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BMC Medicine Aug 2022Medical cannabinoids differ in their pharmacology and may have different treatment effects. We aimed to conduct a pharmacology-based systematic review (SR) and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Medical cannabinoids differ in their pharmacology and may have different treatment effects. We aimed to conduct a pharmacology-based systematic review (SR) and meta-analyses of medical cannabinoids for efficacy, retention and adverse events.
METHODS
We systematically reviewed (registered at PROSPERO: CRD42021229932) eight databases for randomized controlled trials (RCTs) of dronabinol, nabilone, cannabidiol and nabiximols for chronic pain, spasticity, nausea /vomiting, appetite, ALS, irritable bowel syndrome, MS, Chorea Huntington, epilepsy, dystonia, Parkinsonism, glaucoma, ADHD, anorexia nervosa, anxiety, dementia, depression, schizophrenia, PTSD, sleeping disorders, SUD and Tourette. Main outcomes and measures included patient-relevant/disease-specific outcomes, retention and adverse events. Data were calculated as standardized mean difference (SMD) and ORs with confidence intervals (CI) via random effects. Evidence quality was assessed by the Cochrane Risk of Bias and GRADE tools.
RESULTS
In total, 152 RCTs (12,123 participants) were analysed according to the type of the cannabinoid, outcome and comparator used, resulting in 84 comparisons. Significant therapeutic effects of medical cannabinoids show a large variability in the grade of evidence that depends on the type of cannabinoid. CBD has a significant therapeutic effect for epilepsy (SMD - 0.5[CI - 0.62, - 0.38] high grade) and Parkinsonism (- 0.41[CI - 0.75, - 0.08] moderate grade). There is moderate evidence for dronabinol for chronic pain (- 0.31[CI - 0.46, - 0.15]), appetite (- 0.51[CI - 0.87, - 0.15]) and Tourette (- 1.01[CI - 1.58, - 0.44]) and moderate evidence for nabiximols on chronic pain (- 0.25[- 0.37, - 0.14]), spasticity (- 0.36[CI - 0.54, - 0.19]), sleep (- 0.24[CI - 0.35, - 0.14]) and SUDs (- 0.48[CI - 0.92, - 0.04]). All other significant therapeutic effects have either low, very low, or even no grade of evidence. Cannabinoids produce different adverse events, and there is low to moderate grade of evidence for this conclusion depending on the type of cannabinoid.
CONCLUSIONS
Cannabinoids are effective therapeutics for several medical indications if their specific pharmacological properties are considered. We suggest that future systematic studies in the cannabinoid field should be based upon their specific pharmacology.
Topics: Cannabinoids; Chronic Pain; Dronabinol; Humans; Nausea; Vomiting
PubMed: 35982439
DOI: 10.1186/s12916-022-02459-1 -
Nutrients Jun 2023Previously, narrative reviews have considered the effects of intermittent fasting on appetite. One suggestion is that intermittent fasting attenuates an increase in... (Meta-Analysis)
Meta-Analysis Review
Previously, narrative reviews have considered the effects of intermittent fasting on appetite. One suggestion is that intermittent fasting attenuates an increase in appetite that typically accompanies weight loss. Here, we conducted the first systematic review and meta-analysis to quantify the effects of intermittent fasting on appetite, when compared to a continuous energy restriction intervention. Five electronic databases and trial registers were searched in February 2021 and February 2022. Abstracts (N = 2800) were screened and 17 randomized controlled trials (RCTs), consisting of a variety of intermittent fasting regimes, met our inclusion criteria. The total number of participants allocated to interventions was 1111 and all RCTs were judged as having either some concerns or a high risk of bias (Cochrane RoB 2.0 tool). Random effects meta-analyses were conducted on change-from-baseline appetite ratings. There was no clear evidence that intermittent fasting affected hunger (WMD = -3.03; 95% CI [-8.13, 2.08]; = 0.25; N = 13), fullness (WMD = 3.11; 95% CI [-1.46, 7.69]; = 0.18; N = 10), desire to eat (WMD = -3.89; 95% CI [-12.62, 4.83]; = 0.38; N = 6), or prospective food consumption (WMD = -2.82; 95% CI [-3.87, 9.03]; = 0.43; N = 5), differently to continuous energy restriction interventions. Our results suggest that intermittent fasting does not mitigate an increase in our drive to eat that is often associated with continuous energy restriction.
Topics: Humans; Appetite; Intermittent Fasting; Energy Intake; Hunger; Weight Loss; Fasting
PubMed: 37299567
DOI: 10.3390/nu15112604 -
Obesity Reviews : An Official Journal... Jan 2015Very-low-energy diets (VLEDs) and ketogenic low-carbohydrate diets (KLCDs) are two dietary strategies that have been associated with a suppression of appetite. However,... (Meta-Analysis)
Meta-Analysis Review
Very-low-energy diets (VLEDs) and ketogenic low-carbohydrate diets (KLCDs) are two dietary strategies that have been associated with a suppression of appetite. However, the results of clinical trials investigating the effect of ketogenic diets on appetite are inconsistent. To evaluate quantitatively the effect of ketogenic diets on subjective appetite ratings, we conducted a systematic literature search and meta-analysis of studies that assessed appetite with visual analogue scales before (in energy balance) and during (while in ketosis) adherence to VLED or KLCD. Individuals were less hungry and exhibited greater fullness/satiety while adhering to VLED, and individuals adhering to KLCD were less hungry and had a reduced desire to eat. Although these absolute changes in appetite were small, they occurred within the context of energy restriction, which is known to increase appetite in obese people. Thus, the clinical benefit of a ketogenic diet is in preventing an increase in appetite, despite weight loss, although individuals may indeed feel slightly less hungry (or more full or satisfied). Ketosis appears to provide a plausible explanation for this suppression of appetite. Future studies should investigate the minimum level of ketosis required to achieve appetite suppression during ketogenic weight loss diets, as this could enable inclusion of a greater variety of healthy carbohydrate-containing foods into the diet.
Topics: Appetite Regulation; Diet, Carbohydrate-Restricted; Diet, Ketogenic; Diet, Reducing; Energy Intake; Humans; Hunger; Ketosis; Obesity; Risk Factors; Treatment Outcome; Weight Loss
PubMed: 25402637
DOI: 10.1111/obr.12230 -
Journal of Cachexia, Sarcopenia and... Apr 2023Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may reflect deficient understanding of clinical sequelae. Therefore,... (Review)
Review
Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may reflect deficient understanding of clinical sequelae. Therefore, we performed a systematic literature review to assess the morbidity and mortality burden of anorexia/appetite loss in older populations. Following PRISMA guidelines, searches were run (1 January 2011 to 31 July 2021) in PubMed, Embase® and Cochrane databases to identify English language studies of adults aged ≥ 65 years with anorexia/appetite loss. Two independent reviewers screened titles, abstracts and full text of identified records against pre-defined inclusion/exclusion criteria. Population demographics were extracted alongside risk of malnutrition, mortality and other outcomes of interest. Of 146 studies that underwent full-text review, 58 met eligibility criteria. Most studies were from Europe (n = 34; 58.6%) or Asia (n = 16; 27.6%), with few (n = 3; 5.2%) from the United States. Most were conducted in a community setting (n = 35; 60.3%), 12 (20.7%) were inpatient based (hospital/rehabilitation ward), 5 (8.6%) were in institutional care (nursing/care homes) and 7 (12.1%) were in other (mixed or outpatient) settings. One study reported results separately for community and institutional settings and is counted in both settings. Simplified Nutritional Appetite Questionnaire (SNAQ Simplified, n = 14) and subject-reported appetite questions (n = 11) were the most common methods used to assess anorexia/appetite loss, but substantial variability in assessment tools was observed across studies. The most commonly reported outcomes were malnutrition and mortality. Malnutrition was assessed in 15 studies, with all reporting a significantly higher risk of malnutrition in older individuals with anorexia/appetite loss (vs. without) regardless of country or healthcare setting (community n = 9, inpatient n = 2, institutional n = 3, other n = 2). Of 18 longitudinal studies that assessed mortality risk, 17 (94%) reported a significant association between anorexia/appetite loss and mortality regardless of either healthcare setting (community n = 9, inpatient n = 6, institutional n = 2) or method used to assess anorexia/appetite loss. This association between anorexia/appetite loss and mortality was observed in cohorts with cancer (as expected) but was also observed in older populations with a range of comorbid conditions other than cancer. Overall, our findings demonstrate that, among individuals aged ≥ 65 years, anorexia/appetite loss is associated with increased risk of malnutrition, mortality and other negative outcomes across community, care home and hospital settings. Such associations warrant efforts to improve and standardize screening, detection, assessment and management of anorexia/appetite loss in older adults.
Topics: Humans; Aged; Anorexia; Appetite; Malnutrition; Hospitals; Europe
PubMed: 36807868
DOI: 10.1002/jcsm.13186 -
Neuroscience and Biobehavioral Reviews Sep 2017The brain-gut-axis is an interdependent system affecting neural functions and controlling our eating behaviour. In recent decades, neuroimaging techniques have... (Review)
Review
The brain-gut-axis is an interdependent system affecting neural functions and controlling our eating behaviour. In recent decades, neuroimaging techniques have facilitated its investigation. We systematically looked into functional and neurochemical brain imaging studies investigating how key molecules such as ghrelin, glucagon-like peptide-1 (GLP-1), peptide tyrosine-tyrosine (PYY), cholecystokinin (CCK), leptin, glucose and insulin influence the function of brain regions regulating appetite and satiety. Of the 349 studies published before July 2016 identified in the database search, 40 were included (27 on healthy and 13 on obese subjects). Our systematic review suggests that the plasma level of ghrelin, the gut hormone promoting appetite, is positively correlated with activation in the pre-frontal cortex (PFC), amygdala and insula and negatively correlated with activation in subcortical areas such as the hypothalamus. In contrast, the plasma levels of glucose, insulin, leptin, PYY, GLP-1 affect the same brain regions conversely. Our study integrates previous investigations of the gut-brain matrix during food-intake and homeostatic regulation and may be of use for future meta-analyses of brain-gut interactions.
Topics: Appetite; Brain; Gastrointestinal Tract; Hormones; Humans; Satiation
PubMed: 28669754
DOI: 10.1016/j.neubiorev.2017.06.013 -
Diabetes, Metabolic Syndrome and... 2023Obesity is an epidemiological issue that negatively affects public health and has led to a high global burden on the healthcare system. Several approaches to control and... (Review)
Review
The Efficacy of GLP-1 Analogues on Appetite Parameters, Gastric Emptying, Food Preference and Taste Among Adults with Obesity: Systematic Review of Randomized Controlled Trials.
BACKGROUND
Obesity is an epidemiological issue that negatively affects public health and has led to a high global burden on the healthcare system. Several approaches to control and overcome the obesity crisis have been established. However, Nobel discoverers found that glucagon-like peptide-1 analogues (GLP-1 analogues) positively regulate appetite and food intake, eventually leading to weight loss.
OBJECTIVE
The present systematic review aims to summarize the currently available evidence of the impact of GLP-1 analogues on appetite, gastric emptying, taste sensitivity, and food preferences among adults with obesity without other chronic diseases.
METHODS
A systematic literature search was conducted from October 2021 to December 2021 from three electronic databases (PubMed, Scopus, and ScienceDirect), including only randomized clinical trials (RCTs). Studies were based on the use of GLP-1 analogues, of any dosage and duration among adults with obesity without other medical diseases; studies measured appetite, gastric emptying, food preferences, and taste as a primary or secondary outcome. The risk of publication bias in each study was assessed independently using the updated Cochrane risk-of-bias tool (RoB2).
RESULTS
Twelve studies met the inclusion criteria with a total sample size of 445 participants. All the included studies measured at least one or more of the primary outcomes. The promising effect was evidenced by most studies showing appetite suppression, delayed gastric emptying, and changes in taste and food preferences.
CONCLUSION
GLP-1 analogues are effective obesity management therapy that could decrease food intake and eventually reduce weight by suppressing appetite, reducing hunger, decreasing gastric emptying, and altering food preferences and taste. However, high-quality, long-term, large sample size studies are crucial to examine the efficacy and effective dose of GLP-1 analogues intervention.
PubMed: 36890965
DOI: 10.2147/DMSO.S387116 -
Appetite Jun 2019A systematic review identifying the use of cyproheptadine (CY) as an appetite stimulant was completed.
OBJECTIVE
A systematic review identifying the use of cyproheptadine (CY) as an appetite stimulant was completed.
METHOD
Studies of any design exploring the efficacy of CY as an appetite stimulant in all age groups and populations were included. Primary outcomes of studies included were weight gain, appetite stimulation, and/or caloric/nutritional intake increase. The review was completed in accordance with PRISMA standards.
RESULTS
A total of 46 articles across 21 different treatment populations met criteria for the review, including 32 randomized controlled trials, 4 prospective cohort studies, 4 retrospective cohort studies, 4 case reports and 2 case series. Of these, 39 demonstrated that CY resulted in significant weight gain in the sample under study. Studies exploring the use of CY in those with malignant/progressive disease states, such as HIV and cancer, showed minimal to no benefit of the medication. Transient mild to moderate sedation was the most commonly reported side effect. Studies included were heterogeneous in terms of methods as well as study patient demographics, characteristics and concurrent medical conditions. Few studies provided objective measures of appetite change.
DISCUSSION
CY appears to be a safe, generally well-tolerated medication that has utility in helping facilitate weight gain in patients drawn from a variety of underweight populations. Future prospective randomized controlled studies in low weight patients that include objective measures of appetite and intake are needed to better understand the mechanism by which CY augments weight gain.
Topics: Anorexia Nervosa; Appetite; Appetite Stimulants; Cyproheptadine; Humans; Malnutrition; Randomized Controlled Trials as Topic; Thinness; Weight Gain
PubMed: 30825493
DOI: 10.1016/j.appet.2019.02.012 -
Appetite Apr 2018It is well established that stress is linked to changes in eating behaviors. Research using adult populations has shown that stress is associated with both increases and... (Meta-Analysis)
Meta-Analysis Review
It is well established that stress is linked to changes in eating behaviors. Research using adult populations has shown that stress is associated with both increases and decreases in the amount and type of food consumed. However, due to a lack of research reviews, the relationship between stress and eating behaviors in children is unclear. This systematic research review and meta-analysis aimed to identify whether stress is associated with healthy and unhealthy eating behaviors in children aged 8-18 years. Studies were included in the review if they measured stress and included a measure of food consumption. All unique studies retrieved (N = 28,070) were assessed for their eligibility at title, abstract and full text levels. A total of 13 studies were included in the final review and data were analysed using Comprehensive Meta-Analysis. Using random-effects modelling, overall stress was not associated with a change in overall eating behaviors. However, additional analyses indicated stress was associated with unhealthy eating behaviors in both younger (Hedge's g = 0.283, p < 0.001) and older (Hedge's g = 0.274, p = 0.001) children. In contrast, stress was not associated with healthy eating behaviors in younger children (Hedge's g = 0.093, p = 0.156), but was negatively associated with healthy eating behaviors in older children (Hedge's g = -0.384, p < 0.001). The current findings are concerning as they suggest the impact of stress on unhealthy eating may begin as early as 8 or 9 years old. Future research ought to investigate further the role of psychological, behavioral and endocrine factors in the development of stress-related eating in children.
Topics: Adolescent; Bias; Child; Diet; Eating; Health Behavior; Humans; Obesity; Prevalence; Sensitivity and Specificity; Stress, Psychological
PubMed: 29203444
DOI: 10.1016/j.appet.2017.11.109 -
Progress in Neuro-psychopharmacology &... Jul 2021Gastrointestinal side effects (SEs) are frequently observed in patients with major depressive disorder (MDD) while taking antidepressants and may lead to treatment... (Meta-Analysis)
Meta-Analysis
Gastrointestinal side effects (SEs) are frequently observed in patients with major depressive disorder (MDD) while taking antidepressants and may lead to treatment discontinuation. The aim of this meta-analysis is to provide quantitative measures on short-term rates of gastrointestinal SEs in MDD patients treated with second-generation antidepressants. An electronic search of the literature was conducted by using MEDLINE, ISI Web of Science - Web of Science Core Collection, and Cochrane Library databases. Eligible studies had to focus on the use of at least one of 15 antidepressants commonly used in MDD (i.e., agomelatine, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, mirtazapine, paroxetine, reboxetine, sertraline, venlafaxine, and vortioxetine) and report data on treatment-emergent gastrointestinal SEs (i.e. nausea/vomiting, diarrhoea, constipation, abdominal pain, dyspepsia, anorexia, increased appetite and dry mouth) within 12 weeks of treatment. Overall, 304 studies were included in the meta-analyses. All the considered antidepressants showed higher rates of gastrointestinal SEs than placebo. Escitalopram and sertraline were shown to be the least tolerated antidepressants on the gastrointestinal tract, being associated with all the considered SEs with the exception of constipation and increased appetite, while mirtazapine was shown to be the antidepressant with fewer side effects on the gut, being only associated with increased appetite. In conclusion, commonly used antidepressants showed different profiles of gastrointestinal SEs, possibly related to their mechanisms of action. The specific tolerability profile of each compound should be considered by clinicians when prescribing antidepressants in order to improve adherence to treatment and increase positive outcomes in patients with MDD.
Topics: Antidepressive Agents; Constipation; Depressive Disorder, Major; Diarrhea; Humans; Nausea; Vomiting
PubMed: 33549697
DOI: 10.1016/j.pnpbp.2021.110266 -
Biological Research For Nursing Jul 2022Current guidelines for obesity treatment recommend reducing daily caloric intake for weight loss. However, long-term weight loss continues to be an issue in obesity...
Current guidelines for obesity treatment recommend reducing daily caloric intake for weight loss. However, long-term weight loss continues to be an issue in obesity management. Alternative weight loss strategies have increased in popularity, such as intermittent energy restriction (IER), a type of eating pattern with periods of fasting alternating with unrestricted eating. The effects of IER on weight loss, cardiovascular risk factors, inflammation, and appetite are not clear. The purpose of this systematic review was to analyze short- (<24 weeks) and long-term (≥24 weeks) effects of IER on anthropometric, cardiometabolic, inflammatory, and appetite outcomes in adults with overweight/obesity. PubMed, CINAHL, Embase, and PsycInfo were searched from inception to July 2020. Human randomized controlled trials (RCTs) on IER with participants with a body mass index ≥25 kg/m were included in this review. A total of 42 articles (reporting on 27 different RCTs) were included. In short-term studies, IER showed pre-to-post treatment improvements in eight of nine studies that assessed weight. Weight outcomes were sustained in the long-term. However, no significant long-term between group differences were observed in fat mass, other anthropometric, cardiometabolic, inflammatory, or appetite outcomes. Compared to continuous energy restriction (CER), IER showed no significant long-term differences in anthropometric, cardiometabolic, inflammatory, or appetite outcomes in included studies. More long-term studies are needed to assess the benefits of IER on health outcomes.
Topics: Adult; Appetite; Caloric Restriction; Cardiovascular Diseases; Diet, Reducing; Energy Intake; Humans; Obesity; Weight Loss
PubMed: 35531785
DOI: 10.1177/10998004221078079