Older People with Poor Weight (Lean) and Nutrition Facing Greater Risk for Developing Diabetes
Today, whether one is considered overweight or obese depends on the BMI. The Body Mass Index or BMI is used to assess the weight status of individuals. In adults, the weight status based on the BMI is as follows:
- BMI less than 18.5 = Underweight.
- BMI 18.5 - 24.9 = Normal.
- BMI 25 - 29 = Overweight.
- BMI over 30 = Obese
Due to loss of loved ones, health problems, trouble paying bills, or other reasons, many older people feel lonely, sad, or stressed in their daily lives. Feelings like these may cause you to lose energy, not feel like doing anything, not eat enough, or overeat. Being active can help you live on your own for a longer time and lower your chance of getting type 2 diabetes, coronary heart disease, and colon cancer. Underweight babies suffering from malnutrition are also equally at risk for subsequent diabetes.
Age-adjusted diabetes death rates by race and sex in Georgia shown that about 35% of diabetes deaths are in persons under the age of 65. In 2003, the proportion of diabetes deaths that were premature (before 65 years) was highest among black males (49.2%), followed by white males (38.3%), black females (31.7%), and white females (24.9%). Under-nourishment precipitates nutrient deficiencies leading to such conditions as anemia, osteoporosis, or wasting in adults.
Even undernutrition early in life, followed by weight gain -- as developing nations adopt Western lifestyles and eating habits -- can lead to a virulent form of obesity. This condition can later cause diabetes, heart disease and some forms of cancer. Intriguingly, a contrasting theory suggests that undernutrition of the developing fetus, independent of genetic inheritance, determines the later onset of obesity, hypertension, and type 2 diabetes. Research over the last decade has shown that heart disease and diabetes among people aged 60-70 is closely correlated with maternal malnutrition in the womb and during the first one or two years of life; according to UNICEF.
In 1994, one of eight Americans was over the age of 65, and it is estimated that by 2020, one in every six Americans will be over the age of 65. Increasing age is a major risk factor for the development of type 2 diabetes. The Third National Health and Nutrition Examination Survey (NHANES III) indicated that 18.5% of people aged 6574 years have diabetes. Reduced life expectancy makes the consequences of chronic hyperglycemia irrelevant. According to diabetes Journal suggested that unlike younger people with type 2 diabetes, who are often overweight, obesity is not that common among older diabetes patients. In nursing homes, the problem of being underweight is as common as that of being overweight. Thus, nutritional management should focus on weight gain for underweight elderly patients as much as it is focused on weight loss for obese patients.
Scientific evidence indicates that a significant number of elderly fail to get proper amount and types of food necessary to meet essential energy and nutrient needs. While many physical and clinical factors contribute to under-nutrition in the elderly, equally important social and economic factors further complicate the nutritional well being of an older individual. Poor nutrition can prolong recovery from illnesses, increase the costs and incidence of institutionalization and lead to a poorer quality of life.
A study is based on very recent data from the Health and Retirement Study, a decades-long national effort to assess the health of adults over age 50 through regular completion of intensive questionnaires and health examinations. Funded by the National Institute on Aging, and based at the U-M Institute for Social Research, the HRS began assessing the blood sugar levels of participants in 2003. In the older age groups where Type II diabetes is mostly found, this study (Sep. 26, 2007) is larger than the other major source of population-wide data on this issue, the National Health and Nutrition Examination Survey (NHANES) run by the Centers for Disease Control and Prevention.
Being underweight may be a correlate of the initial stages of Alzheimer's disease. A study (Sep. 24, 2007) by University Medical Center and John H. Stroger Hospital of Cook County in Chicago shown that weight loss or low BMI in old age who were underweight may be a precursor of cognitive decline or Alzheimer's disease."
A major fact to keep in mind is that the meal planning needs of a person with Type I diabetes is quite different than the needs of a person with Type II diabetes. Also, the meal plan for a person who is either overweight or underweight will differ from that for a person who is at his normal weight.
Chronic depression or depression that worsens over time may cause diabetes in older adults, according to Northwestern University research in 2007. This means doctors need to take depressive symptoms in older adults very seriously because of the effect it has on the likelihood of developing diabetes. An estimated 2 million older adults suffer from clinical depression, the second highest incidence of any age group. People 65 and older also have the highest prevalence of Type 2 diabetes; study stated.
Some evidence (Nov. 7, 2007) suggests that modestly higher weights may improve survival in a number of circumstances, which may partly explain our findings regarding overweight. Overweight is not strongly associated with increased cancer, diabetes, kidney disease, CVD risk, but may be associated with improved survival during recovery from adverse conditions, such as infections or medical procedures, and with improved prognosis for some diseases. Such findings may be due to greater nutritional reserves or higher lean body mass associated with overweight.
University of California - Los Angeles (UCLA) researchers report that for patients hospitalized with acute heart failure, a higher body mass index (BMI) was associated with a substantially lower in-hospital mortality rate. The study found that by weight category, in-hospital mortality rate was 6.3 percent for underweight, 4.6 percent for healthy weight, 3.4 percent for overweight and 2.4 percent for obese patients.
Older people with high waist-hip ratios (WHRs) have a higher mortality risk than those with a high body mass index, or BMI, a study by American Journal of Clinical Nutrition, was carried out by a team based at the London School of Hygiene & Tropical Medicine reveals. Very underweight men (those with a BMI of under 18.5) were found to be particularly at risk because of its positive relation with risk of death, and that attention should also be paid to the problem of underweight in old age.
Diseases such as diabetes and high blood pressure increase the risk of preterm labor. The prevalence of total (diagnosed and undiagnosed) diabetes increased by 55 percent over the past 40 years, likely the result of the dramatic increase in obesity during this time period; according to CDC. But they also found using data collected from the most recent NHANES that both obesity and being underweight are associated with excess deaths when compared with the normal weight population and most of the excess deaths among the underweight occurred in people age 70 or older.
A study published (07 Nov 2007) in the Journal of the American Medical Association (JAMA) and was carried out by Dr Katherine M Flegal, of the US Centers for Disease Control and Prevention (CDC), based in Hyattsville, Maryland suggested that while the link between weight and causes of death varies considerably, being modestly overweight may actually lower death risk in a number of circumstances by providing the body with essential nutritional reserves during recovery from illness and major operations. They concluded that, compared with people of normal weight, the overweight had a decreased death risk and the underweight and obese had increased risk.
a new study shows that 92 percent of older people with the disease have at least one other major chronic medical condition -- and that nearly half have three or more major diseases besides their diabetes. The researchers say, for doctors to "treat the whole person" by helping diabetes patients learn how to deal with their other conditions in ways that will also allow them to control their diabetes. For one condition, heart failure, they also assessed how the severity of another condition affected diabetes management. That lack of awareness may mean that they don't put as much emphasis on their blood pressure or cholesterol, when in fact controlling those risk factors can greatly influence the health of a person with diabetes and vulnerable to risk of blindness, heart attack, kidney failure, foot amputation, long-term diabetes complications including high blood pressure, coronary artery disease, a history of stroke or mini-stroke, or heart failure.
Being underweight may place men and women over age 60 at increased risk for developing diabetes, Japanese researchers report. "Older people who are underweight may need to take care of their poor nutrition status," Dr. Toshimi Sairenchi noted in comments to Reuters Health recently (March 12, 2008).
To examine the association between underweight and diabetes risk, Sairenchi and colleagues collected information in 1993 from 39,201 men and 88,012 women who were between 40 and 79 years old and who did not have diabetes. They followed the men and women for an average of 5.3 years.
The results suggest that being underweight is associated with about 30 percent excess risk of diabetes, reported Sairenchi, of Dokkyo Medical University in Tochigi, Japan. Annual checkups for diabetes during follow up resulted in a diagnosis of diabetes for 3,863 men and 4,584 women. Sixty to 79 year olds who were underweight -- defined as a body mass index below 18.5 -- had an excess risk for diabetes compared with those of optimal weight (BMI between 18.5 and 24.9).
Excess risk was 32 percent in men and 31 percent in women, after adjusting for other factors that affect diabetes risk such as age, blood sugar, blood pressure, cholesterol levels, smoking status, and alcohol intake. Underweight men and women aged 40 to 59 years old were not at increased risk for diabetes.
These findings highlight the health benefits of maintaining optimal weight, but additional research should further investigate the mechanisms behind these associations, Sairenchi and colleagues conclude.
The main implication of our findings is that diabetes-related mortality may be expected to increase in relative importance compared to other causes of death in the elderly, given recent trends of increasing diabetes prevalence. These new findings suggest that prevention of diabetes among the elderly should be a priority.
Dr. Mitchell Gail, a cancer institute scientist and an author, though, had some advice, which, he said, is his personal opinion as a physician and researcher: “If you are in the pink and feeling well and getting a good amount of exercise and if your doctor is very happy with your lab values and other test results, then I am not sure there is any urgency to change your weight.”