Preventing Weight Loss in Patients With Dementia

The link between dementia and weight loss has been established: Weight loss is associated with even mild dementia, increasing with advancing disease severity and duration. But with a large multicountry study, researchers from the National Institutes of Health in Bethesda, Maryland, King’s College London and Newcastle University, both in the United Kingdom, and Universidad Nacional Pedro Henriquez Ureña in Santo Domingo, Dominican Republic, add new information about the universality of the association.

The researchers surveyed 16,538 older adults, asking them or a caregiver whether the patient had lost ≥ 10 pounds in the previous 3 months. The prevalence of weight loss ranged from 2% in China to 26% in the Dominican Republic and was lowest for participants with no dementia and highest in those with a Clinical Dementia Rating Scale Severity of two-thirds in all countries. The association increased and strengthened linearly through stages of dementia severity in all the study countries.

Weight loss in people with dementia can lead to further morbidity, worse prognosis, and death, the researchers note. They call for more studies, but in the meantime, they emphasize that treating and preventing weight loss is critical, particularly for institutionalized dementia patients.

One intervention that could help is giving patients nutritionally complete oral supplements, say researchers from The Royal Berkshire Hospital NHS Foundation Trust and the University of Reading, both in the United Kingdom. They reviewed 12 studies involving 1,824 patients. Most interventions, which ranged from 3 weeks to 1 year, were compared with a normal diet and care.

Two findings had to do with how weight loss is measured in older people. Skin-fold thickness and arm muscle circumference are not affected by supplement use, the researchers found. They add that those anthropometric measurements have a low level of reproducibility and are not an accurate method for obtaining evidence of changes in body composition (mid-arm muscle circumference is calculated from the skin-fold measurements). Further, measuring by body mass index (BMI) is less accurate in older patients, they note, when determining fat mass and subsequent nutritional status due to changes in height and age-related redistribution of fat mass.

However, the studies were short enough to allow BMI and weight measurements to detect the influence of the supplements. And the conclusion was that the nutritional supplement drinks had positive effects on weight gain and BMI. Overall, the consumption was “fairly good”; however, consumption was lowest in one of the longest studies. That might have been due to changes in staff behavior—increased vigilance and verbal prompting, common in the shorter studies, may have dropped off in longer studies.

Supplement use was significantly associated with improved overall energy intake and a small but statistically significant change in weight and BMI (P < .0001). However, where the control was a macro- or micronutrient supplement, findings were less positive. That may indicate that comparisons of nutritional supplements to vitamin/mineral tablets and high protein-calorie shots needs more research, the researchers conclude.

Sources
Albanese E, Taylor C, Siervo M, Stewart R, Prince MJ, Acosta D. Alzheimer’s Dement. 2013;9(6):649-656.
doi: 10.1016/j.jalz.2012.11.014.
Allen VJ, Methven L, Gosney MA. Clin Nutr. 2013;32(6):950-957.
doi: 10.1016/j.clnu.2013.03.015.

The link between dementia and weight loss has been established: Weight loss is associated with even mild dementia, increasing with advancing disease severity and duration. But with a large multicountry study, researchers from the National Institutes of Health in Bethesda, Maryland, King’s College London and Newcastle University, both in the United Kingdom, and Universidad Nacional Pedro Henriquez Ureña in Santo Domingo, Dominican Republic, add new information about the universality of the association.

The researchers surveyed 16,538 older adults, asking them or a caregiver whether the patient had lost ≥ 10 pounds in the previous 3 months. The prevalence of weight loss ranged from 2% in China to 26% in the Dominican Republic and was lowest for participants with no dementia and highest in those with a Clinical Dementia Rating Scale Severity of two-thirds in all countries. The association increased and strengthened linearly through stages of dementia severity in all the study countries.

Weight loss in people with dementia can lead to further morbidity, worse prognosis, and death, the researchers note. They call for more studies, but in the meantime, they emphasize that treating and preventing weight loss is critical, particularly for institutionalized dementia patients.

One intervention that could help is giving patients nutritionally complete oral supplements, say researchers from The Royal Berkshire Hospital NHS Foundation Trust and the University of Reading, both in the United Kingdom. They reviewed 12 studies involving 1,824 patients. Most interventions, which ranged from 3 weeks to 1 year, were compared with a normal diet and care.

Two findings had to do with how weight loss is measured in older people. Skin-fold thickness and arm muscle circumference are not affected by supplement use, the researchers found. They add that those anthropometric measurements have a low level of reproducibility and are not an accurate method for obtaining evidence of changes in body composition (mid-arm muscle circumference is calculated from the skin-fold measurements). Further, measuring by body mass index (BMI) is less accurate in older patients, they note, when determining fat mass and subsequent nutritional status due to changes in height and age-related redistribution of fat mass.

However, the studies were short enough to allow BMI and weight measurements to detect the influence of the supplements. And the conclusion was that the nutritional supplement drinks had positive effects on weight gain and BMI. Overall, the consumption was “fairly good”; however, consumption was lowest in one of the longest studies. That might have been due to changes in staff behavior—increased vigilance and verbal prompting, common in the shorter studies, may have dropped off in longer studies.

Supplement use was significantly associated with improved overall energy intake and a small but statistically significant change in weight and BMI (P < .0001). However, where the control was a macro- or micronutrient supplement, findings were less positive. That may indicate that comparisons of nutritional supplements to vitamin/mineral tablets and high protein-calorie shots needs more research, the researchers conclude.

Sources
Albanese E, Taylor C, Siervo M, Stewart R, Prince MJ, Acosta D. Alzheimer’s Dement. 2013;9(6):649-656.
doi: 10.1016/j.jalz.2012.11.014.
Allen VJ, Methven L, Gosney MA. Clin Nutr. 2013;32(6):950-957.
doi: 10.1016/j.clnu.2013.03.015.

The link between dementia and weight loss has been established: Weight loss is associated with even mild dementia, increasing with advancing disease severity and duration. But with a large multicountry study, researchers from the National Institutes of Health in Bethesda, Maryland, King’s College London and Newcastle University, both in the United Kingdom, and Universidad Nacional Pedro Henriquez Ureña in Santo Domingo, Dominican Republic, add new information about the universality of the association.

The researchers surveyed 16,538 older adults, asking them or a caregiver whether the patient had lost ≥ 10 pounds in the previous 3 months. The prevalence of weight loss ranged from 2% in China to 26% in the Dominican Republic and was lowest for participants with no dementia and highest in those with a Clinical Dementia Rating Scale Severity of two-thirds in all countries. The association increased and strengthened linearly through stages of dementia severity in all the study countries.

Weight loss in people with dementia can lead to further morbidity, worse prognosis, and death, the researchers note. They call for more studies, but in the meantime, they emphasize that treating and preventing weight loss is critical, particularly for institutionalized dementia patients.

One intervention that could help is giving patients nutritionally complete oral supplements, say researchers from The Royal Berkshire Hospital NHS Foundation Trust and the University of Reading, both in the United Kingdom. They reviewed 12 studies involving 1,824 patients. Most interventions, which ranged from 3 weeks to 1 year, were compared with a normal diet and care.

Two findings had to do with how weight loss is measured in older people. Skin-fold thickness and arm muscle circumference are not affected by supplement use, the researchers found. They add that those anthropometric measurements have a low level of reproducibility and are not an accurate method for obtaining evidence of changes in body composition (mid-arm muscle circumference is calculated from the skin-fold measurements). Further, measuring by body mass index (BMI) is less accurate in older patients, they note, when determining fat mass and subsequent nutritional status due to changes in height and age-related redistribution of fat mass.

However, the studies were short enough to allow BMI and weight measurements to detect the influence of the supplements. And the conclusion was that the nutritional supplement drinks had positive effects on weight gain and BMI. Overall, the consumption was “fairly good”; however, consumption was lowest in one of the longest studies. That might have been due to changes in staff behavior—increased vigilance and verbal prompting, common in the shorter studies, may have dropped off in longer studies.

Supplement use was significantly associated with improved overall energy intake and a small but statistically significant change in weight and BMI (P < .0001). However, where the control was a macro- or micronutrient supplement, findings were less positive. That may indicate that comparisons of nutritional supplements to vitamin/mineral tablets and high protein-calorie shots needs more research, the researchers conclude.

Sources
Albanese E, Taylor C, Siervo M, Stewart R, Prince MJ, Acosta D. Alzheimer’s Dement. 2013;9(6):649-656.
doi: 10.1016/j.jalz.2012.11.014.
Allen VJ, Methven L, Gosney MA. Clin Nutr. 2013;32(6):950-957.
doi: 10.1016/j.clnu.2013.03.015.