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Regular and balanced intake of food is the necessary condition to allow the performance of all the functions of the human body. Inadequate food intake triggers pathological conditions that, in the long run, can cause the death of the individual. So appetite and the feeling of hunger are two essential stimuli to draw attention to the need to eat.

During many oncological diseases, complex mechanisms are triggered that cause a pathological alteration of the physiological stimuli that push to feed. This results in the state of anorexia, which is one of the causes of cachexia which characterizes patients suffering from oncological diseases.

Neo-plastic anorexia-cachexia syndrome is a multifactorial syndrome, characterized by progressive loss of muscle mass, which cannot be completely corrected only thanks to food support and which leads to progressive functional damage. The protein and energy balance become negative due to both the reduced caloric intake and the metabolic alterations that are triggered because of the oncological disease. In progressively reducing lean mass as in reducing appetite stimulation, inflammation and oxidative stress play a central role.

Medical specialists consider it very important to adopt assessment and follow-up tools for the cancer patient to identify the state of pre-cachexia and avoid or delay the evolution towards full-blown cachexia and refractory cachexia. In fact, in the full-blown cachexia stage, weight loss and the chronic inflammatory component have already triggered cyclic strengthening mechanisms and the event tends to generate a domino effect that leads to refractory cachexia, where weight loss is associated with a clear compromise of the performance status and reduced life expectancy.

Among the most relevant phenomena triggered by the anorexia-cachexia neoplastic syndrome are asthenia, reduced mobility following the loss of muscle mass, dyspnea following the weakening of the muscles of the respiratory system, the increased susceptibility to infections, anxious-depressive states, the negative impact on self-image and the objective perception of one’s decline.

Some drugs have proven effective in restoring appetite to patients who experience neoplastic anorexia-cachexia syndrome but are burdened with important side effects.

For all the reasons mentioned, the doctor, once he has identified the state of pre-cachexia in the cancer patient, implements all the measures that can slow down the progression of the syndrome and improve the quality of life. Among the measures adopted are food counseling, the integration of nutrition and the administration of substances with an orexigenic effect, possibly not burdened by side effects and contraindications.

Inappetence is a frequent symptom attributable to multiple causes. Short periods of loss of appetite are quite common in critical periods such as pre-adolescence and adolescence, but they are also common in the life of young children, both during weaning, and around 10 – 12 months and around 2 – 3 years.

Lack of appetite can also be observed after a vaccination or during a tooth eruption and in conjunction with diseases such as respiratory, mouth, gastrointestinal and urinary infections. A transitory lack of appetite often represents the consequence of a change, such as a change in diet, a change in the living environment or a simple change of season. There are also some psychological situations related to the relationship of the child or adolescent with their parents, to the domestic environment in which the meal is eaten, as well as to the character and personal psychomotor development of the subject, which accompany or manifest themselves with lack of appetite , often transient. Children, like teenagers, tend to manifest stressful conditions by changing their attitude towards food, often by rejecting it.

The consequences of persistent appetite include nutritional deficiencies of macro and micronutrients, weight loss, weakening of the immune system and stunting.

The lack of appetite must not be neglected but the causes for undertaking the most appropriate therapeutic strategy must be properly investigated, thanks to the specialist doctor. Causal therapy is always the most suitable. Alongside this, it is possible to resort to food supplements containing substances that tend to restore appetite without the risk of generating adverse effects, or that supplement, at least temporarily, micronutrients, such as vitamins, which otherwise would tend to be missing, negatively affecting the state of subject’s health.

According to ISTAT (National Institute Of Statistics), chronic obstructive pulmonary disease (COPD) in Italy affects 5.6% of adults (equal to approximately 3.5 million people) and causes 55% of the deaths attributed to respiratory diseases.

Chronic obstructive pulmonary disease consists of a progressive limitation of air flow in the respiratory system caused by an inflammatory response to toxic or irritating substances that are inhaled, often tobacco smoke or other inhaled substances also for professional reasons. The chronic inflammation that occurs, associated with oxidative stress, leads to the progressive destruction of the respiratory tissue and the excessive production of mucus. Genetic causes have also been identified. The symptomatology is characterized by productive cough, difficulty in breathing (the so-called dyspnea) and wheezing that develop over the years.

Chronic bronchitis is defined as the condition in which productive cough occurs almost every day of the week for at least 3 months lasting for 2 consecutive years. Chronic bronchitis becomes chronic obstructive bronchitis when airflow obstruction also appears.

Emphysema is defined as the destruction of lung tissue which increases its tendency to collapse. The result is an air flow limitation and air entrapment. The airspace expands and can eventually form bubbles.

Various factors cause airflow limitation and other complications of chronic obstructive pulmonary disease.

Both viral and bacterial infections of the respiratory tract, to which patients with chronic obstructive pulmonary disease are particularly exposed, can accelerate the progression of the destruction of lung tissue. In fact, about 30% of patients suffering from chronic obstructive pulmonary disease have a bacterial colonization of the lower airways, the obstruction to the air flow worsens the clearance of the mucus, facilitating the onset of infections, which further aggravate inflammation, accelerating the progression of the disease. However, there is no evidence that long-term use of antibiotics can slow the progression of chronic obstructive pulmonary disease.

Acute seizures also occur during the course of chronic obstructive pulmonary disease, characterized by an aggravation of symptoms. Often it is impossible to ascertain the causes of any exacerbation, but they are usually attributed to viral infections of the upper respiratory tract or acute bacterial bronchitis or exposure to irritants. As chronic obstructive pulmonary disease progresses, acute seizures tend to become more frequent, on average about 1 to 3 episodes per year.

Among the numerous, even very serious, complications of chronic obstructive pulmonary disease there is the loss of appetite and muscle mass, mainly caused by inflammation and oxidative stress, up to the trigger of the so-called anorexia-cachexia syndrome, which further aggravates the degree of suffering of the patient. Other important complications are represented by cardiovascular diseases.

The management of chronic obstructive pulmonary disease involves the use of appropriate drugs, food supplements and oxygen both for the treatment of chronic disease, in order to prevent exacerbations and improve, as far as possible, the respiratory function, and for the treatment of exacerbations themselves, both to control complications such as loss of appetite and lean mass.

The current perspective on food-related diseases focuses primarily on obesity and its pathological consequences. However, there is also a serious malnutrition problem.

Micronutrient deficiencies contribute to many age-related ailments. A particular risk group for micronutrient deficiencies is the elderly. Many elderly people, such as the most fragile, those suffering from chronic diseases and those living in health care homes, gradually lose their appetite and rely on meals with an insufficient content of micronutrients to cover their daily nutritional needs.

It has been estimated that in Western countries a significant part of public health and social care is devoted to the treatment of malnutrition and about half of this expense is devoted to older people. Although the focus of malnutrition in the elderly, especially over 75, is the lack of proteins and energy sources, not least are the deficiencies of micronutrients such as vitamins and minerals. A review of scientific studies conducted to investigate this problem in Western countries has shown that, in the elderly over 65, the intake of vitamin B12, vitamin D, vitamin B1, vitamin B2, calcium, magnesium and selenium are systematically insufficient.

In addition, a growing number of elderly people are diagnosed with a condition of intestinal malabsorption and this is linked to an increased risk of micronutrient deficiencies, in particular iron, calcium, folic acid and fat-soluble vitamins, such as vitamin A and vitamin D.

The initial effects of micronutrient deficiencies can be relatively mild, widespread and without clear clinical signs and therefore can easily escape both the elderly person and the attending physician. For example, deficiencies in B complex vitamins can cause mild cognitive decline or mild anemia, insufficiency of vitamin B1 increases the levels of end products of advanced glycation in the blood, which are linked to the development of type 2 diabetes. Vitamin B12 and folate deficiencies increase homocysteine ​​levels linked to cardiovascular disease and forms of decline in cognitive functions and vitamin D deficiency impairs the function of the immune system. As the deficiencies continue over time or worsen, the disturbances determined by them worsen and can become irreversible.

Prevention and treatment by means of nutrition or dietary supplementation of micronutrient deficiencies, both by restoring the appetite to the elderly and by integrating the appropriate micronutrients, such as B complex vitamins, vitamin A and vitamin D, they are the keys to effective management of malnutrition in older people. This allows an improvement in the quality of life of the subjects and also determines a significant saving compared to the cost of treating the diseases deriving from malnutrition.

Children and adolescents have a high need for both calories, therefore macronutrients, and vitamins, the so-called micronutrients. An adequate and constant presence of vitamins in the diet allows for complete growth and harmonious development. An occasional reinforcement of the quantity of vitamins introduced allows to better face school commitments, sports activities or convalescence after an illness.

The B complex vitamins, vitamin D, vitamin A are indispensable for the correct functioning of all cells: they are indispensable for the cellular functions necessary to obtain energy from food, as they are indispensable for the biochemical reactions necessary to build the structure of the organism or to allow the performance of all its functions. Vitamin D, for example, in children and adolescents is essential for harmonious growth, since it contributes to the development and well-being of the musculoskeletal system and teeth. This vitamin is little present in food and is synthesized thanks to sun exposure. If this exposure is insufficient, its availability in the body may be inadequate with negative repercussions on the development of the subject.

The increased requirement of vitamins that characterizes childhood and adolescence, if it is not properly satisfied by means of nutrition, can lead to a feeling of frequent tiredness, a reduction in the ability to concentrate and a greater exposure to the risk of infections with consequent reduction of the subject’s physical and intellectual performance. Furthermore, it can adversely affect development. So you need to carefully evaluate the diet and possibly resort to the appropriate food supplements based on B complex vitamins, vitamin D and vitamin A.