To fight anorexia

Anorexia is the loss of appetite

It is a major cause of weight loss in diseased and elderly populations.


Risk factors of anorexia

Anorexia is the loss of appetite, a major cause of weight loss. Senile anorexia is frequent in geriatric populations ranging from 3.3% among women and 10.3% among men living at home to >30% of institutionalized patients. Higher values are observed among older persons (1,2).

Senile anorexia is associated with a diminished nutritional state and significant functional, cognitive and emotive impairment (1,2). Appetite decreases, linked to a drop in smell and taste perception, reduction of visual and hearing acuity together with aging and monotonous food supply (2-5). Perception of food and food flavor is affected by age-associated changes in the chemical senses of taste and smell and changes in the facial nerves which control biting and chewing. Also, elderly with dental problems reduce their consumption of solid food, such as meat, vegetables and raw fruits. They are given mixed and mashed food instead (6-8). Elderly people have difficulties perceiving and identifying mixed food (2).

Poly-medication is another cause of anorexia as well as the inability to modify eating habits in stressful conditions. Hospital stay or institutional living means changes in environment, meal times, food habits and lack of assistance for eating.  After a few weeks, it is difficult to reverse anorexia (6). There is also an emerging concept of iatrogenic disability, common for Alzheimer patients after a hospital stay (9).

 senior heureux

The link between anorexia and monotonous food

A recent study of 526 patients (all over 65) in Italy demonstrated that intake in all food groups was lower in anorexic subjects compared to subjects with normal eating habits. There is a progressive reduction in daily caloric intake in anorexic patients, linked to an important reduction of food with high fat content. There were also significant differences in high-protein food: 27.6% of anorexic subjects did not consume red meat, 10.7% did not eat poultry, 55.6% did not eat fish and 82.1% did no eat eggs. Conversely, there was no reduction in carbohydrate intake (2).

Memories largely influence food preferences in healthy people. A review of research documentation shows that food memory, as well as aroma and spice perception, decrease with the evolution of Alzheimer’s disease (2,10). The decrease of sensory perceptions induces monotony in diet composition, which in turn has been linked both to reduced food intake (11) and to poor prognosis (12,13). Thus, there are specific difficulties involved with nourishing Alzheimer patients, who frequently need a protein and energy-rich diet. Conversely, review of the recent medical literature shows that:

1. Finger food is particularly adapted to Alzheimer patients.

2. Despite cognitive, smell, taste and visual alterations, the pleasure to cook and to eat persists and must be encouraged for Alzheimer patients to fight anorexia and malnutrition (10).

 Anorexia: to enrich and to vary nourishment

When compared to normal eating subjects, elderly with anorexia often used oral nutritional supplements (41.3% versus 5.9%) and reduced consistency meals (49.9% versus 21.7%). However, edentulous patients often complain of the monotony of mixed, mashed and soft food, which is a well-known cause of anorexia (11-13).

To fight against anorexia, it is necessary to offer food which pleases a malnourished person. It is also necessary to favor meals and snacks distributed throughout the day, even in small quantities. Finally, it is necessary to serve food which is high in protein and energy but small in volume.

Protibis cookies: proven effective in the fight against anorexia

Protibis cookies are designed to stimulate the pleasure to eat in anorexic persons, even in those who have dental problems because they are easily broken up and chewed. Several clinical studies showed that the familiar aspect, the natural aroma and the crunchy texture of Protibis cookies pleased anorexic elderly (14-17). Protibis cookies have a favorable impact on the weight gain and the appetite in connection with the pleasure to eat, even in Alzheimer patients (17).

Free comments of patients who participated in these studies showed an appreciation of a familiar, traditional product, its small-size and natural aroma. Patients taking several medications, at home or in institutions, looked for food with a natural aspect in order to feel that they were not taking an additional medicine. Hospitalized persons also looked for an aspect and a familiar taste "reminds them of home" or "feels like we are eating ordinary cookies".

Contrary to ordinary cookies, the taste of Protibis cookies is a bit more sweet, at the request of the majority of the anorexic patients. The pleasure to chew was important for the patients in soft or mixed diets, including Alzheimer patients (18,19). Breaking up cookies in the hand, for example, and then dropping into the morning milk as an alternative to semolina, was a pleasure. The taste and texture of Protibis cookies, dipped into tea or coffee, was also appreciated by patients suffering from oral dryness caused by Gougerot-Sjögren sicca syndrome or by malfunctioning salivary glands after radiotherapy. Finally, the glycemic index of 46.1 allowed to give cookies to malnourished patients suffering from diabetes mellitus (20).


1. HAS : Haute Autorité de Santé. Recommandations professionnelles. Stratégie de prise en charge en cas de dénutrition protéino-énergétique chez la personne âgée. Avril 2007.

2. Donini LM, Dominguez LJ, Barbagallo EM et al. Senile anorexia in different geriatric settings in Italy. J Nutr Health Aging 2011;15:775-781.

3. Morley JE. Anorexia and weight loss in older persons. J Gerontol A Biol Sci Med Med Sci 2003;58,131-137.

4. Bartali B, Salvini S, Turini A et al. Age and disability affect di

etary intake. JU Nutr 2003;133:2868-2873.

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7. Suzuki K, Nomura T, Sakurai M et al. Relationship between number of present teeth and nutritional intake in institutionalized elderly. Bull Tokyo Dent Coll 2005;46:135-143

8. Thomas B, Kouyoumdjian C, Duverneuil G et al. L’état bucco-dentaire des persones âgées dépendantes: bilan après 5 ans. Le Chirurgien-Dentiste de France 2011 ;1503 :33-41.

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10. Benattar L. Finger food : redonner le plaisir de manger aux personnes âgées atteintes de la maladie d'Alzheimer. Groupe Orpéa 2011,ère de la santé et des solidarités. Deuxième programme national nutrition santé 2006-2010. Actions et

mesures. Septembre 2006.

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12. Bernstein MA, Tucker KL, Ryan ND et al. Higher dietary variety is associated with better nutritional status in frail elderlypeople. J Am Diet Assoc 2002;102:1096-1104.

13. Roberts SB, Hajduk CL, Howarth NC et al. Dietary variety predicts low body mass index and inadequate macronutrient and micronutrient intakes in community dwelling older adults. J Gerontol A Biol Sci Med Sci 2005;60:613-621.

14. Prêcheur I, Brocker P, Schneider S. Development of hyperproteic and hyperenergetic cookies: a solid nutritional supplement for patients with masticatory disabilities. European Society for Clinical Nutrition and Metabolism ESPEN2010-LB-014 2010, Nice France.

15. Prêcheur I, Brocker P, Schneider SM, Barthélémi C, Pesci-Bard

on C. Compléments nutritionnels solides pour les personnes ayant des difficultés à mastiquer : enquête de satisfaction sur 30 seniors hospitalisés. Congrès International Francophone de Gériatrie et Gérontologie (CIFGG), P3.3-107, Nice 2010.

16. Solere JP, Brocker P, Schneider SM, Prêcheur I, Reichert E, Breugnon F et al. Distribution de galettes hyperprotidiques hyperénergétiques. Etude multicentrique auprès de seniors dénutris institutionnalisés : résultats intermédiaires sur 63 sujets. Journées Annuelles Francophones de la Société Française de Gériatrie et Gérontologie (JASFGG), P4-12.52, Paris 2011.

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er, un exemple. Revue Geriatr 2012 ;37 :141-2.

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19. Nijs K, de Graaf C, van Staveren WA, de Groot LC. Malnutrition and mealtime ambiance in nursing homes. J Am Med Dir Assoc 2009;10:226-9.

20. Haute Autorité de Santé. Ministère de la santé et des solidarités. Deuxième programme national nutrition santé 2006-2010. Actions et mesures. Septembre 2006.