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Lin HY, Lin YC, Chen LK, Hsiao FY. Untangling the Complex Interplay between Social Isolation, Anorexia, Sarcopenia, and Mortality: Insights from a Longitudinal Study. J Nutr Health Aging 2023; 27:797-805. [PMID: 37960901 DOI: 10.1007/s12603-023-1993-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Social isolation is a pervasive and debilitating condition that has adverse prognostic impacts. This condition often co-occurs with other geriatric syndromes, further exacerbating negative health outcomes. Given these considerations, the present study aims to elucidate the roles of social isolation in older adults with anorexia of aging and/or sarcopenia with respect to long-term mortality using a nationally representative cohort study. METHODS Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with a sample size of 3,762 study participants aged 50 years and older. Data from 1999 (wave 4) to 2015 (wave 9) were analyzed. The TLSA questionnaire was used to define social isolation, anorexia, and sarcopenia. Logistic regressions were employed to explore the associations between social isolation, anorexia, and sarcopenia. The Cox proportional hazard model was utilized to examine the synergistic effects of social isolation and anorexia or sarcopenia on 16-year all-cause mortality. RESULTS After controlling for demographic information and comorbidities, older adults with social isolation were significantly associated with anorexia (adjusted odds ratio [aOR] 1.46 [95% confidence interval: 1.00-2.12, p=0.0475]) and sarcopenia (aOR 1.35 [95% CI: 1.12-1.64, p=0.0021]). Furthermore, the synergistic effects of social isolation with anorexia (aOR 1.65 [95% CI: 1.25-2.18, p=0.0004]) or sarcopenia (aOR 1.65 [95% CI: 1.42-1.92, p<0.0001]) were both significantly associated with higher risks of all-cause mortality, while social isolation alone revealed borderline statistical significance. CONCLUSIONS Our findings indicate that social isolation is closely linked to anorexia and sarcopenia among middle-aged and older adults. Additionally, social isolation significantly exacerbates the long-term mortality risk associated with anorexia of aging and sarcopenia. However, social isolation alone appears to have borderline long-term mortality risk in this cohort. These findings underscore the importance of addressing social isolation in older adults with anorexia and/or sarcopenia to optimize their health outcomes and mitigate long-term mortality risk.
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Affiliation(s)
- H-Y Lin
- Fei-Yuan Hsiao, Ph.D., Professor and Director, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Linsen S. Rd, Taipei 10050, Taiwan. Tel.: 886-2-33668787, E-mail: ; Liang-Kung Chen, Professor, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei 11217, Taiwan. Tel: +886-2-28757830; Fax: +886-2-28757711; E-mail:
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Hara LM, Freiria CN, Silva GM, Fattori A, Corona LP. Anorexia of Aging Associated with Nutrients Intake in Brazilian Elderly. J Nutr Health Aging 2019; 23:606-613. [PMID: 31367723 DOI: 10.1007/s12603-019-1224-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study evaluated the association between anorexia of aging and nutrients intake. It was a cross-sectional study with 130 individuals aged 60 years or older, undergoing outpatient care in the city of Campinas, São Paulo. Anorexia of Aging (AA) was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ), and food consumption was evaluated using the 24-hour recall (24HR). The prevalence of AA was 27.7%, in which 66.7% were women and 38.9% were older than 80 years. Elderly with AA presented lower intake of calories (1172.6 kcal vs 1477.9 kcal; p = 0.003), carbohydrates (158.5 g vs 194.1 g; p = 0.015), proteins (49.9 g vs 68.5 g; p = 0.004) and lipids (34.6 g vs 46.1 g; p = 0.006). They also had lower intake of fibers (12.6 g vs 19.4 g; p < 0.001), iron (6.4 mg vs 8.9 mg; p < 0.001) and zinc (6.0 mg vs 8.5 mg; p = 0.004). Our results show that intake of most nutrients is significantly lower in AA elderly, except carbohydrates, which may point to worse-quality diets. The diagnosis of AA, as well as the evaluation of elderly food intake, are essential to prevent undernutrition, vulnerabilities, and increased morbidity and mortality.
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Affiliation(s)
- L M Hara
- L. M. Hara, School of Applied Sciences, University of Campinas, St. Pedro Zaccaria, 1300, ZIP code 13484-350, Limeira, SP, Brazil, Tel.: +55 (19) 3701-6758, E-mail:
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Porell FW, Carter M. Discretionary Hospitalization of Nursing Home Residents With and Without Alzheimer’s Disease. J Aging Health 2016; 17:207-38. [PMID: 15750052 DOI: 10.1177/0898264304274302] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study analyzes facility variations in hospital admission rates of nursing home (NH) residents with and without Alzheimer’s disease (AD) or related dementia with the aim of better understanding how facility-level contextual factors differentially affect hospitalization risks. Method: The sample population consists of 19,217 and 18,399 Medicaid residents with and without AD, respectively, from 546 NHs in Massachusetts between 1991 and 1993. Hospital use is measured as annual nonpsychiatric discretionary hospital admissions to short-term general hospitals. Multilevel estimation methods are used to obtain facility and market area parameter estimates. Results: There was greater interfacility variation in discretionary hospital admission rates of AD residents than residents without AD, particularly among more vulnerable subgroups of AD residents. Discussion: The findings underscore the importance of licensed nursing personnel in reducing discretionary hospitalizations among NH residents with AD.
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Affiliation(s)
- Frank W Porell
- Gerontology Center, University of Massachusetts at Boston, Boston, MA 02125-3393 USA
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Hazif-Thomas C, Thomas P. [Anorexia and refusal to eat in the elderly]. SOINS. GERONTOLOGIE 2016; 21:34-36. [PMID: 26805646 DOI: 10.1016/j.sger.2015.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The question of the links between anorexia and the refusal to eat in the elderly is often the cause of major difficulties with regard to therapeutic strategies within caregiving teams. Likewise, few studies have been carried out into the diachronic links between teenage anorexia and that of the elderly. The role of the multi-disciplinary team is essential.
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Affiliation(s)
- Cyril Hazif-Thomas
- Intersecteur de psychiatrie de la personne âgée, Hôpital de Bohars, CHU de Brest, Route de Ploudalmézeau, 29820 Bohars, France.
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Abstract
Abstract
During the period between 2000 and 2030, the number of persons older than 65 years is projected to grow from 550 to 937 million worldwide. Globally, this growth represents an increase from 6.9 to 12 %. Studies have found that 74.6 % of women and 67.4 % of men aged 65 years or older suffer from many clinical and subclinical syndromes and problems, including anorexia, undernutrition, weight loss, sarcopenia, and cachexia, which are often overlooked or managed inadequately. These issues are very common in the elder. The key clinical question is whether these changes in the elder are distinct entities or an interdependent continuum. In this article, we reviewed these issues of related basic, clinical knowledge. The purpose of this review is to enhance the recognition of anorexia, undernutrition, weight loss, sarcopenia, and cachexia.
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Starr ME, Saito H. Age-related increase in food spilling by laboratory mice may lead to significant overestimation of actual food consumption: implications for studies on dietary restriction, metabolism, and dose calculations. J Gerontol A Biol Sci Med Sci 2012; 67:1043-8. [PMID: 22451471 PMCID: PMC3437968 DOI: 10.1093/gerona/gls009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
It is widely accepted that food consumption in humans declines with advanced age;
however, data from mice remain controversial. Based on our previous observation that mice
spill a considerable amount of food while eating, we hypothesized that increased food
spillage in old mice masks actual food intake. To investigate whether mice exhibit
age-associated declines in food consumption, we evaluated the actual food consumption of
C57BL/6 mice at various ages by measuring both the amount of food in the food receptacle
and the amount dropped to the cage bottom during feeding. We found that old mice dropped
significantly more food (36% ± 8%) than young mice (18% ± 5%), which led to
overestimations of food consumption, particularly in old mice. Although actual food
consumption decreased in very old mice, food intake per body weight did not significantly
change. These findings suggest that caution should be taken to accurately quantify food
consumption by aged animals.
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Affiliation(s)
- Marlene E Starr
- Department of Surgery, Physiology, and Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0298, USA
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Abstract
Because of its wide prevalence and its grave consequences on the health of older persons, malnutrition requires immediate attention. Physicians in general have been described as being nutritionally blind in their slowness to recognize undernutrition. A high degree of suspicion, a thorough history and physical examination, and pertinent laboratory data can identify patients at risk. When a more comprehensive assessment is needed; screening tools, dietary history, and special biochemical parameter can be used.
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Affiliation(s)
- M Louay Omran
- Division of Geriatric Medicine, St. Louis University Health Sciences Center, 1402 South Grand Boulavard, Room M238, St. Louis, MO 63104, USA.
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Abstract
BACKGROUND Malnutrition in elderly has become an important problem of health, and is associated with an increase of morbidity and mortality in this age group. The aim of this study was to determine the prevalence of malnutrition in the Spanish institutionalized and living home elderly people. SUBJECTS AND METHOD A sample of 3,460 representative Spanish subjects older than 65 years old were studied (response rate of 96%). Nutritional status was gathered by Mini Nutritional Assessment questionnaire. RESULTS The prevalence of malnutrition was 3,3% among elderly living at home and 7,7% among institutionalized people. Malnutrition was more prevalent in women and people with a lower income. Increase of malnutrition with age was observed. CONCLUSIONS The observed prevalence of malnutrition in Spanish non-institutionalized elderly people was similar to observed in another populations. Sex, age and income were associated with a risk of malnutrition
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Affiliation(s)
- J M Ramon
- Area de Medicina Preventiva, Departamento de Salud Pública, Universidad de Barcelona, Spain.
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Mermelstein HT, Basu R. Can you ever be too old to be too thin? Anorexia nervosa in a 92-year-old woman. Int J Eat Disord 2001; 30:123-6. [PMID: 11439419 DOI: 10.1002/eat.1064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED Anorexia nervosa is a common psychiatric condition that most often affects young adults. If left untreated, it can have significant morbidity and mortality. METHODS AND DISCUSSION In this report, we describe a woman first diagnosed with anorexia nervosa at age 92 and we discuss the relevant diagnostic and treatment-related issues. CONCLUSION This case underscores the need to heighten diagnostic sensitivity for this and other eating disorders at any age.
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Affiliation(s)
- H T Mermelstein
- Department of Psychiatry, North Shore University Hospital, Manhasset, New York
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Moriguti JC, Moriguti EK, Ferriolli E, de Castilho Cação J, Iucif N, Marchini JS. Involuntary weight loss in elderly individuals: assessment and treatment. SAO PAULO MED J 2001; 119:72-7. [PMID: 11276170 DOI: 10.1590/s1516-31802001000200007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
CONTEXT The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful. DESIGN Narrative review.
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Affiliation(s)
- J C Moriguti
- Division of General Internal and Geriatric Medicine, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
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Abstract
Poor nutritional status is one of the major factors associated with functional decline and mortality in older persons. Older persons are at increased risk for malnutrition because of the physiologic anorexia of aging. During a stay in a subacute care facility, attention to nutrition is a major component of the rehabilitative process. The pathophysiology of malnutrition, diagnostic techniques available to diagnose malnutrition, causes and management of protein energy malnutrition, specific nutritional problems caused by vitamin and trace element deficiency, and nutritional management of specific diseases (e.g., hip fracture and diabetes mellitus) are reviewed.
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Affiliation(s)
- J E Morley
- Geriatric Research, Education, and Clinical Center, St. Louis Veterans Affairs Medical Center, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, Missouri63104, USA
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Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools. Nutrition 2000; 16:50-63. [PMID: 10674236 DOI: 10.1016/s0899-9007(99)00224-5] [Citation(s) in RCA: 215] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Protein-energy malnutrition is a prevalent problem in older persons. Its relation to increased morbidity and mortality has been well documented. Early recognition of malnutrition allows for a timely intervention. A large proportion of chronic diseases affecting older persons can be either prevented or significantly improved by improving nutrition, which underscores the importance of developing a screening system that can trigger a more comprehensive evaluation when indicated. Screening for malnutrition in older persons can be difficult because of the normal age-related changes in many of the commonly used parameters. A comprehensive nutritional evaluation includes a complete history and physical examination in addition to a more specific nutrition-oriented assessment. Specific nutritional assessment includes estimating food intake, anthropometric measurements, and evaluation of several biochemical parameters commonly affected by changes in nutritional status. In this article, we review the commonly used tools for nutritional assessment in older persons. The goal is to promote disease-free, active, and successful aging.
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Affiliation(s)
- M L Omran
- Geriatric Research, Education, and Clinical Center, St. Louis VAMC, Missouri, USA
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Clarke DM, Wahlqvist ML, Rassias CR, Strauss BJ. Psychological factors in nutritional disorders of the elderly: part of the spectrum of eating disorders. Int J Eat Disord 1999; 25:345-8. [PMID: 10192001 DOI: 10.1002/(sici)1098-108x(199904)25:3<345::aid-eat14>3.0.co;2-t] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To illustrate common psychogenic factors involved in undereating and undernutrition in the elderly. METHOD Two cases are described. RESULTS In the context of age-related physical and social factors, obsessional, phobic, and hypochondriacal anxieties can lead to significant food restrictions and undernutrition. DISCUSSION Psychogenic factors need to be considered in undernutrition of the elderly and the phenomena considered in the spectrum of eating disorders.
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Affiliation(s)
- D M Clarke
- Monash Medical Centre, Melbourne, Australia
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Affiliation(s)
- J E Morley
- Geriatric Research, Education and Clinical Center, St Louis VAMC, MO 63125, USA.
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Abstract
PURPOSE To assess the prevalence, common causes, and frequency of recognition and treatment of undernutrition in older and younger medical outpatients using a cross-sectional survey design with 2-year follow-up of undernourished subjects. PATIENTS AND METHODS Charts of 1017 adult patients attending a hospital outpatient department were reviewed for the presence of undernutrition, and 85 patients meeting inclusion criteria for undernutrition were evaluated and followed for 2 years. An initial evaluation focused on nutritional, cognitive, and affective status and on nutritional attitudes using two subscales of the EAT-26 eating disorder inventory. After 2 years, initial data plus outpatient records were evaluated by 2 independent reviewers to determine a primary cause of undernutrition and to assess the recognition and treatment of undernutrition by the primary physician. RESULTS Undernutrition was identified in 46 (11%) and 44 (7%) of older and younger subjects respectively; odds ratio (OR) (95% [confidence interval (CI)]) for older versus younger=1.65 (1.06 to 2.51). The primary cause of undernutrition differed between age groups but was deemed treatable in nearly 90% of all subjects. Undernutrition was recognized in 19 (43%) older subjects and 5 (12%) younger subjects (OR=5.47 [1.87 to 16.0]), and appropriate intervention(s) were instituted in 6 (14%) and 2 (5%) of older and younger subjects, respectively (OR=3.08 [0.668 to 14.21]). Older subjects scored higher on the EAT-26 oral control subscale than did younger subjects (4.7 versus 2.5, P=0.004) but similarly on the EAT-26 dieting subscale (5.2 versus 6.3, P=0.332); these relationships did not change with control for potentially confounding variables. CONCLUSIONS In this study, undernutrition was relatively common, usually amenable to treatment, but frequently undetected and undertreated in both older and younger medical outpatients. Older undernourished subjects exhibited higher oral control needs than younger persons, which may have implications for the pathophysiology and treatment of their malnutrition. Further improvement in detection and intervention is warranted in both younger and older age groups.
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Affiliation(s)
- M M Wilson
- St. Louis University Health Sciences Center, Missouri, USA
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Fioravanti M, Ferrario E, Massaia M, Cappa G, Rivolta G, Grossi E, Buckley AE. Low folate levels in the cognitive decline of elderly patients and the efficacy of folate as a treatment for improving memory deficits. Arch Gerontol Geriatr 1998; 26:1-13. [PMID: 18653121 DOI: 10.1016/s0167-4943(97)00028-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/1997] [Revised: 07/22/1997] [Accepted: 07/23/1997] [Indexed: 02/05/2023]
Abstract
The relevance of low folate levels as determinants of cognitive deficits and the usefulness of folate supplementation in the treatment of cognitive deficits was reviewed from the literature. Over 40 papers and book chapters published in English, French, German, Italian and Spanish were examined. This represents those papers published in the international literature in the last 10 years which were identified by various key words including folate, cognition and aging (or ageing). Among these papers, only 13 articles specifically addressed issues relevant to the criteria adopted for this review. The remaining papers were principally concerned with depression and or with other pathologies of the aged associated with folate deficiency. Although the specific role of low folate levels in the physiopathology of dementia is still under debate, a growing consensus is emerging in the literature where low folate as well as cobalamin levels in aged patients with cognitive deficits are being considered as a sign of functional problems in the absorption and utilization of vitamins, and not merely as a sign of bad eating habits. In studies where folate compounds were evaluated for treatment effects, the results of a majority of investigations indicated that folate treatment was effective in lessening cognitive deficits. Treatment efficacy, however, has not yet been sufficiently demonstrated by these results because there were no controlled studies and the methodology was heterogeneous for the evaluation of cognitive characteristics. An ad hoc double-blind, controlled versus placebo pilot study was undertaken to evaluate the efficacy of folic acid in 30 aged patients with abnormal cognitive decline and folate level below 3 ng/ml to better understand the value of this type of intervention. Our results from this preliminary study demonstrated that patients treated with folic acid for 60 days showed a significant improvement on both memory and attention efficiency when compared with a placebo group. The intensity of memory improvement was positively correlated with initial severity of folate deficiency. On the contrary, the severity of initial cognitive decline was unrelated to the degree of folate deficiency.
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Affiliation(s)
- M Fioravanti
- Department of Psychiatric Science and Psychological Medicine, University of Rome La Sapienza, P.le A. Moro 5, 00185 Rome, Italy
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Arnalich F, Hernanz A, Vázquez JJ, Amores A. Cell-mediated immune response and cytokine production in idiopathic senile anorexia. Mech Ageing Dev 1994; 77:67-74. [PMID: 7731274 DOI: 10.1016/0047-6374(94)90047-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Some aspects of humoral and cell-mediated immunity and the capacity of peripheral blood mononuclear cells (PBMCs) of fourteen elderly persons with idiopathic anorexia to produce several cytokines, such as tumor necrosis factor alpha (TNF alpha), interleukin-1 beta (IL-1 beta), interleukin-6 and interferon-gamma (IFN gamma), were studied and the results were compared with those obtained in a control group of ten age-matched, normal weight healthy subjects. In addition, spontaneous and induced production of these cytokines was also measured in cultures of PBMCs of fourteen healthy young individuals as a control group of age. A significant decrease in CD2 (pan T-cells) and CD4 (T-helper) lymphocyte subpopulations, but unchanged CD8 (T-suppressor) subset, and a reduced response in delayed cutaneous hypersensitivity tests were observed in senile underweight anorectic patients. Monocyte counts did not show significant differences between patients and control subjects. The spontaneous release by PBMCs of all the cytokines measured did not differ between the anorectic and either the elderly or young control group. A significant increase in IL-6 production after mitogen stimulation with tetradecanoylphorbol acetate (TPA) and phytohemagglutinin (PHA) after 24 and 48 h of culture, as well as a greater induced TNF alpha production after 48 h of incubation with the same mitogens, was found in the anorectic patients as compared with the elderly controls. However, stimulated production of both IL-1 beta with TPA and of IFN gamma with PHA did not differ significantly between anorectics and aged controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Arnalich
- Department of Internal Medicine, La Paz Hospital, Universidad Autónoma de Madrid, Spain
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Affiliation(s)
- J E Morley
- Geriatrics Research Education and Clinical Center, St. Louis VA Medical Center, Missouri
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Martinez M, Hernanz A, Gómez-Cerezo J, Peña JM, Vazquez JJ, Arnalich F. Alterations in plasma and cerebrospinal fluid levels of neuropeptides in idiopathic senile anorexia. REGULATORY PEPTIDES 1993; 49:109-17. [PMID: 7907801 DOI: 10.1016/0167-0115(93)90432-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Plasma and cerebrospinal fluid (CSF) concentrations of three well-known satiety neuropeptides, cholecystokinin (CCK), somatostatin and calcitonin gene-related peptide (CGRP), along with two powerful orexigenic neuropeptides, neuropeptide Y (NPY) and beta-endorphin have been measured in elderly persons with idiopathic anorexia and normal weight healthy subjects in a similar age range. Plasma and CSF immunoreactivity levels of the two main fractions of CCK (CCK8s and CCK33) after being separated by HPLC were measured by a radioimmunoassay (RIA) developed in our laboratory, whereas the other neuropeptides were assayed by commercially available RIA kits. Elderly underweight anorectic patients had significantly lower levels of beta-endorphin but increased concentrations of NPY in both plasma and CSF when compared to controls. In addition to significantly higher levels of CCK8s but not CCK33 in plasma, we found a trend to higher CSF concentrations of CCK8s and a positive correlation between the body mass index and either beta-endorphin (r = 0.58, P < 0.05) or CCK8s (r = 0.69, P < 0.01) concentrations in CSF in the anorectic group. CSF somatostatin concentrations were decreased significantly, but plasma somatostatin levels and plasma and CSF concentrations of CGRP were similar in senile anorectics and controls. Treatment of five anorectic patients with megestrol acetate, 480 mg daily for 6 months, reversed only the decrease in CSF beta-endorphin levels but did not normalize the body weight or the fat body mass. On the basis of our findings, we hypothesize that a decrease in CSF beta-endorphin concentration along with a rise in plasma levels of CCK8s might be accounted for the primary anorexia of aging.
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Affiliation(s)
- M Martinez
- Department of Biochemistry, La Paz Hospital and School of Medicine, Autonomous University, Madrid, Spain
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Abstract
Reviewed here are the major nutritional problems of older females, stressing where older female nutrition differs from that of older males. Older females have a higher body mass index and lower waist-to-hip ratio than do older males. Older females reduce their food intake compared to younger females much less than do older males compared to younger males. Total energy expenditure is minimally reduced in older females compared to young females. Resting metabolic rate is reduced by 13% in older females. The major nutritional problem faced by older females, protein energy malnutrition, and its reversible causes are addressed. Inability to recognize the need for fluids is a common problem leading to dehydration in older persons. Older persons are at major risk for ingesting less than two-thirds of the recommended dietary allowance for vitamins. Older women are more likely than men to take vitamin or mineral supplements. Osteopenia is a common problem leading to fractures in older women, and decreased calcium intake and vitamin D deficiency, as well as estrogen deficiency, play a role in the pathogenesis of osteopenia. Total cholesterol levels increase with age in older women, while high-density lipoprotein cholesterol levels decline. However, cholesterol levels that are optimum for survival are higher in older women than in older men. At < 65 years of age, diabetes mellitus (DM) is more common in females, and at > 65 years of age it is more common in males. Over one-half of older persons with DM are undiagnosed. Management of DM in older persons requires a judicious approach to balance the potential problems of hypo- and hyperglycemia.
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Affiliation(s)
- J E Morley
- Geriatric Research, Education and Clinical Center, St. Louis University Medical Center, MO 63104
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Martinez M, Arnalich F, Vazquez JJ, Hernanz A. Altered cerebrospinal fluid amino acid pattern in the anorexia of aging: relationship with biogenic amine metabolism. Life Sci 1993; 53:1643-50. [PMID: 7694027 DOI: 10.1016/0024-3205(93)90188-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To study the possible role of several amino acids on feeding in the anorexia of aging, we have measured plasma and cerebrospinal fluid (CSF) concentrations of 22 amino acids in 14 elderly persons with idiopathic anorexia and 10 healthy subjects with normal weight in a similar age range. Plasma and CSF amino acid concentrations and CSF homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) levels were all measured by HPLC methods. Elderly anorectic subjects had significantly lower levels of glutamic acid but increased concentrations of glutamine in both plasma and CSF compared to controls. Likewise, a significant increase of histidine, threonine, alanine, arginine, valine, methionine, isoleucine, leucine, phenylalanine, tryptophan, ornithine and lysine was found in CSF, but not in plasma, from patients with anorexia. Besides, the CSF histidine/LNAA (large neutral amino acids) and tryptophan/LNAA ratios were elevated in anorectic patients as compared with controls of similar age. In addition, we found higher CSF concentrations of HVA and 5-HIAA, as well as a positive correlation between CSF LNAA and either HVA (r = 0.74, p = 0.002) or 5-HIAA (r = 0.61, p = 0.020) concentrations in elderly anorectics. CSF tryptophan correlated positively with 5-HIAA levels (r = 0.59, p = 0.026) and CSF tyrosine with HVA levels (r = 0.77, p = 0.002). Our results suggest that changes in the CSF concentration of amino acids could contribute to an increased biogenic amine metabolism in the central nervous system of elderly anorectic subjects, possibly increasing the synaptic liberation of biogenic amines involved in the appetite regulation.
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Affiliation(s)
- M Martinez
- Department of Biochemistry, La Paz Hospital, Madrid, Spain
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Miller DK, Morley JE, Rubenstein LZ, Pietruszka FM. Abnormal eating attitudes and body image in older undernourished individuals. J Am Geriatr Soc 1991; 39:462-6. [PMID: 2022797 DOI: 10.1111/j.1532-5415.1991.tb02490.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An anorexia nervosa-like syndrome has been reported in older persons. To gain additional insight into this condition, a questionnaire designed to assess the severity of eating disorders (the EAT-26) was administered to 183 male outpatients. Thirty-four subjects were found to be undernourished by midarm circumference measurement and 21 by weight adjusted for age-sex-height. Approximately 60% of malnourished subjects acknowledged inappropriate self-control around food, up to 26% described other unsuitable eating attitudes, and 3% to 52% evidenced various forms of distorted body image. They scored high on EAT-26 Oral Control subscale but low to normal on Dieting and Bulimia and Food Preoccupation subscales. These results indicate that abnormal eating attitudes and body image occur in an important minority of undernourished elderly males, but the pattern of abnormalities differs from that seen in classical anorexia nervosa. This association deserves additional investigation, with special attention to the psychopathology producing high Oral Control responses and to females as well as males. In the meantime, clinicians need to consider anorexia-like attitudes when caring for malnourished seniors.
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Affiliation(s)
- D K Miller
- Division of Geriatric Medicine, St. Louis University Medical Center 63104
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