Age related changes in food intake, weight and body composition. Keerti Sharma, MD AGSF

Transcription

1 Age related changes in food intake, weight and body composition Keerti Sharma, MD AGSF

2 Objectives Understand age related changes in appetite and food intake Discuss age related changes in weight and body composition. Define 'significant weight loss' and understand its association with morbidity and mortality. Discuss the causes of weight loss in Older adults. 2 WEIGHT LOSS IN THE ELDERLY

3 Appetite and Food Intake with increasing age Less hungry and eat less More full before meals Consume smaller meals slowly Eat fewer snacks between meals Become more rapidly satiated Consume less varied and more monotonous food Clarkston WK et al. Evidence for anorexia of aging : gastrointestinal transit and hunger in healthy elderly vs young adults. Am J of Physiol 1997;272 (1Pt 2):R243-8 Morley JE. Anorexia of aging : physiologic and pathologic. Am J Clin Nutr 1997; 66(4): WEIGHT LOSS IN THE ELDERLY

4 Body weight Mean BMI declines after age 60 Prevalence of underweight increases 4 WEIGHT LOSS IN THE ELDERLY Villareal DT et al. Obesity in older adults : Technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society. Am J Clin Nutr 2005; 82(5):923-34

5 BMI BMI associated with maximum life expectancy increases with age 5 WEIGHT LOSS IN THE ELDERLY xxxxxxxxxxxxx

6 Body Composition Progressive increase in fat and decrease in fat free mass Loss of up to 3 kg lean body mass per decade after age 50 6 WEIGHT LOSS IN THE ELDERLY

7 Increased Body fat Multifactorial Decreased physical activity is a major cause Reduced growth hormone Declining sex hormone action Reduced BMR and thermic effect of food 7 WEIGHT LOSS IN THE ELDERLY

8 Age related Skeletal muscle loss Presence of Sarcopenia is an independent predictor of poor gait, balance, falls and fractures. Probably happens due to reduced exercise and anabolic hormone action 8 WEIGHT LOSS IN THE ELDERLY

9 Age related changes in appetite

10 Healthy individuals have recorded intakes up to 44% greater when eating with other people than eating alone Higher food intakes are reported to occur when women eat with men rather than other women, and when both men and women dine with family or friends rather than with coworkers. a simple and inexpensive way to increase caloric intake in homebound older adults is to make arrangements for family members or caregivers to eat with them De Castro. How can eating Behavior be regulated in the complex environments of free living humans? 10 Neurosci WEIGHT LOSS Biobehav IN THE ELDERLY rev 1996 Locher JL et al. The effect of the presence of others on caloric intake in homebound older adults J Gerontol A Biol Sci Med Sci. 2005;60(11):1475.

11 Diminished sense of smell and taste Sense of taste probably declines with aging Stronger evidence that sense of smell declines after age 50 years Strong correlation between impaired sense of smell and reduced interest and intake of food Doty RL, Shaman P, Applebaum SL, et al. Smell identification ability: changes with age. Science 1984; 226(4681): WEIGHT LOSS IN THE ELDERLY

12 Reduced sensory-specific satiety Normal decline in pleasantness of the taste of a food after it has been consumed Leads to less varied diet and the development of micronutrient deficiencies Rolls BJ, McDermott TM. Effects of age on sensory-specific satiety. Am J Clin Nutr Dec;54(6): WEIGHT LOSS IN THE ELDERLY

13 Peripheral factors Sensory signals induced by distension by food contribute to initial sensations of fullness during a meal Extent of antral filling and distension relates more closely to feelings of fullness and satiety than proximal gastric distension 13 WEIGHT LOSS IN THE ELDERLY

14 The aging gut Aging probably is related to impaired receptive relaxation of the gastric fundus. Increased Nitric Oxide with aging may contribute to the slower gastric emptying observed in the elderly. 14 WEIGHT LOSS IN THE ELDERLY

15 Cholecystokinin Exogenous CCK administration decreases food intake and administration of CCK antagonists increases food intake in 15animals WEIGHT and LOSS humans IN THE ELDERLY

16 Ghrelin Ghrelin a peptide hormone produced in the gastric fundus increases food intake and releases growth hormone 16 WEIGHT LOSS IN THE ELDERLY

17 Central Factors 17 WEIGHT LOSS IN THE ELDERLY

18 Age related impairment in homeostasis following overfeeding, younger men exhibited spontaneous hypophagia, whereas the older men did not (mean [+/- SD] changes in energy intake relative to control values were [+/- 2.18] and 1.55 [+/- 2.11] MJ/d, respectively; P =.006). As a result, the younger men lost the excess body weight gained during overfeeding but the older men did not. Similarly, following underfeeding, the younger men exhibited hyperphagia while the older men did not (mean [+/- SD] changes in energy intake relative to control values were 1.88 [+/- 2.31] and [+/- 1.54] MJ/d, respectively; P =.02), and as a result the older men failed to regain the weight lost during underfeeding. Roberts SB, Fuss P, Heyman MB et al. Control of food intake in older men. JAMA WEIGHT LOSS IN THE ELDERLY Nov 23-30;272(20):

19 Cytokines Age associated increases in the production or effect of satiating cytokines may contribute to the anorexia of aging. Age itself maybe a form of stress Morley JE, Baumgartner RN. Cytokine-related aging process. J Gerontol A Biol Sci Med Sci 2004;59:M Chapman IM. The anorexia of aging. Clin Geriatr Med 2007;23:735 56, V. 19 WEIGHT LOSS IN THE ELDERLY

20 Condition Disease related cachexia and associated cytokines Associated Cytokines Pulmonary cachexia Cardiac cachexia ESRD Cachexia Cancer cachexia HIV cachexia Rheumatological Cachexia TNF TNF/ proinflammatory Alpha2 macroglobulin & CRP Fibrinogen and TNFs Reduced Body Cell Mass TNF &Interleukin-1 20 WEIGHT LOSS IN THE ELDERLY

21 Causes and effect of Undernutrition in Older people

22 Meals On Wheels Medication effects Emotional problems Anorexia nervosa, alcoholism Late life Paranoia Swallowing disorders Oral factors No money, Nosocomial infections Wandering and other dementia related behaviors Hyperthyroidism, hypothyroidism, HPTH, Hypoadrenalism Enteric problems Eating problems Low salt, low cholesterol diet Stones, Social problems ( isolation, inability to obtain preferred foods) 22 WEIGHT LOSS IN THE ELDERLY

23 Effects of Protein Energy Under nutrition Immune dysfunction Infections Cognitive abnormalities Anemia Muscle weakness Fatigue Edema Pressure ulcers Hip fractures Mortality 23 WEIGHT LOSS IN THE ELDERLY

24 Consequences of weight loss Nursing home residents had a significantly higher mortality rate in the 6 months after loosing 10% of their body weight irrespective of diagnosis or cause of death. ( Murden et al, JGIM 1994) Institutionalized elderly who loose 5% of their body weight in 1 month were 4 times more likely to die within one year.( Ryan et al, SMJ 1995) In Alzheimer's patient weight loss correlates with disease progression, and a weight loss of at least 5% is a significant predictor of death. (White et al, JAGS 1998) 24 WEIGHT LOSS IN THE ELDERLY

25 Consequences of weight loss Cardiovascular Health Study homebound elderly without known cancer-, 17% lost 5% or more wt fold increased mortality in this group. Systolic HTN in Elderly Program Studysubjects with wt loss of 1.6 kg/yr or more had 4.9 times greater death rate. 25 WEIGHT LOSS IN THE ELDERLY

26 QUESTIONS 26 WEIGHT LOSS IN THE ELDERLY