Zusammenfassung
Der Altersprozess ist sowohl mit quantitativen als auch mit qualitativen Veränderungen der Körperzusammensetzung verbunden. Ältere Menschen haben im Vergleich zu jüngeren Erwachsenen weniger fettfreie Körpermasse, bedingt durch eine Atrophie der Skelettmuskulatur und der inneren Organe, Abnahme des Körperwassergehalts und der Knochenmasse. Dem gegenüber steht eine Expansion von Fettgewebe, verbunden mit der Umverteilung von Fett von peripheren zu zentralen Speichern. Das Ausmaß der Altersveränderungen wird in verschiedenen Studien unterschiedlich eingeschätzt, ist individuell sehr variabel und wesentlich von der Entwicklung des Körpergewichts abhängig. Qualitative Veränderungen ergeben sich dadurch, dass die Zellmasse, insbesondere die Muskelmasse, schneller und stärker abnimmt als interzelluläres Bindegewebe und Wasser. Der Anteil der Zellmasse an der fettfreien Masse ist im Alter deutlich geringer als bei jüngeren Erwachsenen, zwischen den an Anzahl und Größe reduzierten Muskelzellen finden sich zunehmend Bindegewebs- und Fetteinlagerungen. Die Altersveränderungen der Körperzusammensetzung haben unter funktionellen und metabolischen Aspekten weit reichende Konsequenzen und zählen im Hinblick auf Leistungsfähigkeit, Gesundheitszustand und Lebenserwartung zu den bedeutendsten Altersveränderungen überhaupt. Sowohl die geringere Muskelmasse als auch der höhere (viszerale) Körperfettgehalt gehen mit eingeschränkter körperlicher Leistungsfähigkeit und weit reichenden metabolischen Risiken einher. Die reduzierte Knochenmasse ist mit erhöhtem Osteoporose- und Frakturrisiko verbunden. Im Hinblick auf eine Minimierung der Altersveränderungen und den Erhalt von Zell-, Muskel- und Knochenmasse spielen körperliche Aktivität und bedarfsgerechte Energie- und Nährstoffzufuhr eine Schlüsselrolle. Pharmakologische Maßnahmen sind aufgrund zweifelhafter Wirkung und der Gefahr unerwünschter Nebenwirkungen dagegen nicht zu empfehlen.
Abstract
Aging is accompanied by changes in body composition that are quantitative as well as qualitative in nature. Body composition in the elderly is characterized on the one hand by reduced fat free mass, due to an atrophy of skeletal muscle, visceral and bone mass and a reduction of total body water. On the other hand there is an increase in adipose tissue, associated with the redistribution of fat from peripheral to central stores. The extent of these age-related changes varies between different investigations and between individuals and is considerably dependent on the direction and extent of body weight changes. Qualitative changes are observed because of a more pronounced decrease in body cell mass - particularly skeletal muscle mass - compared to intercellular connective tissue and water. In the elderly, the ratio of body cell mass to fat-free mass is clearly reduced in comparison with younger adults. Skeletal muscle in the elderly is characterized by a decrease in number and size of muscle cells and infiltration of fat and connective tissue. Age-related changes of body composition are accompanied by extensive functional and metabolic consequences. With respect to physical capacity, health status and life expectancy they are counted among the most significant age-related changes at all. Reduced skeletal muscle mass as well as increased (visceral) body fat mass go along with reduced physical performance and increased metabolic risks. Reduced bone mass is associated with increased risk of osteoporosis and bone fractures. With regard to minimization of age-related changes and maintenance of cell mass, muscle mass and bone mass, physical activity and adequate energy and nutrient intake play a key role. Pharmacological interventions, in contrast, are not recommended because of doubtful success and risk of adverse effects.
Schlüsselwörter
Körperzusammensetzung - Altern - ältere Menschen - Muskelmasse - Sarkopenie
Key words
Body composition - age-related changes - elderly - muscle mass - muscle quality - sarcopenia
Literatur
-
1
Forbes G B.
Body composition: overview.
J Nutr.
1999;
129
270S-272S
-
2 Forbes G B. Human Body Composition. Growth, Aging, Nutrition and Activity. New York, Berlin, Heidelberg; Springer Verlag 1987
-
3 Kehayias J J. Aging and body composition. In: Rosenberg IH, Sastre A (eds) Nutrition and Aging. Basel; Karger AG 2002: 63-78
-
4
Borkan G A, Hults D E, Gerzof S G, Robbins A H.
Comparison of body composition in middle-aged and elderly males using computed tomography.
Am J Phys Anthropol.
1985;
66
289-295
-
5
Seidell J C, Oosterlee A, Deurenberg P, Hautvast J G, Ruijs J H.
Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age.
Eur J Clin Nutr.
1988;
42
805-815
-
6
Horber F F, Gruber B, Thomi F, Jensen E X, Jaeger P.
Effect of sex and age on bone mass, body composition and fuel metabolism in humans.
Nutrition.
1997;
13
524-534
-
7
Flynn M A, Nolph G B, Baker A S, Martin W M, Krause G.
Total body potassium in aging humans: a longitudinal study.
Am J Clin Nutr.
1989;
50
713-717
-
8
Cohn S H, Vartsky D, Yasumura S, Sawitsky A, Zanzi I. et al .
Compartmental body composition based on total-body nitrogen, potassium and calcium.
Am J Physiol.
1980;
239
E524-E530
-
9
Novak L P.
Ageing, total body potassium, fat-free mass and cell mass in males and females between ages 18 an 85 years.
J Gerontol.
1972;
24
438-443
-
10
Kehayias J J, Fiatarone M A, Zhuang H, Roubenoff R.
Total body potassium and body fat: relevance to aging.
Am J Clin Nutr.
1997;
66
904-910
-
11
Kyle U G, Genton L, Slosman D O, Pichard C.
Fat-free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years.
Nutrition.
2001;
17
534-541
-
12
Kyle U G, Genton L, Hans D, Karsegard L, Slosman D O, Pichard C.
Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years.
Eur J Clin Nutr.
2001;
55
663-672
-
13
Gallagher D, Ruts E, Visser M, Heshka S, Baumgartner R N, Wang J, Pierson R N, Pi-Sunyer F X, Heymsfield S B.
Weight stability masks sarcopenia in elderly men and women.
Am J Physiol Endocrinol Metab.
2000;
279
366-375
-
14
Suominen H.
Changes in physical characteristics and body composition during 5-year follow-up in 75- and 80-year-old men and women.
Scand J Soc Med.
1997;
53
19-24
-
15
Baumgartner R N, Stauber P M, McHugh D, Koehler K M, Garry P J.
Cross-sectional age differences in body composition in persons 60+ years of age.
Journal of Gerontology.
1995;
50A
307-316
-
16
Reed R L, Pearlmutter L, Yochum K, Meredith K E, Mooradian A D.
The relationship between muscle mass and muscle strength in the elderly.
J Am Geriatr Soc.
1991;
39
555-561
-
17
Nuti R, Martini G, Gennari C.
Age-related changes of whole skeleton and body composition in healthy men.
Calcif Tissue Int.
1995;
57
336-339
-
18 Herbert B M. Körpergewicht und Körperzusammensetzung älterer Menschen unter besonderer Berücksichtigung methodischer Aspekte. Gießen; Köhler Fachverlag 2000
-
19
Kyle U G, Genton L, Hans D, Karsegard V L, Michel J P, Slosman D O, Pichard C.
Total body mass, fat mass, fat-free mass, and skeletal muscle in older people: cross-sectional differences in 60-year old persons.
J Am Geriatr Soc.
2001;
49
1633-1640
-
20
Forbes G B, Reina J C.
Adult lean body mass declines with age: some longitudinal observations.
Metabolism.
1970;
19
653-663
-
21
Roubenoff R, Baumgartner R N, Harris T B, Dallal G E, Hannan M T, Economos C D, Stauber P M, Wilson P WF, Kiel D P.
Application of bioelectrical impedance analysis to elderly populations.
J Gerontol.
1997;
52A
M129-M136
-
22
Zamboni M, Turcato E, Santana H, Maggi S, Harris T B, Pietrobelli A, Heymsfield S B, Micciolo R, Bosello O.
The relationship between body composition and physical performance in older women.
J Am Geriatr Soc.
1999;
47
1403-1408
-
23
Hughes V A, Frontera W R, Roubenoff R, Evans W J, Singh M A.
Longitudinal changes in body composition in older men and women: role of body weight change and physical activity.
Am J Clin Nutr.
2002;
76
473-481
-
24
Steen B, Isaksson B, Svanborg A.
Body compostition at 70 and 75 years of age. A longitudinal population study.
J Clin Exp Gerontol.
1979;
1
185-200
-
25
Murray L A, Reilly J J, Choudhry M, Durnin J V.
A longitudinal study of changes in body composition and basal metabolism in physically active elderly men.
Eur J Appl Physiol.
1996;
72
215-218
-
26
Heymsfield S B, Wang J, Lichtman S. et al .
Body composition in elderly subjects: a critical appraisal of clinical methodology.
Am J Clin Nutr.
1989;
50
1167-1175
-
27
Forbes G B.
Longitudinal changes in adult fat-free mass: influence of body weight.
Am J Clin Nutr.
1999;
70
1025-1031
-
28
Bergmann K E, Mensink G BM.
Körpermaße und Übergewicht.
Gesundheitswesen.
1999;
61
S115-S120
-
29
Groot C P de, Enzi G, Matthys C, Moreiras O, Roszkowski W, Schroll M.
Ten-year changes in anthropometric characteristics of elderly Europeans.
J Nutr Health Aging.
2002;
6
4-8
-
30
Ellis K J.
Reference man and woman more fully characterized. Variations on the basis of body size, age, sex, and race.
Biol Trace Elem Res.
1990;
26 - 27
385-400
-
31
Roubenoff R, Hughes V A.
Sarcopenia: Current concepts.
J Gerontol.
2000;
55A
M716-M724
-
32 Koronchevsky V. Physiological and Pathological Aging. New York; Hafner 1961
-
33 Munro H N. Aging. In: Kinney JM, Jeejeebhoy KN, Hill GH, Owen OE (eds) Nutrition and Metabolism in Patient Care. Philadelphia PA; WB Saunders Company 1988: 145-166
-
34
Munro H N, Young V R.
Urinary excretion of N gamma-methylihistidine (3-methylihistidine): a tool to study metabolic responses in relation to nutrient and hormonal status in health and disease of man.
Am J Clin Nutr.
1978;
31
1608-1614
-
35
Tzankoff S P, Norris A H.
Effect of muscle mass decrease on age-related BMR changes.
J Appl Physiol.
1977;
43
1001-1006
-
36
Rosenberg I H.
Sarcopenia: origins and clinical relevance.
J Nutr.
1997;
127
990S-991S
-
37
Lexell J.
Human aging, muscle mass, and fiber type composition.
J Gerontol A Biol Sci Med Sci.
1995;
50 Spec No
11-16
-
38
Lexell J, Taylor C C, Sjostrom M.
What is the cause of the ageing atrophy? Total number, size and proportion of different fiber types studied in whole vastus lateralis muscle from 15- to 83-year old men.
J Neurol Sci.
1988;
84
275-294
-
39
Coggan A R, Spina R J, King D S, Rogers M A, Brown M, Nemeth P M, Holloszy J O.
Histochemical and enzymatic comparison of the gastrocnemius muscle of young and elderly men and women.
J Gerontol.
1992;
47
71-76
-
40
Imamura K, Ashida H, Ishikawa T, Fujii M.
Human major psoas muscle and sacrospinalis muscle in relation to age: a study by computed tomography.
J Gerontol.
1983;
38
678-681
-
41
Pahor M, Kritchevsky S.
Research hypotheses on muscle wasting, aging, loss of function and disability.
J Nutr Health & Aging.
1998;
2
97-100
-
42
Goodpaster B H, Carlson C L, Visser M, Kelley D E, Scherzinger A, Harris T B, Stamm E, Newman A B.
Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study.
J Appl Physiol.
2001;
90
2157-2165
-
43
Inokuchi S, Ishikawa H, Iwamoto S, Kimura T.
Age-related changes in the histological composition of the rectus abdominis muscle of the adult human.
Hum Biol.
1975;
47
231-249
-
44
Baumgartner R N.
Body composition in healthy aging.
Ann N Y Acad Sci.
2000;
904
437-448
-
45
Frontera W R, Hughes V A, Lutz K J, Evans W J.
A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women.
J Appl Physiol.
1991;
71
644-650
-
46
Larsson L, Grimby G, Karlsson J.
Muscle strength and speed of movement in relation to age and muscle morphology.
J Appl Physiol.
1979;
46
451-456
-
47
Frontera W R, Hughes V A, Fielding R A, Fiatarone M A, Evans W J, Roubenoff R.
Aging of skeletal muscle: a 12-yr longitudinal study.
J Appl Physiol.
2000;
88
1321-1326
-
48
Baumgartner R N, Waters D L, Gallagher D, Morley J E, Garry P J.
Predictors of skeletal muscle mass in elderly men and women.
Mech Ageing Dev.
1999;
107
123-136
-
49
Kallman D A, Plato C C, Tobin J D.
The role of muscle loss in the age-related decline of grip strength: cross-sectional and longitudinal perspectives.
J Gerontol.
1990;
45
82-88
-
50
Evans W J.
What is sarcopenia?.
J Gerontol A Biol Sci Med Sci.
1995;
50 Spec No
5-8
-
51
Frontera W R, Meredith C N, O'Reilly K P, Knuttgen H G, Evans W J.
Strength conditioning in older men: skeletal muscle hypertrophy and improved function.
J Appl Physiol.
1988;
64
1038-1044
-
52
Bassey E J, Bendall M J, Pearson M.
Muscle strength in the triceps surae and objectively measured customary walking activity in men and women over 65 years of age.
Clin Sci.
1988;
74
85-89
-
53
Fiatarone M A, O'Neill E F, Ryan N D, Clements K M, Solares G R. et al .
Exercise training and nutritional supplementation for physical frailty in very elderly people.
N Engl J Med.
1994;
330
1769-1775
-
54
Bassey E J, Fiatarone M A, O'Neill E F, Kelly M, Evans W J, Lipsitz L A.
Leg extensor power and functional performance in very old men and women.
Clin Sci.
1992;
82
321-327
-
55
Janssen I, Heymsfield S B, Ross R.
Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability.
J Am Geriatr Soc.
2002;
50
889-896
-
56
Visser M, Kritchevsky S B, Goodpaster B H, Newman A B, Nevitt M, Stamm E, Harris T B.
Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study.
J Am Geriatr Soc.
2002;
50
897-904
-
57
Zuliani G, Romagnoni F, Volpato S, Soattin L, Leoci V, Bollini M C, Buttarello M, Lotto D, Fellin R.
Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes.
J Gerontol A Biol Sci Med Sci.
2001;
56
212-216
-
58
Evans W.
Functional and metabolic consequences of sarcopenia.
J Nutr.
1997;
127
998S-1003S
-
59
Groot C P de, Broek T van der, Staveren W van.
Energy intake and micronutrient intake in elderly Europeans: seeking the minimum requirement in the SENECA study.
Age Ageing.
1999;
28
469-474
-
60
Hébuterne X, Bermon S, Schneider S M.
Ageing and muscle: the effects of malnutrition, re-nutrition, and physical exercise.
Curr Opin Clin Nutr Metab Care.
2001;
4
295-300
-
61
Seidell J C, Visscher T LS.
Body weight and weight change and their health implications for the elderly.
Eur J Clin Nutr.
2000;
54, Suppl 3
S33-S39
-
62
Visser M, Harris T B, Langlois J, Hannan M T, Roubenoff R, Felson D T, Wilson P W, Kiel D P.
Body fat and skeletal muscle mass in relation to physical disability in very old men and women of the Framingham Heart Study.
J Gerontol A Biol Sci Med Sci.
1998;
53
214-221
-
63
Sternfeld B, Ngo L, Satariano W A, Tager I B.
Associations of body composition with physical performance and self-reported functional limitation in elderly men and women.
Am J Epidemiol.
2002;
156
110-121
-
64
Launer L J, Harris T, Rumpel C, Madans J.
Body mass index, weight change and risk of mobility disability in middle-aged and older women - the epidemiologic follow-up study of NHANES I.
J Am Med Assoc.
1994;
271
1093-1098
-
65
Jensen G L, Friedmann J M.
Obesity is associated with functional decline in community-dwelling rural older persons.
J Am Geriatr Soc.
2002;
50
918-923
-
66
Davison K K, Ford E S, Cogswell M E, Dietz W H.
Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III.
J Am Geriatr Soc.
2002;
50
1802-1809
-
67
Beaufrère B, Morio B.
Fat and protein redistribution with aging: metabolic considerations.
Eur J Clin Nutr.
2000;
54, Suppl 3
S48-S53
-
68
Bjorntorp P.
Metabolic implications of body fat distribution.
Diabetes Care.
1991;
14
1132-1143
-
69
Roubenoff R.
Catabolism of aging: is it an inflammatory process?.
Curr Opin Clin Nutr Metab Care.
2003;
6
295-299
-
70
Cummings S R, Kelsey J L, Nevitt M C, O'Dowd K J.
Epidemiology of osteoporosis and osteoporotic fractures.
Epidemiol Rev.
1985;
7
178-208
-
71
Roubenoff R, Harris T B, Abad L W, Wilson P WF, Dallal G E, Dinarello C A.
Monocyte cytokine production in an elderly population: Effect of age and inflammation.
J Gerontol.
1998;
53A
M20-M26
-
72
Paolisso G, Rizzo M R, Mazziotti G, Tagliamonte M R, Gambardella A, Rotondi M, Carella C, Giugliano D, Varricchio M, D'Onofrio F.
Advancing age and insulin resistance: role of plasma tumor necrosis factor-alpha.
Am J Physiol.
1998;
275
294-299
-
73
Yeh S-S, Schuster M W.
Geriatric cachexiea: The role of cytokines.
Am J Clin Nutr.
1999;
70
183-197
-
74
Fiatarone M A, Marks E C, Ryan N D, Meredith C N, Lipsitz L A, Evans W J.
High-intensity strength training in nonagenarians.
J Am Med Assoc.
1990;
263
3029-3034
-
75
Nelson M E, Fiatarone M A, Moraganti C M, Trice I, Greenberg R A, Evans W J.
Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures.
J Am Med Assoc.
1994;
272
1909-1914
-
76
Aloia J F, Cohn S H, Ostuni J A, Cane R, Ellis K.
Prevention of involutional bone loss by exercise.
Ann Intern Med.
1978;
89
356-358
-
77
Dalsky G P, Stocke K S, Ehsani A A, Slatopolsky E, Lee W C, Birge S J.
Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women.
Ann Intern Med.
1988;
108
824-828
-
78
Pruitt L A, Jackson R D, Bartels R L, Lehnhard H J.
Weight-training effects on bone mineral density in early postmenopausal women.
J Bone Miner Res.
1992;
7
179-185
-
79
Menkes A, Mazel S, Redmond R A, Koffler K, Libanati C R, Gundberg C M, Zizic T M, Hagberg J M, Pratley R E, Hurley B F.
Strength training increases regional bone mineral density and bone remodeling in middle-aged and older men.
J Appl Physiol.
1993;
74
2478-2484
-
80
Castaneda C, Charnley J M, Evans W J, Crim M C.
Elderly women accomodate to a low-protein diet with losses of body cell mass, muscle function, and immune response.
Am J Clin Nutr.
1995;
62
30-39
-
81
Campbell W W, Evans W J.
Protein requirements of elderly people.
Eur J Clin Nutr.
1996;
50
S180-S185
-
82
Campbell W W, Crim M C, Young V R, Evans W J.
Increased energy requirements and changes in body composition with resistance training in older adults.
Am J Clin Nutr.
1994;
60
167-175
-
83
Esmarck B, Andersen J L, Olsen S, Richter E A, Mizuno M, Kjaer M.
Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans.
J Physiol.
2001;
535
301-311
-
84
Dawson-Hughes B, Dallal G E, Krall E A, Sadowski L, Sahyoun N.
A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women.
N Engl J Med.
1990;
323
878-883
-
85
Dawson-Hughes B, Harris S S, Krall E, Dallal G E.
Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older.
N Engl J Med.
1997;
337
670-676
-
86
Chapuy M C, Arlot M E, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas P D, Meunier M J.
Vitamin D3 and calcium to prevent hip fractures in elderly women.
N Engl J Med.
1992;
237
1637-1642
-
87
Chapuy M C, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier P J.
Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study.
Osteoporos Int.
2002;
13
257-264
-
88
Blumsohn A, Herrington K, Hannon R A, Shao P, Eyre D R, Eastell R.
The effect of calcium supplementation on the circadian rhythm of bone resorption.
J Clin Endocrinol Metab.
1994;
79
730-735
-
89
Dawson-Hughes B, Harris S S.
Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women.
Am J Clin Nutr.
2002;
75
773-779
-
90
Zittermann A.
Vitamin D in preventive medicine: are we ignoring the evidence?.
Br J Nutr.
2003;
89
552-572
-
91
Vance M L.
Can growth hormone prevent aging?.
N Engl J Med.
2003;
348
779-780
Priv.-Doz. Dr. Dorothee Volkert
Institut für Ernährungswissenschaft · Rheinische Friedrich-Wilhelms-Universität
Endenicher Allee 11 - 13
53115 Bonn
Email: d.volkert@uni-bonn.de
