Representação social de mães sobre alimentação e uso de estimulantes do apetite em crianças: satisfação, normalidade e poder / Social representation of mothers about feeding and use of appetite stimulants in children: satisfaction, normality and power

Resumo: Este estudo teve como objetivo identificar as representações sociais elaboradas por mães sobre o apetite dos filhos e os medicamentos utilizados para modificá-lo. A abordagem qualitativa desta pesquisa empregou como suporte a teoria das representações sociais. Por meio de entrevistas realizadas com 15 mães que administraram em seus filhos medicamentos para estimular o apetite, foi possível identificar uma insatisfação materna com o volume habitual e seletividade de alimentos ingeridos por seus filhos. Essas foram as principais razões para o uso de medicamentos. Outras razões que encontram espaço são o desenvolvimento da criança, com ganho de massa corpórea, além da vontade de regular as horas em que a criança deveria comer. Esses resultados apontam para a importância das representações sociais maternas sobre a percepção corporal, papel dos alimentos e medicamentos nas práticas do cuidado alimentar infantil.

Abstract: Social representation of mothers about feeding and use of appetite stimulants in children: satisfaction, normality and power This study aimed to identify the social representations elaborated by mothers about the appetite of children and the drugs used to modify this appetite. The qualitative approach used in this study employed as theoretical support the theory of social representations. Through interviews with 15 mothers who administered their children drugs to stimulate appetite, it was possible to identify a maternal dissatisfaction with the usual volume and selectivity of food eaten by their children. These were the main reasons for using drugs. Other related reasons were the growth of the children, with a body mass gain, beyond the desire to regulate the times which the child should eat. These results point to the importance of maternal social representations of body perception , and the role of food and medicine in child care practices.

Appetite stimulants for older persons

Anorexia is one of the most common issues in older patients. Although there is a tendency for loss of appetite in older persons due to decreased physical activity and reduced resting metabolic rate, this physiological anorexia of aging can easily develop into progressive anorexia and weight loss. This pathologic anorexia and resultant weight loss is associated with increased morbidity and mortality, especially in the frail elderly. To prevent older persons from entering a vicious cycle of frailty, that is, anorexia-malnutrition-sarcopenia-functional impairment, routine screening for anorexia and malnutrition should be implemented in geriatric clinical practice. All anorexic elderly patients should be strongly encouraged to maintain their nutrition, and appetite stimulants can be considered if non-pharmacological interventions are not effective. Although there are no US or Korea Food and Drug Administration approved medications for geriatric-specific anorexia and weight loss, several appetite stimulants can be prescribed and are used widely. Megestrol acetate is the most widely studied and commonly used of these drugs. Cyproheptadine, dronabinol, mirtazapine, corticosteroids, anabolic steroids (e.g., testosterone or oxandrolone), and growth hormone are also effective in increasing appetite or weight. However, the use of these orexigenic agents should occur only after their benefit-to-risk ratio has been carefully considered.

Pharmacologic Therapy for Cancer Anorexia-Cachexia Syndrome

Cancer-related anorexia-cachexia syndrome (CACS) is a hypercatabolic state, characterized by reduced appetite and weight loss due to ongoing loss of skeletal muscle mass and adipose tissue. CACS occurs mainly in patients with advanced cancer; thus, weight loss in CACS is often associated with poor prognosis and decreased survival. A large number of studies have been conducted on various pharmacologic agents for palliation of cancer-related anorexia. The purpose of this article is to review the pre-existing pharmacologic agents used for CACS and to evaluate the evidence from current studies on each pharmacologic agent. First, appetite stimulants such as corticosteroids, progestins, cyproheptadine, and cannabinoid have been shown to be beneficial by improving appetite and helping with weight changes even if they had no effect on survival rate. Several other agents with anti-inflammatory effects (e.g., eicosapentaenoic acid, thalidomide, and melatonin), prokinetic agents (e.g., metoclopramide), anabolic agents (e.g., androgens and growth hormone), antipsychotics (e.g., mirtazapine and olanzapine), and antiemetics have also been studied in patients in CACS; however further investigations would be required to confirm the beneficial effects.

Ensaio clínico randomizado, duplo-cego e controlado por placebo de ciproheptadina para estímulo do apetite na fibrose cística / A randomized, double-blind, placebo-controlled trial of cyproheptadine for appetite stimulation in cystic fibrosis

OBJETIVO: O objetivo deste estudo foi determinar se a administração de ciproheptadina é capaz de induzir ganho de peso em pacientes com fibrose cística. MÉTODOS: Foi realizado um estudo duplo-cego, controlado com placebo em dois centros no Brasil. Vinte e cinco pacientes com fibrose cística entre 5 e 18 anos completaram o estudo. Os pacientes foram randomizados em dois grupos, para receber ciproheptadina 4 mg três vezes por dia durante 12 semanas ou placebo. Todos os dados foram coletados no início e no final do período de estudo e incluíram peso, altura e espirometria. RESULTADOS: O ganho de peso médio foi de 0,67 kg e 1,61 kg nos grupos placebo e ciproheptadina, respectivamente (p = 0,036). O índice de massa corporal (IMC) diminuiu 0,07 kg/m² no grupo placebo e aumentou 0,46 kg/m² no grupo intervenção (p = 0,027). A mudança no IMC para a idade (escore z) foi de -0,19 no grupo placebo e 0,20 no grupo ciproheptadina (p = 0,003). O IMC escore z diminuiu 0,19 no grupo placebo e aumentou 0,2 no grupo ciproheptadina (p = 0,003). Alterações na função pulmonar não foram estatisticamente diferentes. CONCLUSÃO: O uso de ciproheptadina em pacientes com fibrose cística foi bem tolerado, apresentando um ganho de peso significativo e um aumento no IMC após 12 semanas. Foi encontrado um tamanho de efeito clinicamente relevante para o peso/idade (escore z) e IMC para idade (escore z). Tais achados sugerem que a prescrição de ciproheptadina pode ser uma abordagem alternativa para pacientes que precisam de suporte nutricional por um curto período de tempo.

OBJECTIVE: To determine whether the administration of cyproheptadine was able to induce weight gain in patients with cystic fibrosis. METHODS: We performed a double-blind, placebo-controlled trial in two centers in Brazil. Twenty-five patients with cystic fibrosis between 5 and 18 years completed the study. Patients were randomized into two groups, to receive either cyproheptadine 4 mg three times per day for 12 weeks or placebo. All data were collected at the beginning and at the end of the study period and included weight, height and spirometry. RESULTS: Average weight gain was 0.67 kg in the placebo group and 1.61 kg in the cyproheptadine group (p = 0.036). Body mass index (BMI) decreased 0.07 kg/m² in the placebo group and increased 0.46 kg/m² in the intervention group (p = 0,027). The change in BMI for age (z score) was -0.19 in the placebo group and +0.20 in the cyproheptadine group (p = 0.003). BMI z score decreased 0.19 in the placebo group and increased 0.2 in the cyproheptadine group (p = 0.003). Changes in pulmonary function were not statistically different. CONCLUSION: Use of cyproheptadine in cystic fibrosis patients was well tolerated, showing a significant weight gain and a significant increase in BMI after 12 weeks. A clinically relevant effect size for weight/age (z score) and body mass index for age (z score) was found. Such findings suggest that the prescription of cyproheptadine can be an alternative approach for patients who need nutritional support for a short period of time.

Efficacy of a Polyherbal Appetite Stimulant in the Treatment of Anorexia in Children.

A post marketing surveillance study was done on children with ages 1-15 years, who were evaluated on the basis of the symptoms of loss of appetite, nausea/vomiting, icterus, irritability and hepatomegaly. A polyherbal appetite stimulant, New Livfit was administered 1 teaspoon twice daily to children > 3 years and 10-20 drops thrice daily to children < 3 years, respectively, before meals for 3 weeks. The severity of anorexia was recorded at baseline and at the 4th week and 6th week after initiation of therapy. It was observed that only 0.8% children had normal appetite at baseline which increased to 67.4% and 78.9% at 4 and 6 weeks after the initiation of treatment. There was a statistically significant improvement (p < 0.0001) in appetite score in children with anorexia at 4 weeks and 6 weeks after initiation of treatment as compared to baseline. The results show that New Livfit is an efficacious and safe treatment for anorexia in children.

Cancer cachexia: pathophysiologic aspects and treatment options.

Cancer cachexia is a syndrome characterized with progressive weight loss and abnormal wasting of fat and muscle tissue, and affects 40 to 85% of all terminally ill patients, accounting more than 20% of all cancer deaths. Current treatment for cancer cachexia principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. Although the exact mechanism and predisposing factors have yet to be clarified in detail, our growing knowledge about the pathophysiology and biochemical changes considering this life threatening condition should help in development of future therapeutic strategies. In the present paper, the current preclinical and clinical features considering the pathophysiology and treatment of cancer related cachexia are reviewed.

Endocannabinoid system--a novel target for cardiometabolic risk.

The endocannabinoid system (EC) plays a significant role in appetite drive and associated behaviours. Therefore attenuation of the activity of the EC system would have therapeutic benefit in treating disorders that might have a component of excess appetite drive or over-activity of the endocannabinoid system, such as obesity, ethanol and other drug abuse, and a variety of central nervous system and other disorders. Antagonists of cannabinoid receptors have been designed through rational drug discovery essential to exploit these novel targets for potential in obesity, metabolism, addiction, pain and neurologic disorders. Rimonabant is the only compound in this group which along this pathway is now approved as a selective CB (1) (cannabinoid receptor subtype 1) antagonist, or inverse agonist, in the European Union and India and under regulatory review in the United States for the treatment of obesity and associated cardiometabolic risk.

Ghrelin; Influences on Helicobacter pylori-associated Gastric Diseases / 대한소화기학회지

Recently, gastric Helicobacter pylori (H. pylori) colonization has been shown to affect the expression of leptin and ghrelin, hormones that control appetite and satiety. Gastric leptin, produced by chief and parietal cells and released in response to meals, may play a role in weight gain after eradication of H. pylori infection, whereas ghrelin, produced by X/A-like enteroendocrine cells in oxyntic gland, is released during fasting, and suppressed by feeding and leptin. Whether either that H. pylori genes represent microbial contributions to the complement of thrifty genes of humans, or that H. pylori disappearance plays a role in adiposity remains to be determined. Simply, ghrelin-leptin might tango in body weight regulation, gastric inflammation, and gastric motility. In the current review about the possible role of ghrelin in gastric inflammation, we found that high serum albumin condition decreased ghrelin expression, whereas serum albumin deprivation significantly increased ghrelin expression, however, of which regulation was abolished after H. pylori infection. Ghrelin significantly attenuated the inflammatory stimuli imposed after H. pylori, shown with inactivation of phospho-extracellular signal-regulated kinase (p-ERK) and nuclear factor-KappaB (NF-KappaB)-DNA binding activities. Conclusively, besides orexigenic and weight gaining actions of gastric hormone, ghrelin, it likely endows the stomach the protective effect from exogenous damages.

Fattening practices among Moroccan Saharawi women

To study obesity in Moroccan Saharawi culture, 249 women were questioned about their desired body size and diet practices. The majority of women [90.4%] reported wanting to gain weight currently or at some time in the past. To gain weight, women used a fattening period [tablah] of at least 40 days of overeating with a reduction of physical activity and special traditional meals. Appetite enhancers [therapeutic drugs or fenugreek] and traditional suppositories were also used. Some women used corticosteroids to gain weight rapidly. The study highlights the need for health education about the dangers of obesity and steroid use in this culture

Desarrollo de la conducta alimentaria en la infancia y sus alteraciones / Development of feeding behavior in childhood and its alterations

El desarrollo de la conducta alimentaria es un proceso complejo en el que participan componentes fisiológicos de regulación de la ingesta alimentaria, del crecimiento y peso corporal; componentes psicológicos del niño, de los padres y de la familia y además componentes culturales y sociales. Son frecuentes sus alteraciones en los primeros años de vida, las que se pueden traducir en un retraso del crecimiento, aversiones alimentarias y dificultades secundarias en la convivencia familiar. El manejo de estas alteraciones debiera estar basado principalmente en una educación preventiva en los primeros dos años de vida a la madre, en la modificación conductual del ambiente familiar (madre, hijo, otros miembros de ella) y sólo secundariamente considerar el manejo con fármacos

Supportive role of a micronutrient appetite normaliser in convalescing patients.

A total of 722 patients recruited from various clinics across Western India, particularly in Western Maharashtra and South Gujarat, recovering from a variety of clinical conditions such as infections of the respiratory tract, malaria, enteric fever, jaundice, surgical procedures and so on were administered a micronutrient appetite normaliser formulation (neogadine) for periods up to 30 days. There was a significant and steady increase in the scores of appetite and well-being during the study period. Very good to good response were reported in 83% of patients. Neogadine was well tolerated with no significant adverse effects on any patients. Based on past experience with this micronutrient formulation as well as the findings of the present study, it is reasonable to conclude that neogadine plays a useful supportive role in the restoration of appetite and well-being in conditions that apply to private practice situations in India.

Intoxicación por ciproheptadina / Intoxication by cyproheptadine

La intoxicación por ciproheptadina, principal componente de los estimulantes del apetito, se ha transformado en un importante motivo de consulta en los servicios de urgencia a lo largo del país. Estos fármacos, utilizados muchas veces sin prescripción médica, dado su agradable sabor resultan atractivos para los preescolares quienes los ingieren en dosis que sobrepasan el nivel terapéutico, desencadenando cuadros muy variados, que van desde excitación psicomotora hasta la muerte

Vademecum / Vademecum

El doctor Enrique Revollo,ha realizado un fertil trabajo que lo ofrece al cuerpo medico mediante este valioso vademecun,siendo facil prever la buena acogida que recibira por el nucleo profesional al que se halla destinado,la ventaja de este vademecun,es que ofrecemos una lista de la totalidad de los productos que se expenden en el comercio farmaceutico nacional,incluye detalles de presentacion asi como la dosificado recomendado por los fabricantes.

Regulación neuropeptídica de la secreción ácido-gástrica / Neuropeptidic regulation of acid-gastric secretion

La secreción ácida gástrica es el resultado de la actividad habitual de las células oxínticas, activadas por un interjuego estimulador e inhibidor de factores que actúan por vía neurocrina, paracrina y endocrina. Hoy se sabe que los centros nerviosos superiores a través del vago, mantienen una influencia permanente sobre estas células y su secreción. El vago fúndico estimula colinérgicamente la célula parietal, y por otro lado, inhibe colinérgicamente la liberación antral de gastrina. El vago antral estimula a través de bombesina y/o péptido liberador de gastrina (PLG) la liberación de gastrina. Además, participa de un mecanismo inhibidor neuroendocrino de la secreción ácida o acción vagogastrona. La alimentación, aminoácidos en especial, provoca el mayor estímulo de la secreción de gastrina, que por vía endocrina sistémica o por vía endocrina portal, constituye el estímulo mas eficiente de la secreción ácida. La regulación o feed-back de la secreción ácida se efectiviza por agonistas y antagonistas neurocrinos, paracrinos o endocrinos, a través de un verdadero tandem integrado por somatostatina, VIP, secretina y GIP, entre otros.