An approach to the management of unintentional weight loss in elderly people

Alibhai, Shabbir M.H.; Greenwood, Carol E.; Payette, Hélène

doi:10.1503/cmaj.1031527

Cited by 229 publications

(166 citation statements)

References 98 publications

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“…In conclusion, our findings highlight the importance of monitoring changes in weight in older persons with poor cognition with the aim of reducing the negative consequences of loss of fat and muscle, such as increased mortality, morbidity and progressive disability [36]. It will, therefore, be important to develop strategies to prevent weight and muscle loss.…”

Section: Discussionmentioning

confidence: 71%

Associations of fat and muscle tissue with cognitive status in older adults: the AGES-Reykjavik Study

et al. 2017

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Background/Objective: studies on the association of dementia with specific body composition (BC) components are scarce. Our aim was to investigate associations of BC measures with different levels of cognitive function in late-life. Methods: we studied 5,169 participants (mean age 76 years, 42.9% men) in the AGES-Reykjavik Study of whom 485 (9.4%) were diagnosed with mild cognitive impairment (MCI) and 307 (5.9%) with dementia. Visceral fat, abdominal and thigh subcutaneous fat, and thigh muscle were assessed by computed tomography. MCI and dementia were based on clinical assessment and a consensus meeting; those without MCI or dementia were categorised as normal. Multinomial regression models assessed the associations stratified by sex and in additional analyses by midlife body mass index (BMI). Results: among women, there was a decreased likelihood of dementia per SD increase in abdominal subcutaneous fat (OR 0.72; 95% CI: 0.59-0.88), thigh subcutaneous fat (0.81; 0.67-0.98) and thigh muscle (0.63; 0.52-0.76), but not visceral fat, adjusting for demographics, vascular risk factors, stroke and depression. Inverse associations of fat with dementia were attenuated by weight change from midlife and were strongest in women with midlife BMI <25. In men, one SD increase in thigh muscle was associated with a decreased likelihood of dementia (0.75; 0.61-0.92). BC was not associated with MCI in men or women. Conclusion: a higher amount of abdominal and thigh subcutaneous fat were associated with a lower likelihood of dementia in women only, while more thigh muscle was associated with a lower likelihood of dementia in men and women.

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Section: Discussionmentioning

confidence: 71%

Associations of fat and muscle tissue with cognitive status in older adults: the AGES-Reykjavik Study

et al. 2017

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“…111 A neutral effect on body weight represents an advantage in other clinical settings, for example in elderly patients who are at risk of unintentional weight loss. 112,113 Certainly, as metformin did not reduce body weight in the UKPDS, it is unlikely that its effects on glycemia or cardiovascular outcomes resulted from a weight-dependent mechanism, in contrast to antiobesity drugs which rely on weight loss for a substantial proportion of their effects on cardiometabolic risk factors. 22,23,25 While the favorable effects of metformin on body weight are modest, considerations relating to body weight have profoundly affected its therapeutic use.…”

Section: Discussionmentioning

confidence: 99%

Metformin and body weight

2007

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Most patients with type 2 diabetes are overweight or obese, overweight or obesity increases the risk of developing type 2 diabetes and obesity per se is strongly associated with multiple cardiometabolic risk factors. However, many antidiabetic treatments increase body weight. The oral antidiabetic agent, metformin, has been evaluated in hundreds of clinical studies in diverse patient populations during approximately five decades of clinical use. This review summarizes the effects of metformin on body weight, with special reference to studies of longer duration (X6 months) as both diabetes and obesity are long-term conditions. Approximately half of studies in drug-naive type 2 diabetic patients demonstrated significant weight loss with metformin compared with baseline or comparator drugs, although pooled analyses have suggested no significant effect versus placebo. Similarly, metformin has been shown to induce weight loss in obese nondiabetic populations, although studies of long duration in this population are scarce. Metformin does appear to mitigate the adverse effects of insulin on body weight. The weight-neutral or weight-sparing effects of metformin constitute a therapeutic advantage in diabetes management where other first-line oral antidiabetic treatments often promote clinically significant weight gain.

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“…Calcium and vitamin D intake should be optimized. Given the changes in appetite and satiety, it has also been suggested that snacking during the day may be beneficial [1,83].…”

Section: Management Of Undernutritionmentioning

confidence: 99%

“…The evidence supporting any pharmacologic agent for the treatment of weight loss is limited [1]. Medications trialed to date, such as megesterol acetate, dronabinol, and human recombinant growth hormone have serious side effects especially in frail older people in whom weight loss is commonly seen and therefore cannot be recommended for routine clinical use at this stage.…”

Section: Management Of Undernutritionmentioning

confidence: 99%

Anorexia, undernutrition, weight loss, sarcopenia, and cachexia of aging

Hao

Guo

2012

Eur Rev Aging Phys Act

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During the period between 2000 and 2030, the number of persons older than 65 years is projected to grow from 550 to 937 million worldwide. Globally, this growth represents an increase from 6.9 to 12 %. Studies have found that 74.6 % of women and 67.4 % of men aged 65 years or older suffer from many clinical and subclinical syndromes and problems, including anorexia, undernutrition, weight loss, sarcopenia, and cachexia, which are often overlooked or managed inadequately. These issues are very common in the elder. The key clinical question is whether these changes in the elder are distinct entities or an interdependent continuum. In this article, we reviewed these issues of related basic, clinical knowledge. The purpose of this review is to enhance the recognition of anorexia, undernutrition, weight loss, sarcopenia, and cachexia.

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An approach to the management of unintentional weight loss in elderly people

Cited by 229 publications

References 98 publications

Associations of fat and muscle tissue with cognitive status in older adults: the AGES-Reykjavik Study

Associations of fat and muscle tissue with cognitive status in older adults: the AGES-Reykjavik Study

Metformin and body weight

Anorexia, undernutrition, weight loss, sarcopenia, and cachexia of aging

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