Nestle Supplement 2

INTRODUCTION TO WEIGHT LOSS IN OLDER PERSONS David R. Thomas, MD, FACP, AGSF, GSAF From the Division of Geriatric Medicine, Saint Louis University Health Sciences Center, Saint Louis, Missouri Correspondence: David R. Thomas, MD, FACP, AGSF, GSAF, Professor of Medicine Division of Geriatric Medicine Saint Louis University Health Sciences Center Saint Louis, MO 63104 W eight loss is common in older adults and is a harbinger of poor outcome. A loss of 10% or more body weight between age 50 and old age is associated with a 60% increase in mortality compared to persons with stable weight.1 The mortality rate is substantially higher (28%) in older community-dwelling male veterans2 who had an unintended weight loss greater than 4% body weight than in those who did not lose weight (11%). The risk of dying increases by 76% among home-bound older adults with weight loss, an effect independent of initial body mass index, smoking, health status, and functional status.3 Weight loss of more than 5% in community-dwelling women 60 to 74 years old is associated with a 2-fold increase in risk of disability over time, compared to women who did not lose weight.4 In nursing home residents, a 10-fold increased risk for death was observed for persons who lost 5% of their body weight in any month compared with those who gained weight.5 Other studies have shown that nursing home residents who lost at least 5% of their body weight were 4.6 times more likely to die within one year compared to control subjects.6 A 10% loss of body weight over a 6-month interval strongly predicts mortality in the ensuing 6 months in nursing home residents.7 For this reason, the nutrition guidelines for long-term care residents define a loss of greater than 10% of body weight within 180 days or 5% within 30 days as an important clinical threshold for triggering nutritional assessment protocols.8 BODY MASS INDEX Weight adjusted for height (body mass index, or BMI; the weight in kilograms divided by height in meters squared) of less than 22 kg/m2 has been associated with a higher one-year mortality rate and with poorer functional status among older community-dwelling persons.9 The risk for higher mortality in men10 older than 65 years begins at a BMI of less than 22 and increases to a 20% higher risk in men older than 75 years with a BMI of less than 20.5. Similarly, a higher mortality risk in women10 begins at a BMI of less than 22 in women older than 65 years and increases to a 40% higher risk in women older than 75 years with a BMI of less than 18.5. Body mass index less than the 15th percentile is an independent predictor of 180-day mortality following hospitalization.11 Although there is a strong association between BMI and mortality, the key factor in the mortality risk appears to be recent weight loss. Weight loss appears to be more important than having a stable low body mass. Large epidemiological studies have found little relationship between BMI and mortality after excluding subjects with weight loss of 10% or more of their body weight.12 In persons over age 50 years who reported an unintended loss of 10 lb or more in the year before evaluation, the age-adjusted death rate was much higher compared to persons who lost weight through diet or exercise or who maintained or gained weight.13 Nearly all of the observational studies have found that any weight loss is associated with increased rather than decreased risk for death.14–16 The importance of weight loss lies not only in increased mortality but also in the fact that it is associated with a decline in functional status.17 Weight loss of more than 5% in community-dwelling women 60 to 74 years old is associated with a 2-fold increase in risk of disability over time, compared to women who did not lose weight, after adjustment for age, smoking, education, study duration, and health conditions.4 DECEMBER 2007 • 3

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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