Stress as a common risk factor for obesity and addiction

Behavioral and neural mechanisms underlying habitual and compulsive drug seeking

Addiction is characterized by compulsive drug use despite negative consequences. Here we review studies that indicate that compulsive drug use, and in particular punishment resistance in animal models of addiction, is related to impaired cortical control over habitual behavior. In humans and animals, instrumental behavior is supported by goal-directed and habitual systems that rely on distinct corticostriatal networks. Chronic exposure to addictive drugs or stress has been shown to bias instrumental response strategies toward habit learning, and impair prefrontal cortical (PFC) control over responding. Moreover, recent work has implicated prelimbic PFC hypofunction in the punishment resistance that has been observed in a subset of animals with an extended history of cocaine self-administration. This may be related to a broader role for prelimbic PFC in mediating adaptive responding and behavioral flexibility, including exerting goal-directed control over behavior. We hypothesize that impaired cortical control and reduced flexibility between habitual and goal-directed systems may be critically involved in the development of maladaptive, compulsive drug use.

Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland's drug and alcohol services

Background

The ‘perfect’ journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain ‘trapped’ in the high risk, specialist clinical setting.

Methods

Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland’s Health Service Executive (HSE) Drug and Alcohol Services, entitled ‘HSE Mid-West Limerick Drug and Alcohol Service’. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP.

Results

Participants’ life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants’ loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a ‘time-limit’ on clients to engage with the programme or indeed for their treatment to be postponed.

Conclusions

To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross- departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.

Perceived Postoperative Support Differentiates Responders from Non-Responders 3 Years After Laparoscopic Roux-en-Y Gastric Bypass

BACKGROUND

Bariatric surgery is an effective intervention for the majority of patients with morbid obesity, but a significant minority fails to achieve substantial weight loss. In the search of possible predictors of weight loss following bariatric surgery, preoperative factors turn out to have limited predictive power. This study will examine the impact of two postoperative factors on weight loss: perceived social support and stressful life events.

METHODS

From the entire 2013 cohort that underwent laparoscopic Roux-and-Y gastric bypass (LRYGB) in a general hospital in the Netherlands, a group of 56 non-responders and a matched group of 56 responders were selected, using an alterable weight loss (%AWL)-based percentile chart. Patients from both groups were interviewed by phone to collect data on demographics, medical complications and comorbidities, social support and stressful life events. A total of 61 patients completed the data collection (54% response rate).

RESULTS

One-way ANOVA analysis showed that responders and non-responders differed with regard to perceived support (F(1) = 8.60, p = .005). In a model with place of birth, level of education and pre-surgery diabetes mellitus as covariates, perceived social support was able to classify 83.6% of patients correctly as either responder or non-responder (χ ² = 28.26, p < .001). Stressful life events turned out to be unrelated to weight loss.

CONCLUSIONS

Perceived social support differentiates responders from non-responders after LRYGB. When patients present themselves after LRYGB with sub-optimal weight loss, social support should be a focus of attention.

Emotion regulation moderates the association between chronic stress and cardiovascular disease risk in humans: a cross-sectional study

Chronic stress is a risk factor for incident cardiovascular (CV) disease. Emotion regulation is the ability to modulate one's state or behavior in response to a given situation or stressor, and may mitigate the effect of chronic stress on CV disease risk. Data from a cohort of 754 community-dwelling young to middle-aged adults who were assessed between 2007 and 2012 on stress, emotion regulation, and CV risk measures were used to test the hypothesis that emotion regulation mitigates the effect of chronic stress on CV risk. Emotion regulation was measured using the Difficulties in Emotion Regulation Scale (DERS). We created a composite stress score using data from the Cumulative Adversity Interview and the Perceived Stress Scale. Our outcomes included blood pressure, body mass index, and insulin resistance separately and combined into a composite CV risk score. Covariates included age, sex, race, years of education, and smoking status. We used multivariable logistic regression to evaluate associations between stress measures and CV risk among participants and the impact of emotion regulation (DERS scores) on this association. We found that composite stress interacted significantly with the DERS score to affect CV risk (p = .007). A median split of the DERS scores indicated that CV risk was associated with the composite stress score in the fully adjusted model (ß = 0.206; p = .005) among participants with low emotion regulation, but not among those with high emotion regulation (ß = 0.048; p = .59). Chronic stress was associated with CV risk only among participants with poor emotion regulation. Emotion regulation is a teachable skill, and may play a role in preventing CV disease.Lay summaryEmotion regulation is the ability to modify one's reaction to a negative or stressful event, and is a teachable skill. Effective emotion regulation dampens the negative effect of chronic stress on the body, which may reduce risk for cardiovascular disease.

Preventing Childhood Obesity Through a Mindfulness-Based Parent Stress Intervention: A Randomized Pilot Study

OBJECTIVE

To assess the feasibility of engaging stressed, low-income parents with obesity in a novel mindfulness-based parent stress intervention aimed at decreasing the risk of early childhood obesity.

STUDY DESIGN

An 8-week mindfulness-based parent stress group intervention (parenting mindfully for health) plus nutrition and physical activity counseling (PMH+N) was developed for parents with obesity aimed at preventing obesity in their at-risk 2- to 5-year-old children. PMH+N was compared with a control group intervention (C+N), and improvement in parenting was assessed before and after the intervention using the laboratory-based toy wait task (TWT). In addition, nutrition, physical activity, and stress were assessed using a multimethod approach.

RESULTS

After establishing feasibility in 20 parent-child dyads (phase 1), 42 dyads were randomized to PMH+N vs C+N (phase 2). Compared with the C+N group, the PMH+N group demonstrated significantly better group attendance (P < .015), greater improvement in parental involvement (P < .05), and decreased parental emotional eating rating (P < .011). Furthermore, C+N, but not PMH+N, was associated with significant increases in child body mass index percentile during treatment (P < .03) when accounting for the TWT before and after changes in parenting scores.

CONCLUSIONS

These findings suggest that a mindfulness-based parent stress intervention to decrease childhood obesity risk is feasible, requires further testing of therapeutic mechanisms in larger samples, and may be a potential way to attenuate the risk of childhood obesity.

TRIAL REGISTRATION

ClinicalTrials.govNCT01974102.

Allostatic load and disordered white matter microstructure in overweight adults

Overweight and stress are both related to brain structural abnormalities. The allostatic load model states that frequent disruption of homeostasis is inherently linked to oxidative stress and inflammatory responses that in turn can damage the brain. However, the effects of the allostatic load on the central nervous system remain largely unknown. The current study aimed to assess the relationship between the allostatic load and the composition of whole-brain white matter tracts in overweight subjects. Additionally, we have also tested for grey matter changes regarding allostatic load increase. Thirty-one overweight-to-obese adults and 21 lean controls participated in the study. Our results showed that overweight participants presented higher allostatic load indexes. Such increases correlated with lower fractional anisotropy in the inferior fronto-occipital fasciculi and the right anterior corona radiata, as well as with grey matter reductions in the left precentral gyrus, the left lateral occipital gyrus, and the right pars opercularis. These results suggest that an otherwise healthy overweight status is linked to long-term biological changes potentially harmful to the brain.

Socioeconomic status differences in food consumption following a laboratory-induced stressor

We examined food consumption in response to a laboratory-induced stressor (two challenging neuropsychological tasks) among non-Hispanic White women categorized as lower or higher in socioeconomic status based on education. The two socioeconomic status groups did not differ with respect to current hunger or baseline dietary habits. Perceived stress was measured pre- and post-challenge. Snacks were offered post-challenge; food consumption was measured by weighing snack bowls pre- and post-offering. Perceived stress increased pre- to post-challenge for both groups, but this effect was stronger for women lower in socioeconomic status. In addition, women lower versus higher in socioeconomic status consumed more food overall and more high-fat sweet food in particular (large effect sizes). These findings provide evidence of socioeconomic status differences in food consumption following an acute stressor.

Association between noise exposure and diabetes: A systematic review and meta-analysis

BACKGROUND

The prevalence of diabetes is on rise worldwide and environmental factors are being increasingly recognized to be involved in this rise. An emerging body of evidence has evaluated the impact of long-term exposure to noise on diabetes mellitus, highlighting the need to synthesize this evidence.

OBJECTIVES

To systematically review and conduct meta-analysis of the available evidence on the association between long-term exposure to transport and occupational noise exposure and diabetes mellitus.

METHODS

Selected databases were searched for available evidence published till September 13th, 2017 following MOOSE guidelines. The quality of articles was assessed using the Newcastle-Ottawa Scale. Random effects meta-analysis was applied to abstract combined estimates for diabetes mellitus per 5 dB increase in noise exposure. We evaluated the heterogeneity applying Cochran's Q test and quantified it using I² statistic. Meta-regressions were conducted to identify sources of heterogeneity. Publication bias was evaluated using funnel plot and Egger's test.

RESULTS

Fifteen studies met our inclusion criteria of which nine including five prospective cohorts, two cross-sectional and two case-control studies with a total number of 444460 adult participants and 17430 diabetes mellitus cases included in meta-analyses. We observed a 6% (95% confidence interval (CI): 3%, 9%) increase in the risk of diabetes mellitus per 5 dB increase in noise exposure regardless of its source. Source-specific analyses were suggestive for stronger associations for air traffic noise (combined odds ratio: 1.17; 95% CI: 1.06, 1.29 per 5 dB increase in exposure) flowed by road traffic noise (combined odds ratio: 1.07; 95% CI: 1.02, 1.12). We observed some indications of publication bias; however the findings were robust after trim and fill test. Meta-regression analyses showed that the adjustment in general, and not specifically related to air pollution, could predict the between-study heterogeneity in reported associations.

CONCLUSIONS

The results indicate an increased risk of diabetes mellitus associated with noise exposure, mainly related to air and road traffic.

The Neuroendocrinology of the Microbiota-Gut-Brain Axis: A Behavioural Perspective

The human gut harbours trillions of symbiotic bacteria that play a key role in programming different aspects of host physiology in health and disease. These intestinal microbes are also key components of the gut-brain axis, the bidirectional communication pathway between the gut and the central nervous system (CNS). In addition, the CNS is closely interconnected with the endocrine system to regulate many physiological processes. An expanding body of evidence is supporting the notion that gut microbiota modifications and/or manipulations may also play a crucial role in the manifestation of specific behavioural responses regulated by neuroendocrine pathways. In this review, we will focus on how the intestinal microorganisms interact with elements of the host neuroendocrine system to modify behaviours relevant to stress, eating behaviour, sexual behaviour, social behaviour, cognition and addiction.

Association of Reported Concern About Increasing Societal Discrimination With Adverse Behavioral Health Outcomes in Late Adolescence

IMPORTANCE

Public expressions of discrimination may generate stress and behavioral health problems, particularly in racial/ethnic minority or socioeconomically disadvantaged youths.

OBJECTIVES

To determine whether concern about increasing discrimination in society reported among adolescents during 2016 and the magnitude of increase in concern from 2016 to 2017 were associated with behavioral health outcomes by 2017 and to examine racial/ethnic or socioeconomic differences in associations.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort survey collected data at baseline from January 2 through September 28, 2016 (11th grade), and at follow-up from January 1 through August 10, 2017 (12th grade), at 10 high schools in Los Angeles, California, recruited through convenience sampling. A total of 2572 students completed both surveys.

EXPOSURES

Reported concern, worry, or stress regarding "increasing hostility and discrimination of people because of their race, ethnicity, sexual orientation/identity, immigrant status, religion, or disability status in society" were scored as "not at all" (0) to "extremely" (4). Mean ratings were calculated in a 3-item composite (range, 0-4).

MAIN OUTCOMES AND MEASURES

Self-reported days of cigarette, alcohol, or marijuana use in the past month (range, 0-30 days), number of substances used in the past 6 months (range, 0-27), mild to moderate depression (yes or no), and attention-deficit/hyperactivity disorder (ADHD) (yes or no) at follow-up.

RESULTS

The sample of 2572 students (54.4% female; mean [SD] baseline age, 17.1 [0.4] years; 1969 [87.7%] had at least 1 parent with high school diploma) included 2530 with race/ethnicity data (1198 [47.4%] Hispanic; 482 [19.0%] Asian; 104 [4.1%] African American; 155 [6.1%] multiracial; 419 [16.6%] white; 172 [6.8%] other). Appreciable numbers of students reported feeling very or extremely concerned (baseline, 1047 [41.5%]; follow-up, 1028 [44.6%]), worried (baseline, 743 [29.7%]; follow-up, 795 [34.7%]), or stressed (baseline, 345 [13.9%]; follow-up, 353 [15.5%]) about increasing societal discrimination. Each 1-SD increase on the societal discrimination concern composite in 2016 was associated with more days of past-month cigarette (incidence rate ratio [IRR], 1.77; 95% CI, 1.42-2.20; P < .001), marijuana (IRR, 1.13; 95% CI, 1.01-1.26; P = .03), and alcohol (IRR, 1.11; 95% CI, 1.02-1.21; P = .01) use, more substances used (IRR, 1.07; 95% CI, 1.01-1.17; P = .04), and greater odds of depression (odds ratio [OR], 1.11; 95% CI, 1.01-1.23; P = .04) and ADHD (OR, 1.12; 95% CI, 1.01-1.26; P = .04) symptoms in 2017. The magnitude of increase in societal discrimination concern from 2016 to 2017 was also associated with several behavioral health problems in 2017; some associations were amplified among teenagers who were African American (IRR for cigarette smoking, 2.97; 95% CI, 1.45-6.09) or Hispanic (IRR for cigarette smoking, 1.30; 95% CI, 1.09-1.54) or had parents with less educational attainment (IRR for alcohol use, 1.41 [95% CI, 1.14-1.74]; OR for ADHD, 1.81 [95% CI, 1.13-2.89]).

CONCLUSIONS AND RELEVANCE

Concern over societal discrimination was common among youths in Los Angeles in 2016 and was associated with behavioral health problems 1 year later. Adolescents' behavioral responses to recent societal expressions of discrimination may warrant public health attention.

Can Mindfulness Address Maladaptive Eating Behaviors? Why Traditional Diet Plans Fail and How New Mechanistic Insights May Lead to Novel Interventions

Emotional and other maladaptive eating behaviors develop in response to a diversity of triggers, from psychological stress to the endless external cues in our modern food environment. While the standard approach to food- and weight-related concerns has been weight-loss through dietary restriction, these interventions have produced little long-term benefit, and may be counterproductive. A growing understanding of the behavioral and neurobiological mechanisms that underpin habit formation may explain why this approach has largely failed, and pave the way for a new generation of non-pharmacologic interventions. Here, we first review how modern food environments interact with human biology to promote reward-related eating through associative learning, i.e., operant conditioning. We also review how operant conditioning (positive and negative reinforcement) cultivates habit-based reward-related eating, and how current diet paradigms may not directly target such eating. Further, we describe how mindfulness training that targets reward-based learning may constitute an appropriate intervention to rewire the learning process around eating. We conclude with examples that illustrate how teaching patients to tap into and act on intrinsic (e.g., enjoying healthy eating, not overeating, and self-compassion) rather than extrinsic reward mechanisms (e.g., weighing oneself), is a promising new direction in improving individuals' relationship with food.

Kejadian Obesitas, Obesitas Sentral, dan Kelebihan Lemak Viseral pada Lansia Wanita

Background: Obesity, central obesity, and visceral fat is an excessive fat that can release various types of diseases such as cardiovascular disease, stroke and can increase the risk of bone damage in the elderly. Objectives: The purpose of this study was to analyze the risk factors of obesity, central obesity, and visceral fat in elderly women. Methods:This was an observational analytic study with cross sectional design. The samples of the study were 81 elderly women registered as member of Posyandu Lansia in the working area of Puskesmas Jagir, Wonokromo, Surabaya. The data collected using 3 times 24-hour food recall, anthropometry (body weight, body height, and waist circumference), visceral fat using Bio Impedance Analysis (BIA), and questionnaire related to subject’s characteristic. The data were analyzed using logistic regression analysis. Results: The results showed that the mean age of the subjects were 67.12±5.97 years old. Most of the subjects have low education (71.6%) and 87.7% of subjects didn’t work. The mean value of daily energy intake was 1074.31±298.67 kcal.  There were 34.6% obese subjects, only 17.3% subjects didn’t experience central obesity, and 28.4% of subjects had excess body visceral fat. The statistical test showed significant correlation between age with obesi (p-value=0.042), age with central obesity (p-value=0.009) but age with visceral fat had no significant correlation (p-value=0.163). Daily food intake, education, and occupation did not show significant correlation with obesity, central obesity, or visceral fat (p-value>0.05).  Conclusions: The risk for obesity and central obesity was decreased with aging in elderly but not with visceral fat.ABSTRAKLatar Belakang: Obesitas, obesitas sentral, dan lemak viseral merupakan penumpukan lemak tubuh yang berlebihan dan berisiko untuk menimbulkan berbagai penyakit degeneratif seperti jantung iskemi dan stroke serta dapat meningkatkan risiko kerusakan tulang pada lansia.  Tujuan: Tujuan dari penelitian ini adalah untuk menganalisis faktor risiko obesitas, obesitas sentral, dan kelebihan lemak viseral pada lansia wanita.Metode: Penelitian ini menggunakan desain studi cross sectional dengan pendekatan kuantitatif.  Sampel dari penelitian ini adalah 81 lansia wanita yang menjadi anggota posyandu lansia di wilayah kerja Puskesmas Jagir, Wonokromo, Surabaya. Pengumpulan data menggunakan food recall 3 x 24 jam, antropometri (berat badan, tinggi badan, dan lingkar perut), lemak viseral menggunakan Bio Impedance Analysis (BIA), serta kuesioner terkait data diri subjek. Data dianalisis dengan menggunakan analisis regresi logistik.Hasil: Hasil penelitian menujukkan rata-rata usia subjek adalah 67,12±5,97. Sebagian besar subjek memiliki riwayat pendidikan rendah (71,6%) dan sebanyak 87,7% subjek tidak bekerja. Rata-rata asupan zat gizi subjek lebih rendah jika dibandingkan dengan Angka Kecukupan Gizi (AKG). Sebanyak 34,6% subjek mengalami obesitas; angka kejadian obesitas sentral yaitu 17,3%; dan 28,4% subjek memiliki lemak viseral tubuh berlebih. Uji statistik menunjukkan hubungan signifikan antara usia dengan obesitas (p-value = 0,042), usia dengan obesitas sentral (p-value = 0,009) tetapi usia dengan lemak viseral tidak memiliki hubungan signifikan (p-value = 0,163). Asupan makanan harian, pendidikan, dan pekerjaan tidak  menunjukkan hubungan signifikan dengan obesitas, obesitas sentral, maupun lemak viseral (p-value > 0,05).Kesimpulan: Pada lansia, risiko mengalami obesitas maupun obesitas sentral semakin menurun seiring dengan bertambahnya usia. Lemak viseral tidak berhubungan dengan usia.

Psychosocial stress and central adiposity: A Brazilian study with a representative sample of the public health system users

Objective

To assess the association between indicators of psychosocial stress and central adiposity in adult users of the Unified Health System (SUS) from Southeast of Brazil.

Methods

This cross-sectional study was conducted with 384 adults (20 to 59 years old) from the city of Alegre, Southeastern Brazil. The simple random sample represented the population using the public health system of the municipality. The prevalence of obesity was based on the Body Mass Index, and central adiposity (dependent variable) was measured by waist circumference in centimeters. The independent variables were the following indicators of psychosocial stress: food and nutrition insecurity (yes/no), serum cortisol (μg/dL), symptoms suggestive of depression using the Beck Depression Inventory-II ≥ 17 (yes/no), and altered blood pressure ≥ 130/85 mmHg (yes/no). Univariate linear regression was performed between central adiposity and each stress indicator, and later the models were adjusted for socioeconomic, health, and lifestyle variables. All analyses were made separately by rural and urban location.

Results

The prevalence of weight excess, by the classification of the Body Mass Index ≥ 25.0 kg/m2, was 68.3% and, by waist circumference, 71.5% of individuals presented an increased risk for metabolic complications related to central adiposity. Mean waist circumference scores for the rural and urban population were 89.3 ± 12.7 cm and 92.9 ± 14.7 cm, respectively (p = 0.012). Indicators of stress that were associated with central adiposity were: cortisol in the rural population (β = -0.60; 95% CI = -1.09;-0.11) and altered blood pressure in the urban population (β = 6.66; 95% CI = 2.14;11.18). This occurred both in the raw analysis and in the models adjusted for confounding factors.

Conclusion

Central adiposity was inversely associated with cortisol in the rural population and directly associated with higher arterial blood pressure in the urban population, suggesting a local influence on how individuals react to stress.

Pathways Linking Adverse Childhood Experiences to Cigarette Smoking Among Young Black Men: a Prospective Analysis of the Role of Sleep Problems and Delayed Reward Discounting

BACKGROUND

African American men experience increases in smoking during the young adult transition. Exposure to childhood adversity, a risk factor which disproportionately affects African American men, has been identified as a robust precursor to health risk behavior in general and cigarette smoking in particular. The intermediate mechanisms that transmit the influence of early adversity to smoking behavior are not well understood.

PURPOSE

We tested a model of the escalation of smoking behaviors among young adult African American men, investigating sleep disturbance and delayed reward discounting as intermediate factors linking adverse childhood experiences with smoking.

METHODS

Hypotheses were tested with three waves of data (M _age-T1 = 20.34, M _age-T2 = 21.92, M _age-T3 = 23.02) from 505 African American men living in rural counties in South Georgia. Men provided self-report data on their adverse childhood experiences, sleep problems, and smoking behavior using audio-assisted computer self-interviews. Men also completed a computer-based delayed reward discounting task.

RESULTS

Structural equation modeling analyses supported our hypotheses: Adverse childhood experiences predicted poor sleep adequacy, which forecast increases in delayed reward discounting; discounting, in turn, predicted increased smoking. Significant indirect pathways were detected linking adversity to discounting via sleep adequacy and linking sleep adequacy to smoking via discounting.

CONCLUSIONS

Prevention and intervention researchers can draw on these findings to develop programs that focus on sleep adequacy to reduce smoking in African American men exposed to childhood adversity.

Opioid Abuse as Maladaptive Coping to Life Stressors in U.S. Adults

The Threat Appraisal and Coping Theory suggests that when individuals face life stressors, especially if they have poor self-esteem, they may rely on maladaptive coping behaviors that ease distress but worsen their condition over time. The present study compared five life stressors (health, money, work, family, romance) for their association with opioid use, then examined poor self-esteem as a mediator of these associations. Study participants included 1,047 U.S. adults gathered in a quota sample by SurveyMonkey (54.3% women; 53.3% 45+ years of age; 76.7% White; 60.2% with US$50,000 or higher income; 11.1% using opioids). Participants completed online surveys to report demographics, five life stressors, self-esteem, and indications of opioid use as measured with the PROMIS Questionnaire. Pearson correlation found poor self-esteem associated with high opioid use; multiple regression found health, family, and romance stressors associated with high opioid use ( R2 = .089); and multiple regression found health, money, family, and romance stressors associated with poor self-esteem ( R2 = .283). Then, bootstrapping mediational analyses examined the sequence of HIGH LIFE STRESSORS → POOR SELF-ESTEEM → HIGH OPIOID USE, finding that poor self-esteem was a significant mediator between each life stressor (health, money, family, romance) and increased risk for opioid use. The present sample included mostly individuals with a White ethnic identity and high incomes, so future research should examine these patterns with more diverse samples. In addition, the amount of opioids consumed, present motivations for use, the sequence of events leading to present use, exposure to substance-abuse treatment, and where individuals presently are on the use-recovery process could moderate associations found between life stressors and opioid use.

The TALENT II study: a randomized controlled trial assessing the impact of an individual health management (IHM) on stress reduction

Background

Unfavorable lifestyle factors influence the risk of stress disorders. For risk reduction, lifestyle modifications, such as regular physical activity, balanced nutrition and competence in stress management, are a means of choice. The clinical study examines the efficacy of an intensive lifestyle intervention, named Individual Health Management (IHM), − with regard to a reduction of perceived stress. The study is supported by the major regional health insurance, which conducts, in cooperation with the Traditional Chinese Medicine (TCM) hospital, Bad Kötzting, a local model project offering insurants the IHM program as prevention measure against stress and related aftermath.

Methods

The study is a controlled, randomized, monocentric trial with a 12-months intervention phase. Feasible persons are checked according to inclusion and exclusion criteria and assigned to the intervention or control group. Randomization ratio is 1:1. (A) Participants of the intervention group receive the lifestyle program IHM, have access to a web-based health portal (www.viterio.de), and join 3 full-day and 10 two-hour training sessions during the first 3 months. During the remaining 9 months, 4 training sessions and a weekly monitoring are performed with remote assistance. Besides measurement of perceived stress, examinations include burnout symptoms, heart rate variability, laboratory and physical findings. Further patient reported outcomes are documented (e.g. well-being, life satisfaction, severity of mood state, sense of coherence, psycho-vegetative test, cardio-metabolic risk factors, hypertension and diabetes risk. (B) Participants in the control group have access to the intensive lifestyle intervention IHM after a waiting period of at least 6 months. Examinations are conducted at baseline, after 3 and 6 months and in the intervention group additionally after 9 and 12 months. The confirmatory analysis examines the differences between the two groups with regard to changes in perceived stress after 6 months compared to the initial value.

Discussion

In order to enhance adherence, avoid attrition and to insure data quality, different measures will be implemented in the study. Based on a blended learning concept including a web-based e-health tool named VITERIO®, the program promises to achieve sustainable effects in perceived stress.

Trial registration

German Clinical Trial Register Freiburg (DRKS): DRKS00013040 (date registered 2017–10-1).

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5756-3) contains supplementary material, which is available to authorized users.

Stress and Obesity

Many pathways connect stress and obesity, two highly prevalent problems facing society today. First, stress interferes with cognitive processes such as executive function and self-regulation. Second, stress can affect behavior by inducing overeating and consumption of foods that are high in calories, fat, or sugar; by decreasing physical activity; and by shortening sleep. Third, stress triggers physiological changes in the hypothalamic-pituitary-adrenal axis, reward processing in the brain, and possibly the gut microbiome. Finally, stress can stimulate production of biochemical hormones and peptides such as leptin, ghrelin, and neuropeptide Y. Obesity itself can be a stressful state due to the high prevalence of weight stigma. This article therefore traces the contribution of weight stigma to stress and obesogenic processes, ultimately describing a vicious cycle of stress to obesity to stigma to stress. Current obesity prevention efforts focus solely on eating and exercise; the evidence reviewed in this article points to stress as an important but currently overlooked public policy target.

A US/Mexico Study of Joint Associations of Physical Activity and Sedentary Behavior on Anthropometric Indicators, Migration Status, Country of Birth and Country of Residence

Background: This study examined the influence of migration status, nativity and country of residence on joint associations of physical activity (PA) and sedentary behavior (SB) in anthropometric indicators of Mexicans and Mexican-Americans living in the US and in Mexico. Methods: We examined data from two large national surveys, the National Health and Nutrition Examination Survey from the US (NHANES, 2011–2012) and Mexico (ENSANUT, 2012). Using self-reported minutes of moderate to vigorous physical activity and SB, we calculated four categories for analyses. Anthropometric measures consisted of body mass index (BMI) and waist circumference (WC). We used data of migration status, nativity and country of residence. Linear regression models examined how joint categories of PA and SB were associated with BMI and WC according to migration status, nativity and country of residence, controlling for health risk behaviors. Results: Analyses showed that even among those in the category with the lowest risk behavior, “physically active and low sedentary”, there were differences in BMI and WC by migration status, nativity and country of residence. Within this lower risk category, Mexican immigrants living in the US had the greatest association with high BMI, while US-born Mexican-Americans living in the US had the highest WC values when compared with the group of Mexicans living in Mexico. Conclusions: Joint categories of PA and SB were associated with BMI and WC by migration status, nativity and country of residence among populations with Mexican ethnicity.

Cross-Sectional and Longitudinal Associations of Systolic Blood Pressure With Quality of Life and Depressive Mood in Older Adults With Cardiovascular Risk Factors: Results From the Observational DIAST-CHF Study

OBJECTIVE

Although diagnosed arterial hypertension and antihypertensive medication usually have an adverse impact on quality of life, recent studies suggest that actual blood pressure may be positively related to better well-being. However, data in older patients with cardiovascular risk factors are lacking, for whom such an association may be of particular relevance.

METHODS

In 1300 adults aged 50 to 85 years with cardiovascular risk factors (51.5% men, mean age = 65.7 ± 8.2 years) participating in an observational study, we performed standardized measurements of blood pressure and assessed quality of life and depressive symptoms at baseline and 1-year follow-up using the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Bivariate analysis demonstrated that systolic blood pressure was associated with higher SF-36 mental component summary scores (r = 0.100, p < .001) and reduced HADS depression (r = -0.082, p = .003). Multivariate regression models adjusting for age, sex, and disease severity confirmed that higher systolic blood pressure significantly predicted both better mental quality of life (β = 0.070, p = .012) and less depressive mood (β = -0.083, p = .003) at baseline, independently of antihypertensive medication and diagnosed hypertension. Moreover, the beneficial effects of baseline systolic blood pressure remained stable for both summary components of the SF-36 as well as HADS depression at 1-year follow-up. All results remained unchanged, when limiting the analyses to the 1072 patients with diagnosed hypertension.

CONCLUSIONS

In older adults with cardiovascular risk factors, higher systolic blood pressure readings are independently related to better quality of life and fewer depressive symptoms in both cross-sectional and longitudinal settings, although the magnitude of the effect sizes is typically small.

Neural, Hormonal, and Cognitive Correlates of Metabolic Dysfunction and Emotional Reactivity

OBJECTIVE

Prediabetes and type 2 diabetes (i.e., hyperglycemia) are characterized by insulin resistance. These problems with energy metabolism may exacerbate emotional reactivity to negatively valenced stimuli and related phenomena such as predisposition toward negative affect, as well as cognitive deficits. Higher emotional reactivity is seen with hyperglycemia and insulin resistance. However, it is largely unknown how metabolic dysfunction correlates with related neural, hormonal, and cognitive outcomes.

METHODS

Among 331 adults from the Midlife in the United States study, eye-blink response (EBR) we cross sectionally examined to gauge reactivity to negative, positive, or neutrally valenced pictures from international affect picture system stimuli proximal to an acoustic startle probe. Increased EBR to negative stimuli was considered an index of stress reactivity. Frontal alpha asymmetry, a biomarker of negative affect predisposition, was determined using resting electroencephalography. Baseline urinary cortisol output was collected. Cognitive performance was gauged using the Brief Test of Adult Cognition by telephone. Fasting glucose and insulin characterized hyperglycemia or the homeostatic model assessment of insulin resistance.

RESULTS

Higher homeostatic model assessment of insulin resistance corresponded to an increased startle response, measured by EBR magnitude, for negative versus positive stimuli (R = 0.218, F(1,457) = 5.48, p = .020, euglycemia: M(SD) = .092(.776), hyperglycemia: M(SD) = .120(.881)). Participants with hyperglycemia versus euglycemia showed greater right frontal alpha asymmetry (F(1,307) = 6.62, p = .011, euglycemia: M(SD) = .018(.167), hyperglycemia: M(SD) = -.029(.160)), and worse Brief Test of Adult Cognition by telephone arithmetic performance (F(1,284) = 4.25, p = .040, euglycemia: M(SD) = 2.390(1.526), hyperglycemia: M(SD) = 1.920(1.462)). Baseline urinary cortisol (log10 μg/12 hours) was also dysregulated in individuals with hyperglycemia (F(1,324) = 5.09, p = .025, euglycemia: M(SD) = 1.052 ± .332, hyperglycemia: M(SD) = .961 (.362)).

CONCLUSIONS

These results suggest that dysmetabolism is associated with increased emotional reactivity, predisposition toward negative affect, and specific cognitive deficits.

Chronic Stress and Impulsive Risk-Taking Predict Increases in Visceral Fat over 18 Months

OBJECTIVE

The aim of this study was to examine whether baseline chronic stress and impulsive risk-taking synergistically predict changes in visceral fat among healthy mothers in an observational, longitudinal, 18-month study.

METHODS

A prospective cohort of 113 adult women (age, mean ± SD: 42.83 ± 4.70; BMI, mean ± SD: 24.86 ± 4.32; 74%, n = 84 white) completed assessments at baseline and 18-month follow-up. Chronically stressed mothers caring for a child with an autism spectrum disorder ("caregivers"; n = 72 participants) were compared with lower stress mothers caring for a neurotypical child ("controls"; n = 41). This study objectively assessed impulsive risk-taking by using the Behavioral Analog Risk Task at baseline and assessed visceral fat at baseline and 18-month follow-up by using bioelectrical impedance (ViScan; Tanita Corporation, Tokyo, Japan).

RESULTS

The interaction of baseline chronic caregiving stress and impulsive risk-taking predicted an 18-month change in visceral fat, such that greater impulsive risk-taking was associated with greater 18-month increases in visceral fat among caregivers (ß = 0.423; P = 0.005) but not among controls (ß = -0.030; P = 0.802), both in unadjusted models and after accounting for covariates. Neither chronic stress nor impulsive risk-taking independently predicted 18-month changes in visceral fat.

CONCLUSIONS

The combination of high chronic stress and high impulsive risk-taking may increase risk for visceral fat gain over time and therefore may be an important intervention target in obesity prevention.

Role of Exogenous Progesterone in the Treatment of Men and Women with Substance Use Disorders: A Narrative Review

Substance use disorders (SUDs) remain problematic as many individuals are untreated or do not benefit from the currently available interventions. Thus, there is an urgent need to develop novel pharmacological interventions to treat SUDs. Evidence suggests that the female sex hormone, progesterone, attenuates the craving for and the euphoric effects of drugs of abuse. Research to date has demonstrated that progesterone may modulate responses to drugs of abuse and may have utility as a novel treatment for SUDs. A literature search was conducted to identify and examine studies that administered exogenous progesterone. Sixteen publications were identified, exploring the utility of exogenous progesterone or its metabolite, allopregnanolone, among a range of substances, including amphetamines (one study), benzodiazepines (one study), cocaine (nine studies), and tobacco/nicotine (five studies). Results indicated that exogenous progesterone and, its metabolite allopregnanolone, demonstrated preliminary efficacy as a treatment for substance use in both men and women. Notably, progesterone appears to target negative affect and augment cognitive functioning, especially among female substance users. Additional research is needed to explore the potential use of exogenous progesterone and allopregnanolone in the treatment of SUDs, including that associated with alcohol and opioids, but considering the current promising findings, exogenous progesterone and allopregnanolone may have utility as novel pharmacological treatments for SUDs.

Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures: Psychosocial Domain

BACKGROUND

Within the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, the psychosocial domain addresses how psychosocial processes underlie the influence of obesity treatment strategies on weight loss and weight maintenance. The subgroup for the psychosocial domain identified an initial list of high-priority constructs and measures that ranged from relatively stable characteristics about the person (cognitive function, personality) to dynamic characteristics that may change over time (motivation, affect).

OBJECTIVES

This paper describes (a) how the psychosocial domain fits into the broader model of weight loss and weight maintenance as conceptualized by ADOPT; (b) the guiding principles used to select constructs and measures for recommendation; (c) the high-priority constructs recommended for inclusion; (d) domain-specific issues for advancing the science; and (e) recommendations for future research.

SIGNIFICANCE

The inclusion of similar measures across trials will help to better identify how psychosocial factors mediate and moderate the weight loss and weight maintenance process, facilitate research into dynamic interactions with factors in the other ADOPT domains, and ultimately improve the design and delivery of effective interventions.

Gut microbiota varies by opioid use, circulating leptin and oxytocin in African American men with diabetes and high burden of chronic disease

Objective

The gut microbiota is known to be related to type 2 diabetes (T2D), psychiatric conditions, and opioid use. In this study, we tested the hypothesis that variability in gut microbiota in T2D is associated with psycho-metabolic health.

Methods

A cross-sectional study was conducted among African American men (AAM) (n = 99) that were outpatients at a Chicago VA Medical Center. The main outcome measures included fecal microbiota ecology (by 16S rRNA gene sequencing), psychiatric disorders including opioid use, and circulating leptin and oxytocin as representative hormone biomarkers for obesity and psychological pro-social behavior.

Results

The study subjects had prevalent overweight/obesity (78%), T2D (50%) and co-morbid psychiatric (65%) and opioid use (45%) disorders. In the analysis of microbiota, the data showed interactions of opioids, T2D and metformin with Bifidobacterium and Prevotella genera. The differential analysis of Bifidobacterium stratified by opioids, T2D and metformin, showed significant interactions among these factors indicating that the effect of one factor was changed by the other (FDR-adjusted p [q] < 0.01). In addition, the pair-wise comparison showed that participants with T2D not taking metformin had a significant 6.74 log2 fold increase in Bifidobacterium in opioid users as compared to non-users (q = 2.2 x 10⁻⁸). Since metformin was not included in this pair-wise comparison, the significant ‘q’ suggested association of opioid use with Bifidobacterium abundance. The differences in Bifidobacterium abundance could possibly be explained by opioids acting as organic cation transporter 1 (OCT1) inhibitors. Analysis stratified by lower and higher leptin and oxytocin (divided by the 50^th percentile) in the subgroup without T2D showed lower Dialister in High-Leptin vs. Low-Leptin (p = 0.03). Contrary, the opposite was shown for oxytocin, higher Dialister in High-Oxytocin vs. Low-Oxytocin (p = 0.04).

Conclusions

The study demonstrated for the first time that Bifidobacterium and Prevotella abundance was affected by interactions of T2D, metformin and opioid use. Also, in subjects without T2D Dialister abundance varied according to circulating leptin and oxytocin.

Somatostatin Neurons in the Basal Forebrain Promote High-Calorie Food Intake

Obesity has become a global issue, and the overconsumption of food is thought to be a major contributor. However, the regulatory neural circuits that regulate palatable food consumption remain unclear. Here, we report that somatostatin (SOM) neurons and GABAergic (VGAT) neurons in the basal forebrain (BF) play specific roles in regulating feeding. Optogenetic stimulation of BF SOM neurons increased fat and sucrose intake within minutes and promoted anxiety-like behaviors. Furthermore, optogenetic stimulation of projections from BF SOM neurons to the lateral hypothalamic area (LHA) selectively resulted in fat intake. In addition, activation of BF VGAT neurons rapidly induced general food intake and gnawing behaviors. Whole-brain mapping of inputs and outputs showed that BF SOM neurons form bidirectional connections with several brain areas important in feeding and regulation of emotion. Collectively, these results suggest that BF SOM neurons play a selective role in hedonic feeding.

Relationship between Burnout and Body Mass Index in Senior and Middle Managers from the Mexican Manufacturing Industry

This research relates Burnout Syndrome (BS) with the Body Mass Index (BMI) among middle and senior managers of the Mexican manufacturing industry. Even though BS incidence is high in the Mexican industrial population, few systematic studies have explored BS and its relationship with other health problems, such as obesity. The goal of this research is to determine the relationship between BS and the BMI in employees with normal weight, overweight, and obesity. We present three structural equation models to relate BS and the BMI. The BMI ranges were determined according to the parameters (normal weight, overweight, and obesity) proposed by the World Health Organization (WHO). The sample includes 361 employees that voluntarily answered a 31-item questionnaire. We measure the levels of BS using the Maslach Burnout Inventory-General Survey (MBI-GS) and analyze anthropometric and sociodemographic data from the participants. Then, we determine the relationships between the variables through structural equation models and estimate the direct, indirect, and total effects in the three models, which show acceptable reliability. As main findings, the normal weight model has a larger explanatory power than the overweight and obesity models. The same research hypotheses were tested and the effects of BS on the BMI differ across the three models. Such results are presented by taking into account that obesity and overweight require additional factors, such as genetic factors and personal eating habits, to be better explained.

Interplay Between the Gut-Brain Axis, Obesity and Cognitive Function

Obesity continues to be one of the major public health problems due to its high prevalence and co-morbidities. Common co-morbidities not only include cardiometabolic disorders but also mood and cognitive disorders. Obese subjects often show deficits in memory, learning and executive functions compared to normal weight subjects. Epidemiological studies also indicate that obesity is associated with a higher risk of developing depression and anxiety, and vice versa. These associations between pathologies that presumably have different etiologies suggest shared pathological mechanisms. Gut microbiota is a mediating factor between the environmental pressures (e.g., diet, lifestyle) and host physiology, and its alteration could partly explain the cross-link between those pathologies. Westernized dietary patterns are known to be a major cause of the obesity epidemic, which also promotes a dysbiotic drift in the gut microbiota; this, in turn, seems to contribute to obesity-related complications. Experimental studies in animal models and, to a lesser extent, in humans suggest that the obesity-associated microbiota may contribute to the endocrine, neurochemical and inflammatory alterations underlying obesity and its comorbidities. These include dysregulation of the HPA-axis with overproduction of glucocorticoids, alterations in levels of neuroactive metabolites (e.g., neurotransmitters, short-chain fatty acids) and activation of a pro-inflammatory milieu that can cause neuro-inflammation. This review updates current knowledge about the role and mode of action of the gut microbiota in the cross-link between energy metabolism, mood and cognitive function.

How foraging works: Uncertainty magnifies food-seeking motivation

Food uncertainty has the effect of invigorating food-related responses. Psychologists have noted that mammals and birds respond more to a conditioned stimulus that unreliably predicts food delivery, and ecologists have shown that animals (especially small passerines) consume and/or hoard more food and can get fatter when access to that resource is unpredictable. Are these phenomena related? We think they are. Psychologists have proposed several mechanistic interpretations, while ecologists have suggested a functional interpretation: The effect of unpredictability on fat reserves and hoarding behavior is an evolutionary strategy acting against the risk of starvation when food is in short supply. Both perspectives are complementary, and we argue that the psychology of incentive motivational processes can shed some light on the causal mechanisms leading animals to seek and consume more food under uncertainty in the wild. Our theoretical approach is in agreement with neuroscientific data relating to the role of dopamine, a neurotransmitter strongly involved in incentive motivation, and its plausibility has received some explanatory and predictive value with respect to Pavlovian phenomena. Overall, we argue that the occasional and unavoidable absence of food rewards has motivational effects (called incentive hope) that facilitate foraging effort. We show that this hypothesis is computationally tenable, leading foragers in an unpredictable environment to consume more food items and to have higher long-term energy storage than foragers in a predictable environment.

Obesity, Dietary Factors, Nutrition, and Breast Cancer Risk

PURPOSE OF REVIEW

To synthesize the critical role of obesity-associated inflammation, dietary factors, and nutrition in determining breast cancer risk.

RECENT FINDINGS

Obesity-associated inflammation is strongly linked to breast cancer risk and progression, largely via two processes: inflammatory pathways and dysregulated metabolism. Cytokine production in excess adipose tissues creates a chronic inflammatory microenvironment, which favors tumor development. Lifestyle factors, including diet, have long been recognized as important determinants of breast cancer risk and mortality.

SUMMARY

Obesity increases the risk of developing breast cancer in both pre- and postmenopausal women and also negatively affects breast cancer recurrence and survival. Poor dietary habits characterized by the high intake of refined starches, sugar, and both saturated and trans-saturated fats, as well as the low intake of omega-3 fatty acids, natural antioxidants, and fiber, modulate inflammation and, thereby, appear to be linked to increased risk of breast cancer and mortality.

Norepinephrine in the Medial Pre-frontal Cortex Supports Accumbens Shell Responses to a Novel Palatable Food in Food-Restricted Mice Only

Previous findings from this laboratory demonstrate: (1) that different classes of addictive drugs require intact norepinephrine (NE) transmission in the medial pre Frontal Cortex (mpFC) to promote conditioned place preference and to increase dopamine (DA) tone in the nucleus accumbens shell (NAc Shell); (2) that only food-restricted mice require intact NE transmission in the mpFC to develop conditioned preference for a context associated with milk chocolate; and (3) that food-restricted mice show a significantly larger increase of mpFC NE outflow then free fed mice when experiencing the palatable food for the first time. In the present study we tested the hypothesis that only the high levels of frontal cortical NE elicited by the natural reward in food restricted mice stimulate mesoaccumbens DA transmission. To this aim we investigated the ability of a first experience with milk chocolate to increase DA outflow in the accumbens Shell and c-fos expression in striatal and limbic areas of food–restricted and ad-libitum fed mice. Moreover, we tested the effects of a selective depletion of frontal cortical NE on both responses in either feeding group. Only in food-restricted mice milk chocolate induced an increase of DA outflow beyond baseline in the accumbens Shell and a c-fos expression larger than that promoted by a novel inedible object in the nucleus accumbens. Moreover, depletion of frontal cortical NE selectively prevented both the increase of DA outflow and the large expression of c-fos promoted by milk chocolate in the NAc Shell of food-restricted mice. These findings support the conclusion that in food-restricted mice a novel palatable food activates the motivational circuit engaged by addictive drugs and support the development of noradrenergic pharmacology of motivational disturbances.

Impulsive responding in threat and reward contexts as a function of PTSD symptoms and trait disinhibition

We examined current posttraumatic stress disorder (PTSD) symptoms, trait disinhibition, and affective context as contributors to impulsive and self-destructive behavior in 94 trauma-exposed Veterans. Participants completed an affective Go/No-Go task (GNG) with different emotional contexts (threat, reward, and a multidimensional threat/reward condition) and current PTSD, trait disinhibition, and risky/self-destructive behavior measures. PTSD interacted with trait disinhibition to explain recent engagement in risky/self-destructive behavior, with Veterans scoring high on trait disinhibition and current PTSD symptoms reporting the highest levels of these behaviors. On the GNG task, commission errors were also associated with the interaction of PTSD symptoms and trait disinhibition. Specifically, PTSD symptoms were associated with greater commission errors in threat vs. reward contexts for individuals who were low on trait disinhibition. In contrast, veterans high on PTSD and trait disinhibition exhibited the greatest number of commission errors in the multidimensional affective context that involved both threat and reward processing. Results highlight the interactive effects of PTSD and disinhibited personality traits, as well as threat and reward systems, as risk factors for impulsive and self-destructive behavior in trauma-exposed groups. Findings have clinical implications for understanding heterogeneity in the expression of PTSD and its association with disinhibited behavior.

Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa?

Decades of research have reported only weak associations between the intakes of specific foods or drinks and weight gain and obesity. Randomized controlled dietary intervention trials have only shown very modest effects of changes in nutrient intake and diet composition on body weight in obese subjects. This review summarizes the scientific evidence on the role mental stress (either in or not in association with impaired sleep) may play in poor sleep, enhanced appetite, cravings and decreased motivation for physical activity. All these factors contribute to weight gain and obesity, possibly via decreasing the efficacy of weight loss interventions. We also review evidence for the role that lifestyle and stress management may play in achieving weight loss in stress-vulnerable individuals with overweight.

Epigenome-wide association analysis revealed that SOCS3 methylation influences the effect of cumulative stress on obesity

Chronic stress has a significant impact on obesity. However, how stress influences obesity remains unclear. We conducted an epigenome-wide DNA methylation association analysis of obesity (N=510) and examined whether cumulative stress influenced the DNA methylation on body weight. We identified 20 CpG sites associated with body mass index at the false discovery rate q<0.05, including a novel site, cg18181703, in suppressor of cytokine signaling 3 (SOCS3) gene (coefficient β=-0.0022, FDR q=4.94×10-5). The interaction between cg18181703 and cumulative adverse life stress contributed to variations in body weight (p=0.002). Individuals with at least five major life events and lower methylation of cg1818703 showed a 1.38-fold higher risk of being obese (95%CI: 1.17-1.76). Our findings suggest that aberrant in DNA methylation is associated with body weight and that methylation of SOCS3 moderates the effect of cumulative stress on obesity.

Backpack Programs and the Crisis Narrative of Child Hunger-A Critical Review of the Rationale, Targeting, and Potential Benefits and Harms of an Expanding but Untested Model of Practice

In recent years, school-based food backpack programs (BPPs) have come into national prominence as a response to a perceived crisis of child hunger in America. Distributing bags of free food directly to schoolchildren for their own personal consumption each weekend, BPPs bring together private donors, faith communities, and public schools around an intuitively appealing project: children are hungry, and so we give them food. Perhaps because of their intuitive appeal, BPPs have expanded rapidly, without rigorous evaluation to determine their impacts on children, families, and schools. This Perspective aims to open up thinking about BPPs, first articulating the implicit conceptual model that undergirds BPPs, drawing on documentation offered by major program providers and on our own experience working with several schools implementing BPPs, to provide a window into what BPPs do and how and why they do it. We focus in particular on how the crisis narrative of child hunger has shaped the BPP model and on the related interplay between public sympathy and the neoliberal climate in which structural solutions to family poverty are eschewed. We then assess the BPP model in light of existing knowledge, concluding that BPPs fit poorly with the needs of the majority of children living in food-insecure households in the United States and consequently put children at risk of negative consequences associated with worry, shame, stigma, and disruptions to family functioning. Finally, we provide recommendations for practice and research, emphasizing the importance of 1) responding to children's actual needs throughout program implementation, 2) avoiding unnecessary risks by effective targeting of services to only those children who need them, and 3) rigorously evaluating program outcomes and unintended consequences to determine whether, even for the small number of US children who experience hunger, the benefits of the BPP model outweigh its psychosocial costs.

Stress and Addiction: When a Robust Stress Response Indicates Resiliency

OBJECTIVE

Stress reactivity research has traditionally focused on the idea that exaggerated responses to stress may have adverse effects on health. Accumulating evidence suggests that attenuated responses to stress and delayed recovery may also be problematic.

METHODS

This review focuses on the role of the stress response of the hypothalamic-pituitary-adrenocortical axis, the endogenous opioid system, and the cardiovascular system in hypertension, pain perception, and addictive behaviors. Results from multiple methods of assessment and stress paradigms conducted in our laboratory over the past two decades are integrated with research from other investigators and with existing theories.

RESULTS

Research indicates that exaggerated biological and physiological responses to stress and attenuated pain perception are associated with hypertension and risk for cardiovascular diseases. This research complements work linking reduced stress responses with enhanced pain sensitivity and discomfort. Multiple studies have also demonstrated that an attenuated stress response is linked to exacerbation of withdrawal symptoms and relapse in nicotine addiction. Evidence indicates important moderators (i.e., sex, personality traits, and early life adversity) and hypothalamic-pituitary-adrenocortical- and endogenous opioid system-related mechanisms in the altered response to stress. I integrate these findings in a conceptual model emphasizing that robust stress responses in the context of addiction and relapse should be considered as a marker of resiliency.

CONCLUSIONS

A blunted stress response may indicate long-term physiological dysregulation that could usher harmful consequences for cardiovascular disease, pain perception, and addictive disorders. The impact of dysregulation is influenced by multiple individual and situational factors that should be considered in evaluating the clinical significance of stress response dysregulation.

Association between neuropeptide Y receptor Y2 promoter variant rs6857715 and major depressive disorder

Stress increases the risk for major depressive disorder (MDD), overeating, and alcohol dependence (AD). The neuropeptide Y system is one of the best-known modulators of the stress response, and some of its effects are mediated through the neuropeptide Y receptor Y2 (NPY2R). The functional NPY2R variant rs6857715 (C-599T) has been implicated in both obesity and AD, but with opposing alleles. The present study explored whether rs6857715 is also associated with MDD. Analysis of the overall sample (595 MDD cases; 1295 controls) showed an association with the AD risk allele C [P=0.020, odds ratio (OR) (C-allele)=1.18]. The association remained significant after excluding MDD patients with AD/alcohol abuse [P=0.038, OR (C-allele)=1.18]; increased weight/appetite [P=0.006, OR (C-allele)=1.23]; or both [P=0.008, OR (C-allele)=1.25]. The present findings suggest that the NPY2R rs6857715 C-allele makes a genuine contribution toward MDD.

An insulin resistance associated neural correlate of impulsivity in type 2 diabetes mellitus

Central insulin resistance (IR) influences striatal dopamine (DA) tone, an important determinant of behavioral self-regulation. We hypothesized that an association exists between the degree of peripheral IR and impulse control, mediated by the impact of IR on brain circuits controlling the speed of executing “go” and/or “stop” responses. We measured brain activation and associated performance on a stop signal task (SST) in obese adults with type 2 diabetes (age, 48.1 ± 6.9 yrs (mean ± SD); BMI, 36.5 ± 4.0 kg/m²; HOMA-IR, 7.2 ± 4.1; 12 male, 18 female). Increasing IR, but not BMI, was a predictor of shorter critical stop signal delay (cSSD), a measure of the time window during which a go response can be successfully countermanded (R² = 0.12). This decline was explained by an IR-associated increase in go speed (R² = 0.13) with little impact of IR or BMI on stop speed. Greater striatal fMRI activation contrast in stop error (SE) compared with stop success (SS) trials (CON_SE>SS) was a significant predictor of faster go speeds (R² = 0.33, p = 0.002), and was itself predicted by greater IR (CON_SE>SS vs HOMA-IR: R² = 0.10, p = 0.04). Furthermore, this impact of IR on striatal activation was a significant mediator of the faster go speeds and greater impulsivity observed with greater IR. These findings suggest a neural mechanism by which IR may increase impulsivity and degrade behavioral self-regulation.

Impact of the economic crisis on health-related behaviors in Italy

BACKGROUND

Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population.

AIM

To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy.

METHODS

Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000-2015). Statistics performed by means of linear regression models.

RESULTS

Increased smokers (β = 1.68, p = .03), heavy smokers, that is, people smoking 11-20 cigarettes per day (β = 2.18, p = .04) or more than 20 cigarettes per day (β = 1.04, p < .01) and mean number of smoked cigarettes per day (β = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (β = 0.91, p = .04), while the Italian families' expenditure for alcoholic beverages decreased (β = -812.80, p = .01). Alcohol consumption decreased (β = -0.60, p < .01), especially in men (β = -0.95, p < .01); binge drinking increased in years 2009-2010. No change was noticeable in the diet indicators collected.

CONCLUSION

The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

Factors increasing the risk for psychosocial stress among Korean adults living in rural areas: using generalized estimating equations and mixed models

Background

This study was conducted to analyze the distribution of the psychosocial well-being index among adults living in two rural communities in Korea and to examine its correlation with lifestyle variables such as sleep duration, regular exercise, and sedentary time.

Methods

Using the cohort data of the Atherosclerosis Risk of a Rural Area Korean General Population, this study examined 3631 participants living in Wonju and Pyeongchang in Gangwon Province; their preliminary data were established from 2005 to 2007 while their follow-up data were collected 3 years later. This study investigated demographic characteristics, lifestyle habits, disease history, Psychosocial Well-being Index-Short Form (PWI-SF) scores, sleep duration, regular exercise, and sedentary time during work. Using repeated measures ANOVA, this study examined how the variables and PWI-SF scores changed over the course of 3 years and identified the correlation between them based on mixed model analysis. Afterwards, using the generalized estimation equation, this study identified each variable's risk towards the PWI-SF high-risk group and performed a stratified analysis by occupation after dividing the participants into farmers and non-farmers.

Results

The PWI-SF high-risk group was found to be 18.9% of the participants from preliminary data and 15.5% from follow-up data. The odds ratio towards the PWI-SF high-risk group was 1.503 (95% CI 1.241-1.821) in the short sleep duration group and 1.327 (95% CI 1.136-1.550) in the non-regular exercise group. A stratified analysis by occupation showed that middle and long sedentary time in the white-collar group increased the risk toward the PWI-SF high-risk group.

Conclusions

Short sleep duration, no regular exercise, and long sedentary time in the white-collar group were identified as risk factors toward the PWI-SF high-risk group in the rural communities, and policy interventions are needed to address this issue.

Are emotionally driven and addictive-like eating behaviors the missing links between psychological distress and greater body weight?

There is now a large body of evidence suggesting a significant association between emotional discomfort management, disordered eating behaviors and weight status. In the field of overweight and obesity, emotionally driven eating habits that resemble addictive behaviors are considered as a risk factor. This study aimed to investigate in a large sample of French university students 1) the associations between self-reported levels of psychological distress (PD), emotional eating (EE), food addiction (FA) and Body Mass Index (BMI); and 2) the potential mediation effect of eating behaviors (EE and FA) between PD and BMI. The responses of 1051 students (76.3% females) to self-reports assessing PD (Perceived Stress Scale, Hospital Anxiety and Depression Scale), EE (Intuitive Eating Scale-2) and FA (modified Yale Food Addiction Scale) were analysed. Associations between variables (Spearman correlation) and group comparisons by sex and BMI categories (Student's t tests/ANOVA) were tested, followed by Structural Equation Modeling (SEM) by sex. Among females and males, EE and FA scores were positively inter-related and correlated with PD scores and BMI. Moreover, among females and males, SEM showed that both EE and FA acts as mediators between PD and BMI. Hence, among educated young adults, using food consumption for down-regulating negative mood places the individual at risk for overweight and obesity. This study further emphasizes the necessity to take into account emotionally driven and addictive-like eating behaviors in interventions for promoting healthy eating and weight management.

A graduated food addiction classifications approach significantly differentiates depression, anxiety and stress among people with type 2 diabetes

AIMS

To examine differences in depression, anxiety, and stress across people with type 2 diabetes mellitus (t2d) classified according to a four level processed food addiction (PFA) severity indicator dichotomy.

METHODS

Four hundred and eight participants with a t2d diagnoses completed an online survey including the Yale Food Addiction Scale (YFAS) and the DASS-21. Based on YFAS symptom counts participants were classified as either: non-PFA; mild-PFA; moderate-PFA; or severe-PFA.

RESULTS

Multivariate, λ=0.422, F(9,978.51)=46.286, p<0.001, n_p²=0.250, and univariate analyses of variance demonstrated that depression F(3,408)=159.891, p<0.001, n_p²=0.543, anxiety F(3,408)=127.419, p<0.001, n_p²=0.486, and stress scores F(3,408)=129.714, p<0.001, n_p²=0.491, significantly and meaningfully increased from one PFA classification level to the next. Furthermore, the proportion of participants with more severe classifications of depression χ² (12)=297.820, p<0.001, anxiety χ² (12)=271.805, p<0.001, and stress χ² (12)=240.875, p<0.001, were significantly higher in the more severe PFA groupings.

CONCLUSION

For people with t2d, PFA is an important and meaningful associate of depression, anxiety, and stress, and that the adopted four level PFA severity indicator dichotomy is valid and useful.

The relationship between obesity and cognitive health and decline

The relationship between obesity and cognitive impairment is important given the globally ageing population in whom cognitive decline and neurodegenerative disorders will carry grave individual, societal and financial burdens. This review examines the evidence for the link between obesity and cognitive function in terms of both the immediate effects on cognitive performance, and effects on the trajectory of cognitive ageing and likelihood of dementia. In mid-life, there is a strong association between obesity and impaired cognitive function. Anthropometric measures of obesity are also associated with reduced neural integrity (e.g. grey and white matter atrophy). Increasing age coupled with the negative metabolic consequences of obesity (e.g. type 2 diabetes mellitus) are likely to significantly contribute to cognitive decline and incidence of dementia. Stress is identified as a potential risk factor promoting abdominal obesity and contributing to impaired cognitive function. However, the potentially protective effects of obesity against cognitive decline in older age require further examination. Finally, surgical and whole diet interventions, which address obesity may improve cognitive capacity and confer some protection against later cognitive decline. In conclusion, obesity and its comorbidities are associated with impaired cognitive performance, accelerated cognitive decline and neurodegenerative pathologies such as dementia in later life. Interventions targeting mid-life obesity may prove beneficial in reducing the cognitive risks associated with obesity.