Moriguti J C, Moriguti E K, Ferriolli E, de Castilho Cação J, Iucif N, Marchini J S
Division of General Internal and Geriatric Medicine, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
Sao Paulo Med J. 2001 Mar;119(2):72-7. doi: 10.1590/s1516-31802001000200007.
The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful.
Narrative review.
即使排除了已有疾病的老年受试者，晚年体重和脂肪的减少仍与过早死亡及残疾风险增加相关。虽然认识到能量平衡显著正向或负向以及体重波动是生活中的正常部分很重要，但6个月内体重下降超过5%仍应进行调查。老年人体重减轻的主要原因可分为4类：社会因素、精神因素、疾病因素和与年龄相关的因素。临床评估应包括详细的病史和体格检查。如果这些检查未能为体重减轻提供线索，则需进行简单的诊断性检查。如果这些初始检查结果正常，与其盲目进行可能产生很少有用数据的额外诊断性检查，观察等待一段时间更为可取。管理体重减轻患者的第一步是识别并治疗任何特定的病因或相关情况，并在必要时提供营养支持。非食欲增强药物在蛋白质-能量营养不良的管理中已占据一席之地。在急性应激期间，尤其是住院期间，早期关注营养和预防体重减轻可能极其重要，因为重新进食的努力往往并不成功。
叙述性综述
