1. JEANNE Y. WEI, MD, PhD Executive Director, Donald W. Reynolds Institute in Aging; Chair, Donald W. Reynolds Department of Geriatrics; University of Arkansas for Medical Sciences; Staff Physician, GRECC -VISN 16 & CAVHS; Little Rock, AR Obesity, Nutrition & Cardiovascular Health in Seniors

2. Nutritional needs change with age 1.Aging may be associated with: –reduced appetite, –inadequate protein intake and inappropriate low caloric intake with weight loss; –Decreased energy requ’mts ~8% /decade, 55 -75; 2.Lean muscle mass is lost at ~ 1% per yr, after age 30 yrs; 3.Muscle fibers gradually decrease in size and number. 4.Sarcopenia, in > 50% of those > age 80 yrs, increases disability & healthcare costs; Feed the body, mind and soul with 5 colors on the plate Williams, 2012

3. Diabetes & Obesity in Older Cardiac Patients What is the overall treatment goal? HbA1c goal of 7.5 - 8.5 ( or 9.0) % Risk of further nutritional restrictions, including suboptimal nutrition and symptomatic hypoglycemia, may outweigh any potential benefit. Avoiding adverse effects of treatment is most important. Munshi et al., 2012

4. Nutritional Needs in Obese Cardiac Seniors Obese elderly may have malnutrition and sarcopenia; Approach with caution: assess nutritional status first; Treat with nutrition plus protein, adequate daily hydration and exercise, and gradual weight loss (reduction of sweets and snacks).

5. Malnutrition in the Elderly Malnutrition occurs in 15-50% of older adults; Symptoms: weight loss, confusion, lightheadedness, lethargy and poor appetite; 30% of seniors skip > one meal a day; 16% of seniors consume < 1000 calories a day. Beattie et al., 2012