Increased brain and behavioural susceptibility to portion size in children with loss of control eating.

BACKGROUND: Portion size influences intake (i.e. the portion size effect [PSE]), yet determinants of susceptibility to the PSE are unclear. OBJECTIVE: We tested whether children who reported an episode of loss of control (LOC) eating over the last 3 months would be more susceptible to the PSE and would show differential brain responses to food cues compared with children with no-LOC. METHODS: Across five sessions, children (n = 47; 7-10 years) consumed four test meals at 100%, 133%, 167% and 200% conditions for portion size and completed a functional magnetic resonance imaging scan while viewing pictures of foods varied by portion size and energy density (ED). Incidence of LOC over the past 3 months was self-reported. Random coefficient models were tested for differences in the shape of the PSE curve by LOC status. A whole-brain analysis was conducted to determine response to food cues during the functional magnetic resonance imaging. RESULTS: Reported LOC (n = 13) compared with no-LOC (n = 34) was associated with increased susceptibility to the PSE, as evidenced by a positive association with the linear slope (P < 0.005), and negative association with the quadratic slope (P < 0.05) of the intake curve. Children who reported LOC compared with no-LOC showed increased activation in the left cerebellum to small relative to large portions (P < 0.01) and right cerebellum to High-ED relative to Low-ED food cues (P < 0.01). CONCLUSION: Children who reported LOC were more susceptible to the PSE and showed alterations in food-cue processing in the cerebellum, a hindbrain region implicated in satiety signalling.

Relationship of pressure to be thin with gains in body weight and fat mass in adolescents.

BACKGROUND: Sociocultural pressure to be thin is commonly reported by adolescents; yet, to what extent such pressure is associated with weight gain has not been evaluated longitudinally. OBJECTIVE: Examine whether pressure to be thin was positively associated with weight and fat gain in adolescents. METHODS: Participants were 196 healthy adolescent (age 15 ± 1 years old) girls (65%) and boys of varying weights (BMI 25 ± 7 kg/m2 ) studied at baseline and 1-year follow-up. At baseline, adolescents and their mothers reported pressure to be thin by questionnaire. At baseline and follow-up, BMI was calculated, and fat mass was assessed with air displacement plethysmography. Multiple regression was used to examine associations between baseline pressure to be thin and 1-year changes in BMI and fat mass. RESULTS: Accounting for multiple covariates, including baseline BMI or fat, adolescent-reported pressure from parents and peers and mother-reported pressure toward their teen were associated with greater gains in either adolescent BMI or fat (ps < .05). Adolescent weight status was a moderator of multiple effects (ps < .05). CONCLUSIONS: Parental and peer pressure to be thin were associated with increases in BMI and fat mass during adolescence, particularly in heavier adolescents. Further research is necessary to clarify how this association operates reciprocally and to identify underlying explanatory mechanisms.

Behavioral and neurodevelopmental precursors to binge-type eating disorders: support for the role of negative valence systems.

BACKGROUND: Pediatric loss-of-control (LOC) eating is a robust behavioral precursor to binge-type eating disorders. Elucidating precursors to LOC eating and binge-type eating disorders may refine developmental risk models of eating disorders and inform interventions. METHOD: We review evidence within constructs of the Negative Valence Systems (NVS) domain, as specified by the Research Domain Criteria framework. Based on published studies, we propose an integrated NVS model of binge-type eating-disorder risk. RESULTS: Data implicate altered corticolimbic functioning, neuroendocrine dysregulation, and self-reported negative affect as possible risk factors. However, neuroimaging and physiological data in children and adolescents are sparse, and most prospective studies are limited to self-report measures. CONCLUSIONS: We discuss a broad NVS framework for conceptualizing early risk for binge-type eating disorders. Future neural and behavioral research on the developmental trajectory of LOC and binge-type eating disorders is required.

Serum leptin and loss of control eating in children and adolescents.

BACKGROUND: Both insufficiency and resistance to the actions of the adipocyte-derived hormone leptin promote hunger, increased food intake and greater body weight. Some studies suggest that adults reporting binge eating have increased serum leptin compared with those without binge eating, even after adjusting for the greater adiposity that characterizes binge eaters. Pediatric binge or loss of control (LOC) eating are prospective risk factors for excessive weight gain and may predict development of metabolic abnormalities, but whether LOC eating is associated with higher leptin among children is unknown. We therefore examined leptin and LOC eating in a pediatric cohort. METHODS: A convenience sample of 506 lean and obese youth (7-18 years) was recruited from Washington, DC and its suburbs. Serum leptin was collected after an overnight fast. Adiposity was measured by dual-energy X-ray absorptiometry or air displacement plethysmography. LOC eating was assessed by interview methodology. RESULTS: Leptin was strongly associated with fat mass (r=0.79, P<0.001). However, even after adjusting for adiposity and other relevant covariates, youth with LOC eating had higher serum leptin compared with those without LOC episodes (15.42±1.05 vs 12.36±1.04 ng ml(-1), P<0.001). Neither reported amount of food consumed during a recent LOC episode nor number of LOC episodes in the previous month accounted for differences in leptin (P>0.05). The relationship between LOC eating and leptin appeared to be significant for females only (P=0.002). CONCLUSIONS: Reports of LOC eating were associated with higher fasting leptin in youth, beyond the contributions of body weight. Prospective studies are required to elucidate whether LOC eating promotes greater leptin or whether greater leptin resistance may promote LOC eating.

Children's binge eating and development of metabolic syndrome.

BACKGROUND: Binge eating predisposes children to excessive weight gain. However, it is unknown if pediatric binge eating predicts other obesity-associated adverse health outcomes. OBJECTIVE: The objective of this study was to investigate the relationship between binge eating and metabolic syndrome (MetS) in children. METHOD: Children aged 5-12 years at high risk for adult obesity, either because they were overweight/obese when first examined or because their parents were overweight/obese, were recruited from Washington, DC and its suburbs. Children completed a questionnaire assessment of binge eating at baseline and underwent measurements of MetS components at baseline and at a follow-up visit approximately 5 years later. Magnetic resonance imaging was used to measure the visceral adipose tissue (VAT) in a subset. RESULTS: In all, 180 children were studied between July 1996 and August 2010. Baseline self-reported binge eating presence was associated with a 5.33 greater odds of having MetS at follow-up (95% confidence interval (CI): 1.47, 19.27, P=0.01). The association between binge eating and body mass index (BMI) only partially explained changes in MetS components: baseline binge eating predicted higher follow-up triglycerides, even after accounting for baseline triglycerides, baseline BMI, BMI change, sex, race, baseline age and time in study (P = 0.05). Also, adjusting for baseline VAT and demographics, baseline binge eating predicted greater follow-up L(2-3) VAT (P = 0.01). DISCUSSION: Children's reports of binge eating predicted development of MetS, worsening triglycerides and increased VAT. The excessive weight gain associated with children's binge eating partly explained its adverse metabolic health outcomes. Reported binge eating may represent an early behavioral marker upon which to focus interventions for obesity and MetS.

Construct validity of the emotional eating scale adapted for children and adolescents.

BACKGROUND: Emotional eating, defined as eating in response to a range of negative emotions, is common in youths. Yet, there are few easily administered and well-validated methods to assess emotional eating in pediatric populations. OBJECTIVE: The current study tested the construct validity of the Emotional Eating Scale (EES) Adapted for Children and Adolescents (EES-C) by examining its relationship to observed emotional eating at laboratory test meals. METHOD: A total of 151 youths (8-18 years) participated in two multi-item lunch buffet meals on separate days. They ate ad libitum after being instructed to 'eat as much as you would at a normal meal' or to 'let yourself go and eat as much as you want'. State negative affect was assessed immediately before each meal. The EES-C was completed 3 months, on average, before the first test meal. RESULTS: Among youths with high EES-C total scores, but not low EES-C scores, higher pre-meal state negative affect was related to greater total energy intake at both meals, with and without the inclusion of age, race, sex and body mass index (BMI) standard deviation as covariates (ps<0.03). DISCUSSION: The EES-C demonstrates good construct validity for children and adolescents' observed energy intake across laboratory test meals designed to capture both normal and disinhibited eating. Future research is required to evaluate the construct validity of the EES-C in the natural environment and the predictive validity of the EES-C longitudinally.

The Yale Interpersonal Stressor (YIPS): affective, physiological, and behavioral responses to a novel interpersonal rejection paradigm.

Given links between interpersonal functioning and health as well as the dearth of truly interpersonal laboratory stressors, we present a live rejection paradigm, the Yale Interpersonal Stressor (YIPS), and examine its effects on mood, eating behavior, blood pressure, and cortisol in two experiments. The YIPS involves one or more interaction(s) between the participant and two same-sex confederates in which the participant is made to feel excluded and isolated. In Experiment 1, 50 female undergraduates were randomly assigned to the YIPS or a control condition. Participants in the YIPS condition experienced greater negative affect and less positive affect than did those in the control condition. Further, restrained eaters ate more following the YIPS than did nonrestrained eaters. In Experiment 2, 25 male and female undergraduates completed the YIPS. The YIPS induced significant increases in tension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) from baseline, while significantly decreasing positive affect. The YIPS appeared particularly relevant for women, resulting in significantly greater increases in cortisol and SBP for women compared to men. The YIPS, then, provides an alternative to traditional, achievement-oriented laboratory stressors and may allow for the identification of individuals most vulnerable to interpersonal stress.

Impact of interpersonal and ego-related stress on restrained eaters.

OBJECTIVE: This study examined the impact of different types of stress, one interpersonal and two ego-related versus a control condition, on the eating behavior of individuals with varying degrees of dietary restraint. METHOD: Eighty-two females were randomly assigned to one of three manipulations or a control group, and then all groups completed an ice cream taste test. RESULTS: A significant interaction revealed that for participants with higher restraint, those in the stressful manipulations ate significantly more than participants in the control group. Further, the pattern of consumption based on restraint for the interpersonal group differed from the other three conditions. In the interpersonal group, the greater the restraint, the more participants ate, whereas in the other three conditions, the pattern was reversed although not significantly so. DISCUSSION: Findings are discussed in terms of the role that interpersonal stress plays in the eating behavior of dieters and potential implications regarding the development of eating disorders.

Photorefractive keratectomy for low-to-moderate myopia and astigmatism with a small-beam, tracker-directed excimer laser.

OBJECTIVE: To assess the safety and effectiveness of the Autonomous Technologies Corporation LADARVision excimer laser system for photorefractive keratectomy correction of myopia and astigmatism. DESIGN: A multicenter, prospective, noncomparative case series. PARTICIPANTS: The cohort consisted of 467 eyes corrected for spherical myopia and 211 eyes corrected for myopia with astigmatism. INTERVENTION: Treatments were performed at six sites in the United States using a 6-mm ablation zone for spherical myopes and a 5.5-mm zone with a 1.0-mm blend for astigmats. MAIN OUTCOME MEASURES: Visual acuity, subjective refraction, corneal haze, intraocular pressure, complications, adverse reactions, patient satisfaction, and corneal endothelial changes. RESULTS: Twelve-month follow-up was available on 414 spherical eyes and 175 astigmatic eyes. The results for spherical eyes with correction between -1 and -5.99 diopters (D) were: uncorrected visual acuity (UCVA) of 20/40 or better achieved by 98.1%, 20/20 or better by 72%, 1.8% lost 2 lines and 0.3% lost greater than 2 lines of best spectacle-corrected visual acuity (BSCVA); 76.4% were within 0.50 D of the target correction and 94.4% were within 1.00 D. The results for myopia with astigmatism with spherical equivalent correction between -1 and -5.99 D were: UCVA of 20/40 or better in 97.4%, 20/20 or better in 61.7%, 2.5% lost 2 lines and no eyes lost greater than 2 lines BSCVA; 73.9% were within 0.50 D of the target correction and 95% were within 1.00 D. For spherical myopes combined with myopic astigmats corrected for 6 to 10 D, results were: UCVA of 20/40 or better in 93.4%, 20/20 or better in 61.2%, 2.3% lost 2 lines and no eyes lost greater than 2 lines of BSCVA; 67.2% were within 0.50 D of the desired correction and 87.8% were within 1.00 D. Refractive stability was achieved between 3 and 6 months for the spherical and astigmatic groups. No eyes had corneal haze graded as moderate or greater, and there was no significant decrease in endothelial cell density. CONCLUSIONS: Patients treated for 1 to 10 D of spherical equivalent myopia, with or without astigmatism, showed early refractive stability, excellent UCVA, no significant loss of BSCVA, no loss of endothelial cell density, and very low levels of corneal haze to 12 months after surgery.

Efficacy of diclofenac sodium ophthalmic solution versus placebo in reducing inflammation following cataract extraction and posterior chamber lens implantation.

One hundred forty-eight patients were enrolled in a randomized, prospective, placebo-controlled clinical trial evaluating the efficacy of diclofenac sodium (Voltaren Ophthalmic) in reducing ocular inflammation following extracapsular cataract extraction with posterior chamber intraocular lens implantation. Eligible patients were enrolled and randomized (2:1 diclofenac:placebo) if the sum of anterior chamber cells plus flare one day postoperatively (baseline) was at least four. None of the patients received concomitant steroidal anti-inflammatory treatment. The 99 patients receiving diclofenac sodium had significantly greater improvement from baseline in summed flare plus cell score than the 49 placebo patients at two to five days and seven to nine days after baseline. Similarly, diclofenac sodium patients had significantly less post-baseline conjunctival erythema and ciliary flush than placebo patients. Significantly more diclofenac sodium patients than placebo patients showed moderate to marked improvement from baseline in overall assessment of inflammatory response. Forty-nine percent of placebo patients but only 17% of diclofenac patients were considered therapeutic failures (P < .001). By five to seven days, 82% of diclofenac sodium patients and 59% of placebo patients had corrected visual acuities of 20/40 or better (P < .001). There were no clinically important differences in mean intraocular pressure at any visit.

Changing practice patterns in refractive surgery: results of a survey of the American Society of Cataract and Refractive Surgery.

A questionnaire on refractive surgical practice was sent to the entire membership of the American Society of Cataract and Refractive Surgery in 1992. One thousand eight hundred and forty-one (1,841) of the 4,950 members returned the survey for a response rate of 37.2%. The questionnaire was designed to be self-administered and elicited information on types of refractive procedures performed in the survey year and the preceding year, as well as the intent to perform refractive procedures in the future. Surgeons who perform radial keratotomy (RK) increased from 22% in 1991 to 30% in 1992; 45% expected to perform RK in 1993-1994. The following categories of information were requested: characteristics of RK patients, techniques used by the surgeon, characteristics of the surgeon's overall practice, type of RK training, surgical outcome, and prevalence of complications. The results of this survey indicate that the use of RK and astigmatic keratotomy (AK), as well as other refractive procedures, is steadily increasing. Radial keratotomy was mainly performed on patients 20 to 49 years of age who had low to moderate myopia. The majority of surgeons used four to eight radials, centrally directed incisions, and single depth settings. Three quarters of the surveyed RK surgeons used the Casebeer nomogram. The survey results indicated that 42% of surgeons performing photorefractive keratectomy (PRK) did not perform RK or other refractive procedures, suggesting that growth in the practice of PRK following FDA approval may come from both current RK surgeons and novice refractive surgeons.

Initial experience with the HydroSonics instrument to soften cataracts before phacoemulsification.

An ultrasonically driven needle placed into the body of the nucleus, with subsequent injection of balanced salt solution (BSS), can be used to fragment the nucleus into sections or lamellae that can potentially be emulsified with greater ease and less ultrasound energy delivered to the eye. This separation of the nucleus has been designated hydrodelineation. The six surgeons participating in this study subjectively reported that the use of hydrodelineation facilitated phacoemulsification, on average, in 91% of their cases. Review of study data indicated that significantly less ultrasound time and cumulative displayed energy were noted in phacoemulsification of grade 2+ and 3+ cataracts after hydrodelineation than in cases in which hydrodelineation was not performed. The results in cases performed with and without hydrodelineation were statistically equivalent in complications and postoperative patient outcomes.

Improvement in visual acuity in chronic aphakic and pseudophakic cystoid macular edema after treatment with topical 0.5% ketorolac tromethamine.

Ketorolac tromethamine 0.5% ophthalmic solution treatment was compared to placebo treatment in 120 patients with chronic aphakic or pseudophakic cystoid macular edema (six-month or more duration of distance visual acuity of 20/40 or less and angiographic evidence of cystoid changes) during a four- to five-month double-masked, multicenter study in which patients were randomly assigned. A statistically significant improvement in distance visual acuity (two lines or more) was observed in the ketorolac-treated group as compared to the placebo-treated group after 30 days (P = .038), 60 days (P = .017), and 90 days (P = .008) of treatment. This improvement in visual acuity remained statistically significant one month after cessation of treatment (P = .001). Nine ketorolac-treated patients and two placebo-treated patients demonstrated a decrease in visual acuity one month after treatment was discontinued. Seven of the nine ketorolac-treated patients experienced an improvement in visual acuity after retreatment as compared to none of the placebo-treated patients. This study offers evidence for a more optimistic outlook in the medical treatment of chronic aphakic and pseudophakic cystoid macular edema.

Incidence of retinal detachment following posterior chamber intraocular lens surgery.

We examined the three-year incidence of retinal detachment in a consecutive cohort of 4,329 eyes which had cataract surgery with implantation of a posterior chamber intraocular lens between 1979 and 1984. The overall three-year incidence was 1.4%. The three-year incidence for open capsule cases (1.9%) was over twice that for intact capsule cases (0.8%). Axial myopes (axial length greater than or equal to 25 mm) overall were at least three times as likely to develop retinal detachment within three years (3.6%) as eyes with axial lengths less than 25 mm (1.1%). The combination of open capsule and axial myopia increased the three-year retinal detachment risk tenfold over that of the intact capsule in normal length eyes.

Development of the SRK/T intraocular lens implant power calculation formula.

A new implant power calculation formula (SRK/T) was developed using the nonlinear terms of the theoretical formulas as its foundation but empirical regression methodology for optimization. Postoperative anterior chamber depth prediction, retinal thickness axial length correction, and corneal refractive index were systematically and interactively optimized using an iterative process on five data sets consisting of 1,677 posterior chamber lens cases. The new SRK/T formula performed slightly better than the Holladay, SRK II, Binkhorst, and Hoffer formulas, which was the expected result as any formula performs superiorly with the data from which it was derived. Comparative accuracy of this formula upon independent data sets is addressed in a follow-up report. The formula derived provides a primarily theoretical approach under the SRK umbrella of formulas and has the added advantage of being calculable using either SRK A-constants that have been empirically derived over the last nine years or using anterior chamber depth estimates.

Comparison of the SRK/T formula and other theoretical and regression formulas.

We compared the predictive accuracy of the SRK/T formula to the SRK II, Binkhorst II, Hoffer, and Holladay formulas in seven series of cases totaling 1,050 eyes. In the combined group, the SRK/T and Holladay formulas performed only slightly better than the other formulas. In short eyes (less than 22 mm), all formulas performed well, with the SRK/T, SRK II, and Holladay formulas performing marginally better. In moderately long eyes (greater than 24.5 mm, less than or equal to 27 mm), the Hoffer and Binkhorst II formulas had a greater proportion of cases with greater than 2 diopters (D) of error and the SRK/T and Holladay were again marginally better. In the very long eyes (greater than 27 mm and less than or equal to 28.4 mm), there were only 11 cases and all formulas performed well since none had greater than 2 D of prediction error. In an extremely long eye data set (greater than 28.4 mm), the SRK II formula clearly gave the poorest result. Eyes of this length occurred in only 0.1% of cases in our unselected series. Results support the contention that the present second and third generation IOL power formulas give fairly equivalent accuracy. Other factors, such as availability, ease of use, and ability to tailor or individualize, become major considerations.

Inhibition of blood-aqueous humor barrier breakdown with diclofenac. A fluorophotometric study.

Various doses of a new topical nonsteroidal anti-inflammatory agent, diclofenac sodium, were tested against prednisolone sodium phosphate in a randomized double-masked study to determine comparative efficacy and safety regarding the reduction of postsurgical ocular inflammation. Inflammation was assessed by measuring fluorescein leakage into the anterior chamber using fluorophotometry techniques. Increased leakage in each patient's operated-on eye compared with the unoperated-on control eye was attributed to a breakdown in the blood-aqueous barrier caused by the cataract surgery. Elimination or significant reduction of fluorescein leakage within a treatment group constituted increased efficacy in controlling inflammation. A total of 124 cases were analyzed. There were no preoperative differences among groups in fluorescein leakage. At 1 week after surgery, all three diclofenac groups had significantly less fluorescein leakage compared with the prednisolone group. Mean percent increases were 56% to 118% in diclofenac groups vs 324% in the prednisolone group. No differences among diclofenac concentrations were detected. The differences between prednisolone and diclofenac were also present, although of lesser magnitude, at 3 weeks. This demonstration of increased efficacy of the nonsteroidal anti-inflammatory agent vs prednisolone is promising given the known side effects of ocular steroids.

Effect of a pupillary light occluder on cystoid macular edema.

A prospective, randomized study of 291 patients was performed to determine the effect of a pupillary light occluder on the incidence of angiographic cystoid macular edema (CME) in patients having extracapsular surgery with implantation of a posterior chamber lens. Patients were randomized preoperatively into two groups: those having surgery with and without a pupillary light occluder on the cornea. The occluder was placed on the cornea during suture placement, following the extracapsular lens extraction and intraocular lens implantation. Of the 291 patients, 198 had angiograms readable for the presence or absence of CME. The incidence of angiographic CME in patients with the occluder was 15.0%; in those without the occluder it was 12.5%. The difference was not statistically significant. The presence or absence of an occluder on the cornea during suture placement does not affect the incidence of angiographic CME or the visual results of these cases.

The quantitative effect of 0.5% ketorolac tromethamine solution and 0.1% dexamethasone sodium phosphate solution on postsurgical blood-aqueous barrier.

Anterior chamber fluorophotometry was performed after the oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction and posterior chamber intraocular lens insertion before and after surgery. The administration of 0.5% ketorolac tromethamine solution (ketorolac solution) eye drops before and after surgery decreased the breakdown of the blood-aqueous barrier as compared with 0.1% dexamethasone sodium phosphate solution (dexamethasone solution) eye drops at each period, as measured by fluorophotometry. A single injection below Tenon's capsule of a short-acting corticosteroid had been given to each patient at the end of each surgical procedure. Slit-lamp observations of postoperative ocular inflammation were not different between treatment groups. Both ketorolac and dexamethasone solutions were well tolerated by patients. Ketorolac solution was more effective than dexamethasone solution in facilitating reestablishment of the blood-aqueous barrier after surgery, as measured by fluorophotometry, and was equal to dexamethasone solution as observed by slit-lamp observations. This study suggests that ketorolac ophthalmic solution may be effective and safe as a nonsteroidal anti-inflammatory agent for topical use after cataract surgery and intraocular lens implantation in place of topically administered corticosteroids.

Comparison of the SRK II formula and other second generation formulas.

A simple modification of the SRK formula was developed for use with extreme axial length cases (short and long eyes) to maximize prediction accuracy in these groups. For "average" eyes (over 75% of all cases), SRK needed no modifications to maintain maximum predictive accuracy. The new, modified SRK formula (SRK II) was compared with current second generation formulas and the Binkhorst formula. The SRK II formula, while maintaining the simplicity and ease of the SRK, was comparable to and in some cases superior to the other formulas. Overall, 80.0% of 2,068 posterior chamber intraocular lenses from seven different manufacturers demonstrated less than one diopter of prediction error and only 0.5% had three or more diopters of error. In short eyes (less than 22 mm), 74.0% were corrected to within one diopter and less than 2.0% had three or more diopters of error. In long eyes (greater than or equal to 24.5 mm), 78.0% of cases demonstrated less than one diopter of error and less than 1.0% had three or more diopters of error. Although the SRK II formula is incorporated in most new A-scan units, the modifications are so simple that surgeons can take the standard SRK predictions and mentally calculate the modifications for extreme cases.