Parental perceptions of body weight and appetite in infants and toddlers with cystic fibrosis.

Nutritional status has clinical relevance and is a target of guidance to parents of children with cystic fibrosis (CF). Growth is routinely monitored in CF clinics but there is no standardized way of assessing appetitive behaviors or parents' perceptions of their children's appetite. Greater understanding of these factors could improve clinical guidance regarding parent feeding behaviors. We therefore aimed to assess parent perceptions of child weight, and parent reports of child appetite using the Baby Eating Behavior Questionnaire (BEBQ), in a sample of infants and toddlers with CF, compared with a community sample. We additionally assessed relationships of parent perceptions of child weight with parent feeding behaviors in the sample with CF. Anthropometric and questionnaire data were collected for 32 infants and toddlers with CF, as well as 193 infants and toddlers drawn from RESONANCE, a community cohort study. Parents perceived children with CF to be lower in weight than their actual weight, to a greater extent than was evident in the community sample. Parents who perceived their children with CF to be underweight vs. right weight reported greater slowness in eating on the BEBQ. Parents perceived children with CF to have greater slowness in eating and lower enjoyment of food, compared to parents of children in the community sample, independent of sample differences in child weight, age, and sex. Our results demonstrate the potential utility of the BEBQ in a clinical sample and suggest it may be helpful for clinicians to assess parents' perceptions of their child's weight and appetite to promote a fuller understanding of the child's nutritional status, facilitate appropriate feeding behaviors and alleviate unnecessary concerns.

Milkshake Acutely Stimulates Dopamine Release in Ventral and Dorsal Striatum in Healthy-Weight Individuals and Patients with Severe Obesity Undergoing Bariatric Surgery: A Pilot Study.

The overconsumption of palatable energy-dense foods drives obesity, but few human studies have investigated dopamine (DA) release in response to the consumption of a palatable meal, a putative mediator of excess intake in obesity. We imaged [11C]raclopride in the brain with positron emission tomography (PET) to assess striatal dopamine (DA) receptor binding pre- and post-consumption of a highly palatable milkshake (250 mL, 420 kcal) in 11 females, 6 of whom had severe obesity, and 5 of whom had healthy-weight. Those with severe obesity underwent assessments pre- and 3 months post-vertical sleeve gastrectomy (VSG). Our results demonstrated decreased post- vs. pre-meal DA receptor binding in the ventral striatum (p = 0.032), posterior putamen (p = 0.012), and anterior caudate (p = 0.018), consistent with meal-stimulated DA release. Analysis of each group separately suggested that results in the caudate and putamen were disproportionately driven by meal-associated changes in the healthy-weight group. Baseline (pre-meal) DA receptor binding was lower in severe obesity than in the healthy-weight group. Baseline DA receptor binding and DA release did not change from pre- to post-surgery. The results of this small pilot study suggest that milkshake acutely stimulates DA release in the ventral and dorsal striatum. This phenomenon likely contributes to the overconsumption of highly palatable foods in the modern environment.

The relationship between weight loss and cognitive function in bariatric surgery.

BACKGROUND: Previously, we reported short-term improvements in auditory attention, oromotor processing speed, and executive function during the active weight loss phase following bariatric surgery that persisted out to 3 months. In this study, our aims were to investigate the relationship between weight loss and cognitive performance in these patients 1 year following vertical sleeve gastrectomy (VSG) and Roux-en Y gastric bypass (RYGB) surgery and to determine whether preoperative cognitive performance predicted weight loss. METHODS: Adult women ages 18-55 approved for bariatric surgery completed a cognitive battery prior to and at 2, 12, 24, and 52 weeks following VSG (N = 17) or RYGB (N = 18). Scores from each task were assigned to one of the following cognitive domains: auditory attention, processing speed, memory, and executive functioning. Weight loss and cognitive scores for each domain were calculated and compared between cohorts. RESULTS: RYGB surgery resulted in greater weight loss at 1-year follow-up relative to VSG. Both VSG and RYGB procedures resulted in improved performance on different measures of auditory attention and both surgery groups improved across all processing speed tasks. Within the executive function domain, both groups showed improvements, but only the RYGB procedure resulted in improved performance in the Trail Making Test. Baseline auditory attention and memory performance predicted weight loss at 1 year following RYGB but not VSG surgery. Controlling for baseline cognitive performance, percent total weight loss predicted auditory attention at 1 year following RYGB but not VSG surgery. CONCLUSIONS: Bariatric surgery type may result in selective improvements in cognition during the first year following surgery. Presurgical cognitive performance as well as surgery type appears to influence weight loss outcomes.

Correlates of neural adaptation to food cues and taste: the role of obesity risk factors.

Identifying correlates of brain response to food cues and taste provides critical information on individual differences that may influence variability in eating behavior. However, a few studies examine how brain response changes over repeated exposures and the individual factors that are associated with these changes. Using functional magnetic resonance imaging, we examined how brain response to a palatable taste and proceeding cues changed over repeated exposures and how individual differences in weight, familial obesity risk, dietary restraint and reward responsiveness correlate with these changes. In healthy-weight adolescents (n = 154), caudate and posterior cingulate cortex (PCC) response increased with repeated cue presentations, and oral somatosensory cortex and insula response increased with repeated milkshake tastes. The magnitude of increase over exposures in the left PCC to cues was positively associated with body mass index percentile (r = 0.18, P = 0.026) and negatively associated with dietary restraint scores (r = -0.24, P = 0.003). Adolescents with familial obesity risk showed higher cue-evoked caudate response across time, compared to the low-risk group (r = 0.12, P = 0.035). Reward responsiveness positively correlated with right oral somatosensory cortex/insula response to milkshake over time (r = 0.19, P = 0.018). The results show that neural responses to food cues and taste change over time and that individual differences related to weight gain are correlated with these changes.

Obesity and acute stress modulate appetite and neural responses in food word reactivity task.

Obesity can result from excess intake in response to environmental food cues, and stress can drive greater intake and body weight. We used a novel fMRI task to explore how obesity and stress influenced appetitive responses to relatively minimal food cues (words representing food items, presented similarly to a chalkboard menu). Twenty-nine adults (16F, 13M), 17 of whom had obesity and 12 of whom were lean, completed two fMRI scans, one following a combined social and physiological stressor and the other following a control task. A food word reactivity task assessed subjective food approach (wanting) as well as food avoidant (restraint) responses, along with neural responses, to words denoting high energy-density (ED) foods, low-ED foods, and non-foods. A multi-item ad-libitum meal followed each scan. The obese and lean groups demonstrated differences as well as similarities in activation of appetitive and attention/self-regulation systems in response to food vs. non-food, and to high-ED vs. low-ED food words. Patterns of activation were largely similar across stress and non-stress conditions, with some evidence for differences between conditions within both obese and lean groups. The obese group ate more than the lean group in both conditions. Our results suggest that neural responses to minimal food cues in stressed and non-stressed states may contribute to excess consumption and adiposity.

Time of day differences in appetite and gut hormone responses to meal and stress challenges in adults with normal-weight and obesity.

BACKGROUND: Lifestyle factors like time of eating and stress exposure may impact physiology to promote excess weight gain. To understand behavioral and physiological mechanisms underlying these potential effects, we compared appetite and gut hormone responses to a series of meal and stress challenges beginning in the morning and the afternoon, in adults with normal-weight and obesity. METHOD: Thirty-two adults (16 with normal-weight, 16 with obesity) underwent the same test protocol on different days, each following an 8 h fast. On one day the protocol began in the morning (AM condition); on the other day it began in the late afternoon (PM condition). On each day they first received a standardized liquid meal (9:00am/4:00pm), then a stress test (Socially-Evaluated Cold Pressor Test, 11:10am/6:10pm), then an ad libitum buffet meal (11:40am/6:40pm). Appetite and stress ratings were obtained, and blood was drawn for measures of ghrelin, PYY, GLP-1, insulin, glucose, cortisol and leptin. Acetaminophen was administered as a tracer to assess gastric emptying of the liquid meal. RESULTS: Across all three challenges, AUC cortisol was lower in the PM vs. AM condition (all p<.001), and AUC insulin and leptin were higher in the obesity vs. normal-weight group (all p<.001). For the standardized liquid meal only, AUC hunger, desire to eat and ghrelin were greater in the PM vs. AM condition (all p<0.05), and AUC ghrelin was lower in the obesity vs. normal-weight group, even when controlling for baseline values (p<0.05). AUC glucose was higher in the evening for the normal-weight group only (condition x group interaction p<0.05). Post-liquid meal gastric emptying as indexed by AUC acetaminophen was slower in the PM vs. AM (p<.01). For the stress test, AUC cortisol was lower in the PM than the AM condition even when controlling for baseline values (p<.05). AUC leptin was lower in the evening in the obesity group only (condition x group interaction p<0.01). PYY showed an acute decrease post-stressor in the normal-weight but not the obesity group (p<.05). Post-stress ad libitum buffet meal intake was similar in the evening and morning conditions, and higher in the obesity group (p<0.05). Only among the obesity group in the evening condition, higher stressor-associated stress and cortisol were associated with greater meal-associated appetite (p<0.05). CONCLUSIONS: Normal-weight individuals and those with obesity may be at risk of evening overeating as a result of differential appetite and gut hormone responses following meal intake and stress exposure.

Genetically-predicted prefrontal DRD4 gene expression modulates differentiated brain responses to food cues in adolescent girls and boys.

The dopamine receptor 4 (DRD4) in the prefrontal cortex (PFC) acts to modulate behaviours including cognitive control and motivation, and has been implicated in behavioral inhibition and responsivity to food cues. Adolescence is a sensitive period for the development of habitual eating behaviors and obesity risk, with potential mediation by development of the PFC. We previously found that genetic variations influencing DRD4 function or expression were associated with measures of laboratory and real-world eating behavior in girls and boys. Here we investigated brain responses to high energy-density (ED) and low-ED food cues using an fMRI task conducted in the satiated state. We used the gene-based association method PrediXcan to estimate tissue-specific DRD4 gene expression in prefrontal brain areas from individual genotypes. Among girls, those with lower vs. higher predicted prefrontal DRD4 expression showed lesser activation to high-ED and low-ED vs. non-food cues in a distributed network of regions implicated in attention and sensorimotor processing including middle frontal gyrus, and lesser activation to low-ED vs non-food cues in key regions implicated in valuation including orbitofrontal cortex and ventromedial PFC. In contrast, males with lower vs. higher predicted prefrontal DRD4 expression showed minimal differences in food cue response, namely relatively greater activation to high-ED and low-ED vs. non-food cues in the inferior parietal lobule. Our data suggest sex-specific effects of prefrontal DRD4 on brain food responsiveness in adolescence, with modulation of distributed regions relevant to cognitive control and motivation observable in female adolescents.

One Year Follow-Up of Taste-Related Reward Associations with Weight Loss Suggests a Critical Time to Mitigate Weight Regain Following Bariatric Surgery.

BACKGROUND: Weight regain is a concerning issue in bariatric patients. We previously demonstrated that taste-related reward processing was associated with six-month weight loss outcomes following Roux-en-Y gastric bypass (RYGB) but not vertical sleeve gastrectomy (VSG). Here, we assessed whether these taste factors persisted in predicting weight loss, and weight regain, at one year post-surgery. METHODS: Adult women enrolled in a longitudinal study of taste preferences following bariatric surgery completed behavioral and neuroimaging assessments at one year post-surgery. RESULTS: RYGB produced better weight loss relative to VSG, with weight regain and greater weight loss variability observed from six months to one year post-VSG. Changes in liking for high fat at 2 weeks post-surgery from baseline remained a predictor of weight loss in RYGB, but other predictors did not persist. Average liking ratings rebounded to baseline and higher self-reported food cravings and dietary disinhibition correlated with poorer weight loss at one year post-surgery. CONCLUSION: Initial anatomical and metabolic changes resulting from RYGB that reset neural processing of reward stimuli in the mesolimbic pathway appear to be temporary and may be contingent upon post-operative eating behaviors returning to preoperative obesogenic tendencies. Six months post-surgery may be a critical window for implementing interventions to mitigate weight gain.

Longitudinal Associations Between Taste Sensitivity, Taste Liking, Dietary Intake and BMI in Adolescents.

Taste sensitivity and liking drive food choices and ingestive behaviors from childhood to adulthood, yet their longitudinal association with dietary intake and BMI is largely understudied. Here, we examined the longitudinal relationship between sugar and fat sensitivity, sugar and fat liking, habitual dietary intake, and BMI percentiles in a sample of 105 healthy-weight adolescents (baseline: BMI %tile 57.0 ± 24.3; age 14-16 years) over a 4-year period. Taste sensitivity was assessed via a triangle fat and sweet taste discrimination test. Taste liking were rated on a visual analog scale for four milkshakes that varied in sugar and fat contents (high-fat/high-sugar (HF/HS), low-fat/high-sugar (LF/HS), high-fat/low-sugar (HF/LS), low-fat/low-sugar (LF/LS) milkshakes). A modified version of the reduced Block Food Frequency Questionnaire (BFFQ) was used to assess dietary intake. All measurements were repeated annually. Repeated measures correlations and linear mixed effects models were used to model the associations between the variables. Sugar sensitivity was negatively associated with liking for the LF/HS milkshake over the 4-year period. Low sugar sensitivity at baseline predicted increases in BMI percentile over time, but this association didn't survive a correction for multiple comparisons. Percent daily intake from fat was positively associated with liking for the HF/HS milkshake and negatively associated with liking for the LF/LS milkshake over 4 years. Together, these results demonstrate that lower sensitivity to sweet taste is linked to increased hedonic response to high-sugar foods and increased energy intake from fat seems to condition adolescents to show increased liking for high-fat/high-sugar foods.

Pilot multi-site and reproducibility study of hypothalamic gliosis in children.

OBJECTIVE: Quantitative magnetic resonance imaging (MRI) evidence of mediobasal hypothalamic (MBH) gliosis positively correlates with body mass index (BMI) in adults. This has neither been well explored in children nor have other brain regions involved in appetitive processing been tested for evidence of gliosis. METHODS: Multi-site cross-sectional study in children to test for differences in quantitative T2 signal (measure of gliosis) by region and to assess relationships with age and BMI. Participants underwent brain MRI using the same equipment and protocol to quantify T2 relaxation time in six bilateral regions of interest (ROIs): putamen, caudate, ventral striatum, amygdala, hippocampus and MBH, and three control regions: white matter, motor cortex and dorsal hypothalamus. RESULTS: Thirty-one participants (61% female) were included in a combined sample from the University of Washington (N = 9) and John Hopkins University (N = 22). Mean age was 14 ± 3 years, and BMI z-score was 0.7 ± 1.1 (26% with obesity). No study site-related differences were seen in T2 relaxation time across all nine regions (chi2 (8): 9.46, P = .30). Regional differences in T2 relaxation time were present (P < .001). MBH presented longer T2 relaxation time, suggestive of gliosis, when compared to all regions (P < .001), including an intra-hypothalamic control. Physiological age-related declines in T2 relaxation times were found in grey matter ROIs, but not in the MBH (r = -0.14, P = .46). MBH was the only region with a positive correlation between T2 relaxation time and BMI z-score (r = 0.38, P = .03). CONCLUSIONS: In a multi-site study, pilot data suggest that quantitative MRI detected normal maturation-related brain variation as well as evidence that MBH gliosis is associated with increased adiposity in children.

Familial Obesity Risk and Current Excess Weight Influence Brain Structure in Adolescents.

OBJECTIVE: Obesity risk transmits from parents to children. Underlying neural mechanisms were investigated in this study by evaluating influences of familial obesity risk defined by maternal obesity and influences of current overweight on three indices of brain structure in adolescents. METHODS: In total, 22 lean adolescents with lean mothers (lean low-risk), 25 lean adolescents with mothers with obesity/overweight (lean high-risk), and 36 adolescents with obesity/overweight underwent structural MRI scans for estimation of regional gray and white matter volume and cortical thickness. RESULTS: The lean high-risk compared with the lean low-risk group demonstrated lower gray and white matter volume and cortical thickness in the postcentral gyrus (somatosensory cortex), lower gray and white matter volume in the opercular cortex (taste cortex), lower gray matter volume and cortical thickness in the anterior cingulate cortex, and lower cortical thickness in the precuneus. Comparisons of the lean and obesity/overweight groups revealed further structural alterations in the postcentral gyrus, posterior cingulate gyrus, and middle temporal gyrus. CONCLUSIONS: Familial obesity risk and current obesity/overweight were associated with overlapping and distinct patterns of brain structure alterations. Longitudinal studies are warranted to investigate whether structural changes associated with familial obesity risk predict future weight trajectories.

Earlier onset of menstruation is related to increased body mass index in adulthood and altered functional correlations between visual, task control and somatosensory brain networks.

Later onset of puberty has been associated with lower body mass index (BMI) in adulthood independent of childhood BMI. However, how the relationship between time of onset of puberty and BMI in adulthood is associated with neurocognitive outcomes is largely unstudied. In the present study, women were sampled from the Human Connectome Project 1200 parcellation, timeseries and netmats1 release (PTN) release. Inclusion criteria were: four (15 minutes) resting state fMRI scans, current measured BMI, self-reported age at onset of menstruation (a proxy of age at onset of puberty) and no endocrine complications (eg, polycystic ovarian syndrome). The effect of age at onset of menstruation, measured BMI at scan date and the interaction of age at onset of menstruation by BMI on brain functional correlation was modelled using fslnets (https://fsl.fmrib.ox.ac.uk/fsl/fslwiki/FSLNets) controlling for race and age at scan. Corrected significance was set at a family-wise error probability (pFWE) < 0.05. A final sample of n = 510 (age 29.5 years ± 3.6, BMI at scan 25.9 ± 5.6 and age at onset of menstruation 12.7 ± 1.6 were included. Age at onset of menstruation was negatively associated with BMI at scan (r = - 0.19, P < 0.001). The interaction between age at onset of menstruation and BMI at scan was associated with stronger correlation between a somatosensory and visual network (t = 3.45, pFWE = 0.026) and a visual network and cingulo-opercular task control network (t = 4.74, pFWE = 0.0002). Post-hoc analyses of behavioural/cognitive measures showed no effect of the interaction between BMI and age at onset of menstruation on behavioural/cognitive measures. However, post-hoc analyses of heritability showed adult BMI and the correlation between the visual and somatosensory networks have high heritability. In sum, we report increased correlation between visual, taste-associated and self-control brain regions in women at high BMI with later age at onset of menstruation.

Behavioral and physiological characteristics associated with learning performance on an appetitive probabilistic selection task.

Individuals show meaningful variability in food choices. Choices are affected by individual differences in sensitivity to food reward and punishment, so understanding correlates of response to food reinforcement can help characterize food choices. Here, we examined behavioral and physiological correlates of individual differences in how individuals learn from food reward and punishment, as measured by performance on an appetitive probabilistic selection task that used sweet and bitter tastes as reinforcement. Sensitivity to food reward, sensitivity to food punishment, and overall learning performance were measured in 89 adults. Multivariate linear regressions were used to test if variables including body mass index (BMI), external eating, emotional eating, behavioral inhibition/behavioral activation scales (BIS/BAS), and perceived sensitivity to reward and punishment (SPQ/SRQ) were associated with measures of learning performance. External eating (ß=-.035, p=.019), BIS (ß=-.066, p=.004), and SPQ (ß=.003, p=.023) were associated with overall learning performance. BMI (ß=-.000, p=.012), emotional eating (ß=.055, p=.006), and external eating (ß=-.062, p=.004) were associated with sensitivity to food reward. No variables were associated with sensitivity to food punishment. In post hoc analyses, the interaction of sex and SPQ was associated with overall performance (ß=-.005, p=.025), such that the relationship was positive in women only (ß=.006, p=0.002). Results support that, controlling for key individual characteristics, BMI and susceptibility to food cues are associated with lower sensitivity to food reward, which may affect future food choices and eating behavior.

Predicted DRD4 prefrontal gene expression moderates snack intake and stress perception in response to the environment in adolescents.

Body weight is substantially determined by eating behaviors, which are themselves driven by biological factors interacting with the environment. Previous studies in young children suggest that genetic influences on dopamine function may confer differential susceptibility to the environment in such a way that increases behavioral obesity risk in a lower socioeconomic status (SES) environment but decreases it in a higher SES environment. We aimed to test if this pattern of effect could also be observed in adolescence, another critical period for development in brain and behavior, using a novel measure of predicted expression of the dopamine receptor 4 (DRD4) gene in prefrontal cortex. In a sample of 76 adolescents (37 boys and 39 girls from Baltimore, Maryland/US, aged 14-18y), we estimated individual levels of DRD4 gene expression (PredDRD4) in prefrontal cortex from individual genomic data using PrediXcan, and tested interactions with a composite SES score derived from their annual household income, maternal education, food insecurity, perceived resource availability, and receipt of public assistance. Primary outcomes were snack intake during a multi-item ad libitum meal test, and food-related impulsivity assessed using a food-adapted go/no-go task. A linear regression model adjusted for sex, BMI z-score, and genetic ethnicity demonstrated a PredDRD4 by composite SES score interaction for snack intake (p = 0.009), such that adolescents who had lower PredDRD4 levels exhibited greater snack intake in the lower SES group, but lesser snack intake in the higher SES group. Exploratory analysis revealed a similar pattern for scores on the Perceived Stress Scale (p = 0.001) such that the low PredDRD4 group reported higher stress in the lower SES group, but less stress in the higher SES group, suggesting that PredDRD4 may act in part by affecting perceptions of the environment. These results are consistent with a differential susceptibility model in which genes influencing environmental responsiveness interact with environments varying in obesogenicity to confer behavioral obesity risk in a less favorable environment, but behavioral obesity protection in a favorable one.

Taste-related reward is associated with weight loss following bariatric surgery.

BACKGROUNDBariatric surgeries are the most effective treatments for successful and sustained weight loss, but individuals vary in treatment response. Understanding the neurobiological and behavioral mechanisms accounting for this variation could lead to the development of personalized therapeutic approaches and improve treatment outcomes. The primary objectives of this study were to investigate changes in taste preferences and taste-induced brain responses after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) and to identify potential taste-related predictors of weight loss.METHODSFemales, ages 18 to 55, with a body mass index greater than or equal to 35 kg/m2, and approved for bariatric surgery at the Johns Hopkins Center for Bariatric Surgery were recruited for participation. Demographics, anthropometrics, liking ratings, and neural responses to varying concentrations of sucrose plus fat mixtures were assessed before and after surgery via visual analog scales and functional MRI.RESULTSBariatric surgery produced decreases in liking for sucrose-sweetened mixtures. Greater preference for sucrose-sweetened mixtures before surgery was associated with greater weight loss in RYGB, but not VSG. In the RYGB group only, individuals who showed lower taste-induced activation in the ventral tegmental area (VTA) before surgery and greater changes in taste-induced VTA activation 2 weeks following surgery experienced increased weight loss.CONCLUSIONThe anatomical and/or metabolic changes associated with RYGB may more effectively "reset" the neural processing of reward stimuli, thereby rescuing the blunted activation in the mesolimbic pathway found in patients with obesity. Further, these findings suggest that RYGB may be particularly effective in patients with a preference for sweet foods.FUNDINGNIH K23DK100559 and Dalio Philanthropies.

Network organization during probabilistic learning via taste outcomes.

Reinforcement learning guides food decisions, yet how the brain learns from taste in humans is not fully understood. Existing research examines reinforcement learning from taste using passive condition paradigms, but response-dependent instrumental conditioning better reflects natural eating behavior. Here, we examined brain response during a taste-motivated reinforcement learning task and how measures of task-based network structure were related to behavioral outcomes. During a functional MRI scan, 85 participants completed a probabilistic selection task with feedback via sweet taste or bitter taste. Whole brain response and functional network topology measures, including identification of communities and community segregation, were examined during choice, sweet taste, and bitter taste conditions. Relative to the bitter taste, sweet taste was associated with increased whole brain response in the hippocampus, oral somatosensory cortex, and orbitofrontal cortex. Sweet taste was also related to differential community assignment of the ventromedial prefrontal cortex and ventrolateral prefrontal cortex compared to bitter taste. During choice, increasing segregation of a community containing the amygdala, hippocampus, and right fusiform gyrus was associated with increased sensitivity to punishment on the task's posttest. Further, normal BMI was associated with differential community structure compared to overweight and obese BMI, where high BMI reflected increased connectivity of visual regions. Together, results demonstrate that network topology of learning and memory regions during choice is related to avoiding a bitter taste, and that BMI is associated with increased connectivity of area involved in processing external stimuli. Network organization and topology provide unique insight into individual differences in brain response to instrumental conditioning via taste reinforcers.

Short-term improvements in cognitive function following vertical sleeve gastrectomy and Roux-en Y gastric bypass: a direct comparison study.

BACKGROUND: Cognitive deficits are observed in individuals with obesity. While bariatric surgery can reverse these deficits, it remains unclear whether surgery type differentially influences cognitive outcome. We compared the extent to which vertical sleeve gastrectomy (VSG) and Roux-en Y gastric bypass (RYGB) ameliorated cognitive impairments associated with obesity. METHODS: Female participants approved for VSG (N = 18) or RYGB (N = 18) were administered cognitive measures spanning the domains of attention [Hopkins Verbal Learning Test (HVLT) Trial 1 and Letter Number Sequencing], processing speed [Stroop Color Trial, Symbol Digit Modalities Test, and Trail Making Part A], memory [HVLT Retained and HVLT Discrimination Index], and executive functioning (Stroop Color Word Trials and Trail Making Part B-A) prior to surgery and at 2 weeks and 3 months following surgery. Scores for each cognitive domain were calculated and compared between surgical cohorts using repeated measures analyses of variance. RESULTS: Significant weight loss was observed 2 weeks and 3 months following RYGB and VSG and was accompanied by improvements in processing speed and executive functioning. Patients who received RYGB also experienced improved attention as early as 2 weeks, which persisted at 3 months. This was not observed in individuals who underwent VSG. No changes in memory were observed from baseline measures in either group. CONCLUSIONS: This is the first report of cognitive improvements following VSG and the first direct comparison of cognitive improvements following RYGB and VSG. Short-term improvements in specific domains of cognitive function are observed at the beginning of the active weight loss phase following bariatric surgery that persisted to 3 months. The anatomical distinction between the two surgeries and resulting differential metabolic profiles may be responsible for the improvements in attention observed following RYGB but not following VSG.

Appetitive characteristics in children with cystic fibrosis: Questionnaire validation and associations with nutritional status.

BACKGROUND: Appetitive characteristics are an important factor in the nutritional status of children with cystic fibrosis (CF). We administered a brief parent-report eating behavior questionnaire, validated in healthy children, to determine the relationship between appetitive characteristics and body weight in children with CF. METHODS: Parents of children attending the Johns Hopkins Pediatric CF Clinic completed the Child Eating Behavior Questionnaire (CEBQ) at a routine clinic visit. Responses were correlated with anthropometric and other clinical data. RESULTS: Parents of 64 children with CF aged 7.74 ±â€¯3.17 years (mean ±â€¯SD) completed the CEBQ. The CEBQ subscales demonstrated good internal consistency (Cronbach's α = 0.76-0.94). Higher scores on food avoidance subscales (Slowness in Eating) were associated with lower body mass index (BMI) z-scores, and higher scores on food approach subscales (Food Responsiveness, Enjoyment of Food, Emotional Overeating) with higher BMI z-scores. Children with feeding aids (i.e. gastric tube or appetite-stimulating medications) demonstrated greater food avoidance (Slowness in Eating) and lesser food approach (Enjoyment of Food) when compared to those without feeding aids. Children with pancreatic insufficiency also demonstrated greater food avoidance (Slowness in Eating). CONCLUSIONS: The CEBQ can be used in a clinical setting to identify children with CF with appetitive characteristics associated with difficulty gaining weight. These children could potentially benefit from earlier interventions to aid in weight gain. Characterization of appetite using the CEBQ could aid investigation of the biological etiology of low appetite, and optimization of clinical and parental approaches to achieving a healthy nutritional status.