Genetic associations with consumption of palatable foods in the absence of hunger in response to food cues in children.

OBJECTIVE: The objective of this study is to evaluate obesity-related genetic factors in relation to excess consumption and assess if food cues modify associations. METHODS: Children (9-12 years) completed a randomized crossover experiment. During two visits, children ate a preload and then snacks ad libitum while watching television, embedded with food or non-food advertisements to assess eating in the absence of hunger (EAH). Primary exposures were obesity-associated genotypes, FTO rs9939609 and MC4R rs571312, and a paediatric-specific polygenic risk score (PRS). Outcomes included consumption of all snacks (total EAH) and gummy candy only (gummy candy EAH). Linear mixed-effects models tested whether genetic exposures related to EAH outcomes. We tested for effect modification by food cues using multiplicative interaction terms. RESULTS: Among 177 children, each FTO risk allele was associated with a 30% increase in gummy candy EAH (p = 0.025) in adjusted models. Food cue exposure exacerbated associations between the FTO variant with gummy candy EAH (p = 0.046). No statistically significant associations were found between MC4R and EAH. CONCLUSION: The results suggest children with the FTO rs9939609 risk allele may be predisposed to excess consumption of candy and that this association may be exacerbated by food cues.

A Latent Class Analysis of Family Eating Behaviors and Home Environment Habits on Preschool-Aged Children's Body Mass Index.

Background: The etiology of obesity is multifaceted, with multiple risk factors occurring during early childhood (e.g., fast food frequency, eating dinner as a family, TV in the bedroom). Many past studies have largely considered obesity risk factors in isolation, when in reality, the risk factors likely cluster together. A latent class analysis can be used to identify patterns in child eating behaviors, parent feeding behaviors, and household habits among preschool-aged children and their families to identify distinct, heterogenous classes and to determine if classes are associated with overweight and obesity. Methods: We used data from a community-based study of 624 three- to five-year-old children and a parent in New Hampshire, from March 2014 to October 2015. Parent-reported data were used to determine frequency of eating behaviors and household habits. Height and weight were objectively measured. Results: Four classes were identified; Class 1: "Healthy/Mildly accommodating," Class 2: "Healthy/Accommodating," Class 3: "Moderately healthy/Moderately accommodating," and Class 4: "Least healthy/Least accommodating." Compared with Class 1, children in Class 4 had increased odds of being overweight or obese [adjusted odds ratio (aOR): 1.64, 95% confidence interval (CI): 1.13-2.15], whereas Classes 2 and 3 were not associated with BMI (Class 2: aOR: 1.24, 95% CI: 0.62-1.86; Class 3: aOR: 1.31, 95% CI: 0.81-1.81). Conclusion: Study findings highlight that child-parent interactions around meals differentially relate to children's weight status given the context of children's eating habits. Most important, our study findings confirm the importance of adapting multiple healthy habits within the home social and physical environment to offset obesity risk in young children.

Association of Food Desert Residence and 5-Year Mortality in Lung Cancer Patients Undergoing Resection.

INTRODUCTION: Food desert (FD) residence has emerged as a risk factor for poor outcomes in breast, colon and esophageal cancers. The purpose of this retrospective study was to examine FD residence as an associated risk factor in nonsmall cell lung cancer (NSCLC) patients treated with anatomic lung resection (ALR). METHODS: All consecutive ALRs for stage I-III NSCLC from January 2015 to December 2017 at a single institution were reviewed. The primary exposure of interest was FD residence as defined by the United States Department of Agriculture. The primary outcome was 5-y overall mortality. Secondary outcomes were 30-d complications and 1- and 3-y mortality. Cox proportional hazard analysis was used to model factors associated with each outcome, adjusted for covariates. RESULTS: A total of 348 ALRs were included, with 101 (29%) patients residing in an FD. In the unadjusted Cox model, those residing in FD had an associated lower 5-year mortality risk compared to those not residing in an FD (hazard ratio = 0.56, 95% confidence interval (0.33-0.97); P = 0.04). That association was not statistically significant once adjusted for covariates (hazard ratio = 0.59, 95% confidence interval (0.34-1.04); P = 0.07). CONCLUSIONS: In this study, FD residence was not associated with an increase in the risk of 5-y mortality. Selection bias of patients deemed healthy enough to undergo surgery may have mitigated the negative association of FD residence demonstrated in other cancers. Future work will evaluate all NSCLC patients undergoing treatments at our institution to further evaluate FDs as a risk factor for worse outcomes.

Association of diet with per- and polyfluoroalkyl substances in plasma and human milk in the New Hampshire Birth Cohort Study.

Per- and polyfluoroalkyl substances (PFAS) are related to various adverse health outcomes, and food is a common source of PFAS exposure. Dietary sources of PFAS have not been adequately explored among U.S. pregnant individuals. We examined associations of dietary factors during pregnancy with PFAS concentrations in maternal plasma and human milk in the New Hampshire Birth Cohort Study. PFAS concentrations, including perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), and perfluorodecanoate (PFDA), were measured in maternal plasma collected at ∼28 gestational weeks and human milk collected at ∼6 postpartum weeks. Sociodemographic, lifestyle and reproductive factors were collected from prenatal questionnaires and diet from food frequency questionnaires at ∼28 gestational weeks. We used adaptive elastic net (AENET) to identify important dietary variables for PFAS concentrations. We used multivariable linear regression to assess associations of dietary variables selected by AENET models with PFAS concentrations. Models were adjusted for sociodemographic, lifestyle, and reproductive factors, as well as gestational week of blood sample collection (plasma PFAS), postpartum week of milk sample collection (milk PFAS), and enrollment year. A higher intake of fish/seafood, eggs, coffee, or white rice during pregnancy was associated with higher plasma or milk PFAS concentrations. For example, every 1 standard deviation (SD) servings/day increase in egg intake during pregnancy was associated with 4.4 % (95 % CI: 0.6, 8.4), 3.3 % (0.1, 6.7), and 10.3 % (5.6, 15.2) higher plasma PFOS, PFOA, and PFDA concentrations respectively. Similarly, every 1 SD servings/day increase in white rice intake during pregnancy was associated with 7.5 % (95 % CI: -0.2, 15.8) and 12.4 % (4.8, 20.5) greater milk PFOS and PFOA concentrations, respectively. Our study suggests that certain dietary factors during pregnancy may contribute to higher PFAS concentrations in maternal plasma and human milk, which could inform interventions to reduce PFAS exposure for both birthing people and offspring.

The associations between attentional bias to food cues, parent-report appetitive traits, and concurrent adiposity among adolescents.

OBJECTIVE: To assess whether attentional bias to food cues and appetitive traits are independently and interactively associated with adiposity in adolescents. METHOD: Eighty-five adolescents, 14-17-years had their attentional bias to food images measured in a sated state by computing eye tracking measures of attention (first fixation duration, cumulative fixation duration) to food and control distractor images that bordered a computer game. Parents reported adolescent appetitive traits including the food approach domains of enjoyment of food, food responsiveness, emotional overeating, and the food avoidance domains of satiety responsiveness and emotional overeating through the Children's Eating Behavior Questionnaire. RESULTS: First fixation bias to food cues was positively associated with enjoyment of food, and negatively associated with satiety responsiveness. In a series of regression models adjusted for relevant covariates, first fixation bias to food cues (ß = 0.83, p = 0.007), higher food responsiveness (ß = 0.74, p < 0.001), higher emotional overeating (ß = 0.51, p = 0.002), and a composite appetite score (ß = 1.42, p < 0.001) were each significantly associated with greater BMI z-scores. In models assessing the interactive effects between attentional bias and appetitive traits, higher first fixation bias to food cues interacted synergistically with food responsiveness and emotional overeating in relation to BMI z-score. A synergistic interaction between first fixation bias to food cues and the composite appetite score in relation to BMI z-score was also observed. CONCLUSION: Individuals with high attentional bias to food cues and obesogenic appetitive traits may be particularly susceptible to weight gain.

Children's Perception of Food Marketing Across Digital Media Platforms.

Introduction: Exposure to food marketing increases the risk of poor diet. Children's perception and interpretation of food marketing across digital media platforms is understudied. Children aged 9-11 years are uniquely susceptible to food marketing because children may watch content alone, and it is unclear whether embedded ads are decipherable by children (e.g., social media influencers) and if children are receptive to advertisements. Methods: The authors collected data from 21 child-parent dyads in 2022 to fill this gap. Children were interviewed about their food marketing exposure and media use and were asked to share their perspectives on food advertisements. Parents completed a survey for household digital devices, demographics, and perception of their child's food advertising knowledge. Results: This study found that all children generally recognized direct food advertisements, could describe them with varying levels of confidence, and shared examples. Despite self-identifying ads and understanding the intent of advertising, many children are still receptive to advertisements on the basis of engaging content (e.g., liking the ads as entertainment, watching ads even when given the chance to skip the ad) and the food items marketed (e.g., liking the taste of foods). Conclusions: These findings suggest that knowledge of advertisement exposure and intent of advertising are not sufficient to reduce receptiveness of unhealthy food ad exposure. Additional research on the potential impacts of embedded ads, such as through social media influencers, is needed to understand children's interaction with the current digital media landscape.

Factors Correlated With Ultra-Processed Food (UPF) Intake in Preschool-Aged Children and Association With Weight.

OBJECTIVE: Understand the correlates of ultra-processed food (UPF) intake and examine the association of UPF on body mass index in children aged 3-5 years. DESIGN: Secondary analysis of a prospective cohort of 3-5-year-olds/parent, followed 1-year between March 2014 and October 2016. Usual UPF intake from 2 3-day food records completed 1 year apart, a standardized nutrient database customized with child-specific foods, and a NOVA food classification system was used. Child/parent characteristics and media use were measured via parent-reported surveys. Child weight/height objectively measured. SETTING: New Hampshire community. PARTICIPANTS: Six hundred and sixty-seven parent-child dyads were screened, and 624 were enrolled with 90% follow-up. MAIN OUTCOME MEASURE(S): Primary outcome: identify correlates of UPF intake. SECONDARY OUTCOME: determine if UPF intake is associated with body mass index change. ANALYSIS: Adjusted ß linear regression, linear regression, P <0.05. RESULTS: Ultra-processed food accounted for 67.6% of total caloric intake. In adjusted models, children's UPF intake was positively associated with increasing child age, greater hours watching television, and more frequent parent soda/fast-food intake. Ultra-processed food intake was negatively associated with higher parent education and reported race/ethnicity other than non-Hispanic White. There was no association between UPF intake and weight. CONCLUSIONS AND IMPLICATIONS: There are several predictors of UPF intake in young children. Family-level interventions could be implemented to encourage the intake of minimally processed foods before and during preschool years.

Associations between sleep and appetitive traits in higher-income preschoolers: A six-month study.

BACKGROUND: Short sleep is consistently linked with childhood obesity, possibly via disrupting appetite hormones and increasing food responsiveness. Few studies have objectively examined this association in early childhood. OBJECTIVE: To evaluate associations of sleep quantity and quality with child appetitive traits and eating in the absence of hunger (EAH) in a higher-income cohort of 86 preschool-age children (age 4.0 ± 0.8 years; 42% female; 93% non-Hispanic white, Northern New England, US). METHODS: Children's sleep duration and quality were assessed via parent report (Children's Sleep Habits Questionnaire, CSHQ) at baseline and 6-month follow-up and via accelerometry at baseline. Parents also completed the Child Eating Behaviors Questionnaire to assess the child's appetitive traits. EAH, an objective measure of overeating, was observed at baseline during an in-person visit. Associations between sleep measures and appetitive traits were examined with linear mixed-effect or linear regression models, as appropriate, adjusting for child age, sex, and household income. RESULTS: Shorter sleep duration per parent report was associated with less satiety responsiveness (standardized ß = 0.14, 95% CI: 0.01, 0.26; p = 0.03). Further, satiety responsiveness was inversely related to EAH (Pearson's r = -0.35, p = 0.02). No associations were found between accelerometer-measured sleep parameters and appetitive traits, and no sleep measures were related to EAH. CONCLUSIONS: Shorter usual sleep, per the parent report, was cross-sectionally associated with reduced satiety responsiveness in this sample of higher-income preschoolers. Future studies should consider whether socioeconomic status may modify the impact of poor sleep on appetitive traits in early childhood.

Elucidating pathways to pediatric obesity: a study evaluating obesity polygenic risk scores related to appetitive traits in children.

BACKGROUND/OBJECTIVES: Obesity polygenic risk scores (PRS) explain substantial variation in body mass index (BMI), yet associations between PRSs and appetitive traits in children remain unclear. To better understand pathways leading to pediatric obesity, this study aimed to assess the association of obesity PRSs and appetitive traits. SUBJECTS/METHODS: This study included 248 unrelated children aged 9-12 years. DNA from the children was genotyped (236 met quality control thresholds) and four weighted polygenic risk scores from previous studies were computed and standardized: a 97 SNP PRS, 266 SNP pediatric-specific PRS, 466 SNP adult-specific PRS, and ~2 million SNP PRS. Appetitive traits were assessed using a parent-completed Child Eating Behavior Questionnaire, which evaluated food approach/avoidance traits and a composite obesogenic appetite score. BMI was directly measured and standardized by age and sex. Three associations were evaluated with linear regression: (1) appetitive traits and BMI, (2) PRSs and BMI, and (3) PRSs and appetitive traits, the primary association of interest. RESULTS: Expected positive associations were observed between obesogenic appetitive traits and BMI and all four PRSs and BMI. Examining the association between PRSs and appetitive traits, all PRSs except for the 466 SNP adult PRS were significantly associated with the obesogenic appetite score. Each standard deviation increase in the 266 SNP pediatric PRS was associated with an adjusted 2.1% increase in obesogenic appetite score (95% CI: 0.6%, 3.7%, p = 0.006). Significant partial mediation of the PRS-BMI association by obesogenic appetite score was found for these PRSs; for example, 21.3% of the association between the 266 SNP pediatric PRS and BMI was explained by the obesogenic appetite score. CONCLUSIONS: Genetic obesity risk significantly predicted appetitive traits, which partially mediated the association between genetic obesity risk and BMI in children. These findings build a clearer picture of pathways leading to pediatric obesity.

What Is Food Noise? A Conceptual Model of Food Cue Reactivity.

As GLP-1 receptor agonists, like semaglutide, emerge as effective treatments for weight management, anecdotal reports from patients and clinicians alike point to a reduction in what has been colloquially termed "food noise", as patients report experiencing less rumination and obsessive preoccupation about food. In this narrative review, we discuss concepts used in studies to investigate human eating behavior that can help elucidate and define food noise, particularly food cue reactivity. We propose a conceptual model that summarizes the main factors that have been shown to determine the magnitude of the reactivity elicited by external and internal food cues and how these factors can affect short- and long-term behavioral and clinical outcomes. By integrating key research conducted in this field, the Cue-Influencer-Reactivity-Outcome (CIRO) model of food cue reactivity provides a framework that can be used in future research to design studies and interpret findings related to food noise and food cue reactivity.

Equivalent efficacy of indoor daylight and lamp-based 5-aminolevulinic acid photodynamic therapy for treatment of actinic keratosis.

Background: Photodynamic therapy (PDT) is widely used as a treatment for actinic keratoses (AK), with new sunlight-based regimens proposed as alternatives to lamp-based treatments. Prescribing indoor daylight activation could help address the seasonal temperature, clinical supervision, and access variability associated with outdoor treatments. Objective: To compare the AK lesion clearance efficacy of indoor daylight PDT treatment (30 min of 5-aminolevulinic acid (ALA) pre-incubation, followed by 2 h of indoor sunlight) versus a lamp-based PDT treatment (30 min of ALA preincubation, followed by 10 min of red light). Methods: A prospective clinical trial was conducted with 41 patients. Topical 10% ALA was applied to the entire treatment site (face, forehead, scalp). Patients were assigned to either the lamp-based or indoor daylight treatment. Actinic keratosis lesion counts were determined by clinical examination and recorded for pre-treatment, 1-month, and 6-month follow-up visits. Results: There was no statistical difference in the efficacy of AK lesion clearance between the red-lamp (1-month clearance = 57 ± 17%, 6-month clearance = 57 ± 20%) and indoor daylight treatment (1-month clearance = 61 ± 19%, 6-month clearance = 67 ± 20%). A 95% confidence interval of the difference of the means was measured between -4.4% and 13.4% for 1-month, and -2.2% and +23.6% for 6-month timepoints when comparing the indoor daylight to the red-lamp treatment, with a priori interval of equivalence of ±20%. Limitations: Ensuring an equivalent dose between the indoor and lamp treatment cohorts limited randomisation since it required performing indoor daylight treatments only during sunny days. Conclusion: Indoor-daylight PDT provided equivalent AK treatment efficacy to a lamp-based regimen while overcoming temperature limitations and UV-block sunscreen issues associated with outdoor sunlight treatments in the winter. Clinical trial registration: Clinicaltrials.gov listing: NCT03805737.

Novel integration of governmental data sources using machine learning to identify super-utilization among U.S. counties.

Background: Super-utilizers consume the greatest share of resource intensive healthcare (RIHC) and reducing their utilization remains a crucial challenge to healthcare systems in the United States (U.S.). The objective of this study was to predict RIHC among U.S. counties, using routinely collected data from the U.S. government, including information on consumer spending, offering an alternative method for identifying super-utilization among population units rather than individuals. Methods: Cross-sectional data from 5 governmental sources in 2017 were used in a machine learning pipeline, where target-prediction features were selected and used in 4 distinct algorithms. Outcome metrics of RIHC utilization came from the American Hospital Association and included yearly: (1) emergency rooms visit, (2) inpatient days, and (3) hospital expenditures. Target-prediction features included: 149 demographic characteristics from the U.S. Census Bureau, 151 adult and child health characteristics from the Centers for Disease Control and Prevention, 151 community characteristics from the American Community Survey, and 571 consumer expenditures from the Bureau of Labor Statistics. SHAP analysis identified important target-prediction features for 3 RIHC outcome metrics. Results: 2475 counties with emergency rooms and 2491 counties with hospitals were included. The median yearly emergency room visits per capita was 0.450 [IQR:0.318, 0.618], the median inpatient days per capita was 0.368 [IQR: 0.176, 0.826], and the median hospital expenditures per capita was $2104 [IQR: $1299.93, 3362.97]. The coefficient of determination (R2), calculated on the test set, ranged between 0.267 and 0.447. Demographic and community characteristics were among the important predictors for all 3 RIHC outcome metrics. Conclusions: Integrating diverse population characteristics from numerous governmental sources, we predicted 3-outcome metrics of RIHC among U.S. counties with good performance, offering a novel and actionable tool for identifying super-utilizer segments in the population. Wider integration of routinely collected data can be used to develop alternative methods for predicting RIHC among population units.

Associations between behavioral self-regulation and external food cue responsiveness (EFCR) in preschool-age children and evidence of modification by parenting style.

Decreased behavioral regulation is hypothesized to be a risk factor for excess weight gain among children, possibly via reduced appetite-specific regulation. Little research has specifically focused on behavioral regulation and food cue responsiveness, a conditioned precursor to eating, at a young age. This study examined the association between behavioral regulation and external food cue responsiveness among preschool-age children and explored if a more structured parenting style moderated that association. Baseline data from a prospective study on media use among preschool-age children (n = 83) in Northern New England were used. Parents reported on three domains of children's behavioral regulation (attentional focusing, inhibitory control, and emotional self-regulation), the children's external food cue responsiveness (EFCR), and their parenting styles (authoritative and permissive) via validated questionnaires. Mean age among children was 4.31 (SD 0.91) years, 57% of children were male, 89% were non-Hispanic white, and 26.2% had overweight or obesity. In a series of adjusted linear regression models, lower attentional focusing (standardized ß, ßs = -0.35, p = 0.001), inhibitory control (ßs = -0.30, p = 0.008), and emotional self-regulation (standardized beta, ßs = -0.38, p < 0.001) were each significantly associated with greater EFCR. In exploratory analyses, a more structured parenting style (more authoritative or less permissive) mitigated the associations between inhibitory control and EFCR (Bonferroni-adjusted p-interaction < 0.017). Findings support that lower attentional focusing, inhibitory control, and emotional self-regulation relate to greater ECFR in preschool-age children. The association between inhibitory control and EFCR may be modified by parenting style. Further research is needed to understand if children's responsiveness to external food cues may account for reported associations between lower behavioral regulation and adiposity gain over time.

Obesity-Related Discourse on Facebook and Instagram Throughout the COVID-19 Pandemic: Comparative Longitudinal Evaluation.

BACKGROUND: COVID-19 severity is amplified among individuals with obesity, which may have influenced mainstream media coverage of the disease by both improving understanding of the condition and increasing weight-related stigma. OBJECTIVE: We aimed to measure obesity-related conversations on Facebook and Instagram around key dates during the first year of the COVID-19 pandemic. METHODS: Public Facebook and Instagram posts were extracted for 29-day windows in 2020 around January 28 (the first US COVID-19 case), March 11 (when COVID-19 was declared a global pandemic), May 19 (when obesity and COVID-19 were linked in mainstream media), and October 2 (when former US president Trump contracted COVID-19 and obesity was mentioned most frequently in the mainstream media). Trends in daily posts and corresponding interactions were evaluated using interrupted time series. The 10 most frequent obesity-related topics on each platform were also examined. RESULTS: On Facebook, there was a temporary increase in 2020 in obesity-related posts and interactions on May 19 (posts +405, 95% CI 166 to 645; interactions +294,930, 95% CI 125,986 to 463,874) and October 2 (posts +639, 95% CI 359 to 883; interactions +182,814, 95% CI 160,524 to 205,105). On Instagram, there were temporary increases in 2020 only in interactions on May 19 (+226,017, 95% CI 107,323 to 344,708) and October 2 (+156,974, 95% CI 89,757 to 224,192). Similar trends were not observed in controls. Five of the most frequent topics overlapped (COVID-19, bariatric surgery, weight loss stories, pediatric obesity, and sleep); additional topics specific to each platform included diet fads, food groups, and clickbait. CONCLUSIONS: Social media conversations surged in response to obesity-related public health news. Conversations contained both clinical and commercial content of possibly dubious accuracy. Our findings support the idea that major public health announcements may coincide with the spread of health-related content (truthful or otherwise) on social media.

Food Deserts Increase Readmission After Esophagectomy for Cancer: A Multi-institutional Study.

BACKGROUND: Food deserts are low-income census tracts with poor access to supermarkets and are associated with worse outcomes in breast, colon, and a small number of esophageal cancer patients. This study investigated residency in food deserts on readmission rates in a multi-institutional cohort of esophageal cancer patients undergoing trimodality therapy. METHODS: A retrospective review of patients who underwent trimodality therapy at 6 high-volume institutions from January 2015 to July 2019 was performed. Food desert status was defined by the United States Department of Agriculture by patient ZIP Code. The primary outcome was 30-day readmission after esophagectomy. Multilevel, multivariable logistic regression was used to model readmission on food desert status adjusted for diabetes, insurance type, length of stay, and any complication, treating the institution as a random factor. RESULTS: Of the 453 records evaluated, 425 were included in the analysis. Seventy-three patients (17.4%) resided in a food desert. Univariate analysis demonstrated food desert patients had significantly increased 30-day readmission. No differences were seen in length of stay, complications, or 30-day mortality. In the adjusted logistic regression model, residing in a food desert remained a significant risk factor for readmission (odds ratio, 2.11; 95% CI, 1.07-4.15). There were no differences in 30-day, 90-day, or 1-year mortality based on food desert status, although readmission was associated with worse 90-day and 1-year mortality. CONCLUSIONS: Food desert residence was associated with 30-day readmission after esophagectomy in patients undergoing trimodality treatment for esophageal cancer in this multi-institutional population. Identification of patients residing in a food desert may allow surgeons to focus preventative interventions during treatment and postoperatively to improve outcomes.

Corrigendum: Differential neural reward reactivity in response to food advertising medium in children.

[This corrects the article DOI: 10.3389/fnins.2023.1052384.].

Differential neural reward reactivity in response to food advertising medium in children.

Introduction: Food cues including food advertisements (ads) activate brain regions related to motivation and reward. These responses are known to correlate with eating behaviors and future weight gain. The objective of this study was to compare brain responses to food ads by different types of ad mediums, dynamic (video) and static (images), to better understand how medium type impacts food cue response. Methods: Children aged 9-12 years old were recruited to complete a functional magnetic resonance imaging (fMRI) paradigm that included both food and non-food dynamic and static ads. Anatomical and functional images were preprocessed using the fMRIPrep pipeline. A whole-brain analysis and a targeted region-of-interest (ROI) analysis for reward regions (nucleus accumbens, orbitofrontal cortex, amygdala, insula, hypothalamus, ventral tegmental area, substantia nigra) were conducted. Individual neural responses to dynamic and static conditions were compared using a paired t-test. Linear mixed-effects models were then constructed to test the differential response by ad condition after controlling for age, sex, BMI-z, physical activity, and % of kcal consumed of a participant's estimated energy expenditure in the pre-load prior to the MRI scan. Results: A total of 115 children (mean=10.9 years) completed the fMRI paradigm. From the ROI analyses, the right and left hemispheres of the amygdala and insula, and the right hemisphere of the ventral tegmental area and substantia nigra showed significantly higher responses for the dynamic food ad medium after controlling for covariates and a false discovery rate correction. From the whole-brain analysis, 21 clusters showed significant differential responses between food ad medium including the precuneus, middle temporal gyrus, superior temporal gyrus, and inferior frontal gyrus, and all regions remained significant after controlling for covariates. Discussion: Advertising medium has unique effects on neural response to food cues. Further research is needed to understand how this differential activation by ad medium ultimately affects eating behaviors and weight outcomes.

Association between tobacco product use and asthma among US adults from the Population Assessment of Tobacco and Health (PATH) Study waves 2-4.

BACKGROUND: Research on cigarettes and adult asthma offers mixed findings, perhaps due to overlap with chronic obstructive pulmonary disease (COPD) and inadequate adjustment for other smoke exposures. Associations between other tobacco products, including e-cigarettes, and asthma are also understudied. RESEARCH QUESTION: Using Population Assessment of Tobacco and Health Study waves 2-4 (2014/2015-2016/2017) data, we assessed the relation between tobacco product use and asthma in persons unlikely to have COPD. STUDY DESIGN AND METHODS: Prospective study of 10 267 adults aged 18-39 years without COPD diagnoses. Past-month tobacco use at wave 2 was modelled first as combustible versus non-combustible use and second as specific product categories (former, cigarettes, e-cigarettes, cigars, hookah, smokeless tobacco). Outcomes included lifetime asthma prevalence at wave 2, incidence (waves 3 and 4) and Asthma Control Test score (lower=worse). Multivariable regressions adjusted for predictors of asthma, including other smoke exposures: cigarette pack-years, secondhand smoke and marijuana use. Sensitivity analyses examined findings when persons >39 years and those with both COPD and asthma were added, and when smoke exposure adjustments were removed. RESULTS: No product, including cigarettes and e-cigarettes, was associated with prevalence or incidence of asthma. Among people with asthma at wave 2, combustible tobacco (beta=-0.86, 95% CI (-1.32 to -0.39)) and cigarettes (beta=-1.14, 95% CI (-1.66 to -0.62)) were associated with worse asthma control. No tobacco product was associated with asthma control over time. In sensitivity analyses, tobacco use became associated with incident asthma as adults >39 years and those with asthma+COPD were added, and as adjustments for other smoke exposures were omitted. INTERPRETATION: Although cigarette use was associated with worse asthma control, there were no longitudinal associations between combustible tobacco or e-cigarette use and new onset or worsening asthma in these preliminary analyses. Research on tobacco and asthma should exclude COPD and adjust for smoking history and other smoke exposures.

Characterizing the Prevalence of Obesity Misinformation, Factual Content, Stigma, and Positivity on the Social Media Platform Reddit Between 2011 and 2019: Infodemiology Study.

BACKGROUND: Reddit is a popular social media platform that has faced scrutiny for inflammatory language against those with obesity, yet there has been no comprehensive analysis of its obesity-related content. OBJECTIVE: We aimed to quantify the presence of 4 types of obesity-related content on Reddit (misinformation, facts, stigma, and positivity) and identify psycholinguistic features that may be enriched within each one. METHODS: All sentences (N=764,179) containing "obese" or "obesity" from top-level comments (n=689,447) made on non-age-restricted subreddits (ie, smaller communities within Reddit) between 2011 and 2019 that contained one of a series of keywords were evaluated. Four types of common natural language processing features were extracted: bigram term frequency-inverse document frequency, word embeddings derived from Bidirectional Encoder Representations from Transformers, sentiment from the Valence Aware Dictionary for Sentiment Reasoning, and psycholinguistic features from the Linguistic Inquiry and Word Count Program. These features were used to train an Extreme Gradient Boosting machine learning classifier to label each sentence as 1 of the 4 content categories or other. Two-part hurdle models for semicontinuous data (which use logistic regression to assess the odds of a 0 result and linear regression for continuous data) were used to evaluate whether select psycholinguistic features presented differently in misinformation (compared with facts) or stigma (compared with positivity). RESULTS: After removing ambiguous sentences, 0.47% (3610/764,179) of the sentences were labeled as misinformation, 1.88% (14,366/764,179) were labeled as stigma, 1.94% (14,799/764,179) were labeled as positivity, and 8.93% (68,276/764,179) were labeled as facts. Each category had markers that distinguished it from other categories within the data as well as an external corpus. For example, misinformation had a higher average percent of negations (ß=3.71, 95% CI 3.53-3.90; P<.001) but a lower average number of words >6 letters (ß=-1.47, 95% CI -1.85 to -1.10; P<.001) relative to facts. Stigma had a higher proportion of swear words (ß=1.83, 95% CI 1.62-2.04; P<.001) but a lower proportion of first-person singular pronouns (ß=-5.30, 95% CI -5.44 to -5.16; P<.001) relative to positivity. CONCLUSIONS: There are distinct psycholinguistic properties between types of obesity-related content on Reddit that can be leveraged to rapidly identify deleterious content with minimal human intervention and provide insights into how the Reddit population perceives patients with obesity. Future work should assess whether these properties are shared across languages and other social media platforms.

Quantifying differences in packaged food and drink purchases among households with diet-related cardiometabolic multi-morbidity: a cross-sectional analysis.

BACKGROUND: Diet is important for chronic disease management, with limited research understanding dietary choices among those with multi-morbidity, the state of having 2 or more chronic conditions. The objective of this study was to identify associations between packaged food and drink purchases and diet-related cardiometabolic multi-morbidity (DRCMM). METHODS: Cross-sectional associations between packaged food and drink purchases and household DRCMM were investigated using a national sample of U.S. households participating in a research marketing study. DRCMM households were defined as household head(s) self-reporting 2 or more diet-related chronic conditions. Separate multivariable logistic regression models were used to model the associations between household DRCMM status and total servings of, and total calories and nutrients from, packaged food and drinks purchased per month, as well as the nutrient density (protein, carbohydrates, and fat per serving) of packaged food and drinks purchased per month, adjusted for household size. RESULTS: Among eligible households, 3795 (16.8%) had DRCMM. On average, households with DRCMM versus without purchased 14.8 more servings per capita, per month, from packaged foods and drinks (p < 0.001). DRCMM households were 1.01 times more likely to purchase fat and carbohydrates in lieu of protein across all packaged food and drinks (p = 0.002, p = 0.000, respectively). DRCMM households averaged fewer grams per serving of protein, carbohydrates, and fat per month across all food and drink purchases (all p < 0.001). When carbonated soft drinks and juices were excluded, the same associations for grams of protein and carbohydrates per serving per month were seen (both p < 0.001) but the association for grams of fat per serving per month attenuated. CONCLUSIONS: DRCMM households purchased greater quantities of packaged food and drinks per capita than non-DRCMM households, which contributed to more fat, carbohydrates, and sodium in the home. However, food and drinks in DRCMM homes on average were lower in nutrient-density. Future studies are needed to understand the motivations for packaged food and drink choices among households with DRCMM to inform interventions targeting the home food environment.