Nutrition, energy metabolism and body composition in the frail elderly
Author: Lammes, Eva
Date: 2007-01-10
Location: Föreläsningssalen B64, Karolinska Universitetssjukhuset, Huddinge
Time: 10.00
Department: Institutionen för laboratoriemedicin / Department of Laboratory Medicine
View/ Open:
thesis.pdf (867.0Kb)
Abstract
During aging a reduction of energy metabolism, energy intake and fat free
mass can be seen. Some elderly patients experience more pronounced body
weight loss that may lead to malnutrition states. The reasons for the
unintentional body weight loss, that often accompanies chronic disease,
are poorly understood. A combination of poor nutritional state and
impaired physical function increases the risk for dependency in the daily
living and further deterioration of health. Treatment needs to focus on
the one hand of optimizing disease management and on the other on
nutrition and physical function.
The aim of this thesis was to study several nutrition related parameters
in frail elderly people and try to gain a deeper understanding of the
mechanisms contributing to the nutritional problems in elderly patients,
also focusing on treatment and follow-up. This was done by analyzing
energy intake, body composition and energy metabolism in both nursing
home patients and free-living, frail elderly individuals. Individualized
nutritional treatments were applied and analyzed longitudinally. In the
free-living group a three-month randomized controlled trial (RCT) with
four arms was performed (nutritional treatment, physical training, both
combined or control).
The results showed that energy intake was low (mean total intake below
1600 kcal/day, mean relative intake was 25-27 kcal/kg body weight/day).
Individual nutritional intervention was difficult to manage and the
effects difficult to analyze. Nutrient intake was low for about half of
the nutrients analyzed. Nutrient density was also low, especially
considering the low level of energy intake. Resting metabolic rate was
related to fat free mass and was in accordance with previous studies.
Mean body weight was stable. At an individual level there was no relation
between changes in energy intake and body weight. In the RCT no evident
treatment effects could be seen on any of the nutrition parameters
analyzed. Of those in need of an increased energy intake, about one third
managed to actually increase their intake, regardless of intervention.
These individuals seemed to be protected against further weight loss.
As energy metabolism was normal and the physical activity low in these as
in previous studies in the literature, future research needs to focus on
the reasons for the poor energy and nutrient intake in the frail elderly.
The relative contribution of diseases and/or injuries, effects of
medication, low physical activity, social deprivation and mechanisms
related to ageing are unclear and should be considered. There is a strong
need for more treatment trials regarding malnutrition and frailty states.
There is a large variety between individuals and therefore attention to
the needs of the individual should be emphasized. The importance of
preventing frailty will increase, as the number of very elderly people
grows in society.
List of papers:
I. Lammes E, Akner G. (2006). "Resting metabolic rate in elderly nursing home patients with multiple diagnoses." J Nutr Health Aging 10(4): 263-70
Pubmed
II. Lammes E, Akner G. (2006). "Repeated assessment of energy and nutrient intake in 52 nursing home residents." J Nutr Health Aging 10(3): 222-30
Pubmed
III. Lammes E, Törner A, Akner G. (2006). "Nutrient density and variation in nutrient intake with changing energy intake in nursing home residents." (Submitted)
IV. Lammes E, Akner G (2006). "No effect of nutritional and physical treatment on energy intake, metabolic rate and body composition in frail elderly. A randomized, controlled pilot treatment study." (Submitted)
I. Lammes E, Akner G. (2006). "Resting metabolic rate in elderly nursing home patients with multiple diagnoses." J Nutr Health Aging 10(4): 263-70
Pubmed
II. Lammes E, Akner G. (2006). "Repeated assessment of energy and nutrient intake in 52 nursing home residents." J Nutr Health Aging 10(3): 222-30
Pubmed
III. Lammes E, Törner A, Akner G. (2006). "Nutrient density and variation in nutrient intake with changing energy intake in nursing home residents." (Submitted)
IV. Lammes E, Akner G (2006). "No effect of nutritional and physical treatment on energy intake, metabolic rate and body composition in frail elderly. A randomized, controlled pilot treatment study." (Submitted)
Issue date: 2006-12-20
Rights:
Publication year: 2007
ISBN: 91-7357-058-3
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