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PubMed2002

Behavioral, plasma, and calorimetric changes related to food texture modification in men.

We hypothesized that food texture modifications might alter anticipatory reflexes, feeding behavior, and the postabsorptive consequences of ingestion. Two sets of complete meals with different textures but the same macronutrient composition were prepared. The first set was either a soup containing chunks of food (mixture) or the same soup blended until smooth (purée). The second set was either a rusk (R), a sandwich loaf (SL), or a liquid rusk meal (LR). We measured hunger and fullness feelings after ingestion of each food in a calibrated lunch, the ingestion rate, the duration between lunch and a spontaneous dinner request, the energy value, and the macronutrient composition of the ad libitum dinner. We also studied plasma modifications and respiratory gas exchanges from lunch to dinner. Feelings of hunger and fullness were not affected by texture modifications. The purée soup was consumed faster than the mixture (P < 0.05), and insulin, triacylglycerol, and energy expenditure were greater with the purée (P < 0.05). LR was less palatable than the other rusk lunch versions (P < 0.001), and R was ingested more slowly (P < 0.05). The lowest increase in plasma glucose occurred with SL, and the highest energy expenditure was seen with LR (P < 0.05). In humans, food texture modification affects not only eating patterns and palatability of ingestants but also metabolic management.

Adult↗

PubMed1999

Effect of nitric oxide synthase inhibitors on short-term appetite and food intake in humans.

Animal studies suggest that nitric oxide (NO) may be a physiological regulator of appetite; NO synthase (NOS) inhibition suppresses food intake in rats, mice, and chickens. It is not known whether NO has any effect on appetite in humans. We have used NG-monomethyl-L-arginine (L-NMMA) and NG-nitro-L-arginine methyl ester (L-NAME), both competitive, nonselective inhibitors of NOS, in two separate studies to evaluate the role of NO in the short-term regulation of appetite in humans. In study I, 13 men (18-25 yr) underwent paired studies, in randomized, double-blind fashion, after an overnight fast. L-NMMA (4 mg. kg-1. h-1) or saline (0.9%) was infused intravenously at a rate of 40 ml/h for 1.5 h. In study II, eight men (18-26 yr) underwent three randomized, double-blind studies after an overnight fast. L-NAME (75 or 180 micrograms . kg-1. h-1) or saline (0.9%) was infused intravenously at a rate of 20 ml/h for 120 min. Hunger and fullness were measured using visual analog scales; blood pressure and heart rate were monitored, and 30 min before the end of the infusion, subjects were offered a cold buffet meal. Total caloric intake and the macronutrient composition of the meal were determined. Both L-NMMA (P = 0.052) and L-NAME (P < 0.05; both doses) decreased heart rate, L-NMMA increased diastolic blood pressure (P < 0.01), and L-NAME increased systolic blood pressure (P = 0.052). Neither drug had any effect on caloric intake or sensations of hunger or fullness. Despite having significant effects on cardiovascular function in the doses used, neither L-NMMA nor L-NAME had any effect on feeding, suggesting that NO does not affect short-term appetite or food intake in humans.

Adolescent↗

PubMed1999

Psychological and physiological reactivity to stress: an experimental study on bulimic patients, restrained eaters and controls.

BACKGROUND: Binge eating behavior in bulimic patients is thought to play a crucial role in the regulation of psychophysiological arousal in stressful situations. Previous results suggest that interpersonal stress and achievement challenge are perceived as particularly stressful by bulimic individuals. It is not clear, however, whether bulimic individuals respond to stress with an increased desire to binge, and whether this increase is accompanied by higher psychophysiological reactivity compared to healthy controls. METHODS: Twenty-seven patients with bulimia nervosa (DSM-IV), 27 restrained eaters, and 27 controls participated in two experimental sessions in which continuous measures of heart rate, blood pressure, respiration rat e, and ecectrodermal activity were monitored under conditions of achievement challenge (mental arithmetic, Stroop test) and interpersonal stress provoking feelings of loneliness and social rejection (film, imagery task). Ratings of desire to binge, negative mood, and hunger were obtained between experimental trials. Groups were matched for age and body mass index. RESULTS: There was a marked difference in subjective ratings during interpersonal stress. Bulimic patients responded to the imagery task with increases in both desire to binge and hunger, whereas restrained eaters and controls showed no change. There were no substantial group differences in psychophysiological reactivity. CONCLUSIONS: The dissociation between emotional responses and physiological activation may have important therapeutic implications.

Adaptation, Psychological↗

PubMed2001

The three-factor eating questionnaire in the evaluation of eating behaviour in subjects seeking participation in a dietotherapy programme.

AIM: To evaluate the eating behaviour in normal-weight, overweight, and obese women seeking participation in a diet-based programme of weight reduction or achievement of ideal body weight. METHODS: Thirty-seven obese, 42 overweight, and 14 normal-weight subjects, seen at an Italian university outpatient clinic, were asked to complete the Stunkard and Messick three-factor eating questionnaire (TFEQ). The TFEQ is designed to evaluate three different factors in eating behaviour: restraint, disinhibition, and hunger. Forty-eight mothers of children attending public primary schools (25 normal weight and 23 overweight) served as controls. RESULTS: Significantly altered scores of cognitive restraint were observed both in normal-weight and in overweight subjects of the outpatient clinic as compared with normal-weight and overweight control women. Outpatient clinic overweight women scored significantly higher in terms of disinhibition as compared with overweight control subjects. Among outpatient clinic subjects, overweight women showed higher scores of disinhibition but similar values of cognitive restraint as compared with outpatient clinic normal-weight subjects. In obese patients, the scores of disinhibition and hunger were higher than those observed in outpatient clinic normal-weight subjects, whereas values of cognitive restraint were significantly lower. As compared with outpatient clinic overweight women, obese subjects showed significantly lower values of cognitive restraint. CONCLUSIONS: Alterations in TFEQ results are a frequent feature in subjects seeking participation in programmes of weight reduction or ideal body weight achievement. This may reflect a possible impairment in eating behaviour.

Adult↗

PubMed2002

Diet, breakfast, and academic performance in children.

OBJECTIVE: To determine whether nutrient intake and academic and psychosocial functioning improve after the start of a universal-free school breakfast program (USBP). METHODS: Information was gathered from 97 inner city students prior to the start of a USBP and again after the program had been in place for 6 months. Students who had total energy intakes of <50% of the recommended daily allowance (RDA) and/or 2 or more micronutrients of <50% of RDA were considered to be at nutritional risk. RESULTS: Prior to the USBP, 33% of all study children were classified as being at nutritional risk. Children who were at nutritional risk had significantly poorer attendance, punctuality, and grades at school, more behavior problems, and were less likely to eat breakfast at school than children who were not at nutritional risk. Six months after the start of the free school breakfast programs, students who decreased their nutritional risk showed significantly greater: improvements in attendance and school breakfast participation, decreases in hunger, and improvements in math grades and behavior than children who did not decrease their nutritional risk. CONCLUSION: Participation in a school breakfast program enhanced daily nutrient intake and improvements in nutrient intake were associated with significant improvements in student academic performance and psychosocial functioning and decreases in hunger.

Absenteeism↗

PubMed2004

Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity.

OBJECTIVE: To determine the levels of interoceptive awareness (IA), which measures the ability of an individual to discriminate between sensations and feelings, and between the sensations of hunger and satiety, in eating disorder patients and to identify the clinical, psychopathological and personal variables correlated with IA. SAMPLING AND METHODS: Sixty-one restrictor anorectics, 61 binge-purging anorectics, 104 purging bulimics, 49 obese subjects with binge eating disorder (BED) and 47 obese subjects without BED were compared. They were assessed with the Eating Disorder Inventory-2, the Temperament and Character Inventory, and the Beck Depression Inventory, and their clinical and sociodemographic features were recorded. RESULTS: In all patients, the levels of IA were higher than the 'normal' ones; in bulimia nervosa, they were higher than in anorexia nervosa and obesity. Similar personal features and eating attitudes are shared by patients with bulimia nervosa and BED. In the total sample, the following variables independently correlate with IA: the Beck Depression Inventory, self- directedness and persistence. CONCLUSIONS: The importance of an altered IA in eating disorders is supported. Both depression and a perfectionist and poorly self-directive personality can lead to greater difficulties in discriminating hunger and satiety.

Adult↗

PubMed1992

Regulation of appetite and cholecystokinin secretion in anorexia nervosa.

Six patients with anorexia nervosa, the same patients after weight normalization, and six healthy control subjects had similar fasting and postprandial plasma cholecystokinin concentrations. These data do not support the hypothesis that low levels of hunger and food intake in anorexic patients reflect hypersecretion of this endogenous hormone, which is thought to inhibit hunger, promote satiety, and reduce feeding.

Adult↗

PubMedDate not supplied

Effect of i.v. amino acids on satiety in humans.

BACKGROUND: Parenteral nutrients suppress oral food intake. Separate i.v. infusion of amino acids (IVAA) at high doses affects gastrointestinal motility and secretion. However, little is known on the effects of separate i.v. infusion of amino acids at these high doses on satiety. Therefore, we have studied the effect of two different doses of a commercially available mixed amino acids solution on satiety and food intake. METHODS: Six healthy volunteers (ages 20 to 34 years) were studied on three separate occasions in random order during (a) i.v. saline (control), (b) low-dose IVAA ([LDA] 125 mg protein/kg/h, Vamin 18EF; Kabi Pharmacia BV, Woerden, The Netherlands), or (c) high-dose IVAA ([HDA] 250 mg protein/kg/h) for 360 minutes. Subjective criteria such as wish to eat, prospective feeding intentions, and feelings of hunger and fullness were scored on 100-mm visual analog scales at 30-minute intervals. Food preference also was measured every 60 minutes with food selection lists. At the end of the experiment a meal was presented. RESULTS: Feelings of fullness were significantly (p < .05) increased during both LDA and HDA. The wish to eat was significantly (p < .05) decreased during HDA compared with control and LDA. Prospective feeding intentions also tended to be reduced during HDA (not significant). Feelings of hunger were not significantly different between the three experiments. Total food selection was significantly (p < .05) decreased during LDA and HDA, mainly because of a significantly (p < .05) decreased preference for fat-rich items. However, the total amount of food consumed at the end of the experiment was not significantly different between the three experiments. CONCLUSIONS: The present study shows that in healthy volunteers, IVAA (1) increase satiety ratings, (2) increase feelings of fullness, (3) decrease preprandial food selection, and (4) have no effect on subsequent oral food intake.

Adult↗

PubMed1986

The political economy of famine.

This paper explores some of the reasons why the well-laid plans of the 1970's failed to be an effective bulwark against hunger. It is reflective rather than critical because we are faced with the certainty that just as surely as the famines of the 1980's followed the famines of the 1970's, the 1990's will again see drought, crop failure and, unless things change a great deal, famine as well. The analysis of the causes of hunger current in the 1970's can be summarized somewhat brutally as follows. Either there is not enough to eat, or what is available is poor in nutritional quality. Poor nutrition is synergistic with disease. Together they result in increasing debility and finally death. Famine is an unusual event, precipitated by this same triad of factors, on a catastrophic scale. The strategies which emerged from this analysis can be placed similarly under three broad headings. The first is that food production must be increased so that there is more available for everyone. The second is that national food security strategies should be developed and implemented. The third is that nutritional quality of people's diets should be improved. These are three major goals which have dominated international thinking for a decade. This paper argues that this analysis is at the very least incomplete and that the strategies based upon it have failed to make a marked impact on the risk vulnerable households face to famine. It goes on to suggest that, irrespective of the quantity and quality of food generally available, the households, poorer communities and poorer countries are able to lay claim to a share of what is available. These claims are mediated by a hierarchy of relationships--households within communities, communities within countries and countries in the world at large--and the nature of the relationships constitutes the 'political economy' within which famines arise and must be analysed.

Africa↗

PubMed2003

A framework for assessing the effectiveness of antihunger advocacy organizations.

Food insufficiency is a major public health problem that has been linked to poor nutritional intake, poor diabetes management, poor cognitive development in children, and other adverse health outcomes. Since the 1960s, antihunger advocacy organizations (AHAOs) have fought to alleviate hunger at the local, state, and federal levels. Few studies have investigated the organizational structure, programs, advocacy activities, and outcomes of these organizations, although many organizations have been instrumental in advocating for state and federal food policy, creating measurements for hunger, and conducting research. Four state-level AHAOs were studied by using multiple case study methodology and grounded theory for analysis to assess organizational effectiveness. The findings highlight a conceptual framework that identified 19 important organizational characteristics that reflect organizational capacity, performance, achievement, and effectiveness. The conceptual framework may be useful in assessing effectiveness of public health organizations and coalitions.

Health Care Coalitions↗

PubMed2004

Reliability and validity of a short form household food security scale in a Caribbean community.

BACKGROUND: We evaluated the reliability and validity of the short form household food security scale in a different setting from the one in which it was developed. METHODS: The scale was interview administered to 531 subjects from 286 households in north central Trinidad in Trinidad and Tobago, West Indies. We evaluated the six items by fitting item response theory models to estimate item thresholds, estimating agreement among respondents in the same households and estimating the slope index of income-related inequality (SII) after adjusting for age, sex and ethnicity. RESULTS: Item-score correlations ranged from 0.52 to 0.79 and Cronbach's alpha was 0.87. Item responses gave within-household correlation coefficients ranging from 0.70 to 0.78. Estimated item thresholds (standard errors) from the Rasch model ranged from -2.027 (0.063) for the 'balanced meal' item to 2.251 (0.116) for the 'hungry' item. The 'balanced meal' item had the lowest threshold in each ethnic group even though there was evidence of differential functioning for this item by ethnicity. Relative thresholds of other items were generally consistent with US data. Estimation of the SII, comparing those at the bottom with those at the top of the income scale, gave relative odds for an affirmative response of 3.77 (95% confidence interval 1.40 to 10.2) for the lowest severity item, and 20.8 (2.67 to 162.5) for highest severity item. Food insecurity was associated with reduced consumption of green vegetables after additionally adjusting for income and education (0.52, 0.28 to 0.96). CONCLUSIONS: The household food security scale gives reliable and valid responses in this setting. Differing relative item thresholds compared with US data do not require alteration to the cut-points for classification of 'food insecurity without hunger' or 'food insecurity with hunger'. The data provide further evidence that re-evaluation of the 'balanced meal' item is required.

Adult↗

PubMed1989

Perceptivity and paraceptivity during measurement of gastric emptying in anorexia and bulimia nervosa.

Gastric emptying of a mixed meal was measured in 22 patients with anorexia nervosa, ten with bulimia nervosa and ten controls. Ratings on a visual analogue scale (VAS) were made during the test. Patients with anorexia nervosa felt fuller and less hungry than controls, although satiety was not related to gastric emptying rate, controls showed a correlation of about 0.6 between gastric contents and reported hunger and satiety. Patients with anorexia nervosa had significantly lower correlations between gastric contents and hunger, but normal correlations with fullness. Significant correlations were often observed between gastric contents and symptoms of eating disorder in both anorexic and bulimic groups, but not in controls.

Adolescent↗

PubMed2002

High circulating ghrelin: a potential cause for hyperphagia and obesity in prader-willi syndrome.

Prader-Willi syndrome (PWS) is a genetic disorder occurring in 1 of 10,000-16,000 live births and is characterized by excessive appetite with progressive massive obesity as well as short stature and mental retardation. Most patients have GH deficiency and hypogonadotropic hypogonadism. The causes of the hyperphagia and abnormal GH secretion are unknown. To determine whether ghrelin, a novel GH secretagogue with orexigenic properties, is elevated in PWS, we measured fasting plasma ghrelin concentration; body composition (dual-energy x-ray absorptiometry); and subjective ratings of hunger (visual analog scale) in seven subjects (6 males and 1 female; age, 26 +/- 7 yr; body fat, 39 +/- 11%, mean +/- SD) with PWS (diagnosis confirmed by genetic test) and 30 healthy subjects (reference population, 15 males and 15 females; age, 32 +/- 7 yr; body fat, 36 +/- 11%) fasted overnight. All subjects were weight stable for at least 6 months before admission to the study. The mean plasma ghrelin concentration was higher in PWS than in the reference population (307 +/- 164 vs. 109 +/- 24 fmol/ml; P < 0.001), and this difference remained significant after adjustment for percentage body fat (P < 0.001). Plasma ghrelin was also higher (P = 0.0004) in PWS than in five healthy subjects fasted for 36 h. A positive correlation was found between plasma ghrelin and subjective ratings of hunger (r = 0.71; P = 0.008). Furthermore, in subjects with PWS, the concentration of the hormone was not different before and after ingestion of 2 ml and a satiating amount of the same liquid meal (ghrelin concentrations: 307 +/- 164 vs. 306 +/- 205 vs. 260 +/- 134 fmol/ml, respectively; ANOVA for repeated measures, P = 0.56). This is the first evidence that ghrelin, a novel orexigenic hormone, is elevated in subjects with PWS. Our finding suggests that ghrelin may be responsible, at least in part, for the hyperphagia observed in PWS.

Adult↗

PubMed2004

Postprandial response of plasma ghrelin levels to various test meals in relation to food intake, plasma insulin, and glucose.

Ghrelin is an orexigenic gastric hormone that decreases in peripheral blood after carbohydrate-rich meals but increases after protein ingestion. In the present study plasma ghrelin was determined together with hunger and satiety ratings and with insulin and glucose concentrations after the ingestion of satiating quantities of carbohydrate-, fat-, protein-, fruit-, and vegetable-rich meals in 14 healthy subjects. Four hours later, standardized sandwiches were consumed. After carbohydrate, ghrelin decreased, whereas fat, protein, fruit, and vegetable ingestion significantly increased ghrelin levels. Considering all test meals, no significant correlation existed between changes of ghrelin levels and satiety ratings (r = 0.05; not significant), whereas a significant inverse relationship was observed between plasma ghrelin and insulin levels (r = -0.44; P < 0.001). During the second meal, sandwich consumption was significantly greater after the preceding fruit and vegetable meals, which was significantly correlated with the fourth-hour increase of ghrelin (r = 0.44; P < 0.001). In conclusion, after an overnight fast, ghrelin release depends on the ingested macronutrients and is most likely not a major regulator of acute food intake, although it is of greater importance for the recurrence of hunger and subsequent meal size.

Adult↗

PubMed2004

Endocrine and metabolic effects of physiologic r-metHuLeptin administration during acute caloric deprivation in normal-weight women.

Leptin is a nutritionally regulated hormone that may modulate neuroendocrine function during caloric deficit. We hypothesized that administration of low-dose leptin would prevent changes in neuroendocrine function resulting from short-term caloric restriction. We administered physiologic doses of r-metHuLeptin [(0.05 mg/kg sc daily or identical placebo in divided doses (0800, 1400, 2000, and 0200 h)] to 17 healthy, normal-weight, reproductive-aged women during a 4-d fast. Leptin levels were lower in the placebo-treated group during fasting (3.3 +/- 0.2 vs. 9.6 +/- 1.0 ng/ml, P < 0.001, placebo vs. leptin-treated at end of study). Fat mass decreased more in the leptin than the placebo-treated group (-0.6 +/- 0.1 vs. -0.2 +/- 0.1 kg, P = 0.03). Both overnight LH area (38.9 +/- 21.5 vs. 1.2 +/- 11.1 microIU/ml.min, P = 0.05) and LH peak width increased (15.8 +/- 7.1 vs. -2.3 +/- 6.7 min, P = 0.06) and LH pulsatility decreased (-2.0 +/- 0.9 vs. 1.0 +/- 0.8 peaks/12 h, P = 0.03) more in the leptin vs. placebo group. LH pulse regularity was higher in the leptin-treated group (P = 0.02). Twenty-four-hour mean TSH decreased more in the placebo than the leptin-treated group, respectively (-1.06 +/- 0.27 vs. -0.32 +/- 0.18 microIU/ml, P = 0.03). No differences in 24-h mean GH, cortisol, IGF binding protein-1, and IGF-I were observed between the groups. Hunger was inversely related to leptin levels in the subjects randomized to leptin (r = -0.76, P = 0.03) but not placebo (r = -0.18, P = 0.70) at the end of the study. Diminished hunger was seen among subjects achieving the highest leptin levels. Our data provide new evidence of the important role of physiologic leptin regulation in the neuroendocrine response to acute caloric deprivation.

Adult↗

PubMed2004

Combining laparoscopic adjustable gastric banding and biliopancreatic diversion after failed bariatric surgery.

BACKGROUND: A percentage of all types of bariatric surgery will fail. Our experience with failed biliopancreatic diversion (BPD) as a primary operation or revision operation for failed laparoscopic adjustable gastric banding (LAGB) convinced us that uncontrolled hunger is often the underlying cause. To control hunger after failed bariatric surgery,a novel approach combining LAGB with BPD-duodenal switch (DS) has been tried. METHODS: Patients who had failed to lose weight after BPD or LAGB were considered in 2 groups. Group 1: patients who had failed LAGB underwent laparoscopic BPD-DS without sleeve gastrectomy, with the LAGB left in-situ. Group 2: patients who had failed primary (subgroup 2a) or revision (subgroup 2b) BPD had a LAGB placed with no other revision of their surgery. RESULTS: 11 patients have undergone this form of revision surgery with little morbidity. Mean age at the original operation was 45 years, mean (range) BMI was 45.3 (38-62) kg/m(2). After the reoperation, at 3 months (9 patients) mean BMI was 30 kg/m(2) and at 6 months (4 patients) mean BMI was 27 kg/m(2). CONCLUSION: In this small study, combination surgery was safe and effective for failed BPD or LAGB. LAGB failure may be best managed with DS malabsorption without gastric resection.

Adult↗

PubMed2006

Pre-surgery binge eating status: effect on eating behavior and weight outcome after gastric bypass.

BACKGROUND: The impact of pre-surgical binge eating on postoperative outcomes is poorly understood. Previous studies have found marked preoperative differences between binge eaters (BE) and non-binge eaters (NBE) in hunger and disinhibition using the Three-Factor Eating Questionnaire (TFEQ). Short-term prospective data are mixed regarding whether these differences persist after surgery and if preoperative binge eating impacts postoperative weight outcomes. The purpose of the present study was to compare self-reported eating behavior and weight outcomes between BE and NBE after the first postoperative year. METHODS: Prior to surgery, 72 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWP-Revised (QEWP-R), to assess binge eating status which was defined as one objective binge episode per week over the past 6 months. Subjects also completed the TFEQ prior to surgery and again > or = 12 months after surgery. RESULTS: For BE, higher scores were found for both hunger and disinhibition prior to surgery. At a mean of 18 months after surgery, BE and NBE were indistinguishable on these subscales and there were no differences in weight lost. CONCLUSIONS: RYGBP surgery has an equally positive impact on eating behavior and weight loss for both BE and NBE. Within a multidisciplinary clinic, preoperative BE status does not appear to be a negative prognostic indicator for RYGBP surgery in the domains of weight loss and disinhibition. Further replication is needed with longer follow-up times and larger samples.

Adult↗

PubMed2005

Inhibitory effect of alcohol on ghrelin secretion in normal man.

BACKGROUND: Human appetite is stimulated by alcohol but the underlying mechanism is unknown. It is possible that hunger-stimulating hormones are mediators of this effect of alcohol. Ghrelin stimulates hunger, but how alcohol affects human ghrelin secretion has never been studied before. OBJECTIVE: To investigate whether alcohol ingestion exerts an acute influence on serum ghrelin concentrations in healthy subjects. SUBJECTS AND DESIGN: Eight healthy non-obese subjects participated in the study. All were investigated on two occasions (experiments A and B). Alcohol (0.55 g ethanol/kg body weight) was ingested in experiment A, and drinking-water in experiment B. Venous blood was collected before, and 30 and 60 min after consumption of the drinks. Serum concentrations of ghrelin, cortisol and ethanol were determined and neuropeptide Y (NPY) concentrations were determined in plasma. RESULTS: Alcohol lowered the ghrelin level by 13.9+/-5.0% at 30 min and by 17.5+/-2.6% at 60 min, in contrast to drinking-water which was without significant effect. Serum levels of cortisol and insulin were similar after alcohol and water as was plasma NPY. CONCLUSION: Alcohol has an acute inhibitory influence on human ghrelin secretion but no measurable effect on the secretion of NPY and cortisol. Hence, none of these hormones mediate the orexigenic effect of the drug.

Adult↗