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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #25, #72

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LEARNING OBJECTIVES

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Learning Objectives

  • Describe the important interrelationship between diet and physical activity in maintaining or restoring lean body mass (LBM) and the resulting effects this interaction has on total body mass in older adults.

  • Describe the changes in body composition that occur over the adult lifespan and what physiologic, dietary, lifestyle, and disease factors are responsible for these changes.

  • Describe the changing prevalence of obesity among older adults and be able to assess the impact of excess weight on the health status of older patients.

  • Advise older adults about what constitutes an optimal diet and the advisability of using nutrient supplements given their health status.

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Key Clinical Points

  1. With advancing age, the ratio of fat to total body mass increases regardless of whether total body weight increases or remains constant.

  2. Although skeletal muscle mass generally declines with advancing age, the rate of decline in healthy individuals is highly dependent on the individual’s habitual level of physical activity and the quality of his/her diet.

  3. Although the impact of excess weight (ie, body mass index [BMI] > 25 kg/m2) on long-term survival is highly controversial, there is a strong direct relationship between the level of obesity and the risk of developing disabling chronic diseases such as severe osteoarthritis, type 2 diabetes, and heart disease.

  4. There is no evidence of benefit for any micronutrient supplement in healthy older adults who do not have a documented deficiency of the given nutrient or a condition that places them at high risk for the development of such a deficiency. Supplements of vitamins and minerals do not prevent or treat cardiovascular disease (CVD), cancer, or dementia.

  5. Vitamin and mineral supplements, above the recommended upper limit (UL), increase adverse health outcomes. The Institute of Medicine (IOM) provides evidence-based guidelines for recommended dietary intakes of vitamins and minerals for most individuals.

  6. Laboratory blood tests of serum proteins (such as albumin and prealbumin) are indicators of inflammatory status, disease severity, and morbidity risk, rather than nutritional status.

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INTRODUCTION

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Throughout life, nutrition is an important determinant of health, physical and cognitive function, vitality, overall quality of life, and longevity. The quantity and variety of available foods, as well as the meaningfulness of the social interactions provided by meals, are important to psychological well-being. The composition of the diet and the amount that is consumed are strongly linked to physiologic function. When a well-balanced diet is not maintained, malnutrition may develop with consequent detrimental effects on health and well-being.

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Malnutrition can have many manifestations. As outlined in Chapter 35, a diet that is deficient in one or more required nutrients (eg, calories, protein, minerals, fiber, or vitamins) can lead to a state of nutritional deficiency. The greater the magnitude and duration of the nutritional deprivation and the more fragile the individual, the more likely ...

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