Emotional influences on food choice: sensory, physiological and psychological pathways

A review of weight control strategies and their effects on the regulation of hormonal balance

The estimated prevalence of obesity in the USA is 72.5 million adults with costs attributed to obesity more than 147 billion dollars per year. Though caloric restriction has been used extensively in weight control studies, short-term success has been difficult to achieve, with long-term success of weight control being even more elusive. Therefore, novel approaches are needed to control the rates of obesity that are occurring globally. The purpose of this paper is to provide a synopsis of how exercise, sleep, psychological stress, and meal frequency and composition affect levels of ghrelin, cortisol, insulin GLP-1, and leptin and weight control. We will provide information regarding how hormones respond to various lifestyle factors which may affect appetite control, hunger, satiety, and weight control.

Fatty acid-induced gut-brain signaling attenuates neural and behavioral effects of sad emotion in humans

Although a relationship between emotional state and feeding behavior is known to exist, the interactions between signaling initiated by stimuli in the gut and exteroceptively generated emotions remain incompletely understood. Here, we investigated the interaction between nutrient-induced gut-brain signaling and sad emotion induced by musical and visual cues at the behavioral and neural level in healthy nonobese subjects undergoing functional magnetic resonance imaging. Subjects received an intragastric infusion of fatty acid solution or saline during neutral or sad emotion induction and rated sensations of hunger, fullness, and mood. We found an interaction between fatty acid infusion and emotion induction both in the behavioral readouts (hunger, mood) and at the level of neural activity in multiple pre-hypothesized regions of interest. Specifically, the behavioral and neural responses to sad emotion induction were attenuated by fatty acid infusion. These findings increase our understanding of the interplay among emotions, hunger, food intake, and meal-induced sensations in health, which may have important implications for a wide range of disorders, including obesity, eating disorders, and depression.

Relationship between adiposity, emotional status and eating behaviour in obese women: role of inflammation

BACKGROUND

Obesity is characterized by chronic low-grade inflammation that may lead to emotional distress and behavioural symptoms. This study assessed the relationship between adiposity, low-grade inflammation, eating behaviour and emotional status in obese women awaiting gastric surgery and investigated the effects of surgery-induced weight loss on this relationship.

METHOD

A total of 101 women with severe or morbid obesity awaiting gastric surgery were recruited. Assessments were performed before and at 1 year post-surgery and included the measurement of neuroticism and extraversion using the revised Neuroticism-Extraversion-Openness personality inventory (NEO-PI-R) and eating behaviour using the Three-Factor Eating Questionnaire (TFEQ). Blood samples were collected for the measurement of serum inflammatory markers [interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP)] and adipokines (leptin, adiponectin).

RESULTS

At baseline, body mass index (BMI) was positively correlated with inflammatory markers and adipokines. Regression analyses adjusting for age and diabetes revealed that baseline concentrations of IL-6 and hsCRP were associated with the depression and anxiety facets of neuroticism, with higher inflammation predicting higher anxiety and depression. This association remained significant after adjusting for BMI. Gastric surgery induced significant weight loss, which correlated with reduced inflammation. After controlling for BMI variations, decreases in inflammatory markers, notably hsCRP, were associated with reduced anxiety and TFEQ-cognitive restraint scores.

CONCLUSIONS

These findings indicate strong associations between adiposity, inflammation and affectivity in obese subjects and show that surgery-induced weight loss is associated concomitantly with reduced inflammation and adipokines and with significant improvement in emotional status and eating behaviour. Inflammatory status appears to represent an important mediator of emotional distress and psychological characteristics of obese individuals.

Ghrelin mediates stress-induced food-reward behavior in mice

The popular media and personal anecdotes are rich with examples of stress-induced eating of calorically dense "comfort foods." Such behavioral reactions likely contribute to the increased prevalence of obesity in humans experiencing chronic stress or atypical depression. However, the molecular substrates and neurocircuits controlling the complex behaviors responsible for stress-based eating remain mostly unknown, and few animal models have been described for probing the mechanisms orchestrating this response. Here, we describe a system in which food-reward behavior, assessed using a conditioned place preference (CPP) task, is monitored in mice after exposure to chronic social defeat stress (CSDS), a model of prolonged psychosocial stress, featuring aspects of major depression and posttraumatic stress disorder. Under this regime, CSDS increased both CPP for and intake of high-fat diet, and stress-induced food-reward behavior was dependent on signaling by the peptide hormone ghrelin. Also, signaling specifically in catecholaminergic neurons mediated not only ghrelin's orexigenic, antidepressant-like, and food-reward behavioral effects, but also was sufficient to mediate stress-induced food-reward behavior. Thus, this mouse model has allowed us to ascribe a role for ghrelin-engaged catecholaminergic neurons in stress-induced eating.

Effects of recovery from immobilization stress on striatal preprodynorphin- and kappa opioid receptor-mRNA levels of the male rat

Previously, we have reported that brain regions that are thought to be involved in motivated behavior are altered in animals undergoing repeated exposures to immobilization stress. The goal of the present study was to determine the effects of recovery from this type of stress on these same mesolimbic brain regions. For this purpose, adult male Sprague-Dawley rats were initially exposed to immobilization stress either once (2 h) or repeatedly (2 h×10 days). Rats were then either allowed to recover from the stressor for a shorter (2 days) or longer period of time (9 days) in their home cages. At the end of this recovery period, rats were euthanized and trunk blood and brains were processed for serum corticosterone (CORT) and neurochemistry, respectively. Brain mRNA levels were determined via in situ hybridization for the opioid preprodynorphin (DYN) and its cognate receptor (kappa, KOR), in striatal and accumbal subregions. A pattern of selective transcriptional activation emerged in the four resultant treatment conditions where a short recovery from either a single or repeated exposure to immobilization produced increases in KOR-mRNA levels in striatal and nucleus accumbens (Acb) subregions. Relative to controls, these differences were diminished after a longer recovery period. Interestingly, DYN-mRNA levels were unchanged after the shorter recovery period and after single or repeated immobilizations but appeared to be induced after a longer recovery period after repeated immobilizations. A relative amount of weight loss occurred after immobilization following repeated but not single exposure to stress. In addition, only those rats recovering from repeated stress exposures had higher CORT levels compared with non-immobilized controls. These results suggest that recovery from immobilization stress may alter the motivational system after as little as a single immobilization and that a possible dysphoric effect on appetitive behavior may be reflected by an altered striatal dynorphin system.

Functional variability in corticosteroid receptors is a major component of strain differences in fat deposition and metabolic consequences of enriched diets in rat

We aimed to distinguish mineralocorticoid (MR) from glucocorticoid receptor (GR) actions in the nutritional differences between the Fischer 344 (F344) and LOU/C (LOU) rat strains. The decrease of urinary Na+/K+ ratio induced via MR activation by aldosterone and decrease of circulating lymphocyte counts exerted via GR activation by dexamethasone revealed a higher efficiency of corticosteroid receptor in LOU than in F344 rats. Afterward, we submitted F344 and LOU male rats to adrenalectomy and to substitution treatments with agonists of MR or GR under 3 successive diets--standard, free choice between chow and pork lard, and an imposed high-fat/high-sugar diet--to explore the involvement of the interactions between activation of corticosteroid receptors and diet on food intake, body composition, and metabolic blood parameters in these rats. Lastly, we measured energy expenditure and substrate oxidization in various experimental conditions in LOU and F344 rats by indirect calorimetry. In LOU rats, we showed greater basal and MR-induced energy expenditure, diet-induced thermogenesis, and lipid oxidization. We showed that the F344 rat strain constitutes a relevant model of the unfavorable effects exerted by glucocorticoids via GR on food preference for high-calorie diets, abdominal fat deposition, diabetes, and other deleterious consequences of visceral obesity. Contrary to F344 rats, the LOU rats did not exhibit the expected visceral fat deposition linked to GR activation. This strain is therefore a relevant model of resistance to diet-induced obesity and to the deleterious effects exerted by glucocorticoids on metabolism.

Stress and adiposity: a meta-analysis of longitudinal studies

Psychosocial stress has been strongly implicated in the biology of adiposity but epidemiological studies have produced inconsistent results. The aim of this analysis was to bring together results from published, longitudinal, prospective studies examining associations between psychosocial stress and objectively measured adiposity in a meta-analysis. Searches were conducted on Medline, PsycINFO, Web of Science, and PubMed (to January 2009) and reference lists from relevant articles were examined. Prospective studies relating psychosocial stress (general life stress (including caregiver stress), work stress) to BMI, body fat, body weight, waist circumference, or waist-to-hip ratio were included. Analyses from 14 cohorts were collated and evaluated. There was no significant heterogeneity, no evidence of publication bias, and no association between study quality and outcomes. The majority of analyses found no significant relationship between stress and adiposity (69%), but among those with significant effects, more found positive than negative associations (25 vs. 6%). Combining results in a meta-analysis showed that stress was associated with increasing adiposity (r = 0.014; confidence interval (CI) = 0.002-0.025, P < 0.05). Effects were stronger for men than women, in analyses with longer rather than shorter follow-ups, and in better quality studies. We conclude that psychosocial stress is a risk factor for weight gain but effects are very small. Variability across studies indicates there are moderating variables to be elucidated.

Race/ethnicity, psychological distress, and fruit/vegetable consumption. The nature of the distress-behavior relation differs by race/ethnicity

OBJECTIVE

We explored how the relation between psychological distress and fruit/vegetable consumption differed as a function of race/ethnicity.

METHOD

Data from the 2007 Health Information National Trends Survey was analyzed. Participants reported current psychological distress, race/ethnicity, and current fruit and vegetable consumption. Linear regression analyses were used to examine the association between race/ethnicity, distress, and their interaction and fruit and vegetable consumption.

RESULTS

There was a significant interaction between race/ethnicity and psychological distress in predicting fruit and vegetable consumption. Follow-up analyses indicated that distress was related to fruit and vegetable consumption for White and Hispanic but not for African American respondents.

CONCLUSION

The association between psychological distress and fruit/vegetable consumption differs as a function of race/ethnicity. The findings have implications for understanding the role of distress in eating behavior regulation and for developing interventions to address fruit/vegetable consumption targeted to members of different race/ethnic groups.

"Snacking" causes long term attenuation of HPA axis stress responses and enhancement of brain FosB/deltaFosB expression in rats

A history of limited, intermittent intake of palatable food (sucrose drink) attenuates hypothalamic-pituitary-adrenal (HPA) axis stress responses and induces markers of neuronal plasticity in stress- and reward-regulatory brain regions. Synaptic plasticity could provide a mechanism for long-term changes in neuronal function, implying that sucrose stress-dampening may endure over long periods of time. The present study tests the persistence of HPA axis dampening and plasticity after cessation of palatable drinking. Adult, male Long-Evans rats (n=10-13) with free access to water and chow were given additional twice-daily access to 4ml sucrose (30%) or water for 14days. Rats were subsequently tested for HPA responsiveness to an acute (20min) restraint stress at 1, 6 and 21days after the cessation of sucrose. Brains were collected for immunohistochemical analysis of FosB/deltaFosB, a marker of long-term neuronal plasticity, in the basolateral amygdala (BLA) and nucleus accumbens (NuAc). Prior sucrose consumption significantly decreased the plasma corticosterone response to restraint at 1day after the last palatable drink presentation, and also increased FosB/deltaFosB-positive cells in the BLA and in the NuAc core. This HPA-dampening persisted through 21days after the termination of the palatable drink, as did the increased FosB/deltaFosB immunoreactivity in both the BLA and the NuAc core. These data suggest that chronic palatable food intake causes lasting changes in stress/reward-modulatory circuitry and that the suppressed hormonal response to stress that can persist well beyond periods of palatable drink exposure.

A laboratory-based study of mood and binge eating behavior in overweight children

PURPOSE

Associations between negative mood and binge eating in the laboratory are well-established in adults, but such data are limited in youth. We investigated the relation between mood and binge eating in children using a laboratory feeding paradigm.

METHOD

Overweight girls, aged 6-12 years, with (BE; n=23) and without (control, CON; n=23) reported objective and/or subjective binge eating underwent both sad and neutral mood inductions, followed by multi-item buffet meals.

RESULTS

The Group × Mood Condition interaction for overall energy intake was non-significant. However, BE girls consumed more energy from fat in the sad condition as compared to the neutral condition. Baseline mood predicted BE girls' likelihood of reporting loss of control during the sad condition test meal.

CONCLUSIONS

Results suggest that emotional eating episodes in children reporting aberrant eating may be characterized by the experience of loss of control, rather than the consumption of objectively large amounts of food. Interventions focused on affect regulation may minimize the adverse consequences of pediatric binge eating.

HPA axis dampening by limited sucrose intake: reward frequency vs. caloric consumption

Individuals often cope with stress by consuming calorically-dense, highly-palatable 'comfort' foods. The present work explores the stress-relieving properties of palatable foods in a rat model of limited sucrose intake. In this model, adult male rats with free access to chow and water are given additional access to a small amount of sucrose drink (or water as a control). A history of such limited sucrose intake reduces the collective (HPA axis, sympathetic, and behavioral-anxiety) stress response. Moreover, the stress-dampening by sucrose appears to be mediated primarily by its rewarding properties, since beneficial effects are reproduced by the noncaloric sweetener saccharin but not oral intragastric gavage of sucrose. The present work uses an alternate strategy to address the hypothesis that the rewarding properties of sucrose mediate its stress-dampening. This work varies the duration, frequency, and/or volume of sucrose and assesses the ability to attenuate HPA axis stress responses. The data indicate that HPA-dampening is optimal with a greater duration and/or frequency of sucrose, whereas increasing the volume of sucrose consumed is without effect. This finding suggests that the primary factor mediating stress-dampening is the number/rate of reward (i.e., sucrose) exposures, rather than the total sucrose calories consumed. Collectively, these data support the hypothesis that stress relief by limited palatable food intake is mediated primarily by its hedonic/rewarding properties. Moreover, the results support the contention that naturally rewarding behaviors are a physiological means to produce stress relief.

Pleasurable behaviors reduce stress via brain reward pathways

Individuals often eat calorically dense, highly palatable "comfort" foods during stress for stress relief. This article demonstrates that palatable food intake (limited intake of sucrose drink) reduces neuroendocrine, cardiovascular, and behavioral responses to stress in rats. Artificially sweetened (saccharin) drink reproduces the stress dampening, whereas oral intragastric gavage of sucrose is without effect. Together, these results suggest that the palatable/rewarding properties of sucrose are necessary and sufficient for stress dampening. In support of this finding, another type of natural reward (sexual activity) similarly reduces stress responses. Ibotenate lesions of the basolateral amygdala (BLA) prevent stress dampening by sucrose, suggesting that neural activity in the BLA is necessary for the effect. Moreover, sucrose intake increases mRNA and protein expression in the BLA for numerous genes linked with functional and/or structural plasticity. Lastly, stress dampening by sucrose is persistent, which is consistent with long-term changes in neural activity after synaptic remodeling. Thus, natural rewards, such as palatable foods, provide a general means of stress reduction, likely via structural and/or functional plasticity in the BLA. These findings provide a clearer understanding of the motivation for consuming palatable foods during times of stress and influence therapeutic strategies for the prevention and/or treatment of obesity and other stress-related disorders.

Infant temperament is associated with potentially obesogenic diet at 18 months

OBJECTIVE

This study investigated whether infants' temperament at 18 months is associated with the feeding of foods and drinks that may increase the risk for later obesity.

METHODS

This was a cross-sectional study of mothers and infants (N = 40 266) participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Data were collected by questionnaire. Predictor variables were: infants' temperament at 18 months (internalizing, externalizing, and surgency/extraversion), and mothers' negative affectivity. Outcome variables were feeding of sweet foods, sweet drinks, and night-time caloric drinks at 18 months (all dichotomized). Confounders were child's gender, weight-for-height at 1 year, breastfeeding, and mother's level of education.

RESULTS

After controlling for confounders, infant temperament dimensions at 18 months were significantly associated with mothers' feeding of potentially obesogenic foods and drinks independent of mothers' negative affectivity. Infants who were more internalizing were more likely to be given sweet foods (OR 1.47, CI 1.32-1.65), sweet drinks (OR 1.76, CI 1.56-1.98), and drinks at night (OR 2.91, CI 2.54-3.33); infants who were more externalizing were more likely to be given sweet food (OR 1.53, CI 1.40-1.67) and sweet drinks (OR 1.22, CI 1.11-1.34); and infants who were more surgent were more likely to be given drinks at night (OR 1.66, CI 1.42-1.92).

CONCLUSIONS

The association between infant temperament and maternal feeding patterns suggests early mechanisms for later obesity that should be investigated in future studies.

The high-sweet-fat food craving among women with premenstrual dysphoric disorder: emotional response, implicit attitude and rewards sensitivity

This study aimed to: (1) evaluate food craving and high-sweet-fat food craving across the menstrual cycle; (2) compare the craving and explicit/implicit emotional response to different food; and (3) investigate the reward sensitivity among PMDD and control groups. The PMDD group without treatment history and control group were evaluated for food craving, emotional response to food, implicit attitude task to food, and responsiveness to reward both in luteal and follicular phases. A total of 59 women with PMDD and 60 controls had completed the study. The results revealed that both PMDD diagnosis and luteal phase were associated with higher body mass index. The high-sweet-fat food provoked higher craving, positive emotional, and positive implicit response more than other foods. The luteal phase contributed to higher food and high-sweet-fat food cravings. Besides, the PMDD women had higher reward sensitivity, emotional response, positive implicit attitude, and craving response to high-sweet-fat foods. Further, the rewarding sensitivity was associated with emotional response to high-sweet-fat food which was associated with high-sweet-fat food craving. These results would suggest emotional response and implicit attitude might play a role for high-sweet-fat food craving of PMDD. Further, PMDD women with higher reward sensitivity should be a target group of intervention for high-sweet-fat food craving.

Diet choice, cortisol reactivity, and emotional feeding in socially housed rhesus monkeys

Chronic psychosocial stress produces an array of adverse health consequences that are highly comorbid, including emotional eating, affective disorders, and metabolic syndrome. The consumption of high caloric diets (HCDs) is thought to provide comfort in the face of unrelenting psychosocial stress. Using social subordination in female rhesus monkeys as a model of continual exposure to daily stressors in women, we tested the hypothesis that subordinate females would consume significantly more calories from a HCD compared to dominant females, and this pattern of food intake would be associated with reduced cortisol release and reduced frequency of anxiety-like behaviors. Food intake, parameters of cortisol secretion, and socio-emotional behavior were assessed for 3 weeks during a no choice phase when only a low caloric diet (LCD) was available and during a choice condition when both a LCD and HCD were available. While all animals preferred the HCD, subordinate females consumed significantly more of the HCD than did dominant females. A flattening of the diurnal cortisol rhythm and a greater increase in serum cortisol to an acute social separation occurred during the diet choice condition in all females. Furthermore, the rate of anxiety-like behavior progressively declined during the 3-week choice condition in subordinate but not dominant females. These data provide support for the hypothesis that daily exposure to psychosocial stress increases consumption of calorically dense foods. Furthermore, consumption of HCDs may be a metabolic stressor that synergizes with the psychosocial stress of subordination to further increase the consumption of these diets.

Association between maternal intimate partner violence and incident obesity in preschool-aged children: results from the Fragile Families and Child Well-being Study

OBJECTIVE

To examine the impact of chronicity of maternal intimate partner violence (IPV) on obesity risk among preschool-aged children.

DESIGN

Prospective cohort study.

SETTING

Several large US cities.

PARTICIPANTS

A subsample of the Fragile Families and Child Well-being Study participants (n = 1595), who were children born between 1998 and 2000 and their parents interviewed at baseline and at 12, 36, and 60 months.

MAIN EXPOSURE

Maternal report of restrictive, sexual, and physical abuse from an intimate partner. Chronic IPV was defined as any maternal IPV exposure during both pregnancy or infancy (0-12 months) and early childhood (36-60 months).

MAIN OUTCOME MEASURE

Repeated measures of child body mass index.

RESULTS

Among the 1595 children, 16.5% were obese at age 5 years and 49.4% of the mothers reported some form of IPV. Compared with those who had no IPV exposure, children whose mothers reported chronic IPV had an elevated risk for obesity at age 5 years (adjusted odds ratio = 1.80; 95% confidence interval, 1.24-2.61). Stratified analyses indicated increased risk for obesity among girls with a maternal history of chronic IPV (adjusted odds ratio = 2.21; 95% confidence interval, 1.30-3.75) compared with boys (adjusted odds ratio = 1.66; 95% confidence interval, 0.94-2.93) and a larger effect of any maternal IPV on obesity among children living in less safe neighborhoods (adjusted odds ratio = 1.56; 95% confidence interval, 1.03-2.36).

CONCLUSIONS

Chronic maternal IPV is associated with increased risk of obesity among preschool-aged children. Preventing family violence and improving community safety may help reduce childhood obesity.

Stress-induced obesity and the emotional nervous system

Stress and emotional brain networks foster eating behaviors that can lead to obesity. The neural networks underlying the complex interactions among stressors, body, brain and food intake are now better understood. Stressors, by activating a neural stress-response network, bias cognition toward increased emotional activity and degraded executive function. This causes formed habits to be used rather than a cognitive appraisal of responses. Stress also induces secretion of glucocorticoids, which increases motivation for food, and insulin, which promotes food intake and obesity. Pleasurable feeding then reduces activity in the stress-response network, reinforcing the feeding habit. These effects of stressors emphasize the importance of teaching mental reappraisal techniques to restore responses from habitual to thoughtful, thus battling stress-induced obesity.

Emotional eating, depressive symptoms and self-reported food consumption. A population-based study

We examined the associations of emotional eating and depressive symptoms with the consumption of sweet and non-sweet energy-dense foods and vegetables/fruit, also focusing on the possible interplay between emotional eating and depressive symptoms. The participants were 25-64-year-old Finnish men (n=1679) and women (n=2035) from the FINRISK 2007 Study (DILGOM substudy). The Three-Factor Eating Questionnaire-R18, Center for Epidemiological Studies Depression Scale, and a 132-item Food Frequency Questionnaire were used. Emotional eating and depressive symptoms correlated positively (r=0.31 among men and women), and both were related to a higher body mass. Emotional eating was related to a higher consumption of sweet foods in both genders and non-sweet foods in men independently of depressive symptoms and restrained eating. The positive associations of depressive symptoms with sweet foods became non-significant after adjustment for emotional eating, but this was not the case for non-sweet foods. Depressive symptoms, but not emotional eating, were related to a lower consumption of vegetables/fruit. These findings suggest that emotional eating and depressive symptoms both affect unhealthy food choices. Emotional eating could be one factor explaining the association between depressive symptoms and consumption of sweet foods, while other factors may be more important with respect to non-sweet foods and vegetables/fruit.

Happy aging

Aging is a normal physiological process in human life. The decline in the ability to repair and regenerate predisposes the aging person to develop disabling problems in the cardiovascular and skeletal systems. Full awareness of aging problems and advocations on the means to prevent their occurrence are mounting. European and US groups rely on scientific, target-oriented means to treat aging manifestations. Oriental medicine aims at prevention, using nutrition and exercise to maintain internal harmony.

Vagus nerve stimulation and emotional responses to food among depressed patients

BACKGROUND

Approved for treatment of treatment-resistant depression and for epilepsy, vagus nerve stimulation (VNS) therapy involves stimulation of the vagus nerve, affecting both mood and appetite regulating systems. VNS is associated with changes in food intake and weight loss in animals. Studies of its impact on food intake and weight with humans are limited. It is not known whether or how VNS influences emotional response to food, but vagus afferents project to regions in the insula involving satiety and taste.

METHOD

Thirty-three participants were recruited for three groups: depressed patients undergoing VNS therapy, depressed patients not undergoing VNS therapy, and healthy controls. All participants viewed images of foods twice in random order. When applicable, VNS devices were turned on for one viewing and off for the other. Participants were instructed to rate immediately after the viewings how each picture made them feel on a visual analog on three dimensions (unhappy to happy, calm to aroused, and small/submissive to big/domineering).

RESULTS

Controlling for time since last meal, a significant main effect was found for arousal ratings in response to sweet food images. Post-hoc analyses indicated that the VNS group demonstrated significant changes in arousal ratings between paired food image viewings compared to controls. Sixty-four percent of VNS participants demonstrated increases and 36% demonstrated decreases in arousal. Higher body mass indexes and greater levels of self-reported sweet cravings were associated with increased arousal during VNS activation.

CONCLUSIONS

This study was the first to examine the effects of acute left cervical VNS on emotional ratings of food in adults with major depression. Results suggest that VNS device activation may be associated with acute alteration in arousal response to sweet foods among depressed patients. Future research is needed to replicate these findings and to assess how activation of the vagus nerve affects eating and weight.

Psychosocial factors and the pain experience of osteoarthritis patients: new findings and new directions

PURPOSE OF REVIEW

The present paper reviews recent psychosocial research in the area of osteoarthritis pain. First, the review highlights studies of psychosocial factors that can influence osteoarthritis pain. Next, research testing the efficacy of psychosocial treatments for osteoarthritis pain is summarized.

RECENT FINDINGS

Recent studies suggest that asking osteoarthritis patients to recall pain experiences may not be as accurate as having them keep daily pain records. New studies also support the notion that fatigue and increased weight are linked to higher osteoarthritis pain. Osteoarthritis patients who report higher levels of depression are more prone to report increased osteoarthritis pain. New studies also indicate that social factors such as ethnic background, ability to communicate pain to others, and participation in social activities can influence osteoarthritis pain and disability. Cognitions about pain (i.e. pain catastrophizing, acceptance, self-efficacy for pain) also have been found to relate to pain in patients with osteoarthritis. Recent, randomized controlled studies suggest that psychosocial interventions (i.e. self-management programs, exercise) can decrease osteoarthritis pain and disability.

SUMMARY

Several psychosocial variables have been suggested as influencing osteoarthritis pain and disability. There is evidence that psychosocial interventions may decrease osteoarthritis pain and disability.

Role of depressive symptoms in explaining socioeconomic status disparities in dietary quality and central adiposity among US adults: a structural equation modeling approach

BACKGROUND

The link between socioeconomic status (SES), depression, dietary quality, and central adiposity remains unclear.

OBJECTIVE

Pathways linking SES to dietary quality and central adiposity through depressive symptoms were examined across sex-ethnicity groups.

DESIGN

Extensive data on US adults aged 30-64 y from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used in multiple linear logistic regression models and structural equation models to test pathway associations. Measures included Center for Epidemiologic Studies-Depression (CES-D) scores, 2005 Healthy Eating Index (HEI) values, and dual-energy X-ray absorptiometry. Sample sizes for most analyses ranged between 1789 for anthropometric outcomes and 1227 for trunk fat outcomes.

RESULTS

The CES-D score was associated with lower HEI scores in all sex-ethnicity groups, except in African American men, and with higher waist-to-hip ratios (WHRs) among African American women. A CES-D score > or =16 was positively associated with waist circumference (WC) and with trunk fat among white women and men, respectively. SES was positively related to central adiposity among African American men (central obesity and WC) and African American women (central obesity and percentage trunk fat) but was inversely related to central adiposity among white women. Among whites only, the total positive effect of SES on HEI was significantly mediated by CES-D score. Among white women, the total inverse effect of SES on WC and WHR was significantly explained by the CES-D score and HEI, whereas the CES-D score was positively associated with WHR among African American women, independently of SES.

CONCLUSION

Future mental health interventions targeted at reducing SES disparities in dietary quality and central adiposity may have different effects across sex-ethnicity groups.

Palatable foods, stress, and energy stores sculpt corticotropin-releasing factor, adrenocorticotropin, and corticosterone concentrations after restraint

Previous studies have shown reduced hypothalamo-pituitary-adrenal responses to both acute and chronic restraint stressors in rats allowed to ingest highly palatable foods (32% sucrose +/- lard) prior to restraint. In this study we tested the effects of prior access (7 d) to chow-only, sucrose/chow, lard/chow, or sucrose/lard/chow diets on central corticotropin-releasing factor (CRF) expression in rats studied in two experiments, 15 and 240 min after onset of restraint. Fat depot, particularly intraabdominal fat, weights were increased by prior access to palatable food, and circulating leptin concentrations were elevated in all groups. Metabolite concentrations were appropriate for values obtained after stressors. For unknown reasons, the 15-min experiment did not replicate previous results. In the 240-min experiment, ACTH and corticosterone responses were inhibited, as previously, and CRF mRNA in the hypothalamus and oval nucleus of the bed nuclei of the stria terminalis were reduced by palatable foods, suggesting strongly that both neuroendocrine and autonomic outflows are decreased by increased caloric deposition and palatable food. In the central nucleus of the amygdala, CRF was increased in the sucrose-drinking group and decreased in the sucrose/lard group, suggesting that the consequence of ingestion of sucrose uses different neural networks from the ingestion of lard. The results suggest strongly that ingestion of highly palatable foods reduces activity in the central stress response network, perhaps reducing the feeling of stressors.

A psycho-genetic study of associations between the symptoms of binge eating disorder and those of attention deficit (hyperactivity) disorder

OBJECTIVE

Some recent studies have reported intriguingly strong correlations between ADHD and obesity. This study examined whether ADHD symptoms were more pronounced in adults with symptoms of binge eating disorder (BE) than in their non-binging obese counterparts, and whether the links were stronger with inattentive vs impulsive/hyperactive symptoms. We also assessed the role of the dopamine D3 receptor in ADHD symptoms since the DRD3 gene has been associated with impulsivity and drug addiction - both relevant features of ADHD.

METHODS

A case (BE: n=60) double-control (normal weight: n=61 and obese: n=60) design was employed. Assessments of both childhood and adults ADHD symptoms were made, as well as genotyping of seven markers of DRD3 including the functional Ser9Gly polymorphism.

RESULTS

Three DRD3 genotypes, including Ser/Ser, had significantly elevated scores on the hyperactive/impulsive symptom scale. In turn, the four ADHD symptom scales were all significantly elevated in the BE and obese groups, who did not differ from each other, compared to those with normal weight.

CONCLUSIONS

Results indicated a role for the D3 receptor in the manifestation of the hyperactive/impulsive symptoms of ADHD, and that symptoms of ADHD are significantly, but not differentially, elevated in obese adults with and without binge eating. Our findings suggest that ADHD screening in adults seeking treatment for obesity, including those with BE, may be warranted as methods used to treat ADHD may help some to better manage overeating and other factors contributing to weight gain.

Laboratory assessment of the food intake of children and adolescents with loss of control eating

BACKGROUND

Loss of control (LOC) eating in youth predicts excessive weight gain. However, few studies have measured the actual energy intake of children reporting LOC eating.

OBJECTIVE

The objective was to characterize the energy intake and macronutrient composition of "normal" and "binge" laboratory meals in nonoverweight and overweight boys and girls with LOC eating.

DESIGN

Children aged 8-17 y (n = 177) consumed 2 lunchtime meals ad libitum from a multi-item food array after being instructed to either binge eat (binge meal) or to eat normally (normal meal). Prior LOC eating was determined with a semistructured clinical interview.

RESULTS

Participants consumed more energy at the binge meal than at the normal meal (P = 0.001). Compared with youth with no LOC episodes (n = 127), those reporting LOC (n = 50) did not consume more energy at either meal. However, at both meals, youth with LOC consumed a greater percentage of calories from carbohydrates and a smaller percentage from protein than did those without LOC (P < 0.05). Children with LOC ate more snack and dessert-type foods and less meats and dairy (P < 0.05). LOC participants also reported greater increases in postmeal negative affect at both meals than did those without LOC (P < or = 0.05). Secondary analyses restricted to overweight and obese girls found that those with LOC consumed more energy at the binge meal (P = 0.025).

CONCLUSIONS

When presented with an array of foods, youth with LOC consumed more high-calorie snack and dessert-type foods than did those without LOC. Further research is required to determine whether habitual consumption of such foods may promote overweight. This trial was registered at clinicaltrials.gov as NCT00320177.

Children's Nutritional Health: Running on Empty?

This review discusses evidence-based perspectives on promoting children's nutritional health. Future directions for inquiry and empirically driven public policy initiatives also are addressed.

Need states based on eating occasions experienced by midlife women

OBJECTIVE

To identify a comprehensive set of distinct "need states" based on the eating occasions experienced by midlife women.

DESIGN

Series of 7 focus group interviews.

SETTING

Meeting room on a university campus.

PARTICIPANTS

A convenience sample of 34 multi-ethnic women (mean age = 46 years).

PHENOMENON OF INTEREST

Descriptions of eating occasions by "need states," specific patterns of needs for the occasion.

ANALYSIS

Interviews were audiotaped, transcribed verbatim, and analyzed for common themes using qualitative data analysis procedures.

FINDINGS

Eight need states suggested a hypothetical framework reflecting a wide range in emotional gratification. Need states with a low level of emotional gratification were dominated by sets of functional needs, such as coping with stress, balancing intake across occasions, meeting external demands of time and effort, and maintaining a routine. Food was a means for reinforcing family identity, social expression, and celebration in need states with high levels of emotional gratification. Occurrence of need states varied by day and meal/snack occasion, with food type and amount dependent on need state.

CONCLUSIONS AND IMPLICATIONS

Eating occasions are driven by specific sets of needs ranging from physical/functional to more emotional/social needs. Addressing need states may improve weight intervention programs for midlife women.

Depression, diabetes and metabolic-nutritional factors in elderly Hispanics

OBJECTIVE

To examine the relationship of depression to metabolic and nutritional risk factors in older Hispanics.

DESIGN

Crossectional study.

SETTING

Subjects were part of a community-based, cognitive evaluation project that examined 301 subjects in the Eastern San Fernando Valley of Southern California.

PARTICIPANTS

Two elderly Hispanic groups: 53 clinically depressed, with memory complaints but not demented subjects, and 33 generally healthy, cognitively asymptomatic subjects.

MEASUREMENTS

The results of functional and nutritional questionnaires, a medical and neurological examination, 12-hour fasting clinical laboratory tests, MRI or CT scans, and neuropsychological testing.

RESULTS

Both groups were nearly identical along socio-demographic variables. However, the depressed group differed significantly from the general healthy group not only in percent of diabetics (38% vs.18%), but in the amount of poorly controlled diabetes, and the depressed group consumed about half the amount of fish that the generally healthy group did.

CONCLUSIONS

This study suggests that factors such as poorly controlled diabetes combined with low consumption of foods high in omega-3 fatty acid content such as sea fish may be associated with an increased risk of developing depression in late life. These factors may be socio-economically and culturally influenced and are therefore amenable to modification.

Personality traits in overweight and obese women: associations with BMI and eating behaviors

This study aimed at assessing the extent to which personality traits are related to BMI and eating behaviors in overweight and obese women (N=154; mean body mass index (BMI) of 30.5+/-3.0 kg/m(2)). The NEO Five-Factor Inventory was used to capture the five dimensions of personality (neuroticism, extraversion, openness to experience, agreeableness and conscientiousness). Anthropometric measurements (weight, height and BMI) were performed and eating behaviors (cognitive dietary restraint, disinhibition and susceptibility to hunger) were measured by the Three-Factor Eating Questionnaire. Regressional analyses showed that only conscientiousness was positively related to BMI. A higher level of neuroticism was identified as a significant predictor of higher scores for cognitive dietary restraint, disinhibition and susceptibility to hunger. Conscientiousness was also found to be a positive determinant of cognitive dietary restraint and a higher level of agreeableness predicted a lower score of susceptibility to hunger. Results also underline the presence of other psychological factors, i.e. dysphoria and body esteem, involved in the associations between personality traits and some eating behaviours. These findings suggest that particular dimensions of personality may contribute, either directly or through their association with other psychological factors, to a better understanding of weight and eating behaviors in overweight and obese women.

Implicit and explicit attitudes to high- and low-calorie food in females with different BMI status

The study compared implicit and explicit attitudes to three types of foods (high-calorie non-sweet HCNS, high-calorie sweet HCS and low-calorie LC) among females varying in BMI status. Eight three participants completed an affective priming task (implicit attitudes), followed by explicit rating of food images. The results of ANOVA showed a significant difference in implicit attitudes to different types of food, F(3,246)=3.90, p<.01 and the difference among BMI groups (F(6, 213)=2.15, p<.05). The implicit attitudes to HCS were positive in the healthy-weight and overweight groups but negative in obese; the reversed pattern was revealed in attitudes to HCNS. All groups showed negative implicit attitudes to LC foods. The ANOVA performed on explicit ratings revealed a significant effect of food type (F(3,213)=22.54, p<001) but no interaction between food type and BMI status. All participants rated HCNS significantly lower than HCS and LC foods. Our results indicate dissociation in implicit and explicit attitudes to foods among BMI groups, especially in attitudes to HCNS and HCS foods.

Correlates of dietary intake among men involved in the MAN for Health study

The clustering of diet and other lifestyle behaviors and their psychosocial correlates were examined among 455 Latino and African American men in the U.S. Southeast. Men were recruited by male community health workers and surveys were self-administered in a group format. Latino men were younger, less educated, and more likely to be employed than African American men and reported a lower household income and larger household size. Fruit and vegetable consumption was associated with physical activity (p < or = .001). A more positive attitude toward health was associated with meeting vegetable dietary guidelines (p < or = .05) and consuming fast food less frequently (p < or = .01). Active coping was associated with meeting fruit and vegetable dietary guidelines (p < or = .01 and p < or = .001, respectively), and avoidant coping was associated with greater fast-food consumption (p < or = .001). Latino fast-food consumption was associated with binge drinking (p < or = .001). This research provides evidence for tailoring dietary intervention for men of color.

Perceived stress and eating behaviors in a community-based sample of African Americans

Previous studies have reported that psychological stress is associated with greater food consumption, particularly consumption of high fat foods. We are unaware of any studies that have examined stress-induced eating among African Americans (AAs). The goals of the current study were to examine the relationship between perceived stress and high fat eating behaviors in a sample of AAs, to examine whether this relationship is stronger among overweight and obese participants, and to examine whether haphazard meal planning mediates the relationship between perceived stress and high fat eating behaviors. One hundred fifty-nine adults from a metropolitan area completed the Perceived Stress Scale (PSS-10), the Eating Behaviors Pattern Questionnaire (EBPQ), a demographic questionnaire, and body mass was assessed with BMI. Perceived stress was associated with haphazard planning and emotional eating, but not related to other high fat eating domains in the overall sample. These findings held for overweight and obese participants with the addition of snacking on sweets. High fat eating behaviors were not mediated by haphazard meal planning. These findings are consistent with other studies which demonstrate a link between stress and eating. Long-term interventions for high fat consumption and obesity should include an examination of perceived stress among AAs.

Efforts to achieve healthy aging

Longevity is a blessing as long as good health is not lost. However, the tendency to have a decline on normal physiological activities is inevitable because of the natural processes of degeneration at all levels: molecular, cellular and organic. Hence, the elderly people frequently suffer from cardiovascular problems and skeletal deteriorations that gradually develop to disabilities. Awareness of factors leading to unhealthy aging has led to the formation of different professional groups that aim at the maintenance of health of aging community. The approach tends to be target orientated for the European and US groups, aiming at hormonal replacements and detoxification. In contrast, the oriental groups have been keeping their traditional belief of prevention and internal balance, using nutritional arrangements and non-strenuous exercise as means of maintaining health.

Managing Excessive Weight Gain During Pregnancy and the Postpartum Period

Childbearing is a period in the life cycle during which some women may gain weight, become overweight, or become obese. Despite guidelines issued in 1990 for gestational weight gain, many women exceed them. Women who are overweight before pregnancy are most vulnerable to excessive gestational weight gain. Prenatal interventions to prevent excessive gain have had mixed results. During the postpartum period, 14% to 20% of women may retain weight from pregnancy, which elevates risk of later health problems. Although postpartum weight loss interventions have been shown to have efficacy, these have been tested primarily with White women. Continued efforts are needed in practice and research to develop effective approaches for managing weight during pregnancy and postpartum, especially for low-income and ethnic minority women.

How emotions affect eating: a five-way model

Despite the importance of affective processes in eating behaviour, it remains difficult to predict how emotions affect eating. Emphasizing individual differences, previous research did not pay full attention to the twofold variability of emotion-induced changes of eating (variability across both individuals and emotions). By contrast, the present paper takes into account both individual characteristics and emotion features, and specifies five classes of emotion-induced changes of eating: (1) emotional control of food choice, (2) emotional suppression of food intake, (3) impairment of cognitive eating controls, (4) eating to regulate emotions, and (5) emotion-congruent modulation of eating. These classes are distinguished by antecedent conditions, eating responses and mediating mechanisms. They point to basic functional principles underlying the relations between emotions and biologically based motives: interference, concomitance and regulation. Thus, emotion-induced changes of eating can be a result of interference of eating by emotions, a by-product of emotions, and a consequence of regulatory processes (i.e., emotions may regulate eating, and eating may regulate emotions).

Afferent signalling through the common hepatic branch of the vagus inhibits voluntary lard intake and modifies plasma metabolite levels in rats

The common hepatic branch of the vagus nerve is a two-way highway of communication between the brain and the liver, duodenum, stomach and pancreas that regulates many aspects of food intake and metabolism. In this study, we utilized the afferent-specific neurotoxin capsaicin to examine if common hepatic vagal sensory afferents regulate lard intake. Rats implanted with a corticosterone pellet were made diabetic using streptozotocin (STZ) and a subset received steady-state exogenous insulin replacement into the superior mesenteric vein. These were compared with non-diabetic counterparts. Each group was then subdivided into those whose common hepatic branch of the vagus was treated with vehicle or capsaicin. Five days after surgery, the rats were offered the choice of chow and lard to consume for a further 5 days. The STZ-diabetic rats ate significantly less lard than the non-diabetic rats. Capsaicin treatment restored lard intake to that of the insulin-replaced, STZ-diabetic rats, but modified neither chow nor total caloric intake. This increased lard intake led to selective fat deposition into the mesenteric white adipose tissue depot, as opposed to an increase in all visceral fat pad depots evident after insulin replacement-induced lard intake. Capsaicin treatment also increased the levels of circulating glucose and triglycerides and negated the actions of insulin on these and free fatty acids and ketone bodies. Collectively, these data suggest that afferent signalling through the common hepatic branch of the vagus inhibits lard, but not chow, intake, directs fat deposition and regulates plasma metabolite levels.

Daily limited access to sweetened drink attenuates hypothalamic-pituitary-adrenocortical axis stress responses

Stress can promote palatable food intake, and consumption of palatable foods may dampen psychological and physiological responses to stress. Here we develop a rat model of daily limited sweetened drink intake to further examine the linkage between consumption of preferred foods and hypothalamic-pituitary-adrenocortical axis responses to acute and chronic stress. Adult male rats with free access to water were given additional twice-daily access to 4 ml sucrose (30%), saccharin (0.1%; a noncaloric sweetener), or water. After 14 d of training, rats readily learned to drink sucrose and saccharin solutions. Half the rats were then given chronic variable stress (CVS) for 14 d immediately after each drink exposure; the remaining rats (nonhandled controls) consumed their appropriate drinking solution at the same time. On the morning after CVS, responses to a novel restraint stress were assessed in all rats. Multiple indices of chronic stress adaptation were effectively altered by CVS. Sucrose consumption decreased the plasma corticosterone response to restraint stress in CVS rats and nonhandled controls; these reductions were less pronounced in rats drinking saccharin. Sucrose or saccharin consumption decreased CRH mRNA expression in the paraventricular nucleus of the hypothalamus. Moreover, sucrose attenuated restraint-induced c-fos mRNA expression in the basolateral amygdala, infralimbic cortex, and claustrum. These data suggest that limited consumption of sweetened drink attenuates hypothalamic-pituitary-adrenocortical axis stress responses, and calories contribute but are not necessary for this effect. Collectively the results support the hypothesis that the intake of palatable substances represents an endogenous mechanism to dampen physiological stress responses.