OBJECTIVES : To describe the incidence, anthropometric parameters, and clinical significance of weight loss in older outpatients. DESIGN : Four‐year prospective cohort study. SETTING : University‐affiliated Veterans Affairs Medical Center. PATIENTS : Two hundred forty‐seven community‐dwelling male veterans 65 years of age or older. MEASUREMENTS : Anthropometrics (weight, height, skinfolds, and circumferences), health status measures (Sickness Impact Profile scores, health care utilization, self‐reported ratings of health), and bloodwork (cholesterol, albumin, others) were obtained at baseline and followed annually for 2 years. Outcome measures (hospitalization, nursing home placement, and mortality rates) were followed for a minimum of 2 years after any identified weight change. MAIN RESULTS : The mean annual percentage weight change for the study population was −0.5% (SD: ± 4.0%; range: −17% to +25%). Four percent annual weight loss was determined to be the optimal cutpoint for defining clinically important involuntary weight loss using ROC curve analysis. The annual incidence of this degree of involuntary weight loss was 13.1%. At baseline, involuntary weight losers were similar to nonweight losers in age (73.9 ± 7.9 vs 73.3 ± 6.7 years), body mass index (26.8 ± 3.9 vs 26.9 ± 4.1 kg/m 2 ), and all other anthropometric, health status, and laboratory measures. Relative to nonweight losers, involuntary weight losers had significantly ( P ≤ .05) greater decrements in central skinfold and circumference measures (subscapular skinfolds, −2.9 vs −0.4 mm; suprailiac skinfolds, −4.2 vs −0.2 mm; and waist to hip ratio, −.01 vs + .00). Both groups had significant decreases in their triceps skinfolds (an estimate of peripheral subcutaneous fat), whereas arm muscle area and albumin levels did not decline significantly in either group. Over a 2‐year follow‐up period, mortality rates were substantially higher (RR = 2.43; 95% CI = 1.34–4.41) among involuntary weight losers (28%) than among nonweight losers (11%). Of interest, a similar increase in 2‐year mortality (36%) was also observed among subjects with voluntary weight loss (by dieting). Survival analyses adjusting for differences between weight losers and nonweight losers in baseline age, BMI, tobacco use, and other health status and laboratory measures yielded similar results. CONCLUSIONS : These results indicate that involuntary weight loss occurred frequently (13.1% annual incidence) in this population of older veteran outpatients. When involuntary weight loss occurred, the predominant anthropometric changes were decrements in measures of centrally distributed fat (trunkal skinfolds and circumferences). Finally, involuntary weight loss greater than 4% of body weight appears to be clinically important as an independent predictor of increased mortality.
WHO WE AREThe American Geriatrics Society (AGS) is a not-for-profi t organization of close to 6,000 health professionals devoted to improving the health, independence and quality of life of all older people.The Society provides leadership to healthcare professionals, policy makers and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. OUR MISSIONTo improve the health, independence, and quality of life of all older people. OUR VISION FOR THE FUTUREEvery older American will receive high-quality patient-centered care. STRATEGIES FOR ACHIEVING OUR VISION• Expand the geriatrics knowledge base through research.• Increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons • Recruit physicians and other healthcare professionals into careers in geriatrics • Guide public policy efforts and provide public education to continually improve the health and health care of seniors • Raise public awareness of the need for high-quality, culturally sensitive, interdisciplinary geriatric health care LEARN MOREVisit www.americangeriatrics.org to learn more about the Society and its programs. JAGS Recognized as Among Most Infl uential Journals in the WorldIn June 2009, the Journal of the American Geriatrics Society (JAGS) was offi cially recognized by the Special Library Association as among the top 100 most infl uential biomedical journals in the world in the past 100 years.It is the only geriatrics/gerontology journal to be selected for inclusion in this list.JAGS supports the Society's vision that all older adults will receive high-quality, patient-centered care.
The number of AIDS patients over age 60 has risen steadily in the past decade. The number of transfusion-acquired AIDS cases probably has peaked--or will soon peak. Homosexual (or bisexual) behavior remains the predominant risk factor for AIDS until the seventh decade. Disease progression appears to be more rapid in the elderly, although the observed shorter survival time may result from a delay in diagnosis. Symptoms of HIV infection are often nonspecific, such as fatigue, anorexia, weight loss, and decreased physical and cognitive function. The five most common opportunistic infections in older HIV-infected patients are Pneumocystis carinii pneumonia, tuberculosis, Mycobacterium avium complex, herpes zoster, and cytomegalovirus. A number of features of HIV-related dementia may help to distinguish it from Alzheimer's disease.
Study Objective. To evaluate the association between involuntary weight loss and serum concentrations of tumor necrosis factor (TNF)-α in elderly, community-dwelling adults. Design. Cross-sectional, single—time point investigation. Setting. Two primary care ambulatory clinics. Subjects. Ambulatory adults aged 70 years or older with involuntary weight loss of 2.27 kg (5 lbs) or more, or with stable weight (+ 0.91 kg [2 lbs]) for the 3 months before enrollment. Measurements and Main Results. Ten subjects with weight loss (mean + SD −4.9 + 2.6 kg) and 25 subjects with stable weight (+ 0.06 + 0.55 kg) were enrolled. The latter group was recruited to serve as a comparison group to the weight-loss group. Subjects donated a venous blood sample and were administered the Mini Nutritional Assessment at a single clinic visit. Serum concentrations of TNF-α were measured by using enzyme-linked immunosorbent assay. The TNF-α concentrations were significantly higher in subjects with weight loss (mean + SD 19.3 + 24.9 pg/ml) than in subjects with stable weight (mean + SD 1.1 + 2.0 pg/ml, p<0.01). No relationship was found between the TNF-α concentration and the degree of weight loss expressed as a percentage of total body weight. Conclusion. Older adults with involuntary weight loss had increased circulating concentrations of TNF-α. Whether TNF-α plays a causal role in involuntary weight loss among older adults is unclear; however, this finding is consistent with those in other disease states associated with cachexia. Further research is necessary to clarify this relationship and to determine if pharmacotherapeutic interventions targeted at TNF-α can prevent or reverse involuntary weight loss and its associated morbidity and mortality.
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