Lack of adaptation to severe malnutrition in elderly patients.
OBJECTIVE
Sarcopenia is a common feature in the healthy elderly. However, little is known on age-related modifications of body composition in malnourished patients. The aims of this cross-sectional study were to evaluate the effects of aging per se on body composition and resting energy expenditure (REE) in malnourished patients.


METHODS
Ninety-seven non-stressed patients referred for chronic malnutrition (C-reactive protein <5 mg/l) were separated into two groups: middle-aged (26 female, 19 male, 48+/-15 yr), and elderly (26 female, 26 male, 79+/-6 yr). Body composition was assessed by bioelectrical impedance analysis and REE by indirect calorimetry.


RESULTS
In middle-aged patients, body composition remained stable between moderate (body-mass index [BMI; in kg/m(2)] 16-18.5) and severe (BMI < 16) malnutrition, with similar values of fat-free mass (FFM), body cell mass (BCM) and fat mass (FM) as percentages of body weight, whereas in elderly patients malnutrition occurred at the expense of FFM and BCM, with unchanged FM absolute values. REE/FFM values remained stable in middle-aged patients at every stage of malnutrition, whereas they increased in elderly patients along with their degree of malnutrition. In multivariate analysis, both body composition and REE/FFM were influenced by sex, age, BMI and mid-arm circumference.


CONCLUSIONS
Compared to younger patients, weight loss in the elderly leads to cachexia, with a preferential loss of FFM and BCM that may participate in the more severe outcomes observed in these patients. They also show elevated REE/FFM values that induce higher energy needs.
Schneider
Stephane M
SM
Gastroenterology and Nutrition Department, Archet University Hospital, University of Nice Sophia-Antipolis, France.
Al-Jaouni
Rima
R
Pivot
Xavier
X
Braulio
Valeria B
VB
Rampal
Patrick
P
Hebuterne
Xavier
X
D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000886:Anthropometry; D001481:Basal Metabolism / Q000502:physiology*; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D002153:Calorimetry, Indirect; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000378:metabolism / Q000503:physiopathology*; D012737:Sex Factors