{ "schema_version": 1, "kind": "condition", "id": "underweight-low-body-weight", "name": "Underweight", "category": "chronic", "sources": "Anorexia and Cachexia - StatPearls - NCBI Bookshelf (NBK430977) - https://www.ncbi.nlm.nih.gov/books/NBK430977/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TS50 - condition scope only, no dose · Egyptian drug register - availability only, no dose", "review_status": "reviewed", "verified_against": "Anorexia and Cachexia - StatPearls - NCBI Bookshelf (NBK430977) - https://www.ncbi.nlm.nih.gov/books/NBK430977/, Treatment / Management (protein 1-1.5 g/kg/day; supplements 200-300 kcal and 10-20 g protein per 100 mL; EPA 1.8-2.2 g daily; no dose stated for any appetite stimulant) · Egyptian drug register (megestrol only as an unlicensed import; anamorelin and dronabinol absent; mirtazapine and olanzapine stocked)", "verified_date": "2026-09", "treatments": [ { "id": 1865, "generic": "High-energy, high-protein nutrition (First-line treatment)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Protein 1 to 1.5 g per kg of body weight daily, from fortified food and oral supplements. Commercial oral supplements provide about 200 to 300 kcal and 10 to 20 g of protein per 100 mL. In renal failure, keep protein under 1.3 g per kg daily", "adult_duration": "continuous, alongside treatment of the underlying cause", "dose_source": "Anorexia and Cachexia - StatPearls - NCBI Bookshelf (NBK430977) - https://www.ncbi.nlm.nih.gov/books/NBK430977/, Treatment / Management - verbatim: \"High-protein diets, typically providing 1 to 1.5 g/kg of body weight daily, help maintain adequate nutritional status and stabilize weight, improve lean body mass, and enhance overall quality of life.\" \"Commercially available oral supplements generally provide 200 to 300 kcal and 10 to 20 g of protein per 100 mL.\" \"Patients with renal failure should consume less than 1.3 g of protein per kg of body weight daily.\"", "rationale": "This is the treatment with a stated amount, and it is the one primary care delivers. The article: \"Nutritional interventions should focus on high-energy, high-protein diets with fortified foods and oral supplements when necessary\", combined with exercise tailored to the patient. It is deliberately first here because the drugs that stimulate appetite have no stated dose in the source and poor evidence behind them - see the row below.", "cautions": [ "Cachexia is not starvation and food alone will not reverse it. The article: the metabolic dysregulation, systemic inflammation, alimentary tract dysfunction and anorexia together make \"conventional nutritional support ineffective in reversing the condition.\" Nutrition stabilises weight and preserves function; treating the underlying disease is what changes the course.", "Do not escalate to tube or drip feeding for this alone. The article states plainly: \"No evidence supports routine enteral tube feeding supplementation or parenteral nutrition.\"", "Know what you are actually looking at. The article's cachexia definition: weight loss of more than 5% in 6 months, or a BMI under 20 kg/m2 with ongoing loss of more than 2%, plus at least one of - anorexia or reduced intake, reduced grip strength, or an inflammatory marker such as C-reactive protein above 5 mg/L.", "Eicosapentaenoic acid is the one supplement with a number attached, and the evidence is weak. The article: \"Studies have shown increased body weight or muscle mass with an eicosapentaenoic acid dose between 1.8 and 2.2 g daily. However, adverse effects include gastrointestinal distress, liver dysfunction, and bleeding tendencies, which limit its use\", and ASCO guidelines note further research is needed. Vitamin D is mentioned as supporting muscle protein synthesis, without a dose." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "This article is about adult anorexia and cachexia and gives no paediatric figures. An underweight child is a different problem - growth faltering - and is assessed on growth centiles.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "underweight-low-body-weight" }, { "id": 1866, "generic": "Find the cause, and the drugs that have no stated dose (Referral & Advice)", "line": 2, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Being underweight is a finding, not a diagnosis. The GP's task is to identify and treat the underlying cause - malnutrition, chronic disease, an eating disorder, an overactive thyroid, malignancy - rather than prescribe for the weight itself. The article's own framing is that cachexia accompanies advanced cancer, chronic infection, COPD, renal failure, heart failure and late-stage inflammatory autoimmune disease.", "adult_duration": "Refer", "dose_source": "No dose - the causes to find, and the appetite drugs for which Anorexia and Cachexia - StatPearls - NCBI Bookshelf (NBK430977) - https://www.ncbi.nlm.nih.gov/books/NBK430977/, Treatment / Management states no amount", "rationale": "Being underweight is a finding, not a diagnosis. The GP's task is to identify and treat the underlying cause - malnutrition, chronic disease, an eating disorder, an overactive thyroid, malignancy - rather than prescribe for the weight itself. The article's own framing is that cachexia accompanies advanced cancer, chronic infection, COPD, renal failure, heart failure and late-stage inflammatory autoimmune disease.", "cautions": [ "RED FLAG - Unintentional significant weight loss can be the first sign of malignancy, tuberculosis, or another serious systemic illness. Investigate the cause before treating the weight.", "The appetite stimulants, with the article's own verdicts and no doses - because it states none. Progesterone analogues (megestrol acetate, medroxyprogesterone acetate) stimulate appetite, but megestrol \"is associated with adverse effects of fluid retention, thromboembolic events, and an increased risk of death\", and in Egypt the only entry, MEGACE 160 mg, is flagged an unlicensed import. Corticosteroids such as dexamethasone \"can improve appetite in the short term, but risks of immunosuppression, osteoporosis, fluid retention, and hypertension limit chronic use.\"", "Olanzapine and mirtazapine are the better-tolerated options and both are stocked in Egypt, but again with no dose in the source. The article: olanzapine \"has been shown to increase appetite and weight when administered in small doses, with minimal adverse effects\" and its antiemetic effect helps chemotherapy nausea; mirtazapine \"can be useful in patients with depression-related anorexia\", though \"evidence for the overall efficacy of mirtazapine in treating cancer cachexia is more limited compared to olanzapine.\" \"Small doses\" is not a dose, so none is printed.", "Anamorelin, the ghrelin receptor agonist the article describes as promising, is not approved by the FDA for cancer cachexia and has no entry in the Egyptian register at all. Neither does dronabinol. They are named so you know they exist, not as options here.", "No single drug reverses cachexia. The article: \"Although no single therapy completely reverses cachexia, treatment can alleviate symptoms and improve quality of life.\" That is the honest thing to tell the patient and the family." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "underweight-low-body-weight" } ] }