Possible Predictors of Involuntary Weight Loss in Patients with Alzheimer's Disease

Massimo Venturelli, Emiliano Cè, Eloisa Limonta, Ettore Muti, Renato Scarsini, Anna Brasioli, Federico Schena, Fabio Esposito, Massimo Venturelli, Emiliano Cè, Eloisa Limonta, Ettore Muti, Renato Scarsini, Anna Brasioli, Federico Schena, Fabio Esposito

Abstract

Loss in body mass (∆BM) is a common feature in patients with Alzheimer's disease (AD). However, the etiology of this phenomenon is unclear. The aim of this cohort study was to observe possible ∆BM in AD patients following a standard institutionalized diet. Secondary objective was to identify possible predictors of ∆BM. To this end, 85 AD patients (age: 76±4 yrs; stature: 165±3 cm; BM: 61.6±7.4 kg; mean±standard deviation) and 86 controls (CTRL; age: 78±5 yrs; stature: 166±4 cm; BM: 61.7±6.4 kg) were followed during one year of standard institutionalized diet (~1800 kcal/24h). BM, daily energy expenditure, albuminemia, number of medications taken, and cortisolism, were recorded PRE and POST the observation period. Potential predictors of ∆BM in women (W) and men (M) with AD were calculated with a forward stepwise regression model. After one year of standard institutionalized diet, BM decreased significantly in AD (-2.5 kg; p < 0.01), while in CTRL remained unchanged (-0.4 kg; p = 0.8). AD patients and CTRL exhibited similar levels of daily energy expenditure (~1625 kcal/24h). The combination of three factors, number of medications taken, albuminemia, and cortisolism, predicted ∆BM in W with AD. At contrary, the best predictor of ∆BM in M with AD was the cortisolism. Despite a controlled energy intake and similar energy expenditure, both W and M with AD suffered of ∆BM. Therefore, controlled diet did not prevent this phenomenon. The assessments of these variables may predict W and M with AD at risk of weight loss.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Participant flow diagram.
Fig 1. Participant flow diagram.
AD, Alzheimer’s disease; CTRL, controls; BM, body mass; Nmed, number of medications; MMSE, Mini-Mental State Examination; ADL, activities of daily life; POMA; performance-oriented assessment of mobility.
Fig 2. Distribution of diet-adherence in patients…
Fig 2. Distribution of diet-adherence in patients with AD and CTRL.
Fig 3. body mass at baseline (PRE)…
Fig 3. body mass at baseline (PRE) and after 12 months (POST) of controlled diet.
*P

Fig 4. Circadian secretion of salivary cortisol.

Fig 4. Circadian secretion of salivary cortisol.

AD, Patients with Alzheimer’s disease; CTRL, aged matched…

Fig 4. Circadian secretion of salivary cortisol.
AD, Patients with Alzheimer’s disease; CTRL, aged matched controls; Avg, daily averaged cortisol. †P

Fig 5. Causal mechanisms linking Alzheimer’s disease…

Fig 5. Causal mechanisms linking Alzheimer’s disease (AD) and involuntary weight loss (WL).

Resting metabolic…

Fig 5. Causal mechanisms linking Alzheimer’s disease (AD) and involuntary weight loss (WL).
Resting metabolic rate (RMR); daily physical activity (PA); hypothalamic–pituitary–adrenal axis (HPA-axis); reactive oxygen species (ROS).
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References
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Grant support
The study was supported by grant #15-6-3016000-115 accorded to MV by the Department of Biomedical Sciences for Health, University of Milan, by the grant #KL2Y73_004 from the Italian Ministry for Research (PRIN 2010), accorded to FS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Fig 4. Circadian secretion of salivary cortisol.
Fig 4. Circadian secretion of salivary cortisol.
AD, Patients with Alzheimer’s disease; CTRL, aged matched controls; Avg, daily averaged cortisol. †P

Fig 5. Causal mechanisms linking Alzheimer’s disease…

Fig 5. Causal mechanisms linking Alzheimer’s disease (AD) and involuntary weight loss (WL).

Resting metabolic…

Fig 5. Causal mechanisms linking Alzheimer’s disease (AD) and involuntary weight loss (WL).
Resting metabolic rate (RMR); daily physical activity (PA); hypothalamic–pituitary–adrenal axis (HPA-axis); reactive oxygen species (ROS).
Fig 5. Causal mechanisms linking Alzheimer’s disease…
Fig 5. Causal mechanisms linking Alzheimer’s disease (AD) and involuntary weight loss (WL).
Resting metabolic rate (RMR); daily physical activity (PA); hypothalamic–pituitary–adrenal axis (HPA-axis); reactive oxygen species (ROS).

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