Association of anorexia/appetite loss with malnutrition and mortality in older populations: a systematic literature review

Authors: GROARKE, JOHN - Pfizer, Inc; TARASENKO, LISA - Pfizer, Inc; SMOYER, KAREN - Envision Pharma Group; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; FRANCESCO, LANDI - Università Cattolica Del Sacro Cuore

Submitted to: Journal of Cachexia, Sarcopenia and Muscle
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/16/2023
Publication Date: 2/20/2023
Citation: Groarke, J., Tarasenko, L., Smoyer, K., Fielding, R., Francesco, L. 2023. Association of anorexia/appetite loss with malnutrition and mortality in older populations: a systematic literature review. Journal of Cachexia, Sarcopenia and Muscle. https://doi.org/10.1002/jcsm.13186.
DOI: https://doi.org/10.1002/jcsm.13186

Interpretive Summary: In many cases, loss of appetite is not recognized in the clinical setting when older adults are receiving healthcare. In this study, investigators conducted a systematic review of studies that have already been published on the topic of anorexia/appetite loss in older adults. They identified 58 published studies on this topic. Of note, only a few US-led studies were identified with most coming from Europe and Asia. Interestingly, most studies reported a significant association of appetite loss with malnutrition and mortality (death). These results highlights the potential clinical importance of appetite loss among older adults that may influence important health outcomes including nutritional status and survival.

Technical Abstract: Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may in part be due to deficient understanding of clinical sequelae. Therefore, we performed a systematic literature review (SLR) to assess the morbidity and mortality burden of anorexia/appetite loss in older populations. Following PRISMA guidelines, searches were run (1 January 2011-31 July 2021) in PubMed, Embase (c), and Cochrane databases to identify English language studies of adults aged >/= 65 years with anorexia/appetite loss. Two independent reviewers screened titles, abstracts, and full text of identified records against pre-defined inclusion/exclusion criteria. Population demographics were extracted alongside risk of malnutrition, mortality, and other outcomes of interest. Of 146 studies that underwent full-text review, 58 met eligibility criteria. Most studies were from Europe (n = 34; 58.6%) or Asia (n = 16; 27.6%), with few (n = 3; 5.2%) from the United States. Most studies were conducted in a community setting (n = 35; 60.3%), 12 (20.7%) were inpatient-based (hospital/rehabilitation ward), 5 (8.6%) were in institutional care (nursing/care homes), and 7 (12.1%) were in other (mixed or outpatient) settings. One study reported results separately for community and institutional settings and is counted in both settings. Simplified Nutritional Appetite Questionnaire (SNAQ Simplified, n=14) and subject-reported appetite questions (n = 11) were the most common methods used to assess anorexia/appetite loss, but substantial variability in assessment tools was observed across studies. The most commonly reported outcomes were malnutrition and mortality. Malnutrition was assessed in 15 studies, with all reporting a significantly higher risk of malnutrition in older individuals with anorexia/appetite loss (vs without) regardless of country or healthcare setting (community n = 9, inpatient n = 2, institutional n = 2, other n = 3). Of 18 longitudinal studies that assessed mortality risk, 17 (94%) reported a significant association between anorexia/appetite loss and mortality regardless of either healthcare setting (community n = 9, inpatient n = 6, institutional n = 2) or method used to assess anorexia/appetite loss. This association between anorexia/appetite loss and mortality was observed in cohorts with cancer (as expected) but was also observed in older populations with a range of comorbid conditions other than cancer. Overall, our findings demonstrate that, among individuals aged >/= 65 years, anorexia/appetite loss is associated with increased risk of malnutrition, mortality, and other negative outcomes across community, care home, and hospital settings. Such associations warrant efforts to improve and standardize the screening, detection, assessment, and management of anorexia/appetite loss in older adults.