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PubMed2006

Training to estimate blood glucose and to form associations with initial hunger.

BACKGROUND: The will to eat is a decision associated with conditioned responses and with unconditioned body sensations that reflect changes in metabolic biomarkers. Here, we investigate whether this decision can be delayed until blood glucose is allowed to fall to low levels, when presumably feeding behavior is mostly unconditioned. Following such an eating pattern might avoid some of the metabolic risk factors that are associated with high glycemia. RESULTS: In this 7-week study, patients were trained to estimate their blood glucose at meal times by associating feelings of hunger with glycemic levels determined by standard blood glucose monitors and to eat only when glycemia was < 85 mg/dL. At the end of the 7-week training period, estimated and measured glycemic values were found to be linearly correlated in the trained group (r = 0.82; p = 0.0001) but not in the control (untrained) group (r = 0.10; p = 0.40). Fewer subjects in the trained group were hungry than those in the control group (p = 0.001). The 18 hungry subjects of the trained group had significantly lower glucose levels (80.1 +/- 6.3 mg/dL) than the 42 hungry control subjects (89.2 +/- 10.2 mg/dL; p = 0.01). Moreover, the trained hungry subjects estimated their glycemia (78.1 +/- 6.7 mg/dL; estimation error: 3.2 +/- 2.4% of the measured glycemia) more accurately than the control hungry subjects (75.9 +/- 9.8 mg/dL; estimation error: 16.7 +/- 11.0%; p = 0.0001). Also the estimation error of the entire trained group (4.7 +/- 3.6%) was significantly lower than that of the control group (17.1 +/- 11.5%; p = 0.0001). A value of glycemia at initial feelings of hunger was provisionally identified as 87 mg/dL. Below this level, estimation showed lower error in both trained (p = 0.04) and control subjects (p = 0.001). CONCLUSION: Subjects could be trained to accurately estimate their blood glucose and to recognize their sensations of initial hunger at low glucose concentrations. These results suggest that it is possible to make a behavioral distinction between unconditioned and conditioned hunger, and to achieve a cognitive will to eat by training.

Journal Article↗
PubMed2004

Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike.

The current practice of non-consensual medical treatment of hunger-striking asylum seekers in detention needs closer inquiry. An Australian Government regulation empowers the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) to authorise non-consensual medical treatment for a person in immigration detention if they are at risk of physical harm, but there are doubts about whether the regulation would withstand legal challenge. Authorisation by DIMIA does not compel medical practitioners to enforce treatment if such action is contrary to their "ethical, moral or religious convictions". The World Medical Association has established guidelines for doctors involved in managing people on hunger strikes. The Declaration of Tokyo (1975) and the Declaration of Malta (1991) both prohibit the use of non-consensual force-feeding of hunger strikers who are mentally competent. If called upon to treat hunger strikers, medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.

Australia↗
PubMed2003

[Clinical manifestations of "Hunger Disease" among children in the ghettos during the Holocaust].

The harsh life in the ghettos were characterized by overcrowding, shortage of supplies (e.g. money, sanitation, medications), poor personal hygiene, inclement weather and exhaustion. Under these conditions, morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with a high mortality rate. The dominant feature was hunger. Daily caloric allowance was 300-800, and in extreme cases (i.e. Warsaw ghetto) it was only 200 calories. The food was lacking important nutrients (e.g. vitamins, trace elements) leading to protean clinical expression, starvation and death. The clinical manifestations of starvation were referred to as "the Hunger Disease", which became the subject of research by the medical doctors in the ghettos, mainly in the Warsaw ghetto in which a thorough documentation and research were performed. The first victims of hunger were children. First they failed to thrive physically and later mentally. Like their elders, they lost weight, but later growth stopped and their developmental milestones were lost with the loss of curiosity and motivation to play. The mortality rate among babies and infants was 100%, as was described by the ghetto doctors: "when the elder children got sick, the small ones were already dead...". In the last weeks of the ghettos there were no children seen in the streets. In this article the environmental conditions and daily life of children in the ghettos are reviewed, and the manifestations of "Hunger Disease" among them is scrutinized.

Child↗
PubMed1992

Handling hunger strikers.

Hunger strikes are being used increasingly and not only by those with a political point to make. Whereas in the past, hunger strikes in the United Kingdom seemed mainly to be started by terrorist prisoners for political purposes, the most recent was begun by a Tamil convicted of murder, to protest his innocence. In the later stages of his strike, before calling it off, he was looked after at the Hammersmith Hospital. So it is not only prison doctors who need to know how to handle a hunger strike. The following guidelines, adopted by the 43rd World Medical Assembly in Malta in November 1991, are therefore a timely reminder of the doctor's duties during a hunger strike.

Enteral Nutrition↗
PubMed1963

Effects of hunger and VI value on VI pacing.

In two experiments, each involving four rats, responses preceded by an inter-response time between 8 and 10 sec in duration were intermittently reinforced. In Experiment I, final performance was compared under two hunger levels, while the frequency of reinforcement was held constant by a VI 5 schedule. In Experiment II, hunger was held constant and VI 3 was compared with VI 8. Both hunger and frequency of reinforcement increased the over-all rate of response, but the exact effects of these operations on temporal discrimination were different for different rats. Usually, a peak "response probability" (IRTs/Op ratio) was obtained 8 to 10 sec after the preceding response, indicating adaptation to the reinforcement contingency, but in some cases this peak was about 2 sec earlier. One rat exhibited unusually pronounced bursting which seemed to alternate with adaptive temporally spaced responding. Prolonged pauses, observable in the cumulative records, particularly following reinforcement, were attributed to the fact that inter-response times greater than 10 sec were not reinforced, so that as the interval of time since the preceding response became discriminably greater than 10 sec, the probability of a response became small.

Animals↗
PubMed2003

The role of palatable food and hunger as trigger factors in an animal model of stress induced binge eating.

OBJECTIVE: Dieting and stress are etiological factors in eating disorders, and dieting strongly predicts stress-induced overeating in the nonclinical population. We developed an animal model of binge eating in sated rats that is evoked by stress, but only in rats with a history of caloric restriction and only if highly palatable food (HPF) is available after stress. This study investigated the effect of known binge triggers, a taste of HPF and of hunger, on this type of binge eating. METHOD: Female rats were cycled through the R/S protocol but this time were given just a taste of HPF with ad lib regular chow. After another R/S cycle, rats were stressed during restriction (while hungry) and were given HPF and chow. RESULTS: Although binge eating did not occur if only chow was available after stress, just a taste of HPF sufficed to increase chow intake to more than 160% (p < 0.001) of rats with a history of restriction only, stress-only, or neither. Hunger increased the proportion of chow consumed by both restricted groups, but stress magnified this hunger-induced overeating by increasing HPF intake to 137% of restriction-only rats (p < 0.001). DISCUSSION: These effects suggest that binge eating in this model is motivated by reward, not metabolic need, and parallels observations of binge triggers described in clinical binge-eating disorders. This strengthens the validity of using this animal model to target the physiology and treatment of eating disorders preceded by dieting and stress.

Animals↗
PubMed1997

Dietary intake in relation to restrained eating, disinhibition, and hunger in obese and nonobese Swedish women.

The aims of this study were to: describe dietary intakes of obese and nonobese middle-aged women using a validated food frequency questionnaire; to assess dietary restraint, disinhibition, and hunger by the three factor eating questionnaire (TFEQ) in obese and nonobese samples and determine which of the factors are independently associated with obesity; and to examine correlations between selected nutritional variables and the TFEQ factors. Subjects studied included 179 obese Swedish women (BMI > 32) and 147 nonobese population-based controls (BMI < 28). Age-adjusted mean energy intake was significantly higher in obese women (2730 +/- 78 vs. 2025 +/- 85 kcal, p < 0.0001). In absolute and relative terms, fat intake was higher and alcohol intake was lower in the obese subjects. Disinhibition was the strongest TFEQ factor independently differentiating the obese and nonobese states, i.e., after adjustment for restraint and hunger. Within the obese sample, strong associations were seen between energy intake and disinhibition (p = 0.0005) and hunger (p = 0.0004). The association between energy intake and restrained eating was negative and weaker (p = 0.04). No such associations were seen in nonobese women. Thus, using a dietary instrument that is valid and unbiased with respect to obesity, strong psychological correlates, possibly causal, of variability in energy intake were detected in middle-aged women with obesity. Disinhibition is associated with both obesity and high-energy intakes and is therefore an important factor to consider in the treatment of women with obesity.

Adult↗
PubMed1998

Relationship between hunger-satiety feelings and various metabolic parameters in women with obesity during controlled weight loss.

OBJECTIVE: Satiety plays an important role in weight control. The meaning of fasting hormone levels and satiety feelings, and how post-absorptive changes after meals high in carbohydrate regulate appetite remains to be demonstrated. RESEARCH METHODS AND PROCEDURES: Prospective metabolic study with 25 non-diabetic obese women at the Energy Metabolism Research Unit of the Department of Nutrition Sciences, University of Alabama at Birmingham. We analyzed fasting and postprandial ratings of hunger-satiety and values of various metabolic parameters (serum glucose and insulin, plasma cholecystokinin, respiratory quotient) during controlled weight loss. The postprandial measures were assessed following a test meal providing 320 kcal and yielding a food quotient of 0.89. RESULTS: In the fasting state, there was no correlation between hunger-satiety ratings and any of the measured metabolic parameters. Under postprandial conditions, satiety was positively related to glucose (p=0.002) and insulin (p=0.002) responses to the test meal. In multivariate analysis including glucose, insulin, cholecystokinin, hunger-satiety ratings and respiratory quotient, insulin was the only independent predictor of satiety in the postprandial state. DISCUSSION: These data suggest an association between the endogenous insulin response and feelings of postprandial satiety. Insulin's satiation properties, which could well be mediated by other hormones, may represent a primary factor of food intake regulation after meals relatively high in carbohydrate.

Adult↗
PubMed1995

The effect on hunger and satiety of slowing the absorption of glucose: relationship with gastric emptying and postprandial blood glucose and insulin responses.

To investigate the relative potency of short-term control mechanisms for carbohydrate satiety, ten fasted, healthy male volunteers consumed a 250-ml, 30% glucose drink with and without the addition of guar gum (2%). Gastric emptying, hunger and fullness ratings and blood glucose and insulin levels were monitored over the following 3 h and energy intake was recorded from a test meal given 3.5 h after the drinks. The addition of the guar gum to the glucose drink lowered both postprandial glucose and insulin levels over the following 2 h. This was associated with a reduction in the ratings for hunger and desire to eat and an increase in ratings for fullness and satiety, but energy intake from the test meal was unchanged. There was no difference between values for the half time for gastric emptying for the two drinks. The short-term increase in satiety and decrease in hunger seen when glucose absorption was slowed with guar gum is unlikely to be explained by the reduction in postprandial glycaemia or differences in gastric emptying, and instead may implicate increased contact of the carbohydrate with receptors in the small intestine and consequent enhanced release of putative satiety peptides.

Adult↗
PubMed1996

Effects of high- and low-energy meals on hunger, physiological processes and reactions to emotional stress.

The effects of a reduced energy content of two meals on hunger motivation, physiological variables and reactions to emotional stress were investigated. Healthy normal-weight male students received breakfast and lunch in the laboratory. Half of the subjects (n = 28) received meals with normal energy content (1700 kcal), and half received meals with reduced energy content (260 kcal). Psychological and physiological variables were obtained for 8 h from morning to afternoon, including during a period of emotional stress in the afternoon. Psychophysical state was altered by the reduction of energy in food (e.g. increased subjective motivation to eat, decreased systolic blood pressure). Noise decrease feelings of relaxation in subjects who had received low-energy meals, but not in subjects who had received high-energy meals. This enhanced emotional reactivity after low-energy intake is interpreted as a biologically meaningful consequence of the heightened hunger motivation. Furthermore, subjective hunger motivation was potentiated by stress when energy intake in the preceding hours was low. The latter result may be due to increased emotional reactions and/or an augmentation of deprivation-induced physiological changes by noise-induced emotional stress.

Adult↗
PubMed1998

Plasma leptin and hunger ratings in healthy humans.

Leptin, the ob gene product, is considered as a signal involved in the regulation of energy stores through centrally mediated effects on ingestive behavior and metabolism. To investigate the relationships between appetite-related sensations and circulating leptin in humans, 12 healthy male volunteers were served two test lunches (1200 kcal, 38% carbohydrate, 50% fat, 12% protein) with comparable palatability but resulting in different postprandial hunger ratings, and plasma leptin concentrations were monitored during 8 h after meal ingestion. Whereas postprandial hunger ratings (assessed by visual analog scales) and plasma insulin patterns differed significantly between meals, no significant difference in postprandial plasma leptin concentrations was observed between the two meals. A moderate but significant increase in mean plasma leptin was found over time. We conclude that postprandial plasma leptin concentrations do not significantly differ between two meals inducing different effects on hunger subjective feelings. These data are in agreement with a role for leptin in the regulation of energy balance as a long-term adiposity-related signal rather than a short-term meal-related factor.

Adult↗
PubMed1983

Differential dose-response effects of dexamphetamine sulphate on hunger, arousal and mood in human volunteers.

The effect of dexamphetamine (d-Amp) and placebo on visual analogue scale (VAS) ratings of hunger, arousal and mood in nine male volunteers was observed. d-Amp (10 mg) significantly depressed hunger ratings but did not significantly affect arousal and mood ratings. d-Amp (20 mg) had a significant effect on all three ratings. There was a difference in the pattern of dose-response effects. Whereas 20 mg d-Amp produced greater changes than 10 mg in ratings of mood and arousal, there was no significant difference on ratings of hunger. These differences in dose-response relationships may reflect differences in the underlying neurochemical mechanisms mediating the stimulant and anorectic effects of d-Amp.

Adult↗
PubMed1992

Effects of nicotine on hunger and eating in male and female smokers.

We tested whether the inverse relationship between smoking and body weight may be due in part to nicotine's acute effects on reducing hunger and eating. On four mornings, male and female smokers (n = 10 each), abstinent overnight from smoking and food, received one of three nicotine doses (7.5, 15, and 30 micrograms/kg) or placebo (0) via nasal spray every 30 min for 2 h. Self-reported hunger and satiety ("fullness") and craving for cigarettes were obtained after each dose presentation. Subjects subsequently ate ad lib from a large array of food items varying in sweet taste and fat content. For both males and females, nicotine had no effect on self-reported hunger, but cigarette craving was decreased. Rather than being decreased, caloric intake during the meal was unexpectedly increased following nicotine compared with placebo. Cigarette craving increased after the meal, and this increase was unaffected by nicotine dose. There were virtually no differences between males and females in any effects of nicotine. These results indicate that nicotine may not acutely suppress appetite in fasting smokers and suggest that other actions of nicotine or smoking may account for the lower body weights of smokers.

Adolescent↗
PubMed1984

Potentiation of reward by hunger is opioid mediated.

In tests of frequency threshold for brain stimulation-induced feeding, naloxone (s.c.) did not affect the first in a brief series of threshold estimates but elevated subsequent estimates progressively. It was demonstrated that neither the time-course of drug action nor any cumulative disruptive effect of brain stimulation itself, accounts for the progressive elevation of threshold. Self-stimulation in 'feeding' electrodes was therefore studied, in combination with hunger manipulations, to inferentially evaluate naloxone's effect on feeding mechanisms. Results suggest naloxone's anoretic effect does not reflect heightened responsiveness of a satiety mechanism. Reversal by naloxone of the potentiating effect of hunger on self-stimulation, however, suggests the anoretic effect is due to blockade of an opioid process associated with hunger that otherwise enhances the reward value of food.

Animals↗
PubMed1982

Opiate receptor blockade in man reduces 2-deoxy-D-glucose-induced food intake but not hunger, thirst, and hypothermia.

Opioid peptides may act as neuromodulators in the central nervous system to conserve energy stores and water in mammals. To examine this hypothesis in man, the effect of opiate receptor blockade with naloxone on the hunger, thirst, and hypothermic response to 2-deoxy-D-glucose-induced glucoprivic stress was assessed. Opiate receptor blockade decreased stress-induced food intake but did not reduce marked increases in hunger produced by glucoprivation. Naloxone infusions did not change the hypercortisolemic, polydipsic, hypothermic, and thermogenic response to 2-deoxy-D-glucose. While these results do not suggest a major role for a beta-endorphin modulation of stress-induced hunger, hypothermia and water conservation, the reduction of food intake could be due to augmented satiety, perhaps associated with retardation of gastric emptying during opiate receptor blockade.

Blood Glucose↗
PubMed1995

Gender, dietary restraint, and smoking's influence on hunger and the reinforcing value of food.

Smoking may enhance satiety following meal consumption, thereby reducing subsequent eating (i.e., between-meal snacks), especially in women high in dietary restraint. Female smokers (n = 20, 10 high and 10 low restraint) and male smokers (n = 10) participated in two sessions, involving overnight abstinence from food and smoking (smoking abstinence day) or from food only (smoking day), in a within-subjects design. The reinforcing value of food was determined by the number of responses made to obtain food reinforcers (100-kcal snack portions) vs. money using a concurrent schedules computer task. Subjects were given a small caloric load on each day followed by access to food vs. money. On the smoking day, subjects were allowed to smoke every 30 min during the session as well as ad lib before the session. Self-reported hunger was also assessed upon arrival (after fasting) and following the caloric load during each session. Results indicated no effect of smoking on initial hunger rating, after fasting, but hunger ratings following the caloric load declined significantly more during smoking vs. abstinence days for all subjects, consistent with an enhancement of postmeal satiety due to smoking. There was no overall main effect of smoking on food-reinforced responding. However, responding for food was significantly less during the smoking vs. abstinence days for high-restraint females only and not for low-restraint females or for males. These findings indicate that smoking's acute influence on reducing food intake does not reflect a broad gender difference but may be specific to dietary restraint.

Adolescent↗
PubMed1989

Hunger and food intake following consumption of low-calorie foods.

Although high-intensity sweeteners are widely used to decrease the energy density of foods, little is known about how this affects hunger and food intake. We have studied the effects of consumption of commercially available foods sweetened with either sucrose or aspartame on subjective appetite ratings and food intake. When normal-weight non-dieting males and females were given large portions of either a high- or low-calorie pudding or jello and instructed to eat as much as they liked, they ate similar weights of the different caloric versions of each food. Despite the resulting difference in caloric intake (up to 206 kcal), subjects showed only a non-significant trend towards caloric compensation when presented with a variety of foods 2 h later. Total caloric intake (preload plus test meal) did not differ between conditions. Ratings of hunger, desire to eat, the amount subjects wanted to eat, and the pleasantness of the taste of the eaten food were similarly decreased and fullness similarly increased by consumption of the different caloric versions of the foods. Awareness of the caloric content of the foods did not influence intake or appetite in that both informed and uniformed subjects responded similarly in the tests. Thus reduced calorie foods suppressed ratings of hunger for several hours after consumption, but were not associated with a significant reduction in total energy intake.

Adolescent↗
PubMed2005

Effects of hunger and visuo-spatial interference on imagery-induced food cravings.

The present study investigated the effects of hunger and visuo-spatial interference on imagery-induced food cravings. Forty-two women were randomly assigned to a hungry (no food for prior 4h) or not hungry condition. Participants were asked to form and maintain images of desired foods while looking at a blank computer screen (control condition) or performing a task designed to load the visuo-spatial sketchpad of working memory (dynamic visual noise). They then rated the vividness of their images and their craving intensity. Although hungry participants reported stronger food cravings, dynamic visual noise made images less vivid and cravings less intense, irrespective of participant hunger status. Thus concurrent visuo-spatial processing may offer a useful technique for treating problematic food cravings that are predominantly psychological in origin, as well as those that are hunger-driven.

Adolescent↗