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Background & Aims: The incidence of tube feeding dependency seems to increase worldwide, and these children may remain on prolonged tube feeding for many months to years. The multidisciplinary clinical hunger provocation (CHP) program is an intensive inpatient intervention of usually 2-3 weeks, aimed at weaning children from tube feeding. CHP has been proven highly effective on the short term (80-86%), particularly when applied before the age of two years but long-term data are lacking. The aims of our study were to determine the long-term efficacy of the CHP program and factors associated with success or failure and to assess anthropometrics, feeding behavior, and medical outcomes at long-term follow-up., Methods: All tube-dependent children who underwent CHP at a tertiary hospital in Amsterdam, the Netherlands, between 2001 and 2014, and had a minimum follow-up of 12-months in 2015, were eligible to participate in this retrospective cohort study. During the CHP program, tube feeding is ceased stepwise to create appetite, according to a strict protocol. The program was defined successful if patients achieved oral intake and could be fully weaned from tube feeding following the CHP program. Acute malnourishment was defined as weight for height <2 SD or loss of >1 SD within 3 months, chronic malnourishment as height for age <2 SD and both acute and chronic malnourishment as both a height for age and weight for height <2 SD. Long-term efficacy (tube free at varying follow-up periods), anthropometrics (height for age, weight for height), feeding behavior and medical outcomes were assessed by a structured cross-sectional parental interview., Results: In total, 57 patients were admitted to the CHP program. Fifty-two patients could be contacted of whom 42 participated in the study (response rate 81%) with a median age at admittance of 19 (IQR 13-22) months (62% female). The program was initially successful in 36/42 (86% (Bca CI 95% 75.0-95.2)) patients. A younger age upon initiation of tube feeding was negatively correlated with success (p 0.016). At follow-up, a median period of 67.0 (IQR 37.0-101.5) months after discharge, long-term efficacy was 32/41 (78% (Bca CI 95% 64.1-90.0)) (1 missing data). Patients with a successful CHP had beneficial outcomes compared to those with an unsuccessful CHP, showing less selective eating behavior (p 0.025), nocturnal feeding (p 0.044), forced feeding (p 0.044) and hospital admissions (p 0.028). However, 44% of successfully weaned patients fulfilled the criteria for malnourishment at long-term follow-up (13% acute, 22% chronic, and 9% both acute and chronic (compared to 22% at admittance: 13% acute, 6% chronic, and 3% both)). 59.4% of successfully weaned patients showed signs of developmental delays or were diagnosed with new medical diagnoses (43.8%) at long-term follow-up., Conclusions: The multidisciplinary CHP is a highly effective short-term (86%) and long-term (78%) intervention to wean young children from tube feeding, with beneficial feeding outcomes. However, at long-term follow-up, many successfully weaned patients were malnourished, showed signs of developmental delay, and were diagnosed with new medical diagnoses. For these reasons, patients should be monitored carefully during and after tube weaning, also after successful CHP. Tube dependency might be an early expression of medical diagnoses., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

While studying the effect of structure on satiety, effects of mode of consumption, additional water to drink, and thirst have been neglected. The objective was to assess effects of structure, mode of consumption of food, and additional drinking of water on fullness and thirst. In study 1, 20 subjects (BMI 22.5 ± 0.5 kg/m(2); age 21.4 ± 3 years) underwent consumption conditions; SEW: solids to eat + 750 ml water to drink; LEW: liquefied soup to eat including 500 ml water + 250 ml water separately to drink; LDW: the same as LEW but served as drinks; SE, LE, and LD: the same as previous but without water to drink. In study 2, a subset of subjects underwent consumption conditions: solid carbohydrate, solid protein, solid fat: the same as SEW, but for each macronutrient separately; liquefied carbohydrate, liquefied protein, liquefied fat: the same as LEW, but for each macronutrient separately. Appetite, insulin concentration, glucose concentration, and ghrelin concentration were measured. Eating, independent of structure, suppressed desire to eat more than drinking (P < 0.01). Drinking water separately vs. water consumption in the food suppressed thirst more (P < 0.001). Regarding protein, satiety was higher in the solid vs. liquefied condition, while blood parameters were not significantly different. Only after drinking a meal most subjects (80%) wanted to consume more of the same meal, in order to alleviate hunger (63%) or quench thirst (37%). We conclude that mode of consumption plays a role in alleviating hunger and thirst. Subjects required further consumption after drinking the meal, motivated by hunger or thirst, showing that drinking a meal causes confusion that may imply a risk of overconsumption.

External eaters reportedly increase snack intake when stressed, which could be due to an attentional shift towards food stimuli. Attentional biases for food stimuli were tested in high and low external eaters in stress and control conditions, using a computerised Stroop. A significant interaction was observed between external eating group and condition for snack word bias. This suggested that low external eaters have a greater bias for snack words when unstressed and that stressed, high external eaters have a greater bias for snack words than stressed, low external eaters, which could contribute to stress-induced snack intake in high external eaters.

Background: In investigating anorexia of ageing, attention is often given to physical and psychological determinants of appetite in the elderly but little has been done to provide information on self-assessment of appetite and sensory perceptions in the elderly., Objectives: to provide data and detect possible differences in self-assessment of appetite, hunger feelings and sensory perception in different health group of elderly using the Appetite, Hunger feelings and Sensory Perception (AHSP) questionnaire., Methods: three health categories of elderly subjects were used for the present study: free-living with no help, free-living with help and nursing home elderly. For each group, collected data were general characteristics, anthropometry and answers to the AHSP. The AHSP questionnaire includes 29-items focusing on feelings of hunger and appetite as well as taste and smell perception addressing both the present situation and the period before retirement., Results: Significant differences were observed between the 3 health groups for appetite, hunger feelings, present taste perception and present smell perception (P<0.05). Appetite and hunger were found to be related to body weight in the healthiest but not in the others., Conclusion: A decline in health status is paired with a decrease in appetite, hunger feelings and sensory perceptions of elderly subjects.