Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
Neurogastroenterol Motil. 2013 Apr;25(4):291-e245. doi: 10.1111/nmo.12055. Epub 2012 Dec 13.
The mechanisms involved in anorexia in frail elderly people remain unclear. The objective of this study was to establish whether fasting and postprandial levels of gastrointestinal peptides, gastrointestinal motility, and hunger are modified by age and frailty.
Three groups of subjects were studied: (a) frail elderly (>70 years) persons, (b) non-frail elderly (>70 years) persons, and (c) healthy adults (aged 25-65 years). After an overnight fast, participants ingested a 400 Kcal liquid meal and appetite, hormonal, and gastrointestinal responses were monitored during early (0-60 min) and late (60-240 min) postprandial periods.
Frail persons showed poor nutritional status, sarcopenia, and almost absence of hunger during fasting and postprandial periods. Older persons presented higher levels of glucose and insulin during fasting, enhanced postprandial CCK release in early postprandial period and postprandial hyperglycemia and hyperinsulinemia, but similar ghrelin levels than younger adults. Ultrasound scan showed that the fasting antral area was higher and antral compliance lower in old persons. The paracetamol absorption test showed enhanced postprandial gastric emptying in the frail. Non-gallbladder contractors showed no CCK peak in younger and non-frail groups, but the same high CCK peak as contractors in the frail.
CONCLUSIONS & INFERENCES: Frailty was associated with anorexia, risk of malnutrition, and sarcopenia. Frail persons showed impaired gastric motility (larger antral area at rest, impaired antral compliance, and enhanced postprandial emptying), impaired gallbladder motility, and fasting and/or postprandial alterations in CCK, glucose, and insulin release. Further studies are needed to determine if these factors may contribute to anorexia of aging in frail persons.
虚弱老年人厌食的机制仍不清楚。本研究旨在确定禁食和餐后胃肠肽、胃肠动力和饥饿感是否受年龄和虚弱程度的影响。
研究了三组受试者：（a）虚弱老年人（>70 岁），（b）非虚弱老年人（>70 岁）和（c）健康成年人（25-65 岁）。受试者禁食一夜后，摄入 400kcal 液体餐，监测早（0-60min）和晚（60-240min）餐后期间的食欲、激素和胃肠反应。
虚弱者在禁食和餐后期间表现出较差的营养状态、肌肉减少症和几乎没有饥饿感。老年人在禁食期间血糖和胰岛素水平较高，早餐后胆囊收缩素（CCK）释放增强，餐后高血糖和高胰岛素血症，但与年轻成年人相比，胃饥饿素水平相似。超声扫描显示，老年人空腹时胃窦面积较高，胃窦顺应性较低。对乙酰氨基酚吸收试验显示，虚弱者餐后胃排空加快。非胆囊收缩者在年轻和非虚弱组中没有 CCK 峰值，但在虚弱者中与收缩者一样有高 CCK 峰值。
虚弱与厌食、营养不良风险和肌肉减少症有关。虚弱者表现为胃动力受损（空腹时胃窦面积增大、胃窦顺应性降低、餐后胃排空加快）、胆囊动力受损以及禁食和/或餐后 CCK、血糖和胰岛素释放改变。需要进一步研究以确定这些因素是否可能导致虚弱者的衰老性厌食。
