The Salted Food Addiction Hypothesis may explain overeating and the obesity epidemic

Breadth of substance use is associated with the selection of a larger food portion size via elevated impulsivity

Substance use is associated with altered or elevated food consumption and disordered eating. In the present study we examined whether breadth (variety) of drug use was associated with elevated portion size in a general population sample as it was in persons in recovery from substance use disorder. Furthermore, measures of emotional eating, impulsivity, food misuse, food craving were taken as possible mediators and reward responsiveness was examined as a potential moderator of this association. 444 adults (48.6 % women, mean age of 47.8 years) completed an online study in which they were asked to make judgements of ideal portion size for 6 different foods using a validated online tool that allowed participants to adjust the portion size of images of foods. Ideal portion size has been identified as a strong predictor of actual consumption. Participants were also asked to report the number of substances used in the past and provide anthropometric information. The results confirmed that breadth of drug use was associated with selection of higher portion size. Reward responsiveness was not a moderator of this relationship. Of the tested mediators, only impulsivity mediated the association between breadth of drug use and portion size. The results show that impulsivity may underlie the association between eating and substance use.

Taste Preferences at Different Ambient Temperatures and Associated Changes in Gut Microbiota and Body Weight in Mice

Taste, dietary choices, and gut microbiota are often analyzed as major factors of metabolic health. Populations living in cold or hot regions have different dietary habits. This study aims to investigate the potential association among ambient temperature, food taste preferences, and cecal microbiota community profiles in mice. By exposing mice to mixed diets containing sweet, sour, salty, and bitter flavors at low (4 °C) and high (37 °C) ambient temperatures, the taste preferences of mice at both ambient temperatures were in the order of saltiness > sweetness > bitterness > sourness. Exposing mice to sweet, sour, salty, and bitter diets, respectively, revealed that in a low-temperature environment, mice consuming salty (5.00 ± 1.49 g), sweet (4.99 ± 0.35 g), and sour (3.90 ± 0.61 g) diets had significantly higher weight gain compared to those consuming normal feeds (2.34 ± 0.43 g, p < 0.05). Conversely, in a high-temperature environment, no significant changes in body weight were observed among mice consuming different flavored diets (p > 0.05). In a low-temperature environment, mice fed sour and sweet diets showed a significant difference in the gut microbiota composition when compared to those fed a normal diet. A higher abundance of Lachnospiraceae, UBA1819, and Clostridiales was identified as the most significant taxa in the sour group, and a higher abundance of Ruminiclostridium was identified in the sweet group. These differences were associated with microbial pathways involved in carbohydrate metabolism, amino acid metabolism, and energy metabolism. A high-temperature environment exhibited only minor effects on the gut microbiota profile. Overall, our findings provide evidence for temperature-modulated responses to the taste, gut microbiota functions, and body weight changes in mice.

Food selection in a buffet scenario by persons in recovery from substance use disorder: Testing a parallel mediation model including impulsivity, food craving, and breadth of drug use

Elevated food cravings and higher food consumption and body weight have been reported in studies of people in recovery from substance use disorder (SUD). In a previous study, SUD recovery status predicted the energy from selected food images in a virtual buffet meal, most strongly in those with high reward responsiveness. The present study was conducted to determine which psychological variables might mediate the relationship between SUD recovery status and food selection and to replicate the finding that reward responsiveness moderated this relationship. In an online study, 216 women and men (109 in recovery from SUD) were asked to choose from among 16 food images in an all-you-can-eat buffet scenario. Food craving, impulsivity, "food addiction", irrational food beliefs, anhedonia, and breadth of drug use were examined as potential mediators while reward responsiveness was examined as a potential moderator. The amount of energy in the selected foods was the outcome variable. Results indicated that breadth of drug use was a mediator; being in SUD recovery predicted higher variety of drug use which predicted higher food selection. However, reward responsiveness did not moderate the relationship between SUD recovery status and energy from the selected foods. Exploratory analysis indicated that lack of premeditation, a measure of impulsivity, with food craving partially mediated the relationship between breadth of drug use and energy from selected foods and that lack of premeditation fully mediated it for sweet foods. The results confirm an association between substance use and food selection and suggest a mechanism via impulsivity.

Nutritional intake, environmental factors, and their impact on myopia prevalence in Korean children aged 5-12 years

BACKGROUND

Myopia is a complex condition influenced by numerous factors, including genetic predisposition, environmental factors, and lifestyle choices. Although evidence indicates that certain dietary factors may influence the development of myopia, this relationship is still not completely understood and is a topic of ongoing research.

METHODS

This study analyzed the relationship between dietary habits, environmental factors, and the prevalence of myopia in a sample of 24,345 children aged 5-12 years from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The average daily intake of dietary nutrients associated with the refractive error status of the participants was analyzed using analysis of variance (GLM) and the Scheffe method for post-hoc comparison. Multiple logistic regression analysis was conducted between the participant's refractive error status and daily dietary nutrient intake, while taking into consideration the age, sex, BMI, parental myopia, and near-work hours.

RESULTS

The risk of myopia increased with age, especially notable between ages 11 and 12, and was higher in children with both parents having myopia. Dietary factors played a crucial role; children with myopia had significantly lower intake of fat, omega-3 fatty acids, and retinol but higher intake of other nutrients compared to emmetropic and hyperopic counterparts. High consumption of carbohydrates, protein, phosphorus, iron, potassium, and sodium was associated with increased myopia risk. High sodium intake was particularly associated with a 2.05-fold increased myopia risk.

CONCLUSIONS

This study highlights the significant role of diet and lifestyle choices in the development of myopia in children. Our findings suggest the importance of considering these specific factors in the management and prevention strategies for myopia, underscoring the need for targeted interventions in children's health and vision care.

Sodium and potassium consumption in Jamaica: National estimates and associated factors from the Jamaica Health and Lifestyle Survey 2016-2017

This study aimed to estimate dietary sodium and potassium consumption among Jamaicans and evaluate associations with sociodemographic and clinical characteristics. A cross-sectional study was conducted using data from the Jamaica Health and Lifestyle Survey 2016-2017. Participants were noninstitutionalized Jamaicans aged ≥15 years. Trained staff collected sociodemographic and health data via interviewer-administered questionnaires and spot urine samples. The Pan American Health Organization formula was used to estimate 24-hour urine sodium and potassium excretion. High sodium level was defined as ≥2000 mg/day, and low potassium levels as <3510 mg/day (World Health Organization criteria). Associations between these outcomes and sociodemographic and clinical characteristics were explored using multivariable ANOVA models using log-transformed 24-hour urine sodium and potassium as outcome variables. Analyses included 1009 participants (368 males, 641 females; mean age 48.5 years). The mean sodium excretion was 3582 mg/day (males 3943 mg/day, females 3245 mg/day, P < .001). The mean potassium excretion was 2052 mg/day (males, 2210 mg/day; females, 1904 mg/day; P = .001). The prevalence of high sodium consumption was 66.6% (males 72.8%, females 60.7%, P < .001) and that of low potassium intake was 88.8% (85.1% males, 92.3% females, P < .001). Sodium consumption was inversely associated with older age, higher education, and low glomerular filtration rate but was directly associated with being male, current smoking, and obesity. Overall, males had higher sodium consumption than women, with the effect being larger among hypertensive men. Women with hypertension had lower sodium consumption than nonhypertensive women; however, hypertensive men had higher sodium consumption than nonhypertensive men. Potassium consumption was higher among men, persons with obesity, and those with high total cholesterol but was lower among men with "more than high school" education compared to men with "less than high school" education. We conclude that most Jamaican adults have diets high in sodium and low in potassium. In this study, sodium consumption was directly associated with male sex, obesity, and current smoking but was inversely associated with older age and higher education. High potassium consumption was associated with obesity and high cholesterol levels. These associations should be further explored in longitudinal studies and population-based strategies should be developed to address these cardiovascular risk factors.

Linking drug and food addiction: an overview of the shared neural circuits and behavioral phenotype

Despite a lack of agreement on its definition and inclusion as a specific diagnosable disturbance, the food addiction construct is supported by several neurobiological and behavioral clinical and preclinical findings. Recognizing food addiction is critical to understanding how and why it manifests. In this overview, we focused on those as follows: 1. the hyperpalatable food effects in food addiction development; 2. specific brain regions involved in both food and drug addiction; and 3. animal models highlighting commonalities between substance use disorders and food addiction. Although results collected through animal studies emerged from protocols differing in several ways, they clearly highlight commonalities in behavioral manifestations and neurobiological alterations between substance use disorders and food addiction characteristics. To develop improved food addiction models, this heterogeneity should be acknowledged and embraced so that research can systematically investigate the role of specific variables in the development of the different behavioral features of addiction-like behavior in preclinical models.

Reactivity to food cues in spicy food cravers: Physiological and behavioral responses

In China, the rate of spicy food consumption is rising, and chili pepper is among the most popular spicy foods consumed nationwide. According to the 'cued overeating' model, visual and olfactory cues of food can lead to changes in physiological responses and increase the likelihood and amount of food intake. However, no studies have explored the role of spicy food cues in cue reactivity among spicy food cravers. The exploratory study aimed to investigate cue-induced physiological responses, subjective cravings, eating behaviors and their associations in spicy food cravers. A group of spicy cravers (n = 59) and a group of age- and sex-matched non-cravers (n = 60) were exposed to food cues that contained or did not contain chili, during which physiological responses and food consumption were measured. The results revealed that spicy food cravers showed increased salivation and heart rate in response to food cues that contained chili compared to cues without chili and consumed significantly more chili oil after chili exposure. For cravers, heart rate during chili exposure was positively correlated with changes in subjective spicy food craving, and increases in subjective spicy food craving during chili exposure positively predicted subsequent chili oil consumption. The current exploratory study confirms the 'cued overeating' model and extends previous findings on food cravings, showing that even though chili peppers can elicit aversive oral burns and pain, they share the same physiological mechanism underlying cue reactivity as other kinds of cravings.

Development of Chinese food picture library for inducing food cravings

Cue-induced food cravings are strong desires directed toward specific foods, usually ones with high caloric content, and can lead to overeating. However, although food cravings vary according to individual preferences for specific high-calorie food subtypes, a structured library of food craving-inducing pictures including multiple categories of high-calorie foods does not yet exist. Here, we developed and validated a picture library of Chinese foods (PLCF) consisting of five subtypes of high-calorie foods (i.e., sweets, starches, salty foods, fatty foods, and sugary drinks) to allow for more nuanced future investigations in food craving research, particularly in Chinese cultural contexts. We collected 100 food images representing these five subtypes, with four food items per subtype depicted in five high-resolution photographs each. We recruited 241 individuals with overweight or obesity to rate the food pictures based on craving, familiarity, valence, and arousal dimensions. Of these participants, 213 reported the severity of problematic eating behaviors as a clinical characteristic. Under the condition of mixing multiple subtypes of high-calorie foods, we did not observe significant differences in craving ratings for high- and low-calorie food images (p _tukey > 0.05). Then, we compared each subtype of high-calorie food images to low-calorie ones, and found craving ratings were greater for the images of salty foods and sugary drinks (ps < 0.05). Furthermore, we conducted a subgroup analysis of individuals according to whether they did or did not meet the criteria for food addiction (FA) and found that greater cravings induced by the images of high-calorie food subtypes (i.e., salty foods and sugary drinks) only appeared in the subgroup that met the FA criteria. The results show that the PLCF is practical for investigating food cravings.

The Severity of Obesity Promotes Greater Dehydration in Children: Preliminary Results

The state of hydration of the body depends on the balance between the amount of water and salt consumed and excreted (the urinary extraction of excess sodium requires water). Inappropriate nutrition, particularly consuming too much processed food, causes obesity in children and additionally causes excessive sodium consumption, thus increasing the risk of excessive water loss. The aim of this study was to assess the hydration status of children with obesity and the relation between hydration, body composition, urinary sodium extraction, and nutrient intake. The study group consisted of 27 patients with obesity, with a mean age of 12.89 ± SD 2.79. Each patient's height, weight, body composition (electrical bioimpedance (BIA)), diet (7-day record), and biochemical tests were assessed. The hydration status was assessed using 24-hour urine collection, 24-hour urine osmolality, and an ultrasound of the vena cava (IVC/Ao index). Overall, 55% of children (n = 15) had urine osmolality values above 800 mOsm/kgH₂O, which indicates significant dehydration, and 53% (n = 14) were dehydrated, based on the IVC/Ao index. Children with obesity and dehydration had a significantly higher BMI (31.79 vs. 27.32; p = 0.0228), fat mass percentage (37.23% vs. 30.07% p = 0.0051), and fat mass in kg (30.89 vs. 20.55; p = 0.0158), and significantly higher sodium intake from their diet (3390.0 mg vs. 2921.0 mg; p = 0.0230), as well as their sodium/potassium ratio (2.4 vs. 2.0; p = 0.0043). The 24-hour urinary sodium excretion and osmolality values were directly related to fat-mass percentage and fat-mass (in kg) in a simple linear correlation analysis. Our preliminary results confirm that obesity is related to dehydration. The overall high sodium excretion in children with obesity indicates an excessive salt intake along with low potassium intake, which is a significant predictor of dehydration, regardless of the total water intake (TWI).

Association of Dietary Patterns with Metabolic Syndrome in Chinese Children and Adolescents Aged 7–17: The China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017

This study aims to determine the associations of dietary patterns with metabolic syndrome (MetS) and its components in Chinese children and adolescents aged 7–17 in 2016–2017. Using the data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, the sociodemographic information, diet, anthropometric measurements and clinical examinations of subjects were obtained, and a total of 13,071 school-aged children and adolescents were included in this study. The Cook criteria were used to define MetS and its components. Dietary intake was derived from 24-h dietary records for three consecutive days, combined with the weighing method. Factor analysis was used to identify major dietary patterns. The associations of dietary patterns with MetS and its components were examined by logistic regression analysis. Consequently, five distinct dietary patterns were identified by factor analysis, and the relationships between dietary patterns with MetS and its components were observed. After adjusting for covariates, the animal product and vegetable patterns may have a positive association with MetS; the condiment pattern was positively associated with low HDL-C; the fruit and junk food patterns had positive relationships with MetS, abdominal obesity and high TG; the cereals and tubers pattern was positively associated with MetS, abdominal obesity, high TG and low HDL-C; the beans pattern was positively associated with high TG.

Co-occurring alcohol use disorder and obesity in U.S. military veterans: Prevalence, risk factors, and clinical features

Obesity and alcohol use disorder (AUD) are two of the most prevalent and costly clinical conditions among U.S. military veterans, and these conditions often co-occur. However, little is known about the clinical correlates of co-occurring obesity and AUD, which is critical to informing effective interventions. The current study analyzed data from a nationally representative sample of 4069 (3463 males, 479 females) veterans, who completed an online survey. The Alcohol Use Disorder Identification Test was used to identify veterans who screened positive for probable AUD (pAUD) and self-reported height and weight was used to calculate body mass index and identify veterans with obesity. Multinomial logistic regression was used to examine differences between four groups: controls (no current AUD or obesity), pAUD only, obesity only, and pAUD + obesity. A total of 1390 (36.1%) veterans had obesity, 10.5% (n = 359) had pAUD, and 3.7% (n = 124) had pAUD and obesity. Relative to veterans without AUD, Veterans with pAUD were less likely to have normal/lean weight (14.6% versus 21.4%) and more likely to have overweight (49.6% versus 41.7%). Veterans with pAUD + obesity were nearly twice as likely than veterans with pAUD to report three or more adverse childhood experiences. The results of this study help inform the clinical presentation and needs of veterans with co-occurring obesity and AUD. They also underscore the importance of regularly monitoring weight among veterans with AUD, and considering the role of childhood adversity as a risk factor for co-occurring AUD and obesity.

Solid or Liquid Food-The Intention to Eat Different Foods under Negative Emotions

Food can relieve an individual's emotions, especially for emotional eaters. For instance, chewing alleviates negative emotions. Solid and liquid foods comprise a huge part of our daily lives, and the chewiness of solid foods is always high. Here, we explored whether people, especially emotional eaters, have higher eating intentions to eat highly chewy foods while experiencing negative emotions by comparing their eating intentions toward solid and liquid foods. To this end, we conducted a survey of 147 participants using a questionnaire (Experiment 1) to understand their eating intention toward five types of food (purple potato, maize, black soya bean, mango, and soybean; each food group contained a solid food and a liquid food) while experiencing negative emotions. The results showed that individuals exhibited higher eating intention toward solid food compared with liquid food while experiencing negative emotions. In Experiment 2, we selected 85 and 65 high-emotional and low-emotional eaters, respectively, and further explored their preference for solid foods. The results showed that individuals with high levels of emotional eating exhibited higher intentions toward solid food while experiencing negative emotions compared with those with low levels of emotional eating. In conclusion, this study proved that individuals' higher eating intentions toward highly chewable food were pronounced among individuals with high levels of emotional eating under negative emotion conditions.

Perceived stress and willingness to quit smoking among patients with depressive and anxiety disorders seeking treatment

Rationale and objectives

Little are known about nicotine dependence (ND), perceived stress, and willingness to quit smoking at different treatment stages in patient with affective disorders (AD). This study aimed to evaluate the association between ND and perceived stress among patients with AD presenting with psychiatric treatment at different clinical stages (first visit or follow‐up), and in different nicotine type users (cigarette and waterpipe smokers). We also aimed to evaluate the willingness to quit smoking and its association with barriers to quitting.

Methods

This cross‐sectional mixed‐method study collected quantitative and qualitative data from patients (n = 57) presenting for treatment with AD and ND at different sites in Saudi Arabia. Quantitative validated scales were used to assess the 70 of depression symptoms, anxiety symptoms, perceived stress, and ND. Qualitative questions assessed barriers to quit smoking. We used a linear regression modeling to estimate the association between ND and perceived stress as well as to estimate the association between barrier to quit and willingness to quit.

Results

ND had a statistically significant association with perceived stress (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.20‐3.63). Participants in the follow‐up group had a higher ND score than those in the first‐visit group. One of the most commonly reported barriers to quitting was using nicotine as a stress management (33.3%), which predicted positive willingness to quit (OR: 2.23; 95% CI: 1.48‐3.37; P < .01). Boredom was reported as a barrier in the waterpipe group more than cigarette group.

Conclusion

ND has a significant association with perceived stress regardless of treatment status in patients with AD, indicating the need to evaluate smoking cessation during the early stages of treatment for patients with AD and ND. It will be critical for clinicians to offer patients with AD alternative coping mechanisms to manage stress and boredom.

Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income, Predominantly Latino Urban Residents: An Agent-Based Model

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)−(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.

The Effects of Dietary Pattern on Metabolic Syndrome in Jiangsu Province of China: Based on a Nutrition and Diet Investigation Project in Jiangsu Province

Metabolic syndrome, a complex group of metabolic disorders of energy use and storage, is considered as an important determinant risk factor for many cardiovascular diseases. This study aimed to examine the association between metabolic syndrome (MetS) and dietary pattern among adults in Jiangsu Province of China. Data were from three rounds of cross–sectional nutrition and diet investigation projects in Jiangsu Province of China, which were conducted in 2002, 2007, and 2014 by Jiangsu Provincial Center for Disease Control and Prevention. A total of 13,944 participants with complete food frequency questionnaire (FFQ) were eventually included in this study after further data screening. The 2009 Joint Interim Statement for China was used to define metabolic syndrome. Three distinct dietary patterns were identified by factor analysis: the modern dietary pattern (rich in pork, poultry, vegetables, seafood, pastry food, other animal meats, fruits, milk and its products, soft drink, whole grains, nuts, and seeds, but low in wheat), vegetable oils/condiments/soy products dietary pattern (rich in vegetable oils, other condiments, salt, soy products, and fruits and low in dry legumes), and modern high–wheat dietary pattern (rich in wheat, tubers, fruits, and other animal meats, but low in rice). Higher intake of the modern dietary pattern and modern high–wheat dietary pattern were positively associated with metabolic syndrome in both unadjusted and adjusted models by genders, whereas higher intake of the vegetable oils/condiments/soy products dietary pattern had a negative relationship with metabolic syndrome in both unadjusted and adjusted models by genders (p < 0.05). Our study recommends reducing the consumption of animal meat products, especially processed meat products, and replacing animal oils with vegetable oils as the main supply of daily oils. Furthermore, more prospective and experimental studies are needed to confirm the relationship between dietary patterns and metabolic syndrome.

Transdiagnostic Perspective of Impulsivity and Compulsivity in Obesity: From Cognitive Profile to Self-Reported Dimensions in Clinical Samples with and without Diabetes

Impulsive and compulsive behaviors have both been observed in individuals with obesity. The co-occurrence of obesity and type 2 diabetes (T2D) is more strongly associated with impulsivity, although there are no conclusive results yet. A multidimensional assessment of impulsivity and compulsivity was conducted in individuals with obesity in the absence or presence of T2D, compared with healthy, normal-weight individuals, with highly impulsive patients (gambling disorders), and with highly compulsive patients (anorexia nervosa). Decision making and novelty seeking were used to measure impulsivity, and cognitive flexibility and harm avoidance were used for compulsivity. For impulsivity, patients with obesity and T2D showed poorer decision-making ability compared with healthy individuals. For compulsivity, individuals with only obesity presented less cognitive flexibility and high harm avoidance; these dimensions were not associated with obesity with T2D. This study contributes to the knowledge of the mechanisms associated with diabetes and its association with impulsive–compulsive behaviors, confirming the hypothesis that patients with obesity and T2D would be characterized by higher levels of impulsivity.

Association between childhood obesity and familial salt intake: analysis of data from Korean National Health and Nutrition Examination Survey, 2014-2017

High salt intake is known as a risk factor of childhood obesity. As family members share not only genes but also their diet habit, parents' salt intake may affect to their children's obesity. In this study, we investigated correlations between childhood obesity and parents' or children's sodium intakes based on a nationwide survey data. From the Korean National Health and Nutrition Examination Survey data from 2014 to 2017, 802 boys and 657 girls aged 10-18 years, and their parents were included. BMI z-score and 24-hour urinary sodium excretion, which is estimated through Tanaka's equation, were used to examine associations between obesity and sodium intakes. The BMI status and the prevalence of obesity between children and their parents showed strong positive correlations in both sexes (all p < 0.001). The urinary sodium excretion between children and their parents showed positive correlations in both sexes (all p < 0.05). Children with higher urinary sodium excretion showed higher BMI (in both sexes, p < 0.001) and higher parental obesity compared to those with lower urinary sodium excretion, however, statistical significances of the latter relationship were varied by sex. In conclusion, our study suggests close relationship between childhood obesity and their sodium intakes, which also correlate well with parental BMIs and diet behavior. Therefore, parental education and active participation could be crucial in regulating childhood obesity.

Decoding the Role of Gut-Microbiome in the Food Addiction Paradigm

Eating behaviour is characterised by a solid balance between homeostatic and hedonic regulatory mechanisms at the central level and highly influenced by peripheral signals. Among these signals, those generated by the gut microbiota have achieved relevance in recent years. Despite this complex regulation, under certain circumstances eating behaviour can be deregulated becoming addictive. Although there is still an ongoing debate about the food addiction concept, studies agree that patients with eating addictive behaviour present similar symptoms to those experienced by drug addicts, by affecting central areas involved in the control of motivated behaviour. In this context, this review tries to summarise the main data regarding the role of the gut microbiome in eating behaviour and how a gut dysbiosis can be responsible for a maladaptive behaviour such as “food addiction”.

Is Food Addictive? A Review of the Science

As ultraprocessed foods (i.e., foods composed of mostly cheap industrial sources of dietary energy and nutrients plus additives) have become more abundant in our food supply, rates of obesity and diet-related disease have increased simultaneously. Food addiction has emerged as a phenotype of significant empirical interest within the past decade, conceptualized most commonly as a substance-based addiction to ultraprocessed foods. We detail (a) how approaches used to understand substance-use disorders may be applicable for operationalizing food addiction, (b) evidence for the reinforcing potential of ingredients in ultraprocessed foods that may drive compulsive consumptions, (c) the utility of conceptualizing food addiction as a substance-use disorder versus a behavioral addiction, and (d) clinical and policy implications that may follow if ultraprocessed foods exhibit an addictive potential. Broadly, the existing literature suggests biological and behavioral parallels between food addiction and substance addictions, with ultraprocessed foods high in both added fat and refined carbohydrates being most implicated in addictive-like eating. Future research priorities are also discussed, including the need for longitudinal studies and the potential negative impact of addictive ultraprocessed foods on children. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Foods and Nutritional Characteristics Associated With Addictive-Like Eating

Emerging literature is exploring the contribution of specific nutritional characteristics and food additives to the development of addictive-like eating, implicating highly processed foods and those high in fat and sugar in its pathophysiology. To our knowledge, no mixed methods study has yet aimed to investigate the relationship between food characteristics and addictive-like eating. Towards this end, we applied an a priori classification scheme to open-ended answers to enable us to use quantitative methods to analyze qualitative data. A sample of individuals who endorsed self-perceived "food addiction" (N = 182; 50% female; M_age = 34.1) reported the foods to which they believed they were "addicted." We classified these foods according to their levels of fat, carbohydrates, sugar, and sodium, and evaluated their predictive power on addictive-like eating. Pizza, chocolate, hamburgers, and pasta respectively, were the most reported food items to which participants felt they were addicted. Addictive-like eating was significantly predicted by endorsement of "addiction" to high-sodium foods. In contrast, "addiction" to high-sugar foods negatively predicted addictive-like eating symptoms. Findings support an association between highly processed and high-sodium foods with addictive-like eating behavior among humans, consistent in large part with prior human and animal literature. Results also suggest that people are readily able to report on their experiences of addiction to foods; specifically, they can freely endorse the experience of addictive-like eating and offer experiences of addictive foods that are largely consistent with theory and the literature.

Relationship of Sodium Intake with Overweight/Obesity among Chinese Children and Adolescents: Data from the CNNHS 2010-2012

This study aims to examine association between sodium intake and overweight/obesity among Chinese children and adolescents. Data were obtained from China National Nutrition and Health Surveillance (CNNHS), 2010–2012. All participants recruited in this study aged 7–18 years old and provided complete dietary data on three-day consecutive 24 h dietary recalls combining with the household weighing method. Body Mass Index (BMI) was used to define overweight/obesity, and waist-to-height ratio (WHtR) was used to define abdominal obesity. Sodium intake showed association with risk of overweight/obesity assessed by BMI in the highest tertile group with OR of 1.48 (95%CI 1.13–1.94) and 1.89 (95%CI 1.33–2.67) for WHtR. After adjusted for gender, age, household income, area, energy, carbohydrates, protein, fat, saturated fatty acids, and fiber intake, the relationship between sodium intake and overweight/obesity and abdominal obesity are not changed. The same results were founded in subjects aged 10–18 years old. Our results reveal a positive association between sodium intake and overweight/obesity in Chinese children and adolescents, independent of energy consumption.

Ultraprocessed Food: Addictive, Toxic, and Ready for Regulation

Past public health crises (e.g., tobacco, alcohol, opioids, cholera, human immunodeficiency virus (HIV), lead, pollution, venereal disease, even coronavirus (COVID-19) have been met with interventions targeted both at the individual and all of society. While the healthcare community is very aware that the global pandemic of non-communicable diseases (NCDs) has its origins in our Western ultraprocessed food diet, society has been slow to initiate any interventions other than public education, which has been ineffective, in part due to food industry interference. This article provides the rationale for such public health interventions, by compiling the evidence that added sugar, and by proxy the ultraprocessed food category, meets the four criteria set by the public health community as necessary and sufficient for regulation—abuse, toxicity, ubiquity, and externalities (How does your consumption affect me?). To their credit, some countries have recently heeded this science and have instituted sugar taxation policies to help ameliorate NCDs within their borders. This article also supplies scientific counters to food industry talking points, and sample intervention strategies, in order to guide both scientists and policy makers in instituting further appropriate public health measures to quell this pandemic.

The association between dietary sodium intake, adiposity and sugar-sweetened beverages in children and adults: a systematic review and meta-analysis

Higher intakes of Na may contribute to weight gain. The primary aim of this systematic review and meta-analysis was to examine the relationship between dietary Na intake and measures of adiposity in children and adults. Given the previous link between Na intake and the consumption of sugar-sweetened beverages (SSB), which are a known risk factor for obesity, a secondary aim examining the relationship between Na intake and SSB consumption was assessed. A systematic literature search identified cross-sectional and longitudinal studies and randomised controlled trials (RCT) which reduced dietary Na (≥3 months). Meta-analysis was performed for outcomes with ≥3 studies. Cross-sectionally higher Na intakes were associated with overweight/obesity in adults (five studies; n 11 067; OR 1·74; 95 % CI 1·43, 2·13) and in children (three studies; n 3625, OR 3·29; 95 % CI 2·25, 4·80), and abdominal obesity (five studies; n 19 744; OR 2·04; 95 % CI 1·72, 2·42) in adults. Overall, associations remained in sensitivity analyses which adjusted for energy. Findings from longitudinal studies were inconsistent. RCT in adults indicated a trend for lower body weight on reduced-Na compared with control diets (fifteen studies; n 5274; -0·29 kg; 95 % CI -0·59, 0·01; P = 0·06); however, it is unclear if energy intakes were also altered on reduced-Na diets. Among children higher Na intakes were associated with higher intake of SSB (four studies, n 10 329, b = 22, 16 and 26 g/d); no studies were retrieved for adults. Overall, there was a lack of high-quality studies retrieved. While cross-sectional evidence indicates Na intake was positively associated with adiposity, these findings have not been clearly confirmed by longitudinal studies or RCT.

Neurological correlates of brain reward circuitry linked to opioid use disorder (OUD): Do homo sapiens acquire or have a reward deficiency syndrome?

The extant literature confirms that an array of polymorphic genes related to- neurotransmitters and second messengers govern the net release of dopamine in the Nucleus Accumbens (NAc) in the mesolimbic region of the brain. They are linked predominantly to motivation, anti-stress, incentive salience (wanting), and wellbeing. Notably, in 2000 the Nobel Prize was awarded to Carlsson, Greengard, and Kandel for their work on the molecular and cellular function of dopaminergic activity at neurons. This historical psychopharmacological work involved neurotransmission of serotonin, endorphins, glutamate, and dopamine, and the seminal work of Blum, Gold, Volkow, Nestler, and others related to neurotransmitter function and related behaviors. Currently, Americans are facing their second and worst opioid epidemic, prescribed opioids, and easy access drive this epidemic of overdoses, and opioid use disorders (OUDs). Presently the clinical consensus is to treat OUD, as if it were an opioid deficiency syndrome, with long-term to life-long opioid substitution therapy. Opioid agonist administration is seen as necessary to replace missing opioids, treat OUD, and prevent overdoses, like insulin is used to treat diabetes. Treatment of OUD and addiction, in general, is similar to the endocrinopathy conceptualization in that it views opioid agonist MATs as an essential core to therapy. Is this approach logical? Other than as harm reduction, is using opioids to treat OUD therapeutic or harmful in the long term? This historical Trieste provides a molecular framework to understand the current underpinnings of endorphinergic/dopaminergic mechanisms related to opioid deficiency syndrome and generalized reward processing depletion. WC 249.

Is urinary sodium excretion related to anthropometric indicators of adiposity in adults?

Background

Although increasing salt intake is associated with greater odds of obesity, little is known about its relationship with body fat. We investigated the relation of urinary sodium (UNa) with obesity indices, including Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), a body shape index (ABSI), body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR).

Materials and Methods

A total of 508 free-living adults aged ≥ 19 years were selected through stratified multistage random method as a representative of general population from central parts of Iran and were included in this cross-sectional study. Dietary sodium intake was measured using 24-h UNa (24-UNa) excretion. Weight, height, and WC were measured using standard protocols and calibrated equipment and used to measure obesity indicators, including BMI, WHtR, ABSI, and CUN-BAE. Adjusted univariate multiple logistic regression was used to assess the risk of having greater obesity measures across the tertiles of 24-UNa.

Results

Individuals in the top tertile of 24-UNa in comparison with those in the first tertile had greater body weight (72.02 ± 1.00 vs. 66.02 ± 0.89 kg; P < 0.0001), BMI (26.14 ± 0.33 vs. 24.82 ± 0.29 kg/m²; P = 0.007), and CUN-BAE (29.89 ± 0.42 vs. 28.38 ± 0.78; P = 0.036). There was a trend toward an increment in WC by increasing sodium intake (P = 0.073). After controlling for potential confounders, individuals with greater sodium consumption had greater chance for overweight (odds ratio [OR]: 1.004, 95% confidence interval [CI]: 1.001-1.007; P = 0.015), abdominal obesity (OR: 1.004, 95% CI: 1.00-1.008; P = 0.031), and more body fat (OR: 1.007, 95% CI: 1.003-1.01; P = 0.001). No significant association was found for sodium and WHtR and ABSI.

Conclusion

Greater 24-UNa excretion was associated with greater means of body weight, BMI, WC, and CUN-BAE. Although changes in obesity indices per each additional 24-UNa excretion were small, our findings are relevant because of the rising obesity epidemic.

Salt need needs investigation

Expensive and extensive studies on the epidemiology of excessive Na intake and its pathology have been conducted over four decades. The resultant consensus that dietary Na is toxic, as well as the contention that it is less so, ignores the root cause of the attractiveness of salted food. The extant hypotheses are that most Na is infiltrated into our bodies via heavily salted industrialised food without our knowledge and that mere exposure early in life determines lifelong intake. However, these hypotheses are poorly evidenced and are meagre explanations for the comparable salt intake of people worldwide despite their markedly different diets. The love of salt begins at birth for some, vacillates in infancy, climaxes during adolescent growth, settles into separate patterns for men and women in adulthood and, with age, fades for some and persists for others. Salt adds flavour to food. It sustains and protects humans in exertion, may modulate their mood and contributes to their ailments. It may have as yet unknown benefits that may promote its delectability, and it generates controversy. An understanding of the predilection for salt should allow a more evidence-based and effective reduction of the health risks associated with Na surfeit and deficiency. The purpose of this brief review is to show the need for research into the determinants of salt intake by summarising the little we know.

The Modified Yale Food Addiction Scale 2.0: Validation Among Non-Clinical and Clinical French-Speaking Samples and Comparison With the Full Yale Food Addiction Scale 2.0

OBJECTIVES

The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) was designed to assess food addiction using a shorter version than the YFAS 2.0. We lack data about the psychometric properties of the mYFAS 2.0 in patients with obesity, as well as studies comparing the psychometric properties of the mYFAS 2.0 versus the full YFAS 2.0. This study aimed to validate the French-language mYFAS 2.0 in a non-clinical population (study 1, n = 250), to determine the yet unknown psychometric properties of this scale in patients with obesity (study 2, n = 345), and to compare the full YFAS 2.0 and the mYFAS 2.0 in terms of food addiction (FA) prevalence and symptoms detection in both populations.

METHOD

Study 1 included 250 non-clinical individuals (non-underweight and non-obese persons screened negative for eating disorders). Study 2 included 345 bariatric surgery candidates recruited in three centers (Québec, Canada; Reims and Tours, France). The mYFAS 2.0 structure was investigated using confirmatory factorial analyses with tetrachoric correlations. Convergent validity was tested using the full YFAS 2.0, the Binge Eating Scale (both studies), the revised 18-item Three Factor Eating Questionnaire (study 1), the Beck Depression Inventory (study 2), and the body mass index (BMI; both studies).

RESULTS

The mYFAS 2.0 was unidimensional, and had adequate (study 1: KR-20 = .78) and acceptable (study 2: KR-20 = .73) internal consistency. In study 1, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, BMI, binge eating, cognitive restraint, uncontrolled eating and emotional eating; in study 2, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, binge eating, depression, but not BMI. Participants endorsed fewer symptoms with the mYFAS 2.0 than with the YFAS 2.0; FA prevalences were similar between questionnaires in the non-clinical, but not in the clinical sample. A FA 'diagnosis' and risk of binge eating disorder were associated but did not completely overlap.

CONCLUSIONS

The mYFAS 2.0 has close psychometric properties to the YFAS 2.0 in non-clinical and clinical samples. However, the use of the mYFAS 2.0 in bariatric surgery candidates might lead to a significant underestimation of FA prevalence and number of FA symptoms.

Sodium Intake from Foods Exceeds Recommended Limits in the Spanish Population: The ANIBES Study

Excessive sodium consumption is associated with adverse health effects. An elevated dietary intake of salt (sodium chloride) has been related to high blood pressure or hypertension, a major but modifiable risk factor for cardiovascular disease, as well as to other ill health conditions. In the present work, our aim was to describe the contribution of foods to sodium consumption within the Spanish population in a representative sample from the "anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain" (ANIBES) study (9-75 years), to identify high consumer groups, as well as the major food groups that contribute to sodium intake in the Spanish diet. Intakes were assessed by 3-day food records collected on a tablet device. Sodium intakes across the ANIBES study population exceeded recommendations, as total intakes reached 2025 ± 805 mg of sodium per day, that is approximately 5.06 g/day of salt (excluding discretionary salt, added at the table or during cooking). Sodium intakes were higher in males than in females and within the youngest groups. Main dietary sources of sodium were meat and meat products (27%), cereals and grains (26%), milk and dairy products (14%) and ready-to-eat meals (13%). Given the established health benefits of dietary salt reduction, it would be advisable to continue and even improve the current national initiatives of awareness and educational campaigns and particularly food reformulation to decrease overall salt intakes across the Spanish population.

The influence of opioid dependence on salt consumption and related psychological parameters in mice and humans

BACKGROUND

The consumption of dietary salt (NaCl) is controlled by neuronal pathways that are modulated by endogenous opioid signalling. The latter is disrupted by chronic use of exogenous opioid receptor agonists, such as morphine. Therefore, opioid dependence may influence salt consumption, which we investigated in two complimentary studies in humans and mice.

METHODS

Human study: three groups were recruited: i. Individuals who are currently opioid dependent and receiving opioid substitution treatment (OST); ii. Previously opioid dependent individuals, who are currently abstinent, and; iii. Healthy controls with no history of opioid dependence. Participants tasted solutions containing different salt concentrations and indicated levels of salt 'desire', salt 'liking', and perceptions of 'saltiness'. Mouse study: preference for 0.1 M versus 0.2 M NaCl and overall levels of salt consumption were recorded during and after chronic escalating morphine treatment.

RESULTS

Human study: Abstinent participants' 'desire' for and 'liking' of salt was shifted towards more highly concentrated salt solutions relative to control and OST individuals. Mouse study: Mice increased their total salt consumption during morphine treatment relative to vehicle controls, which persisted for 3 days after cessation of treatment. Preference for 'low' versus 'high' concentrations of salt were unchanged.

CONCLUSION

These findings suggest a possible common mechanistic cross-sensitization to salt that is present in both mice and humans and builds our understanding of how opioid dependence can influence dietary salt consumption. This research may help inform better strategies to improve the diet and overall wellbeing of the growing number of individuals who develop opioid dependence.

The validation of the Malay Yale Food Addiction Scale 2.0: factor structure, item analysis and model fit

Objective:

The development of a second version of the Yale Food Addiction Scale (YFAS) coincides with the latest updates in the diagnosis of addiction as documented in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The objective of the present study was to translate the YFAS 2.0 into the Malay language and test its psychometric properties in a primary-care population.

Design:

Patients were assessed for food addiction utilizing the Malay YFAS 2.0. The participants were also assessed for eating disorder using the validated Malay Binge Eating Scale. The psychometric properties of the YFAS 2.0 were determined by analysing factor structure, overall item statistics, internal consistency and construct validity.

Setting:

Between 2017 and 2018, participants were chosen from a regional primary-care clinic in the district of Seremban, Malaysia.

Participants:

Patients (n 382) from a regional primary-care clinic.

Results:

The prevalence of food addiction was 5·0%. A two-factor structure of the YFAS was confirmed as the most optimal solution for the scale via confirmatory factor analysis. In both its diagnostic and symptom count version, the YFAS 2.0 had good internal consistency (Kuder–Richardson α > 0·80 and McDonald’s ω > 0·9).

Conclusions:

We validated a psychometrically sound Malay version of the YFAS 2.0 in a primary-care population. Both diagnostic and symptom count versions of the scale had robust psychometric properties. The questionnaire can be used to develop health promotion strategies to detect food addiction tendencies in a general population.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Food selection, food craving, and body mass index in persons in treatment for substance use disorder

Studies of persons in treatment for substance use disorder (SUD) frequently report significant body weight gain and higher food consumption. It is unclear what psychological variables might mediate a relationship between SUD treatment status and food selection. To examine the association between SUD treatment status and food selection, 212 men and women (104 in treatment for SUD) were asked, in an online survey, to choose from among 16 food images in an imagined all-you-can-eat buffet scenario. Food craving, emotional eating (EE), impulsivity, and drugs used were examined as potential mediators while reward responsiveness (RR) was examined as a potential moderator. The amount of energy from foods selected was the predicted variable. Results indicated that those in treatment for SUD had significantly higher food cravings, positive EE, and attentional and motor impulsivity (but not RR or negative EE) which were (with the exception of RR) not correlated with energy selected from food images. Those in SUD treatment selected more energy (M = 2655.10 kcal, SEM = 156.97) from food images than those in the control group (M = 2221.52 kcal, SEM = 112.29), t(188) = -2.25, p = 0.026. In a multiple regression moderation analysis, SUD treatment status (β = 419.58, p = 0.029) and RR (β = 39.23, p = 0.016) were significant predictors of energy from foods selected. The amount of energy selected from food images predicted by SUD treatment status was dependent on values of RR. Mean BMI was not significantly higher for the SUD group but there were more participants with BMI values over 29 and fewer with BMI between 25 and 29 in the SUD treatment group. While the cause remains unclear, the results show that persons in treatment for SUD and with higher RR do select more energy from food images in a meal scenario.

The effects of individual circadian rhythm differences on insomnia, impulsivity, and food addiction

PURPOSE

Individuals can generally be divided into morning, neither and evening types according to behavioral, psychological, and biological variables including appetite levels, usual meal times, sleep times, and melatonin secretion. These factors together identify a person as being part of a certain chronotype, i.e., as feeling more efficient either in the morning (morning type) or later in the day (evening type). Food addiction is defined as addictive behavior toward palatable foods and is thought to be one of the underlying risk factors for obesity. Our aim in this study was to investigate the relationship between circadian rhythm differences and food addiction via insomnia and impulsivity in university students.

METHOD

Participants were 1323 university students, filled out a package of psychological tools, including the Morningness-Eveningness Questionnaire, Insomnia Severity Index, Barratt Impulsiveness Scale Short Form, and Yale Food Addiction Scale. Logistic regression analysis was used to investigate direct relation of food addiction with insomnia, impulsivity and obesity, and mediation regression analysis was used to investigate the indirect effect of circadian rhythm differences on food addiction.

RESULTS

Our findings indicated that evening types were more prone to insomnia and impulsivity, and also insomnia and impulsivity significantly contributed to the variance of food addiction. Although there was no significant linear relationship between circadian rhythm differences and food addiction, evening-type circadian preferences were indirectly associated with higher food addiction scores mediated by insomnia and impulsivity.

CONCLUSION

The most remarkable result of our work was that circadian rhythm differences seem to indirectly effect on food addiction through elevated insomnia and impulsivity.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Association of usual 24-h sodium excretion with measures of adiposity among adults in the United States: NHANES, 2014

Background

Both excessive sodium intake and obesity are risk factors for hypertension and cardiovascular disease. The association between sodium intake and obesity is unclear, with few studies assessing sodium intake using 24-h urine collection.

Objectives

Our objective was to assess the association between usual 24-h sodium excretion and measures of adiposity among US adults.

Methods

Cross-sectional data were analyzed from a sample of 730 nonpregnant participants aged 20-69 y who provided up to 2 complete 24-h urine specimens in the NHANES 2014 and had data on overweight or obesity [body mass index (kg/m2) ≥25] and central adiposity [waist circumference (WC): >88 cm for women, >102 cm for men]. Measurement error models were used to estimate usual sodium excretion, and multiple linear and logistic regression models were used to assess its associations with measures of adiposity, adjusting for sociodemographic, health, and dietary variables [i.e., energy intake or sugar-sweetened beverage (SSB) intake]. All analyses accounted for the complex survey sample design.

Results

Unadjusted mean ± SE usual sodium excretion was 3727 ± 43.5 mg/d and 3145 ± 55.0 mg/d among participants with and without overweight/obesity and 3653 ± 58.1 mg/d and 3443 ± 35.3 mg/d among participants with or without central adiposity, respectively. A 1000-mg/d higher sodium excretion was significantly associated with 3.8-units higher BMI (95% CI: 2.8, 4.8) and a 9.2-cm greater WC (95% CI: 6.9, 11.5 cm) adjusted for covariates. Compared with participants in the lowest quartile of sodium excretion, the adjusted prevalence ratios in the highest quartile were 1.93 (95% CI: 1.69, 2.20) for overweight/obesity and 2.07 (95% CI: 1.74, 2.46) for central adiposity. The associations also were significant when adjusting for SSBs, instead of energy, in models.

Conclusions

Higher usual sodium excretion is associated with overweight/obesity and central adiposity among US adults.

Explaining Excessive Weight Gain during Early Recovery from Addiction

BACKGROUND

Many people receiving treatment for addiction gain an excessive amount of weight during early recovery. We outline two hypothesized mechanisms that might explain weight gain: The Addiction Transfer Hypothesis, which suggests that some individuals respond to cravings with non-nutritive eating behavior, and the Propensity for Behavioral Addiction Hypothesis, which suggests that some people are at higher risk for addiction, and that excess weight gain results from a rebound of appetitive processes that were temporarily suppressed during active addiction.

METHOD

We evaluate the extent of support for these alternative hypotheses using repeated measures of cravings and eating behavior collected in real time using a combination of ecological momentary assessment methodology and interviewer-based 24-hour dietary recall. Participants included N = 111 individuals receiving treatment for substance use disorder who were currently abstaining from use, but who had used their primary treatment substance within the past 12 months.

RESULTS

Using linear mixed models to test the temporal effects of cravings on subsequent eating behaviors hypothesized by the Addiction Transfer Hypothesis and generalized linear models to evaluate the effect of a common propensity for behavioral addiction factor on eating behaviors (a test of the Propensity for Behavioral Addiction Hypothesis), we find no evidence to support the Addiction Transfer Hypothesis, but we find modest support for the Propensity for Behavioral Addiction Hypothesis. Findings do not account for appetitive effects of psychotropic medications.

CONCLUSIONS

General nutrition education and encouragement of health eating behaviors may be useful for reducing excessive weight gain among people recovering from substance dependence.

Associations of dietary patterns with hypertension among adults in Jilin Province, China: a structural equation modelling approach

OBJECTIVE

To explore the direct and indirect associations of dietary patterns with hypertension using structural equation modelling (SEM).

DESIGN

Factor analysis with varimax rotation was used to classify different dietary patterns and SEM was employed to investigate the associations of dietary patterns with hypertension. Total cholesterol to HDL-cholesterol (TC:HDL-C) ratio and LDL-cholesterol to HDL-cholesterol (LDL-C:HDL-C) ratio were used as observed indicator variables of the lipid latent variable. Waist circumference, body fat percentage and BMI, which were associated with hypertension, were used as observed indicator variables of the obesity latent variable.

SETTING

International Chronic Disease Cohort (ICDC) that began in 2005 with the purpose of describing the frequency and determinants of chronic diseases in Jilin Province, China.ParticipantsA total of 1492 adults (40-79 years) were enrolled in the baseline study from August 2010 to August 2011.

RESULTS

Hypertension prevalence in our study population was 34·9 %. It was found that the wine pattern, condiment pattern, obesity latent variable, lipid latent variable, glucose, age and family history of hypertension were factors that had an association with hypertension via SEM, and the corresponding coefficients were 0·056, 0·011, 0·230, 0·281, 0·098, 0·232 and 0·116, respectively.

CONCLUSIONS

The wine pattern and lipid latent variable had positive direct associations with hypertension. The condiment pattern had a positive indirect association with hypertension via the obesity latent variable. The vegetables pattern, modern pattern and snack pattern were not associated with hypertension.

Exploring the consumption of ultra-processed foods and its association with food addiction in overweight children

The present study explored the consumption of ultra-processed foods and its association with food addiction in overweight children. The prevalence of food addiction was investigated using the Yale Food Addiction Scale for Children in overweight 9-11 year-old children (BMI/age ≥1 Z score) of both sexes from two schools (n = 139). Food intake was estimated by a food frequency questionnaire and the food items were classified into 4 categories: minimally processed, culinary ingredients, processed foods and ultra-processed foods (UPF), based on their degree of processing. Among the children, 95% showed at least one of the seven symptoms of food addiction and 24% presented with a diagnosis of food addiction. In analysis of covariance adjusted for age and sex, a tendency of higher consumption of added sugar (refined sugar, honey, corn syrup) and UPF was found among those diagnosed with food addiction. Multiple logistic regression adjusted for sugar, sodium and fat ingestion showed that consumption of cookies/biscuits (OR = 4.19, p = 0.015) and sausages (OR = 11.77, p = 0.029) were independently associated with food addiction. The identification of foods that may be associated with addictive behavior is very important for correctly treating and preventing childhood obesity, which continues to be one of the greatest health problems in the world.

Dopamine genetic risk is related to food addiction and body mass through reduced reward-related ventral striatum activity

The prevalence rate of obesity continues to rise in the U.S., but effective treatment options remain elusive resulting in increased emphasis on prevention. One such area of prevention research capitalizes on the relatively novel behavioral construct of food addiction, which has been implicated in obesity. Food addiction reflects an individual's propensity for compulsive eating despite negative consequences, and shares not only symptoms with both eating and substance use disorders but also genetic and neural correlates within neural reward-circuitry modulated by dopamine. Here, we examined associations between food addiction scores, body mass index (BMI), reward-related ventral striatum activity, and a polygenic score approximating dopamine signaling in 115 non-Hispanic Caucasian young adult university students. As predicted, polygenic dopamine scores were related to ventral striatum activity, which in turn was associated with higher food addiction scores. In addition, food addiction was related to BMI. An exploratory post-hoc path analysis further indicated that polygenic scores were indirectly related to both food addiction and BMI, in part, through ventral striatum activity. Collectively, our results provide evidence supporting the utility of food addiction in weight gain prevention research by establishing links with known risk-related neural and genetic biomarkers.

Addictive salt may not be solely responsible for causing hypertension: A sweet and fatty hypothesis

In literature, since many decades, it is often believed and condoned that excessive common salt (Nacl) ingestion can lead to hypertension. Hence, every health organisation, agencies and physicians have been advising salt restriction to hypertensive patients. However, there is no concrete evidence suggesting that salt restriction can reduce the risk of hypertension (HTN). The present article is based on the current literature search which was performed using MEDLINE, EMBASE, Google Scholar and PubMed. The meta-analysis, randomised control trials, clinical trials and review articles were chosen. The present review article suggests that consumption of high salt diet does not lead to hypertension and there are other factors which can lead to hypertension, sugar and fats being the main reasons. Salt can however lead to addiction and generally, these salty food items have a larger proportion of sugar and fats, which if over-consumed has a potential to cause obesity, hyperlipidaemia and subsequently, hypertension and other cardiovascular disorders. Hence, through the present review, I would like to suggest all the physicians to ask the hypertensive patients to cut down the intake of sugar and fat containing food items and keep a check on addiction of salty food items.

A narrative review of potential treatment strategies for food addiction

The concept of food addiction (FA) remains controversial with research being in the nascent stages; FA like any addiction can have a devastating impact on the lives of those afflicted. There exists a clinical need for treatment strategies for those affected. This article reviews potential treatment strategies for FA. The treatment strategies target four core behaviours of the addiction phenotype specifically craving through the opioid system, impulsivity as a personality trait, compulsivity through the serotonergic system and lastly motivation through the dopaminergic system. A range of pharmacological and psychological interventions are reviewed. Future research should seek to test and validate the proposed clinical treatment strategies.

Foods are differentially associated with subjective effect report questions of abuse liability

OBJECTIVES

The current study investigates which foods may be most implicated in addictive-like eating by examining how nutritionally diverse foods relate to loss of control consumption and various subjective effect reports. Subjective effect reports assess the abuse liabilities of substances and may similarly provide insight into which foods may be reinforcing in a manner that triggers an addictive-like response for some individuals.

DESIGN

Cross-sectional.

SETTING

Online community.

PARTICIPANTS

507 participants (n = 501 used in analyses) recruited through Amazon MTurk.

MEASUREMENTS

Participants (n = 501) self-reported how likely they were to experience a loss of control over their consumption of 30 nutritionally diverse foods and rated each food on five subjective effect report questions that assess the abuse liability of substances (liking, pleasure, craving, averseness, intensity). Hierarchical cluster analytic techniques were used to examine how foods grouped together based on each question.

RESULTS

Highly processed foods, with added fats and/or refined carbohydrates, clustered together and were associated with greater loss of control, liking, pleasure, and craving. The clusters yielded from the subjective effect reports assessing liking, pleasure, and craving were most similar to clusters formed based on loss of control over consumption, whereas the clusters yielded from averseness and intensity did not meaningfully differentiate food items.

CONCLUSION

The present work applies methodology used to assess the abuse liability of substances to understand whether foods may vary in their potential to be associated with addictive-like consumption. Highly processed foods (e.g., pizza, chocolate) appear to be most related to an indicator of addictive-like eating (loss of control) and several subjective effect reports (liking, pleasure, craving). Thus, these foods may be particularly reinforcing and capable of triggering an addictive-like response in some individuals. Future research is warranted to understand whether highly processed foods are related to these indicators of abuse liability at a similar magnitude as addictive substances.

Further Evidence of a Specific Psychopathology of Addiction. Differentiation from Other Psychiatric Psychopathological Dimensions (Such as Obesity)

Introduction: In this study, we used a symptomatology checklist (SCL-90) to substantiate the hypothesis that Substance Use Disorder (SUD) has its own five-dimensional psychopathology. The aim of the present study was to test whether this psychopathology can be differentiated from other psychiatric psychopathological dimensions (such as obesity). Methods: The severity and frequency of each of the five dimensions were investigated, at univariate and multivariate levels, by comparing 972 Heroin Use Disorder (HUD) patients (83.5% male, mean age 30.12 ± 6.6, range: 16–59) and 106 obese individuals (50.0% male, mean age 37.59 ± 7.6, range: 24–52). The correlations between the Body Mass Index (BMI) of obese individuals with these psychopathological dimensions were also studied. Results: Obese individuals showed higher SCL-90 total scores, global severity index scores, number of items rated positively, and positive symptoms distress index scores than HUD patients. The severity of all psychopathological dimensions was significantly higher in obese individuals. Discriminant analysis showed that Panic-Anxiety and Violence-Suicide severity were more frequent in obese patients, sufficiently so to allow differentiation between HUD (lower severity) and obese individuals (greater severity). At the reclassification level, 70.8% of obese individuals in the sample were reclassified as HUD patients. Psychopathological subtypes characterized by Panic-Anxiety and Violence-Suicide typology were more frequent in obese patients and sufficiently so as to discriminate between groups. Of obese patients, 47.2% were reclassified as HUD patients. The severity of the Worthlessness-Being Trapped dimension was sufficient to predict the BMI of obese individuals. Conclusions: Our results suggest that the five-factor psychopathology found in HUD can discriminate between HUD and obese patients, but that there is an area of overlap between the forms of psychopathology found in SUD and those found in obese patients.

Is Salt a Culprit or an Innocent Bystander in Hypertension? A Hypothesis Challenging the Ancient Paradigm

For decades the notion that an excessive consumption of salt (NaCl) leads to hypertension has persisted. However, this idea is based on opinion, not scientific proof. Despite this, every health organization, agency, and clinicians around the world have been advising salt restriction, especially to hypertensive patients. The present review article suggests that the consumption of a high-salt diet is not the cause of hypertension and that there are other factors, such as added sugars, which are causative for inducing hypertension and cardiovascular disease.