第一部分 中文版简化营养食欲问卷的信效度检验

【目的】验证中文版简化营养食欲问卷（simplified nutritional appetite questionnaire, SNAQ）的信度与效度，评估其作为社区老年厌食症筛查工具的适用性。

【方法】通过翻译-回译法对SNAQ进行跨文化调适，2023年11月至2024年1月选取北京市社区年龄≥60岁的社区老年人，采用面对面调查收集SNAQ、微型营养评估简表（Mini-Nutritional Assessment Short-Form, MNA-SF）、衰弱筛查量表（Fatigue, Resistance, Ambulation, Illness, Loss of weight, the FRAIL scale）、肌肉减少症筛查问卷（Strength, climb stairs, assistance in walking, rise from a chair, fall, SARC-F）、老年抑郁量表（15-item Geriatric Depression Scale, GDS-15）、广泛性焦虑量表（7-item Generalized Anxiety Disorder, GAD-7）、口腔衰弱指数（8-item Oral Frailty Index , OFI-8）、进食评估工具（10-item Eating Assessment Tool, EAT-10）及简易精神状态检查量表（Mini-Mental State Examination, MMSE）。通过Cronbach’s α系数分析内部一致性，KMO-Bartlett检验评估结构效度，以MNA-SF为标准验证校标效度。
【结果】共纳入122例受试者，平均年龄73.23±10.05岁，女性占85.2%（104/122）。中文版SNAQ的Cronbach’s α系数为0.694，若删除第4条目后提升至0.796；分半信度为0.725。KMO-Bartlett值为0.648（P<0.001），SNAQ与MNA-SF得分呈正相关（r=0.345, P=0.001）。
【结论】中文版SNAQ具有良好的信效度，适用于社区老年厌食症的初步筛查。

【关键词】简化营养食欲问卷；社区老年人；老年厌食症；信度；效度

第二部分 社区老年人老年厌食症的患病特征及其与内在能力的关系

【目的】随着健康老龄化提出，老年人内在能力维护得到重视，其中活力维度受损营养不良发生率高，并影响内在能力其他维度。相较于微型营养评估简表，中文版简化营养食欲问卷（simplified nutritional appetite questionnaire, SNAQ）可以更早发现食欲和摄入问题，但中国少有相关报告。本调查采用已经验证的中文版SNAQ，调查老年厌食症（anorexia of aging, AA）与内在能力下降的关系，为在社区早期筛查、早干预老年厌食症提供依据，并在线上初步验证应用可行性。

【方法】根据自愿原则，从2023年6月到2024年7月，采用社区招募方法选取北京社区65岁及以上的老年人进行纸质版自评问卷调查。除了调查参与者的一般信息和临床状况外，使用中文版SNAQ调查AA。使用二元逻辑回归分析检查AA与内在能力下降的关系。同时通过问卷星和微信宣传对65岁及以上的老年人进行在线自评问卷调查，初步探索线上SNAQ的应用。

【结果】1、研究包括254名北京市社区居住的老年人，分为AA组（SNAQ≤14）和非AA组，结果显示AA的检出率为16.5%，AA组中73.8%有衰弱问题，非AA组中24.1%有衰弱问题，AA组中50%患营养不良及风险，非AA组中16.5%患营养不良及风险，组间差异具有统计学意义（P＜0.05）。在内在能力方面，AA组中50%活力维度受损，38.1%心理维度受损，40%运动能力受损，16.7%认知维度受损，71.4%感官维度受损。

2、与内在能力五维度的二元逻辑回归分析揭示，在调整混杂因素（年龄、性别、CCI）后，AA与营养不良及其风险[OR (95% CI): 5.271 (2.441-11.382)]，心理维度受损[OR (95% CI): 3.826 (1.714-8.541)]，认知维度受损[OR (95% CI): 3.456 (1.061-11.260)]均独立相关，差异具有统计学意义。AA与运动维度及感官维度受损正相关，但差异无统计学意义。

3、通过对线下及线上人群特征对比，发现线上组的AA占比更高(29% vs.16.5%, P＜0.05)，教育水平较低(初中及以下占51% vs. 26.1%, P＜0.05)，体质指数较低(23.5±2.9 vs. 24.5±3.7, P＜0.05)，多重用药数目较少(14.7% vs. 30%, P＜0.05)，1年内跌倒史占比更多(29% vs.18.6%, P＜0.05)，嗅觉/味觉减退者占比更高(24%vs.9.8%, P＜0.05)。

【结论】北京市社区居住老年人中使用中文版SNAQ量表评估AA的检出率16.5%，线上组29%；AA与内在能力的活力、心理、认知维度受损均显著独立相关，提示AA可能预测老年人内在能力下降，早期干预AA可能对预防不良后果有意义。

【关键词】老年厌食症；中文版简化营养食欲问卷；老年人；社区；内在能力

第三部分 营养补充剂与营养宣教对老年厌食症患者的食欲影响研究——一项非随机干预对照研究

【目的】全球老龄化人口加剧，国外学者证实营养宣教及口服营养补充剂（Oral Nutritional Supplements, ONS）可以改善老年人的营养状况和食欲。然而，在中国关于老年厌食症（Anorexia of Aging, AA）的干预措施研究有限。因此，本研究的目的是验证口服ONS及营养宣教是否能改善中国社区老年人AA。

【方法】本研究采用开放标签非随机对照试验方法，招募符合入选标准（SNAQ 值≤14分，无急性病，自愿参与）的老年人，以非随机分为干预组和对照组。干预组接受ONS补充，对照组接受营养宣教。使用中文版简化营养食欲问卷（Simplified Nutritional Appetite Questionnaire, SNAQ）评估中国社区居住老年人的厌食状况。3个月随访评估SNAQ、体重和老年综合评估（comprehensive geriatric assessment, CGA），主要结局是SNAQ提高，次要结局包括体重增加、握力增加、营养状况、心理健康、生活质量和认知功能等各个方面的影响。

【结果】最终纳入对照组28人，干预组36人。较年轻、非独居、营养状况更差的社区老年人更愿意参加ONS补充干预组（P＜0.05）。口头饮食宣教组在第4周(1.57±1.55)、8周(1.63±1.90)、12周(2.18±1.66)表现出SNAQ相较于基线的增加(P＜0.05)，而ONS干预组在第2周(2.04±1.45)、4周(1.42±2.12)、8周(2.04±2.80)、12周(2.52±2.71)均表现出SNAQ相较于基线的增加，并且第2周干预组SNAQ提高值相比于对照组明显增加(2.04±1.45 vs. -0.07±2.34)，差异具有统计学意义(P＜0.05)。两组体重较基线变化在第2、4、8、12周未见明显增加，两组体重变化差异无统计学意义(P＞0.05)。对照组12周后握力增加2.73±2.90kg(P＜0.05)，而在老年综合健康的营养方面、认知、运动、心理、生活质量维度未见明显改善。

【结论】在社区老年厌食症患者中，ONS及口头营养宣教在12周内对AA均有所改善。ONS干预第2周即可显著提高SNAQ评分，ONS干预组对AA的改善起效较口头宣教组早且效果更好。ONS补充12周可能对社区老年人体重及综合健康状况（营养、衰弱、运动、认知）改善有限，仍需进一步试验验证。

【试验注册】该研究已获得北京协和医院伦理委员会的批准（I-23PJ661），并已在中国临床试验注册中心注册，通用试验编号为MR-11-23-023104。

PART I：Reliability and Validity of Chinese Version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in Community-dwelling Old People

Objective: To investigate the reliability and validity of the Chinese version of the Simplified Nutritional Appetite Questionnaire (SNAQ).

Methods: The SNAQ was translated and back-translated for the study population. We surveyed community-dwelling residents aged ≥60 years in Beijing's residential communities. Participants underwent face-to-face surveys including the SNAQ, Mini-Nutritional Assessment Short-Form (MNA-SF), the FRAIL scale, Sarcopenia-Five (SARC-F), 15-item Geriatric Depression Scale (GDS-15), 7-item Generalized Anxiety Disorder (GAD-7), 8-item Oral Frailty Index (OFI-8), 10-item Eating Assessment Tool (EAT-10), and Mini-Mental State Examination (MMSE). Cronbach's alpha was used to measure the internal consistency and the relationship between individual items. The construct validity was verified using the KMO-Bartlett. Concurrent validity was established to validate measures of the same constructs. 

Results:  Cronbach's alpha measured the internal consistency of the questionnaire at 0.694. The split-half reliability stood at 0.725. The construct validity of the SNAQ was confirmed using a KMO-Bartlett value of 0.648(P<0.001). The MNA-SF, as validation benchmark, has a correlation coefficient of 0.345 (P=0.001).

Conclusion:  The Chinese version of the SNAQ has good reliability and validity for older adults in community settings.

Keywords: SNAQ, reliability, validity, Chinese

Part II: Epidemiological Characteristics of Anorexia of Aging and Its Association with Intrinsic Capacity in Community-Dwelling Older Adults

Objective：With the proposal of healthy aging, maintaining intrinsic capacity in older adults has gained increasing attention. Malnutrition, which is highly prevalent and affects other dimensions of intrinsic capacity, is a critical concern. Compared to the Mini-Nutritional Assessment Short Form (MNA-SF), the Chinese version of the Simplified Nutritional Appetite Questionnaire (SNAQ) can detect appetite and intake issues earlier. However, few studies in China have explored this tool. This study utilized our validated Chinese SNAQ to investigate the relationship between anorexia of aging (AA) and declines in intrinsic capacity, aiming to provide evidence for early screening and intervention of AA in community settings.

Methods：From June 2023 to July 2024, community-dwelling adults aged ≥65 years in Beijing were recruited voluntarily to complete a self-administered paper-based questionnaire. Participants’ general information, clinical status, and AA (assessed by the Chinese SNAQ) were collected. Binary logistic regression was used to analyze the association between AA and intrinsic capacity decline. Additionally, an online self-administered survey via Wenjuanxing (a survey platform) and WeChat was conducted to preliminarily explore the online application of SNAQ.

Results：1.The study included 254 older adults. Participants were divided into an AA group (SNAQ ≤14) and a non-AA group. The AA detection rate was 16.5%. The AA group showed significantly higher rates of frailty (73.8% vs. 24.1%, P<0.05) and malnutrition/risk (50% vs. 16.5%, P<0.05). For intrinsic capacity dimensions, the AA group exhibited impairments in vitality (50%), psychological health (38.1%), mobility (40%), cognition (16.7%), and sensory function (71.4%).

2.After adjusting for confounders (age, sex, Charlson Comorbidity Index), binary logistic regression revealed that AA was independently associated with malnutrition/risk [OR=5.271 (2.441–11.382)], psychological impairment [OR=3.826 (1.714–8.541)], and cognitive impairment [OR=3.456 (1.061–11.260)] (P<0.05). AA was positively correlated with mobility and sensory impairments (P＞0.05).

3.Compared to offline participants, the online group had a higher AA prevalence (29%), lower education levels, lower BMI, fewer polypharmacy cases, more fall histories, and higher rates of olfactory/taste decline.

Conclusion：Using the Chinese version of the SNAQ, the detection rate of AA among older adults in Beijing communities was found to be 16.5% in community settings and 29% in online surveys. AA is associated with a decline in intrinsic capacity. It is recommended to incorporate appetite assessment into community evaluations to refine the assessment of the vitality dimension within intrinsic capacity. Early intervention may help preserve intrinsic capacity at an earlier stage.

Keywords：Anorexia of Aging, Chinese Simplified Nutritional Appetite Questionnaire, Older Adults, Community, Intrinsic Capacity

Part III: Comparative Effects of Oral Nutritional Supplementation vs. Nutritional Education on Appetite and Weight in Older Adults with Anorexia of Aging: A 12-Week Non-Randomized Controlled Trial

Objective：With the global aging population, international studies have demonstrated that nutritional education and oral nutritional supplements (ONS) can improve nutritional status and appetite in older adults. However, research on interventions for anorexia of aging (AA) in China remains limited. This study aimed to validate whether ONS and nutritional education improve AA in community-dwelling older adults in China.

Methods：An open-label, non-randomized controlled trial was conducted. Eligible participants (SNAQ score ≤14, no acute illness, voluntary participation) were non-randomly allocated to intervention and control groups. The intervention group received ONS, while the control group received dietary education. The Chinese version of the Simplified Nutritional Appetite Questionnaire (SNAQ) was used to assess AA. Outcomes were evaluated at 3-month follow-up, including SNAQ score (primary outcome), weight gain, handgrip strength, nutritional status, mental health, quality of life, and cognitive function via comprehensive geriatric assessment (CGA).

Results：The study enrolled 36 participants in the ONS group and 28 in the control group. Younger, non-living-alone individuals with poorer baseline nutritional status were more likely to join the ONS group (P<0.05). The dietary education group showed increased SNAQ scores at Week 4 (1.57±1.55), Week 8 (1.63±1.90), and Week 12 (2.18±1.66) compared to baseline (P<0.05). The ONS group demonstrated significant SNAQ improvements at Week 2 (2.04±1.45), Week 4 (1.42±2.12), Week 8 (2.04±2.80), and Week 12 (2.52±2.71). Notably, the ONS group showed greater improvement than controls at Week 2 (2.04±1.45 vs. -0.07±2.34, P<0.05). No significant weight changes were observed in either group at any timepoint (P>0.05). Handgrip strength increased by 2.73±2.90 kg in the control group at Week 12 (P<0.05), but no improvements were observed in CGA domains (nutrition, cognition, mobility, psychology, quality of life).

Conclusion：Both ONS and dietary education improved AA in community-dwelling older adults over 12 weeks. ONS demonstrated earlier efficacy, with significant SNAQ improvement by Week 2. However, 12-week ONS supplementation showed limited effects on weight and comprehensive health outcomes (nutrition, frailty, mobility, cognition), warranting further investigation.

Trial Registration：Approved by the Ethics Committee of Peking Union Medical College Hospital (I-23PJ661) and registered with the Chinese Clinical Trial Registry (Universal Trial Number: MR-11-23-023104).