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Iljin A, Wlaźlak M, Sitek A, Antoszewski B, Zieliński T, Gmitrowicz A, Kropiwnicki P, Strzelczyk J. Mental Health, and Eating Disorders in Patients After Roux-en-Y Gastric Bypass Surgery (RYGB). POLISH JOURNAL OF SURGERY 2024; 96:1-11. [PMID: 38979584 DOI: 10.5604/01.3001.0054.5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.
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Affiliation(s)
- Aleksandra Iljin
- Department of Plastic, Reconstructive and Aesthetic SurgeryMedical University of Lodz, Poland
| | - Michał Wlaźlak
- Department of General and Transplant Surgery, Medical University of Lodz, Poland
| | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Poland
| | - Tomasz Zieliński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Poland
| | | | - Paweł Kropiwnicki
- Department of Adolescent Psychiatry, Medical University of Lodz, Poland
| | - Janusz Strzelczyk
- Department of General and Transplant Surgery, Medical University of Lodz, Poland
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Urhan M, Gezmen Karadağ M. Diet quality, nutritional status and taste recognition are impaired in men with substance use disorder. NUTR BULL 2024; 49:40-51. [PMID: 38115211 DOI: 10.1111/nbu.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
This study aimed to (1) evaluate the nutritional status, prevalence of malnutrition and dietary habits in individuals using substances and (2) examine the possible effects of substance use on the perception of five basic tastes. Ninety male individuals with substance use disorder (SUD) (heroin = 78, cocaine = 12) and 32 non-users participated in the study conducted at Manisa Alcohol and Substance Addiction Treatment Center (AMATEM), Turkey. To determine the quality of the diet, the mean nutrient adequacy ratio (MAR) was calculated based on 24-h recall food consumption records of the individuals. Subjective Global Assessment (SGA) was employed to determine nutritional status, and anthropometric measurements were also taken from the individuals. The taste detection and recognition thresholds were determined with solutions with different concentrations for bitter, sour, sweet, umami and salty tastes and scored, with higher scores indicating lower thresholds. Mild-moderate malnutrition was determined in 50% of the individuals with SUD based on SGA. The body mass index (BMI) of individuals with SUD was found to be 21.2 ± 1.88 kg/m2 , and 24.1 ± 1.64 kg/m2 for non-users (p < 0.001). Diet quality, evaluated by MAR, was lower in individuals with SUD (54.7 ± 18.9%) than in non-users (93.5 ± 9.0%) (p < 0.001). The taste detection and taste recognition thresholds of individuals with SUD were impaired, and the threshold scores for sour, salty, sweet and umami taste recognition were significantly lower compared with non-users, with the lowest substance user threshold scores observed for the sweet recognition threshold. Standardised nutritional and behavioural interventions designed by dietitians should be provided for drug users in treatment centres and integrated with medical treatment practices.
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Affiliation(s)
- Murat Urhan
- Department of Nutrition and Dietetics, Faculty of Health Science, Ege University, Karşıyaka, İzmir, Turkey
| | - Makbule Gezmen Karadağ
- Department of Nutrition Dietetics, Gazi University Faculty of Health Science, Çankaya, Ankara, Turkey
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3
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Li X, Langleben DD, Lynch KG, Wang GJ, Elman I, Wiers CE, Shi Z. Association between body mass index and treatment completion in extended-release naltrexone-treated patients with opioid dependence. Front Psychiatry 2023; 14:1247961. [PMID: 37599869 PMCID: PMC10433165 DOI: 10.3389/fpsyt.2023.1247961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Background Excessive consumption of opioids is associated with impaired metabolic function including increased body mass index (BMI). Opioid antagonist naltrexone (NTX) is an effective treatment for opioid use disorder (OUD) that has the potential to mitigate such metabolic disturbances. Understanding the relationship between treatment adherence and BMI in NTX-treated OUD patients may provide valuable insights into optimizing clinical outcomes. Methods Patients with opioid dependence were offered up to three monthly injections of extended-release (XR) NTX. Treatment completers (n = 41) were defined as those who had received all three XR-NTX injections, and non-completers (n = 20) as those missing at least one injection. Logistic regression was performed to examine the association between pre-treatment BMI and treatment completion. Results BMI was positively associated with treatment completion. This association remained significant after adjusting for potentially confounding variables. Conclusion Our findings suggest that baseline BMI may serve as a potential predictor of XR-NTX treatment adherence in patients with OUD and could help healthcare providers and policy makers alike in developing strategies to improve retention and tailor interventions for specific patient subgroups.
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Affiliation(s)
- Xinyi Li
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Daniel D. Langleben
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kevin G. Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Igor Elman
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, United States
| | - Corinde E. Wiers
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Zhenhao Shi
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Kauffman BY, Gallagher MW, Viana AG, Schmidt NB, Zvolensky MJ. Computer-delivered intervention for individuals with obesity and elevated anxiety sensitivity: feasibility, acceptability, and initial test. Cogn Behav Ther 2022; 51:353-370. [PMID: 35037832 DOI: 10.1080/16506073.2021.2018487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Obesity is one the fastest growing public health problems related to numerous chronic diseases and frequently co-occurs with negative mood states. One promising approach to address the heterogeneity of affective vulnerabilities and obesity is to focus on processes (e.g. anxiety sensitivity [AS]) that underpin both conditions. Thus, this study aimed to evaluate the feasibility, acceptability, and initial efficacy of a brief, computer-delivered AS reduction program (AST) for adults with obesity and elevated AS. Participants were 131 individuals with obesity and elevated AS who received either AST or a health information control (HC). Latent growth curve modeling was utilized to examine the effect of treatment condition on change in AS, emotional eating, expectancies of eating to manage mood, and exercise self-efficacy from baseline to 1-week, 2-weeks, and 1-month follow-up. Results indicated it was feasible to recruit and retain individuals with obesity and elevated AS through the 1-month follow-up. Positive qualitative feedback was also provided for both AST and HC. AST was a statistically significant predictor of change in expectancies of eating to manage negative affect. No other statistically significant treatment effects were indicated. Current data provide initial empirical support for future work focused on persons with obesity and elevated AS.
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Affiliation(s)
- Brooke Y Kauffman
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Andres G Viana
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Behavioral Science, The University of Texas Md Anderson Cancer Center, Houston, Texas, USA.,Health Institute, University of Houston, Houston, Texas, USA
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O'Sullivan SJ, Schwaber JS. Similarities in alcohol and opioid withdrawal syndromes suggest common negative reinforcement mechanisms involving the interoceptive antireward pathway. Neurosci Biobehav Rev 2021; 125:355-364. [PMID: 33647322 PMCID: PMC8555739 DOI: 10.1016/j.neubiorev.2021.02.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022]
Abstract
Alcohol and opioids are two major contributors to so-called deaths of despair. Though the effects of these substances on mammalian systems are distinct, commonalities in their withdrawal syndromes suggest a shared pathophysiology. For example, both are characterized by marked autonomic dysregulation and are treated with alpha-2 agonists. Moreover, alcohol and opioids rapidly induce dependence motivated by withdrawal avoidance. Resemblances observed in withdrawal syndromes and abuse behavior may indicate common addiction mechanisms. We argue that neurovisceral feedback influences autonomic and emotional circuits generating antireward similarly for both substances. Amygdala is central to this hypothesis as it is principally responsible for negative emotion, prominent in addiction and motivated behavior, and processes autonomic inputs while generating autonomic outputs. The solitary nucleus (NTS) has strong bidirectional connections to the amygdala and receives interoceptive inputs communicating visceral states via vagal afferents. These visceral-emotional hubs are strongly influenced by the periphery including gut microbiota. We propose that gut dysbiosis contributes to alcohol and opioid withdrawal syndromes by contributing to peripheral and neuroinflammation that stimulates these antireward pathways and motivates substance dependence.
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Affiliation(s)
- Sean J O'Sullivan
- Daniel Baugh Institute for Functional Genomics and Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - James S Schwaber
- Daniel Baugh Institute for Functional Genomics and Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA.
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Whatnall MC, Skinner J, Pursey K, Brain K, Collins R, Hutchesson MJ, Burrows TL. Efficacy of dietary interventions in individuals with substance use disorders for illicit substances or illicit use of pharmaceutical substances: A systematic review. J Hum Nutr Diet 2021; 34:981-993. [PMID: 33650747 DOI: 10.1111/jhn.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Disordered eating habits, poor dietary intake and nutritional status, and altered body composition are highly prevalent among individuals with substance use disorders. This systematic review aimed to evaluate the efficacy of dietary interventions in adults with substance use disorders for illicit substances or illicit use of pharmaceutical substances. METHODS Eight scientific databases were searched using predetermined text word and subject heading (MeSH) searches for experimental studies published up to March 2020 that evaluated interventions aiming to improve dietary intake in adults with substance use disorders for illicit substances or illicit use of pharmaceutical substances, which included dietary intake outcomes. RESULTS Of 9299 articles identified, five studies were included. Three studies (60%) were conducted in outpatient/community clinic settings and two studies (40%) were conducted in inpatient/residential treatment centres. Dietary interventions ranged in duration from 5 weeks to 24 months. These included education and behaviour change advice for nutrition and other lifestyle behaviours (n = 3 studies), nutrition education and provision of healthy food choices within the residential treatment centre (n = 1 study), and polyunsaturated fatty acid supplementation (n = 1 study). Three studies (60%) reported small but significant change in one or more dietary outcome at post-intervention, including reductions in sweets, fast food or caffeine intake, as well as increases in fruit and vegetable intake. CONCLUSIONS This review has identified a small number of studies, despite the strong evidence that dietary intervention is needed in substance use rehabilitation. More research is needed to determine the most effective intervention approaches for this group, including robust study designs.
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Affiliation(s)
- Megan C Whatnall
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Janelle Skinner
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Kirrilly Pursey
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Katherine Brain
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Melinda J Hutchesson
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Tracy L Burrows
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Shockcor N, Adnan SM, Siegel A, Wise E, Zafar SN, Kligman M. Marijuana use does not affect the outcomes of bariatric surgery. Surg Endosc 2020; 35:1264-1268. [DOI: 10.1007/s00464-020-07497-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/02/2020] [Indexed: 01/10/2023]
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Morris G, Puri BK, Walker AJ, Maes M, Carvalho AF, Bortolasci CC, Walder K, Berk M. Shared pathways for neuroprogression and somatoprogression in neuropsychiatric disorders. Neurosci Biobehav Rev 2019; 107:862-882. [PMID: 31545987 DOI: 10.1016/j.neubiorev.2019.09.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/13/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022]
Abstract
Activated immune-inflammatory, oxidative and nitrosative stress (IO&NS) pathways and consequent mitochondrial aberrations are involved in the pathophysiology of psychiatric disorders including major depression, bipolar disorder and schizophrenia. They offer independent and shared contributions to pathways underpinning medical comorbidities including insulin resistance, metabolic syndrome, obesity and cardiovascular disease - herein conceptualized as somatoprogression. This narrative review of human studies aims to summarize relationships between IO&NS pathways, neuroprogression and somatoprogression. Activated IO&NS pathways, implicated in the neuroprogression of psychiatric disorders, affect the pathogenesis of comorbidities including insulin resistance, dyslipidaemia, obesity and hypertension, and by inference, metabolic syndrome. These conditions activate IO&NS pathways, exacerbating neuroprogression in psychiatric disorders. The processes whereby proinflammatory cytokines, nitrosative and endoplasmic reticulum stress, NADPH oxidase isoforms, PPARγ inactivation, SIRT1 deficiency and intracellular signalling pathways impact lipid metabolism and storage are considered. Through associations between body mass index, chronic neuroinflammation and FTO expression, activation of IO&NS pathways arising from somatoprogression may contribute to neuroprogression. Early evidence highlights the potential of adjuvants targeting IO&NS pathways for treating somatoprogression and neuroprogression.
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Affiliation(s)
- Gerwyn Morris
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Basant K Puri
- Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Adam J Walker
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Chiara C Bortolasci
- Deakin University, CMMR Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia
| | - Ken Walder
- Deakin University, CMMR Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Geelong, Victoria, Australia; Deakin University, CMMR Strategic Research Centre, School of Medicine, Geelong, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
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9
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Abstract
Background: Inconsistent evidence exists regarding the strength, direction, and moderators in the relationship between obesity and psychiatric disorders. Aim: This study aims to summarize the evidence on the association between psychiatric illness and obesity with particular attention to the strength and direction of association and also the possible moderators in each postulated link. Materials and Methods: Systematic electronic searches of MEDLINE through PubMed, ScienceDirect, PsycINFO, and Google Scholar were carried out from inception till October 2016. Generated abstracts were screened for eligibility to be included in the review. Study designs that evaluated the strength of relationship between obesity and psychiatric disorders were included in the study. Quality assessment of included studies was done using the Newcastle–Ottawa checklist tool. Results: From a total of 2424 search results, 21 eligible articles were identified and reviewed. These included studies on obesity and depression (n = 15), obesity and anxiety (four) and one each on obesity and personality disorders, eating disorder (ED), attention deficit hyperactivity disorder, and alcohol use. Maximal evidence existed for the association between depression and obesity with longitudinal studies demonstrating a bidirectional link between the two conditions. The odds ratios (ORs) were similar for developing depression in obesity (OR: 1.21–5.8) and vice versa (OR: 1.18–3.76) with a stronger association observed in women. For anxiety disorders, evidence was mostly cross-sectional, and associations were of modest magnitude (OR: 1.27–1.40). Among other disorders, obesity, and EDs appear to have a close link (OR: 4.5). Alcohol use appears to be a risk factor for obesity and not vice versa but only among women (OR: 3.84). Conclusion: Obesity and depression have a significant and bidirectional association. Evidence is modest for anxiety disorders and inadequate for other psychiatric conditions. Gender appears to be an important mediator in these relationships.
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Affiliation(s)
- T M Rajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - V Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract
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.
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Affiliation(s)
- Nisha C Gottfredson
- a Department of Health Behavior , UNC Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Rebeccah L Sokol
- a Department of Health Behavior , UNC Gillings School of Global Public Health , Chapel Hill , NC , USA
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Bauer FL, Donahoo WT, Hollis HW, Tsai AG, Pottorf BJ, Johnson JM, Silveira LJ, Husain FA. Marijuana's Influence on Pain Scores, Initial Weight Loss, and Other Bariatric Surgical Outcomes. Perm J 2018; 22:18-002. [PMID: 30010532 DOI: 10.7812/tpp/18-002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Pain management can be challenging following bariatric surgery, and patients with obesity tend to increase opioid use after undergoing surgery. This report quantifies marijuana (MJ) use and its relationship to pain and other surgery-related outcomes in a population from a state that has legalized MJ. METHODS Data were collected for consecutive patients undergoing weight reduction surgeries between May 1, 2014 and July 31, 2015. Demographics, preoperative comorbidities, medications, and perioperative opioid use were analyzed. The primary outcome evaluated was inpatient opioid pain medication use quantified using natural log morphine equivalents. Secondary outcomes included percentage of total body weight loss after three months, postoperative complications, and changes in medical comorbidities. RESULTS A total of 434 patients, among whom 36 (8.3%) reported MJ use, comprised the study population. Perioperative opioid requirements were significantly higher in the MJ-user group (natural log morphine equivalents of 3.92 vs 3.52, p = 0.0015) despite lower subjective pain scores (3.70 vs 4.24, p = 0.07). MJ use did not affect percentage of 90-day total body weight loss, development of postoperative complications, or improvement in medical comorbidities. CONCLUSION Perioperative opioid use was significantly higher in the MJ-user group despite lower subjective pain scores. The difference in opioid requirements suggests an interaction between MJ use and opioid tolerance or pain threshold. The percentage of total body weight loss, improvement in medical comorbidity, and incidence of postoperative complications at 90-day follow-up were not affected by MJ use in this cohort analysis.
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Affiliation(s)
- Frank L Bauer
- At the time of this study a Surgeon in the Department of Graduate Medical Education General Surgery at Saint Joseph Hospital in Denver, CO.
| | - William T Donahoo
- At the time of this study an Attending Physician in the Department of Metabolic-Surgical Weight Management at Kaiser Permanente Colorado, and a Clinical Associate Professor of Medicine in the Division of Endocrinology, Diabetes & Metabolism at the University of Florida in Gainesville.
| | - Harris W Hollis
- At the time of this study a Senior Research Advisor in the Department of Graduate Medical Education General Surgery at Saint Joseph Hospital in Denver, CO.
| | - Adam G Tsai
- Attending Physician in the Department of Metabolic-Surgical Weight Management at Kaiser Permanente Colorado.
| | - Brian J Pottorf
- Attending General Surgeon at Longmont United Hospital in Longmont, CO.
| | - Jason M Johnson
- Program Director of the General Surgery Residency in the Department of Graduate Medical Education General Surgery at Saint Joseph Hospital in Denver, CO.
| | | | - Farah A Husain
- At the time of this study an Attending Physician in the Department of Metabolic-Surgical Weight Management at Kaiser Permanente Colorado, and an Assistant Professor of Surgery in the Bariatric Surgery Division in the Department of Surgery at Oregon Health and Science University in Portland.
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12
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Prevalence of obesity for opioid- and stimulant-dependent participants in substance use treatment clinical trials. Drug Alcohol Depend 2018; 190:255-262. [PMID: 30077926 DOI: 10.1016/j.drugalcdep.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022]
Abstract
AIMS To estimate obesity prevalence among drug-dependent individuals and to compare prevalence across different types of drug dependence. METHODS 1596 opioid- and/or stimulant-dependent participants were extracted from six clinical trials within the National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse (NIDA CTN) to estimate obesity prevalence among drug-dependent users. Age-, sex-, and race-matched National Health and Nutrition Examination Survey (NHANES) samples were used as a general population reference. Standardized prevalence ratios (SPRs) were calculated to compare the CTN sample to NHANES as well as to compare within the CTN sample. Logistic regression estimated associations between the type of drug dependence and obesity. RESULTS The standardized obesity prevalence among the drug-dependent CTN trial participants was 67% of expected for age-, sex- and race-matched NIHANES participants (SPR = 0.67, 95% CI: 0.60-0.74). Obesity was least prevalent among opioid-dependent-only participants (SPR = 0.36, 95% CI: 0.27-0.46 compared to the NHANES, and SPR = 0.33, 95% CI: 0.23-0.46 compared to the stimulant-dependent-only participants). Compared to stimulant-dependent-only users (p < 0.0001), the odds of obesity were 67% lower among opioid-dependent-only users (adjusted odds ratio [AOR] = 0.33, 95% CI: 0.23-0.46) and 33% lower among opioid and stimulant-co-dependent users (AOR = 0.67, 95%CI: 0.49-0.90) after controlling for age, sex, race, education and employment pattern. CONCLUSIONS The prevalence of obesity among drug-dependent clinical trial participants was lower than the general population, and lowest among opioid-dependent-only users, suggesting an inverse relationship between obesity prevalence and drug dependence, most notable among opioid-dependent-only users.
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Escobar M, Scherer JN, Ornell F, Bristot G, Soares CM, Guimarães LSP, Von Diemen L, Pechansky F. Leptin levels and its correlation with crack-cocaine use severity: A preliminary study. Neurosci Lett 2018; 671:56-59. [DOI: 10.1016/j.neulet.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/18/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
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Escobar M, Scherer JN, Soares CM, Guimarães LSP, Hagen ME, von Diemen L, Pechansky F. Active Brazilian crack cocaine users: nutritional, anthropometric, and drug use profiles. ACTA ACUST UNITED AC 2018; 40:354-360. [PMID: 29451589 PMCID: PMC6899369 DOI: 10.1590/1516-4446-2017-2409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/07/2017] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the nutritional status of crack users and to analyze its correlation with drug use profiles. Methods: Cross-sectional study with 108 crack users. Anthropometric data were assessed through body mass index (BMI) and bioimpedance (BIA) measurements. A blood test to analyze hematocrit, hemoglobin, glucose, and lipid profiles was also performed. Crack use was determined through a standardized interview. Results: Based on BMI and BIA, most individuals were eutrophic (about 70%). Regarding hematological parameters, we found that hemoglobin and hematocrit levels were below normal for 32.4 and 30.6% of patients, respectively. Considering normal parameters, a large part of the sample (60.2%) had low levels of HDL cholesterol and high levels of triglycerides (38%). There were no significant correlations between drug profile and nutritional variables. Conclusion: This is a pioneering study that examines the nutritional status of crack users. Our results showed that most crack users present normal anthropometric findings and the prevalence of underweight is low. However, blood analysis showed changes and a specific type of malnutrition.
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Affiliation(s)
- Mariana Escobar
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.,Departamento de Nutrição, Centro de Estudos em Alimentação e Nutrição (CESAN), Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Juliana N Scherer
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Cassia M Soares
- Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | | | - Martine E Hagen
- Departamento de Nutrição, Centro de Estudos em Alimentação e Nutrição (CESAN), Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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15
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Blanco-Gandía MC, Aracil-Fernández A, Montagud-Romero S, Aguilar MA, Manzanares J, Miñarro J, Rodríguez-Arias M. Changes in gene expression and sensitivity of cocaine reward produced by a continuous fat diet. Psychopharmacology (Berl) 2017; 234:2337-2352. [PMID: 28456841 DOI: 10.1007/s00213-017-4630-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/03/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE Preclinical studies report that free access to a high-fat diet (HFD) alters the response to psychostimulants. OBJECTIVES The aim of the present study was to examine how HFD exposure during adolescence modifies cocaine effects. Gene expression of CB1 and mu-opioid receptors (MOr) in the nucleus accumbens (N Acc) and prefrontal cortex (PFC) and ghrelin receptor (GHSR) in the ventral tegmental area (VTA) were assessed. METHODS Mice were allowed continuous access to fat from PND 29, and the locomotor (10 mg/kg) and reinforcing effects of cocaine (1 and 6 mg/kg) on conditioned place preference (CPP) were evaluated on PND 69. Another group of mice was exposed to a standard diet until the day of post-conditioning, on which free access to the HFD began. RESULTS HFD induced an increase of MOr gene expression in the N Acc, but decreased CB1 receptor in the N Acc and PFC. After fat withdrawal, the reduction of CB1 receptor in the N Acc was maintained. Gene expression of GHSR in the VTA decreased during the HFD and increased after withdrawal. Following fat discontinuation, mice exhibited increased anxiety, augmented locomotor response to cocaine, and developed CPP for 1 mg/kg cocaine. HFD reduced the number of sessions required to extinguish the preference and decreased sensitivity to drug priming-induced reinstatement. CONCLUSION Our results suggest that consumption of a HFD during adolescence induces neurobiochemical changes that increased sensitivity to cocaine when fat is withdrawn, acting as an alternative reward.
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Affiliation(s)
- M Carmen Blanco-Gandía
- Departamento de Psicobiología, Facultad de Psicología, Unidad de Investigación Psicobiología de las Drogodependencias, , Universitat de València, Avda. Blasco Ibáñez, 21, 46010, Valencia, Spain
| | | | - Sandra Montagud-Romero
- Departamento de Psicobiología, Facultad de Psicología, Unidad de Investigación Psicobiología de las Drogodependencias, , Universitat de València, Avda. Blasco Ibáñez, 21, 46010, Valencia, Spain
| | - Maria A Aguilar
- Departamento de Psicobiología, Facultad de Psicología, Unidad de Investigación Psicobiología de las Drogodependencias, , Universitat de València, Avda. Blasco Ibáñez, 21, 46010, Valencia, Spain
| | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Alicante, Spain
| | - José Miñarro
- Departamento de Psicobiología, Facultad de Psicología, Unidad de Investigación Psicobiología de las Drogodependencias, , Universitat de València, Avda. Blasco Ibáñez, 21, 46010, Valencia, Spain
| | - Marta Rodríguez-Arias
- Departamento de Psicobiología, Facultad de Psicología, Unidad de Investigación Psicobiología de las Drogodependencias, , Universitat de València, Avda. Blasco Ibáñez, 21, 46010, Valencia, Spain.
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16
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Stoutenberg M, Rethorst CD, Vidot DC, Greer TL, Trivedi MH. Cardiorespiratory fitness and body composition of stimulant users: A baseline analysis of the STRIDE cohort. J Subst Abuse Treat 2017; 78:74-79. [PMID: 28554607 DOI: 10.1016/j.jsat.2017.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Relatively little has been reported about the physical characteristics, such as cardiorespiratory fitness (CRF) and body composition, of stimulant users. Identifying risk factors associated with the physical health of stimulant users is an important public health issue as new treatments should better address the entire range of health concerns experienced by this population. METHODS We examined cross-sectional data gathered at baseline from the STimulant Reduction Intervention using Dosed Exercise (STRIDE) study, a multisite randomized clinical trial that examined exercise as an adjunct to treatment as usual for individuals in residential treatment programs (RTPs). Clients were approached after intake to the RTP. Prior to randomization, eligible individuals underwent a comprehensive screening process that included medical screening, where CRF was assessed through a maximal exercise test (time on treadmill), and a series of baseline examinations assessing domains of substance use and mental health. RESULTS Data from 295 individuals with recent stimulant use disorders were analyzed. The mean body mass index (BMI) and waist circumference (WC) and for all participants was 27.8±5.7kg/m2 and 93.5±14.2cm, respectively, while the mean time on treadmill was 13.7±2.9min. Few significant associations were observed between CRF, BMI, or WC and substance use and mental health measures. CONCLUSIONS Stimulant users in this study presented with low CRF levels and would be considered overweight based on their BMI. These individuals would likely benefit from interventions that address both their stimulant use, as well as their physical health.
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Affiliation(s)
- Mark Stoutenberg
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Chad D Rethorst
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Denise C Vidot
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL, United States
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
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17
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Billing L, Ersche KD. Cocaine’s appetite for fat and the consequences on body weight. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 41:115-8. [DOI: 10.3109/00952990.2014.966196] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lawrence Billing
- Departments of Psychology and Psychiatry, University of Cambridge and
| | - Karen D. Ersche
- Departments of Psychology and Psychiatry, University of Cambridge and
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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18
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Ersche KD, Stochl J, Woodward JM, Fletcher PC. The skinny on cocaine: insights into eating behavior and body weight in cocaine-dependent men. Appetite 2013; 71:75-80. [PMID: 23920064 PMCID: PMC3863945 DOI: 10.1016/j.appet.2013.07.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/25/2013] [Accepted: 07/26/2013] [Indexed: 12/20/2022]
Abstract
There is a general assumption that weight loss associated with cocaine use reflects its appetite suppressing properties. We sought to determine whether this was justified by characterizing, in detail, alterations in dietary food intake and body composition in actively using cocaine-dependent individuals. We conducted a cross-sectional case-control comparison of 65 male volunteers from the local community, half of whom satisfied the DSM-IV-TR criteria for cocaine dependence (n=35) while the other half had no personal or family history of a psychiatric disorder, including substance abuse (n=30). Assessments were made of eating behavior and dietary food intake, estimation of body composition, and measurement of plasma leptin. Although cocaine users reported significantly higher levels of dietary fat and carbohydrates as well as patterns of uncontrolled eating, their fat mass was significantly reduced compared with their non-drug using peers. Levels of leptin were associated with fat mass, and with the duration of stimulant use. Tobacco smoking status or concomitant use of medication did not affect the significance of the results. Weight changes in cocaine users reflect fundamental perturbations in fat regulation. These are likely to be overlooked in clinical practice but may produce significant health problems when cocaine use is discontinued during recovery.
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Affiliation(s)
- Karen D Ersche
- University of Cambridge, Department of Psychiatry, Cambridge CB2 0SZ, UK; University of Cambridge, Behavioural and Clinical Neuroscience Institute, Cambridge CB2 0SZ, UK.
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19
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Higgins GA, Sellers EM, Fletcher PJ. From obesity to substance abuse: therapeutic opportunities for 5-HT2C receptor agonists. Trends Pharmacol Sci 2013; 34:560-70. [PMID: 24041919 DOI: 10.1016/j.tips.2013.08.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/26/2013] [Accepted: 08/02/2013] [Indexed: 12/25/2022]
Abstract
The recent US Food and Drug Administration (FDA) approval of the serotonin (5-hydroxytryptamine, 5-HT) 5-HT2C receptor agonist lorcaserin for the treatment of obesity represents a new therapeutic drug class available to the clinic. Preclinical evidence supports the potential for this drug class to treat other related conditions such as substance abuse. In the present article we review this evidence and further suggest that overlapping neurobiological systems may contribute to an anti-addictive and anti-obesity profile. The availability of selective 5-HT2C agonists provides an opportunity to evaluate their potential as treatments for nicotine dependence or psychostimulant abuse, conditions for which there is significant medical need but only limited available treatment options.
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Affiliation(s)
- Guy A Higgins
- InterVivo Solutions Inc, 120 Carlton Street, Toronto, ON M5A 4K2, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada.
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20
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Zubaran C, Lazzaretti R. The use of appetite suppressants among health sciences undergraduate students in Southern Brazil. EINSTEIN-SAO PAULO 2013; 11:47-52. [PMID: 23579743 PMCID: PMC4872967 DOI: 10.1590/s1679-45082013000100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 02/04/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of appetite suppressant use among health sciences students in Southern Brazil. METHODS Undergraduate students (n=300) from seven health science undergraduate courses of the Universidade de Caxias do Sul completed a questionnaire about the use of substances to suppress appetite. RESULTS A significant percentage (15%; n=45) of research participants used appetite suppressants at least once in their lives. The most commonly used substances were sympathomimetic stimulant drugs (5%), including amfepramone (3.3%) and fenproporex (1.7%). The lifetime use of appetite suppressants was more prevalent among Nursing (26.7%) and Nutrition (24.4%%) students. There was no reported use of appetite suppressants among medical students. The use of appetite suppressants was significantly more prevalent among women. The majority of those who used these substances did so under medical recommendation. Most of users took appetite suppressants for more than 3 months. CONCLUSION Lifetime use of appetite suppressants was substantial, being sympathomimetic stimulant drugs the most commonly used agents. Students enrolled in Nursing and Nutrition courses presented a significantly higher prevalence of lifetime use of appetite suppressants.
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Affiliation(s)
- Carlos Zubaran
- The Biological and Health Sciences Center, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
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21
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Yarnell S, Oscar-Berman M, Avena N, Blum K, Gold M. Pharmacotherapies for Overeating and Obesity. ACTA ACUST UNITED AC 2013; 4:131. [PMID: 23826512 DOI: 10.4172/2157-7412.1000131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Obesity has become pandemic, and the annual cost in related illnesses and loss of productivity is already over $100 billion and rising. Research has shown that obesity can and does cause changes in behavior and in the brain itself that are very similar to changes caused by drugs of abuse. While food addiction is not the causal agent of all obesity, it is clear that many people no longer eat to survive, but instead survive to eat. This review considers the importance of the brain's reward system in food intake. The review also examines research developments and current treatments for obesity, including diet and exercise, psychotherapy, surgical interventions, and pharmacotherapies. Finally we discuss alterations in American society that are necessary for change to occur, and the diffculties therein.
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Affiliation(s)
- S Yarnell
- Department of Psychiatry and McKnight Brain Institute, University of Florida College of Medicine, Gainesville, Florida, USA
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22
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Tsai J, Ford ES, Zhao G, Croft JB. Multiple health behaviors and serum hepatic enzymes among US adults with obesity. Prev Med 2011; 53:278-83. [PMID: 21893086 DOI: 10.1016/j.ypmed.2011.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 08/20/2011] [Accepted: 08/20/2011] [Indexed: 01/01/2023]
Abstract
INTRODUCTION This study was to examine the cumulative number and clustering patterns of low-risk health behaviors (i.e., not currently smoking, not excessive drinking, and physically active) associated with elevation of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among adults with obesity in the United States. METHODS We estimated the age-adjusted prevalence of elevated ALT, AST, and GGT from 4547 adults with obesity aged ≥ 20 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. The associations between the cumulative number or clustering patterns of low-risk health behaviors and measures of serum ALT, AST, and GGT were assessed using multivariate regression models. RESULTS Adult men who reported having three low-risk health behaviors were 62%, 39%, and 48% less likely to have elevated serum ALT, AST, and GGT, respectively; adult women were 56% and 73% less likely to have elevated serum AST and GGT, respectively, when compared to their respective counterparts who reported having none of the low-risk health behaviors. CONCLUSIONS The findings of this study indicate that, among adults with obesity, having multiple low-risk health behaviors is associated with decreased likelihoods of elevated hepatic enzymes, including ALT in men, AST and GGT in both men and women.
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Affiliation(s)
- James Tsai
- National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention, Atlanta, GA, USA.
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23
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Barry DT, Beitel M, Breuer T, Cutter CJ, Savant J, Peters S, Schottenfeld RS, Rounsaville BJ. Group-based strategies for stress reduction in methadone maintenance treatment: what do patients want? J Addict Med 2011; 5:181-7. [PMID: 21841430 PMCID: PMC3178342 DOI: 10.1097/adm.0b013e3181ee77cl] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess methadone maintenance treatment (MMT) patients' willingness to use, and perceived efficacy of, conventional and unconventional group stress reduction treatments. METHODS A survey, developed by the authors, was administered to 150 MMT patients. RESULTS Levels of treatment willingness and perceived efficacy for both conventional and unconventional treatments were relatively high; however, ratings for conventional interventions were, on average, significantly higher than those for unconventional ones. The highest rated conventional and unconventional treatments in terms of willingness and perceived efficacy were nutrition and spiritual counseling, respectively, whereas the lowest rated conventional and unconventional group treatments were anger management and visualization training, respectively. White race was a significant predictor of lower willingness to try conventional and unconventional group therapies and lower perceived efficacy of unconventional group treatment, whereas female sex and older age were significant predictors of higher levels of willingness to try unconventional group treatment. Higher levels of substance use problems were associated with increased willingness to try conventional group treatment. Higher levels of anxiety emerged as a significant independent predictor of treatment willingness and perceived efficacy for both conventional and unconventional group treatments. CONCLUSIONS The relatively high levels of treatment willingness and perceived efficacy of conventional and unconventional group stress reduction treatments point to the feasibility of offering these interventions in MMT and suggest that, in particular, high levels of anxiety are associated with greater treatment willingness and perceived treatment efficacy.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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24
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Tsai J, Ford ES, Zhao G, Li C, Greenlund KJ, Croft JB. Co-occurrence of obesity and patterns of alcohol use associated with elevated serum hepatic enzymes in US adults. J Behav Med 2011; 35:200-10. [PMID: 21626151 DOI: 10.1007/s10865-011-9353-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/12/2011] [Indexed: 12/19/2022]
Abstract
The aim of this cross-sectional study was to present nationally representative findings on the co-occurrence of obesity and specific patterns of alcohol use associated with elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among adults in the United States. We analyzed data from 8,373 adults aged ≥ 20 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. We produced prevalence ratios by using the co-occurrence of obesity (i.e., body mass index ≥ 30.0 kg/m(2) or waist circumference ≥ 102 cm in men and ≥ 88 cm in women) and specific patterns of alcohol use (i.e., non-drinkers, non-excessive drinkers, and excessive drinkers) as a predictor; elevations in serum ALT, AST, and GGT were used as an outcome variable while adjusting for covariates in multivariate regression models. Approximately 34.7% of adult men and 38.6% of adult women in the United States had co-occurrence of obesity and any alcohol use, including 16.4% of men and 9.8% of women who had co-occurrence of obesity and excessive drinking during 2005-2008. When compared to male non-drinkers without obesity after multivariate adjustment, male excessive drinkers with obesity were 3.08 (95% CI: 1.80-5.28), 2.42 (95% CI: 1.80-3.26), and 3.15 (95% CI: 1.82-5.46) times more likely to exhibit elevated serum ALT, AST, and GGT, respectively. Similarly, when compared to female non-drinkers without obesity, female excessive drinkers with obesity were 2.36 (95% CI: 1.38-4.04), 3.27 (95% CI: 1.85-5.78), and 3.43 (95% CI: 2.19-5.40) times more likely to have elevated serum ALT, AST, and GGT, respectively. The co-occurrence of obesity and excessive drinking may place adults at an increased risk for potential liver injury. Our study findings provide support for evidence-based clinical and population-based interventions that integrate health behavior change among adults who have these co-occurring risk factors.
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Affiliation(s)
- James Tsai
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop K67, Atlanta, GA 30341, USA.
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Potenza MN, Sofuoglu M, Carroll KM, Rounsaville BJ. Neuroscience of behavioral and pharmacological treatments for addictions. Neuron 2011; 69:695-712. [PMID: 21338880 PMCID: PMC3063555 DOI: 10.1016/j.neuron.2011.02.009] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2011] [Indexed: 01/30/2023]
Abstract
Although substantial advances have been made in behavioral and pharmacological treatments for addictions, moving treatment development to the next stage may require novel ways of approaching addictions, particularly ways based on new findings regarding the neurobiological underpinnings of addictions that also assimilate and incorporate relevant information from earlier approaches. In this review, we first briefly review theoretical and biological models of addiction and then describe existing behavioral and pharmacologic therapies for the addictions within this framework. We then propose new directions for treatment development and targets that are informed by recent evidence regarding the heterogeneity of addictions and the neurobiological contributions to these disorders.
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Affiliation(s)
- Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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