Examining Highly Palatable Food Consumption upon Initiation of Methadone Maintenance Treatment

开始美沙酮维持治疗后检查高度适口的食物消耗

• 批准号: 10369045
• 负责人: Ana M Abrantes
• 金额: $ 20.08万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10369045
• 关键词: Accounting; Affect; Age; American; Analgesics; Anxiety; Area; Attention; Basic Science; Behavior; Body Weight; Body mass index; Cardiovascular Diseases; Cells; Cessation of life; Characteristics; Chronic; Consumption; Data; Development; Diabetes Mellitus; Dietary Assessment; Dietary intake; Dopamine; Dose; Eating; Ecological momentary assessment; Emotional; Fatty acid glycerol esters; Female; Food; Functional disorder; Health; Hypertension; Impaired cognition; Individual; Individual Differences; Intake; Intervention; Lead; Literature; Mental Depression; Mental Health; Methadone; Methodology; Nucleus Accumbens; Nutritional; Obesity; Opioid; Opioid replacement therapy; Overweight; Palate; Pancreas; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Pharmacology; Population; Populations at Risk; Process; Prospective Studies; Public Health; Quality of life; Recovery; Relapse; Reporting; Research; Research Design; Rewards; Risk; Risk Factors; Role; Taste preferences; Time; Treatment outcome; Weight; Weight Gain; brain dysfunction; cigarette smoking; clinically significant; common treatment; comorbidity; cost; craving; drug craving; drug of abuse; early experience; effective intervention; emotion regulation; emotional eating; endogenous opioids; food consumption; heroin use; high risk; illicit opioid; improved; improved outcome; methadone treatment; negative affect; negative emotional state; neuromechanism; nutrition; opioid use; opioid use disorder; physical conditioning; physical inactivity; premature; programs; psychobiologic; psychologic; relapse risk; sex; sleep difficulty; substance use treatment; sugar; sweet taste perception; trait; unhealthy lifestyle

Abstract Increases in Opioid Use Disorder (OUD) in the last decade has created a public health crisis. Methadone maintenance treatment (MMT) is the most common treatment for OUD. While MMT is effective in helping patients improve their quality of life, physical and mental health comorbidities are common and increase risk for premature death. While unhealthy lifestyle behaviors such as physical inactivity and cigarette smoking have been targeted, the role of nutritional intake in this population has been relatively unexplored. Clinically significant increases in weight (at least 10%) have been consistently observed, as well as oft-reported cravings for sweet foods upon MMT initiation. Missing from the existing literature is a clear understanding of why this phenomenon occurs, limiting the ability to effectively target this problem with appropriate intervention. Purported explanations for weight gain have included increased food intake to compensate for undernourishment during the time of active illicit opioid use and the pharmacological effects of methadone on pancreatic cell dysfunction and sweet taste preference. However, these possibilities may only partially explain weight gain as most patients starting treatment are already overweight or obese and increases in weight continue even when methadone doses are stable. We are proposing an additional hypothesis: patients starting MMT will consume foods that are highly palatable (HPF; i.e., high in fat, sugar, or both) in an effort to manage negative affect and opioid cravings that are common during early recovery. Anecdotal reports of patients in substance use treatment provide support for this hypothesis – HPF provide emotional relief and decrease drug cravings. An emerging body of basic science literature demonstrates shared neural mechanisms of both HPF and drugs of abuse. As with drugs, HPF potentiates endogenous opioid and dopamine release in the nucleus accumbens, which, through repeated overconsumption, can also lead to disrupted reward pathways. Indeed, in non-substance using populations, overconsumption of HPF can lead to poorer psychological functioning such as depression and anxiety (known relapse risks in those with OUD). Therefore, while HPF may have a short-term beneficial effect on improving negative affect and decreasing opioid cravings among patients in MMT, it may also confer a longer-term risk for relapse in this population. Understanding the within-person associations between negative affect, opioid cravings, and consumption of HPF at the daily level and over the course of early MMT initiation is critical for informing the development of adjunctive, nutrition-focused interventions in this at-risk population. We propose to conduct a 26-week prospective study of 80 patients who recently initiated MMT utilizing ecological momentary assessment (EMA; through three, 21-day bouts). In doing so, we can answer the question of whether HPF consumption during early MMT is beneficial or detrimental to risk for returning to illicit opioid use. With this information, more effective interventions could be developed to extend recovery and decrease the public health impact of OUD.

摘要 在过去的十年里，阿片类药物使用障碍(OUD)的增加已经造成了公共健康危机。美沙酮 维持治疗(MMT)是治疗尿毒症最常见的治疗方法。虽然MMT在帮助人们方面很有效 患者改善生活质量，身心健康并存是常见的，增加了罹患 过早死亡。而不健康的生活方式，如不运动和吸烟， 作为目标，营养摄入量在这一人群中的作用相对来说还没有被探索。临床上 体重的显著增加(至少10%)一直被观察到，以及经常报告的渴望 在MMT印心时用于甜食。现有文献中缺少对这一现象原因的明确理解 这种现象的发生，限制了通过适当的干预有效地针对这一问题的能力。 据称，体重增加的解释包括增加食物摄入量以弥补 阿片类药物活跃使用期间的营养不良及美沙酮的药理作用 胰腺细胞功能障碍和甜味偏好。然而，这些可能性可能只能部分解释 体重增加，因为大多数患者在开始治疗时已经超重或肥胖，体重增加 即使在美沙酮剂量稳定的情况下也可以继续服用。我们提出了一个额外的假设：患者 开始摄入适口性很好的食物(HPF；即高脂肪、高糖或两者兼而有之)，以努力 管理不良情绪和阿片类药物的渴望，这是在早期康复过程中常见的。轶事般的报道 物质使用治疗中的患者支持这一假说-HPF提供情绪缓解和 减少对毒品的渴求。一批新兴的基础科学文献展示了共享的神经 HPF和药物滥用的机制。与药物一样，HPF增强内源性阿片类药物和 伏隔核中释放的多巴胺，通过反复过量摄入，也可以导致 扰乱了奖励途径。事实上，在非物质使用人群中，HPF的过度消费可能导致 心理功能较差，如抑郁和焦虑(已知的复发风险在OUD患者中)。 因此，虽然HPF可能在短期内对改善负面情绪和减少 在MMT患者中，阿片类药物的渴望，这也可能增加这一人群中复发的长期风险。 了解负面情绪、阿片类药物渴求和消费之间的内在联系 HPF在日常水平和在早期MMT启动过程中的变化对于通知 在这一高危人群中进行以营养为重点的辅助干预。我们建议进行为期26周的 使用生态瞬时评估(EMA； 通过三场，21天的比赛)。通过这样做，我们可以回答这样一个问题，即HPF在 早期的MMT对重新使用非法阿片类药物的风险有利或有害。有了这些信息，更多 可以制定有效的干预措施，延长恢复时间，减少艾滋病对公共卫生的影响。