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. 2019 Jan 11;11(1):144.
doi: 10.3390/nu11010144.

Assessment and Treatment of the Anorexia of Aging: A Systematic Review

Natalie J Cox  1   2 , Kinda Ibrahim  3 , Avan A Sayer  4   5   6 , Sian M Robinson  7 , Helen C Roberts  8   9   10
Affiliations

Assessment and Treatment of the Anorexia of Aging: A Systematic Review

Natalie J Cox et al. Nutrients. .

Abstract

(1) Background: Appetite loss in older people, the 'Anorexia of Aging' (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment. (2) Methods: Study inclusion: participants aged ≥65, intervention for AA, and appetite assessment, any design, and comparator. Exclusion: studies on specific health cohorts. Searches in four databases with hand searching of references and citing works. Two researchers independently assessed eligibility and quality. (3) Results: Authors screened 8729 titles, 46 full texts. Eighteen articles were included describing nine intervention types: education (n = 1), exercise (n = 1), flavor enhancement (n = 2), increased meal variety (n = 1), mealtime assistance (n = 1), fortified food (n = 1), oral nutritional supplement (ONS) (n = 8), amino acids (n = 1), and medication (n = 2). Three studies evaluated combinations: education + exercise, ONS + exercise, and ONS + medication. Five intervention types exhibited favorable effects on appetite but in single datasets or not replicated. Appetite was assessed predominantly by Likert (n = 9), or visual analogue scales (n = 7). (4) Conclusions: A variety of interventions and methods of appetite assessments were used. There was a lack of clarity about whether AA or undernutrition was the intervention target. AA is important for future research but needs standardized assessment so that effectiveness of a range of interventions can be fully explored.

Keywords: anorexia; appetite; assessment; frailty; nutrition; older people; systematic review; treatment.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Multi-factorial causes of the anorexia of aging. Consequences are mostly attributable to subsequent undernutrition but there is some evidence for an independent association with sarcopenia [2,8,9,10,11,12,13,14,15,16].
Figure 2
Figure 2
PICO statement for study inclusion.
Figure 3
Figure 3
Flow diagram for screening and eligibility of studies for inclusion.
See this image and copyright information in PMC

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