workup could be used to triage patients eligible for cancer pathway referral.

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

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 1^st, 2020 to December 31^st, 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.