Adipositas im Alter und ihre Bedeutung für Funktionalität und Frailty

Abstract

In later life a high body mass index (BMI) is associated with the lowest age-related mortality rate. The BMI range used by the World Health Organization (WHO) to classify overweight, a BMI of 25-30 kg/m, can be regarded as normal weight in old age; nevertheless, obesity is associated with an increased risk of disability and of a deterioration in physical functionality, particularly among older age groups. This relationship to obesity has also been established for frailty. For this reason, a reduction in weight may be appropriate under functional aspects if BMI values exceed 30 kg/m; however, such a decision cannot be made on the basis of an individual BMI alone. The functional status, body composition, comorbidities and, in particular the life perspectives of the patient should also be taken into consideration. If weight loss is intended, it must always be performed under strict medical supervision involving optimized protein intake, a carefully calculated moderate reduction in calories and adequate physical training. In the case of chronically ill elderly patients, weight reduction is not usually appropriate. Restrictive diets of any kind should principally be critically viewed in old age because even temporary inadequate energy intake may lead to accelerated deterioration of muscle and bone structure.

Should weight loss in elderly people be recommended?

“…The Korean National Health and Nutrition Examination Surveys IV and V (2008-2011) showed a correlation between the degree of sarcopenia and reduced bone density [43]. Similar results were described in the aforementioned work by Wojzischke et al [27]. In addition, in old age excessive body weight may mask undernutrition that has been developing for some time.…”

“…Inflammatory and cachexia biomarkers such as CRP or elevated levels of proinflammatory cytokines are associated with an unfavourable prognosis in older patients. Chronic inflammation alsolies at the base of the frailty syndrome; moreover, the authors indicate that the frailty syndrome is a clinical manifestation of cardiovascular diseases, including heart failure [26,27]. Chronic inflammation and elevated levels of inflammatory indicators are associated with adverse cardiovascular events.…”

“…Biomarkery zapalenia i wyniszczenia, takie jak CRP czy podwyższone stężenia cytokin prozapalnych, są związane z niekorzystnym rokowaniem u pacjentów starszych. Przewlekłe zapalenie leży także u podstawy zespołu kruchości, któryjak wskazują autorzy -jest kliniczną manifestacją chorób układu sercowo-naczyniowego, w tym niewydolności serca [26,27]. Przewlekłe zapalenie i podwyższone stężenie wskaźników zapalnych wiążą się z wystąpieniem niekorzystnych zdarzeń sercowo-naczyniowych, a także ze stymulacją wydzielania IL-1, IL-6 czy TNF-α.…”

“…The diet should ensure a proper supply of protein and physical exercise should be optimised. In elderly patients with chronic diseases, weight loss should not be recommended because it may also lead to increased muscle and bone atrophy [27,28]. Fluctuations in body mass, both its increase and decrease, are important predictors of death.…”

“…Dieta powinna zapewniać prawidłową podaż białka, a wysiłek fizyczny należy zoptymalizować. W przypadku osób starszych, chorych przewlekle redukcja masy ciała nie powinna być zalecana, gdyż może prowadzić do nasilenia zaników mięśni i masy kostnej [27,28]. Wahania masy ciała -zarówno jej wzrost, jak i zmniejszenie -są istotnym predyktorem zgonu.…”