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      The Relationship between Executive Function and Obesity in Children and Adolescents: A Systematic Literature Review

      review-article
      1 , 2 , 2 , 3 , *
      Journal of Obesity
      Hindawi Publishing Corporation

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          Abstract

          The objective of this paper is to examine the relationship between the development of executive function (EF) and obesity in children and adolescents. We reviewed 1,065 unique abstracts: 31 from PubMed, 87 from Google Scholar, 16 from Science Direct, and 931 from PsycINFO. Of those abstracts, 28 met inclusion criteria and were reviewed. From the articles reviewed, an additional 3 articles were added from article references ( N = 31). Twenty-three studies pertained to EF (2 also studied the prefrontal and orbitofrontal cortices (OFCs); 6 also studied cognitive function), five studied the relationship between obesity and prefrontal and orbitofrontal cortices, and three evaluated cognitive function and obesity. Inhibitory control was most often studied in both childhood (76.9%) and adolescent (72.7%) studies, and obese children performed significantly worse ( P < 0.05) than healthy weight controls on various tasks measuring this EF domain. Although 27.3% of adolescent studies measured mental flexibility, no childhood studies examined this EF domain. Adolescents with higher BMI had a strong association with neurostructural deficits evident in the OFC. Future research should be longitudinal and use a uniform method of EF measurement to better establish causality between EF and obesity and consequently direct future intervention strategies.

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          Most cited references51

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          The Dimensional Change Card Sort (DCCS): a method of assessing executive function in children.

          The dimensional change card sort (DCCS) is an easily administered and widely used measure of executive function that is suitable for use with participants across a wide range of ages. In the standard version, children are required to sort a series of bivalent test cards, first according to one dimension (e.g., color), and then according to the other (e.g., shape). Most 3-year-olds perseverate during the post-switch phase, exhibiting a pattern of inflexibility similar to that seen in patients with prefrontal cortical damage. By 5 years of age, most children switch when instructed to do so. Performance on the DCCS provides an index of the development of executive function, and it is impaired in children with disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism. We describe the protocol for the standard version (duration = 5 min) and the more challenging border version (duration = 5 min), which may be used with children as old as 7 years.
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            Structural and functional brain development and its relation to cognitive development.

            Despite significant gains in the fields of pediatric neuroimaging and developmental neurobiology, surprisingly little is known about the developing human brain or the neural bases of cognitive development. This paper addresses MRI studies of structural and functional changes in the developing human brain and their relation to changes in cognitive processes over the first few decades of human life. Based on post-mortem and pediatric neuroimaging studies published to date, the prefrontal cortex appears to be one of the last brain regions to mature. Given the prolonged physiological development and organization of the prefrontal cortex during childhood, tasks believed to involve this region are ideal for investigating the neural bases of cognitive development. A number of normative pediatric fMRI studies examining prefrontal cortical activity in children during memory and attention tasks are reported. These studies, while largely limited to the domain of prefrontal functioning and its development, lend support for continued development of attention and memory both behaviorally and physiologically throughout childhood and adolescence. Specifically, the magnitude of activity observed in these studies was greater and more diffuse in children relative to adults. These findings are consistent with the view that increasing cognitive capacity during childhood may coincide with a gradual loss rather than formation of new synapses and presumably a strengthening of remaining synaptic connections. It is clear that innovative methods like fMRI together with MRI-based morphometry and nonhuman primate studies will transform our current understanding of human brain development and its relation to behavioral development.
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              Differential activation of the dorsal striatum by high-calorie visual food stimuli in obese individuals.

              The neural systems regulating food intake in obese individuals remain poorly understood. Previous studies applied positron emission tomography and manipulated hunger and satiety to investigate differences in appetitive processing between obese and normal-weight individuals. However, it is not known whether manipulation of stimulus value may yield different neural activity in obese as compared to control subjects when intrinsic physiological states are kept constant. We used functional magnetic resonance imaging to investigate 13 obese and 13 normal-weight subjects and manipulated food motivation by presenting visual food stimuli differing in their caloric content and energy density. In contrast to controls, obese women selectively activated the dorsal striatum while viewing high-caloric foods. Moreover, in the high-calorie condition body mass index (BMI) predicted activation in the dorsal striatum, anterior insula, claustrum, posterior cingulate, postcentral and lateral orbitofrontal cortex. The results indicate that in obese individuals simple visual stimulation with food stimuli activates regions related to reward anticipation and habit learning (dorsal striatum). Additionally, high-calorie food images yielded BMI-dependent activations in regions associated with taste information processing (anterior insula and lateral orbitofrontal cortex), motivation (orbitofrontal cortex), emotion as well as memory functions (posterior cingulate). Collectively, the results suggest that the observed activation is independent of the physiological states of hunger and satiation, and thus may contribute to pathological overeating and obesity. Some of the observed activations (dorsal striatum, orbitofrontal cortex) are likely to be dopamine-mediated.
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                Author and article information

                Journal
                J Obes
                J Obes
                JOBES
                Journal of Obesity
                Hindawi Publishing Corporation
                2090-0708
                2090-0716
                2013
                21 February 2013
                : 2013
                : 820956
                Affiliations
                1Medical Student at the Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC 29403, USA
                2Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Avenue, 2nd Floor, Nashville, TN 37212, USA
                3Diabetes Research and Training Center, Vanderbilt University School of Medicine, 1211 Medical Center Drive, Nashville, TN 37212, USA
                Author notes

                Academic Editor: Ajay K. Gupta

                Article
                10.1155/2013/820956
                3595670
                23533726
                4e5b533b-cf72-4ad9-a7fb-c82e10bdb3e5
                Copyright © 2013 Kaela R. S. Reinert et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 November 2012
                : 7 January 2013
                : 21 January 2013
                Categories
                Review Article

                Nutrition & Dietetics
                Nutrition & Dietetics

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