Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents

Correlation between gross motor coordination and basic coordination capacities in normal-weight and overweight/obese children aged 9-10 years

Background

Gross motor coordination (GMC) plays a crucial factor in children's motor development and daily activities. It encompasses various sub-capacities, such as spatial orientation, rhythm, and motor reaction, collectively referred to as basic coordination capacities (BCC). However, children who are overweight and obese (OW/OB) often display poorer GMC. This study aims to examine the impact of gender and weight status (BMI categories) on children's GMC and BCC. It also seeks to investigate the impact of BCC and BMI on GMC.

Method

The study involved 266 participants, 135 in the NW group (boys: n = 75; girls: n = 60) and 131 in the OW/OB group (boys: n = 68; girls: n = 63). An NW status is defined by a BMI z-score between ≥-2SD to ≤1SD, while an OW/OB status corresponds to a BMI z-score > 1SD. Physical activity was assessed using the Physical Activity Questionnaire for Children, developed by the University of Saskatchewan, Canada. We used six field tests to evaluate BCC, including single leg standing test (static balance), YBT (dynamic balance), rhythmic sprint test (rhythm), reaction time test (motor reaction), target standing broad test (kinesthetic differentiation), and numbered medicine ball running test (spatial orientation). GMC was evaluated with Kiphard-Schilling's Body Coordination Test (KTK).

Result

The motor quotient (MQ) was primarily affected by weight status (F = 516.599, p < 0.001; gender: F = 6.694, p = 0.01), with no significant interaction effect (F = 0.062, p = 0.803). In BCC, gender had a significant main effect on rhythm capacity (F = 29.611, p < 0.001) and static balance (F = 11.257, p = 0.001) but did not significant influence other sub-capacities (p > 0.05). Weight status impacted dynamic balance (F = 11.164, p = 0.001). The interaction of gender and weight status significantly impacted motor reaction (F = 1.471, p = 0.024) and kinesthetic differentiation (F = 5.454, p = 0.02), but did not affect other sub-capacities (p > 0.05). The physical activity was not significant affected by gender (F = 0.099, p = 0.753), weight status (F = 0.171, p = 0.679) and the interactions of two variables (F = 0.06, p = 0.806). In the regression analysis, except motor reaction (p > 0.05), other BCC sub-capacities influenced GMC to varying extents (β = -0.103-0.189, p < 0.05). Nonetheless, only two types of balance significantly mediated the relationship between BMI and GMC (BMI→MQ: β = -0.543, p < 0.001; BMI→YBT: β = -0.315, p < 0.001; BMI→SLS: β = -0.282, p < 0.001; SLS→MQ: β = 0.189, p < 0.001; YBT→MQ: β = 0.182, p < 0.001).

Conclusion

Compared to gender, the main effect of weight status on most GMC and BCC's sub-capacities was more pronounced. OW/OB children exhibited poorer GMC, which is related to their reduced static and dynamic balance due to excess weight. Kinesthetic differentiation, spatial orientation, and rhythm capacity are not significantly associated with BMI, but these sub-capacities positively influence gross motor coordination (GMC), except for hand-eye motor reaction.

Daily fat intake is associated with basolateral amygdala response to high-calorie food cues and appetite for high-calorie food

OBJECTIVES

Animal studies have indicated that fat intake mediates amygdala activation, which in turn promotes fat intake, while amygdala activation increases the preference for fat and leads to increased fat intake. However, the association among fat intake, amygdala activation, and appetite for high-calorie foods in humans remains unclear. Thus, to examine this association, we conducted a functional magnetic resonance imaging (fMRI) experiment.

METHODS

Fifty healthy-weight adults (18 females; mean age: 22.9 ± 3.02 years) were included. Participants were shown images of high-calorie and low-calorie foods and were instructed to rate their desire to eat the food items during fMRI. All participants provided information on their daily fat intake using a self-reported questionnaire. Associations among fat intake, the desire to eat high-calorie or low-calorie food items, and amygdala responses to food items were examined.

RESULTS

The basolateral amygdala (BLA) response was positively associated with fat intake ([x, y, z] = [24, -6, -16], z = 3.91, pFWE-corrected = 0.007) and the desire to eat high-calorie food items ([26, -4, -16], z = 3.75, pFWE-corrected = 0.010). Structural equation modeling showed that the desire for high-calorie food items was predicted by BLA response to high-calorie food items (p = 0.013, β = 3.176), and BLA response was predicted by fat intake (p < 0.001, β = 0.026).

DISCUSSION

Fat intake influences BLA response to high-fat food, which in turn increases the desire to eat palatable high-fat food. This may lead to additional fat intake and increase the risk of weight gain.

Association of Overweight and Obesity with Impaired Executive Functioning in Mexican Adolescents: The Importance of Inhibitory Control

Overweight and obesity are major public health issues worldwide, including in Mexico, particularly among adolescents. This study aimed to analyze the associations between nutritional status and impaired executive function (EF) in Mexican adolescents. A case-control study was conducted with 98 male and female adolescents, categorized into normal weight and overweight/obese groups based on body mass index. EF was assessed using the BANFE-2 test. The prevalence of overweight and obesity was 54.3%. The EF assessment revealed that 82.45% of the overweight/obese group exhibited mild-to-severe impairment, compared to only 36.58% in the normal weight group (X2 = 21.69, p < 0.0001). In the inhibitory control assessment, adolescents with overweight and obesity performed worse than their normal-weight counterparts. Specifically, females with overweight/obesity scored lower than females with normal weight on the risk-benefit processing test. The risk of severe EF impairment significantly increased with the presence of overweight/obesity (OR = 7.8, p < 0.0001). These findings indicate that EF, particularly inhibitory control and risk-benefit processing, is impaired in adolescents with overweight or obesity.

Cognitive function 10 years after adolescent bariatric surgery

BACKGROUND

Adolescent bariatric surgery produces substantial weight loss and reduction of medical co-morbidities. Research in adult samples shows improved cognitive function postoperatively, although much less is known about the potential cognitive benefits of bariatric surgery in adolescents-especially at extended follow-up.

OBJECTIVE

Examine cognitive function 10 years after adolescent bariatric surgery.

SETTING

University hospital.

METHODS

A total of 99 young adults who underwent bariatric surgery as adolescents completed a computerized cognitive test battery as part of a larger 10-year postoperative assessment. All had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.

RESULTS

Cognitive dysfunction was prevalent on tests of attention and executive function (e.g., Continuous Performance Test - Reaction Time 30%; Maze Errors - Overrun 30%), and 53.5% met research criteria for mild cognitive impairment (MCI). Modified Poisson regression with robust error variance revealed participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at 10-year follow-up.

CONCLUSIONS

The current findings indicate that cognitive deficits are common 10 years after bariatric surgery. Additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 yr after surgery), and identify underlying mechanisms and mitigation strategies.

The BDNF Val66Met polymorphism and health-related quality of life in youth with obesity

The brain derived-neurotrophic factor (BDNF) Val66Met polymorphism causes functional changes in BDNF, and is associated with obesity and some psychiatric disorders, but its relationship to health-related quality of life (HRQoL) remains unknown. This study examined, in youth with obesity, whether carriers of the BDNF Val66met polymorphism Met-alleles (A/A or G/A) differed from noncarriers (G/G) on HRQoL. The participants were 187 adolescents with obesity. Ninety-nine youth were carriers of the homozygous Val/Val (G/G) alleles, and 88 were carriers of the Val/Met (G/A) or Met/Met (A/A) alleles. Blood samples were drawn in the morning after an overnight fast for genotyping. HRQoL was measured using the Pediatric-Quality of Life core version. Compared to carriers of the Val66Met Val (G/G) alleles, carriers of the Met-Alleles reported significantly higher physical -HRQoL (p = 0.02), school-related HRQoL, (p = 0.05), social-related HRQoL (p = 0.05), and total HRQoL (p = 0.03), and a trend for Psychosocial-HRQoL. Research is needed to confirm our findings and determine whether carriers of the BDNF Val66Met homozygous Val (G/G) alleles may be at risk of diminished HRQoL, information that can influence interventions in a high-risk population of inactive youth with obesity.

The association between obesity severity and food reward in adolescents with obesity: a one-stage individual participant data meta-analysis

BACKGROUND

Food reward and cue reactivity have been linked prospectively to problematic eating behaviours and excess weight gain in adults and children. However, evidence to date in support of an association between degree of adiposity and food reward is tenuous. A non-linear relationship between reward sensitivity and obesity degree has been previously proposed, suggesting a peak is reached in mild obesity and decreases in more severe obesity in a quadratic fashion.

OBJECTIVE

To investigate and characterise in detail the relationship between obesity severity, body composition, and explicit and implicit food reward in adolescents with obesity.

METHODS

Data from seven clinical trials in adolescents with obesity were aggregated and analysed in an independent participant data meta-analysis. Linear and curvilinear relationships between the degree of obesity and explicit and implicit reward for sweet and high fat foods were tested in fasted and fed states with BMI-z score as a continuous and discrete predictor using clinically recognised partitions.

RESULTS

Although positive associations between obesity severity and preference for high-fat (i.e. energy dense) foods were observed when fasted, none reached significance in either analysis. Conversely, adiposity was reliably associated with lower reward for sweet, particularly when measured as implicit wanting (p = 0.012, ηp2 = 0.06), independent of metabolic state. However, this significant association was only observed in the linear model. Fat distribution was consistently associated with explicit and implicit preference for high-fat foods.

CONCLUSIONS

A limited relationship was demonstrated between obesity severity and food reward in adolescents, although a lower preference for sweet could be a signal of severe obesity in a linear trend. Obesity is likely a heterogenous condition associated with multiple potential phenotypes, which metrics of body composition may help define.

CLINICAL TRIAL REGISTRATIONS

NCT02925572: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT02925572 . NCT03807609: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03807609 . NCT03742622: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03742622 . NCT03967782: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03967782 . NCT03968458: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03968458 . NCT04739189: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT04739189 . NCT05365685: https://www.

CLINICALTRIALS

gov/study/NCT05365685?tab=history .

Electrophysiological Characteristics of Inhibitive Control for Adults with Different Physiological or Psychological Obesity

Individuals exhibiting high scores on the fatness subscale of the negative-physical-self scale (NPSS-F) are characterized by heightened preoccupation with body fat accompanied by negative body image perceptions, often leading to excessive dieting behaviors. This demographic constitutes a considerable segment of the populace in China, even among those who are not obese. Nonetheless, scant empirical inquiries have delved into the behavioral and neurophysiological profiles of individuals possessing a healthy body mass index (BMI) alongside elevated NPSS-F scores. This study employed an experimental paradigm integrating go/no-go and one-back tasks to assess inhibitory control and working memory capacities concerning food-related stimuli across three adult cohorts: those with normal weight and low NPSS-F scores, those with normal weight and high NPSS-F scores, and individuals classified as obese. Experimental stimuli comprised high- and low-caloric-food pictures with concurrent electroencephalogram (EEG) and photoplethysmogram (PPG) recordings. Individuals characterized by high NPSS-F scores and normal weight exhibited distinctive electrophysiological responses compared to the other two cohorts, evident in event-related potential (ERP) components, theta and alpha band oscillations, and heart rate variability (HRV) patterns. In essence, the findings underscore alterations in electrophysiological reactivity among individuals possessing high NPSS-F scores and a healthy BMI in the context of food-related stimuli, underscoring the necessity for increased attention to this demographic alongside individuals affected by obesity.

Physical activity level correlates with obesity-related factors, but not with fundamental movement skills in preschool children: a cross-sectional study

This study aimed to examine the differences in physical activity (PA) level, fundamental movement skill (FMS), and obesity-related factors in preschoolers. A cross-sectional study was conducted in 426 preschool children aged 3-5 years. Participants were assigned to the low PA group (LPAG), moderate PA group (MPAG), and high PA group (HPAG) according to the total score obtained in the PA questionnaire for young children. FMS and obesity-related factors were also analyzed. PA was compared by age and sex, and FMS and obesity-related factors were compared between groups. Significant differences were found according to sex. Boys were more active than girls in the 3-4 years age group, but no significant differences were observed at the age of 5 years. LPAG showed lower FMS than MPAG and HPAG, although this was not statistically significant. However, body mass index (BMI), BMI z-score, body fat, and muscle mass showed significant differences in terms of PA levels. Consideration of age and sex is crucial in promoting PA among preschoolers. Additionally, better obesity-related factors are associated with higher PA levels, and FMS may be a useful tool in evaluating health and fitness.

Understanding risk and causal mechanisms for developing obesity in infants and young children: A National Institutes of Health workshop

Obesity in children remains a major public health problem, with the current prevalence in youth ages 2-19 years estimated to be 19.7%. Despite progress in identifying risk factors, current models do not accurately predict development of obesity in early childhood. There is also substantial individual variability in response to a given intervention that is not well understood. On April 29-30, 2021, the National Institutes of Health convened a virtual workshop on "Understanding Risk and Causal Mechanisms for Developing Obesity in Infants and Young Children." The workshop brought together scientists from diverse disciplines to discuss (1) what is known regarding epidemiology and underlying biological and behavioral mechanisms for rapid weight gain and development of obesity and (2) what new approaches can improve risk prediction and gain novel insights into causes of obesity in early life. Participants identified gaps and opportunities for future research to advance understanding of risk and underlying mechanisms for development of obesity in early life. It was emphasized that future studies will require multi-disciplinary efforts across basic, behavioral, and clinical sciences. An exposome framework is needed to elucidate how behavioral, biological, and environmental risk factors interact. Use of novel statistical methods may provide greater insights into causal mechanisms.

Prenatal exposure to metal mixtures and childhood temporal processing in the PROGRESS Birth Cohort Study: Modification by childhood obesity

Children are frequently exposed to various biological trace metals, some essential for their development, while others can be potent neurotoxicants. Furthermore, the inflammatory and metabolic conditions associated with obesity may interact with and amplify the impact of metal exposure on neurodevelopment. However, few studies have assessed the potential modification effect of body mass index (BMI). As a result, we investigated the role of child BMI phenotype on the relationship between prenatal exposure to metal mixtures and temporal processing. Leveraging the PROGRESS birth cohort in Mexico City, children (N = 563) aged 6-9 years completed a Temporal Response Differentiation (TRD) task where they had to hold a lever down for 10-14 s. Blood and urinary metal (As, Pb, Cd, and Mn) measurements were collected from mothers in the 2nd and 3rd trimesters. Child BMI z-scores were dichotomized to normal (between -2 and +0.99) and high (≥1.00). Covariate-adjusted weighted quantile sum (WQS) regression models were used to estimate and examine the combined effect of metal biomarkers (i.e., blood and urine) on TRD measures. Effect modification by the child's BMI was evaluated using 2-way interaction terms. Children with a high BMI and greater exposure to the metal mixture during prenatal development exhibited significant temporal processing deficits compared to children with a normal BMI. Notably, children with increased exposure to the metal mixture and higher BMI had a decrease in the percent of tasks completed (β = -10.13; 95 % CI: -19.84, -0.42), number of average holds (β = -2.15; 95 % CI: -3.88, -0.41), longer latency (β = 0.78; 95 % CI: 0.13, 1.44), and greater variability in the standard deviation of the total hold time (β = 2.08; 95 % CI: 0.34, 3.82) compared to normal BMI children. These findings implicate that high BMI may amplify the effect of metals on children's temporal processing. Understanding the relationship between metal exposures, temporal processing, and childhood obesity can provide valuable insights for developing targeted environmental interventions.

Tunneling, cognitive load and time orientation and their relations with dietary behavior of people experiencing financial scarcity - an AI-assisted scoping review elaborating on scarcity theory

BACKGROUND

The concept of a financial scarcity mindset has raised much attention as an explanation for poor decision-making and dysfunctional behavior. It has been suggested that financial scarcity could also impair dietary behavior, through a decline in self-control. Underlying cognitive mechanisms of tunneling (directing attention to financial issues and neglecting other demands), cognitive load (a tax on mental bandwidth interfering with executive functioning) and time orientation (a shift towards a present time horizon, versus a future time horizon) may explain the association between financial scarcity and self-control related dietary behavior. The current scoping review gathers recent evidence on how these mechanisms affect dietary behavior of people experiencing financial scarcity. It builds on a theoretical framework based on insights from behavioral economics and health psychology.

METHODS

A literature search was executed in six online databases, which resulted in 9.975 papers. Search terms were tunneling, cognitive load and time orientation, financial scarcity, and dietary behavior. Screening was performed with ASReview, an AI-ranking tool. In total, 14 papers were included in the scoping review. We used PRISMA-ScR guidelines for reporting.

RESULTS

Limited evidence indicates that a scarcity mindset could increase tunneling, through attentional narrowing on costs of food, which then directly impacts dietary behavior. A scarcity mindset involves experiencing financial stress, which can be understood as cognitive load. Cognitive load decreases attentional capacity, which could impair self-control in dietary choices. Financial scarcity is related to a present time orientation, which affects dietary choices by shifting priorities and decreasing motivation for healthy dietary behavior.

CONCLUSIONS

A scarcity mindset affects dietary behavior in different ways. Tunneling and a shift in time orientation are indicative of an attentional redirection, which can be seen as more adaptive to the situation. These may be processes indirectly affecting self-control capacity. Cognitive load could decrease self-control capacity needed for healthy dietary behavior because it consumes mental bandwidth. How a changing time orientation when experiencing financial scarcity relates to motivation for self-control in dietary behavior is a promising theme for further inquiry.

Evaluation of executive functions in children and adolescents with obesity

The purpose of this study is to evaluation of executive functions of obese children and adolescents. Thirty children and adolescents with obesity between the ages of 11 and 18 and thirty age- and sex-matched healthy weight-peers were included. Participants with a body mass index (BMI) value of 5 to 85thpercentile and >95thpercentile were classified as normal and obese, respectively. Turkish Version of Kiddy Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-T) was applied for excluding participants with psychiatric diagnoses. All children and their parents were asked to fill out Strengths and Difficulties Questionnaire (SDQ), Wisconsin Card Sorting Test (WCST), and Stroop Color and Word Test (SCWT) to evaluate executive functions. Children with obesity tended to complete Part 4 and Part 5 of SCWT in longer time (p = 0.043 and p = 0.018, respectively). Rate of obesity was higher among nuclear family members (p = 0.001) with a higher number of relatives positive for history of a psychiatric disorder (p = 0.020). While children with obesity reported higher rates of peer problems as measured by SDQ (p = 0.030), there was no significant difference in parent forms. In conclusion, although children with obesity may have disruptions in their executive functions to some degree, this does not refer a generalized impairment.

The hormesis principle of neuroplasticity and neuroprotection

Animals live in habitats fraught with a range of environmental challenges to their bodies and brains. Accordingly, cells and organ systems have evolved stress-responsive signaling pathways that enable them to not only withstand environmental challenges but also to prepare for future challenges and function more efficiently. These phylogenetically conserved processes are the foundation of the hormesis principle, in which single or repeated exposures to low levels of environmental challenges improve cellular and organismal fitness and raise the probability of survival. Hormetic principles have been most intensively studied in physical exercise but apply to numerous other challenges known to improve human health (e.g., intermittent fasting, cognitive stimulation, and dietary phytochemicals). Here we review the physiological mechanisms underlying hormesis-based neuroplasticity and neuroprotection. Approaching natural resilience from the lens of hormesis may reveal novel methods for optimizing brain function and lowering the burden of neurological disorders.

Executive function differences as a function of parent-reported binge eating and weight: Results from the adolescent brain cognitive development study

Background

Binge eating is a relatively common disordered eating behavior among children, and is associated with poor health outcomes. Executive function (EF)-higher order cognitive abilities related to planning and impulse control-may be implicated in both binge eating and pediatric obesity. Although EF deficits are evident among individuals with obesity and/or binge eating, findings are mixed across the lifespan.

Methods

The present study examined differences in EF among children with varying weight statuses and parent-reported binge eating. The sample included 10,017 children from the Adolescent Brain Cognitive Development study, aged 9-10 years.

Results

Children with parent-reported binge eating-either with overweight/obesity or normal weight-had significantly lower EF than those with no binge eating and a normal weight status but did not differ from those with no binge eating and overweight/obesity. Children with no binge eating and overweight/obesity also had statistically significantly lower EF than those with normal weight status. Although all significant differences between groups were negligible to very small, results may indicate similar neurocognitive profiles among children with binge eating and those with overweight/obesity.

Conclusions

Alterations in EF among children with binge eating may not be solely related to weight-specific factors, as significant differences also emerged among children with normal weight status, with versus without parent-reported binge eating. Future research is needed to understand temporal associations between obesity, disordered eating, and neurocognition in children using multi-informant methods for assessing binge eating.

State-level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study

BACKGROUND

Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait-level working memory (WM), which may limit adaptive responding to intra- and extra-personal cues related to eating. Understanding of how WM performance relates to eating behavior in real-time is currently limited.

METHODS

We studied 32 youth (ages 10-17 years) with LOC eating and overweight/obesity (LOC-OW; n = 9), overweight/obesity only (OW; n = 16), and non-overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone-based ecological momentary assessment. Linear mixed effects models estimated group-level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating.

RESULTS

LOC-OW were less accurate on numerical WM tasks compared to OW and NW (ps < .01); groups did not differ on spatial task accuracy (p = .41). Adjusting for between-subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within-subject effects (reflecting variations in moment-to-moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p = .013). There were no associations between WM performance and LOC eating severity (ps > .05).

CONCLUSIONS

Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory-based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal-weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment-to-moment basis.

Association of obesity with mild traumatic brain injury symptoms, inflammatory profile, quality of life and functional outcomes: a TRACK-TBI Study

OBJECTIVES

Obesity is associated with chronic inflammation, which may impact recovery from mild traumatic brain injury (mTBI). The objective was to assess the role of obesity in recovery of symptoms, functional outcome and inflammatory blood biomarkers after mTBI.

METHODS

TRACK-TBI is a prospective study of patients with acute mTBI (Glasgow Coma Scale=13-15) who were enrolled ≤24 hours of injury at an emergency department of level 1 trauma centres and followed for 12 months. A total of 770 hospitalised patients who were either obese (body mass index (BMI) >30.0) or healthy mass (BMI=18.5-24.9) were enrolled. Blood concentrations of high-sensitivity C reactive protein (hsCRP), interleukin (IL) 6, IL-10, tumour necrosis factor alpha; Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Quality of Life After Brain Injury and Glasgow Outcome Score-Extended reflecting injury-related functional limitations at 6 and 12 months were collected.

RESULTS

After adjusting for age and gender, obese participants had higher concentrations of hsCRP 1 day after injury (mean difference (MD)=0.65; 95% CI: 0.44 to 0.87, p<0.001), at 2 weeks (MD=0.99; 95% CI: 0.74 to 1.25, p<0.001) and at 6 months (MD=1.08; 95% CI: 0.79 to 1.37, p<0.001) compared with healthy mass participants. Obese participants had higher concentrations of IL-6 at 2 weeks (MD=0.37; 95% CI: 0.11 to 0.64, p=0.006) and 6 months (MD=0.42; 95% CI: 0.12 to 0.72, p=0.006). Obese participants had higher RPQ total score at 6 months (MD=2.79; p=0.02) and 12 months (MD=2.37; p=0.049).

CONCLUSIONS

Obesity is associated with higher symptomatology at 6 and 12 months and higher concentrations of blood inflammatory markers throughout recovery following mTBI.

Effects and possible mechanisms of intermittent fasting on health and disease: a narrative review

The imbalance between energy intake and expenditure in an environment of continuous food availability can lead to metabolic disturbances in the body and increase the risk of obesity and a range of chronic noncommunicable diseases. Intermittent fasting (IF) is one of the most popular nonpharmacological interventions to combat obesity and chronic noncommunicable diseases. The 3 most widely studied IF regimens are alternate-day fasting, time-restricted feeding, and the 5:2 diet. In rodents, IF helps optimize energy metabolism, prevent obesity, promote brain health, improve immune and reproductive function, and delay aging. In humans, IF's benefits are relevant for the aging global population and for increasing human life expectancy. However, the optimal model of IF remains unclear. In this review, the possible mechanisms of IF are summarized and its possible drawbacks are discussed on the basis of the results of existing research, which provide a new idea for nonpharmaceutical dietary intervention of chronic noncommunicable diseases.

Variation in executive function relates to BMI increases in youth who were initially of a healthy weight in the ABCD Study

OBJECTIVE

The study aim was to determine whether (A) differences in executive function (EF) and cognition precede weight gain or (B) weight gain causes changes to EF and cognition.

METHODS

Data were gathered from the Adolescent Brain Cognitive Development (ABCD) Study (release 4.0; ages 9-12 years old [N = 2794]; 100% had healthy weight at baseline [i.e., 9/10 years old], 12.4% had unhealthy weight by ages 11/12 years). EF and cognition were assessed across several domains (e.g., impulsivity, inhibitory control, processing speed, memory); BMI was calculated from height and weight. Nested random-effects mixed models examined (A) BMI ~ EF × Time (i.e., variation in EF/cognition precedes weight gain) and (B) EF ~ BMI × Time (weight gain causes changes to EF/cognition) and controlled for sex, puberty, and caregiver education; random effects were site and subject.

RESULTS

Variation in impulsivity, memory, learning, and processing speed was associated with greater increases in BMI trajectories from 9 to 12 years old. Weight gain was associated with a decrease in inhibitory control, but no other associations were observed.

CONCLUSIONS

Underlying variation in EF and cognition may be important for weight gain, but 2 years of weight gain may not be enough to have clinical implications for EF and cognition beyond inhibitory control. These findings suggest that more attention should be paid to the inclusion of EF programs in obesity prevention efforts.

Body mass index, systemic inflammation and cognitive performance in adolescents: A cross-sectional study

BACKGROUND

Excessive body weight has been related to lower cognitive performance. One of the mechanisms through which excess body weight may affect cognition is inflammation.

HYPOTHESIS

Our hypothesis is that both body mass index (BMI) and circulating levels of inflammatory biomarkers will be negatively related to cognitive performance.

DESIGN

Cross-sectional study.

SETTING

Users of the public health centres of the Consorci Sanitari de Terrassa (Terrassa, Spain) between 2010 and 2017 aged 12-21 years.

PARTICIPANTS

One hundred and five adolescents (46 normoweight, 18 overweight, 41 obese).

MEASUREMENTS

Levels of high sensitivity C-reactive protein, interleukin 6, tumour necrosis factor α (TNFα) and fibrinogen were determined from blood samples. Cognitive performance was evaluated and six cognitive composites were obtained: working memory, cognitive flexibility, inhibitory control, decision-making, verbal memory, and fine motor speed. A single multivariate general lineal model was used to assess the influence of the four inflammatory biomarkers, as well as participants' BMI, sex, and age on the 6 cognitive indexes.

RESULTS

An inverse relationship between BMI and inhibitory control (F = 5.688, p = .019; β = -0.212, p = .031), verbal memory (F = 5.404, p = .022; β = -0.255, p = .009) and fine motor speed (F = 9.038, p = .003; β = -0.319, p = .001) was observed. Levels of TNFα and fibrinogen were inversely related to inhibitory control (F = 5.055, p = .027; β = -0.226, p = .021) and verbal memory (F = 4.732, p = .032; β = -0.274, p = .005), respectively.

LIMITATIONS

The cross-sectional nature of the study, the use of cognitive tests designed for clinical purposes, and the use of BMI as a proxy for adiposity are limitations of our study that must be taken into account when interpreting results.

CONCLUSIONS

Our data indicate that some components of executive functions, together with verbal memory, are sensitive to specific obesity-related inflammatory agents at early ages.

Associations between body mass index, sleep-disordered breathing, brain structure, and behavior in healthy children

Pediatric overweight/obesity can lead to sleep-disordered breathing (SDB), abnormal neurological and cognitive development, and psychiatric problems, but the associations and interactions between these factors have not been fully explored. Therefore, we investigated the associations between body mass index (BMI), SDB, psychiatric and cognitive measures, and brain morphometry in 8484 children 9-11 years old using the Adolescent Brain Cognitive Development dataset. BMI was positively associated with SDB, and both were negatively correlated with cortical thickness in lingual gyrus and lateral orbitofrontal cortex, and cortical volumes in postcentral gyrus, precentral gyrus, precuneus, superior parietal lobule, and insula. Mediation analysis showed that SDB partially mediated the effect of overweight/obesity on these brain regions. Dimensional psychopathology (including aggressive behavior and externalizing problem) and cognitive function were correlated with BMI and SDB. SDB and cortical volumes in precentral gyrus and insula mediated the correlations between BMI and externalizing problem and matrix reasoning ability. Comparisons by sex showed that obesity and SDB had a greater impact on brain measures, cognitive function, and mental health in girls than in boys. These findings suggest that preventing childhood obesity will help decrease SDB symptom burden, abnormal neurological and cognitive development, and psychiatric problems.

Effects of Cognitively Engaging Physical Activity on Preschool Children's Cognitive Outcomes

Research combining physical activity with the training of cognitive skills such as executive functions is emerging as a novel and fruitful intervention approach for children. Purpose: This study aimed to examine the impact of an intervention program including cognitively engaging physical activity on preschool children's cognitive outcomes and physical activity. Methods: Children (N = 144, 65 female; Mage = 4.41 years, SD = 0.61), randomly assigned to one of three groups: cognitively engaging physical activity (CPA; i.e., storytelling, cognitive activities, and motor tasks, n = 55), cognition (i.e., storytelling and cognitive activities without motor tasks, n = 48), or control (i.e., traditional storytelling, n = 41). Sessions lasted approximately 17 minutes, conducted twice a week, for 6 weeks. Children's executive function, self-regulation, and related outcomes (i.e., numeracy) were assessed at baseline and again-along with perceived enjoyment-at the end of the program. Accelerometers measured children's physical activity during each session. Teachers completed a logbook for each session, and two fidelity checks per preschool took place by the researcher. Main analyses used linear mixed models adjusted for covariates (age, sex) and clustering at the preschool level. Results: Results showed no significant group by time interaction for executive function, self-regulation, numeracy, enjoyment. During the sessions, children in the CPA group were more physically active than children in the cognition and control groups. Conclusion: While we did not find the expected amplified cognitive benefits, making storytelling more active has the potential to meet two needs (increase cognitive stimulation and physical activity levels) in one deed.

Changes in Branched-Chain Amino Acids One Year after Sleeve Gastrectomy in Youth with Obesity and Their Association with Changes in Insulin Resistance

Adults with obesity have a reduction in branched-chain amino acid (BCAA) levels following metabolic and bariatric surgery (MBS), which is hypothesized to contribute to the metabolic advantages of MBS. We examined this relationship in 62 youth 13-24 years old with severe obesity (47 female) over 12 months. Thirty had sleeve gastrectomy (SG) and 32 were non-surgical controls (NS). We measured fasting insulin, glucose, glycated hemoglobin (HbA1c), isoleucine, leucine, and valine concentrations, and post-prandial insulin and glucose, following a mixed meal tolerance test. Twenty-four-hour food recalls were collected. At baseline, groups did not differ in the intake or the serum levels of BCAAs, HbA1C, HOMA-IR, Matsuda index, insulinogenic index, or oral Disposition index (oDI). Over 12 months, SG vs. NS had greater reductions in serum BCAAs, and SG had significant reductions in BCAA intake. SG vs. NS had greater reductions in HbA1c and HOMA-IR, with increases in the Matsuda index and oDI. In SG, baseline leucine and total BCAA concentrations were negatively correlated with the baseline Matsuda index. Reductions in serum leucine were positively associated with the reductions in HOMA-IR over 12 months. These associations suggest a potential role of BCAA in regulating metabolic health. Reducing dietary intake and serum BCAA concentrations may reduce insulin resistance.

Paediatric obesity and metabolic syndrome associations with cognition and the brain in youth: Current evidence and future directions

Obesity and components of the metabolic syndrome (MetS) are associated with differences in brain structure and function and in general and food-related cognition in adults. Here, we review evidence for similar phenomena in children and adolescents, with a focus on the implications of extant research for possible underlying mechanisms and potential interventions for obesity and MetS in youth. Current evidence is limited by a relative reliance on small cross-sectional studies. However, we find that youth with obesity and MetS or MetS components show differences in brain structure, including alterations in grey matter volume and cortical thickness across brain regions subserving reward, cognitive control and other functions, as well as in white matter integrity and volume. Children with obesity and MetS components also show some evidence for hyperresponsivity of food reward regions and hyporesponsivity of cognitive control circuits during food-related tasks, altered brain responses to food tastes, and altered resting-state connectivity including between cognitive control and reward processing networks. Potential mechanisms for these findings include neuroinflammation, impaired vascular reactivity, and effects of diet and obesity on myelination and dopamine function. Future observational research using longitudinal measures, improved sampling strategies and study designs, and rigorous statistical methods, promises to further illuminate dynamic relationships and causal mechanisms. Intervention studies targeted at modifiable biological and behavioural factors associated with paediatric obesity and MetS can further inform mechanisms, as well as test whether brain and behaviour can be altered for beneficial outcomes.

Mental Health and Cognitive Development in Symptomatic Children and Adolescents Scoring High on Habitual Snoring: Role of Obesity and Allergy

BACKGROUND

Obstructive sleep apnea can have a negative impact on children's and adolescents' neurocognitive abilities and hinder their academic and adaptive progress in academic, social, and/or behavioral dimensions. In this retrospective cross-sectional study, we investigated the influence of body weight conditions and allergy status on long-term mental health, cognitive development, and quality of life in children and adolescents who snored.

METHODS

The study sample included 47 subjects (age range 4.1 to 15.3 years) who exhibited high levels of snoring and underwent home-based polysomnography between 2015 and 2019. Follow-up assessments (3 years on average between baseline and follow-up) entailed phone interviews with the subject's parents/caregivers who completed three validated questionnaires investigating sleep, quality of life, and parental ratings.

RESULTS

We found a correlation between age at diagnosis and being retrospectively overweight and high levels of snoring. In addition to a higher risk of developing emotional symptoms (8.2% increase in retrospective overweight status for each unit increase in the emotional score at follow-up) and oppositional behavior (9% increase in retrospective overweight status for each unit of oppositional T points at follow-up), we also noted reduced long-term social symptoms (11% decrease in retrospective overweight status for each unit increase in the social score at follow-up) and cognitive symptoms (10.6% decrease in retrospective overweight status for each unit increase in the cognitive score at follow-up), as well as a 6.1% increase in retrospective allergy status for each unit increase in academic performance at follow-up.

CONCLUSIONS

Snoring can have negative impacts on mental health and cognitive development in the long term. Early detection and intervention for neuropsychological disorders is important in children and adolescents who score high on snoring. In the long term, the effects of snoring on neuropsychological disorders may vary based on previous body weight and allergy status.

Aberrant functional connectivity between reward and inhibitory control networks in pre-adolescent binge eating disorder

BACKGROUND

Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied.

METHODS

58 pre-adolescent children (aged 9-10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses.

RESULTS

Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses.

CONCLUSIONS

Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.

Systematic Review of General Parenting Intervention Impacts on Child Weight as a Secondary Outcome

General parenting interventions have improved parent-child relationships and child behavior, with emerging evidence that they may also reduce prevalence of pediatric overweight/obesity. We conducted a systematic review on interventions that were designed to promote positive parenting and examined child weight post-hoc. We searched for studies published through January 2022 that promoted positive parenting among parents of children ages 0-18 years and reported effects on body weight as an ancillary outcome, with no intervention content focused on energy balance (e.g., feeding, physical activity). This search was carried out within ClinicalTrials.gov, ISRCTN Registry, PubMed, PsycINFO, Web of Science, and Connected Papers. Studies were imported into EndNote X9 and assessed independently by two investigators. In total, 753 clinical trials and 723 publications were assessed, and six publications met inclusion criteria. All cohorts were low-income and interventions targeted expectant mothers up through parents of adolescents. Follow-ups occurred when participants were between 2 and 25 years. Significant improvements in weight-related outcomes were observed across all studies for the intervention arm as a whole or for certain subgroups, and reasons underlying these gains tended to differ by participants' age. The magnitude of effect sizes ranged from medium to large. Interventions focused on general positive parenting are efficacious at lowering risk of overweight/obesity without focusing on physical health. Promoting attachments among infants, restructuring a toddler's home environment, praising preschoolers, and communicating with adolescents may optimize weight outcomes in parenting interventions adapted for obesity prevention.

Weight status impacts children's incidental statistical learning

The expanding literature investigating the cognitive effects of childhood weight status has not included examinations of incidental statistical learning, the process by which children unintentionally acquire knowledge about patterns in their environments, despite evidence that it underlies many higher-level information processing capabilities. In the present study, we measured event-related potentials (ERPs) while school-aged participants completed a variation of an oddball task in which stimuli predicted the appearance of a target. Children were asked to respond to the target but were not given any information about the existence of predictive dependencies. We found that children with a healthy weight status had larger P3 amplitudes in response to the predictors that were most meaningful in completing the task, a finding that may suggest optimized learning mechanisms influenced by weight status. These findings offer an important first step to understanding how healthy lifestyle factors may influence incidental statistical learning.

Longitudinal weight status and academic achievement in elementary schoolchildren in the United States

BACKGROUND/OBJECTIVES

Childhood overweight and obesity have a well-established negative impact on children's health. Overweight and obesity might also negatively impact children's academic performance, but existing literature on this association is inconclusive. This study uses a longitudinal design in a large, diverse elementary school sample to rigorously test the association between longitudinal weight status and academic achievement. Analyses also investigate modification by sex, race/ethnicity, and cardiorespiratory fitness (CRF).

SUBJECTS/METHODS

In a large suburban school district in the United States, 4936 Grade 4 students were recruited. Demographic, course grade, and standardized test data were collected from school records for Grades 3-5, and body mass index and CRF were assessed each year. Students wore accelerometers during the school day for up to 15 days across three semesters (Grade 4 Fall and Spring, Grade 5 Fall) to objectively measure physical activity. Multiple imputation addressed missing data and multilevel analyses controlled for student demographics and clustering within schools.

RESULTS

Unadjusted multilevel models found small negative associations between persistent obesity and course grades and standardized test scores, but these associations largely disappeared when controlling for demographic characteristics. Residual associations for math and writing course grades were attenuated when controlling for CRF, though some marginal negative associations for math and writing remained for students who developed obesity during follow-up. There was also evidence of marginal negative associations with course grades for students who developed overweight/obesity. There was no evidence of modification by sex or race/ethnicity.

CONCLUSIONS

Results suggest very small associations between weight status and academic achievement that were largely explained by sociodemographic factors and CRF. Evidence of an association between weight status and achievement was stronger among students who developed overweight/obesity. Interventions promoting healthy weight and high CRF remain critical for schools given the link between student health and achievement.

Excess BMI in early adolescence adversely impacts maturating functional circuits supporting high-level cognition and their structural correlates

BACKGROUND/OBJECTIVES

Adverse effects of excess BMI (affecting 1 in 5 children in the US) on brain circuits during neurodevelopmentally vulnerable periods are incompletely understood. This study investigated BMI-related alterations in maturating functional networks and their underlying brain structures, and high-level cognition in early adolescence.

SUBJECTS/METHODS

Cross-sectional resting-state fMRI, structural sMRI, neurocognitive task scores, and BMI from 4922 youth [median (IQR) age = 120.0 (13.0) months, 2572 females (52.25%)] from the Adolescent Brain Cognitive Development (ABCD) cohort were analyzed. Comprehensive topological and morphometric network properties were estimated from fMRI and sMRI, respectively. Cross-validated linear regression models assessed correlations with BMI. Results were reproduced across multiple fMRI datasets.

RESULTS

Almost 30% of youth had excess BMI, including 736 (15.0%) with overweight and 672 (13.7%) with obesity, and statistically more Black and Hispanic compared to white, Asian and non-Hispanic youth (p < 0.01). Those with obesity or overweight were less physically active, slept less than recommended, snored more frequently, and spent more time using an electronic device (p < 0.01). They also had lower topological efficiency, resilience, connectivity, connectedness and clustering in Default-Mode, dorsal attention, salience, control, limbic, and reward networks (p ≤ 0.04, Cohen's d: 0.07-0.39). Lower cortico-thalamic efficiency and connectivity were estimated only in youth with obesity (p < 0.01, Cohen's d: 0.09-0.19). Both groups had lower cortical thickness, volume and white matter intensity in these networks' constituent structures, particularly anterior cingulate, entorhinal, prefrontal, and lateral occipital cortices (p < 0.01, Cohen's d: 0.12-0.30), which also mediated inverse relationships between BMI and regional functional topologies. Youth with obesity or overweight had lower scores in a task measuring fluid reasoning - a core aspect of cognitive function, which were partially correlated with topological changes (p ≤ 0.04).

CONCLUSIONS

Excess BMI in early adolescence may be associated with profound aberrant topological alterations in maturating functional circuits and underdeveloped brain structures that adversely impact core aspects of cognitive function.

Computational mechanisms underpinning greater exploratory behaviour in excess weight relative to healthy weight adolescents

Obesity in adolescence is associated with cognitive changes that lead to difficulties in shifting unhealthy habits in favour of alternative healthy behaviours, similar to addictive behaviours. An outstanding question is whether this shift in goal-directed behaviour is driven by over-exploitation or over-exploration of rewarding outcomes. Here, we addressed this question by comparing explore/exploit behaviour on the Iowa Gambling Task in 43 adolescents with excess weight against 38 adolescents with healthy weight. We computationally modelled both exploitation behaviour (e.g., reinforcement sensitivity and inverse decay parameters), and explorative behaviour (e.g., maximum directed exploration value). We found that overall, adolescents with excess weight displayed more behavioural exploration than their healthy-weight counterparts - specifically, demonstrating greater overall switching behaviour. Computational models revealed that this behaviour was driven by a higher maximum directed exploration value in the excess-weight group (U = 520.00, p = .005, BF₁₀ = 5.11). Importantly, however, we found substantial evidence that groups did not differ in reinforcement sensitivity (U = 867.00, p = .641, BF₁₀ = 0.30). Overall, our study demonstrates a preference for exploratory behaviour in adolescents with excess weight, independent of sensitivity to reward. This pattern could potentially underpin an intrinsic desire to explore energy-dense unhealthy foods - an as-yet untapped mechanism that could be targeted in future treatments of obesity in adolescents.

Obesity is associated with decreased gray matter volume in children: a longitudinal study

Childhood obesity has become a global health problem. Previous studies showed that childhood obesity is associated with brain structural differences relative to controls. However, few studies have been performed with longitudinal evaluations of brain structural developmental trajectories in childhood obesity. We employed voxel-based morphometry (VBM) analysis to assess gray matter (GM) volume at baseline and 2-year follow-up in 258 obese children (OB) and 265 normal weight children (NW), recruited as part of the National Institutes of Health Adolescent Brain and Cognitive Development study. Significant group × time effects on GM volume were observed in the prefrontal lobe, thalamus, right precentral gyrus, caudate, and parahippocampal gyrus/amygdala. OB compared with NW had greater reductions in GM volume in these regions over the 2-year period. Body mass index (BMI) was negatively correlated with GM volume in prefrontal lobe and with matrix reasoning ability at baseline and 2-year follow-up. In OB, Picture Test was positively correlated with GM volume in the left orbital region of the inferior frontal gyrus (OFCinf_L) at baseline and was negatively correlated with reductions in OFCinf_L volume (2-year follow-up vs. baseline). These findings indicate that childhood obesity is associated with GM volume reduction in regions involved with reward evaluation, executive function, and cognitive performance.

Inflammation, Executive Function, and Adiposity in Children With or at Risk for Obesity: A Pilot Study

OBJECTIVE

Obesity is associated with executive function (EF) deficits across the lifespan. Higher body mass index (BMI), obesity severity, and poorer adherence and weight outcomes in obesity treatment have all been associated with EF deficits. Adult literature has begun to emphasize neuroinflammation in obesity as a possible pathway to later cognitive impairment in EF. However, pediatric obesity literature has yet to establish associations between peripheral inflammation and EF. Thus, the present study examined associations and variability in inflammation, EF, and adiposity in children with or at risk for obesity. Additionally, inflammation was examined as a mediator of the relationship between adiposity and EF.

METHODS

Children (N = 39) aged 8-12 years with BMI ≥ 50th percentile were recruited. The NIH Toolbox Cognitive Battery was used to assess performance-based EF. Peripheral inflammation was assessed in fasted sera. Dual-energy X-ray absorptiometry scans were conducted to assess body composition. Linear regression and Hayes' PROCESS Model 4 (Hayes, 2017) were used to evaluate associations between adiposity and inflammation, inflammation and EF, and whether adiposity effects EF through its effect on inflammation.

RESULTS

Positive associations were identified between adiposity and inflammation, and negative to null associations were identified between inflammation and EF. Medium indirect effects of adiposity on EF through inflammation were detected.

CONCLUSION

Pilot evidence suggests greater adiposity is linked with greater inflammation, which in turn is associated with less EF in some domains. Directionality and causality cannot yet be established, but with replication, findings may inform efforts to target EF in pediatric obesity.

A school-family blended multi-component physical activity program for Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC): protocol for a cluster randomized controlled trial

BACKGROUND

Fundamental motor skills (FMSs) are crucial for children's health and comprehensive development. Obese children often encounter a considerable challenge in the development of FMSs. School-family blended PA programs are considered a potentially effective approach to improve FMSs and health-related outcomes among obese children, however, empirical evidence is still limited. Therefore, this paper aims to describe the development, implementation, and evaluation of a 24-week school-family blended multi-component PA intervention program for promoting FMSs and health among Chinese obese children, namely the Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC) employing behavioral change techniques (BCTs) and building on the Multi-Process Action Control (M-PAC) framework as well as using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for improving and evaluating the program.

METHODS

Using a cluster randomized controlled trial (CRCT), 168 Chinese obese children (8-12 years) from 24 classes of six primary schools will be recruited and randomly assigned to one of two groups by a cluster randomization, including a 24-week FMSPPOC intervention group and a non-treatment waiting-list control group. The FMSPPOC program includes a 12-week initiation phase and a 12-week maintenance phase. School-based PA training sessions (2 sessions/week, 90 min each session) and family-based PA assignments (at least three times per week, 30 min each time) will be implemented in the initiation phase (semester time), while three 60-min offline workshops and three 60-min online webinars will be conducted in the maintenance phase (summer holiday). The implementation evaluation will be undertaken according to the RE-AIM framework. For intervention effectiveness evaluation, primary outcome (FMSs: gross motor skills, manual dexterity and balance) and secondary outcomes (health behaviors, physical fitness, perceived motor competence, perceived well-being, M-PAC components, anthropometric and body composition measures) will be collected at four time-points: at baseline, 12-week mid-intervention, 24-week post-intervention, and 6-month follow-up occasions.

DISCUSSION

The FMSPPOC program will provide new insights into the design, implementation, and evaluation of FMSs promotion among obese children. The research findings will also supplement empirical evidence, understanding of potential mechanisms, and practical experience for future research, health services, and policymaking.

TRIAL REGISTRATION

Chinese Clinical Trial Registry; ChiCTR2200066143; 25 Nov 2022.

Influence of Executive Function Training on BMI, Food Choice, and Cognition in Children with Obesity: Results from the TOuCH Study

BACKGROUND

Children with obesity have a higher risk of future health and psychological problems. Executive functions (EFs) play a key role in successful dietetic and exercise planning; therefore, new treatments aimed at improving EFs may optimize outcomes.

OBJECTIVES

This study evaluates the impact of EF training on body mass index (BMI), food choice, and cognition in children with obesity. We also examine their real-life executive functioning, emotional state, and quality of life.

METHODS

Randomized controlled double-blind trial. Forty-six children with obesity were randomly allocated into an executive functions training or a control task training group and attended 30-45 min of daily training (5/week over 6 weeks), with both groups receiving counseling on diet and wearing an activity/sleep tracker. Participants were evaluated at baseline and after treatment.

RESULTS

BMI decreased over time in the whole sample, although there were no differences between groups at post-training in BMI, food choice, and cognition. Both groups showed significant improvements in attention, speed, cognitive flexibility, and inhibitory control. Additionally, there were some benefits in real-life executive functioning and self-esteem. Over the 6 weeks, participants showed worse food choices in both groups.

CONCLUSIONS

EFs training showed a lack of significant effects. The executive function enhancement alone did not explain these changes, as there were no significant differences between the experimental groups. It might be that the control task training could also produce some benefits, and multi-component interventions might be useful for weight loss.

Beyond BMI: cardiometabolic measures as predictors of impulsivity and white matter changes in adolescents

Obesity is characterized by cardiometabolic and neurocognitive changes. However, how these two factors relate to each other in this population is unknown. We tested the association that cardiometabolic measures may have with impulse behaviors and white matter microstructure in adolescents with and without an excess weight. One hundred and eight adolescents (43 normal-weight and 65 overweight/obesity; 11-19 years old) were medically and psychologically (Temperament Character Inventory Revised, Three-Factor Eating Questionnaire-R18, Conners' Continuous Performance Test-II, Stroop Color and Word Test, Wisconsin Card Sorting Test, Kirby Delay Discounting Task) evaluated. A subsample of participants (n = 56) underwent a brain magnetic resonance imaging acquisition. In adolescents, higher triglycerides and having a body mass index indicative of overweight/obesity predicted a more impulsive performance in Conners' Continuous Performance Test-II (higher commission errors). In addition, higher glucose and diastolic blood pressure values predicted increments in the Three-Factor Eating Questionnaire-R18 emotional eating scale. Neuroanatomically, cingulum fractional anisotropy showed a negative relationship with glycated hemoglobin. The evaluation of the neurocognitive differences associated with obesity, usually based on body mass index, should be complemented with cardiometabolic measures.

Bidirectional Associations Between Adiposity and Cognitive Function and Mediation by Brain Morphology in the ABCD Study

Importance

Most epidemiologic studies examine the brain as an outcome in relation to adiposity (ie, the brain-as-outcome perspective), but it is also a potential risk factor associated with adiposity accumulation over time (ie, the brain-as-risk factor perspective). The bidirectionality hypothesis has not been fully explored in adolescent samples previously.

Objective

To assess bidirectional associations between adiposity and cognitive function in youth and test mediational pathways through brain morphology (specifically the lateral prefrontal cortex [LPFC]), lifestyle behaviors, and blood pressure.

Design, Setting, and Participants

This cohort study uses data (wave 1-3; 2 years of follow-up) from the Adolescent Brain Cognitive Development (ABCD) Study, a long-term longitudinal investigation of brain development in the United States launched in 2015, which recruited 11 878 children aged 9 to 10 years at inception. Data analysis was performed from August 2021 to June 2022.

Main Outcomes and Measures

Multivariate multivariable regression analyses were used to assess bidirectional associations of indicators of cognitive function (eg, executive function, processing speed, episodic memory, receptive vocabulary and reading skills) and adiposity (eg, body mass index z scores [zBMI] and waist circumference [WC]). Mediators considered for this investigation were lifestyle variables (eg, diet and physical activity), blood pressure, and the morphology of the LPFC and its subregions.

Results

A total of 11 103 individuals (mean [SD] age, 9.91 [0.6] years; 5307 females [48%]; 8293 White individuals [75%] and 2264 Hispanic individuals [21%]) were included in the current study. Multivariate multivariable regression analyses revealed that higher baseline zBMI and WC were associated with worse follow-up episodic memory (β, -0.04; 95% CI, -0.07 to -0.01) and better vocabulary (β, 0.03; 95% CI, 0.002 to 0.06) task performance, in covariate adjusted models. Similarly, superior baseline executive function (zBMI: β, -0.03; 95% CI, -0.06 to -0.01; WC: β, -0.04; 95% CI, -0.07 to -0.01) and episodic memory (zBMI: β, -0.04; 95% CI, -0.07 to -0.02; WC: β, -0.03; 95% CI, -0.06 to -0.002) task performance were associated with better follow-up adiposity status in covariate adjusted models. Cross-lagged panel models with latent variable modeling had a bidirectional association with executive function task performance (brain-as-outcome: β, -0.02; 95% CI, -0.05 to -0.001; brain-as-risk factor: β, -0.01; 95% CI, -0.02 to -0.003). The hypothesized associations were statistically mediated by LPFC volume and thickness, physical activity, and blood pressure.

Conclusions and Relevance

In this cohort study, executive function and episodic memory were bidirectionally associated with adiposity indices over time in this adolescent sample. These findings suggest that the brain can be both a risk factor and an outcome of adiposity; this complex bidirectional association should be taken into account in future research and clinical practice.

Obesity-Induced Brain Neuroinflammatory and Mitochondrial Changes

Obesity is defined as abnormal and excessive fat accumulation, and it is a risk factor for developing metabolic and neurodegenerative diseases and cognitive deficits. Obesity is caused by an imbalance in energy homeostasis resulting from increased caloric intake associated with a sedentary lifestyle. However, the entire physiopathology linking obesity with neurodegeneration and cognitive decline has not yet been elucidated. During the progression of obesity, adipose tissue undergoes immune, metabolic, and functional changes that induce chronic low-grade inflammation. It has been proposed that inflammatory processes may participate in both the peripheral disorders and brain disorders associated with obesity, including the development of cognitive deficits. In addition, mitochondrial dysfunction is related to inflammation and oxidative stress, causing cellular oxidative damage. Preclinical and clinical studies of obesity and metabolic disorders have demonstrated mitochondrial brain dysfunction. Since neuronal cells have a high energy demand and mitochondria play an important role in maintaining a constant energy supply, impairments in mitochondrial activity lead to neuronal damage and dysfunction and, consequently, to neurotoxicity. In this review, we highlight the effect of obesity and high-fat diet consumption on brain neuroinflammation and mitochondrial changes as a link between metabolic dysfunction and cognitive decline.

Associations between waist circumference and executive function among Chinese Tibetan adolescents living at high altitude

Background

Associations between body composition and execution function (EF) were currently studied in low altitude (LA) areas. However, the research on the correlation between waist circumference (WC) and EF among adolescents living at high altitude (HA) was limited.

Objective

We sought to explore the association between WC and EF in Chinese Tibetan adolescents aged 13-18 years in HA areas.

Methods

After excluding invalid data and extreme values, 1,228 participants (583 boys and 645 girls) were eventually included. The areas of Lhasa (average elevation of 3650 m), Nagqu (4500 m), Qamdo (3500 m), and Nyingchi (3100 m) in China were chosen as study sites. Participants completed tasks to measure inhibitory control, working memory, and cognitive flexibility. The predictive association between WC and EF was explored by One-way ANOVA, Pearson correlation, and linear regression analysis.

Results

After controlling for concomitant variables, the reaction time (RT) of responding to inhibitory control (difference incongruent and congruent), working memory (1-back, 2-back), and cognitive flexibility (heterogeneous, difference in heterogeneous and homogeneous) stimuli in subjects with WC ≥ 85th percentile was longer than that in those with WC of the 15th percentile or below [by 1.785 ms (95% CI: 0.078, 3.491), 208.734 ms (95% CI: 96.886, 320.582), 106.679 ms (95% CI: 16.485, 196.873), 82.307 ms (95% CI: 19.171, 145.442), and 58.397 ms (95% CI: 0.343,116.452), respectively], (P < 0.05).

Conclusion

After adjustment for concomitant variables, WC was significantly positively associated with the RT of inhibitory control, working memory, and cognitive flexibility among Chinese Tibetan adolescents in HA areas.

Adherence to Screen Time and Physical Activity Guidelines is Associated with Executive Function in US Toddlers Participating in the STRONG Kids 2 Birth Cohort Study

OBJECTIVE

To test the hypothesis that healthy weight status and adherence to American Academy of Pediatrics (AAP) guidelines for diet and physical activity would extend to greater executive function (EF) at age 24 months.

STUDY DESIGN

Parents of 24-month-old children from the STRONG Kids 2 cohort study (n = 352) completed the Behavioral Rating Inventory of Executive Function for Preschoolers (BRIEF-P) and reported physical activities, diet, and screen time. Toddlers met AAP guidelines if they consumed at least 5 servings of fruits and vegetables, were physically active, refrained from sugar-sweetened beverages, and limited daily screen time to <60 minutes. Relationships between EF, 24-month weight status, and meeting AAP guidelines were tested independent of child sex, ethnicity, socioeconomic status, weight status at birth, and maternal pregnancy weight status.

RESULTS

Weight-for-length z-score had no effect on EF. Toddlers meeting the screen time guideline had greater EF (β, -0.125; 95% CI, 0.234 to -0.008), inhibitory self-control (β, -0.142; 95% CI, -0.248 to -0.029), and emergent metacognition (β, -0.111; 95% CI, -0.221 to 0.002), indicated by lower BRIEF-P scores. Those with more minutes of screen time had poorer overall EF (β, 0.257; 95% CI, 0.118-0.384), inhibitory self-control (β, 0.231; 95% CI, 0.099-0.354), cognitive flexibility (β, 0.217; 95% CI, 0.082-0.342), and emergent metacognition (β, 0.257; 95% CI, 0.120-0.381). Daily physical activity was associated with greater emergent metacognition (β, -0.116; 95% CI, -0.225 to -0.005).

CONCLUSIONS

Meeting AAP guidelines for physical activity and screen time was related to greater EF in a demographically homogenous sample of toddlers. Future randomized control trials and more diverse samples are needed to confirm the directionality of this relationship.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT03341858.

Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise

Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.

Altered brain activation in uncomplicated pediatric obesity: The second moment is more sensitive than the first

Traditionally, studies of the neurocognitive correlates of obesity have computed a central tendency across trials of a task to estimate the functional abilities of individual members of obese and non-obese groups. This computation assumes that the correlate is stable over time-a questionable assumption when individuals are impulsive, periodically inattentive, and capable of overcompensation following awareness of failure. The present investigation departs from the tradition by focusing on the second moment, or variability, in brain activation during a simple selective attention task. It compared 124 non-obese and 80 obese teenaged girls on the across-trial average amplitude and inter-trial variability (ITV) of a sensitive biomarker of attention, the P300 event-related electroencephalographic potential. It found that P300 ITV outperformed P300 average amplitude in differentiating the groups. Further, it found that the elevated P300 ITV among obese teenagers was associated with other indicators of impulsivity and inattention as well as slower reaction times and a trend toward more variable reaction times. Future studies should investigate the value of P300 ITV as an objective and sensitive endpoint for cognitive training focused on improving the attention skills of obese children.

Association between executive function and excess weight in pre-school children

The association between executive function and excess weight is becoming increasingly evident. However, the results of previous studies are still inconclusive, and there is a lack of evidence in early childhood. This study aims to examine the association between executive function, in terms of overall and subscales of executive function (e.g., inhibition, working memory, and shifting), and weight excess in preschoolers. A population-based cross-sectional study was conducted on children aged 2–5 years of age from public and private schools in Chiang Mai, Thailand. Participants’ weights and heights were measured and classified into three weight status groups (i.e., children with normal weight, overweight, and obesity groups). Executive function was assessed using the parent-report Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P). Multivariable polynomial regression was performed to analyze the association between executive function and weight status. A total of 1,181 children were included in the study. After adjusting for confounders, impaired overall executive function significantly increased the probability of being overweight (odds ratio [OR] = 2.47; 95% confidence interval [CI] 1.33 to 4.56). A similar trend of association was also found between impaired inhibition and overweight status (OR = 2.33; 95%CI 1.11 to 4.90). Furthermore, poor working memory was associated with both overweight and obesity (OR = 1.87; 95%CI 1.09 to 3.20 and OR = 1.74; 95%CI 1.09 to 2.78, respectively). Our data suggest that deficits in executive function, particularly inhibition and working memory, are associated with weight excess in preschoolers. Early promotion of executive function may be needed at this developmental age to prevent unhealthy weight status.

Overweight and executive functions, psychological and behavioral profile of Spanish adolescents

The prevalence of overweight and obesity among children and adolescents has risen dramatically increasing a major risk factor for non-communicable diseases and cognitive dysfunctions. This study aimed to analyze differences in the executive function´s development between overweight and normal-weight adolescents. As a secondary objective, we aimed to assess differences in adolescents' psychological and behavioral profiles between groups. In order to achieve the study's aim, 105 adolescent students (17.61 ± 7.43 years) completed an online questionnaire that analyzed variables regarding their executive functions' processes, their psychological and physical health as well as lifestyle habits. Results showed that executive functions development is associated with adolescent weight. A higher range of weight presents a lower ability to assess abstract reasoning and to shift cognitive strategies. Nevertheless, no differences were found between groups in the capacity to hold information in mind nor the ability to control impulsive responses. Furthermore, groups showed differences in the number of meals and gastritis, but no significant differences have been found in lifestyle variables such as mobile usage, smoking, physical activity, and hours of sleep per day. The results from the present study could be used to implement multidisciplinary programs to develop healthier habits.

The association between overweight/obesity and poor cognitive function is mediated by inflammation in patients with major depressive disorder

BACKGROUND

Cognitive dysfunction is a common and core feature of major depressive disorder (MDD). Evidences exerted a potentially harmful role of obesity and higher peripheral levels of inflammation in cognitive function, but few studies have explored whether markers of peripheral inflammation might mediate the association between overweight/obesity and deficits in cognitive function. Our study aimed to examine the cognitive function in MDD patients and clarify the effects of overweight/obesity and inflammatory cytokines on cognitive dysfunction in this population.

METHOD

We used a cross-sectional design in this study. A total of 265 patients with MDD were enrolled and divided into underweight, normal weight and overweight/obese groups. The MATRICS Consensus Cognitive Battery (MCCB) was administered to measure the cognition. Plasma levels of nineteen cytokines were measured using high sensitivity multiplex bead-based assays.

RESULTS

We found overweight/obese MDD patients associated with higher plasma levels of tumor necrosis factor (TNF)-α, interleukin (IL)-8, and macrophage inflammatory protein (MIP)-1β and worse performance in speed of processing and working memory. The mediation analysis found higher levels of IL-8 (direct: β = -0.591 (95 % Confidence Interval (CI): -1.0 to -0.2), P = 0.002; indirect: β = 0.060 (95 % CI.: 0.0-0.2), P = 0.032) and TNF-α (direct: β = -0.589 (95 % CI.: -1.0 to -0.2), P = 0.002; indirect: β = 0.059 (95 % CI.: 0.1-0.2), P = 0.037) were associated with more deficits in speed of processing, and partially mediated the relationship between body mass index and speed of processing.

CONCLUSION

Our results suggest that elevated inflammation might be one biological mechanism underlying the link between higher body mass and deficits in processing speed in patients with MDD.

Development of Spatial Orientation in Two-to-Three-Year-Old Children in Relation to Lifestyle Factors

Various lifestyle factors, including diet, physical activity, and sleep, have been studied in the context of children’s health. However, how these lifestyle factors contribute to the development of cognitive abilities, including spatial cognition, remains vastly understudied. One landmark in spatial cognitive development occurs between 2.5 and 3 years of age. For spatial orientation at that age, children learn to use allocentric reference frames (using spatial relations between objects as the primary reference frame) in addition to, the already acquired, egocentric reference frames (using one’s own body as the primary reference frame). In the current virtual reality study in a sample of 30–36-month-old toddlers (N = 57), we first demonstrated a marginally significant developmental shift in spatial orientation. Specifically, task performance with allocentric performance increased relative to egocentric performance (η_p² = 0.06). Next, we explored a variety of lifestyle factors, including diet, in relation to task performance, to explain individual differences. Screen time and gestational weight gain of the mother were negatively associated with spatial task performance. The findings presented here can be used to guide future confirmatory studies about the role of lifestyle factors in the development of spatial cognition.

Bidirectional prediction between weight status and executive function in children and adolescents: A systematic review and meta-analysis of longitudinal studies

This study examined the predictability of child weight status on executive function (EF) and vice versa. We searched PubMed, CINAHL, Web of Science, and EMBASE for longitudinal studies conducted in children and adolescents on October 31, 2021. A pairwise meta-analysis was performed using a frequentist random-effects approach. The quality of all included studies was evaluated using Newcastle-Ottawa Scale and GRADE assessments. This study included 18 longitudinal studies (N = 30,101). Overall executive functioning was a significant negative predictor of child weight status (pooled beta coefficient = -0.14; 95% confidence interval [CI] [-0.22 to -0.07]; I²  = 97%). The pooled odds ratio also revealed that high EF children had a significant lower risk for developing overweight/obesity (odds ratio [OR] = 0.72; 95% CI [0.59 to 0.87]; I²  = 72%). Conversely, child weight status was a significant negative predictor of overall executive functioning (pooled beta coefficient = -0.06; 95% CI [-0.12 to -0.01]; I²  = 81%). These results suggest a bidirectional prediction between child weight status and EF. These predictabilities are low but potentially beneficial for implementation in childcare systems.

Does artistic activity help kids avoid obesity? Emergent considerations in the ecology of childhood BMI

Although the positive relationship between arts engagement and mental health is well documented, arts participation may be an emergent factor in the ecology of childhood obesity. Prior research hypothesized several potential health benefits of arts participation including healthy diet and lifestyles, but the available evidence is mainly limited to cross-sectional covariate-adjustment models for the adult population. We employed a newly released panel of the Early Childhood Longitudinal Study kindergarten cohort (ECLS-K: 2011), which is a nationally representative sample of American children who entered kindergarten in 2010-2011 (n = 15,820). We applied both dynamic panel models with Maximum Likelihood estimation as well as difference-in-differences models to address unobserved heterogeneity. Our results showed that childhood arts activity is significantly associated with reduced weight status in elementary schooling. In particular, arts participation in elementary schooling reduced the risk of being overweight on a year-to-year basis; the effect size was between 12% and 23% of a SD of BMI for all children. Arts participation at kindergarten also had a significant relationship with cumulative changes in BMI over the course of elementary schooling, especially for female and White female children (about 22% and 32% of a SD of BMI). There are considerable arts participation gaps between families and regions, and these early artistic experiences appear to affect the risk of being overweight. This suggests the possibility of a larger social reproduction process via an ecological pathway that might be easily overlooked-the accumulation of arts experience and concurrent health inequalities in childhood.