Unintentional weight loss: Diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre

Abstract

Objectives. To establish the incidence and causes of unintentional weight loss and to compare prognoses. Design. Prospective. Setting. Secondary referral centre, Subjects. 158 patients (89 female, 56%; 69 male, 44%) referred by general physicians for unexplained weight loss or for other reasons, In the latter case, weight loss was established after admission to hospital. Follow-up lasted for up to 3 years, Main outcome measure. Determining the course of weight loss in patients with diagnosed and undiagnosed causes. Results. The cause of weight loss was established in 132 (84%) patients and remained unclear in 26 (16%). Reasons were non-malignant (60% of patients) and malignant (24%) diseases. Psychological disorders represented 11% of the non-malignant group. A gastrointestinal disease caused weight loss in 50 (30%) patients. Of malignant disorders, 53% (20 of 38 patients) were gastrointestinal. Amongst the nonmalignant group, 39% (30 of 77 patients) had somatic disorders. The prognosis for unknown causes of weight loss was the same as for non-malignant causes. Conclusion. Contrary to common belief, weight loss is not usually due to a malignant disease. A gastrointestinal tract disorder accounts for weight loss in every third patient. If minimal diagnostic procedures cannot establish a diagnosis, then endoscopic investigation of the upper and lower gastrointestinal tract and function tests should be performed to exclude malabsorption.