Ask The Experts

Warning signs of unexplained weight loss

Q I am over 68 years old and I have lost about 4kg in four months.

I had been exercising on the stationary bicycle about five times a week for a few weeks and also did some springcleaning before the weight loss.

I did a computed tomography (CT) scan and it showed hepatic cysts and calcified granuloma. No suspicious lesion was seen in the thorax, abdomen and pelvis.

Is my sudden weight loss due to liver lesions? What are these lesions caused by and do they need to be investigated further?

A In general, there are multiple factors that lead to weight changes, more so for people who are older.

An older person who loses 4kg in four months should be investigated and monitored closely, especially if your weight had been quite consistent previously. The increase in activity level may not be the sole cause of the weight loss.

Some considerations are one's calorie intake, activity level, overall health and nutrient absorption, as well as economic and social factors.

Hence, any changes in body weight should not be attributed to a single contributing factor.

The point at which unexplained weight loss becomes a medical concern is not exact.

But many doctors agree that a medical evaluation is called for if you lose more than 5 per cent of your weight in six months to a year, especially if you are an older adult.

Unexplained weight loss has many causes, both medical and non-medical.

An older person who loses 4kg in four months should be investigated and monitored closely, especially if your weight had been quite consistent previously. The increase in activity level may not be the sole cause of the weight loss.

There are some warning signs to look out for when it comes to weight loss in the elderly.

•Depression: Sudden weight loss can be associated with depression, social withdrawal or losing the will to live.

•Loss of smell and taste: As people age, there is a tendency to lose certain senses which can be exacerbated by medication or disease, and can result in anorexia.

•Poor dentition: This can cause difficulty in chewing and swallowing food.

•Constipation: This can be the result of a diet that is lacking adequate nutrients and fluids, a common complaint that causes an uneasy stomach.

•Loss of appetite: A sudden disinterest in food is a concern, whether as a result of chewing problems or disease.

•Bleeding: The incidence of lower gastrointestinal bleeding increases with age and needs to be monitored.

•Unexplained fevers: Fever generally indicates the presence of serious infection, often caused by bacteria.

There are many causes of lesions (masses, growths) in the liver. Most are non-cancerous and usually need no specific treatment.

However, it is important to seek advice to differentiate the cause.

Liver cysts occur in approximately 5 per cent of the population. However, only about 5 per cent of these patients develop symptoms.

In general, cysts are thin-walled structures that contain fluid. Most people have a single cyst, although some may have several.

The symptoms associated with liver cysts include upper abdominal fullness, discomfort or pain.

A small number of patients bleed into the cyst, which causes sudden and severe right upper quadrant and shoulder pain. The bleeding should stop naturally and the pain should lessen over the next several days.

Liver cysts do not impair the liver's ability to function.

Simple liver cysts are usually benign. Patients who require treatment are those who develop symptoms.

Simply removing the fluid from the cyst with a needle is not effective because the cyst will fill up again within several days.

The best treatment is to remove a large portion of the cyst wall. Most patients recover fully within two weeks and the risk of the cyst recurring is very low.

Dealing with unintentional weight changes and other health complications require more than just health interventions.

Holistic emotional and psychological support are important to sustain an older person's motivation to stay healthy.

It is important to eat a balanced diet, stay active, take supplements when necessary and go for regular check-ups.

Dr Carol Tan

Senior consultant geriatrician at The Good Life Medical Center at Mount Alvernia Hospital

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A version of this article appeared in the print edition of The Straits Times on July 26, 2016, with the headline 'Warning signs of unexplained weight loss'. Print Edition | Subscribe