Thomas David R
Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri, USA.
Am J Geriatr Pharmacother. 2011 Apr;9(2):97-108. doi: 10.1016/j.amjopharm.2011.04.001.
The loss of appetite, anorexia, is commonly observed in older persons and associated with adverse outcomes. It is becoming increasingly apparent that anorexia is the chief factor in producing weight loss in older adults. Although common and expected in acute illness, anorexia is also frequently associated with chronic diseases and leads to inadequate nutrient intake.
The aim of this paper was to review clinical studies on the use of orexigenic drugs to stimulate appetite.
Clinical trials were identified related to improving appetite and/or weight gain in older persons. Articles were identified by Ovid search using terms nutrition, anorexia, cachexia, weight loss, orexigenic drugs, and by searching references from retrieved papers.
Environmental and nutritional interventions to improve intake should be the first intervention. When these fail to produce adequate intake, orexigenic drugs should be considered. No drug has received approval from the US Food and Drug Administration for geriatric anorexia.
In the presence of adequate food, weight loss most often is due to cytokine-associated cachexia and anorexia. Assessment of changes in appetite is essential to evaluating older persons with weight loss. When anorexia is identified, a search for reversible causes should be instituted. Intervention should first be aimed at the provision of adequate calories and protein, often in the form of high-density nutritional supplements. Failure to respond to adequate nutrition or supplements should trigger a concern for cachexia. Orexigenic drugs have been reported to improve appetite and produce weight gain. The mechanism is unknown, but it may relate to suppression of proinflammatory cytokines.
食欲减退，即厌食，在老年人中很常见，且与不良后果相关。越来越明显的是，厌食是导致老年人体重减轻的主要因素。尽管厌食在急性疾病中很常见且是预期会出现的情况，但它也经常与慢性疾病相关，并导致营养摄入不足。
本文旨在综述关于使用促食欲药物来刺激食欲的临床研究。
确定与改善老年人食欲和/或体重增加相关的临床试验。通过使用营养、厌食、恶病质、体重减轻、促食欲药物等术语在Ovid数据库中进行检索，并通过检索所获论文的参考文献来识别文章。
改善摄入量的环境和营养干预应作为首要干预措施。当这些措施未能产生足够的摄入量时，应考虑使用促食欲药物。目前尚无药物获得美国食品药品监督管理局批准用于治疗老年厌食症。
在有充足食物的情况下，体重减轻通常是由于细胞因子相关的恶病质和厌食所致。评估食欲变化对于评估体重减轻的老年人至关重要。当发现厌食时，应寻找可逆性病因。干预应首先旨在提供足够的热量和蛋白质，通常以高密度营养补充剂的形式。对充足营养或补充剂无反应应引发对恶病质的关注。据报道，促食欲药物可改善食欲并使体重增加。其机制尚不清楚，但可能与抑制促炎细胞因子有关。
