Decreased food intake with aging

No effect of 16 weeks flavor enhancement on dietary intake and nutritional status of nursing home elderly

There is a lack of data to support the long-term effect of flavor enhancement on food intake and nutritional status. Our aim was to determine if daily addition of 700 mg flavor and/or 300 mg monosodium glutamate (MSG) to the animal protein part of the cooked meal for 16 weeks leads to an increase in energy intake and in body weight in nursing home elderly. We performed a single blind randomized 16 weeks parallel study consisting of a control group (n=23), a MSG group (n=19), a flavor group (n=19) and a flavor plus MSG group (n=22). Main outcome measures were intake of the cooked meal, which was measured by weighing back leftovers during 14 days and body weight. Both were measured before and at the end of the intervention period. After 16 weeks, energy intake and body weight did not increase within the control group, the flavor group, the flavor plus MSG group and the MSG group. Between the groups, no differences were found in changes in energy intake and body weight. Enhancing the taste of a cooked meal with flavor and/or MSG does not lead to a higher energy intake and body weight among nursing home elderly. More research is needed to determine the efficacy of flavor enhancement on intake and nutritional status.

Risk factors for dietary variety decline among Japanese elderly in a rural community: a 8-year follow-up study from TMIG-LISA

OBJECTIVE

To examine the factors related to the decline of dietary variety among the rural community-dwelling Japanese elderly people and the implication on the planning of elderly people's nutritional improvement program in the future.

DESIGN

A prospective cohort study during 8-year follow-up from 1992 to 2000.

SETTING

This study was conducted in Nangai Village, a rural and mainly agricultural area of Akita Prefecture in the northern part of Honshu, one of four main islands in Japan.

SUBJECTS

A total of 417 elderly people (160 men, 257 women) who completed interviews and food intake frequency surveys conducted in 1992, 1994, 1996, 1998, and 2000 were studied.

METHODS

Dietary variety and variables potentially associated with dietary variety decline were identified from a face-to-face interview at the baseline and 8-year follow-up surveys. The dietary variety was measured using the dietary variety score (DVS), which covers the 10 main food groups in Japanese meals.

RESULTS

During the 8-year follow-up, 36.2% of the subjects showed a decline in dietary variety. Health characteristics also change among the 8-year follow-up and these changes have an effect on the decline of dietary variety. Significant predictors for decline in dietary variety included loss of spouse, deterioration in self-perceived chewing ability, and decrease in intellectual activity score.

CONCLUSIONS

Loss of spouse, deterioration in chewing ability, and decline in intellectual activity may increase the risk of decline in dietary variety in community-dwelling Japanese elderly people.

Malnutrition and ageing

This article aims to provide an overview of the problems that exist in relation to malnutrition and the elderly population. The changes that occur in body composition during ageing are described and how this may affect disease risk. The possible metabolic processes behind weight loss are discussed and the numerous factors that affect nutritional status in the older age group are described. Prevention of malnutrition in this group is important and so the roles of nutrition screening and assessment are examined.

Chemosensory Declines in Older Adults with HIV: Identifying Interventions

Olfactory and gustatory impairments are observed with aging and with HIV infection. Thus, the synergistic effects of aging with HIV infection on olfactory and gustatory declines may be profound. Such declines can jeopardize several areas for an older adult living with HIV such as safety, appetite and malnutrition, cognition, mood, and quality of life. Potential interventions that need to be investigated include hormone replacement therapy, lifestyle changes, medical assessment, and compensation strategies. Nurses are the primary providers of care and education to address sensory alterations of those who have HIV and those who are aging.

Spend less, live longer. The "thrifty aged" hypothesis

Evolutionary biology has rejected any argument in favour of planned ageing. In this article, the metabolic changes that follow in ageing have been analysed, and in accordance with that, an evolutionary explanation for the senescence program has been proposed. Ageing is characterised by a set of metabolic features all of them designed to reduce energy expenditure and to promote energy storage. Otherwise, the undoubted beneficial effect to fitness that means to live longer could generate a conflict between parents and offspring for energy resources. The solution to that conflict is an adult economical individual, a "thrifty aged". The way to obtain this cheaper individual is through the genetically induced physiological changes that finally lead the process. In conclusion, it is proposed that ageing is the condition, imposed by natural selection, that let organisms to outlast the obligatory reproductive time.

Orchiectomized Fischer 344 male rat models body composition in hypogonadal state

The hypogonadal state in men is accompanied by substantial decreases in muscle and bone mass and by an increase in adiposity. Most of the strains of orchiectomized (ORX) rat that have been used to model this state display substantial losses in bone, but only subtle changes in adiposity and muscle mass. In order to identify a rat model displaying a robust catabolic response to ORX, we studied three strains: Fischer 344 (F344), Brown Norway and Wistar. ORX caused a significant and sustained decrease in weight gained by F344, but only a trend toward reduced weight gain in Brown Norway rats and a modest reduction weight gain in Wistar rats that was significant only after 56days. ORX suppressed food intake in F344 rats, and to a lesser degree in Brown Norway and Wistar rats. ORX reduced muscle mass significantly in F344 rats, but not in Brown Norway or Wistar rats. ORX increased adiposity moderately in F344 rats and substantially in Wistar rats. ORX caused a marked reduction in prostate mass and increase in bone resorption in all three strains. Thus, F344 was the only strain in which ORX produced substantial decreases in food intake, body weight and muscle mass with increased adiposity and increased bone resorption. We conclude that the F344 rat displays a broad range of catabolic effects following ORX and is the best rat model for studying the androgenic pathway and strategies for reversing catabolic changes induced by hypogonadism.

Intake of vitamin and mineral supplements in an elderly german population

AIM

To assess the prevalence of vitamin and mineral supplement use in a free-living elderly population and the contribution of these supplements to usual dietary intake.

METHODS

Analyses are based on data obtained from 388 subjects (>or=60 years) participating in the longitudinal study on nutrition and health status in an ageing population in Giessen (GISELA), Germany, in 2002. Nutrient intake from food was assessed by means of a 3-day estimated dietary record. Supplement use was recorded over a period of 3 days using a self-administered questionnaire.

RESULTS

Nearly half of the study population consumed at least 1 supplement within these 3 days. The use of supplements was more prevalent among women than among men (51.5 vs. 33.9%). On average women consumed 2.03+/-1.30 products and men 1.65+/-1.07 products. Magnesium, vitamin C and vitamin E were supplemented most often by men, while women supplemented magnesium, vitamin E and calcium most often. Most of the supplemented nutrients did not distinctly increase the average intake of the respective nutrients from the diet in this population. However, supplement use markedly decreased the proportions of elderly subjects with an intake below the current reference values for certain nutrients, particularly for vitamin E.

CONCLUSION

Results indicate that the intake of supplements is a common behavior in the population under investigation and therefore has to be considered when nutrient intake is evaluated.

Position of the American Dietetic Association: Liberalization of the Diet Prescription Improves Quality of Life for Older Adults in Long-Term Care

It is the position of the American Dietetic Association (ADA) that the quality of life and nutritional status of older residents in long-term care facilities may be enhanced by liberalization of the diet prescription. The Association advocates the use of qualified dietetics professionals to assess and evaluate the need for medical nutrition therapy according to each person's individual medical condition, needs, desires, and rights. In 2003, ADA designated aging as its second "emerging" area. Nutrition care in long-term settings must meet two goals: maintenance of health and promotion of quality of life. The Nutrition Care Process includes assessment of nutritional status through development of an individualized nutrition intervention plan. Medical nutrition therapy must balance medical needs and individual desires and maintain quality of life. The recent paradigm shift from restrictive institutions to vibrant communities for older adults requires dietetics professionals to be open-minded when assessing risks vs benefits of therapeutic diets, especially for frail older adults. Food is an essential component of quality of life; an unacceptable or unpalatable diet can lead to poor food and fluid intake, resulting in weight loss and undernutrition and a spiral of negative health effects. Facilities are adopting new attitudes toward providing care. "Person-centered" or "resident-centered care" involves residents in decisions about schedules, menus, and dining locations. Allowing residents to participate in diet-related decisions can provide nutrient needs, allow alterations contingent on medical conditions, and simultaneously increase the desire to eat and enjoyment of food, thus decreasing the risks of weight loss, undernutrition, and other potential negative effects of poor nutrition and hydration.

Developments in ghrelin biology and potential clinical relevance

The spiropiperidine, MK0677, has been exploited to characterize and expression clone the growth hormone secretagogue receptor (GHS-R). Cloning of this receptor led to identification of its natural ligands, ghrelin and adenosine. Targeted disruption of the Ghsr gene demonstrated unambiguously that the GH-releasing and orexigenic properties of ghrelin are dependent on Ghsr expression and that the orexigenic signal is mediated through neuropeptide Y and agouti-related peptide neurons. This review summarizes new developments in our understanding of the physiological roles of ghrelin and its receptor (GHS-R). Recent discoveries of the effects of ghrelin on the thymus and proinflammatory and chemotactic cytokine pathways stimulate renewed interest in potential clinical applications, which include age-associated disorders, such as metabolic disease, sarcopenia, congestive heart failure, atherosclerosis and anorexia.

Malnutrition and associated factors among aged residents in all nursing homes in Helsinki

OBJECTIVE

To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland.

DESIGN

Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents' backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care.

SETTING

All nursing homes in Helsinki community, the capital of Finland.

SUBJECTS

Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82 y, were examined.

RESULTS

One-third (29%) of the studied residents suffered from malnutrition (MNA < 17), and 60% were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patient-related factors predicted malnutrition: impaired functioning (OR 3.71, 95% CI 2.76-4.99), swallowing difficulties (OR 3.03, 95% CI 2.10-4.37), dementia (OR 2.06, 95% CI 1.45-2.93), constipation (OR 1.84, 95% CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95% CI 2.21-4.15).

CONCLUSIONS

Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.

Lack of meal intake compensation following nutritional supplements in hospitalised elderly women

Undernutrition contributes to poor clinical outcomes in hospitalised elderly patients but the potential impact of oral nutritional supplements may be reduced by suppressing subsequent food intake. We investigated this possibility in elderly female patients recovering mainly from hip fracture by studying the effect of oral supplements on subsequent food intake during an ad libitum buffet luncheon meal. We tested the effect in seven women by giving the supplement 90 min before the meal and compared energy and macronutrient intake with a control water pre-load condition. A similar study was carried out in another seven women with the supplement or water drink given 30 min beforehand. Both self-rated appetite and energy intake were low in these women. The nutritional supplement did not alter ratings of hunger, fullness or prospective consumption or subsequent energy and macronutrient consumption whether given 90 or 30 min before the meal. There were significant independent correlations between the lack of adequate compensation of energy intake at meals and chronic undernutrition (as assessed by skinfold thickness) and energy intake during the control meal. We conclude that elderly women during the recovery phase after major fractures have low appetites and energy intakes and markedly impaired adjustment of energy intake following liquid oral nutritional supplements. The reasons for this are unknown but are related to anorexia and undernutrition. The consumption of liquid oral supplements given up to 30 min before a meal does not suppress subsequent energy intake from meals.

Determinants of healthy eating in Canada: an overview and synthesis

This article uses a population health perspective to examine the complex set of interactions among the determinants of healthy eating. An overview of current knowledge on determinants of healthy eating was organized as follows: 1) individual determinants of personal food choices and 2) collective determinants, including a) environmental determinants as the context for eating behaviours and b) public policies as creating supportive environments for healthy eating. A conceptual synthesis of the literature revealed that individual determinants of personal food choice (physiological state, food preferences, nutritional knowledge, perceptions of healthy eating and psychological factors) are necessary, but not sufficient, to explain eating behaviour, which is highly contextual. Collective determinants of eating behaviour include a wide range of contextual factors, such as the interpersonal environment created by family and peers, the physical environment, which determines food availability and accessibility, the economic environment, in which food is a commodity to be marketed for profit, and the social environment, in which social status (income, education and gender) and cultural milieu are determinants of healthy eating that may be working "invisibly" to structure food choice. Policy is a powerful means of mediating multiple environments. There are gaps in our understanding of the process of intervening in macro-level environments and the impact of such interventions on the promotion of healthy eating. Collective determinants of food choice and policy contexts for promoting healthy eating, therefore, require investment in research. Applying a population health promotion lens to understanding the multiple contexts influencing healthy eating provides insight into prioritizing research and action strategies for the promotion of healthy eating.

Dietary variety predicts low body mass index and inadequate macronutrient and micronutrient intakes in community-dwelling older adults

BACKGROUND

Low body mass index (BMI) and micronutrient deficiencies are associated with increased morbidity and mortality rates in old age. Whether adverse patterns of dietary variety predict both low BMI and low micronutrient intakes in older adults was investigated.

METHODS

A cross-sectional analysis of national survey data was conducted in 1174 healthy adult men and women (ages 21 to 90 years) who provided physiologically plausible dietary data in the 1994-1996 Continuing Survey of Food Intakes by Individuals. Measurements included reported energy intake, protein intake (percentage meeting Recommended Dietary Allowance), micronutrient intakes (percentage meeting Estimated Average Requirements for 14 micronutrients), and BMI.

RESULTS

Adults who were 61 years or older consumed a greater total variety of foods, chose foods from a wider range of food groups, had a greater variety of micronutrient-dense foods and energy-weak foods, and had a lower variety of micronutrient-weak foods compared with adults ages 21 to 60 years (p < .05 to.001). However, older adults with low BMIs (< 22 kg/m2) consumed a lower variety of energy-dense foods compared with older adults with higher BMIs (p < .05). The variety of energy-dense foods predicted both energy intake and BMI at all ages in multiple regression models controlling for confounding variables (R2 = .124 for energy, R2 = .574 for BMI, p < .001). A higher percentage of older persons had inadequate micronutrient intakes compared with younger persons (p < .05), especially vitamin E, calcium, and magnesium, but consumption of a particularly wide variety of micronutrient-rich foods helped counterbalance these trends (p < .05). Older adults who had a low BMI and consumed a low variety of micronutrient-dense foods were particularly at nutritional risk, with only 65.4% consuming the Recommended Dietary Allowance for protein and none meeting the Estimated Average Requirements for all 14 micronutrients.

CONCLUSIONS

In contrast to previous suggestions that older persons consume a monotonous diet, this study showed that adults who were 61 years or older consumed a greater total food variety, and a greater variety of micronutrient-dense and energy-weak foods, compared with adults who were 60 years or younger. Although consumption of a low variety of energy-dense foods may contribute to reduced energy intake and body weight at any age, the variety of micronutrient-dense foods consumed needs to increase in old age to prevent micronutrient deficiencies. These findings suggest that all adults need advice on the changing needs for dietary variety with aging to maintain health, and that older persons with low BMI are particularly vulnerable to dietary shortfalls.

An approach to the management of unintentional weight loss in elderly people

Unintentional weight loss, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed.

Variables associated with reduced dietary intake in hemodialysis patients

BACKGROUND

Among the causes of malnutrition in hemodialysis (HD) patients, inadequate dietary intake (IDI) seems to be one of the most frequent and important. Although it has been hypothesized that IDI might be secondary to uremia, anorexia, underlying illness, psychosocial conditions, loss of dentures, depression, aging, or chronic inflammation, definite data on the etiology of IDI in HD patients are still lacking. The goal of this study was to measure the actual dietary energy and protein intakes in stable HD patients and to evaluate which demographic, clinical, dialytic, and humoral variables were associated with a dietary intake lower than recommended by international guidelines.

METHODS

Thirty-seven patients maintained on regular HD, 3 times per week for 4 hours per session, were included in the study. In addition to epidemiologic data, patients were scrutinized for dry weight, weight change in the last 6 months, height, Body Mass Index, Kt/V, serum leptin, leptin-BMI ratio, presence of anorexia, and dietary energy and protein intake. Anorexia was assessed by means of a questionnaire in which the presence of major symptoms, namely meat aversion, taste and smell alterations, nausea and/or vomiting, and early satiety, was investigated. Dietary intake was recorded for 3 days after questionnaire administration by means of 3-day diet diaries.

RESULTS

Overall, the mean (+/- standard deviation) dietary energy and protein intakes were 24.9 +/- 10.1 kcal/kg/day and 0.64 +/- 0.4 g protein/kg/day, respectively. Twenty-six patients (70.2%) had energy and protein intakes lower than recommended, 7 (18.9%) had adequate energy intake but inadequate protein intake, 1 (2.7%) had adequate protein intake and inadequate energy intake, and 3 (8.1%) had both adequate energy and adequate protein intakes. Anorexia was present in 14 of the 26 (53%) patients with low protein and energy intakes, and was absent in the other groups ( P =.003). The age of patients with inadequate energy and protein intakes was significantly higher than the age of patients with adequate energy and protein intakes (62.1 +/- 10.4 versus 37 +/- 20.8, P <.001) and the age of patients with only adequate energy intake (40.5 +/- 10.4, P <.001). Twenty-seven patients (73%) had an energy intake <30 kcal/kg/day, and 10 (27%) had an energy intake > or =30 kcal/kg/day. Compared with patients with energy intakes > or =30 kcal/kg/day, patients with energy intakes <30 kcal/kg/day were significantly older ( P =.0001) and more frequently were anorexic (P <.05). Compared with patients with protein intakes > or =1.2 g/kg/day, patients with protein intakes <1.2 g/kg/day were significantly older (P <.001). Limiting the analysis to the 33 patients with protein intakes <1.2 g/kg/day, we found a significant negative correlation between age and energy intake ( r =-0.612; P <.001) and between age and protein intake ( r =-0.723; P <.001). Correlations between both energy and protein intakes and age, dialytic age, Kt/V, C-reactive protein, parathyroid hormone, and leptin-BMI were not statistically significant.

CONCLUSIONS

This study shows that dietary energy and protein intakes are inadequate in the majority of HD patients and are negatively related to the presence of anorexia and age. These data may be potentially useful in the identification of nutritional strategies as well as in improving food intake in HD patients.

Molecular endocrinology and physiology of the aging central nervous system

Aging is associated with a progressive decline in physical and cognitive functions. The impact of age-dependent endocrine changes regulated by the central nervous system on the dynamics of neuronal behavior, neurodegeneration, cognition, biological rhythms, sexual behavior, and metabolism are reviewed. We also briefly review how functional deficits associated with increases in glucocorticoids and cytokines and declining production of sex steroids, GH, and IGF are likely exacerbated by age-dependent molecular misreading and alterations in components of signal transduction pathways and transcription factors.

Position paper of the American Dietetic Association: Nutrition across the spectrum of aging

It is the position of the American Dietetic Association that older Americans receive appropriate care; have broadened access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies across the spectrum of aging. Food and water and nutritional well-being are essential to the health, self-sufficiency, and quality of life for the fast growing, heterogeneous, multiracial, and ethnic populations of older adults. Many people, as they age, remain fully independent and actively engaged in their communities; however, others fare less well and need more support. A broad array of appropriate, culturally sensitive food and nutrition services, physical activities, and health and supportive care customized to the population of older adults are necessary. National, state, and local policies that promote coordination and integration of food and nutrition services into health and supportive systems are needed to maintain independence, functional ability, chronic disease management, and quality of life. Dietetics professionals can take the lead by researching and developing national, state, and local collaborative networks to incorporate effectively the food and nutrition services across the spectrum of aging.

Differences in the appetite-stimulating effect of orexin, neuropeptide Y and ghrelin among young, adult and old rats

Aging is associated with a progressive decrease in appetite and food intake. The appetite-stimulating peptides orexin A, neuropeptide Y (NPY) and ghrelin are known to play a critical role in food intake. In this study, the stimulatory effect of intracerebroventricular administration of these peptides on food intake was compared among young (4 months old), adult (11 months old) and old (24-27 months old) male Wistar rats. A stainless steel cannula was implanted stereotactically into the left lateral ventricle. After a 7-day recovery period, different doses of orexin A (0.25-3 nmol), NPY and ghrelin (0.03-1 nmol) were injected into the left lateral ventricle without anesthesia. Food consumption was measured at 1, 2 and 4 h after injection. We also examined the plasma levels of acylated and desacyl ghrelin in young and old rats by ELISA. Intracerebroventricular administration of orexin A and NPY stimulated food intake in young and adult rats, but no effects were observed at any dose in old rats. Ghrelin increased food intake in a dose-dependent manner in all groups, and the effect of ghrelin was reduced with advancing age. Neither the acylated nor the desacyl plasma ghrelin level differed significantly between young and old rats. In conclusion, the orexigenic effect of the peptides orexin A, NPY and ghrelin decreased in old rats, and this reduction may have been responsible for the age-related decrease in food intake.

Age-related decline in caloric intake and motivation for food in rhesus monkeys

Human studies have documented age-related declines in caloric intake that are pronounced at advanced ages. We examined caloric intake from a longitudinal study of aging in 60 male and 60 female rhesus monkeys (Macaca mulatta) collected for up to 10 years. Monkeys were provided a standardized, nutritionally fortified diet during two daily meals, and intake was measured quarterly. About half of the monkeys were on a regimen of caloric restriction (CR) representing about a 30% reduction in caloric intake compared to controls (CON) of comparable age and body weight. CR was applied to determine if this nutritional intervention retards the rate of aging in monkeys similar to observations in other mammalian studies. Following reproductive maturity at 6 years of age, there was a consistent age-related decline in caloric intake in these monkeys. Although males had higher intake than females, and CON had higher intake compared to CR, the sex and diet differences converged at older ages (>20 years); thus, older CR monkeys were no longer consuming 30% less than the CON. When adjusted for body weight, an age-related decline in caloric intake was still evident; however, females had higher intake compared to males while CR monkeys still consumed less food, and again differences converged at older ages. Motivation for food was assessed in 65 of the monkeys following at least 8 years in their respective diet groups. Using an apparatus attached to the home cage, following an overnight fast, monkeys were trained to reach out of their cage to retrieve a biscuit of their diet by pushing open a clear plastic door on the apparatus. The door was then locked, and thus the biscuit was irretrievable. The time spent trying to retrieve the biscuit was recorded as a measure of motivation for food. We observed an age-related decline in this measure, but found no consistent differences in retrieval time between CR and CON groups of comparable age and time on diet. The results demonstrate an age-related decline in food intake and motivation for food in rhesus monkeys paralleling findings in humans; however, we found no evidence that monkeys on a long-term CR regimen were more motivated for food compared to CON. Examining the relationship of selected blood proteins to food intake following 7-11 years on the study, we found a negative correlation between globulin and intake among males and females after accounting for differences in age. In addition, a positive correlation was observed between leptin and intake in males.

Orexin-A does not stimulate food intake in old rats

Aging is associated with a progressive decrease in appetite and food intake. Both A and B orexins, expressed in specific neurons of the lateral hypothalamic area, have been implicated in the regulation of sleep and feeding. In this study, the stimulatory effect of intracerebroventricular administration of the orexins on food intake was compared between young (4-mo-old) and old (25- to 27-mo-old) male Wistar rats. A stainless steel cannula was implanted stereotactically into the left lateral ventricle. After a 7-day recovery period, different doses (0-30 nmol) of orexins were injected into the left lateral ventricle without anesthesia. Food and water consumptions were measured at 1, 2, and 4 h after injection. The protein levels of orexin receptors, a specific receptor for orexin-A (OX1R) and a receptor for both orexin-A and -B (OX2R), in the hypothalamus were determined by Western blot analysis and compared between young and old rats. Intracerebroventricular administration of orexin-A stimulated food intake in a dose-dependent manner in young rats. However, no effects were observed at any dose in old rats. The protein level of OX1R in the hypothalamus was significantly lower in old rats than in young rats, although the protein level of OX2R was comparable between groups. Results of the present study indicate that the function of the orexin system is diminished in old rats. The decrease in the OX1R protein level in the hypothalamus could be responsible for orexin-A's lack of stimulation of food intake in old rats.

Impact des facteurs de fragilité sur le devenir des sujets âgés de 75 ans et plus opérés d'une prothèse de hanche

OBJECTIVE

Hip pathology of hip requiring a surgical assumption of responsibility (coxarthrose invalidating, hip fracture) is increasing, and after the year 2025, the number of interventions will double. In parallel, the number of elderly people (older than 75 years) with malnutrition associated with cognitive impairment and reduced autonomy is on the increase. So the concept of frail elderly identified by specific criteria allows for better defining the health needs of heterogeneous elderly people. The objective of this study was to determine the influence of frailty factors on autonomy and clinical outcome after intervention for prosthesis of the hip.

METHODOLOGY

This prospective work, completed over 8 months, included 55 patients with total or intermediate prostheses of hip, whatever the cause, recruited from rehabilitation wards. Results from a pre-established questionnaire defined the personal status and social framework of these patients. A medical examination evaluated cognitive function Mini Mental State (MMS), nutritional state (IMC) and the level of autonomy immediately after surgery (the first 2 weeks) by the measurement of functional independence (MIF). The second MIF was carried out by the same operator at the end of the assumption of responsibility by the institution.

RESULTS

Three factors of frailty influenced progress at the time of reacquisition of autonomy: cognitive impairment (P < 0001; 1 patient out of 2 [50%] had an MMS score < 22); reduced nutrition? (P < 0.0026; [29% had a BMI score < 20 or a perimeter of the calf < 30 cm]; and accommodations before the intervention (P < 0.028; [15% lived in an institution]).

CONCLUSION

Nutritional state, cognitive level and social activity must be evaluated regularly in elderly subjects with hip prosthesis to evaluate optimal load and adaptation.

Expression of NPY Y1and Y5receptors in the hypothalamic paraventricular nucleus of aged Fischer 344 rats

Many mammals, nearing the end of life, spontaneously decrease their food intake and body weight, a stage we refer to as senescence. The spontaneous decrease in food intake and body weight is associated with attenuated responses to intracerebroventricular injections of neuropeptide Y (NPY) compared with old presenescent or with young adult rats. In the present study, we tested the hypothesis that this blunted responsiveness involves the number and expression of hypothalamic paraventricular nucleus (PVN) Y1and/or Y5NPY receptors, both of which are thought to mediate NPY-induced food intake. We found no significant difference in mRNA levels, via quantitative PCR, for Y1and Y5receptors in the PVN of senescent vs. presenescent rats. In contrast, immunohistochemistry indicated that the number of PVN neurons staining for Y1receptor protein was greater in presenescent compared with senescent rats. We conclude that a decreased expression and number of Y1or Y5receptors in the PVN cannot explain the attenuated responsiveness of the senescent rats to exogenous NPY.

Anti-aging medicine--the good, the bad, and the ugly

Complementary and alternative medicine has flourished since the beginning of time because of a human need to postpone the aging process and to reverse disease. Complementary and alternative medicine sells, because in some cases it works as well or better than mainstream medicine. In addition, many practitioners of complementary medicine understand Hippocrates' aphorism: "It is more important to know the person that has the disease than the disease the person has." It is important to recognize that spending time with the patient is often as therapeutic as drugs. CAM offers patients the time, touch, attention, and level of personal interaction that are increasingly uncommon in contemporary medical care. There is a major need for large and appropriately designed studies to test the effectiveness of complementary techniques. As in other areas of health care, studies in the elderly are consistently lacking. With the growing interest in CAM, it is important for medical providers to keep an open mind--to both the potential benefits and potential harms of alternative treatments. When treatments are shown to be dangerous or ineffective, we must educate the public and work to remove these therapies from the market place. When treatments are proven effective, Western and Eastern medical providers must work together with patients to provide the most appropriate and comprehensive health care.

The Disease That Caused Weight Loss in King David the Great

BACKGROUND

Older people have suffered from loss of weight since the dawn of history. This research is unique in character, as it combines contemporary medical knowledge with the presentation of a case taken from Ancient History.

OBJECTIVE

To analyze from a modern perspective the biblical description of a geriatric patient who suffered from weight loss.

METHODS

Biblical texts associated with the aged were examined and passages relating to geriatric patients who suffered from loss of weight were closely studied. This study is based on the evaluation of the biblical passages, and not on the interpretations of various rabbis and scholars.

RESULTS

Passages such as: ". I forget to eat my bread" and "My knees are weak through fasting; and my flesh failed of fatness" and ". my bones cleave to my skin" indicate anorexia, fasting, extreme loss of weight, and subsequent cachexia. Among the numerous causes associated with weight loss, malignancy, social problems such as loneliness, social isolation and neglect by others, and psychological causes including depressed mood were most likely responsible. With regard to malignancy, it seems that the King was affected by primary carcinoma of the prostate or kidney with subsequent metastases to bones.

CONCLUSION

This report demonstrates that the roots of geriatric medicine can be traced to biblical times.

The endocrine pharmacology of testosterone therapy in men

The review starts off by outlining the history of the discovery of the male sex hormone testosterone and the historical background to the various, often dubious, approaches to the treatment of age-related endocrine disorders in older men. A discussion of congenital androgen deficiency in young men is followed by methods of diagnosing hypogonadism in older men. Among therapeutic options, the alternatives to direct testosterone replacement are discussed, although none of them have proved to be particularly successful in clinical practice. For testosterone replacement itself, various routes of administration and pharmaceutical formulations are now available, facilitating good monitoring and individualized therapy.

Age-dependent hypothalamic expression of neuropeptides in wild-type and melanocortin-4 receptor-deficient mice

In young (35- to 56-day-old) and middle-aged (9-mo-old) wild-type (+/+) and melanocortin-4 receptor (MC4R)-deficient (+/−, −/−) mice, expressions of neuropeptide Y (NPY), agouti-related protein (AGRP), pro-opiomelanocortin (POMC), and cocaine-and-amphetamine-regulated transcript (CART) were analyzed in the arcuate nucleus (ARC) and adjacent regions comprising the dorsomedial (DMN) and ventromedial (VMN) nucleus. In the ARC of young mice, NPY and AGRP expression increased and POMC and CART expression decreased with body fat content. Adjusting for the influence of body fat content by ANCOVA showed that the levels of NPY, POMC, and CART were highest and of AGRP lowest in young −/− mice. In the middle-aged mice, feedback from body fat content was weakened. For −/− mice ANCOVA revealed higher NPY and AGRP, lower POMC, and unchanged CART expression levels relative to young −/− mice. In the DMN and VMN, POMC and AGRP signals were absent at each age. CART was expressed in the DMN independent of age, fat content, and genotype. For NPY expression, an age-dependent induction was found in the DMN and VMN; it was absent in the young but present in the middle-aged mice, showing close positive correlations between body fat content and the numbers of NPY-labeled cells which were further enhanced in −/− mice. Thus MC4R deficiency augments age-induced NPY expression in the DMN and VMN with no feedback from body fat content. Negative feedback control by body fat content on ARC neuropeptide expression is present in young animals but vanishes with age and is modulated by MC4R deficiency.

Invited review: Aging and energy balance

Humans over 70 yr of age often lose weight. This appears to be due to a physiological anorexia of aging as well as a loss of lean mass (sarcopenia) and, to a lesser extent, fat mass. The causes of the physiological anorexia of aging include changes in taste and smell and a decrease in adaptive relaxation of the fundus of the stomach, which leads to more rapid antral filling and early satiation. In addition, basal and stimulated levels of the satiating hormone, cholecystokinin, are increased. In men, the decline in testosterone leads to an increase in leptin and a loss of lean mass. Although resting metabolic rate declines with aging, this is mainly due to the decline in lean body mass. Energy metabolism is also decreased due to a decline in Na+-K+-ATPase activity, decreased muscle protein turnover, and possibly changes in mitochondrial membrane protein permeability. Physical energy expenditure declines with aging. Meal-induced thermogenesis shows a delay to peak, possibly due to a delay in gastric emptying. Inadequate data are available on the effect of aging in humans on other energy-producing mechanisms such as adaptive thermogenesis. These physiological changes place older men and women at major risk of developing pathological weight loss when they develop disease states, especially those associated with cytokine elaboration.

Ageing purpose: another thrifty genotype

For evolutionary biology, ageing is a non-adaptive process. The 'disposable soma' theory proposes that senescence is the consequence of a reduction in the energy invested in the processes of cell maintenance and repair due to the fact that it is more beneficial to invest it in reproduction. Recently, various genes have been identified whose mutations modify the life span of certain animals. Most of these genes are related to energy metabolism, especially insulin, IGF-1 and their receptors. Furthermore, it has also been demonstrated that there is a modification in metabolic pathways during ageing. As a result, the energy-storing pathways are strengthened and there is a reduction in the pathways that use energy. All these findings suggest that ageing is a strategy designed by natural selection to save energy, in accordance with other saving strategies. This way the energy that is not used can be dedicated to offspring to improve their pre-reproductive survival.

Andropause:

There is increasing evidence that the common condition of hypogonadism in older men when associated with symptoms responds well to testosterone replacement. Over the last few years there has been a marked increase in the awareness and treatment of the andropause [137]. Long-term side effects of testosterone are uncertain with only eight people over 50 years having been studied for 10 years [138]. Testosterone needs to be considered a quality-of-life drug, similar to sildenafil, and at present it should be used only if it produces symptomatic improvement. There is a need for a men's health study to determine the long-term efficacy and safety of testosterone replacement in older persons.

Hormones and the aging process

For more than a century, it has been suggested that failure of the secretions of the ductless glands leads to aging. Replacement of these hormones has been suggested as a method of slowing the aging process. Clearly, modern research has demonstrated that the concept of a "hormonal fountain of youth" is predominantly mythology. The best evidence for hormonal replacement is vitamin D and estrogen replacement to prevent hip fractures. Other than that, treatment should be limited to hormone replacement in persons who have endocrine disease.

Sarcopenia, weight loss, and nutritional frailty in the elderly

The progression of the aging process leads to a decreased margin of homeostatic reserve and a reduced ability to accommodate metabolic challenges, including nutritional stress. Nutritional frailty refers to the disability that occurs in old age owing to rapid, unintentional loss of body weight and loss of lean body mass (sarcopenia). Sarcopenia, a loss of muscle mass and strength, contributes to functional impairment. Weight loss is commonly due to a reduction in food intake; its possible etiology includes a host of physiological and nonphysiological causes. The release of cytokines during chronic disease may also be an important determinant of frailty. In addition to being anorectic, cytokines also contribute to lipolysis, muscle protein breakdown, and nitrogen loss. Whereas the multiple causes of nutritional frailty are not completely understood, clinical interventions for weight loss, sarcopenia, and cytokine alterations have been used with modest success.

Orexigenic and anabolic agents

Anorexia and weight loss represent a major cause of morbidity and mortality. At present in the United States two effective anorectic agents are commonly used, namely, megestrol acetate and dronabinol. These two agents are compared in Table 1. In persons with a large excess cytokine production. megestrol acetate should be tried at a does of 800 mg per day for no longer than 3 months. Megestrol acetate should be administered with testosterone in men. It should be avoided in persons who are bed-bound because of the risk of deep vein thrombosis. Dronabinol should be used for most anorectic patients. Dronabinol should initially be given in a low dose (2.5 mg) in the evening. The dose should be increased to 5 mg per day if no improvement in appetite is seen after 2 to 4 weeks. Dronabinol can be continued indefinitely. It seems to have a particularly good profile for persons with anorexia who are at the end of life. In persons with depression and anorexia. mirtazapine seems to be the antidepressant of choice. In addition, the use of taste enhancers can be considered in persons who complain that the food does not taste good. The appropriate use of anabolic agents in older persons with weight loss is controversial. Certainly all older men who are losing weight should have bioavailable testosterone measured and, if the testosterone level is low, should receive testosterone replacement therapy. Women who are losing weight may benefit from the use of low-dose testosterone (eg, Estratest). Anabolic agents, such as oxandrolone, should be reserved for those who have profound cachexia. An approach to the management of anorexia and weight loss in older persons is given in Fig. 1. Thomas et al have provided a more complex algorithm the management of weight loss in nursing home residents.

Molecular-based therapeutic approaches in treatment of anorexia of aging and cancer cachexia

Loss of appetite, or anorexia, has profound implications for older persons, altering social interactions, reducing quality of life, and leading to weight loss with grave health consequences. Two conditions associated with anorexia considered in this article are the multidetermined anorexia of aging and the wasting syndrome termed cachexia induced by cancer. Nutritional interventions may have some benefit in the former, but are of limited value in the latter. Emerging studies at the molecular level relating to appetite regulation and energy balance may offer new approaches to arrest progressive weight loss in the anorexia of aging and cancer cachexia.

Age-related changes in the social, psychological, and temporal influences on food intake in free-living, healthy, adult humans

BACKGROUND

Elderly humans often have a reduction in intake that can produce malnutrition and impaired health. As a result, there is a need to investigate age-related changes in the eating behaviors of free-living humans.

METHODS

To address this issue, 7-day diet diary records that had been collected from 762 paid participants were reanalyzed, separating the participants into four age groups: 20-34 years, 35-49 years, 50-64 years, and 65 years and older.

RESULTS

The elderly ate with fewer other people present and earlier in the day than younger people. The elderly were found to be as responsive as younger groups to social facilitation of intake, palatability, cognitive restraint, time of day, day of week, and location, but showed blunted responses to self-reported hunger.

CONCLUSIONS

There does not appear to be a decline with age in the ability of nonphysiological factors to influence the nutrient intakes of the elderly, but they may not have as great an influence due to lower absolute levels. This suggests that the deficient intakes in the elderly might be corrected or ameliorated by manipulation of nonphysiological factors, such as the number of other people present at meals, the palatability of meals, and the time of day and location of meals.