Citation, DOI and article data
A clinical presentation of weight loss is extremely common and often a source of marked anxiety for the patient. The commonest cause of unintentional weight loss (UWI) is gastrointestinal tract disease, and not malignancy.
The published literature lacks a consistent definition of what constitutes clinically-significant unintended weight loss. A loss of body weight of ≥5% in ≤6 months is often employed for this purpose 2. Although in the context of lymphoma, the presence of weight loss, as one of the B symptoms, is defined as a loss of body weight of ≥10% within six months 3.
Although severe weight loss (in adults) is almost always a feature of cachexia, the latter term refers specifically to a complex metabolic syndrome seen in the context of malignancy and other chronic diseases in which there is severe decrease in muscle bulk (sarcopenia) 5.
Unintentional weight loss
- alcohol excess
Intentional weight loss
- physical exercise
- surgery: bariatric surgery, cosmetic surgery (e.g. liposuction)
- medications (purgatives, anxiolytics, diuretics, etc.)
- self-induced vomiting
On cross-sectional imaging, the most striking feature of a patient who has lost a large amount of weight is usually the distinct lack of subcutaneous and intra-abdominal fat. This often makes studies difficult to read as the solid organs, bowel loops and nodes may be difficult to separate visually, especially on non-contrast CT examinations.
The use of imaging to identify the underlying cause of unintentional weight loss is increasingly common. In a retrospective study of 200 patients with unexplained weight loss, from 2018, whole body CT was able to elucidate the primary cause in a third of patients (33.5%) 4.
- 1. Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A. Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients. (2017) PloS one. 12 (4): e0175125. doi:10.1371/journal.pone.0175125 - Pubmed
- 2. Lankisch P, Gerzmann M, Gerzmann JF, Lehnick D. Unintentional weight loss: diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre. (2001) Journal of internal medicine. 249 (1): 41-6. doi:10.1046/j.1365-2796.2001.00771.x - Pubmed
- 3. Shanbhag S, Ambinder RF. Hodgkin lymphoma: A review and update on recent progress. (2018) CA: a cancer journal for clinicians. 68 (2): 116-132. doi:10.3322/caac.21438 - Pubmed
- 4. Goh Y, Dan YY, Chua W, Jagmohan P, Lee JK, Thian YL. Diagnostic utility of whole body CT scanning in patients with unexplained weight loss. (2018) PloS one. 13 (7): e0200686. doi:10.1371/journal.pone.0200686 - Pubmed
- 5. Evans W, Morley J, Argilés J et al. Cachexia: A New Definition. Clinical Nutrition. 2008;27(6):793-9. doi:10.1016/j.clnu.2008.06.013 - Pubmed