New horizons in appetite and the anorexia of ageing

Cox, Natalie; Morrison, Leanne; Ibrahim, Kinda; Robinson, Siân; Sayer, Avan A.; Roberts, Helen

doi:10.1093/ageing/afaa014

Cited by 80 publications

(76 citation statements)

References 44 publications

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“…In addition, upregulation of proinflammatory cytokines, as seen in COVID-19, is associated with induction of leptin and anorexia [48]. Combined with the effects of anorexia of ageing [49], older adults may be particularly vulnerable to these effects. In addition, sarcopenia in itself has been shown to be associated with weakness in masticatory muscles, which may further exacerbate diminished food intake [50].…”

Section: Nutritionmentioning

confidence: 99%

COVID-19 and Acute Sarcopenia

Welch¹,

Greig²,

Masud³

et al. 2020

Aging and disease

130

142

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The COVID-19 pandemic has had a devastating global impact, with older adults being most at risk of death from the disease. However, acute sarcopenia occurs in survivors of COVID-19; older adults and the most critically unwell patients are the most at risk. Acute sarcopenia is an under-recognised condition of acute muscle insufficiency, defined by declines in muscle function and/or quantity within six months, usually following a stressor event. This commentary reviews definition and mechanisms of acute sarcopenia in COVID-19 and suggests recommendations for research and clinical practice. Research should now focus on the longer-term consequences of acute sarcopenia in patients who have suffered from COVID-19. At the same time, clinicians need to be increasingly aware of the condition, and measurements of muscle strength, quantity, and physical performance should be embedded into clinical practice. Clinicians should consider the risks of acute sarcopenia when weighing up the risks and benefits of treatment (e.g. dexamethasone), and instigate multidisciplinary treatment including dietetics input.

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Section: Nutritionmentioning

confidence: 99%

COVID-19 and Acute Sarcopenia

Welch¹,

Greig²,

Masud³

et al. 2020

Aging and disease

130

142

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“…1 However, it is also due to multiple underlying determinants as part of the ageing process in the anorexia of ageing. 1,6 This includes well-recognized alterations in mechanical and neuroendocrine functioning of the gut. 4,7 An integral component of gut neuroendocrine activity is the interaction with resident gut microbiota (bacteria, archaea, viruses, and eukaryotic microbes).…”

Section: Introductionmentioning

confidence: 99%

“…Loss of appetite in older individuals can often be attributed to medical conditions, such as chronic obstructive pulmonary disease, heart or renal failure, and medication including opiates and certain antimicrobials among others 1 . However, it is also due to multiple underlying determinants as part of the ageing process in the anorexia of ageing 1,6 . This includes well‐recognized alterations in mechanical and neuroendocrine functioning of the gut 4,7 .…”

Section: Introductionmentioning

confidence: 99%

The composition of the gut microbiome differs among community dwelling older people with good and poor appetite

Cox

Bowyer

Lochlainn

et al. 2021

J cachexia sarcopenia muscle

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Background Anorexia of ageing is common and important in the development of sarcopenia in older individuals. Links have been proposed between the gut microbiota and sarcopenia. Disordered gut function is also recognized in anorexia of ageing, but how this may relate to resident gut microbiota is unexplored. Understanding this relationship may provide a basis for novel interventions for anorexia of ageing and sarcopenia. This study explores compositional differences of the gut microbiota between community dwelling healthy older adults with good or poor appetite, and associated differences in sarcopenia. Methods We assessed appetite by the Simplified Nutritional Appetite Questionnaire (SNAQ) in members of the TwinsUK cohort aged ≥65 years. Using a pool of 776 individuals with existing microbiome data estimated from 16S rRNA sequencing data, we identified 102 cases (SNAQ score < 14) (95% female, mean age 68 years) matched to controls (SNAQ > 14) on body mass index, gender, age, diet, calorie consumption, frailty, antibiotic use, socio-economic status, and technical variables to minimize confounding microbiota associations. Species abundance and diversity, compositional differences, and paired differences in taxa abundance were compared between cases and controls. Additionally, we compared case and controls for sarcopenia as measured by muscle mass (appendicular lean mass/height 2 ) and strength (chair stand time in seconds). Results Cases with poor appetite had reduced species richness and diversity of their gut microbiome (adjusted OBSERVED: beta = À0.2, P < 0.001; adjusted SHANNON: beta = À0.17, P = 0.0135), significant compositional differences (adjusted non-parametric multivariate analysis of variance, P = 0.0095), and significant differences in taxa abundance including reduction of genus Lachnospira (logFC = À1.015, q = 0.023). In all-female subgroup analysis, cases with poor appetite demonstrated reduction in muscle strength (11.03 s vs. 9.26 s, P = 0.02). Conclusions This study is the first to observe differences in the composition of gut microbiota between healthy community dwelling older individuals with good and poor appetite. We found female individuals with reduced muscle strength had poor appetite compared with those with normal strength. These associations require further examination to understand causality and mechanisms of interaction, to inform potential strategies targeting the gut microbiota as a novel intervention for anorexia of ageing and sarcopenia.

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“…Malnutrition and AA are often used interchangeably, when in fact one is a precursor of the other and early interventions may prevent malnutrition, weight loss, and cachexia ( 53 – 55 ). Slightly more than half of older adults at risk of malnutrition are known to be either frail or pre-frail ( 56 ).…”

Section: Discussionmentioning

confidence: 99%

Rapid Geriatric Assessment Using Mobile App in Primary Care: Prevalence of Geriatric Syndromes and Review of Its Feasibility

et al. 2020

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With the aging population and consequent increase in associated prevalence of frailty, dementia, and multimorbidity, primary care physicians will be overwhelmed with the complexity of the psychosocial and clinical presentation. Geriatric syndromes including frailty, sarcopenia, cognitive impairment, and anorexia of aging (AA) either in isolation or in combination are associated with an increased risk of adverse outcomes and if recognized early, and appropriately managed, will lead to decreased disability. Primary care practices are often located in residential settings and are in an ideal position to incorporate preventive screening and geriatric assessment with personalized management. However, primary care physicians lack the time, multidisciplinary resources, or skills to conduct geriatric assessment, and the limited number of geriatricians worldwide further complicates the matter. There is no one effective strategy to implement geriatric assessment in primary care which is rapid, cost-effective, and do not require geriatricians. Rapid Geriatric Assessment (RGA) takes <5 min to complete. It screens for frailty, sarcopenia, AA, and cognition with assisted management pathway without the need of a geriatrician. We developed RGA iPad application for screening with assisted management in two primary care practices and explored the feasibility and overall prevalence of frailty, sarcopenia, and AA. The assessment was conducted by trained nurses and coordinators. Among 2,589 older patients ≥65 years old, the prevalence of frailty was 5.9%, pre-frail 31.2%, and robust 62.9%. Fatigue was present in 17.8%, and among them, the prevalence of undiagnosed depression as assessed by the Patient Health Questionnaire (PHQ)-9 was 76.4% and 13.5% of total. The prevalence of sarcopenia was 15.4%, and 13.9% experienced at least one fall in the past year. AA was prevalent in 10.9%. The time taken to do the assessment with defined algorithm was on average 5 min or less per patient, and 96% managed to complete the assessment prior to seeing their doctor in the same session. The RGA app is a rapid and feasible tool to be used by any healthcare professional in primary care for identification of geriatric syndrome with assisted management.

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New horizons in appetite and the anorexia of ageing

Cited by 80 publications

References 44 publications

COVID-19 and Acute Sarcopenia

COVID-19 and Acute Sarcopenia

The composition of the gut microbiome differs among community dwelling older people with good and poor appetite

Rapid Geriatric Assessment Using Mobile App in Primary Care: Prevalence of Geriatric Syndromes and Review of Its Feasibility

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