Salience of loss of control for pediatric binge episodes: does size really matter?

OBJECTIVE: The subjective experience of loss of control (LOC) during eating, independent of overeating, may be a salient marker of disordered eating and risk for overweight in youth. However, few studies have directly tested this notion in an adequately powered sample. METHOD: Three-hundred-sixty-seven youth (M ± SD age = 12.7 ± 2.8 y) were categorized as reporting objective binge eating (OBE; 12.5%), subjective binge eating (SBE; 11.4%), objective overeating without LOC (OO; 18.5%), or no episodes (NE; 57.5%). Disordered eating attitudes, general psychopathology, and adiposity were assessed. RESULTS: Children with OBE and SBE generally did not differ in their disordered eating attitudes, emotional eating, eating in the absence of hunger, depressive and anxiety symptoms, or adiposity. However, both OBE and SBE youth had significantly greater disordered eating attitudes, emotional eating, eating in the absence of hunger, depressive and anxiety symptoms, and adiposity compared to those with OO or NE (ps < .05). DISCUSSION: For non-treatment-seeking youth, LOC during eating episodes, rather than episode size, appears to be the most salient marker of eating and weight problems.

O uso de drogas e seus efeitos na cavidade oral

Objetivos: Descrever as principais manifestações bucais associadas ao uso das drogas lícitas e ilícitas mais utilizadas atualmente, bem como os cuidados que devem ser tomados durante o atendimento odontológico desses pacientes. Revisão de literatura: Na revisão foi abordada a classificação das substâncias químicas, as principais manifestações orais e os cuidados que o cirurgião-dentista deve ter durante o atendimento odontológico. As substâncias descritas foram álcool, tabaco, benzodiazepínicos, maconha, anfetaminas e cocaína/crack. As complicações de saúde bucal associadas ao abuso de drogas podem resultar da exposição direta dos tecidos orais às drogas durante o fumo ou ingestão, da interação biológica das drogas com a fisiologia normal da cavidade oral e dos efeitos das drogas na função cerebral que resultam em um espectro de comportamentos de dependência, como comportamento de risco, falta de higiene e descuido. Considerações finais: O consumo de substâncias psicoativas, seja a curto ou longo prazo, pode desencadear consequências, tanto na saúde geral como na saúde bucal do usuário. Sob essa perspectiva, o cirurgião-dentista deve estar ciente das manifestações orais e sistêmicas causadas pelas substâncias psicoativas e estar capacitado para diagnosticar, tratar ou também encaminhar o usuário, se necessário, visando um cuidado integral e multiprofissional.

Objective: to describe the main oral manifestations associated with the use of the most commonly used licit and illicit drugs today, as well as the care that should be taken during the dental care of these patients. Literature review: The review covered the classification of chemical substances, the main oral manifestations and the care that dentist should take during dental care. The substances described were alcohol, tobacco, benzodiazepines, marijuana, amphetamines and cocaine/crack. Oral health complications associated with drug abuse can result from direct exposure of oral tissues to drugs during smoking or ingestion, from the biological interaction of drugs with the normal physiology of the oral cavity, and from the effects of drugs on brain function that result in a spectrum of addictive behaviors, such as risk behavior, poor hygiene and carelessness. Final considerations: The consumption of psychoactive substances, whether in the short or long term, can have consequences for both the general health and the oral health of the user. From this perspective, the dentist must be aware of the oral and systemic manifestations caused by psychoactive substances and be able to diagnose, treat or also refer the user, if necessary, aiming for comprehensive, multi-professional care.

A prospective study of pediatric loss of control eating and psychological outcomes.

Loss of control (LOC) eating in youth is associated cross-sectionally with eating-related and psychosocial distress and is predictive of excessive weight gain. However, few longitudinal studies have examined the psychological impact and persistence of pediatric LOC eating. We administered the Eating Disorder Examination and self-reported measures of depressive and anxiety symptoms to 195 boys and girls (mean age = 10.4 years, SD = 1.5) at baseline and again 4.7 years (SD = 1.2) later to 118 of these youth. Missing data were imputed. Baseline report of LOC was associated with the development of partial- or full-syndrome binge eating disorder (p = .03), even after accounting for the contribution of sex, race, baseline characteristics (age, disordered eating attitudes, and mood symptoms), body mass index growth between baseline and follow-up, and years in study. Half (52.2%; 95% CI [1.15, 6.22]) of children who endorsed experiencing LOC at baseline reported persistence of LOC at follow-up (p = .02). Compared with children who never reported LOC eating or reported LOC only at baseline, those with persistent LOC experienced significantly greater increases in disordered eating attitudes (ps < .001) and depressive symptoms (p = .027) over time. These data suggest that LOC eating in children is a problematic behavior that frequently persists into adolescence and that persistent LOC eating is associated with worsening of emotional distress.

The FTO gene rs9939609 obesity-risk allele and loss of control over eating.

BACKGROUND: Children with rs9939609 FTO variant alleles (homozygous = AA and heterozygous = AT) are predisposed to greater adiposity than are those with 2 wild-type alleles (TT). OBJECTIVE: Because FTO is highly expressed in hypothalamic regions that are important for appetite, FTO genotype may affect energy balance by influencing eating behavior. Loss of control (LOC) eating, a behavior commonly reported by overweight youth, predicts excessive weight gain in children. However, the relation between FTO genotype and LOC eating has not been previously examined. DESIGN: Two-hundred eighty-nine youth aged 6-19 y were genotyped for rs9939609, underwent body-composition measurements, and were interviewed to determine the presence or absence of LOC eating. A subset (n = 190) participated in a lunch buffet test meal designed to model an LOC eating episode. Subjects with AA and AT genotypes were grouped together for comparison with wild-type TT subjects. RESULTS: Subjects with at least one A allele (67.7%) had significantly greater body mass indexes, body mass index z scores (P < 0.01), and fat mass (P < 0.05). Of the AA/AT subjects, 34.7% reported LOC compared with 18.2% of the TT subjects (P = 0.002). Although total energy intake at the test meal did not differ significantly by genotype (P = 0.61), AA/AT subjects consumed a greater percentage of energy from fat than did the TT subjects (P < 0.01). CONCLUSIONS: Children and adolescents with 1 or 2 FTO rs9939609 obesity-risk alleles report more frequent LOC eating episodes and select foods higher in fat at a buffet meal. Both LOC eating and more frequent selection of energy-dense, palatable foods may be mechanisms through which variant FTO alleles lead to excess body weight.

Energy intake and energy expenditure among children with polymorphisms of the melanocortin-3 receptor.

BACKGROUND: Homozygosity for 2 protein-altering polymorphisms in the melanocortin-3 receptor gene (MC3R) coding sequence, C17A and G241A, has been reported to be associated with an obesity phenotype in children, yet how these polymorphisms affect energy homeostasis is unknown. Association between adult body weight and +2138InsCAGACC, another variant in the 3' untranslated region of MC3R, has also been described. OBJECTIVE: The objective of this study was to examine associations of C17A + G241A and +2138InsCAGACC MC3R variants with children's energy balance. DESIGN: Children aged 6-19 y were genotyped for MC3R C17A, G241A, and +2138InsCAGACC. Subjects underwent studies of energy intake from a 9835-kcal food array (n = 185), resting energy expenditure (REE) by using indirect calorimetry (n = 302), or total daily energy expenditure (TEE) by using doubly labeled water (n = 120). Linear regression was used to examine the associations between MC3R polymorphisms and the measures of energy balance. RESULTS: Body mass index and fat mass were greater in those with double homozygosity for C17A + G241A (P = 0.001). After accounting for covariates (including body composition), the number of minor C17A + G241A alleles was associated with significantly greater energy intake (beta = +0.15, P = 0.02) but not altered REE or TEE. No significant associations were observed between +2138InsCAGACC and measures of either fat mass or energy balance. CONCLUSIONS: C17A + G241A polymorphisms may be associated with pediatric obesity because of greater energy intake rather than because of diminished energy expenditure. +2138InsCAGACC does not appear to be associated with obesity or measures of energy balance in children.