Curbing craving: behavioral and brain evidence that children regulate craving when instructed to do so but have higher baseline craving than adults

Brain regulation of food craving: relationships with weight status and eating behavior

OBJECTIVES

Food craving is a driving force for overeating and obesity. However, the relationship between brain mechanisms involved in its regulation and weight status is still an open issue. Gaps in the studied body mass index (BMI) distributions and focusing on linear analyses might have contributed to this lack of knowledge. Here, we investigated brain mechanisms of craving regulation using functional magnetic resonance imaging in a balanced sample including normal-weight, overweight and obese participants. We investigated associations between characteristics of obesity, eating behavior and regulatory brain function focusing on nonlinear relationships.

SUBJECTS/METHODS

Forty-three hungry female volunteers (BMI: 19.4-38.8 kg m(-2), mean: 27.5±5.3 s.d.) were presented with visual food stimuli individually pre-rated according to tastiness and healthiness. The participants were instructed to either admit to the upcoming craving or regulate it. We analyzed the relationships between regulatory brain activity as well as functional connectivity and BMI or eating behavior (Three-Factor Eating Questionnaire, scales: Cognitive Restraint, Disinhibition).

RESULTS

During regulation, BMI correlated with brain activity in the left putamen, amygdala and insula in an inverted U-shaped manner. Functional connectivity between the putamen and the dorsolateral prefrontal cortex (dlPFC) correlated positively with BMI, whereas that of amygdala with pallidum and lingual gyrus was nonlinearly (U-shaped) associated with BMI. Disinhibition correlated negatively with the strength of functional connectivity between amygdala and dorsomedial prefrontal (dmPFC) cortex as well as caudate.

CONCLUSIONS

This study is the first to reveal quadratic relationships of food-related brain processes and BMI. Reported nonlinear associations indicate inverse relationships between regulation-related motivational processing in the range of normal weight/overweight compared with the obese range. Connectivity analyses suggest that the need for top-down (dlPFC) adjustment of striatal value representations increases with BMI, whereas the interplay of self-monitoring (dmPFC) or eating-related strategic action planning (caudate) and salience processing (amygdala) might be hampered with high Disinhibition.

Neurocognitive bases of emotion regulation development in adolescence

Emotion regulation is the ability to recruit processes to influence emotion generation. In recent years there has been mounting interest in how emotions are regulated at behavioural and neural levels, as well as in the relevance of emotional dysregulation to psychopathology. During adolescence, brain regions involved in affect generation and regulation, including the limbic system and prefrontal cortex, undergo protracted structural and functional development. Adolescence is also a time of increasing vulnerability to internalising and externalising psychopathologies associated with poor emotion regulation, including depression, anxiety and antisocial behaviour. It is therefore of particular interest to understand how emotion regulation develops over this time, and how this relates to ongoing brain development. However, to date relatively little research has addressed these questions directly. This review will discuss existing research in these areas in both typical adolescence and in adolescent psychopathology, and will highlight opportunities for future research. In particular, it is important to consider the social context in which adolescent emotion regulation develops. It is possible that while adolescence may be a time of vulnerability to emotional dysregulation, scaffolding the development of emotion regulation during this time may be a fruitful preventative target for psychopathology.

Normative development of ventral striatal resting state connectivity in humans

Incentives play a crucial role in guiding behavior throughout our lives, but perhaps no more so than during the early years of life. The ventral striatum is a critical piece of an incentive-based learning circuit, sharing robust anatomical connections with subcortical (e.g., amygdala, hippocampus) and cortical structures (e.g., medial prefrontal cortex (mPFC), insula) that collectively support incentive valuation and learning. Resting-state functional connectivity (rsFC) is a powerful method that provides insight into the development of the functional architecture of these connections involved in incentive-based learning. We employed a seed-based correlation approach to investigate ventral striatal rsFC in a cross-sectional sample of typically developing individuals between the ages of 4.5 and 23-years old (n=66). Ventral striatal rsFC with the mPFC showed regionally specific linear age-related changes in connectivity that were associated with age-related increases in circulating testosterone levels. Further, ventral striatal connectivity with the posterior hippocampus and posterior insula demonstrated quadratic age-related changes characterized by negative connectivity in adolescence. Finally, across this age range, the ventral striatum demonstrated positive coupling with the amygdala beginning during childhood and remaining consistently positive across age. In sum, our findings suggest that normative ventral striatal rsFC development is dynamic and characterized by early establishment of connectivity with medial prefrontal and limbic structures supporting incentive-based learning, as well as substantial functional reorganization with later developing regions during transitions into and out of adolescence.

Cross-validation of the reduced form of the Food Craving Questionnaire-Trait using confirmatory factor analysis

Objective: The Food Craving Questionnaire-Trait (FCQ-T) is commonly used to assess habitual food cravings among individuals. Previous studies have shown that a brief version of this instrument (FCQ-T-r) has good reliability and validity. This article is the first to use Confirmatory factor analysis to examine the psychometric properties of the FCQ-T-r in a cross-validation study.

Method: Habitual food cravings, as well as emotion regulation strategies, affective states, and disordered eating behaviors, were investigated in two independent samples of non-clinical adult volunteers (Sample 1: N = 368; Sample 2: N = 246). Confirmatory factor analyses were conducted to simultaneously test model fit statistics and dimensionality of the instrument. FCQ-T-r reliability was assessed by computing the composite reliability coefficient.

Results: Analysis supported the unidimensional structure of the scale and fit indices were acceptable for both samples. The FCQ-T-r showed excellent reliability and moderate to high correlations with negative affect and disordered eating.

Conclusion: Our results indicate that the FCQ-T-r scores can be reliably used to assess habitual cravings in an Italian non-clinical sample of adults. The robustness of these results is tested by a cross-validation of the model using two independent samples. Further research is required to expand on these findings, particularly in children and adolescents.

Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity

Functional, molecular and genetic neuroimaging has highlighted the existence of brain anomalies and neural vulnerability factors related to obesity and eating disorders such as binge eating or anorexia nervosa. In particular, decreased basal metabolism in the prefrontal cortex and striatum as well as dopaminergic alterations have been described in obese subjects, in parallel with increased activation of reward brain areas in response to palatable food cues. Elevated reward region responsivity may trigger food craving and predict future weight gain. This opens the way to prevention studies using functional and molecular neuroimaging to perform early diagnostics and to phenotype subjects at risk by exploring different neurobehavioral dimensions of the food choices and motivation processes. In the first part of this review, advantages and limitations of neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), pharmacogenetic fMRI and functional near-infrared spectroscopy (fNIRS) will be discussed in the context of recent work dealing with eating behavior, with a particular focus on obesity. In the second part of the review, non-invasive strategies to modulate food-related brain processes and functions will be presented. At the leading edge of non-invasive brain-based technologies is real-time fMRI (rtfMRI) neurofeedback, which is a powerful tool to better understand the complexity of human brain-behavior relationships. rtfMRI, alone or when combined with other techniques and tools such as EEG and cognitive therapy, could be used to alter neural plasticity and learned behavior to optimize and/or restore healthy cognition and eating behavior. Other promising non-invasive neuromodulation approaches being explored are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS). Converging evidence points at the value of these non-invasive neuromodulation strategies to study basic mechanisms underlying eating behavior and to treat its disorders. Both of these approaches will be compared in light of recent work in this field, while addressing technical and practical questions. The third part of this review will be dedicated to invasive neuromodulation strategies, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). In combination with neuroimaging approaches, these techniques are promising experimental tools to unravel the intricate relationships between homeostatic and hedonic brain circuits. Their potential as additional therapeutic tools to combat pharmacorefractory morbid obesity or acute eating disorders will be discussed, in terms of technical challenges, applicability and ethics. In a general discussion, we will put the brain at the core of fundamental research, prevention and therapy in the context of obesity and eating disorders. First, we will discuss the possibility to identify new biological markers of brain functions. Second, we will highlight the potential of neuroimaging and neuromodulation in individualized medicine. Third, we will introduce the ethical questions that are concomitant to the emergence of new neuromodulation therapies.

Age-related changes in reappraisal of appetitive cravings during adolescence

The ability to regulate temptation and manage appetitive cravings is an important aspect of healthy adolescent development, but the neural systems underlying this process are understudied. In the present study, 60 healthy females evenly distributed from 10 to 23years of age used reappraisal to regulate the desire to consume personally-craved and not craved unhealthy foods. Reappraisal elicited activity in common self-regulation regions including the dorsal and ventral lateral prefrontal cortex (specifically superior and inferior frontal gyri), dorsal anterior cingulate cortex, and inferior parietal lobule. Viewing personally-craved foods (versus not craved foods) elicited activity in regions including the ventral striatum, as well as more rostral and ventral anterior cingulate cortex extending into the orbitofrontal cortex. Age positively correlated with regulation-related activity in the right inferior frontal gyrus, and negatively correlated with reactivity-related activity in the right superior and dorsolateral prefrontal cortices. Age-adjusted BMI negatively correlated with regulation-related activity in the predominantly left lateralized frontal and parietal regions. These results suggest that the age-related changes seen in the reappraisal of negative emotion may not be as pronounced in the reappraisal of food craving. Therefore, reappraisal of food craving in particular may be an effective way to teach teenagers to manage cravings for other temptations encountered in adolescence, including alcohol, drugs, and unhealthy food.