title: Appetite predicts mortality in free-living older adults in association with dietary diversity. A NAHSIT cohort study.
abstract: This study aimed to assess the predictive ability of appetite for mortality among representative free-living Taiwanese older adults. A total of 1856 participants aged 65 years or over from the Elderly Nutrition and Health Survey during 1999-2000 completed an appetite question in a larger questionnaire. Personal information was obtained by face-to-face interview at baseline, together with a 24-hour dietary recall and simplified food frequency questionnaire which provided a dietary diversity score and food intake frequency. Survivorship was ascertained from the Death Registry until December 31, 2008. Participants with a poor appetite had lower dietary diversity scores (DDS) and intake frequencies of meat, fish and sea food, egg, vegetable and fruit intake, along with lower energy, protein, vitamin B-1, niacin, iron and phosphate intakes. Those who had fair and poor appetites had a higher risk of all-cause mortality compared to those with good appetite, with hazard ratios (HR) (95% confidence interval, CI) of 1.28 (1.03-1.58) and 2.27 (1.71-3.02), respectively. After adjustment for confounders, the HRs (95% CI) were 1.05 (0.83-1.33) and 1.50 (1.03-2.18), respectively. With further adjustment for DDS or general health these HRs became non-significant. The joint HR (95% CI) for "DDS ≤ 4 and poor appetite" was 1.77 (1.04-3.00) compared to "DDS > 4 and good appetite" as referent. Poor appetite is associated with lower food and nutrient intakes and an independent risk for mortality in older Taiwanese. In conclusion, appetite is separate, mediated by general health and modulated by dietary quality in its predictive capacity for mortality.
authors.affiliation: Graduate Institute of Life Sciences, National Defense Medical Center, 161 Minchuan East Road, Sec 6, Taipei 114, Taiwan.
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, No 35, Keyan Road, Zhunan Town, Miaoli County 35053, Taiwan; National Defense Medical Center, School of Public Health, 161 Minchuan East Road, Sec. 6, Taipei 114, Taiwan; Monash Asia Institute, Monash University, 5th Floor, H Building, 900 Dandenong Road, Caulfield East, Melbourne, Vic. 3145, Australia.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wahlqvist
authors.affiliation: Graduate Institute of Life Sciences, National Defense Medical Center, 161 Minchuan East Road, Sec 6, Taipei 114, Taiwan; National Defense Medical Center, School of Public Health, 161 Minchuan East Road, Sec. 6, Taipei 114, Taiwan; Monash Asia Institute, Monash University, 5th Floor, H Building, 900 Dandenong Road, Caulfield East, Melbourne, Vic. 3145, Australia. Electronic address: mmsl@ndmctsgh.edu.tw.
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000401:mortality*; D001066:Appetite; D015331:Cohort Studies; D004032:Diet / Q000592:standards; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D008297:Male; D011939:Mental Recall; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D009752:Nutritional Status; D012306:Risk; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology
keywords: Appetite; Dietary diversity; Mortality; Older adults