Failure to Thrive
Definition and Management
The National Institute of Aging described FTT as a "syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol"
Many recommend against using this term as it discourages a thorough evaluation
4 Syndromes are commonly associated FTT: impaired physical functioning, malnutrition, depression, and cognitive impairment, each of which has poor prognostic value
Frailty, one component of FTT, has been defined by several societies for research purposes
For example, the Study of Osteoporotic Fractures, defines Frailty as at least 2/3 criteria:
* Weight loss of 5 percent or more over two years
* Inability to stand from a chair five times without using arms to push up
* Negative response to the question "Do you feel full of energy?
Weight Loss is concerning when it is >5% body weight in </= 1 yr
Recall that optimal BMI in the elderly is 25-29; those with BMI <22 have adverse outcomes
In case series of inpatients with FTT, malignancy is the most likely diagnosis
See attached table for an extensive list of diagnoses in pt admitted with FTT
In a study of elder Veterans, cancer was the most common underlying diagnosis (30%)> infection (18%), dehydration (13%), and depression (12%)
Approach to FTT should include:
Thorough History including social, medication, functional history
Assessing for Depression and Elder abuse are essential
Physical should evaluate for lympadenopathy and include hearing, visual and neuro exams
Labs and imaging should be guided by H & P
Most agree with the following in all patients with FTT:
* CBC with differential
* CMP
* Urinalysis
* Calcium, phosphate
* TSH
* Vitamin B12 and folate
* Albumin and total cholesterol (markers of malnutrition)
* 25 (OH) vitamin D
*CXR to detect occult infections or malignancy
*ECG to detect ischemia, arrhythmia
Other:
ESR/CRP may be helpful in diagnosing PMR
RPR if history suggests
(Ellen Eaton MD, 12/7/10)