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To study the intervention mechanism of pediatric massage on intestinal flora and host metabolism in children with anorexia.
Gao, H, Zhang, X, He, W, Zhao, X, Han, J, Li, D, Yang, H, Li, S
Medicine. 2020;(47):e23349
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Abstract
BACKGROUND As a common and frequent disease in pediatric patients, pediatric anorexia (PN) poses a serious threat to childhood growth and health. In recent years, societal changes in lifestyle and diet have increased the incidence of this PN, which has attracted extensive attention from both the medical community and parents. It has been shown that massage therapy represents an effective intervention for the treatment of anorexia, but investigation on its mechanism(s) of action remains limited. In this study, we will explore the biological mechanism(s) of PN from the perspective of intestinal flora, to further reveal its site of action and therapeutic mechanism(s). METHODS A total of 60 healthy children will be randomly selected for physical examination. According to a random number generated by a computer, children with anorexia who meet the inclusion criteria will be selected. In strict accordance with the time sequence of inclusion, subjects will be randomly assigned to either the massage or control group (n = 60 per group). The blank group will receive no treatment. Children in the massage group will receive a designated massage protocol. The control group will be administered oral Jianweixiaoshi tablets over 4 weeks. Each group will be compared for intestinal flora structure, fecal short chain fatty acids levels, serum trace elements, urine D-xylose-excretion rates, gastric fluid emptying, gastric motility, and hemoglobin levels before and after treatment. RESULTS We will review the clinical trial registry in China (http://www.chictr.org.cn/searchprojen.aspx), peer-reviewed journals and academic conferences. CONCLUSION This study will verify the intervention mechanism(s) of pediatric massage on intestinal flora and host metabolism in children with anorexia. TRIAL REGISTRATION NUMBER ChiCTR2000033274.
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Automated Requests for Thyroid-Stimulating Hormone and Ferretin Tests in Young Primary Care Patients with Anorexia as an Intervention to Improve Detection of Underlying Conditions.
Salinas, M, López-Garrigós, M, Flores, E, Leiva-Salinas, C
Laboratory medicine. 2019;(3):268-272
Abstract
OBJECTIVE To improve clinical laboratory contribution to the treatment of primary care patients with anorexia through automated computerized strategies. METHODS We recorded the number of laboratory requests due to anorexia; the demographic data, laboratory values, and presence of pathological values for the applicable patients. In a prospective study, the laboratory information management system (LIMS) automatically added thyroid-stimulating hormone (TSH) and/or ferritin testing when it was not requested by general practitioners for all primary care patients with anorexia who were younger than 16 years. RESULTS A total of 3562 patients underwent laboratory testing due to anorexia, of whom 47% were younger than 16 years. The tests in which the results most frequently were abnormal were hemoglobin, ferritin, and TSH. TSH results were abnormal in 20% of patients younger than 16 years. Through the intervention, we detected 3 low ferritin values and 7 cases of pathological TSH levels. CONCLUSIONS The LIMS required TSH and ferritin testing in young patients even when not requested, potentially avoiding the adverse effects of iron deficiency and thyroid disorders on neurological development and cognition in those patients.
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Anorexia of Aging - An Updated Short Review.
Jadczak, AD, Visvanathan, R
The journal of nutrition, health & aging. 2019;(3):306-309
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Abstract
The anorexia of aging affects approximately a quarter of older people and is a major contributor to the development of under-nutrition and many other adverse health outcomes in older people. Despite the high prevalence, the anorexia of aging is frequently overlooked by clinicians and, of even more concern, it is commonly accepted as inevitable and a part of 'normal' aging. Early identification of risk coupled with efforts to mitigate these risks through appropriate interventions might stem the deleterious consequences of the anorexia of aging. This review aims to provide an update on the current knowledge base whilst making some practical suggestions that may be of use in clinical practice. Interventions such as exercise and good nutrition remain the preferred treatment while pharmacological options, whilst they continue to be trialed, are not currently recommended for routine clinical use.
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Cachexia Anorexia Syndrome and Associated Metabolic Dysfunction in Peritoneal Metastasis.
Archid, R, Solass, W, Tempfer, C, Königsrainer, A, Adolph, M, Reymond, MA, Wilson, RB
International journal of molecular sciences. 2019;(21)
Abstract
: Patients with peritoneal metastasis (PM) of gastrointestinal and gynecological origin present with a nutritional deficit characterized by increased resting energy expenditure (REE), loss of muscle mass, and protein catabolism. Progression of peritoneal metastasis, as with other advanced malignancies, is associated with cancer cachexia anorexia syndrome (CAS), involving poor appetite (anorexia), involuntary weight loss, and chronic inflammation. Eventual causes of mortality include dysfunctional metabolism and energy store exhaustion. Etiology of CAS in PM patients is multifactorial including tumor growth, host response, cytokine release, systemic inflammation, proteolysis, lipolysis, malignant small bowel obstruction, ascites, and gastrointestinal side effects of drug therapy (chemotherapy, opioids). Metabolic changes of CAS in PM relate more to a systemic inflammatory response than an adaptation to starvation. Metabolic reprogramming is required for cancer cells shed into the peritoneal cavity to resist anoikis (i.e., programmed cell death). Profound changes in hexokinase metabolism are needed to compensate ineffective oxidative phosphorylation in mitochondria. During the development of PM, hypoxia inducible factor-1α (HIF-1α) plays a key role in activating both aerobic and anaerobic glycolysis, increasing the uptake of glucose, lipid, and glutamine into cancer cells. HIF-1α upregulates hexokinase II, phosphoglycerate kinase 1 (PGK1), pyruvate dehydrogenase kinase (PDK), pyruvate kinase muscle isoenzyme 2 (PKM2), lactate dehydrogenase (LDH) and glucose transporters (GLUT) and promotes cytoplasmic glycolysis. HIF-1α also stimulates the utilization of glutamine and fatty acids as alternative energy substrates. Cancer cells in the peritoneal cavity interact with cancer-associated fibroblasts and adipocytes to meet metabolic demands and incorporate autophagy products for growth. Therapy of CAS in PM is challenging. Optimal nutritional intake alone including total parenteral nutrition is unable to reverse CAS. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) stabilized nutritional status in a significant proportion of PM patients. Agents targeting the mechanisms of CAS are under development.
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Altered Eating Attitudes in Nursing Home Residents and Its Relationship with their Cognitive and Nutritional Status.
María Pérez-Sánchez, C, Nicolás Torres, D, Hernández Morante, JJ
The journal of nutrition, health & aging. 2018;(7):869-875
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Abstract
BACKGROUND although eating disorders are usually linked to young adolescents, these mental disorders can also appear in the elderly, especially in those living in nursing homes, which might be associated or not with the cognitive decline; however, there are few data regarding elderly subjects. OBJECTIVES the objective of the present work was to evaluate the presence of abnormal eating attitudes in nursing home residents and its relation with several cognitive, nutritional and psychological factors that could be influencing their nutritional state. DESIGN AND SETTING a observational experimental study was carried out at several nursing homes of Murcia, Spain. SUBJECTS 139 nursing home residents. METHODS EAT-26 test was used to screen classic eating disorders (anorexia and bulimia). Blandford's scale was employed to determine aversive eating attitudes. Moreover, subjective appetite sensations, body image perception, nutritional (MNA and diet composition) and biochemical data were also evaluated. RESULTS 33% of the subjects had malnutrition. No subject showed symptoms of anorexia or bulimia; however, subjects with cognitive decline frequently showed aversive feeding behaviours (21.6%). Albumin values were significantly lower in subjects with cognitive impairment. CONCLUSIONS our data showed a clear relation between cognitive impairment and altered eating attitudes, which was reflected by both biochemical (albumin) and nutritional parameters, while no classic eating disorder was observed in residents with normal cognitive-status. These data confirm the need to strengthen our efforts towards maintaining the nutritional status of the subjects with cognitive impairment.
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Guarana (Paullinia cupana) Improves Anorexia in Patients with Advanced Cancer.
Palma, CG, Lera, AT, Lerner, T, de Oliveira, MM, de Borta, TM, Barbosa, RP, Brito, GM, Guazzelli, CA, Cruz, FJ, del Giglio, A
Journal of dietary supplements. 2016;(2):221-31
Abstract
PURPOSE Anorexia is prevalent in cancer patients with advanced disease. In this pilot phase II, open label, nonrandomized trial, we evaluated the efficacy and safety of guarana (Paullinia cupana) in patients with cancer and weight loss. METHODS We included advanced cancer patients with decreased appetite and weight loss of more than 5% from their baseline. All of the patients received 50 mg of the crude dry extract of guarana twice a day for 4 weeks. The trial was designed in two phases (Simon model). We considered a positive response in the first phase to be at least 5% weight gain or a three-point improvement in the appetite scale in at least three of the first 18 evaluable patients. RESULTS Of the 34 eligible patients, 30 were included and 18 completed the protocol. Only one patient abandoned the protocol due to toxicity (grade II arthralgia). No grade 3 or 4 toxicities and no significant differences in nausea, weight loss, or quality of life (FACT-G) occurred. Only two of the 18 patients who completed the study had weight gain above 5% from their baseline, whereas six patients had at least a 3-point improvement in the visual appetite scale. The M.D. Anderson Symptom Inventory (MDASI) was used to evaluate several symptoms, and we observed a significant decrease in the lack of appetite (p = 0.02) and in somnolence (p = 0.0142). CONCLUSION We concluded that the weight stabilization and increased appetite that we observed in this study justify further studies of guarana in this patient population.
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Mechanisms of the anorexia of aging-a review.
Wysokiński, A, Sobów, T, Kłoszewska, I, Kostka, T
Age (Dordrecht, Netherlands). 2015;(4):9821
Abstract
Many, even healthy, older people fail to adequately regulate food intake and experience loss of weight. Aging-associated changes in the regulation of appetite and the lack of hunger have been termed as the anorexia of aging. The etiology of the anorexia of aging is multi-factorial and includes a combination of physiological changes associated with aging (decline in smell and taste, reduced central and peripheral drive to eat, delayed gastric emptying), pathological conditions (depression, dementia, somatic diseases, medications and iatrogenic interventions, oral-health status), and social factors (poverty, loneliness). However, exact mechanisms of the anorexia of aging remain to be elucidated. Many neurobiological mechanisms may be secondary to age-related changes in body composition and not associated with anorexia per se. Therefore, further studies on pathophysiological mechanisms of the anorexia of aging should employ accurate measurement of body fat and lean mass. The anorexia of aging is associated with protein-energy malnutrition, sarcopenia, frailty, functional deterioration, morbidity, and mortality. Since this symptom can lead to dramatic consequences, early identification and effective interventions are needed. One of the most important goals in the geriatric care is to optimize nutritional status of the elderly.
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Loss of appetite in acutely ill medical inpatients: physiological response or therapeutic target?
Schütz, P, Bally, M, Stanga, Z, Keller, U
Swiss medical weekly. 2014;:w13957
Abstract
Loss of appetite and ensuing weight loss is a key feature of severe illnesses. Protein-energy malnutrition (PEM) contributes significantly to the adverse outcome of these conditions. Pharmacological interventions to target appetite stimulation have little efficacy but considerable side effects. Therefore nutritional therapy appears to be the logical step to combat inadequate nutrition. However, clinical trial data demonstrating benefits are sparse and there is no current established standard algorithm for use of nutritional support in malnourished, acutely ill medical inpatients. Recent high-quality evidence from critical care demonstrating harmful effects when parenteral nutritional support is used indiscriminately has led to speculation that loss of appetite in the acute phase of illness is indeed an adaptive, protective response that improves cell recycling (autophagy) and detoxification. Outside critical care, there is an important gap in high quality clinical trial data shedding further light on these important issues. The selection, timing, and doses of nutrition should be evaluated as carefully as with any other therapeutic intervention, with the aim of maximising efficacy and minimising adverse effects and costs. In light of the current controversy, a reappraisal of how nutritional support should be used in acutely ill medical inpatients outside critical care is urgently required. The aim of this review is to discuss current pathophysiological concepts of PEM and to review the current evidence for the efficacy of nutritional support regarding patient outcomes when used in an acutely ill medical patient population outside critical care.
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Use of corticosteroids for anorexia in palliative medicine: a systematic review.
Miller, S, McNutt, L, McCann, MA, McCorry, N
Journal of palliative medicine. 2014;(4):482-5
Abstract
BACKGROUND Anorexia is a significant problem in patients approaching the end of life, for which corticosteroids are widely prescribed. It is not clear which regimen is the most safe and effective for this indication. OBJECTIVE The study objective was to identify the evidence for the use of corticosteroids, and the most safe and effective dosing regimen for management of anorexia in palliative care patients. METHODS A search of MEDLINE and CINAHL was carried out to identify original studies relevant to this question. These were reviewed against inclusion criteria and articles for inclusion were identified. Data was extracted and a narrative analysis was carried out. Subjects were adult patients with life-limiting diagnoses prescribed corticosteroids for anorexia in any care setting. Quality of studies was assessed using the system used by the Scottish Intercollegiate Guidelines Network for grading evidence. RESULTS Eight articles were identified that met the inclusion criteria. The corticosteroid drugs and dosing regimens used were wide ranging, and a variety of tools were used to assess appetite within these studies. All studies showed improvement in appetite with the corticosteroid used, although this did not always reach statistical significance. It was not possible to identify the most effective corticosteroid drug, dose, or duration of treatment from the identified studies: the best quality evidence was for an eight-week course of intravenous methylprednisolone; however the studies using this regimen had the highest attrition rates. CONCLUSIONS Corticosteroids are beneficial in treating anorexia in palliative care patients with malignancies; however there is no evidence for their use in anorexia due to end-stage nonmalignant disease. There is insufficient evidence to recommend any particular corticosteroid drug over another, or to recommend a dosing regimen.
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Pathophysiology of the anorexia of aging.
Morley, JE
Current opinion in clinical nutrition and metabolic care. 2013;(1):27-32
Abstract
PURPOSE OF REVIEW Anorexia represents a major problem for older persons leading to weight loss, sarcopenia, functional decline, and mortality. There is increasing information on the pathophysiological mechanisms that lead to anorexia. RECENT FINDINGS Increasing evidence has shown the importance of gastrointestinal hormones (ghrelin, cholecystokinin, and glucagon-like peptide) and adipokines in producing the anorexia of aging. Numerous neurotransmitters have been shown to be involved in this aging anorexia, but evidence in humans is lacking. SUMMARY The early recognition of anorexia of aging is important to allow intervention and prevent functional deterioration in older persons. Screening tests for anorexia have been developed. New approaches to managing anorexia are being tested.