Nestle Supplement 2

NUTRITION AND THE OLDER PERSON Lipolysis and Atherosclerosis Lipolysis Triglyceride Enriched VLDL Cholesterylester LDL Hepatic Lipase Small Dense LDL Retained preferentially by arterial wall Readily oxidized Figure 1. Accelerated atherogenesis caused by low-density lipoprotein TABLE 2. Reasons why weight loss leads to poor outcomes 1. Increased small dense LDL leading to atherogenesis 2. Increased circulating toxins released from adipose tissue 3. Increased bone loss (osteopenia) and hip fracture 4. Toxic effects of protein-bound and fat-soluble medications 5. Protein energy malnutrition 6. Muscle loss extremes of temperature. Fat plays an important role in organ protection, particularly protecting the older person from hip fracture when he or she falls. Finally, fat produces numerous hormones that play a key role in the body’s metabolism of food. For example, adiponectin plays a key role in ameliorating the development of insulin resistance. The importance of adipose tissue has been demonstrated in younger persons as when during weight loss fat is depleted they die. During refeeding following starvation, fat gain occurs before muscle is regained.This is because fat provides calories for vital organs, eg, brain and heart, but muscle does not generate its own thermic energy. These findings lead to the conclusion that fat is at least as important as lean tissue. 24 • DECEMBER 2007 REASONS WHY WEIGHT LOSS IS BAD FOR OLDER PERSONS There are numerous reasons why weight loss can lead to poor outcomes in older persons (Table 2). Obviously, severe weight loss is associated with protein energy malnutrition, which in itself is associated with multiple deleterious effects (Table 3).Weight loss can also be a harbinger of occult disease. Loss of fat from muscle and liver leads to lipolysis with a triglyceride enriched very low-density lipoprotein (LDL), which results in the production of small dense low-density lipoprotein (sdLDL). Small dense low-density lipoprotein is retained preferentially by the arterial wall and readily oxidized. This leads to accelerated atherogenesis (Figure 1). This also increases the risk of unstable plaques being disrupted. Starvation-induced lipolysis is associated with release of toxins from fat, such as PCBs and DDEs. This has been characterized as the poisonous infusion of weight loss. Weight loss results in altered drug effects for drugs that are fat soluble and those that are bound to albumin as aforementioned weight loss is associated with bone loss and hip fracture. Finally, fat loss is associated with an increased loss of muscle mass leading to frailty and increased disability. CHOLESTEROL, ALBUMIN, AND MORTALITY In older persons, low albumin and cholesterol are predictive of poor outcomes. Most of the increase in cholesterol and

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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