0:00 Unintentional weight loss is defined as a 5% reduction of the usual body weight 0:08 over 0:09 6 to 12 months. 0:11 Weight loss like this is associated with increase in mortality. 0:14 There's a few definitions that we need to go over. 0:19 Anorexia is the decrease in appetite. 0:23 Kexia is weight loss from loss of muscle mass, with or without fat loss. 0:29 And sarcopenia is a geriatric syndrome characterized by loss of muscle mass, 0:34 strength and performance. 0:37 There are many causes of weight loss. 0:39 And if no fever or other cause of increased expenditure state such as 0:45 exercising, then 0:46 weight loss is probably due to a reduced dietary intake. 0:54 Let's go over some causes of unintentional weight loss. 0:58 The first two probably most important is if someone has reduced dietary intake 1:02 or if 1:03 they're vigorously exercising. 1:08 An important cause to know is malignancy, and this can be any malignancy such 1:11 as from 1:12 the gastrointestinal system, esophagus, gastric cancer, pancreatic cancer or 1:17 colorectal cancer, 1:20 renal cancer, prostate cancer, lung cancer or hematological malignancy such as 1:26 lymphoma. 1:27 Unintentional weight loss should always raise suspicion of malignancy, 1:31 especially in the 1:31 elderly. 1:33 Malignancy causes weight loss either by suppressing appetite due to discomfort 1:37 or pain in a certain 1:38 area or because it steals the nutrients that otherwise the healthy body needs. 1:47 Let's focus on non-malignant causes, firstly by focusing on non-malignant 1:51 causes of the 1:52 gastrointestinal tract, which typically are the ones that cause malabsorption. 1:57 But, it also can include things such as dysphagia, difficulty swallowing, gast 2:03 roparesis which 2:04 is slowing down of the stomach so you have slowing of gastric emptying, peptic 2:09 ulcer disease, 2:11 chronic pancreatitis, celiac disease which is an autoimmune attack on the small 2:19 intestine 2:20 on exposure to gluten. 2:22 This causes damage to the microvilli of the intestine which causes poor 2:27 digestion and 2:27 absorption of the nutrients. 2:30 There's also inflammatory bowel disease such as Crohn's disease which is a 2:35 transmural inflammatory 2:36 process or ulcerative colitis, a superficial inflammation of the bowel leading 2:41 to reduced 2:42 absorption of nutrients. 2:47 Other causes include chronic bowel ischemia caused by stenosis of the mesenter 2:51 ic artery 2:52 or a clot because someone has AF and is not anticoagulated. 2:59 Multiple causes of weight loss include dementia because they're forgetting and 3:02 they have trouble 3:03 eating by themselves. 3:05 Parkinson's disease and modern neuron disease can manifest with dysphagia. 3:13 Rheumatological causes because of this inflammatory state it really just supp 3:17 resses appetite and 3:18 increases expenditure. 3:20 These include namely giant cell arthritis which is the type of vasculitis and r 3:24 heumatoid 3:24 arthritis. 3:29 Endocrineopathies are things related to the endocrine system which really just 3:34 increased 3:34 energy expenditure. 3:36 These include hyperthyroidism and type 1 diabetes mellitus as well as adrenal 3:42 insufficiency. 3:43 Then you have importantly psychiatric disorders which involve really reduced 3:49 oral intake. 3:50 These include depression, anorexia nervosa and bulimia. 3:56 Chronic infections cause weight loss because the body is unwell, there's 4:01 increased energy 4:02 expenditure and sometimes the parasites for example steal the nutrients that 4:06 otherwise 4:07 the body needs. 4:09 These infections I'm talking about include human immunodeficiency virus, 4:14 tuberculosis 4:15 and health infections. 4:21 Medications that cause weight loss include alcohol chronically, cocaine amphet 4:26 amines, 4:27 tobacco, anti-diabetic agents specifically GLP1 agonists and SGLT2 inhibitors, 4:35 thyroxine 4:36 as well because they're really giving some thyroid hormones. 4:41 Chronic diseases can cause weight loss through a multi-factorial process but 4:46 these chronic 4:47 conditions are namely congestive cardiac failure, chronic obstructive pulmonary 4:52 disease 4:52 and chronic kidney disease. 5:01 When talking about unintentional weight loss it's important to talk about 5:05 weight loss from 5:05 a geriatrics perspective so aged care people. 5:10 This is usually a multi-factorial process and includes inadequate dietary 5:16 intake, caquexia, 5:18 anorexia and sarcopenia. 5:21 And all of these are interconnected and play a role in weight loss in an old 5:27 person. 5:28 Going deeper though, old people have loss of smell, loss of taste, difficulty 5:34 with swallowing, 5:36 some have difficulty accessing food, they have normally delayed gastric empt 5:41 ying, gastroparesis 5:43 and also they have less response to hunger hormones. 5:48 Further because of age in general there's reduced physical activity and muscle 5:54 strength. 5:54 There's muscle atrophy and strength loss. 5:57 There's reduced hormones including testosterone and estrogen which are quite 6:01 important for 6:01 these. 6:02 There's also an increased likelihood of having chronic diseases which also play 6:06 a role in 6:06 weight loss. 6:12 Weight loss treatment itself involves treating and addressing the underlying 6:16 cause which 6:17 we talked about but also especially in the elderly population we have to 6:22 address all 6:23 those factors that we just talked about. 6:26 It's important to encourage one to increase their oral intake, the food intake, 6:30 have a 6:31 balanced diet, high in calories and remember nutritional replacement for 6:35 example vitamins 6:36 and minerals. 6:40 There are pharmacological options available which include appetite stimulants 6:44 also known 6:45 as orexigenics. 6:49 These are mainly used for people who are old or those who have significant 6:54 chronic diseases 6:54 such as AIDS. 6:57 Within the central nervous system there are neurotransmitters that are released 7:01 that 7:01 especially promote hunger and weight gain. 7:04 Alpha 1 adrenergic receptors in the presynaptic neuron here inhibit the release 7:09 of these neurotransmitters 7:11 which lead to weight loss rather than weight gain. 7:15 Mertazapine is a drug commonly used in the elderly which inhibits alpha 1 adren 7:20 ergic 7:20 receptors and allows the neurotransmitters to be released which in turn leads 7:25 to weight 7:26 gain. 7:28 Side effects of this medication include somnolence and nausea. 7:34 There are also ghrelin mimicas which can be used which stimulates appetite. 7:40 Ghrelin is a normal hormone produced by the stomach and its function is to 7:45 stimulate appetite 7:45 and so ghrelin mimicas stimulates appetite. 7:49 Finally there are megastrol acetate which are synthetic progestins and these 7:54 also help 7:55 with stimulating appetite. 7:57 The side effects for this importantly include heart failure, deep vein thromb 8:00 osis and generalized 8:01 weakness. 8:02 Finally you have aurona binol which is a cannabinoid and really works on 8:07 receptors of the neurons 8:09 and promotes through various mechanisms weight gain. 8:15 Thank you for watching. 8:16 In summary we talked about weight loss and the different causes namely malign 8:21 ancy and 8:21 non-malignant causes of which there are many. 8:24 We also talked about weight loss in the geriatrics population which has a multi 8:28 -factorial cause 8:31 include sarcopenia, anorexia, kekexia and reduced oral intake in general. 8:36 Finally we talked briefly about the treatment options available namely 8:40 increasing calorie 8:41 intake and some pharmacological interventions. 8:45 Thank you for watching and I hope you enjoyed this video.
