Executive Functioning, Weight Trajectories, and Loss of Control Eating in Children with Overweight/Obesity: A Prospective Study

项目摘要/摘要 儿童超重和肥胖仍然是主要的公共卫生问题。失控进食是一种 影响大约30%超重/肥胖儿童和青少年的肥胖相关表型 并可能阻碍成功的体重控制。儿童超重/肥胖和低脂饮食频繁出现 在儿童和青春期，如果不治疗，倾向于遵循慢性和坚持不懈的过程。两者都有 这些情况与执行功能(EF)的相对缺陷有关，包括工作记忆， 计划、抑制控制和决策。这些递减可能会削弱一个人适当地 规范体重和饮食行为。先前研究的一个局限性是，它主要是横断面的 自然，这阻碍了对相互关联中所涉及的影响的时机和方向的理解 EF、体重变化和饮食病理。此外，人们对相对EF的领域特异性知之甚少 青少年超重/肥胖和低脂饮食的缺陷，也不是他们潜在的神经底物。一个 提高对青少年EF损害的性质和预期结果的理解 超重/肥胖和进食低碳水化合物可以通过指示治疗是否 应该专注于改善一般的和/或食物特有的EF，以及哪些神经通路应该 有针对性地对饮食和体重产生最强劲和最持久的影响。拟议的R01研究将 检查EF表现和相关神经底物以及儿童体重之间的预期关联 换衣服，吃零食。以社区为基础的儿童代表各种风险，包括非 超重/肥胖(n=60)、超重/肥胖(n=60)、超重/肥胖合并低脂饮食(n=60)， 将提供对身高/体重、低脂饮食病理以及一般和特定食物的EF的重复评估 每隔6-12个月进行一次为期2年的随访。每个风险类别的参与者子集将完成一份 基线和18个月的功能磁共振成像方案评估一般和特定食物工作的神经底物 记忆。具体目标是调查一般EF和特定食物EF之间的预期关联， 和他们的神经基质，体重变化和摄食LOC的轨迹(包括汇款和 坚持不懈)2年以上。这些数据将阐明体重变化和LOC进食的时间和轨迹 与EF表现及其相关的神经激活模式的关系。这项研究是第一次 前瞻性地检查一般和特定食物的EF、体重轨迹和低碳水化合物摄入量之间的关系， 有明显的潜力促进科学和临床理解促进发病和 在青少年中维持不适应饮食，并告知干预措施，以减轻他们累积的个人和 社会负担。此外，这个应用程序建立在首席调查员的编程路线上 研究神经认知因素与饮食和体重相关的问题，并提供了明确的 通向未来临床和科学影响研究的道路。

PROJECT SUMMARY/ABSTRACT Pediatric overweight and obesity continue to be major public health issues. Loss of control (LOC) eating is an obesity-related phenotype that affects approximately 30% of children and adolescents with overweight/obesity and may impede successful weight control. Pediatric overweight/obesity and LOC eating frequently emerge during childhood and adolescence, and tend to follow a chronic and unremitting course if untreated. Both conditions are associated with relative deficiencies in executive functioning (EF), including working memory, planning, inhibitory control, and decision-making. These decrements may impair one’s ability to appropriately regulate weight and eating behavior. A limitation of prior research is that it has been primarily cross-sectional in nature, which inhibits understanding of the timing and direction of influence involved in the associations among EF, weight change, and eating pathology. Moreover, little is known about the domain specificity of relative EF deficits in youth with overweight/obesity and LOC eating, nor about their underlying neural substrates. An improved understanding of the nature and prospective outcomes of EF impairments in youth with overweight/obesity and LOC eating could inform intervention development by indicating whether treatments should focus on improving general and/or food-specific EF, as well as which neural pathways should be targeted to achieve the most robust and sustained effects on eating and weight. The proposed R01 study will examine prospective associations between EF performance and related neural substrates, and child weight change and LOC eating. Community-based children representing a spectrum of risk, including non- overweight/obese (n=60), overweight/obese (n=60), and overweight/obese with comorbid LOC eating (n=60), will provide repeated assessments of height/weight, LOC eating pathology, and general and food-specific EF every 6-12 months over 2 years of follow-up. A subset of participants from each risk category will complete a baseline and 18-month fMRI protocol assessing neural substrates of general and food-specific working memory. Specific aims are to investigate prospective associations between both general and food-specific EF, and their neural substrates, and trajectories of weight change and LOC eating (including remittance and persistence) over 2 years. These data will clarify timing and trajectory of weight change and LOC eating in relation to EF performance and its associated neural activation patterns. This study, which is the first to prospectively examine associations among general and food-specific EF, weight trajectories, and LOC eating, has clear potential to advance scientific and clinical understanding of mechanisms that promote the onset and maintenance of maladaptive eating in youth and inform interventions to alleviate their cumulative personal and societal burden. Furthermore, this application builds on the principal investigator’s programmatic line of research on neurocognitive factors involved in eating- and weight-related problems, and provides a clear pathway to future clinically and scientifically impactful studies.