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

项目概要/摘要 儿童超重和肥胖仍然是主要的公共卫生问题。饮食失控（Loss of Control） 肥胖相关表型，影响约30%的超重/肥胖儿童和青少年 并且可能妨碍成功的体重控制。儿童超重/肥胖和暴食经常出现 在儿童和青少年时期，如果不治疗，往往会出现慢性和持续的过程。两 这些病症与执行功能（EF）的相对缺陷有关，包括工作记忆， 规划、抑制控制和决策。这些减少可能会损害一个人的能力， 调节体重和饮食行为。先前研究的一个局限性是，它主要是在 自然，这抑制了对参与关联的影响的时间和方向的理解， EF、体重变化和饮食病理学。此外，对相对EF的结构域特异性知之甚少 超重/肥胖和过量饮食的青少年的缺陷，也不涉及其潜在的神经基质。一个 提高对青年EF损伤的性质和预期结果的理解， 超重/肥胖和暴食可以通过指示治疗是否 应该专注于改善一般和/或食物特异性EF，以及哪些神经通路应该 有针对性地实现对饮食和体重的最强大和持续的影响。R 01研究将 检查EF表现与相关神经基质和儿童体重之间的前瞻性关联 改变和饮食。基于社区的儿童代表着一系列风险， 超重/肥胖（n=60）、超重/肥胖（n=60）和超重/肥胖伴共病暴食（n=60）， 将提供身高/体重、进食病理学以及一般和食物特异性EF的重复评估 每6-12个月随访2年。每个风险类别的一部分参与者将完成一份 基线和18个月fMRI方案评估一般和食物特异性工作的神经基质 记忆具体目标是调查一般和食物特异性EF之间的前瞻性关联， 和他们的神经基质，以及体重变化和进食的轨迹（包括汇款和 持续2年以上。这些数据将阐明体重变化的时间和轨迹， 与EF性能及其相关的神经激活模式的关系。这项研究，这是第一个 前瞻性地检查一般和食物特异性EF、体重轨迹和暴食之间的关联， 具有明显的潜力，可以促进对促进发病机制的科学和临床理解， 维持青少年适应不良的饮食，并采取信息干预措施，以减轻他们累积的个人和 社会负担。此外，该应用程序建立在主要研究者的编程线上， 研究涉及饮食和体重相关问题的神经认知因素，并提供了一个明确的 为未来临床和科学上有影响力的研究铺平道路。

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.