Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, 34390, Istanbul, Turkey.
Sancaktepe Training and Research Hospital, Sancaktepe, Istanbul, Turkey.
Aging Clin Exp Res. 2024 Jan 23;36(1):3. doi: 10.1007/s40520-023-02650-1.
The prevalence of obesity by fat percentage has seen a steady increase in older adults in recent years, secondary to increases in fat mass in body composition, even in healthy aging. Malnutrition is a common geriatric syndrome with serious clinical outcomes. Increases in fat mass and waist circumference with healthy aging should not prevent the risk of malnutrition from being masked. Malnutrition is often ignored in obese older people due to low BMI cut-off values in many screening tests. The present study seeks to raise awareness of the need to assess the frequency of undernutrition and related factors in obese older adults.
The data of 2013 community-dwelling patients aged ≥ 60 years who applied to a university geriatrics outpatient clinic between April 2012 and November 2022 were analyzed retrospectively, of which 296 were found to be obese based on fat percentage and were included in the study. Demographic data and the presence of any geriatric syndromes were obtained retrospectively from the patient files, functional status was assessed using the KATZ Activities of Daily Living (ADL) Scale and the LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL); frailty was screened using FRAIL-scale; and the sample was assessed for malnutrition using the Mini Nutritional Assessment-Short Form (MNA-SF), with undernutrition defined as an MNA-SF score of [Formula: see text] The patients' fat percentage and weight were measured using a bioimpedance analyzer. Fatty obesity was defined using the Zoico methodology (fat percentage [Formula: see text] 27.3% for males, [Formula: see text] 40.7% for females)[Formula: see text] handgrip strength (HGS) was measured using a hand dynamometer, and probable sarcopenia was defined as low HGS based on regional cut-off values (35 kg for males, 20 kg for females).
The mean age of the 296 fatty obese older adults (102 males/194 females) was 74.4 + 6.5 years, and the median fat was 42.2% (27.4-59.5). Undernutrition was detected in 19.6% of the patients based on MNA-SF screening. A univariate analysis revealed age, sex, educational status, daily physical activity status, depression, difficulty in swallowing, chewing difficulty, probable sarcopenia, number of chronic diseases, and IADL to be associated with undernutrition, while a multivariate logistic regression analysis revealed depression [OR = 3.662, 95% CI (1.448-9.013), p = 0.005] and daily physical activity status [OR:0.601, 95% CI (0.417-0.867), p = 0.006] to be independently associated with malnutrition in obese older adults based on fat percentage.
The present study clarifies the significance of undernutrition in obese older adults also in our country, and recommends undernutrition screening to be carried out, by fat percentage, on obese older adults, especially with depression and low daily physical activity.
近年来，由于身体成分中脂肪量的增加，即使在健康衰老的情况下，老年人的肥胖率（按体脂百分比计算）也在稳步上升。营养不良是一种常见的老年综合征，会导致严重的临床后果。随着健康衰老，脂肪量和腰围的增加不应掩盖营养不良的风险。由于许多筛查测试中的 BMI 截断值较低，肥胖的老年人往往会忽略营养不良。本研究旨在提高对评估肥胖老年人营养不足频率及相关因素的必要性的认识。
回顾性分析了 2012 年 4 月至 2022 年 11 月期间向大学老年病门诊就诊的年龄≥60 岁的 2013 名社区居住患者的数据，其中 296 名患者根据体脂百分比被确定为肥胖，并纳入本研究。从患者病历中回顾性获取人口统计学数据和任何老年综合征的存在情况，使用 Katz 日常生活活动（ADL）量表和 Lawton-Brody 日常生活活动工具（IADL）量表评估功能状态；使用 FRAIL 量表筛查虚弱；使用 Mini Nutritional Assessment-Short Form（MNA-SF）评估样本的营养不良情况，MNA-SF 评分[Formula: see text]定义为营养不良。使用生物阻抗分析仪测量患者的体脂百分比和体重。采用 Zoico 方法（男性体脂百分比[Formula: see text]27.3%，女性[Formula: see text]40.7%）定义肥胖性肥胖[Formula: see text]使用手持测力计测量握力（HGS），并根据区域截断值（男性 35kg，女性 20kg）定义可能的肌肉减少症为低 HGS。
296 名肥胖老年患者（男性 102 名/女性 194 名）的平均年龄为 74.4±6.5 岁，中位数体脂百分比为 42.2%（27.4-59.5）。根据 MNA-SF 筛查，19.6%的患者存在营养不良。单因素分析显示，年龄、性别、教育程度、日常体力活动状态、抑郁、吞咽困难、咀嚼困难、可能的肌肉减少症、慢性疾病数量和 IADL 与营养不良有关，而多因素逻辑回归分析显示，抑郁[OR=3.662，95%CI（1.448-9.013），p=0.005]和日常体力活动状态[OR：0.601，95%CI（0.417-0.867），p=0.006]与肥胖老年人基于体脂百分比的营养不良独立相关。
本研究阐明了肥胖老年人营养不良的重要性，建议对肥胖老年人进行基于体脂百分比的营养不良筛查，特别是对有抑郁和低日常体力活动的患者。
