Sian Robinson is a nutritional epidemiologist, with research interests in the role of nutrition and lifestyle across the lifecourse as determinants of inequalities in adult health, with a particular focus on early life influences on growth, development and later function, and effects on sarcopenia and ageing. She is lead for Nutrition and Healthy Ageing at the NIHR Southampton Biomedical Research Centre.
Poor nutrition in older age: what can appetite screening tell us?
Background: Screening tools used to assess nutritional status in older populations often focus on malnutrition – identifying risk from weight loss and thinness; they may not be designed to detect other aspects of poor nutrition. While trajectories of nutritional risk in older age are not well characterised, declining food consumption and low diet quality are commonly reported by older community-dwelling adults. As other approaches to screening may therefore be needed to identify nutritional risk in these populations, we examined whether a simple assessment of appetite is informative.
Methods: 86 older men and women were recruited from outpatient clinics at a large teaching hospital; exclusion criteria: aged <60 years, cognitive impairment, acutely unwell. Participants were interviewed at home; data on background characteristics, psychosocial factors and health were collected, including number of comorbidities and medications taken. Appetite was assessed using the SNAQ (Simplified Nutritional Appetite Questionnaire) (1); this tool scores responses to four appetite-related questions (maximum score 20; <14 indicates poor appetite). Diet quality was assessed using a short questionnaire developed for older adults (2). Diet quality scores were calculated for all participants; higher scores indicate diets characterised by greater consumption of fruits, vegetables, wholegrain cereals and lower consumption of refined cereals, sugar and processed meat. Weight and height were measured. Predictors and outcomes associated with appetite scores were evaluated in regression models, using the SNAQ score as a continuous variable.
Results: The mean age of the participants was 78 (SD 8.3) years; 62% were female. Most (81%) participants were living in their own homes; 36% were living alone. Median (IQR) number of comorbidities was 4 (3-6), and daily medications 5 (2-9). Median SNAQ score was 15 (IQR 14-16), with poor appetite reported by 14 (16%) participants. Lower SNAQ scores were associated with having a greater number of comorbidities and taking more medications (both before and after adjusting for age and gender). SNAQ scores were not related to weight or reported weight loss. However, independently of number of comorbidities and number of medications taken, lower scores were associated with poorer diet quality. (P=0.032).
Conclusion: Self-reported appetite may provide valuable information about quality of diet, potentially indicating changes occurring ahead of weight loss. A move towards earlier identification of nutritional risk may offer better opportunities for prevention of malnutrition, with implications for policies supporting older adults.