Hunger and aversion: drives that influence food intake of hospitalized geriatric patients

Diminished appetite occurs frequently with aging and is considered an important clinical symptom of malnutrition, a condition associated with negative clinical outcome, decreased quality of life, and increased health care costs in hospitalized geriatric patients. Yet, in this population, research is scant on hunger and aversion, the two underlying drives that shape appetite, or on their influence on food intake. This study aimed (a) to examine their interrelationship and respective contribution to food intake; (b) to determine how each relate to other health-related contemporaneous subjective states preceding the meal (good physical health, positive mood, pain); and (c) to explore clinical variables as moderators of the drives-intake relationships to identify population segments for which these relationships are the strongest.

32 patients (21 women, 11 men; age range, 65-92 years) were observed during repeated meals in a geriatric rehabilitation unit (for a total of 1477 meals). Perceived hunger, aversion, and contemporaneous subjective states were reported before each meal. Protein and energy consumption was calculated from plate leftovers. Clinical measures were obtained from participants' medical charts.

The hunger-aversion relationship had a low inverse correlation (p =.001), with each uniquely contributing to protein intake (positive and negative effects, respectively; all p <.05). Hunger was positively associated with the perception of physical health and with mood (all p =.001). Aversion was associated with pain (p =.001). Furthermore, aversion-intake relationships were influenced by moderators, whereas hunger-intake relationships remained constant.

From a clinical perspective, these results suggest that nutritional interventions aimed at bolstering hunger and curbing aversion may be necessary to ensure optimal food intake. Subgroups of patients who would particularly benefit from these interventions are suggested.