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Eating Behavior Disorders in Uremia: A Question of Balance in Appetite Regulation
ABSTRACT Eating and appetite disorders are frequent complications of the uremic syndrome which contribute to malnutrition in dialysis patients. The data suggest that uremic anorexia may occur with or without abdominal and visceral fat accumulation despite a lower food intake. This form of obesity (i...
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Published in: | Seminars in dialysis 2004-01, Vol.17 (1), p.44-52 |
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creator | Aguilera, Abelardo Codoceo, Rosa Bajo, María A. Iglesias, Pedro Diéz, Juan J. Barril, Guillermina Cigarrán, Secundino Álvarez, Vicente Celadilla, Olga Fernández-Perpén, Antonio Montero, Agustín Selgas, Rafael |
description | ABSTRACT
Eating and appetite disorders are frequent complications of the uremic syndrome which contribute to malnutrition in dialysis patients. The data suggest that uremic anorexia may occur with or without abdominal and visceral fat accumulation despite a lower food intake. This form of obesity (i.e., with low food intake and malnutrition) is more common in dialysis patients than obesity with high food intake. This article reviews the current knowledge regarding mechanisms responsible for appetite regulation in normal conditions and in uremic patients. Anorexia in dialysis patients has been historically considered as a sign of uremic toxicity due to ‘‘inadequate’’ dialysis as judged by uncertain means (‘‘middle molecule’’ accumulation, Kt/V, ‘‘peak‐concentration hypothesis,’’ and others). We propose the tryptophan‐serotonin hypothesis, based on a uremia‐induced disorder in patients’ amino acid profile—low concentrations of large neutral and branched‐chain amino acids with high tryptophan levels. A high rate of tryptophan transport across the blood‐brain barrier increases the synthesis of serotonin, a major appetite inhibitor. Inflammation may also play a role in the genesis of anorexia and malnutrition. For example, silent infection with Helicobacter pylori may be a source of cytokines with cachectic action; its eradication improves appetite and nutrition. The evaluation of appetite should take into account cultural and social aspects. Uremic patients showed a universal trend to carbohydrate preference and red meat refusal compared to healthy people. In contrast, white meat was less problematic. Uremic patients also have a remarkable attraction for citrics and strong flavors in general. Eating preferences or refusals have been related to the predominance of some appetite peptide modulators. High levels of cholecystokinin (CCK) (a powerful anorexigen) are associated with early satiety for carbohydrates and neuropeptide Y (NPY) (an orexigen) with repeated food intake. Obesity and elevated body mass index often falsely suggest a good nutritional status. In uremic patients (a hyperinsulinemia state), disorders in the regulation of fat distribution (insulin, leptin, insulin‐like growth factor [IGF]‐1, fatty acids, and disorders in receptors for insulin, lipoprotein lipase, mitochondrial uncoupling protein‐2, and β3‐adrenoreceptors) may cause abdominal fat accumulation without an increase in appetite. Finally, appetite regulation in uremia is highly complex. D |
doi_str_mv | 10.1046/j.0894-0959.2004.16086.x |
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Eating and appetite disorders are frequent complications of the uremic syndrome which contribute to malnutrition in dialysis patients. The data suggest that uremic anorexia may occur with or without abdominal and visceral fat accumulation despite a lower food intake. This form of obesity (i.e., with low food intake and malnutrition) is more common in dialysis patients than obesity with high food intake. This article reviews the current knowledge regarding mechanisms responsible for appetite regulation in normal conditions and in uremic patients. Anorexia in dialysis patients has been historically considered as a sign of uremic toxicity due to ‘‘inadequate’’ dialysis as judged by uncertain means (‘‘middle molecule’’ accumulation, Kt/V, ‘‘peak‐concentration hypothesis,’’ and others). We propose the tryptophan‐serotonin hypothesis, based on a uremia‐induced disorder in patients’ amino acid profile—low concentrations of large neutral and branched‐chain amino acids with high tryptophan levels. A high rate of tryptophan transport across the blood‐brain barrier increases the synthesis of serotonin, a major appetite inhibitor. Inflammation may also play a role in the genesis of anorexia and malnutrition. For example, silent infection with Helicobacter pylori may be a source of cytokines with cachectic action; its eradication improves appetite and nutrition. The evaluation of appetite should take into account cultural and social aspects. Uremic patients showed a universal trend to carbohydrate preference and red meat refusal compared to healthy people. In contrast, white meat was less problematic. Uremic patients also have a remarkable attraction for citrics and strong flavors in general. Eating preferences or refusals have been related to the predominance of some appetite peptide modulators. High levels of cholecystokinin (CCK) (a powerful anorexigen) are associated with early satiety for carbohydrates and neuropeptide Y (NPY) (an orexigen) with repeated food intake. Obesity and elevated body mass index often falsely suggest a good nutritional status. In uremic patients (a hyperinsulinemia state), disorders in the regulation of fat distribution (insulin, leptin, insulin‐like growth factor [IGF]‐1, fatty acids, and disorders in receptors for insulin, lipoprotein lipase, mitochondrial uncoupling protein‐2, and β3‐adrenoreceptors) may cause abdominal fat accumulation without an increase in appetite. Finally, appetite regulation in uremia is highly complex. Disorders in adipose tissue, gastrointestinal and neuropeptides, retained or hyperproduced inflammatory end products, and central nervous system changes may all play a role. Uremic anorexia may be explained by a hypothalamic hyperserotoninergic state derived from a high concentration of tryptophan and low branched‐chain amino acids.</description><identifier>ISSN: 0894-0959</identifier><identifier>EISSN: 1525-139X</identifier><identifier>DOI: 10.1046/j.0894-0959.2004.16086.x</identifier><identifier>PMID: 14717811</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Inc</publisher><subject>Appetite - physiology ; Feeding and Eating Disorders - etiology ; Feeding and Eating Disorders - physiopathology ; Feeding and Eating Disorders - psychology ; Feeding Behavior ; Helicobacter pylori ; Humans ; Inflammation - physiopathology ; Malnutrition - etiology ; Obesity - etiology ; Renal Dialysis ; Uremia - complications ; Uremia - physiopathology ; Uremia - psychology</subject><ispartof>Seminars in dialysis, 2004-01, Vol.17 (1), p.44-52</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4376-cb365f19535b48c9fb96ed2cb1641010217d43f1e8b158d093cda376bd82d1293</citedby><cites>FETCH-LOGICAL-c4376-cb365f19535b48c9fb96ed2cb1641010217d43f1e8b158d093cda376bd82d1293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14717811$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aguilera, Abelardo</creatorcontrib><creatorcontrib>Codoceo, Rosa</creatorcontrib><creatorcontrib>Bajo, María A.</creatorcontrib><creatorcontrib>Iglesias, Pedro</creatorcontrib><creatorcontrib>Diéz, Juan J.</creatorcontrib><creatorcontrib>Barril, Guillermina</creatorcontrib><creatorcontrib>Cigarrán, Secundino</creatorcontrib><creatorcontrib>Álvarez, Vicente</creatorcontrib><creatorcontrib>Celadilla, Olga</creatorcontrib><creatorcontrib>Fernández-Perpén, Antonio</creatorcontrib><creatorcontrib>Montero, Agustín</creatorcontrib><creatorcontrib>Selgas, Rafael</creatorcontrib><title>Eating Behavior Disorders in Uremia: A Question of Balance in Appetite Regulation</title><title>Seminars in dialysis</title><addtitle>Semin Dial</addtitle><description>ABSTRACT
Eating and appetite disorders are frequent complications of the uremic syndrome which contribute to malnutrition in dialysis patients. The data suggest that uremic anorexia may occur with or without abdominal and visceral fat accumulation despite a lower food intake. This form of obesity (i.e., with low food intake and malnutrition) is more common in dialysis patients than obesity with high food intake. This article reviews the current knowledge regarding mechanisms responsible for appetite regulation in normal conditions and in uremic patients. Anorexia in dialysis patients has been historically considered as a sign of uremic toxicity due to ‘‘inadequate’’ dialysis as judged by uncertain means (‘‘middle molecule’’ accumulation, Kt/V, ‘‘peak‐concentration hypothesis,’’ and others). We propose the tryptophan‐serotonin hypothesis, based on a uremia‐induced disorder in patients’ amino acid profile—low concentrations of large neutral and branched‐chain amino acids with high tryptophan levels. A high rate of tryptophan transport across the blood‐brain barrier increases the synthesis of serotonin, a major appetite inhibitor. Inflammation may also play a role in the genesis of anorexia and malnutrition. For example, silent infection with Helicobacter pylori may be a source of cytokines with cachectic action; its eradication improves appetite and nutrition. The evaluation of appetite should take into account cultural and social aspects. Uremic patients showed a universal trend to carbohydrate preference and red meat refusal compared to healthy people. In contrast, white meat was less problematic. Uremic patients also have a remarkable attraction for citrics and strong flavors in general. Eating preferences or refusals have been related to the predominance of some appetite peptide modulators. High levels of cholecystokinin (CCK) (a powerful anorexigen) are associated with early satiety for carbohydrates and neuropeptide Y (NPY) (an orexigen) with repeated food intake. Obesity and elevated body mass index often falsely suggest a good nutritional status. In uremic patients (a hyperinsulinemia state), disorders in the regulation of fat distribution (insulin, leptin, insulin‐like growth factor [IGF]‐1, fatty acids, and disorders in receptors for insulin, lipoprotein lipase, mitochondrial uncoupling protein‐2, and β3‐adrenoreceptors) may cause abdominal fat accumulation without an increase in appetite. Finally, appetite regulation in uremia is highly complex. Disorders in adipose tissue, gastrointestinal and neuropeptides, retained or hyperproduced inflammatory end products, and central nervous system changes may all play a role. Uremic anorexia may be explained by a hypothalamic hyperserotoninergic state derived from a high concentration of tryptophan and low branched‐chain amino acids.</description><subject>Appetite - physiology</subject><subject>Feeding and Eating Disorders - etiology</subject><subject>Feeding and Eating Disorders - physiopathology</subject><subject>Feeding and Eating Disorders - psychology</subject><subject>Feeding Behavior</subject><subject>Helicobacter pylori</subject><subject>Humans</subject><subject>Inflammation - physiopathology</subject><subject>Malnutrition - etiology</subject><subject>Obesity - etiology</subject><subject>Renal Dialysis</subject><subject>Uremia - complications</subject><subject>Uremia - physiopathology</subject><subject>Uremia - psychology</subject><issn>0894-0959</issn><issn>1525-139X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNqNkMlOwzAQQC0EgrL8AvKJW4IndhKbA1JboCCxiE1ws5xkAi5pU-wUyt-T0AqunDyHN8-jRwgFFgITyeE4ZFKJgKlYhRFjIoSEySRcrJEexFEcAFfP66T3C22Rbe_HjAGPUrFJtkCkkEqAHrk9NY2dvtABvpoPWzt6Yn3tCnSe2il9dDix5oj26e0cfWPrKa1LOjCVmebYAf3ZDBvbIL3Dl3llOmKXbJSm8ri3enfI49npw_A8uLwZXQz7l0EueJoEecaTuAQV8zgTMldlphIsojyDRAADFkFaCF4CygxiWTDF88K0i1khowIixXfIwdI7c_V7d52eWJ9j1d6G9dzrCDiXraYF5RLMXe29w1LPnJ0Y96WB6S6nHuuulO5K6S6n_smpF-3q_uqPeTbB4m9x1a8FjpfAp63w699ifX9y8TO2gmApsL7Bxa_AuDedpDyN9dP1SMPVdToYiTt9xr8BIgmRsA</recordid><startdate>200401</startdate><enddate>200401</enddate><creator>Aguilera, Abelardo</creator><creator>Codoceo, Rosa</creator><creator>Bajo, María A.</creator><creator>Iglesias, Pedro</creator><creator>Diéz, Juan J.</creator><creator>Barril, Guillermina</creator><creator>Cigarrán, Secundino</creator><creator>Álvarez, Vicente</creator><creator>Celadilla, Olga</creator><creator>Fernández-Perpén, Antonio</creator><creator>Montero, Agustín</creator><creator>Selgas, Rafael</creator><general>Blackwell Science Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope></search><sort><creationdate>200401</creationdate><title>Eating Behavior Disorders in Uremia: A Question of Balance in Appetite Regulation</title><author>Aguilera, Abelardo ; Codoceo, Rosa ; Bajo, María A. ; Iglesias, Pedro ; Diéz, Juan J. ; Barril, Guillermina ; Cigarrán, Secundino ; Álvarez, Vicente ; Celadilla, Olga ; Fernández-Perpén, Antonio ; Montero, Agustín ; Selgas, Rafael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4376-cb365f19535b48c9fb96ed2cb1641010217d43f1e8b158d093cda376bd82d1293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Appetite - physiology</topic><topic>Feeding and Eating Disorders - etiology</topic><topic>Feeding and Eating Disorders - physiopathology</topic><topic>Feeding and Eating Disorders - psychology</topic><topic>Feeding Behavior</topic><topic>Helicobacter pylori</topic><topic>Humans</topic><topic>Inflammation - physiopathology</topic><topic>Malnutrition - etiology</topic><topic>Obesity - etiology</topic><topic>Renal Dialysis</topic><topic>Uremia - complications</topic><topic>Uremia - physiopathology</topic><topic>Uremia - psychology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aguilera, Abelardo</creatorcontrib><creatorcontrib>Codoceo, Rosa</creatorcontrib><creatorcontrib>Bajo, María A.</creatorcontrib><creatorcontrib>Iglesias, Pedro</creatorcontrib><creatorcontrib>Diéz, Juan J.</creatorcontrib><creatorcontrib>Barril, Guillermina</creatorcontrib><creatorcontrib>Cigarrán, Secundino</creatorcontrib><creatorcontrib>Álvarez, Vicente</creatorcontrib><creatorcontrib>Celadilla, Olga</creatorcontrib><creatorcontrib>Fernández-Perpén, Antonio</creatorcontrib><creatorcontrib>Montero, Agustín</creatorcontrib><creatorcontrib>Selgas, Rafael</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Seminars in dialysis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aguilera, Abelardo</au><au>Codoceo, Rosa</au><au>Bajo, María A.</au><au>Iglesias, Pedro</au><au>Diéz, Juan J.</au><au>Barril, Guillermina</au><au>Cigarrán, Secundino</au><au>Álvarez, Vicente</au><au>Celadilla, Olga</au><au>Fernández-Perpén, Antonio</au><au>Montero, Agustín</au><au>Selgas, Rafael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Eating Behavior Disorders in Uremia: A Question of Balance in Appetite Regulation</atitle><jtitle>Seminars in dialysis</jtitle><addtitle>Semin Dial</addtitle><date>2004-01</date><risdate>2004</risdate><volume>17</volume><issue>1</issue><spage>44</spage><epage>52</epage><pages>44-52</pages><issn>0894-0959</issn><eissn>1525-139X</eissn><abstract>ABSTRACT
Eating and appetite disorders are frequent complications of the uremic syndrome which contribute to malnutrition in dialysis patients. The data suggest that uremic anorexia may occur with or without abdominal and visceral fat accumulation despite a lower food intake. This form of obesity (i.e., with low food intake and malnutrition) is more common in dialysis patients than obesity with high food intake. This article reviews the current knowledge regarding mechanisms responsible for appetite regulation in normal conditions and in uremic patients. Anorexia in dialysis patients has been historically considered as a sign of uremic toxicity due to ‘‘inadequate’’ dialysis as judged by uncertain means (‘‘middle molecule’’ accumulation, Kt/V, ‘‘peak‐concentration hypothesis,’’ and others). We propose the tryptophan‐serotonin hypothesis, based on a uremia‐induced disorder in patients’ amino acid profile—low concentrations of large neutral and branched‐chain amino acids with high tryptophan levels. A high rate of tryptophan transport across the blood‐brain barrier increases the synthesis of serotonin, a major appetite inhibitor. Inflammation may also play a role in the genesis of anorexia and malnutrition. For example, silent infection with Helicobacter pylori may be a source of cytokines with cachectic action; its eradication improves appetite and nutrition. The evaluation of appetite should take into account cultural and social aspects. Uremic patients showed a universal trend to carbohydrate preference and red meat refusal compared to healthy people. In contrast, white meat was less problematic. Uremic patients also have a remarkable attraction for citrics and strong flavors in general. Eating preferences or refusals have been related to the predominance of some appetite peptide modulators. High levels of cholecystokinin (CCK) (a powerful anorexigen) are associated with early satiety for carbohydrates and neuropeptide Y (NPY) (an orexigen) with repeated food intake. Obesity and elevated body mass index often falsely suggest a good nutritional status. In uremic patients (a hyperinsulinemia state), disorders in the regulation of fat distribution (insulin, leptin, insulin‐like growth factor [IGF]‐1, fatty acids, and disorders in receptors for insulin, lipoprotein lipase, mitochondrial uncoupling protein‐2, and β3‐adrenoreceptors) may cause abdominal fat accumulation without an increase in appetite. Finally, appetite regulation in uremia is highly complex. Disorders in adipose tissue, gastrointestinal and neuropeptides, retained or hyperproduced inflammatory end products, and central nervous system changes may all play a role. Uremic anorexia may be explained by a hypothalamic hyperserotoninergic state derived from a high concentration of tryptophan and low branched‐chain amino acids.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Inc</pub><pmid>14717811</pmid><doi>10.1046/j.0894-0959.2004.16086.x</doi><tpages>9</tpages></addata></record> |
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subjects | Appetite - physiology Feeding and Eating Disorders - etiology Feeding and Eating Disorders - physiopathology Feeding and Eating Disorders - psychology Feeding Behavior Helicobacter pylori Humans Inflammation - physiopathology Malnutrition - etiology Obesity - etiology Renal Dialysis Uremia - complications Uremia - physiopathology Uremia - psychology |
title | Eating Behavior Disorders in Uremia: A Question of Balance in Appetite Regulation |
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