Food insecurity, poor diet, and metabolic measures: The roles of stress and cortisol.

Food insecurity is highly prevalent and linked to poorer diet and worse metabolic outcomes. Food insecurity can be stressful, and could elicit chronic psychological and physiological stress. In this study, we tested whether stress could be used to identify those at highest risk for worse diet and metabolic measures from food insecurity. Specifically, we hypothesized that cortisol (a physiological marker of stress) and perceived psychological stress would amplify the link between food insecurity and hyperpalatable food intake as well as metabolic measures. In a sample of 624 Black and White women aged 36-43 who participated in the NHLBI Growth and Health Study's midlife assessment, we assessed associations between food insecurity with hyperpalatable food intake (high fat + high sodium foods; high fat + high sugar foods; and high carbohydrate + high sodium foods), and metabolic measures (fasting glucose, insulin resistance, and waist circumference). We found that food insecurity was associated with higher levels of perceived stress (R2 = 0.09), and greater intake of high fat + high sugar (hyperpalatable) foods (R2 = 0.03). In those with higher cumulative cortisol (as indexed by hair cortisol), food insecurity was associated with higher levels of fasting glucose. Neither cortisol nor perceived stress moderated any other relationships, and neither variable functioned as a mediator in sensitivity analyses. Given these largely null findings, further research is needed to understand the role stress plays in the chronic health burdens of food insecurity.

Adverse Childhood Experiences and BMI: Lifecourse Associations in a Black-White U.S. Women Cohort.

INTRODUCTION: Although adverse childhood experiences (ACEs) have been positively associated with adiposity, few studies have examined long-term race-specific ACE-BMI relationships. METHODS: A Black and White all-women cohort (N=611; 48.6% Black) was followed between 1987 and 1997 from childhood (ages 9-10 years) through adolescence (ages 19-20 years) to midlife (ages 36-43 years, between 2015 and 2019). In these 2020-2022 analyses, the interaction between race and individual ACE exposures (physical abuse, sexual abuse, household substance abuse, multiple ACEs) on continuous BMI at ages 19-20 years and midlife was evaluated individually through multivariable linear regression models. Stratification by race followed as warranted at α=0.15. RESULTS: Race only modified ACE-BMI associations for sexual abuse. Among Black women, sexual abuse was significantly associated with BMI (Badjusted=3.24, 95% CI=0.92, 5.57) at ages 19-20 years and marginally associated at midlife (Badjusted=2.37, 95% CI= -0.62, 5.35); among White women, corresponding associations were null. Overall, having ≥2 ACEs was significantly associated with adolescent BMI (Badjusted=1.47, 95% CI=0.13, 2.80) and was marginally associated at midlife (Badjusted=1.45, 95% CI= -0.31, 3.22). This was similarly observed for physical abuse (adolescent BMI: Badjusted=1.23, 95% CI= -0.08, 2.54; midlife BMI: Badjusted=1.03, 95% CI= -0.71, 2.78), but not for substance abuse. CONCLUSIONS: Direct exposure to certain severe ACEs is associated with increased BMI among Black and White women. It is important to consider race, ACE type, and life stage to gain a more sophisticated understanding of ACE-BMI relationships. This knowledge can help strengthen intervention, prevention, and policy efforts aiming to mitigate the impacts of social adversities and trauma on persistent cardiometabolic health disparities over the lifecourse.

Associations Between Different Cortisol Measures and Adiposity in Children: A Systematic Review and Meta-Analysis.

This study examined associations between hair, salivary, serum, and urinary cortisol concentration with adiposity-related indicators in children, and explored their potential effects modification by age, sex, cortisol measurement method, and country developmental context. We systematically searched PubMed, Web of Science, and Embase for studies examining at least one of the four aforementioned cortisol with objectively measured adiposity-related outcomes in children. Meta-analyses of cross-sectional studies revealed that hair cortisol concentration was associated with fat mass index (FMI)-standard deviation score (SDS)/FMI z-score (pooled-ß = 0.04, 95% CI: 0.01, 0.08) and BMI/BMI z-score (pooled-ß = 0.15, 95% CI: 0.06, 0.25), and these associations were significant among children aged ≤ 12 years (pooled-ß = 0.15, 95% CI: 0.05, 0.26) and >12 years (pooled-ß = 0.13, 95% CI: 0.04, 0.22), children from developed countries (pooled ß = 0.12, 95% CI: 0.03, 0.21) and developing countries (pooled-ß = 0.193, 95% CI: 0.188, 0.198), and in studies extracting cortisol via LC-MS/MS (pooled-ß = 0.18, 95% CI: 0.06, 0.29) but not ELISA (pooled-ß = 0.08, 95% CI: -0.06, 0.22). Meta-analyses of both cohort and cross-sectional studies revealed non-significant associations of morning salivary cortisol concentration and total daily cortisol output with BMI/BMI z-score. Serum cortisol concentration was not associated with BMI or waist circumference. Meta-analysis of urinary cortisol concentration and adiposity was hindered by insufficient data. These findings further corroborate understanding of chronic stress' physiological contribution to increased pediatric obesity risk. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020215111].

Problematic Social Media Use and Depressive Outcomes among College Students in China: Observational and Experimental Findings.

Aims: Problematic social media use is increasing in China and could be a risk factor for depression. We investigated cross-sectional associations between problematic social media use and depressive outcomes among Chinese college students with potential mediation by perceived social support, social media violence, and loneliness. Thereafter, we evaluated the effectiveness of a one-month group counseling intervention in reducing depressive symptoms related to social media addiction. Methods: Depressive symptoms, social media addiction, perceived social support, social media violence, and loneliness were self-reported among 21,000 college students in Shaanxi province, China. A randomized controlled trial was designed based on the results of the observational study and Satir Transformational Systemic Therapy (STST) among 60 college students assigned to intervention (N = 30) or control/no treatment (N = 30). Self-administered surveys were completed at baseline (T1), at the end of the 1-month intervention (T2), and at 2-month follow-up post-intervention (T3). Results: After controlling for relevant covariates, more problematic social media use was associated with more depressive symptoms (ß = 0.18, p < 0.001) and depression (OR = 1.08, 95% CI: 1.075, 1.092). Multiple mediation analyses found that perceived social support, social media violence, and loneliness significantly mediated associations between problematic social media use and depressive symptoms (model fit: RMSEA = 0.065, GFI = 0.984, CFI = 0.982). Bootstrapping revealed significant indirect effects of problematic social media use on depressive symptoms through the mediators named above (0.143, 95% CI: 0.133, 0.156). The subsequently informed intervention significantly reduced depressive symptoms at T2 (mean difference: −12.70, 95% CI: −16.64, −8.76, p < 0.001) and at T3 (mean difference: −8.70, 95% CI: −12.60, −4.80, p < 0.001), as well as levels of social media addiction, perceived social support, social media violence, and loneliness. Conclusions: Problematic social media use is a risk factor for depressive outcomes among Chinese college students, and perceived social support, social media violence, and loneliness mediate this association. STST-based group counseling may reduce depressive symptoms related to high social media usage in this population.

Childhood stress and midlife depression in women: the influence of diet quality.

OBJECTIVE: How does diet quality (DQ) moderate associations between serious childhood stress exposures and adult depression? METHODS: We analyzed a cohort of Californian women at midlife (N=382; age 36-42). Serious childhood stress was defined as high perceived stress during childhood or adverse childhood experiences (ACEs) of physical abuse, sexual abuse, and/or household substance abuse. Women were dichotomized by current depression risk (high/low). The Healthy Eating Index (HEI)-2015 and Alternate Healthy Eating Index (AHEI)-2010 measured current DQ from 3-day food records. Interactions between childhood stress exposures and DQ indices were tested one-by-one in multivariable Poisson regression models. RESULTS: Depression risks associated with endorsing all 3 ACEs differed by HEI and AHEI scores, as did risks associated with endorsing high perceived stress, physical abuse, and sexual abuse by AHEI. Where DQ moderated stress-depression associations, predicted prevalences of high depression risk did not vary with DQ among women endorsing the particular childhood stressors. However, among non-endorsing women, predicted high depression risk prevalences were significantly lower with higher DQ compared to in their stress-exposed counterparts - e.g. at the 90th AHEI percentile, depression prevalences were ∼20% among 'non-childhood-stressed' women versus 48.8% (high perceived stress, sexual abuse), 52.0% (physical abuse), and 73.0% (3 ACEs) in 'childhood-stressed' women. CONCLUSIONS: Higher current DQ, particularly as aligned with chronic disease prevention guidelines, predicts lower depression risk in women with low childhood adversity. DQ did not buffer depression risk in women with high childhood stress. Further research is warranted to examine persistent pathways of depression risk and diet's role within.

A longitudinal study of sleep, weight status, and weight-related behaviors: Childhood Obesity Study in China Mega-cities.

BACKGROUND: The aim of the study was to examine correlates of sleep and assess its associations with weight status and related behaviors. METHODS: Data were collected in 2015-2017 for 3298 children aged 6-17 years and their parents in 5 Chinese mega-cities. One thousand six hundred and ninety-one children with measured weight, height, and waist circumference in ≥2 surveys were included for longitudinal data analyses. Sleep and behaviors were self-reported. RESULTS: Cross-sectional data analyses found that older (ß = -0.29, 95% CI: -0.32, -0.27) and secondary school children (ß = -1.22, 95% CI: -1.31, -1.13) reported shorter sleep than their counterparts. Children with ≥college-educated (vs

Depressive symptoms prevalence, associated family factors, and gender differences: A national cohort study of middle school students in China.

BACKGROUND: This study examined prevalence and change in depressive symptoms in Chinese adolescents, and roles of inter-parental (I-P) relationship and parent-child (P-C) relationships in its etiology and gender differences. METHODS: Survey data on depressive symptoms, I-P relationship, and indicators of P-C relationships were collected in China Education Panel Survey (2013-2015) from a nationally representative sample of adolescents (n=9,869) at 7th (at baseline), 8th and 9th (follow-up) grades. RESULTS: Prevalence of depressive symptoms was 17.9% in 7th graders and higher at 25.7% for 9th graders, more remarkably in girls. Better I-P relationship could reduce the risk of depressive symptoms among all (OR=0.53, 95%CI: 0.48, 0.58), girls (OR=0.61, 95%CI: 0.54, 0.69), and boys (OR=0.54, 95%CI: 0.49, 0.61). Greater mother-child (M-C) and father-child (F-C) closeness were protective of depressive symptoms in all and girls (ORs=0.94 to 0.96, p<0.01). More P-C interactions was associated with reduced risk of depressive symptoms among all (OR=0.91, 95%CI: 0.89, 0.93), boys (OR=0.91, 95%CI: 0.89, 0.94), and girls (OR=0.93, 95%CI: 0.91, 0.96). Better I-P relationship increased M-C closeness, F-C closeness, and P-C interactions, which in turn reduced depressive symptoms risk (indirect effects: ß=-0.03, 95% CI: -0.04, -0.03). LIMITATIONS: The brief depressive inventory was only able to capture higher depressive symptoms, not clinical depression. CONCLUSIONS: Depressive symptoms are prevalent in Chinese adolescents with increases from early to middle adolescence. I-P and P-C relationships reduce depressive symptoms risk. P-C relationships mediated associations between I-P relationship and depressive symptoms. Future interventions may target these family factors to reduce depression among Chinese adolescents.

Overweight and Obesity Impair Academic Performance in Adolescence: A National Cohort Study of 10,279 Adolescents in China.

OBJECTIVE: This study aimed to examine the associations of overweight and obesity (ov/ob) and changes in weight status with academic performance among Chinese adolescents. METHODS: Self-reported weight and height were collected from adolescents (n = 10,279) each year from seventh grade (baseline, 2013-2014) to ninth grade (2015-2016). Academic performance included standardized scores on math, Chinese, and English examinations and responses to a school-life experience scale. RESULTS: All adolescents with ov/ob had lower academic performance than their counterparts without overweight (ß = -0.46 to -0.08; P < 0.05), except for school-life experience for boys. All adolescents with obesity had lower academic performance than their counterparts without obesity (ß = -0.46 to -0.17; P < 0.01), except for English test scores for boys. Changes in weight status between grades 7 and 9 impacted academic performance at grade 9. Adolescents with ov/ob throughout grades 7 to 9 and those who developed ov/ob from normal weight had lower test scores (ß = -0.80 to -0.25; P < 0.05) than those who maintained normal weight. Those who developed ov/ob after having normal weight had poorer school-life experiences (ß = -0.55 to -0.25; P < 0.05). CONCLUSIONS: Ov/ob and maintaining and developing ov/ob had adverse academic impacts on adolescents. Relevant stakeholders should consider detrimental impacts of obesity on academic outcomes.

OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans): Design of a Multilevel, Multicomponent Obesity Intervention for Native American Adults and Households.

Obesity prevalence is high in Native American (NA) adults, and there is a critical need to establish and implement evidence-based social, behavioral, and policy interventions that are theoretically informed. The use of multilevel, multicomponent (MLMC) interventions has been shown to be an effective strategy for comprehensive health behavior change; however, there is little guidance available in the literature to facilitate implementation in this underserved and understudied population. To decrease obesity and related comorbidities in NA adults, an MLMC intervention called OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans) was implemented in 5 rural NA communities to modify the food-purchasing environment, improve diet, and increase physical activity (PA). Five NA communities across the Upper Midwest and Southwest United States were randomly assigned to Immediate (n = 3) or Delayed (n = 2) Intervention. OPREVENT was implemented in Immediate Intervention community food stores, worksites, schools, and media over 1 y. A community-randomized controlled trial was used to evaluate intervention impact in adults at the individual and institutional levels, with individual-level data being collected on diet, PA, and psychosocial variables at baseline and follow-up; and institutional-level data being collected on food stores, worksites, and schools, media, and process measures. The OPREVENT intervention was one of the first MLMC obesity interventions in this population and provides evidence-based practices for future program development. The purpose of this article is to describe the design, implementation, and evaluation of OPREVENT. This trial was registered at isrctn.com as ISRCTN76144389.