Recognizing and Treating Anorexia of Aging

Anorexia of aging is a geriatric wasting disorder which involves the ability to compensate energy needs and satiation. A person with this disorder experiences a decrease in energy expenditure, metabolism and also muscle mass.¹ Other aging issues play a role in this disorder such as declines in vision caused by cataracts, macular degeneration or other vision issues, as well as a decline in their sense of smell and also taste that can cause a decrease in the desire to eat food. Medications can also alter the taste of food and make eating less enjoyable. Some elderly people experience a decline in mucus secretions which can affect swallowing. Over a long period of time, the lowered food intake can lead to weight-loss and malnourishment. Around adult middle-age or in the 40’s, people can acquire body fat but beginning in the older adult years or 70’s, a decline in both lean body mass and also fat can occur.²

The primary physiological and pathological factors include a delay in gastric emptying which involves the gastrointestinal hormones cholecystokinin (CCK), glucagon-like peptide 1 (GLP-1) and ghrelin. CCK is associated with satiation and GLP-1 is an anorexic hormone that causes slow gastric emptying. Both hormones have been found to be increased in elderly people. Ghrelin on the other hand, which activates nitric oxide synthase, a stimulator of eating enzyme, has been found by research to be lower in malnourished elderly people. So with aging comes not only a decline in the senses which make food more enjoyable, but also changes in gastrointestinal hormones which can cause satiation and suppress hunger. This disorder is more prevalent in men and is associated with the development of sarcopenia, frailty, poor outcomes with hip fracture, institutionalization and mortality.¹ Elderly people are already at an increased risk for malabsorption issues due to a decline in hydrochloric acid which affects their ability to breakdown foods for absorption. This can cause deficiencies in essential nutrients such as B₁₂. Medications can also prevent absorption of nutrients. Various health conditions and infections can affect the body’s ability to maintain homeostasis and therefore disrupt nutrient absorption or cause loss of nutrients due to chronic diarrhea etc. Additionally, a change in eating ability can prohibit a person from consuming enough foods to maintain energy balance, or a healthy diet that is necessary to promote the growth of healthy microorganisms which are important for digestion, absorption of food as well as the formation of nutrients and prevention against disease.

FACTORS WHICH CONTRIBUTE TO ANOREXIA OF AGING:¹
1) Depression is the most common cause linked with malnutrition.
2) Decline in olfactory function (vision, smell, taste) which makes food less enjoyable.
3) Delayed gastric emptying and antral stretch issues which cause increases in satiation.
4) Increases in gastrointestinal hormones cholecystokinin and glucagon-like peptide.
5) Decreases in the hormone ghrelin which lowers activation of the enzyme nitric oxide synthase.
6) Inflammation involves elevated cytokines which are linked with wasting. Inflammation also causes elevated tryptophan which leads to an increase of serotonin and anorexia.
7) Increased leptin, a hormone which decreases food intake.
8) Low Testosterone causes an elevation in leptin because this hormone reduces leptin. An elevation of leptin can lead to anorexia because it decreases food intake.
9) Decline in orexigenic neurotransmitters. There more than 50 different neurotransmitters that are involved in stimulating the drive to eat.
10) Mental Illness such as paranoia and dementia can affect food intake.
11) Medications can cause many issues including affecting the taste of food, dry mouth, nausea, swallowing issues, malabsorption and iatrogenic caused pathogenic microbial overgrowth.
12) Dysphagia is a swallowing issue caused by a decline in mucus secretions.
13) Dental Issues making it hard to chew food.
14) Infections such as Helicobacter Pylori, tuberculosis, and urinary tract infections, as they cause elevations in cytokines.
15) Cholecystitis which is inflammation of the gallbladder.
16) Various Diseases such as cancer, heart failure and COPD make it difficult for people to have the ability to shop or prepare foods for their self.

CRITICAL ROLE OF A CLINICAL NUTRITIONIST FOR THESE PATIENTS:
It is critical for these patients to work with a clinical nutritionist who can help them address nutrient and energy needs to prevent muscle wasting and bone loss as well as other metabolic dysfunction and gastrointestinal dysbiosis. A complete nutrition assessment is needed to identify patient health conditions, symptoms and eating ability. Certain treatments, for example kidney dialysis, can cause wasting issues, and it is very important for a patient to learn how to meet their nutritional needs so that they can live longer with a better quality of life. A clinical nutritionist can provide the patient with specific nutritional therapies and diet plans which can provide enough calories, protein, and other essential vitamins and minerals.

These patients could benefit greatly from customized free form amino acid mixes that are based on their own individual diagnostic report of amino acid status. Because there is a decrease in appetite, it is very important that the quality of food these patients consume is both high calorie and nutrient dense. All calories are not created equal as some forms of calories cause increased inflammation and progress disease. A clinical nutritionist can help patients incorporate beneficial foods for their specific condition.

As people age and chewing, swallowing and digestion becomes more difficult, there is a greater need for more cooked building foods. Because of lower hydrochloric acid, cooked foods can also reduce the risk of food borne illness which can be fatal for an elderly person.

Sources:

1) Morley J. Pathophysiology of the anorexia of aging. Clinical Nutrition and Metabolic Care. 2013 Jan;16(1):27-32. doi: 10.1097/MCO.0b013e328359efd7. http://journals.lww.com/co-clinicalnutrition/Fulltext/2013/01000/Pathoph.... Accessed May 26, 2015.
2) Morley J. Anorexia of aging: physiologic and pathologic. Am J Clin Nutr. 1997 Oct;66(4):760-763. http://www.ncbi.nlm.nih.gov/pubmed/9322549. Accessed May 26, 2015.

If you would like to partner with a clinical nutritionist to create a more vibrant and healthy life please contact me today! I can help you 866-330-5421. Services are provided nationally via telephone or in office sessions.

Thank you very much for reading my blog and please continue to visit often.

I wish you good health, happiness and love!

Danielle

Follow Artemis in the City!

Please subscribe to the RSS feed so that you will be updated when new articles are posted Artemis in the City Blog. I also have YouTube and Vimeo video channels!