Unplanned Weight Loss (Crazy Theory)

[mcaslin]

My father started this year weighing 270 pounds.  He went all the way down to 198 or so while still eating HUGE amounts of scrambled egg whites, turkey sausage links and taking in a lot of powdered protein shakes.  I took him to see 5 different doctors to try to explain the weight loss and nobody could suggest anything that made sense.  Then I found an Internet story about how some older people (my father is 74) with kidney failure reach a point where their bodies cannot process or take in protein any more, which leads to catabolization, which leads to severe/total muscle loss.  My father can barely walk, now, and his legs look like sticks.  He's managed to put weight back on, but only by eating cookies and junk food.  Has anyone else experienced/heard of this sudden involuntary weight loss associated with an inability to process protein?

[obsidianom]

Notice they mention unexplained weight loss in this abstract . It obviously can happen. He should be completely worked up for any other issues. Talk to his nephrologist/.

Hemodial Int. 2013 Oct 9. doi: 10.1111/hdi.12098. [Epub ahead of print]

Correlates of ADL difficulty in a large hemodialysis cohort.

Kutner NG, Zhang R, Allman RM, Bowling CB.


Source

United States Renal Data System, Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, Georgia, USA.


Abstract


Needing assistance with activities of daily living (ADL) is an early indicator of functional decline and has important implications for individuals' quality of life. However, correlates of need for ADL assistance have received limited attention among patients undergoing maintenance hemodialysis (HD). A multicenter cohort of 742 prevalent HD patients was assessed in 2009-2011 and classified as frail, prefrail and nonfrail by the Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity). Patients reported need for assistance with 4 ADL tasks and identified contributing symptoms/conditions (pain, balance, endurance, weakness, others). Nearly 1 in 5 patients needed assistance with 1 or more ADL. Multivariable analysis showed increased odds for needing ADL assistance among frail (odds ratio [OR] 11.35; 95% confidence interval [CI] 5.50-23.41; P < 0.001) and prefrail (OR 1.93; 95% CI 1.01-3.68; P = 0.046) compared with non-frail patients. In addition, the odds for needing ADL assistance were lower among blacks compared with whites and were higher among patients with diabetes, lung disease, and stroke. Balance, weakness, and "other" (frequently dialysis-related) symptoms/conditions were the most frequently named reasons for ADL difficulty. In addition to interventions such as increasing physical activity that might delay or reverse the process of frailty, the immediate symptoms/conditions to which individuals attribute their ADL difficulty may have clinical relevance for developing targeted management and/or treatment approaches.

[obsidianom]

Here is an article that mentions catabolism directly , so it is not far fetched. Sorry to see it happen to him.

Prevalence of protein-energy wasting syndrome and its association with mortality in haemodialysis patients in a centre in Spain.

 [Article in English, Spanish]

Gracia-Iguacel C, González-Parra E, Pérez-Gómez MV, Mahíllo I, Egido J, Ortiz A, Carrero JJ.


Source

Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain. CGraciaI@fjd.es


Abstract


INTRODUCTION:

Malnutrition has been described in patients with chronic kidney disease as well as its association with cardiovascular risk and mortality in haemodialysis patients. Recently, the new term "protein energy wasting" has been proposed with new diagnostic criteria (biochemical and anthropometric markers) for early identification of patients at risk for protein energy wasting and mortality. The aim of this study was to examine the prevalence, evolution over time and prognostic significance of PEW in a Spanish dialysis centre for the first time in Spain.

PATIENTS AND METHODS:

an observational study that included 122 prevalent haemodialysis patients at our centre. Between January 2010 and October 2012, three visits were carried out in which clinical, biochemical, anthropometric and body composition parameters were collected using BIS (bioelectrical impedance spectroscopy) along with their respective dialytic characteristics, in accordance with the criteria of the new definition. We analysed the prevalence of PEW in each visit, progression of the malnutrition parameters and factors potentially associated with PEW. After a mean follow-up period of 461 days, we analysed survival. Statistical analysis was performed using the R software.

RESULTS:

The prevalence of PEW remained constant over time: 37% at baseline visit, 40.5% at 12 months and 41.1% at 24 months. With the introduction of the dynamic variable muscle mass loss, included in the definition of PEW, prevalence increased to 50% at 24 months. The PEW situation is dynamic, as demonstrated by the fact that 26%-36% of patients without PEW develop it de novo each year and 12%-30% annually recover from this situation. The presence of PEW was associated with higher rates of resistance to erythropoietin (irEPO) and higher pulse pressure at the end of dialysis. In the multivariable regression model, PEW predictive clinical variables were over-hydration, irEPO, intracellular water and the extracellular water/intracellular water ratio. Twenty-six (21%) patients died. The Kaplan-Meier curve did not show any differences in mortality risk between patients with and those without PEW, but the loss of muscle mass was associated with increased mortality.

CONCLUSION:

The present observational study highlights the high prevalence of PEW, which has a dynamic nature in haemodialysis patients. Only the criterion of muscle mass loss (increased protein catabolism) was associated with increased mortality, while the other PEW criteria according to the ISRNM classification were not associated with increased mortality. We also observed a state of over-hydration in patients with PEW. This state of over-hydration (increased extracellular water due to occupation of muscle loss without an increase in total body water) cannot be evaluated by dry weight or the body mass index. Intervention studies are necessary in order to assess whether or not the prevention of sarcopaenia improves survival.


PMID: 23897181 [PubMed - in process] Free full text


Publication Types

[mcaslin]

Thanks for the info, Obsidianom.  Yeah we've been to two nephrologists and several other doctors;  most of them came up with the 'he's expending too much energy just breathing' as an explanation for the weight loss.  Our faith in the nephrologists' medical opinions is not high, to say it nicely.  I noticed in the report that you posted;  the one that came from Spain, mentioned that '12%-30% annually recover from this situation'.  I wonder how those patients recovered?  Is there any other way for someone to add muscle if the protein isn't being absorbed?  My father is still taking in about 130 grams of protein a day, and still he's shriveling up.  Thanks for your help!

[obsidianom]

I thought of this and decided to look for any info on it. I know testosterone can be used to build muscles so I found this article. Its worth asking the doctor about it. They mentioned renal disease .

 
Therapeutic effects of anabolic androgenic steroids on chronic diseases associated with muscle wasting.

Woerdeman J, de Ronde W.


Source

VU University Medical Center, Department of Endocrinology, de Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands.


Abstract


INTRODUCTION:

A variety of clinical conditions are complicated by loss of weight and skeletal muscle which may contribute to morbidity and mortality. Anabolic androgenic steroids have been demonstrated to increase fat-free mass, muscle mass and strength in healthy men and women without major adverse events and therefore could be beneficial in these conditions.

AREAS COVERED:

This review provides an overview of clinical trials with anabolic androgenic steroids in the treatment of chronic diseases including HIV-wasting, chronic renal failure, chronic obstructive lung disease, muscular disease, alcoholic liver disease, burn injuries and post operative recovery. Relevant studies were identified in PubMed (years 1950 - 2010), bibliographies of the identified studies and the Cochrane database.

EXPERT OPINION:

Although the beneficial effects of AAS in chronic disorders are promising, clinically relevant endpoints such as quality of life, improved physical functioning and survival were mainly missing or not significant, except for burn injuries. Therefore, more studies are needed to confirm their long term safety and efficacy.