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

超重/肥胖儿童的执行功能、体重轨迹和饮食失控：一项前瞻性研究

• 批准号: 9885199
• 负责人: Andrea Beth Goldschmidt
• 金额: $ 55.21万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9885199
• 关键词: Address; Adolescence; Adolescent; Affect; Age; Area; Behavior; Behavioral; Body Weight Changes; Body Weight decreased; Brain; Categories; Child; Childhood; Chronic; Clinical; Cognitive; Communities; Data; Decision Making; Development; Diet; Disease; Dorsal; Early Intervention; Eating; Eating Behavior; Eating Disorders; Emotional; Emotions; Etiology; Executive Dysfunction; Food; Functional Magnetic Resonance Imaging; Future; Health; Healthcare Systems; Height; Impairment; Impulsivity; Intervention; Investigation; Knowledge; Maintenance; Measures; Medical; Modeling; Nature; Neural Pathways; Neurocognitive; Neurophysiology - biologic function; Obesity; Outcome; Overweight; Parietal Lobe; Participant; Pathway interactions; Pattern; Performance; Phenotype; Prefrontal Cortex; Preventive Intervention; Principal Investigator; Process; Prospective Studies; Protocols documentation; Public Health; Publishing; Regulation; Remittance; Research; Research Design; Risk; Role; Sampling; Scientific Advances and Accomplishments; Short-Term Memory; Specificity; Structure; Time; Training; Weight; Weight Gain; Weight maintenance regimen; Youth; base; brain pathway; comorbidity; design; eating pathology; executive function; follow-up; healthy weight; improved; inter-individual variation; loss of control over eating; middle childhood; negative affect; neglect; neural correlate; neuroimaging; neuromechanism; obesity in children; prevent; prospective; psychosocial; relating to nervous system; restraint; therapy development

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.

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（LOC）是一种 影响约 30% 超重/肥胖儿童和青少年的肥胖相关表型 并可能妨碍成功的体重控制。儿童超重/肥胖和LOC饮食频繁出现 在儿童期和青春期，如果不及时治疗，往往会形成慢性且持续的病程。两个都 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。这些减量可能会损害一个人适当地 调节体重和饮食行为。先前研究的一个局限性是它主要是横断面的 性质，这阻碍了对涉及之间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，人们对相对 EF 的域特异性知之甚少。 青少年超重/肥胖和LOC饮食的缺陷，也不是其潜在的神经基质的缺陷。一个 提高对青少年 EF 损伤的性质和预期结果的了解 超重/肥胖和 LOC 饮食可以通过表明治疗是否有效来为干预措施的制定提供信息 应重点改善一般和/或特定食物的 EF，以及应改善哪些神经通路 旨在对饮食和体重产生最强劲和持续的影响。拟议的 R01 研究将 检查 EF 表现和相关神经基质以及儿童体重之间的前瞻性关联 改变和LOC饮食。社区儿童代表一系列风险，包括非 超重/肥胖 (n=60)、超重/肥胖 (n=60) 以及超重/肥胖伴有 LOC 饮食共病 (n=60)， 将提供对身高/体重、LOC 饮食病理学以及一般和特定食物 EF 的重复评估 在 2 年的随访期间每 6-12 个月进行一次。每个风险类别的一部分参与者将完成 基线和 18 个月的功能磁共振成像协议评估一般和食物特定工作的神经基质 记忆。具体目标是调查一般 EF 和特定食品 EF 之间的前瞻性关联， 及其神经基质，以及体重变化和 LOC 饮食的轨迹（包括汇款和 坚持）2年多。这些数据将阐明体重变化和 LOC 饮食的时间和轨迹 与 EF 表现及其相关神经激活模式的关系。这项研究首次 前瞻性地研究一般和特定食物 EF、体重轨迹和 LOC 饮食之间的关联， 具有明显的潜力，可以促进对促进发病和发生的机制的科学和临床理解。 维持青少年适应不良的饮食，并为干预措施提供信息，以减轻他们累积的个人和 社会负担。此外，该应用程序建立在首席研究员的程序线之上 对涉及饮食和体重相关问题的神经认知因素的研究，并提供了明确的 未来具有临床和科学影响力的研究的途径。