Gestational diabetes mellitus (GDM) carries a small but potentially important risk of adverse perinatal outcomes and a long-term risk of obesity and glucose intolerance in offspring. Mothers with GDM ...have an excess of hypertensive disorders during pregnancy and a high risk of developing diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements complement maternal glucose monitoring in the identification of pregnancies that require such intensification. Glucose testing shortly after delivery can stratify the short-term diabetes risk in mothers. Thereafter, annual glucose and HbA(1c) testing can detect deteriorating glycaemic control, a harbinger of future diabetes mellitus, usually type 2 diabetes mellitus. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes mellitus. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning enables optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity.
Prior studies suggest that fructose compared with glucose may be a weaker suppressor of appetite, and neuroimaging research shows that food cues trigger greater brain reward responses in a fasted ...relative to a fed state. We sought to determine the effects of ingesting fructose versus glucose on brain, hormone, and appetitive responses to food cues and food-approach behavior. Twenty-four healthy volunteers underwent two functional magnetic resonance imaging (fMRI) sessions with ingestion of either fructose or glucose in a double-blinded, random-order cross-over design. fMRI was performed while participants viewed images of high-calorie foods and nonfood items using a block design. After each block, participants rated hunger and desire for food. Participants also performed a decision task in which they chose between immediate food rewards and delayed monetary bonuses. Hormones were measured at baseline and 30 and 60 min after drink ingestion. Ingestion of fructose relative to glucose resulted in smaller increases in plasma insulin levels and greater brain reactivity to food cues in the visual cortex (in whole-brain analysis) and left orbital frontal cortex (in region-of-interest analysis). Parallel to the neuroimaging findings, fructose versus glucose led to greater hunger and desire for food and a greater willingness to give up long-term monetary rewards to obtain immediate high-calorie foods. These findings suggest that ingestion of fructose relative to glucose results in greater activation of brain regions involved in attention and reward processing and may promote feeding behavior.
Significance Fructose compared with glucose may be a weaker suppressor of appetite. Here we sought to determine the effects of fructose versus glucose on brain, hormone, and appetitive responses to food cues and food-approach behavior. We show that the ingestion of fructose compared with glucose resulted in smaller increases in plasma insulin levels and greater brain responses to food cues in the visual cortex and left orbital frontal cortex. Ingestion of fructose versus glucose also led to greater hunger and desire for food and a greater willingness to give up long-term monetary rewards to obtain immediate high-calorie foods. These findings suggest that ingestion of fructose relative to glucose activates brain regions involved in attention and reward processing and may promote feeding behavior.
Exposure in utero to maternal obesity or gestational diabetes mellitus (GDM) is linked to a high risk for obesity in offspring. Animal studies suggest that these exposures disrupt the development of ...the hypothalamus, a brain region that regulates body weight, predisposing offspring to develop obesity. This study tested the hypothesis in humans that in utero exposure to maternal obesity and/or GDM is associated with alterations in the hypothalamic response to glucose and the altered hypothalamic response would predict greater increases in child adiposity 1 year later.
Participants were 91 children aged 7-11 years with and without in utero exposure to GDM. Maternal prepregnancy BMI and GDM exposures were determined from electronic medical records. Arterial spin labeling MRI was used to determine the child's hypothalamic blood flow response to oral glucose. Anthropometric measures were acquired in all children at their initial visit and again 1 year later in a subset of 44 children.
Children exposed to GDM diagnosed at ≤26 weeks' gestation had increased hypothalamic blood flow (a marker of hypothalamic activation) in response to glucose when compared with unexposed children, and results remained after adjustments for child age, sex, BMI, and maternal prepregnancy BMI. Maternal prepregnancy BMI was positively associated with the child's hypothalamic response to glucose. Greater hypothalamic response to glucose predicted greater increases in child's BMI 1 year later.
Increased glucose-linked hypothalamic activation during childhood represents a possible mechanism by which exposure to maternal metabolic disorders during fetal development increases future risk for obesity.
Disordered eating behaviors consistently associated with emotion regulation difficulties. However, most studies have focused on affect intensity without considering dynamic affective patterns. We ...examined these patterns in relation to daily overeating, loss of control eating (LOCE), dietary restraint, and food craving in young adults using ecological momentary assessment (EMA).Adults (N = 24) completed a 10-day EMA protocol during which they reported momentary affect and eating patterns. Generalized linear mixed-models examined each index in relation to eating variable.Higher PA instability (within-person) was associated with higher ratings of binge-eating symptoms (B = 0.15, SE = 0.06,
= 0.007). Lower NA differentiation (within-person) was associated with higher levels of food craving (B = -10.11, SE = 4.74,
= 0.033).Our results support previous findings suggesting that acute fluctuations in PA may increase risk of binge-eating symptoms. Further, inability to differentiate between momentary states of NA was associated with cravings. This study highlights the importance of examining multiple facets of NA and PA in relation to eating regulation.
ClinicalTrials.gov identifier: NCT02945475.
Objective To determine the effects of maternal gestational diabetes mellitus (GDM) on offspring adiposity in a well-characterized cohort of Mexican American mother-child pairs. Study design This ...study included 62 Mexican American mothers and their index offspring. Maternal GDM and normal glucose status during index pregnancy were documented, and mothers were previously matched by age, body mass index (BMI), and parity. Mother-child pairs were recruited when offspring were between the ages of 5 and 16 years. A medical history was collected, and anthropometrics were measured. Main outcome measures were offspring BMI, BMI z-scores, BMI percentiles, and hip and waist circumferences. Results GDM-exposed offspring (n = 37) had greater measures of BMI (all P ≤ .02) and greater waist and hip circumferences (both P = .002) compared with 25 offspring of non-GDM mothers. Adjustment for offspring age, sex, Tanner stage, birth weight, months of breastfeeding, maternal prepregnancy BMI, and pregnancy weight gain attenuated the differences, but BMI z-score and BMI percentile remained significantly greater in the GDM-exposed group ( P < .05). Conclusion Intrauterine exposure to GDM is associated with greater adiposity in Mexican American children, and this relationship is not mediated by maternal obesity. In contrast to previous reports, this study included only Mexican Americans; thus, ethnic variations may influence the contributions of maternal GDM and maternal obesity to offspring adiposity.
Increases in fructose consumption have paralleled the increasing prevalence of obesity, and high-fructose diets are thought to promote weight gain and insulin resistance. Fructose ingestion produces ...smaller increases in circulating satiety hormones compared with glucose ingestion, and central administration of fructose provokes feeding in rodents, whereas centrally administered glucose promotes satiety.
To study neurophysiological factors that might underlie associations between fructose consumption and weight gain.
Twenty healthy adult volunteers underwent 2 magnetic resonance imaging sessions at Yale University in conjunction with fructose or glucose drink ingestion in a blinded, random-order, crossover design.
Relative changes in hypothalamic regional cerebral blood flow (CBF) after glucose or fructose ingestion. Secondary outcomes included whole-brain analyses to explore regional CBF changes, functional connectivity analysis to investigate correlations between the hypothalamus and other brain region responses, and hormone responses to fructose and glucose ingestion.
There was a significantly greater reduction in hypothalamic CBF after glucose vs fructose ingestion (-5.45 vs 2.84 mL/g per minute, respectively; mean difference, 8.3 mL/g per minute 95% CI of mean difference, 1.87-14.70; P = .01). Glucose ingestion (compared with baseline) increased functional connectivity between the hypothalamus and the thalamus and striatum. Fructose increased connectivity between the hypothalamus and thalamus but not the striatum. Regional CBF within the hypothalamus, thalamus, insula, anterior cingulate, and striatum (appetite and reward regions) was reduced after glucose ingestion compared with baseline (P < .05 significance threshold, family-wise error FWE whole-brain corrected). In contrast, fructose reduced regional CBF in the thalamus, hippocampus, posterior cingulate cortex, fusiform, and visual cortex (P < .05 significance threshold, FWE whole-brain corrected). In whole-brain voxel-level analyses, there were no significant differences between direct comparisons of fructose vs glucose sessions following correction for multiple comparisons. Fructose vs glucose ingestion resulted in lower peak levels of serum glucose (mean difference, 41.0 mg/dL 95% CI, 27.7-54.5; P < .001), insulin (mean difference, 49.6 μU/mL 95% CI, 38.2-61.1; P < .001), and glucagon-like polypeptide 1 (mean difference, 2.1 pmol/L 95% CI, 0.9-3.2; P = .01).
In a series of exploratory analyses, consumption of fructose compared with glucose resulted in a distinct pattern of regional CBF and a smaller increase in systemic glucose, insulin, and glucagon-like polypeptide 1 levels.
Summary
Background
There is concern regarding how the COVID‐19 pandemic may impact the psychological and physical health of children, but to date, studies on mental health during the pandemic in ...children are limited. Furthermore, unprecedented lifestyle stressors associated with the pandemic may aggravate the childhood obesity epidemic, but the role of BMI on child activity levels and psychological outcomes during COVID‐19 is unknown.
Objectives
We investigated how emotional responses (positive/negative affect), physical activity (PA) and sedentary behaviours related to anxiety among U.S. children with healthy weight and overweight/obesity during the pandemic.
Methods
Sixty‐four typically developing children (63% girls, 53% healthy weight) aged 9 to 15 years completed two virtual visits during the height of ‘stay‐at‐home’ measures from April 22 to July 29, 2020. Children completed 24‐hours PA recalls, state portion of State‐Trait Anxiety Inventory for Children and the 10‐item Positive and Negative Affect Schedule for Children.
Results
Independent of child BMI status, child anxiety scores were over five standard deviations greater than normative values from paediatric populations prior to the pandemic. Higher positive affect and PA were each associated with reduced anxiety levels in children with overweight/obesity, whereas higher positive affect was associated with reduced anxiety in children with healthy weight. Greater leisure screen time was associated with higher negative affect irrespective of child BMI status.
Conclusions
These associations highlight the potential mental health benefits of maintaining positive affect, engaging in PA and limiting leisure screen time for children during the pandemic and suggest that these associations may be particularly relevant for children with overweight/obesity.
Objective
Physical activity (PA) promotes weight maintenance, potentially because of its beneficial effects on feeding behavior regulation via diminished food cue reactivity within brain reward ...regions. This study examined how levels of PA and sedentary behavior (SB) relate to brain responses to food cues.
Methods
Participants (22 lean, 18 with obesity) completed three to five PA recalls over 2 months. Average minutes per day of moderate to vigorous PA (MVPA) and SB were calculated. Participants completed a functional magnetic resonance imaging session, viewing food and nonfood images following glucose ingestion. Region of interest (ROI) analysis examined associations between MVPA and brain percent signal change in response to food versus nonfood images, controlling for obesity and sex. Secondary analysis examined associations between SB and brain responses to food cues.
Results
Greater MVPA was associated with decreased food cue reactivity after glucose across brain ROIs (β = −0.00057, P = 0.005), controlling for obesity and sex. Greater SB was associated with increased food cue reactivity after glucose across brain ROIs in unadjusted analyses (β = 0.00041, P = 0.026).
Conclusions
PA may have beneficial effects on brain regulation of feeding behavior after caloric intake in lean individuals and individuals with obesity.
Obesity is a worldwide epidemic resulting in part from the ubiquity of high-calorie foods and food images. Whether obese and nonobese individuals regulate their desire to consume high-calorie foods ...differently is not clear. We set out to investigate the hypothesis that circulating levels of glucose, the primary fuel source for the brain, influence brain regions that regulate the motivation to consume high-calorie foods. Using functional MRI (fMRI) combined with a stepped hyperinsulinemic euglycemic-hypoglycemic clamp and behavioral measures of interest in food, we have shown here that mild hypoglycemia preferentially activates limbic-striatal brain regions in response to food cues to produce a greater desire for high-calorie foods. In contrast, euglycemia preferentially activated the medial prefrontal cortex and resulted in less interest in food stimuli. Indeed, higher circulating glucose levels predicted greater medial prefrontal cortex activation, and this response was absent in obese subjects. These findings demonstrate that circulating glucose modulates neural stimulatory and inhibitory control over food motivation and suggest that this glucose-linked restraining influence is lost in obesity. Strategies that temper postprandial reductions in glucose levels might reduce the risk of overeating, particularly in environments inundated with visual cues of high-calorie foods.
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