Assessment of Glycemic Response to Model Breakfasts Varying in Glycemic Index (GI) in 5-7-Year-Old School Children.

Reduced Glycemic Index (GI) of breakfast has been linked to improved cognitive performance in both children and adult populations across the morning. However, few studies have profiled the post-prandial glycemic response (PPGR) in younger children. The aim of this study was to assess PPGR to breakfast interventions differing in GI in healthy children aged 5-7 years. Eleven subjects completed an open-label, randomized, cross-over trial, receiving three equicaloric test beverages (260 kcal) consisting of 125 mL semi-skimmed milk and 50 g sugar (either glucose, sucrose, or isomaltulose). On a fourth occasion, the sucrose beverage was delivered as intermittent supply. PPGR was measured over 180 min using Continuous Glucose Monitoring (CGM). The incremental area under the curve (3h-iAUC) was highest for the glucose beverage, followed by intermittent sucrose (-21%, p = 0.288), sucrose (-27%, p = 0.139), and isomaltulose (-48%, p = 0.018). The isomaltulose beverage induced the smallest Cmax (7.8 mmol/L vs. >9.2 mmol/L for others) and the longest duration with moderate glucose level, between baseline value and 7.8 mmol/L (150 vs. <115 min for others). These results confirm that substituting mid-high GI sugars (e.g., sucrose and glucose) with low GI sugars (e.g., isomaltulose) during breakfast are a viable strategy for sustained energy release and glycemic response during the morning even in younger children.

Evaluation of Treatment Descriptions and Alignment With Clinical Guidance of Apps for Depression on App Stores: Systematic Search and Content Analysis.

BACKGROUND: The use of apps for the treatment of depression shows great promise. However, there is uncertainty regarding the alignment of publicly available apps for depression with clinical guidance, their treatment fidelity and evidence base, and their overall safety. OBJECTIVE: Built on previous analyses and reviews, this study aims to explore the treatment and safety issues of publicly available apps for depression. METHODS: We conducted a content analysis of apps for depression in the 2 main UK app stores (Google Play and Apple App Store). App store listings were analyzed for intervention content, treatment fidelity, and fit with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of depression in adults. RESULTS: A total of 353 apps for depression were included in the review. App descriptions reported the use of 20 treatment approaches and 37 treatment strategies. Many apps used transdiagnostic (155/353, 43.9%) and multitheoretical interventions to treat multiple disorders including depression. Although many interventions appeared to be evidence-informed, there were issues with treatment fidelity, research evidence, and fit with clinical guidelines. None of the apps fully aligned with the NICE guidelines for depression. CONCLUSIONS: App developers have adopted many evidence-informed treatments in their interventions; however, more work is needed to improve clinical validity, treatment fidelity, and the safety of apps. We urge developers to consult relevant guidelines and standards, and to engage in reflective questioning on treatment and safety to address these issues and to improve treatment content and intervention design.

Sugar rush or sugar crash? A meta-analysis of carbohydrate effects on mood.

The effect of carbohydrate (CHO) consumption on mood is much debated, with researchers reporting both mood improvements and decrements following CHO ingestion. As global consumption of sugar-sweetened products has sharply increased in recent years, examining the validity of claims of an association between CHOs and mood is of high importance. We conducted a systematic review and meta-analysis to evaluate the relationship between acute CHO ingestion and mood. We examined the time-course of CHO-mood interactions and considered the role of moderator variables potentially affecting the CHO-mood relationship. Analysis of 176 effect sizes (31 studies, 1259 participants) revealed no positive effect of CHOs on any aspect of mood at any time-point following their consumption. However, CHO administration was associated with higher levels of fatigue and less alertness compared with placebo within the first hour post-ingestion. These findings challenge the idea that CHOs can improve mood, and might be used to increase the public's awareness that the 'sugar rush' is a myth, inform health policies to decrease sugar consumption, and promote healthier alternatives.

Breakfast, Glycemic Index, and Cognitive Function in School Children: Evidence, Methods, and Mechanisms.

Breakfast has been claimed to improve cognitive function and academic performance, leading to the provision of breakfast initiatives by public health bodies. Children may be particularly sensitive to the nutritional effects of breakfast due to greater energetic needs compared to adults. However, there is a lack of acute intervention studies assessing what type of breakfast is optimal for cognitive performance. In this paper, the impact of breakfast-based glycemic response on cognition in children will be reviewed. The data suggest that a more stable blood glucose profile which avoids greater peaks and troughs in circulating glucose levels is associated with better cognitive function across the morning. Although the evidence to date is promising, it is currently insufficient to allow firm and evidence-based recommendations. What limits our ability to draw conclusions from previous findings is that the studies have differed widely with respect to subject characteristics, cognitive tests used, and timing of cognitive assessment. In addition, few studies have profiled glycemic response in children specifically. There is, therefore, an urgent need for hypothesis-driven, randomized, controlled trials that evaluate the role of different glycemic manipulations on cognition.

The impact of diet-based glycaemic response and glucose regulation on cognition: evidence across the lifespan.

The brain has a high metabolic rate and its metabolism is almost entirely restricted to oxidative utilisation of glucose. These factors emphasise the extreme dependence of neural tissue on a stable and adequate supply of glucose. Whereas initially it was thought that only glucose deprivation (i.e. under hypoglycaemic conditions) can affect brain function, it has become apparent that low-level fluctuations in central availability can affect neural and consequently, cognitive performance. In the present paper the impact of diet-based glycaemic response and glucose regulation on cognitive processes across the lifespan will be reviewed. The data suggest that although an acute rise in blood glucose levels has some short-term improvements of cognitive function, a more stable blood glucose profile, which avoids greater peaks and troughs in circulating glucose is associated with better cognitive function and a lower risk of cognitive impairments in the longer term. Therefore, a habitual diet that secures optimal glucose delivery to the brain in the fed and fasting states should be most advantageous for the maintenance of cognitive function. Although the evidence to date is promising, it is insufficient to allow firm and evidence-based nutritional recommendations. The rise in obesity, diabetes and metabolic syndrome in recent years highlights the need for targeted dietary and lifestyle strategies to promote healthy lifestyle and brain function across the lifespan and for future generations. Consequently, there is an urgent need for hypothesis-driven, randomised controlled trials that evaluate the role of different glycaemic manipulations on cognition.

A temporary deficiency in self-control: Can heightened motivation overcome this effect?

Self-control is important for everyday life and involves behavioral regulation. Self-control requires effort, and when completing two successive self-control tasks, there is typically a temporary drop in performance in the second task. High self-reported motivation and being made self-aware somewhat counteract this effect-with the result that performance in the second task is enhanced. The current study explored the relationship between self-awareness and motivation on sequential self-control task performance. Before employing self-control in an antisaccade task, participants initially applied self-control in an incongruent Stroop task or completed a control task. After the Stroop task, participants unscrambled sentences that primed self-awareness (each started with the word "I") or unscrambled neutral sentences. Motivation was measured after the antisaccade task. Findings revealed that, after exerting self-control in the incongruent Stroop task, motivation predicted erroneous responses in the antisaccade task for those that unscrambled neutral sentences, and high motivation led to fewer errors. Those primed with self-awareness were somewhat more motivated overall, but motivation did not significantly predict antisaccade performance. Supporting the resource allocation account, if one was motivated-intrinsically or via the manipulation of self-awareness-resources were allocated to both tasks leading to the successful completion of two sequential self-control tasks.

The role of motivation, glucose and self-control in the antisaccade task.

Research shows that self-control is resource limited and there is a gradual weakening in consecutive self-control task performance akin to muscle fatigue. A body of evidence suggests that the resource is glucose and consuming glucose reduces this effect. This study examined the effect of glucose on performance in the antisaccade task - which requires self-control through generating a voluntary eye movement away from a target - following self-control exertion in the Stroop task. The effects of motivation and individual differences in self-control were also explored. In a double-blind design, 67 young healthy adults received a 25g glucose or inert placebo drink. Glucose did not enhance antisaccade performance following self-control exertion in the Stroop task. Motivation however, predicted performance on the antisaccade task; more specifically high motivation ameliorated performance decrements observed after initial self-control exertion. In addition, individuals with high levels of self-control performed better on certain aspects of the antisaccade task after administration of a glucose drink. The results of this study suggest that the antisaccade task might be a powerful paradigm, which could be used as a more objective measure of self-control. Moreover, the results indicate that level of motivation and individual differences in self-control should be taken into account when investigating deficiencies in self-control following prior exertion.

Response variability to glucose facilitation of cognitive enhancement.

Glucose facilitation of cognitive function has been widely reported in previous studies (including our own). However, several studies have also failed to detect glucose facilitation. There is sparsity of research examining the factors that modify the effect of glucose on cognition. The aims of the present study were to (1) demonstrate the previously observed enhancement of cognition through glucose administration and (2) investigate some of the factors that may exert moderating roles on the behavioural response to glucose, including glucose regulation, body composition (BC) and hypothalamic­pituitary­adrenal axis response. A total of twenty-four participants took part in a double-blind, placebo-controlled, randomised, repeated-measures study, which examined the effect of 25 and 60 g glucose compared with placebo on cognitive function. At 1 week before the study commencement, all participants underwent an oral glucose tolerance test. Glucose facilitated performance on tasks of numeric and spatial working memory, verbal declarative memory and speed of recognition. Moderating variables were examined using several indices of glucoregulation and BC. Poorer glucoregulation predicted improved immediate word recall accuracy following the administration of 25 g glucose compared with placebo. Those with better glucoregulation showed performance decrements on word recall accuracy following the administration of 25 g glucose compared with placebo. These findings are in line with accumulating evidence that glucose load may preferentially enhance cognition in those with poorer glucoregulation. Furthermore, the finding that individuals with better glucoregulation may suffer impaired performance following a glucose load is novel and requires further substantiation.

Stress reactivity and cognitive performance in a simulated firefighting emergency.

BACKGROUND: During emergencies maladaptive behavior can reduce survival. This study compared the effects of a basic firefighter training course on 21 volunteers (with no firefighting experience) with age and gender-matched controls. METHODS: Stress reactivity (salivary cortisol and anxiety) were monitored across the course: day 1 (classroom), day 2 (physical equipment training), and day 3 (simulated fire emergency). Cognitive performance (visual attention, declarative and working memory) considered important in surviving a fire emergency were measured immediately post-training or after a 20-min delay. RESULTS: Prior to threat subjects showed an anticipatory cortisol increase but no corresponding increase in self-reported anxiety. On day 3 cortisol was higher in firefighters tested immediately after (10.37 nmol x L(-1) and 20 min after training (7.20 nmol L(-1)) compared to controls (3.13 nmol x L(-1)). Differences in cognitive performance were observed post-threat, with impairments in visual declarative memory in the firefighting subjects tested immediately, and working memory impairments observed in those tested after a 20-min delay. CONCLUSIONS: Cognitive impairments were found following a simulated emergency and could explain maladaptive responses observed during real fires. Moreover, the results suggest the type of cognitive impairments observed may be time dependent, with different cognitive difficulties becoming evident at different times following an emergency.

Acute ingestion of different macronutrients differentially enhances aspects of memory and attention in healthy young adults.

The role of carbohydrates on mood and cognition is fairly well established, however research examining the behavioural effects of the other macronutrients is limited. The current study compared the effects of a 25 g glucose drink to energetically matched protein and fat drinks and an inert placebo. Following a blind, placebo-controlled, randomised crossover design, 18 healthy young adults consumed drinks containing fat, glucose, protein and placebo. Cognitive performance was examined at baseline and again 15- and 60 min post drink. Mood was assessed at baseline and then 10-, 35- and 80 min post drink. Attention and speed were enhanced 15 min following fat or glucose ingestion and working memory was enhanced 15 min following protein ingestion. Sixty minutes post drink memory enhancements were observed after protein and memory impairment was observed following glucose. All drinks increased ratings of alertness. The findings suggest that macronutrients: (i) have different windows of opportunity for effects (ii) target different cognitive domains.

The effect of energy drinks on cortisol levels, cognition and mood during a fire-fighting exercise.

RATIONALE: Acute stress has been associated with changes in cognitive performance and mood, and these have been in part associated with stress-related increased release of cortisol. Both glucose and caffeine consumed in isolation have been shown to moderate cortisol response and affect cognitive performance and affect mood; however, there has been very little research into their behavioural and physiological effects when taken in combination. The aim of this study was to assess the effect of the two substances in combination under stressful and physically demanding conditions (fire-fighting training) on cognition, mood and cortisol release. METHODS: Using a double-blind, mixed measures design, 81 participants were administered a 330-ml drink containing either (1) 50 g glucose and 40 mg caffeine, (2) 10.25 g of fructose/glucose and 80 mg caffeine or a placebo drink and tested across a range of cognitive tasks, mood and physiological measures. RESULTS: The results showed an increase in grip strength and improved memory performance after ingestion of the drink containing 50 g glucose and 40 mg caffeine, and both active drinks resulted in improved performance on the information-processing task compared to the placebo. In terms of mood effects, the drink containing 50 g glucose and 40 mg caffeine led to a reduction in anxiety and significantly reduced self-reported levels of stress following the fire-fighter training. CONCLUSIONS: Based on the results of this study, in situations of stress combined with physical performance, administration of an energy drink containing glucose and caffeine might be an easy to implement and cost effective way to maintain mental performance levels and to ameliorate the negative effects of stress on mood.

The effect of glucose dose and fasting interval on cognitive function: a double-blind, placebo-controlled, six-way crossover study.

RATIONALE: Previous research has identified a number of factors that appear to moderate the behavioural response to glucose administration. These include physiological state, dose, types of cognitive tasks used and level of cognitive demand. Another potential moderating factor is the length of the fasting interval prior to a glucose load. OBJECTIVES: Therefore, we aimed to examine the effect of glucose dose and fasting interval on mood and cognitive function. METHODS: The current study utilised a double-blind, placebo-controlled, balanced, six period crossover design to examine potential interactions between length of fasting interval (2 versus 12 hours) and optimal dose for cognition enhancement. RESULTS: Results demonstrated that the higher dose (60 g) increased working memory performance following an overnight fast, whereas the lower dose (25 g) enhanced working memory performance following a 2-h fast. CONCLUSIONS: The data suggest that optimal glucose dosage may differ under different conditions of depleted blood glucose resources. In addition, glucoregulation was observed to be a moderating factor. However, further research is needed to develop a model of the moderating and mediating factors under which glucose facilitation is best achieved.

Dose-response investigation into glucose facilitation of memory performance and mood in healthy young adults.

It has been suggested that the memory enhancing effect of glucose follows an inverted U-shaped curve, with 25 g resulting in optimal facilitation in healthy young adults. The aim of this study was to further investigate the dose dependency of the glucose facilitation effect in this population across different memory domains and to assess moderation by interindividual differences in glucose regulation and weight. Following a double-blind, repeated measures design, 30 participants were administered drinks containing five different doses of glucose (0 g, 15 g, 25 g, 50 g, and 60 g) and were tested across a range of memory tasks. Glycaemic response and changes in mood state were assessed following drink administration. Analysis of the data showed that glucose administration did not affect mood, but significant glucose facilitation of several memory tasks was observed. However, dose-response curves differed depending on the memory task with only performance on the long-term memory tasks adhering largely to the previously observed inverted U-shaped dose-response curve. Moderation of the response profiles by interindividual differences in glucose regulation and weight was observed. The current data suggest that dose-response function and optimal dose might depend on cognitive domain and are moderated by interindividual differences in glucose regulation and weight.

Metabolic agents that enhance ATP can improve cognitive functioning: a review of the evidence for glucose, oxygen, pyruvate, creatine, and L-carnitine.

Over the past four or five decades, there has been increasing interest in the neurochemical regulation of cognition. This field received considerable attention in the 1980s, with the identification of possible cognition enhancing agents or "smart drugs". Even though many of the optimistic claims for some agents have proven premature, evidence suggests that several metabolic agents may prove to be effective in improving and preserving cognitive performance and may lead to better cognitive aging through the lifespan. Aging is characterized by a progressive deterioration in physiological functions and metabolic processes. There are a number of agents with the potential to improve metabolic activity. Research is now beginning to identify these various agents and delineate their potential usefulness for improving cognition in health and disease. This review provides a brief overview of the metabolic agents glucose, oxygen, pyruvate, creatine, and L-carnitine and their beneficial effects on cognitive function. These agents are directly responsible for generating ATP (adenosine triphosphate) the main cellular currency of energy. The brain is the most metabolically active organ in the body and as such is particularly vulnerable to disruption of energy resources. Therefore interventions that sustain adenosine triphosphate (ATP) levels may have importance for improving neuronal dysfunction and loss. Moreover, recently, it has been observed that environmental conditions and diet can affect transgenerational gene expression via epigenetic mechanisms. Metabolic agents might play a role in regulation of nutritional epigenetic effects. In summary, the reviewed metabolic agents represent a promising strategy for improving cognitive function and possibly slowing or preventing cognitive decline.

Glucose effects on long-term memory performance: duration and domain specificity.

RATIONAL: Previous research has suggested that long-term verbal declarative memory is particularly sensitive to enhancement by glucose loading; however, investigation of glucose effects on certain memory domains has hitherto been neglected. Therefore, domain specificity of glucose effects merits further elucidation. OBJECTIVES: The aim of the present research was to provide a more comprehensive investigation of the possible effects of glucose administration on different aspects of memory by 1) contrasting the effect of glucose administration on different memory domains (implicit/explicit memory; verbal/non-verbal memory, and recognition/familiarity processes), 2) investigating whether potential effects on memory domains differ depending on the dose of glucose administered (25 g versus 60 g), 3) exploring the duration of the glucose facilitation effect (assessment of memory performance 35 min and 1 week after encoding). METHODS: A double-blind between-subjects design was used to test the effects of administration of 25 and 60 g glucose on memory performance. RESULTS: Implicit memory was improved following administration of 60 g of glucose. Glucose supplementation failed to improve face recognition performance but significantly improved performance of word recall and recognition following administration of 60 g of glucose. However, effects were not maintained 1 week following encoding. CONCLUSIONS: Improved implicit memory performance following glucose administration has not been reported before. Furthermore, the current data tentatively suggest that level of processing may determine the required glucose dosage to demonstrate memory improvement and that higher dosages may be able to exert effects on memory pertaining to both hippocampal and non-hippocampal brain regions.

The effects of glucose dose and dual-task performance on memory for emotional material.

Whilst previous research has shown that glucose administration can boost memory performance, research investigating the effects of glucose on memory for emotional material has produced mixed findings. Whereas some research has shown that glucose impairs memory for emotional material, other research has shown that glucose has no effect on emotional items. The aim of the present research was therefore to provide further investigation of the role of glucose on the recognition of words with emotional valence by exploring effects of dose and dual-task performance, both of which affect glucose facilitation effects. The results replicated past research in showing that glucose administration, regardless of dose or dual-task conditions, did not affect the memorial advantage enjoyed by emotional material. This therefore suggests an independent relationship between blood glucose levels and memory for emotional material.

Glucose enhancement of memory depends on initial thirst.

This double-blind, placebo-controlled study examined the influence of appetitive state on glucose enhancement of memory. Participants rated their mood, hunger and thirst, then consumed a 25 g glucose drink or a matched placebo 20 min prior to a verbal memory task. There was a double dissociation when the effects of thirst ratings and drink on subsequent memory performance were considered. Those who were initially less thirsty recalled significantly more words following glucose than placebo; those who were more thirsty recalled significantly fewer words after glucose than placebo. Glucose enhancement of memory may therefore critically depend on participants' initial thirst.

Glucose modulates event-related potential components of recollection and familiarity in healthy adolescents.

INTRODUCTION: Behavioural evidence supports the notion that oral glucose ingestion enhances recognition memory judgements based on recollection, but not familiarity. The present study sought to clarify and extend upon these behavioural findings by investigating the influence of glucose administration on event-related potential (ERP) components that are thought to be differentially mediated by recollection and familiarity processes in healthy adolescents. METHODS: In a within-subjects design, participants performed a recognition memory task, during which time electroencephalogram (EEG) was recorded, subsequent to ingestion of either (a) glucose or (b) placebo in a counterbalanced order. RESULTS: Response times during the recognition memory task were observed to be faster for the glucose condition, relative to a placebo control. Further, glucose ingestion was associated with an enhanced left parietal old/new ERP effect (a marker of recollection) and an enhanced mid-frontal old/new ERP effect (known to be mediated by familiarity). DISCUSSION: These findings (a) support the results of previous research that the 'glucose memory facilitation effect' can be extended to healthy adolescents, but (b) suggest that glucose enhances both the recollection and familiarity components of recognition memory. The observed ERP profile has important implications for the proposal that glucose specifically targets the hippocampus in modulating cognitive performance.

Glucose administration prior to a divided attention task improves tracking performance but not word recognition: evidence against differential memory enhancement?

RATIONALE: The cognition-enhancing effects of glucose administration to humans have been well-documented; however, it remains unclear whether this effect preferentially targets episodic memory or other cognitive domains. OBJECTIVES: The effect of glucose on the allocation of attentional resources during memory encoding was assessed using a sensitive dual-attention paradigm. MATERIALS AND METHODS: One hundred and twenty volunteers (mean age 21.60, SD 4.89, 77 females) took part in this randomised, double-blind, placebo-controlled, parallel groups study where each consumed a 25-g glucose drink or a placebo. Half of the participants in each drink condition attempted to track a moving on-screen target during auditory word presentation. The distance between the cursor and the tracking target was used as an index of attentional cost during encoding. Effects of drink and tracking on recognition memory and drink on tracking performance were assessed. Self-rated appetite and mood were co-monitored. RESULTS: Co-performing the tracking task significantly impaired memory performance irrespective of drink condition. In the placebo-tracking condition, there was a cost to tracking manifest as greater deviation from target during and immediately following word presentation. Compared with placebo, the glucose drink significantly improved tracking performance during encoding. There were significant time-related changes in thirst and alertness ratings but these were not differentially affected by drink or tracking conditions. CONCLUSION: Tracking but not memory was enhanced by glucose. This finding suggests that, under certain task conditions, glucose administrations does not preferentially enhance memory performance. One mechanism through which glucose acts as a cognition enhancer is through allowing greater allocation of attentional resources.

The effect of glucose administration on the recollection and familiarity components of recognition memory.

Previous research has demonstrated that glucose administration facilitates long-term memory performance. The aim of the present research was to evaluate the effect of glucose administration on different components of long-term recognition memory. Fifty-six healthy young individuals received (a) a drink containing 25 g of glucose or (b) an inert placebo drink. Recollection and familiarity components of recognition memory were measured using the 'remember-know' paradigm. The results revealed that glucose administration led to significantly increased proportion of recognition responses based on recollection, but had no effect on the proportion of recognition responses made through participants' detection of stimulus familiarity. Consequently, the data suggest that glucose administration appears to facilitate recognition memory that is accompanied by recollection of contextual details and episodic richness. The findings also suggest that memory tasks that result in high levels of hippocampal activity may be more likely to be enhanced by glucose administration than tasks that are less reliant on medial temporal lobe structures.