Cox Natalie J, Morrison Leanne, Ibrahim Kinda, Robinson Sian M, Sayer Avan A, Roberts Helen C
Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Age Ageing. 2020 Jul 1;49(4):526-534. doi: 10.1093/ageing/afaa014.
Appetite drives essential oral nutritional intake. Its regulation is complex, influenced by physiology, hedonism (the reward of eating) and learning from external cues within a person's society and culture. Appetite loss is common in the older population and not always attributable to medical conditions or treatment. Although the physiological basis of the anorexia of ageing (loss of appetite due to the ageing process) has been established, the effect of ageing on hedonism and external cues, which may be equally important, is less well understood. The anorexia of ageing is associated with reductions in dietary diversity and oral intake, and increased risk of malnutrition, sarcopenia and frailty. Early identification of poor appetite could allow timely intervention before weight loss occurs. There is no standardised tool for assessing appetite in clinical settings at present but the 4-item Simplified Nutritional Appetite Questionnaire (SNAQ) has the potential to be used in this way. This review, designed for clinicians, will discuss the regulation of appetite and the pathogenesis of the anorexia of ageing. It will describe the current evidence for interventions to manage the anorexia of ageing, which is limited, with little benefit reported from individual studies of education, physical activity and medication. There is some positive evidence for flavour enhancement, fortified food and oral nutritional supplements but mainly within single studies. Looking ahead, the aim is to develop multicomponent approaches to the treatment of the anorexia of ageing based on growing understanding of the role of physiological signalling, hedonism and external cues.
食欲驱动着必需的经口营养摄入。其调节过程复杂，受生理因素、享乐主义（进食的奖赏）以及从个人所处社会和文化中的外部线索学习的影响。食欲减退在老年人群中很常见，且并不总是由疾病状况或治疗引起。尽管衰老性厌食（因衰老过程导致的食欲丧失）的生理基础已明确，但衰老对享乐主义和外部线索的影响（可能同样重要）却了解较少。衰老性厌食与饮食多样性和经口摄入量的减少以及营养不良、肌肉减少症和身体虚弱风险的增加有关。尽早识别食欲不佳情况可在体重减轻发生前及时进行干预。目前在临床环境中尚无评估食欲的标准化工具，但4项简化营养食欲问卷（SNAQ）有潜力用于此目的。本综述专为临床医生设计，将讨论食欲调节及衰老性厌食的发病机制。它将描述目前针对衰老性厌食进行干预的证据，这些证据有限，个别关于教育、体育活动和药物治疗的研究报告的益处很少。对于风味增强、强化食品和口服营养补充剂有一些积极证据，但主要来自单项研究。展望未来，目标是基于对生理信号传导、享乐主义和外部线索作用的日益深入理解，开发多成分方法来治疗衰老性厌食。
