Elucidating the role of the gut microbiota in the physiological effects of dietary fiber

BACKGROUND

Dietary fiber is an integral part of a healthy diet, but questions remain about the mechanisms that underlie effects and the causal contributions of the gut microbiota. Here, we performed a 6-week exploratory trial in adults with excess weight (BMI: 25-35 kg/m2) to compare the effects of a high-dose (females: 25 g/day; males: 35 g/day) supplement of fermentable corn bran arabinoxylan (AX; n = 15) with that of microbiota-non-accessible microcrystalline cellulose (MCC; n = 16). Obesity-related surrogate endpoints and biomarkers of host-microbiome interactions implicated in the pathophysiology of obesity (trimethylamine N-oxide, gut hormones, cytokines, and measures of intestinal barrier integrity) were assessed. We then determined whether clinical outcomes could be predicted by fecal microbiota features or mechanistic biomarkers.

RESULTS

AX enhanced satiety after a meal and decreased homeostatic model assessment of insulin resistance (HOMA-IR), while MCC reduced tumor necrosis factor-α and fecal calprotectin. Machine learning models determined that effects on satiety could be predicted by fecal bacterial taxa that utilized AX, as identified by bioorthogonal non-canonical amino acid tagging. Reductions in HOMA-IR and calprotectin were associated with shifts in fecal bile acids, but correlations were negative, suggesting that the benefits of fiber may not be mediated by their effects on bile acid pools. Biomarkers of host-microbiome interactions often linked to bacterial metabolites derived from fiber fermentation (short-chain fatty acids) were not affected by AX supplementation when compared to non-accessible MCC.

CONCLUSION

This study demonstrates the efficacy of purified dietary fibers when used as supplements and suggests that satietogenic effects of AX may be linked to bacterial taxa that ferment the fiber or utilize breakdown products. Other effects are likely microbiome independent. The findings provide a basis for fiber-type specific therapeutic applications and their personalization.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT02322112 , registered on July 3, 2015. Video Abstract.

Acceptance of oat-based beverages tailored for patients with cancer

Oat-based beverages are a nutritious product with the potential to support increased nutrient intake of patients with cancer. The aim of this research was to evaluate the sensory acceptance of oat-based beverages and perceptions of oats among patients with cancer as future vehicles for nutrient delivery. In study 1, three flavors of oat-beverages were well accepted without significant difference in liking among flavors or serving temperature, or between patients with cancer and healthy participants. Patients with cancer more frequently rated the beverages as too sweet compared to healthy participants; flavor intensity was just about right for all participants. In the second study, one of two formulations fortified with protein and fish oil was not different in liking compared to the unfortified chocolate product. Patients associated oat food products with specific oat-based food products and oat health benefits in a free-word association task in the third study. Together, sensory acceptance and the perceived health benefits of oats indicate the potential for oats to be incorporated in fortified and unfortified products tailored for patients with cancer. PRACTICAL APPLICATION: The three studies presented here to assess the sensory acceptance of oat-based beverages and perceptions of oats among patients with cancer demonstrate that oats can be incorporated in fortified and unfortified products tailored for patients with cancer. Inadequate nutrition is highly prevalent among oncology patients and there is a lack of available products targeted to improve their nutritional intake. These findings can support product developers and sensory scientists in the development and evaluation of food products acceptable to this population.

The influence of companion foods on sensory attribute perception and liking of regular and sodium-reduced foods

Among major contributors of dietary sodium intake, many foods are consumed together with companion foods, specifically condiments and carriers. This study compared sensory profiles and overall liking between commercially available regular and sodium-reduced foods consumed with or without companion foods; and examined changes in sensory profiles and overall liking when foods are consumed in condiment-carrier pairs. Three distinct consumer panels evaluated one of the three condiment-carrier pairs, salsa-corn chips (n = 98, 63% female), ketchup-tater tots (n = 100, 69% female), and soy sauce-cooked rice (n = 98, 70% female). For each panel, consumers evaluated five samples; including the regular and sodium-reduced carriers/condiments alone, the companion food alone, and the regular and sodium-reduced foods each with its companion food. Samples were rated for overall liking (9-point hedonic scale) and the intensity of defining sensory attributes (3-point Rate-All-That-Apply scale). Consumers perceived sensory attribute differences between regular and sodium-reduced corn chips (salty) and soy sauce (salty, sweet), but not ketchup. The presence of the companion food reduced consumer ability to discriminate sensory attributes between regular and sodium-reduced products and changed sensory profiles and liking of the foods. Additionally, consumer heterogeneity in hedonic response identified three consumer segments in each consumer panel. Consumer segments differed in their sensory attribute perception. PRACTICAL APPLICATION: It is possible for the food industry to reduce sodium in a range of companion foods without changing consumer preference. The selection of companion foods is important to consumer evaluation of foods under the context of food pairing; corn chips-salsa and ketchup-tater tots are appropriate food pairs. Future sensory studies on food reformulation toward sodium reduction should target specific consumer segments of product liking and sensory attribute perception, which may in turn be influenced by food consumption frequency.

Meat and sensory quality of major muscles from Angus, Charolais, and Angus crossbred steers with high and low residual feed intake

Effects of residual feed intake (RFI) and genetic group on growth, carcass, and meat quality characteristics of bovine longissimus lumborum (LL), triceps brachii (TB), semimembranosus (SM), and gluteus medius (GM) muscles were investigated using 72 purebred Angus, purebred Charolais, and Angus crossbred steers (n = 24 per genetic group) classified as either high (inefficient) or low (efficient) RFI (n = 12 high and low RFI steers within genetic group). There was no RFI effect (P > 0.05) on growth, carcass, and meat quality measurements except high RFI steers had the highest dry matter intake (P < 0.05), and low RFI TB was rated as having reduced beef flavour intensity and sustained juiciness (P < 0.05). Purebred Angus and Charolais LL and GM had lower shear force values (P < 0.05) than Angus crossbreds and ageing reduced mean shear force values except in TB. For TB, SM, and GM, Angus crossbred steers had the highest mean beef flavour intensity scores, and Charolais SM and TB were less tender than those of Angus crossbred (P < 0.05). Overall, RFI did not influence most meat quality traits; therefore, low RFI animals may contribute to reducing feed costs or environmental impact without compromising meat quality and palatability.

Consumer Sensory Comparisons Among Beef, Horse, Elk, and Bison Using Preferred Attributes Elicitation and Check-All-That-Apply Methods

Despite their nutritional benefits, consumption of red meat from alternative sources such as bison, elk, and horse is low when compared to beef. Sensory attributes and drivers of liking were identified for these meats using the Preferred Attributes Elicitation (PAE) and Check-All-That-Apply (CATA) methods. For the PAE study, 25 panelists evaluated beef, horse, bison, and elk meats in three different group sessions (n = 7, 7, and 11), whereas 63 panelists participated in the CATA study. Consumers in both PAE and CATA studies associated horse meat with dry and fibrous appearance, whereas beef was associated with meaty/beefy flavor and aroma: bison with metallic and livery aroma and intense aftertaste and elk meat with livery, fishy, metallic flavor, musky aroma, and bloody aftertaste. Penalty analysis on the CATA data identified similar drivers of meat liking as the PAE groups. The attributes were juiciness, meaty/beefy aroma, tender texture, meaty/beefy flavor, and mild flavor and aroma. Attributes with significantly negative mean impact on liking were dryness, tough texture, livery flavor, and aftertaste. Association of these attributes with horse and elk meats has implication on drivers of dislike for these meat types. Cluster analysis identified a small group of consumers with preference for horse and elk meats, and this may present niche market opportunities for these meat types. Results showed that the PAE method was comparable to CATA for the evaluation of meat from different species and for identification of drivers of liking and that both methods are effective for meat sensory characterization. PRACTICAL APPLICATION: Lean red meat from unconventional sources such as elk, bison, and horse has unique sensory attributes that may influence acceptance. This study characterized the sensory attributes of these meats and their impact on liking using two rapid consumer descriptive profiling methods-PAE and CATA. Undesirable flavor and aftertaste attributes were identified as the major drivers of disliking for these unconventional meats. Both methods gave similar description of the samples, thus confirming the suitability of PAE for descriptive meat profiling by consumer panels.

Poor Vitamin Status is Associated with Skeletal Muscle Loss and Mucositis in Head and Neck Cancer Patients

Mucositis and muscle wasting are two common toxicity effects of cancer treatment in head and neck cancer (HNC). There is limited data evaluating cancer treatment toxicities in relation to vitamin status. This study aimed to assess changes in vitamin status during HNC treatment in relation to body composition, inflammation and mucositis. In this prospective cohort study, dietary intakes (3-day food record), plasma levels of vitamins and C-reactive protein (CRP) were assessed at baseline (at diagnosis) and post-treatment (after 6–8 weeks of radiation therapy with or without chemotherapy). Computed tomography images were used to quantify body composition. Mucositis information was collected from health records of patients. Twenty-eight HNC patients (age 60 ± 10 years) completed both study time points. Patients who developed mucositis had significantly lower dietary intake of vitamins and plasma 25-hydroxy vitamin D (25-OHD) and all-trans retinol levels (p < 0.02). Patients lost a considerable amount of muscle mass (3.4 kg) and fat mass (3.6 kg) over the course of treatment. There was a trend toward greater muscle loss in patients with 25-OHD < 50 nmol/L compared to patients with 25-OHD ≥ 50 nmol/L (p = 0.07). A significant negative correlation was found between plasma all-trans retinol and CRP level at the end of treatment (p = 0.03). Poor vitamin status could be a contributing factor in developing treatment-induced toxicities.

A systematic review of smell alterations after radiotherapy for head and neck cancer

PURPOSE

To review the current knowledge on radiotherapy associated olfactory dysfunction among head and neck cancer (HNC) patients.

METHODS

A systematic review of RT-related olfactory dysfunction in HNC was performed. Searches were conducted in several databases (Medline, EMBASE, CINAHL, CAB Abstracts, SCOPUS, Proquest Dissertations and Theses, PROSPERO, ALLEBM Reviews - Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED). Publications investigating olfactory dysfunction as an explicit side effect of Radiotherapy (RT, or RT-chemo or RT-monoclonal antibodies) were eligible, no limits were applied.

RESULTS

Two hundred and twenty-nine papers were screened and 23 met inclusion criteria.

CONCLUSIONS

Odor detection, identification and discrimination are olfactory functions impaired after RT for HNC. An RT dose-effect has been calculated for odor identification and odor discrimination. There were no studies of the effect of olfactory dysfunction on weight loss or energy intake among RT-treated HNC patients. To improve our understanding of RT associated olfactory dysfunction among HNC patients, future studies should include a multi-dimensional assessment of olfactory function in a longitudinal design, track other conditions affecting olfaction, assess retronasal olfactory perception, adopt validated self-report tools and explore the impact of olfactory dysfunction on the eating experience of HNC patients.

A review of chemosensory perceptions, food preferences and food-related behaviours in subjects with Prader-Willi Syndrome

Hyperphagia and obsessive preoccupation with food are hallmark characteristics of Prader-Willi Syndrome (PWS). Although hyperphagia in PWS is linked to hypothalamic dysfunction, the underlying mechanisms behind this problem are poorly understood. Moreover, our understanding of how chemosensory perceptions and food choice/preferences relate to hyperphagia in individuals with PWS is very limited. This narrative review synthesizes studies that assessed chemosensory perceptions, food choices and food-related behaviours in PWS individuals and highlights knowledge gaps in research for further exploration. Twenty seven publications from relevant databases met inclusion criteria and were organized thematically by study technique in the review. Results suggested that PWS individuals have consistent preferences for sweet tastes and in most studies have exhibited a preference for calorie-dense foods over lower calorie foods. No firm conclusions were drawn concerning the chemosensory perceptions of PWS individuals and their influence on food preferences or choices; chemosensation among PWS individuals is an understudied topic. Current evidence suggests that eating behaviour in PWS is a complex phenomenon that involves a dysfunctional satiation and not excessive hunger. Food preferences, choices, and related behaviours and the impact of these on obesity management in those with PWS remain poorly understood and require further study using validated tools and methodologies.

The impact of taste and smell alterations on quality of life in head and neck cancer patients

PURPOSE

Taste and smell alterations (TSAs) are among the most frequent and troublesome symptoms reported by head and neck cancer (HNC) patients after treatment. Little is known about the relationship between TSAs and quality of life (QoL) among HNC patients. The aim of this study was to determine the effect of TSAs on overall QoL among tube-fed and orally fed HNC patients before treatment, at end of treatment and at 2.5-month follow-up.

METHODS

Data were collected in a longitudinal study prior to treatment (n = 126), at end of treatment (n = 100) and at 2.5-month follow-up (n = 85). Chemosensory Complaint Score (CCS) and the University of Washington Quality of Life Questionnaire version 3 were used to assess TSAs and QoL, respectively. Generalized estimated equation modeling was used to estimate the effect of CCS on QoL.

RESULTS

At end of treatment, QoL and CCS had declined for both tube-fed and orally fed patients and thereafter improved, but not to pre-treatment levels. Neither QoL nor CCS mean scores were different between the two groups at any time point. CCS was a significant predictor of overall QoL (β = -1.82, p < 0.0001), social-emotional (β = -1.76, p < 0.0001), physical (β = -1.12, p < 0.0001) and overall functions (β = -1.15, p < 0.0001) at a multivariate level. Taste was reported as an important symptom for both tube-fed and orally fed groups at end of treatment and follow-up.

CONCLUSIONS

TSAs are an important symptom and an independent predictor of QoL for both tube-fed and orally fed HNC patients. HNC patients need support to manage TSAs, regardless of the method of nutritional intake.

Reframing eating during chemotherapy in cancer patients with chemosensory alterations

PURPOSE

Our purpose was to describe how eating is reframed among cancer patients experiencing chemosensory alterations.

METHODS

Using data collection and analysis strategies from a qualitative design called ethnoscience, we interviewed 12 patients experiencing taste and smell alterations during chemotherapy. We asked participants to provide a description of a meal and the process by which they decide what and how to eat. Each person was interviewed twice. We compared participants' descriptions of eating, and used this comparison to identify some core beliefs about eating. Participants also completed measures of dietary intake, symptom burden and quality of life.

RESULTS

Based on the interviews, we identified specific constraints to eating, beliefs about the value of eating, and behaviours participants used to work around the constraints to eat during chemotherapy. Chemosensory complaints and other symptoms (i.e. pain, anorexia, tiredness), personal experiences and food preferences were the main constraints. Core beliefs about the value of eating included its social benefits, benefits of eating for health per se, and benefits related to preparing for the next chemotherapy cycle. These beliefs reframed the purpose of eating and were used by participants to develop specific strategies to work around the constraints to eating.

CONCLUSION

To date, interventions to promote eating among cancer patients have focused extensively on symptom management and on recommendations for macro/micronutrient intake. This study underscores the importance of understanding beliefs about eating. These beliefs may help clinicians develop patient-centered nutritional interventions.

Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial

BACKGROUND

A pilot study (NCT00316563) to determine if delta-9-tetrahydrocannabinol (THC) can improve taste and smell (chemosensory) perception as well as appetite, caloric intake, and quality of life (QOL) for cancer patients with chemosensory alterations.

PATIENTS AND METHODS

Adult advanced cancer patients, with poor appetite and chemosensory alterations, were recruited from two sites and randomized in a double-blinded manner to receive either THC (2.5 mg, Marinol(®); Solvay Pharma Inc., n = 24) or placebo oral capsules (n = 22) twice daily for 18 days. Twenty-one patients completed the trial. At baseline and posttreatment, patients completed a panel of patient-reported outcomes: Taste and Smell Survey, 3-day food record, appetite and macronutrient preference assessments, QOL questionnaire, and an interview.

RESULTS

THC and placebo groups were comparable at baseline. Compared with placebo, THC-treated patients reported improved (P = 0.026) and enhanced (P < 0.001) chemosensory perception and food 'tasted better' (P = 0.04). Premeal appetite (P = 0.05) and proportion of calories consumed as protein increased compared with placebo (P = 0.008). THC-treated patients reported increased quality of sleep (P = 0.025) and relaxation (P = 0.045). QOL scores and total caloric intake were improved in both THC and placebo groups.

CONCLUSIONS

THC may be useful in the palliation of chemosensory alterations and to improve food enjoyment for cancer patients.

Blinded taste panel evaluations to determine if fish from near the oil sands are preferred less than fish from other locations in Alberta, Canada

The oil sands industry is rapidly expanding surface mining and bitumen extraction operations near the Athabasca River in northeastern Alberta, Canada. There are anecdotal comments that the fish from the Athabasca River have an off-taste, implying that the oil sands operations are the cause. This study was done to determine if the taste of wild fishes caught near the Athabasca oil sands was less preferred than the taste of fishes collected from two other river basins in Alberta. In blinded experiments, consumer sensory panels, of 40 to 44 participants, tasted steamed samples of each of three fish species (walleye (Sander vitreus), northern pike (Esox lucius), and lake whitefish (Coregonus clupeaformis)) from three different sources in Alberta (the Athabasca River, Buck Lake, and McGregor Lake). Data analyses showed that there was no evidence from the consumer preference rankings that the taste of the fish from the Athabasca River was preferred less than the taste of fish from two other water bodies in Alberta.

Odor detection thresholds of naphthenic acids from commercial sources and oil sands process-affected water

Naphthenic acids (NAs) occur naturally in various petroleums and in oil sands tailings waters and have been implicated as potential fish tainting compounds. In this study, trained sensory panels and the general population from a university were used to determine the odor detection thresholds of two commercial NAs preparations (Acros and Merichem) and of NAs extracted from an oil sands experimental reclamation pond (Pond 9). Using the three-alternative forced choice method, a concentration series of NAs were presented to the sensory panels in phosphate buffer (pH 8) and in steamed fish (Sander vitreus). In buffer, the odor detection thresholds of Acros, Merichem and Pond 9 NAs, as evaluated by the trained panelists, were 1.5, 0.04, and 1.0 mg L(-1), respectively. Only the detection threshold for the Merichem NAs was significantly different (p<0.01) than the other two sources. Based on the general population assessments, all three odor detection thresholds were significantly different from one another; 4.8, 0.2, and 2.5 mg L(-1) for Acros, Merichem, and Pond 9 NAs, respectively (p<0.01). The odor detection thresholds of Merichem and Pond 9 NAs in steamed fish were 0.6 and 12 mg kg(-1), respectively and were significantly different from each other (p<0.01). The detection threshold of Acros NAs was estimated to be >21 mg kg(-1). For the steamed fish evaluations, the odor descriptors of all three of the NAs preparations was given as chemical in nature (Acros: oil, plastic; Merichem: gasoline; Pond 9: gasoline, tar). Exposure of live rainbow trout to a non-lethal concentration of Merichem NAs (3 mg L(-1) for 10 d) imparted an odor to the fish flesh. Analyses of the three NAs preparations by gas chromatography-mass spectrometry showed that each had a unique distribution of acids. We conclude that the source of the NAs is important when interpreting odor threshold data and that the two commercial preparations of NAs that were tested do not represent oil sands waters' tainting potential.

Estimating naphthenic acids concentrations in laboratory-exposed fish and in fish from the wild

Naphthenic acids (NAs) are the most water-soluble organic components found in the Athabasca oil sands in Alberta, Canada, and these acids are released into aqueous tailing waters as a result of bitumen extraction. Although the toxicity of NAs to fish is well known, there has been no method available to estimate NAs concentrations in fish. This paper describes a newly developed analytical method using single ion monitoring gas chromatography-mass spectrometry (GC-MS) to measure NAs in fish, down to concentrations of approximately 0.1mgkg(-1) of fish flesh. This method was used to measure the uptake and depuration of commercial NAs in laboratory experiments. Exposure of rainbow trout (Oncorhynchus mykiss) to 3mg NAsl(-1) for 9d gave a bioconcentration factor of approximately 2 at pH 8.2. Within 1d after the fish were transferred to NAs-free water, about 95% of the NAs were depurated. In addition, the analytical method was used to determine if NAs were present in four species of wild fish - northern pike (Esox lucius), lake whitefish (Coregonus clupeaformis), white sucker (Catostomus commersoni), walleye (Sander vitreus) - collected from near the oil sands. Flesh samples from 23 wild fish were analyzed, and 18 of these had no detectable NAs. Four fish (one of each species) contained NAs at concentrations from 0.2 to 2.8mgkg(-1). The GC-MS results from one wild fish presented a unique problem. However, with additional work it was concluded that the NAs concentration in this fish was <0.1mgkg(-1).

Shifting to conscious control: psychosocial and dietary management of anorexia by patients with advanced cancer

The psychosocial strategies used by advanced cancer patients to manage anorexia are poorly described. A greater understanding of them may guide clinicians to provide appropriate interventions to patients and caregivers.

METHODS

Glaserian Grounded Theory was used to recruit and analyse data from two women and seven men with advanced cancer suffering from anorexia. They were interviewed about the emotional and social impact of appetite loss and the strategies that they used to compensate for reduced food intake.

RESULTS

Shifting to conscious control (overeating) was the basic social psychological process employed by participants to manage the emotional and social consequences of declining intake. Although a number of symptoms were found to contribute, nausea or the anticipation of emesis provoked by food was most commonly named as the ultimate barrier to eating.

DISCUSSION

Participants retained the motivation and ability to eat without appetite, providing the intake of food did not provoke nausea or the anticipation of emesis. Nutritional interventions must be tailored around patients' eating capabilities. Counselling and education programmes that assist family members in understanding the shift to conscious control over eating are required.

Chemosensory dysfunction is a primary factor in the evolution of declining nutritional status and quality of life in patients with advanced cancer

Alterations in taste and smell functions have been reported in cancer patients. Although these senses are known to be particularly affected by chemotherapy, many features of chemosensory perception in cancer patients remain obscure. The relative importance of chemosensory changes in the etiology of malnutrition and wasting is not known. To assess this relationship, self-perceived taste and smell function were evaluated using a validated questionnaire in 66 patients with advanced cancer receiving palliative care (median survival 7.4 months). Participants also completed 3-day food records to assess dietary intake, and the Functional Assessment of Anorexia/Cachexia Therapy questionnaire to assess quality of life (QOL). Total chemosensory complaint scores ranged from 0 to 14 on a 16-point scale. Only 14% of the subjects reported no chemosensory complaints of any kind, whereas 86% reported some degree of chemosensory abnormality. The most common complaints were persistent bad taste in the mouth, taste distortion, and heightened sensitivity to odors. Subjects with severe chemosensory complaints showed substantially lower energy intakes (by 900-1,100 kcal/day), higher rates of weight loss, and lower QOL scores than subjects with mild or moderate chemosensory complaints. Severe chemosensory dysfunction is persistent well beyond the window of active therapy in patients with advanced cancer and represents a primary factor relating to malnutrition, wasting, and poor QOL. Further research is required to identify appropriate strategies to alleviate this important group of symptoms, to determine whether intervention will improve QOL, and to match foods and diet to the unique chemosensory profile of advanced cancer patients.

Dietary patterns in patients with advanced cancer: implications for anorexia-cachexia therapy

BACKGROUND

Severe malnutrition and wasting are considered hallmarks of advanced malignant disease, and clinical research into anorexia-cachexia therapy and nutritional support for cancer patients is ongoing. However, information on typical dietary intakes and food choices for this population is notably lacking; proposed therapies for anorexia and wasting are not framed within the context of current intake.

OBJECTIVE

The objective of the study was to characterize the food intake patterns of patients with advanced cancer.

DESIGN

Patients with advanced cancer (n = 151) recruited from a regional cancer center and palliative-care program completed a 3-d dietary record a mean (+/-SD) 8 +/- 7 mo before death. Food items were categorized according to macronutrient content and dietary use and subsequently entered into cluster analysis.

RESULTS

Wide variations in intakes of energy (range: 4-53 kcal . kg body wt(-1) . d(-1); x +/- SD: 25.1 +/- 10.0 kcal . kg body wt(-1) . d(-1)) and protein (range: 0.2-2.7 g . kg body wt(-1) . d(-1); x +/- SD: 1.0 +/- 0.4 g . kg body wt(-1) . d(-1)) were observed. Even the subjects with the highest intakes had a recent history of weight loss, which suggests that the diets of those persons were consistently inadequate for weight maintenance. Cluster analysis found 3 dietary patterns that differed in food choice and caloric intake. Low intakes and a high risk of weight loss were associated with decreased frequency of eating and dietary profiles with little variety and unusually high proportions of liquids.

CONCLUSION

These data provide a glimpse into dietary habits toward the end of life. Unique dietary patterns were found in this nutritionally vulnerable patient population.

The management of anorexia by patients with advanced cancer: a critical review of the literature

This report presents the results of a critical review of the literature on the experience of anorexia (loss of appetite) by patients with advanced cancer. Although several studies have investigated this experience, the adaptive strategies used by patients to compensate for appetite loss remain poorly elucidated. Based on the small body of extant research, it was concluded that, in many instances, a gap exists between the ability of patients and caregivers to come to terms and deal realistically with the emotional and social consequences of patient anorexia. Patients generally appear to suffer greater discord as a result of this disparity, than from the direct psychological impact of anorexia. A greater understanding of the management of anorexia by patients is essential for the development of dietary and psychosocial interventions that would aid both patients and caregivers to cope with this common symptom.