Breastfeeding duration and brain-body development in 9-10-year-olds: modulating effect of socioeconomic levels.

OBJECTIVE: To investigate relationships of breastfeeding duration with brain structure and adiposity markers in youth and how these relationships are modified by neighborhood socioeconomic environments (SEEs). METHODS: This was a cross-sectional study of youth enrolled in the Adolescent Brain and Cognitive Development (ABCD) Study® (n = 7511). Mixed effects models examined associations of breastfeeding duration with global brain measures and adiposity markers, adjusting for sociodemographic, pre- and post-natal covariates. Stratified analysis was performed by area deprivation index (ADI) tertiles. RESULTS: Total cortical surface area (SA) (False Discovery Rate - FDR corrected P < 0.001), cortical (FDR corrected P < 0.001) and subcortical gray matter (GM) volume (FDR corrected P < 0.001) increased with increased breastfeeding duration. Body mass index (BMI) z-scores (FDR corrected P = 0.001), waist circumference (FDR corrected P = 0.002) and waist-to-height ratio (WHtR) (FDR corrected P = 0.001) decreased with increased breastfeeding duration. Breastfeeding duration was inversely associated with adiposity in youth from high- and medium- ADI neighborhoods, but positively associated with SA across ADI tertiles. CONCLUSIONS: In this cross-sectional study, longer breastfeeding duration was associated with lower adiposity indices, particularly in youth from lower SEEs and greater SA across SEE levels. Longer breastfeeding duration showed long-term associations with brain and body development for offspring. IMPACT: Building on previous findings that longer breastfeeding duration is associated with healthier weight gain, lower obesity risk, and brain white matter development in infancy, our results find longer breastfeeding duration to be associated with lower adiposity indices and greater cortical and subcortical gray matter volume, and cortical surface area during peri-adolescence. Children from lower socioeconomic environments (SEEs) demonstrated stronger negative associations of breastfeeding duration and adiposity indices, and children across SEEs showed positive relationships between breastfeeding duration and cortical surface area. Promoting breastfeeding, particularly among women from lower SEEs would confer long-term benefits to offspring.

Associations among prenatal exposure to gestational diabetes mellitus, brain structure, and child adiposity markers.

OBJECTIVE: The aim of this study was to investigate the mediating role of child brain structure in the relationship between prenatal gestational diabetes mellitus (GDM) exposure and child adiposity. METHODS: This was a cross-sectional study of 9- to 10-year-old participants and siblings across the US. Data were obtained from the baseline assessment of the Adolescent Brain Cognitive Development (ABCD) Study®. Brain structure was evaluated by magnetic resonance imaging. GDM exposure was self-reported, and discordance for GDM exposure within biological siblings was identified. Mixed effects and mediation models were used to examine associations among prenatal GDM exposure, brain structure, and adiposity markers with sociodemographic covariates. RESULTS: The sample included 8521 children (7% GDM-exposed), among whom there were 28 sibling pairs discordant for GDM exposure. Across the entire study sample, prenatal exposure to GDM was associated with lower global and regional cortical gray matter volume (GMV) in the bilateral rostral middle frontal gyrus and superior temporal gyrus. GDM-exposed siblings also demonstrated lower global cortical GMV than unexposed siblings. Global cortical GMV partially mediated the associations between prenatal GDM exposure and child adiposity markers. CONCLUSIONS: The results identify brain markers of prenatal GDM exposure and suggest that low cortical GMV may explain increased obesity risk for offspring prenatally exposed to GDM.

Long-term benefits of breastfeeding on brain and body development among 9-10-year-olds: modulated by socioeconomic environment.

Importance: It is yet unknown if breastfeeding (bf) benefits, to brain and body development of children, persist into peri-adolescence and vary by socioeconomic environments (SEEs). Objective: We aim to investigate SEE-independent and SEE-modulated relationships between bf duration and child brain structure and adiposity markers during peri-adolescence. Design setting and participants: This was a cross-sectional study of children aged 9-10 enrolled in the multi-center Adolescent Brain and Cognitive Development (ABCD) Study®. Exposures: Bf duration was self-reported. Neighborhood-level SEE was assessed using area deprivation index (ADI). Main Outcomes: T1-weighted magnetic resonance imaging was used to assess global brain measures: volumes of white, cortical, and subcortical gray matter (GM), cortical thickness, and surface area (SA). Adiposity markers included age- and sex-specific body mass index (BMI z- scores), waist circumference, and waist-to-height ratio (WHtR). Mixed effects models examined associations of bf duration with brain structure and adiposity markers controlling for sociodemographic, pre- and post-natal covariates. Stratified analysis was performed by tertiles of ADI. Results: The sample consisted of 7,511 children (51.7% males; 18.8% no bf, 35.3% 1-6 months, 24.9% 7-12 months, 21.0% >12 months). Child's total SA (ß (95% CI) = 0.053 (0.033, 0.074); FDR corrected P <0.001), cortical (ß (95% CI) = 0.021 (0.010, 0.032); FDR corrected P <0.001) and subcortical GM volume (ß (95% CI) = 0.016 (0.003, 0.030); FDR corrected P <0.001) increased monotonically with bf duration, after controlling for covariates. Child's BMI z -scores (ß (95% CI) = -0.040 (-0.063, -0.016); FDR corrected P =0.001), waist circumference (ß (95% CI) = -0.037 (-0.060, -0.014), FDR corrected P =0.002) and WHtR (ß (95% CI) = -0.040 (-0.064, -0.018), FDR corrected P =0.001) decreased monotonically with increased bf duration, after controlling for covariates. Bf duration was inversely associated with adiposity in children from high- and medium-ADI neighborhoods. Bf duration was positively associated with SA across ADI tertiles. Conclusions and Relevance: Our results imply that long-term benefits of bf on body and brain development in offspring increase as bf duration increases, particularly in children from low SEEs. Policies and social support aimed to incremental increases in bf duration among women from low SEEs would confer long-term benefits for offspring. Key Points: Question: Do benefits of breastfeeding(bf), on children's brain and body development, persist long-term and are these benefits uniform across socioeconomic environments (SEEs)?Findings: Longer bf duration is associated with lower adiposity, greater cortical and subcortical gray matter volume, and cortical surface area in 9-10-year-old children. Children from lower SEEs showed stronger negative relationships between bf duration and adiposity. Children across all SEEs demonstrated positive relationships between bf duration and surface area.Meaning: Our results imply that long-term benefits to child brain and body development increase with bf duration; and children from lower SEEs benefited more from longer bf duration.

Fixed Attributes and Discounting Behavior.

Delay discounting tasks present alternatives that differ in two attributes: amount and delay. Typically, choice is modeled by application of a discount function to each option, allowing alternative-wise comparison. However, if participants make decisions by comparing attributes, manipulations that affect the salience of either attribute may affect patience. In Experiment 1, participants completed one block of trials in which amount was a fixed attribute (constant across trials), and another in which delay was fixed. Consistent with the hypothesis that the varying attribute would be more salient, participants exhibited less patience in the amount-fixed condition. Moreover, this effect was larger for participants who responded more quickly when making choices that favored the varying attribute. In Experiment 2, these findings were extended by adding trial blocks with a working memory dual task. We replicated the fixed-attribute effect, along with the aforementioned association with reaction time. Contrary to expectation, the fixed-attribute effect was not larger when participants were under working memory load. Instead, working memory load was associated with more patient responses, which may be related to idiosyncrasies of the task including the absence of immediate rewards. Overall, results suggest a fixed-attribute effect on patience, which is consistent with a multi-attribute decision framework.

Impacts of Acute Sucralose and Glucose on Brain Activity during Food Decisions in Humans.

It is not known how acute sucralose and glucose alter signaling within the brain when individuals make decisions about available food. Here we examine this using Food Bid Task in which participants bid on visually depicted food items, while simultaneously undergoing functional Magnetic Resonance Imaging. Twenty-eight participants completed three sessions after overnight fast, distinguished only by the consumption at the start of the session of 300 mL cherry flavored water with either 75 g glucose, 0.24 g sucralose, or no other ingredient. There was a marginally significant (p = 0.05) effect of condition on bids, with 13.0% lower bids after glucose and 16.6% lower bids after sucralose (both relative to water). Across conditions, greater activity within regions a priori linked to food cue reactivity predicted higher bids, as did greater activity within the medial orbitofrontal cortex and bilateral frontal pole. There was a significant attenuation within the a priori region of interest (ROI) after sucralose compared to water (p < 0.05). Activity after glucose did not differ significantly from either of the other conditions in the ROI, but an attenuation in signal was observed in the parietal cortex, relative to the water condition. Taken together, these data suggest attenuation of central nervous system (CNS) signaling associated with food valuation after glucose and sucralose.

Fasting may increase incentive signaling for nonfood rewards.

During acute energy deprivation, hunger signaling mechanisms support homeostasis by enhancing incentive for food. There is some evidence (primarily based on nonhuman experiments) that fasting heightens incentive signaling for nonfood reward as well. We hypothesized that, consistent with results from research in rodent and nonhuman primates, human participants would evidence increased incentive-related brain activity for nonfood rewards during fast (relative to satiety) and that this increase would be heightened when available rewards were immediate. To assess these possibilities, healthy participants with body mass index between 18 and 29 kg/m2 completed a task which engaged participants in opportunities to win immediate and delayed money (Monetary Incentive Delay Task) during 2 neuroimaging sessions (1 postprandial, 1 fasted). Analyses of participants (N = 18 included, body mass index 22.12±â€¯2.72, age 21.39±â€¯3.52) focused on brain activity during the incentive window of the task. Region of interest, as well as whole-brain analyses, supported the hypothesized increase in incentive signaling during fasting in regions that included caudate and putamen. No evidence of interaction was observed between fasting and the effect of reward immediacy or reward magnitude. Although provisional given the modest sample size, these results suggest that acute fasting can heighten incentive signaling for nonfood rewards.

Low Dopamine D2/D3 Receptor Availability is Associated with Steep Discounting of Delayed Rewards in Methamphetamine Dependence.

BACKGROUND: Individuals with substance use disorders typically exhibit a predilection toward instant gratification with apparent disregard for the future consequences of their actions. Indirect evidence suggests that low dopamine D2-type receptor availability in the striatum contributes to the propensity of these individuals to sacrifice long-term goals for short-term gain; however, this possibility has not been tested directly. We investigated whether striatal D2/D3 receptor availability is negatively correlated with the preference for smaller, more immediate rewards over larger, delayed alternatives among research participants who met DSM-IV criteria for methamphetamine (MA) dependence. METHODS: Fifty-four adults (n = 27 each: MA-dependent, non-user controls) completed the Kirby Monetary Choice Questionnaire, and underwent positron emission tomography scanning with [(18)F]fallypride. RESULTS: MA users displayed steeper temporal discounting (p = 0.030) and lower striatal D2/D3 receptor availability (p < 0.0005) than controls. Discount rate was negatively correlated with striatal D2/D3 receptor availability, with the relationship reaching statistical significance in the combined sample (r = -0.291, p = 0.016) and among MA users alone (r = -0.342, p = 0.041), but not among controls alone (r = -0.179, p = 0.185); the slopes did not differ significantly between MA users and controls (p = 0.5). CONCLUSIONS: These results provide the first direct evidence of a link between deficient D2/D3 receptor availability and steep temporal discounting. This finding fits with reports that low striatal D2/D3 receptor availability is associated with a higher risk of relapse among stimulant users, and may help to explain why some individuals choose to continue using drugs despite knowledge of their eventual negative consequences. Future research directions and therapeutic implications are discussed.

Increased functional coupling between the left fronto-parietal network and anterior insula predicts steeper delay discounting in smokers.

In previous work, smokers showed steeper devaluation of delayed rewards than non-smokers. While the neural correlates of this link between nicotine dependence and delay of discounting are not established, altered activity in executive networks may relate to impaired delayed gratification. The goal of this study was to examine neural correlates of discounting and their relation to nicotine dependence. Thirty-nine smokers and 33 non-smokers completed a functional magnetic resonance imaging (fMRI) intertemporal choice task in which they made individualized Hard (similarly valued), easy (dissimilarly valued), and control monetary choices. FMRI data were analyzed using a group independent component analysis and dual regression. Smokers discounted more steeply than non-smokers, although this difference was only significant among severely dependent smokers. Intertemporal choices recruited distinct left- and right-lateralized fronto-parietal networks. A group-by-difficulty interaction indicated that smokers, relative to non-smokers, exhibited less difficulty-sensitivity in the right fronto-parietal network. In contrast, smokers showed greater functional connectivity between the left fronto-parietal network and the left fronto-insular cortex. Moreover, the degree of functional connectivity between the left fronto-parietal network and left fronto-insular cortex was significantly correlated with individual differences in discounting. Thus, greater functional coupling between the anterior insula and left fronto-parietal network is a candidate neural substrate linking smoking and impulsivity. Given the anterior insula's role in interfacing cognitive and interoceptive processing, this altered functional connectivity may relate to an addiction-related bias towards immediate rewards.

Risk factors associated with recurrent homelessness after a first homeless episode.

Alcohol and drug use are commonly associated with the experience of homelessness. In order to better understand this, we explored the prevalence of drug and alcohol use as it related to successful re-housing within a sample of first-time single homeless adults at municipal shelters. From within this sample, we compared the features of recurrent homelessness with those of chronic homelessness and of being stably housed. We interviewed 344 subjects upon shelter entry and followed each one every six months for 18 months using standardized social and mental health measures. We analyzed baseline assessments relative to housing experiences during follow-up using Chi square and multinomial logistic regression. Eighty-one percent (N = 278) obtained housing over 18 months, of which 23.7 % (N = 66) experienced homelessness again. Recurrent homelessness was more common among those with a high school education and if initially re-housed with family. Bivariate analysis resulted in the observation of the highest rate of alcohol and other drug use among this recurrent group and multinomial logistic regression supported this only with the coupling of arrest history and diagnosed antisocial personality disorder. With relatively high rates of recurrent homelessness, there were differences between subjects who experienced recurrent homelessness compared to those who were stably housed and with chronic homelessness. That alcohol and other substance use disorders were associated with recurrent homelessness only if they were linked to other risk factors highlights the complexity of causes for homelessness and a resultant need to organize them into constellations of causal risk factors. Consistent with this, there should be initiatives that span bureaucratic boundaries so as to flexibly meet multiple complex service needs, thus improving outcomes concerning episodes of recurrent homelessness.

Rates and correlates of HIV and STI infection among homeless women.

We studied the prevalence of biologically confirmed HIV, Chlamydia, and gonorrhea in a randomly selected sample of sheltered homeless women in New York City, and explored their association with demographic, homeless history, and clinical risk factors. 329 women were randomly selected from 28 family and single adult shelters. The estimated prevalence of HIV in the study sample is 0.6 % (±0.3 %); for Chlamydia it is 6.7 % (±2.2 %); for gonorrhea it is 0.9 % (±0.04 %). A history of childhood sexual abuse, arrest history, current psychotic symptoms, and substance use disorder placed women at greater risk of infection. We consider contextual factors that may yield underestimates of HIV prevalence in our sample and discuss how a more comprehensive prevalence estimate might be constructed. Findings underscore the importance of offering HIV/STI testing, counseling, and HIV risk prevention interventions to homeless women and suggest that interventions should be tailored to the needs of specific subgroups of homeless women.

Health, access to health care, and health care use among homeless women with a history of intimate partner violence.

Among a sample of sheltered homeless women, we examined health, access to health care, and health care use overall and among the subgroup of participants with and without intimate partner violence (IPV). We recruited homeless women from a random sampling of shelters in New York City, and queried them on health, access to health care and health care use. Using multivariable logistic regression, we determined whether IPV was associated with past-year use of emergency, primary care and outpatient mental health services. Of the 329 participants, 31.6% reported one or more cardiovascular risk factors, 32.2% one or more sexually transmitted infections, and 32.2% any psychiatric condition. Three-fourths (73.5%) had health insurance. Health care use varied: 55.4% used emergency, 48.9% primary care, and 75.9% outpatient mental health services in the past year. Across all participants, 44.7% reported IPV. Participants with IPV compared to those without were more likely to report medical and psychiatric conditions, and be insured. Participants with IPV reported using emergency (64.4%) more than primary care (55.5%) services. History of IPV was independently associated with use of emergency (Adjusted odds ratio (AOR) 1.7, 95% CI 1.0-2.7), but not primary care (AOR 1.5, 95% CI 0.9-2.6) or outpatient mental health services (AOR 1.9, 95% CI 0.9-4.1). Across the whole sample and among the subgroup with IPV, participants used emergency more than primary care services despite being relatively highly insured. Identifying and eliminating non-financial barriers to primary care may increase reliance on primary care among this high-risk group.

A prospective 2-year study of emergency department patients with early-phase primary psychosis or substance-induced psychosis.

OBJECTIVE: The authors examined treatment utilization and outcomes over 2 years among patients admitted to emergency departments with early-phase primary or substance-induced psychosis. The main hypothesis was that patients with substance-induced psychosis would have a more benign course of illness than those with primary psychosis METHOD: Using a prospective naturalistic cohort study design, the authors compared 217 patients with early-phase primary psychosis plus substance use and 134 patients with early-phase substance-induced psychosis who presented to psychiatric emergency departments at hospitals in Upper Manhattan. Assessments at baseline and at 6, 12, 18, and 24 months included psychiatric diagnoses, service use, and institutional outcomes using the Psychiatric Research Interview for Substance and Mental Disorders; psychiatric symptoms using the Positive and Negative Syndrome Scale; social, vocational, and family functioning using the World Health Organization Psychiatric Disability Assessment Schedule; and life satisfaction using the Quality of Life Interview. Longitudinal analyses were conducted using generalized estimating equations. RESULTS: Participants with primary psychosis were more likely to receive antipsychotic and mood-stabilizing medications, undergo hospitalizations, and have outpatient psychiatric visits; those with substance-induced psychosis were more likely to receive addiction treatments. Only a minority of each group received minimally adequate treatments. Both groups improved significantly over time on substance dependence, psychotic symptoms, homelessness, and psychosocial outcomes, and few group-by-time interactions emerged. CONCLUSIONS: Patients presenting to Upper Manhattan emergency departments with either early-phase primary psychosis or substance-induced psychosis improved steadily over 2 years despite minimal use of mental health and substance abuse services.

Risk factors for long-term homelessness: findings from a longitudinal study of first-time homeless single adults.

OBJECTIVES: We examined risk factors for long-term homelessness among newly homeless men and women who were admitted to New York City shelters in 2001 and 2002. METHODS: Interviews were conducted with 377 study participants upon entry into the shelter and at 6-month intervals for 18 months. Standardized assessments of psychiatric diagnosis, symptoms, and coping skills; social and family history; and service use were analyzed. Kaplan-Meier survival analysis and Cox regression were used to examine the association between baseline assessments and duration of homelessness. RESULTS: Eighty-one percent of participants returned to community housing during the follow-up period; the median duration of homelessness was 190 days. Kaplan-Meier survival analysis showed that a shorter duration of homelessness was associated with younger age, current or recent employment, earned income, good coping skills, adequate family support, absence of a substance abuse treatment history, and absence of an arrest history. Cox regression showed that older age group P<.05) and arrest history (P<.01) were the strongest predictors of a longer duration of homelessness. CONCLUSIONS: Identification of risk factors for long-term homelessness can guide efforts to reduce lengths of stay in homeless shelters and to develop new preventive interventions.