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Carter SA, Lin JC, Chow T, Martinez MP, Alves JM, Feldman KR, Qiu C, Page KA, McConnell R, Xiang AH. Maternal obesity and diabetes during pregnancy and early autism screening score at well-child visits in standard clinical practice. Autism 2024; 28:975-984. [PMID: 37646431 PMCID: PMC10902177 DOI: 10.1177/13623613231188876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
LAY ABSTRACT Early intervention and treatment can help reduce disability in children diagnosed with autism spectrum disorder. Screening for autism spectrum disorder in young children identifies those at increased likelihood of diagnosis who may need further support. Previous research has reported that exposure to maternal obesity and diabetes during pregnancy is associated with higher likelihood of autism spectrum disorder diagnosis in children. However, little is known about whether these maternal conditions are associated with how very young children score on autism spectrum disorder screening tools. This study examined associations between exposure to maternal obesity and diabetes during pregnancy and offspring scores on the Quantitative Checklist for Autism in Toddlers, an autism spectrum disorder screening questionnaire administered between 18-24 months at well-child visits. A higher score on the Quantitative Checklist for Autism in Toddlers suggests a higher likelihood of autism spectrum disorder; children with scores 3 or greater are referred to developmental pediatricians for evaluation. Our study found that children of mothers with obesity or diabetes during pregnancy had higher scores than children whose mothers did not have these conditions. Associations with maternal obesity and gestational diabetes diagnosed at or before 26 weeks of pregnancy were also present in children who did not have later autism spectrum disorder diagnoses, suggesting that exposure to these conditions during early pregnancy may be associated with a broad range of social and behavioral abilities. Identifying associations between maternal health conditions and early Quantitative Checklist for Autism in Toddlers screening scores could influence future screening and provision of support for children of mothers with these conditions.
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Affiliation(s)
- Sarah A. Carter
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jane C. Lin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mayra P. Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jasmin M. Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Klara R. Feldman
- Department of Anesthesiology & Perioperative Medicine, Kaiser Permanente Southern California, Baldwin Park, CA
| | - Chunyuan Qiu
- Department of Anesthesiology & Perioperative Medicine, Kaiser Permanente Southern California, Baldwin Park, CA
| | - Kathleen A. Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Smith A, Page KA, Smith KE. Associations between affect dynamics and eating regulation in daily life: a preliminary ecological momentary assessment study. Cogn Emot 2024:1-7. [PMID: 38427387 DOI: 10.1080/02699931.2024.2323478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
Disordered eating behaviors consistently associated with emotion regulation difficulties. However, most studies have focused on affect intensity without considering dynamic affective patterns. We examined these patterns in relation to daily overeating, loss of control eating (LOCE), dietary restraint, and food craving in young adults using ecological momentary assessment (EMA).Adults (N = 24) completed a 10-day EMA protocol during which they reported momentary affect and eating patterns. Generalized linear mixed-models examined each index in relation to eating variable.Higher PA instability (within-person) was associated with higher ratings of binge-eating symptoms (B = 0.15, SE = 0.06, p = 0.007). Lower NA differentiation (within-person) was associated with higher levels of food craving (B = -10.11, SE = 4.74, p = 0.033).Our results support previous findings suggesting that acute fluctuations in PA may increase risk of binge-eating symptoms. Further, inability to differentiate between momentary states of NA was associated with cravings. This study highlights the importance of examining multiple facets of NA and PA in relation to eating regulation.Trial registration: ClinicalTrials.gov identifier: NCT02945475.
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Affiliation(s)
- Alexandro Smith
- Department of Psychiatry and Behavioral Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathleen A Page
- Department of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Semeia L, Veit R, Zhao S, Luo S, Angelo B, Birkenfeld AL, Preissl H, Xiang AH, Kullmann S, Page KA. Influence of insulin sensitivity on food cue evoked functional brain connectivity in children. bioRxiv 2024:2024.02.12.579924. [PMID: 38405878 PMCID: PMC10888780 DOI: 10.1101/2024.02.12.579924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objective Insulin resistance during childhood is a risk factor for developing type 2 diabetes and other health problems later in life. Studies in adults have shown that insulin resistance affects regional and network activity in the brain which are vital for behavior, e.g. ingestion and metabolic control. To date, no study has investigated whether brain responses to food cues in children are associated with peripheral insulin sensitivity. Methods We included 53 children (36 girls) between the age of 7-11 years, who underwent an oral Glucose Tolerance Test (oGTT) to estimate peripheral insulin sensitivity (ISI). Brain responses were measured using functional magnetic resonance imaging (fMRI) before and after glucose ingestion. We compared food-cue task-based activity and functional connectivity (FC) between children with low and high ISI, adjusted for age and BMIz. Results Independent of prandial state (i.e., glucose ingestion), children with lower ISI showed higher FC between the anterior insula and caudate and lower FC between the posterior insula and mid temporal cortex than children with higher ISI. Sex differences were found based on prandial state and peripheral insulin sensitivity in the insular FC. No differences were found on whole-brain food-cue reactivity. Conclusions Children with low peripheral insulin sensitivity showed differences in food cue evoked response particularly in insula functional connectivity. These differences might influence eating behavior and future risk of developing diabetes.
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Affiliation(s)
- Lorenzo Semeia
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Ralf Veit
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Sixiu Zhao
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Shan Luo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brendan Angelo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, University of Tübingen, Germany
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Kathleen A Page
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
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Xiang AH, Lin JC, Chow T, Martinez MP, Negriff S, Page KA, McConnell R, Carter SA. Types of diabetes during pregnancy and risk of depression and anxiety in offspring from childhood to young adulthood. Diabetes Obes Metab 2024; 26:224-232. [PMID: 37823225 PMCID: PMC10962903 DOI: 10.1111/dom.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023]
Abstract
AIMS To assess maternal pre-existing type 1 diabetes (T1D), type 2 diabetes (T2D), gestational diabetes mellitus (GDM) during pregnancy and risk of depression and anxiety from childhood to young adulthood in offspring. MATERIALS AND METHODS This birth cohort included singletons born during 1995-2015, followed using electronic medical records through 2020. Cox regression was used to estimate hazard ratio (HR) of depression or anxiety diagnosis during follow-up associated with in-utero exposure to maternal diabetes. RESULTS Among 439 590 offspring, 29 891 (6.8%) had depression and 51 918 (11.8%) had anxiety. T1D, followed by T2D and GDM requiring antidiabetes medication were associated with risk of depression and anxiety in offspring. Compared with no diabetes during pregnancy, the adjusted HRs (95% confidence interval) of depression in offspring associated with T1D, T2D or GDM requiring medications were 1.44 (1.09-1.91), 1.30 (1.15-1.47) and 1.18 (1.11-1.26) respectively; conversely, HRs were 0.97 (0.82-1.15) for T2D and 0.99 (0.94-1.04) for GDM without medications. The associations with anxiety followed similar patterns. The significant associations were observed for offspring ages 5-12 and >12-18 years and attenuated for 18-25 years. CONCLUSION These data suggest that the severity of diabetes (T1D vs. T2D requiring medications vs. GDM requiring medications) during pregnancy may increase the vulnerability of offspring for depression or anxiety.
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Affiliation(s)
- Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jane C. Lin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Mayra P. Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Sonya Negriff
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Kathleen A. Page
- Division of Endocrinology, Diabetes and Obesity Research Institute
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Sarah A. Carter
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Luo S, Hsu E, Lawrence KE, Adise S, Pickering TA, Herting MM, Buchanan T, Page KA, Thompson PM. Associations among prenatal exposure to gestational diabetes mellitus, brain structure, and child adiposity markers. Obesity (Silver Spring) 2023; 31:2699-2708. [PMID: 37840377 PMCID: PMC11025497 DOI: 10.1002/oby.23901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the mediating role of child brain structure in the relationship between prenatal gestational diabetes mellitus (GDM) exposure and child adiposity. METHODS This was a cross-sectional study of 9- to 10-year-old participants and siblings across the US. Data were obtained from the baseline assessment of the Adolescent Brain Cognitive Development (ABCD) Study®. Brain structure was evaluated by magnetic resonance imaging. GDM exposure was self-reported, and discordance for GDM exposure within biological siblings was identified. Mixed effects and mediation models were used to examine associations among prenatal GDM exposure, brain structure, and adiposity markers with sociodemographic covariates. RESULTS The sample included 8521 children (7% GDM-exposed), among whom there were 28 sibling pairs discordant for GDM exposure. Across the entire study sample, prenatal exposure to GDM was associated with lower global and regional cortical gray matter volume (GMV) in the bilateral rostral middle frontal gyrus and superior temporal gyrus. GDM-exposed siblings also demonstrated lower global cortical GMV than unexposed siblings. Global cortical GMV partially mediated the associations between prenatal GDM exposure and child adiposity markers. CONCLUSIONS The results identify brain markers of prenatal GDM exposure and suggest that low cortical GMV may explain increased obesity risk for offspring prenatally exposed to GDM.
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Affiliation(s)
- Shan Luo
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Eustace Hsu
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Katherine E. Lawrence
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shana Adise
- Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Division of Research on Children, Youth, and Families, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Trevor A. Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Megan M. Herting
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Thomas Buchanan
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kathleen A. Page
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
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Yunker AG, Chakravartti SP, Kullmann S, Veit R, Angelo B, Jann K, Monterosso JR, Page KA. Sweet taste preference is associated with greater hypothalamic response to glucose and longitudinal weight gain. Physiol Behav 2023; 270:114292. [PMID: 37442357 DOI: 10.1016/j.physbeh.2023.114292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
The hypothalamus has an abundant expression of sweet taste receptors that play a role in glucose sensing and energy homeostasis. Evidence suggests that liking "sweets" can be associated with weight gain, but the relationship between sweet taste preference and hypothalamic regulation of appetite is unknown. This study tested the hypothesis that sweet taste preference is associated with increased hypothalamic activation in response to glucose (a purported neural marker for weight gain risk) and greater longitudinal increases in body mass index (BMI). Fifty-four adults aged 18-35 years with a mean (± SD) BMI of 27.99 ± 5.32 kg/m2 completed the study. Height and weight were measured at baseline and 6-12 months later in a subset of 36 participants. Sweet taste preference was assessed via the Monell 2-series, forced-choice tracking procedure. Arterial spin labeling magnetic resonance imaging was performed before and after oral glucose ingestion to determine hypothalamic blood flow response to glucose. Linear models were used to examine relationships between sweet taste preference and the hypothalamic response to glucose and longitudinal changes in BMI, adjusting for age, sex, and baseline BMI. Sweet taste preference was positively associated with glucose-linked hypothalamic blood flow (beta = 0.017, p = 0.043), adjusted for age, sex and BMI. We also observed a positive association between sweet taste preference and longitudinal change in BMI (beta = 0.088, p = 0.015), adjusted for age, sex and baseline BMI. These findings suggest that heightened sweet taste preference is associated with glucose-linked hypothalamic activation and may be linked to increased susceptibility for weight gain.
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Affiliation(s)
- Alexandra G Yunker
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Sandhya P Chakravartti
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA 90089, USA; Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90033, USA; Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Ralf Veit
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Brendan Angelo
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90033, USA; Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Kay Jann
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Kathleen A Page
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90033, USA; Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Alves JM, Smith A, Chow T, Negriff S, Carter S, Xiang AH, Page KA. Prenatal Exposure to Gestational Diabetes Mellitus is Associated with Mental Health Outcomes and Physical Activity has a Modifying Role. Res Sq 2023:rs.3.rs-3290222. [PMID: 37693617 PMCID: PMC10491372 DOI: 10.21203/rs.3.rs-3290222/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Studies suggest a link between prenatal gestational diabetes mellitus (GDM) exposure and poor mental health outcomes. We examined associations between prenatal GDM exposure and depressive and anxiety symptoms in children and assessed physical activity as a potential modifier of these associations. Method Seventy children (AgeM(SD): 12(2.0), 56% GDM, 59% female) and their parents completed surveys: Center for Epidemiological Studies Depression Scale for Children (CES-DC), State-Trait Anxiety Inventory for Children (STAIC), Child Behavior Checklist (CBCL), and 3-day physical activity recall (3DPAR). Associations between mental health measures with GDM exposure and interactions between GDM exposure and child moderate-to-vigorous physical activity (MVPA) were assessed using regression. Results GDM-exposed children had higher anxiety (p = 0.03) and internalizing symptoms (CBCL) (p = 0.04) than unexposed children. There was an interaction between GDM exposure and child MVPA on anxiety (p = 0.02), internalizing (p = 0.04) and externalizing symptoms (p = 0.004). In the low MVPA group, GDM exposed children had more depressive (p = 0.03), anxiety (p = 0.003), and internalizing symptoms (p = 0.03) than unexposed children. In the high MVPA group, there were no group differences except with externalizing symptoms (p = 0.04). Conclusion Prenatal GDM is associated with higher anxiety and internalizing symptoms in children. Child MVPA modified the relationship between GDM exposure and mental health outcomes suggesting that physical activity during childhood could mitigate the negative mental health outcomes associated with prenatal GDM exposure.
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Affiliation(s)
| | | | - Ting Chow
- Kaiser Permanente Southern California
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Angelo BC, DeFendis A, Yau A, Alves JM, Thompson PM, Xiang AH, Page KA, Luo S. Relationships between physical activity, healthy eating and cortical thickness in children and young adults. Brain Imaging Behav 2022; 16:2690-2704. [DOI: 10.1007/s11682-022-00728-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
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Presseller EK, Patarinski AGG, Zhang F, Page KA, Srivastava P, Manasse SM, Juarascio AS. Glucose variability: A physiological correlate of eating disorder behaviors among individuals with binge-spectrum eating disorders. Int J Eat Disord 2022; 55:1788-1798. [PMID: 36305323 DOI: 10.1002/eat.23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Elevated glucose variability may be one mechanism that increases risk for significant psychological and physiological health conditions among individuals with binge-spectrum eating disorders (B-EDs), given the impact of eating disorder (ED) behaviors on blood glucose levels. This study aimed to characterize glucose variability among individuals with B-EDs compared with age-matched, sex-matched, and body mass index-matched controls, and investigate the association between frequency of ED behaviors and glucose variability. METHODS Participants were 52 individuals with B-EDs and 22 controls who wore continuous glucose monitors to measure blood glucose levels and completed ecological momentary assessment surveys to measure ED behaviors for 1 week. Independent samples t-tests compared individuals with B-EDs and controls and multiple linear regression models examined the association between ED behaviors and glucose variability. RESULTS Individuals with B-EDs demonstrated numerically higher glucose variability than controls (t = 1.42, p = .08, d = 0.43), although this difference was not statistically significant. When controlling for covariates, frequency of ED behaviors was significantly, positively associated with glucose variability (t = 3.17, p = .003) with medium effect size (f2 = 0.25). Post hoc analyses indicated that binge eating frequency was significantly associated with glucose variability, while episodes of 5+ hours without eating were not. DISCUSSION Glucose variability among individuals with B-EDs appears to be positively associated with engagement in ED behaviors, particularly binge eating. Glucose variability may be an important mechanism by which adverse health outcomes occur at elevated rates in B-EDs and warrants future study. PUBLIC SIGNIFICANCE This study suggests that some individuals with binge ED and bulimia nervosa may experience elevated glucose variability, a physiological symptom that is linked to a number of adverse health consequences. The degree of elevation in glucose variability is positive associated with frequency of eating disorder behaviors, especially binge eating.
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Affiliation(s)
- Emily K Presseller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA.,Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA.,Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kathleen A Page
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Paakhi Srivastava
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA.,Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
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Chandrasekaran S, Melhorn S, Olerich KL, Angelo B, Chow T, Xiang A, Schur EA, Page KA. Exposure to Gestational Diabetes Mellitus Prior to 26 Weeks Is Related to the Presence of Mediobasal Hypothalamic Gliosis in Children. Diabetes 2022; 71:2552-2556. [PMID: 36095276 PMCID: PMC9750940 DOI: 10.2337/db22-0448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/08/2022] [Indexed: 01/29/2023]
Abstract
Intrauterine exposure to metabolic dysfunction leads to offspring metabolic dysfunction in human and rodent models, but underlying mechanisms are unclear. The mediobasal hypothalamus (MBH) is involved in energy homeostasis and weight regulation, and MBH gliosis is associated with obesity and insulin resistance. We tested the hypothesis that offspring exposed to gestational diabetes mellitus (GDM) in utero versus those unexposed would show evidence of MBH gliosis. Participants in the BrainChild Study (age 7-11 years with confirmed GDM exposure or no GDM exposure) underwent brain MRI to acquire T2-weighted images. By using the amygdala (AMY) and white matter (WM) as reference regions, MBH:AMY and MBH:WM T2 signal ratios were calculated as a radiologic measure of MBH gliosis. Linear regressions were used to examine associations between GDM exposure (GDM overall) and by timing of GDM exposure (≤26 weeks or >26 weeks) and MBH gliosis. Associations between prepregnancy BMI and child MBH gliosis were examined in secondary analyses. There were no differences in T2 signal ratios in children exposed versus not exposed to GDM overall, but children exposed to early GDM (≤26 weeks of gestation) had higher MBH:WM signal ratios than those not exposed (β = 0.147; SE 0.06; P = 0.03), adjusting for child's age, sex, and BMI z score and maternal prepregnancy BMI, whereas no associations were seen for the control ratio (AMY:WM). Prepregnancy BMI was not associated with evidence of MBH gliosis. Early exposure to GDM was associated with radiologic evidence of MBH gliosis in children. These data provide mechanistic insight into brain pathways by which exposure to GDM may increase risk for metabolic dysfunction.
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Affiliation(s)
| | - Susan Melhorn
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Ting Chow
- Kaiser Permanente Southern California Permanente Medical Group, Pasadena, CA
| | - Anny Xiang
- Kaiser Permanente Southern California Permanente Medical Group, Pasadena, CA
| | - Ellen A. Schur
- Department of Medicine, University of Washington, Seattle, WA
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Page KA. A gut reaction: Microbiome-driven glycemic effects of non-nutritive sweeteners. Cell 2022; 185:3282-3284. [DOI: 10.1016/j.cell.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 10/14/2022]
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Zink J, Yang CH, McAlister KL, Huh J, Pentz MA, Page KA, Belcher BR, Dunton GF. Patterns of Objectively Measured Sedentary Time and Emotional Disorder Symptoms Among Youth. J Pediatr Psychol 2022; 47:757-768. [PMID: 35260899 PMCID: PMC9297093 DOI: 10.1093/jpepsy/jsac014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE We examined the within-person longitudinal and bidirectional associations between patterns of sedentary time accumulation [alpha (sedentary bout duration/length), sedentary breaks (number of breaks in sedentary bouts)], and symptoms of major depressive disorder and generalized anxiety disorder. METHODS Children [N = 167, 10.1(0.9) years old, 54.5% female, 59.3% Hispanic, 35.9% overweight/obese at baseline] participated in a 3-year longitudinal study that consisted of assessments of sedentary time, and depressive and anxiety symptoms. At each assessment, participants wore accelerometers and completed the Revised Child Anxiety and Depression Scale. Separate random intercept cross-lagged panel models estimated the within-person longitudinal and bidirectional associations between alpha, sedentary breaks, and symptoms of major depressive disorder and generalized anxiety disorder across chronological age intervals. RESULTS Having greater than one's own usual depressive symptoms at age 11 was associated with fewer sedentary breaks 1 year later. Having greater than one's own usual generalized anxiety symptoms at age 11 was associated with longer sedentary bouts and fewer sedentary breaks 1 year later. In contrast, having greater than one's own usual sedentary breaks at age 10 was associated with fewer generalized anxiety symptoms 1 year later. All other associations, including at younger ages, were null. CONCLUSION Deviations from one's usual levels of depressive or anxiety symptoms may be important for how sedentary time is subsequently accumulated. Intraindividual processes appear to be at play, therefore more within-person research is needed. Intervention strategies for promoting a healthier accumulation of sedentary time may consider targeting occasions when depressive and anxiety symptoms are greater than usual.
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Affiliation(s)
- Jennifer Zink
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Chih-Hsiang Yang
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, USA
| | - Kelsey L McAlister
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Mary Ann Pentz
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Kathleen A Page
- Department of Medicine, Keck School of Medicine, University of Southern California, USA
| | - Britni R Belcher
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Genevieve F Dunton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
- Department of Psychology, University of Southern California, USA
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Zink J, Yang CH, Alves JM, McAlister KL, Huh J, Pentz MA, Page KA, Dunton GF, Belcher BR. Time-Varying Associations Between Device-Based and Ecological Momentary Assessment-Reported Sedentary Behaviors and the Concurrent Affective States Among Adolescents: Proof-of-Concept Study. JMIR Form Res 2022; 6:e37743. [PMID: 35687383 PMCID: PMC9233247 DOI: 10.2196/37743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Previous studies on affective state-sedentary behavior (SB) associations have not accounted for their potentially time-varying nature and have used inconsistent SB measurement modalities. We investigated whether the strength of the associations between affective states and SB varied as a function of the time of day and by SB measurement modality (device-measured SB vs ecological momentary assessment-reported screen-based SB) in youth. OBJECTIVE This study aimed to establish a proof of concept that SB-affective state associations may not be static during the day. In addition, we aimed to inform the methodology of future work, which may need to model associations as functions of the time of day and carefully consider how SB is operationalized or measured. METHODS A total of 15 adolescents (age: mean 13.07, SD 1.03 years; 10/15, 67% female; 6/15, 40% Hispanic; 10/15, 67% healthy weight) wore thigh-mounted activPAL accelerometers and simultaneously reported their screen-based SBs and concurrent positive and negative affective states via ecological momentary assessment for 7 to 14 days (N=636 occasions). Time-varying effect models (varying slopes) examined how each measure of SB was associated with concurrent affective states from 7 AM to 8 PM. RESULTS Time-varying effect model plots revealed that these associations varied in strength throughout the day. Specifically, device-based SB was related to greater concurrent negative affect only after approximately 5 PM and was unrelated to concurrent positive affect. Screen-based SB was related to greater concurrent negative affect only from 7 AM to approximately 9 AM. This was also related to greater concurrent positive affect from 7 AM to approximately 9:30 AM and from approximately 3 PM to approximately 7 PM. CONCLUSIONS We provide preliminary evidence to suggest that future confirmatory studies investigating the SB-affective state relationship should consider the time-varying nature of these associations and SB measurement modality. There may be critical time windows when specific types of SBs co-occur with affect, suggesting that interventions may need tailoring to the time of day and type of SB if future studies using similar methodologies can replicate our findings.
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Affiliation(s)
- Jennifer Zink
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Chih-Hsiang Yang
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jasmin M Alves
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kelsey L McAlister
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mary Ann Pentz
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kathleen A Page
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Genevieve F Dunton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Britni R Belcher
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Alves JM, Yunker AG, Luo S, Jann K, Angelo B, DeFendis A, Pickering TA, Smith A, Monterosso JR, Page KA. FGF21 response to sucrose is associated with BMI and dorsal striatal signaling in humans. Obesity (Silver Spring) 2022; 30:1239-1247. [PMID: 35491674 DOI: 10.1002/oby.23432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study examined associations between BMI and dietary sugar intake with sucrose-induced fibroblast growth factor 21 (FGF21) and whether circulating FGF21 is associated with brain signaling following sucrose ingestion in humans. METHODS A total of 68 adults (29 male; mean [SD), age 23.2 [3.8] years; BMI 27.1 [4.9] kg/m2 ) attended visits after a 12-hour fast. Plasma FGF21 was measured at baseline and at 15, 30, and 120 minutes after sucrose ingestion (75 g in 300 mL of water). Brain cerebral blood flow responses to sucrose were measured using arterial spin labeling magnetic resonance imaging. RESULTS Higher circulating FGF21 levels were associated with reduced blood flow in the striatum in response to sucrose (β = -7.63, p = 0.03). This association was greatest among persons with healthy weight (β = -15.70, p = 0.007) and was attenuated in people with overweight (β = -4.00, p = 0.63) and obesity (β = -12.45, p = 0.13). BMI was positively associated with FGF21 levels in response to sucrose (β = 0.53, p = 0.02). High versus low dietary sugar intake was associated with greater FGF21 responses to acute sucrose ingestion in individuals with healthy weight (β = 8.51, p = 0.04) but not in individuals with overweight or obesity (p > 0.05). CONCLUSIONS These correlative findings support evidence in animals showing that FGF21 acts on the brain to regulate sugar consumption through a negative feedback loop.
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Affiliation(s)
- Jasmin M Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexandra G Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Kay Jann
- Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brendan Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexis DeFendis
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Trevor A Pickering
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexandro Smith
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Ge BB, Jann K, Luo S, Yunker AG, Jones S, Angelo B, Alves JM, Defendis A, Monterosso JR, Xiang AH, Page KA. Brain responses to glucose ingestion are greater in children than adults and are associated with overweight and obesity. Obesity (Silver Spring) 2021; 29:2081-2088. [PMID: 34724360 DOI: 10.1002/oby.23296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study investigated whether brain regions involved in the regulation of food intake respond differently to glucose ingestion in children and adults and the relationship between brain responses and weight status. METHODS Data included 87 children (ages 7-11 years) and 94 adults (ages 18-35 years) from two cohorts. Healthy weight, overweight, and obesity were defined by Centers for Disease Control and Prevention criteria. Brain responses to glucose were determined by measuring cerebral blood flow using arterial spin labeling magnetic resonance imaging in brain regions involved in the regulation of eating behavior. RESULTS Children showed significantly larger increases in brain responses to glucose than adults in the dorsal striatum (p < 0.01), insula (p < 0.01), hippocampus (p < 0.01), and dorsal-lateral prefrontal cortex (p < 0.01). Responses to glucose in the dorsal striatum (odds ratio [OR] = 1.52, 95% CI 1.05-2.20; p = 0.03), hippocampus (OR = 1.51, 95% CI: 1.02-2.22; p = 0.04), insula (OR = 1.64, 95% CI: 1.11-2.42; p = 0.01), and orbitofrontal cortex (OR = 1.63 95% CI: 1.12-2.39; p = 0.01) were positively associated with overweight or obesity, independent of age group. CONCLUSIONS Children have greater brain responses to glucose ingestion than adults in regions involved in eating behavior, and these responses are associated with weight status.
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Affiliation(s)
- Brandon B Ge
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
| | - Kay Jann
- Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shan Luo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Alexandra G Yunker
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
| | - Sabrina Jones
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
| | - Brendan Angelo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
| | - Jasmin M Alves
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
| | - Alexis Defendis
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Kathleen A Page
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
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Yunker AG, Alves JM, Luo S, Angelo B, DeFendis A, Pickering TA, Monterosso JR, Page KA. Obesity and Sex-Related Associations With Differential Effects of Sucralose vs Sucrose on Appetite and Reward Processing: A Randomized Crossover Trial. JAMA Netw Open 2021; 4:e2126313. [PMID: 34581796 PMCID: PMC8479585 DOI: 10.1001/jamanetworkopen.2021.26313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Nonnutritive sweeteners (NNSs) are used as an alternative to nutritive sweeteners to quench desire for sweets while reducing caloric intake. However, studies have shown mixed results concerning the effects of NNSs on appetite, and the associations between sex and obesity with reward and appetitive responses to NNS compared with nutritive sugar are unknown. OBJECTIVE To examine neural reactivity to different types of high-calorie food cues (ie, sweet and savory), metabolic responses, and eating behavior following consumption of sucralose (NNS) vs sucrose (nutritive sugar) among healthy young adults. DESIGN, SETTING, AND PARTICIPANTS In a randomized, within-participant, crossover trial including 3 separate visits, participants underwent a functional magnetic resonance imaging task measuring blood oxygen level-dependent signal in response to visual cues. For each study visit, participants arrived at the Dornsife Cognitive Neuroimaging Center of University of Southern California at approximately 8:00 am after a 12-hour overnight fast. Blood was sampled at baseline and 10, 35, and 120 minutes after participants received a drink containing sucrose, sucralose, or water to measure plasma glucose, insulin, glucagon-like peptide(7-36), acyl-ghrelin, total peptide YY, and leptin. Participants were then presented with an ad libitum meal. Participants were right-handed, nonsmokers, weight-stable for at least 3 months before the study visits, nondieters, not taking medication, and with no history of eating disorders, illicit drug use, or medical diagnoses. Data analysis was performed from March 2020 to March 2021. INTERVENTIONS Participants ingested 300-mL drinks containing either sucrose (75 g), sucralose (individually sweetness matched), or water (as a control). MAIN OUTCOMES AND MEASURES Primary outcomes of interest were the effects of body mass index (BMI) status and sex on blood oxygen level-dependent signal to high-calorie food cues, endocrine, and feeding responses following sucralose vs sucrose consumption. Secondary outcomes included neural, endocrine, and feeding responses following sucrose vs water and sucralose vs water (control) consumption, and cue-induced appetite ratings following sucralose vs sucrose (and vs water). RESULTS A total of 76 participants were randomized, but 2 dropped out, leaving 74 adults (43 women [58%]; mean [SD] age, 23.40 [3.96] years; BMI range, 19.18-40.27) who completed the study. In this crossover design, 73 participants each received water (drink 1) and sucrose (drink 2), and 72 participants received water (drink 1), sucrose (drink 2), and sucralose (drink 3). Sucrose vs sucralose was associated with greater production of circulating glucose, insulin, and glucagon-like peptide-1 and suppression of acyl-ghrelin, but no differences were found for peptide YY or leptin. BMI status by drink interactions were observed in the medial frontal cortex (MFC; P for interaction < .001) and orbitofrontal cortex (OFC; P for interaction = .002). Individuals with obesity (MFC, β, 0.60; 95% CI, 0.38 to 0.83; P < .001; OFC, β, 0.27; 95% CI, 0.11 to 0.43; P = .002), but not those with overweight (MFC, β, 0.02; 95% CI, -0.19 to 0.23; P = .87; OFC, β, -0.06; 95% CI, -0.21 to 0.09; P = .41) or healthy weight (MFC, β, -0.13; 95% CI, -0.34 to 0.07; P = .21; OFC, β, -0.08; 95% CI, -0.23 to 0.06; P = .16), exhibited greater responsivity in the MFC and OFC to savory food cues after sucralose vs sucrose. Sex by drink interactions were observed in the MFC (P for interaction = .03) and OFC (P for interaction = .03) after consumption of sucralose vs sucrose. Female participants had greater MFC and OFC responses to food cues (MFC high-calorie vs low-calorie cues, β, 0.21; 95% CI, 0.05 to 0.37; P = .01; MFC sweet vs nonfood cues, β, 0.22; 95% CI, 0.02 to 0.42; P = .03; OFC food vs nonfood cues, β, 0.12; 95% CI, 0.02 to 0.22; P = .03; and OFC sweet vs nonfood cues, β, 0.15; 95% CI, 0.03 to 0.27; P = .01), but male participants' responses did not differ (MFC high-calorie vs low-calorie cues, β, 0.01; 95% CI, -0.19 to 0.21; P = .90; MFC sweet vs nonfood cues, β, -0.04; 95% CI, -0.26 to 0.18; P = .69; OFC food vs nonfood cues, β, -0.08; 95% CI, -0.24 to 0.08; P = .32; OFC sweet vs nonfood cues, β, -0.11; 95% CI, -0.31 to 0.09; P = .31). A sex by drink interaction on total calories consumed during the buffet meal was observed (P for interaction = .03). Female participants consumed greater total calories (β, 1.73; 95% CI, 0.38 to 3.08; P = .01), whereas caloric intake did not differ in male participants (β, 0.68; 95% CI, -0.99 to 2.35; P = .42) after sucralose vs sucrose ingestion. CONCLUSIONS AND RELEVANCE These findings suggest that female individuals and those with obesity may be particularly sensitive to disparate neural responsivity elicited by sucralose compared with sucrose consumption. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02945475.
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Affiliation(s)
- Alexandra G. Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jasmin M. Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles
- Department of Psychology, University of Southern California, Los Angeles
| | - Brendan Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles
| | - Alexis DeFendis
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles
| | - Trevor A. Pickering
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - John R. Monterosso
- Department of Psychology, University of Southern California, Los Angeles
| | - Kathleen A. Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles
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Alves JM, Yunker AG, DeFendis A, Xiang AH, Page KA. BMI status and associations between affect, physical activity and anxiety among U.S. children during COVID-19. Pediatr Obes 2021; 16:e12786. [PMID: 33720550 PMCID: PMC8250275 DOI: 10.1111/ijpo.12786] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/29/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is concern regarding how the COVID-19 pandemic may impact the psychological and physical health of children, but to date, studies on mental health during the pandemic in children are limited. Furthermore, unprecedented lifestyle stressors associated with the pandemic may aggravate the childhood obesity epidemic, but the role of BMI on child activity levels and psychological outcomes during COVID-19 is unknown. OBJECTIVES We investigated how emotional responses (positive/negative affect), physical activity (PA) and sedentary behaviours related to anxiety among U.S. children with healthy weight and overweight/obesity during the pandemic. METHODS Sixty-four typically developing children (63% girls, 53% healthy weight) aged 9 to 15 years completed two virtual visits during the height of 'stay-at-home' measures from April 22 to July 29, 2020. Children completed 24-hours PA recalls, state portion of State-Trait Anxiety Inventory for Children and the 10-item Positive and Negative Affect Schedule for Children. RESULTS Independent of child BMI status, child anxiety scores were over five standard deviations greater than normative values from paediatric populations prior to the pandemic. Higher positive affect and PA were each associated with reduced anxiety levels in children with overweight/obesity, whereas higher positive affect was associated with reduced anxiety in children with healthy weight. Greater leisure screen time was associated with higher negative affect irrespective of child BMI status. CONCLUSIONS These associations highlight the potential mental health benefits of maintaining positive affect, engaging in PA and limiting leisure screen time for children during the pandemic and suggest that these associations may be particularly relevant for children with overweight/obesity.
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Affiliation(s)
- Jasmin M. Alves
- Division of Endocrinology, Department of MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Diabetes and Obesity Research Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alexandra G. Yunker
- Division of Endocrinology, Department of MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Diabetes and Obesity Research Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alexis DeFendis
- Division of Endocrinology, Department of MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Diabetes and Obesity Research Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Anny H. Xiang
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Kathleen A. Page
- Division of Endocrinology, Department of MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Diabetes and Obesity Research Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Luo S, Angelo BC, Chow T, Monterosso JR, Thompson PM, Xiang AH, Page KA. Erratum. Associations Between Exposure to Gestational Diabetes Mellitus In Utero and Daily Energy Intake, Brain Responses to Food Cues, and Adiposity in Children. Diabetes Care 2021;44:1185-1193. Diabetes Care 2021; 44:dc21er10. [PMID: 34321290 PMCID: PMC8740942 DOI: 10.2337/dc21-er10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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19
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Alves JM, Angelo BC, Zink J, Chow T, Yunker AG, Clark K, Luo S, Belcher BR, Herting MM, Dieli-Conwright CM, Xiang AH, Page KA. Child physical activity as a modifier of the relationship between prenatal exposure to maternal overweight/obesity and neurocognitive outcomes in offspring. Int J Obes (Lond) 2021; 45:1310-1320. [PMID: 33731834 PMCID: PMC8164988 DOI: 10.1038/s41366-021-00794-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/04/2021] [Accepted: 02/11/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES With rising obesity rates among pregnant women, more children are exposed in utero to maternal obesity. In prior epidemiological studies, exposure to maternal obesity was associated with lower intelligence quotient (IQ) scores and worse cognitive abilities in offspring. Further studies have shown that offspring exposed to maternal obesity, exhibit differences in the white matter microstructure properties, fractional anisotropy (FA) and mean diffusivity (MD). In contrast, physical activity was shown to improve cognition and white matter microstructure during childhood. We examined if child physical activity levels modify the relationship between prenatal exposure to maternal obesity with IQ and white matter microstructure in offspring. SUBJECTS/METHODS One hundred children (59% girls) age 7-11 years underwent brain magnetic resonance imaging and IQ testing. Maternal pre-pregnancy BMI was abstracted from electronic medical records. White matter was assessed using diffusion tensor imaging with the measures, global FA, MD. The 3-day physical activity recall was used to measure moderate-to-vigorous physical activity and vigorous physical activity (VPA). Linear regression was used to test for interactions between prenatal exposure to maternal overweight/obesity and child PA levels on child IQ and global FA/MD. RESULTS The relationship between prenatal exposure to maternal overweight/obesity and child IQ and global FA varied by child VPA levels. Children exposed to mothers with overweight/obesity who engaged in more VPA had higher IQ scores and global FA compared to exposed children who engaged in less VPA. Associations were independent of child age, sex, BMI Z-score and socioeconomic status. Children born to normal-weight mothers did not differ in either IQ or global FA by time in VPA. CONCLUSIONS Our findings support findings in rodent models and suggest that VPA during childhood modifies the relationship between prenatal exposure to maternal obesity and child IQ and white matter microstructure.
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Affiliation(s)
- Jasmin M Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Brendan C Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Jennifer Zink
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Alexandra G Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Kristi Clark
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Britni Ryan Belcher
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Megan M Herting
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
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20
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Luo S, Angelo BC, Chow T, Monterosso JR, Thompson PM, Xiang AH, Page KA. Associations Between Exposure to Gestational Diabetes Mellitus In Utero and Daily Energy Intake, Brain Responses to Food Cues, and Adiposity in Children. Diabetes Care 2021; 44:1185-1193. [PMID: 33827804 PMCID: PMC8132328 DOI: 10.2337/dc20-3006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Children exposed to gestational diabetes mellitus (GDM) or maternal obesity in utero have an increased propensity to develop obesity. Little is known about the mechanisms underlying this phenomenon. We aimed to examine relationships between exposure to GDM or maternal obesity and daily energy intake (EI), brain responses to food cues within reward regions, and adiposity in children. RESEARCH DESIGN AND METHODS Participants were 159 children ages 7-11 years. Repeated 24-h recalls were conducted to assess mean daily EI. A subset of children (n = 102) completed a food cue task in the MRI scanner. A priori regions of interest included the orbital frontal cortex (OFC), insula, amygdala, ventral striatum, and dorsal striatum. Adiposity measurements, BMI z-scores, percent body fat, waist-to-height ratio (WtHR), and waist-to-hip ratio (WHR) were assessed. RESULTS Exposure to GDM was associated with greater daily EI, and children exposed to GDM diagnosed before 26 weeks gestation had greater OFC food cue reactivity. Children exposed to GDM also had larger WHR. Results remained significant after adjusting for child's age and sex, maternal education and race/ethnicity, maternal prepregnancy BMI, and child's physical activity levels. Furthermore, children who consumed more daily calories had greater WHR, and the relationship between GDM exposure and WHR was attenuated after adjustment for daily EI. Prepregnancy BMI was not significantly related to daily EI or food cue reactivity in reward regions. However, prepregnancy BMI was significantly related to all adiposity measurements; results remained significant for BMI z-scores, WtHR, and WHR after controlling for child's age and sex, maternal education and race/ethnicity, maternal GDM exposure, and child's physical activity levels. CONCLUSIONS Exposure to GDM in utero, in particular before 26 weeks gestation, is associated with increased EI, enhanced OFC food cue reactivity, and increased WHR. Future study with longitudinal follow-up is merited to assess potential pathways of daily EI and food cue reactivity in reward regions on the associations between GDM exposure and childhood adiposity.
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Affiliation(s)
- Shan Luo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA.,Department of Psychology, University of Southern California, Los Angeles, CA.,Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Brendan C Angelo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA
| | - Kathleen A Page
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA .,Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
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21
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Lynch KM, Alves JM, Chow T, Clark KA, Luo S, Toga AW, Xiang AH, Page KA. Selective morphological and volumetric alterations in the hippocampus of children exposed in utero to gestational diabetes mellitus. Hum Brain Mapp 2021; 42:2583-2592. [PMID: 33764653 PMCID: PMC8090774 DOI: 10.1002/hbm.25390] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/03/2021] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
Prior epidemiological studies have found that in utero exposure to gestational diabetes mellitus (GDM) is associated with increased risk for neurodevelopmental disorders. However, brain alterations associated with GDM are not known. The hippocampus is pivotal for cognition and emotional regulation. Therefore, we assessed relationships between in utero exposure to GDM and hippocampal morphology and subfield structure during childhood. One hundred seventeen children aged 7–11 years (57% girls, 57% exposed to GDM), born at Kaiser Permanente Southern California, participated in the BrainChild Study. Maternal GDM status was determined from electronic medical records. Children underwent brain magnetic resonance imaging. Freesurfer 6.0 was used to measure hippocampal and individual hippocampal subfield gray matter volume (mm3). Morphological analyses on the hippocampal surface were carried out using shape analysis. GDM‐exposed children exhibited reduced radial thickness in a small, spatially‐restricted portion of the left inferior body of the hippocampus that corresponds to the CA1 subfield. There was a significant interaction between GDM‐exposure and sex on the right hippocampal CA1 subfield. GDM‐exposed boys had reduced right CA1 volume compared to unexposed boys, but this association was no longer significant after controlling for age. No significant group differences were observed in girls. Our results suggest that GDM‐exposure impacts shape of the left hippocampal CA1 subfield in both boys and girls and may reduce volume of right hippocampal CA1 only in boys. These in‐depth findings illuminate the unique properties of the hippocampus impacted by prenatal GDM‐exposure and could have important implications for hippocampal‐related functions.
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Affiliation(s)
- Kirsten M Lynch
- Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Jasmin M Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kristi A Clark
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arthur W Toga
- Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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22
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Luo S, Angelo B, Chow T, Monterosso JR, Xiang AH, Thompson PM, Page KA. The role of maternal BMI on brain food cue reactivity in children: a preliminary study. Brain Imaging Behav 2021; 15:2746-2755. [PMID: 33738669 DOI: 10.1007/s11682-021-00466-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 01/24/2023]
Abstract
Children of overweight and obese parents have an increased risk of obesity. Little is known the neural mechanisms underlying this relationship, specifically the brain systems implicated in self-regulation of food intake. The primary goal here is to examine relationships between maternal body mass index (BMI) and brain responses to food cues in children. Seventy-six children (8.62 ± 1.02 years; 28 M,48F) were included in this study. Height and weight were assessed for children and their biological parents. Maternal height and weight before pregnancy were extracted from the Electronic Medical Records (EMR). BMI (kg/m2) or BMIz (age- and sex-specific BMI) were calculated. Children underwent a magnetic resonance imaging session where they viewed food and non-food images before and after glucose ingestion. The dorsolateral prefrontal cortex (dlPFC) and anterior cingulate cortex (ACC) food cue reactivity was the measurement of interest for region-of-interest (ROI) analyses. Whole-brain exploratory analysis was performed as well. Non-parametric methods were used for data analysis. ROI and whole brain analyses showed that maternal current BMI was inversely associated with child's ACC and dlPFC food cue reactivity after glucose ingestion, adjusting for age and sex. No significant relationships were found between paternal BMI and child's food cue reactivity. Child BMIz was negatively associated with the ACC food cue reactivity after glucose ingestion. Our results supported the role of maternal adiposity on child's responses to appetitive food cues in brain self-regulation circuitry, which may influence eating behavior and obesity risk in children.
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Affiliation(s)
- Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA. .,Diabetes and Obesity Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA. .,Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA. .,Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Brendan Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Diabetes and Obesity Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Diabetes and Obesity Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
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23
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Yunker AG, Luo S, Jones S, Dorton HM, Alves JM, Angelo B, DeFendis A, Pickering TA, Monterosso JR, Page KA. Appetite-Regulating Hormones Are Reduced After Oral Sucrose vs Glucose: Influence of Obesity, Insulin Resistance, and Sex. J Clin Endocrinol Metab 2021; 106:654-664. [PMID: 33300990 PMCID: PMC7947782 DOI: 10.1210/clinem/dgaa865] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Fructose compared to glucose has adverse effects on metabolic function, but endocrine responses to oral sucrose vs glucose is not well understood. OBJECTIVE We investigated how oral sucrose vs glucose affected appetite-regulating hormones, and how biological factors (body mass index [BMI], insulin sensitivity, sex) influence endocrine responses to these 2 types of sugar. DESIGN Sixty-nine adults (29 men; 23.22 ± 3.74 years; BMI 27.03 ± 4.96 kg/m2) completed the study. On 2 occasions, participants consumed 300-mL drinks containing 75 g of glucose or sucrose. Blood was sampled at baseline, 10, 35, and 120 minutes post drink for plasma glucose, insulin, glucagon-like peptide (GLP-1)(7-36), peptide YY (PYY)total, and acyl-ghrelin measures. Hormone levels were compared between conditions using a linear mixed model. Interaction models were performed, and results were stratified to assess how biological factors influence endocrine responses. RESULTS Sucrose vs glucose ingestion provoked a less robust rise in glucose (P < .001), insulin (P < .001), GLP-1 (P < .001), and PYY (P = .02), whereas acyl-ghrelin suppression was similar between the sugars. We found BMI status by sugar interactions for glucose (P = .01) and PYY (P = .03); obese individuals had smaller increases in glucose and PYY levels after consuming sucrose vs glucose. There were interactions between insulin sensitivity and sugar for glucose (P = .003) and insulin (P = .04), and a sex by sugar interaction for GLP-1 (P = .01); men demonstrated smaller increases in GLP-1 in response to oral sucrose vs glucose. CONCLUSION Sucrose is less efficient at signaling postprandial satiation than glucose, and biological factors influence differential hormone responses to sucrose vs glucose consumption.
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Affiliation(s)
- Alexandra G Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Sabrina Jones
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hilary M Dorton
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Jasmin M Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brendan Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexis DeFendis
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Trevor A Pickering
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Correspondence and Reprint Requests: Kathleen A. Page, MD, USC Keck School of Medicine, Division of Endocrinology, Diabetes and Obesity Research Institute, 2250 Alcazar St, CSC 209, Los Angeles, CA 90089, USA. E-mail:
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24
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Alves JM, Yunker AG, DeFendis A, Xiang AH, Page KA. Prenatal exposure to gestational diabetes is associated with anxiety and physical inactivity in children during COVID-19. Clin Obes 2021; 11:e12422. [PMID: 33128335 DOI: 10.1111/cob.12422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) is associated with adverse child mental health outcomes and reduced physical activity. Moreover, prenatal exposure to gestational diabetes (GDM) is associated with increased risk for adverse psychological outcomes in children. OBJECTIVES Assess prenatal exposure to GDM on anxiety levels and physical activity in children during the COVID-19 pandemic. METHODS Sixty-five children age 9 to 15 reported their physical activity and anxiety levels using the 24-hours physical activity recall and the State-Trait Anxiety Inventory for Children via phone or video meetings. Prenatal exposure to GDM was obtained from maternal electronic medical records. RESULTS The 38 GDM-exposed children reported significantly higher anxiety levels and were less likely to engage in any vigorous physical activity (VPA) (5% vs 30%) compared to the 27 GDM-unexposed children. Lower levels of physical activity were significantly associated with higher levels of anxiety. Less engagement in VPA explained 75% of the association between GDM exposure and anxiety levels. CONCLUSIONS Engaging in physical activity during the COVID-19 pandemic may be beneficial for reducing anxiety, particularly amongst GDM-exposed children.
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Affiliation(s)
- Jasmin M Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexandra G Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexis DeFendis
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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25
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Jones S, Luo S, Dorton HM, Angelo B, Yunker AG, Monterosso JR, Page KA. Evidence of a Role for the Hippocampus in Food-Cue Processing and the Association with Body Weight and Dietary Added Sugar. Obesity (Silver Spring) 2021; 29:370-378. [PMID: 33491312 PMCID: PMC7842690 DOI: 10.1002/oby.23085] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The current analysis used functional magnetic resonance imaging (fMRI) to explore a model of energy regulation postulating that the hippocampus integrates interoceptive signals and environmental stimuli to suppress responding to food cues. It was hypothesized that hippocampal activity would increase in response to food cues under postnutritive relative to fasted conditions, given the role of the hippocampus in integrating postnutritive signals with food cues, and that obesity, added sugar intake, or a combination of these factors would alter this response. METHODS Data were analyzed on 65 participants (29 males). Participants consumed drinks containing 75 g of glucose or water and underwent an fMRI-based food-cue task. Blood-oxygen-level-dependent (BOLD) fMRI was used to examine hippocampal responses to food and nonfood cues. RESULTS In lean participants, the hippocampal BOLD signal was higher following glucose compared with water, but participants with obesity showed the opposite pattern. BMI interacted with added sugar intake such that BMI was more negatively correlated with hippocampal food-cue reactivity after glucose ingestion in individuals who consumed high levels of added sugar. Hippocampal BOLD was negatively correlated with prospective food intake. CONCLUSIONS The findings are consistent with the view that energy regulation involves hippocampal processes in humans and that added sugar and excess weight may impair this function.
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Affiliation(s)
- Sabrina Jones
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Hilary M. Dorton
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Brendan Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
| | - Alexandra G. Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
| | - John R. Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Kathleen A. Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
- Correspondence and reprint requests can be made to Dr. Kathleen A. Page, MD, Associate Professor of Medicine, USC Keck School of Medicine, Division of Endocrinology, Diabetes and Obesity Research Institute, 2250 Alcazar Street; CSC 209, Los Angeles, CA 90089.
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26
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Jones S, Luo S, Dorton HM, Yunker AG, Angelo B, Defendis A, Monterosso JR, Page KA. Obesity and Dietary Added Sugar Interact to Affect Postprandial GLP-1 and Its Relationship to Striatal Responses to Food Cues and Feeding Behavior. Front Endocrinol (Lausanne) 2021; 12:638504. [PMID: 33868172 PMCID: PMC8044510 DOI: 10.3389/fendo.2021.638504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/15/2021] [Indexed: 01/25/2023] Open
Abstract
It has been hypothesized that the incretin hormone, glucagon-like peptide-1 (GLP-1), decreases overeating by influencing mesolimbic brain regions that process food-cues, including the dorsal striatum. We previously showed that habitual added sugar intake was associated with lower glucose-induced circulating GLP-1 and a greater striatal response to high calorie food cues in lean individuals. Less is known about how dietary added sugar and obesity may interact to affect postprandial GLP-1 and its relationship to striatal responses to food cues and feeding behavior. The current study aimed to expand upon previous research by assessing how circulating GLP-1 and striatal food cue reactivity are affected by acute glucose consumption in participants with varied BMIs and amounts of habitual consumption of added sugar. This analysis included 72 participants from the Brain Response to Sugar Study who completed two study visits where they consumed either plain water or 75g glucose dissolved in water (order randomized; both drinks were flavored with non-caloric cherry flavoring) and underwent repeated blood sampling, a functional magnetic resonance imaging (fMRI) based food-cue task, and an ad-libitum buffet meal. Correlations between circulating GLP-1 levels, striatal food-cue reactivity, and food intake were assessed, and interactions between obesity and added sugar on GLP-1 and striatal responses were examined. An interaction between BMI and dietary added sugar was associated with reduced post-glucose GLP-1 secretion. Participants who were obese and consumed high levels of added sugar had the smallest increase in plasma GLP-1 levels. Glucose-induced GLP-1 secretion was correlated with lower dorsal striatal reactivity to high-calorie versus low-calorie food-cues, driven by an increase in reactivity to low calorie food-cues. The increase in dorsal striatal reactivity to low calorie food-cues was negatively correlated with sugar consumed at the buffet. These findings suggest that an interaction between obesity and dietary added sugar intake is associated with additive reductions in postprandial GLP-1 secretion. Additionally, the results suggest that changes to dorsal striatal food cue reactivity through a combination of dietary added sugar and obesity may affect food consumption.
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Affiliation(s)
- Sabrina Jones
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Hilary M. Dorton
- Keck School of Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
| | - Alexandra G. Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
| | - Brendan Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
| | - Alexis Defendis
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
| | - John R. Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
| | - Kathleen A. Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Keck School of Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Kathleen A. Page,
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Lynch KM, Page KA, Shi Y, Xiang AH, Toga AW, Clark KA. The effect of body mass index on hippocampal morphology and memory performance in late childhood and adolescence. Hippocampus 2020; 31:189-200. [PMID: 33174346 DOI: 10.1002/hipo.23280] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 01/15/2023]
Abstract
Childhood obesity is associated with negative physiological and cognitive health outcomes. The hippocampus is a diverse subcortical structure involved in learned feeding behaviors and energy regulation, and research has shown that the hippocampus is vulnerable to the effects of excess adiposity. Previous studies have demonstrated reduced hippocampal volume in overweight and obese children; however, it is unclear if certain subregions are selectively affected. The purpose of this study was to determine how excess body weight influences regional hippocampal surface morphology and memory performance in a large cross-sectional cohort of 588 children and adolescents between 8.33 and 19.92 years of age using body mass index expressed as a percentage of the 95th percentile cutoff (%BMIp95). We demonstrate %BMIp95 is associated with reduced radial thickness in the superior anterior region of the left hippocampus, and this relationship is predominantly driven by children younger than 14 years. We also found %BMIp95 was associated with worse performance on a spatial episodic memory task and this relationship was partially mediated by the radial thickness of the significant shape cluster. These results demonstrate the differential influence of excess body weight on regional hippocampal structure and hippocampal-dependent behavior in children and adolescents.
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Affiliation(s)
- Kirsten M Lynch
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yonggang Shi
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kristi A Clark
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Abstract
We investigated how emotional responses (positive and negative affect), physical activity (PA), and sedentary behaviors related to anxiety among US children during the COVID-19 pandemic. Sixty-four typically-developing children (63% girls) age 9–15 years old completed two virtual visits during height of “stay-at-home” measures between April 22 – July 29, 2020. Children completed 24-hour PA recalls, state portion of State-Trait Anxiety Inventory for Children (STAIC), and the shortened 10-item Positive and Negative Affect Schedule for Children (PANAS-C). Children reported state anxiety scores that were more than 5 standard deviations greater than values from healthy pediatric populations prior to the pandemic. Children with higher positive affect and who reported more time in PA reported less state anxiety. Sedentary and leisure screen time were positively correlated with negative affect. Our findings suggest that maintaining positive affect, engaging in PA, and limiting leisure screen time may be important for child mental health during stressful periods.
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Affiliation(s)
- Jasmin M Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
| | - Alexandra G Yunker
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
| | - Alexis DeFendis
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles CA 90089
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Alves J, Yunker AG, DeFendis A, Xiang AH, Page KA. Children's Anxiety and Physical Activity during COVID-19 in Relation to Prenatal Exposure to Gestational Diabetes. medRxiv 2020. [PMID: 32793932 DOI: 10.1101/2020.08.06.20169565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Research goal: Assess the relationships between anxiety levels, physical activity and in utero exposure to Gestational Diabetes mellitus (GDM) in children age 9 to 15, during the COVID-19 pandemic. METHODS During the COVID-19 pandemic, participants completed phone call or video calls with study personnel where they were asked to report on their physical activity and anxiety levels using the 24-hour physical activity recall and the State-Trait Anxiety Inventory for Children. GDM-exposure was assessed using electronic medical records. RESULTS Children who reported higher levels of moderate to vigorous physical activity or vigorous physical activity, reported lower anxiety symptoms. Children exposed to GDM in utero reported higher anxiety scores and lower engagement in vigorous physical activity compared to unexposed children. Moreover, the pathway through which children exposed to GDM in utero, reported higher anxiety was partially explained by reduced engagement in vigorous physical activity (75%, p=0.05). CONCLUSIONS Engaging in physical activity during the COVID-19 pandemic may be beneficial for reducing anxiety, particularly among children exposed to GDM in utero, who are at increased risk for adverse psychological outcomes.
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Zink J, Nicolo M, Imm K, Ebrahimian S, Yu Q, Lee K, Zapanta K, Huh J, Dunton GF, Goran MI, Page KA, Dieli-Conwright CM, Belcher BR. Interstitial glucose and subsequent affective and physical feeling states: A pilot study combining continuous glucose monitoring and ecological momentary assessment in adolescents. J Psychosom Res 2020; 135:110141. [PMID: 32447156 PMCID: PMC7452157 DOI: 10.1016/j.jpsychores.2020.110141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Circulating glucose may relate to affective and physical feeling states reflective of emotional disorder symptoms. No prior studies have investigated within-day associations between glucose and subsequent affective and physical feeling states (positive affect, negative affect, and fatigue) as they occur naturally among healthy adolescents; this pilot study assessed these associations by combining data collected from ecological momentary assessment (EMA) and continuous glucose monitors (CGM). METHODS Participants (N = 15, mean age = 13.1[±1.0] years, 66.7% female, 40.0% Hispanic, 66.7% healthy weight) wore a CGM for 7-14 days. Simultaneously, participants reported on their current positive affect, negative affect, and fatigue randomly during specified windows up to 7 times daily via EMA. CGM-measured mean interstitial glucose was calculated during the time windows (mean minutes = 122.5[±47.3]) leading up to each EMA prompt. Multilevel models assessed within-subject (WS) associations between mean interstitial glucose since the previous EMA prompt and EMA-reported affective and physical feeling states at the current prompt. RESULTS Participants provided 532 interstitial glucose-matched EMA reports of affective and physical feeling states. During intervals when interstitial glucose was higher than one's usual, higher positive affect (WS β = 0.01, p < .0001, f2 = 0.02) and lower fatigue (WS β = -0.01, p < .0001, f2 = 0.09) were subsequently reported. Interstitial glucose was unrelated to negative affect (WS β = -0.002, p = .10, f2 = 0.01). Associations were weakened, but remained significant following further adjustment for time of day. CONCLUSIONS Though effect sizes were small, within-person variations in interstitial glucose may relate to subsequent affective and physical feeling states among healthy youth. Investigations using similar methodologies in larger, more diverse samples are warranted.
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Affiliation(s)
- Jennifer Zink
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Michele Nicolo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Kellie Imm
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Shayan Ebrahimian
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Qihan Yu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Kyuwan Lee
- Division of Cardiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California
| | - Kaylie Zapanta
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Genevieve F. Dunton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California,Department of Psychology, University of Southern California
| | - Michael I. Goran
- Department of Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles
| | - Kathleen A. Page
- Department of Medicine, Keck School of Medicine, University of Southern California
| | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School
| | - Britni R. Belcher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
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31
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Alves JM, Zink J, Chow T, Luo S, Belcher BR, Xiang AH, Page KA. Contributions of Prenatal Exposures and Child Lifestyle to Insulin Sensitivity. J Clin Endocrinol Metab 2020; 105:dgaa201. [PMID: 32301999 PMCID: PMC7271763 DOI: 10.1210/clinem/dgaa201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
CONTEXT Prenatal exposures and lifestyle factors are important for metabolic health. OBJECTIVE Determine how prenatal exposures to maternal obesity and/or gestational diabetes mellitus (GDM) and childhood lifestyle factors independently contribute to child insulin sensitivity. DESIGN AND PARTICIPANTS Ninety children aged 7 to 11 years (56% girls, 60% exposed to GDM), born at Kaiser-Permanente Southern California, completed an oral glucose tolerance test (OGTT) as part of the BrainChild Study. Matsuda insulin sensitivity index (ISI) was used to estimate insulin sensitivity. Participants completed two 24-hour dietary recalls, and daily energy intake (EI), dietary added sugar, and total sugar were calculated. The 3-day physical activity recall determined the average minutes per day of moderate to vigorous physical activity (MVPA) and the average minutes per day spent sedentary. Maternal prepregnancy body mass index (BMI) and GDM status were extracted from electronic medical records. MAIN OUTCOME MEASURE Matsuda-ISI. RESULTS Linear regression showed that children who spent more time in MVPA had better ISI (β = 0.33; P = 0.001), and results remained after adjustment for maternal prepregnancy BMI, GDM exposure, child age, sex, daily EI, dietary added sugar (β = 0.34; P = 0.001), and further adjustment for child adiposity (β = 0.29; P = 0.001). Time spent sedentary, maternal prepregnancy BMI, GDM exposure, dietary added sugar, total sugar, and EI were not associated with ISI. CONCLUSIONS Physical activity was the only predictor of ISI at this age, suggesting that engaging in physical activity during childhood is beneficial for insulin sensitivity and may ameliorate future risk for metabolic disease.
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Affiliation(s)
- Jasmin M Alves
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jennifer Zink
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Shan Luo
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Britni R Belcher
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Kathleen A Page
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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32
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Alves JM, Luo S, Chow T, Herting M, Xiang AH, Page KA. Sex differences in the association between prenatal exposure to maternal obesity and hippocampal volume in children. Brain Behav 2020; 10:e01522. [PMID: 31903710 PMCID: PMC7010582 DOI: 10.1002/brb3.1522] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Animal studies have shown that male but not female offspring exposed to maternal obesity have abnormal hippocampal development. Similar sex differences were observed in animal models of developmental programming by prenatal stress or maternal diabetes. We aimed to translate this work into humans by examining sex-specific effects of exposure to maternal obesity on hippocampal volume in children. METHODS Eighty-eight children (37 boys and 51 girls) aged 7-11 years completed the study. Maternal prepregnancy body mass index (BMI) was obtained from electronic medical records. A high-resolution anatomical scan was performed using a 3-Tesla magnetic resonance imaging (MRI) scanner. Total hippocampal volume and hippocampal subfield volumes were analyzed using FreeSurfer 6.0. Linear regression was used to investigate sex differences in relationships between maternal prepregnancy BMI and child hippocampal volume. RESULTS Maternal prepregnancy BMI ranged from 19.0 to 50.4 kg/m2 . We observed a significant interaction between maternal prepregnancy BMI and sex on total hippocampal volume (p < .001) such that boys (r = -.39, p = .018) but not girls (r = .11, p = .45) had a significant negative relationship between maternal prepregnancy BMI and total hippocampal volume. This relationship in boys remained significant after adjusting for child and maternal covariates (β = -126.98, p = .012). The sex interactions with prepregnancy BMI were consistently observed in hippocampal subfields CA1 (p = .008), CA2/3 (p = .016), CA4 (p = .002), dentate gyrus (p < .001), and subiculum (p < .001). CONCLUSIONS Our results support findings in animal models and suggest that boys may be more vulnerable to the adverse effects of exposure to maternal obesity on hippocampal development than girls.
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Affiliation(s)
- Jasmin M Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ting Chow
- Department of Research and Evaluation, Pasadena, CA, USA
| | - Megan Herting
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Pasadena, CA, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Xiang AH, Chow T, Martinez MP, Getahun D, Page KA, Buchanan TA, Feldman RK. Hemoglobin A1c Levels During Pregnancy and Risk of Autism Spectrum Disorders in Offspring. JAMA 2019; 322:460-461. [PMID: 31177273 PMCID: PMC6563556 DOI: 10.1001/jama.2019.8584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study uses electronic medical record (EMR) data to examine the association between maternal hemoglobin A1c levels during pregnancy and risk of autism spectrum disorder in offspring.
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Affiliation(s)
- Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Mayra P. Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kathleen A. Page
- Division of Endocrinology and Diabetes, University of Southern California Keck School of Medicine, Los Angeles
| | - Thomas A. Buchanan
- Division of Endocrinology and Diabetes, University of Southern California Keck School of Medicine, Los Angeles
| | - R. Klare Feldman
- Obstetrics and Gynecology, Kaiser Permanente Southern California, Pasadena
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Page KA, Luo S, Wang X, Chow T, Alves J, Buchanan TA, Xiang AH. Children Exposed to Maternal Obesity or Gestational Diabetes Mellitus During Early Fetal Development Have Hypothalamic Alterations That Predict Future Weight Gain. Diabetes Care 2019; 42:1473-1480. [PMID: 31332028 PMCID: PMC6647040 DOI: 10.2337/dc18-2581] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Exposure in utero to maternal obesity or gestational diabetes mellitus (GDM) is linked to a high risk for obesity in offspring. Animal studies suggest that these exposures disrupt the development of the hypothalamus, a brain region that regulates body weight, predisposing offspring to develop obesity. This study tested the hypothesis in humans that in utero exposure to maternal obesity and/or GDM is associated with alterations in the hypothalamic response to glucose and the altered hypothalamic response would predict greater increases in child adiposity 1 year later. RESEARCH DESIGN AND METHODS Participants were 91 children aged 7-11 years with and without in utero exposure to GDM. Maternal prepregnancy BMI and GDM exposures were determined from electronic medical records. Arterial spin labeling MRI was used to determine the child's hypothalamic blood flow response to oral glucose. Anthropometric measures were acquired in all children at their initial visit and again 1 year later in a subset of 44 children. RESULTS Children exposed to GDM diagnosed at ≤26 weeks' gestation had increased hypothalamic blood flow (a marker of hypothalamic activation) in response to glucose when compared with unexposed children, and results remained after adjustments for child age, sex, BMI, and maternal prepregnancy BMI. Maternal prepregnancy BMI was positively associated with the child's hypothalamic response to glucose. Greater hypothalamic response to glucose predicted greater increases in child's BMI 1 year later. CONCLUSIONS Increased glucose-linked hypothalamic activation during childhood represents a possible mechanism by which exposure to maternal metabolic disorders during fetal development increases future risk for obesity.
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Affiliation(s)
- Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA .,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Xinhui Wang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jasmin Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Thomas A Buchanan
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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35
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Abstract
Diabetes risk is shaped at birth.
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Affiliation(s)
- Kathleen A. Page
- Division of Endocrinology, Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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Luo S, Alves J, Hardy K, Wang X, Monterosso J, Xiang AH, Page KA. Neural processing of food cues in pre-pubertal children. Pediatr Obes 2019; 14:e12435. [PMID: 30019454 PMCID: PMC6336530 DOI: 10.1111/ijpo.12435] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/27/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Neuroimaging investigations of brain pathways involved in reward and motivation have primarily focused on adults. This study sought to identify brain responses to visual food cues and explore its relationships with adiposity and sex in pre-pubertal children. METHODS Brain responses to palatable food vs. non-food cues were measured in 53 children (age: 8.18 ± .66 years; sex: 22 boys, 31 girls) after an overnight fast. Whole-brain analysis (cluster-correction Z > 2.3, P < .05) was performed to examine brain food cue reactivity and its relationships with adiposity and sex. RESULTS Greater brain activity in response to food vs. non-food cues was observed in regions implicated in reward (orbital frontal cortex, striatum), taste (insula, postcentral gyrus), appetite (hypothalamus), emotion (amygdala), memory (hippocampus), visual processing (occipital cortex) and attention (parietal cortex). A negative association was found between percent body fat and food cue reactivity in the medial prefrontal cortex and lateral orbital frontal cortex adjusting for age and sex. Boys compared with girls had increased food cue reactivity in right hippocampus and visual cortex. CONCLUSIONS These data suggest that body fat and sex are important moderators of brain food cue reactivity in children.
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Affiliation(s)
- Shan Luo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, 90089,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089
| | - Jasmin Alves
- Division of Endocrinology, Keck School of Medicine, University of Southern California, 90089,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089
| | - Kristen Hardy
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089
| | - Xinhui Wang
- Department of Research and Evaluation, Kaiser Permanente Southern California, 91101
| | - John Monterosso
- Neuroscience Graduate Program, University of Southern California, 90089,Department of Psychology, University of Southern California, 90089
| | - Anny H. Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, 91101
| | - Kathleen A. Page
- Division of Endocrinology, Keck School of Medicine, University of Southern California, 90089,Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089,Neuroscience Graduate Program, University of Southern California, 90089,Corresponding Author: Kathleen A. Page, Associate Professor of Medicine USC Keck School of Medicine Division of Endocrinology, Diabetes and Obesity Research Institute, 2250 Alcazar Street; CSC 209, Los Angeles, CA 90089, T: (323) 442-2804, F: (323) 442-2809,
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37
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Abstract
Researchers used neuroimaging to show that the best predictor of successful weight loss was greater brain activity in prefrontal areas in the brain involved in self-control.
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Affiliation(s)
- Kathleen A. Page
- Division of Endocrinology, Department of Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA
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Xiang AH, Wang X, Martinez MP, Getahun D, Page KA, Buchanan TA, Feldman K. Maternal Gestational Diabetes Mellitus, Type 1 Diabetes, and Type 2 Diabetes During Pregnancy and Risk of ADHD in Offspring. Diabetes Care 2018; 41:2502-2508. [PMID: 30373735 DOI: 10.2337/dc18-0733] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/02/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the relative importance of maternal preexisting type 1 diabetes (T1D), preexisting type 2 diabetes (T2D), and gestational diabetes mellitus (GDM) on risk of attention deficit/hyperactivity disorder (ADHD) in offspring. RESEARCH DESIGN AND METHODS This retrospective birth cohort study included 333,182 singletons born in 1995-2012 within Kaiser Permanente Southern California hospitals. Children were prospectively followed through electronic medical records from age 4 years. Relative risks of ADHD associated with diabetes exposures in utero were estimated by hazard ratios (HRs) using Cox regression with adjustment for potential confounders. For GDM, timing of exposure was evaluated by gestational age at diagnosis and severity was assessed by the need for antidiabetes medication treatment during pregnancy. RESULTS A total of 37,878 (11.4%) children were exposed to diabetes (522 exposed to T1D, 7,822 T2D, and 29,534 GDM). During a median of 4.9 years (interquartile range 2.2, 9.6) of follow-up after age 4 years, 17,415 (5.2%) children were diagnosed with ADHD. ADHD risk was not associated with GDM taken as a whole (P = 0.50) or with gestational age at GDM diagnosis (P = 0.16). However, the risk was significantly greater for the GDM requiring versus not requiring antidiabetes medications (P < 0.001). Compared with children unexposed to diabetes, the adjusted HRs for ADHD in children were 1.57 (95% CI 1.09-2.25) for exposure to T1D, 1.43 (1.29-1.60) for T2D, 1.26 (1.14-1.41) for GDM requiring antidiabetes medications, and 0.93 (0.86-1.01) for GDM not requiring medications. CONCLUSIONS The hierarchy of risks suggests that severity of maternal diabetes (T1D vs. T2D vs. GDM requiring antidiabetes medications) influences the risk of ADHD in offspring of mothers with diabetes.
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Affiliation(s)
- Anny H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Xinhui Wang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Mayra P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Kathleen A Page
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Klara Feldman
- Obstetrics and Gynecology, Kaiser Permanente Southern California, Pasadena, CA
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Page KA. Sustained obesity starts in early childhood. Sci Transl Med 2018. [DOI: 10.1126/scitranslmed.aav3890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Accelerated weight gain during early childhood predicts sustained obesity.
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Affiliation(s)
- Kathleen A. Page
- Division of Endocrinology, Department of Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA
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Affiliation(s)
- Kathleen A. Page
- Southern Oregon University Department of Biology, 1250 Siskiyou Boulevard, Ashland, Oregon 97520
| | - Meghan K. Flannery
- Southern Oregon University Department of Biology, 1250 Siskiyou Boulevard, Ashland, Oregon 97520
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Abstract
Interrupting sitting with short bouts of walking improves glucose metabolism in overweight and obese children.
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Affiliation(s)
- Kathleen A. Page
- Division of Endocrinology, Department of Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA
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Abstract
Altered fat cell lipolysis predicts long-term weight gain and risk of type 2 diabetes.
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Affiliation(s)
- Kathleen A. Page
- Division of Endocrinology, Department of Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA
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Page KA. Mother’s inflammation shapes baby’s brain. Sci Transl Med 2018. [DOI: 10.1126/scitranslmed.aat8524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Exposure to maternal inflammation during pregnancy affects newborn brain organization and cognitive abilities during early childhood.
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Affiliation(s)
- Kathleen A. Page
- Division of Endocrinology, Department of Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA
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Abstract
The small intestine may shield the liver from the damaging effects of fructose.
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Affiliation(s)
- Kathleen A. Page
- Division of Endocrinology, Department of Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA
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Luo S, O’Connor SG, Belcher BR, Page KA. Effects of Physical Activity and Sedentary Behavior on Brain Response to High-Calorie Food Cues in Young Adults. Obesity (Silver Spring) 2018; 26:540-546. [PMID: 29352524 PMCID: PMC5821522 DOI: 10.1002/oby.22107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/25/2017] [Accepted: 11/28/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Physical activity (PA) promotes weight maintenance, potentially because of its beneficial effects on feeding behavior regulation via diminished food cue reactivity within brain reward regions. This study examined how levels of PA and sedentary behavior (SB) relate to brain responses to food cues. METHODS Participants (22 lean, 18 with obesity) completed three to five PA recalls over 2 months. Average minutes per day of moderate to vigorous PA (MVPA) and SB were calculated. Participants completed a functional magnetic resonance imaging session, viewing food and nonfood images following glucose ingestion. Region of interest (ROI) analysis examined associations between MVPA and brain percent signal change in response to food versus nonfood images, controlling for obesity and sex. Secondary analysis examined associations between SB and brain responses to food cues. RESULTS Greater MVPA was associated with decreased food cue reactivity after glucose across brain ROIs (β = -0.00057, P = 0.005), controlling for obesity and sex. Greater SB was associated with increased food cue reactivity after glucose across brain ROIs in unadjusted analyses (β = 0.00041, P = 0.026). CONCLUSIONS PA may have beneficial effects on brain regulation of feeding behavior after caloric intake in lean individuals and individuals with obesity.
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Affiliation(s)
- Shan Luo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, USA
| | - Sydney G. O’Connor
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Britni R. Belcher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathleen A. Page
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, USA
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Luo S, Melrose AJ, Dorton H, Alves J, Monterosso JR, Page KA. Resting state hypothalamic response to glucose predicts glucose-induced attenuation in the ventral striatal response to food cues. Appetite 2017; 116:464-470. [PMID: 28551112 DOI: 10.1016/j.appet.2017.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/12/2017] [Accepted: 05/21/2017] [Indexed: 11/15/2022]
Abstract
Feeding behavior is regulated by a complex interaction of central nervous system responses to metabolic signals that reflect nutrient availability and to food cues that trigger appetitive responses. Prior work has shown that the hypothalamus is a key brain area that senses and responds to changes in metabolic signals, and exposure to food cues induces the activation of brain areas involved in reward processing. However, it is not known how the hypothalamic responses to changes in metabolic state are related to reward responses to food cues. This study aimed to understand whether changes in hypothalamic activity in response to glucose-induced metabolic signals are linked to food-cue reactivity within brain areas involved in reward processing. We combined two neuroimaging modalities (Arterial Spin Labeling and Blood Oxygen Level Dependent) to measure glucose-induced changes in hypothalamic cerebral blood flow (CBF) and food-cue task induced changes in brain activity within reward-related regions. Twenty-five participants underwent a MRI session following glucose ingestion and a subset of twenty individuals underwent an additional water session on a separate day as a control condition (drink order randomized). Hunger was assessed before and after drink consumption. We observed that individuals who had a greater reduction in hypothalamic CBF exhibited a greater reduction in left ventral striatum food cue reactivity (Spearman's rho = 0.46, P = 0.048) following glucose vs. water ingestion. These results are the first to use multimodal imaging to demonstrate a link between hypothalamic metabolic signaling and ventral striatal food cue reactivity.
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Affiliation(s)
- Shan Luo
- Division of Endocrinology, Keck School of Medicine, University of Southern California, 90089, United States; Department of Psychology, University of Southern California, 90089, United States; Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089, United States
| | - A James Melrose
- Department of Psychology, University of Southern California, 90089, United States; Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089, United States
| | - Hilary Dorton
- Neuroscience Graduate Program, University of Southern California, 90089, United States; Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089, United States
| | - Jasmin Alves
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089, United States
| | - John R Monterosso
- Department of Psychology, University of Southern California, 90089, United States; Neuroscience Graduate Program, University of Southern California, 90089, United States
| | - Kathleen A Page
- Division of Endocrinology, Keck School of Medicine, University of Southern California, 90089, United States; Neuroscience Graduate Program, University of Southern California, 90089, United States; Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, 90089, United States.
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Bider-Canfield Z, Martinez MP, Wang X, Yu W, Bautista MP, Brookey J, Page KA, Buchanan TA, Xiang AH. Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years. Pediatr Obes 2017; 12:171-178. [PMID: 26956226 DOI: 10.1111/ijpo.12125] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/21/2016] [Accepted: 02/10/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Maternal obesity, excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and breastfeeding are four important factors associated with childhood obesity. OBJECTIVES The objective of the study was to assess the interplay among these four factors and their independent contributions to childhood overweight in a cohort with standard clinical care. METHODS The cohort included 15 710 mother-offspring pairs delivered in 2011. Logistic regression was used to assess associations between maternal exposures and childhood overweight (body mass index >85th percentile) at age 2 years. RESULTS Mothers with pre-pregnancy obesity or overweight were more likely to have EGWG, GDM and less likely to breastfeed ≥6 months. Mothers with GDM had 40-49% lower EGWG rates and similar breastfeeding rates compared with mothers without GDM. Analysis adjusted for exposures and covariates revealed an adjusted odds ratio (95% confidence interval) associated with childhood overweight at age 2 years of 2.34 (2.09-2.62), 1.50 (1.34-1.68), 1.23 (1.12-1.35), 0.95 (0.83-1.10) and 0.76 (0.69-0.83) for maternal obesity, overweight, EGWG, GDM and breastfeeding ≥6 months vs. <6 months, respectively. CONCLUSIONS In this large clinical cohort, GDM was not associated with, but maternal pre-pregnancy obesity or overweight and EGWG were independently associated with an increased risk, and breastfeeding ≥6 months was associated with a decreased risk of childhood overweight at age 2 years.
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Affiliation(s)
- Z Bider-Canfield
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - M P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - X Wang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - W Yu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - M P Bautista
- Consulting & Implementation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - J Brookey
- Quality and Risk, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - K A Page
- Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - T A Buchanan
- Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - A H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Dorton HM, Luo S, Monterosso JR, Page KA. Influences of Dietary Added Sugar Consumption on Striatal Food-Cue Reactivity and Postprandial GLP-1 Response. Front Psychiatry 2017; 8:297. [PMID: 29403396 PMCID: PMC5777392 DOI: 10.3389/fpsyt.2017.00297] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022] Open
Abstract
Sugar consumption in the United States exceeds recommendations from the American Heart Association. Overconsumption of sugar is linked to risk for obesity and metabolic disease. Animal studies suggest that high-sugar diets alter functions in brain regions associated with reward processing, including the dorsal and ventral striatum. Human neuroimaging studies have shown that these regions are responsive to food cues, and that the gut-derived satiety hormones, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY), suppress striatal food-cue responsivity. We aimed to determine the associations between dietary added sugar intake, striatal responsivity to food cues, and postprandial GLP-1 and PYY levels. Twenty-two lean volunteers underwent a functional magnetic resonance imaging (fMRI) scan during which they viewed pictures of food and non-food items after a 12-h fast. Before scanning, participants consumed a glucose drink. A subset of 19 participants underwent an additional fMRI session in which they consumed water as a control condition. Blood was sampled for GLP-1, and PYY levels and hunger ratings were assessed before and ~75 min after drink consumption. In-person 24-h dietary recalls were collected from each participant on three to six separate occasions over a 2-month period. Average percent calories from added sugar were calculated using information from 24-h dietary recalls. A region-of-interest analysis was performed to compare the blood oxygen level-dependent (BOLD) response to food vs. non-food cues in the bilateral dorsal striatum (caudate/putamen) and ventral striatum (nucleus accumbens). The relationships between added sugar, striatal responses, and hormone changes after drink consumption were assessed using Spearman's correlations. We observed a positive correlation between added sugar intake and BOLD response to food cues in the dorsal striatum and a similar trend in the nucleus accumbens after glucose, but not water, consumption. Added sugar intake was negatively associated with GLP-1 response to glucose. Post hoc analysis revealed a negative correlation between GLP-1 response to glucose and BOLD response to food cues in the dorsal striatum. Our findings suggest that habitual added sugar intake is related to increased striatal response to food cues and decreased GLP-1 release following glucose intake, which could contribute to susceptibility to overeating.
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Affiliation(s)
- Hilary M Dorton
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States.,Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States
| | - Shan Luo
- Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States.,Internal Medicine, Division of Endocrinology, University of Southern California, Los Angeles, CA, United States
| | - John R Monterosso
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States.,Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Kathleen A Page
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States.,Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, United States.,Internal Medicine, Division of Endocrinology, University of Southern California, Los Angeles, CA, United States
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Adam TC, Tsao S, Page KA, Hu H, Hasson RE, Goran MI. Insulin sensitivity and brain reward activation in overweight Hispanic girls: a pilot study. Pediatr Obes 2015; 10:30-6. [PMID: 24357646 PMCID: PMC4065230 DOI: 10.1111/j.2047-6310.2013.00210.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 09/18/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Insulin resistance is a link between obesity and the associated disease risk. In addition to its role as an energy regulatory signal to the hypothalamus, insulin also modulates food reward. OBJECTIVE To examine the relationship of insulin sensitivity (SI) and fasting insulin with cerebral activation in response to food and non-food cues in children. METHODS Twelve overweight Hispanic girls (age: 8-11) participated in two study visits, a frequently sampled intravenous glucose tolerance test and a functional neuroimaging session (GE HDxt 3.0Tesla) with visual stimulation tasks. Blocks of images (high calorie [HC], low calorie [LC] and non-food [NF]) were presented in randomized order. RESULTS Comparing HC with NF, SI was inversely associated with activation in the anterior cingulate (r(2) = 0.65; P < 0.05), the insula (r(2) = 0.69; P < 0.05), the orbitofrontal cortex (r(2) = 0.74; P < 0.05), and the frontal and rolandic operculum (r(2) = 0.76; P < 0.001). Associations remained significant after adjustment for body mass index. Association of fasting insulin and cerebral activation disappeared after adjustment for waist circumference. CONCLUSION In addition to weight loss, insulin sensitivity may pose an important target to regulate neural responses to food cues in the prevention of excessive weight gain.
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Affiliation(s)
- Tanja C. Adam
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sinchai Tsao
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089
| | - Kathleen A. Page
- Department of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Houchun Hu
- Department of Radiology, Childrens Hospital Los Angeles, Los Angeles, CA 90027,Department of Electrical Engineering, University of Southern California, Los Angeles, CA 90089
| | - Rebecca E. Hasson
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94118
| | - Michael I. Goran
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033
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