What nutrients are given as supplements to increase appetite?

Nutrients for Appetite Stimulation in Supplements

For appetite stimulation, the most effective nutrients given as supplements are progestins, corticosteroids, and long-chain N-3 fatty acids (fish oil), with progestins showing the strongest evidence for appetite enhancement and weight gain. 1

First-Line Options

Progestins

• Mechanism: Increase appetite and body weight, potentially by decreasing cytokine levels 1
• Evidence: High-quality evidence from multiple randomized clinical trials showing significant appetite stimulation and weight gain 1
• Dosage: Megestrol acetate 480-800 mg/day is the optimal dose range 1
• Caution: May cause serious side effects including thromboembolism, impotence, and vaginal spotting 1

Corticosteroids

• Mechanism: Rapid appetite stimulation effect
• Evidence: High-quality evidence supporting short-term use 1
• Duration: Limited to 1-3 weeks due to side effects 1
• Caution: Side effects include muscle wasting, insulin resistance, infections, and immunosuppression 1
• Best for: Patients with short life expectancy or those who may benefit from other effects (pain/nausea relief) 1

Long-chain N-3 Fatty Acids (Fish Oil)

• Mechanism: Anti-inflammatory effects and metabolic modulation
• Evidence: Low-quality evidence but several positive trials 1
• Benefits: Stabilizes or improves appetite, food intake, lean body mass, and body weight 1
• Best for: Patients with advanced cancer undergoing chemotherapy 1
• Caution: May cause mild GI effects, fishy aftertaste; avoid with ibrutinib due to risk of epistaxis 1

Second-Line Options

Prokinetic Agents

• Indication: For patients with early satiety after treating constipation 1
• Options: Metoclopramide or domperidone
• Caution: Potential adverse effects on central nervous system (metoclopramide) and cardiac rhythm (domperidone) 1

Multivitamin and Mineral Supplements

• Evidence: Mixed results, with some studies showing appetite improvements in women 2
• Mechanism: May address micronutrient deficiencies that affect appetite regulation
• Note: More effective when combined with other interventions rather than alone 3

Nutrients with Insufficient Evidence

1. Branched-chain amino acids: Insufficient data to recommend for improving fat-free mass 1
2. Cannabinoids: Insufficient consistent clinical data to recommend for taste disorders or anorexia 1, 4
3. Androgenic steroids: Insufficient consistent clinical data to recommend for increasing muscle mass 1
4. Non-steroidal anti-inflammatory drugs: Insufficient consistent data to recommend for weight improvement 1

Implementation Algorithm

1. Assess patient condition and prognosis:

   • For patients with advanced disease and short life expectancy: Consider corticosteroids (1-3 weeks)
   • For patients with advanced disease requiring longer-term therapy: Consider progestins
   • For patients undergoing chemotherapy: Consider long-chain N-3 fatty acids

2. Monitor effectiveness:

   • Track weight changes weekly
   • Assess appetite improvement using validated tools
   • Monitor for side effects specific to the chosen supplement

3. Adjust therapy based on response:

   • If insufficient response after 2-4 weeks, consider switching to alternative option
   • If side effects develop, reduce dose or switch to alternative

Important Considerations

• Protein supplementation: Higher protein content at breakfast (30-45g) can improve satiety and reduce subsequent food intake 5
• Combination approach: Nutritional supplements are most effective when combined with dietary counseling 6
• Vitamin B12: Consider screening and supplementation in high-risk patients (older adults, those on PPIs/metformin, vegans) as deficiency can affect appetite 7

Pitfalls to Avoid

1. Prolonged corticosteroid use: Limit to 1-3 weeks to avoid serious side effects 1
2. Ignoring thromboembolic risk: Monitor carefully when using progestins, especially in patients with risk factors 1, 8
3. Drug interactions: Fish oil supplements should be avoided in patients taking ibrutinib 1
4. Relying solely on supplements: Nutritional interventions should be part of a comprehensive approach 8

The choice of appetite-stimulating nutrient supplement should be guided by the patient's specific medical condition, prognosis, and potential side effect profile, with progestins offering the strongest evidence for sustained appetite improvement.