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The GAIN (Geriatric Anorexia Nutrition) registry: the impact of appetite and weight on mortality in a long-term care population.

PURPOSE: To investigate nursing home residents at high nutritional risk to determine: 1) which baseline nutrition or health status indicators correlated with subsequent weight gain or appetite improvement; and, 2) whether a continued weight loss correlated with higher mortality. METHODS: At study entry, nutritional, health status, and demographic data were extracted from the nursing home chart or the MDS. Each subject was tracked for 6 months with survival, weight gain of 5%, and appetite improvement the primary outcome measures. RESULTS: During the 6-month study, younger age was the strongest correlate of appetite improvement. The odds of gaining weight were negatively correlated with BMI, age, and feeding dependency. Subjects who were receiving appetite stimulants (orexigenics) at study entry had a 70% greater probability of gaining weight than those who were not. A weight loss during the 6-month period was associated with a nearly two-fold increase in the likelihood of dying (adjusted RR: 1.95, 95% CI 1.43 to 2.66). CONCLUSION: The course of nutritional problems within nursing homes is highly variable. Continued weight loss, however, appears to have ominous implications for mortality. Younger residents who are not dependent on others for feeding assistance, and who receive orexigenics tend to experience weight gain.

Age Factors↗

[Appetite and nutrition].

Physiological, pathological and therapeutic aspect of appetite are reviewed. The importance of developmental alterations originated at early infancy and lack of appropriate interactions between mother and infant in abnormalities of appetite are emphasized. The role of vitamins, minerals and appetite stimulating drugs is analyzed and major disturbances of appetite and feeding conducts are described together with some therapeutic considerations on anorexia nervosa, bulimia, pica and rumination.

Anorexia Nervosa↗

Recent studies of bone appetite in cattle.

Cows depleted of phosphorus by loss of saliva from a parotid fistula and low dietary phosphate developed an avid appetite for bones. The behaviour is innate and predominantly cued by olfactory stimuli. Meat, blood or fat were not attractive and bones became more attractive after aging for 1.5-2.0 years. The appetite was also shown for guano-derived rock phosphate and bird excreta. There was no interest in inorganic calcium and phosphate salts or ashed bone. The attractant is therefore an organic constituent of aging bone and was found to be at highest concentration in the marrow fraction. Water, ether and vacuum distillation extracts of old bone or marrow, added to unattractive materials e.g., ashed bone, rendered them attractive. The residues of such extraction were of diminished interest. The attractiveness of the fractionated extracts was highest in the neutral fraction. The bone appetite was abolished by increasing the phosphate concentration in plasma but not in cerebrospinal fluid. The phosphate concentration in the blood appears, therefore, to regulate the bone appetite. The sensors could be in brain regions without a blood-brain barrier. Chronic severe phosphorus deficiency was associated with bone resorption, reduced osteoblastic and hemopoietic activities, and abnormal blood progesterone cycles.

Animals↗

Species differences in the effect of decreased CSF sodium concentration on salt appetite.

During the course of evolution from the beginning of the Caenozoic period, the mammalian species have irradiated into increasingly diverse environments and these physical conditions have imposed powerful selection pressures on the systems of water and salt homeostasis. In the case of physiological actions of hormonal elements of the control systems, effects of antidiuretic hormone and aldosterone on water and salt conservation and of renin-angiotensin II on blood pressure and aldosterone secretion show a general similarity across mammalian species. However, evidence is accruing that there may be large species variation in the vectors of physical, chemical and hormonal changes of the milieu which cause water and salt intake. In the sheep, physiological degree of reduction of CSF [Na] produced by IVT infusion of various hypertonic or isotonic saccharide solutions has a powerful stimulating effect on salt appetite of both Na replete and Na deficient animals. Increasing CSF [Na] reduces appetite. The 0.7 M mannitol CSF infusions initially stimulated thirst but eventually depressed it, presumably due to reduction of CSF [Na]. By contrast, in wild rabbits infusion of 0.9 M mannitol CSF for 2 days at 17 microliter/h caused a large reduction of water intake, a diuresis and no significant increase in salt intake. In laboratory white rats, 0.7 M mannitol CSF infusion at 10 microliter/h for 4 days by Alzet pump, did not increase salt appetite though the infusion was calculated to produce moderate reduction of CSF [Na]. It would appear that there may be significant species differences in effect of reduced CSF [Na] on salt appetite.

Animals↗

Neuropeptides and appetite: contribution of neuropharmacological modeling.

It is now clear that a variety of neuropeptides interact with the more classically defined neurotransmitters to stimulate or inhibit feeding. An extensive peripheral peptide satiety system has been identified. Peptides involved in this system include cholecystokinin, bombesin, gastrin-releasing peptide, glucagon, somatostatin, and possibly thyrotropin-releasing hormone and calcitonin. Some of these peptides appear to inhibit feeding by activating ascending fibers in the vagus, whereas others exert their actions independent of the vagus. In addition, neuropeptides appear to play a role in producing the neuromodulatory effects of taste on appetite, and hormones from the endocrine system modulate neuropeptide effects on feeding. The central appetite regulatory system appears to be arranged in a cascade, with an interaction between dynorphin and dopamine producing a part of the feeding drive. This drive is held in check by a variety of neuropeptides including calcitonin, corticotropin-releasing factor, and bombesin. In turn, these peptides are modulated by a norepinephrine-alpha-aminobutyric acid (GABA) system. Neurotensin, serotonin, cyclohistidyl proline diketopiperazine, and the peripheral satiety system appear to modulate the norepinephrine-GABA disinhibitory system. By the judicious use of neuropharmacological modeling we have developed a model of the neurotransmitter interactions involved in appetite regulation that can act as a springboard for the design of future experiments to unravel the mysteries of appetite regulation.

Animals↗

The renin-angiotensin system and sodium appetite.

Intracranial renin is a potent stimulus to sodium appetite and thirst, the effects being mediated by local generation of angiotensin II. Intakes are persistent and lead to fluid retention during the first 24 h (Avrith and Fitzsimons, 1983). Increased circulating renin after captopril treatment in adrenalectomized rats (Elfont and Fitzsimons, 1981), or in renal hypertension following partial inter-renal aortic ligation (Costales et al., 1982), also leads to increased intakes of 2.7% NaCl and water. Fluid intakes after aortic ligation were independent of the severity of hypertension produced by this procedure. In both the examples given, additional stimulation resulting from the hypovolaemia itself is required for the full expression of increased sodium appetite, but in both cases angiotensin makes a significant contribution to sodium appetite as well as thirst. Therefore, as has been shown for thirst, angiotensin is one of a number of factors that act together to cause increased sodium appetite in hypovolaemia.

Adrenalectomy↗

The dependence of the salt appetite of the rat on the hormonal consequences of sodium deficiency.

Richter's discovery of the salt appetite that follows adrenalectomy (1936) raised the question: how does the brain appreciate the need for sodium so that it can mobilize the search for and ingestion of salty substances? It remains unanswered. Recent work suggests that the answer may come from an understanding of the behavioral effects of the hormones of sodium conservation. Fluharty and I have found (Behavioral Neuroscience, 1983) that treatment of salt replete rats with low doses of both angiotensin (Ang II) and a mineralocorticoid (DOCA) evokes a rapid, reliable, and specific appetite for sodium solutions, and we have proposed that the hormones of renal sodium conservation are also the hormones for the behavioral defense against sodium deficiency. We can now report: That the same combined endocrine treatment will compel rats that do not need salt to search for it in a runway. That is, sodium replete rats that have been primed for 3 days with DOCA (500 micrograms/day), which does not produce an appetite for salt, and are then given a pulse intracerebroventricular (ICV) injection of Ang II (60 ng), which by itself does not produce an appetite for salt, will run in an alleyway in order to ingest small drops of 3% NaCl. The hormones act together to make the rat avid for salt and their action is sufficient to drive it to seek salt at a distance and to ingest it at a concentration that untreated rats avoid.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II↗

Effect of the angiotensin converting enzyme inhibitor, captopril, on NaCl appetite of rats.

Dietary administration of the angiotensin converting enzyme inhibitor, captopril (0.70 g/kg of food), to female rats for 1 week was accompanied by a spontaneous appetite for 0.25, 0.30 or 0.35 M NaCl solution when choice was offered between any one of them and distilled water to drink. An additional experiment was performed to determine the NaCl preference threshold concentration for each group. Control and treated rats were offered choice between two drinking bottles containing distilled water and a NaCl solution, respectively. The concentration of the latter varied from 0.0006 to 0.350 M/l. Control rats could detect the difference between water and NaCl solution at a concentration of 0.030 M/l, whereas captopril-treated rats detected the difference at the lowest concentration offered, i.e., 0.0006 M/l. Captopril-treated rats also preferred 5% glucose solution to distilled water, as did untreated controls. Similar results were observed for 0.25% saccharin. No difference between groups was observed when choice was offered between distilled water and dilute solutions of HCl. Thus, a NaCl appetite developed within 1 week of treatment with captopril. The appetite was accompanied by an ability to detect NaCl at a 50-fold lower concentration than that of the control group. Administration of captopril was also accompanied by an appetite for glucose and saccharin but not for HCl.

Animals↗

Refined salt appetite methodology for rats demonstrated by assessing sex differences.

The salt appetite of the rat is useful for studying certain behavioral and neurological functions. A refined method for inducing and measuring salt appetite for these purposes is described, and the efficiency and reliability of the procedures are demonstrated by parametric studies comparing the appetite behaviors of male and female rats. The method for inducing salt appetite couples 2 days of dietary sodium deprivation with a brief diuretic treatment. The measurement procedure involves a 2-hr period of access to one of several sodium chloride solutions differing in palatability or concentration. The induction procedure allowed precise control of drive levels, and the measurement procedure yielded highly reliable results as a function of the properties of the incentives. Female rats consistently ingested about twice as much sodium chloride solution as did male rats regardless of the palatability of the solution or of body sodium levels. At the same time, female rats lost less sodium in urine following diuretic treatment.

Animals↗

Resistant starch has little effect on appetite, food intake and insulin secretion of healthy young men.

OBJECTIVE: This study investigated whether resistant starch types II and III are more satiating than glucose. DESIGN AND SUBJECTS: During 4 weeks 24 healthy male volunteers consumed a daily supplement with either glucose or high-amylose corn starch (RS2) or extruded and retrograded high-amylose corn starch (RS3) in a cross-over, single-blind, randomised and balanced study design. Each type of supplement was consumed for a week. In the first week each subject consumed the glucose supplement. The RS2 and RS3 supplements provided for 30 g resistant starch/day. At the end of weeks 2, 3 and 4, subjects rated their appetite each whole hour on a visual analogue scale. Food intake was measured 1 day/week using the 24-h recall method. Subjects collected 24-h urine during the last 2 days of weeks 2, 3 and 4 to determine C-peptide excretion as a measure for the 24-h insulin secretion. RESULTS: Supplementation with RS2 caused significantly (P < 0.05) lower appetite scores than supplementation with RS3 and glucose, though subjects paradoxically felt less full while consuming RS2. The cyclic pattern of appetite during the day did not change with the supplements. Energy and macronutrient intake was similar in the three supplementation periods. When consuming RS3, subjects had a significantly (P < 0.0012) lower urinary C-peptide excretion than when consuming RS2 or glucose: 3.74 +/- 1.42 nmol/day for RS3, 4.39 +/- 1.52 nmol/day for RS2 and 4.71 +/- 1.73 nmol/day for glucose. The mechanism for this lower insulin secretion is yet unclear. CONCLUSION: Consumption of 30 g/day RS2 and RS3 had little influence on appetite and food intake, but RS3 reduced the insulin secretion.

Adult↗

Inhibitory effects of estrogen on stimulated salt appetite in rats.

Adult male rats consumed 50-150% more 0.5 M NaCl solution than females did during a 7-hr drinking test when robust salt appetite was elicited by dietary sodium deprivation for 8 days, daily injections of deoxycorticosterone, or adrenalectomy followed by 2 days of sodium deprivation. In contrast, male rats drank much less saline after systemic treatment with the natriuretic agent furosemide, adrenalectomy followed by 1 day of sodium deprivation, or sc treatment with colloid solution after 2 days of sodium deprivation, and female rats drank comparably small volumes. Conversely, 30-day-old prepubescent male and female rats showed equally robust salt appetites after 8 days of sodium deprivation. These and other findings support an inhibitory role of estrogen on salt appetite in rats, which appears to occur only when the appetite is especially pronounced.

Animals↗

[Pharmacological, toxicological, deontologic, and medico-legal aspects of the use of appetite suppressant agents in "weight-loss cures"].

The pharmacological, deontologic and medico-legal aspects in the use of appetite suppressant drugs have been evaluated. Appetite suppressant drugs used in the treatment of obesity are divided into 2 broad pharmacological categories: those acting via brain catecholamine pathways and those acting via serotonin pathways. Of the former group, amphetamines and phenimetrazines are no longer used because of their stimulant properties and addictive potential. The remaining drugs of this group have some sympathomimetic and stimulant properties. Anorectic drugs which promote serotonin neurotransmission have no such stimulant or sympathomimetic properties. They reduce appetite and food intake and are effective in the treatment of obesity. If they are not used appropriately, appetite suppressants can be of no therapeutic benefit and cause marked health risks. As regards to anorectic drugs, the 13/4/1995 act "Rules and limits in preparing drugs containing anorectic substances", precisely defines rules about selling and use of those substances. Behavior of health care personnel neglecting observance of the rule, could be interpreted as "imprudence", "negligence" and "inexpertness" in designing and managing a fat-reducing diet, that may imply, in case of damage to the patient, a professional fault.

Appetite Depressants↗

Utilization of appetite suppressants in England: a putative indicator of poor prescribing practice.

The use of appetite suppressants, a putative inverse marker of prescribing quality, was analysed in the former Northern Regional Health Authority (RHA) and in England using National Health Service prescribing data and sales and patient-linked prescribing data supplied by Intercontinental Medical Statistics (IMS). The number (in thousands) of National Health Service prescriptions for appetite suppressants dispensed fell from 393 in 1991 to 235 in 1994. Per capita prescribing frequency varied threefold between different RHA and between individual Family Health Service Authorities (FHSA) within the former Northern RHA (NRHA). Prescribing frequency was higher in the spring and summer quarters and reduced in the winter quarter. Of 532 general practices in the NRHA, 82 (15%) prescribed no appetite suppressants between April 1993 and March 1994, while 70 (13%) prescribed more than 500 defined daily doses (DDDs) per 1000 patients, accounting for 47% of all prescribing. Only 53% of pharmacy purchases of appetite suppressants were accounted for by NHS prescribing and as little as 21% for phentermine, indicating substantial prescribing outwith the NHS. In 1991, 73,759 DDDs were supplied to pharmacies each day, the majority being diethylpropion (31,226) and phentermine (24,349). The fall in NHS prescribing is welcome as these drugs are of dubious clinical value and may be associated with serious adverse effects. Because of substantial non-NHS prescribing, routinely available prescribing data does not accurately quantify total prescribing of these agents.

Journal Article↗

The influence of practice characteristics on the prescribing of benzodiazepines and appetite suppressant drugs.

BACKGROUND: The prescribing volume of benzodiazepines and of appetite suppressant drugs have been suggested as possible indicators of prescribing quality. OBJECTIVE: To investigate the variation among general practices in the prescribing of benzodiazepines and appetite suppressants by examining the contribution to this variation of training status, partnership status, fundholding status and the level of deprivation in the practice population. METHODS: Prescribing data (PACT) were analysed for 350 practices in the former Mersey Regional Health Authority, for the year ending March 1991 and the year ending March 1994. Data were first standardized for variation in practice population demography. Multiple linear regressions were used to investigate the variation among practices in standardized prescribing volume in both years. RESULTS: For benzodiazepines, training status and partnership status contributed to all models and level of deprivation contributed to some (percentage of variation explained for year ending March 1991: 10% to 21%, year ending March 1994: 8% to 20%). For appetite suppressant drugs fundholding status and an interaction between training status and level of deprivation contributed to all models in both years (percentage of variation explained for year ending March 1991: 19% to 20%, year ending March 1994: 20% to 21%). CONCLUSION: The prescribing of benzodiazepines is lower in training practices, in multi-partner practices and in practices serving a less deprived population, while the prescribing of appetite suppressant drugs is lower in training practices and in fundholding practices. Variation in prescribing knowledge, organizational and management capabilities and patient demand may be explanatory factors.

Journal Article↗

Appetitive responses to sexual stimuli are attenuated in individuals with low levels of sexual desire.

Despite the high prevalence of sexual desire disorders, little is known about their biological underpinnings in humans. Animal studies suggest that dopamine is involved in appetitive sexual behavior; thus, one aim of this study was to elucidate that relationship in humans. This study used measurement of the acoustic startle response (ASR) and prepulse inhibition of the startle response (PPI) as psychophysiological indicators of changes in motivational states to assess the potential relation between sexual desire and appetitive motivation in humans. Responses to sexually provocative stimuli consisting of single nude men and single nude women in a sample of 153 participants (77 men, 76 women) were assessed. The results indicated that ASR was attenuated after exposure to appetitive stimuli (i.e., sexually provocative pictures of attractive individuals) to a greater extent among participants with higher levels of sexual desire, as measured by the Sexual Desire Inventory-2 (Spector, I. P., Carey, M. P., & Steinberg, L. (1996). Journal of Sex & Marital Therapy, 22, 175-190). In addition, PPI was inversely associated with subjective ratings across stimuli such that greater subjective levels of desire were correlated with lower levels of PPI. In general, these results suggest that individuals with lower levels of sexual desire may have a diminished physiological response to appetitive sexual stimuli.

Acoustic Stimulation↗

Changes in volemia and natremia and onset of sodium appetite in sodium depleted rats.

Rats depleted of sodium by the IP injection of 10% b.w. of isotonic glucose for 30 min, developed a specific sodium appetite. The blood volume decreased 16% of the control value immediately after the treatment, returning to normal levels 2 to 4 hr later. The plasma sodium concentration showed a sudden and significant decrease, returning to control value 10-12 hr after the dialysis. In contrast, the sodium appetite became evident 10-12 hr after dialysis and reached the highest volume of ingestion at the sixteenth hr when both volemia and natremia had returned to normal. Since the appearance of the sodium appetite was not initiated during the state of hypovolemia and hyponatremia, the results show that the decrease in plasma volume and sodium concentration of the intravascular fluid that occurs after acute sodium depletion by IPD does not initiate an immediate onset of the sodium appetite.

Animals↗

Differential effects of D1 and D2 dopamine-receptor agonists and antagonists on appetitive and consummatory aspects of male sexual behavior in Japanese quail.

Pharmacological studies in Japanese quail based on behavioral tests with a variety of dopaminergic compounds suggest that the activation of D2 dopamine receptors inhibits, and the activation of D1 dopamine receptors enhances, appetitive and consummatory components of male sexual behavior. This hypothesis was tested by studying the behavioral effects of specific D1 and D2 dopaminergic-receptor agonists and antagonists in castrated male Japanese quail chronically treated with exogenous testosterone (subcutaneous Silastic implants). The effects of 5 compounds were tested: 1 D1 (SKF38393) and 2 D2 (PPHT and quinpirole) agonists, and 1 D1 (SCH23390) and 1 D2 (Spiperone) antagonist. All compounds were tested at a low and a high dose (0.1 and 1 mg/kg, respectively, for all drugs, except spiperone where the doses were 2 and 10 mg/kg). A consistent effect of all drugs on consummatory sexual behavior was observed: it was stimulated by the D1 agonist and the D2 antagonist, but inhibited by the D1 antagonist and the D2 agonists. Far fewer effects of the treatments were detected on the measures of appetitive behavior. Measures of appetitive behavior were decreased by the 2 D2 agonists, but not affected by the other treatments. These data suggest that male copulatory behavior in quail is stimulated by dopamine acting on D1 receptors, but inhibited by activation of the D2 receptor subtype. The partial dissociation observed between the effects of the same treatments on appetitive and consummatory aspects of sexual behavior also suggests that these 2 behavioral systems may be controlled by the action of dopamine on different neuronal systems.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗

Addiction as excessive appetite.

The excessive appetite model of addiction is summarized. The paper begins by considering the forms of excessive appetite which a comprehensive model should account for: principally, excessive drinking, smoking, gambling, eating, sex and a diverse range of drugs including at least heroin, cocaine and cannabis. The model rests, therefore, upon a broader concept of what constitutes addiction than the traditional, more restricted, and arguably misleading definition. The core elements of the model include: very skewed consumption distribution curves; restraint, control or deterrence; positive incentive learning mechanisms which highlight varied forms of rapid emotional change as rewards, and wide cue conditioning; complex memory schemata; secondary, acquired emotional regulation cycles, of which 'chasing', 'the abstinence violation effect' and neuroadaptation are examples; and the consequences of conflict. These primary and secondary processes, occurring within diverse sociocultural contexts, are sufficient to account for the development of a strong attachment to an appetitive activity, such that self-control is diminished, and behaviour may appear to be disease-like. Giving up excess is a natural consequence of conflict arising from strong and troublesome appetite. There is much supportive evidence that change occurs outside expert treatment, and that when it occurs within treatment the change processes are more basic and universal than those espoused by fashionable expert theories.

Behavior Therapy↗