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[The hunger dominant in man and the reactions of the autonomic nervous system].

Formation of hunger dominant takes place in man under the conditions of alimentary deprivation and application of sensory stimuli. Summation reactions, namely, swallowing movements, appear in response to the stimuli. Time of deprivation necessary for dominant formation is different in different subjects. Study of ECG, GSR, and respiration during the dominant formation revealed an increase of vegetative reactivity during application of the testing stimuli and before the summating swallow as well. The obtained data allow to make a conclusion on the active participation of the vegetative component in the formation of dominant constellation. The former joins the summation process earlier than the motor component.

Acoustic Stimulation↗

[The "polarization" hunger dominant (the behavioral characteristics and EEG spectral analysis)].

A new experimental model of dominant was developed by the author, the so-called "polarization" hunger dominant created by application of weak direct current to the lateral hypothalamus in combination with a sound stimulus. There was an increase in the delta component of the electrical activity of the left parietal cortex (the dominant focus) while the EEG spectral power of the other cortical areas, lateral and ventrolateral hypothalamus decreased in the slow-wave ranges.

Acoustic Stimulation↗

[A coherence analysis of the electrical activity of the rabbit brain during the creation of a "polarization" hunger dominant].

In the process of formation of "polarization" hunger dominant under the action of weak direct current on the structures of lateral hypothalamus and sound stimulation, the coherence between the potentials of the right parietal cortical area and the frontal areas of both hemispheres increases in the low-frequency band. At the same time, the coherence between electrical activity led from the other cortical areas under study decreased. An increase in coherence is observed between the potentials led from the lateral hypothalamus and frontal cortical areas of both hemispheres in contrast to a decrease in coherence between the electrical activity of the lateral hypothalamus and parietal cortex. Coherence between potentials recorded in the ventromedial hypothalamus and electrical activity of all the studied cortical areas increases (mainly, in the low-frequency range).

Acoustic Stimulation↗

Pamidronate administration improves the secondary hyperparathyroidism due to "Bone Hunger Syndrome" in a patient with osteoblastic metastases from prostate cancer.

BACKGROUND: The so-called Bone Hunger Syndrome is a metabolic derangement that sometimes complicates the natural history of prostate cancer patients with osteoblastic bone metastases. An excessive bone formation leads to calcium entrapment in bone and the subsequent increase of parathyroid hormone (PTH) levels, in response to calcium demand. PTH elevation stimulates the osteoclasts in sites distant from those involving the tumor, leading to osteomalacia. METHODS: PTH and markers of bone turnover were monitored every 3 weeks, from the start of pamidronate treatment in a prostate cancer patient with progressive disease, to luteinizing hormone releasing hormone analog (LHRH-A) administration, developing hyperparathyroidism, hypophosphatemia, and albumin corrected serum calcium close to the lower limit of normality. Serum bone alkaline phosphatase (BALP), assessed by two different methods: electrophoretic and immunoradiometric, and urinary levels of markers of bone collagen breakdown were also remarkably elevated. RESULTS: As a consequence of pamidronate infusion (60 mg e.v. every 3 weeks for a total of four times), BALP and PTH decreased consistently, serum calcium and phosphorus returned within the normal range, while markers of collagen resorption showed a significant decrease at the 9th week, preceded by a transient rise. CONCLUSIONS: This case report indicates that bisphosphonates could inhibit both osteoclast activity. The anti-osteoblastic effect is mainly responsible for the improvement of the pretreatment calcium imbalance of our patient towards hypocalcemia and the consequent hyperparathyroidism.

Aged↗

Aspects of food refusal in the elderly: the "hunger strike".

OBJECTIVE: To present food refusal in old age as a means of attempting to control the outcome of intergenerational family conflicts. METHOD: Two cases are described. RESULTS: Food refusal does not necessarily arise in the context of a classical eating disorder but may represent a form of protest, or hunger strike. DISCUSSION: Food refusal is seen as distinct from a pure anorectic pattern of behavior. It may be a separate psychobehavioral entity in old age. Behavioral methods may help to encourage a resolution by setting clear limits and encouraging patients to share responsibility in decision making.

Aged↗

The effects of a high-carbohydrate, high-protein or balanced lunch upon later food intake and hunger ratings.

This study compared the satiating properties of three liquid lunches (450 kcal each), one dominant in protein (71.5% of energy), a second in carbohydrates (99% of energy) and a third containing an equal mixture of the first two formulations, in a within-subjects, repeated measures design. At an ad libitum dinner meal, 12 women consumed 31% more kilocalories in the high-carbohydrate lunch condition than in the high-protein lunch condition and 20% more kilocalories than in the mixture lunch condition. Similar results emerged for the amounts of protein and fat ingested at dinner. Subjects also reported significantly greater pre-dinner hunger and excitement about eating in the carbohydrate lunch condition than in the protein lunch condition. Greater enjoyment of dinner was also found after the carbohydrate lunch than after the mixture and protein lunches.

Adolescent↗

A reappraisal of the extent of world hunger.

The variation between different estimates of the magnitude of the world food problem are enormous. The author questions the basis of the major surveys of FAO, the World Bank, and USDA, and suggests that they have grossly overestimated the extent of world hunger. By analyzing the connection between population, food, and economic participation, a more realistic view is obtained, suggesting a return to targeted assistance programs for the improvement of maternal and child health.

Conservation of Natural Resources↗

CCK and other peptides modulate hypothalamic norepinephrine release in the rat: dependence on hunger or satiety.

The purpose of this investigation was to determine the functional relationship between putative satiety peptides and endogenous norepinephrine (NE) activity in the hypothalamus. Permanent guide cannulae for push-pull perfusion were implanted stereotaxically in Sprague-Dawley rats so as to rest above the medial or lateral hypothalamus (LH). Post-operatively, the animals were either satiated with food and water, both available ad lib, or fasted for 18-22 hr prior to an experiment. To perfuse a site in the LH, paraventricular (PVN) or ventromedial nucleus (VMN), a concentric 29-23 ga push-pull cannula system was lowered to a pre-determined site, in most cases after catecholamine stores had been pre-labeled with [3H]-NE. During control tests, an artificial CSF was perfused at a rate of 20-25 microliter/min for 5-8 min with a 5 min interval between each sample. The addition of cholecystokinin (CCK) in a concentration of 2.0-6.0 ng/microliter to the CSF perfused in PVN or VMN of the satiated rat enhanced the efflux of NE; however, in the fasted animal CCK often suppressed the catecholamine's release. Perfused in the LH, CCK exerted opposite effects, typically augmenting NE output when the rat was fasted but not affecting the amine's activity during the sated condition. Proglumide (1.2 micrograms/microliter) attenuated CCK's effect in releasing NE when the antagonist was perfused in the PVN of the satiated rat. Similar experiments in which neurotensin (NT) was perfused in the LH, PVN and VMN revealed virtually the same inverse effects on NE release in the fasted and satiated rat, which again were anatomically specific. Finally, insulin and 2-deoxy-D-glucose (2-DG) exerted similar state-dependent effects on the release of NE within LH and PVN. Overall, the results suggest that CCK or other neuroactive peptide could serve as a "neuromodulator" of the pre-synaptic release of NE within classical hypothalamic structures which are thought to underlie both hunger and satiety. The state-dependent nature of the peptides' activity on the noradrenergic feeding mechanism implies that these substances constitute a pivotal portion of the profile of factors which impinge functionally upon the hypothalamic neurons responsible for the feeding response and its cessation.

Animals↗

Ethical and medico-legal problems concerning so-called hunger strikers.

In the Middle European medico-legal climate, the moral rule 'salus aegroti suprema lex' has been accepted for a long time. In the last few years, under the pressure of fear of accusation of a paternalistic attitude, this postulate has been changed to 'voluntas aegroti suprema lex'. The question stands: Is this valid in each case and in all the situations? For example, it is possible to use compulsory treatment with those who have not given their informed consent. Even the charter of basic human rights and freedom states in its article 6 that everyone has a right of life. The law specifies in which cases an individual can be accepted or can be held in a health care institution without his/her consent. In cases of so-called 'hunger strikers', the strikers refuse food and expose themselves to extreme starvation in order to reach some political goals or to express their views. If, in such situations, the patient endangers his/her life, the physician who is facing this problem is, according to Czech law and similarly to some other Central European laws, and according to the Ethical Code of the Czech Medical Chamber, bound to act to protect and restore the life and the health of that person. The Health Care Act No. 540/1991 of the Czech Republic states the obligation to provide emergency care to anyone whose life or health is threatened. Compulsory treatment is possible, for example, if an individual shows signs of mental disease or if an intoxication threatens him or his neighbourhood.(ABSTRACT TRUNCATED AT 250 WORDS)

Czechoslovakia↗

MRI findings of Wernicke encephalopathy revisited due to hunger strike.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the characteristic magnetic resonance imaging (MRI) findings among a group of patients who presented with Wernicke encephalopathy (WE) due to the neurological complications of a long-term hunger strike (HS). METHODS: MRI studies also including the fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging (DWI) of six male patients with WE aged from 25 to 38 years (mean age 31 years) were evaluated. RESULTS: In all subjects, T2-weighted sequences, FLAIR and DWI revealed a signal hyperintensity within the posteromedial thalami and surrounding the third ventricle. In particular, on coronal images, the hyperintense areas around the third ventricle showed a suggestive "double wing" configuration. We observed an increased signal on proton-density and T2-weighted images in the mamillary bodies of three patients. Four patients demonstrated additional hyperintensities within the periaqueductal region and/or the tectal plate. At least one lesion area in five of six patients demonstrated contrast enhancement. CONCLUSION: The consistent imaging findings of our study suggest that MRI is a reliable means of diagnosing WE. Acute WE is sometimes underdiagnosed, yet early diagnosis and treatment of WE is crucial in order to avoid persistent brain damage. MRI, including postcontrast T1-weighted imaging, DWI beneath standardized T2-weighted imaging, and FLAIR sequences may prove to be a valuable adjunct to clinical diagnosis and to provide additional information in acute and/or subacute WE.

Adult↗

Neuromuscular consequences of prolonged hunger strike: an electrophysiological study.

OBJECTIVES: The purpose of this study was to determine the electrophysiological consequences of neuromuscular and central nervous system involvement in a group of patients presented with the neurological complications of a long-term hunger strike (HS). METHODS: Motor and sensory nerve conduction (NCV), F wave, somatosensory evoked potential (SEP) and motor evoked potential (MEP) studies were performed in 12 male and 3 female patients (mean age: 29.4) following HS. RESULTS: All patients whose weight loss was 11-31 (mean: 22.8) kg after 69-day HS, had neurological findings consistent with Wernicke's encephalopathy or Wernicke-Korsakoff syndrome. Abnormally prolonged latency and/or low amplitude sensory nerve action potentials were found in 7 patients. The amplitudes of compound muscle action potentials were significantly reduced in ulnar, median and tibial motor NCV studies as compared to the controls. F waves elicited by median nerve stimulation at wrist and muscle responses evoked by cervical and lumbar magnetic stimulation had significantly prolonged latencies. MEPs recorded from the lower extremities showed a slight prolongation in central conduction times. The cortical response latencies were prolonged in tibial SEPs. CONCLUSIONS: The most prominent finding in this patient group was the low amplitude of CMAPs elicited in motor NCV studies which was concluded to be resulted from the reversible muscular changes. The other electrophysiological findings suggested that peripheral nerves and long central nervous system pathways were also mildly involved.

Action Potentials↗

Greed and the frightening rumble of psychic hunger.

Many patients are desperately struggling with feelings of envy and greed. For some, greed is experienced as a constant hunger, a feeling of being empty and alone. This type of patient can be aggressive or resentful in the way they feel and act. They are determined to take what they feel is rightly theirs. Other such patients are much more conflicted about their greedy phantasies and striving. This paper focuses on patients who are fearful and anxious about the greedy urges that shape their inner world. Case material is used for illustration.

Adult↗

Acute undernutrition is not associated with excess of females at birth in humans: the Dutch hunger winter.

It has been suggested that maternal undernutrition results in adjustment of the sex ratio at birth, favouring females. We tested this hypothesis using births during the Dutch Hunger Winter of 1944-1945, an acute severe famine of seven months' duration. There was no evidence of an excess of female births among deliveries of human infants exposed to famine in any period in gestation. Indeed, among deliveries to women maximally exposed to famine prior to conception, there was an excess (odds ratio = 1.31, 95% CI 1.09-1.58; p = 0.004) of male offspring. Our data do not provide any support for acute and severe maternal undernutrition as a trigger for an increase in female conceptions or in male foetal deaths in human populations.

Cohort Studies↗

Hunger Modulates the Responses to Gustatory Stimuli of Single Neurons in the Caudolateral Orbitofrontal Cortex of the Macaque Monkey.

1. In order to determine whether the responsiveness of neurons in the caudolateral orbitofrontal cortex (a secondary cortical gustatory area) is influenced by hunger, the activity evoked by prototypical taste stimuli (glucose, NaCl, HCl, and quinine hydrochloride) and fruit juice was recorded in single neurons in this cortical area before, while, and after cynomolgous macaque monkeys were fed to satiety with glucose or fruit juice. 2. It was found that the responses of the neurons to the taste of the glucose decreased to zero while the monkey ate it to satiety during the course of which his behaviour turned from avid acceptance to active rejection. 3. This modulation of responsiveness of the gustatory responses of the neurons to satiety was not due to peripheral adaptation in the gustatory system or to altered efficacy of gustatory stimulation after satiety was reached, because modulation of neuronal responsiveness by satiety was not seen at earlier stages of the gustatory system, including the nucleus of the solitary tract, the frontal opercular taste cortex, and the insular taste cortex. 4. The decreases in the responsiveness of the neurons were relatively specific to the food with which the monkey had been fed to satiety. For example, in seven experiments in which the monkey was fed glucose solution, neuronal responsiveness decreased to the taste of the glucose but not to the taste of blackcurrant juice. Conversely, in two experiments in which the monkey was fed to satiety with fruit juice, the responses of the neurons decreased to fruit juice but not to glucose. 5. These and earlier findings lead to a proposed neurophysiological mechanism for sensory-specific satiety in which the information coded by single neurons in the gustatory system becomes more specific through the processing stages consisting of the nucleus of the solitary tract, the taste thalamus, and the frontal opercular and insular taste primary taste cortices, until neuronal responses become relatively specific for the food tasted in the caudolateral orbitofrontal cortex (secondary) taste area. Then sensory-specific satiety occurs because in this caudolateral orbitofrontal cortex taste area (but not earlier in the taste system) it is a property of the synapses that repeated stimulation results in a decreased neuronal response. 6. Evidence was obtained that gustatory processing involved in thirst also becomes interfaced to motivation in the caudolateral orbitofrontal cortex taste projection area, in that neuronal responses here to water were decreased to zero while water was drunk until satiety was produced.

Journal Article↗

Modulation of feeding by endogenous sugar acids acting as hunger or satiety factors.

Endogenous sugar acids, 3,4-dihydroxybutanoic acid (2-deoxytetronic acid, 2-DTA) and 2,4,5-trihydroxypentanoic acid (3-deoxypentonic acid, 3-DPA), have been identified in the serum of fasted rats. Effects of these sugar acids on rat feeding behavior and neuron activity were investigated. Injections of 2-DTA (2.5 mumol) into the third cerebral ventricle of chronic rats suppressed food intake and single-neuron activity in the lateral hypothalamic area (LHA). Food consumption was reduced for 24 h, even in 72-h food-deprived rats. The same amounts of 3-DPA elicited feeding and increased LHA single-neuron activity with latencies of 6-8 min. Electrophoretically applied 2-DTA significantly and specifically suppressed activity of glucose-sensitive neurons in the LHA, whereas 3-DPA facilitated the activity. Nonglucose-sensitive LHA neurons were not affected by these sugar acids. The high correlation between modulation of feeding behavior and changes in LHA neuron activity after injection of these sugar acids suggested that 2-DTA may act as an endogenous satiety substance and 3-DPA as a hunger substance. The effects may be mediated through glucose-sensitive neurons in the LHA.

Animals↗

Agricultural biodiversity, nutrition, and health: making a difference to hunger and nutrition in the developing world.

BACKGROUND: In spite of the strides made globally in reducing hunger, the problems of micronutrient deficiencies and coexisting obesity and related cardiovascular and degenerative diseases constitute a formidable challenge for the future. Attempts to reverse this trend with single-nutrient intervention strategies have met with limited success, resulting in renewed calls for food-based approaches. The deployment of agricultural biodiversity is an approach that entails greater use of local biodiversity to ensure dietary diversity. OBJECTIVE: To outline a new strategy proposed by the International Plant Genetic Resources Institute (IPGRI) that employs agricultural biodiversity as the primary resource for food security and health. METHODS: The authors carried out a meta-analysis to review and assemble existing information on the nutritional and healthful properties of traditional foods based on a diverse set of case studies and food composition and nutritional analysis studies. The methods highlight particular examples of foods where analysis of nutrient and non-nutrient composition reveals important traits to address the growing problems of malnutrition associated with the rise of chronic diseases. Finally, the authors analyze social, economic, and cultural changes that undermine the healthful components of traditional diets. RESULTS: Based on this multidisciplinary and comparative approach, the authors suggest a holistic food-based approach that combines research to assess and document nutritional and healthful properties of traditional foods, investigating options in which nutritionally valuable traditional foods can contribute to better livelihoods, and ways that awareness and promotional campaigns can identify healthful components of traditional diets that fit the needs of urban and market-oriented consumers. CONCLUSIONS: There is an urgent need for agricultural research centers, national agricultural research systems, universities, and community-based organizations to work together under a shared policy framework with the aim of developing a strong evidence base linking biodiversity, nutrition, and health. Although these initiatives are still ongoing, the gains realized in small-scale and local pilot efforts have encouraged IPGRI to work with local partners toward the implementation of scale-up efforts in various regions.

Biodiversity↗

Increased risk of affective disorders in males after second trimester prenatal exposure to the Dutch hunger winter of 1944-45.

BACKGROUND: Prenatal and perinatal factors have been linked to affective disorders. We therefore undertook an exploratory study to determine whether prenatal exposure to severe famine was associated with an increased risk of affective disorders. METHOD: Monthly birth cohorts that were exposed and unexposed to the Dutch Hunger Winter of 1944-45 were identified. The cumulative incidences of affective psychoses and neurotic depression (ICD-9 criteria) were compared between exposed and unexposed cohorts during each trimester of gestation. RESULTS: The relative risk (RR) of affective psychosis (broad and restricted definitions) among persons exposed to famine during the second trimester was significantly increased (broad: RR (95% confidence interval) = 1.62 (1.19, 2.20); restricted: 1.59 (1.14, 2.21)). Separate analysis by gender showed a significant association among males (broad: 2.26 (1.43, 3.57); restricted: 2.40 (1.49, 3.89), but not females (broad: 1.28 (0.84, 1.94); restricted: 1.17 (0.73, 1.76)). The risk of neurotic depression was not increased after prenatal famine exposure. CONCLUSIONS: These results suggest a possible relationship between prenatal famine during the second trimester and affective psychosis, lending plausibility to reports that have associated affective psychoses with prenatal exposures. Further studies of this relationship are warranted.

Adult↗

Compulsive eating and gastric bypass surgery: what does hunger have to do with it?

BACKGROUND: Binge eating and other patterns of disordered eating in obese patients need further investigation. In a previous study by this author, one-third of patients presenting for bariatric surgery met strict criteria for Binge Eating Disorder. It is important to clarify the role of such eating behaviors on outcome of surgery to determine whether treatments targeted specifically at these behaviors and associated psychological issues can improve surgical outcome. The aim of this paper is to raise awareness of the range of disordered eating patterns in bariatric patients, describe an approach used, and discuss issues reported by patients after surgery. METHODS: Patients completed questionnaires before surgery (QWEP, BES, BDI) and were seen for a pre-surgery mental health evaluation. High risk patients were identified and invited to attend a post-surgery group (CBT approach) as a preventive measure to help them deal with eating patterns as well as emotional adjustment. RESULTS: Disordered eating patterns can persist after surgery. While surgery may decrease actual physical hunger and reduce physical capacity for food, it is still possible to eat compulsively, although the patterns may change somewhat due to the surgical procedure. CONCLUSION: Since long-term weight maintenance depends on post-operative changes in eating behaviors, it is important to identify patients at risk for a range of disordered eating patterns so that a comprehensive treatment plan that targets the eating disturbances and associated psychological components can be implemented.

Bulimia↗