Brain systems and behaviors underlying response to obesity treatment in children

儿童肥胖治疗反应的大脑系统和行为

• 批准号: 9318510
• 负责人: Christian Ludwig Roth
• 金额: $ 51.59万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9318510
• 关键词: Address; Adult; Aftercare; Amygdaloid structure; Appetite Regulation; Attenuated; Behavior; Behavior Therapy; Behavioral; Body Weight decreased; Brain; Brain region; Calories; Child; Childhood; Clinical; Cognitive; Cues; Data; Development; Eating; Eating Behavior; Epidemic; Exercise; Exhibits; Failure; Family; Fatty acid glycerol esters; Food; Functional Magnetic Resonance Imaging; Future; Gold; Health; High Prevalence; Hormonal; Hyperphagia; Image; Impairment; Impulsivity; Individual; Intervention; Link; Maintenance; Measures; Medial; Mediating; Mediator of activation protein; Motivation; Neuraxis; Neurobiology; Non obese; Nucleus Accumbens; Obesity; Outcome; Palate; Parents; Participant; Patient Self-Report; Perception; Pharmacology; Physiological; Predictive Factor; Procedures; Process; Proxy; Research; Resistance; Rewards; Satiation; Satiety Response; Self-control as a personality trait; Social Desirability; System; Testing; Thinness; Translating; Treatment outcome; Visual; Weight; Weight Gain; Weight maintenance regimen; Withholding Treatment; aged; base; behavior measurement; behavior test; cognitive control; cognitive testing; cost; evidence base; experience; food consumption; frontal lobe; improved; improved outcome; insight; interest; lifestyle factors; lifestyle intervention; neuroimaging; obesity in children; obesity treatment; outcome prediction; public health relevance; response; success; theories; treatment response; weight maintenance; Address; Adult; Aftercare; Amygdaloid structure; Appetite Regulation; Attenuated; Behavior; Behavior Therapy; Behavioral; Body Weight decreased; Brain; Brain region; Calories; Child; Childhood; Clinical; Cognitive; Cues; Data; Development; Eating; Eating Behavior; Epidemic; Exercise; Exhibits; Failure; Family; Fatty acid glycerol esters; Food; Functional Magnetic Resonance Imaging; Future; Gold; Health; High Prevalence; Hormonal; Hyperphagia; Image; Impairment; Impulsivity; Individual; Intervention; Link; Maintenance; Measures; Medial; Mediating; Mediator of activation protein; Motivation; Neuraxis; Neurobiology; Non obese; Nucleus Accumbens; Obesity; Outcome; Palate; Parents; Participant; Patient Self-Report; Perception; Pharmacology; Physiological; Predictive Factor; Procedures; Process; Proxy; Research; Resistance; Rewards; Satiation; Satiety Response; Self-control as a personality trait; Social Desirability; System; Testing; Thinness; Translating; Treatment outcome; Visual; Weight; Weight Gain; Weight maintenance regimen; Withholding Treatment; aged; base; behavior measurement; behavior test; cognitive control; cognitive testing; cost; evidence base; experience; food consumption; frontal lobe; improved; improved outcome; insight; interest; lifestyle factors; lifestyle intervention; neuroimaging; obesity in children; obesity treatment; outcome prediction; public health relevance; response; success; theories; treatment response; weight maintenance

DESCRIPTION (provided by applicant): The high prevalence of childhood obesity in the U.S. demands a better understanding of factors that drive weight gain and influence the outcome of pediatric obesity interventions. This project investigates the hypothesis that, as in adults, a subset of obese children experience a diminished satiety response to food consumption, and that these children are more resistant to gold standard family-based behavioral treatment (FBT) for obesity. FBT is targeted almost exclusively toward parents; however, there is evidence that obesity development and response to intervention may depend on additional factors such as individual internal satiety perception and variability in the function of brain centers associated with impulsivity and reward. The proposed research uses functional magnetic resonance imaging (fMRI) to characterize brain function related to satiety and examines fMRI along with behavioral, cognitive, and hormonal testing to fully examine potential mediators of children's experience of satiety and response to FBT. The approach is based on evidence that failure to attenuate the reward value of palatable foods after eating can be a manifestation of a blunted central satiety response that is reliably detected using fMRI. Key objectives will be to determine if differences in the central satiety response exist between obese and non-obese children, and, among obese children, if the strength of the central satiety response is associated with impulsivity and/or the success of obesity treatment. The central hypothesis is that, in obese children, a blunted central nervous system satiety response impairs the success of obesity interventions. To achieve study objectives, brain activation by high-calorie visual food cues before and after food consumption will be measured by fMRI. Participants will be obese and non-obese children aged 9-11 years. The 49 obese children will be evaluated before and after they participate in a 6-month evidence-based FBT intervention. Their pre-intervention fMRI will be compared to those of 20 non-obese controls to test for a blunted central satiety response (Aim 1). The relationship of impulsivity to satiety responses and food intake will be determined in obese children (Aim 2). The longitudinal component tests whether central satiety responses prior to treatment predict treatment outcomes (Aim 3A) and whether changes in central satiety responses during treatment predict maintenance of reduced weight 6 and 12 months after treatment cessation (Aim 3B). Behavioral, cognitive, and hormonal measures will be examined as potential mediating or confounding factors contributing to fMRI responses. The proposed research is guided by an integrated, transdisciplinary team with expertise in pediatric and adult neuroimaging, appetite regulation, and family-based childhood obesity treatment. This research will provide new insights into the neurobiological basis of child obesity and the relevance of neurobiological factors to treatment success. The long-term objective is to translate these findings to improve obesity interventions cost-effectively and sustain better long-term results.

描述（由申请人提供）：美国儿童肥胖症的高流行率要求更好地理解能够增加体重增加并影响小儿肥胖干预效果的因素。该项目调查了以下假设：与成年人一样，肥胖儿童的一部分对食物消费的反应减少了，并且这些儿童对肥胖症的基于黄金标准的基于家庭的行为治疗（FBT）更具抵抗力。 FBT几乎完全针对父母。但是，有证据表明，肥胖的发展和对干预的反应可能取决于其他因素，例如个人内部饱腹感和与冲​​动性和奖励相关的大脑中心功能的可变性。拟议的研究使用功能性磁共振成像（fMRI）来表征与饱腹感相关的大脑功能，并检查fMRI以及行为，认知和激素测试，以充分检查儿童饱腹感和对FBT反应的潜在介体。该方法是基于证据表明，进食后未能减弱可口食品的奖励价值，这表明使用fMRI可靠地检测到钝性的中心饱腹感反应。关键目标将是确定肥胖儿童和非肥胖儿童之间的中心饱腹感反应差异是否存在，并且在肥胖儿童中，如果中心饱腹感反应的力量与冲动性和/或肥胖治疗的成功有关。中心假设是，在肥胖儿童中，中枢神经系统的饱腹感反应会损害肥胖干预的成功。为了实现研究目标，fMRI将测量食物消耗前后的高热量视觉食品提示的大脑激活。参与者将是9-11岁的肥胖和非肥胖儿童。在参加6个月基于证据的FBT干预措施之前和之后，将对49名肥胖儿童进行评估。他们的干预前fMRI将与20种非肥胖对照的功能磁共振成像进行比较，以测试钝性的中心饱腹感反应（AIM 1）。冲动与饱腹感和食物摄入的关系将在肥胖儿童中确定（AIM 2）。纵向成分测试治疗前的中心饱腹感反应是否预测治疗结果（AIM 3A），以及治疗过程中中心饱腹感反应的变化是否可以预测治疗停止后6和12个月的体重减轻（AIM 3B）。行为，认知和激素措施将被检查为导致fMRI反应的潜在介导或混杂因素。拟议的研究由一支综合的跨学科团队指导，在儿科和成人神经影像，食欲调节和基于家庭的儿童肥胖症治疗方面具有专业知识。这项研究将为儿童肥胖的神经生物学基础以及神经生物学因素与治疗成功的相关性提供新的见解。长期目标是将这些发现转化以成本效率改善肥胖干预措施，并维持更好的长期结果。