1

2 http://www.ine.es Hombres Mujeres Brecha de género (mujeres-hombres)Hombres Mujeres Brecha de género (mujeres-hombres) 1991 73,5 80,7 7,2 1992 73,9 81,2 7,3 1993 74,1 7,1 1994 74,5 81,6 1995 81,7 1996 74,6 81,8 1997 75,2 82,2 6,9 1998 75,4 82,3 1999 2000 75,9 82,7 6,8 2001 76,3 83,1 2002 76,4 2003 83,0 6,6 2004 77,0 83,6 2005 83,5 6,5 2006 77,7 84,2 6,4 2007 77,8 84,1 2008 78,2 84,3 6,1 2009 78,6 84,7 6,0 2010 79,1 85,1 2011 79,3 85,2 5,8 2012 79,4 5,7

3 Epidemiología de la obesidad en mayoresHombres Mujeres > 60 años 35,5 % 40,8 % > 80 años 19,4 % 29,2 % Gutiérrez-Fisac . Obes Res.2004; 12: 710 –715 ENCUESTA NACIONAL DE SALUD 55-64 años 65-74 años 75-84 años 85 o más años 22,8% 26,8% 25,5% 16,1% ≥ 65 años ( ) Hombres Mujeres Sobrepeso 51,7% 41,7% Obesidad 30,6 % 38,3 % Obesidad abdominal* 50,9 % 69,7 % *Perímetro de cintura > 102 cm en hombres; > 88 cm en mujeres Gutiérrez-Fisac.Obes Rev.2012; 13: 388 –392

4

5 PREVALENCIA DE OBESIDAD MÓRBIDA> 49 años: 0,3 % a 0,9%, Rev Esp Cardiol. 2011; 64:

6 Sobrepeso/Obesidad en mayoresvs

7 Sobrepeso ≥ 65 años 1,00 (IC 95% 0,97–1,03) Obesity reviews (2007) 8, 41–59

8 Obesity reviews (2007) 8, 41–59 Obesidad ≥ 65 años1,10 (IC 95% 1,06 – 1,13) Only five studies examined the relationship between BMI and mortality in the very old (e.g. studies limited to individuals aged ≥75 years), and most of these studies did not provide the 95% confidence intervals that are required to calculate summary RRs. Thus, a meta-analysis was not performed for this age group and this section is limited to a literature review. A summary of these five studies indicates no clear pattern of the effect of an elevated BMI on mortality risk in individuals aged 75 or older. 10. Rissanen A, Heliovaara M, Knekt P, Aromaa A, Reunanen A, Maatela J. Weight and mortality in Finnish men. J Clin Epidemiol 1989; 42: 781–789. 11. Lindsted K, Tonstad S, Kuzma JW. Body mass index and patterns of mortality among Seventh-day Adventist men. Int J Obes 1991; 15: 397–406. 41. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097–1105. 44. Rajala SA, Kanto AJ, Haavisto MV, Kaarela RH, Koivunen MJ, Heikinheimo RJ. Body weight and the three-year prognosis in very old people. Int J Obes 1990; 14: 997–1003. 45. Ho SC. Health and social predictors of mortality in an elderly Chinese cohort. Am J Epidemiol 1991; 133: 907–921. The findings of the present systematic review and metaanalysis suggest that a BMI in the overweight range is not associated with an increased mortality risk in elderly men and women, and that a BMI in the obese range is only associated with a modest increase (about 10%) in mortality risk in the elderly. The purpose of this systematic review and meta-analysis was to determine the effect of an elevated BMI on all-cause mortality risk in men and women aged 65 years and older. It is clear that a BMI in the overweight range is not associated with a significantly increased risk of mortality in the elderly. Further, a BMI in the moderately obese range is only associated with a modest increase in mortality risk regardless of sex, disease status and smoking status. Despite numerous studies examining the effect of BMI on mortality, the current evidence from observational studies is still immature. Mortality data from well controlled weight loss trials are urgently needed to clarify the BMI– mortality relation in elderly persons. -Selective survival -Limited lifespan -Diminished importance of excess body fat -Body mass index is a poor indicator of body fat and fat distribution in the elderly -Increasing importance of lean mass and fat mass has a nutritional reserve in the elderly -Confounding influence of weight loss -Confounding influence of smoking -Cohort effect Influence of gender Influence of very old age Influence of smoking status Influence of disease status Influence of method used to measure height and weight Influence of follow-up length Influence of study date (baseline period) Use of standard body mass index ranges

9 Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories. A Systematic Review and Meta-analysis Katherine M. Flegal, PhD; Brian K. Kit, MD; Heather Orpana, PhD; Barry I. Graubard, PhD JAMA. 2013;309(1):71-82.

10 Auyeung . J Gerontol A Biol Sci Med Sci. 2010 Vol. 65A, No. 1, 99–104No se miden cambios composición corporal Older men were resistive to the hazard of overweight and adiposity, and mild-grade overweight, obesity, and even central obesity might be protective. This may bear significant implication on the recommended cutoff values for BMI and WHR in the older population. In addition, favorable survival was related more to increasing adiposity than muscle mass. No corresponding relationship, except in WHR, was observed in older women.

11 5 years of follow up Todas las causas Age- and smoking-adjusted relative risks Enfermedad CV De Hollander. Int J Epidemiol ; 41: 805– 817.

12 Age- and smoking-adjusted relative risks5 years of follow up Cáncer Age- and smoking-adjusted relative risks Enfermedad respiratoria Age- and smoking-adjusted relative risks In this elderly population, we found increased mortality risks associated with an increased WC—even across BMI categories—and also with being underweight according to BMI. Clinicians should be made aware of the usefulness of WC to measure adiposity in order to determine mortality risk in the elderly. This meta-analysis provides a solid basis for re-evaluation of WC cut-points in ageing populations. También observaron un menor riesgo de morir en sujetos con sobrepeso. De Hollander. Int J Epidemiol ; 41: 805– 817.

13 Seguimiento medio 4,8 añosAfter adjusting for age, sex, smoking, diabetes, hypertension, intervention group, family history of coronary heart disease, and leisure-time physical activity, WC and WHtR were found to be directly associated with a higher mortality after 4.8 years median follow-up. The multivariable-adjusted HRs for mortality of WHtR (cut-off points: 0.60, 0.65, 0.70) were 1.02 (0.78–1.34), 1.30 (0.97–1.75) and 1.55 (1.06–2.26). When we used WC (cut-off points: 100, 105 and 110 cm), the multivariable adjusted Hazard Ratios (HRs) for mortality were 1.18 (0.88–1.59), 1.02 (0.74–1.41) and 1.57 (1.19–2.08). In all analyses, BMI exhibited weaker associations with mortality than WC or WHtR. The direct association between WHtR and overall mortality was consistent within each of the three intervention arms of the trial In conclusion, our study showed a direct association between adiposity measures reflecting visceral accumulation of fat (WC, WHtR) and all-cause mortality in an elderly population at high cardiovascular risk. The highest risk of death was observed in participants who initally were in the highest quartiles of these anthropometric indexes (WC, WHtR) that better capture abdominal obesity. For BMI, instead, we observed an U-shaped doseresponse pattern, with the highest mortality in participants with the initial lowest values of BMI. However, further research iswarranted to confirm these findings and to extend our findings to other elderly populations with a lower cardiovascular risk. PLoS One Jul 29;9(7):e

14 Nutrition Research Reviews (2009),22, 93–108

15 Pérdida ponderal intencionadaOsteoporotic Fractures in Men Study Group. Pérdida ponderal intencionada 4,331 ambulatory men aged at baseline a-b. Risk of mortality with categories of body composition change for (a) men with weightloss intent and for (b) men without weight-loss intent. Stable is defined by <+5% gain and baseline health, body mass index, congestive heart failure, chronic obstructive pulmonary adjusted for age, race, clinic site, smoking status, alcohol use, education, physical activity, >-5% loss. Loss is defined by ≥-5% loss. Gain is defined by ≥+5% gain. Hazard ratios are truncal fat mass was associated with an increased risk of all-cause mortality compared to In older men, loss of weight, total lean mass, appendicular lean mass, total fat mass or disease and diabet weight was not associated with increased mortality risk. The associations between changes truncal fat mass, had a modest elevation in their risk of mortality, whereas a gain in total those who remained stable in these measures. Older men who gained fat mass, particularly Prior studies using a single measurement of weight or BMI in older adults demonstrated that baseline BMI, health status or age. in weight, lean mass and fat mass with all-cause mortality did not differ by categories of information. While the findings of increased mortality risk with weight loss in older men are measures to identify changes in body composition in this study provided further, novel those with low BMI have an increased risk of mortality (5, 27-29). The use of longitudinal and fat mass, separately. The increased risk of mortality with total body fat gain and increased mortality risk associated with changes in body composition, specifically, total lean consistent with previous reports (10, 11, 30), this study contributes additional results on the 31-33). However, the finding of increased mortality risk in older men with fat mass loss was increased risk of mortality with high levels of adiposity, particularly central adiposity (27, especially truncal fat gain builds on data from prior cross-sectional studies showing an somewhat surprising given health benefits associated with losing fat mass from exercise and epidemiologic study of younger cohorts shows that a loss of fat mass is associated with average years younger than the mean age of this study’s population. Similarly, an diet (20, 34). However, these are intervention studies with obese participants who are on mass may have adverse health consequences or be indicative of poor underlying health increased risk of all-cause mortality with low BMI (5, 8), a progression towards lower fat decreased mortality risk (35). Because cross-sectional studies of older adults demonstrate an baseline lifestyle factors and medical conditions. Given that older men who lose weight Men with lean mass loss also had an increased risk of mortality even after adjustments for status in older men. (14, 37). These data now also show that loss of lean mass in older men confers a higher risk mortality risks associated with weight loss. Low thigh muscle area and loss of extremity fatfree mass are already related to a higher risk of declining physical function and disability disproportionately lose lean mass (36), this finding was expected to correspond with the of all-cause mortality. lean mass change. Because the changes in fat and lean are independently associated with change; associations of fat change categories with mortality risk were also independent of The association of lean mass loss with mortality risk existed independent of fat mass J Am Geriatr Soc. Author manuscript; available in PMC 2012 July 24. Lee et al. Page 6 mortality risk, there may be different mechanisms behind these changes that contribute to a can occur with anorexic and cachectic processes, a greater loss of fat mass than lean mass decline in health and require further investigation. While concurrent lean and fat mass loss NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript decreases in physical activity or androgens in elderly men may contribute to both lean mass fat mass may occur with a cachectic process related to cytokines (40, 41). Age-related may be due to insufficient dietary intake (38, 39), whereas a greater loss of lean mass than loss and fat mass gain (42, 43). Further studies are needed to understand the mechanisms Secondary analyses showed that the risks of mortality associated with fat gain or loss in contributions to mortality. underlying separate and joint changes in fat and lean mass in the elderly and their consistent with the concept that involuntary lean mass loss may occur due to cachexia from mortality risk associated with lean mass loss in the absence of weight-loss intention is weight, fat or lean mass did not differ by baseline BMI, health status and age. The higher on prior studies which reported that intentional weight loss is associated with a decreased mortality with fat mass loss in men who expressed weight-loss intent were surprising based disease occurrence or progression. On the other hand, results showing increased risk of weight. Although a number of health conditions associated with mortality was accounted for intent also reported poor or fair self-rated health, as compared to men without intent to lose risk of mortality in younger adults (22, 23). A higher proportion of men with weight-loss in adjusted analyses, the men who intended to lose weight may have had undiagnosed compared to men with no weight-loss intent. Because the men with weight-loss intent had gain for men reporting weight-loss intent was also associated with a higher risk of mortality medical problems that resulted in fat mass loss and increased their risk of death. Fat mass further fat mass gain. Overall, mechanisms for fat loss or gain for men in this study who diabetes, metabolic abnormalities may play a role in the increased risk of mortality with higher average BMI, fat mass, lean mass, fat gain and greater proportion of self-reported in older adults to be associated with a decreased risk of mortality (44, 45). with controlled, intervention studies which have shown intentional weight and fat mass loss reported weight-loss intent are unknown; therefore intentional weight loss is best examined measure body composition include its ability to estimate total and subcompartments of lean composition and the close follow-up of participants. The advantages of using DXA to This study is unique because of its size, its use of longitudinal measures of body and fat mass, lower cost, and lower radiation exposure compared to techniques such as correlation with CT measurements of visceral fat (46). In contrast, there is a high agreement truncal fat by DXA correlates highly with total abdominal fat by CT, it has a weaker deuterium dilution or CT for visceral adiposity, respectively. While the measurement of approximately 28% of participants who did not follow-up at visit 2 for repeat measures of dilution in older men (47, 48). Because MrOS is a cohort of ambulatory, older males and between DXA measurements of total lean and fat mass and measurements using deuterium ailing, dependent older men. Furthermore, these results cannot be generalized to older than the general population of older men. Therefore, the findings cannot be generalized to body composition or had missing data were excluded, this analytic cohort is likely healthier are needed. There was also insufficient power to analyze mortality risk associated with joint categories of body composition change, and further studies of cause-specific mortality risk women. This study was limited in power to assess cause-specific mortality associated with changes in fat and lean mass. Weight-loss intent was obtained from self-report at visit 2 and of weight-loss intent may be just a marker for underlying illness or progressing metabolic as a consequence of underlying poor health or as a result of gaining weight. This self-report may be subject to reporting bias. It is possible that men reported weight-loss intent at visit 2 composition in preventing mortality cannot be made. composition are unknown; therefore, recommendations for interventions to modify body disease. Given the observational nature of the study, mechanisms behind changes in body Lee et al. Page 7 mass and lean mass, and a slight increase in risk of death with fat mass gain in older men. In conclusion, the findings demonstrate higher mortality associated with loss of weight, fat These risks do not vary based on obesity status, age or baseline health status. Because these are needed to evaluate the health effects and potential mechanisms for changes in fat and weight change and not to just a one-time measurement of weight. Therefore, further studies associations were independent of baseline BMI, attention should be given to the trajectory of lean mass in older men. Pérdida ponderal no intencionada Lee. J Am Geriatr Soc. 2011; 59: 233–240

16 Dahl. J Am Geriatr Soc. 2013; 61: 512–518Old persons who were overweight had a decreased mortality risk compared to old persons having a BMI below 25, even after controlling for weight change and multimorbidity. Compared to persons who had a stable BMI those who increased or decreased in BMI had a higher mortality risk, particularly among people aged 70 to 80. This study lends further support for the opinion that the WHO guidelines are overly restrictive in old age N= 882 70-95 años

17 -12-year follow-up of -ages 60 years and older -n=2603 Sui. JAMA December 5; 298(21): 2507–2516

18 Sui. JAMA. 2007 December 5; 298(21): 2507–2516-12-year follow-up of -ages 60 years and older -n=2603 Sui. JAMA December 5; 298(21): 2507–2516

19 PROGRESS IN CARDIOVASCULAR DISEASES 56 (2014) 382–390

20 PROGRESS IN CARDIOVASCULAR DISEASES 56 (2014) 434–440

21 J Gerontol A Biol Sci Med Sci. 2006 October ; 61(10): 1075–1081

22 n= 318 69 ±6 years body mass index 34 ±5 kg/m2 8 years of follow Shea. J Gerontol A Biol Sci Med Sci May;65A(5):519–525

23 Canning KL, Brown RE, Jamnik VK, Kuk JL (2013) Relationship betweenobesity and obesity-related morbidities weakens with aging. J Gerontol A Biol Sci Med Sci Mar 22. [Epub ahead of print] Masters RK, Powers DA, Link BG (2013) Obesity and U.S. mortality risk over the adult life course. Am J Epidemiol 177: 431–442.

24 Kramer CK, Zinman B, Retnakaran R. (2013) Are metabolically healthyoverweight and obesity benign conditions? Ann Intern Med 159: 758–769

25 Obesidad en mayores. Estudios epidemiológicos-in old age, lower BMI, rather than higher BMI (overweight and obese), is associated with significantly higher mortality risks Heiat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med. 2001; 161:1194–1203. [PubMed: ] 3. Janssen I, Mark AE. Elevated body mass index and mortality risk in the elderly. Obes Rev. 2007; 8:41–59. [PubMed: ] -A number of studies have found that BMI loss in late life is associated with an increased mortality risk although the findings are not consistent -Somes GW, Kritchevsky SB, Shorr RI, et al. Body mass index, weight change, and death in older adults. Am J Epidemiol. 2002; 156:132–138. [PubMed: ] 5. Corrada MM, Kawas CH, Mozaffar F, et al. Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol. 2006; 163:938–949. [PubMed: ] 6. Harrington M, Gibson S, Cottrell RC. A review and meta-analysis of the effect of weight loss on allcause mortality risk. Nutr Res Rev. 2009; 22:93–108. [PubMed: ] 7. Lee CG, Boyko EJ, Nielson CM, et al. Mortality risk in older men associated with changes in weight, lean mass, and fat mass. J Am Geriatr Soc. 2011; 59:233–240. [PubMed: ] 8. Lehmann AB, Bassey EJ. Longitudinal weight changes over four years and associated health factors in 629 men and women aged over 65. Eur J Clin Nutr. 1996; 50:6–11. [PubMed: ]

26 In midlife, BMI gain is associated with decreased survivalIn midlife, BMI gain is associated with decreased survival. Although some findings suggest that this also holds in late life Somes GW, Kritchevsky SB, Shorr RI, et al. Body mass index, weight change, and death in older adults. Am J Epidemiol. 2002; 156:132–138. [PubMed: ] Deeg DJ, Miles TP, Van Zonneveld RJ, et al. Weight change, survival time and cause of death in Dutch elderly. Arch Gerontol Geriatr. 1990; 10:97–111. [PubMed: ] other studies suggest that gain in BMI among the elderly is not associated with mortality -Lehmann AB, Bassey EJ. Longitudinal weight changes over four years and associated health factors in 629 men and women aged over 65. Eur J Clin Nutr. 1996; 50:6–11. [PubMed: ] -Newman AB, Yanez D, Harris T, et al. Weight change in old age and its association with mortality. J Am Geriatr Soc. 2001; 49:1309–1318. [PubMed: ] -Reynolds MW, Fredman L, Langenberg P, et al. Weight, weight change, mortality in a random-sample of older community-dwelling women. J Am Geriatr Soc. 1999; 47:1409–1414. [PubMed: ]

27 Corrada. Am J Epidemiol; 163: 938–949.Mortalidad mayor en los que habían tenido obesidad o sobrepeso con 21 años de edad Therefore, we show the results of all analyses both with and without adjustment for the available medical history variables known to be associated with mortality in our study and others: hypertension, angina, myocardial infarction, stroke, diabetes mellitus, rheumatoid arthritis, and cancer (excluding skin cancer other than melanoma) Our 23-year follow-up study suggests that all-cause mortality in older adults is increased among persons who are underweight or obese during old age and among persons who were overweight or obese at age 21 years. Both weight loss between age 21 and later life (regardless of weight at age 21) and being underweight at age 21 but not gaining weight later in life were associated with increased mortality. Conversely, being of normal weight at age 21 and gaining weight by late adulthood was associated with decreased all-cause mortality.

28 Consecuencias de la obesidad en ancianosIncontinencia urinaria Síndrome metabólico Cáncer Enfermedad de Alzheimer Demencia vascular Disfunción pulmonar Int J Obes. 2008;32:1423–1430 Obes Rev. 2008;9: 204–218 Neurology. 2011;76:1568–1574 Lesiones no intencionadas Obes Facts. 2010;3:363–369 Insuficiencia cardiaca Osteoartritis Nat Rev Cardiol. 2011;8: 30–41 Osteoarthritis Cartilage Nov 29. pii: S (14) Disfunción sexual

29 Clinical Pharmacology & Therapeutics 87, 407-416 (April 2010)

30 OBESIDAD y FRAGILIDAD J Acad Nutr Diet. 2012; 112:

31 Beneficios y riesgos potenciales asociados a la pérdida de peso en los ancianos↓ Riesgo de DM2 ↑Mortalidad? –intencional vs no intencional- Control de glucemia, TA y lípidos ↓ Masa muscular (sin ejercicio) ↓Riesgo cardiovascular ↑ Riesgo de fractura ósea Probable ↓ riesgo CV ↑ Riesgo de deficiencias nutricionales ↑ Función respiratoria ↑ Riesgo de colelitiasis ↑ Capacidad funcional ↓Síntomas depresivos, ↑ bienestar, ↑calidad de vida J Clin Gastroenterol2012;46:533–544

32 ¿A quién tratar?

33 OBESIDAD SARCOPÉNICA Dinapenia Síndrome de dismovilidad Sarcobesidad Adiposidad sarcopénica Obesidad visceral sarcopénica “Low muscularity”

34 FISIOPATOLOGÍA

35 INFLAMACIÓN DE BAJO GRADOFISIOPATOLOGÍA Prado et al. Clin Nutr 2012; 31: OBESIDAD SARCOPÉNICA ENFERMEDAD CRÓNICA INFLAMACIÓN DE BAJO GRADO CAQUEXIA Biolo. Clin Nutr. 2014; 33:

36 Prevalencia: H: 4,4-84,0% M: 3,6-94,0%

37 Fuentes de error Puntos de corte muy variables entre estudios Masa esquelética total vs masa muscular apendicular. Distribuciones matemáticas distintas (gaussianas o quintiles) Raza Método de medida (DEXA) Infiltración grasa del músculo no detectada Propuestas de los autores -Son necesarios puntos de corte específicos de cada población para definir sarcopenia/obesidad. Falta estandarización. -En la definición, deberían introducirse datos sobre fuerza y calidad del músculo. -La definición/punto de corte, tendría que basarse, más que en distribuciones matemáticas, en su valor predictivo con respecto a la función y pronóstico a largo plazo: discapacidad, mortalidad, institucionalización y calidad de vida.

38 TRATAMIENTO

39 Pérdida ponderal Patrones dietéticos/pautas dietéticas utilizadas-Dieta DASH -Dieta hipograsa (American Heart Association) -Restricción calórica simple -Sustitutos de comidas Int J Obes Relat Metab Disord. 2003;27:537–549. Nut J. 2007; 6: 12 J Am Coll Nutr. 1994; 13: 608–614 Nutr J. 2008;7:23 -Baja carga glucémica (?) -Restricción calórica a días alternos Nutrition Reviews. 2012; 70:57

40 Nutrientes “esenciales”

41

42 ¡ ! Desayuno + + 9,5 g de proteínas 10,5 g de proteínasComida y cena 2 huevos grandes = 15 g de proteínas g = g de proteínas Snacks vs 10 g de proteínas 0,6 g de proteínas

43 Osteoporos Int. 2011 Mar;22(3):859-71J Am Geriatr Soc Jul;58(7): Proc Nutr Soc Feb;71(1):46-9

44 Ejercicio físico Rev Esp Geriatr Gerontol. 2015 Mar-Apr;50(2):74-81.Exerciseandphysical activity for older adults. Med Sci Sports Exerc. 2009;41:1510–30 Circulation. 2007;116:1094–105 Med Sci Sports Exerc. 2010; 42: Archives of Internal Medicine,vol.169,no.2, pp.122–131,2009

45 -Fragilidad leve-moderada -1 año -≥ 65 años, obesos. -Fragilidad leve-moderada -En todos los pacientes: suplementos de Ca (1500 mg/día) y vitD (1000 UI/día) -83% concluyeron el estudio. Déficit calórico: -500/750 kcal. 1g de prot/kg/día (a) 90 min x 3 veces/sem Aeróbico, fuerza, flexibilidad y equilibrio (b) (a) +(b)

46 Total one-repetition maximumLBM FM Fuerza Total one-repetition maximum Dieta -3,2 kg (-5%) -7,1 kg (-17%) 0,5 kg (+3%) Dieta y ejercicio -1,8 kg (-3%) -6,3 kg (-16%) 75 kg (+35%) Ejercicio +1,3 kg (+2%) -1,8 kg (-5%) 79 kg (+34%) Control -0,8 kg (-3%) +1,2 kg (+3%) -3 kg (-1%)

47 -mean age≥60 years and mean body mass index≥30 kg/m2-a minimum of 1 year -9 reports Age and Ageing2010;39:176–184

48 Tratamiento farmacológicoJ Clin Endocrinol Metab, February 2015, 100(2):342–362

49 Cirugía bariátrica Bypass gástrico Sleeve gastrectomyDerivación biliopancreática (con switch duodenal y con técnica de Scopinaro) Banda gástrica

50 Al analizar las evidencias que favorecen una decisión quirúrgica por encima de los 60 años de edad, deberían tenerse en cuenta sobre todo los siguientes factores: -Mortalidad -Impacto sobre las comorbilidades asociadas a obesidad -Calidad de vida, con una mención especial a la función física de estos pacientes.

51 Parece aceptable proponer la cirugía bariátrica a sujetos de más de 60 años que cumplen criterios de tratamiento por esta vía, pero la evidencia de los beneficios obtenidos por encima de los 75 años de edad es muy escasa. En todo caso, es necesario realizar una buena valoración previa para detectar problemas asociados a un peor pronóstico tras la cirugía. De momento sólo es posible inferir resultados y perspectiva pronóstica a 6-7 años postcirugía.

52 Cirugía bariátrica /GuíasGuías europeas Int J Obes (Lond) Apr;31(4):569-77 Considerar individualmente por encima de 60 años de edad Consenso de la Sociedad Española para el Estudio de la Obesidad (SEEDO) 2007 Rev Esp Obes 2007; 5 (3): Proponer entre los 18 y los 60 años de edad Guías escocesas BMJ Feb 24;340:c154. No hacen referencia a un límite de edad en obesos adultos Guías holandesas Ned Tijdschr Geneeskd. 2012;156(23):A4630 Límite superior 65 años Guías americanas Obesity (Silver Spring) Mar;21 Suppl 1:S1-27.

53 Revista Española de Obesidad • Vol. 10 • Suplemento 1 • Octubre 2011

54 “Because of changing demographics, there is a need for further research to understand the most appropriate strategies and prescriptions for weight loss for some key populations, including older adults and racial/ethnic groups” Journal of the American College of Cardiology. Vol. 63, No. 25, 2014

55 Conclusiones (anciano obeso)En estudios epidemiológicos no siempre se observa una asociación entre obesidad y morbimortalidad en ancianos. Los estudios de composición corporal, sobre todo de la distribución de la grasa corporal, pueden ser más precisos cuando se trata de valorar riesgos. La capacidad física modifica el riesgo entre adiposidad y muerte. La obesidad puede predisponer a la fragilidad a través del desarrollo de enfermedad crónica y de la pérdida de masa muscular (obesidad sarcopénica). Debe ser abordada con una reducción moderada en el consumo de calorías, con un aumento en la ingesta de proteínas, suplementos de vitamina D y programas de ejercicio físico. El tratamiento farmacológico o las técnicas bariátricas pueden ser una opción en casos muy seleccionados.

56