Malnutrition in the elderly is one of the greatest threats to health, well-being and autonomy, it is therefore crucial to understand and to contrast the causal factors of inadequate energy intake. This review focuses on the mechanisms of the so-called ‘anorexia of aging’. In recent years, it has been shown that elderly subjects have abnormal peripheral signal patterns and alterations in central hypothalamic control relays. Negative feedback from impaired gastric motility, exaggerated long-term adiposity signals (leptin, insulin) and postprandial anorexigenic signals (CCK, PYY) seem to prevail over the central feeding drive. If nutritional strategies of intervention are to be improved, these data need to be taken into account.

These results suggest a high prevalence of co-morbid conditions in severely obese patients undergoing bariatric surgery. Age, ethnicity and gender influence the type of co-morbid conditions. More research is needed to understand why diabetes and other metabolic complications remain undiagnosed and untreated in a large number of these high risk patients.

2. Solfrizzi V, Panza F, Colacicco AM et al. for the Italian Longitudinal Study on Aging Working Group. Vascular risk factors, incidence of MCI, and rates of progression to dementia. Neurology 2004;63:1882-1891. 3. Panza F, D'Introno A, Colacicco AM et al. Current epidemiology of mild cognitive impairment and other predementia syndromes. Am J Geriatr Psychiatry 2005;13:633-644. 4. Panza F, D'Introno A, Colacicco AM et al. Cognitive frailty: Predementia syndrome and vascular risk factors. Neurobiol Aging 2006;27:933-940. 5. Morris JC, Cummings J. Mild cognitive impairment (MCI) represents earlystage Alzheimer's disease. J Alzheimers Dis 2005;7:235-239. 6. Petersen RC, Bennett D. Mild cognitive impairment: Is it Alzheimer's disease or not? J Alzheimers Dis 2005;7:241-245. 7. Di Carlo A, Baldereschi M, Amaducci L et al. ; ILSAWorking Group. Incidence of dementia, Alzheimer's disease, and vascular dementia in Italy. The ILSA Study. J Am Geriatr Soc 2002;50:41-48. 8. Larrieu S, Letenneur L, Orgogozo JM et al. Incidence and outcome of mild cognitive impairment in a population-based prospective cohort. Neurology 2002;59:1594-1599. 9. Ganguli M, Dodge H, Shen C et al. Mild cognitive impairment, amnestic type. An epidemiologic study. Neurology 2004;63:115-121. 10. Busse A, Bischkopf J, Riedel-Heller SG et al. Mild cognitive impairment: Prevalence and incidence according to different diagnostic criteria. Results of the Leipzig Longitudinal Study of the Aged. Br J Psychiatr 2003;182:449-454.

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BI is related to subjective ORQL independently of anthropometrical measurements both at baseline and after treatment. Better psychometrical scores in people still in treatment after 6 months suggest that BI could be considered one of the variables which influence compliance to the treatment program, this fact needs more investigations and could be of interest in obesity treatment outcome studies.

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