A number of bloggers have been using the month of November as an opportunity to made daily declarations of gratitude. I've been following Julana's list. On this, the last day of November, I'm going to make a post of thanksgiving. And it's going to sound silly on the surface but upon further reflection I hope that you'll agree it's not.

I'm thankful for a good appetite.

Yes, it leads me to eat things I shouldn't eat. And yes, it puts me in the constant position of wishing the scale hit a lesser number when I stand on it. Yet, a good appetite is a profound gift.

Why did it occur to me, just now, to sing the praises of appetite?

Because I'm writing a paper on chronic kidney disease and in researching this paper I just read a study linking appetite to clinical outcome in patients with this disease. The risk of dying is 4 to 5 times greater in patients with a poor appetite compared with patients with a good appetite. Aside from the risk of death, patients with a poor appetite have a greater risk for hospitalization and report a lower quality of life compared with patients with a good appetite. The authors of this paper suggest that asking a simple question, "How's your appetite?", is a fairly accurate predictor of clinical outcome in these patients.

Appetite seems to be one of those things we have little control over. It's there in whatever degree that it chooses. From the perspective of this paper, appetite is truly a profound gift.

Now, I don't think this realization gives me license to honor my appetite by walking into kitchen and taking a handful of chocolate chips out of the Nestles bag but maybe just a few can't hurt.