To investigate whether nutrition plays a role in inhibitory control and executive functioning early in life, we collected data on behavior using different tasks (see previous blog). To perform these tasks, we choose to visit the children at home with the aim 1) to burden the families less, and 2) to test the children in their home environments where they are probably more at ease. Testing 3-year-old children is very fun a

October 1

nd can also be challenging at the same time. I will share some anecdotes and experiences of my data collection as inspiration for others testing young children.

Attention
Some tasks had lengthy instructions and required the child to perform several practice trials, resulting in the child losing his/her attention. The sequence of the tasks was constructed in such a way that the child’s attention was maintained as long as possible. For example, the tasks that required more attention, focus and instructions were performed first.

Sometimes children said to be not in the mood to play anymore, or that they didn’t know what to do despite passing the practice trials. Repeating the rules is not possible, because it means that some children will receive more instructions than other children. I solved this problem by telling the child that he/she would be rewarded if he/she finished the task. Rewards could be a fun game they can play next, or some snacks that the parents agreed to giving.

Parents
Parents sometimes tended to help their child. To prevent this, it is very important to instruct the parents not to help their child. Another way to prevent the parent from helping is to keep them busy by having them fill in a questionnaire, or to turn to the child and say things like: “are you a bit nervous because Mum is looking?” Sentences as these work very well, as you are not telling the parent directly what to do, but they understand the hint immediately.

Siblings
Toddlers often have siblings; sometimes younger siblings and sometimes older siblings. If possible, parents are asked to arrange the situation this way that the siblings are not at home and/or are asleep. When not possible, an assistant accompanying the experimenter can take care of the siblings, for example by taking the sibling outside and play soccer in the neighborhood. Everything for science!

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Have you ever done your weekly grocery shopping and ended up with more than actually written on your grocery list?
Everybody has at least once experienced how it is to buy food in a supermarket with hunger and buy much more than planned. The widely known recommendation: Never go grocery shopping when you are hungry!!!

But is it only a myth or is there a grain of truth in that advice?
What exactly is the issue with going grocery shopping when you are hungry? If you do you probably buy more food than you need and planned to buy. Additionally, unhealthy food might be much more attractive for you than healthy food. The consequence: you have more food at home, so you might eat more and unhealthier. Imagine you are hungry and are coming home from work after a stressful day and now you get to choose between a frozen pizza and a healthy meal that has not been prepared yet – What would you choose? In that situation, I think I would definitely choose the frozen pizza.

High-calorie food and unhealthy food are associated with obesity. Obesity research found a moderate relationship between obesity and emotional disorders like depressive disorder and anxiety disorder (1). Thus, having fast food frequently might not only affect your physical, but also your mental well-being.

Let’s rewind to grocery shopping, but now consider you are not hungry. You probably would only buy the things that are on your grocery list, and also rather healthy food than an unhealthy one. So now you come home hungry from a stressful day at work and you don’t have the choice between healthy and unhealthy food, and the temptation of the frozen pizza isn’t there. So you would start to prepare your healthy food and thus automatically eat healthier.

Coming back to the question if these scenarios are devised or true, and thus representative for weekly grocery shopping.
Research has shown that impulsivity, obesity, and food buying behavior are related. People with obesity are more impulsive than slim people. Also, impulsive people eat more than less impulsive people. Hunger influences food buying behavior and food consumption, especially of high caloric food. The relationship between impulsivity and buying food might be state dependent: researchers have found that impulsive people bought more calories, especially from snack food, but only when they were feeling hungry. This means that impulsivity and hunger interact in their influence on consumption. Obese people are found to show a preference for energy-dense, high-fat food and eat more of these foods, compared to slim people (2).

So what’s the conclusion?
Yes, hunger influences your grocery shopping, especially in interaction with impulsivity. If you consider yourself an impulsive person, you might be more prone to buying more than intended when you go shopping hungry.

So if you have the chance: only go shopping for groceries when you are full and focused. If you accidentally get into a hungry grocery shopping situation, keep this blog in mind and try to focus on your grocery list.

REFERENCES:
Scott, K. M., Bruffaerts, R., Simon, G. E., Alonso, J., Angermeyer, M., de Girolamo, G., … & Kessler, R. C. (2008). Obesity and mental disorders in the general population: results from the world mental health surveys. International journal of obesity32(1), 192.

Nederkoorn, C., Guerrieri, R., Havermans, R. C., Roefs, A., & Jansen, A. (2009). The interactive effect of hunger and impulsivity on food intake and purchase in a virtual supermarket. International journal of obesity33(8), 905.

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A healthy diet has numerous benefits. But what does a healthy diet consist of? And how do we, researchers, measure diet quality?

What’s considered a healthy diet in one country or culture, may not be regarded as such in another. For instance, low-fat and unsweetened dairy products are regarded as healthy in my country, the Netherlands, but not in many Asian countries where a vast proportion of the population is lactose intolerant. Differences in regional availability of foods further determine dietary habits across, and even within, countries. Fish, for example, is often at the core of a healthy diet in countries surrounded by water such as Japan (48.6 kg/year per person), but not in landlocked countries such as Hungary (5.1 kg/year per person) [1].

Here I will describe six common ways in which researchers may assess diet quality in Western populations.

1. Fruit and Vegetable Consumption

Probably the quickest way to obtain an estimate of an individual’s diet quality is by assessing fruit and vegetable consumption of the individual. Generally speaking, fruits and vegetables are high in healthy nutrients such as vitamins and fibers. Moreover, fruits and vegetables often replace unhealthier options such as energy-dense snacks. Finally, while fruit and vegetable consumption is only one aspect of diet quality, it has been shown to correlate with overall diet quality. Thus, fruit and vegetable consumption can be seen as a fast but crude way to assess diet quality.

2. Total Energy Intake

One could consider calculating total energy intake as an indicator of diet quality. Generally speaking, unhealthy foods are more energy-dense than healthy foods. Therefore, high-calorie diets likely contain more unhealthy foods. Of course, this is not necessarily the case; some foods, for instance avocado, are both energy-dense and nutrient-rich. Moreover, low energy intake may result in nutritional deficits. Therefore, total energy intake is not generally used as an indicator of diet quality.

3. Mediterranean Diet Score

The Mediterranean Diet Score (MDS) measures compliance to a Mediterranean-type diet, consisting of legumes, fruits, vegetables, unrefined cereals, olive oil and fish. Points are subtracted for dairy and meat [2]. The Mediterranean diet was inspired by the eating habits of Greece and Italy, where people seem to live longer and have lower risk of heart disease compared to other Western regions.

4. Western-Type Diet Score

A Western-style diet is a modern dietary pattern, that is sometimes referred to as the Standard American Diet. A Western diet consists of red and processed meats, pre-packaged foods, fried foods, whole-fat dairy products, refined grains, potatoes and sugar-sweetened beverages, among others [3]. Contrary to most diet quality scores, a higher Western diet score indicates a less healthy diet.

5. Healthy Eating Index

The Healthy Eating Index (HEI) measures how well an individual adheres to the key recommendations of the 2015 Dietary Guidelines for Americans. These guidelines are often used by US-based nutrition and health professionals, to help people to consume a healthful and nutritionally adequate diet. A total score is calculated based on nine advised food groups/components (including fruits and vegetables, whole grains, plant proteins), and four components that should be moderated (including salt and saturated fat) [4].

6. Dietary Approaches to Stop Hypertension

The dietary approaches to stop hypertension (DASH) dietary pattern emphasizes fruits, vegetables, low-fat dairy, whole grains, nuts and legumes, and limits saturated fat, cholesterol, red and processed meats, added sugars, and sugar-sweetened beverages. It was originally developed in the US to treat hypertension without medication [5]. Several medical associations and institutions have since incorporated the diet in their clinical guidelines [6]. 

REFERENCES:

[1] Ritchie & Roser (2019). Meat and Seafood Production & Consumption. Published online at OurWorldInData.org. Retrieved from: https://ourworldindata.org/meat-and-seafood-production-consumption on 28 August 2019

[2] Dinu, Pagliai, Casini & Sofi (2018). Mediterranean diet and multiple health outcomes: an umbrella review of observational studies and randomised trials. European Journal of Clinical Nutrition, 72(1), 30-43. doi: 10.1038/ejcn.2017.58

[3] Cordain, Eaton, Sebastian, Mann, Lindeberg, Watkins et al. (2005). Origins and evolution of the Western diet: health implications for the 21st century. American Journal of Clinical Nutrition, 81(2), 341-354. doi: 10.1093/ajcn.81.2.341

[4] US Department of Agriculture, Food and Nutrition Service. Retrieved from https://www.fns.usda.gov/resource/healthy-eating-index-hei on 28 August 2019

[5] Sacks, Svetkey, Vollmer, Appel, Bray, Harsha et al. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. The New England Journal of Medicine, 344(1), 3-10. doi: 10.1056/NEJM200101043440101

[6] Chiavaroli, Viguiliouk, Nishi, Mejia, Rahelic, Kahleova et al. (2019). DASH Dietary pattern and cardiometabolic outcomes: an umbrella review of systematic reviews and meta-analyses. Nutrients, 11(2), 338. doi: 10.3390/nu11020338

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Recently I had a great chance to participate in the 19th WPA World Congress of Psychiatry which took place in Lisbon 21-24 of August 2019. Such an international scientific event summarizes recent findings and sets a trend for future research.

The effect of lifestyle on mental health was one of the topics discussed at the conference. Focusing on nutritional impact in psychiatry I will review here some of the studies – research done in animal models or patients and literature reviews – which were presented at the Congress.

All the poster presentations can be viewed on the conference website https://2019.wcp-congress.com/.

Dietary patterns and mental health

  1. Sanchez-Villegas and colleagues from Spain1 presented research on the Mediterranean diet’s effects in patients recovered from depressive disorders. They found that adherence to Mediterranean diet supplemented with extra-virgin olive oil led to the improvement of depressive symptoms. This new study supports previous reports about positive effects of traditional dietary patterns compared to so-called “Western diet”, and this topic was nicely reviewed in the poster presentation of M. Jesus and colleagues (Portugal)2.

I presented a poster3 on a study done in a mouse model of Western diet feeding. We found that genetic deficiency of serotonin transporter exacerbates metabolic alterations and such behavioural consequences of the Western diet as depressive-like behaviour and cognitive impairment. In human, carriers of a genetic variant that reduces serotonin transporter expression are known to be more susceptible to emotionality-related disorders and prone to obesity and diabetes.

Vitamin D and Mental Health

Nutritional psychiatry was traditionally focused on the effects of vitamins and micronutrients on mental health. Several presentations at this conference were dedicated to the role of vitamin D in mental disorders.

Scientists from Egypt (T. Okasha and colleagues)4 showed their results on the correlation between serum level of vitamin D and two psychiatric disorders: schizophrenia and depression. They found lower serum vitamin D levels in the patients with schizophrenia or depression compared to healthy volunteers. These findings indicate a role of vitamin D in the development of psychiatric disorders.

However, the team from Denmark (J. Hansen and colleagues)5 did not find any effect of 3 months vitamin D supplementation on depression symptoms in patients with major depression. The contrariety of the studies on vitamin D benefits in mental health was presented on the review poster by R. Avelar and colleagues (Portugal)6.

Microbiome and Mental Health

There is increasing evidence that microbiota-gut-brain axis influences behaviour and mental health. N. Watanabe and colleagues (Japan)7 presented the results of a study on germfree and commensal microbiota-associated mice. They found increased aggression and impaired brain serotonin metabolism in germfree mice.

  1. Dias and colleagues (Portugal)8 performed a literature review on this topic exploring possible effects of microbiome and probiotics in mental disorder development. The most robust evidence was found for the association of microbiome alterations and depression/anxiety. Up to date literature is lacking replicated findings on proving positive effects of probiotics in mental disorders treatment.

Diabetes Type 2 and Mental Disorders

Risk factors for type 2 diabetes include diet and lifestyle habits. It is getting more obvious that there is an association between type 2 diabetes and the development of mental disorders.

  1. Mhalla and colleagues (Tunisia)9 reported a study done on patients with type 2 diabetes. They found a high prevalence of depression in women with type 2 diabetes. Also, depression in these patients was associated with poorer glycemic control.

Depression is an important factor influencing insomnia. H.C. Kim (Republic of Korea)10 found insomnia in one-third of patients with diabetes type 2.

The group from Romania (A. Ciobanu and colleagues)11 created a meta-analysis of the medical literature showing an association of diabetes type 2 with Alzheimer’s disease. They highlighted the role of insulin signaling in cognition and proposed glucose blood level control as a therapeutic approach in Alzheimer’s disease.

 

Thus, a lot of studies were recently done on the role of nutrition in psychiatric disorders development and therapy. However, there is still room for future discoveries!

REFERENCES:
From 19th WPA World Congress of Psychiatry proceedings:

  1. Sanchez-Villegas, B. Cabrera-Suárez, M. Santos Burguete, P. Molero, A. González-Pinto, C. Chiclana, J. Hernández-Fleta. INTERVENTION WITH MEDITERRANEAN DIET IN THE IMPROVEMENT OF DEPRESSIVE SYMPTOMS IN PATIENTS RECOVERED FROM DEPRESSIVE DISORDER. PREDI-DEP TRIAL PRELIMINARY RESULTS;
  2. Jesus, C. Cagigal, T. Silva, V. Martins, C. Silva. DIETARY PATTERNS AND THEIR INFLUENCE IN DEPRESSION;
  3. Veniaminova, A. Gorlova, J. Hebert, D. Radford-Smith, R. Cespuglio, A. Schmitt-Boehrer, K. Lesch, D. Anthony, T. Strekalova. THE ROLE OF GENETIC SEROTONIN TRANSPORTER DEFICIENCY IN CONSEQUENCES OF EXPOSURE TO THE WESTERN DIET: A STUDY IN MICE;
  4. Okasha, W. Sabry, M. Hashim, A. Abdelrahman. VITAMIN D SERUM LEVEL AND ITS CORRELATION WITH MAJOR DEPRESSIVE DISORDER AND SCHIZOPHRENIA;
  5. Hansen, M. Pareek, A. Hvolby, A. Schmedes, T. Toft, E. Dahl, C. Nielsen7, P. Schulz8. VITAMIN D3 SUPPLEMENTATION AND TREATMENT OUTCOMES IN PATIENTS WITH DEPRESSION;
  6. Avelar, D. Guedes, J. Velosa, F. Passos, A. Delgado, A. Corbal Luengo, M. Heitor. VITAMIN D AND MENTAL HEALTH: A BRIEF REVIEW;
  7. Watanabe, K. Mikami, K. Keitaro, F. Akama, Y. Aiba, K. Yamamoto, H. Matsumoto. INFLUENCE OF COMMENSAL MICROBIOTA ON AGGRESSIVE BEHAVIORS;
  8. Dias, I. Figueiredo, F. Ferreira, F. Viegas, C. Cativo, J. Pedro, T. Ferreira, N. Santos, T. Maia. EMOTIONAL GUT: THE RELATION BETWEEN GUT MICROBIOME AND MENTAL HEALTH;
  9. Mhalla, M. Jabeur, H. Mhalla, C. Amrouche, H. Ounaissa, F. Zaafrane3, L. Gaha. DEPRESSION IN ADULTS WITH TYPE 2 DIABETES: PREVALENCE AND ASSOCIATED FACTORS;
  10. Kim. FACTORS RELATED TO INSOMNIA IN TYPE 2 DIABETICS;
  11. A. Ciobanu, L. Catrinescu2, C. Neagu3, I. Dumitru3. THE CONNECTION BETWEEN ALZHEIMER’S DISEASE AND DIABETES

 

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The prevalence of overweight and obesity has increased worldwide and is affecting millions of adults and children 1. The development of obesity is complex with factors like genetics, individual metabolism, dietary and physical activity choices, food and water availability, education and culture, playing a role 2. Several genome wide association studies have revealed an association between obesity and the gene encoding the transcription factor AP-2 beta (TFAP2B) 3,4. TFAP2B plays an important role during early stages of pregnancy in the development of different parts of the nervous system5. It has been demonstrated that overexpression of TFAP2B in fat cells causes a decrease in the production and release of adiponectin, a protein hormone which is involved in glucose metabolism6, and a diminished response to insulin7. But how does TFAP2B contribute to the development of obesity?

We have now shown in our ECPBHS study a very clear association between one TFAP2B variation (intron 2 VNTR) and measures of obesity and insulin resistance. Our findings have just recently published in the International Journal of Obesity8.

We found that men, who inherited the same variant of that gene from both parents (called 5/5 homozygotes), had significantly higher body weight, body mass index, proportion of body fat and insulin resistance, throughout adolescence to young adulthood. Strikingly, women that were 5/5 homozygotes had the same effects, but these appeared later, in young adulthood.

We hypothesized that the people who are TFAP2B 5/5 homozygotes have a higher risk of obesity because they consume more food. But we found the opposite: by age 25 male 5/5 homozygotes had smaller daily calorie intake and consumption of fats and carbohydrates. In females, these differences in caloric and macronutrient intake, were not observed. We therefor think that the risk is not related to increased food intake, but to differences in metabolism.

In conclusion, the gene TFAP2B increases the risk of obesity, abdominal obesity and insulin resistance in this sample, and is probably related to differences in metabolism. We should consider implementing lifestyle interventions already in childhood for individuals who are 5/5 homozygotes, to reduce the effect of TFAP2B on body weight. The physiological role of TFAP2B in body weight regulation and insulin resistance still needs further research.

REFERENCES:

  1. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017; 377: 13-27. doi:10.1056/NEJMoa1614362
  2. Lee BY, Bartsch SM, Mui Y, Haidari LA, Spiker ML, Gittelsohn J. A systems approach to obesity. Nutr Rev. 2017; 75: 94-106. doi:10.1093/nutrit/nuw049
  3. Locke AE, Kahali B, Berndt SI, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015; 518: 197-206. doi:10.1038/nature14177
  4. Felix JF, Bradfield JP, Monnereau C, et al. Genome-wide association analysis identifies three new susceptibility loci for childhood body mass index. Hum Mol Genet. 2016; 25: 389-403. doi:10.1093/hmg/ddv472
  5. Moser M, Rüschoff J, Buettner R. Comparative analysis of AP-2α and AP-2β gene expression during murine embryogenesis. Developmental Dynamics. 1997; 208: 115-124. doi:10.1002/(SICI)1097-0177(199701)208:1<115::AID-AJA11>3.0.CO;2-5
  6. Ikeda K, Maegawa H, Ugi S, et al. Transcription factor activating enhancer-binding protein-2beta. A negative regulator of adiponectin gene expression. J Biol Chem. 2006; 281: 31245-31253. doi:10.1074/jbc.M605132200
  7. Tao Y, Maegawa H, Ugi S, et al. The transcription factor AP-2beta causes cell enlargement and insulin resistance in 3T3-L1 adipocytes. Endocrinology. 2006; 147: 1685-1696. doi:10.1210/en.2005-1304
  8. Joost U, Villa I, Comasco E, Oreland L, Veidebaum T, Harro J. Association between Transcription Factor AP-2B genotype, obesity, insulin resistance and dietary intake in a longitudinal birth cohort study. Int J Obes [in press]. doi:10.1038/s41366-019-0396-y
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Mens sana in corpore sano – healthy mind and healthy body

Food insecurity – defined as an individual or household lacking access to sufficient, safe, and nutritious food that meets individuals’ dietary needs – has been linked to children’s behavioral, academic, and emotional problems and an increased risk of the development of mental health disorders [1, 2].

In a Canadian study on food insecurity in young children, researchers found that children from food-insecure families were disproportionately likely to experience persistent symptoms of hyperactivity and inattention. These results were still true after controlling for immigrant status, family structure, maternal age at child’s birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting [3].

Accordingly, a systematic review on food insecurity and attention-deficit hyperactivity disorder (ADHD) symptoms in children reported a predictive and inverse relationship between the two, with possible lasting impacts into adulthood. Authors concluded that evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children [4].

In 2017 Dr. Raju, President of the Indian Psychiatric Society concluded in a speech on medical nutrition in mental health and disorders that there is growing evidence for a relationship between quality of diet and mental health. According to Raju, the importance of nutrients as important agents for prevention, treatment, or augmentation of treatment for mental disorders has been established. “Empathic interactions and rational nutrition along with specific pharmacological and physical interventions could form an ideal and humane patient-friendly package in psychiatric practice” [5].

Therefore, identifying families in risk of food insecurity and getting children and adolescents the best possible food supply could result in fewer children with ADHD symptoms.

REFERENCES:

  1. Althoff, R.R., M. Ametti, and F. Bertmann, The role of food insecurity in developmental psychopathology. Prev Med, 2016. 92: p. 106-109.
  2. Shankar, P., R. Chung, and D.A. Frank, Association of Food Insecurity with Children’s Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr, 2017. 38(2): p. 135-150.
  3. Melchior, M., et al., Food insecurity and children’s mental health: a prospective birth cohort study. PLoS One, 2012. 7(12): p. e52615.
  4. Lu, S., et al., The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature. Nutrients, 2019. 11(3).
  5. Raju, M., Medical nutrition in mental health and disorders. Indian J Psychiatry, 2017. 59(2): p. 143-148.
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Neurodevelopmental disorders such as attention deficit disorder (ADHD), autism spectrum disorder (ASS) and different types of anxiety disorders are associated with a higher risk of poor dietary, physical activity and sleep habits. Shaping behavior in children with neurodevelopmental symptoms can be challenging. How do parents experience shaping healthy habits in these children? What are tips and tricks to encourage your child to live healthy? We took together the results of a recent study conducted in Boston and our own results from a qualitative interview with parents of children that followed the TRACE-diet to help you encourage your child to be healthy.

What is hard?
For parents of children with a neurodevelopmental disorder (ND) it can be challenging to convince their children to make healthy choices. Some parents explain that taking an unhealthy option from a neurotypical child might also lead to an anger meltdown, but this meltdown is not comparable with a ND meltdown, which can last the whole day. Furthermore, children with ND can be more impulsive, which makes it harder for them to think before they choose. Other children with ND are resistant to change, and/or lack intrinsic motivation to change. The parents that tried taking their child to a health professional, reported a lack of clinical expertise among lifestyle experts to level with children with a neurodevelopmental disorder.

What is helpful?
Agency
Both studies found that allowing your kid agency in making choices is critical to create a healthy habit. It is important to limit the choices, otherwise your child will drown in options. Offer, for instance, a healthy snack and an unhealthy snack and let your child decide whether he/she wants the healthy snack now, or later.

Family engagement
Work as a team! This was a helpful strategy that was reported by most parents in the TRACE study. If you follow the diet with the whole family, the child does not feel left out or punished. Also, just not having snacks at home prevents your child from sneaking into the cabinet and taking one.

Positive reinforcement
It is important to define a goal together with your child. What are we working for? And for how long? You can help your child visualize this goal by making a calendar. Will your child only be rewarded at the end of the goal? Or are there also smaller sub-goals? For some children, a long-term goal such as “sleeping better” or “less belly pains” will be rewarding enough, but other children might need short-term goals.

The role of pets
In the Boston study, almost one-third of the parents reported that they used the role of pets to promote healthy habits. Animals can be used as a positive reinforcement for good choices, but they can also help to maintain healthy routines such as physical activity (walking the dog) and family engagement (walking the dog with the whole family).

 

REFERENCES

  1. Bowling, A. Blaine, R.E., Kaur, R., Davison, K.R. (2019). Shaping healthy habits in children with neurodevelopmental and mental health disorders: parent perceptions of barriers, facilitators and promising strategies. International Journal of Behavioral Nutrition and Physical Activity. 16:52.
  2. TRACE-study. For more information visit project-trace.nl
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Probably the best known example on how the brain and mental health are linked to nutrition and our gut, and the one that we can all identify ourselves with, is stress. We all know it: studying 24/7 for an important exam, pressure in the job or even a house full of work. We have no time to think and – no – we definitely don’t have time to cook. But at the same time we are constantly hungry, craving for a snack. The fastest solution? The next best, nicest looking, edible piece of food we can find.

But why do we change our dietary habits during stress and what happens in our body? What are the consequences and what can we do to avoid this impulsive eating behavior?

A study from Yau and Potenza in 2013 states that about 20% of the population do not change their eating behavior during stress (good for them), while about 40% decrease and another 40% increase their caloric intake. But besides simply increasing the amount of food we consume, we also tend to choose more pleasurable and palatable food when we’re stressed. This usually leads to the consumption of unhealthy and calorie-dense foods, which unfortunately results in gaining weight (at least for most of us).

Stress can have many different causes, ranging from physical stressors like severe illnesses to emotional stressors such as the loss of a loved one. So far, it is known that acute and severe stressors tend to suppress appetite, which results from our evolutionary conserved ‘fight-or-flight’ reaction (Adams und Epel, 2007). On the other hand, lighter – but therefore often chronic – stressors (occurring on a daily basis) seem to increase our appetite, especially towards energy-dense foods. These two roughly categorized types of stress activate two different systems in our body, causing different stress responses:

  • Acute stressors activate the sympathetic adrenal medullary system
  • Chronic stressors activate the hypothalamic-pituitary-adrenal [HPA] axis (Torres & Nowson, 2007)

The sympathetic adrenal medullary system induces the release of adrenaline and noradrenaline. These are the ones increasing our heart rate right before we have to give a talk in front of a huge audience, while they, at the same time, reduce our drive to eat or even make us want to throw up… On the opposite side, the HPA-axis, activated by daily stressors, leads to the release of cortisol. And, cortisol can have some unwanted effects.

This hormone is known to stimulate our appetite by affecting our reward system, in a very similar way as alcohol and drugs affect this system. In the case of chronic stress, chocolate or chips can have the same effects as drugs: they make us feel better for a short amount of time. This “positive” feeling, that might reduce our stress level for a few moments, reinforces the consumption of sweets later on, thereby resulting in some kind of dependence. But as in all cases of addictions, this repeated stimulation of the reward system can lead to an adaptation, eventually increasing this compulsive behavior.

Knowing now that in some strange ways it is our body that makes us crave burgers and pizza in times of stress, what can we do to avoid gaining weight?

Well, the first thing is: listen to your body and try to understand what is going on. Ask yourself why you are stressed and if there is anything you can do to reduce it, like taking more breaks during the day. If this is not possible, try to find other ways to compensate: take walks, do more exercise, find something else that makes you feel better at the end of the day, besides that tasty chocolate donut and popcorn. Before snacking, hesitate and ask yourself if you are really hungry or just eating because you feel like it. And if you absolutely can’t resist, try to substitute the chocolate bar with healthier snacks, like dried fruits or nuts.

But finally, keeping all that in mind, don’t forget that food is not always your enemy and there is no problem with eating what you desire as long as it is in moderation.

REFERENCES:
Yau, Yvonne H. C.; Potenza, Marc N. (2013). Stress and Eating Behaviors. Minerva Endocrinol, 38(3): 255–267. Link: https://www.ncbi.nlm.nih.gov/pubmed/24126546

Adam, Tanja C.; Epel, Elissa S. (2007). Stress, eating and the reward system. Physiology & Behavior 91, 449–458. DOI: 10.1016/j.physbeh.2007.04.011

Torres, Susan J.; Nowson, Caryl A. (2007). Relationship between stress, eating behavior, and obesity. Nutrition Volume 23, Issues 11–12, Pages 887-894. DOI: 10.1016/j.nut.2007.08.008

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MoBa is short for The Norwegian Mother and Child Cohort Study which is a large pregnancy observational study. During the years 1999-2008 pregnant women in Norway were recruited to the study. The study is conducted by the Norwegian Institute of Public Health. Questionnaires regarding health, diet and environment were sent out to the women during and after pregnancy. Women are sent regular follow-up questionnaires. As the child grows up, the child also completes questionnaires. In addition, the fathers were invited to participate with a questionnaire when their partner was pregnant. Biological samples were also collected from the mother, father and child. Today there are 114 500 children, 95 000 mothers and 75 000 fathers participating in the study.

https://www.fhi.no/en/studies/moba/

The study was set up to gain knowledge about the causes behind serious disease. The study is unique because it gathers information from fetal (in vitro) life and follows the offspring into adulthood. In this manner it is possible to look at early influences and later disease. The study is prospective, which means that information about mothers, fathers and their offspring is registered before a disease has manifested itself. With this design, women are asked questions several times during her pregnancy and do not have to try to remember what she did when looking back at her pregnancy.

MoBa is population-based and became nationwide with 50 participating hospitals in Norway. For more information on the many publications based on MoBa data, visit this link:

https://www.fhi.no/en/studies/moba/for-forskere-artikler/publications/

The participating women in MoBa also filled in a questionnaire about eating habits before and during pregnancy.

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Why do some people have a higher craving for carbohydrate-rich and junk-food than others? Why are weight-loss programs more effective in some individuals than others? And why are some people more physically active?

The dopamine system in the brain plays an important role in regulating how much you eat and whether or not you gain weight. When this system does not function optimally, people have a higher craving for junk-food, lower physical activity, and unsuccessful body weight control.

There are two mechanisms that determine food-related behaviour.

The more direct, homeostatic, mechanism constantly surveys the body’s energetic needs and holds them actively in balance. That is homeo-stasis.

The second non-homeostatic mechanism determines the way humans, and other animals, react to food: how willingly and often they will consume it again, and whether they feel anticipation or craving for it.

These behaviours are both largely regulated by the neurotransmitter dopamine, a chemical that conveys information in the brain. Once released by one nerve cell it binds to a receptor, a large molecule on the surface of the adjacent nerve cell, thus changing its functioning. A major component in eating-related behaviour is the dopaminergic D2 receptor (DRD2) that is most abundantly localized in striatum, a brain region activated by food anticipation and consumption1.

The function of the dopaminergic system affects eating and weight-related problems in four ways.

First, in some people, the dopamine system reacts more vigorously in response to food.

Second, this response leads to increased eating and possibly obesity.

Third, overeating and obesity lead to less efficient dopaminergic signaling.

Fourth, this lower dopaminergic signal needs to be compensated by more intense behaviour e.g., more eating2.

For example, in people with lower levels of dopamine D2 receptor, cravings for carbohydrate-rich food and junk-food are more prevalent3,4.

Besides eating-related behaviour, dopamine also affects health/obesity via voluntary physical activity, creating a vicious circle: obesity leads to weaker dopaminergic signal, especially lower levels of DRD2 receptor, and this, in turn, leads to decreased exercise and motivation for physical activity5–7.

Furthermore, individuals with lower levels of DRD2 receptors may benefit less from long-term weight loss programs and are less effective in weight maintenance8,9. Thus, dopamine affects body weight via choice of foods, physical activity, and body weight reduction efficacy. Despite the reasons for food-cravings, part of the solution is acknowledging and managing these impulses. Conscious action towards weight-reduction will lead to less pronounced food-cravings, which in turn leads to favourable solution of weight related problems10.

REFERENCES
1. Wise, R.A. Philos Trans R Soc Lond B Biol Sci 361, 1149–1158 (2006).
2. Alonso-Alonso, M. et al. Nutrition reviews 73, 296–307 (2015).
3. Lek, F.-Y., Ong, H.-H. & Say, Y.-H. Asia Pac J Clin Nutr 27, 707–717 (2018).
4. Yeh, J. et al. Asia Pac J Clin Nutr 25, 424–429 (2016).
5. Kravitz, A.V., O’Neal, T.J. & Friend, D.M. Front Hum Neurosci 10, 514–514 (2016).
6. Matikainen-Ankney, B.A. & Kravitz, A.V. Ann N Y Acad Sci 1428, 221–239 (2018).
7. Ruegsegger, G.N. & Booth, F.W. Front Endocrinol 8, 109–109 (2017).
8. Roth, C.L., Hinney, A., Schur, E.A., Elfers, C.T. & Reinehr, T. BMC Pediatr 13, 197–197 (2013).
9. Winkler, J.K. et al. Nutrition 28, 996–1001 (2012).
10. Smithson, E.F. & Hill, A.J. Eur J Clin Nutr 71, 625 (2016).

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