To the Editor.—Simko and Michael1 recently reported that daily intestinal absorption of more than 300 g of fat and more than 4000 kcal is possible in elderly subjects with debilitating disorders. We agree that in routine realimentation there is no reason to exclude a liberal amount of dietary fat. However, we caution against assuming that this type of diet is appropriate for all elderly persons. Our reasons are that the subjects in this study (1) were very different than older patients previously reported to have malnutrition, and (2) the subjects of Simko and Michael were too young (mean age, 64.0±2.1 years), and they had a high incidence of malignancies.
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Malnutrition is common in the oldest of the old, but most such patients have dementia, poor activity, and anorexia.2 The adaptative change of the pancreas and small intestine have not