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Wang HY, Bai MH, Li Z, Wang J, Wang Q. Appetite variation in sarcopenic old adults with or without overweight/obesity - a nationally cross-sectional survey in China. Appetite 2025; 213:108037. [PMID: 40334789 DOI: 10.1016/j.appet.2025.108037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 10/29/2024] [Accepted: 05/02/2025] [Indexed: 05/09/2025]
Abstract
To investigate the appetite variation of sarcopenic old adults with/without obesity could guide the individualized diet management. Among adults>60 years in the China Psychosomatic Health Survey Based on the Traditional Chinese Medicine, those with normal BMI and without sarcopenia, those with isolated sarcopenia (BMI<24 kg/m2), and those with sarcopenic overweight/obesity (BMI≥24 kg/m2) were included. The related factors of appetite (demographics, eating-related factors, chronic disease, preferred flavor) were analyzed using multivariate logistic regression models. The correlation between preferred flavor and food intake was analyzed using the Kendall's tau-b coefficient. Among 8634 adults (69.6 ± 6.9 years) included, the prevalence of poor appetite among isolated sarcopenia and sarcopenic overweight/obesity were 13.8 % and 8.9 %, respectively. With chronic pain (odds ratio [OR] = 2.79, 95 % confidence interval [CI] 2.07-3.74) and teeth problem (OR = 1.45, 95 %CI 1.14-1.84) were the related factors of poor appetite in adults with isolated sarcopenia, while with gastrointestinal disease (OR = 2.23, 95 %CI 1.15-4.33) was that of poor appetite in those with sarcopenic overweight/obesity. Preferring sour flavor (OR = 2.33, 95 %CI 1.45-3.76) was positively associated with poor appetite only in adults with isolated sarcopenia, but not among those with sarcopenic overweight/obesity. Light flavor was negatively associated with poor appetite among sarcopenic adults with or without overweight/obesity, and negatively correlated to the decrease of food intake among the adults with isolated sarcopenia. In conclusion, poor appetite was the common problem among sarcopenic old adults with or without overweight/obesity. Related factors of appetite in sarcopenic old adults with or without overweight/obesity were different. Changing flavor of food might improve appetite and promote food intake, especially among old adults with isolated sarcopenia.
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Affiliation(s)
- Huai-Yu Wang
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China; College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ming-Hua Bai
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China
| | - Zhuqing Li
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China
| | - Ji Wang
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China.
| | - Qi Wang
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China
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Courtney A, Fitzpatrick M, Volkert D, Horner K, Corish C. Published methods of subjective appetite assessment in older adults living in the community and their validity and reliability: A scoping review. Clin Nutr ESPEN 2025; 67:34-49. [PMID: 39993565 DOI: 10.1016/j.clnesp.2025.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 02/06/2025] [Accepted: 02/17/2025] [Indexed: 02/26/2025]
Abstract
BACKGROUND AND AIMS A decline in appetite is associated with poor health in older adults (≥65 years). Subjective methods of appetite assessment used in older adults living in the community have not previously been fully documented and their validity and reliability have not been evaluated and described. The aims of this scoping review were to identify methods used to assess self-reported/subjective appetite as a primary outcome in studies in older adults living in the community and community settings, and to establish which, and how methods were evaluated for validity and/or reliability. METHODS A scoping review of three online databases: CINAHL, PubMed and Embase was undertaken. RESULTS One-hundred and one articles were included, with 30 different types of appetite assessment methods identified and categorized into three groups: Likert-scales, visual analogue scales (VAS) and question-based methods. Likert-scales were used most frequently (61 %), followed by VAS (23 %) and question-based methods. Twenty-two studies evaluated the validity and/or reliability of 11 types of appetite assessment methods (Likert-scales, n = 10, VAS, n = 1). Thirty comparators were used to evaluate validity and reliability, with predictive validity and internal consistency reliability evaluated most frequently. Likert-scales were predominantly reported to predict health risks; however, have not been validated for appetite per se. In contrast, albeit limited, VAS have been validated against ad libitum test meal energy intake. CONCLUSIONS Agreement on best practice when evaluating the validity and reliability of assessment methods is required. Given the current evidence, a recommended method will likely depend on the context and goals of assessment.
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Affiliation(s)
- Aoife Courtney
- Conway Institute, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Michelle Fitzpatrick
- Conway Institute, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
| | - Katy Horner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Clare Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
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Fernandez SSM, Cipolli GC, Merchant RA, Moreira VG, Klompenhouwer T, Pain A, Ribeiro SML, Duque G, Bauer J, Landi F, Cederholm T, Aprahamian I. Global prevalence of anorexia of aging: A systematic review and meta-analysis. Maturitas 2025; 198:108603. [PMID: 40412145 DOI: 10.1016/j.maturitas.2025.108603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Revised: 04/29/2025] [Accepted: 05/19/2025] [Indexed: 05/27/2025]
Abstract
Anorexia of aging is a major geriatric syndrome that contributes to the development of malnutrition, frailty, and other adverse health outcomes, including death. However, its prevalence has not been clearly established. We examined the scientific literature to estimate the global prevalence and incidence of anorexia of aging, and its trends based on diagnostic tools, settings, and geographical location. A systematic search was conducted in PubMed, Scopus, Web of Science, and EMBASE from the date of database inception to July 2024. Observational cross-sectional and longitudinal studies in adults aged 60 years or more reporting the prevalence of anorexia of aging were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was used to estimate the pooled effects. A total of 40 studies were included in the systematic review. Among these, 36 studies with a total sample size of 29,864,296 individuals were included in the meta-analysis. The overall pooled prevalence of anorexia of aging was 22.7 %, and its incidence was 3.78 %. This prevalence estimate remained relatively steady from 2011 to 2024. The highest prevalence was found in the inpatient population, at 34.7 %, and the most used tool was the Simplified Nutritional Appetite Questionnaire. A significantly higher prevalence was observed in South America, at 27.1 %. Our findings highlight that, globally, more than one-fifth of older populations had anorexia of aging, and they illustrate the need for a global consensus on its diagnosis.
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Affiliation(s)
- Shirley Steffany Muñoz Fernandez
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, R. Francisco Telles 250, CEP 13202-550 Jundiaí, SP, Brazil; Nutrition Department, School of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, CEP 01246-904 São Paulo, SP, Brazil
| | - Gabriela Cabett Cipolli
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, R. Francisco Telles 250, CEP 13202-550 Jundiaí, SP, Brazil; College of Medical Sciences, State University of Campinas, R. Albert Sabin, s/ n°, Cidade Universitária "Zeferino Vaz", CEP: 13083-894 Campinas, SP, Brazil
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, 119228, Singapore
| | - Virgílio Garcia Moreira
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, R. Francisco Telles 250, CEP 13202-550 Jundiaí, SP, Brazil; Human Aging Research Laboratory (GeronLab), State University of Rio de Janeiro, Av. Mal. Rondon 381, São Francisco Xavier, CEP 20950-003 Rio de Janeiro, RJ, Brazil
| | - Tatiana Klompenhouwer
- Society on Sarcopenia, Cachexia and Wasting Disorders, 3780 Old Nordcross Rd Suite 103-50, Duluth, GA 30096, USA
| | - Andreia Pain
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, R. Francisco Telles 250, CEP 13202-550 Jundiaí, SP, Brazil
| | - Sandra Maria Lima Ribeiro
- Nutrition Department, School of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, CEP 01246-904 São Paulo, SP, Brazil; School of Arts, Science, and Humanity, University of São Paulo, R. Arlindo Bettio 1000, CEP 03828-000 São Paulo, SP, Brazil
| | - Gustavo Duque
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Bone, Muscle & Geroscience Research Group, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Room EM1.3226, Montreal, Quebec, Canada
| | - Jürgen Bauer
- Center for Geriatric Medicine, University Clinic Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126 Heidelberg, Germany
| | - Francesco Landi
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden; Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, R. Francisco Telles 250, CEP 13202-550 Jundiaí, SP, Brazil.
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Parlak Baskurt H, Yardımcı H. Consumptıon of ultra-processed foods can accelerate age-related appearance of sarcopenıa. Biogerontology 2025; 26:112. [PMID: 40381073 DOI: 10.1007/s10522-025-10253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Accepted: 05/04/2025] [Indexed: 05/19/2025]
Abstract
Sarcopenia, the loss of muscle mass and function, commonly affects older adults and reduces their quality of life. Frequent consumption of ultra-processed foods, which contain mostly additives and very few natural foods, increases the risk of sarcopenia or accelerates its onset. A diet rich in ultra-processed foods may lead to inadequate nutrition and lower intake of many nutrients, such as protein, dietary fiber, vitamins A, C, E, zinc, selenium, magnesium, and iron. However, obesity may occur because of increased energy and saturated fat intake. Both conditions contribute to the risk of muscle mass loss. A diet poor in antioxidants may increase the risk of sarcopenia by increasing inflammation. The fact that consumption of ultra-processed food contributes to the risk of frailty in older adults may lead to increased physical weakness and falls. Therefore, minimizing the consumption of ultra-processed foods is important to reduce the risk of sarcopenia. Understanding the contribution of the nutrients in this group to the risk of sarcopenia will allow for more accurate nutritional recommendations for old age. In our world, where the elderly population is increasing, it is important to conduct studies that include healthy nutrition to make this process healthier and more prosperous.
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Affiliation(s)
- Hatice Parlak Baskurt
- Department of Nutrition and Dietetics, Graduate School of Health Sciences, Ankara University, Ankara, Turkey.
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey.
| | - Hulya Yardımcı
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey
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Scheufele P, Horner K, Corish C, Visser M, Rappl A, Mullen B, Quinn A, Gonnelli F, Bozzato M, Volkert D. Comparison of appetite assessment methods in older adults from the APPETITE study. Appetite 2025; 208:107909. [PMID: 39952292 DOI: 10.1016/j.appet.2025.107909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 01/24/2025] [Accepted: 02/11/2025] [Indexed: 02/17/2025]
Abstract
Poor appetite is an important health concern in older adults. Numerous methods exist for appetite assessment, without a consensual gold standard. This study aims to compare Simplified Nutritional Appetite Questionnaire (SNAQ) and two single-item appetite questions with appetite ratings from visual analogue scales (VAS) and energy intake (EI). In 126 community-dwelling adults aged ≥65 years from the APPETITE trial, appetite was assessed using SNAQ, SNAQ 1st item, Center for Epidemiologic Studies-Depression scale (CES-D) 2nd item and using VAS appetite ratings (fasting, 0, 30, 60, 120, 180 min post-breakfast, post-lunch) and EI (ad libitum lunch) in a test meal setting. Spearman correlations were calculated between SNAQ, single-items, VAS-fasting, and EI. Differences in VAS-fasting and EI between normal and poor appetite groups (based on SNAQ, single-items) were examined using Mann-Whitney-U-test. Repeated measures Generalized Linear Models were used to compare all VAS ratings across the test morning and post-breakfast response ratings with VAS-fasting as a covariate between appetite groups. SNAQ score was correlated with VAS-fasting (r = 0.26, p < 0.001) and EI (r = 0.22, p < 0.05). VAS-fasting was lower in the SNAQ-based poor appetite group (p = 0.01). Time/group interaction effects (SNAQ, ηp2 = 0.02; CES-D-item, ηp2 = 0.02) for all VAS ratings, and group (SNAQ-item, ηp2 = 0.04) and interaction effects (CES-D-item, ηp2 = 0.03) for post-breakfast ratings were observed (p < 0.05, respectively). SNAQ identified differences in VAS-fasting, possibly reflecting processes related to the drive to eat, while the two single-items identified appetite differences in response to a standardised breakfast. Different methods appear to capture different aspects of appetite, which should be considered when choosing an assessment method.
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Affiliation(s)
- Pia Scheufele
- Institute for Biomedicine of Ageing, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Katy Horner
- School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, 4, Ireland; Institute for Food and Health, University College Dublin, Dublin, 4, Ireland; Institute for Sport and Health, University College Dublin, Dublin, 4, Ireland
| | - Clare Corish
- School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, 4, Ireland; Institute for Food and Health, University College Dublin, Dublin, 4, Ireland
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anja Rappl
- Institute for Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Brian Mullen
- School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, 4, Ireland; Institute for Food and Health, University College Dublin, Dublin, 4, Ireland; Institute for Sport and Health, University College Dublin, Dublin, 4, Ireland
| | - Anna Quinn
- School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, 4, Ireland; Institute for Food and Health, University College Dublin, Dublin, 4, Ireland; Institute for Sport and Health, University College Dublin, Dublin, 4, Ireland
| | - Federica Gonnelli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Matteo Bozzato
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Dorothee Volkert
- Institute for Biomedicine of Ageing, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
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6
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Asghari Hanjani N, Arzhang P, Azadbakht L. Effect of oral nutrition supplements on anthropometric and functional parameters among community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. BMC Nutr 2025; 11:42. [PMID: 39948673 PMCID: PMC11827344 DOI: 10.1186/s40795-025-01010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 01/20/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND Oral nutrition supplement (ONS) prescription in older adults is affordable for preventing malnutrition through the use of multiple nutrients and energy products. However, there is a gap in knowledge regarding the benefits of ONS supplementation on anthropometric and functional parameters in malnourished older adults without complicated conditions, known as community-dwelling older people. METHODS Electronic databases, including PubMed/Medline, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials, were searched to answer this question through August 10, 2023. The study adhered to the PRISMA guidelines and was registered on PROSPERO. The Cochrane risk of bias tool assessed the quality of randomized controlled trials (RCTs). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the certainty of evidence. In total, 12 RCTs (n = 1320) were initially included. RESULTS ONS had a positive effect on body weight (weighted mean difference (WMD): 1.33, 95% CI: 0.94, 1.72, P = 0.00) with moderate certainty, BMI (WMD: 0.36, 95% CI: 0.06, 0.68, P = 0.02), calf circumference (WMD: 0.27, 95% CI: 0.08, 0.46, P < 0.001) with low certainty and midarm circumference (WMD: 0.38, 95% CI: -0.14, 0.89, P = < 0.15, I2: 87.2 P < 0.00) with very low certainty. Significant improvements in grip strength (WMD: 1.012, 95% CI: 0.37, 1.65, P < 0.00) and a slightly positive change in gait speed (WMD: 0.04, 95% CI: 0.004.0.083, P = 0.03, I2:0.0, P:0.72) were also observed. CONCLUSION ONS in community-dwelling older persons without complicated conditions can also have beneficial effects in terms of anthropometric and functional parameters.
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Affiliation(s)
- Nazanin Asghari Hanjani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, PO Box: 1416643931, Tehran, Iran
| | - Pishva Arzhang
- Qods Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, PO Box: 1416643931, Tehran, Iran.
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7
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Ganbavale SG, Cai Z, Mathers JC, Papacosta O, Lennon L, Whincup PH, Weyant R, Wannamethee SG, Ramsay SE. Association between poor oral health and deterioration of appetite in older age: results from longitudinal analyses of two prospective cohorts from the UK and USA. BMJ Open 2025; 15:e083973. [PMID: 39900409 PMCID: PMC11795386 DOI: 10.1136/bmjopen-2024-083973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/14/2025] [Indexed: 02/05/2025] Open
Abstract
OBJECTIVE This study investigated the association of poor oral health with appetite loss and deterioration in appetite longitudinally in older adults. DESIGN Cross-sectional and longitudinal observational study. SETTING Data came from two population-based cohorts of older adults from the UK and USA. PARTICIPANTS The British Regional Heart Study (BRHS) included men (n=1348, age=79-87 years in 2016-2017 at baseline and 81-89 years in 2018-2019 at follow-up). The US Health, Aging and Body Composition (HABC) Study included men and women (n=2998, age=71-77 years in 1998-1999 at baseline and 73-79 years in 2000-2001 at follow-up). Objective and self-reported oral health measures were collected. OUTCOME MEASURES Loss of appetite, at baseline and 2-year follow-up, was based on the Simplified Nutrition Assessment Questionnaire in the BRHS and self-reported appetite loss in the HABC Study. In the BRHS, changes in oral health over time were also assessed. Logistic regression models were adjusted for sociodemographic, behavioural and health-related factors. RESULTS Cross-sectionally, poor self-rated oral health, dry mouth, eating or chewing difficulty, food avoidance and cumulative oral health problems were associated with appetite loss in both studies. Longitudinally, in the BRHS, dry mouth (OR=2.12 (95% CI=1.40 to 3.20)), eating or chewing difficulty (OR=1.59 (95% CI=1.02 to 2.48)), food avoidance (OR=1.75 (95% CI=1.16 to 2.65)) and cumulative oral health problems (OR=2.84 (95% CI=1.80 to 4.50)) at baseline were associated with sustained poor/deterioration in appetite over the follow-up, after full adjustment. In the HABC Study, self-rated oral health ((OR=1.13 (95% CI=1.01 to 1.27)), tooth loss (OR=1.78 (95% CI=1.15 to 2.76)), dry mouth (OR=1.76 (95% CI=1.02 to 3.03)), eating or chewing difficulty (OR=1.88 (95% CI=1.41 to 2.50)) and cumulative oral health problems (OR=1.89 (95% CI=1.33 to 2.70)) at baseline were associated with sustained poor/deterioration in appetite during follow-up. In the BRHS, sustained poor/deterioration in oral health markers (self-rated oral health, dry mouth, eating or chewing difficulty, food avoidance, loose denture/s) over the follow-up were associated with sustained poor/deterioration of appetite. CONCLUSION Oral health is a potentially important contributor to maintaining good appetite in older age.
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Affiliation(s)
- Suruchi G Ganbavale
- Newcastle University Population Health Sciences Institute, Newcastle Upon Tyne, UK
- Department of Public Health, Policy and Systems, University of Liverpool Institute of Population Health, Liverpool, UK
| | - Ziyi Cai
- Newcastle University Population Health Sciences Institute, Newcastle Upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Robert Weyant
- Dental Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Rudzińska A, Pac A, Gryglewska B, Perera I, Gąsowski J, Piotrowicz K. A novel appetite loss in older adults with and without cognitive impairment (ALOC) screening scale. Appetite 2025; 204:107758. [PMID: 39500464 DOI: 10.1016/j.appet.2024.107758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 10/31/2024] [Accepted: 11/02/2024] [Indexed: 11/10/2024]
Abstract
Appetite is a strong determinant of nutritional status. As cognitive impairment is usually linked to alterations in eating behaviour, people with dementia might experience changes in appetite with the loss of ability to express their needs, including dietary choices and preferences. The aim of the study was to develop an appetite loss screening tool for older adults, inclusive for those with mild to moderate cognitive impairment. The study questionnaire, consisting of 44 binary items related to appetite, was employed among 127 hospitalized older patients (55.9% women, mean age 79.4 ± 7.1 years) with and without cognitive impairment (31.5% categorized as suspected mild dementia, 26.0% as suspected moderate dementia). An exploratory factor analysis was performed to identify items that constitute the final scale, with a Cronbach's alpha coefficient of 0.81. The final tool consists of seven questions, with a sensitivity of 80% and specificity of 80.6%, using the Council on Nutrition Appetite Questionnaire score as reference. Acceptability post-test was performed in 20 patients (70% women, mean age 79.6 ± 5.3 years) to test the clinical feasibility of the scale. The customized design of the scale, according to the recommendation for written materials for individuals with dementia, empowers older adults, supports diagnosis and encourages their proactivity in the treatment process. The scale was found to perform similarly in older persons with and without cognitive impairment, which renders it a versatile assessment tool.
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Affiliation(s)
- Anna Rudzińska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30- 688, Kraków, Poland; Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Pac
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30- 688, Kraków, Poland
| | - Ian Perera
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30- 688, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30- 688, Kraków, Poland
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30- 688, Kraków, Poland.
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Dagbasi A, Fuller A, Hanyaloglu AC, Carroll B, McLaughlin J, Frost G, Holliday A. The role of nutrient sensing dysregulation in anorexia of ageing: The little we know and the much we don't. Appetite 2024; 203:107718. [PMID: 39423861 DOI: 10.1016/j.appet.2024.107718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/01/2024] [Accepted: 10/15/2024] [Indexed: 10/21/2024]
Abstract
The age-related decline in appetite and food intake - termed "anorexia of ageing" - is implicated in undernutrition in later life and hence provides a public health challenge for our ageing population. Eating behaviour is controlled, in part, by homeostatic mechanisms which sense nutrient status and provide feedback to appetite control regions of the brain. Such feedback signals, propagated by episodic gut hormones, are dysregulated in some older adults. The secretory responses of appetite-related gut hormones to feeding are amplified, inducing a more anorexigenic signal which is associated with reduced appetite and food intake. Such an augmented response would indicate an increase in gut sensitivity to nutrients. Consequently, this review explores the role of gastrointestinal tract nutrient sensing in age-related appetite dysregulation. We review and synthesise evidence for age-related alterations in nutrient sensing which may explain the observed hormonal dysregulation. Drawing on what is known regarding elements of nutrient sensing pathways in animal models, in other tissues of the body, and in certain models of disease, we identify potential causal mechanisms including alterations in enteroendocrine cell number and distribution, dysregulation of cell signalling pathways, and changes in the gut milieu. From identified gaps in evidence, we highlight interesting and important avenues for future research.
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Affiliation(s)
- Aygul Dagbasi
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, 6th Floor Commonwealth Building, Hammersmith Hospital, London, W12 0NN, UK
| | - Amy Fuller
- Research Centre for Health and Life Sciences, Institute of Health and Wellbeing, Faculty of Health and Life Science, Coventry University, Coventry, CV1 5FB, UK
| | - Aylin C Hanyaloglu
- Institute of Reproductive and Developmental Biology (IRDB), Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Bernadette Carroll
- School of Biochemistry, University of Bristol, University Walk, Bristol, BS1 8TD, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, M13 9PT, UK
| | - Gary Frost
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, 6th Floor Commonwealth Building, Hammersmith Hospital, London, W12 0NN, UK
| | - Adrian Holliday
- School of Biomedical, Nutritional, and Sport Science, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK; Human Nutrition and Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK.
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10
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Yamaga R, Chikaishi M, Iwasaki T, Tada A, Mizutani S, Amano K, Iwase Y, Taniguchi H. Pilot study on the relationship between oral function or subjective symptoms and appetite. J Oral Rehabil 2024; 51:2261-2269. [PMID: 39054906 DOI: 10.1111/joor.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This pilot study evaluated the relationships between appetite and oral function, and between appetite and the subjective symptoms of decreased oral function. METHODS Seventy-one adult dental clinic patients (22 males, 66.0 ± 14.0 years) participated in this study. A Council on Nutrition Appetite Questionnaire score of ≤28 indicated anorexia, and the Mini Nutritional Assessment Short-form, body mass index and skeletal muscle mass index were used to define subject characteristics. Seven oral function tests and seven subjective symptoms related to oral function were evaluated. The relationship between subject characteristics, oral function tests, subjective symptoms and anorexia was analysed using the chi-square test and univariate and multivariate logistic regression. RESULT There were significant differences between the normal appetite group and the anorexia group for the 10-item Eating Assessment Tool (EAT-10) survey and the question 'Food remains in the oral cavity after eating' (p < .05). Univariate logistic regression found significant differences in the items of masticatory function, the EAT-10 survey and the question 'Food remains in the oral cavity after eating'. Multivariate logistic regression revealed significant differences in masticatory function (AOR 4.35; 95% CI: 1.03-18.35; p = .045) and EAT-10 (AOR 6.27; 95% CI: 1.40-24.02; p = .016). CONCLUSION This pilot study investigated the influence of factors related to oral function on appetite. Relationships were found among poor masticatory function, poor swallowing function and anorexia.
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Affiliation(s)
- Ryosuke Yamaga
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Yamaga Dental Clinic, Kuwana, Japan
| | - Masato Chikaishi
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry and Oral-Maxillofacial Surgery, Chikaishi Hospital, Medical Corporation Touhoukai, Gifu, Japan
| | - Toshihiro Iwasaki
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Akira Tada
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Oral Surgery, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Saki Mizutani
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Kota Amano
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Yoko Iwase
- Department of Dentistry for Persons with Disabilities, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Hiroshige Taniguchi
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
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11
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Qi Y, Schaap LA, Schalet BD, Hoogendijk EO, Deeg DJH, Visser M, Koivunen K, Huisman M, van Schoor NM. The development of intrinsic capacity measures for longitudinal research: The Longitudinal Aging Study Amsterdam. Exp Gerontol 2024; 197:112599. [PMID: 39366460 DOI: 10.1016/j.exger.2024.112599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/13/2024] [Accepted: 09/26/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND The World Health Organization has introduced the construct of intrinsic capacity (IC) as an important component of healthy ageing and overall well-being in older adults The present study aimed to develop domain-specific and composite IC scores and to validate these scores by examining their longitudinal relation with functioning. METHODS We used prospective data on participants aged 57 to over 90 years, with a 10-year follow-up, from the Longitudinal Aging Study Amsterdam, an ongoing cohort study of older Dutch men and women Using a formative, stepwise approach, we identified indicators across the different domains of IC, i.e. vitality, sensory, cognition, psychology, and locomotion, using a combination of unidimensional factor analyses and Partial Least Squares Structural Equation Modelling (PLS-SEM). Next, domain-specific and composite IC scores were generated, and the construct validity (score across age groups) and criterion validity (relationship with change in functional limitations) were assessed. RESULTS The multiple unidimensional factor analyses and PLS-SEM identified a total of 18 indicators, covering the five domains of IC. The mean composite IC score was 70.9 (SD = 0.9) in men and 69.7 (0.8) in women. The domain-specific and composite IC scores all showed good construct validity, with known-group validation results indicating age-related declines. A higher composite IC score was associated with less functional limitations over time (B = 0.20, 95%CI [0.19, 0.22]). CONCLUSION The developed domain-specific IC scores and the composite IC score effectively discriminated age-related declines in IC. Additionally, the composite IC score was longitudinally associated with functional limitations. By creating this comprehensive and reliable tool for tracking IC, we aim to provide valuable insights into the dynamics of ageing and support more effective strategies for promoting health and well-being throughout later life. These scores establish a foundation for future research to track longitudinal changes across various IC domains and relate these changes to key age-related outcomes.
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Affiliation(s)
- Yuwei Qi
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, the Netherlands.
| | - Laura A Schaap
- Aging and Later Life, Amsterdam Public Health Research Institute, the Netherlands; Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Benjamin D Schalet
- Amsterdam University Medical Centers, Department of Epidemiology and Data Science, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, the Netherlands; Aging and Later Life, Amsterdam Public Health Research Institute, the Netherlands; Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, the Netherlands
| | - Dorly J H Deeg
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, the Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Kaisa Koivunen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Martijn Huisman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, the Netherlands; Aging and Later Life, Amsterdam Public Health Research Institute, the Netherlands; Department of Sociology, Vrije Universiteit Amsterdam, the Netherlands
| | - Natasja M van Schoor
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, the Netherlands; Aging and Later Life, Amsterdam Public Health Research Institute, the Netherlands
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12
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Dagbasi A, Warner J, Catterall V, Smith K, Crabtree DR, Carroll B, Frost G, Holliday A. Augmented gut hormone response to feeding in older adults exhibiting low appetite. Appetite 2024; 201:107415. [PMID: 38761969 DOI: 10.1016/j.appet.2024.107415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/25/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
Age-related changes in gut hormones may play a role in anorexia of ageing. The aim of this study was to determine concentrations of ghrelin, PYY, and GLP-1 in older adults exhibiting an anorexia of ageing phenotype. Thirteen older adults with healthy appetite (OA-HA; 8f, 75 ± 7 years, 26.0 ± 3.2 kg m-2), fifteen older adults with low appetite (OA-LA; 10f, 72 ± 7 years, 23.6 ± 3.1 kg m-2), and twelve young adults (YA; 6f, 22 ± 2 years, 24.4 ± 2.0 kg m-2) completed the study. Healthy appetite and low appetite were determined based on BMI, habitual energy intake, self-reported appetite, and laboratory-assessed ad libitum lunch intake. Participants provided a fasted measure of subjective appetite and blood sample (0 min) before consuming a standardised breakfast (450 kcal). Appetite was measured and blood samples were drawn throughout a 240-min rest period. At 240 min, an ad libitum lunch meal was consumed. Relative intake at lunch (expressed as percentage of estimated total energy requirement) was lower for OA-LA (19.8 ± 7.7%) than YA (41.5 ± 9.2%, p < 0.001) and OA-HA (37.3 ± 10.0%, p < 0.001). Ghrelin suppression was greater for OA-LA (net AUC, -78719 ± 74788 pg mL-1·240min-1) than both YA (-23899 ± 27733 pg mL-1·240min-1, p = 0.016) and OA-HA (-21144 ± 31161 pg mL-1·240min-1, p = 0.009). There were trends for higher GLP-1 concentrations in OA-LA compared with YA at 90 min (8.85 ± 10.4 pM vs. 1.88 ± 4.63 pM, p = 0.073) and 180 min (5.00 ± 4.71 pM vs. 1.07 ± 2.83 pM, p = 0.065). There was a trend for a greater PYY response for OA-LA compared with OA-HA (net AUC p = 0.062). "Anorexigenic response score" - a composite score of gut hormone responses to feeding - showed greater anorexigenic response in OA-LA, compared with YA and OA-HA. No differences were seen in subjective appetite. These observations suggest augmented anorexigenic responses of gut hormones to feeding may be causal mechanisms of anorexia of ageing.
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Affiliation(s)
- Aygul Dagbasi
- Section of Nutrition, Imperial College London, 6th Floor Commonwealth Building, Hammersmith Hospital, London, UK
| | - Jordan Warner
- School of Biomedical, Nutritional, and Sport Science, Newcastle University, Newcastle Upon Tyne, UK
| | - Victoria Catterall
- School of Biomedical, Nutritional, and Sport Science, Newcastle University, Newcastle Upon Tyne, UK
| | - Kieran Smith
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| | - Daniel R Crabtree
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Bernadette Carroll
- School of Biochemistry, University of Bristol, University Walk, Bristol, UK
| | - Gary Frost
- Section of Nutrition, Imperial College London, 6th Floor Commonwealth Building, Hammersmith Hospital, London, UK
| | - Adrian Holliday
- School of Biomedical, Nutritional, and Sport Science, Newcastle University, Newcastle Upon Tyne, UK; Human Nutrition and Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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13
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Cui G, Zhang S, Zhang X, Li S. Development and validation of a nomogram for predicting anorexia of aging in older people. Appetite 2024; 201:107606. [PMID: 39029530 DOI: 10.1016/j.appet.2024.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/24/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Anorexia of aging (AA) is a common geriatric syndrome that seriously endangers the health of older adults. Early identification of populations at risk of AAand the implementation of appropriate intervention measures hold significant public health importance. This study aimed to develop a nomogram for predicting the risk of AA among older people. METHODS We conducted a cross-sectional study involving 2144 community-dwelling older adults to evaluate the AA using the Simplified Nutritional Appetite Questionnaire. We utilized the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression analysis to select variables and develop a nomogram prediction model. The predictive performance of the nomogram was evaluated using the Receiver Operating Characteristic (ROC) curves, calibration curves, Decision Curve Analysis (DCA), and internal validation. RESULTS The prevalence of AA among Chinese older adults was 21.7% (95%CI: 20.0%-23.5%). Age, sex, family economic level, smoking status, dysphagia, loneliness, depressive symptoms, living alone, health literacy, life satisfaction, and body mass index have been identified as predictive factors for AA among older people. The nomogram constructed based on these predictive factors showed an area under the curve (AUC) of 0.766 (95%CI: 0.742-0.791), indicating good calibration and discrimination ability. Additionally, the results obtained from the 10-fold cross-validation process confirmed the nomogram's good predictive capabilities. Furthermore, the DCA results showed that the nomogram has clinical utility. CONCLUSION The nomogram constructed in this study serves as an effective tool for predicting anorexia of aging among community-dwelling older adults. Its implementation can help community healthcare workers evaluate the risk of AA in this population and identify high-risk groups.
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Affiliation(s)
- Guanghui Cui
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital, Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Shengkai Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Xiaochen Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Shaojie Li
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China.
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14
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Horner KM, Mullen B, Quinn A, Scheufele P, Gola S, Gonnelli F, Bozzato M, Pratt J, Sala W, Mullin S, Kirwan L, Dardevet D, Guillet C, De Vito G, Visser M, Volkert D, Corish CA. Plant protein, fibre and physical activity solutions to address poor appetite and prevent undernutrition in older adults: study protocol for the APPETITE randomised controlled trial. Br J Nutr 2024; 132:823-834. [PMID: 39387205 PMCID: PMC11557289 DOI: 10.1017/s0007114524002125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/20/2024] [Accepted: 09/04/2024] [Indexed: 10/15/2024]
Abstract
Reduced appetite with ageing is a key factor that may increase risk of undernutrition. The objective of this study is to determine the impact of innovative plant protein fibre (PPF) products within a personalised optimised diet (PD), a physical activity (PA) programme, and their combination on appetite, and other nutritional, functional and clinical outcomes in community-dwelling older adults in a multi-country randomised controlled intervention trial. One hundred and eighty community-dwelling adults (approximately sixty per trial centre in Germany, Ireland and Italy) aged 65 years and over will be recruited to participate in a 12-week, parallel-group, controlled trial. Participants will be randomised into one of four groups: 1, PD (incorporating two PPF products): 2, PA; 3, PD + PA; and 4, no intervention (control). The primary outcome is appetite measured by visual analogue scales and energy intake from an ad libitum test meal. Secondary outcomes include fasting and postprandial appetite-related gut hormones, Simplified Nutritional Appetite Questionnaire score, body composition, cardiorespiratory fitness, muscle strength, physical function and PA. In addition, self-efficacy, cognitive status, dietary restraint, depressive symptoms and compliance and acceptability of the intervention will be assessed. Metabolomic profiles, RMR, muscle motor unit properties and gut microbiome will also be assessed to explore potential underlying mechanisms. This multi-centre randomised controlled trial will advance knowledge on how PD (incorporating PPF products), PA and their combination influence appetite, nutritional status and related health outcomes in community-dwelling older adults and contribute to the prevention of undernutrition. Trial registration: Clinical Trials.gov Registry NCT05608707 (registered on 2 November 2022). Protocol Version: NCT05608707 Version 4 (registered on 29 September 2023).
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Affiliation(s)
- Katy M. Horner
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Republic of Ireland
- Institute for Food and Health, University College Dublin, Dublin 4, Republic of Ireland
- Institute for Sport and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Brian Mullen
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Republic of Ireland
- Institute for Food and Health, University College Dublin, Dublin 4, Republic of Ireland
- Institute for Sport and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Anna Quinn
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Republic of Ireland
- Institute for Food and Health, University College Dublin, Dublin 4, Republic of Ireland
- Institute for Sport and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Pia Scheufele
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Susanne Gola
- Fraunhofer Institute for Process Engineering and Packaging, Freising, Germany
| | - Federica Gonnelli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Matteo Bozzato
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Jedd Pratt
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Wiktoria Sala
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Sinead Mullin
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Laura Kirwan
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Republic of Ireland
| | | | | | - Giuseppe De Vito
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Clare A. Corish
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Republic of Ireland
- Institute for Food and Health, University College Dublin, Dublin 4, Republic of Ireland
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15
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Kujawowicz K, Mirończuk-Chodakowska I, Cyuńczyk M, Witkowska AM. Identifying Malnutrition Risk in the Elderly: A Single- and Multi-Parameter Approach. Nutrients 2024; 16:2537. [PMID: 39125416 PMCID: PMC11314023 DOI: 10.3390/nu16152537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Malnutrition is a significant concern affecting the elderly, necessitating a complex assessment. This study aims to deepen the understanding of factors associated with the assessment of malnutrition in the elderly by comparing single- and multi-parameter approaches. In this cross-sectional study, 154 individuals underwent a comprehensive geriatric assessment (CGA). Malnutrition risk was determined using the mini nutritional assessment (MNA). Additional factors assessed included sarcopenia, polypharmacy, depression, appetite, handgrip strength, and gait speed. Phase angle (PA) and body composition were measured using bioelectrical impedance analysis (BIA). The MNA identified a malnutrition risk in 36.8% of individuals. The geriatric depression scale (GDS) and PA demonstrated moderate effectiveness in assessing malnutrition risk, with AUC values of 0.69 (95% CI: 0.60-0.78) and 0.62 (95% CI: 0.54-0.72), respectively. A logistic regression model incorporating handgrip strength, skeletal muscle mass, sarcopenia, osteoporosis, depression, specific antidepressant use, mobility, appetite, and smoking achieved superior performance in predicting malnutrition risk, with an AUC of 0.84 (95% CI: 0.77-0.91). In conclusion, this study demonstrates that integrating multiple parameters into a composite model provides a more accurate and comprehensive assessment of malnutrition risk in elderly adults.
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Affiliation(s)
- Karolina Kujawowicz
- Department of Food Biotechnology, Medical University of Białystok, 15-089 Białystok, Poland; (I.M.-C.); (M.C.); (A.M.W.)
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16
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Ceolin C, De Rui M, Ravelli A, Papa MV, Devita M, Sergi G, Coin A. The potential of cannabinoids in managing cancer-related anorexia in older adults: a systematic review of the literature. J Nutr Health Aging 2024; 28:100299. [PMID: 38917597 DOI: 10.1016/j.jnha.2024.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Anorexia of aging (AoA) is a prevalent geriatric syndrome characterized by a multifactorial decline in appetite and reduced food intake associated with the aging process. This systematic review aims to investigate the use and outcomes of cannabinoids in addressing AoA, with the goal of providing a comprehensive understanding and discussing their potential integration into daily clinical practice. METHODS A thorough search of databases (Embase Ovid, Scopus, PubMed, Cochrane Library, and Web of Science) identified 6100 studies. After eliminating duplicates and screening titles and abstracts, 25 studies underwent full appraisal. Two reviewers assessed inclusion suitability, and study methodologies were evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies and the modified Jadad Scoring Scale for randomized controlled trials. Ultimately, six studies published between 2002 and 2019, involving 869 participants, were included in the review. RESULTS Out of the 6 fin. l papers selected, 5 were randomized trials, and 1 was a prospective study. Megestrol acetate (800 mg/d) proved to be more effective than dronabinol 2.5 mg twice a day in increasing appetite. Nabilone (at a dosage of 0.5 mg per day) did not show superiority over placebo in alleviating symptoms such as pain, nausea, loss of appetite, and weight. However, with a double dosage followed by 1.0 mg/6 weeks, after eight weeks of treatment, patients recorded a significant increase in calorie intake and carbohydrate consumption compared to the placebo group, with some patients also experiencing substantial weight gain. Regarding delta-9-tetrahydrocannabinol (THC), a weight increase of ≥10% was observed in 17.6% of patients with doses of 5 mg or 10 mg capsules daily, without significant side effects. Additionally, patients treated with THC 2.5 mg reported improved chemosensory perception and increased appetite before meals compared to placebo. No significant side effects were reported in older adults taking cannabinoids. CONCLUSIONS Cannabinoids offer promise in enhancing the quality of life for older individuals with active neoplastic disease. However, to establish comprehensive guidelines, further research with larger sample sizes is essential. Only through this approach can we fully grasp the potential and application of cannabinoids in addressing the nutritional concerns associated with neoplastic diseases.
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Affiliation(s)
- Chiara Ceolin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - Marina De Rui
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128 Padova, Italy
| | - Adele Ravelli
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - Mario Virgilio Papa
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - Maria Devita
- Department of General Psychology (DPG), University of Padua, Via Venezia 8, 35131 Padova, Italy.
| | - Giuseppe Sergi
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - Alessandra Coin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128 Padova, Italy.
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17
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Scheufele P, Rappl A, Visser M, Kiesswetter E, Volkert D. Dietary characteristics of community-dwelling older adults with poor appetite: a cross-sectional analysis. Age Ageing 2024; 53:ii4-ii12. [PMID: 38745488 PMCID: PMC11094405 DOI: 10.1093/ageing/afae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Indexed: 05/16/2024] Open
Abstract
RATIONALE Poor appetite is considered a key factor in the development of malnutrition, a link that can be explained by alterations in dietary intake. Given the limited data on dietary characteristics in community-dwelling older adults with poor appetite, the present study aimed to examine whether poor appetite is associated with lower nutrient intake and more unfavourable food choices. METHODS In 569 participants of the Longitudinal Aging Study Amsterdam aged ≥70 years appetite was assessed using the Simplified Nutritional Appetite Questionnaire and dichotomised into normal (>14) and poor (≤14). Intake of energy, 19 nutrients, 15 food groups, the Dutch Healthy Diet Index 2015 (DHD15) and Mediterranean Diet Score (MDS) were calculated from a food frequency questionnaire. Dietary differences between appetite groups were examined using Mann-Whitney U test and binary logistic regression adjusted for potential confounders. RESULTS Mean age was 78 ± 6 years and 52% were female. Appetite was poor in 12.5% of participants. Energy intake was 1951 (median; quartiles 1-3: 1,653-2,384) kcal/day with no difference between appetite groups. Poor appetite was associated with lower intake of protein (OR 0.948, 95%CI 0.922-0.973), folate (0.981, 0.973-0.989), zinc (0.619, 0.454-0.846), vegetables (0.988, 0.982-0.994) and lower scores of DHD15 (0.964, 0.945-0.983) and MDS (0.904, 0.850-0.961), as well as higher intake of carbohydrates (1.015, 1.006-1.023), and vitamins B2 (4.577, 1.650-12.694) and C (1.013, 1.005-1.021). CONCLUSIONS Community-dwelling older adults with poor appetite showed poorer diet quality with a lower intake of protein, folate, zinc and vegetables, compared with those reporting normal appetite and should be advised accordingly.
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Affiliation(s)
- Pia Scheufele
- Institute for Biomedicine of Ageing, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Anja Rappl
- Institute of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marjolein Visser
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Kiesswetter
- Institute for Biomedicine of Ageing, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Ageing, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Marcos-Delgado A, Yévenes-Briones H, Fernández-Villa T, Martín-Sánchez V, Guallar-Castillón P, Rodríguez-Artalejo F, Lopez-Garcia E. Association between diet quality and malnutrition: pooled results from two population-based studies in older adults. BMC Geriatr 2024; 24:417. [PMID: 38730363 PMCID: PMC11088013 DOI: 10.1186/s12877-024-04984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The role of diet quality on malnutrition in older adults is uncertain, due the paucity of the research conducted and the use of use of screening tools that did not consider phenotypic criteria of malnutrition. OBJECTIVE To evaluate the association of two indices of diet quality, namely the Mediterranean Diet Adherence Screener (MEDAS) and the Alternative Healthy Eating Index (AHEI-2010), with malnutrition among community-dwelling older adults in Spain. METHODS Cross-sectional analysis of data from 1921 adults aged ≥ 60 years from the Seniors-ENRICA-1 (SE-1) study, and 2652 adults aged ≥ 65 years from the Seniors-ENRICA-2 (SE-2) study. Habitual food consumption was assessed through a validated diet history. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) phenotypic criteria. Statistical analyses were performed with logistic regression with adjustment for socioeconomic and lifestyle variables as well as for total energy and protein intake. RESULTS The prevalence of malnutrition in the SE-1 study was 9.5% (95% confidence interval: 8.2 to 10.9) and 11.7% (10.5 to 13.9) in the SE-2. Adherence to the MEDAS score was associated with lower prevalence of malnutrition [pooled odds ratio for high (≥ 9 points) vs. low adherence (< 7 points): 0.64 (0.48-0.84); p-trend < 0.001]. Higher adherence to the AHEI-2010 also showed an inverse association with malnutrition (pooled odds ratio for quartile 4 vs. 1: 0.65 (0.49-0.86); p-trend 0.006). Among the individual components, higher consumption of fish and long-chain n-3 fatty acids in MEDAS and AHEI-2010, and of vegetables and nuts and legumes in AHEI-2010, and lower intake of trans-fat and sugar-sweetened beverages and fruit juice in AHEI-2010 were independently associated with lower odds of malnutrition. CONCLUSION Adherence to high diet-quality patterns was associated with lower frequency of malnutrition among older adults. CLINICAL TRIAL REGISTRY ClinicalTrials.gov identifier: NCT02804672. June 17, 2016.; ClinicalTrials.gov NCT03541135. May 30, 2018.
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Affiliation(s)
- Alba Marcos-Delgado
- Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain
- The Research Group in Gene-Environment and Health Interactions, Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
| | - Humberto Yévenes-Briones
- School of Medicine, Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo 2, Madrid, 28029, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Tania Fernández-Villa
- Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain
- The Research Group in Gene-Environment and Health Interactions, Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Vicente Martín-Sánchez
- Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain
- The Research Group in Gene-Environment and Health Interactions, Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pilar Guallar-Castillón
- School of Medicine, Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo 2, Madrid, 28029, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- School of Medicine, Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo 2, Madrid, 28029, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- School of Medicine, Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo 2, Madrid, 28029, Spain.
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain.
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Holliday A, Warner J, Hulston CJ, Corfe BM, Crabtree DR. Anorexia of ageing is associated with elevated fasted and lower post-prandial ghrelin, independent of ghrelin O-acyltransferase. Appetite 2024; 196:107259. [PMID: 38341037 DOI: 10.1016/j.appet.2024.107259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
The role of ghrelin metabolism in anorexia of ageing is unclear. The aim of this study was to determine acyl-ghrelin, total ghrelin, and ghrelin O-acyltransferase concentrations when fasted and in responses to feeding in older adults exhibiting anorexia of ageing. Twenty-five older adults (OA; 15f, 74 ± 7 years, 24.5 kg·m-2) and twelve younger adults (YA; 6f, 21 ± 2 years, 24.4 kg·m-2) provided a fasted measure of subjective appetite and fasted blood sample (0 min) before consuming a standardised porridge breakfast meal (450 kcal). Appetite was measured every 30 min for 240 min and blood was sampled at 30, 60, 90, 120, 180 and 240 min while participants rested. At 240 min, an ad libitum pasta-based lunch meal was consumed. Older adults were identified as those with healthy appetite (HA-OA) or low appetite (LA-OA), based on habitual energy intake, self-report appetite, BMI, and ad libitum lunch intake. YA ate more at lunch (1108 ± 235 kcal) than HA-OA (653 ± 133 kcal, p = 0.007) and LA-OA (369 ± 168 kcal; p < 0.001). LA-OA, but not HA-OA, had higher fasted concentrations of acyl- and total ghrelin than YA (acyl-ghrelin: 621 ± 307 pg·mL-1 vs. 353 ± 166 pg·mL-1, p = 0.047; total ghrelin: 1333 ± 702 pg·mL-1 vs. 636 ± 251 pg·mL-1, p = 0.006). Acyl-ghrelin (60 min and 90 min) and total ghrelin (90 min) were suppressed to a greater extent for LA-OA than for YA (p < 0.05). No differences were observed in subjective appetite, acyl-to-total ghrelin ratio, or plasma GOAT content (p > 0.1). Higher fasting ghrelin and an augmented ghrelin response to feeding in LA-OA, but not HA-OA, suggests that alterations to ghrelin metabolism are not functions of ageing per se and may be independent causal mechanisms of anorexia of ageing.
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Affiliation(s)
- Adrian Holliday
- School of Biomedical, Nutritional, and Sport Science, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Human Nutrition and Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Jordan Warner
- School of Biomedical, Nutritional, and Sport Science, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Carl J Hulston
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Bernard M Corfe
- Human Nutrition and Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Daniel R Crabtree
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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20
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Cox NJ. Consequences of Anorexia of Aging in Hospital Settings: An Updated Review. Clin Interv Aging 2024; 19:451-457. [PMID: 38496748 PMCID: PMC10941985 DOI: 10.2147/cia.s431547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
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21
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Wilson N, Mullaney W. Frailty and nutrition. Br J Community Nurs 2024; 29:118-123. [PMID: 38421891 DOI: 10.12968/bjcn.2024.29.3.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
As the ageing population grows and forms a significant category of over 65s in many societies, along with it comes the risk of developing physical and psychological degenerative changes. This presents many challenges for health and social care services in not only identifying those at risk but also managing that risk to try to preserve health and independence for as long as possible. Screening for frailty has supported services to identify those that may be at risk of hospitalisation, requiring long term care or support services at home in older age. Frailty can be exacerbated by the risk of nutritional deficiencies and more severe malnutrition. Therefore, screening for frailty should also include a nutritional assessment, which can be supported by a recognition of the need for nutritional support along with other holistic frailty management.
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Affiliation(s)
- Neil Wilson
- Senior Lecturer in Nursing, Manchester Metropolitan University
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22
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Ispoglou T, McCullough D, Windle A, Nair S, Cox N, White H, Burke D, Kanatas A, Prokopidis K. Addressing cancer anorexia-cachexia in older patients: Potential therapeutic strategies and molecular pathways. Clin Nutr 2024; 43:552-566. [PMID: 38237369 DOI: 10.1016/j.clnu.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
Cancer cachexia (CC) syndrome, a feature of cancer-associated muscle wasting, is particularly pronounced in older patients, and is characterised by decreased energy intake and upregulated skeletal muscle catabolic pathways. To address CC, appetite stimulants, anabolic drugs, cytokine mediators, essential amino acid supplementation, nutritional counselling, cognitive behavioural therapy, and enteral nutrition have been utilised. However, pharmacological treatments that have also shown promising results, such as megestrol acetate, anamorelin, thalidomide, and delta-9-tetrahydrocannabinol, have been associated with gastrointestinal and cardiovascular complications. Emerging evidence on the efficacy of probiotics in modulating gut microbiota also presents a promising adjunct to traditional therapies, potentially enhancing nutritional absorption and systemic inflammation control. Additionally, low-dose olanzapine has demonstrated improved appetite and weight management in older patients undergoing chemotherapy, offering a potential refinement to current therapeutic approaches. This review aims to elucidate the molecular mechanisms underpinning CC, with a particular focus on the role of anorexia in exacerbating muscle wasting, and to propose pharmacological and non-pharmacological strategies to mitigate this syndrome, particularly emphasising the needs of an older demographic. Future research targeting CC should focus on refining appetite-stimulating drugs with fewer side-effects, specifically catering to the needs of older patients, and investigating nutritional factors that can either enhance appetite or minimise suppression of appetite in individuals with CC, especially within this vulnerable group.
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Affiliation(s)
| | | | - Angela Windle
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; School of Medicine, University of Leeds, Leeds, UK
| | | | - Natalie Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen White
- School of Health, Leeds Beckett University, Leeds, UK
| | - Dermot Burke
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Konstantinos Prokopidis
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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Visser M, Sealy MJ, Leistra E, Naumann E, De van der Schueren MAE, Jager-Wittenaar H. The Malnutrition Awareness Scale for community-dwelling older adults: Development and psychometric properties. Clin Nutr 2024; 43:446-452. [PMID: 38181522 DOI: 10.1016/j.clnu.2023.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND & AIMS Qualitative studies suggest that malnutrition awareness is poor in older adults. The aim of this study was to develop a questionnaire to quantitatively assess malnutrition awareness in community-dwelling older adults aged 60+ years. METHODS The Malnutrition Awareness Scale (MAS) was developed based on the awareness phase of the Integrated-Change model, and included four domains: knowledge, perceived cues, risk perceptions, and cognizance. Twenty-six scale items were developed using results from mainly qualitative research and the expertise of the authors. Items were piloted in 10 Dutch older adults using the Thinking Aloud method to optimize wording. In a feasibility study, annoyance, difficulty and time to complete the MAS and its comprehensibility were tested. After final revisions, the MAS was applied to a large sample to test its psychometric properties (i.e., inter-item correlations, Cronbach's alpha, score distribution) and relevance of the items was rated on a 5-point scale by 12 experts to determine content validity. RESULTS The feasibility study (n = 42, 55 % women, 19 % 80+ y) showed that the MAS took 12 ± 6 min to complete. Most participants found it not (at all) annoying (81 %) and not (at all) difficult (79 %) to complete the MAS, and found it (very) comprehensible (83 %). Psychometric analyses (n = 216, 63 % women, 28 % 80+ y) showed no redundant items, but two items correlated negatively with other items, and one correlated very low. After removal, the final MAS consists of 23 items with a min-max scoring range from 0 to 22 (with higher scores indicating higher awareness) and an overall Cronbach's alpha of 0.67. The mean MAS score in our sample (n = 216) was 14.8 ± 3.2. The lowest obtained score was 6 (n = 3) and the highest 22 (n = 1), indicating no floor or ceiling effects. Based on the relevance rating, the overall median across all 22 items was 4.0 with IQR 4.0-5.0. CONCLUSION The Malnutrition Awareness Scale is a novel, feasible and reliable tool with good content validity to quantitively assess malnutrition awareness in community-dwelling older adults. The scale is now ready to identify groups with poor malnutrition awareness, as a basis to start interventions to increase malnutrition knowledge and awareness.
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Affiliation(s)
- M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - M J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands.
| | - E Leistra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - E Naumann
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Dutch Malnutrition Center of Expertise, The Netherlands.
| | - M A E De van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
| | - H Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; Department of Gastroenterology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Unit Experimental Anatomy, Faculty of Physical Education and Physiotherapy, Department of Physiotherapy and Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
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24
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Dismore L, Sayer A, Robinson S. Exploring the experience of appetite loss in older age: insights from a qualitative study. BMC Geriatr 2024; 24:117. [PMID: 38297212 PMCID: PMC10829396 DOI: 10.1186/s12877-024-04732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Poor appetite is common in older age, with estimated prevalence figures ranging between 15-30% in community-dwelling populations. Despite known links between poor appetite and adverse health outcomes, appetite is not routinely assessed and the causes and impact of appetite loss in older age are not well understood. This study aimed to improve understanding of the influences on, and experiences of, appetite loss among older people who have poor appetite and to consider the implications for prevention and treatment strategies. METHODS Thirteen older adults aged 60-93 years (9 women) identified as having poor appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) scores < 14; ranging from 8-11) took part in semi-structured interviews. Open-ended questions focused on influences on and experiences of appetite and appetite loss in older age. Interviews were transcribed; reflective thematic analysis was conducted using an inductive approach. RESULTS The analysis generated three themes: 1) a complex web of influences on appetite loss, that include biological, psychological, and social factors; 2) living with poor appetite-variation in perceptions of poor appetite and attitudes to appetite loss; 3) living with poor appetite-the role and importance of the eating environment and social interactions. The themes highlight marked differences in individual 'journeys' to poor appetite, with variation in the balance and role of specific causal influences, that impact on the experience of appetite loss and on coping strategies. CONCLUSIONS A broad range of influences (including biological, psychological and social factors) and experiences of appetite loss in older age were described. Future research should consider person-centred approaches, that take account of individual narratives of appetite loss, in the design of effective strategies to support older adults.
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Affiliation(s)
- Lorelle Dismore
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Research and Development, North Tyneside General Hospital, North Shields, UK
| | - Avan Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK.
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25
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Yamamoto M, Nozoe M, Ikeji R, Seike H, Yoshida Y, Shomoto K. Anorexia assessment using the Simplified Nutritional Appetite Questionnaire and its association with activities of daily living in patients with stroke. Nutrition 2024; 117:112238. [PMID: 37924625 DOI: 10.1016/j.nut.2023.112238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire. METHODS This cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment - Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes. RESULTS Among the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13-16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R2 = 0.662). CONCLUSIONS This study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.
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Affiliation(s)
- Miho Yamamoto
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan; Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Rio Ikeji
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Haruka Seike
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Yosuke Yoshida
- Department of Rehabilitation, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Koji Shomoto
- Graduate School of Health Sciences, Kio University, Nara, Japan
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26
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Kerlikowsky F, Schuchardt JP, Hahn A. Folate, vitamin B12 and vitamin D status in healthy and active home-dwelling people over 70 years. BMC Geriatr 2023; 23:673. [PMID: 37853337 PMCID: PMC10585793 DOI: 10.1186/s12877-023-04391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Ageing is characterised by physiological changes that can affect the nutrient availability and requirements. In particular, the status of vitamin D, cobalamin and folate has often been found to be critical in older people living in residential care. However, there is a lack of studies investigating the status of these nutrients in healthy and active home-dwelling elderly people. METHODS The aim of this cross-sectional study was to assess the status of vitamin D based on serum concentrations of 25-hydroxycholecalciferol [25-(OH)D], cobalamin based on serum concentrations of holotranscobalamin (holoTC) and folate based on red blood cell (RBC) folate in unsupplemented, healthy and active German home-dwelling subjects ≥ 70 years of age (n = 134, mean ± SD: 75.8 ± 4.5 years). Dietary intake was assessed by 3-day food recalls. The study was conducted between March and November of 2021 (during the COVID-19 pandemic). RESULTS The mean 25-(OH)D concentration was high at 85.1 ± 26.0 nmol/L, while the majority of women (92%) and men (94%) had 25-(OH)D concentrations ≥ 50 nmol/L. Less than 10% of men and women had 25-(OH)D concentrations < 50 nmol/L. The mean holoTC concentration was 88.9 ± 33.7 pmol/L (94.8 ± 34.6 pmol/L in women and 73.6 ± 25.6 in men). Only 8% of the women were cobalamin deficient (< 50 pmol/L holoTC) compared to 22% of the men. The mean RBC folate concentration was 831 ± 244 nmol/L, while the prevalence of folate deficiency was 10%. Linear regression analysis showed that only folate equivalent intake was associated with the relevant nutrient status marker. CONCLUSION Our findings suggest that healthy, independently living older people with high levels of education, physical activity, and health awareness are not necessarily at higher risk of vitamin D, folate and cobalamin deficiency. Further studies are needed to verify these findings and to identify lifestyle and dietary patterns that can predict adequate nutrient status for healthy ageing. TRIAL REGISTRATION This study is officially recorded in the German Clinical Trials Register (DRKS00021302).
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Affiliation(s)
- Felix Kerlikowsky
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Jan Philipp Schuchardt
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany.
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Göçer K, Öztürk B. Role of Malnutrition in Atrial Fibrillation: A Prospective Study including Individuals ≥ 75 Years of Age. Nutrients 2023; 15:4195. [PMID: 37836479 PMCID: PMC10574320 DOI: 10.3390/nu15194195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common rhythm disorder in the elderly. The AF can cause life-threatening thromboembolic complications. Therefore, there is a need to determine the risk factors of AF. In this study, we aimed to examine the association of markers of malnutrition with AF in individuals aged 75 years and older and to find the factors that may affect mortality. METHODS In this prospective study, 358 consecutive individuals aged 75 years and older presenting to the cardiology outpatient clinic were included. All participants were divided into AF and sinus rhythm (SR) groups. In addition, a questionnaire and scoring system were used to assess malnutrition status. Information was obtained from all patients through outpatient clinic visits or telephone interviews for one year. Death from any cause was considered as the endpoint. RESULTS AF was observed in 71 (19.8%) patients. Death was higher in patients with AF (p < 0.001), high CONUT score (p = 0.018), and GLIM malnutrition (p = 0.018). GLIM malnutrition caused a 2.8-fold increase in the development of AF. CONCLUSIONS Screening for malnutrition in the elderly is essential. According to GLIM criteria, malnutrition may play a role in the development of AF and increase one-year mortality in the elderly.
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Affiliation(s)
- Kemal Göçer
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras 46050, Türkiye
| | - Bayram Öztürk
- Department of Cardiology, Medical Park Goztepe Hospital, Istanbul 34730, Türkiye
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28
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Rudzińska A, Piotrowicz K, Perera I, Gryglewska B, Gąsowski J. Poor Appetite in Frail Older Persons-A Systematic Review. Nutrients 2023; 15:2966. [PMID: 37447292 DOI: 10.3390/nu15132966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Anorexia of aging is a common problem in older adults. Depending on the setting, its prevalence varies from about 10% (among community-dwelling older adults) to over 30% in acute wards and nursing homes. The objective of this systematic review was to establish the prevalence of poor appetite in frail persons ≥60 years of age. We performed a literature search for studies where the prevalence of anorexia of aging among frail and pre-frail old adults was reported. 957 articles on this topic were identified. After eligibility assessment, three articles were included in the review. The studies included 4657 community-dwelling older adults. The weighted total prevalence of anorexia of aging in all the included studies was 11.3%. Among frail and pre-frail participants, loss of appetite was reported in 20.5% (weighted estimate). Overall, robust status was associated with a 63% lower probability of concomitant anorexia of ageing (OR 0.37, 95%CI 0.21-0.65, p = 0.0005). Frailty or risk of frailty are associated with more prevalent anorexia of ageing. This has potential practical implications; however, more research, especially to elucidate the direction of the relation, is needed.
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Affiliation(s)
- Anna Rudzińska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Ian Perera
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
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Dietary diversity predicts the mortality among older people: Data from the fifth Thai national health examination survey. Arch Gerontol Geriatr 2023; 110:104986. [PMID: 36913881 DOI: 10.1016/j.archger.2023.104986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine the association between dietary diversity (DD) and mortality among Thai older people and to investigate whether age, sex, and nutritional status modify this association. METHODS The national survey conducted from 2013 to 2015 recruited 5631 people aged >60 years. Dietary diversity score (DDS) was assessed for the consumption of eight food groups using food frequency questionnaires. The Vital Statistics System provided the data on mortality in 2021. The association between DDS and mortality was analyzed by Cox proportional hazard model and adjusted for the complex survey design. Interaction terms between DDS and age, sex, and BMI were also tested. RESULTS The DDS was inversely associated with mortality (HRadj 0.98, 95%CI: 0.96-1.00). This association was stronger in people aged >70 years (HRadj 0.93, 95%CI: 0.90-0.96 for aged 70-79 years, and HRadj 0.92, 95%CI: 0.88-0.95 for aged >80 years). Inverse association between DDS and mortality was also found in the underweight older population (HRadj 0.95, 95%CI: 0.90-0.99). A positive association was found between DDS and mortality in the overweight/obese group (HRadj 1.03, 95%CI: 1.00-1.05). However, the interaction between the DDS with sex to mortality was not statistically significant. CONCLUSION Increasing DD reduces mortality among Thai older people, especially in those above 70, and underweight. In contrast, an increase in DD also meant an increase in mortality among the overweight/obese group. Focus should be placed on the nutritional interventions aimed to improve DD for those 70 and over and underweight to reduce mortality.
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Characterisation of community-dwelling older adults with poor appetite. Eur J Nutr 2023:10.1007/s00394-023-03129-5. [PMID: 36869911 DOI: 10.1007/s00394-023-03129-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE A poor appetite affects up to 27% of community-dwelling older adults in Europe and is an early predictor of malnutrition. Little is known about the factors associated with poor appetite. The present study, therefore, aims to characterise older adults with poor appetite. METHODS As part of the European JPI project APPETITE, data from 850 participants, aged ≥ 70 years of the Longitudinal Ageing Study Amsterdam (LASA) from 2015/16 were analysed. Appetite during the last week was assessed with a five-point scale and dichotomised into "normal" and "poor". Binary logistic regression was used to examine associations between 25 characteristics from 5 domains-physiological, emotional, cognitive, social, and lifestyle-and appetite. First, domain-specific models were calculated using stepwise backward selection. Second, all variables contributing to poor appetite were combined in a multi-domain model. RESULTS The prevalence of self-reported poor appetite was 15.6%. Fourteen parameters from all five single-domain models contributed to poor appetite and were entered into the multi-domain model. Here, female sex (total prevalence: 56.1%, odds ratio: 1.95 [95% confidence interval 1.10-3.44]), self-reported chewing problems (2.4%, 5.69 [1.88-17.20]), any unintended weight loss in the last 6 months (6.7%, 3.07 [1.36-6.94]), polypharmacy defined as ≥ 5 medications in the past 2 weeks (38.4%, 1.87 [1.04-3.39]), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale without appetite item) (1.12 [1.04-1.21]) were associated with an increased likelihood of having poor appetite. CONCLUSION According to this analysis, older people with the characteristics described above are more likely to have a poor appetite.
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Fielding RA, Landi F, Smoyer KE, Tarasenko L, Groarke J. Association of anorexia/appetite loss with malnutrition and mortality in older populations: A systematic literature review. J Cachexia Sarcopenia Muscle 2023; 14:706-729. [PMID: 36807868 PMCID: PMC10067499 DOI: 10.1002/jcsm.13186] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 02/22/2023] Open
Abstract
Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may reflect deficient understanding of clinical sequelae. Therefore, we performed a systematic literature review to assess the morbidity and mortality burden of anorexia/appetite loss in older populations. Following PRISMA guidelines, searches were run (1 January 2011 to 31 July 2021) in PubMed, Embase® and Cochrane databases to identify English language studies of adults aged ≥ 65 years with anorexia/appetite loss. Two independent reviewers screened titles, abstracts and full text of identified records against pre-defined inclusion/exclusion criteria. Population demographics were extracted alongside risk of malnutrition, mortality and other outcomes of interest. Of 146 studies that underwent full-text review, 58 met eligibility criteria. Most studies were from Europe (n = 34; 58.6%) or Asia (n = 16; 27.6%), with few (n = 3; 5.2%) from the United States. Most were conducted in a community setting (n = 35; 60.3%), 12 (20.7%) were inpatient based (hospital/rehabilitation ward), 5 (8.6%) were in institutional care (nursing/care homes) and 7 (12.1%) were in other (mixed or outpatient) settings. One study reported results separately for community and institutional settings and is counted in both settings. Simplified Nutritional Appetite Questionnaire (SNAQ Simplified, n = 14) and subject-reported appetite questions (n = 11) were the most common methods used to assess anorexia/appetite loss, but substantial variability in assessment tools was observed across studies. The most commonly reported outcomes were malnutrition and mortality. Malnutrition was assessed in 15 studies, with all reporting a significantly higher risk of malnutrition in older individuals with anorexia/appetite loss (vs. without) regardless of country or healthcare setting (community n = 9, inpatient n = 2, institutional n = 3, other n = 2). Of 18 longitudinal studies that assessed mortality risk, 17 (94%) reported a significant association between anorexia/appetite loss and mortality regardless of either healthcare setting (community n = 9, inpatient n = 6, institutional n = 2) or method used to assess anorexia/appetite loss. This association between anorexia/appetite loss and mortality was observed in cohorts with cancer (as expected) but was also observed in older populations with a range of comorbid conditions other than cancer. Overall, our findings demonstrate that, among individuals aged ≥ 65 years, anorexia/appetite loss is associated with increased risk of malnutrition, mortality and other negative outcomes across community, care home and hospital settings. Such associations warrant efforts to improve and standardize screening, detection, assessment and management of anorexia/appetite loss in older adults.
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Affiliation(s)
- Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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Huang T, Chen X, Chen D, Yu B, He J, Yan H, Luo Y, Zheng P, Chen H, Huang Z. Eugenol promotes appetite through TRP channels mediated-CaMKK2/AMPK signaling pathway. Phytother Res 2023. [PMID: 36762415 DOI: 10.1002/ptr.7768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/22/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
Eugenol is a major component of clove oil. A recent study found that inhalation of eugenol promoted the appetite of mice. However, whether oral ingestion of eugenol promoted appetite is unclear and its mechanism await study. Here, mice were divided into four treatments (n = 20) and fed a basal diet supplemented with 0%, 0.005%, 0.01% and 0.02% eugenol for 4 weeks. In addition, mice (n = 7) were injected intraperitoneally with 3 mg/kg body weight eugenol. Our data showed that feeding mice with 0.01% and 0.02% eugenol promoted their appetite. In addition, the short-term intraperitoneal injection of eugenol enhanced the feed intake in mice within 1 h. Further studies found that dietary eugenol increased orexigenic factors expression and decreased anorexigenic factors expression in mice. We then carried out N38 cell experiments to explore the transient receptor potential (TRP) channels-dependent mechanism of eugenol in promoting appetite. We found that eugenol activated the TRP channels mediated-CaMKK2/AMPK signaling pathway in the hypothalamus and N38 cells. Besides, the inhibition of TRPV1 and AMPK eliminated the upregulation of eugenol on the agouti-related protein level in N38 cells. In conclusion, the study suggested that eugenol promotes appetite through TRPV1 mediated-CaMKK2/AMPK signaling pathway.
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Affiliation(s)
- Tengteng Huang
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Xiaoling Chen
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Daiwen Chen
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Bing Yu
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Jun He
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Hui Yan
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Yuheng Luo
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Ping Zheng
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Hong Chen
- College of Food Science, Sichuan Agricultural University, Yaan, Sichuan, People's Republic of China
| | - Zhiqing Huang
- Key Laboratory for Animal Disease-Resistance Nutrition of China Ministry of Education, Institute of Animal Nutrition, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
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Abstract
Fatigue is defined as a symptom leading to the inability to continue functioning at the expected activity level. It is a highly prevalent symptom, challenging to frame into monodimensional pathophysiological mechanisms. As a result, fatigue is often underestimated in the clinical setting and is wrongly considered an unavoidable consequence of ageing. Several potential mechanisms responsible for fatigue have been proposed, including sleep patterns, autonomic nervous system abnormalities and biological complexity. Inflammation and mitochondrial dysfunction are among the most promising mechanisms through which malnutrition may cause fatigue. Not surprisingly, fatigue is highly prevalent in inflammatory conditions (e.g. COVID-19 infection). The nutritional status may also represent a critical factor in the development and presentation of fatigue, which may mimic the exhaustion of the individual's metabolic reserves. For example, the insufficient dietary intake of energy and proteins may determine the catabolism of body fat and muscles, disrupt the homeostatic balance and cause the onset of fatigue. It is necessary to conduct research on fatigue. By characterising its pathophysiological mechanisms, it will be possible to (1) support the design and development of targeted interventions, (2) improve the quality of life of many persons by acting on the symptom and (3) reduce the direct and indirect costs of a burdening condition typical of advancing age. In the present review, we provide an overview of the role that nutrition may play as a determinant of fatigue in older people, also in the context of the COVID-19 pandemic.
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Food consumption, factors affecting food intake and nurses' interventions in elderly orthopedic surgical patients: An analytic observational cross-sectional study. Int J Orthop Trauma Nurs 2023; 48:100983. [PMID: 36592606 DOI: 10.1016/j.ijotn.2022.100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
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Sánchez-Sánchez JL, Rolland Y. Editorial: Social Isolation and Loneliness: Overlooked Therapeutic Targets of Anorexia of Aging? J Nutr Health Aging 2023; 27:794-796. [PMID: 37960900 DOI: 10.1007/s12603-023-2011-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Affiliation(s)
- J L Sánchez-Sánchez
- Juan Luis Sánchez-Sánchez, Department of Health Sciences, Public University of Navarre, Pamplona, Spain,
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Lin HY, Lin YC, Chen LK, Hsiao FY. Untangling the Complex Interplay between Social Isolation, Anorexia, Sarcopenia, and Mortality: Insights from a Longitudinal Study. J Nutr Health Aging 2023; 27:797-805. [PMID: 37960901 DOI: 10.1007/s12603-023-1993-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Social isolation is a pervasive and debilitating condition that has adverse prognostic impacts. This condition often co-occurs with other geriatric syndromes, further exacerbating negative health outcomes. Given these considerations, the present study aims to elucidate the roles of social isolation in older adults with anorexia of aging and/or sarcopenia with respect to long-term mortality using a nationally representative cohort study. METHODS Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with a sample size of 3,762 study participants aged 50 years and older. Data from 1999 (wave 4) to 2015 (wave 9) were analyzed. The TLSA questionnaire was used to define social isolation, anorexia, and sarcopenia. Logistic regressions were employed to explore the associations between social isolation, anorexia, and sarcopenia. The Cox proportional hazard model was utilized to examine the synergistic effects of social isolation and anorexia or sarcopenia on 16-year all-cause mortality. RESULTS After controlling for demographic information and comorbidities, older adults with social isolation were significantly associated with anorexia (adjusted odds ratio [aOR] 1.46 [95% confidence interval: 1.00-2.12, p=0.0475]) and sarcopenia (aOR 1.35 [95% CI: 1.12-1.64, p=0.0021]). Furthermore, the synergistic effects of social isolation with anorexia (aOR 1.65 [95% CI: 1.25-2.18, p=0.0004]) or sarcopenia (aOR 1.65 [95% CI: 1.42-1.92, p<0.0001]) were both significantly associated with higher risks of all-cause mortality, while social isolation alone revealed borderline statistical significance. CONCLUSIONS Our findings indicate that social isolation is closely linked to anorexia and sarcopenia among middle-aged and older adults. Additionally, social isolation significantly exacerbates the long-term mortality risk associated with anorexia of aging and sarcopenia. However, social isolation alone appears to have borderline long-term mortality risk in this cohort. These findings underscore the importance of addressing social isolation in older adults with anorexia and/or sarcopenia to optimize their health outcomes and mitigate long-term mortality risk.
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Affiliation(s)
- H-Y Lin
- Fei-Yuan Hsiao, Ph.D., Professor and Director, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Linsen S. Rd, Taipei 10050, Taiwan. Tel.: 886-2-33668787, E-mail: ; Liang-Kung Chen, Professor, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei 11217, Taiwan. Tel: +886-2-28757830; Fax: +886-2-28757711; E-mail:
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Enhancing the management of anorexia of ageing to counteract malnutrition: are physical activity guidelines optimal? Aging Clin Exp Res 2023; 35:427-431. [PMID: 36662481 PMCID: PMC9894952 DOI: 10.1007/s40520-022-02317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023]
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de Marco Castro E, Valli G, Buffière C, Guillet C, Mullen B, Pratt J, Horner K, Naumann-Gola S, Bader-Mittermaier S, Paganini M, De Vito G, Roche HM, Dardevet D. Peripheral Amino Acid Appearance Is Lower Following Plant Protein Fibre Products, Compared to Whey Protein and Fibre Ingestion, in Healthy Older Adults despite Optimised Amino Acid Profile. Nutrients 2022; 15:35. [PMID: 36615694 PMCID: PMC9824653 DOI: 10.3390/nu15010035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Plant-based proteins are generally characterised by lower Indispensable Amino Acid (IAA) content, digestibility, and anabolic properties, compared to animal-based proteins. However, they are environmentally friendlier, and wider consumption is advocated. Older adults have higher dietary protein needs to prevent sarcopenia, a disease marked by an accelerated loss of muscle mass and function. Given the lower environmental footprint of plant-based proteins and the importance of optimising dietary protein quality among older adults, this paper aims to assess the net peripheral Amino Acid (AA) appearance after ingestion of three different plant protein and fibre (PPF) products, compared to whey protein with added fibre (WPF), in healthy older adults. In a randomised, single-blind, crossover design, nine healthy men and women aged ≥65 years consumed four test meals balanced in AA according to the FAO reference protein for humans, matched for leucine, to optimally stimulate muscle protein synthesis in older adults. A fasted blood sample was drawn at each visit before consuming the test meal, followed by postprandial arterialise blood sampling every 30 min for 3 h. The test meal was composed of a soup containing either WPF or PPF 1-3. The PPF blends comprised pea proteins with varying additional rice, pumpkin, soy, oat, and/or almond protein. PPF product ingestion resulted in a lower maximal increase of postprandial leucine concentration and the sum of branched-chain AA (BCAA) and IAA concentrations, compared to WPF, with no effect on their incremental area under the curve. Plasma methionine and cysteine, and to a lesser extent threonine, appearance were limited after consuming the PPF products, but not WPF. Despite equal leucine doses, the WPF induced greater postprandial insulin concentrations than the PPF products. In conclusion, the postprandial appearance of AA is highly dependent on the protein source in older adults, despite providing equivalent IAA levels and dietary fibre. Coupled with lower insulin concentrations, this could imply less anabolic potential. Further investigation is required to understand the applicability of plant-based proteins in healthy older adults.
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Affiliation(s)
- Elena de Marco Castro
- UCD Conway Institute and UCD Institute of Food and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Giacomo Valli
- Neuromuscular Physiology Laboratory, Department of Biomedical Science, University of Padua, 35122 Padova, Italy
| | - Caroline Buffière
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Rte de Theix, 63122 Saint-Genès-Champanelle, France
| | - Christelle Guillet
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Rte de Theix, 63122 Saint-Genès-Champanelle, France
| | - Brian Mullen
- UCD Conway Institute and UCD Institute of Food and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Jedd Pratt
- Neuromuscular Physiology Laboratory, Department of Biomedical Science, University of Padua, 35122 Padova, Italy
| | - Katy Horner
- UCD Conway Institute and UCD Institute of Food and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Susanne Naumann-Gola
- Fraunhofer Institute for Process Engineering and Packaging IVV, Giggenhauser Str., 85354 Freising, Germany
| | | | - Matteo Paganini
- Neuromuscular Physiology Laboratory, Department of Biomedical Science, University of Padua, 35122 Padova, Italy
| | - Giuseppe De Vito
- Neuromuscular Physiology Laboratory, Department of Biomedical Science, University of Padua, 35122 Padova, Italy
| | - Helen M. Roche
- UCD Conway Institute and UCD Institute of Food and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
- School of Biological Sciences, The Institute for Global Food Security, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Dominique Dardevet
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Rte de Theix, 63122 Saint-Genès-Champanelle, France
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Cox NJ, Howson F, Ibrahim K, Morrison L, Sayer AA, Roberts HC, Robinson SM. Mood and physical activity are associated with appetite in hospitalised older men and women. Age Ageing 2022; 51:6964929. [PMID: 36580556 DOI: 10.1093/ageing/afac297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies. DESIGN Cross sectional observational study. SETTING Eleven wards in one large hospital in England. SUBJECTS Older inpatients aged ≥70 years, admitted non-electively. METHODS Appetite was assessed using the four-item Simplified Nutritional Appetite Questionnaire (SNAQ). Associations between SNAQ score and appetite-related factors present in the dataset were assessed in continuous analyses, including habitual physical activity, mood, medication, cognition and living circumstances. RESULTS 200 participants, mean age of 80.7 years (SD 6.9); 40% were women. Prevalence of poor appetite was 43%. In univariate analyses, lower medication count, higher habitual physical activity and better mood were associated with higher SNAQ scores during admission. In a multivariate analysis, independent associations of higher habitual physical activity and better mood with higher SNAQ scores during hospital admission remained. CONCLUSION In this group of older adults, better mood and higher habitual physical activity were independently associated with better appetite during hospital admission. These are potentially modifiable factors and could be targets for future research into interventions for the anorexia of ageing in the hospitalised older population.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fiona Howson
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Department of Psychology, Faculty of Social, Human, and Mathematical Sciences, University of Southampton, Southampton, UK.,Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Sian M Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
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De Luca V, Femminella GD, Patalano R, Formosa V, Lorusso G, Rivetta C, Di Lullo F, Mercurio L, Rea T, Salvatore E, Korkmaz Yaylagul N, Apostolo J, Silva RC, Dantas C, van Staalduinen WH, Liotta G, Iaccarino G, Triassi M, Illario M. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16050. [PMID: 36498125 PMCID: PMC9739796 DOI: 10.3390/ijerph192316050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Valeria Formosa
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Grazia Lorusso
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Cristiano Rivetta
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Federica Di Lullo
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Teresa Rea
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Joao Apostolo
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Rosa Carla Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | | | | | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
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Temporal Trends in Incidence of Nutritional Deficiency among Older Adults in China: A Secondary Analysis of the Global Burden of Disease Study 1990-2019. Nutrients 2022; 14:nu14235008. [PMID: 36501039 PMCID: PMC9738542 DOI: 10.3390/nu14235008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
Abstract
Nutritional deficiency is prevalent among the elderly, and it is associated with many adverse health consequences. China is rapidly moving toward an aging society with a large population; however, evidence on the epidemiological trends in nutritional deficiency among the Chinese elderly is limited. Data on the incidence of nutritional deficiency among Chinese adults aged 65 years or above from 1990 to 2019 were extracted from the Global Burden of Disease 2019 database. We used the joinpoint regression method to estimate the average annual percentage change (AAPC) and to describe trend patterns. Age, period, and cohort effects were determined using age-period-cohort models. From 1990 to 2019, the incidence of vitamin A deficiency and iodine deficiency among Chinese older adults decreased from 1784.12 and 8.20 to 304.27 and 7.26 per 100,000, with AAPCs of -0.41 (-0.44, -0.38)% and -5.86 (-6.29, -5.43)%, respectively. A continually increasing trend was seen for incidence rates of protein-energy malnutrition, from 1342.02 to 2275.87 per 100,000 person-years, with an AAPC of 1.70 (1.40, 2.01)%. These trends were more pronounced among men than women. A strong age effect and birth cohort effect were present. Specifically, the population that was older or born later had a lower incidence of deficiencies in vitamin A and iodine but a higher incidence of protein-energy malnutrition. The results show a substantial reduction in vitamin A and iodine deficiencies among the Chinese elderly, and health policies and public awareness are needed to address the burden of protein-energy malnutrition in this population.
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Saito A, Sato W, Ikegami A, Ishihara S, Nakauma M, Funami T, Fushiki T, Yoshikawa S. Subjective-Physiological Coherence during Food Consumption in Older Adults. Nutrients 2022; 14:nu14224736. [PMID: 36432423 PMCID: PMC9698163 DOI: 10.3390/nu14224736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Subjective-physiological emotional coherence is thought to be associated with enhanced well-being, and a relationship between subjective-physiological emotional coherence and superior nutritional status has been suggested in older populations. However, no study has examined subjective-physiological emotional coherence among older adults while tasting food. Accordingly, the present study compared subjective-physiological emotional coherence during food consumption among older and younger adults. METHODS Participants consumed bite-sized gel-type foods with different flavors and provided their subjective ratings of the foods while their physiological responses (facial electromyography (EMG) of the corrugator supercilia, masseter, and suprahyoid, and other autonomic nervous system signals) were simultaneously measured. RESULTS Our primary findings were that (1) the ratings of liking, wanting, and valence were negatively correlated with corrugator EMG activity in older and young adult participants; (2) the positive association between masseter EMG activity and ratings of wanting/valence was weaker in the older than in the young adult group; and (3) arousal ratings were negatively correlated with corrugator EMG activity in the older group only. CONCLUSIONS These results demonstrate commonalities and differences in subjective-physiological emotional coherence during food intake between older and young adults.
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Affiliation(s)
- Akie Saito
- Psychological Process Research Team, Guardian Robot Project, RIKEN, Kyoto 619-0288, Japan
- Correspondence: (A.S.); (W.S.); Tel.: +81-774-95-1360 (A.S. & W.S.)
| | - Wataru Sato
- Psychological Process Research Team, Guardian Robot Project, RIKEN, Kyoto 619-0288, Japan
- Field Science Education and Research Center, Kyoto University, Kyoto 606-8502, Japan
- Correspondence: (A.S.); (W.S.); Tel.: +81-774-95-1360 (A.S. & W.S.)
| | | | | | | | | | - Tohru Fushiki
- Faculty of Agriculture, Ryukoku University, Ohtsu 520-2194, Japan
| | - Sakiko Yoshikawa
- Field Science Education and Research Center, Kyoto University, Kyoto 606-8502, Japan
- Faculty of the Arts, Kyoto University of the Arts, Kyoto 606-8501, Japan
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Ishizu Y, Ishigami M, Honda T, Imai N, Ito T, Yamamoto K, Yokoyama S, Ishikawa T, Kawashima H. Decreased appetite is associated with the presence of sarcopenia in patients with cirrhosis. Nutrition 2022; 103-104:111807. [PMID: 36029694 DOI: 10.1016/j.nut.2022.111807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To our knowledge, the relationship between appetite and sarcopenia in patients with cirrhosis is unknown. The aims of this study were to examine the factors associated with decreased appetite and to clarify the relationship between appetite and sarcopenia. METHODS This study included 61 patients with cirrhosis. The patients were asked to describe their appetite using a numerical rating scale (NRS) from 0 (none at all) to 10 (most), with ≤5 defined as decreased appetite. The clinical characteristics, gastrointestinal symptoms as assessed using the Gastrointestinal Symptom Rating Scale, handgrip strength, and skeletal muscle area at the third vertebra were collected retrospectively. Sarcopenia was diagnosed according to the criteria of the Japan Society of Hepatology. The differences in these factors between patients with and without decreased appetite, and the factors associated with the presence of sarcopenia were examined. RESULTS Alcoholic liver disease was the most common etiology. The median Model for End-Stage Liver Disease score was 8 (interquartile range = 7 - 10) and hepatocellular carcinoma was present in 35 patients. Overall, 36% of the patients with cirrhosis had decreased appetite. Patients with decreased appetite had a higher frequency of abdominal pain and acid reflux-related symptoms and significantly lower handgrip strength than patients without, among both men (P = 0.034) and women (P = 0.017). The multivariate analysis identified a decrease in appetite as a significant factor associated with the presence of sarcopenia (NRS one increase, odds ratio, 0.701; 95% confidence interval, 0.502-0.977; P = 0.036). CONCLUSION Decreased appetite was associated with the presence of sarcopenia.
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Affiliation(s)
- Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Ishikawa
- Department of Radiologic and Medical Laboratory Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shirley L, Lord N, Cheung L, Graham G. Recognising eating disorders in older people. Nurs Older People 2022; 34:e1399. [PMID: 36286010 DOI: 10.7748/nop.2022.e1399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 06/16/2023]
Abstract
Changes in eating behaviours, weight and mental health in older people may be related to psychological distress and indicate the presence of a diagnosable eating disorder, rather than 'anorexia of ageing'. Eating disorders in older people may be overlooked because signs and symptoms are assumed to be part of normal ageing. The role of nurses in the care of older people with eating disorders is likely to be detection, referral and support in accessing specialist intervention. This article offers an overview of eating disorders in older people and discusses why they may arise, why they may not be detected and how to recognise them. The authors describe a framework that nurses can use when assessing older people to determine whether they may have an eating disorder.
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Affiliation(s)
- Louisa Shirley
- Division of Psychology and Mental Health, University of Manchester, Manchester, England
| | - Natasha Lord
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, England
| | | | - Gemma Graham
- Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, England
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Nutritional and Nutrition-Related Biomarkers as Prognostic Factors of Sarcopenia, and Their Role in Disease Progression. Diseases 2022; 10:diseases10030042. [PMID: 35892736 PMCID: PMC9326750 DOI: 10.3390/diseases10030042] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/25/2022] Open
Abstract
Due to the multifactorial pathogenesis of sarcopenia, it is crucial to identify biomarkers that are risk factors for sarcopenia, and which therefore have a prognostic function. Aim: This narrative review aims to define a set of biomarkers associated with nutrition and sarcopenia. These biomarkers could contribute to individualized monitoring and enable preventive and therapeutic methods. Methods: Two electronic databases, PubMed and Google Scholar, were used. The search strategy was based on a controlled vocabulary (MeSH) and includes studies published up to February 2022. Discussion: Higher levels of serum uric acid are associated with higher handgrip strength and better muscle function in elderly people and, thus, may slow the progression of sarcopenia. Leptin, an adipokine secreted by adipose tissue, promotes the production of pro-inflammatory cytokines, which in turn lead to sarcopenia. This makes leptin a significant indirect biomarker for physical disability and sarcopenic obesity. Additionally, creatinine is a reliable biomarker for muscle mass status because of its easy accessibility and cost-effectiveness. Vitamin D status acts as a useful biomarker for predicting total mortality, hip fractures, early death, and the development of sarcopenia. Therefore, there is an increasing interest in dietary antioxidants and their effects on age-related losses of muscle mass and function. On the other hand, 3-Methylhistidine is a valuable biomarker for detecting increased muscle catabolism, as it is excreted through urine during muscle degradation. In addition, IGF-1, whose concentration in plasma is stimulated by food intake, is associated with the loss of skeletal muscle mass, which probably plays a crucial role in the progression of sarcopenia. Conclusions: Many nutritional biomarkers were found to be associated with sarcopenia, and can therefore be used as prognostic indexes and risk factors. Nutrition plays an important role in the prevention and management of sarcopenia, affecting muscle mass, strength, and function in elderly people.
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Walker-Clarke A, Walasek L, Meyer C. Psychosocial factors influencing the eating behaviours of older adults: A systematic review. Ageing Res Rev 2022; 77:101597. [PMID: 35219902 DOI: 10.1016/j.arr.2022.101597] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/25/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
Our understanding of how eating behaviours change in later life have been dominated by the studies of physiological and biological influences on malnutrition. Insights from these studies were consequently used to develop interventions, which are predominantly aimed at rectifying nutritional deficiencies, as opposed to interventions that may enable older adults to eat well and enjoy their food-related life well into older age. The objective of the present review is to summarise the existing knowledge base on psychosocial influences on eating behaviours in later life. Following comprehensive searches, review, and appraisal, 53 articles were included (22 qualitative and 31 quantitative) to provide a greater understanding of the mechanisms underpinning the psychosocial factors influencing eating behaviours. Our analysis identified eight underpinning psychosocial factors that influences eating behaviours in later life; (1) health awareness & attitudes, (2) food decision making, (3) perceived dietary control, (4) mental health & mood, (5) food emotions & enjoyment, (6) eating arrangements, (7) social facilitation, and (8) social support. The importance and lasting influence of early food experiences were also identified as contributing to eating behaviours in later life. The review concludes with the call for further investigation into specific psychosocial factors that influence eating behaviour, calls for improvements in methodologies, and a summary of psychosocial barriers and enablers to eating well in later life.
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Affiliation(s)
- Aimee Walker-Clarke
- Applied Psychology Group, Warwick Manufacturing Group (WMG), University of Warwick, Coventry CV4 7AL, United Kingdom.
| | - Lukasz Walasek
- Behavioural Science, Department of Psychology, University of Warwick, Coventry CV4 7AL, United Kingdom.
| | - Caroline Meyer
- Vice-Provost and Chair of the Faculty of Science, Engineering and Medicine, University of Warwick, Coventry CV4 7AL, United Kingdom.
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Czigle S, Bittner Fialová S, Tóth J, Mučaji P, Nagy M, on behalf of the OEMONOM. Treatment of Gastrointestinal Disorders-Plants and Potential Mechanisms of Action of Their Constituents. Molecules 2022; 27:2881. [PMID: 35566230 PMCID: PMC9105531 DOI: 10.3390/molecules27092881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
The worldwide prevalence of gastrointestinal diseases is about 40%, with standard pharmacotherapy being long-lasting and economically challenging. Of the dozens of diseases listed by the Rome IV Foundation criteria, for five of them (heartburn, dyspepsia, nausea and vomiting disorder, constipation, and diarrhoea), treatment with herbals is an official alternative, legislatively supported by the European Medicines Agency (EMA). However, for most plants, the Directive does not require a description of the mechanisms of action, which should be related to the therapeutic effect of the European plant in question. This review article, therefore, summarizes the basic pharmacological knowledge of synthetic drugs used in selected functional gastrointestinal disorders (FGIDs) and correlates them with the constituents of medicinal plants. Therefore, the information presented here is intended as a starting point to support the claim that both empirical folk medicine and current and decades-old treatments with official herbal remedies have a rational basis in modern pharmacology.
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Affiliation(s)
- Szilvia Czigle
- Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University Bratislava, Odbojárov 10, SK-832 32 Bratislava, Slovakia; (S.B.F.); (J.T.); (P.M.); (M.N.)
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de Souto Barreto P, Cesari M, Morley JE, Roberts S, Landi F, Cederholm T, Rolland Y, Vellas B, Fielding R. Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report. J Frailty Aging 2022; 11:129-134. [PMID: 35441188 PMCID: PMC8898654 DOI: 10.14283/jfa.2022.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Appetite loss/anorexia of aging is a highly prevalent and burdensome geriatric syndrome that strongly impairs the quality of life of older adults. Loss of appetite is associated with several clinical conditions, including comorbidities and other geriatric syndromes, such as frailty. Despite its importance, appetite loss has been under-evaluated and, consequently, under-diagnosed and under-treated in routine clinical care. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually on September 27th 2021 to debate issues related to appetite loss/anorexia of aging. In particular, topics related to the implementation and management of appetite loss in at-risk older adult populations, energy balance during aging, and the design of future clinical trials on this topic were discussed. Future actions in this field should focus on the systematic assessment of appetite in the care pathway of older people, such as the Integrated Care for Older People (ICOPE) program recommended by the World Health Organization. Moreover, clinical care should move from the assessment to the treatment of appetite loss/anorexia. Researchers continue to pursue their efforts to find out effective pharmacologic and non-pharmacologic interventions with a favorable risk/benefit ratio.
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Affiliation(s)
- P de Souto Barreto
- Philipe de Souto Barreto, Gérontopôle de Toulouse, Institut du Vieillissement, 37 Allées Jules Guesde, 31000 Toulouse, France, +33 561 145 636,
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Chareh N, Kiesswetter E, Kob R, Hannink A, Brandl B, Skurk T, Hauner H, Sieber CC, Volkert D. Association Between Inflammation and Appetite in Healthy Community-Dwelling Older Adults—An enable Study. FRONTIERS IN AGING 2022; 3:826816. [PMID: 35821805 PMCID: PMC9261305 DOI: 10.3389/fragi.2022.826816] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022]
Abstract
Aging is associated with reduced appetite as well as a slight increase in pro-inflammatory status, which both might contribute to the development of malnutrition. We aimed to evaluate the association between inflammation based on serum C-reactive protein (CRP), and appetite in healthy community-dwelling older adults. In this cross-sectional study of 158 healthy and non-smoking persons (aged 75–85 years), appetite was assessed in personal interviews by a single question with five answer categories. As nobody reported (very) poor appetite, the remaining three categories were dichotomised into “(very) good” and “moderate” appetite. Fasting serum CRP was analysed according to standard procedures, values ≥ 5.0 mg/L were considered as inflammation. The association between inflammation and appetite was examined by binary logistic regression, unadjusted and adjusted for age, sex, waist circumference, leptin, depressive mood, number of medications, interleukin-6 and tumor necrosis factor-α. Appetite was very good in 27.8%, good in 58.9%, and moderate in 13.3% of participants. Inflammation was present in 10.8% overall, in 8.8% of those with (very) good and in 23.8% of those with moderate appetite (p = 0.038). In the unadjusted model, participants with inflammation were 3.2 times more likely to have moderate appetite (95%CI: 1.01–10.44, p = 0.047). In the adjusted model, the odds of having moderate appetite was 3.7 times higher in participants with inflammation, but no longer significant (95%CI: 0.77–18.55, p = 0.102). In healthy older people, we found hints for a potential association between increased levels of CRP and a slightly reduced appetite. More studies in larger samples are needed.
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Affiliation(s)
- Neshat Chareh
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- *Correspondence: Neshat Chareh,
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Anne Hannink
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Beate Brandl
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Thomas Skurk
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Hans Hauner
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Cornel C. Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Zukeran MS, Valentini Neto J, Romanini CV, Mingardi SVB, Cipolli GC, Aprahamian I, Lima Ribeiro SM. The association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults adults. Clin Nutr ESPEN 2022; 47:194-198. [DOI: 10.1016/j.clnesp.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/15/2021] [Accepted: 12/18/2021] [Indexed: 02/08/2023]
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