Medical weight loss in older persons with obesity.

The prevalence of individuals with obesity or overweight has steadily increased over the past decades both worldwide, and in the United States. This trend is also evident in the older adult population, which has experienced a continuous rise in the number of individuals with overweight or obesity. This is relevant due to the impact of obesity in older adults' quality of life, physical function, morbidity, and healthcare costs. This review aims to provide practical guidance and currently available approaches for healthcare professionals in managing this population. Both non-pharmacological methods such as intensive behavioural therapy, nutritional interventions, and physical activity, as well as anti-obesity medications, are discussed, with a focus on their potential positive and negative effects in older adults. Additionally, bariatric therapy is evaluated, including current procedures available and the associated results and risks in the older population.

Sarcopenic obesity in older adults: a clinical overview.

Sarcopenic obesity is characterized by a concurrent decline in muscle mass and function, along with increased adipose tissue. Sarcopenic obesity is a growing concern in older adults owing to significant health consequences, including implications for mortality, comorbidities and risk of developing geriatric syndromes. A 2022 consensus statement established a new definition and diagnostic criteria for sarcopenic obesity. The pathophysiology of this condition involves a complex interplay between muscle, adipose tissue, hormonal changes, inflammation, oxidative stress and lifestyle factors, among others. Sarcopenic obesity is treated with a range of management approaches, such as lifestyle interventions, exercise, nutrition and medical therapies. Emerging therapies that were developed for treating other conditions may be relevant to sarcopenic obesity, including novel pharmacological agents and personalized approaches such as precision medicine. In this Review, we synthesize the current knowledge of the clinical importance of sarcopenic obesity, its assessment and diagnosis, along with current and emerging management strategies.

Changes in Weight or Body Composition by Frailty Status: A Pilot Study.

Weight loss may benefit older adults with obesity. However, it is unknown whether individuals with different frailty phenotypes have different outcomes following weight loss. Community-dwelling adults aged ≥65 (n = 53) with a body mass index ≥30 kg/m2 were recruited for a six-month, single-arm, technology-based weight loss study. A 45-item frailty index identified frailty status using subjective and objective measures from a baseline geriatric assessment. At baseline, n = 22 participants were classified as pre-frail (41.5%) and n = 31 were frail (58.5%), with no differences in demographic characteristics. While weight decreased significantly in both groups (pre-frail: 90.8 ± 2.7 kg to 85.5 ± 2.4 kg (p < 0.001); frail: 102.7 ± 3.4 kg to 98.5 ± 3.3 kg (p < 0.001), no differences were observed between groups for changes in weight (p = 0.30), appendicular lean mass/height2 (p = 0.47), or fat-free mass (p = 0.06). Older adults with obesity can safely lose weight irrespective of frailty status using a technology-based approach. Further investigation is needed to determine whether the impact of specific lifestyle interventions differ by frailty status.

Relationship of Handgrip Strength and Asymmetry with Walking Ability in Older Adults with Excess Adiposity.

When low muscle mass and impaired strength and physical function coexist with excess adiposity, it is termed sarcopenic obesity (SO). Handgrip strength (HGS) is a predictor of disability and mortality. Asymmetry in HGS, particularly ≥ 10% strength differences between hands, may indicate neuromuscular dysfunction observable prior to declines in maximal strength are detectedand therefore could be incorporated to identify those at risk of physical limitations and SO. This study compares HGS values and asymmetry in older adults with excess adiposity and evaluates their relationships with physical function. Baseline data from two previous pilot weight loss studies in 85 older adults with body mass index values ≥ 30 kg m-2 are included with measures of body composition, walking speed, and chair stand ability. Sixty-three participants met the criteria for SO. HGS correlated to gait speed (r = 0.22), distance walked (r = 0.40), chair stand time for 5 repetitions (r = 0.42) and during 30 s (r = 0.31). HGS asymmetry is only correlated to gait speed (r = 0.31) and there are no differences in physical function between those with and without asymmetry. Maximal HGS tests should continue to be used to screen for functional decline and disability.

Sarcopenic Obesity and Cardiovascular Disease: An Overlooked but High-Risk Syndrome.

PURPOSE OF REVIEW: Sarcopenic obesity (SO), defined as the coexistence of excess fat mass and reduced skeletal muscle mass and strength, has emerged as an important cardiovascular risk factor, particularly in older adults. This review summarizes recent findings on the diagnosis, prevalence, health impacts, and treatment of SO. RECENT FINDINGS: Growing evidence suggests SO exacerbates cardiometabolic risk and adverse health outcomes beyond either condition alone; however, the heterogeneity in diagnostic criteria and the observational nature of most studies prohibit the evaluation of a causal relationship. This is concerning given that SO is increasing with the aging population, although that is also difficult to assess accurately given wide-ranging prevalence estimates. A recent consensus definition proposed by the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity provides a framework of standardized criteria to diagnose SO. Adopting uniform diagnostic criteria for SO will enable more accurate characterization of prevalence and cardiometabolic risk moving forward. Although current management revolves around diet for weight loss coupled with resistance training to mitigate further muscle loss, emerging pharmacologic therapies have shown promising results. As the global population ages, diagnosing and managing SO will become imperative to alleviate the cardiovascular burden.

Aging precisely: Precision medicine through the lens of an older adult.

Precision medicine presents an opportunity to use novel, data-driven strategies to improve patient care. The field of precision medicine has undergone many advancements over the past few years. It has moved beyond incorporation of individualized genetic risk into medical decision-making to include multiple other factors such as unique social, demographic, behavioral, and clinical characteristics. Geriatric medicine stands to benefit heavily from the integration of precision medicine into its standard practices. Older adults, compared with other populations, have high clinical and biological heterogeneity that can alter the risks and benefits of different approaches to patient care. These factors have not been routinely considered previously by geriatricians. Yet, geriatricians' ability to address older adults' baseline heterogeneity is increasingly recognized as a cornerstone of delivering quality care in a geriatric medical practice. Given the shared focus of individualized decision-making, precision medicine is a natural fit for geriatric medicine. This manuscript provides, via cases and discussion, examples that illustrate how precision medicine can improve the care of our older patients today. We will share specific and existing tools and evidence, and review the existing multilevel barriers to further incorporate and implement these tools into clinical practice. We propose methods to address these barriers and to help realize the full potential of precision medicine for the care of older adults. We conclude with a brief discussion of potential future directions of research of precision medicine in the care of older adults.

Nutrition interventions for body composition, physical function, cognition in hospitalized older adults: A systematic review of individuals 75 years and older.

BACKGROUND: Globally, the oldest old population is expected to triple by 2050. Hospitalization and malnutrition can result in progressive functional decline in older adults. Minimizing the impact of hospitalization on functional status in older adults has the potential to maintain independence, reduce health and social care costs, and maximize years in a healthy state. This study aimed to systematically review the literature to identify nutritional interventions that target physical function, body composition, and cognition in the older population (≥ 75 years). METHODS: A systematic review was conducted to evaluate the efficacy of nutritional interventions on physical function, body composition, and cognition in adults aged ≥ 75 years or mean age ≥80 years. Searches of PubMed (National Institutes of Health, National Library of Medicine), Scopus (Elsevier), EMBASE (Elsevier), Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCOhost), and PsycInfo (EBSCOhost) were conducted. Screening, data extraction, and quality assessment were performed in duplicate and independently (CRD42022355984; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=355984). RESULTS: Of 8311 citations identified, 2939 duplicates were excluded. From 5372 citations, 189 articles underwent full-text review leaving a total of 12 studies for inclusion. Interventions were food-based, protein-based, carbohydrate-based, personalized, or used parenteral nutrition. Ten studies monitored anthropometric or body composition changes with three showing maintenance or improvements in lean mass, body mass index, triceps skinfold, and mid-upper arm circumference compared with the control group. Six studies monitored physical function but only the largest study found a beneficial effect on activities of daily living. Two of three studies showed the beneficial effects of nutritional intervention on cognition. CONCLUSION: There are few, high-quality, nutrition-based interventions in older adults ≥75 years. Despite heterogeneity, our findings suggest that large, longer-term (>2 weeks) nutritional interventions have the potential to maintain body composition, physical function, and cognition in adults aged 75 years and older during hospitalization.

Using Voice Assistant Systems to Improve Dietary Recall among Older Adults: Perspectives of Registered Dietitians.

Dietary assessments are important clinical tools used by Registered Dietitians (RDs). Current methods pose barriers to accurately assess the nutritional intake of older adults due to age-related increases in risk for cognitive decline and more complex health histories. Our qualitative study explored whether implementing Voice assistant systems (VAS) could improve current dietary recall from the perspective of 20 RDs. RDs believed the implementing VAS in dietary assessments of older adults could potentially improve patient accuracy in reporting food intake, recalling portion sizes, and increasing patient-provider efficiency during clinic visits. RDs reported that low technology literacy in older adults could be a barrier to implementation. Our study provides a better understanding of how VAS can better meet the needs of both older adults and RDs in managing and assessing dietary intake.

Adapting natural language processing and sentiment analysis methods for an intervention in older adults: Positive perceptions of health and technology.

Background: Older adults frequently participate in behavior change studies, yet it is not clear how to quantify a potential relationship between their perception of the intervention and its efficacy. Research Aim: We assessed the relationship between participant sentiment toward the intervention from follow-up interviews with physical activity and questionnaires for the perception of health. Methods: Sentiment was calculated using the transcripts of exit interviews through a bag of words approach defined as the sum of positive and negative words in 28 older adults with obesity (body mass index ≥30kg/m2). Results: Mean age was 73 years (82% female), and 54% lost ≥5% weight loss. Through linear regression we describe a significant association between positive sentiment about the intervention and weight loss; positive sentiment on technology and change in PROMIS-10 physical health and reduced physical activity time, while controlling for sex and age. Conclusions: This analysis demonstrates that sentiment analysis and natural language processing in program review identified an association between perception and topics with clinical outcomes.

Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: a systematic review / Validez de los modelos de predicción del riesgo de enfermedades cardiovasculares en América Latina y en la población hispana en los Estados Unidos de América: una revisión sistemática

Objective. To assess the use and validity of prediction models to estimate the risk of cardiovascular disease (CVD) in Latin America and among Hispanic populations in the United States of America. Methods. This was a systematic review of three databases: Ovid MEDLINE (1 January 1950­15 April 2010), LILACS (1 January 1988­15 April 2010), and EMBASE (1 January 1988­15 April 2010). MeSH search terms and domains were related to CVD, prediction rules, Latin America (including the Caribbean), and Hispanics in the United States. Database searches were supplemented by correspondence with experts in the field. Results. A total of 1 655 abstracts were identified, of which five cohorts with a total of 13 142 subjects met inclusion criteria. A Mexican cohort showed that the predicted/observed event-rate ratio for coronary heart disease (CHD) according to the Framingham risk score (FRS) was 1.68 (95% CI, 1.26­2.11); incident myocardial infarction, 1.36 (95% CI, 0.90­1.83); and CHD death, 1.21 (95% CI, 0.43­2.00). In Ecuador, a prediction model for CVD and total deaths in hypertensive patients had an area under the curve (AUC) of 0.79 (95% CI, 0.72­0.86), while the World Health Organization method had an AUC of 0.74 (95% CI, 0.67­0.82). A study predicting mortality risk in people with Chagas' disease had an AUC of 0.81 (95% CI, 0.72­0.90). Among a United States cohort that included Hispanics, FRS overestimated CVD risk for Hispanics with an AUC of 0.69. Another study in the United States that assessed FRS factors predicting CVD death among Mexican-Americans had an AUC of 0.78. Conclusions. The evidence regarding CVD risk prediction rules in Latin America or among Hispanics in the United States is modest at best. It is likely that the FRS overestimates CVD risk in Hispanics when not properly recalibrated.

Objetivo. Evaluar el uso y la validez de los modelos de predicción para calcular el riesgo de padecer enfermedades cardiovasculares en América Latina y en poblaciones hispanas en los Estados Unidos de América. Métodos. Se llevó a cabo una revisión sistemática de tres bases de datos: Ovid MEDLINE (1 de enero de 1950 al 15 de abril del 2010), LILACS (1 de enero de 1988 al 15 de abril del 2010) y Embase (1 de enero de 1988 al 15 de abril del 2010). Los términos de búsqueda MeSH y los dominios se relacionaron con las enfermedades cardiovasculares, las reglas de predicción, América Latina (que incluye el Caribe) y los hispanos en los Estados Unidos. Las búsquedas en las bases de datos se complementaron con la opinión de expertos en el tema. Resultados. Se identificaron 1 655 resúmenes, de los cuales reunieron los criterios de inclusión cinco cohortes con un total de 13 142 sujetos. En una cohorte mexicana la razón entre las tasas de sucesos previstos y observados para la cardiopatía coronaria según la escala de valoración del riesgo de Framingham (FRS) fue 1,68 (IC de 95%, 1,26­2,11); para el infarto de miocardio nuevo, 1,36 (IC de 95%, 0,90­1,83); y para la muerte por cardiopatía coronaria, 1,21 (IC de 95%, 0,43­2,00). En el Ecuador, un modelo de predicción de defunción por enfermedades cardiovasculares y total en los pacientes hipertensos presentó un área bajo la curva (AUC) de 0,79 (IC de 95%, 0,72­0,86), mientras que el método de la Organización Mundial de la Salud mostró un AUC de 0,74 (IC de 95%, 0,67­0,82). Un estudio enfocado a predecir el riesgo de mortalidad en las personas con enfermedad de Chagas reveló un AUC de 0,81 (IC de 95%, 0,72­0,90). En una cohorte de los Estados Unidos que incluía población hispana, la FRS sobrestimó el riesgo de sufrir enfermedades cardiovasculares para los hispanos con un AUC de 0,69. Otro estudio realizado en los Estados Unidos en el que se evaluó los factores de la FRS que predecían la muerte debida a enfermedades cardiovasculares en estadounidenses de origen mexicano reveló un AUC de 0,78. Conclusiones. Los datos relacionados con las reglas de predicción del riesgo de sufrir enfermedades cardiovasculares en América Latina o en la población hispana en los Estados Unidos son, en el mejor de los casos, limitados. Es probable que la FRS sobrestime el riesgo de sufrir enfermedades cardiovasculares en la población hispana cuando no se la recalibra de manera adecuada.