Nestle Supplement 2

THE DANGER OF WEIGHT LOSS IN THE ELDERLY Robert R. Wolfe, PhD From the Center for Translational Research in Aging and Longevity, Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas Correspondence: Robert R. Wolfe, PhD, Professor of Geriatrics, Director, Center for Translational Research in Aging and Longevity, Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences 4301 W Markham Street, #806, Little Rock, AR 72205 Phone: 501-526-5708 • Fax: 501-526-5710 • E-mail: rwolfe2@uams.edu H ealthy body weight is a key focus of guidelines and recommendations to improve quality of life and decrease health risks. The emphasis on weight loss is due, in great part, to the increasing prevalence of obesity in all populations including older adults and the elderly.1 The most recent dietary guidelines2 recommend that Americans maintain body weight in a healthy range by balancing calories from foods and beverages with calories expended.While diet and exercise are identified as safe and practical means to modify body weight, a definition of what constitutes a “healthy body weight” is not provided. Specific target body weights, based on a substantial amount of literature, are available for adults and children,3 but identification of an ideal body weight is particularly challenging for older persons (> 65 years) for multiple reasons. Older people are more likely to be underweight than young adults and are susceptible to rapid weight loss in response to illness, stress, and the aging process itself.4 Additionally, evidence suggests that excess weight does not confer the same risk in elderly compared to younger adults and may even be protective.5–9 The objective of this article is to assess the risks and dangers relative to benefits of weight loss that may be attained in this population. Average body weight gradually increases during most of adulthood and levels off around 60 years of age after which mean body weight tends to decrease. Most notably, lean body mass, predominantly muscle, is lost at an accelerated rate with and without intentional weight loss as people age.7 Weight loss is often due to a reduction in food intake, which occurs for a variety of reasons, including both physiological and nonphysiological causes.10 Thus, it is important to assess if weight loss is intentional or unintentional. Rapid and significant unintentional body weight loss is indicative of underlying disease. For example, release of cytokines in response to chronic or acute disease can induce anorexia and stimulate lipolysis, muscle protein breakdown, and nitrogen loss.4 Clinical intervention is necessary to identify and address the cause of weight loss, and nutritional and physical therapy should be provided to assist in recovery of lost lean body mass. Even in the absence of disease, nutritional frailty and sarcopenia (a loss of muscle mass and strength) occur with advancing age and are estimated to impair functional capacity11,12 in 30% of people over age 60 and possibly more than 50% of those over age 80.Weight-stable individuals who maintain adult body weight through their 60s and 70s are not necessarily protected from age-related muscle loss.13 In a 5-year study of healthy, ambulatory, weight-stable, elderly subjects, Gallagher et al14 observed a significant shift in body composition marked by progressive skeletal muscle loss.The authors described sarcopenia as a silent, progressive phenomenon similar to osteoporosis and emphasized the need to consider body composition in determining a healthy body weight for older adults. While fat-free mass is almost universally lost with aging, weight gain is common in people as they age, particularly in individuals who decrease their level of physical activity.15 Furthermore, the escalating prevalence of obesity in adults age 25–59 will continue to increase the number of overweight and obese elderly individuals as the population ages. The National Center for Health Statistics estimated in 2000 that 33%–39% of men and women 65–74 years old were overweight or obese.16 The health implications for this cohort are uncertain and present a challenge to geriatricians, healthcare providers, and policy makers who must interpret and extrapolate data available from adults 18 • DECEMBER 2007

Table of Contents Feed for the Digital Edition of Nestle Supplement 2

Nestle Supplement Table of Contents Introduction to Weight Loss in Older Persons Diagnosis and Management of Oropharyngeal Dysphagia in the Elderly The Danger of Weight Loss in the Elderly Nutrients and Frailty

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