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1.
J Med Primatol ; 50(5): 249-258, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34318933

RESUMO

BACKGROUND: Food avoidance secondary to disease or stress can lead to weight loss and rapid deterioration of clinical condition in the common marmoset (Callithrix jacchus). Currently, there are no data supporting the use of any pharmaceuticals as an appetite stimulant in this species; however, benzodiazepines are frequently used for this purpose in other species. METHODS: Six marmosets were used in a crossover study design to evaluate the benzodiazepine midazolam as an appetite stimulant and anxiolytic. Total food intake (TFI) and latency to eat (LTE) were measured following administration of oral and injectable midazolam in non-anxious and anxious states. RESULTS: Injectable midazolam increased TFI and decreased LTE in anxious marmosets, but had no effect in non-anxious animals. Oral midazolam had no effect on appetite in either state. CONCLUSIONS: Injectable midazolam may be an effective treatment for anxiety-induced inappetence in marmosets. Individual response to both oral and injectable midazolam may vary.


Assuntos
Ansiolíticos , Drogas Veterinárias , Animais , Ansiolíticos/farmacologia , Estimulantes do Apetite , Callithrix , Estudos Cross-Over , Midazolam/farmacologia
2.
Nephrol Nurs J ; 48(3): 267-273, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34286938

RESUMO

Nutritional and metabolic abnormalities, or protein energy wasting, is a common complication of chronic kidney disease, leading to significant morbidity and mortality. The cause of these abnormalities is multifactorial, and therefore, difficult to treat. The International Society of Renal Nutrition and Metabolism suggests appetite stimulants, including megestrol, dronabinol, mirtazapine, and cyproheptadine, as adjunctive treatment options in addition to parenteral or oral nutritional supplementation. This article reviews the evidence for use of these drugs as appetite stimulants and discusses their use in patients with chronic kidney disease.


Assuntos
Estimulantes do Apetite , Insuficiência Renal Crônica , Estimulantes do Apetite/uso terapêutico , Humanos , Estado Nutricional , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico
3.
Andes Pediatr ; 92(2): 298-307, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34106171

RESUMO

Feeding problems during childhood have been described over time by various authors. In 2013, Avoi dant/Restrictive Food Intake Disorder (ARFID) was included in the Diagnostic and Statistical Ma nual of Mental Disorders, 5th Edition (DSM-5), as a new diagnosis within the Feeding and Eating di sorders, to describe a group of patients with avoidant or restrictive eating behaviors unrelated to body image disorder or weight loss desire. ARFID may appear as significant weight loss and/or nutritional deficiency and/or a marked interference in psychosocial functioning. There are three forms of pre sentation, which can co-occur or occur independently. The first one includes children with sensory aversions (selective), who reject certain foods due to their taste, texture, smell, or shape; the second one includes those children with poor appetite or limited intake (limited intake); and the third one includes those children who reject certain foods or stop eating as a result of a traumatic event (aversi- ve). Due to the recent incorporation of ARFID into the DSM-5, there is a lack of information regar ding its treatment. The purpose of this review is to clarify diagnostic criteria and to describe targeted management and treatment interventions with a multidisciplinary approach, without deepening on the treatment of organic medical causes.


Assuntos
Transtorno da Evitação ou Restrição da Ingestão de Alimentos , Estimulantes do Apetite/uso terapêutico , Transtorno do Espectro Autista/complicações , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/classificação , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Hipersensibilidade Alimentar/complicações , Humanos , Recém-Nascido Prematuro , Avaliação de Sintomas
4.
Biochem J ; 478(9): 1663-1688, 2021 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-33970218

RESUMO

Cancer cachexia often occurs in malignant tumors and is a multifactorial and complex symptom characterized by wasting of skeletal muscle and adipose tissue, resulting in weight loss, poor life quality and shorter survival. The pathogenic mechanism of cancer cachexia is complex, involving a variety of molecular substrates and signal pathways. Advancements in understanding the molecular mechanisms of cancer cachexia have provided a platform for the development of new targeted therapies. Although recent outcomes of early-phase trials have showed that several drugs presented an ideal curative effect, monotherapy cannot be entirely satisfactory in the treatment of cachexia-associated symptoms due to its complex and multifactorial pathogenesis. Therefore, the lack of definitive therapeutic strategies for cancer cachexia emphasizes the need to develop a better understanding of the underlying mechanisms. Increasing evidences show that the progression of cachexia is associated with metabolic alternations, which mainly include excessive energy expenditure, increased proteolysis and mitochondrial dysfunction. In this review, we provided an overview of the key mechanisms of cancer cachexia, with a major focus on muscle atrophy, adipose tissue wasting, anorexia and fatigue and updated the latest progress of pharmacological management of cancer cachexia, thereby further advancing the interventions that can counteract cancer cachexia.


Assuntos
Anorexia/tratamento farmacológico , Antineoplásicos/uso terapêutico , Caquexia/tratamento farmacológico , Fadiga/tratamento farmacológico , Atrofia Muscular/tratamento farmacológico , Neoplasias/tratamento farmacológico , Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/metabolismo , Tecido Adiposo/patologia , Anorexia/complicações , Anorexia/metabolismo , Anorexia/mortalidade , Anti-Inflamatórios/uso terapêutico , Estimulantes do Apetite/uso terapêutico , Caquexia/complicações , Caquexia/metabolismo , Caquexia/mortalidade , Fadiga/complicações , Fadiga/metabolismo , Fadiga/mortalidade , Humanos , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Atrofia Muscular/complicações , Atrofia Muscular/metabolismo , Atrofia Muscular/mortalidade , Neoplasias/complicações , Neoplasias/metabolismo , Neoplasias/mortalidade , Qualidade de Vida , Análise de Sobrevida , Congêneres da Testosterona/uso terapêutico , Perda de Peso/efeitos dos fármacos
5.
Clin Nutr ESPEN ; 42: 407-409, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33745614

RESUMO

BACKGROUND: Cystic fibrosis (CF) is a multi-organ genetically inherited disease that leads to progressive lung disease and nutrient malabsorption. The aim of this study was to assess the effectiveness of cyproheptadine (CH) (Periactin®) as an appetite stimulant on improving the nutrition status of paediatric patients with CF. METHODS: We conducted a retrospective study of 15 patients with a suboptimal nutrition status prescribed CH for ≥12 months from 2013 to 2018. Change in Body Mass Index (BMI) z-score and lung function before vs. after treatment with CH were measured as well as dose-response relationship. RESULTS: The mean change in BMI z-score over 12 months of treatment with CH was +0.91 compared to -0.52 in the previous 12 months (p∗∗∗ = 0.0002). There was also a trend towards an improvement in lung function over the 12 months of CH treatment compared to the 12 months prior (+2.79 vs -6.2% (p = 0.07)). No dose-response relationship was observed. CONCLUSION: These results suggest that CH is effective at improving the nutrition status of paediatric CF patients with suboptimal nutrition.


Assuntos
Estimulantes do Apetite , Fibrose Cística , Estimulantes do Apetite/uso terapêutico , Índice de Massa Corporal , Criança , Ciproeptadina/uso terapêutico , Fibrose Cística/tratamento farmacológico , Humanos , Estudos Retrospectivos
6.
J Med Primatol ; 50(2): 128-133, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33528049

RESUMO

BACKGROUND: Hyporexia and weight loss are important indicators of physical and psychological well-being in macaque colonies. An FDA-approved transdermal formulated Mirtazapine (MTZ) shows effectiveness in managing feline hyporexia. This study sought to determine its effectiveness as an appetite stimulant in macaques. METHODS: Fourteen macaques with idiopathic hyporexia, intractable to conventional management were treated with transdermal MTZ (0.5 mg/kg) topically administered to aural pinnae once daily for 14 days. Qualitative food consumption was monitored daily for 6 months. Body weights were collected prior to treatment, every 2 weeks for the first 6 weeks, 10 weeks, and 6 months post-treatment. RESULTS: Transdermal MTZ significantly reduced the frequency of hyporexia during treatment and monthly for 6 months. No significant increase in weight noted until approximately 6 months post-treatment. CONCLUSIONS: Results from this study indicate that a short course of transdermal MTZ is an effective way to increase food consumption in macaques chronically.


Assuntos
Anorexia/tratamento farmacológico , Estimulantes do Apetite/administração & dosagem , Macaca fascicularis , Macaca mulatta , Mirtazapina/administração & dosagem , Doenças dos Macacos/tratamento farmacológico , Administração Cutânea , Animais , Feminino , Masculino
7.
Sci Rep ; 11(1): 2421, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33510313

RESUMO

This multi-site, double blind, parallel arm, fixed dose, randomised placebo controlled phase III study compared megestrol acetate 480 mg/day with dexamethasone 4 mg/day for their net effects on appetite in people with cancer anorexia. Patients with advanced cancer and anorexia for ≥ 2 weeks with a score ≤ 4 (0-10 numeric rating scale (NRS) 0 = no appetite, 10 = best possible appetite) were recruited. Participants received megestrol 480 mg or dexamethasone 4 mg or placebo daily for up to 4 weeks. Primary outcomes were at day 7. Responders were defined as having a ≥ 25% improvement in NRS over baseline. There were 190 people randomised (megestrol acetate n = 61; dexamethasone n = 67, placebo n = 62). At week 1 (primary endpoint), 79·3% in the megestrol group, 65·5% in the dexamethasone group and 58·5% in the placebo group (p = 0.067) were responders. No differences in performance status or quality of life were reported. Treatment emergent adverse events were frequent (90·4% of participants), and included altered mood and insomnia. Hyperglycemia and deep vein thromboses were more frequent when on dexamethasone than the other two arms. There was no difference in groups between the three arms, with no benefit seen over placebo with anorexia improving in all arms.Trail registration: The trial was registered on 19/08/2008 with the Australian New Zealand Clinical Trials Registry (ACTRN12608000405314).


Assuntos
Anorexia/tratamento farmacológico , Estimulantes do Apetite/uso terapêutico , Dexametasona/uso terapêutico , Acetato de Megestrol/uso terapêutico , Neoplasias/complicações , Idoso , Idoso de 80 Anos ou mais , Anorexia/diagnóstico , Anorexia/etiologia , Apetite , Estimulantes do Apetite/administração & dosagem , Austrália , Dexametasona/administração & dosagem , Gerenciamento Clínico , Feminino , Humanos , Masculino , Acetato de Megestrol/administração & dosagem , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias/diagnóstico , Neoplasias/terapia , Qualidade de Vida , Resultado do Tratamento
8.
BMJ Support Palliat Care ; 11(1): 75-85, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33246937

RESUMO

AIMS: Randomised controlled trials (RCTs) demonstrated benefits of pharmacological interventions for cachexia in improving weight and appetite. However, comparative efficacy and safety are not available. We conducted a systematic review and network meta-analysis (NMA) to evaluate the relative efficacy and safety of pharmacological interventions for cachexia. METHODS: PubMed, EmBase, Cochrane, and ClinicalTrials.gov were searched for RCTs until October 2019. Key outcomes were total body weight (TBW) improvement, appetite (APP) score and serious adverse events. Two reviewers independently extracted data and assessed risk of bias. NMA was performed to estimate weight gain and APP score increase at 8 weeks, presented as mean difference (MD) or standardised MD with 95% CI. RESULTS: 80 RCTs (10 579 patients) with 12 treatments were included. Majority is patients with cancer (7220). Compared with placebo, corticosteroids, high-dose megestrol acetate combination (Megace_H_Com) (≥400 mg/day), medroxyprogesterone, high-dose megestrol acetate (Megace_H) (≥400 mg/day), ghrelin mimetic and androgen analogues (Androgen) were significantly associated with MD of TBW of 6.45 (95% CI 2.45 to 10.45), 4.29 (95% CI 2.23 to 6.35), 3.18 (95% CI 0.94 to 5.41), 2.66 (95% CI 1.47 to 3.85), 1.73 (95% CI 0.27 to 3.20) and 1.50 (95% CI 0.56 to 2.44) kg. For appetite improvement, Megace_H_Com, Megace_H and Androgen significantly improved standardised APP score, compared with placebo. There is no significant difference in serious adverse events from all interventions compared with placebo. CONCLUSIONS: Our findings suggest that several pharmacological interventions have potential to offer benefits in treatment of cachexia especially Megace_H and short-term use corticosteroids. Nonetheless, high-quality comparative studies to compare safety and efficacy are warranted for better management of cachexia.


Assuntos
Corticosteroides/administração & dosagem , Estimulantes do Apetite/administração & dosagem , Caquexia/tratamento farmacológico , Fármacos Gastrointestinais/administração & dosagem , Acetato de Megestrol/administração & dosagem , Androgênios/administração & dosagem , Apetite/efeitos dos fármacos , Caquexia/etiologia , Pesquisa Comparativa da Efetividade , Quimioterapia Combinada , Grelina/administração & dosagem , Humanos , Medroxiprogesterona/administração & dosagem , Diferença Mínima Clinicamente Importante , Neoplasias/complicações , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Assistência Terminal/métodos , Ganho de Peso/efeitos dos fármacos
9.
J Feline Med Surg ; 22(12): 1176-1183, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32462966

RESUMO

OBJECTIVES: The aim of the study was to evaluate the appetite-stimulating effect of gabapentin by comparing it with mirtazapine in healthy cats in the first 8 h after ovariectomy surgery. METHODS: This double-masked, placebo-controlled, prospective clinical trial included 60 healthy cats presented to the hospital for ovariectomy: 20 received gabapentin, 21 received mirtazapine and 19 received a placebo immediately before and 6 h after surgery. Food was offered at 2, 4, 6 and 8 h post-ovariectomy. After each meal, food intake was measured. Data were analysed using repeated-measure ANOVA and a linear mixed-model analysis. Post-hoc Tukey's honest significant difference test was performed for multiple comparisons. RESULTS: Food intake increased in both treatment groups vs placebo. No statistically significant difference was found between cats treated with gabapentin or mirtazapine. CONCLUSIONS AND RELEVANCE: Cats receiving gabapentin ate more than cats in the placebo group. Thirty percent of cats in the gabapentin group covered their resting energy requirements, while none of the cats in the placebo group did. Gabapentin and mirtazapine produced similar effects on food intake.


Assuntos
Estimulantes do Apetite/farmacologia , Gabapentina/farmacologia , Mirtazapina/farmacologia , Ovariectomia/veterinária , Analgésicos/administração & dosagem , Animais , Anticonvulsivantes/administração & dosagem , Apetite/efeitos dos fármacos , Gatos , Método Duplo-Cego , Feminino , Estudos Prospectivos
10.
Biochim Biophys Acta Rev Cancer ; 1873(2): 188359, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32222610

RESUMO

Advanced cancer patients exhibit cachexia, a condition characterized by a significant reduction in the body weight predominantly from loss of skeletal muscle and adipose tissue. Cachexia is one of the major causes of morbidity and mortality in cancer patients. Decreased food intake and multi-organ energy imbalance in cancer patients worsen the cachexia syndrome. Cachectic cancer patients have a low tolerance for chemo- and radiation therapies and also have a reduced quality of life. The presence of tumors and the current treatment options for cancer further exacerbate the cachexia condition, which remains an unmet medical need. The onset of cachexia involves crosstalk between different organs leading to muscle wasting. Recent advancements in understanding the molecular mechanisms of skeletal muscle atrophy/hypertrophy and adipose tissue wasting/browning provide a platform for the development of new targeted therapies. Therefore, a better understanding of this multifactorial disorder will help to improve the quality of life of cachectic patients. In this review, we summarize the metabolic mediators of cachexia, their molecular functions, affected organs especially with respect to muscle atrophy and adipose browning and then discuss advanced therapeutic approaches to cancer cachexia.


Assuntos
Estimulantes do Apetite/uso terapêutico , Caquexia/patologia , Atrofia Muscular/patologia , Neoplasias/complicações , Apoio Nutricional/métodos , Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/metabolismo , Tecido Adiposo/patologia , Tecido Adiposo/efeitos da radiação , Antineoplásicos/efeitos adversos , Estimulantes do Apetite/farmacologia , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Osso e Ossos/efeitos da radiação , Caquexia/etiologia , Caquexia/metabolismo , Caquexia/terapia , Citocinas/metabolismo , Suplementos Nutricionais , Metabolismo Energético/efeitos dos fármacos , Metabolismo Energético/efeitos da radiação , Glucocorticoides/metabolismo , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Mucosa Intestinal/efeitos da radiação , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Fígado/efeitos da radiação , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Músculo Esquelético/efeitos da radiação , Atrofia Muscular/etiologia , Atrofia Muscular/metabolismo , Neoplasias/terapia , Pâncreas/efeitos dos fármacos , Pâncreas/metabolismo , Pâncreas/patologia , Pâncreas/efeitos da radiação , Hormônio Paratireóideo/metabolismo , Proteína Relacionada ao Hormônio Paratireóideo/metabolismo , Qualidade de Vida , Radioterapia/efeitos adversos , Ganho de Peso/efeitos dos fármacos
11.
BMJ Open Respir Res ; 7(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32213537

RESUMO

INTRODUCTION: Cachexia is common in malignant mesothelioma (MM); half of patients have malnutrition and low skeletal muscle mass. Malnourished patients have worse quality of life (QoL). Weight loss is strongly associated with poor survival. Anamorelin is an oral ghrelin receptor agonist that improves appetite, body weight and QoL in advanced cancer. The aim of this study is to examine the efficacy of anamorelin in improving appendicular skeletal muscle mass (ASM) and patient-reported outcomes in patients with MM with cachexia. METHODS AND ANALYSIS: A single-centre, phase II, randomised, placebo-controlled cross-over pilot study with 28-day treatment periods and 3-day washout. Forty patients will be randomised. Primary outcome is change in ASM relative to height measured by dual energy X-ray absorptiometry at end of period 1. Secondary outcomes include cancer-specific and cachexia-related QoL, objective physical activity, dietary intake and adverse events. Eligible patients will have confirmed MM, Eastern Cooperative Oncology Group 0-2, expected survival >3 months and cachexia (defined as >5% weight loss in 6 months or body mass index <20 kg/m2 with weight loss >2%). ETHICS AND DISSEMINATION: Ethical approval has been granted. Results will be reported in peer-reviewed publications. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (U1111-1240-6828).


Assuntos
Estimulantes do Apetite/uso terapêutico , Caquexia/complicações , Caquexia/tratamento farmacológico , Hidrazinas/uso terapêutico , Mesotelioma Maligno/complicações , Oligopeptídeos/uso terapêutico , Absorciometria de Fóton , Estimulantes do Apetite/efeitos adversos , Austrália , Composição Corporal/efeitos dos fármacos , Caquexia/etiologia , Caquexia/fisiopatologia , Ensaios Clínicos Fase II como Assunto , Estudos Cross-Over , Método Duplo-Cego , Humanos , Hidrazinas/efeitos adversos , Modelos Lineares , Força Muscular/efeitos dos fármacos , Oligopeptídeos/efeitos adversos , Projetos Piloto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso/efeitos dos fármacos
12.
Rom J Intern Med ; 58(2): 55-68, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32134741

RESUMO

Sufficient caloric intake is important to maintain the balanced health status, especially during the period of aging, as aging and sickness share paths. Maintaining adequate nutritional balance is the best preventive measure to counteract the risk of malnutrition. There are several causes for malnutrition in elderly people, and some techniques such as anthropometric measurements, laboratory and clinical parameters could help to diagnose malnutrition in these patients. The use of a simple validated questionnaire called the 'Mini Nutritional Assessment' measures the nutritional status of elderly patients. In this review, we discuss about the malnutrition in elderly people with and without a known cause and we present some of nutritional intervention. There are promising strategies that help overcoming malnutrition.


Assuntos
Envelhecimento/metabolismo , Desnutrição/diagnóstico , Desnutrição/terapia , Estimulantes do Apetite/toxicidade , Suplementos Nutricionais , Humanos , Desnutrição/epidemiologia , Desnutrição/metabolismo , Avaliação Nutricional , Apoio Nutricional , Pré-Albumina/metabolismo , Medição de Risco , Albumina Sérica/metabolismo , Transferrina/metabolismo , Perda de Peso
13.
J Feline Med Surg ; 22(4): 376-383, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31161850

RESUMO

OBJECTIVES: The aim of this study was to assess the appetite stimulation properties of compounded transdermal mirtazapine (CTM) in cats with chronic kidney disease (CKD). METHODS: Two sequential double-blind placebo-controlled crossover prospective studies were performed in client-owned cats with stable stage 2 or 3 CKD and a history of decreased appetite. In the first study nine CKD cats were randomized to receive 3.75 mg/0.1 ml CTM gel or placebo on the inner pinna every other day for 3 weeks, then, after a 4 day washout period, the cats were crossed over to the alternate 3 week treatment. In a second study, 10 CKD cats were randomized to receive 1.88 mg/0.1 ml CTM or placebo on the same schedule. Physical examination and serum biochemistry were performed before and after each treatment period, and owners kept daily logs of appetite, activity and eating behaviors. Mirtazapine concentrations in CTM gels and steady-state mirtazapine serum concentrations were measured using liquid chromatography/tandem mass spectrometry. RESULTS: Administration of both 3.75 mg and 1.88 mg CTM resulted in a statistically significant increase in weight (P = 0.002 for both), increase in appetite (P = 0.01 and P = 0.005, respectively), and increase in rate of food consumption (P = 0.03 and P = 0.008, respectively). No significant difference in activity or vocalization was seen at either dose; however, individual cats experienced excessive meowing. Median weight increase for the 3.75 mg arm was 0.22 kg (range 0.04-0.44 kg), while median weight increase for the 1.88 mg arm was 0.26 kg (range -0.25 to 0.5 kg). Improvement in body condition score was seen in 5/9 cats in the 3.75 mg arm (P = 0.04) and 6/10 cats in the 1.88 mg arm (P = 0.004). CONCLUSIONS AND RELEVANCE: CTM increased appetite and resulted in weight gain in CKD cats despite significant inconsistencies in compounding, and may benefit cats in countries where an approved product is not available.


Assuntos
Estimulantes do Apetite , Doenças do Gato/tratamento farmacológico , Mirtazapina , Insuficiência Renal Crônica , Administração Cutânea , Animais , Estimulantes do Apetite/administração & dosagem , Estimulantes do Apetite/uso terapêutico , Gatos , Método Duplo-Cego , Mirtazapina/administração & dosagem , Mirtazapina/uso terapêutico , Estudos Prospectivos , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/veterinária
14.
J Food Sci ; 84(9): 2666-2673, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31441517

RESUMO

Natural plant extracts are increasingly used as functional feed ingredients in animal husbandry and food ingredients in human alternative medicine to improve welfare and health. We investigated in 20 growing pigs via functional magnetic resonance imaging (fMRI) the brain blood oxygen level-dependent (BOLD) responses to olfactory stimulation with two sensory functional feed ingredients, A and B, at two different concentrations. Functional ingredient A contained extracts from Citrus sinensis (60% to 80%), and ingredient B contained a mixture of extracts Oreganum vulgarae (40% to 55%) and Cymbopogon flexuosus (20% to 25%). Increased concentration of ingredients induced a higher activation in reward and cognitive areas compared to lower concentrations. Moreover, considering both ingredients at the highest concentration, the ingredient A elicited higher brain responses in brain areas involved in hedonism/pleasantness compared to ingredient B, and more specifically in the caudate nucleus and orbitofrontal cortex. Our findings shed new light in the scope of emotion regulation through olfactory modulation via sensory functional ingredients, which opens the way to further preclinical studies in animal models and translational research in the context of nutrition, welfare, and health. PRACTICAL APPLICATION: Functional food/feed ingredients are gaining interest for improving health and welfare in humans and animals. Besides representing an alternative to antibiotics for example, food ingredients and their sensory characteristics might have a positive impact on emotions and consequently on well-being. Functional brain imaging in large animals such as in the pig model is a promising approach to investigate the central and behavioural effects of food ingredients, and determine the most effective blends and concentrations to modulate internal and emotional states.


Assuntos
Estimulantes do Apetite/farmacologia , Encéfalo , Imageamento por Ressonância Magnética , Olfato , Animais , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Emoções/efeitos dos fármacos , Emoções/fisiologia , Ingredientes de Alimentos , Alimento Funcional , Extratos Vegetais , Olfato/efeitos dos fármacos , Olfato/fisiologia , Suínos
15.
Curr Gastroenterol Rep ; 21(10): 51, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31444689

RESUMO

PURPOSE OF REVIEW: This review provides an approach for resolving a variety of feeding difficulties in children, ranging from normal eating behavior that is misperceived as a problem to substantial feeding disorders. RECENT FINDINGS: Criteria to identify pediatric feeding disorders have been thoroughly addressed in the newly established designations of avoidant restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD). These diagnostic criteria improve the accuracy of identifying, classifying, and managing significant feeding disorders in young children. While recent definitions of feeding difficulties are particularly appropriate in multidisciplinary settings, in this paper, we advocate for a progressive approach of managing feeding problems in all clinical settings. It begins by identifying red flags indicative of serious threats to the child, screening for oral motor dysfunction, stabilizing nutrient intake, and eliminating aversive feeding practices. The next step, if eating behavior does not improve, involves strategies that target specific eating behaviors and parental feeding styles. In severe or resistant cases, referral to specialists or interdisciplinary feeding teams is advised.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Apetite , Estimulantes do Apetite/uso terapêutico , Transtorno da Evitação ou Restrição da Ingestão de Alimentos , Criança , Medo , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Seletividade Alimentar , Preferências Alimentares , Humanos , Poder Familiar , Equipe de Assistência ao Paciente/organização & administração
16.
Int Urol Nephrol ; 51(9): 1631-1638, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31359357

RESUMO

PURPOSE: Malnutrition, inflammation and poor quality of life are prevalent among elderly haemodialysis patients. Megestrol acetate (MA) is a synthetic progestin that is widely used to increase appetite and weight in various clinical settings. MA has been indicated to be effective in improving quality of life in patients with cancers. The aim of the present study was to evaluate the efficacy and safety of MA in treating malnourished elderly haemodialysis patients. METHODS: A randomized controlled study involving 46 hypoalbuminemia haemodialysis patients aged 70 years or older was conducted. The patients in MA-treated group (n = 23) took 160 mg of MA daily, while those in control group (n = 23) were enrolled without any intervention. Anthropometric parameters and laboratory results, including height, dry weight, body mass index, and modified subjective global assessment score as well as serum albumin, triglyceride, total cholesterol, hsCRP, IL-1b and IL-6 concentrations were measured in all patients before and after the intervention. Health-related quality of life was also evaluated using the KDQOL-SF 1.3. RESULTS: In the MA-treated group, a total of 18 patients finished the therapy over a 3-month period. Appetite was reported as improved by 15 patients, and a statistically significant increase was observed in dry weight (53.36 ± 6.15 vs. 54.24 ± 6.32, P < 0.01) and serum albumin concentration (29.05 ± 3.91 vs. 37.67 ± 4.88, P < 0.01) in the MA-treated group compared to those of the control group. The quality of life in both the physical domain (46.73 ± 18.17 vs. 63.37 ± 22.35, P < 0.01) and the mental domain (50.28 ± 20.36 vs. 68.02 ± 25.48, P < 0.01) was also improved in the same group. There was no significant change in the inflammatory marker concentrations after the intervention. No serious or unexpected adverse events were observed except that one patient who withdrew due to excessive fluid gain between haemodialysis sessions. CONCLUSION: Our data suggest that MA can be effective in improving nutritional status and quality of life by increasing appetite in elderly haemodialysis patients with acceptable side effects; however, MA might not ameliorate inflammation.


Assuntos
Estimulantes do Apetite/uso terapêutico , Inflamação/tratamento farmacológico , Desnutrição/tratamento farmacológico , Acetato de Megestrol/uso terapêutico , Qualidade de Vida , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
17.
Adv Food Nutr Res ; 88: 275-298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31151726

RESUMO

The production of engineered nanomaterials (ENMs) has increased exponentially over the last few decades. ENMs, made from use of engineered nanoparticles (ENPs), have been applied to the food, agriculture, pharmaceutical, and automobile industries. Of particular interest are their applications in packaging nanocomposites for consumer and non-consumer goods. ENPs in nanocomposites are of interest as a packaging material because they reduce the amount of polymer needed, while improving the physical properties. However, the transformation of ENPs in nanocomposite production, their fate, and their toxicity remain unknown while in contact with the package content or after the end of life. The objectives of this chapter are (a) to provide an overview of the main nanoclays used in packaging; (b) to categorize the main polymeric packaging nanocomposites; (c) to provide an overview of the fate and mass transport of ENPs, especially nanoclays; (d) to describe the mass transfer of nanoclays in food simulants and in compost environments; and (e) to identify current and future research needs.


Assuntos
Estimulantes do Apetite/metabolismo , Argila , Compostagem/normas , Embalagem de Alimentos/métodos , Nanocompostos/normas , Argila/química , Argila/classificação , Argila/normas , Compostagem/métodos , Embalagem de Alimentos/normas , Nanocompostos/toxicidade , Pesquisa/normas , Pesquisa/tendências
18.
Vet Clin North Am Small Anim Pract ; 49(5): 837-854, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176457

RESUMO

Appetite influences perceived quality of life for a dog or cat with cancer. Inappetence often is multifactorial, complicating treatment. Cancer-related anorexia/cachexia syndrome is a metabolic, paraneoplastic syndrome characterized by decreased food intake, involuntary weight loss, and loss of fat and muscle. If weight loss/cachexia has an impact on canine and feline cancer patients as in humans, management may improve survival times and quality of life. The challenge is having effective, proved therapies available for clinical use. Recent Food and Drug Administration approvals for appetite stimulation have renewed interest and discussion and has the potential to alter the course of case management.


Assuntos
Anorexia/veterinária , Caquexia/veterinária , Doenças do Gato/terapia , Doenças do Cão/terapia , Neoplasias/veterinária , Animais , Anorexia/complicações , Anorexia/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Estimulantes do Apetite/uso terapêutico , Caquexia/complicações , Caquexia/terapia , Canabidiol/uso terapêutico , Doenças do Gato/etiologia , Gatos , Doença Crônica , Doenças do Cão/etiologia , Cães , Neoplasias/complicações , Qualidade de Vida
19.
Heart Fail Rev ; 24(5): 617-623, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30923991

RESUMO

Cardiac cachexia is a syndrome of progressive skeletal muscle and fat loss affecting a significant number of congestive heart failure patients. With the potential detrimental effects of cardiac muscle wasting, greater attention is needed to understanding the prevention and treatment of the condition. Potential therapeutic approaches are aimed at the various mechanisms for the pathogenesis of cardiac cachexia including neurohormonal abnormalities, immune activation and inflammation, metabolic hormonal imbalance, and gastrointestinal abnormalities. While there are no current guideline-recommended treatments for the prevention of cardiac cachexia, targeting an imbalance of the renin-angiotensin-aldosterone system with beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers appears to be the most well-studied therapeutic approaches. Treatment of inflammation with monoclonal antibodies, hormonal imbalance with testosterone, and nutritional deficiencies with appetite stimulants has also been suggested. Proposed therapies may prove beneficial in heart failure patients; however, further studies specifically focusing on the cardiac component of cachexia are needed before definitive therapy options can be established.


Assuntos
Caquexia/tratamento farmacológico , Caquexia/prevenção & controle , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/prevenção & controle , Antagonistas Adrenérgicos beta/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Estimulantes do Apetite/uso terapêutico , Diuréticos/uso terapêutico , Humanos , Sistema Renina-Angiotensina/efeitos dos fármacos , Síndrome , Testosterona/uso terapêutico
20.
Appetite ; 137: 62-72, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30825493

RESUMO

OBJECTIVE: A systematic review identifying the use of cyproheptadine (CY) as an appetite stimulant was completed. METHOD: Studies of any design exploring the efficacy of CY as an appetite stimulant in all age groups and populations were included. Primary outcomes of studies included were weight gain, appetite stimulation, and/or caloric/nutritional intake increase. The review was completed in accordance with PRISMA standards. RESULTS: A total of 46 articles across 21 different treatment populations met criteria for the review, including 32 randomized controlled trials, 4 prospective cohort studies, 4 retrospective cohort studies, 4 case reports and 2 case series. Of these, 39 demonstrated that CY resulted in significant weight gain in the sample under study. Studies exploring the use of CY in those with malignant/progressive disease states, such as HIV and cancer, showed minimal to no benefit of the medication. Transient mild to moderate sedation was the most commonly reported side effect. Studies included were heterogeneous in terms of methods as well as study patient demographics, characteristics and concurrent medical conditions. Few studies provided objective measures of appetite change. DISCUSSION: CY appears to be a safe, generally well-tolerated medication that has utility in helping facilitate weight gain in patients drawn from a variety of underweight populations. Future prospective randomized controlled studies in low weight patients that include objective measures of appetite and intake are needed to better understand the mechanism by which CY augments weight gain.


Assuntos
Estimulantes do Apetite/farmacologia , Apetite/efeitos dos fármacos , Ciproeptadina/farmacologia , Ganho de Peso , Anorexia Nervosa/tratamento farmacológico , Humanos , Desnutrição/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Magreza/tratamento farmacológico
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