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Li M, Zhao S, Wu S, Yang X, Feng H. Effectiveness of Oral Nutritional Supplements on Older People with Anorexia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:nu13030835. [PMID: 33802580 PMCID: PMC8001033 DOI: 10.3390/nu13030835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nutrition plays an important role in maintaining the overall health of older people. Inadequate intake may lead to impaired body function, higher morbidity, and mortality. Oral nutritional supplements (ONS) showed positive effect on the nutritional status of the elderly; however, systematic evidence is currently lacking on the effect of ONS on the elderly with anorexia. AIMS The current systematic review and meta-analysis included randomized controlled trial (RCT) articles to investigate the effectiveness of ONS on the main aspects of anorexia of aging (AA). METHODS By using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, researchers independently searched PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, China National Knowledge Infrastructure (CNKI) and other gray literature resources for publications that met the inclusion criteria by October 2020. The Cochrane Risk of Bias Tools were used for quality assessment. The inverse-variance method was used for the fixed model (FM) while the DerSimonian-Laird method was used for the random model (RM). Respective 95% confidence intervals (95% CIs), mean difference (MD) or standardized mean difference (SMD) was used for indices in terms of effect size (ES). RESULTS 2497 records were found through the systematic search, while 17 RCTs (n = 1204) were included, with a mean age of 81.9 years (range: 74-87 years). Supplementation occurred in the morning, mid-day, and evening, while the times varied from one to three times a day. The results of meta-analysis showed that, generally, ONS had a positive effect on the overall appetite, MD = 0.18, 95% CI (0.03, 0.33), p = 0.02, and consumption, MD = 1.43, 95% CI (0.01, 2.86), p = 0.05; but not significant in terms of other aspects of appetite: hunger, p = 0.73; fullness, p = 0.60; desire to eat, p = 0.80; preoccupation, p = 0.15. Additionally, it showed an increase in the overall energy intake, SMD = 0.46, 95% CI (0.29, 0.63), p < 0.001, in protein intake, SMD = 0.59, 95% CI (0.16, 1.02), p = 0.007, and in fat intake, MD = 3.47, 95% CI (1.98, 4.97), p < 0.001, while no positive effect was found on carbohydrates intake, p = 0.06. Significance differences were also found in the body weight, SMD = 0.53, 95% CI (0.41, 0.65), p < 0.001, and body mass index (BMI), MD = 0.53, 95% CI (0.12, 0.95), p = 0.01. Moreover, subgroup analyses were conducted according to the nutrient density with no positive results showed except for the low-density ONS on overall energy intake. CONCLUSIONS The results of the present study indicated that ONS had beneficial effects on overall appetite, energy intake, body weight and BMI.
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Affiliation(s)
| | | | | | | | - Hui Feng
- Correspondence: ; Tel.: +86-151-7312-1969
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Rattanachaiwong S, Warodomwichit D, Yamwong P, Keawtanom S, Hiesmayr M, Sulz I, Singer P. Characteristics of hospitalized patients prescribed oral nutrition supplements in Thailand: A cross-sectional nutrition day survey. Clin Nutr ESPEN 2019; 33:294-300. [PMID: 31451271 DOI: 10.1016/j.clnesp.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/22/2019] [Accepted: 05/21/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the proven benefits of oral nutrition supplements (ONS), its prescription in Thailand are far less than it should mainly due to limitation of reimbursement. Our aim was to compare hospital outcomes between hospitalized patients receiving only hospital food to those receiving hospital food with ONS. METHODS AND STUDY DESIGN An annual cross-sectional survey, NutritionDay (nD), in Thailand was conducted in 2 hospitals from 2010 to 2015. The hospital outcomes were followed at day 30 after first evaluation. Logistic regression and Cox regression were performed to compare outcome between groups. RESULTS 524 hospitalized patients, 472 with only hospital food and 52 with ONS, were included. Patients with ONS had longer hospital stay prior to recruitment, reported more physical dependencies, and ate less food. The ONS group was less likely to be discharged within 30 days as compared to hospital food group (unadjusted OR 0.28, 95% CI 0.16-0.52) but this effect was not significant after adjustment for length of stay before nD and PANDORA score (adjusted OR 0.62, 95% CI 0.3-1.34). Cox regression showed a trend to decreased rate of discharge within 30 days in the ONS group. CONCLUSIONS This cross-sectional study showed a trend of worse outcomes associated with ONS prescription which might be related with higher mortality risk according to PANDORA score and longer previous hospital stay of the patients in the ONS group. Since the 2 studied groups were not comparable, further studies in this specific population should be performed.
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Affiliation(s)
- Sornwichate Rattanachaiwong
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Daruneewan Warodomwichit
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
| | - Preyanuj Yamwong
- Division of Nutrition, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.
| | - Songsri Keawtanom
- Research Center for Nutrition Support, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.
| | - Michael Hiesmayr
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care, Department of Anesthesia, General Intensive Care and Pain Control, Medical University of Vienna, Austria.
| | - Isabella Sulz
- Institute of Medical Statistics, Medical University of Vienna, Austria.
| | - Pierre Singer
- Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel.
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Assessment and Treatment of the Anorexia of Aging: A Systematic Review. Nutrients 2019; 11:nu11010144. [PMID: 30641897 PMCID: PMC6356473 DOI: 10.3390/nu11010144] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Appetite loss in older people, the ‘Anorexia of Aging’ (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment. (2) Methods: Study inclusion: participants aged ≥65, intervention for AA, and appetite assessment, any design, and comparator. Exclusion: studies on specific health cohorts. Searches in four databases with hand searching of references and citing works. Two researchers independently assessed eligibility and quality. (3) Results: Authors screened 8729 titles, 46 full texts. Eighteen articles were included describing nine intervention types: education (n = 1), exercise (n = 1), flavor enhancement (n = 2), increased meal variety (n = 1), mealtime assistance (n = 1), fortified food (n = 1), oral nutritional supplement (ONS) (n = 8), amino acids (n = 1), and medication (n = 2). Three studies evaluated combinations: education + exercise, ONS + exercise, and ONS + medication. Five intervention types exhibited favorable effects on appetite but in single datasets or not replicated. Appetite was assessed predominantly by Likert (n = 9), or visual analogue scales (n = 7). (4) Conclusions: A variety of interventions and methods of appetite assessments were used. There was a lack of clarity about whether AA or undernutrition was the intervention target. AA is important for future research but needs standardized assessment so that effectiveness of a range of interventions can be fully explored.
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Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Undernutrition and the older person. Australas J Ageing 2016; 36:75. [DOI: 10.1111/ajag.12344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Silveira PP, Portella AK, Kennedy JL, Gaudreau H, Davis C, Steiner M, Soares CN, Matthews SG, Sokolowski MB, Dubé L, Loucks EB, Hamilton J, Meaney MJ, Levitan RD. Association between the seven-repeat allele of the dopamine-4 receptor gene (DRD4) and spontaneous food intake in pre-school children. Appetite 2013; 73:15-22. [PMID: 24153108 DOI: 10.1016/j.appet.2013.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/03/2013] [Accepted: 10/05/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies in adults show associations between the hypofunctional seven-repeat allele (7R) of the dopamine-4 receptor gene (DRD4), increased eating behaviour and/or obesity, particularly in females. We examined whether 7R is associated with total caloric intake and/or food choices in pre-schoolers. METHODS 150 four-year-old children taking part in a birth cohort study in Canada were administered a snack test meal in a laboratory setting. Mothers also filled out a food frequency questionnaire to address childrens' habitual food consumption. Total caloric and individual macronutrient intakes during the snack meal and specific types of foods as reported in the food diaries were compared across 7R allele carriers vs. non-carriers, using current BMI as a co-variate. RESULTS We found significant sex by genotype interactions for fat and protein intake during the snack test. Post hoc testing revealed that in girls, but not boys, 7R carriers ate more fat and protein than did non-carriers. Based on the food diaries, across both sexes, 7R carriers consumed more portions of ice cream and less vegetables, eggs, nuts and whole bread, suggesting a less healthy pattern of habitual food consumption. CONCLUSION The 7R allele of DRD4 influences macronutrient intakes and specific food choices as early as four years of age. The specific pattern of results further suggests that prior associations between the 7R allele and adult overeating/obesity may originate in food choices observable in the preschool years. Longitudinal follow-up of these children will help establish the relevance of these findings for obesity risk and prevention.
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Affiliation(s)
- Patrícia Pelufo Silveira
- Department of Psychiatry and Neurology, McGill University, Douglas Mental Health University Institute, Canada; Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul Ramiro Barcelos, 2350 Largo Eduardo Zaccaro Faraco, 90035-903 Porto Alegre, RS, Brazil.
| | - André Krumel Portella
- Department of Psychiatry and Neurology, McGill University, Douglas Mental Health University Institute, Canada
| | - James L Kennedy
- Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health, Canada
| | - Hélène Gaudreau
- Department of Psychiatry and Neurology, McGill University, Douglas Mental Health University Institute, Canada
| | - Caroline Davis
- Department of Kinesiology and Health Sciences, York University, Canada
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Claudio N Soares
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Stephen G Matthews
- Department of Physiology, Obstetrics & Gynecology and Medicine, University of Toronto, Canada
| | - Marla B Sokolowski
- Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, ON, Canada; Institute for Human Development, University of Toronto, Toronto, ON, Canada
| | | | - Eric B Loucks
- Department of Community Health, Epidemiology Section, Center for Clinical Epidemiology and Population Health, Brown University, United States
| | - Jill Hamilton
- Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Michael J Meaney
- Department of Psychiatry and Neurology, McGill University, Douglas Mental Health University Institute, Canada; Singapore Institute for Clinical Sciences, The Agency for Science, Technology and Research, Singapore
| | - Robert D Levitan
- Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health, Canada
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Reider L, Hawkes W, Hebel JR, D'Adamo C, Magaziner J, Miller R, Orwig D, Alley DE. The association between body mass index, weight loss and physical function in the year following a hip fracture. J Nutr Health Aging 2013; 17:91-5. [PMID: 23299386 PMCID: PMC3569623 DOI: 10.1007/s12603-012-0073-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To determine whether body mass index (BMI) at the time of hospitalization or weight change in the period immediately following hospitalization predict physical function in the year after hip fracture. DESIGN Prospective observational study. SETTING Two hospitals in Baltimore, Maryland. PARTICIPANTS Female hip fracture patients age 65 years or older (N=136 for BMI analysis, N=41 for analysis of weight change). MEASUREMENTS Body mass index was calculated based on weight and height from the medical chart. Weight change was based on DXA scans at 3 and 10 days post fracture. Physical function was assessed at 2, 6 and 12 months following fracture using the lower extremity gain scale (LEGS), walking speed and grip strength. RESULTS LEGS score and walking speed did not differ across BMI tertiles. However, grip strength differed significantly across BMI tertiles (p=0.029), with underweight women having lower grip strength than normal weight women at all time points. Women experiencing the most weight loss (>4.8%) had significantly lower LEGS scores at all time points, slower walking speed at 6 months, and weaker grip strength at 12 months post-fracture relative to women with more modest weight loss. In adjusted models, overall differences in function and functional change across all time points were not significant. However, at 12 months post fracture,women with the most weight loss had an average grip strength 7.0 kg lower than women with modest weight loss (p=0.030). CONCLUSIONS Adjustment for confounders accounts for much of the relationships between BMI and function and weight change and function in the year after fracture. However, weight loss is associated with weakness during hip fracture recovery. Weight loss during and immediately after hospitalization appears to identify women at risk of poor function and may represent an important target for future interventions.
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Affiliation(s)
- L Reider
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Room 698, Baltimore, MD 21205, USA.
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Silveira PP, Agranonik M, Faras H, Portella AK, Meaney MJ, Levitan RD. Preliminary evidence for an impulsivity-based thrifty eating phenotype. Pediatr Res 2012; 71:293-8. [PMID: 22278183 DOI: 10.1038/pr.2011.39] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Low birth weight is associated with obesity and an increased risk for metabolic/cardiovascular diseases in later life. RESULTS The results of the snack delay test, which encompassed four distinct trials, indicated that the gender × intrauterine growth restriction (IUGR) × trial interaction was a predictor of the ability to delay the food reward (P = 0.002). Among children with normal birth weights, girls showed a greater ability to delay food rewards than did boys (P = 0.014).In contrast, among children with IUGR, there was no such differential ability between girls and boys. Furthermore, in girls, impulsive responding predicted both increased consumption of palatable fat (P = 0.007) and higher BMIs (P = 0.020) at 48 mo of age, although there was no such association with BMI at 36 mo. DISCUSSION In girls, the quality of fetal growth may contribute to impulsive eating, which may promote an increased intake of fats and consequently higher BMIs. As with the original thrifty phenotype, such a mechanism would be adaptive when food supplies are sparse, but would be problematic in societies with ample access to calorically rich foods. METHODS We examined whether the quality of intrauterine growth programs obesogenic eating behaviors, by investigating (i) the relationship between birth weight and impulsive eating in 3-year-old children (using the snack delay test), and (ii) whether impulsive eating predicts fat intake and/or BMI at 4 years of age (using a laboratory-based test meal).
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Affiliation(s)
- Patrícia P Silveira
- Núcleo de Estudos da Saúde da Criança e do Adolescente, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Mattes RD. Hunger and thirst: issues in measurement and prediction of eating and drinking. Physiol Behav 2010; 100:22-32. [PMID: 20060847 DOI: 10.1016/j.physbeh.2009.12.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 01/03/2023]
Abstract
Associations between hunger and eating and between thirst and drinking are generally weak. This stems, in part, from limitations in the measurement of these sensations which generally rely on temporal, motivational, metabolic and/or self-reported descriptive indices. Each is critically reviewed. Also problematic is the fact that the deterministic depletion-repletion concept of ingestive behavior fails to account for influences of a multitude of contravening cognitive, social, sensory and logistical factors. Although hunger and thirst serve some parallel purposes, sharp distinctions are also present with health implications. Of particular note are the observations that thirst ratings are higher and more stable over the day compared to hunger and thirst may be more motivating to drink than hunger is to eat. Coupling these observations with evidence that beverages have limited satiety value, they pose particular challenges and opportunities. Beverages can facilitate the delivery of nutrients to those desiring or requiring them, but also to those where they are not desired or required. The benefits and risks are a function of their use rather than their inherent properties.
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Affiliation(s)
- Richard D Mattes
- Department of Foods and Nutrition, Purdue University, 212 Stone Hall, 700 W State Street, West Lafayette, IN 47907-2059, USA.
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Hollis JH, Houchins JA, Blumberg JB, Mattes RD. Effects of Concord Grape Juice on Appetite, Diet, Body Weight, Lipid Profile, and Antioxidant Status of Adults. J Am Coll Nutr 2009; 28:574-82. [DOI: 10.1080/07315724.2009.10719789] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Australian and New Zealand Society for Geriatric Medicine Position Statement No. 6 - Under-nutrition and the Older Person. Australas J Ageing 2009; 28:99-105. [DOI: 10.1111/j.1741-6612.2009.00357.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Effect of a nutrient-enriched drink on dietary intake and nutritional status in institutionalised elderly. Eur J Clin Nutr 2009; 63:1241-50. [DOI: 10.1038/ejcn.2009.28] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gunnarsson AK, Lönn K, Gunningberg L. Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation? J Clin Nurs 2009; 18:1325-33. [DOI: 10.1111/j.1365-2702.2008.02673.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Silver HJ. Oral strategies to supplement older adults’ dietary intakes: comparing the evidence. Nutr Rev 2009; 67:21-31. [DOI: 10.1111/j.1753-4887.2008.00131.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Water consumption reduces energy intake at a breakfast meal in obese older adults. ACTA ACUST UNITED AC 2008; 108:1236-9. [PMID: 18589036 DOI: 10.1016/j.jada.2008.04.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 10/15/2007] [Indexed: 11/24/2022]
Abstract
Water consumed before a meal has been found to reduce energy intake among nonobese older adults. However, it is unknown whether this effect is evident among overweight and obese older adults, a population who would benefit from strategies to improve energy intake regulation. Our purpose was to determine whether premeal water consumption reduces meal energy intake in overweight and obese older adults. Twenty-four overweight and obese adults (body mass index=34.3+/-1.2), mean age 61.3+/-1.1 years, were given an ad libitum standardized breakfast meal on two randomly assigned occasions. Thirty minutes before the meal, subjects were given either a 500-mL water preload or no preload. Energy intake at each meal was covertly measured. Meal energy intake was significantly less in the water preload condition as compared with the no-preload condition (500+/-32 vs 574+/-38, respectively; P=0.004), representing an approximate 13% reduction in meal energy intake. The percentage reduction in meal energy intake following the water preload was not related to sex, age, body mass index, or habitual daily water consumption (all P>0.05). Given the high prevalence of overweight and obesity among older adults, future studies should determine whether premeal water consumption is an effective long-term weight control strategy for older adults.
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Yukawa M, Weigle DS, Davis CD, Marck BT, Wolden-Hanson T. Peripheral ghrelin treatment stabilizes body weights of senescent male Brown Norway rats at baseline and after surgery. Am J Physiol Regul Integr Comp Physiol 2008; 294:R1453-60. [DOI: 10.1152/ajpregu.00035.2008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unintentional weight loss may occur spontaneously in older humans and animals. Further weight losses after surgery or illness in the older patients result in increased morbidity, mortality, and hospital readmission rate. A growing body of work has shown increased appetite and weight gain in response to administration of ghrelin, the “hunger hormone.” We conducted two studies in senescent male Brown Norway rats to assess the ability of peripheral administration of ghrelin to increase body weight and food intake. One study assessed the effect of 2 wk of daily subcutaneous ghrelin administration (1 mg·kg−1·day−1) to senescent rats in a baseline condition; a second study used the same administration protocol in an interventional experiment with aged rats subjected to a surgery with 10–15% blood loss as a model of elective surgery. In both studies, animals receiving ghrelin maintained their body weights, whereas control animals lost weight. Body weight stability was achieved in ghrelin-treated animals despite a lack of increase in daily or cumulative food intake in both experiments. Hormone and proinflammatory cytokine levels were measured before surgery and after 14 days of treatment. Ghrelin treatment appeared to blunt declining ghrelin levels and also to blunt cytokine increases seen in the surgical control group. The ability of peripheral ghrelin treatment to maintain body weights of senescent rats without concomitant increases in food intake may be due to its known ability to decrease sympathetic activity and metabolic rate, perhaps by limiting cytokine-driven inflammation.
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McKiernan F, Houchins JA, Mattes RD. Relationships between human thirst, hunger, drinking, and feeding. Physiol Behav 2008; 94:700-8. [PMID: 18499200 DOI: 10.1016/j.physbeh.2008.04.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 04/02/2008] [Indexed: 11/17/2022]
Abstract
There is a widely held view that hunger prompts feeding to ensure energy needs are met, while thirst cues drinking to address hydration requirements. However, recent changes in the nature of the food supply and eating patterns have raised questions about the functionality of these relationships with respect to maintaining energy balance. The increasing consumption of energy-yielding beverages and foods with diluted energy density, through the use of ingredients such as high-intensity sweeteners and fat replacers, poses new challenges to presumed homeostatic energy regulatory mechanisms. This review draws on findings from a recent observational study and other published evidence to explore whether shifts of food composition and use patterns may be disrupting relationships between thirst, hunger, drinking, and eating, resulting in positive energy balance (e.g., drinking low satiety, energy-yielding beverages in response to hunger). The observational study entailed collecting hourly appetitive ratings and dietary recalls from 50 adults for seven consecutive days. These data reveal a clear bimodal daily hunger pattern, whereas thirst is stronger and more stable throughout the day. Further, approximately 75% of fluid intake occurs peri-prandially, with the majority derived from energy-yielding beverages. While there is published evidence that drinking is responsive to feeding, support for the view that drinking is the more tightly regulated behavior is stronger. Our data indicates that, due to a number of plausible factors, neither absolute values nor changes of hunger or thirst are strong predictors of energy intake. However, it is proposed that stable, high thirst facilitates drinking, and with the increased availability and use of energy-yielding beverages that have low satiety properties, can promote positive energy balance. There are marked individual differences in mean daily hunger and thirst ratings with unknown implications for energy balance.
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Van Walleghen EL, Orr JS, Gentile CL, Davy BM. Pre-meal water consumption reduces meal energy intake in older but not younger subjects. Obesity (Silver Spring) 2007; 15:93-9. [PMID: 17228036 DOI: 10.1038/oby.2007.506] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether the consumption of water 30 minutes before an ad libitum meal reduces meal energy intake in young and older adults. RESEARCH METHODS AND PROCEDURES Healthy, non-obese young (n = 29; age, 21 to 35 years) and older (n = 21; age, 60 to 80 years) individuals were provided with an ad libitum lunch meal on two occasions. Thirty minutes before the lunch meals, subjects were given either a water preload (WP: 375 mL, women; 500 mL, men) or no preload (NP). Energy intake at the two lunch meals was measured. Visual analog scales were used to assess changes in hunger, fullness, and thirst during the meal studies. RESULTS There was no significant difference in meal energy intake between conditions in the young subjects (892 + 51 vs. 913 +/- 54 kcal for NP and WP, respectively; p = 0.65). However, meal energy intake after the WP was significantly reduced relative to the NP condition in the older subjects (682 + 53 vs. 624 +/- 56 kcal for NP and WP, respectively; p = 0.02). This effect was caused primarily by the reduction in meal energy intake after water consumption in older men. Hunger ratings were lower and fullness ratings were higher in older compared with younger adults (p < 0.01). Fullness ratings were higher in the WP condition compared with the NP condition for all subjects (p = 0.01). No age differences in thirst were detected during the test meals. DISCUSSION Under acute test meal conditions, pre-meal water consumption reduces meal energy intake in older but not younger adults. Because older adults are at increased risk for overweight and obesity, intervention studies are needed to determine whether pre-meal water consumption is an effective long-term weight management strategy for the aging population.
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Affiliation(s)
- Emily L Van Walleghen
- Department of Human Nutrition, Foods and Exercise, 221 Wallace Hall (0430), Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
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