Publications by authors named "Joanne A Harrold"

42 Publications

Postpartum women's psychological experiences during the COVID-19 pandemic: a modified recurrent cross-sectional thematic analysis.

BMC Pregnancy Childbirth 2021 Sep 17;21(1):625. Epub 2021 Sep 17.

Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.

Background: COVID-19 has placed additional stressors on mothers during an already vulnerable lifecourse transition. Initial social distancing restrictions (Timepoint 1; T1) and initial changes to those social distancing restrictions (Timepoint 2; T2) have disrupted postpartum access to practical and emotional support. This qualitative study explores the postpartum psychological experiences of UK women during different phases of the COVID-19 pandemic and associated 'lockdowns'.

Methods: Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed in the UK (22 April 2020). A separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (10 June 2020). Data were transcribed verbatim, uploaded into NVivo for management and analysis, which followed a recurrent cross-sectional approach to thematic analysis.

Results: Two main themes were identified for T1: 'Motherhood is Much Like Lockdown' and 'A Self-Contained Family Unit'. Each main T1 theme contained two sub-themes. Two main themes were also identified for T2: 'Incongruously Held Views of COVID-19' and 'Mothering Amidst the Pandemic'. Each main T2 theme contained three sub-themes. Comparisons between data gathered at each timepoint identified increased emotional distress over time. Current findings call for the improvement of postpartum care by improving accessibility to social support, and prioritising the re-opening of schools, and face-to-face healthcare appointments and visitation.

Conclusion: Social distancing restrictions associated with COVID-19 have had a cumulative, negative effect on postpartum mental health. Recommendations such as: Allowing mothers to 'bubble' with a primary support provider even at their healthcare appointments; allowing one support partner to attend all necessary healthcare appointments; and providing tailored informational resources, may help to support postpartum emotional wellbeing during this, and similar health crises in the future.
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http://dx.doi.org/10.1186/s12884-021-04071-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445650PMC
September 2021

A andomisd, controlled, double blind tudy to assess mechanstic effects of combination therapy of dapagflozin with xenatide QW versus dapagliflozin alone i obese patients with ype 2 diabetes mellitus (RESILIENT): study protocol.

BMJ Open 2021 07 20;11(7):e045663. Epub 2021 Jul 20.

Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.

Introduction: The newer glucose-lowering therapies for type 2 diabetes (T2D), the glucagon-like peptide-1 receptor agonists (GLP1-RAs) and the sodium-glucose co-transporter 2 inhibitors (SGLT2i), have additional clinical benefits beyond improving glycaemic control; promoting weight loss, addressing associated cardiovascular risk factors and reducing macrovascular and microvascular complications. Considering their independent mechanisms of actions, there is a potential for significant synergy with combination therapy, yet limited data exist. This 32-week randomised, double-blind, placebo-controlled trial will gain mechanistic insight into the effects of coadministration of exenatide QW, a weekly subcutaneous GLP1-RA, with dapagliflozin, a once daily oral SGLT2i, on the dynamic, adaptive changes in energy balance, total, regional and organ-specific fat mass and multiorgan insulin sensitivity.

Methods And Analysis: 110 obese patients with diagnosed T2D (glycated haemoglobin, HbA ≥48 mmol/mol) will be treated for 32 weeks with dapagliflozin (10 mg once daily either alone or in combination with exenatide QW (2 mg once weekly); active treatments will be compared with a control group (placebo tablet and sham injection). The primary objective of the study is to compare the adjusted mean reduction in total body fat mass (determined by dual-energy X-ray absorptiometry, DEXA) from baseline following 32 weeks of treatment with exenatide QW and dapagliflozin versus dapagliflozin alone compared with control (placebo). Secondary outcome measures include changes in (1) (energy intake and energy expenditure measured by indirect calorimetry); (2) (between and within meals) and satiety quotient; (3) including visceral adipose tissue, subcutaneous adipose tissue, liver and pancreatic fat. Exploratory outcome measures include in hepatic and peripheral insulin sensitivity (using a two-stage hyperinsulinaemic, euglycaemic clamp), to food images using blood oxygen level-dependent (BOLD) functional MRI (fMRI) and (using transthoracic echocardiography, cardiac MR and duplex ultrasonography).

Ethics And Dissemination: This study has been approved by the North West Liverpool Central Research Ethics Committee (14/NW/1147) and is conducted in accordance with the Declaration of Helsinki and the Good Clinical Practice. Results from the study will be published in peer-reviewed scientific and open access journals and/or presented at scientific conferences and summarised for distribution to the participants.

Trial Sponsor: University of Liverpool.

Trial Registration Number: ISRCTN 52028580; EUDRACT number 2015-005242-60.
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http://dx.doi.org/10.1136/bmjopen-2020-045663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292819PMC
July 2021

Changes in Circulating Metabolites During Weight Loss are Associated with Adiposity Improvement, and Body Weight and Adiposity Regain During Weight Loss Maintenance: The SATIN Study.

Mol Nutr Food Res 2021 Sep 21;65(17):e2001154. Epub 2021 Jul 21.

Institut d'Investigació Sanitaria Pere Virgili, IISPV, Hospital Universitari Sant Joan, Reus, Spain.

Scope: To examine the relationship between changes in circulating metabolites during diet-induced weight loss and changes of adiposity. This study also investigates changes in these metabolites in relation to body weight and adiposity regain during a weight loss maintenance period.

Methods And Results: This cohort study is nested within the Satiety Innovation (SATIN) study. Participants (n = 162) achieving ≥8% weight loss during an initial 8-week low-calorie formula diet (LCD) are included in a 12-week weight loss maintenance period. A targeted metabolite profiling (123 metabolites) approach is applied using three different platforms (proton nuclear magnetic resonance, liquid chromatography mass spectrometry, gas chromatography mass spectrometry). Changes in several lipid species and citric acid are significantly associated with greater reduction of body weight, total fat, and abdominal adiposity distribution during the LCD. Decreases in the concentrations of lysophosphatidylcholines (LPCs) 14:0, LPC 20:3, phosphatidylcholine (PC) 32:2, PC 38:3, sphingomyelin (SM) 32:2, and increases in citric acid concentrations during the LCD are associated with adiposity regain and loss, respectively, during the weight loss maintenance period.

Conclusions: The results show that weight loss is associated with changes in lipid species and citric acid. These changes are related to subsequent weight and adiposity regain identifying the adipose lipid metabolism as an important factor for the maintenance of lost weight and adiposity.
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http://dx.doi.org/10.1002/mnfr.202001154DOI Listing
September 2021

Circulating Metabolites Associated with Body Fat and Lean Mass in Adults with Overweight/Obesity.

Metabolites 2021 May 13;11(5). Epub 2021 May 13.

Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Rovira i Virgili (URV), 43201 Reus, Spain.

The interplay between fat mass and lean mass within human metabolism is not completely understood. We aimed to identify specific circulating metabolomic profiles associated with these body composition compartments. Cross-sectional analyses were conducted over 236 adults with overweight/obesity from the Satiety Innovation (SATIN) study. Body composition was assessed by dual-energy X-ray absorptiometry. A targeted multiplatform metabolite profiling approach was applied. Associations between 168 circulating metabolites and the body composition measures were assessed using elastic net regression analyses. The accuracy of the multimetabolite weighted models was evaluated using a 10-fold cross-validation approach and the Pearson's correlation coefficients between metabolomic profiles and body compartments were estimated. Two different profiles including 86 and 65 metabolites were selected for % body fat and lean mass. These metabolites mainly consisted of lipids (sphingomyelins, phosphatidylcholines, lysophosphatidylcholines), acylcarnitines, and amino acids. Several metabolites overlapped between these body composition measures but none of them towards the same direction. The Pearson correlation coefficients between the metabolomic profiles and % body fat or lean mass were 0.80 and 0.79, respectively. Our findings suggest alterations in lipid metabolism, fatty acid oxidation, and protein degradation with increased adiposity and decreased lean body mass. These findings could help us to better understand the interplay between body composition compartments with human metabolic processes.
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http://dx.doi.org/10.3390/metabo11050317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153621PMC
May 2021

Creation and validation of the Postpartum Specific Anxiety Scale Research Short-Form (PSAS-RSF).

Arch Womens Ment Health 2021 Apr 26. Epub 2021 Apr 26.

Department of Psychology, University of Liverpool, Bedford Street South, Liverpool, L69 7ZA, Merseyside, UK.

The Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure of postpartum anxiety (PPA). However, it contains 51 items, so is limited by its length. This study aimed to reduce the number of items in the PSAS, produce a small number of high-performing short-form tools, and confirm the factor structure of the most statistically and theoretically meaningful model. A pooled sample of English-speaking mothers (N = 2033) with infants up to 12 months were randomly split into three samples. (1) A principal component analysis (PCA) was conducted to initially reduce the items (n = 672). (2) Four short-form versions of varying length (informed by statistical, theoretical, lay-person, and expert-guided feedback) were developed and their factor structure examined (n = 673). (3) A final confirmatory factor analysis (CFA) was performed to confirm the factor structure of the PSAS Research Short-Form (PSAS-RSF) (n = 688). PCA and theoretical review reduced the items from 51 to 34 (version 1). Statistical review retained 22 items (version 2). Quantitative expert panel data retained 17 items (version 3). Qualitative expert panel data retained 16 items (version 4). The 16-item version was deemed the most theoretically and psychometrically robust. The resulting 16-item PSAS-RSF demonstrated good psychometric properties and reliability. The PSAS-RSF is the first brief research tool which has been validated to measure PPA. Our findings demonstrate it is theoretically meaningful, statistically robust, reliable, and valid. This study extends the use of the measure up to 12 months postpartum, offering broader opportunity for measurement while further enhancing accessibility through brevity.
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http://dx.doi.org/10.1007/s00737-021-01114-7DOI Listing
April 2021

Short-Term Physical Inactivity Induces Endothelial Dysfunction.

Front Physiol 2021 9;12:659834. Epub 2021 Apr 9.

Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.

Objective: This study examined the effects of a short-term reduction in physical activity, and subsequent resumption, on metabolic profiles, body composition and cardiovascular (endothelial) function.

Design: Twenty-eight habitually active (≥10,000 steps/day) participants (18 female, 10 male; age 32 ± 11 years; BMI 24.3 ± 2.5 kg/m) were assessed at baseline, following 14 days of step-reduction and 14 days after resuming habitual activity.

Methods: Physical activity was monitored throughout (SenseWear Armband). Endothelial function (flow mediated dilation; FMD), cardiorespiratory fitness ( peak) and body composition including liver fat (dual-energy x-ray absorptiometry and magnetic resonance spectroscopy) were determined at each assessment. Statistical analysis was performed using one-way within subject's ANOVA; data presented as mean (95% CI).

Results: Participants decreased their step count from baseline by 10,111 steps/day (8949, 11,274; < 0.001), increasing sedentary time by 103 min/day (29, 177; < 0.001). Following 14 days of step-reduction, endothelial function was reduced by a 1.8% (0.4, 3.3; = 0.01) decrease in FMD. Following resumption of habitual activity, FMD increased by 1.4%, comparable to the baseline level 0.4% (-1.8, 2.6; = 1.00). Total body fat, waist circumference, liver fat, whole body insulin sensitivity and cardiorespiratory fitness were all adversely affected by 14 days step-reduction ( < 0.05) but returned to baseline levels following resumption of activity.

Conclusion: This data shows for the first time that whilst a decline in endothelial function is observed following short-term physical inactivity, this is reversed on resumption of habitual activity. The findings highlight the need for public health interventions that focus on minimizing time spent in sedentary behavior.
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http://dx.doi.org/10.3389/fphys.2021.659834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064120PMC
April 2021

Psychosocial experiences of postnatal women during the COVID-19 pandemic. A UK-wide study of prevalence rates and risk factors for clinically relevant depression and anxiety.

J Psychiatr Res 2021 04 2;136:157-166. Epub 2021 Feb 2.

Department of Psychology, Institute of Population Health, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, Merseyside, L69 7ZA, United Kingdom.

Background: When the vulnerabilities of the postnatal period are combined with the impact of the COVID-19 pandemic, psychosocial outcomes are likely to be affected. Specifically, we aim to: a) explore the psychosocial experiences of women in the early postnatal period; b) describe prevalence rates of clinically relevant maternal anxiety and depression; and c) explore whether psychosocial change occurring as a result of COVID-19 is predictive of clinically relevant maternal anxiety and depression.

Methods: A sample of UK mothers (N = 614) with infants aged between birth and twelve weeks were recruited via convenience sampling. A cross-sectional survey design was utilised which comprised demographics, COVID-19 specific questions, and a battery of validated psychosocial measures, including the EPDS and STAI-S which were used to collect prevalence rates of clinically relevant depression and anxiety respectively. Data collection coincided with the UK government's initial mandated "lockdown" restrictions and the introduction of social distancing measures in 2020.

Findings: Descriptive findings from the overall sample indicate that a high percentage of mothers self-reported psychological and social changes as a result of the introduction of social distancing measures. For women who reported the presence of psychosocial change, these changes were perceived negatively. Whilst seventy women (11.4%) reported a current clinical diagnosis of depression, two hundred and sixty-four women (43%) reported a score of ≥13 on the EPDS, indicating clinically relevant depression. Whilst one hundred and thirteen women (18.4%) reported a current clinical diagnosis of anxiety, three hundred and seventy-three women (61%) reported a score of ≥40 on STAI-S, indicating clinically relevant anxiety. After accounting for current clinical diagnoses of depression or anxiety, and demographic factors known to influence mental health, only perceived psychological change occurring as a result of the introduction of social distancing measures predicted unique variance in the risk of clinically relevant maternal depression (30%) and anxiety (33%).

Interpretation: To our knowledge, this is the first national study to examine the psychosocial experiences of postnatal women during the COVID-19 pandemic in the UK. Prevalence rates of clinically relevant maternal depression and anxiety were extremely high when compared to both self-reported current diagnoses of depression and anxiety, and pre-pandemic prevalence studies. Perceived psychological changes occurring as a result of the introduction of social distancing measures predicted unique variance in the risk for clinically relevant maternal depression and anxiety. This study provides vital information for clinicians, funders, policy makers, and researchers to inform the immediate next steps in perinatal care, policy, and research during COVID-19 and future health crises.
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http://dx.doi.org/10.1016/j.jpsychires.2021.01.048DOI Listing
April 2021

A validation of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises with five translations.

BMC Pregnancy Childbirth 2021 Feb 8;21(1):112. Epub 2021 Feb 8.

Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK.

Background: Global crises inevitably increase levels of anxiety in postpartum populations. Effective and efficient measurement is therefore essential. This study aimed to create a 12-item research short form of the 51-item Postpartum Specific Anxiety Scale [PSAS] and validate it for use in rapid response research at a time of global crises [PSAS-RSF-C]. We also present the same 12-items, in five other languages (Italian, French, Chinese, Spanish, Dutch) to increase global accessibility of a psychometric tool to assess maternal mental health.

Methods: Twelve items from the PSAS were selected on the basis of a review of their factor loadings. An on-line sample of UK mothers (N = 710) of infants up to 12 weeks old completed the PSAS-RSF-C during COVID-19 'lockdown'.

Results: Principal component analyses on a randomly split sample (n = 344) revealed four factors, identical in nature to the original PSAS, which in combination explained 75% of the total variance. Confirmatory factor analyses (n = 366) demonstrated the four-factor model fit the data well. Reliability of the overall scale and of the underlying factors in both samples proved excellent.

Conclusions: Findings suggest the PSAS-RSF-C may prove useful as a clinical screening tool and is the first postpartum-specific psychometric scale to be validated during the COVID-19 pandemic. This offers psychometrically sound assessment of postpartum anxiety. By increasing the accessibility of the PSAS, we aim to enable researchers the opportunity to measure maternal anxiety, rapidly, at times of global crisis.
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http://dx.doi.org/10.1186/s12884-021-03597-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868877PMC
February 2021

Is reduction in appetite beneficial for body weight management in the context of overweight and obesity? Yes, according to the SATIN (Satiety Innovation) study.

J Nutr Sci 2019 11 27;8:e39. Epub 2019 Nov 27.

Department of Nutrition, Exercise and Sports, Section for Obesity Research, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.

New dietary-based concepts are needed for treatment and effective prevention of overweight and obesity. The primary objective was to investigate if reduction in appetite is associated with improved weight loss maintenance. This cohort study was nested within the European Commission project Satiety Innovation (SATIN). Participants achieving ≥8% weight loss during an initial 8-week low-energy formula diet were included in a 12-week randomised double-blind parallel weight loss maintenance intervention. The intervention included food products designed to reduce appetite or matching controls along with instructions to follow national dietary guidelines. Appetite was assessed by energy intake and self-reported appetite evaluations using visual analogue scales during standardised appetite probe days. These were evaluated at the first day of the maintenance period compared with baseline (acute effects after a single exposure of intervention products) and post-maintenance compared with baseline (sustained effects after repeated exposures of intervention products) regardless of randomisation. A total of 181 participants (forty-seven men and 134 women) completed the study. Sustained reduction in 24-h energy intake was associated with improved weight loss maintenance ( 0·37; = 0·001), whereas the association was not found acutely ( = 0·91). Suppression in self-reported appetite was associated with improved weight loss maintenance both acutely ( -0·32; = 0·033) and sustained ( -0·33; = 0·042). Reduction in appetite seems to be associated with improved body weight management, making appetite-reducing food products an interesting strategy for dietary-based concepts.
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http://dx.doi.org/10.1017/jns.2019.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984007PMC
November 2019

Predictors of successful weight loss with relative maintenance of fat-free mass in individuals with overweight and obesity on an 8-week low-energy diet.

Br J Nutr 2019 08 27;122(4):468-479. Epub 2019 Jun 27.

Department of Nutrition, Exercise and Sports, Section for Obesity Research, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.

A low-energy diet (LED) is an effective approach to induce a rapid weight loss in individuals with overweight. However, reported disproportionally large losses of fat-free mass (FFM) after an LED trigger the question of adequate protein content. Additionally, not all individuals have the same degree of weight loss success. After an 8-week LED providing 5020 kJ/d for men and 4184 kJ/d for women (84/70 g protein/d) among overweight and obese adults, we aimed to investigate the relationship between protein intake relative to initial FFM and proportion of weight lost as FFM as well as the individual characteristics associated with weight loss success. We assessed all outcomes baseline and after the LED. A total of 286 participants (sixty-four men and 222 women) initiated the LED of which 82 % completed and 70 % achieved a substantial weight loss (defined as ≥8 %). Protein intake in the range 1·0-1·6 g protein/d per kg FFM at baseline for men and 1·1-2·2 g protein/d per kg FFM at baseline for women was not associated with loss of FFM (P = 0·632). Higher Three-Factor Eating Questionnaire (TFEQ) hunger at baseline and reductions in TFEQ disinhibition and hunger during the LED were associated with larger weight loss (all P ≤ 0·020); whereas lower sleep quality at baseline predicted less successful weight loss using intention to treat analysis (P = 0·021), possibly driven by those dropping out (n 81, P = 0·067 v. completers: n 198, P = 0·659). Thus, the protein intakes relative to initial FFM were sufficient for maintenance of FFM and specific eating behaviour characteristics were associated with weight loss success.
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http://dx.doi.org/10.1017/S0007114519001296DOI Listing
August 2019

Do low-calorie sweetened beverages help to control food cravings? Two experimental studies.

Physiol Behav 2019 09 19;208:112500. Epub 2019 Mar 19.

Department of Psychological Sciences, University of Liverpool, UK.

Low-calorie sweetened (LCS) beverages may help consumers to satisfy hedonic food cravings without violating dieting goals, however this remains unexplored. The present research investigated the effect of priming hedonic eating motivations on ad libitum energy intake in frequent and non-consumers of LCS beverages. It was hypothesised that energy intake would be greater after the hedonic eating prime relative to a control prime in non-consumers, but that frequent LCS beverage consumers would be protected from this effect. In Study 1 (N = 120), frequent and non-consumers were exposed to either chocolate or neutral cues (craving vs. control condition) and then completed a beverage-related visual probe task with concurrent eye-tracking. Ad libitum energy intake from sweet and savoury snacks and beverages (including LCS) was then assessed. Study 2 followed a similar protocol, but included only frequent consumers (N = 172) and manipulated the availability of LCS beverages in the ad libitum eating context (available vs. unavailable). Measures of guilt and perceived behavioural control were also included. In Study 1, as hypothesised, non-consumers showed greater energy intake in the craving condition relative to the control condition, but frequent consumers had similar energy intake in both conditions. Frequent consumers (but not non-consumers) also demonstrated an attentional bias for LCS beverage stimuli compared to both sugar and water stimuli. In contrast, in Study 2 frequent consumers showed greater energy intake in the craving condition relative to the control condition; however, overall energy intake was significantly greater when LCS beverages were unavailable compared to when they were available. Ratings of guilt were higher and perceived control was lower in the LCS-unavailable condition relative to the LCS-available condition. Conclusions: LCS beverages did not consistently protect consumers from craving-induced increases in energy intake. However, frequent consumers consumed fewer calories overall when LCS beverages were available (relative to unavailable), as well as perceiving more control over their food intake and feeling less guilty.
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http://dx.doi.org/10.1016/j.physbeh.2019.03.019DOI Listing
September 2019

The emotional and practical experiences of formula-feeding mothers.

Matern Child Nutr 2017 10 14;13(4). Epub 2016 Nov 14.

Department of Psychological Sciences, Eleanor Rathbone Building, Bedford St South, University of Liverpool, Liverpool, UK.

The majority of infant-feeding research is focused on identifying mother's reasons for the cessation of breastfeeding. The experience of mothers who choose to use formula is largely overlooked in quantitative designs. This study aimed to describe the emotional and practical experiences of mothers who formula feed in any quantity, and examine whether these experiences would vary among different cohorts of formula-feeding mothers according to prenatal feeding intention and postnatal feeding method. A total of 890 mothers of infants up to 26 weeks of age, who were currently formula feeding in any quantity, were recruited through relevant international social media sites via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction, and defense as a result of their infant feeding choices. Practical predictor variables included support received from health professionals, respect displayed by their everyday environment, and main sources of infant feeding information. Descriptive findings from the overall sample highlighted a worryingly high percentage of mother's experienced negative emotions as a result of their decision to use formula. Multinomial logit models revealed that negative emotions such as guilt, dissatisfaction, and stigma were directly associated with feeding intention and method. The evidence suggests that the current approach to infant-feeding promotion and support may be paradoxically related to significant issues with emotional well-being. These findings support criticisms of how infant-feeding recommendations are framed by health care professionals and policy makers, and highlight a need to address formula feeding in a more balanced, woman-centered manner.
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http://dx.doi.org/10.1111/mcn.12392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866173PMC
October 2017

A Pilot Study of Obesogenic Eating Behaviors in Children With Migraine.

J Child Neurol 2016 06 10;31(7):895-8. Epub 2016 Feb 10.

Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.

We studied associations between migraine severity and obesogenic eating behaviors in children with a prospective cross-sectional, clinic-based study. Migraine severity was quantified using the PedMIDAS tool and attack frequency. Eating behaviors were assessed using the Dutch Eating Behaviour Questionnaire and the Child Eating Behaviour Questionnaire. Food intake was assessed using a Food Intake Questionnaire. Statistical tests of association between eating behavior, food intake, and adiposity with migraine severity were performed. Sixty children (mean age = 10.9 years, standard deviation = 3.1; 26 males) were recruited. There was a positive correlation between the Child Eating Behaviour Questionnaire desire to drink subscale and PedMIDAS scores (r = 0.41, P = .01). Attack frequency was associated with higher intake of high fat or sugar content food and drink (r = 0.27, P = .04). No association between migraine severity and adiposity was found. Suggestion that migraine severity in children is associated with certain obesogenic eating behaviors requires further large study investigation.
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http://dx.doi.org/10.1177/0883073815627881DOI Listing
June 2016

Satiety Innovations: Food Products to Assist Consumers with Weight Loss, Evidence on the Role of Satiety in Healthy Eating: Overview and In Vitro Approximation.

Curr Obes Rep 2016 Mar;5(1):97-105

Department of Psychological Sciences, University of Liverpool, Liverpool, UK.

The prevalence of overweight and obesity is increasing globally, driven by the availability of energy-dense palatable foods. Most dietary strategies fail because of hunger generated by calorie restriction, and interventions that specifically control hunger and/or promote fullness may aid success. Current consumers have a limited choice of satiety-enhancing products with proven health benefits, and innovative ways to produce new foods (as structural modification) to enhance satiety/satiation may provide new opportunities. However, this potential is hindered by the cost of product testing. Within the SATIN-SATiety INnovation project-an in vitro platform has been developed to offer a cost-effective means of assessing the potential satiation/satiety effect of novel foods. This combines in vitro technologies to assess changes in colonic bacteria metabolism, appetite hormone release and the stability and bioavailability of active compounds in the new products/ingredients. This article provides a brief review of nutrients for which an impact on short-term appetite regulation has been demonstrated, and a summary of the changes to food structure which can be used to produce a change in appetite expression. Furthermore, the SATIN in vitro platform is discussed as a means of assessing the impact of nutritional and structural manipulations on appetite.
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http://dx.doi.org/10.1007/s13679-016-0196-9DOI Listing
March 2016

Heightened eating drive and visual food stimuli attenuate central nociceptive processing.

J Neurophysiol 2015 Mar 4;113(5):1323-33. Epub 2014 Dec 4.

Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; and.

Hunger and pain are basic drives that compete for a behavioral response when experienced together. To investigate the cortical processes underlying hunger-pain interactions, we manipulated participants' hunger and presented photographs of appetizing food or inedible objects in combination with painful laser stimuli. Fourteen healthy participants completed two EEG sessions: one after an overnight fast, the other following a large breakfast. Spatio-temporal patterns of cortical activation underlying the hunger-pain competition were explored with 128-channel EEG recordings and source dipole analysis of laser-evoked potentials (LEPs). We found that initial pain ratings were temporarily reduced when participants were hungry compared with fed. Source activity in parahippocampal gyrus was weaker when participants were hungry, and activations of operculo-insular cortex, anterior cingulate cortex, parahippocampal gyrus, and cerebellum were smaller in the context of appetitive food photographs than in that of inedible object photographs. Cortical processing of noxious stimuli in pain-related brain structures is reduced and pain temporarily attenuated when people are hungry or passively viewing food photographs, suggesting a possible interaction between the opposing motivational forces of the eating drive and pain.
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http://dx.doi.org/10.1152/jn.00504.2014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346715PMC
March 2015

Stigmatisation of a formerly obese young female.

Obes Facts 2013 8;6(5):433-42. Epub 2013 Oct 8.

Kissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, Liverpool, UK.

Background: Weight loss does not necessarily decrease the negative appraisal of a formerly overweight individual. Since past weight history tends to be disclosed in several contexts, this study aims to investigate whether negative appraisals are gender-specific and if they are modulated by the evaluators' own BMI.

Methods: 202 young adults (106 male and 96 female) viewed a picture of a young attractive female (target) accompanied by one of two statements about her past weight (overweight (OW) or always kept a normal weight (NW)), and then rated her using the Fat Phobia Scale (FPS).

Results: Female evaluators rated the target with the OW statement more negatively than the target with the NW statement. In contrast, males exposed to the OW statement rated the target as having fewer emotional/psychological problems and being less stupid/uncreative. BMI only influenced ratings in males, where those with higher BMI ascribed more negative attributes to the target with the NW statement than the OW statement.

Conclusion: Information on weight history impacts upon the appraisal of peers. These effects are dependent on gender and BMI. Knowing that a young female was overweight triggered negative evaluations from females but did not appear to impact the judgment of males.
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http://dx.doi.org/10.1159/000355713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644780PMC
May 2014

Food choice and overconsumption: effect of a premium sports celebrity endorser.

J Pediatr 2013 Aug 13;163(2):339-43. Epub 2013 Mar 13.

Kissileff Laboratory for Study of Human Ingestive Behavior, Department of Experimental Psychology, University of Liverpool, Liverpool, United Kingdom.

Objective: To determine whether exposure to celebrity endorsement in television (TV) food advertising and a nonfood context would affect ad libitum intake of the endorsed product and a perceived alternative brand.

Study Design: A total of 181 children from the UK aged 8-11 years viewed 1 of the following embedded within a cartoon: (1) a commercial for Walker's Crisps (potato chips), featuring a long-standing celebrity endorser; (2) a commercial for a savory food; (3) TV footage of the same endorser in his well-known role as a TV presenter; or (4) a commercial for a nonfood item. Children's ad libitum intake of potato chips labeled "Walker's" and "supermarket brand" was measured using ANOVA.

Results: Children who viewed the endorsed commercial or the TV footage of the endorser outside of a food context consumed significantly more of the Walker's chips compared with children in other groups. These children did not reduce their intake of the supermarket brand product to compensate; thus, the endorser effect contributed to overconsumption.

Conclusion: The influence of a celebrity endorser on food intake in children extends beyond his or her role in the specific endorsed food commercial, prompting increased consumption of the endorsed brand even when the endorser has been viewed in a nonfood context. Our data suggest that the ubiquitous nature of celebrity media presence may reinforce unhealthy eating practices in children, although research with other endorsers is needed.
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http://dx.doi.org/10.1016/j.jpeds.2013.01.059DOI Listing
August 2013

Satiety-enhancing products for appetite control: science and regulation of functional foods for weight management.

Proc Nutr Soc 2012 May 8;71(2):350-62. Epub 2012 Mar 8.

Department of Experimental Psychology, University of Liverpool, Eleanor Rathbone Building', Liverpool L69 7ZA, UK.

The current review considers satiety-based approaches to weight management in the context of health claims. Health benefits, defined as beneficial physiological effects, are what the European Food Safety Authority bases their recommendations on for claim approval. The literature demonstrates that foods that target within-meal satiation and post-meal satiety provide a plausible approach to weight management. However, few ingredient types tested produce the sustainable and enduring effects on appetite accompanied by the necessary reductions in energy intake required to claim satiety/reduction in hunger as a health benefit. Proteins, fibre types, novel oils and carbohydrates resistant to digestion all have the potential to produce beneficial short-term changes in appetite (proof-of-concept). The challenge remains to demonstrate their enduring effects on appetite and energy intake, as well as the health and consumer benefits such effects provide in terms of optimising successful weight management. Currently, the benefits of satiety-enhancing ingredients to both consumers and their health are under researched. It is possible that such ingredients help consumers gain control over their eating behaviour and may also help reduce the negative psychological impact of dieting and the physiological consequences of energy restriction that ultimately undermine weight management. In conclusion, industry needs to demonstrate that a satiety-based approach to weight management, based on single-manipulated food items, is sufficient to help consumers resist the situational and personal factors that drive overconsumption. Nonetheless, we possess the methodological tools, which when employed in appropriate designs, are sufficient to support health claims.
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http://dx.doi.org/10.1017/S0029665112000134DOI Listing
May 2012

CNS regulation of appetite.

Neuropharmacology 2012 Jul 30;63(1):3-17. Epub 2012 Jan 30.

Human Ingestive Behaviour Laboratory, Department of Experimental Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK.

This article reviews the regulation of appetite from a biopsychological perspective. It considers psychological experiences and peripheral nutritional systems (both episodic and tonic) and addresses their relationship with the CNS networks that process and integrate their input. Whilst such regulatory aspects of obesity focus on homeostatic control mechanisms, in the modern environment hedonic aspects of appetite are also critical. Enhanced knowledge of the complexity of appetite regulation and the mechanisms that sustain obesity indicate the challenge presented by management of the obesity epidemic. Nonetheless, effective control of appetite expression remains a critical therapeutic target for weight management. Currently, strategies which utilise a combination of agents to target both homeostatic and hedonic control mechanisms represent the most promising approaches. This article is part of a Special Issue entitled 'Central Control of Food Intake'.
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http://dx.doi.org/10.1016/j.neuropharm.2012.01.007DOI Listing
July 2012

5-HT(2C) receptor agonists and the control of appetite.

Handb Exp Pharmacol 2012 (209):349-56

Kissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, UK.

The role of serotonin (5-HT) in appetite control is well recognised. 5-HT drugs reduce food intake in rodents in a manner consistent with an enhancement of satiety. In humans, they have been shown to reduce caloric intake, an effect associated with reduced hunger and increased satiety. These effects appear to be mediated, at least in part, by the 5-HT(2C) receptor subtype. 5-HT-acting drugs such as fenfluramine, d-fenfluramine, and sibutramine have provided effective anti-obesity treatments in the past. However, more selective agents are needed that produce the same changes in eating behaviour and induce weight loss without unacceptable side effects. Lorcaserin, a selective 5-HT(2C) receptor agonist, is a novel anti-obesity agent that reduces both energy intake and body weight. The effects of lorcaserin on eating behaviour remain to be characterised as does its behavioural specificity.
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http://dx.doi.org/10.1007/978-3-642-24716-3_16DOI Listing
April 2012

Persuasive techniques used in television advertisements to market foods to UK children.

Appetite 2012 Apr 22;58(2):658-64. Epub 2011 Nov 22.

Kissileff Laboratory for the Study of Human Ingestive Behaviour, Department of Experimental Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK.

The aim of this study was to quantify the nature and extent of use of persuasive marketing techniques in television advertisements (adverts) to promote foods to children. Popular UK commercial television channels broadcasting children's/family viewing were recorded for 2 days (6 am-10 pm) every month in 2008 and recordings were screened for adverts. Eighteen thousand eight hundred and eighty eight adverts were for food and these were coded for peak/non-peak children's viewing time and representation of core (healthy)/non-core (unhealthy)/miscellaneous foods. The analysis assessed use of persuasive appeals, premium offers, promotional characters (brand equity and licensed characters), celebrity endorsers and website promotion in food adverts. Promotional characters, celebrity endorsers and premium offers were used more frequently to promote non-core than core foods, even on dedicated children's channels. Brand equity characters featured on a greater proportion of food adverts than licensed characters. A food brand website was promoted in a third of food adverts (websites are not covered by the statutory regulation on food advertising). This extensive analysis of television adverts demonstrated that the use of persuasive marketing techniques to promote unhealthy foods was extensive in broadcasting popular with children despite regulations. Further studies should incorporate an analysis of the content of websites promoted during food adverts.
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http://dx.doi.org/10.1016/j.appet.2011.11.017DOI Listing
April 2012

Serotonergic anti-obesity agents: past experience and future prospects.

Drugs 2011 Dec;71(17):2247-55

Experimental Psychology, University of Liverpool, Liverpool, UK.

The role of serotonin (5-hydroxytryptamine) in appetite control is long established. Serotonergic manipulations reduce food intake in rodents in a manner consistent with satiety. In humans, drugs such as fenfluramine, dexfenfluramine and sibutramine all reduce energy intake, suppress hunger and enhance satiety. Effects on eating behaviour and subjective sensations of appetite are associated with the weight loss-inducing effects of these treatments. Currently, no appetite-suppressing drugs are approved specifically for the treatment of obesity. However, a new generation of serotonergic drugs have progressed through clinical development. The serotonin 5-HT(2C)-receptor selective agonist lorcaserin, a drug specifically developed to target satiety without producing the side effect profiles of its predecessors, has been shown to significantly reduce energy intake and body weight. The weight loss produced by lorcaserin appears modest, and behavioural effects, particularly its supposed satiety-enhancing effects, have yet to be characterized. The monoaminergic re-uptake inhibitor tesofensine has also been shown to produce impressive weight loss in smaller-scale clinical studies. It remains unclear if this drug produces any effects on appetite mediated by serotonin, or whether weight loss is produced largely through enhanced energy expenditure. Evidence indicates that tesofensine strengthens satiety, but behavioural specificity and psychological side effects remain an issue. The serotonergic system remains a viable target for anti-obesity treatment. In this review, we examine the limited behavioural data available on these two new CNS-acting appetite suppressants.
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http://dx.doi.org/10.2165/11596680-000000000-00000DOI Listing
December 2011

The extent of food advertising to children on UK television in 2008.

Int J Pediatr Obes 2011 Oct 16;6(5-6):455-61. Epub 2011 Aug 16.

Department of Experimental Psychology, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.

Objective: To provide the most comprehensive analysis to date of the extent of food advertising on UK television channels popular with young people following regulatory reform of this type of marketing activity.

Methods: UK television was recorded 06:00-22:00 h for a weekday and a weekend day every month between January and December 2008 for 14 of the most popular commercial channels broadcasting children's/family viewing. Recordings were screened for advertisements, which were coded according to predefined categories including whether they were broadcast in peak/non-peak children's viewing time. Food advertisements were coded as core (healthy)/non-core (unhealthy)/miscellaneous foods.

Results: Food and drinks were the third most heavily advertised product category, and there were a significantly greater proportion of advertisements for food/drinks during peak compared to non-peak children's viewing times. A significantly greater proportion of the advertisements broadcast around soap operas than around children's programmes were for food/drinks. Children's channels broadcast a significantly greater proportion of non-core food advertisements than the family channels. There were significant differences between recording months for the proportion of core/non-core/miscellaneous food advertisements.

Conclusions: Despite regulation, children in the UK are exposed to more TV advertising for unhealthy than healthy food items, even at peak children's viewing times. There remains scope to strengthen the rules regarding advertising of HFSS foods around programming popular with children and adults alike, where current regulations do not apply. Ongoing, systematic monitoring is essential for evaluation of the effectiveness of regulations designed to reduce children's exposure to HFSS food advertising on television in the UK.
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http://dx.doi.org/10.3109/17477166.2011.608801DOI Listing
October 2011

Food commercials increase preference for energy-dense foods, particularly in children who watch more television.

Pediatrics 2011 Jul 27;128(1):e93-100. Epub 2011 Jun 27.

Kissileff Laboratory for the Study of Human Ingestive Behaviour, Department of Experimental Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, United Kingdom.

Objective: Our aim was to determine if levels of television viewing (a proxy measure for habitual commercial exposure) affect children's food preference responses to television food commercials.

Methods: A total of 281 children aged 6 to 13 years from northwest England viewed toy or food television commercials followed by a cartoon on 2 separate occasions; they then completed 3 food preference measures, a commercial recognition task, and a television viewing questionnaire.

Results: After viewing the food commercials, all children selected more branded and nonbranded fat-rich and carbohydrate-rich items from food preference checklists compared with after viewing the toy commercials. The food preferences of children with higher habitual levels of television viewing were more affected by food commercial exposure than those of low television viewers. After viewing food commercials, high television viewing children selected a greater number of branded food items compared with after the toy commercials as well as compared with the low television viewers. Children correctly recognized more food commercials than toy commercials.

Conclusions: Exposure to television food commercials enhanced high television viewers' preferences for branded foods and increased reported preferences for all food items (branded and nonbranded) relative to the low television viewers. This is the first study to demonstrate that children with greater previous exposure to commercials (high television viewers) seemed to be more responsive to food promotion messages than children with lower previous advertising exposure.
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http://dx.doi.org/10.1542/peds.2010-1859DOI Listing
July 2011

Pharmacological management of appetite expression in obesity.

Nat Rev Endocrinol 2010 May 16;6(5):255-69. Epub 2010 Mar 16.

School of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, UK.

For obese individuals, successful weight loss and maintenance are notoriously difficult. Traditional drug development fails to exploit knowledge of the psychological factors that crucially influence appetite, concentrating instead on restrictive criteria of intake and weight reduction, allied to a mechanistic view of energy regulation. Drugs are under development that may produce beneficial changes in appetite expression in the obese. These currently include glucagon-like peptide-1 analogs such as liraglutide, an amylin analog davalintide, the 5-HT(2C) receptor agonist lorcaserin, the monoamine re-uptake inhibitor tesofensine, and a number of combination therapies such as pramlintide and metreleptin, bupropion and naltrexone, phentermine and topiramate, and bupropion and zonisamide. However, the effects of these treatments on eating behavior remain poorly characterized. Obesity is typically a consequence of overconsumption driven by an individual's natural sensitivity to food stimuli and the pleasure derived from eating. Intuitively, these processes should be effective targets for pharmacotherapy, and behavioral analysis can identify drugs that selectively affect desire to eat, enjoyment of eating, satiation or postmeal satiety. Rational interventions designed specifically to modulate these processes could limit the normally aversive consequences of caloric restriction and maximize an individual's capacity to successfully gain control over their appetite.
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http://dx.doi.org/10.1038/nrendo.2010.19DOI Listing
May 2010

Neuropharmacology of human appetite expression.

Dev Disabil Res Rev 2008 ;14(2):158-64

Kissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, Liverpool, United Kingdom.

The regulation of appetite relies on the integration of numerous episodic (meal) and tonic (energy storage) generated signals in energy regulatory centres within the central nervous system (CNS). These centers provide the pharmacological potential to modify human appetite (hunger and satiety) to increase or decrease caloric intake, or to normalize aberrant eating behavior. With regard to obesity, the satiety enhancing anti-obesity drug sibutramine has proved effective at reducing body weight. Additionally, the endocannabinoid CB(1) antagonist rimonabant has recently been approved for use in Europe (but not in the US). A 5-HT(2C) agonist lorcaserin is also currently undergoing large-scale clinical trials, but the effect of the drug on human appetite is unknown as yet. Appetite enhancing drugs such as magestrol acetate and dronabiol are currently used to promote weight gain. Finally, sibutramine, selective serotonergic reuptake inhibitors such as fluoxetine and some anti-epileptic drugs have all been used to normalise aberrant eating behaviour. All these drugs act by modifying the expression of human appetite. An assessment of a drug's effects on caloric intake and feelings of hunger and satiety is necessary before they can be considered for clinical use.
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http://dx.doi.org/10.1002/ddrr.20DOI Listing
December 2008

The effect of Korean pine nut oil (PinnoThin) on food intake, feeding behaviour and appetite: a double-blind placebo-controlled trial.

Lipids Health Dis 2008 Feb 28;7. Epub 2008 Feb 28.

School of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.

Certain free fatty acids have been shown to have potent effects on food intake and self-reported changes in appetite; effects associated with increases in the release of endogenous cholecystokinin (CCK) and glucagon like peptide-1 (GLP-1). In the current study, the effects of a Korean pine nut oil product, PinnoThin, at doses 2 g, 4 g and 6 g triglyceride (TG) and 2 g free fatty acid (FFA), on food intake and appetite were examined in a cross-over double-blind placebo-controlled randomised counter-balanced design in 42 overweight female volunteers. 2 g FFA PinnoThin, given 30 minutes prior to an ad-libitum buffet test lunch, significantly reduced food intake (gram) by 9% (F(4,164) = 2.637, p = 0.036) compared to olive oil control. No significant effect of PinnoThin on macronutrient intake or ratings of appetite were observed. Given the recent data showing that the TG form of PinnoThin may also reduce appetite by increasing CCK release, the lack of any effect of the TG form found in this study could be attributed to the timing of the dosing regime. Collectively, these data suggest that PinnoThin may exert satiating effects consistent with its known action on CCK and GLP-1 release, and previously observed effects on self-reported appetite ratings.
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http://dx.doi.org/10.1186/1476-511X-7-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2289823PMC
February 2008

Autoradiographic analysis of ghrelin receptors in the rat hypothalamus.

Brain Res 2008 Feb 3;1196:59-64. Epub 2008 Jan 3.

School of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool L69 7ZA, U.K.

Ghrelin exerts potent stimulatory effects on food intake. It is assumed to increase feeding by binding at growth hormone secretagogue receptors (GHS-R), the only sites of action for this gastric hormone identified to date. Initially, the distribution of ghrelin binding sites could only be determined from expression patterns of GHS-R mRNA or the use of immunohistochemical techniques to examine c-fos expression. However, the characterisation of a novel radioligand ([(125)I-his(9)]-ghrelin), has enabled the distribution of GHS-R receptor protein to be directly demonstrated. Here, using quantitative autoradiography, we investigate the distribution and density of ghrelin receptors in the rodent hypothalamus. Specific binding was identified in the appetite-regulating arcuate nucleus, ventromedial hypothalamic nucleus, paraventricular nucleus, dorsomedial hypothalamic nucleus and the lateral hypothalamic area corresponding to the previously reported distribution pattern of GHS-R mRNA. Surprisingly, variations in receptor density were not identified in any of these binding sites upon a change in nutritional status, despite relevant alterations in plasma ghrelin levels being identified. We suggest that this may relate to the paradigm employed to modify nutritional status in the study or could indicate that peripheral ghrelin is unlikely to be the major source of ghrelin that acts in many hypothalamic sites.
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http://dx.doi.org/10.1016/j.brainres.2007.12.055DOI Listing
February 2008

The hypothalamus and obesity.

Recent Pat CNS Drug Discov 2006 Nov;1(3):305-14

School of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK.

Obesity has reached epidemic proportions across the developed world. Even though there have been numerous scientific advances in terms of the understanding of the regulation of energy homeostasis, few novel anti-obesity drugs have emerged. Furthermore, those that are available have limited efficacy in producing and maintaining a weight loss beyond 10%. This is partly attributable to the complex neuronal circuitry at play within the central nervous system and periphery, which acts to regulate food intake and energy expenditure. This article will focus on a selection of the many products (peptides, neurotransmitters and others) such as endocannabinoids, Neuropeptide Y, Orexins, Melanin-Concentrating Hormone, Melanocortins, Cocaine and Amphetamine Regulated Transcript and Serotonin, expressed within the brain, that have been shown to influence energy balance. The true relevance of many of these to the regulation of human energy balance remains uncertain, but some novel anti-obesity drugs aimed at these targets are likely to emerge in the next few years.
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http://dx.doi.org/10.2174/157488906778773616DOI Listing
November 2006

Orphan G-protein-coupled receptors : strategies for identifying ligands and potential for use in eating disorders.

Drugs R D 2007 ;8(5):287-99

Kissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, Liverpool, UK.

G-protein-coupled receptors (GPCRs) are key regulators of intercellular interactions, participating in almost every physiological response. They exert their effects by being activated by a variety of endogenous ligands. Traditionally, these ligands were identified first, providing tools to characterise the receptors. However, since the late 1980s, homology screening approaches have allowed the GPCRs to be found first, and in turn used as orphan targets to identify their ligands. Over the last decade this method has led to the identification of 12 novel neuropeptide families. Interestingly, four of these deorphanised GPCR systems, melanin-concentrating hormone, ghrelin, orexin and neuropeptide B/neuropeptide W, have been found to play a role in the control of energy balance. This article reviews the role of these GPCR systems in the control of food intake and energy expenditure, and discusses their potential use in therapies directed at eating disorders. As obesity has reached epidemic proportions across the developed world, pharmacotherapy has focused on this condition. However, difficulties in weight control also characterise disorders of binge eating such as bulimia and binge-eating disorder. Consequently, hypophagic treatments may be of potential benefit in normal, overweight or obese individuals displaying aberrant (out of control) eating behaviour.
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http://dx.doi.org/10.2165/00126839-200708050-00003DOI Listing
November 2007
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