Malnutrition measured by unintended weight loss among patients in general practice.

OBJECTIVE: Disease-related malnutrition should be managed before negative consequences occur. The aim of this study was to investigate the prevalence of unintended weight loss and reduced food intake among patients ≥18 y of age attending a general practice. METHODS: All patients visiting five general practices in Denmark, for 4 d in each place, were invited to participate in this questionnaire-based cross-sectional study. The questionnaire consisted of eight questions including unintended weight loss within the previous 2 mo, reduced food intake within the previous week, and symptoms that affected nutrition. Descriptive statistics, χ2 tests, and simple and multivariable logistic regression analysis were performed. The study included 1087 patients with an 88.7% response rate. RESULTS: Unintended weight loss was found in 14.2% and 12.9% had reduced food intake. Of the patients with unintended weight loss, 62.3% also had reduced food intake. Patients 18 to 39 and >80 y of age; underweight patients; and patients visiting general practice for chronic pain, mental discomfort, and suspicion of serious illness had significantly higher odds for unintended weight loss and reduced food intake. Patients with reduced food intake had higher odds for unintended weight loss, and those visiting the general practice due to fatigue had higher odds for reduced food intake. Patients in obesity class 1 to 3 and patients who had come for a general health checkup had lower odds. Patients visiting for follow-up on chronic physical illness had higher odds of having unintended weight loss and reduced food intake combined. CONCLUSION: Overall, 14.2% of the patients had unintended weight loss, 12.9% had reduced food intake, and 62.3% had both, indicating a high prevalence of unintended weight loss among patients in general practice. Unintended weight loss seems relevant and feasible to use as an initial indicator for the need for further nutritional screening in general practice. Studies are needed to investigate the effect of interventions and outcomes.

Chronic obstructive pulmonary disease outpatients bear risks of both unplanned weight loss and obesity.

BACKGROUND & AIMS: Malnutrition is commonly seen in chronic obstructive pulmonary disease (COPD) and has been associated with negative outcomes. The objective of this study was to examine unintended weight loss (UWL) within three months, as a primary indicator for disease related malnutrition among COPD outpatients, to evaluate the prevalence of UWL, and to identify possible characteristics for UWL. METHODS: A cross-sectional study including a patient questionnaire and medical record data extraction was made with all patients visiting a Danish COPD outpatient clinic. RESULTS: Among the 200 included patients (68.7 ± 11.2 years of age), UWL was seen in 21.5%, with a median weight loss of 3.5 (2-16) kg. Underweight (BMI<18.5 kg/m2) was recognized in 13.5%, while 34.5% were obese (BMI>30 kg/m2). Reduced food intake (RFI) within the past week was experienced among 22.0% of the patients. The most common nutrition impact symptoms (NIS) were shortness of breath, reduced appetite and nausea. NIS, RFI and BMI<18.5 kg/m2 were associated to UWL, while co-morbidities, hospitalization within three months and resent exacerbations showed no association to UWL. CONCLUSIONS: A high prevalence of UWL was found in COPD outpatients, and NIS and RFI as characteristics associated with UWL. Shortness of breath, reduced appetite and nausea were the most common NIS. This study found 13.5% of patients underweight, 23.5 overweight and 34.5% obese. Underweight as well as obesity may have negative consequences for the patient and the community.

A Case Report of a Rare Debilitating Complication of Diabetes: Neuropathic Cachexia.

A 56-year-old male with a history of type 2 diabetes mellitus and hypertension presented with complaints of intractable burning paresthesia of bilateral extremities, hyperesthesia, and unintentional weight loss. Other symptoms included anorexia, orthostatic hypotension, bowel and bladder dysfunction, and painful burning sensation on the soles of the feet. Emotional lability and a melancholy mood were noted. After laboratory tests including CSF analysis, biopsies, and three months of treatment that did not bring relief, the patient was diagnosed with diabetic neuropathic cachexia (DNC). While his diabetes remained well-controlled, the patient was unable to improve his nutritional status and his condition progressively worsened, and he later died from cardiac arrest. DNC is an important differential diagnosis to consider in patients with neuropathy and weight loss. Early detection of DNC in conjunction with weight loss investigation may reduce pain and speed recovery with a good prognosis.

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

Unintentional weight loss (UWL) is a common presenting symptom with a wide differential diagnosis. Causes may be organic (e.g., malignancy or gastrointestinal disease) or inorganic (e.g., psychosocial). The purpose of this review is to provide a guide for radiologists and other clinicians to understand the imaging modalities and laboratory studies involved in the diagnosis and treatment of UWL and the evidence supporting their routine use. Cases illustrating both common and uncommon causes of UWL are presented to emphasize both the breadth of pathology that may cause UWL as well as the importance of a multi-modality diagnostic approach. Imaging studies are crucial in the diagnosis of unintentional weight loss, particularly with regard to evaluating for the presence of malignancy. It is important for both the radiologist and other clinicians to understand the relative prevalence of the various causes of UWL and the utility of different imaging modalities in diagnosis and management.

Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience.

BACKGROUND & AIMS: The effect of the COVID-19 infection on nutritional status is not well established. Worldwide epidemiological studies have begun to investigate the incidence of malnutrition during hospitalization for COVID-19. The prevalence of malnutrition during follow-up after COVID-19 infection has not been investigated yet. The primary objective of the present study was to estimate the prevalence of the risk of malnutrition in hospitalized adult patients with COVID-19, re-evaluating their nutritional status during follow-up after discharge. The secondary objective was to identify factors that may contribute to the onset of malnutrition during hospitalization and after discharge. METHODS: We enrolled 142 COVID-19 patients admitted to Careggi University Hospital. Nutritional parameters were measured at three different timepoints for each patient: upon admission to hospital, at discharge from hospital and 3 months after discharge during follow-up. The prevalence of both the nutritional risk and malnutrition was assessed. During the follow-up, the presence of nutritional impact symptoms (NIS) was also investigated. An analysis of the association between demographic and clinical features and nutritional status was conducted. RESULTS: The mean unintended weight loss during hospitalization was 7.6% (p < 0.001). A positive correlation between age and weight loss during hospitalization was observed (r = 0.146, p = 0.08). Moreover, for elderly patients (>61 years old), a statistically significant correlation between age and weight loss was found (r = 0.288 p = 0.05). Patients admitted to an Intensive Care Unit (ICU) or Intermediate Care Unit (IMCU) had a greater unintended weight loss than patients who stayed in a standard care ward (5.46% vs 1.19%; p < 0.001). At discharge 12 patients were malnourished (8.4%) according to the ESPEN definition. On average, patients gained 4.36 kg (p < 0.001) three months after discharge. Overall, we observed a weight reduction of 2.2% (p < 0.001) from the habitual weight measured upon admission. Patients admitted to an ICU/IMCU showed a higher MUST score three months after discharge (Cramer's V 0.218, p = 0.035). With regard to the NIS score, only 7 patients (4.9%) reported one or more nutritional problems during follow-up. CONCLUSIONS: The identification of groups of patients at a higher nutritional risk could be useful with a view to adopting measures to prevent worsening of nutritional status during hospitalization. Admission to an ICU/IMCU, age and length of the hospital stay seem to have a major impact on nutritional status. Nutritional follow-up should be guaranteed for patients who lose more than 10% of their habitual weight during their stay in hospital, especially after admission to an ICU/IMCU.

Approach to Patients with Unintentional Weight Loss.

Unintentional weight loss is a common clinical problem with a broad differential diagnosis that is clinically important because of the associated risks of morbidity and mortality. Community-dwelling adults are often diagnosed with malignancy, nonmalignant gastrointestinal disorders, and psychiatric disorders as the cause of unintentional weight loss, whereas institutionalized older adults are diagnosed most often with psychiatric disorders. Up to a quarter of patients do not have a diagnosis after comprehensive workup, and close follow-up is warranted. Treatment involves management of underlying causes.

Unintended weight loss in hematology outpatients - Work to do.

BACKGROUND: Malnutrition frequently occurs in hematology diseases and may threaten the course of treatment and patient outcomes. While screening for nutritional risk is often done in hospitalized patients, it is rarely described in the outpatient setting. Hematology patients are often followed in outpatient settings before hospitalization and for a longer time after. AIMS: The primary aim of this study was to investigate the prevalence of nutritional risk measured by unintended weight loss within three months and reduced food intake within one week among patients in a hematology outpatient clinic. The second purpose was to investigate the two variables as a quick initial screening tool. METHODS: All patients visiting the outpatient clinic within one week were invited to participate in this study, designed as a questionnaire-based cross-sectional study, consisting of nine questions. Descriptive statistical analyses, chi2 test and simple logistic regression analyses were performed. RESULTS: Of the 219 included patients, 23.7% had an unintended weight loss of mean 13.7% of body weight within the last three months and 13.2% had eaten less than usual within the past week. Patients who had significantly increased odds for unintended weight loss were >80 years of age [CI95%: 1274; 6084], patients visiting for examinations [CI95%: 1.105; 7.227], patients visiting for treatment [CI95%: 1.383; 6598] and patients visiting as part of a course of investigations [CI95%: 1.112; 34.184] as well as patients who had eaten less [CI95%: 2.731; 14.224]. Patients visiting the outpatient clinic for examination had significantly increased odds of having eaten less [CI95%: 1.783; 14.629]. CONCLUSIONS: Based on the statistical analyses, almost one fourth of the patients had a significant unintended weight loss, about 15% had reduced food intake and only 7.8% had both unintended weight loss and reduced food intake. These results indicate that unintended weight loss can be used as a quick screening tool to identify and detect patients at risk of malnutrition and that guidelines should be drawn up for managing patients at nutritional risk in hematology outpatient clinics.

Involuntary weight loss.

Involuntary weight loss remains an important and challenging clinical problem, with a high degree of morbidity and mortality. Because of the frequency of finding a serious underlying diagnosis, clinicians must be thorough in assessment, keeping in mind a broad range of possible causes. Although prediction scores exist, they have not been broadly validated; therefore, clinical judgment remains ever essential.