Restricted Food Intake Research Articles

Parental Attitudes and Behaviors Associated with Selective Eating in Children with Autism Spectrum Disorders

Although sometimes it appears as a natural behavior in children, selective eating can become problematic and severe, implying aliments rejection, a low range of eaten foods, the predominance of some foods in the child’s repertoire, aversion and avoidance of various food based on look, taste, texture, or smell. Consequences of selective eating can be noticed on health and development, interactions and inclusion in social settings, emotional and behavioral problems, low self-esteem, distress, and other family problems. In children with autism spectrum disorders (ASD), it can be associated with sensory processing disorder, mood disorders, and health problems, and can become severe (eg., avoidant restrictive food intake disorder). Parental attitudes and behaviors, family dynamics during mealtimes, the emotional climate of the family, social support, and cultural and social factors have a significant impact on the problem. A case example of a 13-year-old child, diagnosed with severe autism spectrum disorder and intellectual disability, with selective eating (a low variety of foods in his menu, food refusal, and behavioral interference during mealtimes) and a tendency towards overweight will show the co-occurrence of selective eating and parental problematic behaviors. The child’s sensory profile (reported by the parent) revealed no differences from the norms. Parental tendency to overly gratify the child’s behavior, excessive worrying, and excessive assistance were associated with the child’s tendency to eat selectively, as well as to his preference for unhealthy foods and refusal of healthy ones. The attachment between mother and child seems to be anxious and there is a high degree of fusion in the relationship. Intervention for the eating problems can include attachment-based therapies, systemic family therapy, cognitive-behavioral therapies, and training of parenting skills.

Ngā Māuiui Kai: creating Indigenous Māori terms for eating disorders in Aotearoa New Zealand

BackgroundMāori (the Indigenous people of Aotearoa New Zealand) report higher rates of eating disorders than non-Māori, but access treatment at lower rates. Diagnostic terms lacking in cultural relevance likely contribute to Māori exclusion in eating disorder spaces. Developing terms in te reo Māori (the Māori language) presents an opportunity to challenge eating disorder stereotypes and increase cultural safety in the eating disorder workforce.MethodologyGuided by a Māori worldview and the practice of wānanga (to meet, discuss, and think deeply about a topic), we present a Māori language glossary for eating disorders. The glossary is informed by expertise in te reo Māori, mātauranga Māori (the body of Māori knowledge), and eating disorders, and combines terms already in use with newly developed terms.ResultsWe propose an umbrella term for eating disorders (ngā māuiui kai), as well as terms for anorexia nervosa (māuiui whakatiki), bulimia nervosa (pukuruaki), binge eating disorder (māuiui kaihoro), and avoidant restrictive food intake disorder (karo kai, with three subtypes of low interest [arokore kai], sensory-based avoidance [āmaimai rongo kai], and concern about the consequences of eating [wehi-ā-kai]). We also propose terms for related concepts of body image difficulties (māuiui whakawā ata), perfectionism (māuiui kōtihitihi) and emotion dysregulation (kare-a-roto kōtitititi).ConclusionThis glossary is available for use by anyone looking for terms that come from a mana-enhancing (empowering, respectful, and strengths-based) Māori worldview. The kupu (words, terms) in this glossary are offered as possibilities for use, rather than as definitive or correct, in the hopes they will promote discussion about stigma, indigeneity, and language in the eating disorders field.

A US-Based Consensus on Diagnostic Overlap andDistinction for Pediatric Feeding Disorder andAvoidant/Restrictive Food Intake Disorder.

As diagnoses covering dysfunctional feeding and eating in pediatrics, avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) contain inherent areas of overlap in their diagnostic criteria. Areas of overlap include criteria regarding nutritional consequences associated with feeding/eating dysfunction and shared emphasis on possible psychosocial impairment associated with restricted food intake. Complicating the differential diagnosis process is a lack of guidance regarding when the two conditions occur independently, co-qualify, and/or transition into the other. Feeding Matters' Research Initiatives Task Force planned and hosted a PFD-ARFID consensus meeting, with the aim of reaching a consensus regarding diagnostic clarity on PFD and ARFID. Criteria for participation focused on US residents who either: (a) served as an author on the ARFID workgroup or PFD consensus papers, or (b) provided community representation via board or committee roles. The consensus process followed three stages: prework, the meeting, and post-work/writing. Twelve participants were present for the meeting, with 14 involved in pre- and post-work/writing. The final panel included four psychologists representing the ARFID community and seven multidisciplinary members representing PFD's four domains (medical, nutrition, skill, and psychosocial) plus a Zero-to-Three community representative and two representatives from Feeding Matters. Results yielded 10 consensus statements and visuals to support the consensus statements. The consensus process and results underscore an ongoing need to improve diagnostic systems and reinforce calls for strengthening healthcare expertise for both PFD and ARFID. Community-based participatory research is recommended to advance both diagnoses and reduce ambiguity in practice settings.

Neural correlates of children with avoidant restrictive food intake disorder symptoms: large-scale neuroanatomical analysis of a paediatric population.

Avoidant restrictive food intake disorder (ARFID) is a recently recognised feeding and eating disorder and is characterised by a lack of interest and motivation to eat. Despite burgeoning research, few studies to date have explored the underlying neurobiology of ARFID. Research examining the neural underpinnings of ARFID can greatly assist in understanding different mechanisms that play disorder-specific roles. We studied a total of 1,977 10-year-old participants from the Generation R Study, a population-based Dutch cohort, to cross-sectionally examine neuroanatomical differences between those with versus without ARFID-like symptoms. Children were classified with versus without ARFID symptoms using the ARFID Index, a validated evaluative tool comprised of parent-reported and researcher-assessed measurements of picky eating, energy intake, diet quality, growth and psychosocial impact to characterise ARFID symptoms in the paediatric population. Global and regional values of surface area, cortical thickness, and volume from T1-weighted structural magnetic resonance imaging (MRI) scans in those with ARFID symptoms were compared with children not exhibiting symptoms. We identified 121 (6.1%) individuals with ARFID symptoms relative to 1,865 (93.9%) individuals without ARFID symptoms. Neuroanatomical findings identified significantly greater frontal (p = .00743; d = 0.21) and superior frontal (p = 6.56E-04; d = 0.28) cortical thickness among children with ARFID symptoms. This first large-scale study of the neural correlates of ARFID identified greater thickness of frontal cortical regions in children with ARFID symptoms, suggesting a role for executive function in the aetiology of the condition.

Confusion between avoidant restrictive food intake disorder, restricted intake self-harm, and anorexia nervosa: developing a primary care decision tree.

Confusion between avoidant restrictive food intake disorder, restricted intake self-harm, and anorexia nervosa: developing a primary care decision tree.

Eating- and Weight-Related Disorders in the Armed Forces.

Like in the general population, the prevalences of eating- and weight-related health issues in the armed forces are increasing. Relevant medical conditions include the eating disorders (EDs) anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder (ARFID), as well as body dysmorphic disorder, muscle dysmorphia, and the relative energy deficiency in sport (RED-S) syndrome. We performed a narrative literature review on eating- and weight-related disorders in the armed forces. Entry standards might exclude people with obesity, with EDs, or at high risk for EDs from entering the armed forces for military reasons and to protect the individual's health. Relevant potential risk factors of eating- and weight-related disorders in the military are the emphasis on appearance and fitness in the military, high levels of stress, military sexual trauma, post-traumatic stress disorder, deployment, relocation, long commutes, consumption of ultra-processed foods and beverages, limitations on food selection and physical exercise, and intensive combat training and field exercises. Eating- and weight-related disorders negatively impact professional military appearance and lead to problems with cardiorespiratory and neuromuscular fitness; daytime sleepiness; and a higher risk of musculoskeletal injuries, and other physical and mental health problems. Current and potential future therapeutic options include occupational health measures, psychosocial therapies, neuromodulation, and drug treatments. Even though randomized controlled trials (RCTs) have been performed to test treatments for obesity in the armed forces, RCTs for the treatment of EDs, body dysmorphic disorder, muscle dysmorphia, and RED-S syndrome are lacking in the military context.

Impact of daily fasting duration on body composition and cardiometabolic risk factors during a time-restricted eating protocol: a randomized controlled trial

BackgroundTime-restricted eating (TRE) is a dietary regimen that limits food intake for at least 12 h daily. Unlike other fasting protocols, TRE does not dictate what or how much to eat but rather focuses on the timing of meals. This approach has been previously demonstrated to improve body composition in individuals with obesity or metabolic impairments. However, its impact on body composition and cardiometabolic factors in healthy individuals remains unclear. Furthermore, the optimal fasting duration is still debated. Thus, we aimed to compare the effects of 8 weeks of different fasting durations on body composition and biochemical parameters in metabolically healthy, non-trained individuals using a parallel randomized controlled trial.MethodsForty-one volunteers were randomly assigned to one of the four experimental groups: TRE 16:8 (16 h of fasting,8 h of eating), TRE 14:10 (14 h of fasting,10 h of eating), TRE 12:12 (12 h of fasting,12 h of eating) or a normal diet group (ND; no dietary restriction). Participants underwent body composition measurements and blood tests for lipid profiles (i.e., total cholesterol, LDL, HDL, and triglycerides), fasting glucose, leptin, and anabolic hormones (i.e., insulin and testosterone) levels. Data were analyzed using both intention-to-treat (ITT) and per-protocol (PP) analysis to account for compliance. A two-way ANOVA for repeated measures was employed to assess interactions between time and group.ResultsIn the ITT analysis, TRE 16:8 reduced body mass (-2.46%, p = 0.003) and absolute fat mass (-8.65%, p = 0.001) with no changes in lean soft tissue and in calorie intake. These results were consistent with the PP analysis which included 8 participants in TRE 16:8, 5 in TRE 14:10, 9 in TRE 12:12, and the entire ND group. Participants in the TRE 16:8 group spontaneously reduced their total caloric intake, although this reduction was not statistically significant. None of the other measurements significantly changed after 8 weeks.ConclusionsOur results suggest that a 16-hour fasting window, even without caloric restriction, may be a viable strategy for improving body composition in healthy and non-trained individuals, whereas a shorter fasting period may be insufficient to produce significant changes in a healthy population.Trial registrationNCT, NCT04503005. Registered 4 August 2020, https://clinicaltrials.gov/study/NCT04503005.

Should we restrict food intake during labor? A randomized controlled trial.

To evaluate whether consuming food during labor influences its outcomes. This randomized controlled study included healthy, laboring patients at 37-41weeks of gestation. After epidural anesthesia, patients were randomized into groups of eating at will versus drinking clear fluids only. The primary composite outcome included unplanned cesarean delivery, the need for general anesthesia, asphyxia, postpartum fever, and prolonged postpartum admission (more than 5days). Secondary outcomes included the need for oxytocin, length of the second stage of labor, postpartum analgesia requirements, and early maternal and neonatal outcomes. Sample size analysis indicated that 126 patients needed to be randomized to detect a statistically significance difference between the groups. A total of 129 patients were randomized: 58 to the fluids-only group and 71 to the food group. The groups had similar basic characteristics. The composite outcome of complications attributed to eating during labor and delivery was comparable between groups. Labor progression and the need for oxytocin augmentation were similar in both groups. The groups had comparable fetal heart rate tracings, modes of delivery, maternal and neonatal outcomes, and complications. None of the patients in the study experienced aspiration or an indication for general anesthesia. While our data suggest that eating during labor does not adversely affect labor progression or outcomes, we recommend a cautious approach, allowing patients autonomy while considering individual risk factors. The study has been registered in the primary clinical trial registry on 02/12/2023. ISRCTN trial number ISRCTN11794106, registration number 44513. https://www.isrctn.com/ISRCTN11794106 .

Neuroimaging Insights into Brain Mechanisms of Early-onset Restrictive Eating Disorders.

Early-onset restrictive eating disorders (rEO-ED) encompass a heterogeneous group of conditions, including early-onset anorexia nervosa (EO-AN) and avoidant restrictive food intake disorders (ARFID). Almost nothing is known about the consequences of rEO-ED on brain development. We performed the largest comparison of MRI-derived brain features in children and early adolescents (<13 years) with EO-AN (n=124), ARFID (n=50), and typically developing individuals (TD, n=112). Despite similar body mass index (BMI) distributions, EO-AN and ARFID showed divergent structural patterns, suggesting independent brain mechanisms. Half the regional brain measures were correlated with BMI in EO-AN and none in ARFID, indicating a partial mediation of EO-AN signal by BMI. EO-AN was associated with a widespread pattern of thinner cortex, while underweight ARFID patients exhibited smaller surface area and subcortical volumes than TD. Future studies will be required to partition the contribution of low BMI vs. ED mechanisms in neurodevelopmental disorders.

Assessing Fears of Negative Consequences in Children With Symptoms of Avoidant Restrictive Food Intake Disorder.

Fear of Aversive Consequences (FOAC), such as choking or vomiting, is an important associated feature of Avoidant/Restrictive Food Intake Disorder (ARFID). However, the manifestation of FOAC in young children is poorly understood. This study aimed to describe the fears of children with ARFID symptoms and examine the concordance between parent and child ratings of fear. Child-reported FOAC was assessed using an interview designed for children between 6 and 10 years old, the Gustatory Avoidance and Gastrointestinal Stress Symptoms (GAGSS). Parents were administered a semi-structured diagnostic interview regarding their child's symptoms, the Pica, ARFID, and Rumination Interview. Among 68 children with ARFID diagnoses or symptoms (41.2% female, 85.3% White, mean age = 8.2 years, SD = 1.1 years; range 5.2-9.9 years), 91.2% of children endorsed at least one fear relative to 26.5% of parents. Among parent-child dyads, 36.8% disagreed about the child's fear of stomach pain (κ = 0.12) and 48.5% disagreed about the child's fear of vomiting, (κ = 0.08), both indicating low inter-rater reliability. On average, children endorsed 4.3 (SD = 2.3) fears out of 9 options. The most frequently endorsed fears were that food will "taste bad," (n = 43, 63.2%), "make you gag" (n = 37, 54.4%), and "look disgusting" (n = 36, 52.9%). Findings highlight ways in which fear may manifest in children with ARFID that are not easily discernable by adults. Greater precision in depicting childhood fears may facilitate the earlier detection of problematic eating behaviors.

Pediatric Hospital Utilization During Medical Stabilization for Patients With Eating Disorders.

Few studies have examined pediatric hospital utilization across the spectrum of eating disorder (ED) diagnoses among hospitalized patients. We describe sociodemographic and clinical characteristics, hospital utilization, and enteral tube feeding and examine factors associated with hospital utilization among patients with EDs. Using data from the Pediatric Health Information System, we included patients aged 4 to 20 years with primary ED diagnoses hospitalized from 2018 to 2022. We examined sociodemographic factors, length of stay, costs, and enteral tube feeding by ED diagnosis. Adjusted regression models compared hospital utilization by diagnosis, adjusting for sociodemographic and clinical factors. Among N = 10 279 hospitalizations from 49 hospitals, anorexia nervosa (AN) was most common (70.9%), followed by avoidant restrictive food intake disorder (ARFID) (15.6%). Mean age was 15.1 years (SD = 2.5), and most were female (86.6%), of white non-Hispanic race (70.9%), with private insurance (70.1%), with 63.9% occurring after the coronavirus disease 2019 pandemic onset. Median (interquartile range) length of stay was 8.0 days (7.0), and hospital costs were $18 099 ($15 592). A total of 18.8% received enteral tube feeding, with significant hospital variation. In adjusted models, compared with AN, ARFID, binge disorders, and unspecified feeding and ED had shorter stays, whereas hospital costs were lower for binge disorders, and enteral feeding was more likely for ARFID. Our findings indicate long and costly hospitalizations, especially for AN, with implications for hospital and treatment capacity, highlighting the need for earlier diagnosis and treatment to prevent the need for hospitalization.

Nutrition Knowledge and Dietary Adequacy in Powerlifters.

Leonhardt, TPM, Chilibeck, PD, Ko, J, and Zello, GA. Nutrition knowledge and dietary adequacy in powerlifters. J Strength Cond Res 38(11): 1924-1932, 2024-Athletes competing in weight categories (e.g., powerlifters) often restrict food intake approaching competition, which may be detrimental to health and performance. Our purpose was to assess the effect of nutrition knowledge, sex, and time (off-season versus precompetition, when athletes often cut weight) on dietary adequacy in powerlifters. Twenty-three powerlifters (10 females; 30.7 ± 11.2 years) completed questionnaires to assess nutrition knowledge and dietary adequacy. Athletes with higher nutrition knowledge consumed more fruits and nuts and less vitamin B2, B3 across all time points ( p < 0.05) and a greater number (73%) were above the recommended dietary allowance for vitamin D compared with athletes with lower nutrition knowledge (50%) ( p < 0.05). Male powerlifters with higher nutrition knowledge consumed less alcohol and vitamin A than male powerlifters with lower nutrition knowledge ( p < 0.05). Female powerlifters with higher nutrition knowledge consumed less sugar and beverage calories than female powerlifters with lower nutrition knowledge ( p < 0.05). Intake of alcohol and carbohydrate decreased, and meat calories increased from off-season to precompetition ( p < 0.05). Male powerlifters increased B-vitamins, whereas female powerlifters decreased B-vitamin and sugar consumption approaching competition ( p < 0.05). Male powerlifters increased water consumption versus female powerlifters approaching competition (sex × time, p < 0.05). There was no effect of nutrition knowledge on dietary changes approaching competition. Nutrition knowledge, sex, and competitive season affect dietary intake of powerlifters. A higher nutrition knowledge predicts a higher intake of some foods and nutrients important for health and performance. Female powerlifters should pay close attention to the intake of B-vitamins and water before competitions when many are trying to cut weight.

Food choice and neural reward systems in adolescents with anorexia nervosa and atypical anorexia nervosa.

Adolescence is a critical developmental period for the study of anorexia nervosa (AN), an illness characterized by extreme restriction of food intake. The maturation of the reward system during adolescence combined with recent neurobiological models of AN led to the hypothesis that early on in illness, restrictive food choices would be associated with activity in nucleus accumbens reward regions, rather than caudate regions identified among adults with AN. Healthy adolescents (HC, n = 41) and adolescents with AN or atypical AN (atypAN, n = 76) completed a Food Choice Task during fMRI scanning. Selection of high-fat foods and choice-related activation in nucleus accumbens and anterior caudate regions-of-interest (ROIs) were compared between individuals with AN/atypAN and HC. Associations were examined between choice-related activation and choice preferences among the AN group. Exploratory analyses examined associations between choice-related activation and psychological assessments among the patient group. Adolescents with AN or atypAN selected fewer high-fat foods than HC (t = -5.92, p < .001). Counter to predictions, there were no significant group differences in choice-related activation in the ROIs. Among individuals with AN or atypAN, choice-related neural activity in the anterior caudate was significantly negatively associated with high-fat food selections in the task (r = -.32, p = .024). In exploratory analyses, choice-related anterior caudate activation was positively associated with psychological measures of illness severity among patients (p's < .05, uncorrected). In this large cohort of adolescents with AN/atypAN, there was no evidence of altered reward system engagement during food choice. While there was no group difference in choice-related caudate activation, the associations with choices and psychological measures continue to suggest that this neural region is implicated in illness. Longitudinal analyses will clarify whether neural variability relates to longer-term course.

21 Exploring the clinical presentation and health service utilization in autistic children and adolescents diagnosed with avoidant / restrictive food intake disorder: A descriptive study

Abstract Background Avoidant/restrictive food intake disorder (ARFID) is an eating disorder with much clinical variability, negatively impacting growth, nutrition, psychosocial functioning and overall well-being. ARFID is more frequently reported in neurotypical populations than in neurodivergent populations. Little is known about the clinical presentation and healthcare utilization of autistic individuals with ARFID. Objectives The purpose of this study was to understand the clinical presentation, laboratory abnormalities and health system utilization amongst autistic individuals diagnosed with ARFID within the community. Design/Methods We completed a comprehensive multidisciplinary assessment on autistic individuals less than18 years of age who were diagnosed with ARFID by their community physician. Recruitment period: June 2020-June 2021. Results Nineteen autistic individuals completed a comprehensive multidisciplinary assessment; of these, 42.1% (8/19) met criteria for Autism Spectrum Disorder (ASD) severity level 1. The onset of restrictive eating manifested at M(SD)= 2.5 (0.7) years, and the age of ASD diagnosis was 4.2 (3.8) years. Of these, 78.9% (15/19) had the onset of feeding difficulties either prior to or at the time of their ASD diagnosis (Figure 1). Dependence on enteral feeding or nutritional supplements (74%), psychosocial impairment (68%), and nutritional deficiencies (42%) were the criteria commonly met for ARFID. Sensory-based avoidance (100%) and lack of interest in food (89%) were the two most reported potential drivers for the dysfunctional feeding behaviour based on the Pica , ARFID, and Rumination Disorder Interview-AR-Q. Neurodevelopment disorder comorbidities included ADHD (26.3%), Anxiety (21.1%), and Intellectual Developmental Disability (15.8%). Constipation (68.4%) and nutritional deficits (63.15%) were the most common medical comorbidities recorded. Nutritional profile revealed Vitamin D deficit in 50% (8/16), Anaemia 21% (4/19), Vitamin B1 deficit 20% (2/10). Additionally, three participants (17.7%, 3/17) had deficits in Vitamin B12, Zinc, Vitamin C and low ferritin levels. Four autistic individuals (21.1%, 4/19) were hospitalized because of their restrictive eating. 68.4% (13/19) autistic individuals had involvement of at least one allied health professional (OT or SLP or BT). No participants had a prior multidisciplinary feeding assessment or intervention to address restrictive eating. Conclusion ARFID is an eating disorder observed within autistic individuals. Evidence suggests food related sensory sensitivities and lack of interest in food are potential drivers of ARFID in the context of ASD. A comprehensive multidisciplinary assessment is needed to elucidate factors driving restrictive eating to inform targeted evidence-based interventions.

Mapping the global research on feeding and eating disorders and autism spectrum disorder (2014–2023): A bibliometric and network analysis

ObjectiveThis study maps the global research landscape on feeding and eating disorders (FEDs) and autism spectrum disorder (ASD). MethodWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), bibliometrics, and network analyses to assess 199 peer-reviewed articles from the Web of Science Core Collection, published between 2014 and 2023. ResultsThe results show an annual publication increase, especially in the last three years. The Journal of Autism and Developmental Disorders and the European Eating Disorders Review were the main publishers. Anorexia Nervosa, Avoidant Restrictive Food Intake Disorder, food selectivity, mealtime behaviors, parents, children, and females are among the most cited keywords. The main Research Areas were Psychology and Psychiatry, and Pediatrics and Psychology were the most central nodes of the network. The United Kingdom and the United States of America lead in publications and are the most central nodes in the network. King’s College London (KCL) and South London & Maudsley NHS Foundation Trust lead the ranking of organizations, with KCL as the most central node in the network. ConclusionsOur study indicates a growing interest in research related to FEDs and ASD. The global landscape of research produced over the last ten years offers insights for future studies and interinstitutional collaborations.

Avoidant Restrictive Food Intake Disorder: A Case Series

Abstract Avoidant restrictive food intake disorder (ARFID), a recently described eating disorder categorized under DSM-5, has varied clinical presentations. The primary eating disorders have well-established practice parameters for management. However, there is no evidence-based first line of management for ARFID. There is a significant gap in this evolving construct and clinical practice. We present a case series from a tertiary care center in India, focusing on clinical management. Four adolescents with 3 girls and 1 boy between 12 and 17 years of age were included in the study. Diagnosis and management were delayed in all. Mean body mass index was 15.36 (5.26) kg/m2 at the time of diagnosis. Key drivers were dread of choking, sensory characteristics, and avoidance of unpleasant upper and lower gastrointestinal symptoms. This series supports a culturally cognizant hypothesis, an evidence based, viable management model for ARFID in low- and middle-income countries (LMIC). A combination of family-based treatment (FBT) and cognitive behavior therapy is an effective treatment model for India and other LMICs.

Effect of food stimuli presentation on restrained eater's food choice: An ERP study

Restrained eaters are individuals who consciously follow a limited food intake diet to lose or maintain body weight. With the rising numbers of obesity cases, retrained eating has became more prevalent as more people adopt it to cope with obesity. The dual conflict theory states that restrained eaters often encounter conflicting choices of food pleasure and weight management. The present study investigated the difference in food choice regarding different presentations of the weight management goal. The study hypothesized difference in successful and unsuccessful restrained eaters’ food choice when presented with the conflicting food/weight maintenance stimuli. A total of 49 college students participated in the study and the N2, P3 and LPP event-related potentials (ERPs) were investigated during a food choice task. Results showed that the reaction time in unsuccessful restrained eaters (UREs) were greater than successful restrained eaters (SREs). The ERP results showed that SREs exhibited smaller N2 and greater P3 amplitudes than UREs, however, we did not find a difference in LPP amplitudes between the two groups. The findings suggest that the UREs demonstrated greater sensitivity and smaller inhibition to food cues, while we do not have supports for a difference in motivational and emotional salience. This is the first study that investigated the food choice of SREs and UREs when faced with different presentations of conflicting goals, which enriches the theoretical model and provides neural correlates evidence for future studies.

Systematic Review and Meta-Analysis: Iron Deficiency and Iron Deficiency Anemia Among Military Recruits Undergoing Basic Combat Training

ABSTRACT Introduction The first period of military service consists of a physically and mentally challenging basic combat training (BCT) program. Factors like demanding physical exercise, limited recovery time, and restricted diet choice and food intake may challenge iron intake and homeostasis in recruits undergoing BCT. Iron-deficient individuals may experience reduced work capacity, fatigue, weakness, frequent infections, and increased injury risk. Limited knowledge is available on the extent of this potential health risk among military recruits. The aim of the present study was to systematically review published studies on the prevalence and change in prevalence of anemia, iron deficiency (ID), and ID anemia (IDA) among recruits undergoing BCT. Materials and Methods Electronic searches were conducted in the databases Medline (Ovid), Embase (Embase.com), and Web of Science (Clarivate Analytics) from database inception up until April 16, 2024. Inclusion criteria were observational studies with both cross-sectional and observational longitudinal designs that examined the effects of BCT (intervention) on iron status (outcome) in military recruits (population). Extracted data were the number of participants (n), age, sex, country/population, BCT duration, and relevant measures of prevalence and changes in prevalence of anemia, ID, and IDA (primary outcome) and physical performance, mood state, stress fractures, attrition rate, and nutritional supplements (secondary outcomes). The study quality and risk of bias were assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data and The National Institutes of Health Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Meta-analyses were performed using restricted maximum-likelihood models, and the effect size was calculated as Cohen’s h with 95% CI. Results Twenty-two articles were systematically reviewed (n = 111,764 men and 12,650 women), and six of these papers (n = 388 men and 773 women) were included in the meta-analysis. There was a varying prevalence of anemia, ID, and IDA among military recruits at the start of BCT. Results from meta-analyses showed negligible and nonsignificant effects of BCT on the prevalence of anemia, ID, and IDA. The quality of the included cross-sectional studies ranging from fair to good, whereas a large proportion of the included longitudinal studies were classified as poor. No sign of publication bias was found. Conclusions The prevalence of anemia, ID, and IDA in military recruits seems not to be affected by the completion of BCT shorter than 16 weeks, whereas the effects of longer BCT durations remain unclear. Even though body iron homeostasis seems unaffected, adequate energy and nutritional intake should remain a priority. Future research could focus on dietary interventions to determine the optimal diet among female recruits in specifically exposed populations.

Eating concerns in youth with functional abdominal pain disorders.

Adolescents with functional abdominal pain (FAP) often experience pain and other gastrointestinal symptoms in the context of eating, which may place them at risk for eating disorders. This study compared disordered eating and its sequalae in adolescents with FAP to those with chronic headache. Participants in this retrospective chart review study were 270 adolescents and young adults (mean age 15.9; standard deviation [SD] = 1.63; 60% female) attending an intensive, interdisciplinary pain treatment program, including 135 youth with FAP and an age- and gender-matched control group with a primary pain diagnosis of chronic headache. Information was extracted related to eating- and weight-related symptoms. Independent t-tests and χ2 analyses found that compared with adolescents with chronic headache, patients with FAP showed significantly more eating pathology as reflected by scores on the Eating Attitudes Test-26 (EAT-26) (p < 0.001), endorsement of pain-related restrictive eating (p < 0.01), eating disorder history (p < 0.001), and avoidant restrictive food intake disorder (ARFID) diagnoses (p < 0.001). Compared to those with chronic headache, significantly more patients with FAP had lost 10 pounds or more (p < 0.01) and a higher proportion were underweight (p < 0.001). Among all participants, a history of exclusion diets used to manage symptoms significantly increased the risk for ARFID (p < 0.001). The results of this study highlight the increased risk of eating-related concerns among youth with FAP, as well as the judicious use of exclusion diets to manage symptoms in these patients.

A critical role for HNF4α in polymicrobial sepsis-associated metabolic reprogramming and death

In sepsis, limited food intake and increased energy expenditure induce a starvation response, which is compromised by a quick decline in the expression of hepatic PPARα, a transcription factor essential in intracellular catabolism of free fatty acids. The mechanism upstream of this PPARα downregulation is unknown. We found that sepsis causes a progressive hepatic loss-of-function of HNF4α, which has a strong impact on the expression of several important nuclear receptors, including PPARα. HNF4α depletion in hepatocytes dramatically increases sepsis lethality, steatosis, and organ damage and prevents an adequate response to IL6, which is critical for liver regeneration and survival. An HNF4α agonist protects against sepsis at all levels, irrespectively of bacterial loads, suggesting HNF4α is crucial in tolerance to sepsis. In conclusion, hepatic HNF4α activity is decreased during sepsis, causing PPARα downregulation, metabolic problems, and a disturbed IL6-mediated acute phase response. The findings provide new insights and therapeutic options in sepsis.