Nestle Supplement 2

NUTRITION AND THE OLDER PERSON survival.47,48 Correlations between grip strength and bone area, mineral content, and mineral density in both healthy athletes49 and stroke patients50 support the notion that muscle contractions play a significant role in bone strength and mass. Muscle mass and the concomitant energy cost of associated muscle protein turnover can have a significant impact on energy balance.20 Finally, muscle disuse can lead to insulin resistance and type II diabetes, which is fundamentally a disease of muscle.51 The previous discussion of the importance of muscle leads to the conclusion that if the clinical diagnosis of an elderly individual warrants weight loss because of clear detrimental effects of continued obesity, weight loss should be undertaken in a manner that maintains muscle mass to whatever extent possible. In this regard, physical activity beneficially influences energy balance and provides multiple benefits beyond weight management. Studies in young and middleaged adults found that adding endurance or resistance exercise training to weight-loss programs helped to preserve muscle.52 Limited trials in obese older subjects also suggest that regular exercise attenuates the percentage of lean mass that is lost during dieting.18 Increased physical activity also stimulates muscle protein synthesis, increases strength and endurance, improves balance, combats depression, and may prevent deterioration below functional thresholds, enabling activities of daily living.17 Chronic disabilities and disease obviously limit the capacity for physical activity, but appropriate supervision and gradual progression to higher intensity, duration, and frequency should enable even very old and frail persons to participate.44 CONCLUSION The potential detrimental effects of weight loss in elderly individuals must be weighed against real or perceived beneficial effects. The risk:benefit ratio may be considered a function of the interaction between age and severity of obesity. For example, an overweight, elderly person (70–80 years) would likely experience comparatively greater risk and marginal benefit from weight loss compared to a severely obese (BMI > 35) individual between 50–60 years of age. There will be circumstances in which weight loss is desirable, such as when body weight significantly limits mobility and independence. In any circumstance in which clinical examination results in the recommendation for weight loss, attention must be paid to attempting to maintain muscle mass. The successful therapeutic approach will achieve this goal and minimize adverse outcomes by inclusion of physical activity and optimal protein intake, as well as maintenance of micronutrient intakes at adequate levels. I References 1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291(23):2847–2850. 2. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed. Washington DC: US Government Printing Office; January 2005. 3. Sichieri R, Everhart JE, Hubbard VS. Relative weight classifications in the assessment of underweight and overweight in the United States. Int J Obes Relat Metab Disord. 1992;16(4):303–312. 4. Bales CW, Ritchie CS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr. 2002;22:309–323. 5. Ensrud KE, Cauley J, Lipschutz R, Cummings SR. Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1997;157(8):857–863. 6. Grabowski DC, Ellis JE. High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc. 2001;49(7):968–979. 7. Heiat A; National Institutes of Health (NIH: the NIH Consensus Conference on Health Implications of Obesity in 1985); United States Department of Agriculture (the 1990 Department of Agriculture’s Dietary Guidelines for Americans); National Heart, Lung, and Blood Institute. Impact of age on definition of standards for ideal weight. Prev Cardiol. 2003;6(2):104–107. 8. Landi F, Zuccala G, Gambassi G, et al. Body mass index and mortality among older people living in the community. J Am Geriatr Soc. 1999;47(9):1072–1076. 9. Rossner S. Obesity in the elderly — a future matter of concern? Obes Rev. 2001;2(3):182–188. Lennie TA, Moser DK, Heo S, Chung ML, Zambroski CH. Factors 10. influencing food intake in patients with heart failure: a comparison with healthy elders. J Cardiovasc Nurs. 2006;21(2):123–129. 11. Doherty TJ. Invited review: aging and sarcopenia. J Appl Physiol. 2003;95(4):1717–1727. 12. Paddon-Jones D, Short KR, Campbell WW, Garlick PJ, Volpi E, Wolfe RR. Dietary protein and sarcopenia. J Nutr. In press. 13. Zamboni M, Zoico E, Scartezzini T, et al. Body composition changes in stable-weight elderly subjects: the effect of sex. Aging Clin Exp Res. 2003;15(4):321–327. 14. Gallagher D, Ruts E,Visser M, et al.Weight stability masks sarcopenia in elderly men and women. Am J Physiol Endocrinol Metab. 2000;279(2):E366–E375. 15. Gallagher Camden S, Gates J. Obesity: changing the face of geriatric care. Ostomy Wound Manage. 2006;52(10):36–38, 40–44. 16. National Center for Health Statistics. Health, United States, 2004, with Chartbook on Trends in the Health of Americans.Washington, DC: US Government Printing Office; 2004. 17. Elia M. Obesity in the elderly. Obes Res. 2001;9(Suppl 4):244S–248S. 18. Villareal DT, Apovian CM, Kushner RF, Klein S; American Society for Nutrition; NAASO, The Obesity Society. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO,The Obesity Society. Obes Res. 2005;13(11):1849–1863. 19. Poirier P, Giles TD, Bray GA, et al; American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113(6):898–918. 20. Wolfe RR.The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84(3):475–482. Department of Health and Human Services. Centers for Disease 21. Control and Prevention. BMI—Body Mass Index. About BMI for Adults. Available at: www.cdc.gov/nccdphp/dnpa/bmi/ adult_BMI/about_adult_BMI.htm. Accessed October 2007. 22. 1999 Metropolitan Height and Weight Tables for Men and Women. Available at: http://www.bcbst.com/MPManual/HW.htm. Accessed October 2007. DECEMBER 2007 • 21 http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm http://www.bcbst.com/MPManual/HW.htm

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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