Nutrition, Metabolism and GI Research in HIV - CFAR Centers for AIDS Research

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Research Topics: Aging

The so called “advanced aging” associated with HIV appears to be related to chronic inflammation and chronic immune activation (Aberg 2012). As persons with HIV live longer, this is accompanied by increased frequency of non-HIV related co-morbidities. Although there is much debate as to the exact role that HIV plays on aging, there is a wide range of literature on the disadvantages of aging on nutritional status in the general population.

Aging individuals are at risk for becoming frail which is defined as the loss of being able to recover from stressors (Clegg 2013). Frailty can lead to disability, hospitalization, and mortality. In addition, frailty is associated with a clinical syndrome defined by 3 of the following conditions; unintentional weight loss and loss of muscle, self-reported exhaustion, weakness, slow walking speed, and low physical activity (Fried 2001, Fried 2009).

An increasing number of aging individuals are at risk for fragility fractures. In addition to the physiological consequences of aging, there is also an increased risk of impaired cognitive function, depression, and social isolation among the elderly. Inadequate oral intake accompanied by issues of malabsorption of essential nutrients can impact nutritional status and may lead to altered metabolism including sarcopenia or loss of muscle associated with aging, weight loss, and diminished bone health.

There are many factors associated with frailty.  Future research in the area of aging may include strategies to improve adequate oral intake, enhance physical stamina and stability through exercise, and to reduce social isolation through community and peer driven partnerships.

Techniques and assessment tools to assess frailty:

Outcome

Technique

Score

Slowness

Rand -36 Physical Functional Scale

Score < 75

Weakness

Hand grip strength

Score < 30 kg

Poor endurance/exhaustion

Rand-36 Vitality Score

Score  <55

Low Physical activity

Calories of energy expend in the last week of leisure activity (calculated)

Lowest quartile

Shrinking (weight loss and sarcopenia)

Self reported, unintentional weight loss
Measured weight loss

>10 lbs during the previous year
>5% weight loss during the previous year

Data from Cardiovascular Health Study and Women’s Health Initiative


REFERENCES:

Aberg JA. Perspective: Aging, Inflammation, and HIV infection. Top Antiviral Med. 2012;20(3):101-105.

Clegg A, Young J, Iliffe S,Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381:752-62.

Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-156.

Fried LP, Xue Q-L, Cappola AR, et al. Nonlinear multisystem physiological dysregulation associated with frailty in older women:implications for etiology and treatment. J Gerontol A Biol Sci Med Sci. 2009:64:1049-1057.

Woods NF, LaCroix AZ, Gray SL, et al. Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005;53:1321-1330.

 

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For information on our Nutrition, Metabolism & GI Core services,
please contact Chris Wanke, MD (christine.wanke@tufts.edu) or
Tamsin Knox, MD (tamsin.knox@tufts.edu).

Lifespan/Tufts/Brown CFAR is funded by the National Institutes of Health.
Please remember to cite the LTB CFAR (Grant P30 AI042853)
in all publications that have benefited from the Center's Core services.