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Anorexia poor appetite [keywords]
- Predicting survival in cancer patients: the role of cachexia and hormonal, nutritional and inflammatory markers. [Journal Article]
- J Cachexia Sarcopenia Muscle 2012 Dec; 3(4):245-51.
Cancer can lead to weight loss, anorexia, and poor nutritional status, which are associated with decreased survival in cancer patients.Male cancer patients (n = 136) were followed for a mean time of 4.5 years. Variables were obtained at baseline: cancer stage, albumin, hemoglobin, tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, bioavailable testosterone, appetite questionnaire, and weight change from baseline to 18 months. Primary statistical tests included Kaplan-Meier survival analysis and Cox proportional hazard regression (PHREG).Univariate PHREG showed that cancer stage, albumin, hemoglobin, TNF-α, IL-6, and weight change were each significantly associated with mortality risk (P < 0.05), but bioavailable testosterone was not. Multivariate PHREG analysis established that weight change and albumin were jointly statistically significant even after adjusting for stage.In this sample of male oncology patients, cancer stage, serum albumin, and weight loss predicted survival. High levels of inflammatory markers and hemoglobin are associated with increased mortality, but do not significantly improve the ability to predict survival above and beyond cancer stage, albumin, and weight loss.
- The use of herbal medicine in cancer-related anorexia/ cachexia treatment around the world. [Journal Article, Review]
- Curr Pharm Des 2012; 18(31):4819-26.
Cancer-related cachexia, a condition in which the body is consumed by deranged carbohydrate, lipid and protein metabolism that is induced by inflammatory cytokines. Cachexia is associated with poor treatment outcome, fatigue and poor quality of life. Pharmacological intervention in the treatment and/or prevention of cachexia has been mainly aimed at the use of appetite enhancers to increase oral nutritional intake so far. Herbal remedies are part of traditional and folk healing methods with long histories of use. In this report, we have assessed which herbal approaches have had associated cancer cachexia case reports. Commonly used herbal medicines in western countries include essiac, iscador, pau d'arco tea, cannabinoids and so on. Some Kampo herbs and formulations are commonly used by cancer patients reduce the side effects and complications during the antitumor therapy. The relevant herbal medicines include ginseng, C. rhizome and radix astragali, and the related herbal remedies, such as TJ-48, TJ-41, PHY906 and Rikkunshito. However, there still have some adverse effects caused or amplified by herb and drug interactions that are difficult to separate. However, randomized effectiveness of herbal medicines shall be further identified in controlled clinical trials involving cancer patients with cachexia.
- Hypothalamic mitochondrial dysfunction associated with anorexia in the anx/anx mouse. [Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't]
- Proc Natl Acad Sci U S A 2011 Nov 1; 108(44):18108-13.
The anorectic anx/anx mouse exhibits disturbed feeding behavior and aberrances, including neurodegeneration, in peptidergic neurons in the appetite regulating hypothalamic arcuate nucleus. Poor feeding in infants, as well as neurodegeneration, are common phenotypes in human disorders caused by dysfunction of the mitochondrial oxidative phosphorylation system (OXPHOS). We therefore hypothesized that the anorexia and degenerative phenotypes in the anx/anx mouse could be related to defects in the OXPHOS. In this study, we found reduced efficiency of hypothalamic OXPHOS complex I assembly and activity in the anx/anx mouse. We also recorded signs of increased oxidative stress in anx/anx hypothalamus, possibly as an effect of the decreased hypothalamic levels of fully assembled complex I, that were demonstrated by native Western blots. Furthermore, the Ndufaf1 gene, encoding a complex I assembly factor, was genetically mapped to the anx interval and found to be down-regulated in anx/anx mice. These results suggest that the anorexia and hypothalamic neurodegeneration of the anx/anx mouse are associated with dysfunction of mitochondrial complex I.
- Effect of transitioning from extended-release methylphenidate onto osmotic, controlled-release methylphenidate in children/adolescents with ADHD: results of a 3-month non-interventional study. [Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't]
- Curr Med Res Opin 2011.:35-44.
To explore the clinical outcomes of children/adolescents with ADHD who transitioned from extended-release methylphenidate (ER MPH, Medikinet Retard) to osmotic release oral system (OROS) MPH (Concerta). Medikinet Retard is a registered trade name of Medice, Bad Iserlohn, Germany. Concerta is a registered trade name of Janssen-Cilag GmbH, Neuss, Germany.This prospective, non-interventional study included patients aged 6 to 18 years with a confirmed diagnosis of ADHD who experienced insufficient clinical response and/or poor tolerability on ER MPH. Patients transitioned onto OROS MPH and were followed for 12 weeks. Symptoms, functional outcome, health-related quality of life, safety and tolerability were assessed.180 patients were included in the intention-to-treat analysis. The mean ER MPH dose before switching was 28.2 mg/day; mean OROS MPH starting dose was 38.1 mg/day, increasing to 41.2 mg/day at the final visit. Mean treatment duration was 79.49 ± 24.22 days (median 85; range 7-136). Several symptomatic and functional outcomes under OROS MPH treatment changed from baseline and included the Conners' Parent Rating Scale (CPRS; -11.7 ± 11.3; p < 0.0001), C-GAS (12.3 ± 15.2; p < 0.0001) and ILC-LQ0-28 (parents' rating 2.9 ± 4.3 and patients' rating 2.8 ± 3.8; both p < 0.0001). Improvements in social interactions, playing with other children, doing household chores, or school homework, going to bed, and behavior towards visitors/at visits were noted (p < 0.0001). Approximately 40% of patients reported better sleep quality and appetite (p < 0.0001), and 72.8% expressed satisfaction with OROS MPH therapy compared to previous ER MPH. OROS MPH was well tolerated; the most common AEs after switching, with an incidence >2% and possibly related to therapy, were involuntary muscle contractions (tics; 8.9%), insomnia (7.2%) and anorexia (5.0%). No relevant changes in body weight or vital signs were observed. Three patients reported four serious AEs, but none were considered related to OROS MPH. Limitations included those associated with the uncontrolled, open-label design, possible inclusion bias and non-validation of the CPRS in a German population.Transitioning onto OROS MPH improved functionality, symptom control and decreased burden of disease in patients with ADHD who had insufficient response to, and/or poor tolerability of ER MPH. Similarly, care givers benefited from patients' treatment and reported significant reduction in their burden of disease and improvement of their quality of life upon the child's transition onto OROS MPH.
- The purported effects of alcohol on appetite and weight in lung cancer patients. [Journal Article, Research Support, N.I.H., Extramural]
- Nutr Cancer 2011 Nov; 63(8):1251-5.
Loss of appetite and weight predict poor outcomes in patients with advanced cancer. Effective and affordable palliative strategies are lacking; but because an emerging non-cancer literature suggests that alcohol can increase appetite and weight, this study explored associations between alcohol and clinical outcomes in lung cancer patients. Among 404 consecutive lung cancer patients enrolled in the Mayo Clinic Lung Cancer Cohort between 2004 and 2008, alcohol consumption (within 6 mo of diagnosis) was as follows: 199 (49%) used none, 158 (14%) were moderate users (7 drinks per wk or less), and 47 (12%) were heavier consumers (more than 7 drinks per wk). Only heavier consumers had a lower likelihood of anorexia (odds ratio: 0.49; 95% CI: 0.25, 0.94; P = 0.03) and weight loss (odds ratio: 0.43; 95% CI: 0.20, 0.91; P = 0.03) compared to those who consumed no alcohol. These conclusions were sustained in multivariate analyses. Neither moderate nor heavier consumption was associated with better or worse survival, although, in univariate analyses, a drop in alcohol consumption was associated with worse survival. This report suggests a need for further study of alcohol as a palliative agent for cancer-associated loss of appetite and weight.
- Preliminary report: vitamin D deficiency in advanced cancer patients with symptoms of fatigue or anorexia. [Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't]
- Oncologist 2011; 16(11):1637-41.
Vitamin D deficiency in noncancer patients is associated with symptoms of fatigue, muscle weakness, and depression. These symptoms are common among advanced cancer patients. We investigated the prevalence of low serum vitamin D levels in cancer patients with fatigue or poor appetite and their association with symptom burden and other correctable endocrine abnormalities.This was a retrospective review of 100 consecutive cancer patients with appetite or fatigue scores of ≥4 of 10 referred to a supportive care clinic. We investigated serum levels of 25(OH) vitamin D, cortisol, thyroid-stimulating hormone, and bioavailable testosterone. Symptoms were measured by the Edmonton Symptom Assessment Scale. Serum 25(OH) vitamin D <20 ng/mL was considered deficient; ≥20 ng/mL and <30 ng/mL were considered insufficient.Patients were predominantly male (68%) and white (66%), with a median age of 60 years (range, 27-91 years). Gastrointestinal (30%) and lung (22%) cancers were predominant. Forty-seven patients (47%) were vitamin D deficient and 70 (70%) were insufficient. Thirteen of 70 patients (19%) with vitamin D insufficiency were on supplementation. Vitamin D deficiency was more common among nonwhites (82% versus 36%) and females. No significant association was found between vitamin D and symptoms. Hypogonadic males had a significantly lower mean 25(OH) vitamin D level than eugonadic males.Low vitamin D levels were highly prevalent among advanced cancer patients with cachexia or fatigue. Vitamin D deficiency was more frequent among nonwhite and female patients. Vitamin D levels were also significantly lower in male patients with hypogonadism.
- Exploring the impact of once-daily OROS® methylphenidate (MPH) on symptoms and quality of life in children and adolescents with ADHD transitioning from immediate-release MPH. [Clinical Trial, Journal Article]
- Postgrad Med 2011 Sep; 123(5):27-38.
To explore the clinical and health-related quality of life (HRQoL) outcomes in children/adolescents with attention-deficit/hyperactivity disorder (ADHD) who required a therapy switch from immediate-release (IR) methylphenidate (MPH) and were initiated on Osmotic Release Oral System (OROS(®)) MPH.Prospective, noninterventional study including patients (aged 6-18 years) with a confirmed diagnosis of ADHD who transitioned from IR MPH to OROS(®) MPH based on medical needs. Patients were transitioned to OROS(®) MPH and were followed for 12 weeks. Attention-deficit/hyperactivity disorder symptoms, functional outcomes, HRQoL, and tolerability were assessed throughout the study.598 patients entered the intention-to-treat analysis. The mean OROS(®) MPH starting dose was 29.5 ± 12.0 mg/day, increasing slightly to 33.5 ± 13.2 mg/day at final visit. Compared with baseline, there were significant (all P < 0.0001) symptomatic, functional, and HRQoL improvements after transitioning from IR MPH to OROS(®) MPH as assessed by the Conners' Parent Rating Scale (from 29.0 ± 10.5 to 19.5 ± 11.1), Children's Global Assessment Scale (by 11.0 ± 13.3), and Inventory for Assessing Quality of Life (ILC) LQ0-28 scores (parents' rating from 17.2 ± 3.9 to 19.4 ± 4.0; patients' rating from 18.7 ± 4.0 to 20.5 ± 3.9). Overall, no significant changes in quality of sleep or appetite were observed. More than 70% of parents and physicians rated the effectiveness of OROS(®) MPH as at least "good" and were at least "satisfied" with OROS(®) MPH. The most common treatment-emergent adverse events were insomnia and anorexia. No clinically relevant changes in body weight or vital signs were observed.In this naturalistic setting, transitioning from IR MPH to OROS(®) MPH, in patients who showed previously insufficient response and/or poor tolerability, was successful. Patients' and parents' HRQoL as well as burden of disease showed a clinically relevant improvement. OROS(®) MPH was generally safe and well tolerated.
- Clinical outcomes and contributors to weight loss in a cancer cachexia clinic. [Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't]
- J Palliat Med 2011 Sep; 14(9):1004-8.
Cancer cachexia is considered intractable, with few therapeutic options. Secondary nutrition impact symptoms (S-NIS) such as nausea may further contribute to weight loss by decreasing nutrient intake. In addition, treatable metabolic abnormalities such as hypogonadism, vitamin B12 deficiency, hypothyroidism, and hypoadrenalism could exacerbate anorexia and muscle wasting in patients with cancer cachexia. We determined the frequency and type of contributors to appetite and weight loss, and the effect of the cachexia clinic on clinical outcomes.Review of 151 consecutive patients referred to a cachexia clinic. All received dietary counseling and exercise recommendations. Assessments included weight, body mass index (BMI), S-NIS, resting energy expenditure by indirect calorimetry, serum thyroid stimulating hormone (TSH), cortisol, total testosterone, and vitamin B12.Median weight loss in the 100 days before referral was 9% (4%-13%); median BMI at presentation was 20.8. Median number of S-NIS was 3 (2-4), most commonly treated by metoclopramide, laxatives, and antidepressants. Forty-one percent (24/59) of patients were hypermetabolic and 73% (52/71) of males hypogonadic, whereas hypoadrenalism (0/101, 0%), hypothyroidism (4/113, 4%), and low vitamin B12 (3/107, 3%) were uncommon. Poor appetite and weight loss before referral (r = 0.18, p = 0.036) were associated with increased S-NIS (r = 0.22, p = 0.008). Appetite improved (p < 0.001) and 31/92 (34%) of patients returning for a second visit gained weight.Patients had a high frequency of multiple S-NIS, hypogonadism, and hypermetabolism. A combination of simple pharmacological and nonpharmacological interventions improved appetite significantly, and increased weight in one third of patients who were able to return for follow-up. Cachexia clinics are feasible and effective for many patients with advanced cancer.
- Relationship between appetite and symptoms of depression and anxiety in patients on chronic hemodialysis. [Journal Article]
- J Ren Nutr 2012 Jan; 22(1):27-33.
We aimed at evaluating the association between appetite and symptoms of depression and anxiety, cognitive dysfunction, fatigue, and comorbidities in patients on hemodialysis (HD).A cross-sectional study was conducted.The study was conducted in an outpatient HD service of a tertiary level academic hospital.A total of 90 patients on HD were evaluated for appetite (during the past week, how would you rate your appetite?), symptoms of depression (Beck Depression Inventory [BDI]) and anxiety (Hamilton Anxiety Rating Scale [HARS]), cognitive dysfunction (Mini Mental State Examination [MMSE]), and comorbidities (Charlson Comorbidity Index).Relationship between appetite and symptoms of depression and/or anxiety, cognitive dysfunction, and comorbidities was assessed.In 43 patients, the appetite was very good/good (group 1), in 22, it was fair (group 2), and in 25, it was poor/very poor (group 3). Mean and median BDI were significantly higher in group 3 as well as the percentage of patients with BDI ≥16. Mean and median HARS and the percentage of patients with HARS >13 were significantly higher in group 3. MMSE was significantly lower in group 3 as well as the percentage of patients with MMSE ≤23. Multiple linear regression analysis showed a dependence of appetite by age and BDI (P = .007 and P = .002, respectively).Anorexia is associated with older age and symptoms of depression in patients on HD.
- The effect of loneliness on malnutrition in elderly population. [Journal Article]
- Med Arh 2011; 65(2):92-5.
The clinical and epidemiological data show that proper nutrition plays an important role in maintaining health and combating the danger of developing some chronic diseases in the elderly population. Nutrition is an important factor in many physiological and pathological changes that accompany the aging process. More than 50% of elderly patients are suffering from malnutrition which is information that concerns. Due to various factors, older people are potentially vulnerable groups at risk of malnutrition. Loneliness, isolation from society and neglect of parents by children is a big problem to many people in old age.To determine differences in nutritional status of elderly people living alone compared to those who live in family surroundings.The study was conducted in the municipality of Tuzla in 2009-2010, in outpatient family medicine Simin Han. The survey covered a total of 200 elderly subjects (age >65 years). Subject group consisted of 45% of people living alone, and 55% control group consisted of elderly patients who live in traditional family surroundings. Questionnaires used in this study are General geriatric assessment questionnaire and Mini nutritional status.The average age (+/- SD) was 75.4 +/- 6.2 years in subject group, while the same in the control group was 74.9 +/- 5.6 years. In subject group significantly more patients are on the verge of poverty. There are significant differences in the classification of financial status, according to the groups (p = 0.043). Members of subject groups have significantly lower BMI categories (p = 0.03) compared with the control group. In our study, people who live alone are at increased risk of malnutrition (p = 0030), have reduced the number of daily meals, significantly lower daily intake of protein, fruits and vegetables in the diet in relation to persons living in a family environment. Significantly more patients with loss of appetite live alone. According to the existence of self-reported food problems significantly more people are in subject group. There is a difference value score "Small assessment of nutrition" between the two groups (p = 0.001). About 22% of the total number of respondents said they have not so good health status compared to others.Loneliness is a significant predictor of anorexia nervosa, the risk of malnutrition and malnutrition. Results indicate that it is necessary to work on improving the status and protection of elderly.