An examination of state and trait urgency in individuals with binge-eating disorder.

OBJECTIVE: Negative urgency (i.e., acting rashly when experiencing negative affect; NU), is a theorised maintenance factor in binge-eating type eating disorders. This study examined the association between trait NU and eating disorder severity, momentary changes in state NU surrounding episodes of binge eating, and the momentary mechanistic link between affect, rash action, and binge-eating risk. METHODS: Participants were 112 individuals with binge-eating disorder (BED). Baseline measures included the UPPS-P Impulsive Behaviour Scale to assess trait NU and the Eating Disorders Examination to assess binge-eating frequency and global eating disorder severity. Ecological momentary assessment captured real-time data on binge eating, negative affect, and state NU. RESULTS: Multiple regression analysis revealed a strong association between trait NU and eating disorder severity. Generalised estimating equations showed that state NU increased before and decreased after binge-eating episodes, and that this pattern was not moderated by trait-level NU. Finally, a multilevel structural equation model indicated that increases in rash action mediated the momentary relationship between states of high negative affect and episodes of binge eating. CONCLUSION: These findings underscore the importance of both trait and state NU in binge-eating type eating disorders, and suggest NU as a potential key target for intervention.

Trajectories of state impulsivity domains before and after alcohol consumption in the naturalistic environment.

BACKGROUND AND AIMS: Studies have demonstrated that ecological momentary assessment (EMA) can effectively capture within-person variations in impulsive states and that this relates to alcohol use. The current study aimed to examine the daily trajectories of five facets of impulsivity prior to and following drinking initiation. Additionally, we explored how race, sex, baseline trait impulsivity facets, and ADHD may moderate this relation. DESIGN AND SETTING: EMA was used to collect real-time data at 6 semi-random time points and self-initiated reports of drinking onset throughout the day over a 10-day period Measurements Five state and trait impulsivity facets were assessed via the UPPS-P. Naturalistic alcohol use, ADHD history, and demographic characteristics were also assessed PARTICIPANTS: Participants were 135 adult drinkers from a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD FINDINGS: Generalized estimating equations showed that the linear trajectory of negative urgency significantly increased prior to drinking. Following drinking initiation, the linear trajectory of sensation seeking significantly decreased. There was not significant change in the trajectories of positive urgency, lack of premeditation and lack of perseverance before or after drinking initiation. Additionally, race and ADHD history moderated the trajectory of sensation seeking and race moderated the trajectory of lack of planning. CONCLUSIONS: Findings highlight the possibility of identifying proximal changes in impulsivity facets prior to and after initiation of drinking. Results can be used to inform real-time interventions that target risk periods to ultimately decrease alcohol use.

Negative affect and binge eating: Assessing the unique trajectories of negative affect before and after binge-eating episodes across eating disorder diagnostic classifications.

OBJECTIVE: Ecological momentary assessment (EMA) studies suggest that among individuals who binge eat, emotional states and binge eating are functionally related. However, it is unclear whether the trajectory of negative affect (NA) is the same across diagnostic groups or if specific changes in affect are unique to each diagnostic category. This study examined the moderating effect of diagnosis on the trajectory of negative affect before and after binge eating. METHOD: Adults with eating disorder diagnoses (anorexia nervosa [AN] = 118, bulimia nervosa [BN] = 133, binge-eating disorder [BED] = 112) completed an EMA where they reported binge eating and negative affect throughout the day. Generalized estimating equation analyses were used to model the trajectories of NA before and after binge eating. RESULTS: For all individuals, the linear trajectory of NA significantly increased before (B = 0.044, p < .001) and decreased following the binge-eating episode (B = -0.054, p < .001). However, diagnosis moderated this trajectory. Specifically, individuals with BN had a greater change in linear trajectories of NA before (B = 2.305, p < .001) and after (B = -4.149, p < .001) binge eating compared to those with BED, but not those with AN. There were no differences in the trajectory of NA between individuals with BED or AN. DISCUSSION: These findings suggest that binge-eating episodes in BN may be more strongly associated with NA than in BED, but similar to binge-eating episodes in AN.

Exploring Neural Mechanisms Related to Cognitive Control, Reward, and Affect in Eating Disorders: A Narrative Review of FMRI Studies.

Studies using functional magnetic resonance imaging (fMRI) have contributed to our understanding of possible neural abnormalities among individuals with eating disorders. Many of these studies have focused on three domains: 1) cognitive control, 2) reward processing, and 3) affective processing. This review attempts to summarize the recent fMRI findings across these domains among the most well-characterized eating disorders: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Though the literature is a bit murky, a few major themes have emerged. Cognitive control systems are affected among individuals across eating disorder diagnoses, but effects seem least pronounced in AN. Specifically, individuals with all eating disorders appear to show decreased prefrontal activation during cognitive control, but there is less evidence in AN linking decreased prefrontal activation with behavior. There is some evidence that the reinforcing value of food is reduced in AN, but individuals with BN and BED show hyperactivation to rewarding food-related stimuli, suggesting the reinforcing value of food may be enhanced. However, more complex reward processing paradigms show that individuals with BN and BED exhibit hypoactivation to reward anticipation and provide mixed results with regards to reward receipt. There are fewer neuroimaging findings related to affective processing, yet behavioral findings suggest affective processing is important in understanding eating disorders. Though the extant literature is complicated, these studies represent a foundation from which to build and provide insight into potential neurobiological mechanisms that may contribute to the pathophysiology of eating disorders.

Feasibility of a Multidisciplinary and Culturally Adapted Pediatric Weight Management Program for Latino Families: Results From the Vidas Activas y Familias Saludables Pilot Study.

OBJECTIVE: To determine the feasibility of a pediatric weight management program for low-income Latino families. METHODS: A pretest-posttest pilot study was conducted among 60 Latino children, aged 4-9, who were overweight/obese (body mass index-for-age ≥85th percentile). The 10-week group-based community program addressed diet, exercise, and behavior modification. Demand was assessed through recruitment and attendance, acceptability using postintervention surveys with participants, and limited efficacy testing of participant anthropometrics and cardiometabolic markers. RESULTS: Overall 65% of families were retained for follow-up. All families reported feeling more confident in making healthier food choices and would participate in the program again. Pre/post intervention testing found statistically significant decreases (P < .05) in body mass index for age z score, waist circumference, and % body fat. CONCLUSIONS AND IMPLICATIONS: This culturally adapted group intervention for Latino families was acceptable and shows promise for improved health status, although it needs to be replicated with a larger group and longer follow-up.

Intolerance of uncertainty moderates the relationship between high personal standards but not evaluative concerns perfectionism and eating disorder symptoms cross-sectionally and prospectively.

Two dimensions of perfectionism related to eating disorder (ED) symptoms are evaluative concerns and high standards. Evaluative concerns are consistently linked with ED symptoms, whereas there are conflicting results regarding high standards and ED symptoms. High standards are unrelated to ED symptoms in some studies and are linked to higher ED symptoms in others. Intolerance of uncertainty (IU) may influence the relation between high standards and ED symptoms; individuals elevated in both IU and high standards may find it distressing to be uncertain about future situations for fear of not living up to high expectations and use ED behaviors to cope with such uncertainty. In the current study (N = 216), we explored whether IU moderates the relationships between high standards and evaluative concerns and ED symptoms, both cross-sectionally and prospectively across two weeks. IU significantly moderated high standards and ED symptoms both cross-sectionally and across time while accounting for baseline ED symptoms, but did not moderate the relationship between evaluative concerns and ED symptoms. Higher standards were associated with greater ED symptoms in individuals higher, but not lower in IU. These findings suggest high standards may only contribute to ED symptoms when individuals are also high in IU.

Metabolic adaptation of short-living growth hormone transgenic mice to methionine restriction and supplementation.

Extension of mammalian health and life span has been achieved using various dietary interventions. We previously reported that restricting dietary methionine (MET) content extends life span only when growth hormone signaling is intact (no life span increase in GH deficiency or GH resistance). To understand the metabolic responses of altered dietary MET in the context of accelerated aging (high GH), the current study evaluated MET and related pathways in short-living GH transgenic (GH Tg) and wild-type mice following 8 weeks of restricted (0.16%), low (0.43%), or enriched (1.3%) MET consumption. Liver MET metabolic enzymes were suppressed in GH Tg compared to diet-matched wild-type mice. MET metabolite levels were differentially affected by GH status and diet. SAM:SAH ratios were markedly higher in GH Tg mice. Glutathione levels were lower in both genotypes consuming 0.16% MET but reduced in GH Tg mice when compared to wild type. Tissue thioredoxin and glutaredoxin were impacted by diet and GH status. The responsiveness to the different MET diets is reflected across many metabolic pathways indicating the importance of GH signaling in the ability to discriminate dietary amino acid levels and alter metabolism and life span.

Using bivariate latent basis growth curve analysis to better understand treatment outcome in youth with anorexia nervosa.

OBJECTIVE: This study explored the relation between eating-related obsessionality and weight restoration utilizing bivariate latent basis growth curve modelling. Eating-related obsessionality is a moderator of treatment outcome for adolescents with anorexia nervosa (AN). This study examined the degree to which the rate of change in eating-related obsessionality was associated with the rate of change in weight over time in family-based treatment (FBT) and individual therapy for AN. METHOD: Data were drawn from a 2-site randomized controlled trial that compared FBT and adolescent focused therapy for AN. Bivariate latent basis growth curves were used to examine the differences of the relations between trajectories of body weight and symptoms associated with eating and weight obsessionality. RESULTS: In the FBT group, the slope of eating-related obsessionality scores and the slope of weight were significantly (negatively) correlated. This finding indicates that a decrease in overall eating-relating obsessionality is significantly associated with an increase in weight for individuals who received FBT. However, there was no relation between change in obsessionality scores and change in weight in the adolescent focused therapy group. DISCUSSION: Results suggest that FBT has a specific impact on both weight gain and obsessive compulsive behaviour that is distinct from individual therapy.

The impact of neural responses to food cues following stress on trajectories of negative and positive affect and binge eating in daily life.

Stress and affect have been implicated in the maintenance of binge eating for women with symptoms of bulimia nervosa (BN). Neuroimaging and ecological momentary assessment (EMA) have separately examined how these variables may contribute to eating disorder behavior. Though both methodologies have their own strengths, it's unclear how either methodology might inform the other. This study examined the impact of individual differences in neural reactivity to food cues following acute stress on the trajectories of positive affect (PA) and negative affect (NA) surrounding binge eating. Women (n = 16) with BN symptoms viewed palatable food cues before and after a stress induction in the scanner. For two weeks, participants responded to prompts assessing affect and binge episodes several times a day. EMA data revealed NA increased and PA decreased before binge episodes in the natural environment. Additionally, NA decreased while PA increased following binge episodes. Changes in activation in the ACC, amygdala, and the vmPFC significantly moderated the relationship of affect to binge eating. However, lateral differences of each brain region uniquely moderator the trajectory of PA, NA, or both to binge eating. Specifically, those with less change in BOLD response reported significantly increasing NA and decreasing PA prior to binges, while women with greater decreases reported no change in affect. Following binge eating, individuals with decreased change in BOLD response reported decreasing NA and increasing PA. This may suggest individual differences in neural response to food cues under stress appear to underlie affect driven theory on the antecedents to binge eating.

The relation between craving and binge eating: Integrating neuroimaging and ecological momentary assessment.

The role of craving in binge eating characteristic of bulimia nervosa (BN) is inconclusive. A network of regions associated with cue reactivity to food and substances has been identified, comprised of the amygdala, orbitofrontal cortex, insula, and striatum. The goal of this study was to examine individual differences in BOLD response in this appetitive network as moderators of the relationship between craving and binging in the natural environment in women with BN. Women with BN (N = 16) completed a baseline measure of craving and a fMRI scan, where they viewed neutral cues and food cues. After each run, craving for food was assessed. Participants then completed an ecological momentary assessment six times a day via smart phone and recorded binge eating and craving. Participants exhibited significantly increased BOLD response in the left amygdala in response to food cues compared to neutral cues. However, individual differences in BOLD response were not correlated with self-report craving throughout the scan. The relationship between craving and binging in everyday life was moderated by individual differences in activation in the caudate, insula, and amygdala. Women with greater activation in these regions demonstrated significant increases in craving prior to binge eating. Those who did not exhibit increases in activation did not exhibit increases in craving prior to binge eating in the natural environment. Craving may not underlie binge eating for all individuals with BN. However, these results indicate that neural response to food cues may affect individual differences in the daily experience of craving and binge eating.

The Contributing Role of Bile Acids to Metabolic Improvements After Obesity and Metabolic Surgery.

Obesity and metabolic surgery (OMS) leads to several metabolic improvements, which often occur prior to substantial weight loss. Therefore, other factors in addition to weight loss contribute to the metabolic benefits. This literature review offers an overview of studies investigating bile acids (BAs) and their metabolic effects after OMS. Rearrangement of enterohepatic circulation, changes in BA synthesis, BA conjugation, intestinal reabsorption, and alterations in the gut microbiota are potential mechanisms for altered BA profiles after surgery. Increased BA levels are associated with improved glucose homeostasis and lipid profiles, which are mediated by two major receptors: the Transmembrane G-protein Coupled Receptor and the Farnesoid X Receptor. Therefore, pharmacological manipulation of BAs and their receptors may be viable targets for less invasive obesity treatment.

Alcohol and Other Addictive Disorders Following Bariatric Surgery: Prevalence, Risk Factors and Possible Etiologies.

Bariatric surgery is currently the most effective intervention for significant and sustained weight loss in obese individuals. While patients often realize numerous improvements in obesity-related comorbidities and health-related quality of life, a small minority of patients have less optimal outcomes following bariatric surgery. The literature on the emergence of alcohol use disorders (AUDs) following bariatric surgery has grown in the past several years and collectively provides convincing evidence that a significant minority of patients develop new-onset AUDs following bariatric surgery. Rouxen-Y gastric bypass (RYGB) has generally been associated with the risk of developing an AUD, while laparoscopic adjustable gastric banding generally has not, in several large studies. One theory that has been discussed at some length is the idea of 'addiction transfer' wherein patients substitute one 'addiction' (food) for a new 'addiction' (alcohol) following surgery. Animal work suggests a neurobiological basis for increased alcohol reward following RYGB. In addition, several pharmacokinetic studies have shown rapid and dramatically increased peak alcohol concentrations following RYGB. The prevalence of alcohol and other addictive disorders and potential etiological contributors to post-operative AUDs will be explored.

Comparison of Warfarin Dosages and International Normalized Ratios Before and After Roux-en-Y Gastric Bypass Surgery.

STUDY OBJECTIVE: As data are limited for dosing warfarin in patients who have undergone bariatric surgery, our objective was to gather data on warfarin pharmacotherapy to aid in the prescribing practices and dosage adjustment of warfarin after Roux-en-Y gastric bypass (RYGB) surgery. DESIGN: Retrospective medical record review. SETTING: Anticoagulation clinic. PATIENTS: Twelve patients who underwent RYGB surgery between 2009 and 2011. MEASUREMENTS AND MAIN RESULTS: Data were collected on patient demographics, therapeutic indications for warfarin, weekly warfarin doses, and international normalized ratio (INR) values before and after RYGB surgery. To examine whether the relationship between the warfarin dose and therapeutic effect (i.e., INR) of warfarin changed from before to after surgery, we generated a ratio between each INR measurement and the weekly warfarin dose that immediately preceded it (warfarin dose/INR ratio). Mean weekly warfarin dose after RYGB surgery decreased significantly relative to presurgery dose (estimated marginal mean ± SE presurgery dose 37.08 ± 3.31 mg vs postsurgery dose 28.08 ± 3.27 mg; [F(205.63) = 13.23, p<0.001]), whereas INRs increased significantly after surgery from presurgery levels (estimated marginal mean ± SE presurgery INR 2.36 ± 0.15 vs postsurgery INR 2.94 ± 0.14; [F(213.76) = 6.55, p<0.05]). The ratio of warfarin dose/INR from presurgery (estimated marginal mean ± SE 17.64 ± 1.67) to postsurgery (estimated marginal mean ± SE 10.94 ± 1.64) was also significantly reduced [F(206.47) = 20.61, p<0.001], suggesting that a lower warfarin dose was required to produce the desired INR after surgery compared with before surgery. CONCLUSION: Warfarin dosages tended to decrease after RYGB surgery, in agreement with previously published literature. These findings suggest the need for increased INR monitoring and patient education for patients taking warfarin after RYGB surgery.

Examining convergence of retrospective and ecological momentary assessment measures of negative affect and eating disorder behaviors.

OBJECTIVE: Data gathered via retrospective forms of assessment are subject to various recall biases. Ecological momentary assessment (EMA) is an alternative approach involving repeated momentary assessments within a participant's natural environment, thus reducing recall biases and improving ecological validity. EMA has been used in numerous prior studies examining various constructs of theoretical relevance to eating disorders. METHOD: This investigation includes data from three previously published studies with distinct clinical samples: (a) women with anorexia nervosa (N = 118), (b) women with bulimia nervosa (N = 133), and (c) obese men and women (N = 50; 9 with current binge eating disorder). Each study assessed negative affective states and eating disorder behaviors using traditional retrospective assessments and EMA. Spearman rho correlations were used to evaluate the concordance of retrospective versus EMA measures of affective and/or behavioral constructs in each sample. Bland-Altman plots were also used to further evaluate concordance in the assessment of eating disorder behaviors. RESULTS: There was moderate to strong concordance for the measures of negative affective states across all three studies. Moderate to strong concordance was also found for the measures of binge eating and exercise frequency. The strongest evidence of concordance across measurement approaches was found for purging behaviors. DISCUSSION: Overall, these preliminary findings support the convergence of retrospective and EMA assessments of both negative affective states and various eating disorder behaviors. Given the advantages and disadvantages associated with each of these assessment approaches, the specific questions being studied in future empirical studies should inform decisions regarding selection of the most appropriate method.

Growth hormone signaling is necessary for lifespan extension by dietary methionine.

Growth hormone significantly impacts lifespan in mammals. Mouse longevity is extended when growth hormone (GH) signaling is interrupted but markedly shortened with high-plasma hormone levels. Methionine metabolism is enhanced in growth hormone deficiency, for example, in the Ames dwarf, but suppressed in GH transgenic mice. Methionine intake affects also lifespan, and thus, GH mutant mice and respective wild-type littermates were fed 0.16%, 0.43%, or 1.3% methionine to evaluate the interaction between hormone status and methionine. All wild-type and GH transgenic mice lived longer when fed 0.16% methionine but not when fed higher levels. In contrast, animals without growth hormone signaling due to hormone deficiency or resistance did not respond to altered levels of methionine in terms of lifespan, body weight, or food consumption. Taken together, our results suggest that the presence of growth hormone is necessary to sense dietary methionine changes, thus strongly linking growth and lifespan to amino acid availability.

Altered dietary methionine differentially impacts glutathione and methionine metabolism in long-living growth hormone-deficient Ames dwarf and wild-type mice.

BACKGROUND: Extending mammalian health span and life span has been achieved under a variety of dietary restriction protocols. Reducing the intake of a specific amino acid has also been shown to extend health and longevity. We recently reported that methionine (MET) restriction is not effective in life span extension in growth hormone (GH) signaling mutants. To better understand the apparent necessity of GH in the 'sensing' of altered dietary MET, the current study was designed to evaluate MET and glutathione (GSH) metabolism (as well as other pathways) in long-living GH-deficient Ames dwarf and wild-type mice following 8 weeks of restricted (0.16%), low (0.43%), or enriched (1.3%) dietary MET consumption. Metabolite expression was examined in liver tissue, while gene and protein expression were evaluated in liver, kidney, and muscle tissues. RESULTS: Body weight was maintained in dwarf mice on the MET diets, while wild-type mice on higher levels of MET gained weight. Liver MET levels were similar in Ames mice, while several MET pathway enzymes were elevated regardless of dietary MET intake. Transsulfuration enzymes were also elevated in Ames mice but differences in cysteine levels were not different between genotypes. Dwarf mice maintained higher levels of GSH on MET restriction compared to wild-type mice, while genotype and diet effects were also detected in thioredoxin and glutaredoxin. MET restriction increased transmethylation in both genotypes as indicated by increased S-adenosylmethionine (SAM), betaine, and dimethylglycine. Diet did not impact levels of glycolytic components, but dwarf mice exhibited higher levels of key members of this pathway. Coenzyme A and measures of fatty acid oxidation were elevated in dwarf mice and unaffected by diet. CONCLUSIONS: This component analysis between Ames and wild-type mice suggests that the life span differences observed may result from the atypical MET metabolism and downstream effects on multiple systems. The overall lack of responsiveness to the different diets is well reflected across many metabolic pathways in dwarf mice indicating the importance of GH signaling in the ability to discriminate dietary amino acid levels.

The impact of the 2009 Red River Flood on interpersonal risk factors for suicide.

BACKGROUND: Natural disasters are frequently associated with increases in risk factors for suicide, yet research indicates that suicide rates tend to stay the same or decrease in the wake of disasters (e.g., Krug et al., 1999). AIMS: The present research sought to shed light on this counterintuitive phenomenon by testing hypotheses derived from Joiner's (2005) interpersonal-psychological theory of suicidal behavior, which proposes that the desire to die by suicide is the result of feeling like one does not belong and feeling like one is a burden on others. During natural disasters, community members often pull together in volunteering efforts, and it was predicted that such behaviors would boost feelings of belonging and reduce feelings that one is a burden. METHODS: The present study tested these predictions in a sample of 210 undergraduate students in Fargo, North Dakota, following the 2009 Red River Flood. RESULTS: Consistent with prediction, greater amounts of time spent volunteering in flood efforts were associated with increased feelings of belongingness and decreased feelings of burdensomeness. CONCLUSIONS: The findings in the current study are consistent with the notion that communities pulling together during a natural disaster can reduce interpersonal risk factors associated with the desire for suicide.