Metabolic, Affective and Neurocognitive Characterization of Metabolic Syndrome Patients with and without Food Addiction. Implications for Weight Progression

The prognostic role of food addiction for weight loss treatment outcomes in individuals with overweight and obesity: A systematic review and meta-analysis

Food addiction (FA) could be a potential prognostic factor of weight loss intervention outcomes. This systematic review with meta-analysis aimed to (1) estimate this prognostic effect of FA diagnosis and symptom count in individuals with overweight or obesity and (2) explore potential sources of heterogeneity based on properties of the weight loss intervention, study, and sample (e.g., age, gender, ethnicity). We searched PubMed, PsycINFO, and Web of Science for studies reporting on associations between pre-intervention FA (assessed with the Yale Food Addiction Scale) and weight outcomes after weight loss intervention in individuals with overweight or obesity without a medically diagnosed eating disorder. Twenty-five studies met inclusion criteria, including 4904 individuals (71% women, Mage = 41 years, BMI = 40.82 kg/m2), k = 18 correlations of weight loss with FA symptom count, and k = 21 mean differences between FA diagnosis groups. Pooled estimates of random-effects meta-analyses found limited support for a detrimental effect of FA symptom count and diagnosis on weight loss intervention outcomes. Negative associations with FA increased for behavioral weight loss interventions and among more ethnically diverse samples. More research on the interaction of FA with pre-existing mental health problems and environmental factors is needed.

The Link between Metabolic Syndrome and the Brain

BACKGROUND

Metabolic syndrome (MetS) is a cluster of cardiometabolic conditions that has been linked to high risk for cardiovascular disease, liver complications, and several malignancies. More recently, MetS has been associated with cognitive dysfunction.

SUMMARY

Studies have shown an association with minimal cognitive impairment, progression to vascular dementia, and even Alzheimer's disease. MetS components have been individually explored, and glucose intolerance has the strongest association with impairment in several cognitive domains. Several hypotheses have been proposed regarding the pathophysiology underlying the MetS-cognitive dysfunction association, and even though insulin resistance plays a major role, more studies are needed to elucidate this topic. Moreover, several other factors contributing to this association have been identified. Liver disease and more specifically metabolic dysfunction-associated steatotic liver disease can on its own contribute to cognitive decline through systemic inflammation and higher ammonia levels. Gut dysbiosis that has also been identified in MetS can also lead to cognitive impairment through several mechanisms that result in neurotoxicity. Finally, there are several other factors that may modify the MetS-cognitive dysfunction relationship, such as lifestyle, diet, education status, and age. More recently, circadian syndrome was explored and was found to be even more strongly associated with cognitive impairment.

KEY MESSAGE

MetS is associated with cognitive decline. Certain cardiometabolic risk factors have a stronger association with cognitive impairment, and there are several factors that may modify this relationship. The aim of this review was to assess and summarize the existing body of evidence on the association between MetS and cognitive impairment and identify areas that necessitate further investigation.

Reactive hypoglycemia in binge eating disorder, food addiction, and the comorbid phenotype: unravelling the metabolic drive to disordered eating behaviours

BACKGROUND

Impaired metabolic response such as blood glucose fast fluctuations may be hypothesized in binge eating disorder (BED) and food addiction (FA) by virtue of the repetitive consumption of highly processed food. Conversely, rapid changes in plasma glucose (i.e., hypoglycemia) may trigger craving for the same food products. The investigation of early glycemic disturbances in BED and FA could enhance the understanding of the metabolic mechanisms involved in the maintenance of the disorders. Present study investigated hypoglycemia events during a 5-h-long oral glucose tolerance test (OGTT) in people with BED, FA, and the comorbid phenotype. Further, the association between the severity of eating psychopathology and the variability in hypoglycaemia events was explored.

METHODS

Two-hundred participants with high weight and no diabetes completed the extended OGTT and were screened for BED, FA, BED-FA, or no-BED/FA. The four groups were compared in hypoglycemia events, OGTT-derived measures, and eating psychopathology. The association between predictors (eating psychopathology), confounders (demographics, metabolic features), and the outcomes (hypoglycemia, early/late hypoglycemia, severe hypoglycemia, reactive hypoglycemia) was examined through logistic regression.

RESULTS

Hypoglycemia in general, and reactive hypoglycemia were highly frequent (79% and 28% of the sample, respectively). Hypoglycemia events (< 70 mg/dL) were equally experienced among groups, whilst severe hypoglycemia (< 54 mg/dL) was more frequent in BED at the late stage of OGTT (5 h; χ2 = 1.120, p = .011). The FA and BED groups exhibited significantly higher number of reactive hypoglycemia (χ2 = 13.898, p = .003), in different times by diagnosis (FA: 210'-240'; BED: at the 270'). FA severity was the only predictor of early and reactive hypoglycemia.

CONCLUSIONS

People with BED or FA are prone to experiencing reactive hypoglycemia; FA severity may predict early and symptomatic hypoglycemia events. This can further reinforce disordered eating behaviours by promoting addictive responses, both biologically and behaviourally. These results inform professionals dealing with eating disorders about the need to refer patients for metabolic evaluation. On the other hand, clinicians dealing with obesity should screen for and address BED and FA in patients seeking care for weight loss.

Prevalence of food addiction among patients undergoing metabolic/bariatric surgery: A systematic review and meta-analysis

Candidates for metabolic/bariatric surgery show a high prevalence of food addiction (FA). However, few studies have investigated FA prevalence after bariatric surgery, especially using longitudinal studies. This systematic review with a meta-analysis aimed to determine pre- and postoperative prevalence of FA among patients undergoing metabolic/bariatric surgery. It included both cross-sectional and longitudinal studies that used the Yale Food Addiction Scale (YFAS). The following databases were searched: MEDLINE, ScienceDirect, LILACS, PsycArticles, CENTRAL, greylit.org, and opengrey.eu. Studies that used the YFAS to evaluate FA in pre- or postoperative patients were included. A random-effects meta-analysis was performed with cross-sectional studies to calculate the weighted prevalence of FA at the pre- and postoperative moments. For longitudinal studies, which measured FA at both time points for the same individuals, absolute prevalence reduction (APR) was calculated. Of the 6626 records, 40 studies were included in the meta-analysis. The preoperative weighted prevalence of FA was 32% (95% CI: 27-37%; 33 groups), whereas the postoperative prevalence was 15% (95% CI: 12-18%; 14 groups). Seven longitudinal studies showed a weighted APR of 26 p.p. (95% CI: 10-41 p.p.). Observational data suggest a reduction in the prevalence of FA among patients that undergo bariatric surgery. Interventional studies are needed to confirm these findings.

Food Addiction in Application to Obesity Management

Nascent and rapidly growing research into defining the concept of "food addiction" (FA) in relation to obesity is currently underway. Food addiction is present in a subset of patients who are overweight or have obesity, and its presence is associated with other psychosocial disorders such as depression, anxiety, eating disorders, impulse control disorders, and lower quality of life. Food addiction is associated with higher intake of and preference for highly processed foods that have addictive-like properties such as cravings, reward sensitivity, and impaired control. Food addiction is associated with less weight loss in patients with obesity utilizing diet and lifestyle-related interventions. In clinical practice, identifying the subset of patients with obesity with FA-related psychosocial constraints and continued emphasis on avoiding highly processed foods may improve obesity and weight management outcomes. Food addiction is thought to be an addictive-like phenotype.Food addiction is noted to have significant overlap with substance use disorder (SUD) and other eating disorders, but is currently not classified a diagnosis by DSM-IV and DSM-V criteria.Food addiction has similarities to SUD, such as cravings, reduced control over intake, increased impulsivity and altered reward-sensitivity.The Yale Food Addiction Scale, which is a clinical scale modeled by the DSM-IV and DSM-V criteria for SUD, has been used to quantify and study FA.