Obesity, sex and pubertal status affect appetite hormone responses to a mixed glucose and whey protein drink in adolescents

Neural correlates of appetite in adolescents

Appetitive characteristics are associated with child adiposity, but their biological underpinnings are unclear. We sought to investigate the neural correlates of psychometric and behavioral measures of appetitive characteristics in youth. Adolescents (14-18y; 39F, 37M) varying in familial obesity risk and body weight (20% with overweight, 24% with obesity) viewed pictures of high energy-density (ED) foods, low-ED foods and non-foods during fMRI scanning on two separate days. On one day participants consumed a 474 ml preload of water (0 kcal, fasted) and on another (counter-balanced) 474 ml milkshake (480 kcal, fed), before scanning. A multi-item ad libitum meal (ALM) followed scanning. Parents completed Child Eating Behavior Questionnaire (CEBQ) sub-scales assessing food approach and food self-regulation. Caloric compensation was calculated as the percentage of preload intake compensated for by down-regulation of ALM intake in the fed vs. fasted condition. Analyses correcting for multiple comparisons demonstrated that, for the fasted condition, higher CEBQ Food Responsiveness scores were associated with greater activation to high-ED (vs. low-ED) foods in regions implicated in food reward (insula, rolandic operculum, putamen). In addition, higher caloric compensation was associated with greater fed vs. fasted activations in response to foods (vs. non-foods) in thalamus and supramarginal gyrus. Uncorrected analyses provided further support for associations of different measures of appetitive characteristics with brain responses to food cues in each condition. Measures of appetitive characteristics demonstrated overlapping and distinct associations with patterns of brain activation elicited by food cues in fasted and fed states. Understanding the neural basis of appetitive characteristics could aid development of biobehaviorally-informed obesity interventions.

Boys and girls differ in their rationale behind eating: a systematic review of intrinsic and extrinsic motivations in dietary habits across countries

Background

Boys' and girls' food habits diverge in adolescence (13-18 years). This contributes to unequal risks of adverse health outcomes based on sex and gender in adulthood (e.g., heart diseases in men vs. disorder eating in women). Though multi-factorial, why these dietary differences occur is unclear.

Purpose

To identify the reasons why adolescents' motivation behind dietary habits differs among genders.

Methods

Four databases were searched following PRISMA guidelines. Eligible studies had to use qualitative methodology and report at least one gender unique theme. Reported themes were thematically analyzed, with a sub-analysis by country where the studies were conducted. Quality appraisals were assessed using the Critical Appraisal Skills Programme checklist.

Results

In the 34 eligible articles (n = 1,694 returned) two overarching themes emerged that dictated dietary habits in adolescents: Self-motivators and Uncontrollable factors. Gender differences arose whereby girls highlighted more external motivators (e.g., eat healthier, change dietary habits around boys and be thin to fit traditional norms) over their dietary habits. In contrast, boys focused on more internal motivators (e.g., gain autonomy, eat for enjoyment and pursue gains in physical performance). This suggests that motivation underlying how boys and girls eat differs. These trends were largely consistent across countries.

Conclusion

Boys' and girls' food habits are not motivated by the same factors. To create more effective dietary interventions targeting health promotion, unique motivations behind food habits need to be understood and incorporated.

Systematic review registration

Identifier: CRD42022298077.

Medical treatment of weight loss in children and adolescents with obesity

Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.

Neuropeptide Y and Peptide YY in Association with Depressive Symptoms and Eating Behaviours in Adolescents across the Weight Spectrum: From Anorexia Nervosa to Obesity

Neuropeptide Y (NPY) and peptide YY (PYY) are involved in metabolic regulation. The purpose of the study was to assess the serum levels of NPY and PYY in adolescents with anorexia nervosa (AN) or obesity (OB), as well as in a healthy control group (CG). The effects of potential confounders on their concentrations were also analysed. Eighty-nine adolescents were included in this study (AN = 30, OB = 30, and CG = 29). Anthropometric measurements and psychometric assessment of depressive symptoms, eating behaviours, body attitudes, and fasting serum levels of NPY and PYY were analysed. The AN group presented severe depressive symptoms, while the OB group held different attitudes towards the body. The levels of NPY were lower in the AN and OB groups as compared with the CG. The PYY levels were higher in the OB group than in the AN group and the CG. The severity of eating disorder symptoms predicted fasting serum concentrations of NPY. Lower levels of NPY in AN, as well as in OB suggests the need to look for a common link in the mechanism of this effect. Higher level of PYY in OB may be important in explaining complex etiopathogenesis of the disease. The psychopathological symptoms may have an influence on the neurohormones regulating metabolism.

Acute decrease in plasma testosterone and appetite after either glucose or protein beverages in adolescent males

OBJECTIVE

Chronic testosterone blood concentrations associate with food intake (FI), but acute effects of testosterone on appetite and effect of protein and glucose consumption on testosterone response have had little examination.

METHODS

In a randomized, crossover study, twenty-three adolescent (12-18 years old) males were given beverages containing either: (a) whey protein (1 g/kg body weight), (b) glucose (1 g/kg body weight) or (c) a calorie-free control (C). Plasma testosterone, luteinizing hormone (LH), GLP-1 (active), ghrelin (acylated), glucose, insulin and subjective appetite were measured prior (0) and at 20, 35 and 65 minutes after the consumption of the beverage. FI at an ad libitum pizza meal was assessed at 85 minutes.

RESULTS

Testosterone decreased acutely to 20 minutes after both protein and glucose with the decrease continuing after protein but not glucose to 65 minutes (P = 0.0382). LH was also decreased by both protein and glucose, but glucose had no effect at 20 minutes in contrast to protein (P < 0.001). Plasma testosterone concentration correlated positively with LH (r = 0.58762, P < 0.0001) and negatively with GLP-1 (r = -0.50656, P = 0.0003). No associations with appetite, ghrelin or glycaemic markers were found. Food intake was not affected by treatments.

CONCLUSION

Protein or glucose ingestion results in acute decreases in both plasma testosterone and LH in adolescent males. The physiological significance of this response remains to be determined as no support for testosterone's role in acute regulation of food intake was found.

The Effect of Exercise and Protein Source on Food Intake Regulation and Characteristics of Metabolic Syndrome in Obese Female Wistar Rats

Results:

FI and plasma ghrelin (2.7 times) were higher in exercise groups compared with non-exercise groups. BW was lower (6.7%) in groups fed a whey protein diet compared with those fed a soy protein diet. Abdominal fat (% BW) was lower (22.8%) in WPE compared with other groups. Diastolic blood pressure (11.1%) and pulse (6%) were lower in groups fed a soy protein diet compared with groups fed a whey protein diet.

Conclusion:

While exercise affects food intake, source of protein determines BW and BC. Whey protein showed more favorable effect on BW and body composition.

Effect of Commercially Available Sugar-Sweetened Beverages on Subjective Appetite and Short-Term Food Intake in Boys

It is unclear whether sugar sweetened beverages bypass regulatory controls of food intake (FI) in boys. The objective of the present study was to determine the effects of isovolumetric preloads (350 mL) of a fruit-flavoured drink (154 kcal), cola (158 kcal), 1% M.F. chocolate milk (224 kcal), and water (0 kcal) on subjective appetite and FI in boys aged 9–14 years. On four separate mornings, boys consumed one of the preloads in a random order; subjective appetite was measured at 15 min intervals, and FI was measured via an ad libitum pizza lunch at 60 min post-beverage consumption. In the 32 boys (age: 11.8 ± 0.3 years), FI was reduced (p < 0.001) after cola (940 ± 46 kcal) and chocolate milk (878 ± 41 kcal) compared with the water control (1048 ± 35 kcal) and after chocolate milk compared to the fruit drink (1005 ± 44 kcal). Cumulative FI after the fruit drink was greater than the water control (1159 ± 44 vs. 1048 ± 35 kcal; p = 0.03). Average appetite was not affected by the treatment, but the cola treatment resulted in greater fullness (p = 0.04) and lower prospective food consumption (p = 0.004) compared with the fruit drink. In conclusion, chocolate milk and cola suppressed next-meal FI at 60 min, while fruit drink increased cumulative FI (beverage + next meal) over 60 min in boys. Results from this study suggest that beverage composition is an important determinant of FI suppression in boys.

Whey Proteins Reduce Appetite, Stimulate Anorexigenic Gastrointestinal Peptides and Improve Glucometabolic Homeostasis in Young Obese Women

Introduction: Proteins, particularly whey proteins, represent the most satiating macronutrient in animals and humans. A dietetic regimen based on proteins enriched preload before eating might be a strategy to counteract obesity. Aims and Methods: The aim of the present study was to evaluate the effects of an isocaloric drink containing whey proteins or maltodextrins (preload) on appetite (satiety/hunger measured by a visual analogue scale or VAS), glucometabolic control (blood glucose/insulin), and anorexigenic gastrointestinal peptides (pancreatic polypeptide or PP, glucagon-like peptide 1 or GLP-1 and peptide YY or PYY) in a cohort of obese young women (n = 9; age: 18.1 ± 3.0 years; body mass index, BMI: 38.8 ± 4.5 kg/m²). After two and a half hours, they were administered with a mixed meal at a fixed dose; satiety and hunger were measured by VAS. Results: Each drink significantly augmented satiety and reduced hunger, and the effects were more evident with whey proteins than maltodextrins. Similarly, there were significant increases in GLP-1 and PYY levels (but not PP) after the ingestion of each drink; these anorexigenic responses were higher with whey proteins than maltodextrins. While insulinemia identically increased after each drink, whey proteins induced a lower glycemic response than maltodextrins. No differences in satiety and hunger were found after the meal, which is presumably due to the late administration of the meal test, when the hypophagic effect of whey proteins was disappearing. Conclusions: While whey proteins actually reduce appetite, stimulate anorexigenic gastrointestinal peptides, and improve glucometabolic homeostasis in young obese women, further additional studies are mandatory to demonstrate their hypophagic effects in obese subjects, when administered as preload before eating.

Effect of video game playing and a glucose preload on subjective appetite, subjective emotions, and food intake in overweight and obese boys

Video game playing (VGP) is associated with overweight/obesity (OW/OB). VGP and caloric preloads in the pre-meal environment influence short-term food intake (FI) in healthy-weight children. Therefore, the purpose of the present study was to examine the effect of pre-meal VGP and a glucose preload on subjective emotions, subjective appetite, and FI in boys with OW/OB. On 4 separate mornings, boys with OW/OB (n = 22; mean ± SD: age = 11.9 ± 1.6 years; body mass index percentile = 94.3 ± 3.9) participated in 4 test conditions. Two hours after a standardized breakfast, boys consumed equally sweetened preloads (250 mL) of sucralose (0 kcal) or glucose (200 kcal), with or without 30 min of subsequent VGP. Immediately after each test condition, FI was evaluated during an ad libitum pizza meal. Subjective appetite was measured at 0 (baseline), 15, and 30 min. Subjective emotions (aggression, anger, excitement, disappointment, happiness, upset, and frustration) were measured at 0 and 30 min. VGP did not affect FI, but the glucose preload decreased FI compared with the sucralose control (Δ = -103 ± 48 kcal, p < 0.01). However, cumulative FI (preload kcal + meal kcal) was 9% higher after the glucose preload (p < 0.01). Subjective appetite increased with time (p < 0.05) but was not influenced by preload or VGP. Frustration was the only subjective emotion that increased following VGP (p < 0.01). A glucose preload, but not VGP, suppressed FI in boys with OW/OB, suggesting a primary role of physiological factors in short-term FI regulation.

Ghrelin and Peptide YY Change During Puberty: Relationships With Adolescent Growth, Development, and Obesity

CONTEXT

Pubertal adolescents show strong appetites. How this is mediated is unclear, but ghrelin and peptide YY (PYY) play potentially important roles.

OBJECTIVE

To measure ghrelin and PYY change in relation to pubertal growth.

DESIGN

Three-year prospective cohort study.

SETTING

Australian regional community.

PARTICIPANTS

Eighty healthy adolescents (26 girls; 54 boys) recruited at 10 to 13 years.

MAIN OUTCOME MEASURES

Fasting circulating total ghrelin, total PYY, IGF-1, insulin, leptin (via radioimmunoassay), estradiol and testosterone (via mass spectrometry), anthropometry, and body composition (via bioelectrical impedance).

RESULTS

Adolescents exhibited normal developmental change. Mixed models revealed positive associations for ghrelin to age2 (both sexes: P < 0.05), indicating a U-shaped trend over time. Ghrelin was also inversely associated with IGF-1 (both sexes: P < 0.05), leptin in girls (P < 0.01), and insulin in boys (P < 0.05) and negatively correlated with annual height and weight velocity (both sexes: P ≤ 0.01). PYY showed no age-related change in either sex. Neither ghrelin nor PYY were associated with Tanner stage. Weight subgroup analyses showed significant ghrelin associations with age2 in healthy-weight but not overweight and obese adolescents (7 girls; 18 boys).

CONCLUSIONS

Adolescents showed a U-shaped change in ghrelin corresponding to physical and biochemical markers of growth, and no change in PYY. The overweight and obesity subgroup exhibited an apparent loss of the U-shaped ghrelin trend, but this finding may be attributed to greater maturity and its clinical significance is unclear. Further research on weight-related ghrelin and PYY trends at puberty is needed to understand how these peptides influence growth and long-term metabolic risk.

Pre- and within-meal effects of fluid dairy products on appetite, food intake, glycemia, and regulatory hormones in children

The effect of beverages commonly consumed by children in-between or with meals on short-term food intake (FI) and glycemic control has received little attention. Therefore, 2 experiments were conducted in 9- to 14-year-old children following a randomized repeated-measures design. Experiment 1 (n = 32) compared the effects of water (control) and isocaloric (130 kcal) amounts of 2% milk, chocolate milk, yogurt drink, and fruit punch on subjective appetite and FI. Experiment 2 (n = 20) compared the effects of isocaloric (130 kcal) amounts of 2% milk and fruit punch on subjective appetite, FI, and glycemic and appetite hormone responses. One serving of the beverages was given as a pre-meal drink at baseline (0 min) and a second serving 60 min later with an ad libitum pizza meal. Meal FI in experiment 1 was lower by 14% and 10%, respectively, after chocolate milk and yogurt drink (p < 0.001), but not milk, compared with water. Cumulative energy intake (beverages plus meal) was higher after caloric beverages than water. In experiment 2, no differences occurred in pre-meal but post-meal glucose was 83% higher in overweight/obese than normal-weight children (p = 0.02). Milk led to higher pre-meal glucagon-like peptide-1 and post-meal peptide tyrosine tyrosine (PYY) than fruit punch (p < 0.01) but insulin did not differ between treatments. In conclusion, dairy products consumed before and with a meal have more favourable effects on FI, appetite, and satiety hormones than a sugar-sweetened beverage, but all caloric beverages result in more cumulative calories than if water is the beverage.

Pubertal status, pre-meal drink composition, and later meal timing interact in determining children's appetite and food intake

Puberty is a period of development that alters energy intake patterns. However, few studies have examined appetite and food intake (FI) regulation during development of puberty in children and adolescents. Therefore, the objective was to measure the effect of pubertal status on FI and subjective appetite after pre-meal glucose and whey protein drinks in 9- to 14-year-old boys and girls. In a within-subject, randomized, repeated-measures design, children (21 pre-early pubertal, 15 mid-late pubertal) received equally sweetened drinks containing Sucralose (control), glucose, or whey protein (0.75 g/kg body weight) in 250 mL of water 2 h after a standardized breakfast on 6 separate mornings. Ad libitum FI was measured either 30 or 60 min later and appetite was measured over time. In pre-early and mid-late pubertal boys and girls there was no effect of sex on total FI (kcal). Glucose and whey protein drinks reduced calorie intake similarly at 30 min. But at 60 min, whey protein reduced FI (p < 0.001) compared with control and glucose in pre-early pubertal children, but not in mid-late pubertal children. However, sex was a factor (p = 0.041) when FI was expressed per kilogram body weight. Pubertal status did not affect FI/kilogram body weight in boys, but it was 32% lower in mid-late pubertal girls than at pre-early puberty (p = 0.010). Appetite was associated with FI in mid-late pubertal children only. In conclusion, pubertal development affects appetite and FI regulation in children.

Physiology of Food Intake Control in Children

The purpose of this review is to draw attention to the limited information available on food intake (FI) control in children and adolescents 7-17 y of age, which is essential for developing food policies and guidelines in this population. Although environmental factors have been the overwhelming focus of research on the causative factors of obesity, research focusing on the physiologic control of appetite in children and adolescents is a neglected area of research. To present this message, a review of FI regulation and the role of food and food components in signaling processes are followed by an examination of the role of hormones during puberty in intake regulation. To examine the interaction of environment and physiology on FI regulation, the effects of exercise, television programs, and food advertisements are discussed. In conclusion, although limited, this literature review supports a need for children and adolescents to be a greater focus of research that would lead to sound nutrition policies and actions to reduce chronic disease. A focus on the environment must be balanced with an understanding of physiologic and behavioral changes associated with this age group.

Acute decrease in serum testosterone after a mixed glucose and protein beverage in obese peripubertal boys

BACKGROUND AND OBJECTIVES

Delayed puberty and lower levels of testosterone (T) have been observed in adult obese males and some adolescent males. In adult men, enteral glucose ingestion results in acute lowering of serum testosterone levels; however, this has not been studied in adolescents. We aimed to examine the acute effect of a glucose/protein beverage on serum T concentration changes in obese peripubertal males. A second objective was to determine whether change in T concentration was related to appetite hormone levels.

PATIENTS AND METHODS

Twenty-three overweight and obese males aged 8-17 in pre-early (Tanner stage 1-2) and mid-late (Tanner stage 3-5) puberty were included in this cross-sectional study at the Clinical investigative unit at the Hospital for Sick Children. Participants consumed a beverage containing glucose and protein, and blood samples measuring pubertal hormones, ghrelin and glucagon-like peptide-1 (GLP-1) were taken over 60 min.

RESULTS

Across pubertal stages, there was a significant decrease in T levels in adolescent boys (-18·6 ± 3·1%, P < 0·01) with no proportional differences between pre-early and mid-late puberty (P = 0·09). Decrease in T was associated with a decrease in LH (r = 0·52, P = 0·02), and fasting T was inversely correlated with fasting ghrelin (r = -0·51, P = 0·03) with no correlation with GLP-1.

CONCLUSIONS

Intake of a mixed glucose/protein beverage acutely decreases T levels in overweight and obese peripubertal boys. A potential mechanism for this decrease may be secondary to an acute decrease in LH, but this requires further evaluation.

Appetite-related peptides in childhood and adolescence: role of ghrelin, PYY, and GLP-1

During childhood and adolescence, a number of factors, including age, puberty, sex, race, and body composition, may contribute to differences in satiety, food intake, and appetite-related peptides. These peptides include the orexigenic peptide ghrelin and anorexigenic gut peptides peptide YY (PYY) and glucagon-like peptide-1 (GLP-1). For example, lower fasting ghrelin levels, lower postprandial ghrelin suppression, and blunted PYY and GLP-1 responses to food intake could contribute to a dysregulation of appetite in already obese children and adolescents. Whereas, changes in these peptides observed during puberty could facilitate growth. A greater understanding of the major moderating factors of appetite-related peptides in the pediatric population is essential to improve interpretation of study findings and for effective tailoring of strategies targeting appetite control to individuals. While more studies are needed, there is some evidence to suggest that exercise-based lifestyle interventions could be a potential therapeutic strategy to improve appetite-peptide profiles in overweight and obese children and adolescents. The aim of this review is (i) to discuss the potential moderating factors of ghrelin, PYY, and GLP-1, including age and puberty, sex, race and body composition; and (ii) to examine the effects of exercise interventions on these appetite-related gut peptides in children and adolescents.