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Pathophysiologie des Katabolismus bei unterernährten alten Patienten*

Physiopathology of the catabolism associated with malnutrition in the elderly

  • PATHOPHYSIOLOGIE DER MALNUTRITION
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Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Summary

Malnutrition is a common finding amongst our elders. The causes of malnutrition are multifactorial and although they have been extensively studied, they are not entirely understood. Both physiological and pathological processes of aging put this population at a higher risk of being undernourished. These may be related to social, financial, psychological and/or physiological changes directly or indirectly associated to growing old.

Age associated changes increase the risk of malnutrition in older individuals. These alterations range from problems in taste and smell perception, which were previously thought to be the main cause of anorexia in this population, to alterations in either the concentration or efficacy of the previously mentioned feeding modulators.

Increased intestinal malabsorption together with an altered pancreatic exocrine response to different diets, further contributing to subclinical malabsorption in the elderly population aged and may account in part for the malnutrition observed in this group.

Although not directly caused by the aging process, several conditions such as anorexia nervosa, cancer, infectious conditions, and inflammatory processes are associated with decreased food intake and weight loss. These conditions present with elevated levels of immunoregulatory substances known as cytokines. Each of these cytokines has multiple effects and play a leading role in the pathophysiology and maintainance of malnutrition in these situations.

Zusammenfassung

Unterernährung ist bei älteren kranken Personen ein häufiger Befund. Die Ursachen der Unterernährung sind multifaktoriell. Obwohl sie intensiv erforscht wurden, sind sie nicht restlos geklärt. Aufgrund physiologischer als auch pathologischer Prozesse, die mit dem Altern einhergehen, ist diese Bevölkerungsgruppe einem höheren Risiko der Unterernährung unterworfen. Diese Vorgänge sind hauptsächlich auf soziale, finanzielle, psychologische und physiologische alternsbedingte Veränderungen zurückzuführen.

Altersbedingte Ursachen mit erhöhtem Risiko für Malnutrition reichen von Problemen mit der Geschmacks- und Geruchswahrnehmung, die früher als Hauptgrund für die Anorexie bei Betagten angesehen wurden, bis zu Veränderungen der Konzentration oder der Wirksamkeit von appetitmodulierenden Hormonen und Neurotransmittern.

Wichtig scheint auch eine verstärkte intestinale Malabsorption und eine beeinträchtigte exokrine Pankreasfunktion bei der älteren Bevölkerung, die sicher teilweise für die in dieser Gruppe zu beobachtende Malabsorption verantwortlich ist. Man spricht auch von einer subklinischen Malabsorption Betagter.

Bei kranken Betagten spielen auch verschiedene Zustände, die nicht direkt durch den Alterungsprozeß bedingt sind, eine wichtige Rolle bei der Entstehung und Aufrechterhaltung der Malnutrition. Dazu gehören Entzündungen, Verletzungen, Neoplasmen und chronische Krankheiten. In diesen Situationen spielen Cytokine wie IL-1 und Cachektin in der Pathophysiologie der Unterernährung eine dominierende Rolle.

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Literatur

  1. Arsenijevic D, Girardier L, Seydoux J et al. (1997) Altered energy balance and cytokine gene expression in a murine model of chronic infection with Toxoplasma gondii. Am J Physiol 272:E908–E917

    PubMed  CAS  Google Scholar 

  2. Arnalich F, Hernanz A, Vazquez JJ et al. (1994) Cell-mediated immune response and cytokine production in idiopathic senile anorexia. Mech Ageing Dev 77:67–74

    Article  PubMed  CAS  Google Scholar 

  3. Behre HM, Simoni M, Nieschlag E (1997) Strong association between serum levels of leptin and testosterone in men. Clinical Endocrinology 47:237–240

    Article  PubMed  CAS  Google Scholar 

  4. Bellinger LL, Williams FE (1986) Glucagon and epinephrine suppression of food intake in liver denervated rats. Am J Physiol 251:R349–R358

    PubMed  CAS  Google Scholar 

  5. Billington CJ, Briggs JE, Grace M et al. (1991) Effects of intracerebroventricular injection of neuropeptide Y on energy metabolism. Am J Physiol 260:R321– R327

    PubMed  CAS  Google Scholar 

  6. Catania A, Airaghi L, Motta P et al. (1997) Cytokine antagonists in aged subjects and their relation with cellular immunity. J Gerontol: Biological Sciences 52A:B93–B97

    CAS  Google Scholar 

  7. Cederholm T, Arner P, Palmblad J (1997) Low circulating leptin levels in proteinenergy malnourished chronically ill elderly subjects. J Intern Med 242:377–382

    Article  PubMed  CAS  Google Scholar 

  8. Chance WT, Balasubramaniam A, Stallion A et al. (1993) Anorexia following the systemic injection of amylin. Brain Res 607:185–188

    Article  PubMed  CAS  Google Scholar 

  9. Clarkston WK, Pantano MM, Morley JE et al. (1997) Evidence for the anorexia of aging: Gastrointestinal transit and hunger in healthy elderly vs young adults. Am J Physiol 272:R243–R248

    PubMed  CAS  Google Scholar 

  10. Cook CG, Andrews JM, Jones KL et al. (1997) Effects of small intestinal nutrient infusion on appetite and pyloric motility are modified by age. Am J Physiol 273:R755–R761

    PubMed  CAS  Google Scholar 

  11. Cunninham ME, Shaw-Stiffel TA, Bernstein LH et al. (1995) Cholecystokinin stimulated monocytes produce inflammatory cytokines and eicosanoids. Am J Physiol 273:R755–R761

    Google Scholar 

  12. Daun JM, McCarthy DO (1993) The role of cholecystokinin in interleukin-1 induced anorexia. Physiol Behav 54:237–241

    Article  PubMed  CAS  Google Scholar 

  13. Dryden S, Wang Q, Frankish HM et al. (1996) Differential effects of the 5- HT1B/2C receptor agonist mCPP and the 5-HT1A agonist flesinoxan on hypothalamic neuropeptide Yin the rat: evidence that NPY may mediate serotonin’s effect on food intake. Peptides 17:943–949

    Article  PubMed  CAS  Google Scholar 

  14. Elmstahl S, Persson M, Andren M et al. (1997) Malnutrition in geriatric patients: a neglected problem? J of Advanced Nursing 26:851–855

    Article  CAS  Google Scholar 

  15. Espat NJ, Auffenberg T, Rosenberg JJ et al. (1996) Ciliary neurotrophic factor is catabolic and shares with IL-6 the capacity to induce an acute phase response. Am J Physiol 271:R185–R190

    PubMed  CAS  Google Scholar 

  16. Fagiolo U, Cosarizza A, Santacaterina S et al. (1992) Increased cytokine production by peripheral blood mononuclear cells from healthy elderly people. Ann NY Acad Sci 663:490–493

    Article  PubMed  CAS  Google Scholar 

  17. Fantuzzi G, Benigni F, Sironi M et al. (1995) Ciliary neurotrophic factor (CNTF) induces serum amyloid A, hypoglyceaia and anorexia, and potentiates IL-1 induced corticosterone and IL-6 production in mice. Cytokine 7:150–156

    Article  PubMed  CAS  Google Scholar 

  18. Feingold KR, Soued M, Adi S et al. (1991) Effect of interleukin-1 on lipid metabolism in the rate. Similarities to and differences from tumor necrosis factor. Arteriosclerosis & Thrombosis 11:495–500

    CAS  Google Scholar 

  19. Ferraris RP, Vinnakota RR (1993) Regulation of intestinal nutrient transport is impaired in old mice. J Nutr 123:502–511

    PubMed  CAS  Google Scholar 

  20. Figlewikz DP, Stein LJ, Woods SC et al. (1985) Acute and chronic gastrin releasing peptide decreases food intake in baboons. Am J Physiol 248:R578–R583

    Google Scholar 

  21. Finck BN, Johnson RW (1997) Anorexia, weight loss and increased plasma interleukin- 6 caused by chronic intracerebroventricular infusion of interleukin-1 beta in the rate. Brain Res 761:333–337

    Article  PubMed  CAS  Google Scholar 

  22. Flores EA, Bristian BR, Pomposelli JJ et al. (1989) Infusion of tumor necrosis factor/ cachectin promotes muscle catabolism in the rat. Asynergistic effect with interleukin 1. J Clin Invest 83:1614–1622

    Article  PubMed  CAS  Google Scholar 

  23. Fried SK, Zechner R (1989) Cachectin/ tumor necrosis factor decreases human adipose tissue lipoprotein lipase mRNA levels, synthesis, and activity. J Lipid Res 30:1917–1923

    PubMed  CAS  Google Scholar 

  24. Gershenwald JE, Fong YM, Fahey TJ et al. (1990) Interleukin 1 receptor blockage attenuates the host inflammatory response. Proc Natl Acad Sci USA 87:4966–4970

    Article  PubMed  CAS  Google Scholar 

  25. Gosnell BA, Levine AS, Morley JE (1983) The effects of aging on opioid modulation of feeding in rats. Life Sci 32:2793–2799

    Article  PubMed  CAS  Google Scholar 

  26. Greenberg RE, Holt PR (1986) Influence of aging upon pancreatic digestive enzymes. Digestive Diseases and Sciences 31:970–977

    Article  PubMed  CAS  Google Scholar 

  27. Grunfield C, Zhao C, Fuller J et al. (1996) Endotoxin and cytokines induce expression of cytokines, the ob gene product, in hamsters. J Clin Invest 97:2152–2157

    Article  Google Scholar 

  28. Granowitz EV (1997) Transforming growth factor-beta enhances and pro-inflammatory cytokines inhibit OB gene expression in 3T3-L1 adipocytes. Biochemical and Biophysical Research Communications 240:382–385

    Article  PubMed  CAS  Google Scholar 

  29. Gutzwiller JP, Drewe J, Hildebrand P et al. (1994) Effect of intravenous gastrin-releasing peptide on food intake in humans. Gastroenterology 106:1168–1173

    PubMed  CAS  Google Scholar 

  30. Hasselgren PO, Fisher JE (1998) Sepsis: Stimulation of protein-dependent breakdown resulting in protein loss in skeletal muscle. World J Surg 22:203–208

    Article  PubMed  CAS  Google Scholar 

  31. Hill AG, Jacobson L, Gonzalez J et al. (1996) Chronic central nervous system exposure to interleukin-1 beta causes catabolism in rats. Am J Physiol 271:R1142–R1148

    PubMed  CAS  Google Scholar 

  32. Ho LT, Chern YF, Lin MT (1989) The hypothalamic somatostatinergic pathways mediate feeding behavior in rats. Experientia 45:161–162

    Article  PubMed  CAS  Google Scholar 

  33. Hotta M, Shibasaki T, Yamauchi N et al. (1991) The effects of chronic central administration of corticotrophin-releasing factor on food intake, body weight and hypothalamic-pituitary-adrenocortical hormones. Life Sci 48:1483–1491

    Article  PubMed  CAS  Google Scholar 

  34. Janikk J, Curti BD, Considine RV et al. (1997) Interleukin 1 alpha increases serum leptin concentration in humans. J Clin Endocrinol Metab 82:3084–3086

    Article  Google Scholar 

  35. Kavaliers M, Teskey GC, Hirst M (1985) The effects of aging on day-night rhythms of kappa opiate-mediated feeding in the mouse. Psychopharmacology 87:286–291

    Article  PubMed  CAS  Google Scholar 

  36. Kayali A, Young V, Goodman M (1987) Sensitivity of myofibrillar proteins to glucocorticoid- induced muscle proteolysis. Am J Physiol 252:E621

    PubMed  CAS  Google Scholar 

  37. Lambert PD, Wilding JP, Al-Dokhayel AA et al. (1993) A role for neuropeptide-Y, dynorphin, and noradrenaline in the central control of food intake after deprivation. Endocrinology 133:29–32

    Article  PubMed  CAS  Google Scholar 

  38. Leibowitz S, Weiss G, Suh J (1990) Medial hypothalamic nuclei mediate serotonin’s inhibitory effect on feeding behaviour. Pharmac Biochem Behav 37:735–742

    Article  CAS  Google Scholar 

  39. Lieverse RJ, Janssen JB, Masclee AM et al. (1995) Effects of somatostatin on human satiety. Neuroendocrinology 61:112–116

    Article  PubMed  CAS  Google Scholar 

  40. Lilic D, Cant AJ, Abinum M et al. (1997) Cytokine production differs in children and adults. Pediatr Res 42:237–240

    Article  PubMed  CAS  Google Scholar 

  41. Ling PR, Schwartz JH, Bistrian BR (1997) Mechanisms of host wasting induced by administration of cytokines in rats. Am J Physiol 272:E333–E339

    PubMed  CAS  Google Scholar 

  42. Llovera M, Garcia-Martinez C, Lopez- Soriano FJ et al. (1994) The effect of chronic tumor necrosis factor-alpha on urinary nitrogen excretion in the rat. Biochemistry & Molecular Biology International 3:681–689

    Google Scholar 

  43. Lora-Vilchis MC, Chambert G, Rodriquez-Zendejas AM (1988) Ontogeny of alphaand beta-adrenergic anorexia in rats. Am J Physiol 255:R908–913

    PubMed  CAS  Google Scholar 

  44. Maltoni M, Fabbri L, Nanni O et al. (1997) Serum levels of tumor necrosis factor alpha and other cytokines do not correlate with weight loss and anorexia in cancer patients. Support Care Cancer 5:130–135

    PubMed  CAS  Google Scholar 

  45. Martin D, Merkel E, Tucker KK et al. (1996) Cachectic effect of ciliary neurotrophic factor on innervated skeletal muscle. Am J Physiol 271:R1422–R1428

    PubMed  CAS  Google Scholar 

  46. Masclee AA, Geusken LM, Driessen WM et al. (1988) Effect of aging on plasma cholecystokinin secretion and gallbladder emptying. Age 11:136–140

    Article  CAS  Google Scholar 

  47. Mizuno T, Bergen A, Kleopoulus S et al. (1996) Effects of nutritional status and aging on leptin gene expression in mice: Importance of glucose. Horm Metab Res 28:679–684

    Article  PubMed  CAS  Google Scholar 

  48. Mooradian AD, Reed RL, Osterweil D et al. (1990) Lack of an association between the presence of tumor necrosis factor or interleukin- 1 alpha in the blood and weight loss among elderly patients. J Am Geriatr Soc 38:397–401

    PubMed  CAS  Google Scholar 

  49. Morin CJ, Pagliassotti MJ, Windmiller D et al. (1997) Adipose-tissue derived tumor necrosis factor-alpha activity is elevated in older rats. J Gerontol 52:190–195

    Google Scholar 

  50. Morley JE, Flood JF (1991) Amylin decreases food intake in mice. Peptides 12:865–869

    Article  PubMed  CAS  Google Scholar 

  51. Morley JE, Flood JF (1992) Competitive antagonism of nitric oxide synthetase causes weight loss in mice. Life Sci 51:1285–1289

    Article  PubMed  CAS  Google Scholar 

  52. Morley JE, Flood JF, Farr SA et al. (1995) Effects of amylin on appetite regulation and memory. Can J Physiol Pharmacol 73:1042–1046

    PubMed  CAS  Google Scholar 

  53. Morley JE, Flood JF, Silver AJ (1990) Opioid peptides and aging. Ann NY Acad Sci 579:123–132

    Article  PubMed  CAS  Google Scholar 

  54. Morley JE, Kumar VB, Mattammal MB et al. (1996) Inhibition of feeding by a nitric oxide synthase inhibitor: Effects of aging. Eur J Pharmacol 311:15–19

    Article  PubMed  CAS  Google Scholar 

  55. Morley JE, Perry HM, Kaiser FE et al. (1993) Longitudinal changes in testosterone, luteinizing hormone, and follicle stimulating hormone in healthy older males. J Am Geriatr Soc 41:149–152

    PubMed  CAS  Google Scholar 

  56. Morley JE, Suarez MD, Mattammal MB et al. (1997) Amylin and food intake in mice: effects on motivation eat and mechanism of action. Pharmacol Biochem Behav 56:123–129

    Article  PubMed  CAS  Google Scholar 

  57. Oldenburg HS, Rogy MA, Lazarus DD et al. (1993) Cachexia and the acute-phase protein response in inflammation are related by interleukin-6. Eur J Immunol 23:1889–1894

    Article  PubMed  CAS  Google Scholar 

  58. Plata-Salaman CR, Vaselli JR, Sonti G (1997) Differential responsiveness of obese (fa/fa) and lean (Fa/Fa) rats to cytokineinduced anorexia. Obes Res 5:36–42

    PubMed  CAS  Google Scholar 

  59. Poston GJ, Singh F, Draviam EJ et al. (1988) Development and age-related changes in pancreatic cholecystokinin receptors and duodenal cholecystokinin in guinea pigs. Mech Ageing Dev 46:59–66

    Article  PubMed  CAS  Google Scholar 

  60. Rodriguez-Zendejas AM, Chambert G, Lora-Vilchis MC et al. (1986) Ontogeny of epinephrine-induced in rats. Am J Physiol 250:R303–R317

    Google Scholar 

  61. Roubenoff R, Roubenoff RA, Cannon JG et al. (1994) Rheumatoid cachexia: Cytokinedriven hypermetabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest 93:2379–2386

    Article  PubMed  CAS  Google Scholar 

  62. Sakurai T, Amemiya A, Ishii M et al. (1998) Orexins and orexin receptors: A family of hypothalamic neuropeptides and G proteincoupled receptors that regulate feeding behavior. Cell 92:573–585

    Article  PubMed  CAS  Google Scholar 

  63. Sarraf P, Frederich RC, Turner EM, et al. (1997) Multiple cytokines raise mouse leptin levels: Potential role in inflammatory anorexia. J Exp Med 185:171–175

    Article  PubMed  CAS  Google Scholar 

  64. Schneider BS, Monahan JW, Hirsch J (1979) Brain cholecystokinin and nutritional status in rats and mice. Clin Invest 64:1348–1356

    Article  CAS  Google Scholar 

  65. Schwartz MW, Seeley RJ, Campfield LA et al. (1996) Identification of targets of leptin action in rat hypothalamus. J Clin Invest 98:1101–1106

    Article  PubMed  CAS  Google Scholar 

  66. Silver AJ, Flood JF, Morley JE (1988) Effect of gastrointestinal peptides on ingestion in old and young mice. Peptides 9:221–225

    Article  PubMed  CAS  Google Scholar 

  67. Siren AL, Liu Y, Feuerstein G et al. (1993) Increased release of tumor necrosis factoralpha into the cerebrospinal fluid and peripheral circulation of aged rats. Stroke 24:880–886

    PubMed  CAS  Google Scholar 

  68. Sonti G, Ilyin SE, Plata-Salaman CR (1996) Anorexia induced by cytokine interactions at pathophysiological concentrations. Am J Physiol 270:R1394–R1402

    PubMed  CAS  Google Scholar 

  69. Tessitore L, Costelli P, Baccino FM (1993) Humoral mediation for cachexia in tumourbearing rats. Br J Cancer 67:15–23

    PubMed  CAS  Google Scholar 

  70. Uehara A. Sekiya C, Takasugi Y et al. (1989) Anorexia induced by interleukin 1: involvement of corticotrophin-releasing factor. Am J Physiol 257:R613–R617

    PubMed  CAS  Google Scholar 

  71. Voigt JP, Huston JP, Voits M et al. (1996) Effects of cholecystokinin octapeptide (CCK-8) on food intake in adult and aged rats under different feeding conditions. Peptides 17:1313–1315

    Article  PubMed  CAS  Google Scholar 

  72. Warren EJ, Finck BN, Arkins S et al. (1997) Coincidental changes in behavior and plasma cortisol in unrestrained pigs after intracerebroventricular injection of tumor necrosis factor-alpha. Endocrinology 138:2365–2371

    Article  PubMed  CAS  Google Scholar 

  73. Xu B, Dube MG, Kalra PS et al. (1998) Anorectic effects of the cytokine, ciliary neurotrophic factor, are mediate by hypothalamic neuropeptide Y: Comparison with leptin. Endocrinology 139:466–473

    Article  PubMed  CAS  Google Scholar 

  74. Yang ZJ, Koseki M. Meguid MM et al. (1994) Synergistic effect of rhTNF-alpha and rhIL-alpha in inducing anorexia in rats. Am J Physiol 267:R1056–R1064

    PubMed  CAS  Google Scholar 

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  1. Dammert Professor of Gerontology, Saint Louis University Health Sciences Center, Division of Geriatric Medicine, 1402 S. Grand Boulevard, Room M238, St. Louis, MO 63104, USA

    J. E. Morley M.B. B.Ch.

  2. University of Puerto Rico, Medical Sciences Campus, Internal Medicine Department, Geriatric Medicine Section, 365067, San Juan, PR 00936-5067, Puerto Rico

    D. Baez-Franceschi M.D.

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  1. D. Baez-Franceschi M.D.
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*Aus dem Englischen übersetzt von Ernst Grell, lic. phil., Maiengasse 25, CH-4056 Basel, Schweiz

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Baez-Franceschi, D., Morley, J.E. Pathophysiologie des Katabolismus bei unterernährten alten Patienten*. Z Gerontol Geriat 32 (Suppl 1), S12–S19 (1999). https://doi.org/10.1007/s003910050175

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