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Decreased appetite

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Decreased appetite, also known as anorexia, refers to a reduction in the desire to eat. It is a non-specific symptom that may be associated with a variety of underlying causes.

Clinical Features

Weight Loss: Unintentional weight loss may accompany a loss of appetite, indicating malnutrition.
Fatigue:Poor energy and reduced function due to inadequate caloric intake.
Symptoms Related to Underlying Cause: For example, abdominal pain or nausea in gastrointestinal disorders, fever in infections, or depressive symptoms in psychological disorders.

Diagnostic Approach

History: A thorough history of the onset, duration, associated symptoms (e.g., pain, nausea, vomiting), and any medications or recent illnesses.
Physical Examination: Assess for signs of malnutrition (weight loss, muscle wasting), abdominal tenderness, or neurological deficits.
Laboratory Tests:
- Full blood count (FBC) for infection or anaemia.
- U&E, Calcium, Phosphate, Magnesium.
- LFTS, TFTs, Coeliac screen, Blood glucose, HbA1c for diabetes.
Imaging:
- Abdominal USS/CT scan if pathology is suspected.
- CXR: TB, tumour, fibrosis.
Psychological Evaluation: Screening for depression, anxiety, or eating disorders, particularly in adolescents or those with weight loss.

Common Causes

Cause	Clinical Features	Diagnostic Tests	Management
Gastrointestinal Disorders	Abdominal pain, bloating, nausea, vomiting Symptoms due to gastritis, peptic ulcer disease, gastroenteritis, inflammatory bowel disease (IBD)	Upper endoscopy for gastritis or ulcers Stool tests for infection (e.g., gastroenteritis) Abdominal USS or CT scan for IBD or Malignancy	Treat underlying condition (e.g., antibiotics for infections, PPI for ulcers/GORD) Hydration and electrolyte balance for gastroenteritis Nutritional support in severe IBD
Infections	Fever, malaise, systemic symptoms (e.g., viral or bacterial infections such as influenza, tuberculosis, or hepatitis)	FBC: elevated white blood cells (WBC) indicating infection Blood cultures, viral serology, or specific pathogen tests Chest X-ray or sputum test for tuberculosis	Antibiotics or antivirals for the specific infection Supportive care: hydration, antipyretics for fever
Psychological Disorders	Depression, anxiety, stress, or eating disorders like anorexia nervosa Symptoms may include low mood, insomnia, weight loss, or extreme dieting	Psychological evaluation Screening tools for depression (e.g., PHQ-9) or eating disorders	Cognitive behavioral therapy (CBT) or counseling Medications: SSRIs for depression or anxiety Nutritionist referral for eating disorders
Medications	Loss of appetite as a side effect of medications such as antibiotics, iron tablets, chemotherapy, opioids, metformin or stimulants	Review medication history	Consider switching/stopping or adjusting medications Symptomatic treatment for nausea or vomiting
Metabolic and Endocrine Disorders	Fatigue, weight loss, changes in appetite, and symptoms of the underlying metabolic disorder (e.g., hypothyroidism, diabetes, adrenal insufficiency)	TFTs, Blood glucose or HbA1c Cortisol levels (for adrenal insufficiency)	Treat e.g., thyroxine for hypothyroidism, medications/insulin for diabetes
Malignancy	Weight loss, fatigue, persistent loss of appetite, and other cancer-specific symptoms (e.g., abdominal mass, night sweats). Renal cancer, pancreatic cancer, gastric cancer, lymphomas etc.	CBC, tumour markers CT or MRI imaging to locate tumours Biopsy for definitive diagnosis	Chemotherapy, radiation therapy, or surgical intervention depending on the type and stage of cancer Appetite stimulants (e.g., megestrol acetate) Palliative care for advanced cancer
Chronic Conditions	Chronic liver disease, chronic kidney disease, heart failure Symptoms may include nausea, vomiting, fatigue, and edema	Blood tests (renal function, liver function tests) Imaging (ultrasound, CT scan)	Treat underlying condition (e.g., diuretics for heart failure, dialysis for kidney disease) Nutrition support and electrolyte management
Neurological Conditions	Stroke, dementia, or Parkinson’s disease affecting the brain's hunger centers May present with cognitive decline, difficulty swallowing, or reduced food intake	Neurological examination CT or MRI to assess brain structure	Supportive care (e.g., feeding assistance, nutritionist consultation) Management of the underlying neurological disorder

A very comprehensive list

Category	Causes
Medications and Toxic Etiologies	Cancer chemotherapy Analgesics Cardiovascular medications: Digoxin Antiarrhythmics Antihypertensives (β-blockers, Calcium-channel antagonists) Hormonal preparations/therapies: Oral antidiabetics Oral contraceptives Antibiotics/antivirals: Erythromycin Tetracycline Sulfonamides Antituberculous drugs Acyclovir Gastrointestinal medications: Sulfasalazine Azathioprine Nicotine CNS active drugs: Narcotics Antiparkinsonian drugs Anticonvulsants Radiation therapy Ethanol abuse
Disorders of the Gut and Peritoneum	Mechanical obstruction: Gastric outlet obstruction Small bowel obstruction Functional gastrointestinal disorders: Functional dyspepsia Chronic idiopathic nausea Cyclic Vomiting Syndrome Idiopathic vomiting Non-ulcer dyspepsia Irritable bowel syndrome Organic gastrointestinal disorders: Pancreatic adenocarcinoma Peptic ulcer disease Cholecystitis Pancreatitis Hepatitis Crohn’s disease Neuromuscular disorders of the gastrointestinal tract: Gastroparesis Post-operative nausea and vomiting Chronic intestinal pseudo-obstruction
CNS Causes	Migraine Increased intracranial pressure (Malignancy, Haemorrhage, Infarction, Abscess) Meningitis Congenital malformation (Hydrocephalus) Pseudotumour cerebri Seizure disorders Demyelinating disorders
Psychiatric Disease	Psychogenic vomiting Anxiety disorders Depression Pain Eating disorders
Miscellaneous Causes	Cardiac disease: Myocardial infarction Congestive heart failure Radiofrequency ablation Starvation Labyrinthine disorders: Motion sickness Labyrinthitis Tumours Meniere’s disease Iatrogenic causes
Endocrinological and Metabolic Causes	Pregnancy Other endocrine and metabolic disorders Uraemia Diabetic ketoacidosis Hyperparathyroidism Hypoparathyroidism Hyperthyroidism Addison’s disease
Infectious Causes	Gastroenteritis Otitis media Acute intermittent porphyria

Management

Treat Underlying Cause: identify cause of decreased appetite (e.g., treating infections, managing chronic diseases).
Nutritional Support:
- Oral nutritional supplements in cases of malnutrition or weight loss.
- Dietitian consultation for nutritional advice.
Appetite Stimulants:
- Medications like mirtazapine or steroids may be used in some cases to stimulate appetite.
Psychological Support:
- Counseling or cognitive behavioral therapy (CBT) for cases of depression, anxiety, or eating disorders.
- Referral to a psychiatrist for further management if required.
Medication Review: If the patient is taking medications known to affect appetite, consider adjusting or switching the medication.

Prognosis

The prognosis of decreased appetite depends on the underlying cause. Acute appetite loss due to infections usually resolves with treatment, while chronic conditions like cancer or chronic liver disease may require long-term management and nutritional support.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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