Unintended Weight Loss Research Articles

Use of an Abbreviated Geriatric Screening Tool in the Assessment of Older Cancer Patients' Functional Status, Dependency, and Comorbidities: Cross-Sectional Audit and Observations From a Regional Cancer Center in Australia.

BackgroundMalignancies are the leading cause of disease burden in Australia, comprising 19% of total diseases. Approximately 1 in 4 men and 1 in 6 women die from malignancies by 85 years of age, with patients aged 65 years and older contributing to 58% of diagnoses and 76% of cancer mortality. In the context of malignancy-related disease and age-related degeneration, there is a need for comprehensive assessment of older patients to plan for appropriate management and predict prognosis. The utility of available comprehensive geriatric assessment tools has been limited in routine practice because of their time-consuming nature, despite their informing clearer understanding of patients’ functional status, better clinical decision making, prevention of unpredictable admissions and emergency department overload, and support services planning. Though there are several promising tools available, there is a lack of literature on tools that can comprehensively assess functional status in an expedited fashion.ObjectiveThis study aimed to document functional status and comorbidities among a geriatric oncology patient cohort attending a regionally located, dedicated cancer care facility, using the completed Adelaide tool assessments. This study documents cohort characteristics, including sociodemographics, malignancy type, and comorbidities. Secondarily, we observed the utility of an abridged functional assessment in the multidisciplinary team (MDT) management of older cancer patients.MethodsThe study comprised a facility-based cross-sectional audit of results obtained from a screening tool administered to patients aged 65 years and older and attending an outpatient medical oncology clinic for management of cancer from late 2015 to 2017. Data relating to five domains were collected, including instrumental activities of daily living, activities of daily living, performance status, unintended weight loss, and exhaustion. Sociodemographic and disease-related factors were summarized as frequencies with percentages or mean with SD. Distribution of functional status based on sociodemographic characteristics, living status, disease-related factors, and comorbidities was analyzed using a chi-square test. Cumulative dependencies in the five domains were identified, and patients were classified as fit, vulnerable, or frail. Supplementary review of presentation notes for cases discussed at MDT meetings was undertaken to identify discrepancies.ResultsA majority of the study population showed poor functional status, with 88.7% (243/274) categorized as vulnerable and 8.4% (23/274) as frail. Exhaustion and unintended weight loss were identified as the most common contributors to dependency. Polypharmacy was strongly associated with decreased functional status.ConclusionsThe outcomes of this study are congruent with the existence of dependency in various domains, and with similar research in geriatric oncology. The Adelaide tool provided a useful basis for MDT discussion and management, where cases were referred to the MDT. We recommend further examination of the tool’s utility and impact in clinical decision making, and the distribution of dependencies in a rural cohort compared with metropolitan patients.

Could Preoperative Unintended Weight Loss Predispose to Postoperative Thrombosis in Patients Undergoing Colorectal Cancer Surgery? An Analysis of the NSQIP Data

Objective: A significant portion of colorectal cancer patients lose weight preoperatively. Here we examine the influence of pre-operative significant weight loss on venous thromboembolism (VTE) risk and determine whether pre-operative BMI and albumin could influence VTE outcomes in patients who have lost significant weight prior to surgery.Methods: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and identified 103,455 colorectal cancer patients undergoing major surgery from 2008 to 2012. Patients were assigned to one of two groups based on whether they lost significant weight preoperatively or not. Simple and stepwise multiple logistic regressions were used to evaluate the association between pre-operative unintended weight loss and 30-days postoperative outcomes. The association between weight loss and postoperative thrombosis was further assessed across several strata.Results: The overall prevalence of pre-operative significant weight loss was 6.8%. Significant weight loss prior to surgery was significantly and independently associated with a higher risk of VTE (adjusted OR 1.23, 95% CI 1.06-1.44), mortality (adjusted OR 1.55, 95% CI 1.35-1.78), composite morbidity (adjusted OR 1.52, 95% CI 1.42-1.62), bleeding (adjusted OR 1.78, 95% CI 1.67-1.91) and return to operation room (adjusted OR 1.29, 95% CI 1.16-1.42). The effect of pre-operative significant weight loss on thromboembolic outcome was evident across patients with a BMI <18.5 kg/m2, 18.5 < BMI < 24.99 and BMI >40kg/m2.Conclusions: Significant weight loss and BMI both need to be measured preoperatively to stratify patients who are at a higher risk of VTE.

Korean frailty and aging cohort study (KFACS): cohort profile

PurposeThe purpose of the Korean Frailty and Aging Cohort Study (KFACS) is to initiate a nationwide, population-based prospective cohort study of older adults living in the community to assess their...

Unintended weight loss in hematology outpatients - Work to do

Malnutrition frequently occurs in hematology diseases and may threaten the course of treatment and patient outcomes. While screening for nutritional risk is often done in hospitalized patients, it is rarely described in the outpatient setting. Hematology patients are often followed in outpatient settings before hospitalization and for a longer time after. The primary aim of this study was to investigate the prevalence of nutritional risk measured by unintended weight loss within three months and reduced food intake within one week among patients in a hematology outpatient clinic. The second purpose was to investigate the two variables as a quick initial screening tool. All patients visiting the outpatient clinic within one week were invited to participate in this study, designed as a questionnaire-based cross-sectional study, consisting of nine questions. Descriptive statistical analyses, chi2 test and simple logistic regression analyses were performed. Of the 219 included patients, 23.7% had an unintended weight loss of mean 13.7% of body weight within the last three months and 13.2% had eaten less than usual within the past week. Patients who had significantly increased odds for unintended weight loss were >80 years of age [CI95%: 1274; 6084], patients visiting for examinations [CI95%: 1.105; 7.227], patients visiting for treatment [CI95%: 1.383; 6598] and patients visiting as part of a course of investigations [CI95%: 1.112; 34.184] as well as patients who had eaten less [CI95%: 2.731; 14.224]. Patients visiting the outpatient clinic for examination had significantly increased odds of having eaten less [CI95%: 1.783; 14.629]. Based on the statistical analyses, almost one fourth of the patients had a significant unintended weight loss, about 15% had reduced food intake and only 7.8% had both unintended weight loss and reduced food intake. These results indicate that unintended weight loss can be used as a quick screening tool to identify and detect patients at risk of malnutrition and that guidelines should be drawn up for managing patients at nutritional risk in hematology outpatient clinics.

Modification of systemic anti-cancer therapies and weight loss, a population-level real-world evidence study.

Background:Involuntary weight loss may occur during systemic anti-cancer therapy (SACT), causing treatment disruption and poorer prognoses. There remain gaps in clinical awareness as to which patients may benefit from nutritional interventions that aim to prevent unintended weight loss during SACT.We utilised England’s population-level cancer registry data, conducting a pan-cancer assessment of patient weight loss during SACT. We aimed to identify cancers with weight loss-associated treatment modifications, potential beneficiaries of nutritional intervention.Methods:This cross-sectional study used England’s Cancer Analysis System database, including SACT-treated adults with one tumour and ⩾2 weight recordings between 2014 and 2018. Binary weight loss (threshold: 2.5%) was derived from patients’ most negative weight change from first SACT weight recording. The Martin et al. body mass index-adjusted weight loss grading system (BMI-WLG) was assigned. We describe binary weight loss, BMI-WLG and treatment modification status by cancer. Multivariate logistic regression models of weight loss (binary and BMI-WLG) and a composite outcome of patient treatment-modification status by cancer were produced.Results:Our study population contained 200,536 patients across 18 cancers; 28% experienced binary weight loss during SACT. Weight loss patients were more likely to have multiple types of treatment modifications recorded across all cancers. Regression analyses included 86,991 patients. Binary weight loss was associated (p < 0.05) with higher likelihood of treatment modification in; colon [Odds Ratio (OR) = 1.72, 95% confidence interval (CI): 1.42, 2.07]; gynaecologic (excl. ovarian) (OR = 1.48, 95% CI: 1.08, 2.01); stomach (OR = 1.6, 95% CI: 1.04, 2.06); lung (OR = 1.38, 95% CI: 1.21, 1.58); leukaemia (OR = 1.30, 95% CI: 1.09, 1.55); head and neck (OR = 1.30, 95% CI: 1.02, 1.65) and oesophageal (OR = 1.29, 95% CI: 1.01, 1.64) cancers. In lung, colon, and grouped gastro-intestinal cancers, association between BMI-WLG and treatment modification increased by WLG.Discussion:Our study is a wide assessment of weight loss during SACT using England’s cancer registry data. Across different cancers we found patients have weight loss-associated treatment modifications during SACT, a precursor to poorer prognoses. Our findings highlight cancers that may benefit from improved nutritional intervention during SACT.

Maternal Under-Nutrition: A Concept Paper

There has been growing concern over maternal under-nutrition and its effects on pregnancy outcome. The term maternal under-nutrition is complex and rather ambiguous and fails to reflect a clear definition. Defining maternal under-nutrition will help improve diagnosis, monitoring and evaluation of the impact of under-nourishment in women to prevent associated birth outcomes. There is a direct link between maternal under-nutrition and undesired birth outcomes such as intrauterine growth restriction, pre-term labour and prematurity. This is likely to give rise to long lasting effects. Methodology Walker and Avant’s strategic eight-step method of concept analysis was used in analyzing the concept of maternal under-nutrition. Walker and Avant stress the importance of antecedents and attributes in describing a concept of interest. Literature search was done in one month using Google Scholar, Pub Med and Medline as search engines. Results There are several definitions of maternal under-nutrition available online which lacks standardization. The definition for maternal malnutrition was multi-varied in some instances, it was based on clinical evaluation yet in others it was based on BMI calculations and Mid Upper Arm Circumference. Conclusion Malnutrition is both seen in over-nutrition and under-nutrition. For the purpose of this paper we look at malnutrition as it relates to under-nutrition as it is of concern to less developed countries in particular southern Africa. Maternal under-nutrition is perceived to indirectly result in increased mortality and morbidities during the perinatal period. Maternal under-nourishment should be evaluated using BMI, Mid Upper Arm Circumference, skin fold and unintended weight loss for consecutive encounters using a standard scale.

Curcumin dietary supplementation ameliorates disease phenotype in an animal model of Huntington's disease.

Huntington's disease (HD) has traditionally been described as a disorder purely of the brain; however, evidence indicates that peripheral abnormalities are also commonly seen. Among others, severe unintended body weight loss represents a prevalent and often debilitating feature of HD pathology, with no therapies available. It correlates with disease progression and significantly affects the quality of life of HD patients. Curcumin, a naturally occurring polyphenol with multiple therapeutic properties, has been validated to exert important beneficial effects under health conditions as well as in different pathological settings, including neurodegenerative and gastrointestinal (GI) disorders. Here, we investigated the potential therapeutic action that curcumin-supplemented diet may exert on central and peripheral dysfunctions in R6/2 mice, a well-characterized HD animal model which recapitulates some features of human pathology. Maintenance of normal motor function, protection from neuropathology and from GI dysfunction and preservation of GI emptying and conserved intestinal contractility, proved the beneficial role of life-long dietary curcumin in HD and corroborated the potential of the compound to be exploited to alleviate very debilitating symptoms associated with the disease.

3092 A Clinically Confounding Presentation of Dysphagia With Multiple Valid Etiologies

INTRODUCTION: Dysphagia may result from a variety of different disease processes, including inflammation, infection, motility disorders, mechanical causes, or even functional. The etiology is less clear when a patient presents with multiple individual causes of dysphagia, each alone which may account for their symptoms. Our case report describes the coexistence of dysphagia due to several factors in a single patient, and a puzzling presentation warranting further evaluation to ultimately alleviate the underlying complaint. CASE DESCRIPTION/METHODS: We present a case of a 62-year-old female with a past medical history of hypertension that presented to her PCP with 6 months of weakness and limited oral intake. She endorsed issues swallowing and sensation of food stuck in her throat. Dysphagia to solids progressed to include liquids, and with nausea, vomiting, and 40 lbs unintended weight loss. The patient was admitted and failed bedside swallow study. Upper GI series and CT thorax showed hiatal and paraesophageal hernias. EGD revealed GE junction angulation from hernias, as well as esophagitis and gastritis. Manometry demonstrated weak swallows and sparse motility representative of a motility disorder. A gastric tube was placed for continued poor oral intake. She did not tolerate tube feeds, and gastric emptying study showed decreased emptying with marked GERD. EGD biopsies resulted and were consistent with eosinophilic esophagitis and H. pylori. She was prescribed triple therapy and started on PPI. She then had good symptom improvement and was discharged. At 6 week follow-up, the patient was able to tolerate oral intake and plans were initiated for gastric tube removal. DISCUSSION: Our patient exhibited numerous clinical findings that could account for her symptoms: esophageal herniations, eosinophilic esophagitis, H. pylori, an intrinsic motility disorder, and GERD. Though dysphagia has various etiologies, it is exceedingly rare for a single patient to display multiple simultaneous findings that might each individually explain their symptoms. Our case is unique in that the patient demonstrated sources from many different levels, yet given resolution with medication, likely originated from the primary eosinophilic esophagitis. Further investigation revealed the complexities of her case, and culminated in the eventual diagnosis, treatment, and symptomatic improvement. Our case also emphasizes the importance of thorough evaluation, as initial findings may be more complex than first realized.

AIDS and epilepsy

Sudan shares extensive borders with seven countries several of which have high (HIV/AIDS) prevalence. HIV is a virus belong to the family retroviridea and its infection causes profound immune suppression. AIDS is a late symptom of the infection and is associated with an unintended weight loss. This study investigates the presence of epilepsy among Sudanese AIDS patients. This is a descriptive cross sectional hospital based study which was carried out at Khartoum state hospitals during the period March 2007 to November 2017 and 700 AIDS patients were included in this study. Out of the 700 Sudanese AIDS patients almost 5.71% had epilepsy and 50% of them had generalized convulsions. Encephalitis was found to be the commonest cause of epilepsy followed by meningitis, brain abscess, CNS lymphoma and toxoplasmosis. The EEGs showed abnormal discharge in 28 patients (70%). AIDS is a great mimicker. It can present in almost any neurological manifestation. Epilepsy is not an uncommon neurological manifestation associated with AIDS.

2687 A Rare Case of Organoaxial Volvulus of the Stomach

INTRODUCTION: Gastric volvulus is an uncommon and potentially life-threatening clinical entity characterized by rotation of the stomach along its long or short axis provoking variable degrees of gastric outlet obstruction. Clinical presentation varies between acute and chronic volvulus. Here we present a rare case of chronic organoaxial volvulus presenting with dysphagia. CASE DESCRIPTION/METHODS: The patient is an 87 year old male with a medical history of hypertension, obstructive sleep apena, multi-nodular goiter (with thyroid resection resulting in vocal cord paralysis) who was referred to the gastroenterology clinic for dysphagia. The patient states he had dysphagia to solids for one year. The patient denied associated nausea, vomiting, hematemesis, hematochezia, constipation or unintended weight loss. Complete blood count and comprehensive metabolic panel at that time were unremarkable. Physical exam was also unremarkable. Given his symptoms a barium swallow was ordered to further evaluate his gastrointestinal tract. This was done and showed no evidence of esophageal obstruction or esophageal mass, but did incidentally find organoaxial rotation of the stomach. The patient was scheduled to undergo upper esophagogastroduodenoscopy, but was non-compliant with the appointment and lost to follow up. DISCUSSION: Acute gastric volvulus usually presents with sudden onset abdominal or chest pain, severe retching with occasional vomiting, and epigastric distention. Chronic gastric volvulus on the in contrast can present with a complete absence of symptoms to non- specific symptoms, such as abdominal pain, dyspepsia, dysphagia, acid reflux, nocturnal cough, hiccups, non-bilious vomiting, weight loss, and anemia. Diagnosis of gastric volvulus is conventionally achieved with chest radiograph, upper barium studies or CT- scan. Regardging treatment of acute symptomatic gastric volvulus, nasogastric decompression is usually the first step, followed by surgery. Some patients at high risk for surgery, mainly elderly, can also be treated endoscopically with adequate decompression and reduction of the stomach and placement of a gastrostomy tube to gastropexy the stomach to the abdominal wall.

2378 Hepatic Actinomycosis Masquerading as Gastrointestinal Malignancy

INTRODUCTION: Abdominal actinomycosis is a rare cause of liver cysts and rectal masses. It remains a diagnostic challenge. CASE DESCRIPTION/METHODS: A 60 year-old male (patient L) presented with a rectal mass found on colonoscopy. Biopsies were inconclusive; however, staging CT demonstrated liver lesions presumed to be metastases from rectal carcinoma. The patient began to have recurrent fevers, night sweats, and unintended weight loss, prompting an extensive infectious work-up notable only for a positive quantiferon. In the interim, patient L underwent laparoscopy and liver biopsy to further evaluate his presumed malignancy. Frozen sections revealed caseating granulomas with negative AFB and stains. The patient was diagnosed with GI tuberculosis (TB) based on constitutional symptoms, positive quantiferon, and frozen section findings, and was started on standard four-drug therapy. Final pathology resulted in visualization of sulfur granules, diagnostic of actinomycosis. TB treatment was discontinued and augmentin was started for a 6 month course. DISCUSSION: Actinomyces colonizes the oropharynx and digestive and genital tracts. It infrequently causes disease. Abdominal infection accounts for 20% of actinomycoses; of these, only 15% report liver involvement. Infection is associated with compromise of the mucosal barrier, either due to instrumentation or appendicitis. Our patient had recently undergone colonoscopies to diagnose his rectal mass. As in Patient L, actinomycotic liver abscesses usually present with an indolent course; symptoms include insidious abdominal pain, fever, and weight loss. Although these symptoms may be associated with malignancy, fever even in cancer patients should be presumed infectious until proven otherwise. Imaging commonly shows loculated cysts in contrast to patient L’s simple cysts with no loculations. The signs, symptoms, and radiographic findings of abdominal actinomycosis are non-specific and indistinguishable from colorectal cancer, inflammatory bowel disease, and gastrointestinal TB, making diagnosis difficult. In one review, laparotomy was considered essential for diagnosis in 69% of cases; pre-operative diagnosis rate was less than 10%. Treatment generally involves 6-12 months of beta-lactams. In summary, GI actinomycosis poses a diagnostic challenge as it is a rare clinical entity with nonspecific symptoms and endoscopic and radiographic findings. Successful diagnosis often requires a collaborative, multi-disciplinary approach. Treatment is with prolonged antibiotics.

722P - It’s not only about weight loss: Tackling pancreatic cancer-associated cachexia

BackgroundCachexia affects 70-80% patients with pancreatic adenocarcinoma (PA). Systemic inflammation is a key feature of this multifactorial syndrome of unintended weight loss (WL). Despite being often described, cancer-associated cachexia (CAC) remains poorly understood and rarely recognized in clinical settings, therefore an unmet need. This study aims to acknowledge the effect of CAC in PA patients and to study the impact of WL, body mass index (BMI) and other available biomarkers (BM) on survival. MethodsRetrospective analysis of PA patients treated in our institution between 2013 - 2018. Patients were categorized at baseline as having CAC if 1 of 2 criteria were met: WL>5% from previous stable weight; BMI < 20kg/ m2 and ongoing WL>2%. Serum hemoglobin, c-reactive protein (CRP), albumin, inflammation-based score (Glasgow Prognostic Score mGPS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and cancer specific antigen CA 19-9 were assessed at baseline and at 3-month. Data analysis with descriptive statistics, t-test, chi-square test, cox regression and log-rank test were performed with StataIC. Results95 eligible patients (median age 72 [46;98], 60% female) were reviewed. At baseline, cachectic patients (CP) (74%), when compared to non-CP, had higher CA 19-9 (p=0,047), more advanced disease (p=0,001) lower BMI (p=0,016), worse performance status (p=0,016) and mean WL of 13,8 ± 6,7 (%) (p=0,001). Also, NLR>3,5 (p=0,001), PLR>150 (p=0,018) and hypoalbuminemia (p=0,004) were all statistically associated to CP. Median overall survival (OS) of non-CP was 19,13 months versus 5,03 months in CP (HR 2,69 95% CI 1,58-4,59, p=0,001). In the latter, at baseline, higher CA 19.9 (HR 1,0 95% CI 1,01-1,021, p=0,015), higher CRP (HR 1,21 95% CI 1,06-1,39, p=0,006) and PLR>150 (HR 2,45; 95% CI 1,09-5,54, p=0,031) were independent predictors of worst OS. In non-CP, normal baseline albumin (HR 0,04 95CI 0,02-0,72, p=0,029) was an independent predictor of better OS. ConclusionsA better understanding of CAC in PA might improve outcomes for PA patients. Our study suggests that a prompt identification of prognostic BM may lead to a better standardized management of CAC and that nutritional parameters can be optimized, with impact on prognosis. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Do two measures of frailty identify the same people? An age-gender comparison.

Most frailty assessments have been developed for people aged over 65 years. However, there is growing evidence that frailty is detectable in younger people. This paper tests the hypothesis that the Fried frailty phenotype and the CFS categories identify the same people in age-gender subgroups in community-dwelling 40 to 75-year-olds. Participants were recruited via comprehensive community-sampling strategies. They self-reported frailty using the Clinical Frailty Scale (CFS), and frailty was also estimated using the Fried phenotype (self-reported unintended weight loss, exhaustion and low regular exercise; observed slow gait speed and poor grip strength). CFS and Fried scores were compared overall, and for age-gender subgroups (40-49 years, 50-59 years, 60-69 years, and 70-75 years). Spearman rho and differences in mean integer Fried scores were calculated across CFS categories using ANOVA. Correlations were determined between Fried categories of not-frail, pre-frail, and frail and ranked CFS categories, using ranked scores (tau-c) and Cochran-Mantel-Haenszel (C-M-H) tests. Of 656 participants (67% female; mean age 59.9 years, SD 10.6), Fried phenotype classified 59.2% not frail, 39.0% pre-frail, and 1.8% frail, with no gender or age differences. CFS data were missing for 25 participants, with N = 631 reporting categories of very well (24.6%), well (44.6%), managing well (21.9%), vulnerable (6.3%), mildly frail (0.5%), and moderately frail (0.2%). Overall, the mean Fried frailty scores increased incrementally and significantly across ranked CFS categories (P < .01), with weak linear correlation (rho = 0.09). There were variable correlations in age-gender groups, with the best correlation found for women aged 50 years or older, and men aged 60 to 69 years. Frailty assessments using the two assessments became more consistent, as age increased. Pre-frailty was identified by both assessments in all age-gender groups. The validity of self-reported CFS, and of pre-frailty criteria relevant to people younger than 65 years, needs investigation.

Attitudes to and experiences with body weight control and changes in body weight in relation to all-cause mortality in the general population.

Background and aimsIncreased body mass index (BMI = weight/height2; kg/m2) and weight gain is associated with increased mortality, wherefore weight loss and avoided weight gain should be followed by lower mortality. This is achieved in clinical settings, but in the general population weight loss appears associated with increased mortality, possibly related to the struggles with body weight control (BWC). We investigated whether attitudes to and experiences with BWC in combination with recent changes in body weight influenced long-term mortality among normal weight and overweight individuals.Population and methodsThe study population included 6,740 individuals attending the 3rd cycle in 1991–94 of the Copenhagen City Heart Study, providing information on BMI, educational level, health behaviours, well-being, weight half-a-year earlier, and answers to four BWC questions about caring for body weight, assumed benefit of weight loss, current and past slimming experiences. Participants reporting previous unintended weight loss (> 4 kg during one year) were excluded. Cox regression models estimated the associations of prior changes in BMI and responses to the BWC questions with approximately 22 years all-cause mortality with age as ‘time scale’. Participants with normal weight (BMI < 25.0 kg/m2) and overweight (BMI ≥ 25.0 kg/m2) were analysed separately, and stratified by gender and educational level, health behaviours and well-being as co-variables.ResultsCompared with stable weight, weight loss was associated with significantly increased mortality in the normal weight group, but not in the overweight group, and weight gain was not significantly associated with mortality in either group. Participants with normal weight who claimed that it would be good for their health to lose weight or that they were currently trying to lose weight had significantly higher mortality than those denying it. There were no other significant associations with the responses to the BWC questions in either the normal weight or the overweight group. When combining the responses to the BWC questions with the weight changes, using the weight change as either a continuous or categorical variable, there were no significant interaction in their relation to mortality in either the normal weight or the overweight group.ConclusionAttitudes to and experiences with BWC did not notably modify the association of changes in body weight with mortality in either people with normal weight or people with overweight.

Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation.

Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.

MON-LB063 Pheochromocytoma Presenting as Fulminant Renal Failure with Hemolytic Anemia in a Young Male

Background Pheochromocytoma is a rare catecholamine-secreting tumor of the adrenal chromaffin cells. Historically, these tumors have been described by the classic triad of paroxysmal tachycardia, diaphoresis and headaches in the setting of uncontrolled hypertension. However, most patients do not manifest with these typical symptoms; usually uncontrolled hypertension is their only sign. Rarely pheochromocytoma may present with dramatic multiorgan damage. Case A 31-year-old male presented with progressive epigastric pain of two weeks duration. He had associated nausea, non-bloody diarrhea, and unintended weightloss of eight pounds. His only medical history was a remote isolated episode of pancreatitis. Physical exam was positive for hypertension,with a blood pressure of 223/142 mm Hg, inappropriate somnolence and moderate epigastric tenderness. Lab work revealed leukocytosis (12.2x109 /µL, n<10), normocytic anemia (Hb 7.8g/dL, n=14-17), thrombocytopenia (100 x109/L, n=150-450) deranged renal function (BUN 124 mg/dL, n< 20, creatinine 21.6mg/dL, n< 1.3), proteinuria (>= 500 mg/dL, n<20), mild hematuria with metabolic acidosis (pH of 7.25 and anion gap of 20). Noncontrast CT of the abdomen demonstrated acute colitis, and a left adrenal mass measuring 4.4 x 4.4 x 4.5 cm. Blood pressure was controlled using IV Nicardipine infusion and he was prepared for hemodialysis. His anemia worsened, and blood work favored microangiopathic hemolytic anemia. His stay was further complicated by acute respiratory failure warranting intubation, during a session of hemodialysis. Chest radiograph suggested possible ARDS or pulmonary edema as cause for respiratory distress. An evaluation for secondary causes of hypertension suggested pheochromocytoma. While they could be elevated due to the stress of the situation, his plasma metanephrines (153 pg/ml, n<57) and normetanephrines (1197 pg/ml, n<148) were significantly elevated to suggest the diagnosis of pheochromocytoma presenting as hypertensive emergency. He underwent an MRI of the abdomen which further characterized the adrenal lesion. Once he was stabilized, he was transferred to a tertiary center for evaluation of tumor resection. Conclusion This is a very rare case of pheochromocytoma in a previously healthy individual, presenting with malignant hypertension, hemolytic anemia and renal failure. This case also highlights the clinical relevance of plasma metanephrines and plasma catecholamines, as well as the image phenotype when diagnosing pheochromocytoma in a patient with this process. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Body composition changes after left gastric artery embolization in overweight and obese individuals.

To determine the effects of left gastric artery embolization (LGAE) on computed tomography (CT) body composition change. Sixteen overweight or obese patients who had abdominal CT scans before and after LGAE for gastric bleeding were retrospectively reviewed. Body composition analysis was performed with semiautomated imaging processing algorithms (MATLAB 13.0, Math Works, MA). Adipose tissue and lean skeletal muscle were measured using threshold attenuation values. Total body fat index (BFI), subcutaneous fat index (SFI), visceral fat index (VFI), intramuscular fat index (IMFI), and skeletal muscle index (SMI) were determined ([tissue area (cm)]2/[height (m)]2). Excess body weight (EBW) was determined based on the Lorentz formula for ideal body weight. Mean follow-up was 1.5 ± 0.8months. Following LGAE, patients experienced significantly decreased body weight (p = 0.003), BMI (p = 0.005), EBW (p = 0.003), BFI (p = 0.03), SFI (p = 0.03), and SMI (p < 0.001). Changes in VFI and IMFI did not significantly change (p = 0.13 and p = 0.83, respectively). Patients who underwent LGAE had significant unintended weight loss as a result of decreased body fat and skeletal muscle. Body composition analysis can readily assess the extent of fat loss and identify muscle wasting.

Let’s talk about unintended weight loss in older people

Let’s talk about unintended weight loss in older people

P001 CHARACTERIZING CURRENT TREATMENT AND GAPS IN THE INFLAMMATORY BOWEL DISEASE POPULATION IN A LARGE INTEGRATED HEALTHCARE SYSTEM IN NORTHERN CALIFORNIA

Crohn’s disease (CD) and ulcerative colitis (UC), two major types of inflammatory bowel disease (IBD), affect as many as 1.6 million Americans. IBD is a chronic relapsing illness, where effective and efficient care requires seamless coordination of primary care providers, gastroenterologists, and caretakers, coupled with engaged and activated patients. We sought to understand the IBD patient population, to identify gaps in care, and ultimately develop a foundation for personalized patient care by analyzing patient characteristics, symptoms, and medications over a 5-year period using Electronic Health Record (EHR) data from a large integrated healthcare system in Northern California. All adult primary care (PC) patients who had one or more diagnoses of CD (ICD-9 555/ICD-10 K50) or UC (ICD-9 556/ICD-10 K51) associated with outpatient office visit or hospitalization encounters were identified as possible IBD cases. We defined incident-IBD care as first IBD-coded encounter occurring at least 270 days after the first PC encounter. We categorized IBD medications into 4 groups: 5-Aminosalicyclic-Acid (5-ASA) (G1), Steroids (G2), immunomodulators (G3), and biologics (G4). We used descriptive statistics to describe how symptoms and IBD-specific medications varied among those incident cases during pre- and post-diagnosis periods. Among 1,444,711 adult PC patients, 4009 (0.3%) were coded as CD, 5873 (0.4%) as UC, and 479 (5%) of these were coded as both. We identified 728 and 1139 patients as incident CD and UC cases, respectively. Tables 1-2 display demographic characteristics for all IBD patients and incident IBD patients, respectively. 48% of incident IBD patients (CD/UC) had at least one of the 5 common IBD symptoms (diarrhea, abdominal pain/cramping, blood in stool, unintended weight loss, reduced appetite) indicated by ICD diagnosis codes in the EHR prior to the IBD diagnosis. However, among those who had at least 2 encounters with IBD diagnosis codes, only 5% of incident CD patients and 8% of incident UC patients still had at least one of the 5 symptoms recorded at their 2nd visit after IBD diagnosis. Approximately 1/4 of incident IBD patients had orders placed for IBD-specific medications on or after diagnosis over a mean 32-month period as follows: CD cases: G1-10%, G2-5%, G3-5%, G4-5%; UC cases: G1-21%, G2-4%, G3-4%, G4-2%. Similar to many published US estimates, we identified more UC than CD in our healthcare system. Nearly half of incident IBD patients had documented symptoms at diagnosis, but symptoms were not reported at follow-up in most cases. Only a quarter received orders for IBD-specific drugs, with 5-ASAs the most commonly prescribed medication for both conditions. Future work includes further understanding why medication orders are lower than expected and the reasons behind this potential gap in care.

Perceptions of What Is Important for Appetite-An Interview Study With Older People Having Food Distribution.

The proportion of older people in the population increases and more and more continue living in their own homes. Appetite among the elderly people is important to their nutrition and health. The increased risk of unintended weight loss and malnutrition is linked to food distribution among home-living elderly people. The aim was to describe experiences and perceptions of what matters to appetite among home-living elderly people having food distribution. The design was qualitative where interview data were collected among 13 interviewees in 2017 to 2018. Data were analyzed using qualitative content analysis. The results are presented in three domains: the food, the meal situation, and the adaptation to meal service with categories and themes responding to each domain. The six themes related to appetite among the elderly people concerned the following: eating tasty, savory, and culturally adapted food; eating healthy and sustainable food; eating alone or together with others; eating in a pleasant meal environment; having choices to make about the meal; and last, accepting disabilities and increased dependency. One conclusion is that many aspects should be taken into consideration when promoting appetites of people who also get food distribution. It is highly individual and an understanding of which aspects are relevant must be considered; consequently, person-centered care is suggested to promote appetite.