老人饮食 · 胃口、口渴和吸收为什么变了

参考文献 · 18

1. Landi, F., Calvani, R., Tosato, M., Martone, A. M., Ortolani, E., Savera, G., Sisto, A., & Marzetti, E. (2016). Anorexia of aging: Risk factors, consequences, and potential treatments. Nutrients, 8(2), 69. Narrative review. Anorexia of aging is a decrease in appetite and/or food intake in old age and a major contributor to undernutrition; it is not an unavoidable consequence of aging, but advancing age often promotes it through several mechanisms, and changes in lifestyle, disease, and social and environmental factors also affect eating. Simple interventions such as oral nutritional supplements or modified diets could meaningfully improve health and quality of life. 10.3390/nu8020069
2. Clarkston, W. K., Pantano, M. M., Morley, J. E., Horowitz, M., Littlefield, J. M., & Burton, F. R. (1997). Evidence for the anorexia of aging: Gastrointestinal transit and hunger in healthy elderly vs. young adults. American Journal of Physiology, 272(1 Pt 2), R243-R248. Cross-sectional comparison of 19 young (23-50 years) and 14 elderly (70-84 years) healthy volunteers. After a meal the elderly had less desire to eat and less hunger, but not significantly greater fullness. Gastric 50% emptying time was slower in the elderly for solids (182 vs 127 min) and liquids (47 vs 35 min); postprandial hunger was inversely related to solid gastric emptying (r = -0.39). Orocecal and total gut transit did not differ. Autonomic function was abnormal in 11 elderly and no young subjects. Conclusion: slower gastric emptying may contribute to anorexia in aging. 10.1152/ajpregu.1997.272.1.R243
3. Johnson, K. O., Shannon, O. M., Matu, J., Holliday, A., Ispoglou, T., & Deighton, K. (2020). Differences in circulating appetite-related hormone concentrations between younger and older adults: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 32(7), 1233-1244. Thirty-five studies, 710 healthy older adults (mean age 73) and 713 younger adults (mean age 28). Older adults had higher fasted and postprandial cholecystokinin (SMD 0.41 both), higher leptin and higher postprandial insulin, a non-significant trend to higher postprandial peptide YY, lower energy intake (SMD -0.98) and lower fasted hunger (SMD -1.00). Conclusion: higher insulin, leptin, cholecystokinin and peptide YY accord with reduced appetite and energy intake in healthy older adults. Ghrelin is not among the reported differences. 10.1007/s40520-019-01292-6
4. Roberts, S. B., Fuss, P., Heyman, M. B., Evans, W. J., Tsay, R., Rasmussen, H., Fiatarone, M., Cortiella, J., Dallal, G. E., & Young, V. R. (1994). Control of food intake in older men. JAMA, 272(20), 1601-1606. Dietary intervention study in 35 healthy younger and older men of normal weight, overfed (n = 17) or underfed (n = 18) for 21 days, then free to eat. Aging did not change the weight, body composition or energy expenditure response to the feeding period itself. Afterwards, younger men spontaneously ate less after overfeeding and more after underfeeding and returned to their weight; older men did neither, so they kept the weight gained or failed to regain the weight lost. Conclusion: aging may impair the control of food intake after over- or undereating, which may help explain unexplained weight loss and gain in older people. Small study in men only. 10.1001/jama.1994.03520200057036
5. Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., van Asselt, D., Wirth, R., & Bischoff, S. C. (2022). ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clinical Nutrition, 41(4), 958-989. Eighty-two recommendations (full text). Energy guiding value about 30 kcal/kg/day, individually adjusted; protein at least 1 g/kg/day. Older women should be offered at least 1.6 L and men at least 2.0 L of drinks a day unless a clinical condition requires otherwise; heart and renal failure may need fluid restriction. All older persons should be screened for malnutrition with a validated tool. Atrophic gastritis impairs absorption of vitamin B12, calcium and iron; micronutrients follow recommendations for healthy older persons unless there is a deficiency. Dietary restrictions that may limit intake are potentially harmful and should be avoided. Eating in company stimulates intake. Those at risk of malnutrition should be offered fortified food, additional snacks or finger food, and, with chewing or swallowing problems, texture-modified enriched food; oral nutritional supplements when counseling and food modification are not enough. All older persons should be considered at risk of low-intake dehydration; directly measured serum osmolality above 300 mOsm/kg identifies it, while simple signs such as skin turgor, mouth dryness, weight change and urine color shall not be used to assess hydration in older adults. 10.1016/j.clnu.2022.01.024
6. NHS. (2026). Dehydration. Babies, children and older adults are more at risk; it happens more easily in people who take diuretics or rely on other people to get them drinks. Ask for an urgent GP appointment or call NHS 111 for unusual tiredness, dizziness on standing that does not go away, dark yellow urine or peeing less than normal, or fast breathing or heart rate. Call 999 or go to A&E if someone with signs of dehydration has blue, grey, pale or blotchy skin, lips or tongue, cold skin, difficulty breathing, is confused, or is sleepier than normal or difficult to wake; these could be signs of shock (page last reviewed 1 May 2026). www.nhs.uk/conditions/dehydration
7. Doty, R. L., Shaman, P., Applebaum, S. L., Giberson, R., Siksorski, L., & Rosenberg, L. (1984). Smell identification ability: Changes with age. Science, 226(4681), 1441-1443. Cross-sectional smell identification testing in 1955 people aged 5 to 99. Women outperformed men and nonsmokers outperformed smokers at all ages. Performance peaked in the third to fifth decades and declined markedly after the seventh. More than half of those aged 65 to 80, and more than three-quarters of those over 80, had major olfactory impairment. The authors note this fits elderly complaints that food lacks flavor and their excess of accidental gas poisoning. 10.1126/science.6505700
8. Schiffman, S. S. (1997). Taste and smell losses in normal aging and disease. JAMA, 278(16), 1357-1362. Review of MEDLINE literature 1966-1997. Losses of taste and smell are common in the elderly and come from normal aging, certain diseases (especially Alzheimer disease), medications, surgery and environmental exposure. They reduce the pleasure and comfort of food, are risk factors for nutritional and immune deficiencies and for poor adherence to specific diets, and can lead to food poisoning or overexposure to hazardous chemicals. Flavor-enhanced food can increase enjoyment of food and has a positive effect on food intake and immune status. 10.1001/jama.1997.03550160077042
9. Phillips, P. A., Rolls, B. J., Ledingham, J. G., Forsling, M. L., Morton, J. J., Crowe, M. J., & Wollner, L. (1984). Reduced thirst after water deprivation in healthy elderly men. The New England Journal of Medicine, 311(12), 753-759. Seven healthy active men aged 67 to 75 and seven aged 20 to 31, matched for weight loss, went 24 hours without water. The older men had greater rises in plasma osmolality, sodium and vasopressin, but lower urine osmolality; they were less thirsty and drank less afterwards, so their plasma and urine did not return to pre-deprivation levels. Conclusion: a deficit in thirst and water intake in healthy elderly men although vasopressin responsiveness is maintained or increased; the age-related deficit in urine concentrating ability reflects renal causes, not a lack of vasopressin. 10.1056/NEJM198409203111202
10. Nowjack-Raymer, R. E., & Sheiham, A. (2003). Association of edentulism and diet and nutrition in US adults. Journal of Dental Research, 82(2), 123-126. Cross-sectional analysis of NHANES III. After adjusting for social and behavioral factors, people with no teeth wearing complete dentures ate carrots 2.1 times less and tossed salads 1.5 times less than people with all their natural teeth, and 1.2 times less dietary fiber; their serum beta carotene, folate and vitamin C were also lower. Observational association. 10.1177/154405910308200209
11. Baijens, L. W., Clavé, P., Cras, P., Ekberg, O., Forster, A., Kolb, G. F., Leners, J.-C., Masiero, S., Mateos-Nozal, J., Ortega, O., Smithard, D. G., Speyer, R., & Walshe, M. (2016). European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: Oropharyngeal dysphagia as a geriatric syndrome. Clinical Interventions in Aging, 11, 1403-1428. Position paper. Oropharyngeal dysphagia is impaired or uncomfortable transit of food or liquid from the mouth to the esophagus. It can cause malnutrition, dehydration, respiratory infections and aspiration pneumonia. It is prevalent among older patients because the oropharyngeal swallow response is impaired in older people and can cause aspiration; it is underdiagnosed, is diagnosed by validated clinical and instrumental methods, and is treated mainly with compensatory measures. It should be in standard screening protocols. 10.2147/CIA.S107750
12. NHS. (2023). Dysphagia (swallowing problems). Signs include coughing or choking when eating or drinking, bringing food back up sometimes through the nose, a feeling that food is stuck, and a gurgly, wet-sounding voice when eating or drinking; over time it can cause weight loss, dehydration and repeated chest infections. Ask for an urgent GP appointment or get help from NHS 111 if you or your child has difficulty swallowing, coughs or chokes while eating or drinking, feels something is stuck in the throat after eating, keeps bringing food or milk back up sometimes through the nose, cries a lot or arches their back when feeding, has a wet, gurgly voice after eating or drinking, is short of breath after eating or drinking, or gets lots of chest infections (page last reviewed 2 May 2023). www.nhs.uk/symptoms/swallowing-problems-dysphagia
13. Andrès, E., Loukili, N. H., Noel, E., Kaltenbach, G., Abdelgheni, M. B., Perrin, A. E., Noblet-Dick, M., Maloisel, F., Schlienger, J.-L., & Blicklé, J.-F. (2004). Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ, 171(3), 251-259. Review. Cobalamin deficiency is frequent (over 20%) among elderly people and often unrecognized because its signs are subtle, yet potentially serious (neuropsychiatric and hematological). Causes: food-cobalamin malabsorption (over 60% of cases), pernicious anemia (15-20%), insufficient intake and malabsorption. Food-cobalamin malabsorption is the inability to release cobalamin from food or a deficiency of intestinal cobalamin transport proteins, or both. 10.1503/cmaj.1031155
14. NHS. (2023). Vitamin B12 or folate deficiency anaemia: symptoms. Symptoms usually develop gradually and include feeling weak or tired, shortness of breath, headaches, palpitations, a sore or red tongue sometimes with mouth ulcers, and problems with memory; vitamin B12 deficiency can also cause neurological symptoms including numbness, pins and needles, muscle weakness, and problems with balance and coordination. See a GP if you have these symptoms; diagnosis and treatment as soon as possible matters, because some problems can be irreversible if left untreated. www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/symptoms
15. MacLaughlin, J., & Holick, M. F. (1985). Aging decreases the capacity of human skin to produce vitamin D3. The Journal of Clinical Investigation, 76(4), 1536-1538. Surgically obtained skin from people aged 8 to 92 showed an age-dependent decrease in epidermal provitamin D3 (7-dehydrocholesterol). Samples exposed to ultraviolet radiation: the epidermis made more than 80% of the previtamin D3, and skin from 77- and 82-year-olds made less than half as much previtamin D3 as skin from 8- and 18-year-olds. The authors note this matters for elderly people who expose little skin to sunlight. Skin samples studied outside the body. 10.1172/JCI112134
16. National Institutes of Health, Office of Dietary Supplements. (2024). Vitamin D — Fact Sheet for Health Professionals. Fact sheet (updated June 27, 2025; Wayback snapshot 20 September 2026): 25(OH)D below 30 nmol/L (12 ng/mL) is associated with deficiency, 30 to below 50 nmol/L is generally considered inadequate, 50 nmol/L (20 ng/mL) or more is sufficient for most people, and above 125 nmol/L (50 ng/mL) can be associated with adverse effects; RDA 600 IU (15 mcg) to age 70 and 800 IU (20 mcg) above 70; adult UL 4,000 IU (100 mcg); older people and people with darker skin (more melanin) make less vitamin D from sunlight (fact sheet). ods.od.nih.gov/factsheets/VitaminD-HealthProfessional
17. Moore, D. R., Churchward-Venne, T. A., Witard, O., Breen, L., Burd, N. A., Tipton, K. D., & Phillips, S. M. (2015). Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 70(1), 57-62. Retrospective breakpoint analysis of pooled dose-response data: myofibrillar protein synthesis plateaued after 0.24 g/kg body mass in younger men versus 0.40 g/kg in older men (0.25 vs 0.60 g/kg lean body mass), i.e. older men need a greater relative per-meal protein dose. 10.1093/gerona/glu103
18. NHS. (2023). Malnutrition (overview and symptoms). The main sign is unintentional weight loss: losing 5 to 10% or more of body weight over 3 to 6 months; clothes, belts and jewellery becoming looser; a BMI under 18.5. Other symptoms: reduced appetite, lack of interest in food and drink, tiredness, weakness, getting ill often and recovering slowly, wounds healing slowly, poor concentration and feeling cold. People aged 65 and over are particularly at risk, and weight loss is not an inevitable result of old age. See a GP after unintentional weight loss over 3 to 6 months or if worried that an older person in your care may be malnourished. First dietary advice: fortified high-calorie, high-protein foods, snacks between meals and nourishing drinks; nutritional drinks or supplements if that is not enough (page last reviewed 23 May 2023). www.nhs.uk/conditions/malnutrition