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Legal questions surrounding hunger strikes by detainees and prisoners.

The 'right to die' is not of an absolute character but is subject to definite qualification. There are legal and social interests reflecting profound ethical values which militate against an absolute right on the part of a prisoner to die by means of a hunger strike. The declared policy of the South African authorities is that a prisoner who resorts to a hunger strike may not be subjected to force-feeding. This is in accordance with the 1975 Tokyo Declaration. Unfortunately the Declaration is silent on the question of whether a doctor may provide medical treatment once a hunger striker has reached the point where he is no longer capable of rational thought. In this article it is submitted that a doctor would be legally entitled to do so.

Dissent and Disputes↗

Effects of a moderate dietary fibre supplement on hunger rating, energy input and faecal energy output in young, healthy volunteers. A randomized, double-blind, cross-over trial.

The effects of moderate dietary-fibre supplementation on satiety, energy intake and faecal energy excretion were studied in 20 young healthy volunteers of normal body weight, mean body mass index 20.9, receiving a dietary fibre supplement of 7.3 g per day in a randomized, double-blind, cross-over study. Hunger feeling, energy intake, and defaecation pattern, were recorded daily during a 2-week control period and then, during two 4-week treatment periods. Furthermore, faecal energy output was determined during the last week of each treatment period. The fibre treatment, as compared to placebo, resulted in a significantly higher faecal energy excretion: 173 kcal/d (163-183 kcal/d) vs 153 kcal/d (135-171 kcal/d), respectively (P less than 0.05); a decrease in hunger rating (using a visual analogue scale) (P less than 0.05); an increase in number of bowel movements (P less than 0.05), and a softer consistency of the stools (P less than 0.05). There was no significant difference in mean energy intake between the two treatment periods. This study demonstrated that moderate dietary fibre supplementation in normal man increases faecal energy excretion with simultaneously decreased hunger feeling. These beneficial effects may have therapeutic value in the management of obesity.

Adult↗

Consequences of hunger for individuals and societies.

Famine and the manifestations of acute hunger that result are an unnecessary disgrace to our global society and serious in their political, economic, and social consequences. Probably more damaging is the chronic undernutrition that afflicts such a large proportion of the populations of developing countries and the hidden hungers of iron deficiency, avitaminosis A, and iodine deficiency disorders that are enormously widespread. Famine in the modern world is almost invariably superimposed on chronic undernutrition that is not solved with emergency relief. Adaptation to this undernutrition requires a reduction in physical activity needed for household and community improvement as well as work output. Iron deficiency interferes with cognitive performance, resistance to infection, and capacity for work. Other nutrient deficiencies add to the damage to the individual and society. Prevention of famine and hunger is not primarily a technological issue, but a moral, political, and social one.

Adaptation, Physiological↗

Adult perceptions of pain and hunger cries: a synchrony of arousal.

180 male and female nonparent adults rated tape-recordings of the initial, middle, and final 10-sec segments of pain and hunger cries on 4 7-point Likert-type scale items describing how urgent, arousing, aversive, and sick the cry segments sounded. Multivariate analyses of variance showed that the final segment of the pain cry was perceived as less urgent, arousing, and aversive than the initial and middle segments. The hunger cry was perceived as increasingly more urgent, arousing, and aversive from the initial to the middle to the final cry segments, with the final segment receiving higher ratings than the final segment of the pain cry. The middle segment of both cries was the most sick sounding. While females were more aroused than males as the hunger cry intensified, and females were less aroused than males as the pain cry subsided, the initial segments of the pain cry were particularly potent stimuli to both males and females. These results suggest that different segments of cries resulting from the same stimulus provide different messages that communicate the presumed level of infant arousal.

Adult↗

Hunger, food intake and weight: the impact of clomipramine on a refeeding anorexia nervosa population.

This double-blind controlled study examines the impact of clomipramine when taken by an anorexia nervosa population, refeeding in hospital, over and above that generated by the established treatment programme. Of the 16 patients studied, all reached their target weights including three who asked to leave the study. Clomipramine was significantly associated with increased hunger, appetite and energy intake. It tended, though, to be associated with a reduced rate of weight gain, possibly because activity was increased. Patients receiving clomipramine were more stable in their eating habits and maintained body weight better than those on placebo after leaving the trial. These findings indicate the sensitivity of the hypothalamus to changes in body weight. Clomipramine, which is known to act at a hypothalamic level, seems to influence hunger, appetite and dietary intake according to the body weight of the patient. The threshold weights which have been shown to trigger hypothalamic sexual responses, may also influence hunger, appetite, motility and voluntary energy intake.

Anorexia Nervosa↗

[The correlational characteristics of the electrical activity of the rabbit brain in a state of hunger].

Motivational state of hunger, created in rabbit by alimentary deprivation, leads to an increase of coherent connections between potentials of the neocortex. In the state of hunger a complex mosaic of changes of intercentral relations of the cortical and subcortical electrical processes arises, the character of spatial potential interrelations depends on the level of alimentary motivation, created by deprivation of different duration. At daily deprivation coherence values increase in the slow-frequency band between potentials of the lateral, ventromedial hypothalamus, the medial preoptic area, and potentials of the orbitofrontal cortex. Coherence decreases between potentials of the ventromedial hypothalamus, the medial preoptic area and potentials of the sensorimotor cortex. Synchronization of electrical processes of the lateral and ventromedial hypothalamus does not significantly change. At 2-day deprivation changes of the cortical coherence become less regular than at daily deprivation. Synchronization of the electrical processes of the lateral hypothalamus and the orbitofrontal, sensorimotor-2 cortices increases, and decreases with the potentials of the sensorimotor-1 cortex. Coherence between potentials of the ventromedial hypothalamus and the orbitofrontal cortex, on the contrary, decreases, and increases with the potentials of sensorimotor-1 cortex. Synchronization of electrical activity of the lateral and ventromedial hypothalamus attains the level of 100% manifestations. It the state of hunger interhemispheric asymmetry appears in the parameters of coherence due to more regular intensification of interrelations of electrical processes in the left hemisphere.

Animals↗

Asymmetrical interactions between thirst and hunger in Pavlovian-instrumental transfer.

Pavlovian-instrumental transfer experiments have demonstrated that a stimulus paired with a sucrose solution under hunger will increase instrumental performance under thirst relative to a stimulus previously paired with food pellets. In Experiment 1 it was demonstrated that this difference is, in part, produced by suppression induced by the pellet stimulus, which, it was found, acted to reduce instrumental performance under thirst. In Experiment 2, the reverse shift was examined, comparing the effects of stimuli paired with either a saline solution or a sucrose solution under thirst on instrumental performance under hunger. Although the sucrose stimulus was found to elevate performance when hungry, the saline stimulus was found to be without effect. This asymmetry in the interaction between hunger and thirst is discussed in terms of the way motivational states control the interaction between sensory and affective components of the reinforcer.

Animals↗

Relationship between hunger and plasma cholecystokinin during weight reduction with a very low calorie diet.

Based on a large number of studies in various species, cholecystokinin (CCK) is considered to function as an important regulator of satiety. The present study was undertaken to determine the relationship between hunger score and basal and postprandial plasma CCK secretion, in six obese subjects before and after weight loss with modified fasting. Modified fasting (modifast, 240 kcal/day) for ten weeks induced a mean weight loss of 23 kg. The hunger score was reduced by about 75%. However, basal and plasma CCK release induced by 80 kcal of modifast were not different before and after ten weeks of modifast treatment. Thus, the reduction of hunger during modified fasting is not mediated by circulating CCK.

Adult↗

Predicting Hunger: The Effects of Appetite and Delay on Choice.

Preferences often fluctuate as a result of transient changes in hunger and other visceral states. When current decisions have delayed consequences, the preferences that should be relevant are those that will prevail when the consequences occur. However, consistent with the notion of an intrapersonal empathy gap (Loewenstein, 1996) we find that an individual's current state of appetite has a significant effect on choices that apply to the future. Participants in our study made advance choices between healthy and unhealthy snacks (i.e., fruit and junk food) that they would receive in 1 week when they were either hungry (late in the afternoon) or satisfied (immediately after lunch). In 1 week, at the appointed time, they made an immediate choice, an opportunity to change their advance choice. Our main predictions were strongly confirmed. First, advance choices were influenced by current hunger as well as future hunger: hungry participants chose more unhealthy snacks than did satisfied ones. Second, participants were dynamically inconsistent: they chose far more unhealthy snacks for immediate choice than for advance choice. An additional hypothesis related to gender differences was also confirmed. Copyright 1998 Academic Press.

Journal Article↗

Deaths due to hunger strike: post-mortem findings.

Hunger strike is described as voluntary refusal of food and/or fluids. Prolonged starvation may produce many adverse events including even death in rare circumstances. Here, we present three fatal cases (all males, 25-38 years) died from hunger strike. In all corpses, obvious muscle wasting with reduced subcutaneous and internal fat deposits, and atrophy in some organs were demonstrated at autopsy. The extraordinary long starvation period before death could presumably be linked to the thiamine uptake in this period, which had been discontinued by all subjects before the death occurred. Prolonged caloric deficiency with subsequent complications such as multiple organ failure, severe sepsis and ventricular fibrillation could account as major causes of death in these subjects. The competence of the physicians working with hunger strikers about the processes and potential problems is of great importance since they have to acknowledge about them to their patients.

Adipose Tissue↗

Acute partial paralysis alters perceptions of air hunger, work and effort at constant P(CO(2)) and V(E).

Breathing sensations of AIR HUNGER, WORK and EFFORT may depend on projections of central motor discharge (corollary discharge) to the forebrain. Source of motor drive (brainstem or cortex) may determine what is perceived. To test the effect of changing motor discharge at constant ventilation, we induced partial neuromuscular blockade during hypercapnic hyperpnea (31 + or - 9 L min(-1); PET(CO(2))=49 + or - 2 Torr) and during matched volitional hyperpnea (34 + or - 5 L min(-1); PET(CO(2))=41 + or - 1 Torr). Decline of vital capacity was similar between conditions (39%). Ventilation was unchanged with paralysis, indicating increased respiratory motor drive to maintain hyperpnea. Sensations were rated on a seven point ordinal scale. Median EFFORT and WORK increased 3-3.5 points with paralysis during both forms of hyperpnea (P<0.02, Wilcoxon signed rank). Median AIR HUNGER increased 2.5 points with paralysis during hypercapnic (P<0.02) but not during volitional hyperpnea. Data suggests that EFFORT and WORK arise from motor cortex activity (subjects reported engaging volitional control when paralyzed even during hypercapnia) and suggests that AIR HUNGER arises from medullary motor activity.

Adult↗

Hypothalamic alpha- and beta-adrenergic systems regulate both thirst and hunger in the rat.

Adrenergic and adrenolytic drugs were injected directly into the hypothalamus of the rat brain through permanently implanted cannulas and were found to have reliable effects on water consumption in water-satiated and water-deprived subjects. The beta-adrenergic agonist stimulated thirst, and the beta-adrenergic blocker suppressed thirst. Conversely, the alpha-adrenergic agonist suppressed thirst, and the alpha-adrenergic blocker enhanced thirst. These results demonstrate the existence of a hypothalamic beta-adrenergic "thirst" system which opposes a hypothalamic alpha-adrenergic "water-satiety" system. In view of our earlier results demonstrating the existence in the hypothalamus of an alpha-adrenergic "hunger" system which opposes a beta-adrenergic "food-satiety" system, we suggest that a reciprocal inhibitory relationship between these adrenergic hunger- and thirst-regulating systems provides a neurochemical explanation for the ability of organisms to maintain food and water consumption at a constant ratio. In the regulation of both hunger and thirst, the central cholinergic system mimics the hypothalamic beta-adrenergic system and opposes the hypothalamic alpha-adrenergic system.

Adrenergic alpha-Agonists↗

Expression of salt hunger in hypophysectomized rats.

Hypophysectomized and pituitary-intact rats were tested for their expression of salt hunger under a variety of experimental conditions. The results show that hypophysectomized rats ingest less salt in response to salt hunger induced by sodium depletion, captopril or angiotensin in comparison to pituitary-intact rats. In contrast, both groups ingest the same amount of salt in response to mineralocorticoid-induced salt hunger. While sodium excretion and plasma sodium levels were comparable in the two groups, the angiotensinogen mRNA was reduced by hypophysectomy in several limbic brain regions as well as in the liver. These results suggest that reduced salt intake in response to manipulations of the body sodium and renin-angiotensin system in hypophysectomized rats may result from decreased angiotensinogen mRNA levels.

Angiotensin II↗

Effects of flavor and macronutrient composition of food servings on liking, hunger and subsequent intake.

The effects of consuming foods with different macronutrient compositions and flavors on hedonic changes and development of satiety were investigated. Subjects rated their hunger and liking of a set of foods (rating set) before and after eating a serving (preload) of one of the foods in the rating set. The liking of the preload foods dropped more than the liking of the uneaten foods. Foods having the same flavor as the preload generally dropped more in liking than foods having similar macronutrients. The drops in liking increased with the caloric content of the preload but were unrelated to specific macronutrients. Less weight and calories of food were eaten after the high calorie preloads. Eating the high protein or the high-carbohydrate preload decreased hunger more than eating the high-fat food. Eating a high-protein preload decreased the weight of food eaten more than eating a high-fat or a high-carbohydrate preload and decreased total caloric intake more than eating a high-fat preload. However, macronutrient intake was not differentially affected by the macronutrient composition of a preload. Sensory-specific satiety appears to be more related to the sensory characteristics of a food than to the macronutrient composition of a food.

Dietary Carbohydrates↗

Acute effects of tobacco smoking on hunger and eating in male and female smokers.

Cigarette smoking is associated with reduced body weight, an effect which has often been attributed to acute anorectic actions of nicotine. In this study, male and female smokers (n = 10 each), abstinent overnight from smoking and food, participated in three 2-h sessions, involving intermittent, controlled exposure to their usual cigarette (mean yield = 0.75 mg nicotine), a very low nicotine cigarette (0.1 mg) or an unlit cigarette. Hunger and cigarette craving were assessed throughout each session, which ended with ad libitum consumption of a variety of food items ("lunch"). Plasma nicotine analyses confirmed successful control of nicotine exposure via smoking. Results indicated no differences across cigarette conditions in hunger, in contrast to the sharp differences in cigarette craving. There were no differences in total caloric intake, or in macronutrient or taste selection. There were also no differences in any responses to smoking condition as a function of gender. These findings cast into question the commonly held notion that nicotine or smoking has acute anorectic actions in smokers.

Adult↗

Chocolate craving and hunger state: implications for the acquisition and expression of appetite and food choice.

The importance of hunger state for the acquisition and expression of chocolate craving was investigated. Seventeen chocolate cravers and 12 non-cravers were supplied with chocolate and instructed to eat some twice a day for 14 days. Within each group, subjects were allocated to one of two conditions, hungry- or full-trained. Hungry-trained subjects were asked to eat the chocolate exclusively at least 2 h after last eating; full-trained subjects were asked only to eat the chocolate 15-30 min after eating a meal. A diary was kept to encourage and allow assessment of compliance. At the start and end of the 2 weeks, subjects rated their craving for and anticipated intake of chocolate prior to eating it; then, on initial tasting, pleasantness of the taste was rated. All subjects made these ratings on one day when hungry and on another when full, as defined above. For cravers and non-cravers who ate chocolate exclusively when hungry, chocolate craving increased post-training, but, at least for cravers, only when ratings were made while hungry. For full-trained subjects, chocolate craving decreased post-training, but this decrease did not depend on whether subjects were currently hungry or full. A similar pattern of results was found for anticipated intake and pleasantness of taste, except that pleasantness did not increase in hungry-trained subjects. The results are interpreted with reference to learned control of appetite and in particular to recent findings on incentive learning processes. Craving for chocolate or other foods may be an expression of a strong appetite elicited by hunger that has been acquired by repeated experience of eating the craved food when hungry.

Adult↗

Effect of contingent hunger state on development of appetite for a novel fruit snack.

Eating more fruit can reduce risk of cancer and cardiovascular disease. Understanding barriers to this behaviour is critical for strategies to encourage it. We addressed the question whether the level of hunger at which fruit is eaten would influence the development of appetite for fruit. Half the participants were asked to eat a pair of novel fruit snacks (dried fruit bar; 50 kcal each) exclusively when hungry (at least 3 hours since last eating), and half to eat them exclusively when full (20-30 minutes after a meal), twice a day for one week. Rated appetite for the bars, and ad-libitum intake, were measured when hungry and full, on 2 days prior to, and 2 days after this week. Compliance was assessed from dietary diaries. Thirty participants (22 women, 8 men) completed the study satisfactorily. For the group eating the fruit bars only when hungry (hungry-trained), intake increased after the week, but only when full at the time of testing. Other measures of appetite for this group were unaffected, with the exception of a reduced desire to eat the bars when tested hungry. Ranked preference for the trained flavour increased exclusively among hungry-trained subjects, but only for those who had reported their preferred snack food to be fruit. No change in any measure was found for the group eating the fruit bars exclusively when full. The results suggest the hungry-trained group learnt that the bars lacked strong satiation, thus allowing greater intake when full (learnt desatiation). For the same reason, however, the prospect of eating the bars when mildly hungry lost its appeal. Eating fruit between meals may not encourage snacking on fruit, unless hunger is absent at the time of consumption.

Adolescent↗

Coherence analysis of the electrical activity of the rabbit brain in the presence of a hunger dominant.

A hunger dominant was created in rabbits deprived of food for 24 hours. The presence of summations was judged on the basis of the appearance in the response to sound of swallowing or chewing movements. When a hunger dominant is created, the coherence (Coh) of the electrical activity of the frontal, sensorimotor, and parietal areas of the cerebral cortex increases, especially in the range of the delta and theta frequencies. Variously directed coherence of the potentials of the lateral (LH), middle (VmH) hypothalamus and the cortex is established, the Coh of the potentials of the LH and cortex decreases, and of the VmH and the cortex, by contrast, increases. A definite mosaic of the coherence connections of the electrical processes of the hypothalamus appears; the Coh of the potentials of the LH and VmH increases, and the Coh between the potentials of the medial and lateral preoptic areas decreases.

Acoustic Stimulation↗