Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments

Association between Intrinsic Capacity and Sarcopenia in Hospitalized Older Patients

OBJECTIVES

This study aimed to clarify the association between intrinsic capacity (IC) and sarcopenia in hospitalized older patients.

DESIGN

A cross-sectional study.

SETTING

Hospital-based.

PARTICIPANTS

This study included 381 inpatients aged ≥ 60 years (225 men and 156 women).

MEASUREMENTS

IC was evaluated in five domains defined by the World Health Organization: cognition (Mini-Mental State Examination), locomotion (Short Physical Performance Battery test), vitality (Short-Form Mini Nutritional Assessment), sensory (self-reported hearing and vision) and psychological (5-item Geriatric Depression Scale) capacities. IC composite score (0-5) was calculated based on five domains, with lower scores representing greater IC. Sarcopenia was defined in accordance with the criteria recommended by the Asian Working Group for Sarcopenia (AWGS) 2019. Multiple linear and logistic regressions were performed to explore the associations between IC composite score and IC domains with sarcopenia and its defining components.

RESULTS

The mean age of 381 patients included was 81.95±8.42 years. Of them, 128 (33.6%) patients had sarcopenia. The median IC composite score was 1 (1, 2). Cognition, locomotion, vitality, sensory and psychological capacities were impaired in 22.6%, 63.5%, 18.9%, 27.3% and 11.3% of patients. Multiple linear regression analyses showed that favorable IC domain scores in cognition, locomotion and vitality were associated with a stronger handgrip strength. A higher vitality score was associated with a greater appendicular skeletal muscle mass index (ASMI), and a higher locomotion score was associated with a greater gait speed. The multiple logistic regression analysis showed that only vitality impairment was associated with sarcopenia. A higher IC composite score was associated with higher risks of sarcopenia, as well as low ASMI, handgrip strength and gait speed.

CONCLUSION

This study indicated that a more serious impairment of IC was associated with a greater risk of sarcopenia. Vitality was the domain most strongly associated with sarcopenia. IC may be employed to detect and manage sarcopenia.

Untangling the Complex Interplay between Social Isolation, Anorexia, Sarcopenia, and Mortality: Insights from a Longitudinal Study

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.

Age-Related Changes in Central Nervous System 5-Hydroxytryptamine Signalling and Its Potential Effects on the Regulation of Lifespan

Serotonin or 5-hydroxytryptamine (5-HT) is an important neurotransmitter in the central nervous system and the periphery. Most 5-HT (~99%) is found in the periphery where it regulates the function of the gastrointestinal (GI) tract and is an important regulator of platelet aggregation. However, the remaining 1% that is found in the central nervous system (CNS) can regulate a range of physiological processes such as learning and memory formation, mood, food intake, sleep, temperature and pain perception. More recent work on the CNS of invertebrate model systems has shown that 5-HT can directly regulate lifespan.This chapter will focus on detailing how CNS 5-HT signalling is altered with increasing age and the potential consequences this has on its ability to regulate lifespan.

Protein and Energy Supplements for the Elderly

The proportion of elderly individuals is rising globally, and data have shown that as high as 8% of the elderly community suffer from malnutrition. Protein energy malnutrition has shown to elevate morbidity and mortality risk in the elderly; therefore, protein and energy supplement are needed for the elderly populations to create healthy conditions. This chapter describes about general structure of protein, protein turnover, amino acid metabolism including metabolism in the elderly, protein change in aging, supplementation of amino acid as well as vitamin and mineral for the elderly. The discussion in this section aims to provide a general description of protein, amino acids, changes in amino acid metabolism in the elderly, and the benefits of supplementing amino acids as well as vitamins and minerals for the elderly.

Nutrition in Conservative Kidney Management: From Evidence to Practice

Conservative kidney management (CKM) is a treatment option for kidney failure, particularly for the elderly and those with co-morbidities. Dietitians can play an important role in the provision of CKM by enhancing patients' quality of life through the management of nutrition impact symptoms (symptoms that result in decreased eating, including anorexia, nausea, dry mouth, and taste changes), as well as symptoms that result from malnutrition, including fatigue, weakness, activity intolerance, slow wound healing, and low mood. There are many gaps in the literature regarding optimal nutritional recommendations for patients on CKM. More research is needed on symptom management and interventions to delay or slow the progression of malnutrition and frailty. This article provides an overview of important nutritional considerations, a synthesis of the current literature, and recommendations for application of evidence into the practice of CKM.

Mood and physical activity are associated with appetite in hospitalised older men and women

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.

Anorexia of Aging: Metabolic Changes and Biomarker Discovery

The age-associated decrease in appetite and food intake is referred to as "anorexia of aging". Older adults with anorexia show changes in the quantity/quality of energy supplied to the organism which eventually may cause a mismatch between ingested calories and physiological energy demands. Therefore, a state of malnutrition and impaired metabolism may ensue which renders older people more vulnerable to stressors and more prone to incur negative health outcomes. These latter cover a wide range of conditions including sarcopenia, low engagement in physical activity, and more severe consequences such as disability, loss of independence, hospitalization, nursing home placement, and mortality. Malnutrition has been recognized by the European Society of Clinical Nutrition (ESPEN) among the chief risk factors for the development of frailty. Frailty refers to a state of increased vulnerability to stressors stemming from reduced physiologic reserve, and according to ESPEN, is also nutrition-based. Alike frailty, anorexia is highly prevalent among older adults, and its multifactorial nature includes metabolic changes that develop in older age and possibly underly the condition. Circulating factors, including hormones (eg, cholecystokinin, ghrelin, leptin, and inflammatory and microbial mediators of gut dysbiosis), have been proposed as biomarkers for this condition to support early identification and develop personalized nutritional interventions. Additional studies are needed to untangle the interrelationship between gut microbiota and appetite regulation in older adults operating through brain-gut crosstalk. Furthermore, the contribution of the genetic background to appetite regulation and specific nutritional needs warrants investigation. Here, we provide an overview on anorexia of aging in the context of age-related metabolic changes. A special focus is placed on candidate biomarkers that may be used to assist in the early identification of anorexia of aging and in the development of personalized nutritional counseling.

Nutrition in the prevention and management of sarcopenia - A special focus on Asian Indians

Sarcopenia, characterized by loss of muscle mass and strength, is common in advanced old age but can be accelerated by chronic disease, malnutrition and physical inactivity. Early initiation of intervention to achieve and maintain a higher peak muscle mass and strength may allow for prevention or delay of sarcopenia and facilitate independent living even in old age. In this context, malnutrition, a significant contributor to sarcopenia, is often overlooked among the Indian population. Maintenance of an optimal energy and protein balance with adequate physical activity level is essential to preserve physical function in the aging population. However, research on the role of micronutrients in muscle maintenance, is still in its infancy. This narrative review, therefore, aims to explore the current status of International and Indian research on the role of nutrition in sarcopenia mitigation and the way forward.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression

PURPOSE

The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world.

METHODS

An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex.

RESULTS

Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased.

CONCLUSIONS

These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment.

LEVEL OF EVIDENCE

I, systematic review and meta-analysis.

Appetite and quality of life in amyotrophic lateral sclerosis: A scoping review

Loss of appetite is related to undesirable loss of weight in amyotrophic lateral sclerosis (ALS) and affects up to two thirds of people with this disease. Little is known about the instruments used to measure appetite loss, its impact on quality of life (QoL), or strategies used to improve loss of appetite. In this study we aim to characterize the existing literature on the symptom of appetite loss in ALS through a systematic scoping review following the framework by Arksey and O'Malley and PRISMA guidelines. Studies assessing appetite in people with ALS (pALS) published in English and indexed on Web of Science, PubMed, and Scopus databases were included. A total of 156 full references were identified, of which 10 articles met the inclusion criteria and were eligible for data synthesis after screening. Seven unique instruments were used to assess appetite across the included studies, most commonly the Council of Nutrition Appetite Questionnaire. No studies included a subjective assessment of appetite loss. A total of 12 unique potential associated factors across five studies were identified. QoL was measured in seven studies using nine different QoL measurement tools. Few studies measure appetite in pALS and there is no consensus on the assessment tool used. Few studies evaluated the impact of appetite as a symptom on QoL. Furthermore, the heterogeneity of outcomes and risk factors of the existing data limit the clinical application of these findings. Future studies are needed to guide clinical management and interventions for people with ALS and appetite loss.

Recent advances in cell-based and cell-free therapeutic approaches for sarcopenia

Sarcopenia is a progressive loss of muscle mass and function that is connected with increased hospital expenditures, falls, fractures, and mortality. Although muscle loss has been related to aging, injury, hormonal imbalances, and diseases such as malignancies, chronic obstructive pulmonary disease, heart failure, and kidney failure, the underlying pathogenic mechanisms of sarcopenia are unclear. Exercise-based interventions and multimodal strategies are currently being considered as potential therapeutic approaches to prevent or treat these diseases. Although drug therapy research is ongoing, no drug has yet been proven to have a substantial safety and clinical value to be the first drug therapy to be licensed for sarcopenia. To better understand the molecular alterations underlying sarcopenia and effective treatments, we review leading research and available findings from the systemic change to the muscle-specific microenvironment. Furthermore, we explore possible mechanisms of sarcopenia and provide new knowledge for the development of novel cell-free and cell-based therapeutics. This review will assist researchers in developing better therapies to improve muscle health in the elderly.

Recognising eating disorders in older people

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.

Protein Intake and Oral Health in Older Adults-A Narrative Review

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein-energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.

Dietary-Physical Activity Patterns in the Health Context of Older Polish Adults: The 'ABC of Healthy Eating' Project

The study aimed to analyze the dietary–physical activity patterns (D-PAPs) in the health context of Polish people aged 60+ years. A total of 418 respondents across Poland were recruited; however, the final analysis included 361 women and men aged 60–89 years old. D-PAPs were derived using a principal component analysis (PCA); input variables were the frequency of consumption of 10 food groups and physical activity. Finally, three D-PAPs were identified: ‘Pro-healthy eating and more-active’, ‘Sweets, fried foods and sweetened beverages’, and ‘Juices, fish and sweetened beverages’. We developed the Functional Limitations Score (FLS) using the Mini Nutritional Assessment (MNA^®). A logistic regression was applied to verify the association between the D-PAPs and health-condition outcomes. Older adults were more likely to adhere to the upper tertile of the ‘Pro-healthy eating and more-active’ pattern, with good/better self-reported health status in comparison with their peers (OR = 1.86) or with good/very good self-assessed appetite (OR = 2.56), while this was less likely for older adults with malnutrition risk (OR = 0.37) or with a decrease in food intake (OR = 0.46). Subjects with a decrease in food intake (OR = 0.43), who declared a recent weight loss (OR = 0.49), or older adults in the upper tertile of the FLS (OR = 0.34) were less likely to adhere to the upper tertile of the ‘Sweets, fried foods and sweetened beverages’ pattern. The decrease in food intake due to a loss of appetite or chewing or swallowing difficulties was inversely associated with the ‘Pro-healthy eating and more-active’ pattern characterized by a relatively high frequency of consumption of vegetables, fruit, water, dairy, and grains and a high physical activity. In the interest of the good nutritional status and health of older adults, special attention should be paid to removing limitations in meal consumption, including improved appetite.

Nutritional Aspects of Healthy Aging

Proper nutrition and healthy eating are key determinants of healthy aging. In older age, energy requirements decrease, yet micronutrient requirements stay the same or increase, which make older adults susceptible to nutrient deficiencies. Therefore, it is important to encourage older adults to consume nutrient-dense foods. Many older adults do not maintain proper hydration, so adequate water intake should also be encouraged. Most older adults have multiple chronic diseases that may influence their dietary intake and nutritional needs. However, currently, our understanding of how individual chronic diseases and their associated treatments influence dietary requirements is limited.

Protein Intake and Frailty in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

Background: The present systematic review and meta-analysis investigated the cross-sectional and longitudinal associations between protein intake and frailty in older adults. Methods: We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association between protein intake and frailty in older adults. Cross-sectional, case-control, and longitudinal cohort studies that investigated the association between protein intake and frailty as a primary or secondary outcome in people aged 60+ years were included. Studies published in languages other than English, Italian, Portuguese, or Spanish were excluded. Studies were retrieved on 31 January 2022. Results: Twelve cross-sectional and five longitudinal studies that investigated 46,469 community-dwelling older adults were included. The meta-analysis indicated that absolute, bodyweight-adjusted, and percentage of protein relative to total energy consumption were not cross-sectionally associated with frailty. However, frail older adults consumed significantly less animal-derived protein than robust people. Finally, high protein consumption was associated with a significantly lower risk of frailty. Conclusions: Our pooled analysis indicates that protein intake, whether absolute, adjusted, or relative to total energy intake, is not significantly associated with frailty in older adults. However, we observed that frail older adults consumed significantly less animal protein than their robust counterparts.

Efficacy and Safety of Megestrol in the Hospitalized Older Person

Objectives To evaluate the efficacy and safety of megestrol for off-label use in older patients with weight loss. Design Retrospective, nonblinded cohort study. Setting Upstate University Hospital is a 420-bed facility and academic medical center with a level 1 trauma center. Upstate Community Hospital is a 314-bed acute care/hospital/ambulatory care center and long-term care hospital that also provides teaching services. Participants Patients 65 years of age and older without malignancy or acquired immunodeficiency syndrome who were initiated and continued megestrol therapy at the Upstate University hospitals for at least two weeks were included. Of the 1,290 patients initially screened, 16 patients on megestrol were evaluated. An age- and gender-matched control group of 16 patients was utilized for comparison of changes in weight and other variables. Interventions Patients in the megestrol group have received daily doses of megestrol between 160 mg to 800 mg for an average duration of 19 days. Patients in the control group had no history or current use of megestrol utilization. Main Outcome Measurements The primary outcome was an increase in weight. Secondary outcome measures included albumin and thromboembolic events. Changes in weight and albumin were also compared with the control group. Results At a mean duration of 19 days, there was no significant difference in weight gain (0.95 kg, OR = 1.33 [95% CI -1.615-3.527]). Albumin decreased by (0.4 g/dL OR = 0.916 [95% CI 0.12-0.78]) and none of the patients developed a thromboembolic event. Conclusion In older hospitalized patients, megestrol did not increase weight, and did not improve albumin. No thromboembolic events were observed, but this may be because of a limited duration of observation of therapy and the routine use of anticoagulation prophylaxis in the inpatient setting.

Protein and Sport: Alternative Sources and Strategies for Bioactive and Sustainable Sports Nutrition

Nutrition and sport play an important role in achieving a healthy lifestyle. In addition to the intake of nutrients derived from the normal diet, some sport disciplines require the consumption of supplements that contribute positively to improved athletic performance. Protein intake is important for many aspects related to health, and current evidence suggests that some athletes require increased amounts of this nutrient. On the other hand, society's demand for more environmentally friendly products, focus on the search for alternative food sources more sustainable. This review aims to summarize the latest research on novel strategies and sources for greener and functional supplementation in sport nutrition. Alternative protein sources such as insects, plants or mycoproteins have proven to be an interesting substrate due to their high added value in terms of bioactivity and sustainability. Protein hydrolysis has proven to be a very useful technology to revalue by-products, such as collagen, by producing bioactive peptides beneficial on athletes performance and sport-related complications. In addition, it has been observed that certain amino acids from plant sources, as citrulline or theanine, can have an ergogenic effect for this target population. Finally, the future perspectives of protein supplementation in sports nutrition are discussed. In summary, protein supplementation in sports nutrition is a very promising field of research, whose future perspective lies with the search for alternatives with greater bioactive potential and more sustainable than conventional sources.

It's not only swallowing: a clinician primer to adult food refusal beyond dysphagia

PURPOSE OF REVIEW

Medical teams are frequently faced with challenging clinical scenarios when their patients exhibit reduced intake of food and drink. Speech-language pathologists, who serve as oropharyngeal swallowing specialists in medical settings, are frequently the first to be summoned with the referral, 'Poor PO intake. Please evaluate and treat.' As our practices have illuminated, many differentials other than oropharyngeal dysphagia are often at play.

RECENT FINDINGS

Changes to taste, salivary supply/dry mouth, hunger drive, and psychosocial circumstances will significantly impact intake per os - each scenario to be explored further in this paper. Consequences to diminished nutrition and hydration include medical complications, lengthier hospital stays, and diminished quality of life.

SUMMARY

In this review, two medical speech-language pathologists detail more common alternative diagnoses that explain reduced intake by mouth amongst adults with acute and chronic diseases. Ultimately, a multidisciplinary approach should be considered when evaluating such patients to ensure a comprehensive and effective care plan.

Perspective: Role of Micronutrients and Omega-3 Long-Chain Polyunsaturated Fatty Acids for Immune Outcomes of Relevance to Infections in Older Adults-A Narrative Review and Call for Action

The immune system is weakened by advancing age, often referred to as immunosenescence, increasing the vulnerability to, and frequently the severity of, infectious diseases in older people. This has become very apparent in the current coronavirus disease 2019 (COVID-19) pandemic for which older people are at higher risk of severe outcomes, even those who are fully vaccinated. Aging affects both the innate and adaptive immune systems and is characterized by an imbalanced inflammatory response. Increasing evidence shows that optimal status of nutrients such as vitamins C, D, and E and selenium and zinc as well as the omega-3 (n-3) fatty acids DHA and EPA can help compensate for these age-related changes. While inadequate intakes of these nutrients are widespread in the general population, this is often more pronounced in older people. Maintaining adequate intakes is a challenge for them due to a range of factors such as physical, physiological, and cognitive changes; altered absorption; and the presence of noncommunicable diseases. While nutritional requirements are ideally covered by a balanced diet, this can be difficult to achieve, particularly for older people. Fortified foods and nutritional complements are effective in achieving adequate micronutrient intakes and should be considered as a safe and cost-effective means for older people to improve their nutritional status and hence support their defense against infections. Complementing the diet with a combination of micronutrients, particularly those playing a key role in the immune system such as vitamins C, D, and E and selenium and zinc as well as DHA and EPA, is recommended for older people. Optimal nutrition to support the immune system in older people will remain essential, particularly in the face of the current COVID-19 pandemic and, thus, developing strategies to ensure adequate nutrition for the growing number of older adults will be an important and cost-effective investment in the future.

Relationship between physical function at discharge and hospital meal intake in elderly patients with heart failure

The relationship between low physical function (LPF) at discharge and food intake percentage (FIP) during hospitalization is unclear. We aimed to clarify the relationship between LPF at discharge and FIP and the change in nutritional status during hospitalization in elderly patients with heart failure (HF), and determine cutoff values for FIP and change in nutritional status during hospitalization. We included 431 consecutive patients aged ≥ 65 years who were hospitalized for HF and underwent cardiac rehabilitation (CR) from 2017 to 2019. Physical function at discharge was classified into two groups according to the Short Performance Physical Battery (SPPB): low physical function (LPF) (SPPB ≤ 9) and high physical function (HPF) (SPPB > 9). We compared background, clinical parameters, pre-hospital walking level, CR progress, nutritional factors during hospitalization including FIP of the main dish and side dish, and changes in nutritional status using the Geriatric Nutritional Risk Index (ΔGNRI) at admission and discharge. Multiple logistic regression analysis was also performed. The final analysis included 213 patients (age, 81.6 years) divided into the LPF (n = 136) and HPF groups (n = 77). The LPF group showed low FIP and a high ΔGNRI value. Multivariate analysis showed FIP main dish, ΔGNRI, worsening renal function, pre-hospital walking level, and days to start of walking to be factors influencing LPF at discharge. Respective cutoff values for FIP main dish and ΔGNRI predicting LPF at discharge were 82.2% and 4.24. FIP main dish during hospitalization and ΔGNRI were associated with LPF at discharge.

Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report

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.

Diet Diversity Through the Life-Course as an Opportunity Toward Food Allergy Prevention

The prevalence of food allergies (FA) is increasing worldwide. Generally, the onset of allergies, including FA, begins in early childhood and may persist and/or develop through the life-course. Even though epidemiological studies have focused mainly on children, allergies can also occur for the first-time during adulthood. Within the prolongation of life, it is expected that allergies will be encountered more often even in older people. Recent findings suggest that an early exposure to diverse food antigens may promote the development of immune tolerance. Accordingly, diet diversity during the first year of life or even earlier may have a positive impact on the prevention of allergies. The anti-inflammatory properties of some dietary nutrients may positively contribute to a tolerogenic immune environment too. Diet diversity is associated with a more favorable microbiome, and increasing evidence suggests a promising role of gut microbiota manipulation in inducing immune tolerance. Unjustified avoidance of allergenic foods may expose to intakes of some nutrients below recommended levels through the life-course, even more in cases of self-diagnosis and treatment of presumed forms of food intolerance. Nutritional strategies including the early exposure to a variety of food antigens are a promising area of research for preventive purposes through the life-course possibly extending positive outcomes to older stages. The aim of this paper is to highlight the role of diet diversity in preventing the development of FA starting in early life, as well as to provide an overview of the main strategies to prevent related nutritional issues throughout the life-course.

The lack of opportunity to eat together is associated with an increased risk of weight loss among independent older adults: a prospective cohort study based on the JAGES

OBJECTIVE

the present study aimed to investigate the relationship between the frequency of eating together and the risk of weight loss in older adults.

METHODS

this was a three-year follow-up prospective cohort study based on a self-reported questionnaire. We used data from the Japan Gerontological Evaluation Study (JAGES) conducted in 2016 and 2019. The participants were independent older adults aged ≥65 years in Japan. We used >5% weight loss during follow-up as the outcome variable and frequency of eating together as the explanatory variable. The relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated based on the Poisson regression model with a Huber-White sandwich estimator for standard errors, including possible confounders.

RESULTS

among 56,919 participants, the mean age was 73.0 years (1SD = 5.5) at baseline, and 47.9% were male. About 15.1% (n = 8,596) of the participants experienced >5% weight loss during follow-up. The proportion of each category of the eating together frequency was 36.6% for 'every day', 10.3% for 'several times a week', 26.8% for 'several times a month', 20.5% for 'several times a year' and 5.8% for 'seldom'. Compared to 'every day', only 'several times a year (RR = 1.07, 95% CI = 1.01-1.13)' and 'seldom (RR = 1.17, 95% CI = 1.08-1.27)' were significantly associated with the increased risk of >5% weight loss.

CONCLUSION

there is a temporal association between less frequent opportunities to eat together and the increased risk of weight loss among independent older adults.

Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review

Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.

Perspective: Vegan Diets for Older Adults? A Perspective On the Potential Impact On Muscle Mass and Strength

Consumers are increasingly encouraged to consume more plant-based foods and lower their consumption of foods from animal origin. Concurrently, older adults are recommended to consume an adequate amount of high-quality dietary protein for the prevention of age-related muscle loss. In the current Perspective article, we discuss why it may not be preferred to consume a vegan diet at an older age. Our perspective is based on the proposed lower bioavailability and functionality of proteins in a vegan diet due to the matrix of the whole-food protein sources, the lower essential amino acid (EAA) content, and specific EAA deficiencies in proteins derived from plant-based foods. We propose that a vegan diet increases the risk of an inadequate protein intake at an older age and that current strategies to improve the anabolic properties of plant-based foods are not feasible for many older adults. We provide recommendations for further research to substantiate the remaining knowledge gaps regarding the consequences of a vegan diet on skeletal muscle mass and strength at an older age.

Sarcopenia Is a Cause and Consequence of Metabolic Dysregulation in Aging Humans: Effects of Gut Dysbiosis, Glucose Dysregulation, Diet and Lifestyle

Skeletal muscle mass plays a critical role in a healthy lifespan by helping to regulate glucose homeostasis. As seen in sarcopenia, decreased skeletal muscle mass impairs glucose homeostasis, but it may also be caused by glucose dysregulation. Gut microbiota modulates lipopolysaccharide (LPS) production, short-chain fatty acids (SCFA), and various metabolites that affect the host metabolism, including skeletal muscle tissues, and may have a role in the sarcopenia etiology. Here, we aimed to review the relationship between skeletal muscle mass, glucose homeostasis, and gut microbiota, and the effect of consuming probiotics and prebiotics on the development and pathological consequences of sarcopenia in the aging human population. This review includes discussions about the effects of glucose metabolism and gut microbiota on skeletal muscle mass and sarcopenia and the interaction of dietary intake, physical activity, and gut microbiome to influence sarcopenia through modulating the gut–muscle axis. Emerging evidence suggests that the microbiome can regulate both skeletal muscle mass and function, in part through modulating the metabolisms of short-chain fatty acids and branch-chain amino acids that might act directly on muscle in humans or indirectly through the brain and liver. Dietary factors such as fats, proteins, and indigestible carbohydrates and lifestyle interventions such as exercise, smoking, and alcohol intake can both help and hinder the putative gut–muscle axis. The evidence presented in this review suggests that loss of muscle mass and function are not an inevitable consequence of the aging process, and that dietary and lifestyle interventions may prevent or delay sarcopenia.

Validation of the functional assessment of anorexia/cachexia therapy instrument to assess quality of life in maintenance hemodialysis patients with cachexia

BACKGROUND

Many patients on maintenance hemodialysis (MHD) eventually suffer from cachexia. The Functional Assessment of Anorexia/Cachexia Therapy (FAACT) is a tool used to evaluate the quality of life of patients with cachexia related to various diseases, but its suitability for use in MHD patients has yet to be verified. This study aimed to explore the validation of the FAACT in MHD patients by conducting reliability and validity tests.

METHODS

Qualified MHD patients were selected to complete the FAACT and Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaires, and their demographic data and biochemical test results were collected from electronic medical records. Next, the Cronbach's alpha coefficient, paired sample t test and ICC were used to analyze the scale consistency. Additionally, the association between the KDQOL-36 and FAACT was analyzed using Bland-Altman plots and Pearson correlation analysis. Finally, the patients were divided into groups to evaluate discriminant validity.

RESULTS

A total of 299 patients were included in this study. The Cronbach's alpha coefficients of the FAACT and its anorexia-cachexia subscale (ACS) were 0.904 and 0.842, respectively, and their ICC exceeded 0.90. The correlation coefficients between the FAACT and its items ranged from 0.146 to 0.631, and the correlation coefficients between the FAACT and KDQOL-36 dimensions ranged from 0.446 to 0.617. The Bland-Altman plots between the FAACT and KDQOL-36 showed that only 3.3% of the points were outside the 95% limits of agreement. The effects of cachexia status (present or absent) on FAACT and ACS scores had effect sizes of 0.54 (P < 0.001) and 0.60 (P < 0.001), respectively. The FAACT and ACS also significantly discriminated between patients with and without inflammation (P < 0.001).

CONCLUSIONS

The FAACT and ACS have acceptable reliability and validity in MHD patients and are suitable for measuring the quality of life of MHD patients with cachexia.

Calorie restriction or dietary restriction: how far they can protect the brain against neurodegenerative diseases?

Finding the correct nutritional intervention is one of the biggest challenges in treating patients with neurodegenerative diseases. In general, these patients develop strong metabolic alterations, resulting in lower treatment efficacy and higher mortality rates. However, there are still many open questions regarding the effectiveness of dietary interventions in neurodiseases. Some studies have shown that a reduction in calorie intake activates key pathways that might be important for preventing or slowing down the progression of such diseases. However, it is still unclear whether these neuroprotective effects are associated with an overall reduction in calories (hypocaloric diet) or a specific nutrient restriction (diet restriction). Therefore, here we discuss how commonly or differently hypocaloric and restricted diets modulate signaling pathways and how these changes can protect the brain against neurodegenerative diseases.

Chronic gastric dilatation with gastric fundus perforation in anorexia nervosa patient

INTRODUCTION

As a complication of anorexia or bulimia nervosa, gastrointestinal problems such as stomach dilatation and necrosis are extremely rare. Our purpose is this case to pay attention on anorexia and bulimia patients to envisage the occurrence of chronic digestive injuries by performing the accurate diagnosis and selective prompt treatment.

CASE PRESENTATION

A 40-year old female patient admitted to the emergency department with complaints of digestive symptoms. In his history there was just anorexia nervosa. Computed tomography and X-rays showed major gastric distension reaching the pelvis and perforation of the fundus. The large curvature of the stomach and the necrotic part was removed surgically. But the patient died in the second day after admission in the hospital because he was affected by a septic shock as a complication of distribution the infection because the doctors didn't resect whole the stomach during the open surgery.

DISCUSSION

We report a rare case that shows gastric dilatation and necrosis post-anorexia nervosa, which requires accurate X-ray and CT scan, but treatment depends on whether or not gastric necrosis is present and the size of the necrosis. According to what mentioned in the medical literature this is the second case that cause death of the patient after surgery for treatment the gastric dilatation as a complication of anorexia nervosa.

CONCLUSION

The thing that distinguishes this case is the large size of the extension of the stomach from the diaphragm to the pelvis and the perforation of the fundus with a diameter of 5 cm and the death of the patient after surgery, so we can add it in the medical literature to avoid the complications of these psychiatric diseases.

Kampo formulas alleviate aging-related emotional disturbances and neuroinflammation in male senescence-accelerated mouse prone 8 mice

Aging-induced neuroinflammation, also known as neuroinflammaging, plays a pivotal role in emotional disturbances, including depression and anxiety, in older individuals, thereby leading to cognitive dysfunction. Although numerous studies have focused on therapeutic strategies for cognitive impairment in older individuals, little research has been performed on treating its preceding emotional disturbances. Here, we examined whether Kampo formulas (kososan [KS], nobiletin-rich kososan [NKS], and hachimijiogan [HJG]) can ameliorate aging-induced emotional disturbances and neuroinflammation in mice. The depression-like behaviors observed in SAMP8 mice, relative to normally aging SAMR1 mice, were significantly prevented by treatment with Kampo formulas for 13 weeks. Western blot analysis revealed that hippocampal neuroinflammation was significantly abrogated by Kampo formulas. KS and NKS also significantly attenuated the hippocampal neuroinflammatory priming induced by lipopolysaccharide (LPS, 0.33 mg/kg, i.p.) challenge in SAMP8 mice. Hippocampal IL-1β, IL-6, and MCP-1 levels were significantly decreased in NKS-treated SAMP8 mice. KS and NKS showed significantly reduced tau accumulation in the brains of SAMP8 mice. RNA-sequencing revealed that each Kampo formula led to unique dynamics of hippocampal gene expression and appeared to abrogate hippocampal inflammatory responses. HJG significantly blocked the LPS-induced increase in serum IL-6 and MCP-1. These results suggest that Kampo formulas would be useful for treating aging-induced depression, in part by regulating neuroinflammatory pathways. This finding may pave the way for the development of therapeutic strategies for aging-related emotional disturbances, which may contribute to the prevention of cognitive dysfunction in older individuals.

Factors Affecting Adherence, Intake, and Perceived Palatability of Oral Nutritional Supplements: A Literature Review

Oral nutritional supplements (ONS) are a clinically effective and relatively inexpensive way to supplement the diet of patients with, or at risk of, undernutrition. Good adherence is a primary determinant of the effectiveness of ONS. However adherence can be problematic for those with the greatest clinical need, such as undernourished older adults. This review aimed to appraise the available literature for the factors (contextual, personal and product related) affecting patient adherence and perceived palatability of ONS, identify areas requiring improvement and uncover gaps in the evidence to guide the focus of future research. Contextual factors identified were healthcare staff and the timing of administration. Personal factors included sensory changes and motivation which alter experience of and desire to consume ONS. The product's sensory characteristics determined palatability and intake, but undesirable attributes, such as off-flavours, can stem from nutritional ingredients. The contribution made by aroma to older adults' experience of ONS was a comparatively under-researched area. Further research should address this evidence gap to optimise the flavour, aroma profile and palatability for undernourished older consumers, thereby optimising intake. A combined multidisciplinary effort involving strategic expansion of research, industry development and clinical practice should simultaneously address the factors identified, to provide the best approach to improve adherence.

Nutritional Status and Serum Levels of Micronutrients in an Elderly Group Who Participate in the Program for Complementary Food in Older People (PACAM) from the Metropolitan Region, Santiago de Chile

The increase in the Chilean elderly population has promoted public policies to favor an adequate nutrition in later life. This study evaluated the nutritional status, micronutrients intake and serum micronutrients levels of an elderly group beneficiary of the PACAM from the Metropolitan Region, Santiago de Chile. Anthropometric and dietary survey (24 h food recalls) were assessed in 182 elderly individuals (60 and 80 years old). Blood serum collection was used to measure the micronutrient status. The sample was comprised by 12.6%, 46.1%, 28.0% and 13.2% of underweight, normal weight, overweight and obese subjects, respectively. Women presented 11% of underweight, 45% of normal weight and 44% of overweight and obese, while men—18%, 50% and 32%, respectively. Only the 63% of the elderlies consumed PACAM foods, reaching average daily intakes below (50%) the recommended daily serving. Serum deficiencies of 25-hydroxyvitamin D (88%), vitamin B₁₂ (33%) and calcium (36%) were observed, being the highest ones in the PACAM foods women (60–75 years old). Chilean elderlies presented mainly a normal weight; however, an important proportion of overweight/obese subjects was observed. Although PACAM foods consumption significantly increased the micronutrient intake, it was not enough to ensure an adequate serum micronutrient levels in the elderly.

The Effects of Exercise on Appetite in Older Adults: A Systematic Review and Meta-Analysis

Background: The effect of physical activity and exercise on hunger and satiety has been well-studied in younger adults, but the influence of aging is less understood. While some evidence suggests that acute bouts of exercise induce a compensatory eating drive, long-term activity may improve satiety sensitivity. The objective of this study was to investigate the effects of exercise on appetite in older adults.

Methods: We systematically reviewed available literature investigating the effect of exercise on appetite in older adults adults (CRD42020208953). PubMed, PsycINFO, Academic Search Complete, the Sports Medicine & Education Index, and Web of Science, were searched for peer-reviewed articles published in English with no date restriction. Included studies implemented a primary exercise or physical activity intervention with a control group, on a generally healthy population ≥60 years of age. Selected studies included at least one appetite outcome. Risk of bias was assessed using the 11-point Physiotherapy Evidence Database (PEDro) tool. Standardized mean difference summary statistics (Hedge's g effect sizes) and 95% confidence intervals were reported.

Results: We identified 15 reports (13 studies) which met all inclusion criteria (5 resistance training, 3 aerobic, 6 mixed modalities). Studies included 443 participants (Age = 68.9 ± 5.2, 82.3% female) and had generally “good” bias scores (PEDro = 6.4 ± 0.88). Random effects meta-analyses revealed that the exercising group showed statistically significant reductions in glucose [SMD = −0.34 (95% CI: −0.67, −0.02), p < 0.05, PEDro =6.4 ± 0.45] and leptin [SMD = −0.92 (95% CI: −1.28, −0.57), p < 0.00001, PEDro = 6.2 ± 0.75].

Discussion: This systematic review revealed that exercise and physical activity may modulate resting hunger and satiety in older adults. Decreases in fasting leptin and glucose hormones suggest that exercise promotes satiety sensitivity in adults aged 60+. This review highlights that engaging in exercise and activity programs may provide a meaningful avenue for improving chronic and functional disease burden in later life by promoting appetite control and balanced energy intake. Recommendations for future research include investigations of appetite in response to varied exercise modalities within more diverse and representative samples of older adults.

Nutrition and Healthy Aging: Prevention and Treatment of Gastrointestinal Diseases

Nutritional well-being is a fundamental aspect for the health, autonomy and, therefore, the quality of life of all people, but especially of the elderly. It is estimated that at least half of non-institutionalized elderly people need nutritional intervention to improve their health and that 85% have one or more chronic diseases that could improve with correct nutrition. Although prevalence estimates are highly variable, depending on the population considered and the tool used for its assessment, malnutrition in the elderly has been reported up to 50%. Older patients are particularly at risk of malnutrition, due to multiple etiopathogenetic factors which can lead to a reduction or utilization in the intake of nutrients, a progressive loss of functional autonomy with dependence on food, and psychological problems related to economic or social isolation, e.g., linked to poverty or loneliness. Changes in the aging gut involve the mechanical disintegration of food, gastrointestinal motor function, food transit, intestinal wall function, and chemical digestion of food. These alterations progressively lead to the reduced ability to supply the body with adequate levels of nutrients, with the consequent development of malnutrition. Furthermore, studies have shown that the quality of life is impaired both in gastrointestinal diseases, but especially in malnutrition. A better understanding of the pathophysiology of malnutrition in elderly people is necessary to promote the knowledge of age-related changes in appetite, food intake, homeostasis, and body composition in order to better develop effective prevention and intervention strategies to achieve healthy aging.

Prolonged nightly fasting and lower-extremity functioning in community-dwelling older adults

It is unknown if time-restricted feeding confers a protective effect on the physical function of older adults. The aim of this study was to assess prolonged nightly fasting in association with performance-based lower-extremity function (LEF) in a large population of community-dwelling older adults. A cross-sectional study was carried out among 1226 individuals ≥64 years from the Seniors-ENRICA-II (Study on Nutrition and Cardiovascular Risk in Spain) cohort. Habitual diet was assessed through a validated diet history. Fasting time was classified into the following categories: ≤9, 10-11 and ≥12 h/d (prolonged nightly fasting). Performance-based LEF was assessed with the Short Physical Performance Battery (SPPB). After adjusting for potential confounders, a longer fasting period was associated with a higher likelihood of impaired LEF (OR for the second and third categories v. ≤ 9 h/d fasting: 2·27 (95 % CI 1·56, 3·33) and 2·70 (95 % CI 1·80, 4·04), respectively; Ptrend < 0·001). Fasting time showed a significant association with the SPPB subtests balance impairment (OR for highest v. shortest fasting time: 2.48; 95 % CI 1·51, 4·08; Ptrend = 0·001) and difficulty to rise from a chair (OR 1·47; 95 % CI 1·05, 2·06; Ptrend = 0·01). The risk associated with ≥12 h fasting among those with the lowest levels of physical activity was three times higher than among those with ≤9 h fasting with the same low level of physical activity. Prolonged nightly fasting was associated with a higher likelihood of impaired LEF, balance impairment, and difficulty to rise from a chair in older adults, especially among those with low levels of physical activity.

Endocrinological and Nutritional Implications of Anorexia of Aging

Poor appetite—known as anorexia—is a common condition in aging and is associated with poor outcomes, including reduced survival and impaired quality of life. The anorexia of aging is mainly the result of several complex endocrinological, metabolic, and nutritional changes occurring with later age. The modulation of different peptides and hormones has been identified as an important determinant for the development of low appetite; in particular, an altered imbalance of plasma ghrelin, leptin, and cholecystokinin and increased inflammatory markers are implicated in its pathophysiology, and robust evidence of their involvement in anorexia of aging has been produced in the clinical setting. More recently, researchers identified that the gut microbiome composition significantly varies according to the appetite status. Other important clinical factors may worsen the symptoms of the anorexia in the elderly, in particular the potential concomitant presence of chronic catabolic comorbidities. Importantly, data indicate that anorexia is prevalent in frail older adults, negatively impacting body composition and specifically in altering muscle mass and function. For all these reasons, a prompt and early diagnosis of anorexia in the elderly is crucial to implement personalized metabolic and nutrition interventions to improve the outcomes and ameliorate quality of life.

Poor oral health and anorexia in older rehabilitation patients

OBJECTIVE

To investigate the association between anorexia and comprehensive oral health status in older inpatients.

BACKGROUND

Anorexia in older inpatients is a major concern, but whether it is associated with oral problems is currently unclear.

METHODS

This cross-sectional study included 160 participants (42.5% men) aged ≥65 years (mean age 78.6 ± 7.9) who had been admitted to a rehabilitation hospital. A score of ≤14 on the Simplified Nutritional Appetite Questionnaire for Japanese Elderly indicated anorexia. A score of ≥3 on the Oral Health Assessment Tool (OHAT) indicated poor oral health. Malnutrition was diagnosed according to the criteria set out by the Global Leadership Initiative on Malnutrition. Multivariate logistic regression was used to investigate the association between poor oral health and anorexia and, additionally, which subcategory of the OHAT (represented by a score ≥1) was associated with anorexia.

RESULTS

Anorexia and poor oral health status were observed in 86 (53.8%) and 85 (53.1%), respectively. Poor oral health was associated with anorexia after adjusting for potential confounders (adjusted odds ratio [AOR] 2.7; 95% confidence interval [CI]: 1.3-5.9). Additionally, poor status of dentures (AOR 2.6; 95% CI: 1.2-5.7) and poor oral cleanliness (AOR 3.0; 95% CI: 1.4-6.4) were independently associated with anorexia.

CONCLUSIONS

Poor oral health was associated with anorexia in older inpatients. Detection of poor oral health status using a comprehensive oral health assessment may be useful for anorexic patients. Early detection for poor oral health using comprehensive oral health assessments and oral care and prosthetic treatment may be useful for anorexic patients.

Encore Café: An Innovative and Effective Congregate Nutrition Program

Effective community food and nutrition programs are imperative for supporting older adults health and well-being. This three-part study examined to what extent the innovative congregate nutrition program (CNP), Encore Café, and targeted marketing campaign influenced CNP utilization, CNP program satisfaction, and overall CNP impact (e.g., nutritional risk, dietary practices, and loneliness). The Encore Café resulted in increases of 386% in meal distribution and 3,164% in CNP participants during a two-year period compared to a 20.8% reduction at traditional meal sites across the state. Total CNP satisfaction (food and dining) was high for both the Encore Café and Traditional CNP. Encore Café participants maintained their nutritional status and experienced significant reductions in emotional loneliness (p = 0.017) and dietary intake frequencies of processed meat (p = 0.027) compared to non-CNP participants. Utilizing a client-centered approach in marketing and programming for the Encore Café shows promising results for improving the utilization and effectiveness of the CNP.

Onion component, isoalliin, stimulates feeding and activates the arcuate nucleus neuropeptide Y, ghrelin- and Ninjin'yoeito-responsive neurons

Appetite loss or anorexia substantially decreases the quality of life in patients with cancer, depression and gastrointestinal disorders, and can lead to sarcopenia and frailty. Foods that restore appetite have been sought-for but are not currently available. Historically, onion intake was adopted to treat a variety of diseases with reduced appetite including cancer and gastrointestinal disturbances. While isoalliin is a core component of onion, the effects of isoalliin on feeding behavior and feeding centers remain unknown. Neuropeptide Y (NPY) and ghrelin are the most potent central and peripheral inducers of appetite. A Japanese kampo medicine Ninjin'yoeito activates ghrelin-responsive NPY neurons in the hypothalamic arcuate nucleus (ARC) and counteracts anorexia induced by an anti-cancer drug cisplatin. This study explored the effects of isoalliin on feeding behavior and activities of ARC neurons in mice. Isoalliin, injected intraperitoneally, dose-dependently increased food intake during dark phase (DP) and daily without altering light phase (LP) food intake. We measured cytosolic Ca²⁺ concentration ([Ca²⁺]_i) in single ARC neurons including NPY neurons identified by GFP fluorescence. Isoalliin increased [Ca²⁺]_i in 10 of 18 (55.6%) NPY neurons, a majority of which also responded to ghrelin with [Ca²⁺]_i increases, indicating that the ARC ghrelin-responsive NPY neuron is the major target of isoalliin. Isoalliin also increased [Ca²⁺]_i in the ARC neurons that responded to Ninjin'yoeito. These results indicate that isoalliin enhances feeding at the active period and activates ARC ghrelin-responsive NPY neurons and Ninjin'yoeito-responsive neurons. These abilities of isoalliin to stimulate DP feeding and activate ARC orexigenic neurons provide scientific evidence for the health beneficial effects of onion experienced historically and globally.

Helicobacter pylori Infection in Geriatric Patients: Current Situation and Treatment Regimens

Helicobacter pylori (H. pylori) has so far infected more than half the global population. It is the most important and controllable risk factor for gastric cancer. The elderly, who are at a higher incidence of the infection, are also commonly found to develop antibiotic resistance. The symptoms, diagnosis, clinical features (of gastric or extra-digestive diseases), and treatment of H. pylori infection in the elderly, are different from that in the non-elderly. Health conditions, including comorbidities and combined medication have limited the use of regular therapies in elderly patients. However, they can still benefit from eradication therapy, thus preventing gastric mucosal lesions and gastric cancer. In addition, new approaches, such as dual therapy and complementary therapy, have the potential to treat older patients with H. pylori infection.