Low Appetite Research Articles

S2950 The Gutcracker: A Case of Superior Mesenteric Artery Syndrome

Introduction: Superior Mesenteric Artery (SMA) Syndrome is estimated to effect 0.1-0.3% of the population and is not only a rare disease of exclusion but can be detrimental and debilitating making it challenging to treat. We describe a case of a patient with newly diagnosed SMA syndrome. Case Description/Methods: A 66-year-old male with a past medical history significant for congestive heart failure and Barrett’s esophagus presented with acute on chronic atypical chest pain and epigastric pain that has progressively worsened over three days. He described it as most severe after eating and felt that his entire chest and abdomen “was about to explode.” He reported decreased oral intake over the past 15 years due to the same chronic post-prandial epigastric pain. He reported a weight loss of 40-50 lbs. over the last year. He reported severe fatigue and has had trouble taking care of himself. The patient explained living in severe poverty without much of a support system. He also had nausea and decreased appetite with frequent belching. He was a cachectic appearing male with diffuse abdominal tenderness. A CT of the abdomen and pelvis was performed which demonstrated significant narrowing of the third portion of the duodenum at the level of SMA. Once a cardiac etiology of the pain was ruled out, an EGD was performed which discovered a significant amount of several days’ worth of undigested food content in the duodenum with duodenal narrowing. Since the CT and EGD findings were supportive of SMA syndrome, Surgery was consulted for potential surgical options. Surgery recommended an upper GI series to assess the motility and the patient was found to have transient vertical compression of the duodenum and delayed duodenal transit, confirming SMA syndrome. Discussion: Establishing the therapeutic approach was challenging as the patient was too frail to improve his diet on his own and too malnourished for surgical consideration. Conservative therapy with nutritional support was initiated and a multidisciplinary approach involving nutrition, speech pathology, and psychiatry was essential. Surgical management remained a potential option should conservative therapy fail. Due to his nausea, low appetite, and pain, he was started on TPN for further nutritional support. The case illustrates the complexity of SMA syndrome and the importance of a multidisciplinary approach to optimize treatment options and support the mental and physical wellbeing of the patient.Figure 1.: Upper GI Series revealing transient vertical compression of the duodenum and delayed duodenal transit consistent with SMA syndrome.

Prospective observational study of prevalence, assessment and treatment of pancreatic exocrine insufficiency (PEI) in patients with advanced pancreatic cancer (aPC): PanDA.

196 Background: PEI in patients with advanced pancreatic cancer is well documented, but there is a lack of consensus regarding optimal screening. Methods: Eligible patients for this observational study (NCT03616431) were those diagnosed with aPC referred for consideration of palliative therapy who consented to evaluation by a research dietitian. In addition to symptom and full dietetic assessment (including Mid-Upper Arm Circumference (MUAC), handgrip and stair climb test), full nutritional blood panel, faecal elastase (FE) and 13C mixed triglyceride breath test (for diagnostic cohort (DiC)) were performed. Primary objectives: prospective assessment of PEI prevalence (dietitian-assessed; demographic cohort (DeC)), and to design (using breath test as gold standard; DiC) and validate (follow-up cohort (FuC)) the most suitable screening tool for PEI in patients with aPC. Logistic and Cox regression were used for statistical analysis (Stat v.12). Results: Between 1st July 2018 and 30th October 2020, 112 eligible patients [50 (DeC), 25 (DiC), 37 (FuC)]. Prevalence of PEI in the DeC was 64.0% (PEI-related symptoms were flatus (84.0%), weight loss (84.0%), abdominal discomfort (50.0%) and steatorrhea (48.0%)); 70.0% of patients required pancreatic enzyme replacement therapy and 74.0% had anorexia (low appetite); 44.0% and 18.0% had low vitamin D and vitamin A levels, respectively. Designed PEI screening panel (DiC; 19 patients with breath test completed) included FE [normal/missing (0 points); low (1 point)] and MUAC [normal/missing ( > percentile 25 for age/gender) (0 points); low (2 points)] and identified patients at high-risk (2-3 total points) of PEI [vs. low-medium risk (0-1 total points)]. When patients from DeC and DiC) were analysed together, those classified as “high-risk of PEI” according to the screening panel had shorter overall survival (multivariable Hazard Ratio (mHR) 1.86 (95% CI 1.03-3.36); p-value 0.040) when adjusted for other prognostic factors, including presence of PEI symptoms (mHR 2.28 (95% CI 1.19-4.35); p-value 0.013). The screening panel was tested in the FuC; 78.38% were classified as patients at “high-risk of PEI”; of these, 89.6% were confirmed to have PEI by the dietitian. The panel was feasible for use in clinical practice, (64.8% of patients completed fully the assessments required) and acceptability was high (87.5% of patients would do it again). The majority of patients (91.3%) recommended that all future patients with aPC should have dietitian input. Conclusions: PEI is present in the majority of patients with aPC, and early dietetic input is important to provide a holistic nutritional overview, including, but not limited to, PEI. This proposed screening panel could be used to prioritise patients at higher risk of PEI requiring urgent dietitian input. Its prognostic role needs further validation. Clinical trial information: NCT03616431.

CYP1A2 polymorphisms modify the association of habitual coffee consumption with appetite, macronutrient intake, and body mass index: results from an observational cohort and a cross-over randomized study.

Evidence regarding the influence of coffee on appetite and weight control is equivocal and the influence of covariates, such as genetic variation in caffeine metabolism, remains unknown. Herein, we addressed the novel hypothesis that genetic variation in CYP1A2, a gene responsible for more than 95% of caffeine metabolism, differentially impacts the association of coffee consumption with appetite and BMI among individuals with different genetic predispositions to obesity. A cross-over randomized intervention study involving 18 volunteers assessed the effects of coffee consumption on dietary intake, appetite, and levels of the appetite-controlling hormones asprosin and leptin. Data on habitual coffee intake, BMI, and perceived appetite were obtained from an observational cohort of 284 volunteers using validated questionnaires. Participants were stratified according to a validated genetic risk score (GRS) for obesity and to the -163C > A (rs762551) polymorphism of CYP1A2 as rapid (AA), intermediate (AC), or slow (CC) caffeine metabolizers. Coffee consumption led to lower energy and dietary fat intake and circulating asprosin levels (P for interaction of rs762551 genotype*coffee consumption=0.056, 0.039, and 0.043, respectively) as compared to slow/intermediate metabolizers. High coffee consumption was more prevalent in rapid compared to slow metabolizers (P = 0.008 after adjustment for age, sex, and BMI) and was associated with lower appetite perception and lower BMI only in rapid metabolizers (P for interaction of rs762551 genotype*coffee consumption = 0.002 and 0.048, respectively). This differential association of rs762551 genotype and coffee consumption with BMI was more evident in individuals at higher genetic risk of obesity (mean adjusted difference in BMI = -5.82 kg/m2 for rapid versus slow/intermediate metabolizers who consumed more than 14 cups of coffee per week). CYP1A2 rs762551 polymorphism modifies the association of habitual coffee consumption with BMI, in part by influencing appetite, energy intake and circulating levels of the orexigenic hormone asprosin. This association is more evident in subjects with high genetic predisposition to obesity. ClinicalTrials.gov: registered Clinical Trial NCT04514588.

Myrtle (Myrtus communis L.) fruit syrup for gastroesophageal reflux disease in children: A double-blind randomized clinical trial.

This double-blind study was designed to evaluate the efficacy of a syrup made from Myrtus communis L. fruit on children with gastroesophageal reflux disease. Children aged 1-7 years old, diagnosed with gastroesophageal reflux disease (GERD), were randomly allocated to either intervention group (omeprazole and "myrtle fruit syrup") or control group (omeprazole and placebo syrup). GERD symptom questionnaire for young children (GSQ-YC) was filled out for each patient at zeroth and eighth week, and also 4 weeks after cessation of intervention. No statistically significant difference between two groups in terms of GERD score was reported neither in 8th nor in 12th week assessments. During the 4 weeks of the drug-free period, patients in myrtle group did not experience a large shift in GERD score, while patients in placebo syrup group experienced an increase of as much as 19.4. However, this difference was not statistically significant, although it could be significant clinically. For achieving more conclusive results, more studies are needed. The symptom "refusal to eat" in the intervention group was less than in placebo group after 8 weeks (p=.018) and at the end of the study (p=.042). So myrtle fruit syrup may be considered for children with low appetite.

Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer.

In Ontario, Canada, patient-reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non-small cell lung cancer (NSCLC) is associated with substantial disease and treatment-related morbidity, this province-wide study investigated moderate to severe symptom burden in this population. ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance. Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well-being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well-being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior. This province-wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments. In this largest study of lung cancer patient-reported outcomes (PROs), stage IV non-small cell lung cancer patients had worse moderate-to-severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate-to-severe symptoms peaked early and remained high during the first year of follow-up. Symptom burden was associated with recent radiation and systemic treatments. Early and sustained PRO collection is important to detect actionable symptom progression, especially around treatments. Vulnerable patients (e.g., older, high comorbidity) who face barriers in attending in-person clinic visits had lower PRO completion. Virtual PRO collection may improve completion.

Abnormalities of Serum Protein Electrophoresis in Cattle and Comparison between Assays for Markers of Inflammation and Markers of Liver Alteration

This study aims to prove the advantage to use blood serum electrophoresis (BSE) in medicine for cattle. For that, 200 animal’s cases (healthy or diseased) were studied. We found, in order of importance: 47 cases of respiratory diseases, 7 cases of lameness, 9 cases of mastitis and 8 cases of metritis, the rest have developed inflammatory signs (hyperthermia, low appetite) without any other specific clinical signs (15 subjects). The majority of animals reveal the highest ratio A/G (Albumin/globulin). Alpha2 globulins were markedly high during bronchopneumonia. Most of the cattle had a low value of the α1 globulins (3.67±1.16g/l). The majority of cattle had a low value of the α1 zone in comparing with normal range. Seven subjects have developed a monoclonal peak in hyper-gamma globulins. The fibrinogen concentrations did not exceed the threshold of 5g/l. The concentration of Haptoglobin was higher for only ten animals. The electrophoresis of blood serum can replace the biochemical parameters used to determinate the alterations of the liver function: total bilirubin, alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT). We found if the level of the α2 and γ globulins is highest; it gives the same interpretation for the animal’s inflammation status like we have with the increased level of haptoglobin observed for bronchopneumonia. For the other cases, like the insidious pathologies, they are detected by the α2 and γ globulins, but not by haptoglobin. Our study has proved that the use of blood serum electrophoresis confirms the diagnosis of symptomatic pathologies and allows detecting asymptomatic pathologies.

Specific COVID-19 Symptoms Correlate with High Antibody Levels against SARS-CoV-2.

Lasting immunity will be critical for overcoming COVID-19. However, the factors associated with the development of high titers of anti-SARS-CoV-2 Abs and how long those Abs persist remain incompletely defined. In particular, an understanding of the relationship between COVID-19 symptoms and anti-SARS-CoV-2 Abs is limited. To address these unknowns, we quantified serum anti-SARS- CoV-2 Abs in clinically diverse COVID-19 convalescent human subjects 5 wk (n = 113) and 3 mo (n = 79) after symptom resolution with three methods: a novel multiplex assay to quantify IgG against four SARS-CoV-2 Ags, a new SARS-CoV-2 receptor binding domain-angiotensin converting enzyme 2 inhibition assay, and a SARS-CoV-2 neutralizing assay. We then identified clinical and demographic factors, including never-before-assessed COVID-19 symptoms, that consistently correlate with high anti-SARS-CoV-2 Ab levels. We detected anti-SARS-CoV-2 Abs in 98% of COVID-19 convalescent subjects 5 wk after symptom resolution, and Ab levels did not decline at 3 mo. Greater disease severity, older age, male sex, higher body mass index, and higher Charlson Comorbidity Index score correlated with increased anti-SARS-CoV-2 Ab levels. Moreover, we report for the first time (to our knowledge) that COVID-19 symptoms, most consistently fever, body aches, and low appetite, correlate with higher anti-SARS-CoV-2 Ab levels. Our results provide robust and new insights into the development and persistence of anti-SARS-CoV-2 Abs.

Province-wide analysis of patient reported outcomes for stage IV non-small cell lung cancer.

12092 Background: Stage IV NSCLC patients have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC. Methods: Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, income quintiles, and lung cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms. Results: Of 22,799 stage IV NSCLC patients, 13,289 (58.3%) had completed ESAS (84,373 unique assessments) in the year following diagnosis. Patients with older age, high comorbidity, and not receiving active cancer therapy were less likely to complete ESAS. Most (94.4%) reported at least 1 moderate-to-severe score. Most prevalent moderate-to-severe ESAS symptoms within 12 months after diagnosis were tiredness (84.1%), lack of wellbeing (80.7%), low appetite (71.7%), and shortness of breath (67.8%); nausea was the least prevalent (34.6%). Most symptoms peaked at diagnosis and persisted in the year after diagnosis. On adjusted MV analyses, patients with high comorbidity, low income, and urban residency were associated with increased moderate-to-severe symptoms. Moderate-to-severe scores in all ESAS symptoms were associated with delivery of radiotherapy within 2 weeks prior, while moderate-to-severe nausea, drowsiness, tiredness, low appetite, and lack of wellbeing were associated with delivery of systemic therapy within preceding 2 weeks. Conclusions: In this population-based analysis of stage IV NSCLC PROs in the year following diagnosis, moderate-to-severe symptoms were highly prevalent and persistently high, underscoring the need to address supportive requirements in this at-risk population.

PYY Levels and Relationship to Appetite Across Different Presentations of Anorexia Nervosa

Objectives: While the pathophysiology of eating disorders is not well understood, there is evidence that anorexigenic peptide YY (PYY) may play a role. We have shown that PYY levels are high in individuals with anorexia nervosa (AN) and associated with subjective appetite. However, it is unclear whether this represents a general characteristic across AN presentations. Here we investigate PYY levels and their associations with subjective appetite in individuals with atypical (atypAN), binge/purge type (AN-BP), and restricting type (AN-R) AN compared to healthy controls (HC). We hypothesized that PYY levels would be high in all AN presentations compared to HC and associated with subjective appetite. Methods: We performed a cross-sectional study of 106 females (26 atypAN, 11 AN-BP, 29 AN-R and 40 HC, age 10-22 yrs). Research diagnoses were conferred using the Eating Disorder Examination. Fasting blood was drawn for PYY and visual analog scales were administered to assess hunger and desire to eat one’s favorite food. We performed Wilcoxon test to determine between-group differences in clinical characteristics. Spearman’s correlation coefficient was used to determine the relationship between PYY levels and appetite within each group. Results: Mean age±SD of atypAN (18.3±3.3 yrs) and AN-BP (19.9±1.5 yrs) did not differ (ps≥0.11) while AN-R (19.5±2.4 yrs) were older (p=0.013) than HC (17.8±3.1 yrs). BMI was lower in atypAN (18.7±1.2 kg/m2), AN-BP (17.3±0.8 kg/m2), and AN-R (16.6±1.0 kg/m2) than in HC (21.3±2.0 kg/m2; ps<0.0001). Fasting PYY levels were higher in atypAN (107.4±40.8 pg/mL), AN-BP (118.4±56.8 pg/mL) and AN-R (124.1±48.5 pg/mL) than HC (83.2±31.7 pg/mL, ps≤0.045). Hunger and desire to eat one’s favorite food were lower in atypAN and AN-BP compared to HC (ps≤0.042). Between group differences in PYY and appetite remained significant after controlling for age (ps≤0.032). The relationship between PYY and hunger was negative in AN-BP (ρ= -0.71, p=0.012), positive in AN-R (ρ=0.40, p=0.035), and not significant in atyp AN (ρ=0.02, p=0.90). The relationship between PYY and desire to eat favorite food was negative in AN-BP at trend level (ρ=-0.56, p=0.071), positive in AN-R (ρ=0.52, p=0.005), and not significant in atypAN (ρ=0.09, p=0.65). Conclusions: Compared to HC, fasting PYY levels were higher and appetite lower in all AN presentations. Higher fasting PYY levels were associated with lower appetite in AN-BP and greater appetite in AN-R, while no relationship was found in atypAN. The absence of an association in atypAN, which includes females who do not meet low weight criteria for AN-R or AN-BP, may reflect opposing relationships in those who restrict vs. binge/purge. Future research is required to further understand the differences in relationships between PYY levels and subjective appetite across AN presentations.

Analysis of quality of life in patients with locally advanced oral and oropharyngeal cancers

Objective: to study the quality of life in patients who underwent surgical intervention on cancerous tumors of the mucous membrane of the oral cavity and oropharynx.Material and methods. An analysis of the quality of life was performed in 31 patients with tumors of the mucous membrane of the oral cavity and oropharynx using the EORTC QLQ-30 and EORTC QLQ-H &amp; N35 questionnaires.Results. The study of the quality of life using the EORTC QLQ-30 questionnaire in dynamics revealed improved general health status, emotional functioning, cognitive function, lower pain level, decreased frequency of insomnia (p&gt; 0.05). The assessment of clinical meaning and magnitude according to K. Cocks et al. showed that these factors were characterized by a low level of clinical meaning and magnitude of changes in the studied parameters for all scales, except for the insomnia scale corresponding to an average level of clinical meaning and magnitude. At the same time, a statistically significant change score in the fatigue scales (p &lt;0.01) corresponded to a low level of clinical meaning and magnitude, and low appetite (p &lt; 0.05) should be r egarded as irrelevant. The survey of the patients using the EORTC QLQ — H &amp; N35 questionnaire showed deterioration in some functions associated with the consequences of anticancer treatment, including impaired taste and odor perception (p &lt; 0.01), speech disorders (p &lt; 0.05), difficulties related to eating in public places (p &lt; 0.01), difficulties in social contacts (p &lt; 0.05), viscous saliva (p &lt;0.05).Conclusion. The study has revealed positive changes in the quality of life of patients with oral and oropharyngeal cancers in the period from 4 to 6 months after the end of treatment, which indicates a gradual return to the initial level of vital activity and the need for regular monitoring of the quality of life of the patients in the long follow-up.

Associations between Children's Genetic Susceptibility to Obesity, Infant's Appetite and Parental Feeding Practices in Toddlerhood.

Previous findings suggest that parental feeding practices may adapt to children’s eating behavior and sex, but few studies assessed these associations in toddlerhood. We aimed to study the associations between infant’s appetite or children’s genetic susceptibility to obesity and parental feeding practices. We assessed infant’s appetite (three-category indicator: low, normal or high appetite, labelled 4-to-24-month appetite) and calculated a combined obesity risk-allele score (genetic risk score of body mass index (BMI-GRS)) in a longitudinal study of respectively 1358 and 932 children from the EDEN cohort. Parental feeding practices were assessed at 2-year-follow-up by the CFPQ. Three of the five tested scores were used as continuous variables; others were considered as binary variables, according to the median. Associations between infant’s appetite or child’s BMI-GRS and parental feeding practices were assessed by linear and logistic regression models, stratified on child’s sex if interactions were significant. 4-to-24-month appetite was positively associated with restrictive feeding practices among boys and girls. Among boys, high compared to normal 4-to-24-month appetite was associated with higher use of food to regulate child’s emotions (OR [95% CI] = 2.24 [1.36; 3.68]). Child’s BMI-GRS was not related to parental feeding practices. Parental feeding practices may adapt to parental perception of infant’s appetite and child’s sex.

Effects of Divorce on Women and Children

Divorce is a legal separation of husband and wife, leaving each other free to remarry. It is also to break off a marriage legally. Marriage is a state of being legally joined as husband and wife. A family's social support is one of the major ways that family positively impacts health. Marriage is associated with physical health, psychological well-being, and low mortality. Marriage in particular has been studied in the way it affects health. Marriage is thought to protect well-being by providing companionship, emotional support, and economic security. It was also revealed that divorce has psychological and emotional effects on women. This article review discovered that divorced women and children experience more social isolation, which makes them end up producing greater feelings of loneliness, unhappiness, and lower self-esteem. Some psychological and emotional effects of divorce on women which include factors like; low appetite, reduced physical energy and strength, chest pain, severe pressure in chest difficulty in hearing, eye pain, digestive problem, lower abdomen pain, back pain headache, sleeping disturbance, worthless, suicidal attempt, decreased level of confidence, shocked, feeling of shame, feeling of sorrow in her heart, worried, anxious, irritated towards her life, suppressed problem, feeling bad, upset, feeling of miserable life, among other things as the major emotional and psychological effects of divorce on women.

FORMULATION AND EVALUATION OF SOILD LIPID NANOPARTICLES OF SERTRALINE HYDROCHLORIDE

Depression is a global affective and common mental disorder, with over 264 million people experiencing it. It is characterized by depressed mood, loss of interest, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. A new class of colloidal delivery system has been introduced that encompasses a number of advantages over the conventional dosage forms and one of it includes the solid lipid nanoparticles (SLN) with the major advantage of been controlled and site-specific drug delivery. It is made up of a solid core and phospholipid shell having high drug loading to enhance bioavailability. Sertraline hydrochloride is an antidepressant drug used for brain targeting. The main objective of the work was to formulate Sertraline hydrochloride-loaded solid lipid nanoparticles and to screen the effect of formulation with process variables on the performance of these formulated solid lipid nanoparticles. Hot homogenization technique was used to formulate the solid lipid nanoparticles using of 32 factorial designs. The effect of independent variables on the concentration of Poloxamer 188 and Glyceryl monosterate on viscosity and drug release was studied. SLNs containing sertraline hydrochloride were prepared and evaluated. The results depicted F6 as an optimized formulation with an entrapment efficiency of 87.36 ± 1.45% and a drug release of 84.26 ± 1.10%. With the thorough screening study, the enrichment of Sertraline hydrochloride entrapment was attained with good particle size and controlled release. The factorial design confirmed its influence and significance in determining and understanding both formulation and process variables affecting the quality of SLNs.

Adrenal Histoplasmosis-A Therapeutic Restoration of Adrenal Morphology

A 42-year-old man presented with generalized weakness, easy fatigability, hyperpigmentation, low appetite, and significant weight loss of 10 kg and low grade fever over the last 6 months. He did not have cough, abdominal pain, or vomiting. He had hypertension for 5 years but had not required his antihypertensive medications for the last 2 months because of normal blood pressure values. General examination revealed hyperpigmentation on knuckles, oral mucosa, and palmar creases. Systemic examination was unremarkable.

The Economic Value of Restaurant Food Waste in Bogor

Food loss occurs in urban area restaurants, including in Bogor. The consumption activity in restaurants sometimes produces food waste, including of rice, vegetables or side dishes. The research objectives were (1) To identify the restaurant food-wasting process in Bogor, and (2) To estimate the amount and economic value of restaurant food waste in Bogor. The Indonesian National Standard (SNI) 19-3964-1994 about Sampling and Measurement Method and Composition of Urban Waste was used for sampling. Food waste in restaurants occurs from sellers and customers. The unsold food waste of restaurants in Bogor was predominately rice. The occurrence of rice waste was due to large cooking portions and the drying of rice during cooking, making it unable to consume. The food waste produced from unconsumed food by customers included rice and side dishes, such as meat, chicken and fish. Some reasons for food waste occurrence from visitor consumption were unpreferred food taste, large food portion and low appetite. The annual rice waste from unsold and unconsumed food in restaurants in Bogor was 29,742.84 kg or Rp 356,914,080. The annual amounts of meat, chicken, and fish waste are 14,780kg, 28,500kg and 8,460 kg, respectively. The economic value of meat, chicken and fish waste is Rp 1,655,640,000, Rp 712,480,000 and Rp 253,711,500, respectively.&#x0D; Keywords: consumption, the Indonesian National Standard (SNI) 19-3964- 1994, urban waste, consumption chain, weight conversion factor

Exploring patient satisfaction with hospital foodservice: A Swedish study using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire.

The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research. The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05. Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of "good" or "very good." Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals. Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.

Exploring how age, medication usage, and dentures effect the sensory perception and liking of oral nutritional supplements in older adults

Sensory perception of Oral Nutritional Supplements (ONS) by older and younger adults has been investigated, but few studies have examined the sensory perception of ONS within different older adult cohorts. This study sought to investigate effects of older age, dentures, and medications on sensory perception, liking, and intake of a high- and low-viscosity ONS (0.009 and 0.177 Pa.s respectively at 50.1 s−1) and assess effects of ONS on appetite.Eighty older adults (51 aged 65–74 years, 29 aged 75 + years, mean age 74 ± 8 years, age range 65–97 years, 35 men, 45 women) evaluated two ONS over two different days. Each ONS (200 mL) was consumed over five sips (40 mL each). The panellists evaluated each sip using a check-all-that-apply questionnaire (CATA) comprising taste and texture attributes. After each CATA evaluation panellists recorded their liking using a 9-point hedonic scale followed by their hunger, fullness, desire to consume more ONS, and thirst using 100 mm visual analogue scales.The over 75 year olds had significantly lower appetite than the 65–74 year olds on tasting both ONS. Denture wearing influenced the mouthfeel while medication status effected the flavour perception of the high viscosity ONS. Liking did not change across the five sips for any study cohort, however, sensory perception changed with increasing sips. This study provides insight on factors affecting ONS adherence in older adults. Avoiding perceptions of watery/runny mouthfeel while maintaining creaminess may improve acceptability and adherence. The study justifies the CATA methodology for use in different older adult cohorts.

ÖD YOLLARI DİSKİNEZİYALARININ VƏ XRONİKİ XOLESİSTİTİN KLİNİKİ TƏZAHÜRLƏRİNİN DİFFERENSİAL KRİTERİYALARI

For the diagnosis and differentiation of chronic cholesistoxolangiitis from the diseases of the biliary system, 20 patients used modern instrumental and laboratory methods. In these methods, excision cholesistorentgenography, retrograde cholangiography, high frequency ultrasound examination, and cholesterol in the blood, manometric tonometry. In the objective examination, patients were disturbed by the pain on the right side of the neck, on the right side of the breast and in the right rib. Dyspeptic symptoms such as lower appetite, nausea, vomiting, and meteorism have been discovered. Dietotherapy, spasmolitics, antibiotics, gallbladder and physiotherapy have also been used in the treatment. Thus, based on the results of our examination, it is recommended that they be used in early diagnosis of chronic cholesistoxolangitis. Key words: cholangiocholecystitis, gallbladder, symptoms, clinical, diagnosis

FP02.10 Predictors of Moderate-to-Severe Symptoms in Stage IV NSCLC: A Population-Based Study of Patient Reported Outcomes

Patients with metastatic NSCLC have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC. Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, socioeconomic factors, and cumulative cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms. Of the 22,799 stage IV NSCLC patients identified, 13,593 (59.6%) had at least 1 completed ESAS recorded (87,791 unique assessments) in the year following diagnosis. Majority (94.6%) reported at least 1 moderate-to-severe score. Tiredness (peak: 67.4%, overall: 84.3%), lack of wellbeing (peak: 62.1%, overall: 80.9%), low appetite (peak: 50.4%, overall: 72.1%), and shortness of breath (peak: 51.0%, overall: 68.1%) were the most prevalent moderate-to-severe symptoms reported by patients within 12 months after diagnosis (these peaked at diagnosis), while nausea (34.92%) was the least common. Patients receiving chemotherapy alone (17.5%, n= 2,380), radiotherapy alone (36.3%, n=4,936), or both (24.8%, n=3,369) reported more moderate-to-severe symptoms compared to patients receiving no treatment (risk ratio [RR]: 1.04, 1.04, and 1.06 respectively [all p-values<0.0001). Receiving chemotherapy alone or chemotherapy and radiotherapy combinations was associated with score≥4 in all individual ESAS domains (p-values <0.05), while receiving radiotherapy alone was associated with score≥4 in all domains but shortness of breath (RR: 0.98, p=0.26). Immigrants and patients with worst socioeconomic deprivation index were less likely to report moderate-to-severe symptoms. Moderate-to-severe symptoms were prevalent throughout the first year following stage IV NSCLC diagnosis at the population-level. Patients receiving chemotherapy and/or radiotherapy were at increased risk of moderate-to-severe symptoms and may require more supportive care. Further analyses on predictors of severe-to-moderate score on each ESAS domain will be discussed in the presentation.

The effect of garlic (Allium sativum) and turmeric (Curcuma longa) extract addition in commercial feed on feeding rate, feed efficiency and feed conversion ratio of gouramy fish (Osphronemus gouramy)

Gouramy is known to it’s low appetite and slow growth. Attractants are ingredients that are mixed in small amounts of feed to increase feed intake, growth, and fish consumption of feed. Garlic contains at least 33 sulfur components that give a distinctive odor and various medicinal effects. Turmeric contains essential oils composed of monoterpenes and is an effective odor stimulating precursor compound used as an attractant. This study aims to determine the effect of giving turmeric and garlic extracts at different doses on feed consumption, feed efficiency and feed conversion ratio in gouramy. This study used an experimental method with 5 treatments; P0= control, P1=1% garlic extract addition, P2= 1.5% garlic extract addition, P3= 1% turmeric extract addition and P4= 1.5% turmeric extract additions with 4 replications using 10 fish in each.. The results showed that the highest feed consumption value was in the treatment of P1and P2, the lowest conversion ratio and the highest value of feed efficiency was found in the treatment of P2 and P3. So it can be concluded that the addition of 1.5% garlic extract or 1% turmeric extract is effective as an attractant and effective for increasing the growth of gouramy.