Stress as a common risk factor for obesity and addiction

Angiotensin-converting enzyme gene insertion/deletion polymorphism is not associated with BMI in Korean adults

PURPOSE

Recent studies have demonstrated a probable association between ACE I/D polymorphism and obesity. Thus, this study aimed to investigate whether ACE I/D polymorphism influenced the susceptibly of developing obesity in Korean adults.

METHODS

A total of 353 healthy Korean adults aged between 30 and 82 years were recruited, including 157 males and 196 females. Among the participants, 103 (29.2 %) were classified as normal (BMI < 23 kg/m2), 117 (33.1 %) as overweight (23 kg/m2 ≤ BMI < 25 kg/m2), and 133 (37.7 %) as obese (BMI ≥ 25 kg/m2). ACE polymorphism (rs1799752) analysis was performed using the MGB TaqMan® SNP Genotyping assay with 3 types of primers and 2 types of probes. The distributions of the ACE genotypes and allele frequencies were analyzed among the three groups using the Hardy-Weinberg equilibrium, chi-square tests, and multiple regression analysis.

RESULTS

The distribution of the ACE genotypes were as follows: normal [II: n=38 (36.9 %), ID: n=46 (36.8 %), DD: n=19 (18.4 %)], overweight [II: n=43 (36.8 %), ID: n=55 (47.0 %), DD: n=19 (16.2 %)], and obese [II: n=41 (30.8 %), ID: n=76 (57.0 %), DD: n=16 (12.0 %)]. Unexpectedly, the I allele, rather than the D allele, was common in the obese group.

CONCLUSION

ACE I/D polymorphism is not associated with BMI in Korean adults. Thus, it is unlikely to be a powerful candidate gene for obesity in Korean adults.

Using consumer-wearable technology for remote assessment of physiological response to stress in the naturalistic environment

Psychosocial stress is a major risk factor for morbidity and mortality related to a wide range of health conditions and has a significant negative impact on public health. Quantifying exposure to stress in the naturalistic environment can help to better understand its health effects and identify strategies for timely intervention. The objective of the current project was to develop and test the infrastructure and methods necessary for using wearable technology to quantify individual response to stressful situations and to determine if popular and accessible fitness trackers such as Fitbit® equipped with an optical heart rate (HR) monitor could be used to detect physiological response to psychosocial stress in everyday life. The participants in this study were University of Minnesota students (n = 18) that owned a Fitbit® tracker and had at least one upcoming examination. Continuous HR and activity measurements were obtained during a 7-day observation period containing examinations self-reported by the participants. Participants responded to six ecological momentary assessment surveys per day (~ 2 hour intervals) to indicate occurrence of stressful events. We compared HR during stressful events (e.g., exams) to baseline HR during periods indicated as non-stressful using mixed effects modeling. Our results show that HR was elevated by 8.9 beats per minute during exams and by 3.2 beats per minute during non-exam stressors. These results are consistent with prior laboratory findings and indicate that consumer wearable fitness trackers could serve as a valuable source of information on exposure to psychosocial stressors encountered in the naturalistic environment.

Are environmental area characteristics at birth associated with overweight and obesity in school-aged children? Findings from the SLOPE (Studying Lifecourse Obesity PrEdictors) population-based cohort in the south of England

BACKGROUND

Geographical inequalities in overweight and obesity prevalence among children are well established in cross-sectional research. We aimed to examine how environmental area characteristics at birth are related to these outcomes in childhood.

METHODS

Anonymised antenatal and birth data recorded by University Hospital Southampton linked to school-measured weight and height data for children within Southampton, UK, were utilised (14,084 children at ages 4-5 and 5637 at ages 10-11). Children's home address at birth was analysed at the Lower and Middle layer Super Output Area (LSOA/MSOA) levels (areas with average populations of 1500 and 7000, respectively). Area-level indices (walkability, relative density of unhealthy food outlets, spaces for social interaction), natural greenspace coverage, supermarket density and measures of air pollution (PM_2.5, PM₁₀ and NO_x) were constructed using ArcGIS Network Analyst. Overweight/obesity was defined as a body mass index (BMI; kg/m²) greater than the 85th centile for sex and age. Population-average generalised estimating equations estimated the risk of being overweight/obese for children at both time points. Confounders included maternal BMI and smoking in early pregnancy, education, ethnicity and parity. We also examined associations for a subgroup of children who moved residence between birth and outcome measurement.

RESULTS

There were mixed results between area characteristics at birth and overweight/obesity at later ages. MSOA relative density of unhealthy food outlets and PM₁₀ were positively associated with overweight/obesity, but not among children who moved. LSOA greenspace coverage was negatively associated with the risk of being overweight/obese at ages 10-11 in all children (relative risk ratio 0.997, 95% confidence interval 0.995-0.999, p = 0.02) and among children who moved.

CONCLUSIONS

Local access to natural greenspaces at the time of birth was inversely associated with becoming overweight or obese by age 10-11, regardless of migration. Increased access/protection of greenspace may have a role in the early prevention of childhood obesity.

The neural interface between negative emotion regulation and motivation for change in cocaine dependent individuals under treatment

BACKGROUND

Emotion regulation is important for cocaine addiction treatment success, particularly during early abstinence. In addition, the neural underpinnings of emotion processing overlap with those of motivation and goal-directed behavior. We examined if the neural underpinnings of emotion maintenance and its regulation correlate with cocaine treatment motivation.

METHODS

Forty-five cocaine dependent individuals (CDIs) starting outpatient treatment in a public specialized addiction treatment clinic in Granada (Spain) underwent fMRI scans while performing a Reappraisal task, and completed the University of Rhode Island Change Assessment Scale (URICA), to measure treatment motivation. We conducted correlation analyses to examine the association between emotion maintenance and regulation related brain activation and URICA's Readiness to Change scores. We also explored links between Emotional reports during the fMRI reappraisal task, duration of abstinence, and anxiety and depression symptoms.

RESULTS

Readiness to Change scores were positively correlated with activations in the right dorsolateral prefrontal and right parietal cortices, the midbrain (p ≤ 0.001, cluster extents ≥109 voxels), and basolateral amygdala (P_FWE-SVC<0.05), while negatively with emotion maintenance related activation in the same cortical areas and activations in the dorsomedial frontal cortex, the nucleus accumbens and the left fusiform gyrus. Emotional reactivity negatively correlated with right dorsolateral prefrontal cortex reappraisal related activation (r= -0.40, p = 0.007), and the Regulate score positively correlated with the left fusiform gyrus emotion maintenance related activation (r = 0.31, p = 0.04).

CONCLUSIONS

Emotional related activation in frontoparietal, accumbens, fusiform, amygdala and midbrain regions engaged during emotion regulation and its maintenance correlate with early treatment motivation in CDIs.

Are long working hours associated with weight-related outcomes? A meta-analysis of observational studies

The relationship between long working hours and body weight outcomes remains inconclusive; thus, we conducted a meta-analysis to assess the effect of long working hours on weight-related outcomes. PubMed and Embase databases were searched from their inception to June 2019. A random-effects model was used to assess the pooled odds ratio (OR) and corresponding confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Begg's and Egger's tests. A total of 29 articles involving 374 863 participants were included. The pooled OR of long working hours on weight-related outcomes was 1.13 (95% CI, 1.07-1.19). In subgroup analysis stratified by definition of outcomes, the pooled ORs of long working hours on "weight gain/BMI increase," "BMI ≥ 25 kg/m² ," and "BMI ≥ 30 kg/m² " were 1.19 (95% CI, 1.02-1.40), 1.07 (95% CI, 1.00-1.14), and 1.23 (95% CI, 1.09-1.39), respectively. We found evidence of publication bias, but correction for this bias using the trim-and-fill method did not alter the combined OR substantially. There was evidence to suggest that long working hours are associated with adverse weight-related outcomes. Preventative interventions such as improved flexibility and healthy working schedules should be established for employees.

Maternal stress in the first 1000 days and risk of childhood obesity: a systematic review

Objective: Maternal stress is associated with adverse child outcomes. Conception to 2-years postpartum (the first 1000 days) is a developmentally sensitive period for stress exposure. The role of maternal stress in the first 1000 days on child obesity risk is unclear. This review systematically examines the relationship between maternal stress across the first 1000 days and child obesity risk. Methods: The Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, and Maternity and Infant Care were searched from inception to June 2018. Eligible studies included women who experienced maternal stress in the first 1000 days; an included a measure of maternal stress and of child anthropometrics. Results: Sixteen studies met inclusion criteria, the majority of these examined prenatal stress exposure. Inconsistent effects were observed for psychological and physiological stress responses, on child weight outcomes. Environmental stress exposures, including natural disaster and bereavement, were more consistently associated with increased obesity risk. Conclusion: This review does not provide support for the effects of psychological or physiological maternal stress on child weight outcomes; there is some evidence of associations between environmental stress exposures and greater childhood adiposity. Variation in conceptualisation and measurement of stress, timing of stress exposure, and limited examination of stress-related behaviours were noted.

Can oxytocin inhibit stress-induced hyperalgesia?

Stress-induced hyperalgesia is a problematic condition that lacks an effective therapeutic measure, and hence impairs health-related quality of life. The regulation of stress by oxytocin (OT) has overlapping effects on pain. OT can alleviate pain directly mainly at the spinal level and the peripheral tissues. Additionally, OT plays an analgesic role by dealing with stress and fear learning. When OT relieves stress by targeting the prefrontal brain regions and the hypothalamic-pituitary-adrenal axis, the body's sensitivity to pain is attenuated. Meanwhile, OT facilitates fear learning and may, in turn, enhance the anticipatory actions to painful stimulation. The unique therapeutic value of OT in patients suffering from stress and stress-related hyperalgesia conditions is worth considering. We reviewed recent advances in animal and human studies involving the effects of OT on stress and pain, and discussed the possible targets of OT within the descending and ascending pathways in the central nervous system. This review provides an overview of the evidence on the role of OT in alleviating stress-induced hyperalgesia.

Early life socioeconomic circumstances and cardiometabolic health in childhood: Evidence from the Generation XXI cohort

Social adversity is thought to become biologically embedded during sensitive periods of development which could set children on a trajectory of increased risk for later diseases. This study estimated the association between early socioeconomic circumstances and cardiometabolic biomarkers during childhood. We analyzed data from 2962 participants in the birth cohort Generation XXI. Early socioeconomic circumstances included parental education and occupation and household income measured at the child's birth; cardiometabolic biomarkers included a set of parameters that were determined at seven and 10years old. The association between early socioeconomic circumstances and cardiometabolic biomarkers in children aged seven and 10years old was estimated using generalized estimating equations. We observed, after adjustment for birth weight, sex, five-a-day fruit and vegetable intake and sedentary activity, that children with low educated mothers presented higher body mass index z-score (β=0.22; 95%CI: 0.12, 0.33), higher waist circumference (β=1.14; 95%CI: 0.55, 1.73) and increased systolic blood pressure z-score (β=0.15; 95%CI: 0.08, 0.22) at the age of seven. At 10years, children with mothers with low education, presented higher body mass index z-score (β =0.32; 95%CI: 0.21, 0.43), higher waist circumference (β=2.79; 95%CI: 1.94, 3.64), increased diastolic blood pressure z-score (β=0.11; 95%CI: 0.06, 0.17) and increased systolic blood pressure s-score (β=0.20; 95%CI: 0.12, 0.28). When repeated measures of cardiometabolic biomarkers were taken into account, the association between socioeconomic circumstances and cardiometabolic biomarkers remained significant. Low socioeconomic circumstances have a possible detrimental effect on children's cardiometabolic health. Thus, socioeconomic adversity might impact health outcomes already in the first decade of life, emphasizing the early social patterning of cardiometabolic health and the need of social policies targeting children and families to modify or reverse its negative impact on health.

High/low cortisol reactivity and food intake in people with obesity and healthy weight

Increased food intake, termed "comfort eating", is a pathologic coping mechanism in chronic stress. Cortisol reactivity under stress is a potent predictor of stress-induced eating behavior affecting the body mass index (BMI). However, cortisol reactivity and food intake under stress in people with obesity has not been evaluated. The aim of this study was to investigate the effect of high/low cortisol reactivity on food intake in people with obesity and healthy weight test controls, following standardized stress induction and a resting condition. Thirty-six men and women with obesity (BMI: 33.00 ± 3.23 kg/m²), as well as 36 age- and gender-matched healthy weight controls (BMI: 21.98 ± 1.81 kg/m²) were categorized into high cortisol reactors (HCR) and low cortisol reactors (LCR) in the Trier Social Stress Test (TSST). Following the TSST and a resting condition, the food intake of all participants was recorded in a standardized laboratory meal. Obese HCR demonstrated a significantly higher food intake than LCR (t (34) = -2.046, p ≤ 0.05). However, there were no significant differences between HCR and LCR in the healthy weight controls (p = 0.26). In addition, HCR of the people with obesity showed lower values in the emotion coping strategy of cognitive reappraisal than obese LCR (t (32) = 2.087, p ≤ 0.05). In conclusion, the magnitude of the cortisol reactivity to stress predicts stress-induced food intake in people with obesity, but not in the healthy weight controls. Limited use of cognitive reappraisal in emotion regulation in the obese HCR may be a marker of vulnerability to stress-induced eating.

Bored and online: Reasons for using social media, problematic social networking site use, and behavioral outcomes across the transition from adolescence to emerging adulthood

INTRODUCTION

The current study examined motivations for social networking site use across three years during the transition from late adolescence to emerging adulthood. While research has been conducted examining reasons for social networking site usage and behavior, the clear majority have focused on samples of undergraduate college students and are cross-sectional.

METHODS

Changes in motivations for using social networking sites were examined in relation to problematic social networking site use and several behavioral and mental health outcomes in a sample of adolescents over three years.

RESULTS

Using social networking sites to connect with others was relatively stable over a three-year period. However, using social networking sites to seek information increased from late adolescence to emerging adulthood and was not related to any negative outcomes across three years. Using social networking sites to alleviate boredom also increased over time. Initial levels of social media use to alleviate boredom were associated with problematic social networking site use, financial stress, anxiety, and empathy at year three. Increases in using social networking sites to socially connect over time was related to problematic social networking site use, anxiety, delinquency, and empathy at year three. Using social networking sites for any reason was not related to depressive symptoms over three years.

CONCLUSIONS

The current study supports the growing body of literature suggesting that using social networking sites to alleviate boredom and socially connect, may place individuals at increased risk for developing pathological tendencies and patterns of behavior towards social networking sites.

Animal models of liability to post-traumatic stress disorder: going beyond fear memory

In this review, we advocate a dimensional approach on the basis of candidate endophenotypes to the development of animal models of post-traumatic stress disorder (PTSD) capable of including genetic liability factors, variations in symptoms profile and underlying neurobiological mechanisms, and specific comorbidities. Results from the clinical literature pointed to two candidate endophenotypes of PTSD: low sensory gating and high waiting impulsivity. Findings of comparative studies in mice of two inbred strains characterized by different expressions of the two candidate endophenotypes showed different strain-specific neural and behavioral effects of stress experiences. Thus, mice of the standard C57BL/6J strain show stress-induced helplessness, stress-learned helplessness, and stress-extinction-resistant conditioned freezing. Instead, mice of the genetically unrelated DBA/2J strain, expressing both candidate endophenotypes, show stress-induced extinction-resistant avoidance and neural and behavioral phenotypes promoted by prolonged exposure to addictive drugs. These strain differences are in line with evidence of associations between genetic variants and specific stress-promoted pathological profiles in PTSD, support a role of genotype in determining different PTSD comorbidities, and offer the means to investigate specific pathogenic processes.

Differential associations between psychosocial stress and obesity among Ghanaians in Europe and in Ghana: findings from the RODAM study

PURPOSE

Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration. This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana.

METHODS

Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex.

RESULTS

Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (β = 0.78, 95% CI 0.34-1.22) and WC (β = 1.96, 95% CI 0.79-3.12) among male Ghanaian migrants. Similarly, stress at work or at home was positively associated with BMI (β = 0.28, 95% CI 0.00-0.56) and WC (β = 0.84, 95% CI 0.05-1.63) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (β = - 0.66, 95% CI - 1.03 to - 0.28; β = - 1.71 95% CI - 2.69 to - 0.73, respectively) and females (β = - 0.81, 95% CI - 1.20 to - 0.42; β = - 1.46, 95% CI - 2.30 to - 0.61, respectively).

CONCLUSIONS

Negative life events and stress at work or at home are associated with increased body weight among male Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations to assist prevention efforts.

Alcohol Consumption in China Before and During COVID-19: Preliminary Results From an Online Retrospective Survey

Background: Alcohol is an important aspect of Chinese culture, and alcohol use has been traditionally accepted in China. People with stress, anxiety, and depression may use more alcohol. More people reported symptoms of anxiety and depression during the outbreak of COVID-19. Thus, people may drink more alcohol during the outbreak of COVID-19 than before COVID-19. Methods: An online retrospective survey was conducted on a total sample of 2,229 participants. Drinking behaviors before and during COVID-19, current risky drinking and hazardous drinking, and the association between high-risk drinking and mental health problems (depression, anxiety, and stress) were assessed via self-reported measures on the Alcohol Use Disorders Identification Test (AUDIT) and the 21-item Depression Anxiety Stress Scales (DASS-21). Results: This study found that, compared with before COVID-19, alcohol consumption was slightly decreased during COVID-19 (from 3.5 drinks to 3.4 drinks, p = 0.035) in the overall sample. Most (78.7%) alcohol drinkers were males. Before and during COVID-19, males consumed more drinks per week (4.2 and 4.0 vs. 1.3 and 1.2 drinks), had a higher percentage of heavy drinking (8.1 and 7.7% vs. 4.4 and 2.7%), and more drinking days per week (2.1 and 2.1 vs. 1.0 and 0.9 days). Males also had more risky drinking (43.2 vs. 9.3%) and hazardous drinking (70.2 vs. 46.6%) than female counterparts. This study also found that high-risk drinking predicted anxiety in females. Conclusions: This study suggests a slight reduction in alcohol consumption during COVID-19. However, hazardous drinking is common, especially among male alcohol drinkers. Males consumed more alcohol, had more risky and hazardous drinking than female counterparts both before and during COVID-19. Public health policy makers should pay more attention to developing effective, population-based strategies to prevent harmful alcohol consumption.

Stress management in obesity during a thermal spa residential programme (ObesiStress): protocol for a randomised controlled trial study

INTRODUCTION

Stress and obesity are two public health issues. The relationship between obesity and stress is biological through the actions of stress on the major hormones that regulate appetite (leptin and ghrelin). Many spa resorts in France specialise in the treatment of obesity, but no thermal spa currently proposes a specific programme to manage stress in obesity. The ObesiStress protocol has been designed to offer a new residential stress management programme. This thermal spa treatment of obesity implements stress management strategies as suggested by international recommendations.

METHODS AND ANALYSIS

140 overweight or obese participants with a Body Mass Index of >25 kg/m² and aged over 18 years will be recruited. Participants will be randomised into two groups: a control group of usual practice (restrictive diet, physical activity and thermal spa treatment) and an intervention group with stress management in addition to the usual practice. In the present protocol, parameters will be measured on five occasions (at inclusion, at the beginning of the spa (day 0), at the end of the spa (day 21), and at 6 and 12 months). The study will assess the participants' heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometric profile, body composition, psychology and quality of life via the use of questionnaires and bone parameters.

ETHICS AND DISSEMINATION

The ObesiStress protocol complies with the ethics guidelines for Clinical Research and has been approved by the ethics committee (CPP Sud-Est VI, Clermont-Ferrand - ANSM: 2016-A01774-47). This study aimed to highlight the efficacy of a 21-day thermal spa residential programme of stress management in obesity through objective measurements of well-being and cardiovascular morbidity. Results will be disseminated during several research conferences and articles published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03578757.

High-refined carbohydrate diet consumption induces neuroinflammation and anxiety-like behavior in mice

Consumption of poor nutrients diets is associated with fat tissue expansion and with a central and peripheral low-grade inflammation. In this sense, the microglial cells in the central nervous system are activated and release pro-inflammatory cytokines that up-regulate the inducible nitric oxide synthase (iNOS), promoting Nitric Oxide (NO) production. The excess of NO has been proposed to facilitate anxious states in humans and rodents. We evaluated whether consumption of a high-refined carbohydrate-containing diet (HC) in mice induced anxiety-like behavior in the Novelty Suppressed Feeding Test (NFST) trough facilitation of NO, in the prefrontal cortex (PFC) and hippocampus (HIP). We also verified if HC diet induces activation of microglial cells, alterations in cytokine and leptin levels in such regions. Male BALB/c mice received a standard diet or a HC diet for 3 days or 12 weeks. The chronic consumption of HC diet, but not acute, induced an anxiogenic-like effect in the NSF test and an increase in the nitrite levels in the PFC and HIP. The preferential iNOS inhibitor, aminoguanidine (50 mg/kg, i.p.), attenuated such effects. Moreover, microglial cells in the HIP and PFC were activated after chronic consumption of HC diet. Finally, the expression of iNOS in the PFC and TNF, IL6 and leptin levels in HIP were higher in chronically HC fed mice. Taken together, our data reinforce the notion that diets containing high-refined carbohydrate facilitate anxiety-like behavior, mainly after a long period of consumption. The mechanisms involve, at least in part, the augmentation of neuroinflammatory processes in brain areas responsible for anxiety control.

Psychological distress and health-related quality of life in patients with bone marrow edema syndrome

BACKGROUND

The aim of the study was to investigate psychological distress and health-related quality of life (HrQoL) in patients with bone marrow edema syndrome (BMES) of the hip or knee joint.

METHODS

This retrospective study included patients with the diagnosis BMES treated in the period 2016-2017. As well as analyzing the epidemiological data (age, sex, vascular disease, hypertension, etc.), we used the Hospital Anxiety and Depression Scale (HADS) to document anxiety and depression and the five-level version of the EuroQol Group's EQ-5D instrument (EQ-5D-5L) to assess HrQoL and compared it to historical controls of the healthy population.

RESULTS

The study group comprised 56 patients (26 females, 30 males) with a mean age of 55.8 (range, 15-84) years. HADS: there was no difference between the study and control cohorts in the rates of anxiety (P=0.595) or depression (P=0.241). EQ-5D-5L: the HrQoL was significantly lower in the patients with BMES than in the healthy controls both for parameters of the EQ-5D-5L index and in the various age groups. No difference in HrQoL was seen between BMES of the hip and the knee or among the different radiological stages of BMES.

CONCLUSIONS

The patients with BMES displayed a clear reduction in HrQoL, but this was not associated with psychological distress with regard to significant anxiety and depression. Patients with BMES and a high score for anxiety and depression are at great risk of chronic pain, and we recommend they should receive psychological counseling.

Eat to avoid negative self-awareness: Locus of control and core self-evaluation as serial mediators in the effect of stress on food intake

The primary hypothesis of escape theory lies in that those who are under stress eat to escape from negative self-awareness. Although escape theory has been well cited in the eating literature, relatively few studies have directly tested its applicability to stress-induced eating. The aim of the present study is to provide causal evidence on using escape theory to explain the effect of stress on food intake. Specifically, we examined whether locus of control (LOC) and core self-evaluation (CSE) are serial mediators in the effect of stress on food intake. By a longitudinal experimental design, participants were randomly assigned to a stress group or a control group, and data on LOC, CSE, and food intake were collected at 3 waves. The results indicated that LOC and CSE are serial mediators in the effect of stress on food intake, though the direct effect of stress conditions remained significant. Our findings support the applicability of escape theory to interpret why stress increases food intake, and exclusion of LOC as an indicator of CSE. Thus, the present study provides causal evidence on escape theory by shedding light on the sequential mediating effect of LOC and CSE. Future research need to pay more attention to the evaluative process in stress-induced eating.

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually-tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV.

Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model

BACKGROUND

Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity.

METHOD

We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression.

RESULTS

Women in MMT showed significant reductions in perceived stress (β = - 0.16) and depressive symptoms (β = - 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = - 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group.

CONCLUSION

A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population. Clinical Trials.gov #NCT01307683.

Effects of a short residential thermal spa program to prevent work-related stress/burnout on stress biomarkers: the ThermStress proof of concept study

Objective

Work-related stress is a public health issue. Stress has multiple physical and psychological consequences, the most serious of which are increased mortality and cardiovascular morbidity. The ThermStress protocol was designed to offer a short residential thermal spa program for work-related stress prevention that is compatible with a professional context.

Methods

Participants will be 56 male and female workers aged 18 years or above. All participants will undergo a 6-day residential spa program comprising psychological intervention, physical activity, thermal spa treatment, health education, eating disorder therapy and a follow-up. On six occasions, participants’ heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometry and body composition, psychology and quality of life will be measured using questionnaires and bone parameters.

Results

This study protocol reports the planned and ongoing research for this intervention.

Discussion

The ThermStress protocol has been approved by an institutional ethics committee (ANSM: 2016 A02082 49). It is expected that this proof of concept study will highlight the effect of a short-term specific residential thermal spa program on the prevention of occupational burnout and work-related stress. The findings will be disseminated at several research conferences and in published articles in peer-reviewed journals.

Trial Registration: ClinicalTrials.gov ( NCT 03536624, 24/05/2018)

Mindfulness and psychoeducation to manage stress in amnestic mild cognitive impairment: A pilot study

Objectives: Amnestic mild cognitive impairment (aMCI) often corresponds to the prodromal stage of Alzheimer disease (AD). The aMCI stage represents a crucial time window to apply preventive interventions in an attempt to delay cognitive decline. Stress, one of AD's modifiable risk factors frequently co-occurring with aMCI, stands out as a key intervention target. The goal of this study was to assess the impacts of two non-pharmacological interventions, mindfulness and psychoeducation, on stress at the psychological and physiological levels among aMCI older adults. Methods: Forty-eight aMCI participants were randomized between a mindfulness-based intervention (MBI) and a psychoeducation-based intervention (PBI) for eight weekly sessions. Anxiety symptoms, perceived stress levels, cortisol awakening response (CAR), and coping strategies were assessed pre- and post-intervention. Mindfulness attitudes and time dedicated to at-home meditative practices were evaluated in the MBI group. Results: The main results revealed a slight reduction of the CAR among MBI participants who practiced meditation at home the most and a decrease in perceived stress levels in the PBI group. Both interventions enhanced problem-focused coping strategies. Conclusion: In sum, this pilot study supports the potential of MBI and PBI to reduce stress at the physiological and psychological level, respectively, and increase coping strategies in older adults at risk for AD.

Food craving, cortisol and ghrelin responses in modeling highly palatable snack intake in the laboratory

Overeating of highly palatable (HP) foods in the ubiquitous HP food cue environment and under stress is associated with weight gain and contributes to the global obesity epidemic. However, subjective and biobehavioral processes that may increase HP overeating are not clear. Using a novel experimental approach, we examined HP food motivation and intake and neuroendocrine responses in the context of food cues, stress and a control neutral relaxing cue exposure in healthy individuals.

METHODS

Twenty individuals (12 M; 8F; ages 18-45) with body mass index (BMI) in the lean (LN: N = 8; 3/8 female BMI: 18-24.9) or overweight/obese (OW: N = 12; 5/12 female; BMI: 25-37) range were enrolled in a controlled, hospital-based, 3-day laboratory experiment. On each day, subjects were exposed to a brief 5-min individualized guided imagery of stress, food cue or an active neutral-relaxing control cue script, followed by a food snack test (FST), with one imagery condition per day and order of imagery exposure randomized and counterbalanced across subjects. Subjective HP food craving and caloric intake, anxiety, cortisol and total ghrelin was assessed repeatedly during each test day.

RESULTS

Significant condition and condition × group effects for food craving, anxiety and HP calorie intake were observed, with food cue relative to neutral condition increasing HP food craving and intake across all subjects (p < .001), but stress relative to neutral condition increased HP food craving and intake in the OW but not LN group (p < .01). Pre-snack increases in food craving after exposure to food cues and to stress predicted greater subsequent HP food intake (p's < 0.01). Furthermore, ghrelin increased in the food cue and stress conditions (p < .01), but stress-induced increases in ghrelin was associated with HP food intake only in the OW/OB condition (p < .01). Finally, cortisol increased during food cue exposure and increased cortisol responses were associated with greater HP food caving and with intake (p's < 0.05).

CONCLUSIONS

These findings, while preliminary, validate a laboratory model of HP food motivation and intake and identify specific subjective and neuroendocrine responses that may play a role in HP snacking with implications for weight gain and obesity risk. (342 words).

Alexithymia, body mass index and gestational diabetes in pregnant women - FinnBrain birth cohort study

OBJECTIVE

Overweight, obesity, and associated problems in metabolic health are an increasing public health concern. Personality traits and emotional processing styles may play a role in the regulation of food intake and reward. Alexithymia is a personality construct involving difficulties in identifying and expressing emotions and has been previously associated with eating disorders and metabolic problems. We examined associations between alexithymia dimensions, Body Mass Index (BMI) and gestational diabetes in pregnant women.

METHODS

The participants were 1660 pregnant women living in Finland from the FinnBrain Birth Cohort Study. We investigated the associations between alexithymia and its dimensions as measured by the Toronto Alexithymia Scale (TAS-20), overweight, and gestational diabetes. The effects of age, education, and depressive symptoms were controlled for using hierarchical regression analysis.

RESULTS

Alexithymic individuals had a higher prevalence of overweight compared to those with low or moderate levels of alexithymia (66.0% vs. 34.8%, OR 3.6, adjusted OR 3.6, CI95% 1.9-6.8, p < .001). The dimension of Externally Oriented Thinking (EOT) accounted for this association. Compared to the lowest quartile, women in the highest EOT quartile had a higher BMI (24.3 vs. 25.6, p < .001), and a higher prevalence of overweight [adjusted OR 1.94, CI95% 1.43-2.62, p < .001] and gestational diabetes [OR 1.75, CI95% 1.19-2.55, p = .005].

CONCLUSIONS

Alexithymia, and especially its dimension of EOT is associated with overweight and gestational diabetes in pregnant women. Future studies should clarify causality and examine potential mechanisms and associations with pregnancy outcomes and fetal health.

Hypothalamic mechanisms associated with neuropeptide K-induced anorexia in Japanese quail (Coturnix japonica)

Central administration of neuropeptide K (NPK), a 36-amino acid peptide, is associated with anorexigenic effects in rodents and chickens. The mechanisms underlying the potent anorexigenic effects of NPK are still poorly understood. Thus, the aim of the present study was to identify the hypothalamic nuclei and neuropeptides that mediate anorexic effects of NPK in 7 day-old Japanese quail (Coturnix japonica). After a 6 h fast, intracerebroventricular (ICV) injection of NPK decreased food and water intake for 180 min post-injection. Quail injected with NPK had more c-Fos immunoreactive cells in the arcuate nucleus (ARC), lateral hypothalamus, and paraventricular nucleus (PVN) compared to the birds that were injected with the vehicle. In the ARC of NPK-injected quail, there was decreased neuropeptide Y (NPY), NPY receptor sub-type 1, and agouti-related peptide mRNA, and increased CART, POMC, and neurokinin receptor 1 mRNA. NPK-injected quail expressed greater amounts of corticotropin-releasing factor (CRF), CRF receptor sub-type 2, melanocortin receptors 3 and 4, and urocortin 3 mRNA in the PVN. In conclusion, results provide insights into understanding NPK-induced changes in hypothalamic physiology and feeding behavior, and suggest that the anorexigenic effects of NPK involve the ARC and PVN, with increased CRF and melanocortin and reduced NPY signaling.

The Moderating Role of Cortisol Reactivity on the Link Between Maltreatment and Body Mass Index Trajectory Across Adolescence

PURPOSE

Child maltreatment increases risk for obesity, yet differential effects of maltreatment type remain unclear. Cortisol reactivity may help clarify these effects, given links among cortisol reactivity, maltreatment, and obesity. We examined these associations in boys and girls across adolescence.

METHODS

We collected data from 454 adolescents (212 girls) across four waves (aged 8-13 years at Time 1), including 303 maltreated youth. We modeled body mass index (BMI) percentile trajectories arrayed by age separately for boys and girls and tested whether cortisol reactivity at Time 1 moderated the association between maltreatment type and BMI growth.

RESULTS

In girls, cortisol reactivity moderated the association between maltreatment type and quadratic change in BMI. At low levels of cortisol, sexually abused girls had a steeper quadratic increase in BMI compared with comparison (-.65, 95% confidence interval [CI] -1.09 to -.22) and physically abused (-.76, 95% CI -1.29, -.24) girls. At high levels of cortisol, sexually abused girls did not differ from comparison (.15, 95% CI -.40 to .70) or physically abused (.21, 95% CI -.38 to .80) girls in quadratic change in BMI. In boys, cortisol reactivity did not moderate the association between maltreatment type and BMI growth.

CONCLUSIONS

The combination of lower cortisol reactivity and sexual abuse may put girls at risk for BMI increase during later adolescence. Given the negative consequences of high BMI, identifying and intervening with these girls could lead to better health and well-being among this group. Cortisol reactivity may not play the same role among boys.

Negative affect is associated with increased stress-eating for women with high perceived life stress

Perceived life stress (PLS) and cognitive restraint are associated with increased comfort food intake under stress and lead to weight gain and obesity, but the mechanisms by which they do so remain unclear. Stress and negative affect (NA) are associated with increased reward-driven comfort food intake as a means to 'feel better', particularly for individuals with higher PLS and cognitive restraint. Thus, we propose that PLS and cognitive restraint increase stress-eating by strengthening the relationship between stress-induced NA and comfort food intake. Upon comfort eating, individuals with higher PLS show greater reductions in the negative consequences of stress (e.g. NA). The rewarding effects of this 'emotional relief' may promote future stress-induced comfort eating, but this has yet to be examined. Thus, we investigate the pathways by which PLS or cognitive restraint increase snack intake under stress by proposing that 1) stress-induced NA is a stronger predictor of increased snack intake for women with greater PLS and cognitive restraint, and 2) greater PLS will be associated with greater reductions in NA upon snacking under stress (i.e. emotional relief). Forty-three healthy women were given snacks (chips, golden oreos, and M&Ms) to eat after a Trier Social Stress Test or rest period on separate days in counterbalanced order. Following linear regression analyses, we determined that stress-induced NA predicted more snack intake for women with higher PLS, and that higher PLS was associated with heightened emotional relief upon snacking under stress. Future studies are needed to directly assess whether greater emotional relief following stress-eating reinforces the learned association between stress-induced NA and intake, and ultimately explains greater stress-eating and obesity in women with higher PLS. This work may lead clinicians to focus on NA in the treatment of obesity-and stress-related illnesses for women with higher PLS.

Associations Between Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Young, Nulliparous Women

Objectives Preterm birth (PTB) is a leading cause of infant morbidity and mortality. One goal of Healthy People 2020 is to understand the role of preconception lifecourse exposures in relation to pregnancy outcomes, including PTB. The objective of this study was to examine the relationship between maternal exposure to multiple forms of childhood abuse and PTB and very preterm birth (vPTB), utilizing a national, population-based sample. MethodsThis study utilized retrospective self-reported maternal exposure to parent/adult caregiver perpetrated emotional, physical, and sexual abuse; non-parental/adult caregiver perpetrated sexual abuse; and history of PTB and vPTB in the National Longitudinal Study of Adolescent to Adult Health. The cross-sectional analytic study population consisted of first deliveries to 4181 nulliparous women (mean age at time of delivery = 21.7 years). Results With one exception, we did not observe associations between experiences of child abuse and the likelihood of PTB or vPTB. Only sexual abuse, accompanied by physical force and perpetrated by a non-parent/adult caregiver, was associated with an increased odds of vPTB (aOR = 1.94 (95% CI 1.10, 3.44)), particularly in women for whom abuse began after age 9 (aOR = 2.32 (95% CI 1.25, 4.28)).Conclusions for Practice The relationship between maternal exposure to child abuse and PTB may be limited to specific abuse and PTB subtypes, namely non-parent/caregiver perpetrated sexual abuse by force and vPTB. Future studies should also examine possible effect modifiers, such as maternal age and resilience, which may have the potential to inform interventions that can mitigate effects of maternal early life adversity.

A Life History Approach to the Female Sexual Orientation Spectrum: Evolution, Development, Causal Mechanisms, and Health

Women's capacity for sexual fluidity is at least as interesting a phenomenon from the point of view of evolutionary biology and behavioral endocrinology as exclusively homosexual orientation. Evolutionary hypotheses for female nonheterosexuality have failed to fully account for the existence of these different categories of nonheterosexual women, while also overlooking broader data on the causal mechanisms, physiology, ontogeny, and phylogeny of female nonheterosexuality. We review the evolutionary-developmental origins of various phenotypes in the female sexual orientation spectrum using the synergistic approach of Tinbergen's four questions. We also present femme-specific and butch-specific hypotheses at proximate and ultimate levels of analysis. This review article indicates that various nonheterosexual female phenotypes emerge from and contribute to hormonally mediated fast life history strategies. Life history theory provides a biobehavioral explanatory framework for nonheterosexual women's masculinized body morphology, psychological dispositions, and their elevated likelihood of experiencing violence, substance use, obesity, teenage pregnancy, and lower general health. This pattern of life outcomes can create a feedback loop of environmental unpredictability and harshness which destabilizes intrauterine hormonal conditions in mothers, leading to a greater likelihood of fast life history strategies, global health problems, and nonheterosexual preferences in female offspring. We further explore the potential of female nonheterosexuality to function as an alloparental buffer that enables masculinizing alleles to execute their characteristic fast life history strategies as they appear in the female and the male phenotype. Synthesizing life history theory with the female sexual orientation spectrum enriches existing scientific knowledge on the evolutionary-developmental mechanisms of human sex differences.

Multimodal neurocognitive markers of interoceptive tuning in smoked cocaine

Contemporary neurocognitive models of drug addiction have associated this condition with changes in interoception -namely, the sensing and processing of body signals that fulfill homeostatic functions relevant for the onset and maintenance of addictive behavior. However, most previous evidence is inconsistent, behaviorally unspecific, and virtually null in terms of direct electrophysiological and multimodal markers. To circumvent these limitations, we conducted the first assessment of the relation between cardiac interoception and smoked cocaine dependence (SCD) in a sample of (a) 25 participants who fulfilled criteria for dependence on such a drug, (b) 22 participants addicted to insufflated clorhidrate cocaine (only for behavioral assessment), and (c) 25 healthy controls matched by age, gender, education, and socioeconomic status. We use a validated heartbeat-detection (HBD) task and measured modulations of the heart-evoked potential (HEP) during interoceptive accuracy and interoceptive learning conditions. We complemented this behavioral and electrophysiological data with offline structural (MRI) and functional connectivity (fMRI) analysis of the main interoceptive hubs. HBD and HEP results convergently showed that SCD subjects presented ongoing psychophysiological measures of enhanced interoceptive accuracy. This pattern was associated with a structural and functional tuning of interoceptive networks (reduced volume and specialized network segregation). Taken together, our findings provide the first evidence of an association between cardiac interoception and smoked cocaine, partially supporting models that propose hyper-interoception as a key aspect of addiction. More generally, our study shows that multimodal assessments of interoception could substantially inform the clinical and neurocognitive characterization of psychophysiological and neurocognitive adaptations triggered by addiction.

The role of epigenetics in hypothalamic energy balance control: implications for obesity

Despite enormous social and scientific efforts, obesity rates continue to increase worldwide. While genetic factors contribute to obesity development, genetics alone cannot explain the current epidemic. Obesity is essentially the consequence of complex genetic-environmental interactions. Evidence suggests that contemporary lifestyles trigger epigenetic changes, which can dysregulate energy balance and thus contribute to obesity. The hypothalamus plays a pivotal role in the regulation of body weight, through a sophisticated network of neuronal systems. Alterations in the activity of these neuronal pathways have been implicated in the pathophysiology of obesity. Here, we review the current knowledge on the central control of energy balance with a focus on recent studies linking epigenetic mechanisms in the hypothalamus to the development of obesity and metabolic disorders.

Tobacco Smoking, Eating Behaviors, and Body Weight: A Review

Purpose of review

This narrative review provides an overview of the relationships among tobacco smoking, eating behaviors, and body weight. The aims are to (1) examine the concurrent and longitudinal associations between tobacco smoking and body weight, (2) describe potential mechanisms underlying the relationships between smoking and body weight, with a focus on mechanisms related to eating behaviors and appetite, and (3) discuss management of concomitant tobacco smoking and obesity.

Recent findings

Adolescents who smoke tobacco tend to have body mass indexes (BMI) the same as or higher than nonsmokers. However, adult tobacco smokers tend to have lower BMIs and unhealthier diets relative to nonsmokers. Smoking cessation is associated with a mean body weight gain of 4.67 kg after 12 months of abstinence, though there is substantial variability. An emerging literature suggests that metabolic factors known to regulate food intake (e.g., ghrelin, leptin) may also play an important role in smoking-related behaviors. While the neural mechanisms underlying tobacco smoking-induced weight gain remain unclear, brain imaging studies indicate that smoking and eating cues overlap in several brain regions associated with learning, memory, motivation and reward. Behavioral and pharmacological treatments have shown short-term effects in limiting post-cessation weight gain; however, their longer-term efficacy is limited.

Summary

Further studies are needed to identify the exact mechanisms underlying smoking, eating behaviors, and body weight. Moreover, effective treatment options are needed to prevent long-term weight gain during smoking abstinence.

Exploring Differences in the Rate of Type 2 Diabetes Among American Cities: How Urbanization Continues to Challenge the Traditional Epidemiological View

As the world’s largest urban regions continue to expand, a concomitant rise in non-communicable diseases, particularly type 2 diabetes, poses an increasingly ominous challenge to experts in the field of public health. Given that the majority of the world’s population (54%) resides in urban areas, a figure likely to reach two-thirds by 2050, this issue presents serious implications for medical practitioners as well as policymakers seeking to manage long-term healthcare costs while sustaining historic increases in life expectancy. To explore how these trends are continuing to affect the United States, a multiple regression analysis was conducted using data provided by the Centers for Disease Control and Prevention (CDC) through their initiative, 500 Cities: Local Data for Better Health. The regression models revealed that larger cities reported significantly higher rates of type 2 diabetes even after controlling for variables that have been perennially linked to disease onset (e.g., levels of obesity, sedentary behavior). Implications are discussed, most notably the argument for moving beyond the ‘food desert’ paradigm when identifying and explaining which characteristics of larger cities place their residents at increased risk. This approach could help reveal opportunities for intervention that may not have garnered sufficient attention in the extant literature.

Incentive hope: A default psychological response to multiple forms of uncertainty

Our target article proposes that a new concept - incentive hope - is necessary in the behavioral sciences to explain animal foraging under harsh environmental conditions. Incentive hope refers to a specific motivational mechanism in the brain - considered only in mammals and birds. But it can also be understood at a functional level, as an adaptive behavioral strategy that contributes to improve survival. Thus, this concept is an attempt to bridge across different research fields such as behavioral psychology, reward neuroscience, and behavioral ecology. Many commentaries suggest that incentive hope even could help understand phenomena beyond these research fields, including food wasting and food sharing, mental energy conservation, diverse psychopathologies, irrational decisions in invertebrates, and some aspects of evolution by means of sexual selection. We are favorable to such extensions because incentive hope denotes an unconscious process capable of working against many forms of adversity; organisms do not need to hope as a subjective feeling, but to behave as if they had this feeling. In our response, we carefully discuss each suggestion and criticism and reiterate the importance of having a theory accounting for motivation under reward uncertainty.

Hypothalamic mechanisms associated with corticotropin-releasing factor-induced anorexia in chicks

Central administration of corticotropin-releasing factor (CRF), a 41-amino acid peptide, is associated with potent anorexigenic effects in rodents and chickens. However, the mechanism underlying this effect remains unclear. Hence, the objective of the current study was to elucidate the hypothalamic mechanisms that mediate CRF-induced anorexia in 4 day-old Cobb-500 chicks. After intracerebroventricular (ICV) injection of 0.02 nmol of CRF, CRF-injected chicks ate less than vehicle chicks while no effect on water intake was observed at 30 min post-injection. In subsequent experiments, the hypothalamus samples were processed at 60 min post-injection. The CRF-injected chicks had more c-Fos immunoreactive cells in the arcuate nucleus (ARC), dorsomedial nucleus (DMN), ventromedial hypothalamus (VMH), and paraventricular nucleus (PVN) of the hypothalamus than vehicle-treated chicks. CRF injection was associated with decreased whole hypothalamic mRNA abundance of neuropeptide Y receptor sub-type 1 (NPYR1). In the ARC, CRF-injected chicks expressed more CRF and CRF receptor sub-type 2 (CRFR2) mRNA but less agouti-related peptide (AgRP), NPY, and NPYR1 mRNA than vehicle-injected chicks. CRF-treated chicks expressed greater amounts of CRFR2 and mesotocin mRNA than vehicle chicks in the PVN and VMH, respectively. In the DMN, CRF injection was associated with reduced NPYR1 mRNA. In conclusion, the results provide insights into understanding CRF-induced hypothalamic actions and suggest that the anorexigenic effect of CRF involves increased CRFR2-mediated signaling in the ARC and PVN that overrides the effects of NPY and other orexigenic factors.

Nurses and health-promoting self-care: Do we practice what we preach?

AIMS

To examine the health-promoting behaviours performed by registered nurses (RNs), as well as workplace factors that influence participation in those behaviours.

BACKGROUND

Nurses have high levels of overweight/obesity and may not be engaging in health-promoting self-care.

METHODS

A cross-sectional Web-based survey collected information from 335 RNs regarding their physical activity, sedentariness and fruit/vegetable consumption.

RESULTS

More than half were overweight (34.1%) or obese (23.4%), and 80.1% were "sedentary" (≥3 hr sitting/day), particularly those working outside of direct patient care in management, research and education. Only 47.2% consumed 5+ servings of fruits/vegetables daily. Nurses who enjoyed their jobs (higher levels of compassion satisfaction) reported higher levels of physical activity (p = 0.03) and fruit/vegetable consumption (p = 0.02).

CONCLUSION

RNs who work outside of direct patient care might be at increased risk for sedentariness and obesity. RNs who enjoy their jobs may experience less stress and have more energy to exercise and to prepare/consume healthy meals.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should practice self-care by engaging in exercise, proper nutrition and demonstrating work-life balance, both to protect their own health and to serve as role models for RNs in direct patient care.

Responsiveness of hypothalamo-pituitary-adrenal axis to leptin is impaired in diet-induced obese rats

BACKGROUND/OBJECTIVES

Diet-induced obese (DIO) rats have altered stress (HPA) axis activity compared to diet-resistant (DR) rats when chronically exposed to a high-fat (HF) diet. Since stress axis is tightly regulated by leptin, an adipocyte-secreted hormone that is important for controlling body weight, we hypothesized that leptin action is impaired in DIO rats leading to alterations in HPA axis activity.

SUBJECTS/METHODS

We intraperitoneally injected selectively bred DIO and DR rats with either saline or recombinant rat leptin. HPA axis activity was assessed by measuring norepinephrine (NE) in the paraventricular nucleus (PVN), corticotropin-releasing hormone (CRH) in the median eminence, and serum corticosterone (CORT). To test if HF exposure duration and the corresponding increase in leptin differentially affects HPA axis activity, we placed animals on a chow or HF diet for 1 or 6 weeks.

RESULTS

Leptin injection significantly increased serum leptin levels in both DIO and DR animals. It also reduced PVN NE in both groups, indicating that noradrenergic neurons in both groups remain responsive to leptin. HF diet duration-dependently increased serum leptin only in DIO animals whereas PVN NE increased in both groups. While DR rats responded to HF diet by increasing CRH and CORT at both time-points, responses in DIO rats varied, suggesting that they have altered HPA axis activity that may be dependent on HF-induced leptin levels and/or signaling. To understand the underlying mechanisms, we measured pSTAT-3, a marker of leptin signaling, in brainstem noradrenergic neurons and found reduced pSTAT-3 in A1 region of HF-fed DIO rats. We also found higher serum free fatty acids (FFAs) and a pro-inflammatory cytokine, IL-1β.

CONCLUSIONS

Collectively, these findings reveal that DIO rats have inherent neuroendocrine impairment in NE-HPA axis circuitry that worsens with the extent of HF diet exposure, possibly due to brainstem leptin resistance and/or elevated circulating FFAs and IL-1β.

Adolescent Stress Management in a Primary Care Clinic

INTRODUCTION

The American Academy of Pediatrics recommends that adolescents be screened for mental health concerns and receive anticipatory guidance on stress management strategies.

METHODS

Eighty-six participants (50 participants in the intervention group; 36 participants in the control group) participated in the study. Intervention group participants received training in diaphragmatic breathing, progressive muscle relaxation, and use of no-cost/low-cost exercise options. Biofeedback was used to guide relaxation. Subjective distress and heart rate variability was measured before and after the intervention.

RESULTS

After the intervention, decreased levels of perceived stress and increased heart rate variability were reported compared with the control group.

DISCUSSION

This study show that an integrated care model in a primary care setting is feasible and effective at improving stress management.

Unconditional cash transfers and parental obesity

In this study, we evaluate the impact of unconditional family cash transfers on the body mass index (BMI) and obesity of parents. Our approach is based on the implementation of the Universal Child Care Benefit in 2006 for all children in Canada under 6 years of age. We show that the reform caused decreases in BMI and the prevalence of overweight and obesity in mothers with young children. We also report larger changes at the upper tail of the distribution of BMI in both lower-educated mothers and single mothers. In terms of fathers, we find that the policy had no impact on weight outcomes.

Leukocyte coping capacity chemiluminescence as an innovative tool for stress and pain assessment in calves undergoing ring castration

Pain and stress assessment in animals is considered an imperative issue and also a difficult challenge. Unfortunately, no gold standard technique for pain and stress assessment in animals has been validated nowadays. A new tool to assess stress in animals consists of measuring the leukocyte coping capacity (LCC). The aim of this study was to evaluate the whole-blood LCC chemiluminescence as an innovative tool for stress and pain assessment in the bovine species undergoing ring castration. Twenty 2-mo-old male mix-breed Piemontese-Angus-Belgian Blue calves (Bos taurus) weighing 90 ± 4 kg were used. The animals were randomly allocated in 2 groups composed of 10 subjects each as follows: ring castration group (CAS) and sham castration group (SHAM). Blood drawing, scrotal and perineal temperature recording, scrotal lesion score, pain assessment, and LCC Chemiluminescence were performed at different time points, which were as follows: 1 h before castration/sham (-1 h), 30 min postcastration/sham (30 min), 3 d postcastration/sham (3 d), 7 d postcastration/sham (7 d), 14 d postcastration/sham (14 d). Results showed that in CAS LCC values significantly increased (P < 0.05) at 3 d and decreased at 7 d, whereas in SHAM, LCC values did not significantly vary between the study times. Significant differences in LCC values between CAS and SHAM were seen at 7 d (P < 0.0001). In the CAS group, scrotal lesion was scored as 0, 0, 3.8, 2.7, and 0.2 at -1 h, 30 min, 3 d, 7 d, and 14 d, respectively, whereas in SHAM, its score was 0 at every time point. Perineal temperatures did not vary throughout all the study times in both CAS and SHAM. Differences among the 2 groups were noted in scrotal temperatures only at 3, 7, and 14 d (P < 0.05). In CAS, the percentage of animals which obtained a pain score ≥ 1 was: 10% at -1 h, 30% at 30 min, 20% at 3 and 7 d, and 10% at 14 d, whereas in SHAM, no pain signs were noted at any time point. No significant difference between CAS and SHAM was recorded in cortisol blood level at any time point. No stress leukogram nor variation in neutrophil/lymphocyte ratio was noted at any of the time points in both CAS or SHAM. Our results suggest that ring castration might cause long-lasting pain in calves, but its magnitude is not easily detected by conventional methods. We argue that whole-blood LCC chemiluminescence might be a useful tool for detecting pain and stress in calves undergoing ring castration.

Perspectives on ethnic and racial disparities in Alzheimer's disease and related dementias: Update and areas of immediate need

Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise "state-of-the-science" report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.

The Gut⁻Brain Axis in the Neuropsychological Disease Model of Obesity: A Classical Movie Revised by the Emerging Director "Microbiome"

The worldwide epidemic of obesity has become an important public health issue, with serious psychological and social consequences. Obesity is a multifactorial disorder in which various elements (genetic, host, and environment), play a definite role, even if none of them satisfactorily explains its etiology. A number of neurological comorbidities, such as anxiety and depression, charges the global obesity burden, and evidence suggests the hypothesis that the brain could be the seat of the initial malfunction leading to obesity. The gut microbiome plays an important role in energy homeostasis regulating energy harvesting, fat deposition, as well as feeding behavior and appetite. Dietary patterns, like the Western diet, are known to be a major cause of the obesity epidemic, probably promoting a dysbiotic drift in the gut microbiota. Moreover, the existence of a "gut⁻brain axis" suggests a role for microbiome on hosts' behavior according to different modalities, including interaction through the nervous system, and mutual crosstalk with the immune and the endocrine systems. In the perspective of obesity as a real neuropsychological disease and in light of the discussed considerations, this review focuses on the microbiome role as an emerging director in the development of obesity.

Foreclosures and weight gain: Differential associations by longer neighborhood exposure

While home foreclosure can lead to mental and physical health declines in persons experiencing the foreclosure, whether neighborhood foreclosures can affect the health of other residents is debatable. Using a racially/ethnically diverse sample of Chicago metropolitan area residents linked to foreclosure data from 2008 to 2014, we assessed whether exposure to neighborhood foreclosure fillings was associated with changes in objectively measured body mass index (BMI) over time. Using a retrospective longitudinal design, we employed fixed-effects regression models that controlled for individual- and neighborhood-level covariates to test the association of neighborhood foreclosures and BMI in >60,000 individuals and for individuals who did not move during the follow-up period. We also adjusted for the non-linear association of age and BMI and comorbidities and employed a series of sensitivity analysis to test for robustness. In fully adjusted models, a standard-deviation increase in neighborhood foreclosure filings within 500 m was associated with increases in BMI for individuals who did not move (nonmovers) (mean = 0.03 BMI units, 95% confidence interval: 0.01, 0.06). Neighborhood foreclosure rates were not associated with changes in BMI for the full sample. Given the potential deleterious effects of neighborhood foreclosure on individuals with longer exposure to the local vicinity, clarifying the potential health effects of neighborhood foreclosures would help policymakers when planning actions to prevent home losses, predatory home loans, and that aim to more efficiently return foreclosure properties to productive uses.