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Chicken meat is one of the most requested in the crisis at the expense of lamb and veal .. JA GOÑI / FILE
What do they have in common bread, salt, eggs, red meat and seafood? That at some point have been “victims” of a black legend about his role in the daily diet, protagonists of false beliefs and myths that hinder reliable information on healthy balanced diet.
In order to “restore the honor of all foods”, the journalist Antonio Orti, in collaboration with nutrition experts Bernacer Raquel Ana Palencia and has written the book “To eat or not eat. Pitfalls and food myths” ( planet), which contradict some of the circulating blood cells of the diet.
Ginning theories are somewhat bizarre, as there are negative foods with nutrients, which according to its “believers”, consume more calories to be digested than they provide, or that there are fat burning, such as artichoke, grapefruit or stud , which apparently absorb lipids as if it were a dishwasher.
“It makes no sense to think that eating certain foods compensate for the excess calories or fat, absolutely all foods provide calories, to a greater or lesser extent,” says Orti to Efeagro.
The nutritionist José Miguel Martínez Efeagro recognizes that patients come to his office with a series of questionable preconceptions-real base-on food, among which is a sort of phobia towards carbohydrates, which eradicated from the diet for protein-rich foods such as meat or fish.
“These animal foods also contain fat, so that ultimately consume more calories with high protein diets that do without bread and cereals rich in carbohydrates, yet also provide fiber and minerals,” says Martinez.
Eggs, meat or seafood are unsuitable for people with high cholesterol, although many people associate their consumption to the fact fat, added.
Thus, states that “for a vegetarian, the egg is almost their only source of protein, so eat one a day is perfectly adequate, while red meat, if you choose the most lean, or shellfish, are two excellent sources of iron and minerals. ”
The salt-bit recommended for hypertension-also a source of controversy, because “it is believed that when you have fat calories so without it in slimming diets only serve to hold less liquid,” he says.
But, why something as basic as food is a breeding ground for these myths? Orti is the question that is proposed to reveal in his book and which points to several factors, ranging from “the journalist looking for a catchy headline” to “rivalry between universities and research teams struggling to appear in publications and rankings “.
“There is a principle well intentioned tells us that science is neutral, but the fact is that science is who puts in money and often serves the interests of the industry,” he says.
Given the flurry of studies, sometimes contradictory theories about nutrition become almost an “act of faith”, supported by a mythology of foods has been the perfect breeding ground for miracle diets: from grapefruit, to the jars, the dissociated, macrobiotics or the penultimate fashion, Dukan, reviled by experts.
Despite the varied nature of his diets are “boring, monotonous, insufficient and not educated, as they involve no change to healthy lifestyle habits including food,” he adds.
As recalled Orti, the word diet, contrary to what is suggested for many, comes from the Greek word “diatia”, which refers to healthy lifestyle every day, not a limited period, with amazing results.
“The people associate the word diet with starvation and food restriction, when diet is not more than the daily feeding of a person, comprehensive, varied and suitable to their physical conditions and lifestyle,” says Martinez.
Eat everything in perspective. A simple maxim to feed a balanced and healthy, stripped of myths.
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Most weight loss plans are centered around a balance between caloric intake and energy expenditure. However, new research has shed light on a new factor that is necessary for weight loss: the time. Researchers from Brigham and Women’s Hospital (BWH), in collaboration with the University of Murcia and Tufts University have found that it is not just what you eat, but also when you eat, it can help with weight regulation- loss.
The study will be published on January 29, 2013 in the International Journal of Obesity.
“This is the first large prospective study to show that the time predicted meals to lose weight effectively,” said Frank Scheer, PhD, MSc, Director of Medical Chronobiology Program at BWH and associate neuroscientist, assistant professor of medicine at the Harvard Medical School, and lead author of this study. “Our results indicate that people who eat later have a lower rate of weight loss significantly less than those who eat early, suggesting that the large meal times can be a important factor in a weight loss program. “
To evaluate the role of food in the time to lose weight effectively, the researchers studied 420 overweight participants following a 20-week weight loss treatment program in Spain. The participants were divided into two groups: those who eat early and late dining, according to the time of self-selected main meal, which in this Mediterranean population was lunch. During this dinner, 40 percent of total daily calories consumed.
“This study highlights that the timing of food intake itself may play a role in weight regulation,” explains Marta Garaulet, PhD, professor of physiology at the University of Murcia, Spain, and lead author of the study. “Novel therapeutic strategies debne incorporate not only caloric intake and macronutrient distribution, as is traditionally done, but also the time of the meal.”
best weight loss tips is to follow a diet without costing your health, without feeling hungry and most importantly without the excess weight back once you stop the diet. The way to do is to increase your metabolic rate. And the best way to succeed is to increase your physical activity with exercise, to acquire the habit of daily exercise. This article is just about that. It outlines 28 weight loss tips with exercise that you can use to achieve their weight loss goals with the help of physical exercise.
Exercise increases the metabolic rate, and as a result you burn more fat. Metabolism remains at higher levels up to 6 hours after exercise, because the body works to improve muscle tissue and body cleansing products combustion during exercise. This additional energy burns calories.
Increasing physical activity: walking, running, exercising, playing sports, and spending 400-600 more calories a day, you will lose more than 1-2 pounds or more in a month, mostly due to exercise.
An important tip for successful exercise program is to choose an activity that you enjoy, believe in the value of exercise to lose weight, and make this a daily habit and your new way of life.
The general idea behind weight loss and exercise is the following: the amount of calories you burn and consume less that the more weight you lose. Indeed this is true, but if your goal is to burn extra fat, then you should look at other things too. Firstly, it is a fact that exercise can achieve weight loss, the size of which depends on the type of exercise, duration and body weight. Calories burned can range from 200-400 calories per hour.
This rate does not necessarily mean that the body burns fat stores in order to find the energy to exercise. For example, a short-term intense exercise, such as running or cycling at a fast speed for 15-20 minutes, you can burn 200-300 calories, but the calories that come from the burning of carbohydrates and fat reserves not! Only moderate intensity exercise for a long period can “burn” more fat. And, of course, when this physical activity is, at regular intervals (3 times a week is enough and the benefits are many.) So fast walking or jogging do for a long time, dance!, is it a sport that you like, follow the capacity aerobic programs etc and “Record” fat. Whether your goal is not just weight loss, learn that physical activity has many benefits for overall health, as it helps to regulate blood pressure, blood sugar control and helps raise “good” cholesterol HDL.
Below you can find 28 tips to lose weight with exercise. The list is not complete, but covers several important areas in the weight loss process. Emphasis is placed on the importance of exercise – and how to do it properly, and the role diet and appropriate behavior.
Exercise walking is gentle but very effective, of course, that you are walking vigorously and without stop time you choose.
Benefits of walking
1. “Burn” calories, improves the rate of metabolism.
Two. Helps strengthen the body, reduce local subcutaneous fat, helps restore lost body areas as a result of weight loss.
Three. Helps strengthen bones (especially important for women).
April. Reduces symptoms of varicose veins, helps the circulatory system.
May. Lowers blood pressure and pulse when you are relaxed
June. Helping to overcome the headaches.
July. Helps you be more relaxed, less stressed, “intensity”, “nerves” that often causes greed, the need for food.
After a good walk I feel better, more relaxed, less stressed and less “need” of food.
Walking can help you lose weight
Walking can help you lose weight and not only that, it makes you feel less hungry and keeps the blood flow from the digestive system. You can assume that you will burn up to 500 calories an hour (depending on your pace), which corresponds to a modest meal.
The main rules to allow weight loss through walking are:
Start with small distances the first 5-6 days, walking a total of 15-20 minutes, but make a promise to yourself to walk every day.
Gradually expand the distance, walking 10 minutes every day, with the intention of walking for at least an hour.
They follow the same pattern with speed. Starts the first day with a slow but steady pace and the passage of time pace.
Dress comfortably, bring soft shoes, with little or no heel.
Walking without tension, without squeezing the body. Walking comfortably, not bent, not pin your eyes on the ground. Walking briskly without stopping at every corner or shop you will meet. Do not hold something in their hands.
The first time you start walking you may feel numbness and sensitivity. This is natural, because your muscles work. But if you have difficulty breathing, or tachycardia, moderate pace, or stop to rest, resume walking, but at a slower pace and less time.
You can walk anywhere and anytime you want. Among the streets full of traffic, or somewhere quiet with or without company. Choose what suits you the most. Choose a destination every time you walk. A walk from house to house of a friend, or go to the market.
It’s best to make your walk, non-stop, so you will have better results. If this is too difficult for you, was divided into two parts.
The ideal is to walk 5.6 miles in an hour.
Not prevent movement. The more you move more weight you lose.
Use the stairs instead of the elevator
When shopping or any job, not take the car.
Use the bus. This will make you walk to the bus stop when you are going and when you will return.
A good idea is to walk one or two stops and then take the bus, then get off a stop or two before your final destination
Choose compound exercises in the exercise with weights, such as projections and squat, with variations, pressure exercises, exercises that involve the whole body, weights or pulleys to stimulate cardiac and respiratory activity to burn more calories and release more hormones that help burn fat and allow better development agency.
Use less isolated exercises and machines. Get your heart pumping and lungs work during weight training. If you breathe heavily and heart impulses increase, then your body releases hormones that help you lose weight and burn fat and stimulate metabolism.
Many people have heard of the intensity of exercise, but few know about density, which simply means more work done in less time. To achieve this, you can increase the density of exercise decreasing the rest interval between sets in the exercise with weights. To accelerate weight loss, reduce the rest intervals less than 60 seconds, 45 seconds and end at about 20-30 seconds between sets. Experimenting with cyclic training that will be conducted exercises three, four or more times in a row without rest. A more “super-sets” (biceps, triceps, followed by, followed by the chest with the back). Doing crunches and Beyond Diet Reviews calves between exercises instead of relaxing. Take your pulse and breathing during strength training.
Aerobic Exercise in the morning on an empty stomach (note: time is not critical, but will give you the advantage of adding extra). Whether you are interested in keeping the body free of fat, you should eat a light meal protein ( egg whites, for example) or take a protein drink 20-30 minutes before aerobic exercise.
Is the training they have been doing boring? Changing the type of exercise program or intensity. Try 20-30 minutes of high intensity training, alternating with 30-45 minutes of normal. You can apply this to ride cycling or walking outdoors. Make kickboxing, then mountain biking in the replacement of aerobics. combinations are endless. Do not limit yourself.
Replace 1 or 2 sessions of aerobic training with sprint. Execute a flat road or a hill, or even on the track, if you have access, instead of traditional aerobics. Note that before trying this form of exercise you need to be in good shape and have the approval of a physician.
Make your program so that the last meal of the day is 3 hours before bedtime. If you eat something at night, keep calories low, choose something light, with more protein and carbohydrates rich in fiber with little fat.
Do not eat starch carbohydrates after 3pm.
Keep carbohydrates low, approximately 25-30% of total calories 3 days (increased protein and good fats for compensation). On the 4th day consume lots of carbohydrates.
Some people have a sensitivity to gluten-containing grain products, causing inflation, making weight loss difficult. Eliminating certain foods from dietary starch and increase lean protein and vegetables then you can also increase the loss of weight.
Some people have lactose intolerance or milk allergy and do not know. Try to eliminate from your daily diet and see the effect on your weight loss attempts.
The glycemic index is not the main factor in the program for weight loss. The first criterion for choosing carbohydrates is whether the carbohydrate is natural or not. However, if you know you have an intolerance to carbohydrates carbon, then the glycemic index is more important. starch foods to prefer sweet potatoes, brown or basmati rice (not white or instant rice), beans, lentils, peas or barley.
Some people completely cut fruit on a weight loss diet strict. This may be good for short periods, but fruits and vegetables have a high nutritional value and should not be eliminated in most cases. Eating fruits, but calculate the calories and try to prefer low calorie fruits, such as apples, grapes (some fruits like banana has 120 calories, while an apple and orange has 80 on average about 60 calories). Avoid fruits with lots of calories such as grapes. Avoid juice completely, as they are high in calories and is better to eat the whole fruit to make and fiber.
Eat as much green vegetables and salads rich in fiber. They have offer many benefits to your health and diet.
No milk, no juice, no calories in liquid form. Drink lots of water and green tea.
Some “nutritional bars” are made entirely from food ingredients, and are better than others, but all protein bars are processed foods. When it comes to weight loss has to be strict in your diet, so get rid of the bars.
If you feel stressed and if you are on a weight loss diet and exercise without interruption for more than 3-4 months to take a break. Stopping all and relax. Leaving the nervous and endocrine system to rest and prepare for the next stage. Eating less these days because of their calorie requirements are lower, otherwise you may have more weight. After the pause start exercising again, totally relaxing and more stubborn.
Be specific and clear about what exactly you want. Not vague generalities like “I want to lose weight.” Write down your goals on a piece of paper have always with you. Twice a day, morning and evening, take a look at them and mentally planned with the body you want to have. Feel how you feel (emotionally) if it had succeeded. Remember, if you have a negative image for you, you will not be able to lose weight and you will end up sabotaging yourself .
Water is vital for the proper functioning of the body.’s The most important element in our body. Have to try to drink at least four liters of water a day.
If you exercise less than 6 times a week, 30-45 minutes of aerobic exercise, then gradually increase the duration and frequency of six days, 30-45 minutes (if you have already started to lose weight by 4 days a week from 30 of minutes, then no increase in the frequency of the exercises). If you do aerobic exercises daily, increase the intensity and control your diet.
Remember that you can increase exercise intensity and burn more calories at the same time. Challenge yourself to see how many calories you can burn while. Maintain a personal record. Try to exercise with a partner in order to help and inspire others. Doing aerobic exercises more efficient, not only training with weights. Search new limits. Remember, your body can adapt to your needs.
You should not drink alcohol. Not even a beer or a glass of red wine. Not even in controlled amounts. Even if it seems impossible, it is a matter of principle and self-discipline as the program becomes increasingly stringent.
If you have the weight loss results on a weekly basis, then you can reward your self with a “free lunch” once or twice a week. But if you do not have the results that should be stricter. Foods they have to be composed of clean food, as this is enough to increase your metabolic rate, but do not eat junk food, because it will be more difficult to lose fat and weight. Adding the results to determine how strict your diet should be.
Watch and discuss other areas of your life besides exercise and diet. Dreaming, anxiety, recovery, alcohol, snuff, chemicals. Anxiety You can not recover properly? Improve the quality and quantity from sleep, reduce stress and look carefully if you are exercising too much and, as a result of not leaving your car to fully recover from your workout. Smoke? If so, consider that you can get some weight when you decides to stop, but must get rid of this unhealthy habit! Put your life in order and do it now. Analyze your diet more carefully. Block or reduce foods with colorings, flavorings or preservatives. Cutting alcohol and processed foods any kind. Looking for what is unnatural and eliminate it from your diet. You can consume organic products. Maintain a diet as clean as possible.
Finally, if all else fails, see your doctor for a checkup. Perform complete blood tests, hormone tests, endocrine (thyroid). If there is a problem, follow the instructions and the treatment proposed by the doctor (natural or pharmaceuticals). You can get a second opinion if you are given a physical therapy (natural is always better and healthier). If everything is normal, then start exercising immediately! The only thing stopping you is yourself .
You may have gotten half a mountain road, which can temporarily stop to enjoy the view, preparing for the final climb to the top and continue looking for their next target. Notice that is normal peaks and back to their progress because that’s how your body works and adapts.
Besides weight loss tips through exercise there are also some tips on how to lose weight by watching your diet and be selective in what foods to eat and what not.
There are foods that are high in calories, but little nutritional value. There are two main categories of nutrients:
Substances of calories: carbohydrates, proteins and fats. These substances contain calories and are necessary for the proper functioning of the body.
calorie-free substances: This includes vitamins and minerals. substances are also antioxidants.
What kind of foods to avoid:
French fries, fried chicken (nuggets), fries and other fried foods: One serving of fries from a fast food can reach up to 600 calories and 30 grams of fat. What does this mean? Many calories and little value.
Sweet, sugary drinks and other processed sweet foods: A few sweets can contain 100-200 calories, additives and colorings, many calories (sugar) and some trace elements.
Processed carbohydrates such as crackers, cookies, white rice and white bread: The processed carbohydrates contain some B vitamins, but nothing more.
In conclusion, the most important advice is to believe in the value and necessity of exercise for successful weight loss.’s Advice to lose weight with exercises presented above are only a guide to help you create your own plan of action for the loss of weight. The most important thing is being able to change habits and include exercise in your daily routine. Exercising is one of the most important factors in weight loss, especially for long-term preservation of the same.
Note that it is possible to lose weight without negative energy balance, ie you have to eat less and to “burn” calories exercising. Need to make a commitment to your self and others to be persistent in their efforts, they will insist on a daily basis to exercise and follow your diet.
Most articles reporting research on weight loss fail to provide important information on patients, which may confound the results. This is the conclusion of a study published in BMC Medical Research Methodology.
A team from the University of Kansas, led by Cheryl Gibson, has shown that over 90 percent of the studies do not describe diets that make patients work properly or understood, making it difficult for users to interpret the conclusions.
The researchers analyzed 231 papers reporting on the crucial factors for weight loss: restrictive diet, exercise or diet plus exercise only. Also reviewed the research, from 1966-2003, with the participation of obese adults.
The study showed that taking drugs was the most neglected feature in the articles, and that 92 percent of them or mention.
The general health status was a fact ignored by 34 percent of the publications and ethnicity was not indicated in 86 percent. The age had no reference whatsoever in 11 percent of the articles, and analyzing the reference to the size of the sample the researchers concluded that, “without knowing the number of subjects who lost weight, readers are unable to judge the reliability of a treatment. “
Weight loss can be the presenting problem or an incidental finding in a query for other reasons. There are no published guidelines on how to investigate and treat patients with unintentional weight loss, and behaviors ranging from doing nothing (considering the weight loss as a normal part of the aging process) or resulting in many studies for fear there is an underlying cancer. Observational studies have shown that up to 25% of cases there is no identifiable cause, despite much research e. It is unclear to what extent doctors should investigate elderly patients with involuntary weight loss in the absence of obvious medical cause.
We review the available evidence (mainly epidemiological and observational studies) and outlines a structured approach to the investigation and management of elderly patients with unintentional weight loss.
When is that unintentional weight loss is clinically important?
Physiological age produces significant changes in the elderly and contributes to the “anorexia of aging.” These modifications include the reduction in lean body mass, bone mass and basal metabolic rate, decreased sense of taste and smell, and signs of gastric disturbance causing early satiety. However, observational studies of healthy older adults have shown that this weight loss associated with normal aging is 0.1-0.2 kg / yr and older patients maintain weight over a period of time reasonably long, 5-10 years. The major weight loss should not be dismissed by the age-related changes naturally and should be investigated.
Although there is no universally accepted definition of clinically significant weight loss, most observational studies define it as a reduction of ≥ 5% of body weight in 6-12 months. To account for the variability of baseline weight, weight loss is best expressed in percent rather than an absolute value that is a loss of 3.2 kg is less important in a patient of 90 kg in an elderly patient enfeebled already underweight. Mortality at 1-2.5 years to maintain clinically significant weight loss going from 9% to 38%, being particularly at risk frail elderly, elderly with low baseline body weight and elderly patients recently admitted to hospital.
The major weight loss has been shown to be associated with an increased risk within the hospital and disease-related complications, increased disability and dependency, high rates of admission to nursing homes or nursing homes, and worse quality of life. In extreme cachexia (disproportionate loss of skeletal muscle rather than body fat, which leads to loss of skeletal and cardiac muscle, visceral protein loss and changes in physiological functions, including impaired immunity and systemic inflammatory response) contribute to adverse results, through increased rates of infection, poor wound healing, decubitus ulcers, reduced response to medical treatment, and increased risk of mortality.
Weight loss in older people significantly increases the rate of bone loss at the hip and the risk of hip fracture. In a prospective cohort study of 6,785 elderly women, weight loss, both intentional and unintentional, was 5% compared to baseline weight.
What might be the causes of unintentional weight loss in older adults?
Although involuntary weight loss in younger adults often have a medical cause, in older patients the causes are more diverse, with psychiatric and socioeconomic factors play an important role.
Studies conducted in the U.S. and several European countries vary considerably in terms of country, age of patients (most is not limited to the elderly), duration of follow up, and type of patients recruited. However, cancer, non-malignant gastrointestinal diseases and psychiatric problems (including dementia and depression) were constant among the most common causes of unintentional weight loss. Various aids have been developed to allow physicians to consider the multiple possible causes of involuntary weight loss in elderly patients, among which include “9 D weight loss in the elderly” and the mnemonic “MEALS ON WHEELS “
9 D of weight loss in the elderly
Mnemonic “MEALS ON WHEELS”
M: Effects of M edicación,
The authors grouped the possible causes of weight loss in organic (malignant and non-malignant), psychosocial and unknown causes.
Organic causes weight loss include cancer, non-malignant medical conditions and side effects of drugs.
Observational studies published report that psychiatric problems, especially dementia and depression are the main cause of unexplained weight loss in 10-20% of elderly patients. This figure rises to 58% in nursing home residents.
Patients with cognitive impairment who suffer agitation or have a tendency to “wander” and can spend considerable energy. Others may forget that they have to eat or have suspicious paranoid ideas about food. The progression of Alzheimer’s disease is accompanied by loss of the capacity to feed themselves can be developed dysphagia.
Depression can lead to weight loss due to loss of appetite or decreased motivation to buy and prepare food. Often, depression is associated with weight loss in the elderly than in younger adults. In a systematic review of elderly patients (> 65 years) living in the community, depression is associated with increased mortality (relative risk for mortality with depression: 1,73). Another systematic review of 34 community-based studies found that the prevalence of depression varies considerably advanced age (> 55 years), but can be as high as 35% depending on the criteria used to define depression. The highest prevalences have been reported in institutionalized elderly.
In older people, poverty or social isolation can contribute to weight loss due to inadequate nutrition and malnutrition. Physical or cognitive impairment can prevent older people make purchases for themselves, thereby reducing the availability of preferred foods. The inability to cook or feed themselves can contribute to inadequate food intake, since they depend on their families or caregivers who do not attend on a scheduled basis.
In the 16 to 28% of patients participating in prospective observational studies and retrospective, the cause of weight loss is unknown, despite extensive research over periods ranging from 6 months to 3 years. This may be because elderly patients often have multiple comorbidities instead of a serious illness, are under the effect of several drugs and can have psychological or social problems. Each individual factor may not be sufficient to cause significant weight loss, but the cumulative effect of all factors could lead to a clinically significant weight loss.
How Unintentional weight loss in older adults undergoing studies?
The authors present their approach to the study of these patients, based on an extensive literature review. They report that they know of no systematic clinical guidelines or standards for the investigation of this common and complex problem.
The initial patient assessment involves a detailed history, clinical examination and basic research. According to the results, will decide whether or not to continue with the investigation.
They should try to determine the exact extent of weight loss during a specified time. Data on appetite may help to elucidate whether the weight loss is caused by inadequate caloric intake or has occurred despite adequate intake. In patients with cognitive impairment, questioning family members or caregivers can help. The previous and current medical history can identify conditions that could have led to weight loss and drugs that may have contributed through their side effects. Among the side effects are significant anorexia (antibiotics, digoxin, opiates, selective inhibitors of serotonin reuptake, anticonvulsants, antipsychotics, amantadine, metformin, benzodiazepines), nausea and vomiting (antibiotics, bisphosphonates, digoxin, dopamine agonists , levodopa, opioids, selective inhibitors of serotonin reuptake, tricyclic), dry mouth, anticholinergics, diuretics, antihistamines), altered taste and smell (inhibitors of angiotensin converting enzyme, channel blockers calcium, propranolol, spironolactone, iron, antiparkinsonians (levodopa, pergolide, selegiline, opiates, gold, allopurinol), dysphagia (bisphosphonates, antibiotics, levodopa, gold, iron, NSAIDs.
Social history can provide information on the consumption of alcohol (which may contribute to nutritional or vitamin deficiency) and cigarettes (a risk factor for cancer and other organic diseases). To elucidate the social circumstances of the patient, it is important to know: Where do you live? Who buys and prepares the food? Is there any home help or the help of family members?
A story that includes a review of systems may show symptoms that may lead to further investigation. Moreover, standardized tools can be applied to detect patients with cognitive impairment and depression. Some authors recommend a nutritional assessment only when there is no evidence of organic disease. However, the authors of this study believe that all elderly patients presenting Involuntary weight loss should undergo a nutritional assessment by a dietitian. This is because malnutrition is highly prevalent in the elderly and may be present even if it falls an organic cause weight loss. The authors suggest that patients seen in primary care (for general practitioners) where services (and time) to assess cognitive function, mood and nutritional status are not always readily available should be referred to gerontologists .
In patients with involuntary weight loss, complete physical examination should aim to exclude major cardiovascular and respiratory diseases, as well abdominal tumors, organomegaly, enlarged prostate and breast lumps that may indicate cancer. Palpable lymphadenopathy could indicate infection, cancer or blood diseases. Mouth should be examined to exclude any obvious dental problems, poor oral hygiene, dry mouth or injuries that may hinder or make chewing difficult or painful swallowing.
Basic studies for all patients should include complete blood count (complete blood count, urea and electrolytes, liver function tests and thyroid C-reactive protein, glucose, lactate dehydrogenase), chest radiography, urinalysis and occult blood in stool.
Tumor markers are useful diagnostic tests and should not be used as part of the initial evaluation. Its function is to monitor the response to treatment of patients with cancer or detect early tumor recurrence after treatment. Abnormal findings on the initial evaluation should be used to guide future research on the etiology of weight loss. If history, physical examination and basic studies are normal, the published evidence suggests other research discontinue it immediately advised “watchful waiting” for three months, instead of a blind search with additional, more invasive studies or expensive. Because organic disease is only rarely in patients with normal results of physical examination and laboratory tests, it is unlikely that this waiting period has an adverse outcome. Although they have developed three scoring systems to help doctors identify which patients with weight loss are likely to have a physical cause or malignant and not a psychological or social causes, none have been validated in independent populations with loss weight.
Is reassuring basic studies finding normal?
The claim that a negative initial evaluation should reassure the clinician about the lack of serious underlying disease is based on small nonrandomized studies, most of which is not limited to elderly patients (in the UK is defined age advanced as> 70 years). However, most authors agree that it is very unlikely that elderly patients with involuntary weight loss clinically relevant and normal basic studies have a physical illness (especially malignant), and in this case, it is preferable to have a expectantly.
Currently no evidence that computed tomography (CT) as blind screening study is of great help in the investigation of these patients. The disadvantages of CT blind are high costs (low performance) and the probability of finding “incidentalomas.” Several studies have used abdominal ultrasound as part of their initial evaluation, but did not comment on its usefulness in this paper, except to note that 27% of patients with underlying cancer in the examination showed hepatomegaly and a similar percentage had a palpable tumor. Anyway, the abnormal findings on examination (or in liver function tests) require further investigation. Gastrointestinal disorders (malignant and non-malignant) account for approximately one third of all cases of unexplained weight loss in studies of adults of all ages, so that some authors advocate the use of upper endoscopy as first-line study . However, as endoscopy is an invasive procedure not without risk (particularly for elderly patients), the authors believe that should be reserved for patients in whom it is indicated, both by history, physical examination and by the basic studies (eg., history of gastrointestinal bleeding or iron deficiency anemia).
In a study of patients with a normal baseline assessment subject to further investigation by CT and endoscopy, it was only one additional diagnosis (one patient diagnosed with lactose intolerance).
Management of unexplained weight loss in the elderly
The fundamental principle of management is the identification and treatment of underlying causes. The optimal management often requires a multidisciplinary evaluation (doctors, dentists, dietitians, speech therapists, physiotherapists, occupational therapists, social services). The authors suggest reviewing drugs in order to eliminate side effects that may contribute to weight loss.
If the cause of weight loss is mental, such as depression, it is recommended evaluation by a psychogeriatrician or psychologist. In such cases, consider antidepressant treatment because depression is a potentially reversible cause weight loss. If the baseline is negative, recommend re-evaluate the patient at 3 months, to establish whether they be other symptoms or signs and weight control. In the meantime, because there is no evidence to support any drug treatment, you can use a variety of non-pharmacological interventions.
Non-pharmacological interventions for unexplained weight loss in elderly
– Optimize food consumption.
Oral nutritional supplements if recommended by the dietitian
Multivitamin tablets daily
Ensure proper oral health
Tips for non-specialists
• General practitioners and hospital doctors specialists must perform the initial history, examination, and basic analysis.
• Refer any abnormalities that suggest a possible organic cause weight loss to the relevant specialty.
• If there is no obvious cause, you can do a check at 3 months of watchful waiting or patient referral to secondary care (geriatrics), where you can make a multidisciplinary evaluation.
• If the initial assessment and watchful waiting are carried out in primary care, s must repeat history, examination, and investigations at the end of this period. If no cause is identified and the patient continues to lose weight, referred to secondary care.