Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 7;12(4):e0175125.
doi: 10.1371/journal.pone.0175125. eCollection 2017.

Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients

Xavier Bosch  1   2 , Esther Monclús  1   2 , Ona Escoda  1   2 , Mar Guerra-García  1 , Pedro Moreno  2 , Neus Guasch  1 , Alfons López-Soto  2
Affiliations

Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients

Xavier Bosch et al. PLoS One. .

Abstract

Background: Whereas there are numerous studies on unintentional weight loss (UWL), these have been limited by small sample sizes, short or variable follow-up, and focus on older patients. Although some case series have revealed that malignancies escaping early detection and uncovered subsequently are exceptional, reported follow-ups have been too short or unspecified and necropsies seldom made. Our objective was to examine the etiologies, characteristics, and long-term outcome of UWL in a large cohort of outpatients.

Methods: We prospectively enrolled patients referred to an outpatient diagnosis unit for evaluation of UWL as a dominant or isolated feature of disease. Eligible patients underwent a standard baseline evaluation with laboratory tests and chest X-ray. Patients without identifiable causes 6 months after presentation underwent a systematic follow-up lasting for 60 further months. Subjects aged ≥65 years without initially recognizable causes underwent an oral cavity examination, a videofluoroscopy or swallowing study, and a depression and cognitive assessment.

Results: Overall, 2677 patients (mean age, 64.4 [14.7] years; 51% males) were included. Predominant etiologies were digestive organic disorders (nonmalignant in 17% and malignant in 16%). Psychosocial disorders explained 16% of cases. Oral disorders were second to nonhematologic malignancies as cause of UWL in patients aged ≥65 years. Although 375 (14%) patients were initially diagnosed with unexplained UWL, malignancies were detected in only 19 (5%) within the first 28 months after referral. Diagnosis was established at autopsy in 14 cases.

Conclusion: This investigation provides new information on the relevance of follow-up in the long-term clinical outcome of patients with unexplained UWL and on the role of age on this entity. Although unexplained UWL seldom constitutes a short-term medical alert, malignancies may be undetectable until death. Therefore, these patients should be followed up regularly (eg yearly visits) for longer than reported periods, and autopsies pursued when facing unsolved deaths.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of enrollment of patients with unintentional weight loss.
See this image and copyright information in PMC

References

    1. Wong CJ. Involuntary weight loss. Med Clin North Am. 2014;98: 625–643. doi: 10.1016/j.mcna.2014.01.012 - DOI - PubMed
    1. Metalidis C, Knockaert DC, Bobbaers H, Vanderschueren S. Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance? Eur J Intern Med. 2008;19: 345–349. doi: 10.1016/j.ejim.2007.09.019 - DOI - PubMed
    1. Hernández JL, Riancho JA, Matorras P, González-Macías J. Clinical evaluation for cancer in patients with involuntary weight loss without specific symptoms. Am J Med. 2003;114: 631–637. - PubMed
    1. Marton KI, Sox HC Jr, Krupp JR. Involuntary weight loss: diagnostic and prognostic significance. Ann Intern Med. 1981;95: 568–574. - PubMed
    1. Bilbao-Garay J, Barba R, Losa-García JE, Martín H, García de Casasola G, Castilla V, et al. Assessing clinical probability of organic disease in patients with involuntary weight loss: a simple score. Eur J Intern Med. 2002;13: 240–245. - PubMed