Publications by authors named "Fernando Fernandez-Aranda"

303 Publications

Tracking temporal response dynamics in the ventral striatum during social feedback in anorexia nervosa: A functional magnetic resonance imaging exploratory study.

Int J Eat Disord 2021 Sep 6. Epub 2021 Sep 6.

Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona and Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.

Objective: Research suggests abnormalities in reward-based processes in anorexia nervosa (AN). However, few studies have explored if such alterations might be associated with different temporal activation patterns. This study aims to characterize alterations in time-dependent processes in the ventral striatum (VS) during social feedback in AN using functional magnetic resonance imaging (fMRI).

Method: Twenty women with restrictive-subtype AN and 20 age-matched healthy controls (HC) underwent a social judgment experimental fMRI task. Temporal VS hemodynamic responses were extracted in SPM for each participant and each social condition (acceptance/rejection).

Results: Compared with age-matched HC, patients with AN showed a significant time by group interaction of peak VS response throughout the task, with a progressive blunting of peak activation responses, accompanied by a progressive increase in baseline activity levels over time.

Discussion: The results suggest an attenuated response pattern to repetitive social rejection in the VS in patients with AN, together with a difficulty in returning to baseline. The information obtained from this study will guide future, design-specific studies to further explore alterations temporal dynamics.
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http://dx.doi.org/10.1002/eat.23604DOI Listing
September 2021

Interplay between cognition and weight reduction in individuals following a Mediterranean Diet: Three-year follow-up of the PREDIMED-Plus trial.

Clin Nutr 2021 Sep 5;40(9):5221-5237. Epub 2021 Aug 5.

Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital Del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029, Madrid, Spain. Electronic address:

Background & Aims: Some cognitive profiles might facilitate successful weight loss and its maintenance. Also, weight reductions may result in cognitive benefits. However, little work to date has examined the interactions between cognition and weight changes in the context of interventions with the Mediterranean diet (MedDiet). We studied the within-subject longitudinal relationships between cognition, body mass index (BMI), physical activity (PA), and quality of life (QoL), in older adults following a MedDiet.

Methods: The PREDIMED-Plus is a primary prevention trial testing the effect of a lifestyle intervention program with an energy-restricted MedDiet (er-MedDiet), weight-loss goals and PA promotion on cardiovascular disease. The PREDIMED-Plus-Cognition sub-study included 487 participants (50% women, mean age 65.2 ± 4.7 years), with overweight/obesity, metabolic syndrome and normal cognitive performance at baseline. A comprehensive neurocognitive test battery was administered at baseline and after 1 and 3 years.

Results: Baseline higher performance in verbal memory (OR = 1.5; 95%CI 1.0, 2.1), visuoconstructive praxis and attention (OR = 1.5; 95%CI 0.9, 2.3), and inhibition (OR = 1.3; 95%CI 0.9, 1.9) were associated with a higher odd of achieving at least 8% weight loss after 3 years follow-up in participants randomized to the intervention group. There were moderate improvements in specific tests of memory and executive functions during follow-up. Higher adherence to the er-MedDiet was associated with greater improvements in memory. Women exhibited lower rates of change in global cognition, PA and QoL. Moreover, improvements in memory correlated with reductions in BMI after 1 year (β = -0.14) and with improvements in PA after 3 years (β = 0.13). Finally, participants who experienced greater improvements in executive functions and global cognition also experienced greater improvements in their QoL.

Conclusions: This study refines the understanding of the determinants and mutual interrelationships between longitudinally-assessed cognitive performance and weight loss, adding further evidence to the cognitive benefits associated with better adherence to a MedDiet. Our results also suggest that weight loss interventions tailored to the cognitive profile and gender of participants are promising avenues for future studies.
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http://dx.doi.org/10.1016/j.clnu.2021.07.020DOI Listing
September 2021

Subtyping treatment-seeking gaming disorder patients.

Addict Behav 2021 12 14;123:107086. Epub 2021 Aug 14.

Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona - UB, L'Hospitalet de Llobregat, Spain. Electronic address:

Background And Aims: Gaming Disorder (GD) is characterized by a pattern of persistent and uncontrolled gaming behavior that causes a marked impairment in important areas of functioning. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the existence of different subtypes within clinical samples, in order to tailor treatment. This study explored the existence of different profiles of patients seeking treatment for GD through a data-driven approach.

Methods: The sample included n = 107 patients receiving treatment for GD (92% men and 8% women) ranging between 14 and 60 years old (mean age = 24.1, SD = 10). A two-step clustering analysis approach explored the existence of different underlying GD profiles based on a broad set of indicators, including sociodemographic features, clinical course of the condition (e.g., onset or evolution), psychopathological symptoms, and personality traits.

Results: Two GD profiles emerged. The first cluster grouped together patients who presented with a lower psychological impact (n = 72, 66.1%), whereas the second cluster comprised patients with a higher psychological impact (n = 35, 32.7%). Cluster comparisons revealed that those patients presenting the higher impact were older, with a later onset of pathological gaming patterns, and more pronounced psychopathological symptoms and dysfunctional personality profiles.

Conclusions: GD severity is influenced by specific demographic, clinical, and psychopathological factors. The identification of two separate profiles provides empirical evidence that contributes to the conceptualization of this disorder, as well as to the development of reliable and valid screening tools and effective intervention plans focused on the precise characteristics of the treatment-seeking patients.
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http://dx.doi.org/10.1016/j.addbeh.2021.107086DOI Listing
December 2021

Metabolic, Affective and Neurocognitive Characterization of Metabolic Syndrome Patients with and without Food Addiction. Implications for Weight Progression.

Nutrients 2021 Aug 13;13(8). Epub 2021 Aug 13.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain.

According to the food addiction (FA) model, the consumption of certain types of food could be potentially addictive and can lead to changes in intake regulation. We aimed to describe metabolic parameters, dietary characteristics, and affective and neurocognitive vulnerabilities of individuals with and without FA, and to explore its influences on weight loss progression. The sample included 448 adults (55-75 years) with overweight/obesity and metabolic syndrome from the PREDIMED-Plus cognition sub-study. Cognitive and psychopathological assessments, as well as dietary, biochemical, and metabolic measurements, were assessed at baseline. Weight progression was evaluated after a 3-year follow up. The presence of FA was associated with higher depressive symptomatology, neurocognitive decline, low quality of life, high body mass index (BMI), and high waist circumference, but not with metabolic comorbidities. No differences were observed in the dietary characteristics except for the saturated and monounsaturated fatty acids consumption. After three years, the presence of FA at baseline resulted in a significantly higher weight regain. FA is associated with worse psychological and neurocognitive state and higher weight regain in adults with metabolic syndrome. This condition could be an indicator of bad prognosis in the search for a successful weight loss process.
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http://dx.doi.org/10.3390/nu13082779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398101PMC
August 2021

Women and gambling disorder: Assessing dropouts and relapses in cognitive behavioral group therapy.

Addict Behav 2021 12 13;123:107085. Epub 2021 Aug 13.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain. Electronic address:

Background: Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse).

Methods: The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations.

Results: The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption.

Conclusions: Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women.
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http://dx.doi.org/10.1016/j.addbeh.2021.107085DOI Listing
December 2021

Gambling-Like Day Trading During the COVID-19 Pandemic - Need for Research on a Pandemic-Related Risk of Indebtedness and Mental Health Impact.

Front Psychiatry 2021 26;12:715946. Epub 2021 Jul 26.

Department of Psychiatry, Bellvitge University Hospital-L'Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.

Stock exchange trading increasingly has been highlighted as a possible cause of gambling disorder, typically in rapid and excessive "day trading" which may cause over-indebtedness and mental health problems. The COVID-19 pandemic has been suspected to increase online gambling and gambling problems. In a number of recent media reports, day trading has been reported to increase during COVID-19, possibly in relation to changes in everyday life, financial problems and job insecurity during the pandemic. Increasing day trading has thereby been suspected to cause addictive behavior, financial difficulties, and poor mental health. However, there is hitherto a lack of research in the area. The present paper addresses the potential for day trading to cause problem gambling, debts and mental health problems, and calls for research and clinical guidelines in problem gambling related to stock market behavior as a problematic gambling behavior. Screening tools, awareness among clinicians, and longitudinal research studies may be warranted, both during the COVID-19 pandemic and beyond.
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http://dx.doi.org/10.3389/fpsyt.2021.715946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350024PMC
July 2021

Executive functions in binge spectrum eating disorders with comorbid compulsive buying.

Eur Eat Disord Rev 2021 Jul 28. Epub 2021 Jul 28.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.

Objective: The aims were to explore if bulimic spectrum disorders (BSD) patients, who also present comorbid compulsive buying (CB), could represent a specific subtype considering its neuropsychological performance; to present a descriptive analysis of different clinical features; and to explore how these variables could influence treatment outcome. It was hypothesised that the comorbid group will present worse neuropsychological performance that will lead to a worse treatment outcome.

Method: The study has a longitudinal design. Women (N = 75) diagnosed with BSD, BSD + CB and Healthy Controls (HC); completed an evaluation of: cognitive flexibility, decision making, eating disorder (ED) symptomatology, psychopathological state and personality traits.

Results: BSD + CB was the group with the most severe clinical profile, worst treatment outcome and higher neuropsychological impairment, than other groups. Path-analysis evidenced that deficits in decision making were associated with bad treatment outcome, while deficits in flexibility with the presence of the comorbidity. Self-directedness and novelty seeking were associated with the neuropsychological performance and the comorbidity.

Conclusion: BSD + CB exhibit a worse clinical and neuropsychological profile that seems to be related with the treatment outcome, which should be taken into account for the establishment of specific treatment approaches.
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http://dx.doi.org/10.1002/erv.2855DOI Listing
July 2021

Neuropsychological Learning Deficits as Predictors of Treatment Outcome in Patients with Eating Disorders.

Nutrients 2021 Jun 23;13(7). Epub 2021 Jun 23.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 L'Hospitalet de Llobregat, Spain.

Eating disorders (EDs) are severe psychiatric illnesses that require individualized treatments. Decision-making deficits have been associated with EDs. Decision-making learning deficits denote a lack of strategies to elaborate better decisions that can have an impact on recovery and response to treatment. This study used the Iowa Gambling Task (IGT) to investigate learning differences related to treatment outcome in EDs, comparing between patients with a good and bad treatment outcome and healthy controls. Likewise, the predictive role of impaired learning performance on therapy outcome was explored. Four hundred twenty-four participants (233 ED patients and 191 healthy controls) participated in this study. Decision making was assessed using the Iowa Gambling Task before any psychological treatment. All patients received psychological therapy, and treatment outcome was evaluated at discharge. Patients with bad outcome did not show progression in the decision-making task as opposed to those with good outcome and the healthy control sample. Additionally, learning performance in the decision-making task was predictive of their future outcome. The severity of learning deficits in decision making may serve as a predictor of the treatment. These results may provide a starting point of how decision-making learning deficits are operating as dispositional and motivational factors on responsiveness to treatment in EDs.
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http://dx.doi.org/10.3390/nu13072145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308216PMC
June 2021

Lifetime Weight Course as a Phenotypic Marker of Severity and Therapeutic Response in Patients with Eating Disorders.

Nutrients 2021 Jun 13;13(6). Epub 2021 Jun 13.

Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 08907 L'Hospitalet de Llobregat, Spain.

The association between lifetime weight fluctuations and clinical characteristics has been widely studied in populations with eating disorders (ED). However, there is a lack of literature examining the potential role of weight course as a transdiagnostic factor in ED so far. Therefore, the aim of this study is to compare ED severity and treatment outcomes among four specific BMI profiles based on BMI-trajectories across the lifespan: (a) persistent obesity (OB-OB; ( = 74)), (b) obesity in the past but currently in a normal weight range (OB-NW; = 156), (c) normal weight throughout the lifespan (NW-NW; = 756), and (d) current obesity but previously at normal weight (NW-OB; = 314). Lifetime obesity is associated with greater general psychopathology and personality traits such as low persistence and self-directedness, and high reward dependence. Additionally, greater extreme weight changes (NW-OB and OB-NW) were associated with higher psychopathology but not with greater ED severity. Higher dropout rates were found in the OB-OB group. These results shed new light on the BMI trajectory as a transdiagnostic feature playing a pivotal role in the severity and treatment outcome in patients with ED.
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http://dx.doi.org/10.3390/nu13062034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231878PMC
June 2021

Risk patterns in food addiction: a Mexican population approach.

Eat Weight Disord 2021 Jun 18. Epub 2021 Jun 18.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Hospitalet del Llobregat, Barcelona, Spain.

Background: Food addiction (FA) is a construct that has gained interest in recent years but its relevance in Mexican population is still unexplored.

Aims: The present study has the aims of explore FA in a community of Mexican population, as well as identifying the risk patterns associated with it, in relation to the different etiological factors that have been described such as impulsivity, emotional regulation and eating styles. Furthermore, to identify a predictive model of FA severity.

Methods: The sample consisted of 160 female and male university students of Pachuca city in México, who volunteered to participate in the study. Assessment included multidimensional measures for FA, eating disorder severity, eating disorder styles, emotional regulation and impulsivity.

Results: A screening of FA-probable was registered for 13.8% of the sample, while 8.1% met criteria for FA-present. The FA-present group differed from FA-absent in the impulsivity levels and in emotional eating style. Patients with FA-present differed from FA-probable in the impulsivity levels. Differences between FA-probable versus FA-absent were found in the restrained eating style. Path analysis evidenced that FA severity was directly associated with older age, worse eating style profile and higher impulsivity levels, and indirectly related with the ED symptom levels.

Conclusions: Our findings suggest that it is possible to establish a specific predictive model of the development of FA and its severity in Mexican population to implement adequate prevention and treatment strategies.

Evidence Level: Level III: evidence obtained from well-designed cohort or case-control analytic studies.
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http://dx.doi.org/10.1007/s40519-021-01240-2DOI Listing
June 2021

European Network for blood pressure research in children and adolescents (COST Action CA 19115).

An Pediatr (Engl Ed) 2021 Jun 10;94(6):421.e1-421.e4. Epub 2021 Mar 10.

Centro de Pediatría y Medicina de la Adolescencia, Hospital Universitario de Heidelberg, Heidelberg, Germany.

High blood pressure is a clearly established modifiable risk factor for cardiovascular and renal disease. Although most of its adverse effects develop in adulthood, it has become clear that high BP is a lifelong problem that can manifest early in life. While few would dispute the importance of taking effective steps to identify and manage this condition in middle-aged and elderly individuals, relatively little attention has been paid to the problem of high BP in children and adolescents. Therefore, the development of actions focused on early childhood, childhood and adolescence and the investigation of the underlying causes of this epidemic are of utmost importance. There is a pressing need for comprehensive pan-European action to increase the knowledge on the prevention, diagnosis and treatment of high blood pressure in children and adolescents, the current scarcity of which impedes the development of consensus across different research fields and hinders efforts to introduce changes in clinical practice. There are some aspects that demand urgent action: the definition of hypertension, the prevalence of high BP in Europe, accurate measurement for early identification, the assessment of hypertension-mediated organ damage and the development and implementation of prevention strategies. In order to provide answers to all of these unanswered questions and challenges, a multidisciplinary network was established, maintained and funded by the European Cooperation in Science and Technology (COST) Association. COST is a funding organization for the creation of research networks known as COST Actions. In this case, the network will promote coordinated and collaborative activities on personalized preventive measures for children and adolescents across Europe.
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http://dx.doi.org/10.1016/j.anpede.2021.01.003DOI Listing
June 2021

The factorial structure and psychometric properties of the Committed Action Questionnaire (CAQ-8) in a Portuguese clinical sample with eating disorders.

Clin Psychol Psychother 2021 May 28. Epub 2021 May 28.

Psychotherapy and Psychopathology Research Unit, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal.

The Committed Action Questionnaire (CAQ-8) is an instrument developed to measure committed action, an adaptive psychological process. The main goal in the current study was to confirm the factorial structure of the Portuguese version of the CAQ-8 in a transdiagnostic clinical sample of participants diagnosed with an eating disorder (ED). Participants were 102 female outpatients (M  = 28.1, SD = 10.6; M  = 20.0, SD = 5.5) recruited from a clinical setting specialized in the treatment of ED. Confirmatory factor analysis (CFA) was used to confirm the CAQ-8's factorial structure. Both first- and second-order models revealed adequate goodness-of-fit indices (e.g. χ /df = 1.545, p = .06; SRMR = 0.049; RMSEA = 0.073; CFI/TLI > 0.95). A moderation model revealed that the conditional effect of weight, shape and eating concerns on experiential avoidance was significantly moderated by increased levels of committed action, F(3, 97) = 23.79, p < .001, accounting for 42% of the final variance. The present study supports the usefulness of the CAQ-8 as a measure of levels of committed action with patients diagnosed with an ED.
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http://dx.doi.org/10.1002/cpp.2621DOI Listing
May 2021

The neural correlates of delay discounting in obesity and binge eating disorder.

J Behav Addict 2021 Apr 26. Epub 2021 Apr 26.

1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain.

Background And Aims: Increased delay discounting is associated with obesity and binge eating disorder (BED). Although BED and obesity frequently co-occur, the neural mechanisms underlying delay discounting in these conditions remain poorly understood.

Methods: Thirtyfive women with obesity, including 10 participants with obesity and BED and 31 controls completed a monetary delay discounting task during functional magnetic resonance imaging.

Results: We identified that increased discounting rates were associated with decreased activity in the left anterior insula in participants with obesity compared to controls when choosing immediate rewards over delayed rewards (PFWE < 0.05). An exploratory analysis comparing the BED subsample to the other groups did not detect significant differences.

Discussion And Conclusions: Our findings suggest decreased activity in the anterior insula may underlie heightened delay discounting in individuals with obesity, contributing the probability of choosing immediate rewards over delayed rewards based on emotional states. Future studies including larger, more diverse samples are required to confirm these effects.
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http://dx.doi.org/10.1556/2006.2021.00023DOI Listing
April 2021

Effects of a psychosocial intervention at one-year follow-up in a PREDIMED-plus sample with obesity and metabolic syndrome.

Sci Rep 2021 04 28;11(1):9144. Epub 2021 Apr 28.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Feixa Llarga S/N, L'Hospitalet del Llobregat, 08907, Barcelona, Spain.

This study examines if overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms, and if these variables could be modified after 1 year of a multimodal intervention (diet, physical activity, psychosocial support). 342 adults (55-75 years) with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus Cognition study were randomized to the intervention or to the control group (lifestyle recommendations). Cognitive and psychopathological assessments were performed at baseline and after 1-year follow-up. At baseline, higher impulsivity was linked to higher food addiction and depressive symptoms, but not to body mass index (BMI). Food addiction not only predicted higher BMI and depressive symptoms, but also achieved a mediational role between impulsivity and BMI/depressive symptoms. After 1 year, patients in both groups reported significant decreases in BMI, food addiction and impulsivity. BMI reduction and impulsivity improvements were higher in the intervention group. Higher BMI decrease was achieved in individuals with lower impulsivity. Higher scores in food addiction were also related to greater post-treatment impulsivity. To conclude, overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms in mid/old age individuals with MetS. Our results also highlight the modifiable nature of the studied variables and the interest of promoting multimodal interventions within this population.
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http://dx.doi.org/10.1038/s41598-021-88298-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080657PMC
April 2021

Psychological and metabolic risk factors in older adults with a previous history of eating disorder: A cross-sectional study from the Predimed-Plus study.

Eur Eat Disord Rev 2021 Jul 27;29(4):575-587. Epub 2021 Apr 27.

Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.

Goals: To explore affective and cognitive status, later in life, in individuals with and without previous history of eating disorder (ED), and also its association with higher risk for metabolic syndrome (MetS) symptomatology.

Methods: A cross-sectional analysis of 6756 adults, aged 55-75 years with overweight/obesity and MetS participating in the Predimed-Plus study was conducted. Participants completed self-reported questionnaires to examine lifetime history of ED, according to DSM-5 criteria, and other psychopathological and neurocognitive factors. Anthropometric and metabolic measurements were also collected.

Results: Of the whole sample, 24 individuals (0.35%) reported a previous history of ED. In this subsample, there were more women and singles compared to their counterparts, but they also presented higher levels of depressive symptoms and higher cognitive impairment, but also higher body mass index (BMI) and severe obesity, than those without lifetime ED.

Conclusions: This is one of the first studies to analyse the cognitive and metabolic impact of a previous history of ED. The results showed that previous ED was associated with greater affective and cognitive impairment, but also with higher BMI, later in life. No other MetS risk factors were found, after controlling for relevant variables.
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http://dx.doi.org/10.1002/erv.2833DOI Listing
July 2021

Longitudinal Changes in Gambling, Buying and Materialism in Adolescents: A Population-Based Study.

Int J Environ Res Public Health 2021 03 10;18(6). Epub 2021 Mar 10.

Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain.

Gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values lead to impaired functioning in important areas of life. The aims of the present longitudinal study are (1) to evaluate the change produced after one year in those mentioned variables and (2) to examine the gender role in these changes and to analyze the mediational mechanisms among the variables of the study. The sample was composed of 182 adolescents (103 females and 79 males) from secondary education Spanish institutions who completed self-administered questionnaires. Structural equation modeling has been used to explore associations between the different variables. Our results show significant decreases in compulsive buying, materialism, and cognitive biases related to gambling after one year. Gambling disorder severity was directly related to cognitive distortions of gambling and being a man. Compulsive buying was associated with older age and the female gender. Materialism was associated with compulsive buying and the male gender. In conclusion, gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values change over time in different ways, according to gender. The understanding of gambling disorder and compulsive buying in adolescents could potentially lead to early prevention and treatment programs for the specific needs of gender and age.
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http://dx.doi.org/10.3390/ijerph18062811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000979PMC
March 2021

Emotional regulation in eating disorders and gambling disorder: A transdiagnostic approach.

J Behav Addict 2021 Mar 13. Epub 2021 Mar 13.

1Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain.

Background And Aims: Difficulties in Emotion Regulation (ER) are related to the etiology and maintenance of several psychological disorders, including Eating Disorders (ED) and Gambling Disorder (GD). This study explored the existence of latent empirical groups between both disorders, based on ER difficulties and considering a set of indicators of personality traits, the severity of the disorder, and psychopathological distress.

Methods: The sample included 1,288 female and male participants, diagnosed with ED (n = 906) and GD (n = 382). Two-step clustering was used for the empirical classification, while analysis of variance and chi-square tests were used for the comparison between the latent groups.

Results: Three empirical groups were identified, from the most disturbed ER profile (Subgroup 1) to the most functional (Subgroup 3). The ER state showed a linear relationship with the severity of each disorder and the psychopathological state. Different personality traits were found to be related to the level of emotion dysregulation.

Discussion And Conclusion: In this study, three distinct empirical groups based on ER were identified across ED and GD, suggesting that ER is a transdiagnostic construct. These findings may lead to the development of common treatment strategies and more tailored approaches.
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http://dx.doi.org/10.1556/2006.2021.00017DOI Listing
March 2021

A Serious Game to Improve Emotion Regulation in Treatment-Seeking Individuals With Gambling Disorder: A Usability Study.

Front Psychol 2021 4;12:621953. Epub 2021 Mar 4.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.

: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits (e.g., behavioral addictions) have been shown to benefit from serious games. : The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients with gambling disorder (GD). Preliminary results from a pilot sample are also reported. : A pilot sample of 26 patients undergoing treatment for GD was recruited (ranging from 22 to 74 years, mean = 41.2 and = 12.9; 80.8% men). Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate (HR) and heart rate variability (HRV) data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia. : e-Estesia performed comparatively well for all the explored groups (i.e., sex, age, and online vs. offline gambling: mean usability score = 83.8, = 13.1). Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men.
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http://dx.doi.org/10.3389/fpsyg.2021.621953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970032PMC
March 2021

Psychopathogical status and personality correlates of problem gambling severity in sports bettors undergoing treatment for gambling disorder.

J Behav Addict 2021 Mar 2. Epub 2021 Mar 2.

1CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.

Background And Aims: Sports betting has been barely explored independently from other gambling behaviors. Little evidence is available regarding the factors affecting its severity in a clinical sample. The current study explores new determinants for sports betting severity in Spain by the inclusion of psychopathological distress and personality factors.

Methods: A sample of 352 Spanish sports bettors undergoing treatment for gambling disorder was recruited. Multiple regression models were used to evaluate the effects of sociodemographic variables, the age of onset of gambling behavior, the global psychopathological distress (SCL-90R GSI) and the personality profile (TCI-R) on sports betting severity and their influence over frequency (bets per episode) and debts due to gambling.

Results: We found that older age, higher psychopathological distress, lower self-directedness level, and higher novelty seeking level were predictors of gambling severity in Spanish sports bettors. The highest betting frequency was found in men, with the lowest education levels but the highest social status, the highest psychopathological distress, reward dependence score, and self-transcendence trait and the lowest persistence score. Debts were also associated to higher score in cooperativeness as well as older age.

Discussion And Conclusions: Our findings call for further exploration of factors affecting sports betting severity regarded as a separate gambling entity subtype, as some of the traditional factors typically found in gamblers do not apply to sports bettors or apply inversely in our country. Consequently, sports bettors might deserve specific clinical approaches to tackle the singularities of their gambling behavior.
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http://dx.doi.org/10.1556/2006.2020.00101DOI Listing
March 2021

[European Network for blood pressure research in children and adolescents (COST Action CA 19115)].

An Pediatr (Barc) 2021 Jun 27;94(6):421.e1-421.e4. Epub 2021 Feb 27.

Centro de Pediatría y Medicina de la Adolescencia. Hospital Universitario de Heidelberg, Heidelberg, Alemania.

High blood pressure is a clearly established modifiable risk factor for cardiovascular and renal disease. Although most of its adverse effects develop in adulthood, it has become clear that high BP is a lifelong problem that can manifest early in life. While few would dispute the importance of taking effective steps to identify and manage this condition in middle-aged and elderly individuals, relatively little attention has been paid to the problem of high BP in children and adolescents. Therefore, the development of actions focused on early childhood, childhood and adolescence and the investigation of the underlying causes of this epidemic are of utmost importance. There is a pressing need for comprehensive pan-European action to increase the knowledge on the prevention, diagnosis and treatment of high blood pressure in children and adolescents, the current scarcity of which impedes the development of consensus across different research fields and hinders efforts to introduce changes in clinical practice. There are some aspects that demand urgent action: the definition of hypertension, the prevalence of high BP in Europe, accurate measurement for early identification, the assessment of hypertension-mediated organ damage and the development and implementation of prevention strategies. In order to provide answers to all of these unanswered questions and challenges, a multidisciplinary network was established, maintained and funded by the European Cooperation in Science and Technology (COST) Association. COST is a funding organization for the creation of research networks known as COST Actions. In this case, the network will promote coordinated and collaborative activities on personalized preventive measures for children and adolescents across Europe.
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http://dx.doi.org/10.1016/j.anpedi.2021.01.015DOI Listing
June 2021

The prevalence and features of schizophrenia among individuals with gambling disorder.

J Psychiatr Res 2021 04 13;136:374-383. Epub 2021 Feb 13.

Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona - UB, L'Hospitalet de Llobregat, Spain. Electronic address:

Background-objectives: Few studies have analyzed the comorbid presence of gambling disorder (GD) with schizophrenia, its sociodemographic correlates and clinical implications. This study estimated the prevalence of the dual diagnosis (GD with schizophrenia) and the differences in the profiles of patients with and without the dual condition.

Method: The sample included n = 3,754 patients consecutively accepted for treatment for GD. Sociodemographics, gambling-related variables, psychopathological state and personality traits were assessed and compared between the groups.

Results: The prevalence of schizophrenia within patients who met clinical criteria for GD was 4.4% (95% confidence interval: 3.8%-5.1%). Variables related to the dual presence of GD with schizophrenia were single marital status, lower education level, inactive working status, socioeconomic disadvantage, younger age, earlier onset of gambling problems, worse global psychopathological state and more dysfunctional personality profile (higher level in harm avoidance and lower level in cooperativeness, reward dependence, persistence and self-directedness).

Conclusion: The presence of schizophrenia among patients with GD was around 4 times higher than the prevalence rate estimated in the reference general population. The differences in the profiles of GD patients with and without schizophrenia suggest that individuals with the dual diagnosis condition require unique assessment considerations and tailored treatment interventions specifically designed for the clinical and functioning higher risk.
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http://dx.doi.org/10.1016/j.jpsychires.2021.02.025DOI Listing
April 2021

Optimising care pathways for adult anorexia nervosa. What is the evidence to guide the provision of high-quality, cost-effective services?

Eur Eat Disord Rev 2021 May 24;29(3):306-315. Epub 2021 Feb 24.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain.

The aim of this paper is to consider how changes in service planning and delivery might improve the care pathways for adult anorexia nervosa. Although anorexia nervosa has a long history in Europe, its framing as a mental disorder is quite recent. The changing forms and increasing epidemiology of eating disorders has led to the expansion of specialised services. Although some services provide care over the entire clinical course, more often services are divided into those that care for children and adolescents or adults. The transition needs to be carefully managed as currently these services may have a different ethos and expectations. Services for adults have a broad range of diversity (diagnostic subtype, medical severity, comorbidity, stage of illness and psychosocial functioning) all of which impacts on prognosis. A tailored, approach to treatment planning could optimise the pathway. Facilitating early help seeking and rapid diagnosis in primary care and reducing specialised services waiting lists for assessment and treatment could be a form of secondary prevention. The use of precision models and /or continuous outcome monitoring might reduce the third of patients who require more intensive care by applying augmentation strategies. Finally, gains from intensive care might be sustained by relapse prevention interventions and community support to bridge the transition home. Together these measures might reduce the proportion of patients (currently a third) with ill health for over 20 years. For this group rehabilitation strategies may improve functioning until new treatment emerge.
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http://dx.doi.org/10.1002/erv.2821DOI Listing
May 2021

Value of treatment for eating disorders.

Eur Eat Disord Rev 2021 May 18;29(3):303-305. Epub 2021 Feb 18.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL and CIBEROBN, Barcelona, Spain.

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http://dx.doi.org/10.1002/erv.2827DOI Listing
May 2021

The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept.

Eur Eat Disord Rev 2021 May 18;29(3):499-513. Epub 2021 Feb 18.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.

Objective: There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes.

Methods: A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness.

Results: Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits.

Conclusions: Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.
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http://dx.doi.org/10.1002/erv.2822DOI Listing
May 2021

The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept.

Eur Eat Disord Rev 2021 May 18;29(3):499-513. Epub 2021 Feb 18.

Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.

Objective: There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes.

Methods: A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness.

Results: Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits.

Conclusions: Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.
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http://dx.doi.org/10.1002/erv.2822DOI Listing
May 2021

AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure.

J Clin Med 2021 Feb 10;10(4). Epub 2021 Feb 10.

Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d'Hebron 171, 08035 Barcelona, Spain.

In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.
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http://dx.doi.org/10.3390/jcm10040682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916489PMC
February 2021

Milk and Dairy Products Intake Is Related to Cognitive Impairment at Baseline in Predimed Plus Trial.

Mol Nutr Food Res 2021 04 5;65(7):e2000728. Epub 2021 Mar 5.

Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d`Investigació Médica (IMIM)., Carrer del Dr. Aiguader, 88., Barcelona, 08003, Spain.

Scope: To examine the association between milk and dairy products intake and the prevalence of cognitive decline among Spanish individuals at high cardiovascular risk.

Methods And Results: Cross-sectional analyses are performed on baseline data from 6744 adults (aged 55-75 years old). Intake of milk and dairy products is estimated using a food frequency questionnaire grouped into quartiles. The risk of developing cognitive impairment is based on the Mini-Mental State Examination (MMSE). A higher prevalence of cognitive decline was found in subjects who consumed more grams. Patients with worse MMSE score (10-24) consumed a mean of 395.14 ± 12.21 g, while patients with better MMSE score (27-30) consumed a mean of 341.23 ± 2.73 g (p < 0.05). Those subjects with the lower milk consumption (<220 g/day) had a higher MMSE score (28.35 ± 0.045). Higher intake of fermented dairy products was observed in participants with a lower MMSE score (OR 1.340, p = 0.003). A positive correlation was found between the consumption of whole milk and the MMSE score (r = 0.066, p < 0.001).

Conclusions: These findings suggest that greater consumption of milk and dairy products could be associated with greater cognitive decline according to MMSE. Conversely, consumption of whole-fat milk could be linked with less cognitive impairment in the cross-sectional study.
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http://dx.doi.org/10.1002/mnfr.202000728DOI Listing
April 2021

The transition time to gambling disorder: The roles that age, gambling preference and personality traits play.

Addict Behav 2021 05 31;116:106813. Epub 2020 Dec 31.

Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III. Madrid, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain. Electronic address:

Background And Aims: Gambling Disorder (GD) is considered a heterogeneous, multidimensional pathology with high personal and social consequences. The transition time (TT) between problematic gaming and pathological gambling, which varies significantly across patients, may predict the disorder's severity. As only limited studies have investigated the factors implicated in the TT, the current study set out to identify its predictors and their relationships with GD severity.

Methods: Correlation were performed in 725 male GD patients to identify factors associated to TT and GD severity, including: age of onset of gambling behaviors, alcohol/drug use, personality traits and gambling preferences (i.e., strategic, non-strategic, and mixed). Then a regression analysis was performed to identify predictors of TT to GD.

Results: Longer TT correlated with higher GD severity, early age of onset of problematic gambling, substance use and a non-strategic gambling preference. Personality traits including low self-directedness, high novelty seeking, and low cooperativeness were also related with longer TT. The strongest associations with GD severity were substance use, and some of the personality traits (i.e., low self-directedness and cooperativeness, high harm avoidance and self-transcendence). Factors significantly predicting longer transition to GD were older ages, low self-directedness, and non-strategic gambling.

Conclusions: A clinical profile characterized by a longer TT and more severe GD symptoms pertains to older patients with low self-directedness, and preference for non-strategic gambling. Other relevant factors associated with this profile of patients included early age of onset problematic gambling, substance consumption, high novelty seeking and low cooperativeness.
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http://dx.doi.org/10.1016/j.addbeh.2020.106813DOI Listing
May 2021

Illness perception in patients with eating disorders: clinical, personality, and food addiction correlates.

Eat Weight Disord 2021 Oct 2;26(7):2287-2300. Epub 2021 Jan 2.

CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.

Purpose: Although the role of illness perception in the clinical course of many physical diseases and certain mental disorders has been well described, little is known about illness perception in eating disorders (ED) so far. Therefore, the purpose of this study was to extend our understanding of illness perception in different ED diagnostic types and to explore its association between clinical, psychopathological, motivational, personality, and food addiction (FA) features.

Methods: The sample consisted of 104 patients with ED [(23 anorexia nervosa (AN), 39 bulimia nervosa (BN), 19 binge eating disorder (BED), and 23 other specified feeding and eating disorders (OSFED)]. Illness perception was assessed by means of the revised version of the Illness Perception Questionnaire (IPQ-R).

Results: The results supported the association between illness perception and clinical, psychopathological, and personality factors. Patients with BN and BED showed greater illness perception than the other types. Improved illness perception was positively associated with a longer duration of the disorder and FA. Furthermore, a relevant finding suggests that at least half of the patients with ED did not achieve a good level of illness perception until after having the disorder for 20 years on average.

Conclusion: Our findings suggest that higher levels of FA and longer duration of the ED are positively and directly associated with increased illness perception. This may explain the low levels of initial motivation in these patients and their high dropout rates in the early stages of treatment.

Level Of Evidence Iii: Case-control analytic study.
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http://dx.doi.org/10.1007/s40519-020-01083-3DOI Listing
October 2021
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