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Like other segments of the child's development, eating behavior follows a sequential pattern. To understand the infant's or child's feeding problems which can lead to failure to thrive or dwarfism we propose that a child's progression be studied through three stages of development: homeostasis, attachment and separation-individuation. Specific feeding problems can arise at each of these stages of development and consequently impede the child's weight gain. During the period of homeostasis the infant learns to regulate himself, to suck, to swallow and to time the onset and termination of feedings by giving signals of hunger and fullness. If he is unable to master these, he cannot be fed effectively. Failure to master these basic feeding skills interferes with the next developmental task of attachment and also impedes development of motor skills, language and affective engagement. During the period of attachment, the infant establishes distinct interactional patterns with his caretakers. Lack of engagement between mother and infant leads to lack of pleasure and lack of appetite or even to severe dysfunctional feeding patterns like vomiting and rumination. Feeding problems in the third developmental stage of separation and individuation can arise because of maladaption in the attachment phase or because of new difficulties which center around issues of autonomy vs. dependency. At this stage, the infant learns means-end differentiation and begins to understand that his actions elicit certain consequences. If the infant's struggle between autonomy and dependency gets caught in the feeding situation, the infant's emotional needs can dictate his eating behavior. The infant refuses to eat either to have his emotional hunger for mother's attention met or to assert his autonomy and to express his anger toward her. In order for the infant to learn to differentiate between his physiological feelings of hunger and his emotional need states, the caregiver needs to give contingent responses by offering food when the infant is hungry and comfort when the infant is distressed. Feeding problems which can create, co-exist with, or result from a growth problem must be considered within a developmental context. As the infant progresses through the developmental stages of homeostasis, attachment, and separation, he masters phase-appropriate feeding skills which help him to progress from reflex sucking to autonomous feeding. Early identification of maladaptive feeding behavior will assist the pediatrician in making timely interventions.
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PMID:Non-organic failure to thrive: a developmental perspective. 659 32

Among the various eating patterns encountered in anorexia nervosa, the occurrence of bulimia (rapid consumption of large amounts of food in a short period of time) is a perplexing phenomenon, because its presence contradicts the common belief that patients with anorexia nervosa are always firm in their abstinence from food. We studied the eating habits of 105 hospitalized female patients within the context of a prospective treatment study on anorexia nervosa: 53% had achieved weight loss by consistently fasting, whereas 47% periodically resorted to bulimia. The two groups were contrasted with regard to their developmental and psychosocial history, clinical characteristics, and psychiatric symptomatology. Fasting patients were more introverted, more often denied hunger, and displayed little overt psychic distress. In contrast, bulimic patients were more extroverted, admitted more frequently to a strong appetite and tended to be older. Vomiting was frequent, and kleptomania almost exclusively present in bulimic patients, who manifested greater anxiety, depression, guilt, interpersonal sensitivity, and had more somatic complaints. This association of bulimia with certain personality features and a distinct psychiatric symptomatology suggests that patients with bulimia form a subgroup among patients with anorexia nervosa.
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PMID:Bulimia. Its incidence and clinical importance in patients with anorexia nervosa. 693 87

Gastric bypass and gastroplasty are effective in causing a reduction in weight averaging 55 percent of excess weight, 30 percent of initial weight, or 40 kg. in morbidly obese patients. Education in appropriate eating habits helps patients to lose weight and results in fewer complications. Patient education should emphasize behavioral changes, which include eating slowly and chewing well to prevent blockage, vomiting, and disruption of the staples and sutures. High-calorie beverages and frequent snacking should be avoided. Three meals per day eaten slowly and in a pleasant atmosphere will satisfy hunger. Gastric bariatric surgery makes the morbidly obese responsive to instruction. Dietitians have an important part to play in this rapidly expanding and effective treatment of a group of patients who until now have been ignored and rejected.
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PMID:Diet modifications and behavioral changes for bariatric gastric surgery. 721 72

Sixty-nine carefully selected patients underwent extensive behavioral modification training and a standard loop gastric bypass procedure. Patients were followed up at frequent intervals postoperatively to ensure their compliance with dietary requirements: (1) three small, solid meals a day, (2) slowly eaten meals with 5 minutes between bites, (3) no liquids with meals, and (4) cessation of eating immediately after hunger ceased. Analysis of weight loss data at a mean of 20 months postoperatively revealed that 90% of patients lost more than 50% of their excess weight, but that weight loss was inversely related to weight at operation (P less than 0.02) and to estimated pouch size (by upper gastrointestinal series) late postoperatively (P less than 0.01). Patients who failed to maintain regular follow-up visits postoperatively lost significantly less weight (P less than 0.01) than those who were seen regularly. Although fewer than half of the patients lost weight beyond the twelfth postoperative month, significant weight loss was seen in about one fourth of the patients as late as 2 years postoperatively when office follow-up was frequent and compliance with dietary measures complete. Abdominal pain and emesis occurred only when the patient failed to comply with the postoperative dietary regimen. Similarly, inadequate weight loss (premature plateau) was also associated with failure of patients to eat slowly and to stop eating when hunger ceased.
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PMID:Gastric bypass: analysis of weight loss and factors determining success. 726 23

Vagotomy has been shown to reduce body weight in several species of experimental animals. Due to the relative safety and simplicity of the procedure and the long-clinical evaluation of vagotomy in ulcer disease, truncal vagotomy without drainage has been performed in a series of 21 morbidly obese patients. The mean maximum body weight was 12.8 +/- 3 kg (s.e.). In the 14 patients observed for 12-40 months, the mean weight decrease is 20 +/- 4 kg (range: 0-51). Apart from lesion of the oesophagus in one patient, there have been no operative complications. In one 45-year-old patient sudden death due to myocardial fibrosis occurred three years after the operation. Four patients have had short episodes of diarrhea, and vomiting has occurred in two patients who "tested the limits'. There is no evidence of gastric dilatation or ulcers, yet gastric stasis is prevalent. Three patients are failures, two not having reduced and the third regaining 28 of her initial 31 kg weight loss postoperatively. Five patients have participated in programs for weight reduction in which they claim greater ease in complying than before operation, due to the characteristic lack of hunger sensations in all of the successful patients. The mechanisms for weight reduction after vagotomy are not known, yet seem to involve other factors than delayed gastric emptying of solids. Longer follow-up is necessary for evaluation of this procedure in the treatment of morbid obesity.
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PMID:Truncal vagotomy in morbid obesity. 730 28

The impact of culture and community factors on breast feeding and weaning practices is examined by means of interviews among 35 rural women aged 16-43 years from Jalisco, Mexico, and by means of focus group discussions. Breast feeding practices are gleaned from information provided by mothers on their youngest child aged 2 weeks to 17 months for a 24 hour period prior to the interview. All study infants were given breast milk, supplements of water, and other liquids from birth. Fresh or powdered cow's milk was the usual supplement, except for 5 infants who received commercial formula. Boiled water was used in rehydrating powdered milk. Breast milk substitution was a bottle or cup given 2-4 times daily. The introduction of solid foods was made at 1 month to 8 months of age. Foods ranged from beans, tortillas, bread, pasta, fruit, chicken soup, flavored gelatin, to soft drinks. Between 9 months and 23 months, toddlers were fed the same foods in addition to vegetables, beef, fish, egg, cookies, and prepackaged cold cereal. The reasons given for not breast feeding were illness of the mother, a breast problem, insufficient milk, or an ill child. Colostrum was given for the following reasons: doctor's advice, the best interests of the baby, a woman's preference, custom, and no reason. Colostrum was not given for a variety of reasons including, for example, when the doctor advised against it or when a woman was ill or had a breast problem. In the three focus groups (27 persons), breast feeding was mentioned as preferable because of the added protection given the baby, the convenience of the mother, and the exchange between mother and infant. Other important factors were the improved health of the baby, the absence of cleanliness problems, and the milk was the right temperature. Exclusive breast feeding was recommended for a duration of 3-9 months. Breast feeding was withheld for 4-5 hours if a child had vomiting or diarrhea, or had been in the sun too long. Weaning was considered appropriate anytime between 2 months and 12 months of age. Weaning occurred when the mother was unable to continue or the child wanted to stop or had teeth. There was disagreement about how quickly to complete the process of weaning. Food was introduced at 2 to 6 months of age when milk was not enough to satisfy the child's hunger.
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PMID:Breastfeeding and weaning practices in rural Mexico. 806 64

The aim of the study was to assess the association of abdominal symptoms in a random sample of a general population and to find whether the associations could be confirmed at follow-up 5 years later. The study population was a sex- and age-stratified random sample of people living in the western part of Copenhagen County, Denmark. Of 4807 eligible subjects 79% attended the study and filled in a questionnaire on abdominal symptoms. Five years later the study was repeated and 85% of the survivors participated. Data from both studies were analysed separately for sex, age group and the following pain variables: unspecified abdominal pain, pain located to the epigastrium, pain provoked by stress or hunger, pain relieved by eating and pain relieved by defecation. Three clusters of symptoms occurred in all the analyses: borborygmi/altering stool consistency/distension; acid regurgitation/heartburn and nausea/vomiting. Unspecified pain was associated with all three clusters, pain provoked by stress or hunger and pain relieved by defecation associated with the borborygmi/altering stool/distension cluster, whereas pain in the epigastrium and pain relieved by eating did not show consistent relationships to any of the clusters. Additionally, the clusters associated with each other more often than could be expected by chance. As a consequence of our findings we suggest that the three clusters of symptoms constitute three common abdominal syndromes.
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PMID:Abdominal symptom associations in a longitudinal study. 814 91

The results of a small pilot study using Fluvoxamine (Faverin) in the treatment of non-vomiting bingeing female patients and women with bulimia nervosa is presented. Ten non-vomiting subjects and six with bulimia nervosa were treated on an open basis with Fluvoxamine 100-200 mg daily. Assessment was made using established questionnaires for severity of eating disorder and abnormality of mood. Five non-vomiting patients and three with bulimia nervosa completed the study. Non-vomiters showed a significant weight loss; a significant reduction in number of binges; a significant reduction in the scores on the BITE and the EAT; and a significant reduction in anxiety. Those with bulimia nervosa had a significant reduction in hunger and a reduction in depression which tended towards significance. Firm conclusions cannot be drawn from this study as it is an open pilot study of a small number of women. However, the results indicate that Fluvoxamine may have a role in the treatment of eating disorders where bingeing is a prominent symptom and that further research would be valuable. Comments are also made on the usefulness of various questionnaires designed to assess eating disorders.
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PMID:Fluvoxamine: an open pilot study in moderately obese female patients suffering from atypical eating disorders and episodes of bingeing. 838 40

The characteristics of hyperventilation syndrome (HVS) were studied in 508 patients who visited our hospital over 11 years. Information regarding symptoms and laboratory data was collected from the clinical records, and outcome was surveyed with a questionnaire mailed to all patients. Patients with acute HVS ranged in age from 5-85 years, and acute HVS was particularly prevalent among women in their late teens. Triggers of HVS included anxiety, nausea & vomiting, and fever due to the common cold. The primary symptoms were dyspnea and numbness, but these differed from the symptoms that appeared during a provoked attack, Half of the patients had no underlying disorder, but the others were suffering from neurosis, cardiovascular disorders, or other diseases. These characteristics of acute HVS did not differ from those seen in patients in whom the diagnosis of HVS was confirmed with arterial blood gas analysis. Half of the patients recovered without treatment, and the others underwent paper-bag rebreathing or intravenous infusion of sedatives. The prevalence of chronic HVS was 2% and almost all those patients were middle-aged women. In contrast, the questionnaire revealed that half of the patients had repeated HVS attacks. In 10% of the patients, these attacks persisted for more than 3 years. Many of these patients reported that they sighed frequently and felt air hunger while in remission. These findings were compatible with the criteria for chronic HVS. Therefore, it may be possible to diagnose HVS from symptoms alone, without hyperventilation provocation tests. In conclusion, these data underscore the importance of clinical symptoms in the diagnosis of HVS.
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PMID:[Clinical characteristics and outcome of 508 patients with hyperventilation syndrome]. 853 89

The progression of animal life from the paleozoic ocean to rivers and diverse econiches on the planet's surface, as well as the subsequent reinvasion of the ocean, involved many different stresses on ionic pattern, osmotic pressure, and volume of the extracellular fluid bathing body cells. The relatively constant ionic pattern of vertebrates reflects a genetic "set" of many regulatory mechanisms--particularly renal regulation. Renal regulation of ionic pattern when loss of fluid from the body is disproportionate relative to the extracellular fluid composition (e.g., gastric juice with vomiting and pancreatic secretion with diarrhea) makes manifest that a mechanism to produce a biologically relatively inactive extracellular anion HCO3- exists, whereas no comparable mechanism to produce a biologically inactive cation has evolved. Life in the ocean, which has three times the sodium concentration of extracellular fluid, involves quite different osmoregulatory stress to that in freshwater. Terrestrial life involves risk of desiccation and, in large areas of the planet, salt deficiency. Mechanisms integrated in the hypothalamus (the evolutionary ancient midbrain) control water retention and facilitate excretion of sodium, and also control the secretion of renin by the kidney. Over and above the multifactorial processes of excretion, hypothalamic sensors reacting to sodium concentration, as well as circumventricular organs sensors reacting to osmotic pressure and angiotensin II, subserve genesis of sodium hunger and thirst. These behaviors spectacularly augment the adaptive capacities of animals. Instinct (genotypic memory) and learning (phenotypic memory) are melded to give specific behavior apt to the metabolic status of the animal. The sensations, compelling emotions, and intentions generated by these vegetative systems focus the issue of the phylogenetic emergence of consciousness and whether primal awareness initially came from the interoreceptors and vegetative systems rather than the distance receptors.
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PMID:Hypothalamic integration of body fluid regulation. 869 5


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