Maltodextrin preloads reduce food intake without altering the appetiser effect Functional biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise. Anorexia and Eating Patterns in the Elderly Effect of essential amino acid supplementation on quality of life, amino acid profile and strength in institutionalized elderly patients. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials The effects of megestrol acetate suspension for elderly patients with reduced appetite after hospitalization: a phase II randomized clinical trial. The effect of nutritional intervention in elderly subjects residing in group-living for the demented Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults. A randomized controlled trial of low-dose recombinant human growth hormone in the treatment of malnourished elderly medical patients. Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial. Re-validation and Shortening of the Functional Assessmentof Anorexia/Cachexia Therapy (FAACT) Questionnaire Sensory-specific satiety is unaffected by manipulations of flavour intensity Effects of added glutamate on liking for novel food flavors Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients Beneficial effects of antidepressant mirtazapine in functional dyspepsia patients with weight loss. Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: a randomized controlled trial. Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status, and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study. A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss. Compliance with an oral hyperproteic supplement with fibre in nursing home residents No effect of 16 weeks flavor enhancement on dietary intake and nutritional status of nursing home elderly Short-term protein and energy supplementation activates nitrogen kinetics and accretion in poorly nourished elderly subjects. Anorexia, physical function, and incident disability among the frail elderly population: results from the ilSIRENTE study. The association between anorexia of aging and physical frailty: Results from the national center for geriatrics and gerontology's study of geriatric syndromes.
The effects of consumption of a soup preload with added maltodextrin , relative to a no-maltodextrin control soup matched for sensory properties , on intake and the pattern of changes in rated hunger and fullness during lunch were investigated in 24 male volunteers .  Preloads were consumed 30 min before lunch and condition-order counterbalanced . Intake at lunch was reduced significantly by 77 g ( 407 kJ ) after the maltodextrin preload , and this reduced intake was associated with a significant reduction in eating rate but not meal duration . Hunger ratings were significantly lower , and fullness ratings significantly higher , at the start of lunch after the maltodextrin compared with control preload . However , the pattern of changes in subjective appetite once eating had started ( assessed by analyzing best-fit quadratic functions between rated appetite and actual intake ) did not differ between preloads . Neither the rated pleasantness of the lunch food at the start of the test meal nor the pattern of change in pleasantness across the meal differed between preloads . These results imply that the effect of maltodextrin preloads on appetite is to reduce the general desire to eat , and possible mechanisms for this effect are discussed A decline in dietary intake due to inactivity and , consequently , development of a suboptimal nutritional status is a major problem in frail elderly people . However , benefits of micronutrient supplementation , all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly . A 17-wk r and omized controlled trial was performed in 145 free-living frail elderly people ( 43 men , 102 women , mean age , 78 + /- 5.7 y ) . Based on a 2 x 2 factorial design , subjects were assigned to one of the following : 1 ) nutrient-dense foods , 2 ) exercise , 3 ) both ( 1 ) and ( 2 ) or 4 ) a control group . Foods were enriched with micronutrients , frequently characterized as deficient [ 25 - 100 % of the recommended daily allowance ( RDA ) ] in elderly people . Exercises focused on skill training , including strength , endurance , coordination and flexibility . Dietary intake , blood vitamin levels and nutritional and health indicators , including (pre)albumin , ferritin , transferrin , C-reactive protein , hemoglobin and lymphocytes were measured . At baseline , 28 % of the total population had an energy intake below 6.3 MJ , up to a maximum of 93 % having vitamin intakes below two thirds of the Dutch RDA . Individual deficiencies in blood at baseline ranged from 3 % for erythrocyte glutathione reductase-alpha to 39 % for 25-hydroxy vitamin D and 42 % for vitamin B-12 . These were corrected after 17 wk in the two groups receiving the nutrient-dense foods , whereas no significant changes were observed in the control or exercise group . Biochemical and hematologic indicators at baseline were within the reference ranges ( mean albumin , 46 g/L ; prealbumin , 0.25 g/L ; hemoglobin , 8.6 mmol/L ) and were not affected by any of the interventions . The long-term protective effects of nutrient supplementation and exercise , by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values , require further investigation . Other indicative functional variables for suboptimal nutritional status , in addition to those currently selected , should also be explored Objectives To evaluate the change in eating habits occurring in community- dwelling and institutionalized elderly subjects with senile anorexia . Design Cross- sectional , observational . Setting Community , nursing homes and rehabilitation or acute care facilities in four Italian regions . Participants A r and om sample of 526 subjects , aged 65 years and older ( 217 free living individuals , 213 residents in nursing homes , and 93 patients in rehabilitation and acute wards ) . Measurements All subjects underwent a  multidimensional geriatric evaluation of : nutritional status , anthropometric parameters , health and cognitive status , depression , taste , chewing and swallowing function , and some hormones related to appetite . Diet variety  was assessed , considering the frequency of consumption of different food groups ( milk and dairy products ; meat , fish , and eggs ; cereals and derivatives ; fruit and vegetables ) . Results In anorexic elderly subjects the global food intake was reduced , and the eating pattern was characterized by the reduced consumption of certain food groups ( “ meat , eggs and fish ” and “ fruit and vegetables ” ) whereas the frequency of consumption of milk and cereals remained almost unchanged . Nutritional parameters were significantly better in normal eating subjects and correlated with diet variety . Conclusion Because of the high prevalence of senile anorexia in the geriatric population and its impact on the nutritional status , further research should be prompted to establish an intervention . protocol allowing the early diagnosis of anorexia of aging , aim ed at identifying its causes and at optimizing treatment of anorexic patients BACKGROUND & AIMS This study assessed the efficacy of supplemented essential amino acids on depressive symptoms , nutrition , muscle function , daily physical activity , and health-related quality of life ( HRQoL ) of institutionalized elderly patients . METHODS Forty-one patients ( 58.5 % women ; mean age 79.8 yrs ) with sequelae of coronary artery disease ( 73 % ) , femoral fracture ( 34 % ) , were r and omly assigned to receive oral essential amino acids 4 gr 2 times a day for 8 weeks or isocaloric placebo . Before r and omization and 8 weeks after the protocol started , the following variables were measured : depressive symptoms ( Geriatric Depression Scale , GDS ) , nutritional panel ( Mini Nutritional Assessment , MNA ; serum albumin and prealbumin levels ) , muscle strength ( H and Grip , HG ) , Activity Daily Life ( ADL ) , Quality of Life ( SF-36 , HRQoL ) and amino acid profile . RESULTS Compared with the placebo group , EAA patients improved nutrition ( MNA score 22.6 ± 1.5 post vs 21.8 ± 1.6 pre ; p < 0 . 04 , albumin g/dl 4.04 ± 0.35 post vs 3.88 ± 0.3 pre ; p < 0.01 ) , GDS(score 10.3 ± 1.75 post vs 13.85 ± 3.37 pre ; p < 0.001 ) , HG ( Kg 19.75 ± 1.7 post vs 18.68 ± 1.36 pre ; p = 0.001 ) , ADL ( p < 0.04 ) and both physical and mental components of SF-36 ( p < 0.002 ) . CONCLUSIONS Oral supplementation with essential amino acids improved several determinants of quality of life in institutionalized elderly patients , including depressive symptoms , nutrition , muscle function and daily life activity Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To provide preliminary evidence on the effectiveness and optimal dosage of megestrol acetate for older persons with impaired appetite after hospitalization . DESIGN R and omized clinical trial . SETTING Acute care hospital . PARTICIPANTS Forty-seven older persons ( mean age 83 ) who were recently discharged from an acute care hospital and had fair or poor appetite . INTERVENTION Participants were r and omized to placebo or megestrol acetate suspension 200 mg , 400 mg , or 800 mg daily for 9 weeks . MEASUREMENTS Appetite , health-related quality of life , and adverse effects were measured at baseline and 20 , 42 , and 63 days . Serum nutritional markers were measured at baseline and 20 and 63 days . RESULTS During the course of the study , there were no significant differences between treatment groups on any of the appetite questions , although participants in the 400-mg and 800-mg groups demonstrated significant improvement from baseline on some questions . At 20 days , prealbumin increased in a dose-response relationship across the four groups ( by 0.4 , 5.1 , 7.5 , and 9.0 mg/dL , respectively ) . Participants in the 400-mg and 800-mg groups demonstrated greater improvement in prealbumin levels at 20 days than those receiving placebo ( P=.009 and P=.004 , respectively ) and those in the 400-mg group also demonstrated improvement at 63 days ( P=.02 ) . At 20 days , no participant taking placebo had a morning serum cortisol level less than 8 ng/mL ( the lower limit of normal ) . In contrast , 33 % , 70 % , and 78 % of those taking 200 mg , 400 mg and 800 mg , respectively , had values below this level ; by 63 days , these percentages were 11 % , 30 % , 56 % , and 37 % , respectively . No patient reported clinical symptoms of adrenal insufficiency . Diarrhea developed in three subjects , and thromboembolism occurred in two receiving active treatment . CONCLUSION Megestrol acetate at doses of 400 mg and 800 mg increases prealbumin in recently hospitalized older persons . Cortisol suppression is common at higher doses and may be persistent . In this small study , the drug did not confer benefit on other nutritional or clinical outcomes Objectives : We studied the nutritional status and the effects of nutritional intervention on body weight , cognition and activities of daily life (ADL)-function in demented individuals . Design : Controlled non-r and omised study . Setting : Group-living for demented elderly ( GLD ) , ie community assisted housing . Subjects and interventions : Twenty-two residents living in one of two units ( GLD-I ) , received oral liquid supplements ( 1720 kJ/410 kcal/day ) and the personnel of the GLD-I were given nutritional education .  Fourteen residents in the other unit ( GLD-C ) served as controls . After 6 months 21 ( 83 ( 4 ) y , 81 % women ) and 12 ( 85 ( 4 ) y , 100 % women ) of the participants , respectively , were re-examined according to body mass index ( BMI , kg/m2 ) , cognitive function ( Mini Mental State Examination ( MMSE , 0–30 p ) and Clinical Dementia Rating Scale ( CDR ) and the Katz ' ADL index . Results : Body mass index ( BMI ) ≤20 was found in 19 % of the participants and 44 % had BMI ≤23 . BMI correlated with MMSE ( r=0.43 , P<0.01 ) . The weight of the residents in the intervention group increased by 3.4 ( 3 ) kg ( P=0.001 ) at follow-up , whereas the weight remained unchanged in the control group . The cognitive function was low at the start in both groups , ie MMSE∼9 and no apparent positive effect of the nutritional intervention was seen . In addition , the ADL functions appeared to deteriorate in both groups . Conclusions : Being underweight was common among demented elderly in group-living and was related to low cognitive capacity . Five months of oral supplementation , along with education of personnel , was followed by a weight gain . In this study the nutritional treatment did not affect the rate of decline in cognitive function or Katz ' ADL index . Sponsorship : Supported by grants from the Swedish National Board of Health and Social Welfare . Semper Foods AB provided the liquid supplements OBJECTIVE to prevent the occurrence of weight loss during hospitalisation and following discharge by daily oral supplementation . DESIGN in a prospect i ve , r and omised , controlled study of 80 patients aged 75 or more , and at risk of undernutrition based on their initial Mini Nutritional Assessment score , patients were r and omised into a control group or one receiving oral supplementation . The intervention was a prescription of 200 ml sweet or salty sip feed twice daily ( 500 kcal , 21 g protein per day ) throughout hospitalisation and convalescence . Nutritional status was assessed at baseline and after 2 months using Mini Nutritional Assessment and body weight record . RESULTS compliance with oral supplementation was good and daily extra energy intake was 407+/-184 kcal . On day 60 , significant weight loss from upon admission was observed in the control group ( -1.23+/-2.5 kg ; P=0.01 ) , but not in the supplemented group ( 0.28+/-3.8 kg ; NS ) . At the end of the study , Mini Nutritional Assessment scores were higher in the supplemented group than in the control group ( 23.5+/-3.9 versus 20.8+/-3.6 ; P<0.01 ) . CONCLUSION use of daily oral supplementation during and after hospitalisation maintains body weight and increases Mini Nutritional Assessment score in patients at risk of undernutrition BACKGROUND AND OBJECTIVE To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition . The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients ( Protibis ® , Solidages , France ) . DESIGN An open , multicentre , r and omised controlled trial . SETTING Seven nursing homes . PARTICIPANTS One hundred and seventy-five malnourished older adults , aged 86±8 years . INTERVENTION All participants received the st and ard institutional diet . In addition , Intervention group participants received eight cookies daily ( 11.5 g protein ; 244 kcal ) for 6 weeks ( w0-w6 ) . MEASUREMENTS Five visits ( w-4 , w0 , w6 , w10 and w18 ) . MAIN OUTCOME Percentage of weight gain from w0 to w6 ( body mass in kg ) . SECONDARY OUTCOMES Appetite , rated using a numerical scale ( 0 : no appetite to 10 : extremely good appetite ) ; current episodes of pressure ulcers and diarrhea . RESULTS Average weight increased in Intervention group ( n=88 ) compared with Control group ( n=87 ) without cookies supplementation ( + 1.6 versus -0.7 % , P=0.038 ) . Weight gain persisted 1 month ( + 3.0 versus -0.2 % , P=0.025 ) and 3 months after the end of cookies consumption ( + 3.9 versus -0.9 % , P=0.003 ) , with diarrhea reduction ( P=0.027 ) . There was a synergistic effect with liquid/creamy dietary supplements . Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase ( P=0.024 ) , appetite increase ( P=0.009 ) and pressure ulcers reduction ( P=0.031 ) . CONCLUSION The trial suggested that , to fight against anorexia , the stimulation of touch ( finger food ; chewing , even on edentulous gums ) and hearing ( intra-oral sounds ) could be valuable alternatives to sight , smell and taste alterations High-dose recombinant human GH ( rhGH ) has been shown to improve the nutritional status of malnourished older adults . It is uncertain whether low-dose rhGH is effective and whether its effect on nutritional status will lead to any improvement in physical function . There is also no data on the outcome after a short course of rhGH treatment . The objectives of this study were to determine the efficacy of low-dose rhGH treatment for 4 weeks in malnourished elderly patients , its effect on physical functions , and the intermediate term outcome after a 4-week rhGH treatment . The study design was a r and omized , placebo-controlled , double-blind trial conducted in a university teaching hospital . The patients were 19 medically stable malnourished elderly subjects . Intervention in the rhGH group was as follows : rhGH ( Saizen , Serono , Switzerl and ) 0.09 IU/kg body weight ( BW ) 3 times weekly were given together with appropriate dietary intervention as prescribed by the dietitian . In the placebo group , equal volumes of normal saline per kilogram BW were given 3 times weekly together with the dietary intervention . The baseline demographic , anthropometric , nutritional , and hematological variables , measures of physical function , and insulin-like growth factor I levels in both groups were comparable . Compared with the placebo group , the GH-treated group showed a more rapid gain in BW ( after 3 weeks , + 1.27 + /- 0.36 vs. -0.28 + /- 0.37 kg ; P = 0.008 ) , total lean body mass ( change after 3 weeks by bio-impedance analysis , + 1.45 + /- 0.36 vs. -0.37 + /- 0.48 kg ; P = 0.009 ) and a faster improvement in 5-m walking time ( decrease after 4 weeks , 23.79 + /- 9.41 vs. 0.45 + /- 4.62 sec ; P = 0.047 ) . The hemoglobin level rose more in the rhGH than the placebo groups ( change at 8 weeks , + 0.84 + /- 0.34 vs. -0.42 + /- 0.29 g/dL ; P = 0.012 ) . Serum albumin level also showed a greater delayed increase in the rhGH group than in the placebo group ( change at 8 weeks , + 5.1 + /- 0.8 vs. 1.6 + /- 1.2 g/dL ; P = 0.023 ) . There was no statistically significant difference for other nutritional variables . There was a greater rise in the mean serum insulin-like growth factor I level at 4 weeks in the GH than in the placebo groups ( 197 + /- 58 vs. 54 + /- 26 U/L ; P = 0.034 ) . The improvement in the rhGH group gradually diminished on follow-up and became statistically insignificant 8 weeks after stopping rhGH treatment . There were no GH-related adverse effects . Low-dose rhGH was an effective and safe adjuvant to dietary augmentation for stable malnourished elderly subjects . It led to a faster gain in total lean body mass , which was associated with greater improvement in walking speed when compared with dietary intervention alone . There were no apparent side effects OBJECTIVES To vali date a nutritional intervention programme for elderly people living in nursing homes . DESIGN In a prospect i ve , r and omized , controlled study of 88 residents , we determined nutritional status at day 0 and day 60 using a record of dietary intake , anthropometry , h and -grip strength and mini-nutritional assessment . Dietary intake , grip strength and body weight were also recorded at day 30 . We divided subjects into four groups according to their mini-nutritional assessment score . Those with a score 24 received no oral supplementation .  Those at risk of malnutrition ( with a score of 17 - 23.5 ) were r and omized to oral supplementation . Those with a score < 17 received oral supplementation . We recorded the amount of oral supplements consumed daily . RESULTS Compliance with oral supplementation was good , and daily intake averaged about 400 kcal . The total energy intake on day 60 was significantly higher in both of the groups that received supplements . Following supplementation , most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight ( by 1.4 + /- 0.5 kg ) . Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements . Supplementation in the malnourished group result ed in a mean mini-nutritional assessment score increase ( from 13.9 + /- 2.6 to 17.1 + /- 3.9 ) and a mean weight gain of 1.5 + /- 0.4 kg . CONCLUSION Oral nutritional supplements are well accepted and result in increased daily protein and energy intake , body weight and nutritional status in most malnourished patients and in those at risk of malnutrition Purpose : The original Functional Assessment of Anorexia/Cachexia Therapy ( FAACT ) was design ed to measure general aspects of quality of life ( QOL ) as well as specific anorexia/cachexia-related concerns . Our primary purpose was to reduce the number of anorexia/cachexia subscale items in a manner that either retains or improves reliability , validity and precision . Methods : The FAACT was administered using an interactive computer program that allowed immediate entry of the data . A total of 213 patients were recruited . Results : A combined empirical and conceptual approach led to the reduction of the anorexia/cachexia subscale ( A/CS ) from 18 to 12 items . A 26-item trial outcome index ( TOI ) combining physical well-being ( PWB ) , functional well-being ( FWB ) , and the A/CS-12 was highly reliable and sensitive to change in performance status rating ( PSR ) . We found that PWB , FWB , and A/CS-12 subscales performed differently . Specifically , PWB and FWB scores decreased in patients whose ( PSR ) worsened . However , although A/CS-12 scores were responsive to change in PSR over time , average A/CS-12 scores of all patients , even those whose PSR worsened , improved over the course of treatment . Conclusions : Elimination of six items from the anorexia/cachexia subscale of the FAACT was accomplished without loss of internal consistency or sensitivity to change in performance status . The A/CS-12 subscale provides unique , important information not captured by a generic chronic illness question naire Sensory-specific  satiety ( SSS ) refers to the decline in evaluated pleasantness of a food when consumed as compared with other unconsumed foods . In two experiments it was investigated whether SSS is sensitive to manipulations of flavour intensity . In the first experiment , 40 participants ( 36 women ) repeatedly consumed 20 ml of either high- ( group Strong ; n=20 ) or low-intensity ( group Weak ) strawberry lemonade . If flavour intensity affects SSS these two groups should differ , but both groups displayed an equal degree of SSS concerning the evaluation of taste , smell , mouth feel , appearance and prospect i ve consumption ( largest F=1.34 ) . In Experiment 2 , 60 participants ( 54 women ) were r and omly assigned to one of three groups of equal size and repeatedly exposed to 20 ml lemonade that increased ( group Increase ) or decreased ( group Decrease ) in flavour intensity , or retained a given intensity with each exposure ( group Same ) . It was investigated whether online changes in flavour intensity interfere with the development of SSS , but again these groups displayed a similar degree of SSS to the lemonade ( largest F=1.40 ) . It is concluded that manipulation of flavour intensity does not likely affect SSS Adding glutamate to foods increases their umami quality , their acceptability and their consumption . The functional significance of this palatability is unclear . Other highly palatable substances , e.g. sugar and fats , also increase liking for novel flavors with which they are repeatedly paired , especially when ingested . This is thought to reflect the rewarding effects of sugar and fat energy , post-ingestion . To determine if a liking for novel flavors can also be conditioned using glutamate , 44 subjects rated 10 ml sample s of three novel soups for liking and familiarity , both before and after seven daily exposures to each of two soup flavors-one with added monosodium l-glutamate ( MSG ) ( 0.5 % w/w ; MSG+ ) and one without ( MSG- ) . During exposure , subjects received either a 250 ml bowl of soup ( Consume group ) or a 10 ml sample ( Taste group ) . There were no significant differences as a function of sample s or groups , despite some trends for changes in liking to be higher in the consumed MSG+ condition . In a second experiment , 69 subjects were divided into three groups ( Consume MSG+ ; Consume MSG- ; Taste MSG+ ) in which they received nine exposures to one novel soup flavor . The Consume MSG+ group showed a significantly greater increase in liking than either the Consume MSG- or the Taste MSG+ groups , which did not differ . Changes in familiarity ratings reflected amount consumed , not MSG content . Pairing glutamate with a novel flavor can condition liking for that flavor . While post-ingestive effects of glutamate may be rewarding , flavor conditioning can not be ruled out Objectives : To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight , plasma nutrients and activities of daily life . Design : Double-blind , placebo-controlled 12-week intervention study . Setting : Two nursing homes in Boxtel , The Netherl and s . Subjects : Forty-two ( body mass index ( BMI ) < 23 kg/m2 for men or < 25 kg/m2 for women ) psycho-geriatric nursing home patients aged 60 y or over . Interventions : Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ ( 135 kcal ) or placebo twice daily during daytime between main meals . Study parameters were assessed at 0 , 6 and 12 weeks . Main Outcome for Measures : Weight , Barthel index of daily activities , several plasma values ( albumin , C-reactive protein ( CRP ) , homocysteine , thiamine , thiamine diphosphate ( TDF ) , vitamin B6 , vitamin B12 , folic acid , vitamin D ) , bowel function . Results : The supplement was well accepted . Thirty-five patients completed the intervention period ( 16 control group ; 19 supplement group ) . Baseline daily nutrient intake was low . A statistically significant improvement was observed for body weight ( difference between groups 2.2 kg , P=0.03 ) , and homocysteine , vitamin B1 , TDF , vitamin B6 , vitamin B12 , folate and vitamin D in the supplement group compared to the placebo group . No significant difference was observed in the Barthel index ( mean difference −0.3±1.1 for both groups ) . No difference in occurrence of diarrhoea was observed . Conclusions : The study shows that nutritional supplementation is well accepted and can improve the nutritional status of psycho-geriatric nursing home patients .Sponsorship : Numico Research BV AIM To explore the effects and mechanism of action of antidepressant mirtazapine in functional dyspepsia ( FD ) patients with weight loss . METHODS Sixty depressive FD patients with weight loss were r and omly divided into a mirtazapine group ( MG ) , a paroxetine group ( PG ) or a conventional therapy group ( CG ) for an 8-wk clinical trial . Adverse effects and treatment response were recorded . The Nepean Dyspepsia Index-symptom ( NDSI ) checklist and the 17-item Hamilton Rating Scale of Depression ( HAMD-17 ) were used to evaluate dyspepsia and depressive symptoms , respectively . The body composition analyzer was used to measure body weight and fat . Serum hormone levels were measured by ELISA . RESULTS ( 1 ) After 2 wk of treatment , NDSI scores were significantly lower for the MG than for the PG and CG ; ( 2 ) After 4 or 8 wk of treatment , HAMD-17 scores were significantly lower for the MG and PG than for the CG ; ( 3 ) After 8 wk of treatment , patients in the MG experienced a weight gain of 3.58 ± 1.57 kg , which was significantly higher than that observed for patients in the PG and CG . Body fat increased by 2.77 ± 0.14 kg , the body fat ratio rose by 4 % , and the visceral fat area increased by 7.56 ± 2.25 cm(2 ) ; and ( 4 ) For the MG , serum hormone levels of ghrelin , neuropeptide Y ( NPY ) , motilin ( MTL ) and gastrin ( GAS ) were significantly upregulated ; in contrast , those of leptin , 5-hydroxytryptamine ( 5-HT ) and cholecystokinin ( CCK ) were significantly downregulated . CONCLUSION Mirtazapine not only alleviates symptoms associated with dyspepsia and depression linked to FD in patients with weight loss but also significantly increases body weight ( mainly the visceral fat in body fat ) . The likely mechanism of mirtazapine action is regulation of brain-gut or gastrointestinal hormone levels BACKGROUND Social facilitation and meal ambiance have beneficial effects on food intake in healthy adults . Extrapolation to the nursing home setting may lead to less malnutrition among the residents . Therefore , we investigate the effect of family-style meals on energy intake and the risk of malnutrition in Dutch nursing home residents . METHODS In 2002 and 2003 , a r and omized controlled trial was conducted among 178 residents ( mean age 77 years ) in five Dutch nursing homes . Within each home , two wards were r and omized into an intervention ( n = 94 ) and a control group ( n = 84 ) . For 6 months , the intervention group received their meals family style , and the control group received the usual individual preplating services . Outcome measures were intakes of energy ( kJ ) , carbohydrates ( g ) , fat ( g ) , and protein ( g ) and Mini Nutritional Assessment ( MNA ) score ( 0 - 30 ) . RESULTS The change in daily energy intake between the control and intervention group differed significantly ( 991 kJ ; 95 % confidence interval [ CI ] , 504 - 1479 ) . The difference in intake of macronutrients was 29.2 g ( 95 % CI , 13.5 - 44.9 ) for carbohydrate , 9.1 g ( 95 % CI , 2.9 - 15.2 ) for fat , and 8.6 g ( 95 % CI , 3.4 - 13.6 ) for protein . The percentage of residents in the intervention group classified by the MNA as malnourished decreased from 17 % to 4 % , whereas this percentage increased from 11 % to 23 % in the control group . CONCLUSIONS Family-style meals stimulate daily energy intake and protect nursing home residents against malnourishment . Therefore , replacement of the preplating meal services with family-style meals in nursing homes is recommended OBJECTIVES The objective of this study was to assess the effects of a hyperproteic , hypercaloric oral nutritional supplement with prebiotic fiber , vitamin D , and calcium , plus a st and ardized physical intervention , in the functional status , strength , nutritional status , and quality of life of frail institutionalized older adults . DESIGN Multicentric prospect i ve observational study under usual clinical practice conditions . SETTING Four nursing homes from Burgos ( 2 ) , Albacete , and Madrid , Spain . PARTICIPANTS Participants included 91 institutionalized older adults ( age ≥70 ) , able to walk 50 m , and meeting at least 3 of the Fried frailty phenotype criteria . INTERVENTION Daily intake of two 200-mL bottles of an oral nutritional supplement , each bottle containing 300 kcal , 20 g protein , 3 g fiber , 500 IU vitamin D , and 480 mg calcium , plus a st and ardized physical exercise training consisting of flexibility , balance , and strengthening exercises for arms and legs , 5 days per week . MEASUREMENTS Short Physical Performance Battery ( SPPB ) , Short-Form-Late-Life Function and Disability Instrument ( SF-LLFDI ) function subscale , h and grip strength , EuroQoL-5 Dimensions visual analogic scale ( EQ5DVAS ) , weight , body mass index ( BMI ) , and Short-Form Mini Nutritional Assessment ( MNA-SF ) at baseline and 6 and 12 weeks . RESULTS Forty-eight participants ( 52.7 % ) improved at least 1 point in the SPPB at week 6 , and 44 ( 48.4 % ) did so at week 12 ; 39 participants ( 42.9 % ) improved at least 2 points in the SF-LLFDI at week 6 , and 46 ( 50.5 % ) at week 12 . Participants improved their quality of life measured with the EQ5DVAS by 6 % ( 95 % confidence interval [ CI ] 3%-10 % ) at week 6 , and by 5 % ( 95 % CI 0%-10 % ) at week 12 . They also improved their nutritional status ( weight gain , BMI increase , and higher MNA-SF scores at 6- and 12-week follow-up ) . This improvement was higher in participants with more frailty criteria , lower functional level , lower vitamin D levels , and poorer nutritional status . CONCLUSION A 12-week intervention with oral nutritional supplementation plus physical exercise improves function , nutritional status , and quality of life in frail institutionalized older adults BACKGROUND Megestrol acetate ( MA ) is a progestin widely used to treat weight loss and cachexia in patients suffering from AIDS or cancer . Although MA is also frequently prescribed for similarly malnourished elderly individuals , the efficacy and morbidity of MA treatment in this patient population remain unclear . OBJECTIVE The goal of this study was to examine the effects of MA therapy on weight and overall mortality in elderly nursing home residents . METHODS This was a case-control cohort study of 17,328 nursing home residents admitted to Beverly Healthcare nursing home between January 1 , 2000 , and December 31 , 2003 , who had lost either 5 % of total body weight within 3 months or 10 % of total body weight within 6 months . Residents within this weight loss group who received MA therapy -- within 30 days of their weight loss documentation -- were matched ( 1:2 ) with non-MA-treated residents with respect to age , sex , race , weight , and first notation of weight loss . Residents were further matched by propensity score for activities of daily living , cognitive functioning , number of medications taken during the 7 days before data entry , clinical condition ( unstable , acute episode of a recurrent problem , end-stage disease ) , cancer diagnosis , and human immunodeficiency virus diagnosis . RESULTS A total of 709 patients ( mean [SD]age , 84.1 [9.7]years ; 70.9 % female ) who received MA therapy were matched with 1418 non-MA-treated patients ( mean [ SD ] age , 84.2 [ 9.0 ] years ; 70.9 % female ) . Of the 709 MA patients , 281 ( 39.6 % ) were alive and in the nursing home at last follow-up , 149 ( 21.0 % ) were alive and discharged to another facility or to home , and 279 ( 39.4 % ) died in the nursing home . For the controls , 651 ( 45.9 % ) were alive and in the nursing home , 308 ( 21.7 % ) were discharged to another facility or to home , and 459 ( 32.4 % ) died in the nursing home . The median survival of MA-treated residents ( 23.9 months ; 95 % CI , 20.2 - 27.5 ) was significantly less than untreated residents ( 31.2 months ; 95 % CI , 27.8 - 35.9 ) ( P < 0.001 ) . Median weight and median of weight differences were unchanged after 6 months of treatment with MA compared with matched controls . CONCLUSIONS MA treatment of elderly nursing home residents with significant weight loss  was associated with a significant increase in all-cause mortality without a significant increase in weight . R and omized , prospect i ve studies of the use of MA in elderly nursing home residents are necessary to more fully evaluate morbidity and mortality associated with this therapy Background : Undernutrition is a common problem in older individuals that may be related to a low protein dietary intake . Oral supplements may improve the health status in this population , but their use may be limited by compliance and side effects . Objectives To evaluate effects of an oral supplement of protein and fibre on compliance , on nutritional status , and on intestinal habits in nursing home residents . Method : A prospect i ve observational study was carried out in 66 Spanish nursing homes . 358 subjects undernourished or at risk of undernutrition requiring nutritional supplements . After informed consent was given , subjects received 2 daily cartons ( 400 ml ) of a liquid oral supplement rich in protein and fibre along 3 months . Supplement intake compliance was measured at baseline and after 6 and 12 weeks . Nutritional status was assessed using the Mini-Nutritional Assessment ( MNA ) , weight , and Body Mass Index ( BMI ) . Changes in intestinal habits and digestive symptoms were also recorded , as well as subject ’s supplement acceptance . Results : Compliance with the supplement intake was 97.46 % at 6 weeks and 96 % at 12 weeks of follow-up . Significant changes ( p<0.0001 ) were found in nutritional status : mean value of MNA improved from baseline ( MNA=14.0±3.9 ) after 12 weeks ( MNA=17.0±4.0 ) , as well as weight ( + 2.1 kg , a 4.1 % increase ) . The BMI did not change significantly ( BMI = 21.43 at baseline ; BMI = 21.78 at 12 weeks ) . Undernutrition prevalence ( MNA<17 ) decreased from 76.4 to 46.6 % ( p<0.0001 ) . Intestinal habits showed a significant improvement in defecation frequency ( from 4.7 to 6.1 stools per week , p<0.0001 ) and faeces consistency ( from 53.2 % to 74.5 % reporting formed soft stools , p<0.0001 ) . 48.9 % of the subjects considered to have better intestinal habits after 6 weeks and 50.5 % after 3 months of supplementary food intake , the rest reporting no change . Vomits and flatulence were also significantly reduced ( p<0.0001 ) . Conclusion : The administration of an oral hyperproteic supplement with fibre in aged subjects who are undernourished or at risk of malnutrition can be done in nursing homes with a high level of compliance . Supplements improve their nutritional status and their intestinal habits There is a lack of data to support the long-term effect of flavor enhancement on food intake and nutritional status . Our aim was to determine if daily addition of 700 mg flavor and /or 300 mg monosodium glutamate ( MSG ) to the animal protein part of the cooked meal for 16 weeks leads to an increase in energy intake and in body weight in nursing home elderly . We performed a single blind r and omized 16 weeks parallel study consisting of a  control group ( n=23 ) , a  MSG group ( n=19 ) , a  flavor group ( n=19 ) and a flavor plus MSG  group ( n=22 ) . Main outcome measures were intake of the cooked meal , which was measured by weighing back leftovers during 14 days and body weight . Both were measured before and at the end of the intervention period . After 16 weeks , energy intake and body weight did not increase within the control group , the flavor group , the flavor plus MSG group and the MSG group . Between the groups , no differences were found in changes in energy intake and body weight . Enhancing the taste of a cooked meal with flavor and /or MSG does not lead to a higher energy intake and body weight among nursing home elderly . More research is needed to determine the efficacy of flavor enhancement on intake and nutritional status BACKGROUND An increase in protein intake exerts a stimulating effect on protein kinetics in children , young adults , and healthy elderly persons . However , there are few data on the response to such dietary changes in malnourished elderly subjects , despite important medical implication s in this population . OBJECTIVE The objective of this study was to determine the metabolic response to short-term nutritional supplementation in moderately malnourished elderly subjects . DESIGN The influence of 10 d of supplementation ( 1.67 MJ/d and 30 g protein/d ) on body composition , resting energy expenditure , and whole-body protein kinetics was studied in 17 malnourished elderly patients and 12 healthy young adults . A control group of 6 malnourished elderly patients received no supplementation . RESULTS Supplemented elderly subjects had a significantly greater fat-free mass gain than did unsupplemented elderly subjects ( 1.3 and 0.1 kg , respectively ; age effect , P < 0.05 ; diet effect , P < 0.02 ) and a significantly greater increase in fasting rate of protein synthesis than did young supplemented subjects ( 0.6 and 0.2 g*kg FFM(-1)*11 h(-1 ) ; age effect , P < 0.05 ) . The net protein balance in the supplemented elderly subjects in the fed state was positively correlated with protein intake ( r(2 ) = 0.46 ) and in the fasted state was negatively correlated with protein intake ( r(2 ) = 0.27 ) . The sum of these regressions is a line with increasingly positive net diurnal protein balance produced by increasing protein intake . CONCLUSION These data provide evidence of a short-term anabolic response of protein metabolism to dietary supplementation in malnourished elderly patients that is likely to improve muscle strength and functional status OBJECTIVE Increasing evidence suggests that anorexia of aging can cause physical and mental impairment . The aim of the present study was to evaluate the relationship between anorexia of aging and measures of physical performance , muscle strength , and functional status in older persons aged 80 years or older . METHODS Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study . The ilSIRENTE study is a prospect i ve cohort study performed in the mountain community living in the Sirente geographic area ( L'Aquila , Abruzzo ) in central Italy .  Physical performance was assessed using the  physical performance battery score ( SPPB )  , which is based on 3 timed tests : 4-meter walking speed , balance , and chair st and tests .  Muscle strength was measured by h and grip strength . We defined anorexia as the presence of loss of appetite and /or lower food intake . Analyses of covariance were performed to evaluate the relationship of anorexia with physical function . RESULTS In the unadjusted model , all the physical performance , muscle strength , and functional measures showed significant associations with the presence of anorexia . After adjustment for potential confounders ( age , gender , BMI , number of diseases , depression , congestive heart failure , lung diseases ) these associations were weaker but still statistically significant ( physical performance battery score : subjects without anorexia 6.8 , SE 0.2 , subjects with anorexia 5.8 , SE 0.4 , P = .03 ; 4-meter walking speed : subjects without anorexia 0.5 m/s , SE 0.1 , subjects with anorexia 0.3 m/s , SE 0.1 , P = 5.001 h and grip strength : subjects without anorexia 30.8 kg , SE 0.7 , subjects with anorexia 27.9 kg , SE 1.5 , P = .03 ) . Furthermore , relative to participants without anorexia , those subjects with anorexia showed a significantly higher risk of developing disability after 2 years of follow-up ( hazard ratio 2.25 ; 95 % confidence intervals 1.15 - 4.39 ) . CONCLUSIONS Anorexia is common among community older subjects in Italy . Our results suggest that among old-old subjects , the presence of anorexia is associated with impaired physical performance and with a significant increased risk of incident disability , irrespective of potential confounders OBJECTIVES The present study examined the association between anorexia of aging and physical frailty among older people . STUDY DESIGN An observational , cross-sectional cohort design was used with a sample of 4417 elderly Japanese citizens living in a community setting . MAIN OUTCOME MEASURES Frailty was operationalized as the following frailty components : slowness , weakness , exhaustion , low level of physical activity , and weight loss . Participants were grouped as non-frail , pre-frail , and frail , and categorized as anorexic or not using question naire cutoff scores . Measured covariates were as follows : sociodemographic variables , medical history , life style , body mass index , blood nutrition data , self-rated health , depressive symptoms , and cognitive function . RESULTS The prevalence of anorexia of aging in each group was as follows : non-frail , 7.9 % ; pre-frail , 14.8 % ; frail , 21.2 % ( P for trend<0.001 ) . After adjusting for all covariates , independent associations were identified between anorexia of aging and slowness ( OR 1.42 , 95 % CI : 1.14 - 1.75 , P=0.002 ) , exhaustion ( OR 1.39 , 95 % CI : 1.11 - 1.74 , P=0.004 ) and weight loss ( OR 1.37 , 95 % CI : 1.05 - 1.79 , P=0.019 ) , but not weakness or low level of physical activity . CONCLUSIONS Anorexia of aging is importantly associated with frailty and the following frailty components : slowness , exhaustion , and weight loss . Future research should prospect ively examine frailty 's causal connection with anorexia of aging
BACKGROUND Anorexia of ageing ( AA ) may be considered as a risk factor for frailty and has an important impact on quality of life , morbidity and mortality .