Hunger disease
Humans; Nutritional Support; Health Status; Time Factors; Adaptation; Energy Metabolism; Body Composition; Physiological; Starvation/metabolism; Adipose Tissue/metabolism; Appetite/physiology; Eating/physiology; Hunger/physiology; Nutrition Disorders/metabolism; Obesity/metabolism/physiopathology; Weight Loss/physiology
This paper examines three aspects of hunger disease: the effect of initial fat stores on macronutrient fuel selection during total starvation (no energy) and how it influences survival; the effects of different rates of weight loss on tissue and body function; and the importance of appetite sensations, including hunger, during malnutrition and during enteral and parenteral nutritional support. Long-term starvation studies in humans reveal major differences in fat carbohydrate and protein metabolism between lean and obese subjects, including a 2-4-fold lower contribution of protein oxidation to energy expenditure in obese subjects, which ensures that more of the excess body fat is oxidized. The rate of weight loss, determined by recent dietary intake, can have major effects on tissue and body function, including wound healing, the acute phase protein response, muscle fatigue and psychological/behavioural function in both clinical and non-clinical settings. In depleted states uncomplicated by disease, changes in appetite sensations can result in energy intakes as high as 6000 to 10,000 kcal/day ( 25-42 MJ/day). Long-term enteral tube feeding and parenteral nutrition are associated with frequent disturbances in appetite sensations, and in those able to eat normally they tend to add rather than replace oral intake to an extent that appears to depend on the regimen. It is concluded that 1) differences between lean and obese subjects in macronutrient fuel selection during starvation are adaptive because they optimize survival in both groups of subjects; 2) the rate of weight loss in health and disease has a major effect on certain tissue and body functions, independently of the magnitude of weight loss; and 3) clinically relevant disturbances in appetite sensations are common subjects receiving long-term enteral and parenteral nutrition. The clinical modulation of all these variables would be aided by greater knowledge of the mechanisms involved.
2000
Elia M
Clinical Nutrition (edinburgh, Scotland)
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1054/clnu.2000.0157" target="_blank" rel="noreferrer">10.1054/clnu.2000.0157</a>
Tube feeding in palliative care: benefits and problems
Female; Humans; Aged; Gastrostomy; Nutritional Requirements; Enteral Nutrition/methods; Palliative Care/methods; Nutrition Assessment; Terminal Care/methods; Weight Loss/physiology; Energy Intake/physiology; Laryngeal Neoplasms/physiopathology/radiotherapy
Percutaneous endoscopic gastrostomy techniques are becoming more widely available and will be considered increasingly for patients with head and neck or upper gastrointestinal malignancies, and for neurological dysphagia, as occurs in motor neurone disease. This case history illustrates some of the practical and ethical issues raised by their use.
1994
Boyd KJ; Beeken L
Palliative Medicine
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1177/026921639400800210" target="_blank" rel="noreferrer">10.1177/026921639400800210</a>