Inhibitory control as a potential treatment target for obesity.

OBJECTIVES: Strong reward responsiveness to food and insufficient inhibitory control are thought to be implicated in the development and maintenance of obesity. This narrative review addresses the role of inhibitory control in obesity and weight loss, and in how far inhibitory control is a promising target for weight loss interventions. METHODS: PubMed, Web of Science, and Google Scholar were searched for papers up to May 2021. 41 papers were included. RESULTS: Individuals with obesity have poorer food-specific inhibitory control, particularly when hungry, and less concurrent activation of inhibitory brain areas. Moreover, this was strongly predictive of future weight gain. More activation of inhibitory brain areas, on the other hand, was predictive of weight loss: individuals with successful weight loss initially show inhibitory brain activity comparable to that of normal weight individuals. When successful weight maintenance is achieved for at least 1 year, this inhibitory activity is further increased. Interventions targeting inhibitory control in obese individuals have divergent effects. Firstly, food-specific inhibitory control training is particularly effective for people with low inhibitory control and high BMI. Secondly, neuromodulation paradigms are rather heterogeneous: although rTMS to the left dorsolateral prefrontal cortex induced some weight-loss, multiple sessions of tDCS reduced food consumption (desire) and induced weight loss in two thirds of the papers. Thirdly, neurofeedback results in successful upregulation of brain activity and connectivity, but occasionally leads to increased food intake. In conclusion, inhibitory control is implicated in obesity. It can be targeted to promote weight loss although major weight losses have not been achieved.

Examining the neural correlates of goal priming with the NeuroShop, a novel virtual reality fMRI paradigm.

OBJECTIVE: Health goal priming has been shown to stimulate healthy food choices by activating an individual's weight-control goal. The present study combined fMRI with a novel virtual reality food choice task to elucidate the underlying neural mechanisms of health goal priming. Previous research has suggested that the ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) play a role in the incorporation of health considerations into the food choice process. Responses may be more representative for those found in real life when assessed in an environment similar to the actual choice environment. Therefore, the first aim of the study was to explore if a novel virtual reality food choice task is sufficiently sensitive to detect basic valuation processes in food choice. The second aim was to examine whether increased activation in the dlPFC drives the effects of health goal priming. METHODS: Fifty-six female participants performed an fMRI food choice task embedded in a virtual supermarket environment. They chose between perceived healthy and unhealthy products in a health prime, hedonic prime, and non-food control condition, while activation in brain areas involved in self-control and valuation (vmPFC, dlPFC) was assessed. RESULTS: There were no differences in relative preference for perceived healthy products over unhealthy products between the conditions. There were also no main effects of prime condition on brain activation in the vmPFC and dPFC during food choice. Across conditions, activation in the vmPFC correlated with the tastiness of the chosen product during food choice. CONCLUSIONS: Although the study does not provide support for health goal priming triggering neural self-control mechanisms, results did show that virtual reality has potential for a more realistic fMRI food choice paradigm.

Investigating morphological changes in the brain in relation to etiology and duration of olfactory dysfunction with voxel-based morphometry.

Olfactory loss (OL) affects up to 20% of the general population and is related to changes in olfaction-related brain regions. This study investigated the effect of etiology and duration of OL on gray matter volume (GMV) of these regions in 257 patients. Voxel-based morphometry was applied to measure GMV in brain regions of interest to test the effects of etiology and duration on regional GMV and the relation between olfactory function and regional GMV. Etiology of OL had a significant effect on GMV in clusters representing the gyrus rectus and orbitofrontal cortex (OFC), bilaterally. Patients with congenital anosmia had reduced GMV in the gyrus rectus and an increased OFC volume compared to patients with acquired OL. There was a significant association between volume of the left OFC and olfactory function. This implies that changes in GMV in patients with acquired OL are mainly reflected in the OFC and depend on olfactory function. Morphology of olfactory areas in the brain therefore seems to relate to olfactory function and the subsequent degree of exposure to olfactory input in patients with acquired OL. Differences in GMV in congenital anosmia are most likely due to the fact that patients were never able to smell.

Altered neural inhibition responses to food cues after Roux-en-Y Gastric Bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is a highly effective weight-loss intervention that often reduces preference and intake of high-energy foods. Research into the neural mechanisms behind this shift has mainly focused on reward processing of food cues. However, the ability to successfully control food intake and thereby weight-loss also depends on inhibitory control capacity. We investigated whether RYGB leads to alterations in neural inhibitory control in response to food cues. METHODS: A food-specific go/no-go task with pictures of high-energy (desserts) and low-energy foods (vegetables), was used to assess neural inhibition responses before and after RYGB with functional magnetic resonance imaging. Data from 18 morbidly obese patients (15 females; age 41 ±â€¯11 years; BMI 42 ±â€¯4 kg/m2 before; BMI 36 ±â€¯4 kg/m2 after) were analysed. Pre- and post-RYGB BOLD fMRI responses were compared for response inhibition towards high- and low-energy foods. Participants were tested in a satiated state. RESULTS: Response inhibition to high-energy foods was associated with increased activation of the right lateral prefrontal cortex (PFC), right medial PFC, dorsolateral PFC, right middle cingulate cortex and the right inferior frontal operculum (involved in inhibitory control), after compared to before surgery. Response inhibition to low-energy foods elicited diminished post- compared to pre-surgery responses in the left superior temporal pole, right parahippocampal gyrus and right hypothalamus (involved in metabolic control). CONCLUSION: Neural changes indicate improved response inhibition towards high-energy food cues, altered influence of metabolic control during response inhibition towards low-energy food cues and a more positive attitude to both high-energy and low-energy food after RYGB. Alterations in neural circuits involved in inhibitory control, satiety signalling and reward processing may contribute to effective weight-loss after RYGB.

Indirect vs direct assessment of gastric emptying: A randomized crossover trial comparing C-isotope breath analysis and MRI.

BACKGROUND: Indirect methods to assess gastric emptying (GE), such as 13 C breath tests (BT), are commonly used. However, BT usually use a sampling time of 4+ hours. The current study aims to assess the validity of BT for four liquid meals differing in physicochemical properties. To this aim, we compared them to MRI GE-measurements. METHODS: Fifteen healthy males (age 22.6 ± 2.4 years, BMI 22.6 ± 1.8 kg/m2 ) participated in a randomized 2 × 2 crossover experiment. Test foods were liquid meals, which were either thin/thick and 100/500 kcal, labeled with 100 mg of 13 C-octanoate. GE was measured with MRI and assessed by 13 C recovery from breath. Participants were scanned every 10 minutes and at six time points breath samples were collected up to t = 90 minutes. Two curves were fitted to the data to estimate emptying halftime (t50 Ghoos and t50 Bluck ). T50 times were ranked per participant and compared between methods. KEY RESULTS: On average, MRI and BT showed similar t50 rankings for the four liquid meals. In comparison to MRI, t50 Ghoos overestimated, while t50 Bluck underestimated GE time. Moreover, more viscous foods were overestimated. In most participants individual t50 time rankings differed significantly between methods. CONCLUSIONS & INFERENCES: BT can assess relative emptying differences on group level and collecting breath data for 90 minutes constitutes a lower burden for participants and the research facility. However, BT has severe shortcomings compared to MRI for individual GE assessment. Notably, food matrix effects should be considered when interpreting the results of BT.

Effects of hunger state on the brain responses to food cues across the life span.

The abundant exposure to food cues in our environment is one of the main drivers of overconsumption. Food evaluation is important for the regulation of food intake by the brain and it's interaction with hunger state. Children are especially susceptible to food cues. Understanding the mechanisms behind this regulation in healthy individuals across the life span can help to elucidate the mechanisms underlying overconsumption and aid the development of future obesity prevention strategies. Few functional neuroimaging studies have been done in children and elderly. Furthermore, it is unknown how hunger state affects neural food cue reactivity in these groups, since this has not been examined consistently. We examined the effects of hunger state and age on the brain responses to low- and high calorie foods. On two mornings, 122 participants (17 children; 38 teens; 36 adults; 31 elderly) performed a food image viewing task while being scanned using fMRI, either fasted or sated. Hunger induced greater activation during high versus low calorie food image viewing than satiety in the bilateral dorsomedial (dmPFC) and in the right dorsolateral prefrontal cortex (dlPFC) across all age groups. There was no significant main effect of age group on high versus low calorie food image viewing and no interaction between age group and hunger state. The greater activation of the dlPFC across all age groups during high calorie food image viewing in a fasted state might reflect increased inhibitory control in response to these foods. This may underlie the ability to resist overconsumption of high calorie foods. Furthermore, increased medial prefrontal cortex activation during hunger might reflect increased reward value of high calorie foods, which declines with satiation. Further studies are needed to better understand these results. Notably, overweight and obese individuals should be included to examine whether these responses are altered by weight status across the life span.

To like or not to like: neural substrates of subjective flavor preferences.

Flavor preferences vary; what one enjoys may be disgusting to another. Previous research has indicated several brain regions associated with flavor preferences. However, by using different stimuli or different internal states to obtain differences in liking, results of these studies may be confounded. Therefore, we used one target stimulus (grapefruit juice) and fMRI to compare brain activation patterns between participants that either liked (n=16) or disliked (n=18) this stimulus. Our first aim was to investigate whether differential neural activation exists that accounts for the difference in subjective flavor preference for the target stimulus. Secondly, multivariate analysis was used to investigate whether differences in subjective liking for the target revealed similar activation patterns as differences in general liking for a sweet and bitter solution. A direct comparison of likers and dislikers of the target stimulus revealed only small differences in activations in orbitofrontal cortex (OFC) and dorsal anterior cingulate cortex (dACC). However, when using multivariate analysis, a broader activation pattern (including OFC, dACC, pregenual anterior cingulate, anterior insula and ventral striatum) was identified that discriminated likers from dislikers with an 88% success rate. Interestingly though, little overlap was found between this pattern and the pattern that discriminates liking for the sweet and bitter solutions and lesser voxels contributed to the former compared with the latter. These differences between patterns discerning innate versus learned preferences may suggest that different mechanisms are at work and highlight the importance of elucidating the neural processes of how subjective preferences are learned and acquired.

The first taste is always with the eyes: a meta-analysis on the neural correlates of processing visual food cues.

Food selection is primarily guided by the visual system. Multiple functional neuro-imaging studies have examined the brain responses to visual food stimuli. However, the results of these studies are heterogeneous and there still is uncertainty about the core brain regions involved in the neural processing of viewing food pictures. The aims of the present study were to determine the concurrence in the brain regions activated in response to viewing pictures of food and to assess the modulating effects of hunger state and the food's energy content. We performed three Activation Likelihood Estimation (ALE) meta-analyses on data from healthy normal weight subjects in which we examined: 1) the contrast between viewing food and nonfood pictures (17 studies, 189 foci), 2) the modulation by hunger state (five studies, 48 foci) and 3) the modulation by energy content (seven studies, 86 foci). The most concurrent brain regions activated in response to viewing food pictures, both in terms of ALE values and the number of contributing experiments, were the bilateral posterior fusiform gyrus, the left lateral orbitofrontal cortex (OFC) and the left middle insula. Hunger modulated the response to food pictures in the right amygdala and left lateral OFC, and energy content modulated the response in the hypothalamus/ventral striatum. Overall, the concurrence between studies was moderate: at best 41% of the experiments contributed to the clusters for the contrast between food and nonfood. Therefore, future research should further elucidate the separate effects of methodological and physiological factors on between-study variations.

Representation of sweet and salty taste intensity in the brain.

The intensity of the taste of a food is affected mostly by the amount of sugars (mono- and disaccharides) or salt it contains. To season savory-tasting foods mainly table salt (NaCl) is used and to sweeten foods, sugars like sucrose are used. Foods with highly intense tastes are consumed in smaller amounts. The optimal taste intensity of a food is the intensity at which it is perceived as most pleasant. When taste intensity decreases or increases from optimal, the pleasantness of a food decreases. Here, we investigated the brain representation of sweet and salty taste intensity using functional magnetic resonance imaging. Fifteen subjects visited twice and tasted a range of 4 watery solutions (0-1 M) of either sucrose or NaCl in water. Middle insula activation increased with increasing concentration for both NaCl and sucrose. Despite similar subjective intensity ratings, anterior insula activation by NaCl increased more with concentration than that by sucrose. Amygdala activation increased with increasing NaCl concentration but not sucrose concentration. In conclusion, sweet and salty taste intensity are represented in the middle insula. Amygdala activation is only modulated by saltiness. Further research will need to extrapolate these results from simple solutions to real foods.