5 Mar 2017

Significance of involuntary weight loss and its causes.

Significance of involuntary weight loss and its causes.
Weight loss may be voluntary or involuntary. Voluntary weight loss occur due to dieting,exercise and starvation or decreased intake in older people. But the weight loss is involuntary particular attention cshould be given since it may be  an indicator of underlying serious disease.Weight loss can be identified from the hospital or general practice weight record.In some patients weight loss occur without  an underlying cause ,which is regained and stabilise  over time.

What is significant weight loss
Loss of weight more than 4.5 kg or more than 5% of one’s body weight over a
period of 6 - 12 months is called significant weight loss

Important causes of weight loss
They belong to four main group
2.Chronic infection and inflammation
3.Metabolic disorder  such as Diabetes ,hyperthyroidism
4.Psychiatric disorders

Cancer - It is the cause of weight loss in upto 25% of cases. Following are the malignancies which are frequently associated with weight loss .
Gastrointestinal,liver, blood , lung, breast, genitourinary, ovarian, and prostate.20% of cancer death is due to severe weight loss and cachexia.

Gut problems(gastrointestinal)
Almost any disease of gut can result in weight loss.
Inflammatory bowel  disease, Crohn’s disease or ulcerative colitis cause loss of appetite ,fear of eating, loss of blood, protein and nutrients from body. Malabsorption, Peptic ulcer Pancreatitis Obstruction/constipation Pernicious anemia  are the most common gut problems leading to weight loss.

Tuberculosis, parasites, fungal diseases , subacute bacterial endocarditis, and HIV are common treatable causes

Endocrine and metabolic
Hyperthyroidism  Diabetes mellitus  Pheochromocytoma  Adrenal insufficiency

Chronic Heart and lung disease
Causes weight loss due to increased metabolic demand ,decreased food intake due to disease and decreased appetite

Psychiatric causes
Significant weight loss is seen associated with depression and isolation so that patient fail to take care of nutritional needs. Bereavement is also a well known cause of weight loss  especially in men.Alcoholism is an important cause due to  malnutrition and self neglet .Other psychiatric disease causing weight loss are Anxiety and Paranoia, anorexia nervosa, ), bulimia

Neurologic disease
Stroke Parkinson’s disease Neuromuscular disorders Dementia

Old age 
Decreased taste and smell ,functional disabilities ,age related change in body all result in poor nutrition.

Cause loss of  weight due to decreased appetite ,nausea ,vomiting ,stomach ulceration ,diarrhea ,dry mouth,altered taste all these are more common in elderly who are 5 or more drugs .Examples are Sedatives ,Antibiotics Nonsteroidal anti inflammatory drugs ,Serotonin reuptake inhibitors, Metformin Levodopa ,Angiotensin-converting enzyme

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