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Is hunger important to model in fMRI visual food-cue reactivity paradigms in adults with obesity and how should this be done?
Chin, SH, Kahathuduwa, CN, Stearns, MB, Davis, T, Binks, M
Appetite. 2018;:388-397
Abstract
We considered 1) influence of self-reported hunger in behavioral and fMRI food-cue reactivity (fMRI-FCR) 2) optimal methods to model this. Adults (N = 32; 19-60 years; F = 21; BMI 30-39.9 kg/m2) participated in an fMRI-FCR task that required rating 240 images of food and matched objects for 'appeal'. Hunger, satiety, thirst, fullness and emptiness were measured pre- and post-scan (visual analogue scales). Hunger, satiety, fullness and emptiness were combined to form a latent factor (appetite). Post-vs. pre-scores were compared using paired t-tests. In mixed-effects models, appeal/fMRI-FCR responses were regressed on image (i.e. food/objects), with random intercepts and slopes of image for functional runs nested within subjects. Each of hunger, satiety, thirst, fullness, emptiness and appetite were added as covariates in 4 forms (separate models): 1) change; 2) post- and pre-mean; 3) pre-; 4) change and pre-. Satiety decreased (Δ = -13.39, p = 0.001) and thirst increased (Δ = 11.78, p = 0.006) during the scan. Changes in other constructs were not significant (p's > 0.05). Including covariates did not influence food vs. object contrast of appeal ratings/fMRI-FCR. Significant image X covariate interactions were observed in some fMRI models. However, including these constructs did not improve the overall model fit. While some subjective, self-reported hunger, satiety and related constructs may be moderating fMRI-FCR, these constructs do not appear to be salient influences on appeal/fMRI-FCR in people with obesity undergoing fMRI.
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Low subjective socioeconomic status stimulates orexigenic hormone ghrelin - A randomised trial.
Sim, AY, Lim, EX, Leow, MK, Cheon, BK
Psychoneuroendocrinology. 2018;:103-112
Abstract
Recent evidence suggests that lower perceived socioeconomic status is linked to increased appetite and intake of greater calories. Yet, whether insecurity of socioeconomic resources directly influences regulatory systems of appetite and energy intake is not known. Considering psychological states, mindsets and beliefs have shown to meaningfully affect physiological responses to food, the present study tested the hypothesis that low subjective socioeconomic status (SSS) will have a direct influence on physiological responses, such as appetite-related hormones (ghrelin, pancreatic polypeptide and insulin). Forty-eight healthy males were randomly (crossover, counterbalanced) assigned, to two experimental conditions where participants were either experimentally induced to feel low SSS or not (control; CON). Feelings of low SSS resulted in an increase in active ghrelin (an orexigenic hormone) following the SSS manipulation compared with baseline, while no change in active ghrelin was observed in CON. Furthermore, participants reported lower fullness and satiety following low SSS compared with CON. Our findings demonstrate that SSS may influence hunger regulation and appetite, and suggest that physiological systems regulating energy balance (i.e. caloric resources) may also be sensitive to perceived deprivation or imbalances in critical non-food resources (socioeconomic resources).
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The impact of caffeine consumption during 50 hr of extended wakefulness on glucose metabolism, self-reported hunger and mood state.
Grant, CL, Coates, AM, Dorrian, J, Paech, GM, Pajcin, M, Della Vedova, C, Johnson, K, Kamimori, GH, Fidock, J, Aidman, E, et al
Journal of sleep research. 2018;(5):e12681
Abstract
Caffeine is known for its capacity to mitigate performance decrements. The metabolic side-effects are less well understood. This study examined the impact of cumulative caffeine doses on glucose metabolism, self-reported hunger and mood state during 50 hr of wakefulness. In a double-blind laboratory study, participants were assigned to caffeine (n = 9, 6M, age 21.3 ± 2.1 years; body mass index 21.9 ± 1.6 kg/m2 ) or placebo conditions (n = 8, 4M, age 23.0 ± 2.8 years; body mass index 21.8 ± 1.6 kg/m2 ). Following a baseline sleep (22:00 hours-08:00 hours), participants commenced 50 hr of sleep deprivation. Meal timing and composition were controlled throughout the study. Caffeine (200 mg) or placebo gum was chewed for 5 min at 01:00 hours, 03:00 hours, 05:00 hours and 07:00 hours during each night of sleep deprivation. Continual glucose monitors captured interstitial glucose 2 hr post-breakfast, at 5-min intervals. Hunger and mood state were assessed at 10:00 hours, 16:30 hours, 22:30 hours and 04:30 hours. Caffeine did not affect glucose area under the curve (p = 0.680); however, glucose response to breakfast significantly increased after 2 nights of extended wakefulness compared with baseline (p = 0.001). There was a significant main effect of day, with increased tiredness (p < 0.001), mental exhaustion (p < 0.001), irritability (p = 0.002) and stress (p < 0.001) on the second day of extended wake compared with day 1. Caffeine attenuated the rise in tiredness (p < 0.001), mental exhaustion (p = 0.044) and irritability (p = 0.018) on day 1 but not day 2. Self-reported hunger was not affected by sleep deprivation or caffeine. These data confirm the effectiveness of caffeine in improving performance under conditions of sleep deprivation by reducing feelings of tiredness, mental exhaustion and irritability without exacerbating glucose metabolism and feelings of hunger.
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Security Hunger-Strike Prisoners in the Emergency Department: Physiological and Laboratory Findings.
Gordon, D, Drescher, M, Shiber, S
The Journal of emergency medicine. 2018;(2):185-191
Abstract
BACKGROUND Medical treatment of hunger-strike patients, especially those in incarceration facilities, may pose clinical and treatment challenges for the treating physicians. OBJECTIVE The aim of our study is to describe the epidemiology and clinical and laboratory characteristics of hunger-strike prisoners presenting to the emergency department (ED) and to describe etiologies of hospitalization and complications among this group. METHOD We retrospectively examined clinical and laboratory manifestations of 50 hunger-strike prisoners who were referred for evaluation to the ED after a longstanding fast. RESULTS After a mean of 38 (28-44) days of a hunger strike, the most common complaints were chest pain and abdominal pain (14/60 [23.3%], 13/60 [21.6%], respectively). Mean weight loss percentage was 18.5%, and most patients were bradycardic (25/40 [62.5%]), and some hypothermic (16/50, [32%]). We describe several laboratory disturbances observed in these patients; leukopenia was the most common hematologic manifestation (31/50 [62%]), and a prolonged international normalized ratio was observed in 12/29 (41.3%) patients. We hospitalized 12% of the patients; the most common hospitalization cause was bradycardia (3/6 [50%]). CONCLUSIONS Our study found that the most common clinical symptom was chest pain, which has not been previously reported among hunger strikers. We observed a substantial number of laboratory disturbances due to muscle wasting and protein loss and due to presumed vitamin and micronutrient deficiencies. We suggest monitoring electrocardiograms for heart rate, blood count, chemistry, coagulation tests, and vitamin levels.
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A Ketone Ester Drink Lowers Human Ghrelin and Appetite.
Stubbs, BJ, Cox, PJ, Evans, RD, Cyranka, M, Clarke, K, de Wet, H
Obesity (Silver Spring, Md.). 2018;(2):269-273
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Abstract
OBJECTIVE The ketones d-β-hydroxybutyrate (BHB) and acetoacetate are elevated during prolonged fasting or during a "ketogenic" diet. Although weight loss on a ketogenic diet may be associated with decreased appetite and altered gut hormone levels, it is unknown whether such changes are caused by elevated blood ketones. This study investigated the effects of an exogenous ketone ester (KE) on appetite. METHODS Following an overnight fast, subjects with normal weight (n = 15) consumed 1.9 kcal/kg of KE, or isocaloric dextrose (DEXT), in drinks matched for volume, taste, tonicity, and color. Blood samples were analyzed for BHB, glucose, insulin, ghrelin, glucagon-like peptide 1 (GLP-1), and peptide tyrosine tyrosine (PYY), and a three-measure visual analogue scale was used to measure hunger, fullness, and desire to eat. RESULTS KE consumption increased blood BHB levels from 0.2 to 3.3 mM after 60 minutes. DEXT consumption increased plasma glucose levels between 30 and 60 minutes. Postprandial plasma insulin, ghrelin, GLP-1, and PYY levels were significantly lower 2 to 4 hours after KE consumption, compared with DEXT consumption. Temporally related to the observed suppression of ghrelin, reported hunger and desire to eat were also significantly suppressed 1.5 hours after consumption of KE, compared with consumption of DEXT. CONCLUSIONS Increased blood ketone levels may directly suppress appetite, as KE drinks lowered plasma ghrelin levels, perceived hunger, and desire to eat.
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The motilin agonist erythromycin increases hunger by modulating homeostatic and hedonic brain circuits in healthy women: a randomized, placebo-controlled study.
Zhao, D, Meyer-Gerspach, AC, Deloose, E, Iven, J, Weltens, N, Depoortere, I, O'daly, O, Tack, J, Van Oudenhove, L
Scientific reports. 2018;(1):1819
Abstract
The motilin agonist, erythromycin, induces gastric phase III of the migrating motor complex, which in turn generates hunger peaks. To identify the brain mechanisms underlying these orexigenic effects, 14 healthy women participated in a randomized, placebo-controlled crossover study. Functional magnetic resonance brain images were acquired for 50 minutes interprandially. Intravenous infusion of erythromycin (40 mg) or saline started 10 minutes after the start of scanning. Blood samples (for glucose and hormone levels) and hunger ratings were collected at fixed timepoints. Thirteen volunteers completed the study, without any adverse events. Brain regions involved in homeostatic and hedonic control of appetite and food intake responded to erythromycin, including pregenual anterior cingulate cortex, anterior insula cortex, orbitofrontal cortex, amygdala, caudate, pallidum and putamen bilaterally, right accumbens, hypothalamus, and midbrain. Octanoylated ghrelin levels decreased, whereas both glucose and insulin increased after erythromycin. Hunger were higher after erythromycin, and these differences covaried with the brain response in most of the abovementioned regions. The motilin agonist erythromycin increases hunger by modulating neurocircuitry related to homeostatic and hedonic control of appetite and feeding. These results confirm recent behavioural findings identifying motilin as a key orexigenic hormone in humans, and identify the brain mechanisms underlying its effect.
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Neural processing of food and monetary rewards is modulated by metabolic state.
Yousuf, M, Heldmann, M, Göttlich, M, Münte, TF, Doñamayor, N
Brain imaging and behavior. 2018;(5):1379-1392
Abstract
In humans, food is considered a powerful primary reinforcer, whereas money is a secondary reinforcer, as it gains a value through learning experience. Here, we aimed to identify the neural regions supporting the processing of food-related reinforcers, relate it to the neural underpinnings of monetary reinforcers, and explore their modulation by metabolic state (hunger vs satiety). Twenty healthy male participants were tested in two experimental sessions, once hungry and once satiated, using functional magnetic resonance imaging. Participants performed an associative learning task, receiving food or monetary rewards (in the form of images) on separate blocks. Irrespective of incentive type, both food and monetary rewards engaged ventral striatum, medial orbitofrontal cortex and amygdala, regions that have been previously associated with reward processing. Food incentives additionally engaged the opercular part of the inferior frontal gyrus and the insula, collectively known as a primary gustatory cortex. Moreover, in response to negative feedback (here, reward omission), robust activation was observed in anterior insula, supplementary motor area and lateral parts of the prefrontal cortex, including middle and inferior frontal gyrus. Furthermore, the interaction between metabolic state and incentive type resulted in supramarginal gyrus (SMG) activity, among other motor and sensory-related regions. Finally, functional connectivity analysis showed correlation in the hungry state between the SMG and mesolimbic regions, including the hippocampus, midbrain and cingulate areas. Also, the interaction between metabolic state and incentive type revealed coupling between SMG and ventral striatum. Whereas general purpose reward-related regions process incentives of different kinds, the current results suggest that the SMG might play a key role in integrating the information related to current metabolic state and available incentive type.
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Neuromodulation directed at the prefrontal cortex of subjects with obesity reduces snack food intake and hunger in a randomized trial.
Heinitz, S, Reinhardt, M, Piaggi, P, Weise, CM, Diaz, E, Stinson, EJ, Venti, C, Votruba, SB, Wassermann, EM, Alonso-Alonso, M, et al
The American journal of clinical nutrition. 2017;(6):1347-1357
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Abstract
Background: Obesity is associated with reduced activation in the left dorsolateral prefrontal cortex (DLPFC), a region of the brain that plays a key role in the support of self-regulatory aspects of eating behavior and inhibitory control. Transcranial direct current stimulation (tDCS) is a noninvasive technique used to modulate brain activity.Objectives: We tested whether repeated anodal tDCS targeted at the left DLPFC (compared with sham tDCS) has an immediate effect on eating behavior during ad libitum food intake, resulting in weight change, and whether it might influence longer-term food intake-related appetite ratings in individuals with obesity.Design: In a randomized parallel-design study combining inpatient and outpatient assessments over 31 d, 23 individuals with obesity [12 men; mean ± SD body mass index (BMI; in kg/m2): 39.3 ± 8.42] received 15 sessions of anodal (i.e., enhancing cortical activity) or sham tDCS aimed at the left DLPFC. Ad libitum food intake was assessed through the use of a vending machine paradigm and snack food taste tests (SFTTs). Appetite was evaluated with a visual analog scale (VAS). Body weight was measured. We examined the effect of short-term (i.e., 3 sessions) and long-term (i.e., 15 sessions) tDCS on these variables.Results: Relative to sham tDCS, short-term anodal tDCS did not influence ad libitum intake of food from the vending machines. Accordingly, no effect on short-term or 4-wk weight change was observed. In the anodal tDCS group, compared with the sham group, VAS ratings for hunger and the urge to eat declined significantly more (P = 0.01 and P = 0.05, respectively), and total energy intake during an SFTT was relatively lower in satiated individuals (P = 0.01), after long-term tDCS.Conclusions: Short-term anodal tDCS of the left DLPFC did not have an immediate effect on ad libitum food intake or thereby weight change, relative to sham tDCS. Hunger and snack food intake were reduced only after a longer period of anodal tDCS in individuals with obesity. This trial was registered at clinicaltrials.gov as NCT00739362.
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Oral Carbonation Attenuates Feeling of Hunger and Gastric Myoelectrical Activity in Young Women.
Suzuki, M, Mura, E, Taniguchi, A, Moritani, T, Nagai, N
Journal of nutritional science and vitaminology. 2017;(3):186-192
Abstract
We previously reported that carbonated water ingestion induced fullness and gastric motility. In order to determine whether such satiating effects occur through oral carbonic stimulation alone, we conducted modified sham-feeding (SF) tests (carbonated water ingestion (CW), water ingestion (W), carbonated water sham-feeding (CW-SF), and water sham-feeding (W-SF)), employing an equivalent volume and standardized temperature of carbonated and plain water, in a randomized crossover design. Thirteen young women began fasting at 10 p.m. on the previous night and were loaded with each sample (15ºC, 250 mL) at 9 a.m. on separate days. Electrogastrography (EGG) recordings were obtained from 20 min before to 45 min after the loading to determine the power and frequency of the gastric myoelectrical activity. Appetite was assessed using visual analog scales. After ingestion, significantly increased fullness and decreased hunger ratings were observed in the CW group. After the load, transiently but significantly increased fullness as well as decreased hunger ratings were observed in the CW-SF group. The powers of normogastria (2-4 cpm) and tachygastria (4-9 cpm) showed significant increases in the CW and W groups, but not in the CW-SF and W-SF groups. The peak frequency of normogastria tended to shift toward a higher band in the CW group, whereas it shifted toward a lower band in the CW-SF group, indicating a different EGG rhythm. Our results suggest that CO2-induced oral stimulation is solely responsible for the feeling of satiety. Moreover, different gastric-contraction rhythms (slow or fast) were induced by oral carbonic stimulation alone and carbonated water ingestion.
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Small intestinal protein infusion in humans: evidence for a location-specific gradient in intestinal feedback on food intake and GI peptide release.
van Avesaat, M, Ripken, D, Hendriks, HF, Masclee, AA, Troost, FJ
International journal of obesity (2005). 2017;(2):217-224
Abstract
BACKGROUND Protein infusion in the small intestine results in intestinal brake activation: a negative feedback mechanism that may be mediated by the release of gastrointestinal peptides resulting in a reduction in food intake. It has been proposed that duodenum, jejunum and ileum may respond differently to infused proteins. OBJECTIVE To investigate differences in ad libitum food intake, feelings of hunger and satiety and the systemic levels of cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), peptide YY (PYY), glucose and insulin after intraduodenal, intrajejunal and intraileal protein infusion. METHODS Fourteen subjects (four male, mean age: 23±2.1 years, mean body mass index: 21.6±1.8 kg m-2) were intubated with a naso-ileal catheter in this double-blind, randomized, placebo-controlled crossover study. Test days (four in total, executed on consecutive days) started with the ingestion of a standardized breakfast, followed by the infusion of 15 g of protein in the duodenum, jejunum or ileum over a period of 60 min. Food intake was measured by offering an ad libitum meal and Visual Analogue Scale (VAS) scores were used to assess feelings of hunger and satiety. Blood samples were drawn at regular intervals for CCK, GLP-1, PYY, glucose and insulin analyses. RESULTS Intraileal protein infusion decreased ad libitum food intake compared with both intraduodenal and placebo infusion (ileum: 628.5±63 kcal vs duodenum: 733.6±50 kcal, P<0.01 and placebo: 712.2±53 kcal, P<0.05). GLP-1 concentrations were increased after ileal infusion compared with jejunal and placebo infusion, whereas CCK concentrations were only increased after intraileal protein infusion compared with placebo. None of the treatments affected VAS scores for hunger and satiety nor plasma concentrations of PYY and glucose. CONCLUSIONS Protein infusion into the ileum decreases food intake during the next meal compared with intraduodenal infusion, whereas it increases systemic levels of GLP-1 compared with protein infusion into the jejunum and placebo respectively.