Unintended weight loss, sarcopenia, malnutrition, frailty

Unintended Weight Loss - Overview

Causes can be physiological, psychological, or social

Unintended Weight Loss - Physiological causes

Catabolic illness, infection, loss of teeth, impaired absorption

Unintended Weight Loss - Psychological causes

Depression, dementia, and other mental health conditions

Unintended Weight Loss - Social causes

Poverty and isolation

Unintended Weight Loss - Prevalence

Impacts 50-60% of residents of nursing homes

Unintended Weight Loss - Examples of causes

Dementia, cancer, chronic infections or inflammation, COPD, depression, uncontrolled diabetes, hyperthyroidism, malabsorption-related disease, oral disease, polypharmacy, swallowing disorders, therapeutic diets

Catabolic illness

Rapid weight loss with loss of fat and skeletal muscle mass

Sarcopenia

Loss of muscle mass and quality associated with functional decline

Sarcopenia - BMI consideration

Patients may not necessarily have a low BMI

Sarcopenia - Contributing factors

Sedentary lifestyle and low protein intake

Sarcopenia - Inflammation effects

Excess inflammation can lead to muscle wasting, protein breakdown, and decreased energy intake

Cachexia

Wasting syndrome caused by chronic, systemic inflammation

Cachexia - Definition

Disease states causing severe wasting due to chronic inflammation

Common chronic diseases - Abbreviations

COPD - Chronic obstructive pulmonary disease; CKD - Chronic kidney disease; CHF - Congestive heart failure; Cancer

Diagnosis of Sarcopenia

Low muscle mass plus low gait speed

Sarcopenia - Muscle mass criteria

Muscle mass at least 2 standard deviations below the mean of reference population

Sarcopenia - Gait speed criteria

Walking speed below 0.8 meters per second

Prevention of Sarcopenia

Adequate protein intake, adequate calorie intake, and exercise especially resistance training

Sarcopenia - Main nutrition focus

Protein intake

Multi-nutrient supplements

Supplements containing more than one nutrient

Supplementation outcomes

Protein and multi-nutrient supplements associated with increased handgrip strength in older adults

Malnutrition

Inadequacy of nutrients to maintain health

Malnutrition - Causes

Insufficient intake, impaired absorption, increased nutrient needs, or altered nutrient transport and utilization

Malnutrition - U.S. diagnosis criteria

ASPEN and AND criteria used

AND malnutrition criteria

Need at least two criteria present for diagnosis

Interventions - Food preferences

Ensure foods meet cultural, religious, and personal preferences

Interventions - Diet liberalization

Encourage eating whatever the individual is willing or able to eat

Interventions - Increase calories

Add calorie-dense ingredients to foods

Interventions - Increase nutrient density

Add dried milk powder, cheese, eggs, peanut butter

Interventions - Increase fat intake

Add butter, cream, mayo, sauces, gravies

Interventions - Snacks and supplements

Provide oral nutrition supplements and high-calorie snacks between meals

Interventions - Micronutrients

Consider multivitamin and mineral supplements

Interventions - Physical activity

Encourage physical activity

Interventions - Advanced nutrition support

Consider enteral nutrition if needed

Interventions - Appetite stimulants

Physician may prescribe medications such as Megace, Marinol, or Mirtazapine

Frailty

Increased vulnerability across multiple health domains leading to adverse health outcomes

Frailty - Risks

Falls, disability, hospitalization

Frailty - Symptoms

Weakness, weight loss, balance issues, cognitive impairment

Frailty - Diet patterns

Higher intake of fruits, vegetables, and whole grains linked to lower risk

Frailty - Protein intake

Higher habitual protein intake linked to lower risk

Frailty - Dairy intake

Low-fat milk and yogurt associated with decreased risk

Frailty - Ultra-processed foods

High intake linked to increased risk

Nutrition Goals for Frailty

Avoid further weight loss, promote weight gain if appropriate, meet protein needs, and slowly increase activity

Frailty - Intervention evidence

Protein supplementation plus resistance training improves strength and lean body mass more than resistance training alone