"Like hunger, like thirst": patients, journals, and the internet.
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Communication↗
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[The susceptibility of pharaoh ant colonies to hunger with a view to control measures].
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Animals↗
Spiritual hunger. Interview by Pat Anderson.
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Anorexia↗
Measurement of household food security in the USA and other industrialised countries.
OBJECTIVE: To describe the history and current status of household food security measurement. CONCLUSIONS: In the 1980s evidence of rising levels of hunger was a concern for many, but disputed by some, Americans. Acknowledgement and quantification of hunger was hindered by the lack of an accepted definition and measure of hunger. Qualitative research at Cornell provided a conceptual framework, description, definition and survey items for hunger. The Community Childhood Hunger Identification Project developed an instrument used in numerous communities. Based upon these initiatives, widely accepted definitions of hunger and food insecurity, and the US Household Food Security Module for its measurement, now exist. The module classifies households as food-secure, or food-insecure without hunger or with moderate or severe hunger, and contains household-, adult- and child-referent items. Its inclusion in the Current Population Survey (CPS) since 1995 has yielded annual estimates of food insecurity. A six-item short form of the module, for surveys with severe time constraints, classifies households only as food-secure or food-insecure without or with hunger and contains no child-specific items. Surveys using the 18-item or short-form module can compare results with published national data from the CPS. Information about the module is available at http://www.ers.usda.gov/briefing/foodsecurity and http://www.fns.usda/fsec. Current research on food security measurement includes measurement of individual food insecurity and hunger, module performance regarding hunger duration and frequency, performance of the module in population sub-groups, and the effect of translations on module meaning and performance. National surveys in Canada, New Zealand and Australia also have measured food security.
Adult↗
Human eating: evidence for a physiological basis using a modified paradigm.
The aim of these studies was to determine if meal requests and changes in hunger ratings in humans were related to spontaneous changes in blood glucose concentration. In our first study, 18 healthy subjects were acutely isolated from food ant time cues. Blood glucose was continuously monitored online and visual analog ratings of hunger were obtained following an overnight fast. Spoken meal requests, if they occurred, were also recorded. In 83% of the subjects, both the perception and behavioral expression of hunger, as assessed by changes in hunger ratings and meal requests, were preceded by, and correlated with, brief, transient declines in blood glucose (nadir: -10% at 27 min). The pattern, magnitude and time course of these declines was similar to those observed in rats. This significant association, between increased expression of hunger and declines in blood glucose, is being tested in a second, ongoing study using acute insulin infusions to mimic spontaneous transient declines in blood glucose. Each subject was studied twice: either insulin or saline was infused while hunger ratings were obtained. Preliminary results in five subjects indicate that hunger ratings increased after insulin-induced transient declines in blood glucose. No change in hunger ratings occurred when blood glucose concentration was stable. These results suggest that this temporal pattern of blood glucose reflects an antecedent physiological event or provides a signal related to the expression of hunger in humans. Further understanding of human eating may result from investigation of the complex interaction of physiological and other factors in an experimental setting that allows the expression the behavior under study.
Adult↗
Disturbed appetite patterns and nutrient intake in peritoneal dialysis patients.
OBJECTIVE: Malnutrition is common among peritoneal dialysis (PD) patients. Reduced nutrient intake contributes to this. It has long been assumed that this reflects disturbed appetite. We set out to define the appetite profiles of a group of PD patients using a novel technique. DESIGN: Prospective, cross-sectional comparison of PD patients versus controls. SETTING: Teaching hospital dialysis unit. PATIENTS: 39 PD patients and 42 healthy controls. INTERVENTION: Visual analog ratings were recorded at hourly intervals to generate daily profiles for hunger and fullness. Summary statistics were generated to compare the groups. Food intake was measured using 3-day dietary records. MAIN OUTCOME MEASURES: Hunger and fullness profiles. Derived hunger and fullness scores. RESULTS: Controls demonstrated peaks of hunger before mealtimes, with fullness scores peaking after meals. The PD profiles had much reduced premeal hunger peaks. A postmeal reduction in hunger was evident, but the rest of the trace was flat. The PD fullness profile was also flatter than in the controls. Mean scores were similar despite the marked discrepancy in the profiles. The PD group had lower peak hunger and less diurnal variability in their hunger scores. They also demonstrated much less change in fullness rating around mealtimes, while the mean and peak fullness scores were little different. The reported nutrient intake was significantly lower for PD. CONCLUSION: The data suggest that PD patients normalize their mean appetite perception at a lower level of nutrient intake than controls, suggesting that patient-reported appetite may be misleading in clinical practice. There is a loss of the usual daily variation for the PD group, which may contribute to their reduced food intake. The technique described here could be used to assess the impact of interventions upon the abnormal PD appetite profile.
Adult↗
Economic determinants and dietary consequences of food insecurity in the United States.
This paper reviews recent research on the economic determinants and dietary consequences of food insecurity and hunger in the United States. The new Current Population Study (CPS) food insecurity and hunger measure shows that hunger rates decline sharply with rising incomes. Despite this strong relationship, confirmed in other national datasets, a one-to-one correspondence between poverty-level incomes and hunger does not exist. In 1995, 13.1% of those in poverty experienced hunger and half of those experiencing hunger had incomes above the poverty level. Panel data indicate that those who are often food insufficient are much more likely than food-sufficient households to have experienced recent events that stress household budgets, such as losing a job, gaining a household member or losing food stamps. Cross-sectional work also demonstrates the importance of food stamps because benefit levels are inversely related to food insufficiency. Concern for the dietary consequences of domestic food insufficiency is well placed; recent research shows that the odds of consuming intakes <50% of the recommended dietary allowance (RDA) are higher for adult women and elderly individuals from food-insufficient households. Preschoolers from food-insufficient households do not consume significantly lower amounts than those from food-sufficient households, but mean intakes for the rest of members in those very same households are significantly lower for the food insufficient. This research highlights the importance of food insecurity and hunger indicators, further validates the use of self-reported measures and points to areas of need for future research and interventions.
Adult↗
Food insecurity of low-income lone mothers and their children in Atlantic Canada.
OBJECTIVE: To examine the occurrence and predictors of hunger and food insecurity over the past year and month among low-income mother-led households in Atlantic Canada. METHOD: The Cornell-Radimer Questionnaire to Estimate the Prevalence of Hunger and Food Insecurity was administered weekly for a month, with modifications, to a community sample of 141 lone mothers who took part in a larger dietary intake study. Eligible women included those living alone with at least two children under the age of 14 years in the four Atlantic Provinces and having an annual income less than or equal to Statistics Canada's low-income cut-off. RESULTS: Food insecurity over the past year occurred in 96.5% of households. Child hunger was similar to maternal hunger over the one-month study period (23%), however, it was lower than maternal hunger over the past year. On multiple logistic regression analysis, maternal hunger over the past year was predicted by maternal age over 35 years (p < 0.0005), and Nova Scotia residence (p = 0.03). Child hunger over the past year was also predicted by maternal age over 35 years (p = 0.009). Families from New Brunswick experienced less food insecurity over the past month at both the household (p = 0.01) and maternal levels (p < 0.0005). DISCUSSION: Provincial policies that might contribute to the regular occurrence of food insecurity in these families should be investigated.
Adolescent↗
Appetite changes under free-living conditions during Ramadan fasting.
During the fasting month of Ramadan, Muslims abstain from food and drink from sunrise until sunset. This change of eating pattern provides an opportunity to investigate factors controlling hunger and thirst. A group of healthy Muslims (15 men and 26 women) living in Reading, U.K. made hourly ratings of their hunger, mood and thirst, and recorded their food and drink intake on specified days before, during and after Ramadan between January and March 1996. There were no significant changes in body weight over Ramadan. Rated hunger increased substantially during the daily fast, and hunger was higher for the women than the men during the earlier days of Ramadan, whereas later, on average, fasting levels of hunger were very similar for both sexes (significant gender x day interaction,p<0. 001). During Ramadan, the men tended to spend much of their time away from home, and may therefore have largely avoided eating-related cues during the daily fast. The women, however, were frequently involved in preparing food to be eaten later after sunset, which suggests an explanation for the results based on the external cue control of hunger. That is, unreinforced exposure to food cues in this context may have led to a decrease in the capacity of these cues to stimulate hunger.
Adult↗
[The effect of xantham gum on satiety status of obese patients after test meal].
Investigation of soluble fiber-xantham gum on hunger, satiety and epigastric fullness in obese subjects. 21 obese women: age 40.7 +/- 17, BMI 35.4 +/- 5.7 otherwise healthy, actually non dieting. Eating behavior was assessed by Three Factor Eating Behavior Questionnaire (TFEBQ) by evaluating eating restrain, dysinhibition and hunger. Satiety, hunger and epigastric fullness were assessed by visual analogue scale (VAS) and 7-point ratings scale before ingestion of test meal (ham sandwich--90 kcal) and in 20 min intervals during 2-hour observation. The study was done twice: with fiber and with placebo. Ingestion of test meal with drug and placebo causes statistical significant reduction in hunger and increase in satiety feelings in both groups. Afterwards during 2-hour observation the significant increase in hunger was observed. There were no differences in hunger, satiety and epigastric feelings between both groups. The significant positive correlation between third factor of TFEBQ (hunger) and BMI index was found. (r = 48, p < 0.05). 0.5 g of xanthan fiber with test meal didn't cause significant change of satiety. It is probably the effect of too low dose of xantham gum.
Adult↗
Food security status of households in Appalachian Ohio with children in Head Start.
This study measured food security and hunger of households involved in Head Start in a rural Appalachian county and assessed factors that could affect food security and hunger. A convenience sample of households with children enrolled in the Head Start program in Athens County, Ohio, were sampled (n=710), with adults from 297 (42%) households responding. The survey instrument included the 18-question US Household Food Security Survey Module for measuring hunger and food insecurity. Of those responding, 152 households (51.2%) were food secure and 145 (48.8%) were food insecure. Ninety (30.3%) had experienced hunger in the previous 12 months, and 41 (13.8%) households were classified as food insecure with childhood hunger. Hunger was related to a variety of household characteristics and associated with several factors, including participation in food banks, dependence on family members and friends outside of the household for food, lacking reliable transportation, and not having a garden.
Child, Preschool↗
The 18 Household Food Security Survey items provide valid food security classifications for adults and children in the Caribbean.
BACKGROUND: We tested the properties of the 18 Household Food Security Survey (HFSS) items, and the validity of the resulting food security classifications, in an English-speaking middle-income country. METHODS: Survey of primary school children in Trinidad and Tobago. Parents completed the HFSS. Responses were analysed for the 10 adult-referenced items and the eight child-referenced items. Item response theory models were fitted. Item calibrations and subject scores from a one-parameter logistic (1PL) model were compared with those from either two-parameter logistic model (2PL) or a model for differential item functioning (DIF) by ethnicity. RESULTS: There were 5219 eligible with 3858 (74%) completing at least one food security item. Adult item calibrations (standard error) in the 1PL model ranged from -4.082 (0.019) for the 'worried food would run out' item to 3.023 (0.042) for 'adults often do not eat for a whole day'. Child item calibrations ranged from -3.715 (0.025) for 'relied on a few kinds of low cost food' to 3.088 (0.039) for 'child didn't eat for a whole day'. Fitting either a 2PL model, which allowed discrimination parameters to vary between items, or a differential item functioning model, which allowed item calibrations to vary between ethnic groups, had little influence on interpretation. The classification based on the adult-referenced items showed that there were 19% of respondents who were food insecure without hunger, 10% food insecure with moderate hunger and 6% food insecure with severe hunger. The classification based on the child-referenced items showed that there were 23% of children who were food insecure without hunger and 9% food insecure with hunger. In both children and adults food insecurity showed a strong, graded association with lower monthly household income (P < 0.001). CONCLUSION: These results support the use of 18 HFSS items to classify food security status of adults or children in an English-speaking country where food insecurity and hunger are more frequent overall than in the US.
Adolescent↗
Hungry bacteria--definition and properties of a nutritional state.
Bacteria are sometimes neither starving nor under nutrient-excess conditions. When growing with suboptimal levels of nutrients, hungry bacteria express appropriate cellular responses. This review discusses approaches to defining the hunger response in both molecular and growth kinetic terms. The gene expression changes unique to hunger conditions are described, using Escherichia coli as the primary example. Metabolite changes with hunger and starvation and the differing role of the stationary phase regulator RpoS also lead to the hypothesis proposed in this review that bacteria undertake distinct approaches to hunger and starvation. Indeed, an understanding of the difference between hunger and starvation and the incompatibility between hunger and starvation responses explains some of the paradoxical mutational adaptations, such as rpoS inactivation, found in natural populations.
Bacteria↗
Helicobacter pylori infection: a new cause of anorexia in peritoneal dialysis patients.
OBJECTIVE: Helicobacter pylori (HP) infection has frequently been found in dialysis patients. Chronic infections induce overproduction of pro-inflammatory substances. Inflammation has been associated with cachexia and anorexia. We explored the relationship between HP infection, anorexia, and malnutrition in peritoneal dialysis (PD) patients. PATIENTS AND METHODS: The study included 48 clinically stable PD patients divided into four groups: HP+ with anorexia (group I, n = 12); HP+ without anorexia (group II, n = 4); HP- with anorexia (group III, n = 5); and HP- without anorexia (group IV, n = 27). Infection with HP was diagnosed by breath test. Anorexia was evaluated using a personal interview and an eating motivation scale (VAS). The VAS included five questions that are answered before and after eating. The questions concern desire to eat, hunger, feeling of fullness, prospective consumption, and palatability. Biochemical markers of nutrition and inflammation were also determined. RESULTS: At baseline, group I showed lower scores for desire to eat, hunger sensation, prospective consumption, and palatability. They also showed lower lymphocyte counts, prealbumin, transferrin, serum albumin, normalized equivalent of protein-nitrogen appearance (nPNA), and residual renal function (RRF). In addition, the same group showed higher levels of C-reactive protein (CRP) and more sensation of fullness than the remaining groups. In the entire series, we found significant linear correlations between the following markers of nutrition and certain questions on the VAS: albumin with before-lunch desire to eat (r = 0.38, p < 0.05), and prealbumin with before-lunch hunger (r = 0.41, p < 0.05) and after-lunch hunger (r = -0.35, p < 0.05). Negative linear correlations were found between albumin and fullness before lunch (r = -0.45, p < 0.01), and between prealbumin and before-lunch desire to eat (r = -0.39, p < 0.05). Negative linear correlations were also seen between CRP and albumin (r = -0.35, p < 0.05) and between CRP and prealbumin (r = -0.36, p < 0.05). Similarly, CRP showed a negative correlation with before-lunch desire to eat (r = -0.38, p < 0.05) and afterlunch desire to eat (r = -0.45, p < 0.01). After HP eradication, group I showed a significant increase in markers of nutrition and in VAS scores for almost all questions. Simultaneously, they showed a decrease in CRP level. Significant differences were also found in lymphocyte count (1105 +/- 259.4 cells/mm3 vs 1330.8 +/- 316 cells/mm3, p < 0.05), nPNA (0.9 +/- 0.16 g/kg/day vs 1.07 +/- 0.3 g/kg/day, p < 0.05), prealbumin (26.7 +/- 6.5 mg/dL vs 33.9 +/- 56.6 mg/dL, p < 0.01), albumin (3.48 +/- 0.3 g/dL vs 3.67 +/- 0.35 g/dL, p < 0.05), CRP (1.16 +/- 1.14 mg/dL vs 0.88 +/- 1.2 mg/dL, p < 0.054), before-lunch desire to eat (56.6 +/- 6.8 vs 72.2 +/- 4, p < 0.001), after-lunch desire to eat (5.4 +/- 2.6 vs 12.3 +/- 2, p < 0.01), hunger before lunch (55.4 +/- 5.4 vs 73.1 +/- 4.6, p < 0.001), hunger after lunch (5.8 +/- 2.9 vs 11 +/- 4, p < 0.01), fullness before lunch (36.6 +/- 10.3 vs 18.7 +/- 8.8, p < 0.001), consumption after lunch (5 +/- 4.7 vs 17.5 +/- 18, p < 0.05), and palatability (61 +/- 5.3 vs 74.1 +/- 4.1, p < 0.001). CONCLUSION: Infection with HP is associated with anorexia, inflammation, and malnutrition in PD patients. Eradication of HP significantly improves this syndrome. Residual renal function seem to have a protective effect on appetite preservation. The present study supports the hypothesis of the involvement of inflammation in the pathogenesis of malnutrition in PD patients.
Adult↗
Food security in a world without borders.
The alleviation of poverty and the eradication of hunger and malnutrition are within reach. Considerable progress has been made over the past thirty years in reducing the numbers of the hungry, and projections over the next thirty years suggest that this progress will continue. The majority of developing countries have participated in this progress and have improved nutrition but there are significant regional differences. The current challenge is to build upon and accelerate the progress already made. Everyone is involved in this struggle against hunger and malnutrition, and to achieve these goals, global partnerships to enhance co-operation and co-ordination are being strengthened. Successful country experiences for improving food security and nutrition have demonstrated the importance of peace, political stability, and stable economic growth. There is also the need for increased foreign investment and increased ODA, particularly for African agriculture, debt relief, the better integration of LDCs in the global economy, their more secure access to markets and more equitable terms of trade, enhanced South-South co-operation, training and research and new high-yield and drought-resistant crop varieties. While all these have been commented on and recognised before, we must close the credibility gap in our political will by honouring our existing commitments for providing tangible benefits at the local level. For globalisation, the key issue is how the aggregate benefits of globalisation will be distributed and how to translate this into better nutrition. The LDCs, which are the most vulnerable and disadvantaged members of the international community, should be at the centre of this drive towards food security and take genuine ownership of policies, initiatives and activities to improve development. At the same time we need to succeed in making the developed world more aware of and responsive to the conditions of the LDCs. The most effective way to improve nutrition is through community nutrition programmes that encourage the full participation and co-operation of the entire community, maximise the utilisation of local resources, grasp the benefits of new technologies for productivity gains, involve multiple sectors and engage strong political commitment. The international community will be judged by its treatment of its most vulnerable members. The international community has repeatedly declared that it is dedicated to the eradication of poverty. Eliminating hunger and malnutrition is a vital first step. The political will to fight hunger and a firm commitment to invest in agriculture' and rural development are critical elements in any effort to achieve sustainable alleviation of hunger and poverty. This meeting and the WFS:FYL provide the additional impetus to meet the challenge of achieving food and nutritional security in a world without borders and free from hunger and malnutrition.
Food Supply↗
Comfort care for terminally ill patients. The appropriate use of nutrition and hydration.
OBJECTIVE: To determine the frequency of symptoms of hunger and thirst in a group of terminally ill patients and determine whether these symptoms could be palliated without forced feeding, forced hydration, or parenteral alimentation. DESIGN: Prospective evaluation of consecutively admitted terminally ill patients treated in a comfort care unit. SETTING: Ten-bed comfort care unit in a 471-bed long-term care facility. PARTICIPANTS: Mentally aware, competent patients with terminal illnesses monitored from time of admission to time of death while residing in the comfort care unit. MAIN OUTCOME MEASURES: Symptoms of hunger, thirst, and dry mouth were recorded, and the amounts and types of food and fluids necessary to relieve these symptoms were documented. The subjective level of comfort was assessed longitudinally in all patients. RESULTS: Of the 32 patients monitored during the 12 months of study, 20 patients (63%) never experienced any hunger, while 11 patients (34%) had symptoms only initially. Similarly, 20 patients (62%) experienced either no thirst or thirst only initially during their terminal illness. In all patients, symptoms of hunger, thirst, and dry mouth could be alleviated, usually with small amounts of food, fluids, and/or by the application of ice chips and lubrication to the lips. Comfort care included use of narcotics for relief of pain or shortness of breath in 94% of patients. CONCLUSIONS: In this series, patients terminally ill with cancer generally did not experience hunger and those who did needed only small amounts of food for alleviation. Complaints of thirst and dry mouth were relieved with mouth care and sips of liquids far less than that needed to prevent dehydration. Food and fluid administration beyond the specific requests of patients may play a minimal role in providing comfort to terminally ill patients.
Aged↗
Internal and external determinants of eating initiation in humans.
The influence of two internal variables (gender and nutritional state as measured by subjective hunger) and one external variable (either visual pre-exposure to a food stimulus or variation of the visual quality of the stimulus) on appetite for pizza in general or for a specific pizza, was studied in an experiment with 129 male and 225 female adult subjects, which were distributed in almost equal ratios over four sessions per day. They rated their hunger, their appetite for pizza (before and after visual presentation of the product) and their desire to eat a slice of any of four pizza varieties varying on visual characteristics. It was shown that appetite for the item pizza increased with hunger and with pre-exposure to the food, but that these two factors did not interact. Appetite for a specific pizza was influenced by its visual quality and by hunger, both factors acting independently. Compared to hunger, gender, the second internal factor, exerted a lesser influence. Furthermore, the reported appetite for a certain food item proved to be a good predictor of actual eating behaviour.
Adult↗
Audit of an early feeding program after Cesarean delivery: patient wellbeing is increased.
PURPOSE: Early feeding is well tolerated after Cesarean delivery. However, patient wellbeing and nurses' attitudes toward implementation of early feeding have rarely been investigated. METHODS: A quality-assurance program of 18 months duration was implemented because evaluation of traditional practice demonstrated significant deficiencies (phase I). Drinking was then allowed within one hour and feeding within six to eight hours after delivery. Gradual dietary expansion followed according to a detailed program. Three consecutive evaluations (phase II-IV) were performed: 1) to measure implementation by the ward nurses; 2) to record the type of food and the volume of water effectively received; 3) to evaluate patients' gastrointestinal tolerance and patients' levels of hunger and thirst and patients' overall satisfaction. RESULTS: In phase I, 60% of patients received nothing by mouth and 28% received only water on the day of surgery (D0). Moderate or severe hunger and thirst were seen in a large portion of these patients (D0, hunger: 38%, thirst: 63%, D1, hunger: 40%, thirst: 28%). Introduction of the program significantly improved patient wellbeing as well as patient satisfaction. No side effects were encountered. CONCLUSION: Hunger and thirst are frequently encountered after Cesarean delivery when patients are allowed to eat only after return of the first flatus. By using a quality-assurance program, it was possible to reduce the incidence and the severity of these distressing symptoms and to improve patients' satisfaction while no side effects were encountered. These beneficial effects were maintained in phase IV suggesting a high acceptance rate from the nursing staff.
Cesarean Section↗