From the Guidelines
To assess for unintentional weight loss, a general clinical assessment should be performed, including anamnesis, report of unintentional weight loss or decrease in physical performance, physical examination, and general assessment of body composition and muscle mass and strength, if possible, as recommended by the ESPEN guideline on clinical nutrition in the intensive care unit 1. When evaluating unintentional weight loss, it is essential to consider the patient's medical history, including any recent weight changes, and to calculate the percentage of weight lost over a specific period. According to the 2015 ESPEN definition, patients suffering from malnutrition include those with a BMI < 18.5 kg/m2 or suffering from an unintentional weight loss > 10% irrespective of time, or > 5% over the last 3 months combined with either a BMI < 20 if < 70 years of age, or <22 if > 70 1. Key components of the assessment include:
- Anamnesis to gather information about the patient's weight loss history and any associated symptoms
- Physical examination to evaluate the patient's nutritional status, oral cavity, thyroid, abdomen, and lymph nodes
- Calculation of the percentage of weight lost to determine the severity of the weight loss
- Assessment of body composition and muscle mass and strength, if possible, using tools such as ultrasound, computerized tomography (CT) scan, bioelectric impedance, or stable isotopes 1 The assessment of unintentional weight loss is crucial for identifying underlying medical conditions, such as cancer, gastrointestinal disorders, endocrine disorders, psychiatric conditions, or medication side effects, and guiding appropriate treatment. A comprehensive approach, including a thorough medical history, physical examination, and laboratory tests, is necessary to determine the cause of the weight loss and develop an effective treatment plan.
From the Research
Assessment of Unintentional Weight Loss
To assess unintentional weight loss, a thorough approach is necessary, considering various factors and potential etiologies. The following steps and considerations can be taken:
- Initial Evaluation: A comprehensive history and physical examination are crucial in identifying the underlying cause of unintentional weight loss 2.
- Laboratory Tests: Recommended tests include complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein levels, erythrocyte sedimentation rate, glucose measurement, lactate dehydrogenase measurement, and urinalysis 3, 4.
- Imaging Studies: Chest radiography, fecal occult blood testing, and abdominal ultrasonography may be considered as part of the initial evaluation 3, 4.
- Special Considerations: In older adults, social factors such as isolation and financial constraints, as well as medication use and polypharmacy, should not be overlooked as potential causative factors 3, 4.
- Follow-up: If the initial evaluation is unremarkable, a three- to six-month observation period is recommended, with follow-up based on clinician and patient preferences 3, 4.
- Treatment: Treatment should focus on the underlying cause, if known, and may include dietary modifications, feeding assistance, and addressing contributing medications 3, 4.
- Long-term Outcome: Regular follow-up (e.g., yearly visits) is necessary for patients with unexplained unintentional weight loss, as malignancies may be undetectable until death 5.
Potential Etiologies
The potential etiologies of unintentional weight loss are diverse and may include:
- Malignancy: A common cause of unintentional weight loss, particularly in older adults 3, 4, 5.
- Nonmalignant Gastrointestinal Disease: A frequent cause of unintentional weight loss in older adults 3, 4.
- Psychiatric Conditions: Such as depression and anxiety, which can contribute to unintentional weight loss 3, 4.
- Oral Disorders: May be a cause of unintentional weight loss, particularly in older adults 5.
- Social Factors: Such as isolation and financial constraints, which can contribute to unintentional weight loss 3, 4.