Anorexia of Aging: Metabolic Changes and Biomarker Discovery

Anna Picca,1 Riccardo Calvani,1 Hélio José Coelho-Júnior,2 Francesco Landi,1,2 Emanuele Marzetti1,2 1Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy; 2Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, ItalyCorrespondence: Riccardo Calvani, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy, Tel +39-06-3015-5559, Fax +39-06-3051911, Email riccardo.calvani@policlinicogemelli.itAbstract: The age-associated decrease in appetite and food intake is referred to as “anorexia of aging”. Older adults with anorexia show changes in the quantity/quality of energy supplied to the organism which eventually may cause a mismatch between ingested calories and physiological energy demands. Therefore, a state of malnutrition and impaired metabolism may ensue which renders older people more vulnerable to stressors and more prone to incur negative health outcomes. These latter cover a wide range of conditions including sarcopenia, low engagement in physical activity, and more severe consequences such as disability, loss of independence, hospitalization, nursing home placement, and mortality. Malnutrition has been recognized by the European Society of Clinical Nutrition (ESPEN) among the chief risk factors for the development of frailty. Frailty refers to a state of increased vulnerability to stressors stemming from reduced physiologic reserve, and according to ESPEN, is also nutrition-based. Alike frailty, anorexia is highly prevalent among older adults, and its multifactorial nature includes metabolic changes that develop in older age and possibly underly the condition. Circulating factors, including hormones (eg, cholecystokinin, ghrelin, leptin, and inflammatory and microbial mediators of gut dysbiosis), have been proposed as biomarkers for this condition to support early identification and develop personalized nutritional interventions. Additional studies are needed to untangle the interrelationship between gut microbiota and appetite regulation in older adults operating through brain–gut crosstalk. Furthermore, the contribution of the genetic background to appetite regulation and specific nutritional needs warrants investigation. Here, we provide an overview on anorexia of aging in the context of age-related metabolic changes. A special focus is placed on candidate biomarkers that may be used to assist in the early identification of anorexia of aging and in the development of personalized nutritional counseling.Keywords: frailty, geroscience, inflammation, muscle, nutrition, sarcopeni