Association of anorexia/appetite loss with malnutrition and mortality in older populations: A systematic literature review

Abstract

Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may reflect deficient understanding of clinical sequelae. Therefore, we performed a systematic literature review to assess the morbidity and mortality burden of anorexia/appetite loss in older populations. Following PRISMA guidelines, searches were run (1 January 2011 to 31 July 2021) in PubMed, Embase® and Cochrane databases to identify English language studies of adults aged ≥ 65 years with anorexia/appetite loss. Two independent reviewers screened titles, abstracts and full text of identified records against pre‐defined inclusion/exclusion criteria. Population demographics were extracted alongside risk of malnutrition, mortality and other outcomes of interest. Of 146 studies that underwent full‐text review, 58 met eligibility criteria. Most studies were from Europe (n = 34; 58.6%) or Asia (n = 16; 27.6%), with few (n = 3; 5.2%) from the United States. Most were conducted in a community setting (n = 35; 60.3%), 12 (20.7%) were inpatient based (hospital/rehabilitation ward), 5 (8.6%) were in institutional care (nursing/care homes) and 7 (12.1%) were in other (mixed or outpatient) settings. One study reported results separately for community and institutional settings and is counted in both settings. Simplified Nutritional Appetite Questionnaire (SNAQ Simplified, n = 14) and subject‐reported appetite questions (n = 11) were the most common methods used to assess anorexia/appetite loss, but substantial variability in assessment tools was observed across studies. The most commonly reported outcomes were malnutrition and mortality. Malnutrition was assessed in 15 studies, with all reporting a significantly higher risk of malnutrition in older individuals with anorexia/appetite loss (vs. without) regardless of country or healthcare setting (community n = 9, inpatient n = 2, institutional n = 3, other n = 2). Of 18 longitudinal studies that assessed mortality risk, 17 (94%) reported a significant association between anorexia/appetite loss and mortality regardless of either healthcare setting (community n = 9, inpatient n = 6, institutional n = 2) or method used to assess anorexia/appetite loss. This association between anorexia/appetite loss and mortality was observed in cohorts with cancer (as expected) but was also observed in older populations with a range of comorbid conditions other than cancer. Overall, our findings demonstrate that, among individuals aged ≥ 65 years, anorexia/appetite loss is associated with increased risk of malnutrition, mortality and other negative outcomes across community, care home and hospital settings. Such associations warrant efforts to improve and standardize screening, detection, assessment and management of anorexia/appetite loss in older adults.

Transtornos alimentares e sua ocorrência em idosos: os impactos destes distúrbios na terceira idade

“…Outro obstáculo são as campanhas de conscientização contra a perda de peso que podem favorecer a frequência de transtornos alimentares, se não forem bem elaboradas, visto que a ocorrência desses transtornos, pode estar associada ao aumento do risco de desnutrição, mortalidade e outros resultados negativos 32 . As campanhas devem ser focadas na importância de uma alimentação equilibrada, hábitos alimentares saudáveis e prática de atividade física para que sejam mais eficazes e reprodutivas, sem ampliar um estereótipo de corpo a ser conquistado 33 .…”

Efectos de la inseguridad alimentaria en población vulnerable adulto mayor: revisión rápida de la literatura

“…El estado nutricional es valorado principalmente gracias a escalas basadas en cuestionarios, como lo es la MNA (Mini Nutritional Assesment), la cual es una herramienta adecuada y fácil de usar, además de estar validada y relacionada con los resultados de diversos estudios que observan el estado de riesgo de desnutrición, desnutrición o un adecuado estado nutricional de pacientes geriátricos. (22) Entre otros factores relacionados con estados de malnutrición, encontramos la soledad y las preocupaciones económicas, que llevan a la presencia de anorexia (23,24), la cual se asocia con un aumento del 63% de desnutrición (25). También, se han identificado alteraciones gastrointestinales, que fueron determinadas como el principal factor de riesgo según L, Meng, et al (21), y factores como la baja ingesta, el aumento de requerimientos calóricos y la disminución de la biodisponibilidad de nutrientes (26).…”

“…En Colombia, el estudio realizado por Rodríguez et al reportó que la tasa de mortalidad aumentaba con la edad, donde la causa predominante de muerte fue la desnutrición proteico-calórica grave (18). Además, existe una asociación entre la inapetencia y el riesgo de muerte en la población de adultos mayores (25).…”

Impact of Motivation for Eating Habits, Appetite and Food Satisfaction, and Food Consciousness on Food Intake and Weight Loss in Older Nursing Home Patients

“… 13 ) Appetite loss is associated with increased risks of malnutrition, mortality, and decreased muscle strength, as well as decreased physical performance. 14 , 15 ) Anorexia is a diagnostic criterion for cachexia in Asia. 16 ) Therefore, appetite assessment is necessary in older adults who require long-term care.…”