Four questions that may save your grandma’s life: SNAQ screening tool predicts weight loss

New Saint Louis University study validates first questionnaire of its kind

A four-question screening tool can predict which older patients with appetite problems are likely to lose weight, placing them at greater risk of death, according to Saint Louis University research.

The questionnaire is called the SNAQ (pronounced snack), the Simplified Nutritional Appetite Questionnaire, and takes less than two minutes to answer.

“This tool tells us whether a poor appetite is likely to kill you. It identifies the patients who have problems with their appetite and will go on to lose weight,” says Margaret-Mary Wilson, M.D., associate professor of internal medicine and geriatrics at Saint Louis University and lead author.

“The watch-and-wait approach is dangerous when it comes to weight loss in older adults. We’re dealing with a problem that can be fatal.”

Wilson says that most people who are elderly find their appetite isn’t as robust as when they were younger. Their sense of taste and smell is blunted, and many older adults take multiple medications, which reduce appetite.

Chronic pain, multiple illnesses, depression and problems with dentures also make it less appealing or more difficult to eat.

Of this group of seniors with appetite problems, some will go on to lose weight, which triggers illness, frailty and potentially death.

“Weight loss is a disease we want to prevent. We can begin treatment before weight loss occurs and have an impact on outcomes. Using this tool, we can intervene before they begin to lose weight,” Wilson says.

The researchers asked appetite questions of 247 nursing home residents over age 60 from nine long-term facilities in St. Louis. In addition, 868 residents from the St. Louis metropolitan area, about 40 percent of whom were at least 60, also were asked the questions.

The researchers then checked six months later to see if those who completed the questionnaire lost weight.

More than eight times out of 10, scores on the SNAQ identified those who would go on to lose 5 percent of their weight. The test was even more sensitive in predicting who would lose 10 percent of their weight, picking up the problem 88 percent of the time. The questionnaire was equally reliable for old and younger people, Wilson says.

“This is a tool that can be used in either population,” Wilson says. “This could be helpful in treating younger patients with AIDS, cancer and long-term chronic diseases that put them at risk of weight loss. Using this tool, we can intervene before they begin to lose weight.”

The SNAQ includes questions that rank the strength of appetite, feelings of fullness after eating, taste of food and number of meals eaten each day. A score at a certain level indicates the risk of significant weight within six months, and should spark a trip to the doctor and nutritional assessment.

“We’re advocating it is used in all geriatric patient settings,” Wilson says.

“It’s such a simple tool it can even be used by families. Don’t wait for weight loss to occur. Use the SNAQ.”