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Anorexia of Aging
Abstract
The physiopathological decline in appetite and food intake known as "anorexia of aging" can lead to involuntary weight loss and protein-energy malnutrition, with devastating consequences in older men and women. Food intake can be influenced by numerous endogenous and exogenous factors, both physiological and pathological: mechanisms underlying age-related anorexia are multifactorial, and not completely understood. Early recognition of anorexia, nutritional and pharmacological interventions can help prevent the development of malnutrition and poor clinical outcome in the elderly.
... Beberapa subjek mengalami nafsu makan yang menurun setiap hari, namun terdapat juga subjek yang nafsu makannya menurun disebabkan oleh kondisi badan yang sedang tidak sehat, perasaan sedih, atau cemas. Pada lansia terjadi penurunan nafsu makan dan asupan makan (15,25,26). Faktor psikologis seperti depresi, rasa cemas, dan demensia memiliki kontribusi besar terhadap asupan makan pada lansia (26). ...
... Banyak faktor yang dapat mempengaruhi asupan makan pada lansia yaitu gangguan nafsu makan, perubahan fisiologis, perubahan kognitif, perubahan psikososial, penggunaan obat (15,32,25,27) serta faktor dari makanan seperti porsi makanan (33). Walaupun porsi makanan hanya salah satu dari banyak faktor yang mempengaruhi asupan makan pada lansia, penyajian porsi makanan yang tepat merupakan hal yang penting, karena sebagian besar lansia bergantung pada makanan yang disediakan oleh panti (6). ...
p> ABSTRACT
Background : There is a challenge to overcome nutrition problems as the number of older adults increases, including the older adults who live in nursing home. Food service in nursing home often get less attention, such as in the portion size of meals that is served to the older adult. In PSTW Budi Luhur, portion size is served by one representation of the older adults in each group or “pramurukti”, and it is still unknown whether the portion size is served accurately. Portion size infl uenced food and energy intake in adults.
Objectives : To investigate the association between portion accuracy with food intake of older adults in PSTW Budi Luhur, Bantul, Yogyakarta.
Methods : Forty four older adults were recruited in the observational, cross sectional study in PSTW Budi Luhur, Bantul, Yogyakarta from May to June 2015. Portion in distribution unit, portion accuracy, and food intake were measured by food weighing and observation for 15 days at lunch. Spearman rank correlation formula were used to analyze the association between portion accuracy and food intake.
Results : Most of the portion sizes of grains, meat, poultry and fi sh, beans and bean products, fruits, and vegetables were served inaccurately. Food intakes from grains, meat, poultry and fi sh, and vegetables were mainly defi cient, while intakes from beans and bean products, and fruits were largely good. There was signifi cant association between portion accuracy and food intake in all food groups (p-value<0.05) with medium strength of correlation (r=0.4-<0.6).
Conclusion : There was association between food accuracy and food intake in elderly, in which larger food portion leads to higher food intake, and vice versa.
KEYWORDS : portion, portion accuracy, food intake, older adults, nursing home
ABSTRAK
Latar belakang : Peningkatan jumlah lansia memberikan tantangan untuk dilakukannya upaya-upaya mengatasi atau menanggulangi permasalahan gizi yang sering muncul pada lansia termasuk lansia yang tinggal di panti wreda. Pelayanan makan di panti wreda kurang mendapat perhatian termasuk porsi makanan yang disajikan ke lansia. Di Panti Sosial Tresna Werdha Budi Luhur, pembagian porsi dilakukan oleh salah satu lansia pada tiap wisma atau pramurukti, dan tidak diketahui ketepatan porsi yang disajikan ke tiap lansia. Pada orang dewasa, besar porsi mempengaruhi asupan makan dan energi.
Tujuan : Penelitian ini bertujuan untuk mengetahui hubungan antara ketepatan porsi dan asupan makan, gambaran ketepatan porsi dan gambaran asupan makan lansia di PSTW Budi Luhur.
Metode : Penelitian ini merupakan penelitian observasional dengan rancangan studi cross sectional. Penelitian berlangsung pada bulan Mei-Juni 2015 dengan jumlah subjek 44 lansia. Porsi di unit distribusi, ketepatan porsi dan asupan makan diukur menggunakan metode penimbangan makanan dan observasi selama 15 hari pada saat makan siang. Uji yang digunakan adalah uji korelasi Spearman rank correlation.
Hasil : Sebagian besar porsi makanan pokok, lauk hewani, lauk nabati, sayur dan buah yang disajikan tidak tepat. Sebagian besar asupan makanan pokok, lauk hewani dan sayur termasuk kurang, sedangkan lauk nabati dan buah termasuk baik. Hasil uji korelasi menunjukkan hubungan yang bermakna antara ketepatan porsi dan asupan makan makanan pokok, lauk hewani, lauk nabati, sayur dan buah (p<0,05) dengan kekuatan korelasi yang sedang (r=0,4-<0,6).
Kesimpulan : Terdapat hubungan antara ketepatan porsi dan asupan makan pada lansia, semakin besar porsi yang diberikan maka semakin besar asupannya dan sebaliknya.
KATA KUNCI : porsi, ketepatan porsi, asupan makan, lansia, panti wreda </p
... The pathogenesis of anorexia is thought to involve age-related declines in the activities of specific brain areas, including the hypothalamus, in response to peripheral stimuli (fat cell signals, nutrients, circulating hormones) [5][6][7]. Inflammation, which is linked to the aging process, contributes to the pathogenesis of anorexia and also plays a key role in anorexia associated with chronic diseases or cachexia [7,8]. ...
... The pathogenesis of anorexia is thought to involve age-related declines in the activities of specific brain areas, including the hypothalamus, in response to peripheral stimuli (fat cell signals, nutrients, circulating hormones) [5][6][7]. Inflammation, which is linked to the aging process, contributes to the pathogenesis of anorexia and also plays a key role in anorexia associated with chronic diseases or cachexia [7,8]. ...
Anorexia of aging, defined as a loss of appetite and/or reduced food intake, affects a significant number of elderly people and is far more prevalent among frail individuals. Anorexia recognizes a multifactorial origin characterized by various combinations of medical, environmental and social factors. Given the interconnection between weight loss, sarcopenia and frailty, anorexia is a powerful, independent predictor of poor quality of life, morbidity and mortality in older persons. One of the most important goals in the management of older, frail people is to optimize their nutritional status. To achieve this objective it is important to identify subjects at risk of anorexia and to provide multi-stimulus interventions that ensure an adequate amount of food to limit and/or reverse weight loss and functional decline. Here, we provide a brief overview on the relevance of anorexia in the context of sarcopenia and frailty. Major pathways supposedly involved in the pathogenesis of anorexia are also illustrated. Finally, the importance of treating anorexia to achieve health benefits in frail elders is highlighted.
... The mechanisms that are involved in age-related changes in the specific activities of brain areas such as the hypothalamus in response to peripheral stimuli including nutrients, hormones, and adipokines are complex. 4 Reduced appetite and a decreased total energy expenditure are common in older individuals, but the frail elderly and those with chronic comorbidities often show an increased basal metabolism. Reduced total energy expenditure, along with biological and physiological changes (reduced lean body mass, changes in hormonal profiles, fluid-electrolyte dysregulation, delayed gastric emptying, and diminished sense of smell and taste), lead to the anorexia of ageing. ...
Cachexia is a complex metabolic process that is associated with several end‐stage organ diseases. It is known to be also associated with advanced dementia, although the pathophysiologic mechanisms are still largely unknown. The present narrative review is aimed at presenting recent insights concerning the pathophysiology of weight loss and wasting syndrome in dementia, the putative mechanisms involved in the dysregulation of energy balance, and the interplay among the chronic clinical conditions of sarcopenia, malnutrition, and frailty in the elderly. We discuss the clinical implications of these new insights, with particular attention to the challenging question of nutritional needs in advanced dementia and the utility of tube feeding in order to optimize the management of end‐stage dementia.
... Complex mechanisms are involved in the age-related deterioration of specific activities in certain brain areas, such as the hypothalamus, in responses to peripheral stimuli (e.g., circulating hormones, Complex mechanisms are involved in the age-related deterioration of specific activities in certain brain areas, such as the hypothalamus, in responses to peripheral stimuli (e.g., circulating hormones, adipokines, nutrients) [1][2][3]. While an exhaustive description of these processes is beyond the scope of this review, several factors that may contribute to the onset of anorexia of aging warrant a brief discussion (Figure 1). ...
Older people frequently fail to ingest adequate amount of food to meet their essential energy and nutrient requirements. Anorexia of aging, defined by decrease in appetite and/or food intake in old age, is a major contributing factor to under-nutrition and adverse health outcomes in the geriatric population. This disorder is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of aging, advancing age often promotes its development through various mechanisms. Age-related changes in life-style, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviors and nutritional status. In spite of their importance, problems related to food intake and, more generally, nutritional status are seldom attended to in clinical practice. While this may be the result of an “ageist” approach, it should be acknowledged that simple interventions, such as oral nutritional supplementation or modified diets, could meaningfully improve the health status and quality of life of older persons.
... Nadalje, va`no je naglasiti da je prevalencija kroni~nih bolesti me|u starijim osobama visoka, a pothranjenost se u takvim slu~ajevima mo`e povezati sa slabijim ishodom lije~enja, pove}anim rizikom od komplikacija te znatno du`im trajanjem hospitalizacije. 45 Tako|er, uo~eno je da se epizode sepse javljaju znatno ~e{}e u jako pothranjenih hospitaliziranih starijih osoba. 46 Nedostatak vitamina D vodi razvitku osteomalacije, rahitisa i miopatije. ...
Aging produces numerous physical and physiologic changes, which in turn alter nutritional requirements and affect nutritional status. The presence of chronic disease, and/or medications can enhance potential disparities between nutrient needs and dietary intake, leading to malnutrition. Indeed, research suggests that malnutrition is a common condition among the elderly. Therefore, regular nutritional assessment should be done as an integral part of healthcare for elderly. Also, it is important to take in consideration all determinants of geroanthropometry. The physiologic changes associated with aging affect requirement for several essential nutrients. In general, the requirement for many nutrients decreases, concomitant with the decrease in energy needs. However, some nutrients are needed in higher amounts. Additionally, various psychosocial and socioeconomic changes that often attend aging may also alter dietary intake. Dietary planning is important part of nutritional care in the elderly. Also, some elderly persons can benefit with dietary supplements and oral nutritional supplements (enteral formulas) which can be prescribed by diagnosed or threatening malnutrition. Croatian guidelines for nutrition in the elderly have been developed by interdisciplinary expert group of Croatian clinicians, gerontologists, anthropologists, nutritionists and other professionals involved with care for elderly population. The guidelines are based on evidence from relevant medical literature and clinical experience of working group.
Studies 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, both qualitative (22) and quantitative (31) papers to provide a more complete understanding of the mechanisms underpinning the psychosocial factors influencing eating behaviours. An integrated 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, improvements in methodologies, and a summary of psychosocial barriers and enablers to eating well in later life.
Bone fragility is one of the possible complications of the diabetes, either type 1 (T1D) or type 2 (T2D). Bone fragility can affect patients of different age and with different disease severity depending on type of diabetes, disease duration and the presence of other complications. Fracture risk assessment should be started at different stages in the natural history of the disease depending on the type of diabetes and other risk factors. The risk of fracture in T1D is higher than in T2D, imposing a much earlier screening and therapeutic intervention that should also take into account a patient's life expectancy, diabetes complications etc. The therapeutic armamentarium for T2D has been enriched with drugs that may influence bone metabolism, and clinicians should be aware of these effects.
Considering the complexity of diabetes and osteoporosis and the range of variables that influence treatment choices in a given individual, the Working Group on bone fragility in patients with diabetes mellitus has identified and issued recommendations based on the variables that should guide screening of bone fragility and management of diabetes and bone fragility: (A)ge, (B)MD, (C)omplications (C), (D)uration of disease, & (F)ractures (ABCD&F). Consideration of these parameters may help clinicians identify the best time for screening, the appropriate glycaemic target and anti-osteoporosis drug for patients with diabetes at risk of or with bone fragility.
Background:
Older people are likely to develop anorexia of aging. Rostral C1 (rC1) catecholaminergic neurons in rostral ventrolateral medulla (RVLM) are recently discovered its role in food intake control. It is well established that these neurons regulate cardiovascular function.
Objective:
This study aims to determine the effect of age on the function of rostral C1 (rC1) neurons in mediating feeding response.
Method:
Male Sprague Dawley rats at 3-months (n = 22) and 24-months (n = 22) old were used and further divided into two subgroups; 1) treatment group with 2-deoxy-d-glucose (2DG) and 2) vehicle group. Feeding hormones such as cholecystokinin (CCK), ghrelin and leptin were analysed using enzyme-linked immunosorbent assay (ELISA). Rat brain was carefully dissected to obtain the brainstem RVLM region. Further analysis was carried out to determine the level of proteins and genes in RVLM that were associated with feeding pathway. Protein expression of tyrosine hydroxylase (TH), phosphorylated TH at Serine40 (pSer40TH), AMP-activated protein kinase (AMPK), phosphorylated AMPK (phospho AMPK) and neuropeptide Y Y5 receptor (NPY5R) were determined by western blot. Expression of TH, AMPK and NPY genes were determined by real-time PCR.
Results:
This study showed that blood glucose level was elevated in young and old rats following 2DG administration. Plasma CCK-8 concentration was higher in the aged rats at basal and increased with 2DG administration in young rats, but the leptin and ghrelin showed no changes. Old rats showed higher TH and lower AMPK mRNA levels. Glucoprivation decreased AMPK mRNA level in young rats and decreased TH mRNA in old rats. Aged rC1 neurons showed higher NPY5R protein level. Following glucoprivation, rC1 neurons produced distinct molecular changes across age in which, in young rats, AMPK phosphorylation level was increased and in old rats, TH phosphorylation level was increased.
Conclusion:
These findings suggest that glucose-counterregulatory responses by rC1 neurons at least, contribute to the ability of young and old rats in coping glucoprivation. Age-induced molecular changes within rC1 neurons may attenuate the glucoprivic responses. This situation may explain the impairment of feeding response in the elderly.
Purpose
The purpose of this paper is to explore older people’s food consumption experiences. Specifically, the paper seeks to provide understanding on the influence of food intake on consumer vulnerability and how this manifests within people’s lives.
Design/methodology/approach
The study adopts an interpretive, exploratory approach, utilising in-depth interviews with 20 older consumers in the United Kingdom. Thematic analysis is conducted, establishing patterns and contradictions with the data.
Findings
The findings demonstrate how biological, psychological, and social age-related changes can contribute to reduced food intake in later life. The loss of control over one’s consumption experiences as a result of inappropriate portion sizes acts as a source of both immediate and future vulnerability. Resultant food wastage can serve as an immediate reminder of negative associates with ageing, while the accumulative effect of sustained under-consumption contributing to increased frailty. As a result, consumer vulnerability can pervade other contexts of an individual’s life.
Practical implications
The research reveals opportunities for firms to utilise packaging development to reduce experiences of consumer vulnerability through reduced apportionment of packaged food products. However, this needs to be considered within a multi-demographic marketplace.
Originality/value
This paper contributes to literature by providing a unique lens with which to understand consumer vulnerability. The findings offer a developmental perspective on the experience of consumer vulnerability, revealing the stages of proximate, immediate, intermediate and ultimate vulnerability. This perspective has the potential to offer more detailed, nuanced insights into vulnerability in other contexts beyond food consumption.
This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years.
Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates.
There was an inverse relationship between body mass index and mortality; death rates were higher for those who weighed the least. Inclusion of covariates had trivial effects on these results. People who had lost 10% or more of their body weight since age 50 had a relatively high death rate. When that group was excluded, there was no remaining relationship between body mass index and mortality.
The association between higher body mass index and mortality often found in middle-aged populations was not observed in this large cohort of older adults. Over-weight does not seem to be a risk factor for 5-year mortality in this age group. Rather, the risks associated with significant weight loss should be the primary concern.
Social influences on eating were investigated by paying 63 adult humans to maintain 7-d diaries of everything they ingested, time, subjective hunger, and number of people present. Meals eaten with others contained more carbohydrate, fat, protein, and total calories; had smaller deprivation ratios; and had larger satiety ratios than meals eaten alone. The number of people present was positively correlated with meal size even when meals eaten alone were excluded. Adding the number of people present as a factor in a multiple-regression prediction of meal size more than doubled the variance accounted for, without altering the influence of other predictors, suggesting that social factors are associated independently with an increase in meal size. Meal size was positively correlated with the postmeal interval for meals eaten alone but not for meals eaten with other people. This suggests that social factors increase amounts eaten and disrupt postprandial regulation.
Nutrition status was evaluated in 134 consecutive admissions to a general medical service and throughout hospitalization among patients hospitalized 2 weeks or longer. Likelihood of malnutrition was determined using eight nutrition-related parameters: serum folate and vitamin C, triceps skinfold, weight/height, arm muscle circumference, lymphocyte count, serum albumin, and hematocrit. On admission 48% of patients had a high likelihood of malnutrition, which correlated with a longer hospital stay (20 versus 12 days for patients with a low likelihood of malnutrition) and an increased mortality rate (13 versus 4%). Likelihood of malnutrition increased with hospitalization in 69% of patients with paired determinations. Compared to admission, at final follow-up a greater proportion of patients fell into the depleted range of values for folate, triceps skinfold, weight/height, arm muscle circumference, lymphocyte count, and hematocrit. These parameters worsened in over 75% of patients admitted with normal values. Hematocrit fell in all patients with normal admission levels. These findings demonstrate and association between nutrition status and hospital course and a worsening trend during hospitalization.
It has been suggested that changes in fat-free weight may not fully explain the decline of resting metabolic rate (RMR) that occurs with aging. We therefore examined the hypothesis that a reduction in maximal aerobic capacity (VO2max) may partially explain the lower RMR in older men, after accounting for differences in fat-free weight and fat weight. We also considered differences in energy intake and plasma thyroid hormones as possible modulators of the age-related decline in RMR in men. Three-hundred healthy men (aged 17 to 78 years) were characterized for: (1) RMR (kcal/min) from indirect calorimetry; (2) body composition from underwater weighing; (3) maximal aerobic capacity from a test of VO2max; (4) plasma thyroid hormones (total triiodothyronine [T3], free T3, total thyroxine [T4], and free T4); and (5) estimated energy intake (kcal/d) from a 3-day food diary. A curvilinear decline of RMR with age was found (P less than .01), in which no relationship was found in men less than 40 years of age (r = .10, slope = 0.002 kcal/min/yr), whereas in men older than 40 years, RMR was negatively related to age (r = -.52, slope = -0.008 kcal/min/yr). After statistical control for differences in fat-free weight and fat weight, a negative relationship between age and RMR persisted (partial r = -.30, P less than .01). It was only after control for fat-free weight, fat weight, and VO2max (partial r = -.10, P greater than .05) that no association between age and RMR was noted.(ABSTRACT TRUNCATED AT 250 WORDS)
To determine the extent to which patients with objective signs of malnutrition had been diagnosed as such by physicians and the diagnosis documented in the medical record.
Cross-sectional.
All non-critically ill patients (n = 121) aged 70 years or older admitted to an Oslo hospital during a 3-week period.
Compared problem list and other elements of the medical record with observations of height, weight, triceps skinfold, midarm circumference, and arm-muscle circumference made on first weekday in hospital. Serum albumin available on 66 subjects.
Nine patients had weight/height ratios below 60% of normal, 16 patients between 60% and 75%, and 41 patients between 74% and 90% of normal. Of these 66 patients, only 24 were recognized as malnourished on admission, only five received nutritional support, and none was diagnosed as having malnutrition at the time of discharge.
Malnutrition is underdiagnosed and undertreated. The consequences of this are likely to be deleterious to health.
The authors studied distributions of body weight for height, change in body weight with age, and the relationship between body mass index and mortality among participants in the Epidemiologic Follow-up Study of the first National Health and Nutrition Examination Survey (NHEFS) (n = 14,407), a cohort study based on an representative sample of the U.S. population. Percentiles of body weight for height according to age and sex are presented. Cross-sectional analyses of body weight suggest that mean body weight increases with age until late middle age, then plateaus and decreases for older aged persons. However, longitudinal analysis of change in weight with age shows that younger persons in the lower quintile at baseline tend to gain more than those in the higher quintile. Older persons in the higher quintile at baseline have the greatest average loss in weight. The relationship of body mass index to mortality is a U-shaped curve, with increased risks in the lowest and highest 15% of the distribution. Increased risk of mortality associated with the highest 15th percentile of the body mass index distribution, as well as the highest 15% of the joint distribution of body mass index and skinfold thickness, is statistically significant for white women. However, the risk diminishes when adjusted for the presence of disease and factors related to disease. More noteworthy is the fact that there is a statistically significant excess risk of mortality for both race and sex groups in the lowest 15% of the body mass index distribution after adjusting for smoking history, and presence of disease. Those in the lowest 15% of the joint body mass index and skinfold thickness distribution, were also at increased risk. Risk of mortality for both men and women who have lost 10% or more of their maximum lifetime weight within the last 10 years is statistically significant, even when controlling for current weight. This study has replicated previously reported relationships, while correcting for several methodological issues.
Due to increasing evidence for the role of nutrition as a cause of illness and of the efforts of health agencies to induce Americans to change their diets, it is important to monitor populations for changes in their nutrient intakes. Seven-day diet records were collected from 105 free-living men in the 1960s, 1970s, and 1980s. Age range was initially 27 to 65 and finally 50 to 88 years. The men were divided into age groups so that longitudinal, time series, and cross-sectional analyses could distinguish among differences due to aging, cohort, and secular change. Longitudinal decreases over three decades of time include height, intakes of kcal/day, kcal/kg, kcal from fat, and cholesterol (all p less than .0001). Longitudinal increases over time include body weight, intakes of kcal from alcohol (p = .002), kcal from carbohydrate, and polyunsaturated to saturated fatty acid ratio (P/S) (all p less than .0001). Values that correlated cross-sectionally with age in the 1960s were height, kcal/day, kcal/kg, kcal from protein, and P/S ratio; height, intakes of kcal from protein, and fiber in the 1970s; and body weight, height, intakes of kcal from carbohydrate and fiber in the 1980s (all p less than .05). Protein consumption remained constant while carbohydrate increased as time passed. The more striking secular changes were in type and amount of fat consumed (42% to 34% of kcal, a 37% decline in cholesterol and a 72% increase in P/S ratio). Voluntary changes in the diets of these community-dwelling men indicate that, at any age, men can make beneficial changes in intake of nutrients that affect health.
Weight loss and anorexia occur commonly in the elderly. While in many cases the anorexia can be attributed to associated disease processes, it does appear that a true anorexia of aging exists. Animal studies have suggested that older rodents have an excessive satiety effect of cholecystokinin and a decreased opioid feeding drive. Other older persons develop anorexia in association with depression. In these subjects, excess corticotropin-releasing factor may be the neurotransmitter involved in the pathogenesis of the anorexia. In Alzheimer's disease, decreases in norepinephrine and neuropeptide Y may be involved in the anorexia seen in the these patients.