Anorexia of Aging, Malnutrition or Risk of Malnutrition
Conditions
Keywords
appetite decline, elderly, anorexia of aging, malnutrition, Asian seniors, appetite regulation
Brief summary
The study aims to identify key physiological factors that differentiate older adults with healthy appetites from those experiencing appetite decline. The investigators hypothesize that seniors experiencing appetite decline will exhibit distinct oro-sensory, gastrointestinal, and hormonal profiles compared to seniors with healthy appetites, suggesting underlying biological mechanisms contributing to reduced appetite.
Detailed description
Appetite decline in older adults, or anorexia of aging, is a prevalent geriatric syndrome associated with decreased quality of life, increased risk of malnutrition, and accelerated decline in health. While current nutritional guidelines often emphasize increasing nutrient density, these strategies often fail to address the root causes of diminished appetite. Emerging research highlights the critical role of age-related physiological changes, particularly dysregulation of the gut-brain axis, altered sensory perception, and hormonal imbalances, in suppressing appetite. Notably, existing evidence is largely derived from Western populations, which may not fully reflect the influence of cultural and lifestyle factors on appetite in Asian seniors. This leaves a significant gap in understanding and addressing appetite loss within this specific demographic. This study aims to address this gap by comprehensively investigating the physiological mechanisms underlying appetite regulation in Asian seniors, to identify key determinants that differentiate individuals with healthy appetites from those experiencing a decline. By assessing the relationships between oro-sensory function, gastric dynamics, neuro-hormonal regulation, gut microbiome composition and subjective appetite, this study seeks to provide a deeper understanding of the biological pathways driving appetite differences in this population. The findings of this study will lay the groundwork for future research aimed at developing culturally sensitive and effective interventions that can restore appetite, improve nutritional status, and ultimately enhance the health span and quality of life for older adults in Singapore and beyond. Furthermore, this work has the potential to drive innovation in the food and nutrition industry, leading to the development of tailored products and dietary strategies that effectively address the unique nutritional needs of aging populations, ultimately impacting public health recommendations and policies related to senior nutrition.
Interventions
OTHERShredded Chicken Congee
This is a mixed meal tolerance test intended to elicit gut hormone responses reflective of real-world dietary patterns.
Sponsors
Singapore Institute of Food and Biotechnology Innovation
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
Single-arm intervention
Eligibility
Sex/Gender
FEMALE
Age
65 Years to 74 Years
Healthy volunteers
Yes
Inclusion criteria
* Postmenopausal female * Aged 65-74 years * Habitual breakfast consumer (consumes breakfast between 7am to 10am) * Willingness to consume meals and follow intervention protocol * English speaking
Exclusion criteria
* BMI ≥ 27.5 * Diagnosed with medical condition that may influence appetite or microbiome (e.g. diabetes, thyroid disorders, gastrointestinal diseases) * Currently taking any medications or supplements that may influence appetite or the microbiome (e.g. probiotics, antibiotics, appetite stimulants/suppressants) one month prior to their first visit in consultation with study physician, PI and study team * Following a special diet for weight management (e.g. low-calorie, low carbohydrate) * History of bariatrics surgery * Intentional attempt to change body weight or composition * History of severe vasovagal syncope (blackouts or near faints) following blood draw * Drug abuse within last 5 years * Excessive alcoholic beverage consumption \> 2 servings per day (1 serving defined as 360 mL beer, 150 mL wine or 45 mL distilled spirits) * Smoking (cigarette, e-cigarette, cigar, pipe, vape) * Engaging in habitual vigorous physical activity (as defined by physical activity questionnaire-PAQ) * Loose teeth or jaw pain * Not missing \> 2 non-wisdom molars * Involvement in other clinical studies that may influence the outcome of the study * A study team member or their immediate family member
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ad Libitum Lunch | Participants will be given 30 minutes to consume the meal until they are comfortably full, 180 minutes after the start of the intervention. | Participants will be asked to eat as much of the stir-fried beehoon as they want until they are comfortably full, to measure the exact calorie intake by weighing the food before and after eating. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Palatability questionnaire | Administered after consuming test meal and after consuming the ad libitum meal. | Palatability appetite questionnaire, rated on a visual analogue scale is a psychometric assessment tool where participants rate their subjective sensory experience-such as taste, smell, or pleasantness-by marking a point along a continuous 100 mm line anchored by opposing extremes (e.g., "extremely unpleasant" to "extremely pleasant"). |
| Appetite hormones | Blood samples will be collected at timepoints (t = -15 minute (baseline), 30, 60, 90, 120 and 180 minutes) | GLP-1, PYY and Acyl-ghrelin will be used to measure hormones related to appetite. |
| Subjective Appetite Questionnaire | Measurement is taken at t = -15 minute (baseline), 10, 30, 60, 90, 120 and 180 minutes | A subjective appetite questionnaire utilizes a Visual Analogue Scale to quantify a person's current metabolic state by measuring four key sensations: hunger, fullness, desire to eat, and prospective food consumption. |
| Gastric Ultrasound | Measurements will be taken at t = -15 minute (baseline), 15, 45, 105 and 165 minutes | Gastric ultrasound will measure the gastric emptying rate postprandially. |
| Stool collected using the OMNIgene and OMNImet | Baseline stool sample will be collected once between screening and intervention day. | Stool sample will be collected in the OMNIgene-GUT and OMNImet-GUT tube for measurements that may include microbiome profiling, untargeted and targeted metabolome (e.g. bile acids and short-chain fatty acids profiling). |
| Olfactory Acuity (SCENTinel) | Baseline measurement administered once during screening, takes approximately 5-10 minutes | Olfactory acuity will be assessed using a simple, non-invasive SCENTinel rapid smell test. Participants will be presented with test cards containing various odors, and will be asked to detect, rate, and identify the odors. The test assesses the participant's ability to perceive and recognize smells, providing information on their overall sense of smell. |
| Taste Acuity Test (WETT) | Baseline measurement administered once during screening, takes approximately 10-15 minutes | The Waterless Empirical Taste Test (WETT) is a sensory method for assessing how well participants can recognise and detect basic tastes. Participants will taste pre-moistened, paper-based test strips for the five basic tastes: sweet, sour, salty, bitter, and umami. |
| Blood plasma (Cytokines) | t = -15 minute (baseline), 30, 60, 90, 120, 180 minutes | Blood samples may also be analyzed for indicators of inflammation including cytokines testing |
| Blood plasma (Bile acids and short-chain fatty acids profiling) | t= -15 minute (baseline), 30, 60, 90, 120, 180 minutes | Blood samples collected may be used to analyse biomarkers related to nutrition and digestive health e.g. bile acid and short-chain fatty acids profiling |
| Bite Strength | Baseline measurement that may be administered once during screening or test session, as schedule and equipment permits. Takes only a few minutes. | Bite strength will be measured using a bite force device (non-invasive) that records the maximum force a participant can exert while biting. Multiple measurements will be taken with rest periods in between to prevent fatigue. |
| Tongue Strength (Tongue Pressure) | Baseline measurement that may be administered once during screening or test session, as schedule and equipment permits. Takes approximately 5 minutes. | Tongue pressure will be measured using a device equipped with a disposable air-filled bulb placed between the tongue and the hard palate. Participants will be instructed to press the bulb with their tongue as firmly as possible for a few seconds. Multiple measurements will be taken with rest periods in between to ensure accuracy and prevent fatigue. |
Countries
Singapore
Contacts
CONTACTRina Quek, MSc
CONTACTAshley Yu, BSc
PRINCIPAL_INVESTIGATORDarel Toh, PhD
Clinical Nutrition Research Centre
Outcome results
None listed