Eating habits and appetite control in the elderly: The anorexia of aging
Eating habits and appetite control in the elderly: The anorexia of aging
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DOI：
10.1017/s1041610203008779
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发表时间：
2003-03-01
影响因子：
7
通讯作者：
Cannella, C
中科院分区：
文献类型：
--
作者：
Donini, LM;Savina, C;Cannella, C
虽然老年人中超重的发生率很高，但老年人主要关注的问题是据报道食物摄入量减少和饮食动机丧失。这表明存在与调节能量平衡和控制食物摄入有关的问题。能量摄入减少导致体重减轻可能是由社会或生理因素引起的，或者两者兼而有之。贫困、孤独和社会孤立是导致老年人食物摄入量减少的主要社会因素。抑郁症通常与社交网络的丧失或恶化有关，是老年人常见的心理问题，也是食欲不振的重要原因。食物摄入量的减少可能是由于较低的需求状态导致的进食动力（饥饿感）的减少，或者是由于更迅速的作用或更强的抑制（饱腹感）信号而产生的。早期饱足似乎主要是由于胃底适应性松弛减少导致早期胃窦充盈，而胆囊收缩素水平和有效性的增加在衰老的厌食症中起作用。中枢进食驱动（阿片类药物和神经肽Y效应）似乎随着年龄的增长而下降。身体因素，如牙列不良和假牙不合适，或与年龄相关的味觉和嗅觉变化，可能会影响老年人的食物选择，并限制他们所吃食物的种类和数量。老年人的常见疾病，如胃肠道疾病、吸收不良综合征、急性和慢性感染以及代谢亢进，往往导致厌食症、微量营养素缺乏以及能量和蛋白质需求增加。此外，老年人是处方药的主要使用者，其中一些会导致营养吸收不良、胃肠道症状和食欲不振。现在有充分的证据表明，尽管与年龄相关的能量摄入减少主要是健康衰老的生理效应，但它可能导致有害的厌食效应，这些厌食效应是随着年龄的增长而日益频繁出现的心理、社会和身体问题。营养状况不佳与老年人常见病的发生和发展有关。蛋白质能量营养不良与肌肉功能受损、骨量减少、免疫功能障碍、贫血、认知功能下降、伤口愈合不良、手术后恢复延迟以及最终增加发病率和死亡率有关。加深对造成老年人营养不良的因素的了解，应有助于制定适当的预防和治疗战略，并改善老年人的健康。
Although a high prevalence of overweight is present in elderly people, the main concern in the elderly is the reported decline in food intake and the loss of the motivation to eat. This suggests the presence of problems associated with the regulation of energy balance and the control of food intake. A reduced energy intake causing body weight loss may be caused by social or physiological factors, or a combination of both. Poverty, loneliness, and social isolation are the predominant social factors that contribute to decreased food intake in the elderly. Depression, often associated with loss or deterioration of social networks, is a common psychological problem in the elderly and a significant cause of loss of appetite. The reduction in food intake may be due to the reduced drive to eat (hunger) resulting from a lower need state, or it arises because of more rapidly acting or more potent inhibitory (satiety) signals. The early satiation appears to be predominantly due to a decrease in adaptive relaxation of the stomach fundus resulting in early antral filling, while increased levels and effectiveness of cholecystokinin play a role in the anorexia of aging. The central feeding drive (both the opioid and the neuropeptide Y effects) appears to decline with age. Physical factors such as poor dentition and ill-fitting dentures or age-associated changes in taste and smell may influence food choice and limit the type and quantity of food eaten in older people. Common medical conditions in the elderly such as gastrointestinal disease, malabsorption syndromes, acute and chronic infections, and hypermetabolism often cause anorexia, micronutrient deficiencies, and increased energy and protein requirements. Furthermore, the elderly are major users of prescription medications, a number of which can cause malabsorption of nutrients, gastrointestinal symptoms, and loss of appetite. There is now good evidence that, although age-related reduction in energy intake is largely a physiologic effect of healthy aging, it may predispose to the harmful anorectic effects of psychological, social, and physical problems that become increasingly frequent with aging. Poor nutritional status has been implicated in the development and progression of chronic diseases commonly affecting the elderly. Protein-energy malnutrition is associated with impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, and ultimately increased morbidity and mortality. An increasing understanding of the factors that contribute to poor nutrition in the elderly should enable the development of appropriate preventive and treatment strategies and improve the health of older people.