Weight loss is generally regarded as a clinically relevant if it exceeds 5% of body weight or 5 kg over a period of 6 months. However, these traditional definition does not distinguish between loss of lean and fat mass, which can lead to different results. Also accumulation of edema (z. B. in heart failure or chronic kidney disease) may mask a clinically important loss of lean body mass.
Involuntary weight loss usually develops over weeks or months. It may be a sign of a significant physical or mental disorder and is associated with an increased risk of mortality. The causative disorder may be (z. B. chronic diarrhea due to malabsorption syndrome) or hidden (z. B. an undiagnosed cancer) obvious. The discussion focuses on patients who present themselves due to weight reduction, rather than lose those weight than a more or less expected result of known chronic disease (eg. As metastatic cancer, end-stage COPD). Weight loss is generally regarded as a clinically relevant if it exceeds 5% of body weight or 5 kg over a period of 6 months. However, these traditional definition does not distinguish between loss of lean and fat mass, which can lead to different results. Also accumulation of edema (z. B. in heart failure or chronic kidney disease) may mask a clinically important loss of lean body mass. In addition to weight loss, patients may also have other symptoms such as anorexia, fever or night sweats due to the underlying disease. Depending on the cause and severity, symptoms and complaints of malnutrition (vitamin deficiency, dependency and intoxication) may also be present. The incidence of significant involuntary weight loss is about 5% per year in the United States. However, the incidence increases with aging, often up to 50% for nursing home patients. Pathophysiology weight loss occurs when more calories consumed than are recorded (added and absorbed). Disorders which increase the consumption or reduce the absorption, tend to increase the appetite. More common is an inadequate caloric intake, the mechanism for weight loss and those patients tend to have a decreased appetite. Sometimes different mechanisms are involved. For example, cancer tends to decrease appetite, but also increases the basal calorie consumption by cytokine-mediated mechanisms. Etiology Many diseases cause involuntary weight loss, including nearly every serious chronic disease. However, many are clinically obvious of these and are typically diagnosed when the weight loss occurs. Other diseases manifest themselves more in involuntary weight loss (see Some causes of an existing symptom of involuntary weight loss). With increased appetite are the most common hidden causes of involuntary weight loss hyperthyroidism are Uncontrolled diabetes disease, malabsorption causing at reduced appetite, are the most common hidden causes of involuntary weight loss Psychological disorders (eg., Depression) cancer drug side effects drug abuse Some causes of an existing symptom of Diagnostic involuntary weight loss due suspects findings procedure Endocrine disorders Hyperthyroidism Increased appetite heat intolerance, sweating, tremor, anxiety, rapid heart rate, diarrhea thyroid function tests diabetes mellitus, type 1 (newly occurring or poorly controlled) Increased appetite polydipsia, polyuria plasma glucose determination chronic primary adrenal insufficiency, abdominal pain, fatigue, hyperpigmentation, orthostatic dizziness serum electrolytes, cortisol and ACTH levels Yaojiu Back Reclining excessive consumption Spider nevi, Dupuytren’s contracture, testicular atrophy, peripheral neuropathy Sometimes ascites Asterixis Clinical examination Sometimes liver function tests and / or liver biopsy medication (s. Medications and herbal products that can lead to weight loss) Abuse herbal and OTC products prescription drug history Clinical examination If possible, stop trying drugs Mental disorders anorexia nervosa Inappropriate fear of gaining weight at a skinny young woman or female teenager, amenorrhea Clinical examination Depression sadness, fatigue, loss of sexual desire and / or d it pleasure, insomnia, psychomotor retardation Clinical examination kidney disease * Chronic kidney disease edema, nausea, vomiting, stomatitis, dysgeusia, nocturia, fatigue, pruritus, decreased mental alertness, muscle spasms and muscle cramps, peripheral neuropathy, seizures. Serum creatinine and BUN measurement nephrotic syndrome edema, hypertension, proteinuria, fatigue, foamy urine 24-hour urinary protein measurement Alternatively, point-urine / serum protein ratio infections fungal infections (primary usually fungal infections) fever, night sweats , fatigue, cough, dyspnea often risk exposure based on geography Sometimes other organ-specific manifestations In general, cultures and stains Sometimes serological tests If necessary biopsy Helminth (worm) infections fever, abdominal pain, bloating, flatulence, diarrhea, eosinophilia Usually stay or travel to a tropical developing country Disorder specific tests (eg. B. Microscopic examination of stool, culture, serology) HIV / AIDS fever, dyspnea, cough, lymphadenopathy, diarrhea, candidiasis Blutantikörper- or antigen detection Subacute bacterial endocarditis fever, night sweats, joint pain, shortness of breath, fatigue, Roth spots, Janeway lesions Osler-nodes, splinter hemorrhage, embolism, stroke, often in patients with valvular heart disease or iv Drug use, blood cultures echocardiography TB fever, night sweats, cough, coughing up blood Sometimes risk factors (eg. As exposure, poor living conditions) sputum culture and smears Other systemic diseases cancer often night sweats, fatigue, fever Sometimes bone pain at night or other organ-specific symptoms Organ-specific evaluation giant headache, Mus kelschmerzen, claudication of the jaw, fever and / or visual impairment in an older adult ESR and when increased temporal artery biopsy sarcoidosis cough, dyspnea, moist RG fever, fatigue, lymphadenopathy Sometimes symptoms of other organ involvement (eg. As eye, liver, GI, bone) chest x-ray Sometimes chest CT biopsy dental and taste disorders dysgeusia (loss of taste) Usually, risk factors for. B. (cranial nerve disorders, certain medications, aging) Clinical examination bad teeth tooth or gum pain bad breath , periodontal disease, missing and / or decayed teeth Clinical examination * The ansa mmlung edema may mask the loss of fat-free body weight. Medications and herbal products that can lead to weight loss category Examples Prescription drugs Antiretroviral drugs, cancer chemotherapy drugs, digoxin, exenatide, levodopa. Liraglutide, metformin, NSAIDs, SSRIs, topiramate, zonisamide withdrawal after chronic high dose of psychotropic herbal products and OTC drugs Aloe, caffeine, Cascara, chitosan, chromium, dandelion, ephedra, 5-hydroxytryptophan, Garcinia, Guarana, guar gum, glucomannan, vegetable diuretics Ma Huang, pyruvate, St. John’s wort, Yerba Mate drug abuse alcohol, amphetamines, cocaine, opiates some diseases that lead to involuntary weight loss, are usually other symptoms more pronounced, so that weight loss is usually not the main complaint. Examples include the following: Some malabsorptive disorders: GI Trakt- surgery and cystic fibrosis Chronic inflammatory diseases: Severe RA Gastrointestinal disorders: achalasia, Crohn’s disease, chronic pancreatitis, obstructive esophageal disease, ischemic colitis, diabetic enteropathy, gastric ulcers, progressive systemic sclerosis, ulcerative colitis (end) Heavy, chronic heart and lung diseases: COPD, heart failure (stage III or IV), restrictive lung disease Mental disorders (known and poorly controlled): anxiety, bipolar disorder, depression, schizophrenia Neurological disorders: amyotrophic lateral sclerosis, dementia, multiple sclerosis, myasthenia gravis, Parkinson’s disease, stroke social problems: poverty, social isolation with chronic kidney disease and heart failure, ansa mmlung edema may mask the loss of fat-free body weight. Rating The investigation focuses on otherwise hidden causes. Since these are numerous, the evaluation must be extensive. History history of present illness includes questions about the amount and time course of weight loss. A report on the weight loss may be inaccurate; therefore should be sought corroborating evidence, such as weight measurement in ancient medical records, changes in the size of clothing or confirmation by family members. Appetite, food intake, swallowing and bowel pattern should be described. For repeated evaluations Patients should keep a food diary, because the memories are often inaccurate in food intake. Non-specific symptoms of possible causes are detected, such as fatigue, malaise, fever and night sweats. A review of organ systems must be complete, with the search for symptoms in all major organ systems. The past medical history can reveal a disorder that is responsible for the weight loss. Also, the use of prescription drugs, OTC drugs, drugs and herbal Produktem should be addressed addressed. The social history can reveal changes in life situations that could explain why food intake is reduced (eg., Loss of loved ones, loss of independence or work, loss of joint eating routine) .Körperliche examination Vital signs are on fever, tachycardia, tachypnea and hypotension investigated. Weight is detected and the body mass index (BMI) was calculated (Obesity: diagnosis). The triceps skinfold thickness and the middle upper arm circumference can be measured to estimate lean body mass (overview of malnutrition: Physical examination). BMI estimates and lean body mass are helpful v. a. for detecting a trend in follow-up examinations. General examination should be particularly extensive, including the examination of heart, lungs, abdomen, head and neck, breast, neurological system, rectum (including prostate examination and testing for occult blood), reproductive organs, liver, spleen, lymph nodes, joints, skin, mood and Affekt.Warnhinweise fever, night sweats, generalized lymphadenopathy bone pain dyspnea, cough, hemoptysis inappropriate fear of gaining weight in an adolescent or a young woman polydipsia and polyuria headache, claudication of the jaw and / or visual impairment in an older adult Roth spots, Janeway lesions Osler nodes, splinter hemorrhages, embolism interpretation of the findings interpretations of some findings are listed in interpretation of selected findings for involuntary weight loss , Abnormal findings lay the cause of weight loss in about half of patients or more is, including patients who may have a cancer diagnosis. Although many chronic diseases can lead to weight loss, the physician should not assume too quickly that an existing disease is the cause. Although existing disease is the likely cause in patients whose condition is more difficult to control or worsen, stable patients who suddenly begin to lose weight without worsening the disease has occurred, have developed a new requirement to (z . B., patients with stable ulcerative colitis start losing weight because they developed a colon cancer). Tips and risks When a chronic disease remained stable, do not assume that this is the cause of the acute weight loss. Interpretation of selected findings for involuntary weight loss finding some eligible causes fatigue adrenal insufficiency, cancer, chronic kidney disease, depression, infection, giant cell arteritis, nephrotic syndrome, sarcoidosis fever, night sweats cancer, infections, giant lymphadenopathy infections, cancer, sarcoidosis Rectal bleeding, abdominal pain Colorectal cancer cough, dyspnea, hemoptysis lung cancer, tuberculosis, sarcoidosis, fungal pneumonia, HIV / AIDS hematuria kidney or prostate heat intolerance, tremor, anxiety, sweating hyperthyroidism polydipsia, polyuria Diabetes bone pain (eg. B. Multiple not related to activities that prominently (at night) for cancer. B. myeloma, bone metastases from breast, prostate or lung cancer) headaches or blurred vision and muscle pain in an older adult giant arthralgia endocarditis, giant abdominal pain, fatigue, orthostatic dizziness adrenal insufficiency abdominal pain adrenocortical insufficiency, diabetes, Wurminfe ACTIONS of ascites alcoholism, nephrotic syndrome edema Chronic kidney disease, nephrotic syndrome fever cancer, infections, inflammatory diseases insomnia, loss of libido, Sadness Depression Testing Age-appropriate cancer screening (eg. B. colonoscopy, mammography) is indicated if not already done. Other tests for diseases based on abnormal results in the history of, or in studies. There are no universally accepted guidelines for other tests in patients without such a focal abnormal findings. One proposed approach is to perform the following tests: chest X-ray urinalysis blood count with differential counting erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) HIV test serum analysis (serum electrolytes, calcium, liver and renal function tests) TSH levels abnormal results in these tests are further tests follow as indicated. If all test results are normal and clinical findings are otherwise normal, extensive further testing (eg. As CT, MRI) are not recommended. Such tests show only unsatisfactory results and can be misleading and harmful, by revealing a random, independent findings. These patients should learn how to ensure an adequate caloric intake and get a follow-up evaluation in about 1 month that includes a weight measurement. If patients continue to lose weight, the entire history and physical examination should be repeated because patients can report any important, previously unknown information and new, subtle physical abnormalities can then be determined. If the weight loss more stops and all other findings remain normal, further testing (eg. As CT, MRI) should be considered. Therapy The focus is on treating the underlying disorder. If an underlying condition is causing malnutrition and difficult to treat, food aid should be considered (Supportive measures for nutrition). Helpful general behavior measures include eating the encouragement of patients and to support them with food intake, offer them snacks between meals and at bedtime, prepare the favorite or spicy foods and offer only small portions. If performance measures are ineffective and the weight loss is extreme, enteral tube feeding can be attempted, provided the patients have a functioning digestive tract. Measurements of lean body mass followed serially. Appetizer so far have not proven effective. Geriatric Essentials to the normal age-related changes that may contribute to weight loss, include the following: reduced sensitivity to certain appetizing mediators and increased sensitivity to certain inhibitory mediators (e.g., cholecystokinin (e.g., orexins, ghrelin, neuropeptide Y.). , serotonin, corticotropin releasing factor) A reduced rate of gastric emptying (extension of satiety) reduced sensitivity of taste and smell loss of muscle mass (sarcopenia) in older people more chronic conditions often contribute to weight loss. Social isolation appears to reduce food intake. Especially in patients in nursing homes depression are a very common factor. It is difficult to clarify the precise contributions of specific factors due to the interactions between factors such as depression, loss of function, medication, swallowing disorders, dementia, and social isolation. When evaluating elderly patients a useful checklist is the one that consists of potential influencing factors, starting with the letter D: Denture Dementia Depression Diarrhea Diseases (. Eg severe kidney, heart or lung disease) drug dysfunction dysgeusia dysphagia Elderly, who have lost weight on deficiencies of vitamins D (vitamin D deficiency and dependence) and B12 (vitamin B-12 deficiency) should be evaluated. Enteral nutrition is rarely beneficial in elderly patients, except for certain patients in whom such a diet may represent a short-term bridge to normal eating again. Important points V. a. in nursing home patients several factors jointly contribute to weight loss. Involuntary weight loss> 5% of body weight and 5 kg warrants investigation. The main points of the investigation are continuing a careful history and physical examination developed imaging techniques or other extensive tests are not generally recommended, unless clinical findings suggest this before. Do you value performance measures that promote the food and try to avoid enteral nutrition, v. a. in the elderly.