Nestle Supplement 2

NUTRITION AND THE OLDER PERSON Activity Creatine Leucine Food intake Menopause Folate B12 B6 Homocysteine SARCOPENIA Age MU Loss Testosterone CACHEXIA Cachexia occurs when a disease process results in a marked increase in pro-inflammatory cytokines. Cachexia classically occurs in heart failure, chronic obstructive pulmonary disease, renal failure, infections, and cancer. Persons with cachexia have severe weight loss, anorexia, sickness behavior, hypoalbuminemia, and anemia. Weight loss involves loss of both muscle and fat. The major reasons for weight loss are protein catabolism due to excess activity of the ubiquitin-proteosome system and increased lipolysis. Weight loss with cachexia cannot be reversed by nutritional supplementation alone but requires suppression of cytokine excess as well. Vascular Disease IGF-1 Cytokines Figure 2. Agents that slow or reverse sarcopenia promote anabolism through promoting muscle hypertrophy and regeneration Depression is the most common reversible cause. Treatment of sarcopenia involves exercise, high protein intake, and perhaps anabolic steroids. I CONCLUSION Many older persons are at risk of undernutrition. Undernutrition is a greater problem in older persons than overnutrition. Weight loss in an older person is a sentinel event and needs family and physicians to be alert to its causes. To maintain weight, older persons need to eat an adequate diet containing at least 1.2 g/kg–1.5 g/kg of protein. Older persons need to ingest a minimum of 4 glasses of fluid a day. Many older persons need extra vitamin D supplementation. When weight loss occurs, the physician needs to aggressively look for a reversible cause. References 1. Fried LP,Tangen CM,Walston J, et al; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–M156. 2. Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci. 2006;61(6):589–593. 3. Semba RD, Bartali B, Zhou J, Blaum C, Ko CW, Fried LP Low serum . micronutrient concentrations predict frailty among older women living in the community. J Gerontol A Biol Sci Med Sci. 2006;61(6):594–599. 4. Morley JE. Is weight loss harmful to older men? Aging Male. 2006;9(3):135–137. 5. Sullivan DH, Morley JE, Johnson LE, et al. The GAIN (Geriatric Anorexia Nutrition) registry: the impact of appetite and weight on mortality in a long-term care population. J Nutr Health Aging. 2002;6(4):275–281. 6. Wedick NM, Barrett-Connor E, Knoke JD,Wingard DL.The relationship between weight loss and all-cause mortality in older men and women with and without diabetes mellitus: the Rancho Bernardo study. J Am Geriatr Soc. 2002;50(11):1810–1815. 7. Ensrud KE, Fullman RL, Barrett-Connor E, et al; Osteoporotic Fractures in Men Study Research Group.Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metab. 2005;90(4):1998–2004. 8. Kalantar-Zadeh K, Horwich TB, Oreopoulos A, et al. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care. 2007;10(4):433–442. 9. Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. J Clin Epidemiol. 2000;53(6):579–587. DECEMBER 2007 • 29

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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