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[Morbidity in the concentration camps of the Third Reich].

Life in the concentration camps of the Third Reich was like living on another planet. The prisoners, stripped of all rights, experienced constant humiliation, uncertain survival and endless terror. Living conditions were harsh, characterized by crowding, poor sanitation and personal hygiene, lack of proper clothing and heating. The days began early with long marches and slave labor. Sleep was short and interrupted, and fatigue was constant and severe. Above all hoovered the dark cloud of ever-present famine. The prisoners were given about a fourth of the daily calorie requirements, and the food lacked vital components such as vitamins and other essential ingredients. The psychological stress was extreme, yet morbidity and mortality were mainly due to infections, injuries and hunger. Lice, scabies and other skin diseases were common. Typhus fever was ever-present, both endemic and epidemic, with a fatal outcome. Many suffered from tuberculosis, typhoid, dysentery, pneumonia and other infections diseases. Injuries were common, caused by beating, punitive whiplashing and other forms of physical abuse, gunshot wounds and dog-bites. Skull injuries with brain contusions and hemorrhages were prevalent, as well as fractured limbs, ribs and pelvic bones. Blunt injuries to chest and abdomen often had fatal outcomes due to the perforation of viscera and peritonitis or as a result of massive hemorrhage from ruptured blood vessels. The harsh winters were marked by frozen gangrenous limbs and hypothermia. Yet, the most ominous condition was the "hunger disease" with its multiple clinical expressions which, in their extreme form, led to the emaciated "musleman" and eventual death.

Concentration Camps↗

Diabetes risk and obesity in food-insecure households in rural Appalachian Ohio.

INTRODUCTION: In 2003, 11.2% of U.S. households were at some time food insecure; in 1999, when this study was conducted, 10.1% of U.S. households were at some time food insecure. A previous study of individuals from an Appalachian Ohio county suggested that food insecurity is associated with poorer self-reported health status. This larger study assesses the relationship of food security to clinical measurements of several chronic health risks among residents in six rural Appalachian Ohio counties. METHODS: Data for this report are a subset of data gathered by surveys completed by 2580 individuals at community-based sites and by on-site, limited clinical health assessments conducted with a subsample of 808 participants. Descriptive statistics were calculated to describe the sample. Student t tests were used to compare measured BMI, diastolic blood pressure, total cholesterol, random blood glucose, HbA1c levels, and hemoglobin between individuals from food-secure and food-insecure households. RESULTS: Our sample had about three times the level of food insecurity (with and without hunger) and more than seven times the level of food insecurity with hunger as the state population. Diastolic blood pressure, total cholesterol, random blood glucose, HbA1c, and hemoglobin did not differ by food security status (P > .05 for all); however, BMI was greater among individuals from food-insecure households, especially among women (t1272 = -2.0, P = .04), than among their food-secure counterparts. Obesity was greater among individuals from food-insecure households (48.1%) than among those from food-secure households (35.1%, P < .001). CONCLUSION: This study examines possible causes and consequences of food insecurity as it relates to chronic disease development. Further investigation is needed in this community and in other Appalachian communities, as well as the United States, to determine relationships between food insecurity and chronic disease development and management.

Adult↗

[Features of differential inhibition in choice between alimentary and defensive response].

Instrumental defensive (avoidance/escape) and alimentary responses (reinforced with palatable food) in dogs were conditioned by the same stimulus (6-Hz light flashes). Differential inhibition for these responses (0.6-Hz flashes) was formed in unalterable series. Later on, alternative experiments with choice between reinforcements were carried out. In both of experimental series, the degree of alimentary excitability (hunger, satiation) was changed. Numbers of responses to differential and positive conditioned stimuli and their latencies were calculated. Under condition of choice (electrodes on a leg and a pedal in front of a dog) the response depended on a dominant motivation. The dogs differed in the degree of motivation dominance. Differential inhibition was less perfect in unalterable experimental series with dominant motivation. Under conditions of choice between alimentary and defensive reinforcements, the response to the differential stimuli depended on the balance between these motivations: two days of hunger increased the number of alimentary responses, defensive responses prevailed after satiation.

Animals↗

Overweight treated with energy restriction and a dietary fibre supplement: a 6-month randomized, double-blind, placebo-controlled trial.

Fifty-two (41 females, 11 males) overweight patients, mean body mass index (BMI) = 29.3, were treated for 6 months in a randomized, double-blind, placebo-controlled, parallel group design. The treatment consisted of an energy restricted diet and a dietary fibre supplement amounting to 7 g/day. After treatment the weight reduction in the fibre-treated group, 5.5 +/- 0.7 kg, was significantly higher than that of the placebo group, 3.0 +/- 0.5 kg (P = 0.005). Both groups were normotensive and comparable commencing treatment, 126.5/75.6 +/- 2.0/1.3 mm Hg versus 126.7/78.7 +/- 2.5/1.6 mm Hg. The treatment changed blood pressure non-significantly. Hunger feelings using visual analogue scales (VAS) were significantly reduced from 139.8 +/- 8.2 cm to 118.3 +/- 7.0 cm in the fibre-treated group, whereas a significant increase from 129.5 +/- 6.9 cm to 146.9 +/- 8.8 cm (P less than 0.02) was seen in the placebo group. Side-effects were predominantly gastrointestinal and equally distributed in the two groups. It is concluded that a dietary fibre supplement is of value in the management of overweight, enhancing weight loss and decreasing hunger feelings.

Adult↗

[Control of food intake].

The decisions of an individual about his food intake depend upon a variety of internal and external signals. The present contribution describes the physiological mechanisms controlling food intake to preserve body composition and performance. Centers within the hypothalamus including their connections to higher and lower structures within the central nervous system, especially to the limbic system, are involved in the control a food intake. Neuropeptides and neurotransmitters usually initiate more complex actions including the search for food and satiety phenomena. Their production and release are influenced by food consumption as well as intake of specific nutrients, sensorial perceptions, and a variety of other factors. Vagal reflexes and gastro-intestinal hormones, fat cell size, physical activity, and thermogenesis also influence perceptions of hunger and satiety. A model satisfactorily describing the interactions between all known factors that control food intake is still missing. The path from hunger to satiety could be described as sequences of cascades similar to the various steps in blood clotting. Control of food intake during early life dependably relies on energy requirement, and can be utilized for ad-libitum feeding. Obesity and anorexia nervosa are manifestations of disturbed control over food intake. Neuropharmacology offers several therapeutic approaches to specific conditions. However, by and large abnormalities of food intake control have to be treated by behavioral modification.

Adipose Tissue↗

Effects of transdermal clonidine treatment on withdrawal symptoms associated with smoking cessation. A randomized, controlled trial.

In a double-blind, randomized, placebo-controlled trial, we studied 40 cigarette smokers to determine the effects of one week of transdermal clonidine hydrochloride (Catapres-TTS No. 2) treatment on the withdrawal symptoms associated with smoking cessation. Subjects were instructed to maintain their usual cigarette intake during days 1 through 3 and cease smoking for days 4 through 6. All of the withdrawal symptoms measured (craving, irritability, anxiety, restlessness, difficulty concentrating, and hunger) significantly increased during the three days of smoking cessation in the placebo group. There was a 4.3-fold increase in craving, a 3.8-fold increase in irritability, a 3.7-fold increase in anxiety, and a 3.3-fold increase in restlessness in the placebo group compared with the transdermal clonidine group during the three days of smoking cessation. Impairment of concentration and hunger were not significantly diminished by transdermal clonidine treatment during smoking cessation. In addition, a trend was present in the transdermal clonidine group to spontaneously decrease the number of cigarettes smoked per day during the smoking period. Side effects were generally mild. We conclude that transdermal clonidine treatment ameliorates some of the short-term withdrawal symptoms, especially craving, associated with smoking cessation.

Acute Disease↗

[Status and perspectives of agrarian production and food supply in developing countries].

In the early 1980s the agrarian-economic situation and the food supply of most developing countries is characterized by serious complications and vast contradictions. Contrary to the predictions made at the world food conferences in 1970 and 1974, a general retardation has taken place in the rates of increase of food production, and the nutrient crisis has extended. The FAO prognosis 'Agriculture: Toward 2000'- based on annual growth rates of 4%--outlines the enormous problems to be solved in the struggle against hunger and malnutrition in the developing countries. Because of its inadequacies and contradictions this document of the FA cannot, however, be considered as a complex strategy for the fight against hunger, poverty, and underdevelopment, or as a general orientation for shaping the agrarian and nutritional policy in the developing countries.

Agriculture↗

Exercise-induced suppression of appetite: effects on food intake and implications for energy balance.

OBJECTIVE: To examine the effects of exercise on short term energy intake and to investigate the existence of exercise-induced anorexia. DESIGN: Two studies were conducted, both with three treatment conditions and employing a repeated measures design. SETTING: The Human Appetite Research Unit at Leeds University Psychology department. SUBJECTS: Twenty three healthy, lean male subjects (n = 11 and n = 12 respectively) were recruited from the student/staff population of Leeds University. INTERVENTIONS: Subjects were randomly assigned to a control, low intensity and high intensity exercise treatment in the first study and to a control, short duration and long duration exercise treatment (high intensity) in the second. Motivation to eat was measured by visual analogue rating scales and by the length of the time between the end of exercise and the volitional onset of eating. Energy and macronutrient intakes were measured by means of a free-selection test meal and by recorded intakes for the next 2 days. RESULTS: Subjective feelings of hunger were significantly suppressed during and after intense exercise sessions (P 0.01), but the suppression was short-lived. Exercise sessions had no significant effect on the total amount of food consumed in the test meal but intense exercise delayed the start of eating (P < 0.05). When energy intake was assessed relative to the energy expended during the exercise or control periods, only the long duration, high intensity session created a significant short-term negative energy balance (P < 0.001). CONCLUSIONS: These studies indicate that exercise-induced anorexia can be characterized by a brief suppression of hunger, accompanied by a delay to the onset of eating. The temporal aspects of exercise-induced anorexia may best be measured by the resistance to begin eating rather than the amount of food consumed.

Adult↗

Indicators of changes in weight and eating behaviour in severely obese patients treated in a nursing behavioural program.

To assess some possible reasons for the changes of weight and eating behaviour at a one year follow up in 33 severely obese subjects (mean BMI, 39.9 s.d. 5.2) treated in a nursing behavioural-treatment program, three instruments were used; the Self Motivation Inventory (SMI), the Sense of Coherence Scale (SOC) and the Karolinska Scales of Personality (KSP). The Three Factor Eating Questionnaire (EI) measuring restrained eating, disinhibition and hunger, was used to register the change of eating behaviour. The weight lost at the one year follow-up was significantly (P < .01) correlated to the restrained eating score at the time for the follow-up as well as to the difference value (P < .01) of the restraint score before and one year after treatment and to the number of participated booster sessions (P < .05). The SMI score, as measured before treatment, correlated significantly to all the EI subscales scores at the one-year follow-up (P < .05, P < .01, P < .01). Thus, the greater the self motivation, the more restraint and the less disinhibition and hunger. In turn, the SOC score correlated significantly (P < .01) to the SMI score. Thus, the stronger the sense of coherence, the more perceived self-motivation. Finally, there was a significant negative correlation between the KSP subscales Somatic Anxiety (P < .01), Muscular Tension (P < .05), Psychic Anxiety (P < .001), Psychasthenia (P < .01), Hostility (P < .001), and Inhibition of Aggression (P < .001) and a positive correlation between Socialization (P < .05) and the SOC score.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Significant satiety effect of bombesin in lean but not in obese subjects.

The aim of this work was to determine whether infusion of bombesin inhibits intake of a carbohydrate-rich meal in lean and obese women. A double blind study was carried out using bombesin or saline infusion. The subjects were nine lean and nine obese women of the same age. Food intake and hunger feelings were measured. During infusion of bombesin, the amount of food eaten by the lean individuals (294 +/- 55 g) was significantly less than during infusion of saline (467 +/- 69 g, P < 0.01). However, bombesin induced no significant feeding suppression in the obese women when compared to saline (431 +/- 60 vs 499 +/- 99 g). Subjective hunger feelings were significantly affected by bombesin infusion in the lean subjects only. It was concluded that bombesin infusion inhibits food intake and increases satiety in lean women, whereas obese women are less sensitive to these bombesin-induced satiety effects.

Adult↗

Energy restriction, a useful intervention to retard human ageing? Results of a feasibility study.

OBJECTIVE: Energy restriction (ER) retards the ageing process in animal models. It is possible that ER has a similar effect in humans. As a first approach to look after the potential application of ER in man the feasibility of a moderately energy-restricted diet was studied. DESIGN: A controlled intervention study. SETTING: TNO Toxicology and Nutrition Institute. SUBJECTS: 24 middle-aged non-obese men, selected from men responding to advertisements in regional newspapers. INTERVENTIONS: After a run-in period subjects were divided into two groups, a control group (n = 8) and an ER group (n = 16). Groups were matched on age and body mass index. The effects of 10 weeks of moderate ER (80% of habitual energy intake) on body composition, general health (blood pressure, lipid profile, routine clinical chemistry and haematology), physical and mental performance, and feelings of hunger, satiety and state of mind were measured. RESULTS: Subjects in the ER group lost about 7.4 +/- 2.6 kg weight (P < 0.001). This weight loss concerned mainly loss of fat mass. Diastolic and systolic blood pressure decreased significantly within the ER group (P < 0.05 and P < 0.01 respectively). The increase in HDL-cholesterol level was significantly related to weight loss (P < 0.05). CONCLUSIONS: The results show beneficial effects of 10 weeks of moderate ER on blood pressure and lipid profile without adverse effects on physical and mental performance and feelings of hunger, satiety and mood.

Adult↗

Nutritional intake, weight change, symptom distress, and functional status over time in adults with lung cancer.

The purpose of this descriptive longitudinal study was to describe the relationship of nutritional intake to weight change, symptom distress, and functional status over a six-month period in 28 subjects with progressive lung cancer. The majority of the subjects had non-small cell lung cancer and had lost less than 10% of their body weight at the time of study entry. Body weight, hunger, symptom distress, and functional status were measured every six weeks, beginning two months after diagnosis, for a six-month period. Three-day diet records, which were completed immediately prior to each time point, were averaged to obtain nutrient intake data. Average weight change and nutritional intake showed little variation over time, but the ranges were large. Lower intake of kilocalories was moderately related to functional status at Times 1 and 5 (r = -0.56; r = -0.66, respectively). Kilocalorie intake at a previous time was related to subsequent functional decline at two of the six-week data points (r = -0.71; r = -0.75). Weight change was not directly related to kilocalorie intake. Percentage of weight loss over time was greater in subjects younger than 65 years of age, in those with small cell lung cancer, and in those who received chemotherapy. Symptom distress and symptoms of hunger, nausea, and appetite disturbance showed subtle fluctuations over the six-month period and had inconsistent relationships with food intake over time. Further study is needed to describe nutritional changes that follow a diagnosis of lung cancer and to identify areas for nursing intervention.

Activities of Daily Living↗

Effect of amount and type of dietary fiber on food intake in energy-restricted dogs.

OBJECTIVE: To evaluate the effect of adding different amounts of insoluble (IF) or soluble (SF) dietary fiber to a commercial diet formulated for weight reduction on satiety and perception of hunger in dogs. ANIMALS: 6 adult dogs. PROCEDURE: Test diets included 2 low-fiber control diets (CL1 and CL2), 2 diets with increased amount of IF (IF1 and IF2), and 2 diets with increased amount of SF (SF1 and SF2). Each test diet was fed for 12 days to 6 dogs in a Latin square design, and in amounts that correspond to the food allowance recommended for weight reduction. Behavioral characteristics of dogs were recorded for 30-minute periods after introduction of test diets. On 2 occasions during each test period, exactly 3 hours after feeding of the test diet, dogs were given a challenge meal consisting of a standard commercial canned dog food ad libitum. At the end of each 12-day feeding period, all dogs entered a 6-day washout period in which they were offered a standard commercial canned dog food ad libitum. RESULTS: Diet had no significant effect on intake of the challenge meal, intake of food during the subsequent washout period, or perception of hunger, as represented by behavioral characteristics during the 30-minute period after presentation of test diets. In addition, diet had no significant effect on percentage of weight loss. CONCLUSIONS: Inclusion of high amounts of IF or SF in a commercial low-energy diet has no apparent beneficial effects on satiety when fed to dogs on an energy intake regimen corresponding to allowances for weight reduction.

Animal Feed↗

Eating behavior of women with bulimia.

To obtain objective information about binge- and non-binge-eating behavior, 12 women with bulimia and ten women without eating problems (controls) were asked to eat four meals in a structured laboratory setting, on separate nonconsecutive days. The same instructions were given to both groups. On two days, they were asked to eat a normal amount, and on two days, they were asked to eat as much as they could, ie, to binge. For each type of instruction, they were given a single- and a multiple-course meal. The patients ate significantly more than the controls when asked to binge, both on the multiple-course meals that they rated as typical of binges and on the single-course meals. When they were asked to eat normally, there was no significant difference in intake between patients and controls on either single- or multiple-course meals. After all meals, hunger ratings of patients were significantly higher than hunger ratings of controls. There was also a significant positive correlation between intakes of single- and multiple-course binge meals and an inverse correlation between intake of multiple-course binge meals in bulimic patients and their rating of how well they controlled their eating. Thus, a structured laboratory eating situation can be used to reveal differences between bulimic and normal individuals and has the potential for assessing clinical status and exploring mechanisms responsible for binge eating.

Adult↗

The effects of gastric surgery on systemic ghrelin levels in the morbidly obese.

HYPOTHESIS: Circulating ghrelin, produced primarily in the stomach, is a powerful orexigen. Ghrelin levels are elevated in states of hunger, but rapidly decline postprandially. Early alterations in ghrelin levels in morbidly obese patients undergoing weight reduction surgery may be attributed to gastric partitioning. DESIGN AND PATIENTS: Thirty-four patients underwent Roux-en-Y gastric bypass with a completely divided gastroplasty to create a 15-mL vertically oriented gastric pouch. Eight other patients underwent other gastric procedures that did not involve complete division of the stomach, including 4 vertical banded gastroplasties and 4 antireflux surgical procedures. Six additional patients undergoing antireflux surgery served as lean control subjects. Plasma samples were obtained before surgery and immediately after surgery. In a substudy, plasma was collected after Roux-en-Y limb formation and after dividing the stomach to identify any changes in plasma ghrelin levels. SETTING: Tertiary university medical center. MAIN OUTCOME MEASURES: Ghrelin levels at different stages of surgical intervention. RESULTS: Mean +/- SEM preoperative and postoperative ghrelin levels in the gastric bypass group were 355 +/- 20 and 246 +/- 13 pg/mL, respectively (P<.001). In the vertical banded gastroplasty group and in all patients undergoing antireflux surgery, ghrelin levels were not significantly changed. CONCLUSIONS: Compared with morbidly obese humans, lean controls had significantly higher plasma ghrelin levels at baseline. A divided gastroplasty creating a small proximal gastric pouch results in significant early declines in circulating ghrelin levels that are not observed with other gastric procedures. This may explain, in part, the loss of hunger sensation and rapid weight loss observed following gastric bypass surgery.

Adult↗

Gum chewing reduces ileus after elective open sigmoid colectomy.

HYPOTHESIS: Gum chewing after elective open colon resection may stimulate bowel motility and decrease duration of postoperative ileus. DESIGN AND SETTING: Prospective, randomized study in a community-based teaching hospital. PATIENTS: Thirty-four patients undergoing elective open sigmoid resections for recurrent diverticulitis or cancer. MAIN OUTCOME MEASURES: First feelings of hunger, time to first flatus, time to first bowel movement, length of hospital stay, and complications. RESULTS: A total of 34 patients were randomized into 2 groups: a gum-chewing group (n = 17) or a control group (n = 17). The patients in the gum-chewing group chewed sugarless gum 3 times daily for 1 hour each time until discharge. Patient demographics, intraoperative, and postoperative care were equivalent between the 2 groups. All gum-chewing patients tolerated the gum. The first passage of flatus occurred on postoperative hour 65.4 in the gum-chewing group and on hour 80.2 in the control group (P = .05). The first bowel movement occurred on postoperative hour 63.2 in the gum-chewing group and on hour 89.4 in the control group (P = .04). The first feelings of hunger were felt on postoperative hour 63.5 in the gum-chewing group and on hour 72.8 in the control group (P = .27). There were no major complications in either group. The total length of hospital stay was shorter in the gum-chewing group (day 4.3) than in the control group (day 6.8), (P = .01). CONCLUSIONS: Gum chewing speeds recovery after elective open sigmoid resection by stimulating bowel motility. Gum chewing is an inexpensive and helpful adjunct to postoperative care after colectomy.

Chewing Gum↗

Effects of a low-glycemic load diet on resting energy expenditure and heart disease risk factors during weight loss.

CONTEXT: Weight loss elicits physiological adaptations relating to energy intake and expenditure that antagonize ongoing weight loss. OBJECTIVE: To test whether dietary composition affects the physiological adaptations to weight loss, as assessed by resting energy expenditure. DESIGN, STUDY, AND PARTICIPANTS: A randomized parallel-design study of 39 overweight or obese young adults aged 18 to 40 years who received an energy-restricted diet, either low-glycemic load or low-fat. Participants were studied in the General Clinical Research Centers of the Brigham and Women's Hospital and the Children's Hospital, Boston, Mass, before and after 10% weight loss. The study was conducted from January 4, 2001, to May 6, 2003. MAIN OUTCOME MEASURES: Resting energy expenditure measured in the fasting state by indirect calorimetry, body composition by dual-energy x-ray absorptiometry, cardiovascular disease risk factors, and self-reported hunger. RESULTS: Resting energy expenditure decreased less with the low-glycemic load diet than with the low-fat diet, expressed in absolute terms (mean [SE], 96 [24] vs 176 [27] kcal/d; P = .04) or as a proportion (5.9% [1.5%] vs 10.6% [1.7%]; P = .05). Participants receiving the low-glycemic load diet reported less hunger than those receiving the low-fat diet (P = .04). Insulin resistance (P = .01), serum triglycerides (P = .01), C-reactive protein (P = .03), and blood pressure (P = .07 for both systolic and diastolic) improved more with the low-glycemic load diet. Changes in body composition (fat and lean mass) in both groups were very similar (P = .85 and P = .45, respectively). CONCLUSIONS: Changes in dietary composition within prevailing norms can affect physiological adaptations that defend body weight. Reduction in glycemic load may aid in the prevention or treatment of obesity, cardiovascular disease, and diabetes mellitus.

Adult↗

Recorded food intake of obese women with binge eating disorder before and after weight loss.

Because binge eating in obese individuals has been postulated to be a reaction to dietary restriction, we examined the recorded food intake of 17 obese women with and 16 obese women without binge eating disorder (BED) during 1-week periods before and 3 months after a very low calorie diet program in order to determine the effects of dietary restriction on binge eating frequency and severity. Before weight loss, rather than reporting severe caloric restriction, women with BED reported greater average energy intake than nonbinge eaters on both a total (2707 vs. 1869 k cal/day, p < .01) and weight-adjusted (25.1 vs. 18.1 kcal/kg, p < .01) basis, with both higher intake on nonbinge days and an increased frequency of binge days. After weight loss, there was no significant difference in energy intake, on either a total or weight-adjusted basis, between subjects with and without BED. Although average daily energy intake fell for both groups after weight loss, only subjects with BED reported significantly decreased energy intake when adjusted for change in body weight. This resulted from decreased intake on nonbinge days and a decreased frequency of binge days. Before weight loss, subjects with BED reported an average energy intake equivalent to 94% of their predicted energy expenditure. Whereas subjects without BED reported intake only 64% of predicted (p = .002). After weight loss, there was no significant difference between subjects with and without BED in the percentage of predicted energy expenditure reported as intake (64% vs. 58%). Restraint was similar in both groups before weight loss, but those with BED reported greater hunger and disinhibition. After weight loss treatment, restraint increased significantly, whereas disinhibition and hunger remained elevated in subjects with BED. Disinhibition, rather than restraint, appears to be a major contributor to the disordered eating of these individuals. Unlike normal-weight women with bulimia nervosa, dietary restriction does not appear to worsen symptoms of binge eating in obese women with BED. Over the short term, subjects with BED may respond to a standard weight loss treatment program with improvements in binge eating behaviors.

Adolescent↗