La pérdida de más del 5 % del pesocorporal inicial durante un períodode 6 a 12 meses. Es el resultado de la disminución enla ingesta energética, el aumento delgasto, o la pérdida por orina o heces.

INVOLUNTARIA

VOLUNTARIA

Involuntaria: con disminución o aumento del apetito, es casi siempre un signo de una grave enfermedad, psiquiátrica o médica

Voluntaria: paciente con sobrepeso, o puede ser una manifestación de enfermedad psiquiátrica

Historia Clínica Examen Físico

Es la pérdida de peso voluntaria o involuntaria?

El apetito se encuentra aumentado o disminuido?

Cuál es la magnitud de la pérdida de peso, en números absolutos y en porcentaje?

En qué medida el paciente ha cambiado de peso durante la vida adulta?

En cuánto tiempo el paciente ha ido perdiendo peso?

Pérdida de Peso

Voluntaria

Sin apetitoCon apetito

Involuntaria

ObesidadAnorexia nerviosa – bulimiaDrogas anorexígenasProfesiones

Con aumento de apetitoHipertiroidisimoDiabetes mellitus no contoladaMalabsorciónFeocromocitomaAumento de la actividad física

61% perdieron de peso 42% aumento de apetito 16% disminución del peso Ancianos

To determine if aging modifies the clinical presentation of hyperthyroidism and the signs of thyrotoxicosis in older people. DESIGN: Prospective cohort study. SETTING: A French university hospital. SUBJECTS: Eighty-four new patients with overt hyperthyroidism confirmed chemically between January 1992 and January 1993. Controls were 68 older euthyroid patients matched to the older hyperthyroid patients. MEASUREMENTS: Comparison of 19 classical signs of hyperthyroidism between 34 older patients (> or = 70 years; mean age 80.2) and 50 younger patients (< or = 50 years; mean age 37.4). Older patients were also compared with controls (mean age 81.3). RESULTS: Three signs were found in more than 50% of older patients: tachycardia, fatigue, and weight loss. Seven signs were found significantly less frequently in older patients (P < .001): hyperactive reflexes, increased sweating, heat intolerance, tremor, nervousness, polydipsia, and increased appetite. Only anorexia (32% vs 4%) and atrial fibrillation (35% vs 2%) were more found frequently in older people (P < .001). A goiter was present in 94% of the younger and in 50% of the older patients (P < .001). The mean number of clinical signs found in the older subjects was significantly smaller than the number found in younger patients (6 vs 10.8; P < .001). Comparison with older controls showed three signs that were highly associated with thyrotoxicosis in older people: apathy (Odd ratio (OR): 14.8), tachycardia (OR: 11.2), and weight loss (OR: 8.7). CONCLUSION: This study confirms the paucity of clinical signs of hyperthyroidism in older adults. These results suggest the necessity of routine screening for thyroid disease in this age group (Arch Intern Med 1988 Mar;148(3):626-31.)

Causa más común Diabetes tipo 1 + trastornos de la

alimentación

Eating disorders and IDDM. A problematic association.IDDM and eating disorders are common conditions in young women. Whether a specific association exists between these two disorders remains controversial. Some studies have suggested an increased incidence of eating disorders in young women with IDDM, whereas others have not detected such an increase. These differences may be attributable, at least in part, to methodological issues in study design, measurement tools, and relatively small sample sizes. Whether the prevalence of eating disorders in IDDM is increased will be resolved only by larger studies that use standardized diagnostic interviews. We suspect that certain aspects of IDDM and its management may trigger the expression of an eating disorder in susceptible individuals. Required dietary restraint and weight gain related to diabetes management are the factors most likely to be implicated. Eating disorders are relatively common in young women with IDDM and may contribute to impaired metabolic control with hypoglycemia and DKA, and to long-term microvascular complications of diabetes. Omission or reduction of required insulin, an extremely common means of weight control in these young women, is likely an important factor in this regard. Further research is required to determine more precisely the relationship between IDDM and eating disorders, and the effects of eating disorders on metabolic control and chronic complications of IDDM ( Diabetes Care 1992 Oct;15(10):1402-12.)

Con pérdida de apetito Cáncer Infección por HIV Endocrinopatías Enfermedad Cardiopulmonar Enfermedad Crónica Alteraciones Psiquiátricas Abuso de sustancias y medicación

Pérdida gradual: enfermedad intestinal Pérdida rápida: enfermedad secundaria

Insuficiencia suprarrenal Hipercalcemia Hipertiroidismo Diabetes Mellitus

36% pérdida de peso + frec tracto digestivo

Unintentional Weight Loss A Retrospective Analysis of 154 CasesUnintentional weight loss (UWL) was documented in

154patients (2.8%)admitted to an internal medicine

departmentduring a two-year period. A retrospective analysis of

the clinicalcharts showed that more than one third 36.3% were

found tohave a neoplasm, involving preponderantly the

gastrointestinaltract. Patients with neoplasia were older and more

frequentlyHad abnormal physical findings and significantly

lower values of serum albumin as well as higher values of alkaline

phosphatase than other patients. Despite extensive

investigations, in 36patients 23.3% UWL remained unexplained even

after Prolonged follow-up periods. The remaining 62

patients had a variety of disorders, preponderantly

gastrointestinal tract (26patients) and psychiatric (16 patients) diseases.

Endocrinologicdisorders such as diabetes mellitus and

hyperthyroidism were relatively uncommon 3.8%). Unintentional weight

loss is arelatively common problem in clinical

practice.Familiarity with the spectrum of disorders associated with UWL as

well as Selected clinical and laboratory values may help in

the initial examination of these patients.

(Arch Intern Med

1986;146:186-187)

Paciente de 65 años

Pérdida de peso - hiporexia

Pérdida de peso

involuntaria con pérdida de apetito

Infección HIV

Enfermedad Cardiopulmona

r

Enfermedad Crónica

DBT controla

da

Alt. psiquiátricas

Abuso de sustancias

Cánceranemi

a

ldh

albúmina

Endócrinopatías

Laparotomía

Exploradora

Linfoma Intestinal