Publications by authors named "Elissa S Epel"

174 Publications

A Brief Motivational Intervention Differentially Reduces Sugar-sweetened Beverage (SSB) Consumption.

Ann Behav Med 2021 Mar 29. Epub 2021 Mar 29.

Osher Center for Integrative Medicine, University of California San Francisco (UCSF), San Francisco, USA.

Background: Environmental and behavioral interventions hold promise to reduce sugar-sweetened beverage (SSBs) consumption.

Purpose: To test, among frequent SSB consumers, whether motivations to consume SSBs moderated the effects of (a) a workplace SSB sales ban (environmental intervention) alone, and (b) a "brief motivational intervention" (BI) in addition to the sales ban, on changes in SSB consumption.

Methods: We assessed whether (1) baseline motivations to consume SSBs (craving, psychological stress, or taste enjoyment) impacted changes in daily SSB consumption at 6-month follow-up among frequent (>12oz of SSBs/day) SSB consumers (N = 214); (2) participants randomized to the BI (n = 109) versus to the sales ban only (n = 105) reported greater reductions in SSB consumption at follow-up; and (3) motivations to consume SSBs moderated any changes in SSB consumption.

Results: In response to the sales ban alone, individuals with stronger SSB cravings (+1 SD) at baseline showed significantly smaller reductions in daily SSB consumption at 6-month follow-up relative to individuals with weaker (-1 SD) SSB cravings (2.5 oz vs. 22.5 oz), p < .01. Receiving the BI significantly increased reductions for those with stronger SSB cravings: Among individuals with stronger cravings, those who received the BI evidenced significantly greater reductions in daily SSB consumption [M(SE) = -19.2 (2.74) oz] than those who did not [M(SE) = -2.5 (2.3) oz, p < .001], a difference of 16.72 oz.

Conclusions: Frequent SSB consumers with stronger SSB cravings report minimal reductions in daily SSB consumption with a sales ban only, but report greater reductions if they also receive a motivational intervention. Future multilevel interventions for institutions should consider both environmental and individualized multi-level interventions.

Clinical Trial Information: NCT02585336.
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http://dx.doi.org/10.1093/abm/kaaa123DOI Listing
March 2021

The long shadow of childhood trauma for depression in midlife: examining daily psychological stress processes as a persistent risk pathway.

Psychol Med 2021 Mar 26:1-10. Epub 2021 Mar 26.

Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.

Background: Childhood trauma (CT) increases the risk of adult depression. Buffering effects require an understanding of the underlying persistent risk pathways. This study examined whether daily psychological stress processes - how an individual interprets and affectively responds to minor everyday events - mediate the effect of CT on adult depressive symptoms.

Methods: Middle-aged women (N = 183) reported CT at baseline and completed daily diaries of threat appraisals and negative evening affect for 7 days at baseline, 9, and 18 months. Depressive symptoms were measured across the 1.5-year period. Mediation was examined using multilevel structural equation modeling.

Results: Reported CT predicted greater depressive symptoms over the 1.5-year time period (estimate = 0.27, s.e. = 0.07, 95% CI 0.15-0.38, p < 0.001). Daily threat appraisals and negative affect mediated the effect of reported CT on depressive symptoms (estimate = 0.34, s.e. = 0.08, 95% CI 0.22-0.46, p < 0.001). Daily threat appraisals explained more than half of this effect (estimate = 0.19, s.e. = 0.07, 95% CI 0.08-0.30, p = 0.004). Post hoc analyses in individuals who reported at least moderate severity of CT showed that lower threat appraisals buffered depressive symptoms. A similar pattern was found in individuals who reported no/low severity of CT.

Conclusions: A reported history of CT acts as a latent vulnerability, exaggerating threat appraisals of everyday events, which trigger greater negative evening affect - processes that have important mental health consequences and may provide malleable intervention targets.
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http://dx.doi.org/10.1017/S0033291721000921DOI Listing
March 2021

A Pilot Study Comparing the Effects of Consuming 100% Orange Juice or Sucrose-Sweetened Beverage on Risk Factors for Cardiometabolic Disease in Women.

Nutrients 2021 Feb 26;13(3). Epub 2021 Feb 26.

Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA.

Overconsumption of sugar-sweetened beverages increases risk factors associated with cardiometabolic disease, in part due to hepatic fructose overload. However, it is not clear whether consumption of beverages containing fructose as naturally occurring sugar produces equivalent metabolic dysregulation as beverages containing added sugars. We compared the effects of consuming naturally-sweetened orange juice (OJ) or sucrose-sweetened beverages (sucrose-SB) for two weeks on risk factors for cardiometabolic disease. Healthy, overweight women ( = 20) were assigned to consume either 3 servings of 100% orange juice or sucrose-SB/day. We conducted 16-hour serial blood collections and 3-h oral glucose tolerance tests during a 30-h inpatient visit at baseline and after the 2-week diet intervention. The 16-h area under the curve (AUC) for uric acid increased in subjects consuming sucrose-SB compared with subjects consuming OJ. Unlike sucrose-SB, OJ did not significantly increase fasting or postprandial lipoproteins. Consumption of both beverages resulted in reductions in the Matsuda insulin sensitivity index (OJ: -0.40 ± 0.18, = 0.04 within group; sucrose-SB: -1.0 ± 0.38, = 0.006 within group; = 0.53 between groups). Findings from this pilot study suggest that consumption of OJ at levels above the current dietary guidelines for sugar intake does not increase plasma uric acid concentrations compared with sucrose-SB, but appears to lead to comparable decreases of insulin sensitivity.
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http://dx.doi.org/10.3390/nu13030760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996959PMC
February 2021

Emergency physician stressors, concerns, and behavioral changes during COVID-19: A longitudinal study.

Acad Emerg Med 2021 03 16;28(3):314-324. Epub 2021 Feb 16.

Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, California, USA.

Objectives: The objective was to provide a longitudinal assessment of anxiety levels and work and home concerns of U.S. emergency physicians during the COVID-19 pandemic.

Methods: We performed a longitudinal, cross-sectional email survey of clinically active emergency physicians (attending, fellow, and resident) at seven academic emergency departments. Follow-up surveys were sent 4 to 6 weeks after the initial survey and assessed the following: COVID-19 patient exposure, availability of COVID-19 testing, levels of home and workplace anxiety/stress, changes in behaviors, and performance on a primary care posttraumatic stress disorder screen (PC-PTSD-5). Logistic regression explored factors associated with a high PC-PTSD-5 scale score (≥3), indicating increased risk for PTSD.

Results: Of the 426 surveyed initial respondents, 262 (61.5%) completed the follow-up survey. While 97.3% (255/262) reported treating suspected COVID-19 patients, most physicians (162/262, 61.8%) had not received testing themselves. In follow-up, respondents were most concerned about the relaxing of social distancing leading to a second wave (median score = 6, IQR = 4-7). Physicians reported a consistently high ability to order COVID-19 tests for patients (median score = 6, IQR = 5-7) and access to personal protective equipment (median score = 6, IQR = 5-6). Women physicians were more likely to score ≥ 3 than men on the PC-PTSD-5 screener on the initial survey (43.3% vs. 22.5%; Δ 20.8%, 95% confidence interval [CI] = 9.3% to 31.5%), and despite decreases in overall proportions, this discrepancy remained in follow-up (34.7% vs. 16.8%; Δ 17.9%, 95% CI = 7.1% to 28.1%). In examining the relationship between demographics, living situations, and institution location on having a PC-PTSD-5 score ≥ 3, only female sex was associated with a PC-PTSD-5 score ≥ 3 (adjusted odds ratio = 2.48, 95% CI = 1.28 to 4.79).

Conclusions: While exposure to suspected COVID-19 patients was nearly universal, stress levels in emergency physicians decreased with time. At both initial and follow-up assessments, women were more likely to test positive on the PC-PTSD-5 screener compared to men.
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http://dx.doi.org/10.1111/acem.14219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014663PMC
March 2021

Early life adversity, pubertal timing, and epigenetic age acceleration in adulthood.

Dev Psychobiol 2021 Jan 10. Epub 2021 Jan 10.

University of California, San Francisco, CA, USA.

Background: Given associations linking early life adversity, pubertal timing, and biological aging, we examined the direct and indirect effects of early life trauma on adult biological aging (via age of menarche).

Methods: Participants were premenopausal women (N = 183). Path models evaluated whether early life trauma predicted early pubertal timing and thereby, adult epigenetic age acceleration (indexed via four epigenetic clocks: Horvath DNAm Age, Hannum DNAm Age, DNAm PhenoAge, and DNAm GrimAge). Secondary analyses explored the effects of type of trauma (abuse and neglect) and adult chronic stress status (caregiver of child with autism and non-caregiver).

Results: Early life trauma and earlier age at menarche independently predicted accelerated aging based on one of the four epigenetic clocks, DNAm GrimAge, though early life trauma was not associated with age of menarche. Childhood abuse, but not neglect, predicted faster epigenetic aging; results did not differ by chronic stress status.

Conclusions: Early trauma and early menarche appear to exert independent effects on DNAm GrimAge, which has been shown to be the strongest epigenetic predictor of mortality risk. This study identifies a potential correlate or determinant of accelerated epigenetic aging-menarcheal age. Future research should address the limitations of this study by using racially diverse samples.
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http://dx.doi.org/10.1002/dev.22085DOI Listing
January 2021

HPA axis regulation and epigenetic programming of immune-related genes in chronically stressed and non-stressed mid-life women.

Brain Behav Immun 2021 Feb 19;92:49-56. Epub 2020 Nov 19.

Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA; Department of Genetics, University of North Carolina, Chapel Hill, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Carolina Stress Initiative, University of North Carolina School of Medicine, Chapel Hill, NC, USA. Electronic address:

Hypothalamic-pituitary-adrenal (HPA) axis dysregulation has been associated with altered immune function, but the underlying molecular mechanisms are unclear. Epigenetic processes, including DNA methylation, respond to the glucocorticoid end-products of the HPA axis (cortisol in humans) and could be involved in this neuroendocrine-immune crosstalk. Here we examined the extent to which variations in HPA axis regulation are associated with peripheral blood DNA (CpG) methylation changes in 57 chronically stressed caregivers and 67 control women. DNA methylation was determined with the Illumina 450k array for a panel of genes involved in HPA axis and immune function. HPA axis feedback was assessed with the low-dose dexamethasone suppression test (DST), measuring the extent to which cortisol secretion is suppressed by the synthetic glucocorticoid dexamethasone. After multiple testing correction in the entire cohort, higher post-DST cortisol, reflecting blunted HPA axis negative feedback, but not baseline waking cortisol, was associated with lower DNA methylation at eight TNF and two FKBP5 CpG sites. Caregiver group status was associated with lower methylation at two IL6 CpG sites. Since associations were most robust with TNF methylation (32% of the 450k-covered sites), we further examined functionality of this epigenetic signature in cultured peripheral blood mononuclear cells in 33 participants; intriguingly, lower TNF methylation resulted in higher ex vivo TNF mRNA following immune stimulation. Taken together, our findings link chronic stress and HPA axis regulation with epigenetic signatures at immune-related genes, thereby providing novel insights into how aberrant HPA axis function may contribute to heightened inflammation and disease risk.
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http://dx.doi.org/10.1016/j.bbi.2020.11.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897273PMC
February 2021

Exploratory Analysis of Racial/Ethnic and Educational Differences in a Randomized Controlled Trial of a Mindfulness-based Weight Loss Intervention.

Psychosom Med 2020 Nov 18. Epub 2020 Nov 18.

From the Institute of Holistic Health Studies (Daubenmier), San Francisco State University; Osher Center for Integrative Medicine (Chao, Hartogensis, Liu, Moran, Acree, Hecht), University of California, San Francisco, San Francisco, California; Department of Psychology (Kristeller), Indiana State University, Terre Haute, Indiana; and Department of Psychiatry (Epel), University of California, San Francisco, San Francisco, California.

Objective: People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions.

Methods: We analyzed data from a randomized controlled trial of 194 participants with obesity (41% participants of color, 36% without college degree) comparing a 5.5-month mindfulness-based weight loss intervention to an active-control with identical diet-exercise guidelines. We assessed attendance, 18-month attrition, and weight change at 6, 12, and 18 months by race/ethnicity and education level using linear mixed models, adjusting for baseline body mass index, age, and education or race/ethnicity, respectively.

Results: Participants without versus with a college degree attended fewer sessions and had higher attrition across interventions. Participants of color attended fewer intervention sessions in the mindfulness compared with the control intervention. Overall, participants of color lost significantly less weight at 12 and 18 months compared with Whites. However, during the 6- to 18-month maintenance period, we found an interaction of intervention arm, race/ethnicity, and time (p = .035), indicating that participants of color compared with Whites regained more weight in the control (0.33 kg/mo; p = .005) but not mindfulness intervention (0.06 kg/mo; p = .62). Participants without a college degree had greater initial weight loss in the mindfulness compared to control intervention from 0 to 6 months (-0.46 kg/mo; p = .039).

Conclusions: Although disparities persist, mindfulness approaches may mitigate some racial/ethnic and socioeconomic differences in weight loss compared with conventional diet-exercise programs.

Trial Registration: Clinicaltrials.gov registration: NCT00960414.
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http://dx.doi.org/10.1097/PSY.0000000000000859DOI Listing
November 2020

The geroscience agenda: Toxic stress, hormetic stress, and the rate of aging.

Authors:
Elissa S Epel

Ageing Res Rev 2020 11 28;63:101167. Epub 2020 Sep 28.

Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, & Center for Health and Community, University of California, 3333 California St, Ste 465, San Francisco, CA, 94122, United States. Electronic address:

Geroscience offers a counterpoint to the challenged pursuit of curing diseases of aging, by focusing on slowing the biological aging process for extended healthspan earlier in life. Remarkable progress has led this field toward animal trials and the next challenge lies with translation to humans. There is an emerging number of small human trials that can take advantage of new models integrating behavioral and social factors. Understanding dynamic aging mechanisms, given the powerful social determinants of aging (Crimmins, 2020) and human variability and environmental contexts (Moffitt, 2020), will be critical. Behavioral and social factors are intrinsic to aging. Toxic stressors broadly defined can lead to stress-acceleration of aging, either directly impacting aging processes or by shaping poor behavioral health, and underlie the socioeconomic disparities of aging. In contrast, hormetic stressors, acute intermittent stressors of moderate intensity, can produce stress resilience, the ability for quick recovery and possibly rejuvenation of cells and tissues. Although health research usually examines static biomarkers, aging is reflected in dynamic ability to recover from challenges pointing to new interventions and targets for examining mechanisms. A fuller model incorporating stress resilience provides innovative biobehavioral interventions, both for bolstering response to challenges, such as COVID-19, and for improving healthspan.
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http://dx.doi.org/10.1016/j.arr.2020.101167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520385PMC
November 2020

Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials.

Ann Surg 2021 03;273(3):424-432

Department of Psychiatry & Biobehavioral Sciences, and Department of Medicine, University of California, Los Angeles.

Objective: To determine the effects of ESRT (an iteratively adapted and tailored MBI) on perceived stress, executive cognitive function, psychosocial well-being (ie, burnout, mindfulness), and pro-inflammatory gene expression in surgical (ESRT-1) and mixed specialty (ESRT-2) PGY-1 volunteers.

Summary Of Background And Data: Tailored MBIs have proven beneficial in multiple high-stress and high-performance populations. In surgeons, tailored MBIs have been shown to be feasible and potentially beneficial, but whether mindfulness-based cognitive training can improve perceived stress, executive function, well-being or physiological distress in surgical and nonsurgical trainees is unknown.

Methods: In 2 small single-institution randomized clinical trials, ESRT, a tailored mindfulness-based cognitive training program, was administered and iteratively adapted for first-year surgical (ESRT-1, 8 weekly, 2-hour classes, n = 44) and mixed specialty (ESRT-2, 6 weekly, 90-minute classes, n = 45) resident trainees. Primary and secondary outcomes were, respectively, perceived stress and executive function. Other prespecified outcomes were burnout (assessed via Maslach Burnout Inventory), mindfulness (assessed via Cognitive Affective Mindfulness Scale - Revised), and pro-inflammatory gene expression (assessed through the leukocyte transcriptome profile "conserved transcriptional response to adversity").

Results: Neither version of ESRT appeared to affect perceived stress. Higher executive function and mindfulness scores were seen in ESRT-1, and lower emotional exhaustion and depersonalization scores in ESRT-2, at pre-/postintervention and/or 50-week follow-up (ESRT-1) or at 32-week follow-up (ESRT-2), compared to controls. Pooled analysis of both trials found ESRT-treated participants had reduced pro-inflammatory RNA expression compared to controls.

Conclusions: This pilot work suggests ESRT can variably benefit executive function, burnout, and physiologic distress in PGY-1 trainees, with potential for tailoring to optimize effects.
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http://dx.doi.org/10.1097/SLA.0000000000004145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863698PMC
March 2021

Pre-treatment allostatic load and metabolic dysregulation predict SSRI response in major depressive disorder: a preliminary report.

Psychol Med 2020 May 22:1-9. Epub 2020 May 22.

Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA.

Background: Major depressive disorder (MDD) is associated with increased allostatic load (AL; a measure of physiological costs of repeated/chronic stress-responding) and metabolic dysregulation (MetD; a measure of metabolic health and precursor to many medical illnesses). Though AL and MetD are associated with poor somatic health outcomes, little is known regarding their relationship with antidepressant-treatment outcomes.

Methods: We determined pre-treatment AL and MetD in 67 healthy controls and 34 unmedicated, medically healthy MDD subjects. Following this, MDD subjects completed 8-weeks of open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and were categorized as 'Responders' (⩾50% improvement in depression severity ratings) or 'Non-responders' (<50% improvement). Logistic and linear regressions were performed to determine if pre-treatment AL or MetD scores predicted SSRI-response. Secondary analyses examined cross-sectional differences between MDD and control groups.

Results: Pre-treatment AL and MetD scores significantly predicted continuous antidepressant response (i.e. absolute decreases in depression severity ratings) (p = 0.012 and 0.014, respectively), as well as post-treatment status as a Responder or Non-responder (p = 0.022 and 0.040, respectively), such that higher pre-treatment AL and MetD were associated with poorer SSRI-treatment outcomes. Pre-treatment AL and MetD of Responders were similar to Controls, while those of Non-responders were significantly higher than both Responders (p = 0.025 and 0.033, respectively) and Controls (p = 0.039 and 0.001, respectively).

Conclusions: These preliminary findings suggest that indices of metabolic and hypothalamic-pituitary-adrenal-axis dysregulation are associated with poorer SSRI-treatment response. To our knowledge, this is the first study to demonstrate that these markers of medical disease risk also predict poorer antidepressant outcomes.
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http://dx.doi.org/10.1017/S0033291720000896DOI Listing
May 2020

The Effects of Aerobic Exercise on Psychological Functioning in Family Caregivers: Secondary Analyses of a Randomized Controlled Trial.

Ann Behav Med 2021 02;55(1):65-76

School of Kinesiology, University of British Columbia, University Boulevard, Vancouver, BC, Canada.

Background: The responsibility and stress of being a family caregiver are associated with reduced physical and mental health.

Purpose: To examine whether a 24-week aerobic exercise program improves multiple aspects of psychological functioning in family caregivers.

Methods: Family caregivers of patients with Alzheimer's disease and other dementias (n = 68) were recruited and randomized into either an aerobic exercise group (n = 34) or a waitlist control group (n = 34). The exercise group was assigned a 24-week aerobic training program that incrementally increased the intensity, duration, and frequency of the exercise program until 150 min of moderate to vigorous activity were completed per week by the ninth week. Twelve measures of psychological functioning were administered at baseline and compared with responses completed following the intervention.

Results: Multilevel modeling revealed significant decreases in caregiver burden (β = -4.60, 95% confidence interval [CI] = [-8.82, -0.38], RLMM2 = 0.11) and depression (β = -2.59, 95% CI = [-4.79, -0.38], RLMM2 = 0.13), as well as increases in mastery (β = 1.78, 95% CI = [0.09, 3.46], RLMM2 = .04) in the exercise intervention group compared to the control group.

Conclusion: Family caregivers report high levels of depression and caregiver burden. Engagement in a 24-week exercise intervention can ameliorate the perceived burden of caregiving, symptoms of depression, and their sense of mastery.
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http://dx.doi.org/10.1093/abm/kaaa031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880222PMC
February 2021

A Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention on Cardiovascular Reactivity to Social-Evaluative Threat Among Adults with Obesity.

Mindfulness (N Y) 2019 Dec 10;10(12):2583-2595. Epub 2019 Sep 10.

Department of Psychiatry, University of California, San Francisco.

Objective: Mindfulness-based interventions have been found to reduce psychological and physiological stress reactivity. In obesity, however, stress reactivity is complex, with studies showing both exaggerated and blunted physiological responses to stressors. A nuanced view of stress reactivity is the "challenge and threat" framework, which defines adaptive and maladaptive patterns of psychophysiological stress reactivity. We hypothesized that mindfulness training would facilitate increased challenge-related appraisals, emotions, and cardiovascular reactivity, including sympathetic nervous system activation paired with increased cardiac output (CO) and reduced total peripheral resistance (TPR) compared to a control group, which would exhibit an increased threat pattern of psychophysiological reactivity to repeated stressors.

Methods: Adults (N=194) with obesity were randomized to a 5.5-month mindfulness-based weight loss intervention or an active control condition with identical diet-exercise guidelines. Participants were assessed at baseline and 4.5 months later using the Trier Social Stress Task. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during the speech and verbal arithmetic tasks to assess pre-ejection period (PEP), CO, and TPR reactivity.

Results: Mindfulness participants showed significantly greater maintenance of challenge-related emotions and cardiovascular reactivity patterns (higher CO and lower TPR) from pre to post-intervention compared to control participants, but groups did not differ in PEP. Findings were independent of changes in body mass index.

Conclusions: Mindfulness training may increase the ability to maintain a positive outlook and mount adaptive cardiovascular responses to repeated stressors among persons with obesity though findings need to be replicated in other populations and using other forms of mindfulness interventions.
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http://dx.doi.org/10.1007/s12671-019-01232-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138245PMC
December 2019

The stress field ages: A close look into cellular aging processes.

Psychoneuroendocrinology 2020 03 3;113:104537. Epub 2019 Dec 3.

Department of Psychiatry, and Center for Health and Community, University of California, San Francisco, California, USA. Electronic address:

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http://dx.doi.org/10.1016/j.psyneuen.2019.104537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429448PMC
March 2020

Efficacy of Digital Cognitive Behavioral Therapy for the Treatment of Insomnia Symptoms Among Pregnant Women: A Randomized Clinical Trial.

JAMA Psychiatry 2020 05;77(5):484-492

Department of Psychiatry, University of California, San Francisco, San Francisco.

Importance: Despite the prevalence and adverse consequences of prenatal insomnia, a paucity of research is available regarding interventions to improve insomnia symptoms during pregnancy.

Objective: To test the efficacy of digital cognitive behavioral therapy for insomnia (CBT-I) compared with standard treatment among pregnant women with insomnia symptoms.

Design, Setting, And Participants: This randomized clinical trial enrolled pregnant women from November 23, 2016, to May 22, 2018. Of the 2258 women assessed for eligibility using an online self-report questionnaire, 208 were randomized to receive digital CBT-I (n = 105) or standard treatment (n = 103) for insomnia. Participants were pregnant up to 28 weeks' gestation, and they either had elevated insomnia symptom severity or met the criteria for insomnia caseness as determined by self-report questionnaires. Participants completed outcome measures at 10 weeks (postintervention) and 18 weeks (follow-up) after randomization. All study visits were completed remotely, and the intervention was delivered digitally. Data were analyzed between December 12, 2018, and July 2, 2019.

Interventions: Digital CBT-I consisted of 6 weekly sessions of approximately 20 minutes each. Standard treatment reflected standard care. Women receiving standard treatment had no limits placed on the receipt of nonstudy treatments, including medication and psychotherapy.

Main Outcomes And Measures: All outcomes were assessed remotely using self-report questionnaires administered via online survey. The primary outcome was the change in insomnia symptom severity (measured by the Insomnia Severity Index) from baseline to postintervention. Secondary outcomes were sleep efficiency and nightly sleep duration (defined by sleep diary), global sleep quality (measured by the Pittsburgh Sleep Quality Index), depressive symptom severity (measured by the Edinburgh Postnatal Depression Scale), and anxiety symptom severity (measured by the Generalized Anxiety Disorder Scale-7). For each outcome, we also examined the change from baseline to follow-up.

Results: The 208 participants had a mean (SD) age of 33.6 (3.7) years and a mean (SD) gestational age of 17.6 (6.3) weeks at baseline. Most of the participants were white (138 [66.3%]), married or cohabiting (196 [94.2%]), had a college degree (180 [86.5%]), and earned $100 000 or more per year (141 [67.8%]). Women randomized to receive digital CBT-I experienced statistically significantly greater improvements in insomnia symptom severity from baseline to postintervention compared with women randomized to receive standard treatment (time-by-group interaction, difference = -0.36; 95% CI, -0.48 to -0.23; χ2 = 29.8; P < .001; d = -1.03). Improvements from baseline to postintervention for all secondary outcomes, with the exception of sleep duration, were statistically significant. A similar pattern of results was evident for the change from baseline to follow-up.

Conclusions And Relevance: In this trial, digital CBT was an effective, scalable, safe, and acceptable intervention for improving insomnia symptoms during pregnancy.

Trial Registration: ClinicalTrials.gov identifier: NCT02805998.
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http://dx.doi.org/10.1001/jamapsychiatry.2019.4491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990703PMC
May 2020

Understanding the Psychological Distress of Food Insecurity: A Qualitative Study of Children's Experiences and Related Coping Strategies.

J Acad Nutr Diet 2020 03 17;120(3):395-403. Epub 2020 Jan 17.

Background: Food insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress.

Objective: To critically explore the psychological distress associated with children's food insecurity using children's own reports of their experiences.

Design: In-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity.

Participants/setting: Sixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year.

Results: Children discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents' well-being, anger and frustration about not having enough food, embarrassment about their family's food situation, strain on the family's dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family's food situation, and appreciating their parents for providing food and resources.

Conclusions: Food insecurity contributes to children's psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children's growth and development and deserves investigation in future studies.
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http://dx.doi.org/10.1016/j.jand.2019.10.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047973PMC
March 2020

Racial discrimination and telomere shortening among African Americans: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Health Psychol 2020 Mar 13;39(3):209-219. Epub 2020 Jan 13.

Department of Psychiatry, University of California, San Francisco.

Objective: Telomeres are protective sequences of DNA capping the ends of chromosomes that shorten over time. Leukocyte telomere length (LTL) is posited to reflect the replicative history of cells and general systemic aging of the organism. Chronic stress exposure leads to accelerated LTL shortening, which has been linked to increased susceptibility to and faster progression of aging-related diseases. This study examined longitudinal associations between LTL and experiences of racial discrimination, a qualitatively unique source of minority psychosocial stress, among African Americans.

Method: Data are from 391 African Americans in the Coronary Artery Risk Development in Young Adults (CARDIA) Telomere Ancillary Study. We examined the number of domains in which racial discrimination was experienced in relation to LTL collected in Years 15 and 25 (Y15: 2000/2001; Y25: 2010/2011). Multivariable linear regression examined if racial discrimination was associated with LTL. Latent change score analysis (LCS) examined changes in racial discrimination and LTL in relation to one another.

Results: Controlling for racial discrimination at Y15, multivariable linear regression analyses indicated that racial discrimination at Y25 was significantly associated with LTL at Y25. This relationship remained robust after adjusting for LTL at Y15 (b = -.019, = .015). Consistent with this finding, LCS revealed that increases in experiences of racial discrimination were associated with faster 10-year LTL shortening (b = -.019, = .015).

Conclusions: This study adds to evidence that racial discrimination contributes to accelerated physiologic weathering and health declines among African Americans through its impact on biological systems, including via its effects on telomere attrition. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373166PMC
March 2020

Can Childhood Adversity Affect Telomeres of the Next Generation? Possible Mechanisms, Implications, and Next-Generation Research.

Authors:
Elissa S Epel

Am J Psychiatry 2020 01;177(1):7-9

Dr. Epel is Professor and Vice Chair, Department of Psychiatry, University of California, San Francisco.

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http://dx.doi.org/10.1176/appi.ajp.2019.19111161DOI Listing
January 2020

Do stress eating or compulsive eating influence metabolic health in a mindfulness-based weight loss intervention?

Health Psychol 2020 Feb 14;39(2):147-158. Epub 2019 Nov 14.

Department of Psychiatry.

Objective: We aimed to understand the associations of compulsive eating (CE) and stress eating (SE) with metabolic health among adults with obesity and whether mindfulness-based weight loss training may buffer these associations.

Method: We used data from a trial in which we randomized 194 participants with obesity to a diet-exercise weight loss intervention with either mindful eating training plus mindfulness-based eating awareness and stress management training ( = 100) or active control components ( = 94). We measured CE, SE, weight, and fasting blood glucose (FBG) at baseline, and 6, 12 months, and 18 months. We tested CE and SE as both moderators and mediators of intervention effects on changes in metabolic health.

Results: Participants higher (+ 1 ) in CE at baseline randomized to the mindfulness (vs. control) intervention had greater improvements in FBG at 18 months ( = .05). Twelve-month reductions in CE mediated the effect of the intervention on changes in FBG and weight at 12 and 18 months postbaseline ( ≤ .05). Furthermore, those higher (+ 1 ) in SE at baseline were nearly 2 BMI points higher than those lower (-1 ) in SE ( < .01). Decreases in SE ( = 3.42; < .001; 95% CI [2.55, 4.30]) and CE ( = 0.45; < .001; 95% CI [0.36, 0.54]) in all participants at 6 months were associated with greater weight loss at 18 months.

Conclusions: Those with greater compulsive eating may reduce risk for metabolic decline by participating in a mindfulness-based weight loss program. Future obesity interventions should consider tailoring treatment toward trait-level characteristics, such as compulsive eating. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959208PMC
February 2020

Pregnant Patient Perceptions of Provider Detection and Treatment of Insomnia.

Behav Sleep Med 2020 Nov-Dec;18(6):787-796. Epub 2019 Nov 6.

Department of Psychiatry, University of California , San Francisco.

: To survey pregnant patients about whether their health care providers assessed insomnia, the types of treatment recommendations providers made, and the types of treatments patients utilized. : Participants were 423 English-speaking pregnant women. : In this cross-sectional study, participants self-reported insomnia symptoms on the Insomnia Severity Index and indicated whether they discussed their sleep with a health care provider, whether they received any recommendations to improve their sleep, and whether they utilized any interventions or aids to improve their sleep during their current pregnancy. : Approximately one-third (39%) of participants reported that they discussed their sleep with a health care provider at some point during their pregnancy. Among participants who reported moderate to severe insomnia symptoms (Insomnia Severity Index>14), 57% reported that they had discussed their sleep with a health care provider, and 28% reported receiving an insomnia diagnosis. Over-the-counter medication was the most commonly recommended (53%) and utilized (39%) sleep intervention among women with moderate to severe insomnia symptoms. : According to patient report, insomnia may be under-detected during pregnancy. When insomnia is recognized, treatment recommendations do not match clinical practice guidelines or women's preferences for receiving cognitive behavior therapy for insomnia. Taken together with previous research on the prevalence and consequences of prenatal insomnia, these findings suggest the need for an increased focus on the importance of sleep during pregnancy.
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http://dx.doi.org/10.1080/15402002.2019.1688153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200275PMC
February 2021

Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Consumption of Sugar-Sweetened Beverages and Health.

JAMA Intern Med 2019 Oct 28:1-8. Epub 2019 Oct 28.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.

Importance: Reductions in sugar-sweetened beverage (SSB) intake can improve health, but are difficult for individuals to achieve on their own.

Objectives: To evaluate whether a workplace SSB sales ban was associated with SSB intake and cardiometabolic health among employees and whether a brief motivational intervention provides added benefits to the sales ban.

Design, Setting, And Participants: This before-after study and additional randomized trial conducted from July 28, 2015, to October 16, 2016, at a Northern California university and hospital assessed SSB intake, anthropometrics, and cardiometabolic biomarkers among 214 full-time English-speaking employees who were frequent SSB consumers (≥360 mL [≥12 fl oz] per day) before and 10 months after implementation of an SSB sales ban in a large workplace, with half the employees randomized to receive a brief motivational intervention targeting SSB reduction.

Interventions: The employer stopped selling SSBs in all workplace venues, and half the sample was randomized to receive a brief motivational intervention and the other half was a control group that did not receive the intervention. This intervention was modeled on standard brief motivational interventions for alcohol used in the workplace that promote health knowledge and goal setting.

Main Outcomes And Measures: Outcomes included changes in SSB intake, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and measures of abdominal adiposity. The primary associations tested were the correlation between changes in SSB intake and changes in HOMA-IR.

Results: Among the 214 study participants, 124 (57.9%) were women, with a mean (SD) age of 41.2 (11.0) years and a baseline mean (SD) body mass index of 29.4 (6.5). They reported a mean daily intake of 1050 mL (35 fl oz) of SSBs at baseline and 540 mL (18 fl oz) at follow-up-a 510-mL (17-fl oz) (48.6%) decrease (P < .001). Reductions in SSB intake correlated with improvements in HOMA-IR (r = 0.16; P = .03). Those not randomized to receive the brief intervention reduced their SSB intake by a mean (SD) of 246.0 (84.0) mL (8.2 [2.8] fl oz), while those also receiving the brief intervention reduced SSB intake by 762.0 (84.0) mL (25.4 [2.8] fl oz). From baseline to follow-up, there were significant reductions in mean (SE) waist circumference (2.1 [2.8] cm; P < .001).

Conclusions And Relevance: This study's findings suggest that the workplace sales ban was associated with a reduction in SSB intake and a significant reduction in waist circumference among employees within 10 months. The randomized clinical trial portion of this study found that targeting those at high risk with a brief motivational intervention led to additional improvements. Workplace sales bans may offer a promising new private-sector strategy for reducing the health harms of SSB intake.

Trial Registration: ClinicalTrials.gov identifier: NCT02585336.
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http://dx.doi.org/10.1001/jamainternmed.2019.4434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820289PMC
October 2019

Correlates of longitudinal leukocyte telomere length in the Costa Rican Longevity Study of Healthy Aging (CRELES): On the importance of DNA collection and storage procedures.

PLoS One 2019 11;14(10):e0223766. Epub 2019 Oct 11.

Escuela de Biología, Universidad de Costa Rica, San Jose, Costa Rica.

The objective is to identify cofactors of leukocyte telomere length (LTL) in a Latin American population, specifically the association of LTL with 36 socio-demographic, early childhood, and health characteristics, as well as with DNA sample collection and storage procedures. The analysis is based on longitudinal information from a subsample of 1,261 individuals aged 60+ years at baseline from the Costa Rican Study of Longevity and Healthy Aging (CRELES): a nationally representative sample of elderly population. Random effects regression models for panel data were used to estimate the associations with LTL and its longitudinal changes. Sample collection procedures and DNA refrigerator storage time were strongly associated with LTL: telomeres are longer in blood collected in October-December, in DNA extracted from <1-year-old blood cells, and in DNA stored at 4°C for longer periods of time up to five years. The data confirmed that telomeres are shorter at older ages, as well as among males, and diabetic individuals, whereas telomeres are longer in the high-longevity Nicoya region. Most health, biomarkers, and early childhood indicators did not show significant associations with LTL. Longitudinal LTL variation over approximately two years was mainly associated with baseline LTL levels, as found in other studies. Our findings suggest that if there is unavoidable variability in season of sample collection and DNA storage time, these factors should be controlled for in all demographic and epidemiologic studies of LTL. However, due to unobserved components of measurement variation, statistical control may be inadequate as compared to standardization of data collection procedures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223766PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788698PMC
March 2020

Association of Short-term Change in Leukocyte Telomere Length With Cortical Thickness and Outcomes of Mental Training Among Healthy Adults: A Randomized Clinical Trial.

JAMA Netw Open 2019 09 4;2(9):e199687. Epub 2019 Sep 4.

Social Neuroscience Lab, Max Planck Society, Berlin, Germany.

Importance: Telomere length is associated with the development of age-related diseases and structural differences in multiple brain regions. It remains unclear, however, whether change in telomere length is linked to brain structure change, and to what extent telomere length can be influenced through mental training.

Objectives: To assess the dynamic associations between leukocyte telomere length (LTL) and cortical thickness (CT), and to determine whether LTL is affected by a longitudinal contemplative mental training intervention.

Design, Setting, And Participants: An open-label efficacy trial of three 3-month mental training modules with healthy, meditation-naive adults was conducted. Data on LTL and CT were collected 4 times over 9 months between April 22, 2013, and March 31, 2015, as part of the ReSource Project. Data analysis was performed between September 23, 2016, and June 21, 2019. Of 1582 eligible individuals, 943 declined to participate; 362 were randomly selected for participation and assigned to training or retest control cohorts, with demographic characteristics matched. The retest control cohorts underwent all testing but no training. Intention-to-treat analysis was performed.

Interventions: Training cohort participants completed 3 modules cultivating interoception and attention (Presence), compassion (Affect), or perspective taking (Perspective).

Main Outcomes And Measures: Change in LTL and CT.

Results: Of the 362 individuals randomized, 30 participants dropped out before study initiation (initial sample, 332). Data were available for analysis of the training intervention in 298 participants (n = 222 training; n = 76 retest control) (175 women [58.7%]; mean [SD] age, 40.5 [9.3] years). The training modules had no effect on LTL. In 699 observations from all 298 participants, mean estimated changes in the relative ratios of telomere repeat copy number to single-copy gene (T/S) were for no training, 0.004 (95% CI, -0.010 to 0.018); Presence, -0.007 (95% CI, -0.025 to 0.011); Affect, -0.005 (95% CI, -0.019 to 0.010); and Perspective, -0.001 (95% CI, -0.017 to 0.016). Cortical thickness change data were analyzed in 167 observations from 67 retest control participants (37 women [55.2%], mean [SD] age, 39.6 [9.0] years). In this retest control cohort subsample, naturally occurring LTL change was related to CT change in the left precuneus extending to the posterior cingulate cortex (mean t161 = 3.22; P < .001; r = 0.246). At the individual participant level, leukocyte telomere shortening as well as lengthening were observed. Leukocyte telomere shortening was related to cortical thinning (t77 = 2.38; P = .01; r = 0.262), and leukocyte telomere lengthening was related to cortical thickening (t77 = 2.42; P = .009; r = 0.266). All analyses controlled for age, sex, and body mass index.

Conclusions And Relevance: The findings of this trial indicate an association between short-term change in LTL and concomitant change in plasticity of the left precuneus extending to the posterior cingulate cortex. This result contributes to the evidence that LTL changes more dynamically on the individual level than previously thought. Further studies are needed to determine potential long-term implications of such change in relation to cellular aging and the development of neurodegenerative disorders. No effect of contemplative mental training was noted in what may be, to date, the longest intervention with healthy adults.

Trial Registration: ClinicalTrials.gov identifier: NCT01833104.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.9687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763984PMC
September 2019

Chronic psychosocial and financial burden accelerates 5-year telomere shortening: findings from the Coronary Artery Risk Development in Young Adults Study.

Mol Psychiatry 2020 05 27;25(5):1141-1153. Epub 2019 Aug 27.

School of Kinesiology, University of British Columbia, War Memorial Gymnasium, Room 210, 6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.

Leukocyte telomere length, a marker of immune system function, is sensitive to exposures such as psychosocial stressors and health-maintaining behaviors. Past research has determined that stress experienced in adulthood is associated with shorter telomere length, but is limited to mostly cross-sectional reports. We test whether repeated reports of chronic psychosocial and financial burden is associated with telomere length change over a 5-year period (years 15 and 20) from 969 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a longitudinal, population-based cohort, ages 18-30 at time of recruitment in 1985. We further examine whether multisystem resiliency, comprised of social connections, health-maintaining behaviors, and psychological resources, mitigates the effects of repeated burden on telomere attrition over 5 years. Our results indicate that adults with high chronic burden do not show decreased telomere length over the 5-year period. However, these effects do vary by level of resiliency, as regression results revealed a significant interaction between chronic burden and multisystem resiliency. For individuals with high repeated chronic burden and low multisystem resiliency (1 SD below the mean), there was a significant 5-year shortening in telomere length, whereas no significant relationships between chronic burden and attrition were evident for those at moderate and higher levels of resiliency. These effects apply similarly across the three components of resiliency. Results imply that interventions should focus on establishing strong social connections, psychological resources, and health-maintaining behaviors when attempting to ameliorate stress-related decline in telomere length among at-risk individuals.
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http://dx.doi.org/10.1038/s41380-019-0482-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044034PMC
May 2020

Transactions between Maternal and Child Depressive Symptoms Emerge Early in Life.

J Clin Child Adolesc Psychol 2019 Aug 27:1-11. Epub 2019 Aug 27.

Department of Psychiatry, University of California.

Maternal depression is a robust risk factor for children's internalizing symptoms; however, the intergenerational transmission of mood disorders is likely more complex than unidirectional parent-directed effects. Theoretical models support transactional associations between maternal and child symptomatology over time but have not been well examined, especially in younger high-risk samples. The present investigation examined predictive transactional relations between maternal depression and children's internalizing in toddlerhood and early childhood using a cross-lagged panel model. Participants were 162 low-income, largely racial/ethnic minority mothers and their offspring (32% African American, 16% White, 52% Other/Multiethnic; 53% female) who were assessed when children were 18 months and 4 years old. There were significant cross-sectional relations between maternal depressive and child internalizing symptoms when children were 18 months but not 4 years of age. Cross-lagged associations were evident such that maternal depression symptoms at 18 months were positively associated with internalizing symptoms among children at 4 years, adjusting for prior maternal symptom levels and the cross-sectional correlations between maternal-child symptoms at 18 months. Within the same model, children's internalizing symptoms at 18 months were also positively associated with maternal depressive symptoms at 4 years, adjusting for prior child symptom levels and cross-sectional correlations. This study is among the first to demonstrate that transactional relations between maternal and child mood symptoms occur as early as toddlerhood/early childhood. Findings highlight the potential utility of inclusive, family-focused interventions that support both parents and children in the treatment of early emotional problems.
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http://dx.doi.org/10.1080/15374416.2019.1644649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044043PMC
August 2019

Maternal caregivers have confluence of altered cortisol, high reward-driven eating, and worse metabolic health.

PLoS One 2019 10;14(5):e0216541. Epub 2019 May 10.

Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States of America.

Animal models have shown that chronic stress increases cortisol, which contributes to overeating of highly palatable food, increased abdominal fat and lower cortisol reactivity. Few studies in humans have simultaneously examined these trajectories. We examined premenopausal women, either mothers of children with a diagnosis of an autism spectrum disorder (n = 92) or mothers of neurotypical children (n = 91). At baseline and 2-years, we assessed hair cortisol, metabolic health, and reward-based eating. We compared groups cross-sectionally and prospectively, accounting for BMI change. Caregivers, relative to controls, had lower cumulative hair cortisol at each time point, with no decreases over time. Caregivers also had stable levels of poor metabolic functioning and greater reward-based eating across both time points, and evidenced increased abdominal fat prospectively (all ps ≤.05), independent of change in BMI. This pattern of findings suggest that individuals under chronic stress, such as caregivers, would benefit from tailored interventions focusing on better regulation of stress and eating in tandem to prevent early onset of metabolic disease, regardless of weight status.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216541PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510426PMC
January 2020

Sweet cognition: The differential effects of glucose consumption on attentional food bias in individuals of lean and obese status.

Physiol Behav 2019 07 17;206:264-273. Epub 2019 Apr 17.

Center for Health and Community, Department of Psychiatry, UCSF, United States; Department of Medicine, Division of Cardiology, UCSF, United States. Electronic address:

In general, glucose consumption improves cognitive performance; however, it is unknown whether glucose specifically alters attentional food bias, and how this process may vary by BMI status. We hypothesized that glucose consumption would increase attentional food bias among individuals of obese BMI status more so than among individuals of lean BMI status. Participants (N = 35) completed the n-back, a working memory task modified to assess attentional food bias (ATT-Food), under fasting and glucose challenge conditions. We computed pre-post changes in ATT-Food, blood glucose and insulin (∆BG & ∆BI), and perceived task-stress (∆stress). After the second cognitive test and blood draw, participants ate lunch and completed a "taste test" of highly palatable foods, and we recorded food consumption. Pre-post changes in ATT-Food were greater among participants of obese (relative to lean) BMI status (F(1,33) = 5.108, p = .031). Greater ∆ATT-Food was significantly associated with greater ∆BG (r = .462, p = .007) and reduced ∆stress (r =-.422, p = .011), and marginally associated with greater taste-test eating (r =.325, p = .057), but was not associated with ∆BI. Our findings suggest that individuals of obese BMI status may exhibit "sweet cognition," as indexed by greater attentional food bias following glucose ingestion, relative to individuals of lean BMI status. Among individuals of obese BMI status, sweet cognition may arise from difficulty broadening attention toward non-food cues after consuming a high glucose load, thereby potentially perpetuating sugar consumption. If confirmed by further research, measures of sweet cognition may help identify individuals with a phenotype of risk for obesity and greater sugar consumption, who may benefit from tailored interventions.
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http://dx.doi.org/10.1016/j.physbeh.2019.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563839PMC
July 2019

Maternal pro-inflammatory state during pregnancy and newborn leukocyte telomere length: A prospective investigation.

Brain Behav Immun 2019 08 8;80:419-426. Epub 2019 Apr 8.

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Psychological Medicine, Charitéplatz 1, 10117 Berlin, Germany; Department of Pediatrics, University of California, Irvine, CA 92617, USA; Development, Health and Disease Research Program, University of California, Irvine, CA 92617, USA. Electronic address:

Introduction: Telomere biology plays a fundamental role in maintaining the integrity of the genome and cell, and shortened telomeres have been linked to several age-related diseases. The initial (newborn) telomere length (TL) represents a critically important feature of the telomere biology system. Exposure to a variety of adverse prenatal conditions such as maternal stress, suboptimal diet, obesity, and obstetric complications, is associated with shorter offspring TL at birth and in adult life. Many, if not all, of these exposures are believed to have an inflammatory component. In this context, stress-related immunological processes during pregnancy may constitute a potential additional biological pathway because they can affect telomere length and telomerase activity via transcriptions factors such as cyclic adenosine monophosphate-dependent transcription factor (ATF7) and nuclear factor-kappa B (NF-κB). Thus, in the present study we examined the hypothesis that maternal pro-inflammatory state across pregnancy, operationalized as the balance between tumor necrosis factor (TNF)-α, a major pro-inflammatory cytokine, and interleukin-10 (IL-10), the major anti-inflammatory cytokine, is associated with newborn leukocyte telomere length (LTL) at birth.

Methods And Materials: Participants were healthy women (N = 112) recruited in early pregnancy. Concentrations of TNF- α and IL-10 were quantified in early, mid and late pregnancy from maternal blood samples. Telomere length was assessed in newborn blood samples soon after birth.

Results: After adjusting for maternal age, maternal pre-pregnancy BMI, birth weight percentile, and infant sex, a higher mean TNF-α/IL-10 ratio across pregnancy was significantly associated with shorter newborn TL (β = -.205, p = .030). Newborn TL was, on average, 10% shorter in offspring of women in the upper compared to lower quartile of the TNF-α/IL-10 ratio during pregnancy.

Discussion: These findings provide new evidence in humans for a potential "programming" mechanism linking maternal systemic pro-inflammatory processes during pregnancy with the initial (newborn) setting of her offspring's telomere system.
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http://dx.doi.org/10.1016/j.bbi.2019.04.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954441PMC
August 2019

Cumulative lifetime stress exposure and leukocyte telomere length attrition: The unique role of stressor duration and exposure timing.

Psychoneuroendocrinology 2019 06 5;104:210-218. Epub 2019 Mar 5.

Department of Psychiatry, University of California, San Francisco, CA, USA.

Background: Stress exposure occurring across the lifespan increases risk for disease, potentially involving telomere length shortening. Stress exposure during childhood and adulthood has been cross-sectionally linked with shorter telomere length. However, few longitudinal studies have examined telomere length attrition over time, and none have investigated how stressor duration (acute life events vs. chronic difficulties), timing (childhood vs. adulthood), and perceived severity may be uniquely related to telomere length shortening.

Methods: To address these issues, we administered a standardized instrument for assessing cumulative lifetime stress exposure (Stress and Adversity Inventory; STRAIN) to 175 mothers of children with Autism Spectrum Disorder or neurotypical children and measured their leukocyte telomere length (LTL) at baseline and 2 years later.

Results: Greater count of lifetime stressors was associated with shorter LTL at baseline and greater LTL attrition over time. When separating lifetime stressors into acute life events and chronic difficulties, only greater count of chronic difficulties significantly predicted shorter baseline LTL and greater LTL attrition. Similarly, when examining timing of stressor exposure, only greater count of chronic childhood difficulties (age < 18) significantly predicted shorter baseline LTL and greater LTL attrition over the 2-year period in mid-life. Importantly, these results were robust while controlling for stressors occurring during the interim 2-year period. Post-hoc analyses suggested that chronic difficulties occurring during earlier childhood (0-12 years) were associated with greater LTL attrition. Cumulative stressor severity predicted LTL attrition in a parallel manner, but was less consistently associated with baseline LTL.

Conclusions: These data are the first to examine the effects of different aspects of cumulative lifetime stress exposure on LTL attrition over time, suggesting that accumulated chronic difficulties during childhood may play a unique role in shaping telomere shortening in midlife.
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http://dx.doi.org/10.1016/j.psyneuen.2019.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518420PMC
June 2019