Epidemiology of weight loss in humans with special reference to wasting in the elderly
Introduction
Weight loss is a common problem in older adults that has been associated with adverse health outcomes such as decreased functional status, institutionalization, and increased mortality [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Prospective studies of weight change in the elderly indicate that weight loss can be both a marker of, and an independent contributor to, these adverse health outcomes. The problem of weight loss in older adults appears to be heterogeneous, with different clinical and metabolic effects depending on specific underlying causes. Weight loss may occur in isolation or as a primary feature of a constellation of signs and symptoms that characterize syndromes such as “cachexia” [11] and “failure to thrive” [12]. Weight loss may also contribute to the development of “frailty”, a state characterized by diminished reserve, decreased functional status, and increased risk [13]. This article reviews basic considerations regarding definitions, epidemiology, physiologic processes, and clinical management of weight loss in older adults.
Section snippets
Definition of terms
Weight loss occurs as the result of an imbalance between caloric intake and metabolic requirements. In its simplest form, weight loss is due to inadequate caloric intake that is readily reversible with refeeding. In this circumstance food intake is reduced below usual caloric requirements, and the weight loss that ensues tends to consist of 20 to 30% fat-free (or lean body) mass and 70 to 80% fat mass. Although weight loss is a common feature of “cachexia”, this term more accurately represents
Body composition changes with usual aging
Before reviewing causes and consequences of weight loss in older adults it is important to consider changes in body weight and composition that occur with normal or physiologic aging. A number of population-based studies have measured body mass changes in purportedly healthy older persons, however it is often unclear whether observed changes are due to aging or are the result of inactivity, subclinical disease, or other undetected factors. With this caveat in mind, body mass changes associated
Incidence, clinical definition, and significance of weight loss
Incidence rates of 5 to 15% have been reported in studies of involuntary weight loss in community-dwelling older adults [19], and, not surprisingly, weight loss occurs more frequently in frail populations, with rates of over 25% observed among older dependent persons receiving home care services [2]. Weight loss has been associated with increased mortality and disability rates in numerous studies, but the degree of weight loss used to define “weight losers” has been variable. For instance, Ho
Causes and diagnostic evaluation of weight loss in older adults
Explanations for weight loss in the elderly have ranged from physiologic changes of aging to increased prevalence of poverty, psychosocial problems, and chronic disease [19], [21]. These and other commonly implicated factors behind involuntary weight loss have been summarized using a nmemonic “The nine D’s” of weight loss (Table 2) [22]. Although these may be valid causal factors from a clinical standpoint it is probably more informative to review etiologies that have been noted in case series
Management and therapeutic interventions
Fig. 3 provides an algorithmic approach to help guide treatment options for patients with weight loss. The first step in the management of patients with weight loss is to attempt to identify and treat any specific underlying causative or contributing conditions. In many cases, causative factors are found that are amenable to treatment (e.g., depression or peptic ulcer disease) and weight loss resolves—although incomplete recovery of weight lost during an acute stressful event such as illness,
Summary and future directions
Weight loss is a common problem in the elderly that is associated with increased risk of poor health outcomes. Weight loss can occur as a result of numerous underlying processes and is often associated with, and contributes to, syndromes of functional decline that include sarcopenia, failure to thrive and frailty. Weight loss of more that 5% during a 6 to 12 month period requires investigation. A rational stepwise approach is usually effective in establishing a diagnosis and determining
References (37)
- et al.
Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population
J Clin Epidemiol
(2000) Need for body composition information in elderly subjects
Am J Clin Nutr
(1989)- et al.
Rational approach to patients with unintentional weight loss
Mayo Clin Proc
(2001) - et al.
Treatment of protein-energy malnutrition in chronic nonmalignant disorders
Am J Clin Nutr
(2001) - et al.
Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older
J Am Geriatr Soc
(2001) - et al.
Weight, weight change and mortality in a random sample of older community-dwelling women
J Am Geriatr Soc
(1999) - et al.
Weight change between age 50 years and old age is associated with risk of hip fracture in white women aged 67 years and older
Arch Intern Med
(1997) - et al.
Body mass index, weight change, and risk of mobility disability in middle-aged and older women. The epidemiologic follow-up study of NHANES I
J Am Med Assoc
(1994) - et al.
Weight change in old age and its association with mortality
J Am Geriatr Soc
(2001) - et al.
Long-term effects of change in body weight on all-cause mortality. A review
Ann Intern Med
(1993)
Involuntary weight loss in older outpatients: incidence and clinical significance
J Am Geriatr Soc
Descriptive epidemiology of body weight and weight change in U.S. adults
Ann Intern Med
Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study
J Am Med Assoc
Cachexia
Ann Intern Med
“Failure to thrive” in older adults
Ann Intern Med
A conceptual framework for frailty: a review
J Gerontol Med Sci
Human body composition and the epidemiology of chronic disease
Obes Res
Cross-sectional age differences in body composition in persons 60+ years of age
J Gerontol
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