Abstract
Poor appetite—known as anorexia—is a common condition in aging and is associated with poor outcomes, including reduced survival and impaired quality of life. The anorexia of aging is mainly the result of several complex endocrinological, metabolic, and nutritional changes occurring with later age. The modulation of different peptides and hormones has been identified as an important determinant for the development of low appetite; in particular, an altered imbalance of plasma ghrelin, leptin, and cholecystokinin and increased inflammatory markers are implicated in its pathophysiology, and robust evidence of their involvement in anorexia of aging has been produced in the clinical setting. More recently, researchers identified that the gut microbiome composition significantly varies according to the appetite status. Other important clinical factors may worsen the symptoms of the anorexia in the elderly, in particular the potential concomitant presence of chronic catabolic comorbidities. Importantly, data indicate that anorexia is prevalent in frail older adults, negatively impacting body composition and specifically in altering muscle mass and function. For all these reasons, a prompt and early diagnosis of anorexia in the elderly is crucial to implement personalized metabolic and nutrition interventions to improve the outcomes and ameliorate quality of life.
Highlights
Prevalence and Impact of Anorexia of Aging Anorexia of aging is considered an unvoluntary progressive loss of appetite affecting food intake and negatively impacting on nutritional and metabolic status [1]
The loss of appetite is generally known as “secondary anorexia” or “diseaseassociated anorexia”, which may overlap with an already existing low appetite and further decrease it in the elderly population, it represents a phenomenon determined by changes in different metabolic patterns, which are mainly driven by the underlying disease [6]
Anorexia of aging may be considered as the result of deep changes, among others, of hormones, peptides, as well as inflammation and alterations in intestine bacterial products whose mechanisms of action and their potential interaction should be further clarified
Summary
Leptin is a cytokine mainly produced by the adipocytes acting on the central nervous system as a sign of adequate energy storage. In humans, circulating fasting leptin levels were observed to be significantly increased in older healthy adults when compared to younger people [16]. Novel data on metreleptin, an analogue of human leptin, showed that this molecule was effective on modulating positively appetite in anorexia nervosa [18]. These preliminary data were obtained in a very different setting [18], further research may focus on the potential implication(s) of leptin analogues in anorexia of aging
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