Appetite Stimulation Research Articles

Rationed and satiated growth hormone transgenic Coho Salmon (Oncorhynchus kisutch) show tissue specific differences in energy stores.

Growth hormone transgenic coho salmon experience increased growth rates, driven primarily through elevated feed intake and feed conversion. However, neuropeptides that signal appetite stimulation have been shown to exhibit variable responses across fed states, suggesting a more complex system mediating growth in these fish. Studies have proposed that growth hormone may have a modulatory role on the energy reserves of fish, possibly through AMP-activated protein kinase (AMPK) activation. AMPK, an energy sensor in cells, has previously been shown to be upregulated in growth hormone transgenic salmon when compared to wild type, however, whether this effect is seen across fed states is unknown. Here, we tested the hypothesis that growth hormone induces an energetic deficit in metabolic tissues, leading to constitutive AMPK activation in growth hormone transgenic salmon. This study compared AMPK activity, ATP, and glycogen, of the liver, heart, and muscle of wild-type, and growth hormone transgenic salmon either fed to satiation or a wild-type ration. The results suggest that white muscle ATP levels in growth hormone salmon are elevated in satiation and rationed conditions. In the liver, growth hormone transgenic salmon fed a rationed wild-type diet experience reductions in ATP level and glycogen. In none of the tissues examined, did AMPK activity change. Taken together, these results indicate that growth hormone transgenic salmon experience metabolic duress when not fed to satiation.

Histological and Micromeritic Differences Between the Two Varieties of Lonchocarpus sericeus (Poir.) Kunth ex DC. (Fabaceae)

Purpose: Lonchocarpus sericeus (Poir.) kunth ex DC. (Fabaceae) is a tropical plant used in ethnomedicine as an analgesic, appetite stimulant, antibacterial and cytotoxic agent. This study aims to establish histological and micromeritic parameters as standards for the leaves of brown and white varieties. Methods: The leaves of both varieties were collected, dried under shade and pulverized. Microscopic evaluations were done on both the fresh and powdered samples. Micromeritic properties were determined for the plant organs collected. Carr’s index, angle of repose and Hausner’s ratio were calculated. Chemomicroscopic and fluorescence evaluations were also done on the powders. Results: The results obtained from the microscopy of the fresh leaves revealed hypostomatic stomatal distribution and anomocytic type of stomata for the brown variety and paracytic type of stomata for the white variety both on abaxial surfaces. The epidermal cell shapes for the abaxial and adaxial surfaces were both irregular. The stomatal number was found to be 36.9 ± 0.71 and 17.8 + 0.97 for the brown and white varieties respectively. The stomatal index was 8.13 %. and 7.45 % for the brown and white varieties respectively. The angle of repose for the brown and white varieties were 33.7 ± 0.72 and 40.05 ± 0.57 respectively. The chemomicroscopic result revealed that both leaves contained cellulose, mucilage, lignin, protein and starch. Conclusion: The results obtained from this study can be used to distinguish between the two varieties, and could also serve as pharmacopeial standards for quality assurance of the medicinal plant as a herbal drug. Keywords: Lonchocarpus sericeus, Carr’s index, Hausner’s ratio, micromeritic, histological

IMPACT OF FEEDS CONTAINING OPTIFEED®, VÊO® PREMIUM, AND OLEOBIOTEC® ON THE LIPID PEROXIDATION OF MALE BROILERS UNDER HEAT STRESS

The present study was conducted to investigate the effect of adding various levels of Optifeed®, VêO® premium and Oleobiotec® to the diets as appetite stimulants in the production Performance of broiler males under heat stress conditions. The experiment was done for 42 days for the period from 30 August 2018 to 11 of October 2018 at the Poultry Research Station of the Livestock Research Department / Agricultural Research Department / Ministry of Agriculture (Baghdad - Abu Ghraib). In this study, 270 - one-day broiler males (Ross 308) were reared with a mean body weight of 37 g/chick, distributed randomly on 18 pens with dimensions of 2 x 3 m (length x width). The experimental treatments involved six treatments with three replicates for each treatment (per replicate 15 chicks). The treatments were included T1: basal diet as a control with no additions, T2: basal diet + 500 g/ton of Optifeed®, T3: basal diet + 250 g/ton of VêO® premium, T4: basal diet + 250 g/ton of Oleobiotec®, T5: basal diet + 250 g of Optifeed® + 125 g of VêO® premium + 125 g of oleobiotec® /ton of feed, T6: basal diet + 500 g Optifeed® + 250 g VêO® premium + 250 g Oleobiotec® g/ton of feed. The obtained results showed that a significant decrease in all experimental trials of Malondialdehyde (MDA) for broiler liver tissue compared to control treatment. Treatment (T6) recorded the lowest concentration of dehydrode (MDA) compared to other treatments.

THE ROLE OF OPTIFEED®, VÊO® PREMIUM, AND OLEOBIOTEC® IN DIETS FOR IMPROVEMENT OF THE PRODUCTION PERFORMANCE OF MALE BROILERS IN HEAT STRESS

The present study was conducted to investigate the effect of adding various levels of Optifeed®, VêO® premium and Oleobiotec® to the diets as appetite stimulants in the production Performance of broiler males under heat stress conditions. The experiment was done for 42 days for the period from 30 August 2018 to 11 of October 2018 at the Poultry Research Station of the Livestock Research Department / Agricultural Research Department / Ministry of Agriculture (Baghdad - Abu Ghraib). In this study, 270 - one-day broiler males (Ross 308) were reared with the mean body weight of 37 g/chick, distributed randomly on 18 pens with dimensions of 2 x 3 m (length x width). The experimental treatments involved six treatments with three replicates for each treatment (per replicate 15 chicks). The treatments were included T1: basal diet as a control with no additions, T2: basal diet + 500 g/ton of Optifeed®, T3: basal diet + 250 g/ton of VêO® premium, T4: basal diet + 250 g/ton of Oleobiotec®, T5: basal diet + 250 g of Optifeed® + 125 g of VêO® premium + 125 g of oleobiotec® /ton of feed, T6: basal diet + 500 g Optifeed® + 250 g VêO® premium + 250 g Oleobiotec® g/ton of feed. The obtained results showed that the supplemented treatments significantly (p ≤ 0.05) increased the performance characteristics Cumulative (1-42) day, especially the fifth treatment T5 compared with the control treatment, in both live body weight, body weight gain, relative growth rate, feed consumption, The cumulative feed ratio, the production index, and the economic index.

The therapeutic use of cannabis and cannabinoids

Cannabinoids mainly target the endocannabinoid system, which emerges as a potentially interesting therapeutical target due to its major role in modulating key biological processes throughout the body. As such, cannabinoids have already been proposed as, for example, anti-emetics, antispasticity agents, appetite stimulants, anti-epileptic, analgesic, depressants of intraocular pressure or as agents to control movement disorders in Tourette syndrome. Here, we reviewed the research evidence available regarding the use of cannabis and cannabinoids for a set of suggested therapeutical applications, and addressed some of the short- and long-term risks that have been correlated with the use of these substances. We found scarce scientific evidence supporting the use of cannabis-based products for most of the suggested applications, as well as no unmet medical need that is not already tackled by existing medicines (some cannabinoid-based) in the market. In such a scenario, the potential risks associated with the chronic use of these substances may deter their medical use.

Malnutrition screening and treatment in pediatric oncology: a scoping review

BackgroundMalnutrition and cachexia during pediatric cancer treatment worsen toxicity and quality-of-life. Clinical practice varies with lack of standard malnutrition definition and nutrition interventions. This scoping review highlights available malnutrition screening and intervention data in childhood cancer and the need for standardizing assessment and treatment.MethodsOvid Medline, CINAHL, and Cochrane Library were searched for studies containing malnutrition as the primary outcome with anthropometric, radiographic, or biochemical measurements. Secondary outcomes included validated nutritional assessment or screening tools. Two authors reviewed full manuscripts for inclusion. Narrative analysis was chosen over statistical analysis due to study heterogeneity.ResultsThe search yielded 234 articles and 17 articles identified from reference searching. Nine met inclusion criteria with six nutritional intervention studies (examining appetite stimulants, nutrition supplementation, and proactive feeding tubes) and three nutritional screening studies (algorithms or nutrition support teams) each with variable measures and outcomes. Both laboratory evaluations (albumin, prealbumin, total protein) and body measurement (weight loss, mid-upper arm circumference) were used. Studies demonstrated improved weight, without difference between formula or appetite stimulant used. Screening studies yielded mixed results on preventing weight loss, weight gain, and survival.ConclusionOur review demonstrated a paucity of evidence for malnutrition screening and intervention in pediatric cancer treatment. While a variety of malnutrition outcomes, interventions, and screening tools exist, nutritional interventions increased weight and decreased complications. Screening tools decreased malnutrition risk and may improve weight gain. Potential age- and disease-specific nutritional benefits and toxicities also exist, further highlighting the benefit of standardizing malnutrition definitions, screening, and interventions.

Blockade of the orexin 1-receptors and ‘cocaine- and amphetamine-regulated transcript’ in the nucleus accumbens shell alters impulse control in rats

Impulsivity is a multifaceted construct and alterations in impulsiveness are often associated with psychiatric diseases, including drug addiction and binge eating disorder. Impulse control involves several brain regions. The present study assessed the role of the orexigenic, appetite stimulating neuropeptide orexin (OX) and the anorexigenic, appetite reducing neuropeptide cocaine- and amphetamine-regulated transcript (CART) within the nucleus accumbens shell (NAcSh) in impulse control in rats. The animals were ranked for their trait impulsivity based on a screening in the 5-choice serial reaction time task (5-CSRTT). The rats’ performances were analysed after bilateral infusions of the OX 1-receptor antagonist SB-334867 (SB) and CART-antibodies (CART-ABs) into the NAcSh. After SB infusions, there was no change in premature responses observed on average. Further analysis revealed a negative linear correlation between the effect of intra-NAcSh SB infusions on premature responses and trait impulsivity. The effect of SB ranged from an increase, no change to a decrease in premature responses in the individual animals with increasing trait impulsivity. Infusions of CART-ABs led to consistently enhanced impulse control with fewer irrelevant actions, independent of trait impulsivity. These data suggest that both OX, especially OX A, and CART in the NAcSh, can be considered endogenous regulators of impulsive action, dependent on underlying impulsivity in the case of OX and independent from trait impulsivity in the case of CART.

Role of ascorbic acid and appetite stimulants on a few blood serum biochemical characteristics in pregnant Iraqi ewes under heat stress

This study evaluated the effect of VêO® premium (2 or 4)g and ascorbic acid on pregnant ewes on some minerals. Twenty Iraqi ewes are aged 2-4 years in the Fallujah, Al-Anbar Government regions from August 5th, 2019, to February 9th, 2020. The ewes were divided randomly into four groups. It was fed naturally and on one diet, and the (G1) was given VêO® premium 4 g, (G2) was given VêO® premium 2 g, (G3) was given ascorbic acid 40 mg, and (G4) was treated as the control group. Blood samples were taken monthly via the external jugular vein before and during pregnancy. The serum samples were liquated in tubes and immediately stored at -20 °C until assay for analysis of calcium, phosphorus, potassium, sodium and magnesium. The results showed the effect of VêO® Premium and ascorbic acid on calcium concentration in G2 before pregnancy. Phosphorous concentration was significantly higher (P≤0.05) in the (G1, G2, and G4) before pregnancy, but no significant difference in potassium between the groups before and during pregnancy. Sodium concentration was significantly higher (P≤0.05) in the (G1, G2, G3, and G4) before pregnancy. Magnesium concentration was significantly higher (P≤0.05) in the (G2) during pregnancy and (G3) before pregnancy. It was concluded from the current study that the addition of VêO® premium (2 or 4)g and ascorbic acid (40 mg) to the feed increased some minerals before and during pregnancy in Iraqi ewes. Keywords: VêO® premium, ascorbic acid, minerals, pregnancy, Iraqi ewes

Influence of Malnutrition on the Outcomes of Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients

Background: Patients with malignancy are more prone to be malnourished due to a combination of factors including the disease process itself, chemotherapy and the associated catabolism. Studies have shown that Protein Energy Malnutrition (PEM) can adversely affect outcomes in hospitalized patients. We aim to study the impact of PEM in Multiple Myeloma patients undergoing Hematopoietic stem cell transplant (HSCT). Methods: A retrospective cohort study was designed using data obtained from the 2017 to 2019 combined National Inpatient Sample (NIS) database. Adult patients (age >18) admitted with a principal diagnosis of Multiple Myeloma and a principal procedure of autologous HSCT were identified using the International Diseases Classification code, tenth revision (ICD-10). They were further stratified based on the presence of Protein Energy Malnutrition (PEM). Primary outcomes assessed were, mortality, length of stay (LOS), and Total Hospitalization Charges (THC). Secondary outcomes included a diagnosis of Acute Kidney Injury (AKI), Acute Respiratory Failure (ARF), sepsis, neutropenia, blood transfusion. Multivariate linear and logistic regressions were used to adjust for confounders. Results: There was a total of 21,965 adult hospitalizations of MM patients undergoing HSCT and among them 2,955 (0.13%) had a secondary diagnosis of PEM. Those with PEM were older (62 vs 61 p=0.005). The overall mortality was less at 0.007% (N=150) and after adjusting for confounders PEM was associated with an increased odds of mortality, 0.019 vs 0.005% (AOR :3.20, p=0.008, 95% CI: 1.35 - 7.57). There was also an increased LOS in patients with PEM, 19 days vs 16.1 days (adjusted difference of 2.17 days, p=0.000, 95% CI: 1.35 - 2.99), as well as an increase in THC, 221,624 USD vs 195,635 USD (adjusted difference of 17,435 USD, p=0.036, 95% CI: 1173.60 - 33696.16). Similarly, the presence of PEM was associated with an increased odds of several secondary outcomes measured, including anemia (AOR : 1.67, p=0.002, 95% CI: 1.20 - 2.32), intubation (AOR : 4.40, p< 0.001, 95% CI: 2.29 - 8.48) and mechanical ventilation (AOR : 5.10, p< 0.001, 95%CI: 2.63 - 9.90), AKI (AOR : 1.49, p=0.004, 95% CI: 1.14 - 1.95), sepsis (AOR : 2.16, p< 0.001, 95% CI: 1.53 - 3.05), ARF (AOR : 3.39, p< 0.001, 95% CI: 1.99 - 5.75) and pneumonia (AOR : 1.73, p=0.005, 95% CI: 1.18 - 2.53) compared to the other cohort. However, there was no difference in the odds of pressor requirement, neutropenia and UTI between the two groups. Conclusion: Presence of PEM leads to poor clinical outcomes. This highlights the importance of addressing nutritional status as an independent prognostic factor. Appetite stimulants, as well as attention to underlying nausea, vomiting, mucositis can improve oral intake and appetite. A multidisciplinary approach with nutritionists, the nursing team, and social work can identify at-risk patients and help improve outcomes.

Bortezomib Induced Peripheral and Severe Autonomic Neuropathy Characterized By Dizziness, Orthostatic Hypotension, and Weight Loss

INTRODUCTION: It is well known that Bortezomib (B), a proteasome inhibitor used in the treatment of Multiple Myeloma (MM) causes peripheral neuropathy in an estimated 75% of patients and compromises their quality of life. There are reports of dizziness, muscle weakness and other unusual neurologic complications caused by B. Among patients that received B based induction, we observed peripheral neuropathy as expected. In addition, in a small subset we observed profound weight loss, dizziness, orthostatic hypotension (OH) and diarrhea. Some patients with weight loss required appetite stimulants and patients with OH/dizziness required medication for symptom control. The conglomeration of symptoms frequently impairs patients' performance status requiring interruption of therapy. B was given in combination with lenalidomide and dexamethasone (VRD) but we feel the neuropathic symptoms are more due to B since the combination of just lenalidomide and dexamethasone is not known to cause such complications. There are few publications on autonomic neuropathy (AN) caused by B but we believe it is under recognized and under diagnosed. Herein we report a series of patients managed at our center that presented with significant weight loss and dizziness suggestive of AN, prompting us to explore further and bring awareness to this problem. METHODS: From January 2018 to July 2022, patients with MM treated in our own practice and patients induced by our referring practices and sent to our center for transplant were evaluated. We identified patients who complained of significant weight loss and dizziness and reviewed medical records, looked at the characteristics they exhibited, and identified a pattern of symptoms and clinical course. Statistics are descriptive and this retrospective study was approved by our Institutional Review Board. RESULTS: Twelve patients were noted to have symptoms suggestive of AN. 11 of 12 received VRD and one received Daratumumab, B and dexamethasone based induction. B was administered subcutaneously and given twice weekly. The median age was 62.5 years (range 51-76). Eight were African American and 4 White; 8 female, 3 had diabetes but no neuropathy, 8 had bone disease, 2 renal failure at presentation. The interval between initiation of therapy and AN symptoms was a median of 107 days (range 50-219) and the median B dose was 20.8 mg/m2 (range 9-31 mg/m2). All 12 patients had weight loss and was the most recognizable symptom. The median weight loss and percentage weight loss (compared to baseline weight) were 19.5 Kgs (range 7-37 Kgs) and 21% (range 7-41) respectively. 7 of 12 patients had loss of appetite and 8 had diarrhea. Further treatment was held due to decline in performance status in all 12 patients. Six patients received appetite stimulants; 2 megestrol and 4 dronabinol. OH and an increase in heart rate in the standing position was seen in all 12 patients. 10 of the 12 patients had dizziness; 3 patients received fludrocortisone and one received midodrine. 11 of 12 patients also had peripheral neuropathy of whom 10 required medications for neuropathic pain and 10 required narcotic analgesics. 10 of 12 patients received a transplant and 2 declined. Transplant was delayed by 6 months (range 2-11) to enable recovery and the end-point was weight gain, resolution of OH and clinical improvement. Post-transplant 4 patients had persistent diarrhea and 1 had persistent dizziness. One patient developed severe mucositis, dysphagia, poor appetite and required hyperalimentation, nasogastric feeding and a feeding gastrostomy tube. 10 of 12 patients had persistent peripheral neuropathy and are using medications. Two of the 12 patients progressed and are receiving salvage treatment but there are no deaths. With a median follow up of 23 months (range 8-42), the median survival since diagnosis is 27 months. CONCLUSIONS: Severe AN characterized by weight loss, dizziness, OH in association with loss of appetite, diarrhea and painful neuropathy is an under recognized complication of Bortezomib. This generally results in interruption of disease directed therapy and delays autologous transplantation. Transplantation without resolution of symptoms could possibly worsen the morbidity and delay post-transplant recovery. To the best of our knowledge, we are the first group to report a series of patients with this symptom complex and strongly feel it requires to be studied further in a larger cohort of patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The therapeutic properties of Mikania glomerata Spreng. (Asteraceae)

The Mikania glomerata Spreng is a specie found in Europe, Africa, North and South America and is commonly known as “guaco” and “guaco climber”. Many scientific studies confirm the bactericidal, anti-ophidic, antifungal, anti-inflammatory, antimalarial, and bronchodilator pharmacological activities. These studies aim to contribute to new research, report the phytotherapy aspects and describe the therapeutical properties of Mikania glomerata. This study is an integrative review with a descriptive approach. Were found during the study that the guaco therapeutical properties are diverse, such as: antiasthmatic, tonic, antipyretic, expectorant, appetite stimulant, anti-influenza, antirheumatic, soothing, healing, diuretic, emollient, fluidizing, bacterial growth inhibitor, antiallergic, antifungal, antioxidant, anthelmintic. Thereby, the analyzed texts show, besides the properties mentioned above, an expressive performance on duodenal and stomach ulcers, infectious diseases such as tonsillitis and oropharyngeal inflammation, influenzas, and upper airway infections (UAI), usually known as cold. Thus, is essential to highlight the value of the medicinal use of this compound, in a way to accentuate their benefits for the clinical improvement of various conditions that currently affect patients. However, given the data that were shown previously, as well as the limited number of studies, it is fundamental to carry out more research to define more safely the therapeutic properties of the M. glomerata, in addition to showing the long-term effects of the use of your phytotherapic and safe doses, such as side effects.

Too stressed to eat: Investigating factors associated with appetite loss in subordinate rainbow trout

Juvenile rainbow trout (Oncorhynchus mykiss) form dominance hierarchies in which subordinates experience chronic social stress and suppression of food intake. Here we tested the hypothesis that inhibition of food intake reflects increased expression of anorexigenic (appetite inhibiting) signals and decreased expression of orexigenic (appetite stimulating) signals. Trout were confined in pairs for 1 or 4 days, or were confined in pairs for 4 days and then allowed to recover from social interactions for 2 or 4 days; sham fish were handled identically but held alone. Subordinates did not feed during social interaction and had lower food intake than dominants or shams during recovery. In parallel, plasma cortisol (∼18–26x) and liver leptin (lep-a1) transcript abundance (∼10–14x) were elevated in subordinates during social interaction but not recovery, suggesting that these factors contributed to the suppression of food intake. Fish deemed likely to become subordinate based on inhibition of food intake in response to a mild stressor also showed elevated liver lep-a1 transcript abundance (∼5x). The moderate response in these fish coupled with a correlation between liver lep-a1 and cortisol suggest that stress-induced elevation of cortisol increased liver lep-a1 transcript abundance in subordinate trout, contributing to stress-induced suppression of food intake.

The effect of oral nutrition supplements and appetite stimulants on weight status among pediatric cancer patients: A systematic review.

The objective of this study was to identify the use and impact of oral nutrition supplements (ONSs) and appetite stimulants on weight status among pediatric patients diagnosed with malignancy. We performed a literature search of trials using Medline PubMed, CINAHL, Web of Science Core Collection, Scopus, and Cochrane Database of Systematic Reviews and included all prospective studies except review articles and case-reports/series that assessed ONSs or appetite stimulants among patients (0-20 years old) diagnosed with a pediatric malignancy. Databases were searched through May 17, 2022. There were six trials included with three studies related to ONS and the remaining on appetite stimulants. No studies that compared both ONS and appetite stimulants were found. To assess quality, we used the Risk of Bias in Nonrandomized Studies of Interventions and the Revised Cochrane Risk of Bias Tool for Randomized Trials depending on the study design. The studies all had pediatric patients diagnosed with a variety of malignancy types. All studies demonstrated improvement of weight status in the treatment group across various malignancy types. However, none of the studies addressed nutrition intakes outside of ONS consumption, compliance to ONSs, or frequency of ONS use. Despite the short durations (3-6 months) and significant differences in the timing of intervention initiation (ONS or appetite stimulants), these treatment modalities can improve weight status. Further research is needed to identify the best intervention for improving weight status.

The economic burden of HIV-associated wasting in the era of modern antiretroviral therapy.

BACKGROUND: HIV-associated wasting (HIVAW) is associated with increased morbidity and mortality in people living with HIV (PWH). Evaluating health care resource utilization and cost predictors of HIVAW is important in understanding the overall economic burden of the disease. OBJECTIVE: To evaluate the economic burden and cost predictors associated with HIVAW. METHODS: This analysis of the IBM MarketScan Commercial, Medicare Supplemental, and Medicaid databases included members with a claim for HIV (using International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification codes) between July 2012 and September 2018, with the HIV index date defined as the first HIV diagnosis claim in the dataset. PWH were excluded if they were aged less than 18 years, had any malignancy claim, or had less than 6 months of enrollment data pre-HIV or post-HIV index date. Members were defined as having HIVAW using an algorithm of claims for weight loss-related diagnoses, appetite stimulant or nontestosterone anabolic agents, or enteral/parenteral nutrition at any time post-HIV index. Taking antiretroviral therapy (ART) was defined as having at least 1 pharmacy claim of any ART 12 months post-HIV index. Total all-cause costs were calculated as the sum of payments for hospitalizations, emergency department visits, outpatient visits, and pharmacy use. A multivariate generalized linear model with log-link and γ distribution was used to estimate the impact of HIVAW predictors of total all-cause costs. RESULTS: Among 42,587 members with HIV included in the study (64.6% male; mean age: 44 years; 67.5% insured with Medicaid; and 63.9% taking ART), the overall prevalence of HIVAW was 18.3% during the study period. HIVAW prevalence was 17.9% for those taking ART and 19.1% for those not taking ART. Prevalence by payer type was 7.5% for Commercial ± Medicare Supplemental and 23.5% for Medicaid. Members with HIVAW had more comorbidities and opportunistic infections compared with members without HIVAW. Members with HIVAW were also more than twice as likely to be hospitalized (71.1% vs 32.1%) and had 5 times the number of hospitalizations (1.0 vs 0.2) and twice the number of emergency department visits (3.0 vs 1.3) per year post-index compared with members without HIVAW (P < 0.01). HIVAW was associated with 1.3-times-higher mean annualized total all-cause costs per member (95% CI = 1.26-1.36). CONCLUSIONS: HIVAW remains prevalent despite advances in ART and is associated with additional health care resource utilization and costs. Further research is needed to better understand the relationship between HIVAW and comorbidity burden and ART utilization and payer types. DISCLOSURES: This study was sponsored by EMD Serono, Inc., Rockland, MA, USA (CrossRef Funder ID: 10.13039/100004755). Dr Siddiqui has received consulting and speaking fees from AbbVie, BioFire, Cumberland, EMD Serono, Inc., Rockland, MA, USA, and Merck. Dr Samuel, Ms Hayward, Ms Wirka, Dr Phillips, and Dr Harbour are employees of EMD Serono, Inc., Rockland, MA, USA. Drs Deering and Harshaw are employees of EPI-Q, Inc., which received payment from EMD Serono, Inc., Rockland, MA, USA, for the development and execution of this study.

Older adults experiences of using recreational cannabis for medicinal purposes following legalization

Legalization of recreational, or non-medical, cannabis in Canada in 2018 was followed by significant increase in use among older adults. Non-medical cannabis is often used medicinally in this population for issues such as pain, insomnia, and appetite stimulation. The purpose of this study was to explore new cannabis use among older adults within an evolving socio-legal context. Normalization theory provided the theoretical foundation and qualitative description was the guiding methodology. A convenience sample of twelve participants (ten women, two men) aged 71 to 85 years old was recruited. Data were collected using semi-structured interviews and analyzed thematically. Findings illustrate factors that influenced participants' beliefs and contributed to their decisions to begin using cannabis in later life. The most important factor was legalization, which sparked a shift in beliefs around using cannabis and shaped the beginning of de-stigmatization around using this substance. Increasing acceptance in their social networks and visibility of cannabis in the media also informed decision-making. However, using cannabis for non-medicinal or social reasons remained stigmatized. This research indicates that older adults' beliefs about cannabis use are shifting and this is likely related to legalization and broader social acceptance of cannabis. As a consequence, increased public health education is needed to improve health literacy about cannabis use during this stage of the life-course.

200 Efficacy of cyproheptadine for appetite stimulation in children with cystic fibrosis

200 Efficacy of cyproheptadine for appetite stimulation in children with cystic fibrosis

226 Evaluation of use of appetite stimulants in children with cystic fibrosis

226 Evaluation of use of appetite stimulants in children with cystic fibrosis

Examination of pediatric tube feeding schedules and oral intake: A retrospective cross-sectional study.

A common treatment goal for children dependent on enteral feeding is to advance oral nutrition intake and decrease enteral feeding dependence. The purpose of this study was to investigate the relationship between tube feeding schedule and oral intake in feeding tube-dependent children diagnosed with avoidant restrictive food intake disorder (ARFID). A retrospective chart review was completed including 76 tube-dependent children with ARFID between the ages of 1 and 14 years who were evaluated by a registered dietitian, in conjunction with a multidisciplinary feeding team, during January 1, 2018, to May 31, 2019. Eligible participants were diagnosed with ARFID and receiving enteral nutrition via nasogastric or gastrostomy tube during the time of evaluation. The participants were categorized into groups according to tube feeding schedule type (bolus vs. overnight continuous) and further stratified by severity of oral motor deficit, as documented by the speech language pathologist or occupational therapist: none/mild and moderate/severe. The exclusion criteria included children aged <1 year, appetite stimulant listed as an active medication, overnight enteral feeding infusion of >12 h, or calculated percentage of calories from oral intake not specified. The primary study outcome was dichotomized percentage of oral intake, >0% vs 0%. Following adjustment for confounders, this retrospective chart review showed statistically higher odds of percentage of oral intake >0% in ARFID patients receiving overnight continuous enteral feeding schedules (odds ratio = 0.20, 95% CI: 0.05-0.83, P = 0.027). A bolus feeding schedule may not promote oral intake in feeding tube-dependent children diagnosed with ARFID.

Appetite stimulants for people with cystic fibrosis.

Chronic loss of appetite in cystic fibrosis concerns both individuals and families. Appetite stimulants have been used to help cystic fibrosis patients with chronic anorexia attain optimal body mass index (BMI) and nutritional status. However, these may have adverse effects on clinical status. This is an updated version of the original review. To systematically search for and evaluate the evidence on the beneficial effects of appetite stimulants in the management of cystic fibrosis-related anorexia and synthesise reports of any side effects. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register and online trials registries; handsearched reference lists; and contacted local and international experts to identify relevant trials. Last search of the Cystic Fibrosis Trials Register: 23 May 2022. Last search of online trial registries: 10 May 2022. Randomised and quasi-randomised controlled trials of appetite stimulants compared to placebo, control, no treatment or different appetite stimulants, or to the same appetite stimulants at different doses or regimens for at least one month in adults and children with cystic fibrosis. Review authors independently extracted data and assessed risk of bias of the included trials. We used the GRADE approach to assess the certainty of the evidence and performed meta-analyses. We included four trials (70 participants) comparing appetite stimulants (cyproheptadine hydrochloride and megestrol acetate) to placebo; the numbers of adults or children within each trial were not always reported. We assessed the certainty of evidence as low due to the small number of participants, incomplete or selective outcome reporting, and unclear risk of selection bias. Regarding our primary outcomes, a meta-analysis of two trials (42 participants) showed that appetite stimulants may produce a larger increase in weight (kg) at three months (mean difference (MD) 1.25 kg, 95% confidence interval (Cl) 0.45 to 2.05), and one trial (17 participants) showed a similar result at six months (MD 3.80 kg, 95% CI 1.27 to 6.33) (both low-certainty evidence). Results also showed that weight z score may increase with appetite stimulants compared to placebo at three months (MD 0.61, 95% CI 0.29 to 0.93; 3 studies; 40 participants; P < 0.001) and at six months (MD0.74, 95% CI 0.26 to 1.22; 1 trial; 17 participants). There was no evidence of a difference in effect between cyproheptadine hydrochloride and megestrol acetate for either outcome. Only one trial (25 participants) reported analysable data for body composition (BMI), with results favouring cyproheptadine hydrochloride compared to placebo; a further trial (16 participants) narratively agreed with this result. All four trials reported on lung function at durations ranging from two to nine months. Considering analysable data, two trials (42 participants) found that appetite stimulants may make little or no difference in forced expiratory volume at one second (FEV1) % predicted at three months, and one trial (17 participants) found similar results at six months. Two further three-month trials narratively agreed with these results. Limited information was reported for secondary outcomes. Two trials (23 participants) reported results showing that appetite stimulants may increase appetite compared to placebo at three months (odds ratio 45.25, 95% CI 3.57 to 573.33; low-certainty evidence). Only one study reported on quality of life, finding that cyproheptadine reduced fatigue in two participants compared with none with placebo. One study (25 participants) found no difference in energy intake between appetite stimulant or placebo at three months. Insufficient reporting of adverse effects prevented a full determination of their impact. Two studies (33 participants) narratively reported similar requirements for additional antibiotics between appetite stimulants and placebo at three months. AUTHORS' CONCLUSIONS: At six months in adults and children, appetite stimulants improved only two of the outcomes of this review: weight (or weight z score) and subjectively reported appetite. Insufficient reporting of side effects prevented a full determination of their impact. Whilst the data may suggest the potential use of appetite stimulants in treating anorexia in adults and children with cystic fibrosis, this is based upon low-certainty evidence from a small number of trials, therefore firm conclusions cannot be drawn. Clinicians need to be aware of the potential adverse effects of appetite stimulants and actively monitor any individuals prescribed these medications accordingly. Research is required to determine meaningful surrogate measures for appetite and to define what constitutes quality weight gain. Future trials of appetite stimulants should use a validated measure of symptoms including a disease-specific instrument for measuring poor appetite. This review highlights the need for multicentred, adequately powered, and well-designed trials to evaluate agents to safely increase appetite in people with cystic fibrosis and to establish the optimal mode of treatment.

Relationship between psychological stress and ghrelin concentrations in pregnant women with overweight or obesity

Exposure to, perception of, and response to stress have all been shown to influence appetite and dietary behaviors in non-pregnancy human and animal studies, mediated in part by the appetite stimulating hormone ghrelin. Yet, the impact of prenatal stress on biological pathways associated with appetite in the context of pregnancy is not well understood. The objective of this study was to assess the relationship between these layered dimensions of stress with fasting and postprandial plasma ghrelin concentrations among Hispanic pregnant women with overweight or obesity, a population known to experience heightened levels of stress. Thirty-three non-diabetic Hispanic women with pre-pregnancy body mass index of 25.0–34.9 kg/m2 participated in a crossover study at 28–32 weeks’ gestation. At each visit, participants provided fasting blood and saliva samples, consumed a standardized mixed-meal, and completed a 15-minute task: friendly conversation (control) or the Trier Social Stress Test (experimental stress exposure). Six timed blood and saliva samples were collected up to 2 h from baseline and assayed for ghrelin and cortisol, respectively, and area-under-the-curve (AUC) values were computed. Day-to-day stress levels were assessed by the Perceived Stress Scale. Physiological and psychological stress reactivity was determined by cortisol AUC and change in self-reported affect state, respectively, during the experimental stress visit. Maternal perceived stress was positively associated with ghrelin concentrations in the fasted (β = 0.06, p = 0.02) and postprandial state (β = 0.05, p = 0.02). Mean ghrelin AUC was not significantly different following acute stress versus control. Measures of acute stress reactivity were not associated with ghrelin AUC. Contrary to our hypothesis, among Hispanic pregnant women with overweight and obesity, exposure to an acute stress induction task did not alter postprandial ghrelin concentrations, and changes in individual psychological and physiological stress reactivity did not associate with postprandial ghrelin. However, our findings suggest that maternal report of general perceived stress over the last month is associated with higher fasting and postprandial ghrelin concentrations. Differences in the effects of short-term stress exposure versus day-to-day perception of stress on appetite and food intake in pregnancy deserves further investigation.