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衰老性厌食:生理与病理方面

Anorexia of aging: physiologic and pathologic.

作者信息

Morley J E

机构信息

Division of Geriatrics, St Louis University Medical School, MO 63104, USA.

出版信息

Am J Clin Nutr. 1997 Oct;66(4):760-73. doi: 10.1093/ajcn/66.4.760.

Abstract

Despite the increase in body fat and obesity that occurs with aging, there is a linear decrease in food intake over the life span. This conundrum is explained by decreased physical activity and altered metabolism with aging. Thus, older persons fail to adequately regulate food intake and develop a physiologic anorexia of aging. This physiologic anorexia depends not only on decreased hedonic qualities of feeding with aging (an area that remains controversial) but also on altered hormonal and neurotransmitter regulation of food intake. Findings in older animals and humans have provided clues to the causes of the anorexia of aging. An increase in circulating concentrations of the satiating hormone, cholecystokinin, occurs with aging in humans. In addition, animal studies suggest a decrease in the opioid (dynorphin) feeding drive and possibly in neuropeptide Y and nitric oxide. The physiologic anorexia of aging puts older persons at high risk for developing protein-energy malnutrition when they develop either psychologic or physical disease processes. Despite its high prevalence, however, protein-energy malnutrition in older persons is rarely recognized and even more rarely treated appropriately. Screening tools for the early detection of protein-energy malnutrition in older persons have been developed. Multiple treatable causes of pathologic anorexia have been identified. There is increasing awareness of the importance of depression as a cause of severe weight loss in older persons. Approaches to the management of anorexia and weight loss in older persons are reviewed. Although many drugs exist that can enhance appetite, none of these are ideal for use in older persons currently.

摘要

尽管随着年龄增长身体脂肪增加且出现肥胖,但在整个生命周期中食物摄入量呈线性下降。这一难题可通过随着年龄增长身体活动减少和新陈代谢改变来解释。因此,老年人无法充分调节食物摄入量,从而出现生理性衰老厌食。这种生理性厌食不仅取决于随着年龄增长进食享乐性质的降低(这一领域仍存在争议),还取决于食物摄入的激素和神经递质调节的改变。对老年动物和人类的研究为衰老厌食的原因提供了线索。在人类中,随着年龄增长,饱腹感激素胆囊收缩素的循环浓度会升高。此外,动物研究表明阿片类物质(强啡肽)的进食驱动力下降,神经肽Y和一氧化氮可能也会下降。衰老引起的生理性厌食使老年人在患心理或身体疾病时极易发生蛋白质 - 能量营养不良。然而,尽管蛋白质 - 能量营养不良在老年人中普遍存在,但却很少被识别出来,更很少得到恰当治疗。已开发出用于早期检测老年人蛋白质 - 能量营养不良的筛查工具。已确定了病理性厌食的多种可治疗原因。人们越来越意识到抑郁症作为老年人严重体重减轻原因的重要性。本文综述了老年人厌食和体重减轻的管理方法。尽管有许多药物可增强食欲,但目前这些药物都不太适合老年人使用。

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