State craving, food availability, and reactivity to preferred snack foods

Ketogenic diet reduces a neurobiological craving signature in inpatients with alcohol use disorder

Background and aims

Increasing evidence suggests that a ketogenic (high-fat, low-carbohydrate) diet (KD) intervention reduces alcohol withdrawal severity and alcohol craving in individuals with alcohol use disorder (AUD) by shifting brain energetics from glucose to ketones. We hypothesized that the KD would reduce a neurobiological craving signature when individuals undergoing alcohol detoxification treatment were exposed to alcohol cues.

Methods

We performed a secondary analysis of functional magnetic resonance data of 33 adults with an AUD who were randomized to a KD (n = 19) or a standard American diet (SA; n = 14) and underwent 3 weeks of inpatient alcohol detoxification treatment. Once per week, participants performed an alcohol cue-reactivity paradigm with functional magnetic resonance imaging. We extracted brain responses to food and alcohol cues and quantified the degree to which each set of brain images shared a pattern of activation with a recently established 'Neurobiological Craving Signature' (NCS). We then performed a group-by-time repeated measures ANOVA to test for differences in craving signature expression between the dietary groups over the three-week treatment period. We also correlated these expression patterns with self-reported wanting ratings for alcohol cues.

Results

For alcohol relative to food cues, there was a main effect of group, such that the KD group showed lower NCS expression across all 3 weeks of treatment. The main effect of time and the group-by-time interaction were not significant. Self-reported wanting for alcohol cues reduced with KD compared to SA but did not correlate with the NCS score.

Conclusion

A ketogenic diet reduces self-reported alcohol wanting, and induced lower NCS to alcohol cues during inpatient treatment for AUD. However, in the KD group alcohol wanting continued to decrease across the 3 weeks of abstinence while the NCS scores remained stable, suggesting that this cue-induced NCS may not fully capture ongoing, non-cue-induced alcohol desire.

Ketogenic diet reduces a neurobiological craving signature in alcohol use disorder

Background and Aims

Increasing evidence suggests that a ketogenic (high-fat, low-carbohydrate) diet intervention reduces alcohol withdrawal severity and alcohol craving in individuals with alcohol use disorder (AUD) by shifting brain energetics from glucose to ketones. We hypothesized that the ketogenic diet would reduce a brain craving signature when individuals undergoing alcohol detoxification treatment were exposed to alcohol cues.

Methods

We performed a secondary analysis of functional magnetic resonance data of n=33 adults with an AUD were randomized to a ketogenic diet (n=19) or a standard American diet (n=14) and underwent three weeks of inpatient alcohol detoxification treatment. Once per week, participants performed an alcohol cue-reactivity paradigm with functional magnetic resonance imaging. We extracted brain responses to food and alcohol cues and quantified the degree to which each set of brain images shared a pattern of activation with a recently validated 'Neurobiological Craving Signature' (NCS). We then performed a group-by-time repeated measures ANOVA to test for differences in craving signature expression between the dietary groups over the three-week treatment period. We also correlated these expression patterns with self-reported wanting ratings for alcohol cues.

Results

For alcohol relative to food cues, there was a main effect of group, such that the ketogenic diet group showed lower NCS expression across all three weeks of treatment. The main effect of time and the group-by-time interaction were not significant. Self-reported wanting for alcohol cues reduced with KD compared to SA but did not correlate with the NCS score.

Conclusions

A ketogenic diet reduces self-reported alcohol wanting, and induced lower brain craving signatures to alcohol cues during inpatient treatment for AUD.

Ketogenic diet reduces alcohol withdrawal symptoms in humans and alcohol intake in rodents

Individuals with alcohol use disorder (AUD) show elevated brain metabolism of acetate at the expense of glucose. We hypothesized that a shift in energy substrates during withdrawal may contribute to withdrawal severity and neurotoxicity in AUD and that a ketogenic diet (KD) may mitigate these effects. We found that inpatients with AUD randomized to receive KD (n = 19) required fewer benzodiazepines during the first week of detoxification, in comparison to those receiving a standard American (SA) diet (n = 14). Over a 3-week treatment, KD compared to SA showed lower "wanting" and increased dorsal anterior cingulate cortex (dACC) reactivity to alcohol cues and altered dACC bioenergetics (i.e., elevated ketones and glutamate and lower neuroinflammatory markers). In a rat model of alcohol dependence, a history of KD reduced alcohol consumption. We provide clinical and preclinical evidence for beneficial effects of KD on managing alcohol withdrawal and on reducing alcohol drinking.

Dynamic fMRI networks predict success in a behavioral weight loss program among older adults

More than one-third of adults in the United States are obese, with a higher prevalence among older adults. Obesity among older adults is a major cause of physical dysfunction, hypertension, diabetes, and coronary heart diseases. Many people who engage in lifestyle weight loss interventions fail to reach targeted goals for weight loss, and most will regain what was lost within 1-2 years following cessation of treatment. This variability in treatment efficacy suggests that there are important phenotypes predictive of success with intentional weight loss that could lead to tailored treatment regimen, an idea that is consistent with the concept of precision-based medicine. Although the identification of biochemical and metabolic phenotypes are one potential direction of research, neurobiological measures may prove useful as substantial behavioral change is necessary to achieve success in a lifestyle intervention. In the present study, we use dynamic brain networks from functional magnetic resonance imaging (fMRI) data to prospectively identify individuals most likely to succeed in a behavioral weight loss intervention. Brain imaging was performed in overweight or obese older adults (age: 65-79 years) who participated in an 18-month lifestyle weight loss intervention. Machine learning and functional brain networks were combined to produce multivariate prediction models. The prediction accuracy exceeded 95%, suggesting that there exists a consistent pattern of connectivity which correctly predicts success with weight loss at the individual level. Connectivity patterns that contributed to the prediction consisted of complex multivariate network components that substantially overlapped with known brain networks that are associated with behavior emergence, self-regulation, body awareness, and the sensory features of food. Future work on independent datasets and diverse populations is needed to corroborate our findings. Additionally, we believe that efforts can begin to examine whether these models have clinical utility in tailoring treatment.

Modern foraging: Presence of food and energy density influence motivational processing of food advertisements

More energy dense foods are preferable from an optimal foraging perspective, which suggests these foods are more motivationally relevant due to their greater capability of fulfilling biological imperatives. This increase in motivational relevance may be exacerbated in circumstances where foraging will be necessary. This study examined how food energy density and presence of food in the immediate environment interacted to influence motivational processing of food advertisements. N = 58 adults viewed advertisements for foods varying in energy density in contexts where the advertised food was actually present in the viewing room or not. Advertisements for more energy dense foods elicited greater skin conductivity level compared to ads for less energy dense foods when food was not present. All ads elicited decreases in corrugator supercilii activation indicating positive emotional response resultant from appetitive motivational activation, though the greatest activation was exhibited toward higher energy density foods when food was present. This supports an optimal foraging perspective and has implications for healthy eating interventions.

Craving for Food in Virtual Reality Scenarios in Non-Clinical Sample: Analysis of its Relationship with Body Mass Index and Eating Disorder Symptoms

Virtual reality (VR) technology has been successfully used to study the influence of specific and contextual food-related cues on emotional, cognitive and behavioural responses in patients with eating disorders (ED) and healthy controls. Following this research line, the present study assesses the effect on reported food craving of the type of food (low calorie versus high calorie) and the presence or absence of other people (private versus social context) in VR environments. Relationships between craving and body mass index (BMI) and ED symptoms are also explored. Eighty-seven female students were exposed to four VR scenarios presented in random order: a low-calorie kitchen, a high-calorie kitchen, a low-calorie restaurant and a high-calorie restaurant. After 2 minutes of exposure to each virtual scenario, food craving was assessed. Repeated measures analyses of covariance were conducted to assess changes in food craving following exposure to the different VR environments. Time elapsed since the last meal was introduced as a covariate to control for responses produced by food deprivation. Correlation and hierarchical multiple regression analyses were also conducted to assess the relationship between reported food craving and BMI and ED symptoms. Participants experienced higher levels of food craving after exposure to high-calorie foods (in both the kitchen and restaurant environments) than after exposure to low-calorie foods. Being alone in the kitchen or with friends in the restaurant had no effect on reported craving. Overall, neither BMI nor ED symptoms were related with reported food craving; only in the restaurant with low-calorie food was a significant negative correlation found between BMI and food craving. The results suggest that cue exposure in virtual environments is an effective procedure for inducing food craving in healthy controls and may be useful as a research and therapeutic tool in clinical populations.

Cortisol, but not intranasal insulin, affects the central processing of visual food cues

Stress glucocorticoids and insulin are important endocrine regulators of energy homeostasis, but little is known about their central interaction on the reward-related processing of food cues. According to a balanced group design, healthy food deprived men received either 40IU intranasal insulin (n=13), 30mg oral cortisol (n=12), both (n=15), or placebo (n=14). Acoustic startle responsiveness was assessed during presentation of food and non-food pictures. Cortisol enhanced startle responsiveness during visual presentation of "high glycemic" food pictures, but not during presentation of neutral and pleasant non-food pictures. Insulin had no effect. Based on the "frustrative nonreward" model these results suggest that the reward value of high glycemic food items is specifically increased by cortisol.

Meal replacement: calming the hot-state brain network of appetite

There is a growing awareness in the field of neuroscience that the self-regulation of eating behavior is driven by complex networks within the brain. These networks may be vulnerable to “hot states” which people can move into and out of dynamically throughout the course of a day as a function of changes in affect or visceral cues. The goal of the current study was to identify and determine differences in the Hot-state Brain Network of Appetite (HBN-A) that exists after a brief period of food restraint followed either by the consumption of a meal replacement (MR) or water. Fourteen overweight/obese adults came to our laboratory on two different occasions. Both times they consumed a controlled breakfast meal and then were restricted from eating for 2.5 h prior to an MRI scan. On one visit, they consumed a meal replacement (MR) liquid meal after this period of food restriction; on the other visit they consumed an equal amount of water. After these manipulations, the participants underwent a resting fMRI scan. Our first study aim employed an exploratory, data-driven approach to identify hubs relevant to the HBN-A. Using data from the water condition, five regions were found to be the hubs or nodes of the HBN-A: insula, anterior cingulated cortex, the superior temporal pole, the amygdala, and the hippocampus. We then demonstrated that the consumption of a liquid MR dampened interconnectivity between the nodes of the HBN-A as compared to water. Importantly and consistent with these network data, the consumption of a MR beverage also lowered state cravings and hunger.

Startling sweet temptations: hedonic chocolate deprivation modulates experience, eating behavior, and eyeblink startle

Many individuals restrict their food intake to prevent weight gain. This restriction has both homeostatic and hedonic effects but their relative contribution is currently unclear. To isolate hedonic effects of food restriction, we exposed regular chocolate eaters to one week of chocolate deprivation but otherwise regular eating. Before and after this hedonic deprivation, participants viewed images of chocolate and images of high-calorie but non-chocolate containing foods, while experiential, behavioral and eyeblink startle responses were measured. Compared to satiety, hedonic deprivation triggered increased chocolate wanting, liking, and chocolate consumption but also feelings of frustration and startle potentiation during the intertrial intervals. Deprivation was further characterized by startle inhibition during both chocolate and food images relative to the intertrial intervals. Individuals who responded with frustration to the manipulation and those who scored high on a questionnaire of impulsivity showed more relative startle inhibition. The results reveal the profound effects of hedonic deprivation on experiential, behavioral and attentional/appetitive response systems and underscore the role of individual differences and state variables for startle modulation. Implications for dieting research and practice as well as for eating and weight disorders are discussed.

Time course of electrocortical food-cue responses during cognitive regulation of craving

In our current obesogenic environment, exposure to visual food-cues can easily lead to craving and overeating because short-term, pleasurable effects of food intake dominate over the anticipated long-term adverse effects such as weight gain and associated health problems. Here we contrasted these two conditions during food-cue presentation while acquiring event-related potentials (ERPs) and subjective craving ratings. Female participants (n = 25) were presented with either high-calorie (HC) or low-calorie (LC) food images under instructions to imagine either immediate (NOW) or long-term effects (LATER) of consumption. On subjective ratings for HC foods, the LATER perspective reduced cravings as compared to the NOW perspective. For LC foods, by contrast, craving increased under the LATER perspective. Early ERPs (occipital N1, 150-200 ms) were sensitive to food type but not to perspective. Late ERPs (late positive potential, LPP, 350-550 ms) were larger in the HC-LATER condition than in all other conditions, possibly indicating that a cognitive focus on negative long-term consequences induced negative arousal. This enhancement for HC-LATER attenuated to the level of the LC conditions during the later slow wave (550-3000 ms), but amplitude in the HC-NOW condition was larger than in all other conditions, possibly due to a delayed appetitive response. Across all conditions, LPP amplitudes were positively correlated with self-reported emotional eating. In sum, results reveal that regulation effects are secondary to an early attentional analysis of food type and dynamically evolve over time. Adopting a long-term perspective on eating might promote a healthier food choice across a range of food types.

Weight loss and self-regulatory eating efficacy in older adults: the cooperative lifestyle intervention program

OBJECTIVES

Using the weight efficacy lifestyle questionnaire (WEL), we examined whether a group-mediated intervention for weight loss among older, obese adults resulted in changes in self-regulatory self-efficacy for eating behavior and whether these changes mediated weight loss.

METHODS

This was a randomized controlled design, and 288 older adults received 1 of 3 treatments for 6 months: physical activity only (PA), weight loss + physical activity (WL + PA), or a successful aging (SA) health education program. The WEL was administered prior to randomization and again at the 6-month follow-up visit.

RESULTS

A significant treatment effect was observed for the WEL, F (2249) = 15.11, p < .0001, partial eta2 = .11, showing that improvement occurred only in the WL + PA group as compared with PA and SA. Changes in WEL scores partially mediated the effects of the WL + PA intervention on weight loss.

DISCUSSION

These results illustrate that WL + PA can be effective in improving older adults' self-efficacy for the self-regulation of eating behavior and that these changes are prospectively related to the amount of weight loss. Further research is warranted on an expanded concept of self-efficacy as well as controlled experimental studies on eating behavior in older adults.