Appetite Loss, Malnutrition, and Mortality: a Significant Association in Need of Urgent Recognition?

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

Despite its high prevalence among older adults, appetite loss is underrecognized in clinical practice. Explanations for this underrecognition include the lack of uniform terminology for the condition paired with an absence of defined, standardised approaches to assessing it. Moreover, appetite loss is commonly misconstrued as a normal and irreversible part of the ageing process. Together, these reasons create heterogeneity across anorexia of ageing studies, thereby hindering the recognition and management of appetite loss among older adults. To overcome this gap, a better understanding of appetite loss’ effects on morbidity and mortality in older adults is needed.

This systematic literature review aimed to investigate the relationship between appetite loss and negative outcomes in older adults aged ≥ 65 years.

Key learnings:

Malnutrition and mortality were the two most common outcomes reported by the 58 studies assessed. Older adults with anorexia/appetite loss were found to possess a significantly higher risk of malnutrition compared to those without, a link which persisted in spite of differing healthcare settings or measures of malnutrition. Importantly, the odds of malnutrition were found to be increased in institutional-based studies compared to community-based ones. Furthermore, most studies investigating mortality risk observed a significant association between appetite loss and mortality. This relationship was intensified in individuals with a range of comorbidities. Moreover, it persisted across disparate settings and remained significant even after controlling for confounders. Overall, these findings represent a rationale for efforts to standardise screening of appetite loss in older adults and demonstrate the urgent need for comprehensive guidelines delineating the optimal appetite assessment tools and definition for anorexia/appetite loss in older adults.

Reviewed by: S. Duarte