Are obese kids more vulnerable to food advertising than their healthy-weight peers?

A recent investigation found that compared with healthy-weight children, those who are obese show significantly less brain activation in regions associated with cognitive control after viewing familiar food logos, such as McDonald’s “golden arches.” This suggests that obese children may be more responsive to food advertising than their normal-weight peers.

To select the most appropriate food and nonfood logos for their study, investigators asked 32 children to rate on a 5-point scale 239 brand logos as to familiarity, valence (happy/sad), and arousal (exciting/boring). Based on the children’s ratings, investigators chose 120 highly familiar logos: 60 food logos and 60 nonfood logos, such as the Nike “swoosh.”

Twenty other children aged from 10 to 14 years were recruited from pediatric clinics for the study itself. Half the children had a mean body mass index (BMI) in the 50th percentile and the other half a BMI in the 98.9th percentile. After being weighed and measured and having their self-control assessed with a self-report measure, the study subjects underwent functional magnetic resonance imaging while viewing the food and nonfood logos. When viewing food logos, the healthy-weight children showed greater brain activation than the obese children in regions associated with cognitive control and self-control. Specifically, the healthy-weight children showed greater activation bilaterally in the Brodmann area 10 and the inferior frontal gyrus (Bruce AS, et al. J Pediatr. 2013;162[4]:759-764.e2).

COMMENTARY: So, some of us are hardwired to be more susceptible to marketing and other external stimuli to eat. If this trait is genetically coded, and it seems that nearly everything is, it may explain some familial obesity and the difficulty of changing family eating habits.-Michael Burke, MD

Childhood migraine may be associated with infant colic

Children with migraine-with or without aura-are significantly more likely to have had colic as infants than children without migraine, according to a case control study conducted in France and Italy.

Investigators identified 208 patients aged from 6 to 18 years who received a diagnosis of migraine by a pediatric neurologist after visiting an emergency department (ED). The 471 control participants were children in the same age range who visited the ED of the 3 participating centers for minor trauma. Parents of study participants completed a structured questionnaire to determine the patient and family history of infantile colic, which investigators confirmed by reviewing the children’s personal medical records.

In children with migraine, 72.6% reported infantile colic compared with 26.5% of children in the control group. In the migraine with aura group, the prevalence of colic was 69.7% and in the migraine without aura group it was 73.9%. The association between headache and infantile colic was not found for children with tension-type headaches, examined in a separate study in 120 children, confirming the specificity of the association between migraine and colic (Romanello S, et al. JAMA. 2013;309[15]:1607-1612).

COMMENTARY: This is an eye-opening study with some interesting implications. Maybe all our attention to the bellies of babies with colic has been misdirected. Or perhaps the same pathology (or genetics) that causes migraine headaches in adults causes abdominal pain in infants and cyclic vomiting and abdominal migraines in children. Maybe someday we’ll be using probiotics to prevent migraines and beta-blockers to prevent colic. I am looking forward to seeing where this observation leads.-Michael Burke, MD

ADHD poses significant long-term health risks

Having attention-deficit/hyperactivity disorder (ADHD) in childhood increases the risk for suicide in adulthood and for having 1 or more psychiatric disorders other than ADHD, a large prospective epidemiologic study shows. The study also found that ADHD persists into adulthood in nearly one-third of children with childhood ADHD.

Investigators studied a large birth cohort of children born in Rochester, Minnesota, between 1976 and 1982. From this group, they collected prospective data for 232 adults (mean age, 27 years) with childhood ADHD and 335 controls (mean age, 28.6 years) without childhood ADHD, administering standardized neuropsychiatric interviews to study participants. In addition, they compared overall and cause-specific mortality in those with childhood ADHD and the remainder of the entire birth cohort (4,946 individuals) without the condition.

ADHD persisted into adulthood in 29.3% of those with childhood ADHD who were in the prospective study. Participants with childhood ADHD were more likely than controls-56.9% vs 34.9%-to have 1 or more comorbid psychiatric disorders, most often alcohol dependence/abuse (26.3%) followed by other substance dependence/abuse, current or past history of a hypomanic episode, generalized anxiety disorder, or current major depressive episode. Compared with participants who had childhood ADHD that did not persist, those with persistent ADHD were much more likely to have 1 or more comorbid psychiatric disorders (80.9% vs 47.0%, respectively).

Individuals with childhood ADHD were also at greater risk than others in their birth cohort of death-not significantly overall or by accident, but specifically by suicide. Of 7 individuals in the original birth cohort identified as having childhood ADHD who had died, 3 were suicides; 5 had a previous history of both substance use disorder and 1 or more other psychiatric comorbidities (Barbaresi WJ, et al. Pediatrics. 2013;131[4]:637-644).

COMMENTARY: What happens to our patients with ADHD when they grow up? For the 30% of patients who carry the diagnosis of ADHD into adulthood, is there a transition of care to a medical provider for adults who is comfortable treating ADHD? Data reported here don’t include information on whether or not the adult patients studied were treated for ADHD in adulthood. If their condition were treated, would their rate of suicide and likelihood of other psychiatric disorders be changed? This study may generate the questions for which answers will bring adult ADHD into better focus.-Michael Burke, MD

Also of Note

A new study suggests measuring zinc protoporphyrin (ZPP) to screen for iron deficiency. Analysis of baseline screening results for complete blood cell count, lead, and ZPP based on blood draws from more than 2,600 children aged between 8 and 18 months and during follow-up found that almost half had abnormally high ZPP levels. Among those with anemia and abnormal ZPP at baseline, 81.5% of those prescribed iron showed a reduction of ZPP at follow-up compared with 69.7% of those not prescribed iron (Magge H, et al. JAMA Pediatr. 2013;167[4]:361-367).  

COMMENTARY BY MICHAEL G BURKE, MD

DR BURKE, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with or financial interests in any organization that may have an interest in any part of this article.