The executive functions in overweight and obesity: a systematic review of neuropsychological cross-sectional and longitudinal studies

Background: The increasing incidence of people affected by overweight or obesity is a significant health problem. The knowledge of the factors which influences the inappropriate eating behaviors causing excessive body fat is an essential goal for the research. Overweight and obesity are significant risk factors for many health diseases, such as cardiovascular problems, diabetes. Recently, many studies have focused on the relationship between body weight and cognitive processes. Objectives: This systematic review is aimed to investigate the existence and the nature of the relationship between excessive body weight (overweight/obesity) and executive functions, analyzing cross-sectional, and longitudinal studies in order to verify the evidence of a possible causality between these variables. Methods: The review was carried out according to the PRISMA-Statement, through systematic searches in the scientific databases PubMed, Medline, PsychInfo, and PsycArticles. The studies selected examined performance on executive tasks by participants with overweight or obesity, aged between 5 and 70 years. Studies examining eating disorders or obesity resulting from other medical problems were excluded. Furthermore, the results of studies using a cross-sectional design and those using a longitudinal one were separately investigated. Results: Sixty-three cross-sectional studies and twenty-eight longitudinal studies that met our inclusion and exclusion criteria were analyzed. The results confirmed the presence of a relation between executive functions and overweight/obesity, although the directionality of this relation was not clear; nor did any single executive function emerge as being more involved than others in this relation. Despite this, there was evidence of a reciprocal influence between executive functions and overweight/obesity. Conclusions: This systematic review underlines the presence of a relationship between executive functions and overweight/obesity. Moreover, it seems to suggest a bidirectional trend in this relationship that could be the cause of the failure of interventions for weight reduction. The results of this review highlight the importance of a theoretical model able to consider all the main variables of interest, with the aim to structuring integrated approaches to solve the overweight/obesity problems

Executive functions in Alzheimer disease. A systematic review

Alzheimer's disease is a severe irreversible syndrome, characterized by a slow and progressive cognitive decline that interferes with the standard instrumental and essential functions of daily life. Promptly identifying the impairment of particular cognitive functions could be a fundamental condition to limit, through preventive or therapeutic interventions, the functional damages found in this degenerative dementia. This study aims to analyse, through a systematic review of the studies, the sensitivity of four experimental paradigms (Wisconsin Card Sorting Test, Stroop Task, Go/No-Go Task, and Flanker Task) considered as golden standard instruments for executive functions assessment in elderly subjects affected by Alzheimer dementia. This review was carried out according to the PRISMA method. Forty-five studies comparing the executive performance of patients with Alzheimer's dementia (diagnosed according to different classification criteria for dementia) and healthy elderly patients both over the age of sixty, were selected. For the research, PubMed, PsycINFO, PsycArticles databases were used. The study highlighted the importance of using standard protocols to evaluate executive dysfunction in Alzheimer's disease. The Stroop task allows discriminating better between healthy and pathological agin

Emotional regulation and overeating behaviors in children and adolescents: a systematic review

The worldwide prevalence of obesity has dramatically increased, mostly in children and adolescents. The Emotional Eating theoretical model has proposed that the failure in emotional regulation could represent a risk factor for establishing maladaptive overeating behavior that represents an inadequate response to negative emotions and allows increasing body-weight. This systematic review investigates the relationship between overeating and both emotional regulation and emotional intelligence in childhood and adolescence, considering both cross-sectional and longitudinal studies. Moreover, another goal of the review is evaluating whether emotional regulation and emotional intelligence can cause overeating behaviors. The systematic search was conducted according to the PRISMA-statement in the databases Medline, PsychArtcles, PsychInfo, PubMed, Scopus, and Web of Sciences, and allows 484 records to be extracted. Twenty-six studies were selected according to inclusion (e.g., studies focused on children and adolescents without clinical conditions; groups of participants overweight or with obesity) and exclusion (e.g., studies that adopted qualitative assessment or cognitive-affective tasks to measure emotional variables; reviews, commentary, or brief reports) criteria detailed in the methods. Cross-sectional studies showed a negative association between emotional regulation and overeating behavior that was confirmed by longitudinal studies. These findings highlighted the role of maladaptive emotion regulation on overeating and being overweight. The relationship between these constructs in children and adolescents was consistent. The results indicated the complexity of this association, which would be influenced by many physiological, psychological, and social factors. These findings underline the need for further studies focused on emotion regulation in the development of overeating. They should analyze the mediation role of other variables (e.g., attachment style, peer pressure) and identify interventions to prevent and reduce worldwide overweight prevalence

Food-Related Attentional Bias in Individuals with Normal Weight and Overweight: A Study with a Flicker Task

The primary purpose of the present study was to investigate attentional biases for food-related stimuli in individuals with overweight and normal weight using a flicker paradigm. Specifically, it was tested whether attention allocation processes differ between individuals with overweight and normal weight using transient changes of food-related and neutral pictures. Change detection latencies in objects of central interest (CI) or objects of marginal interest (MI) were measured as an index of attention allocation in a sample of fifty-three students with overweight/obesity and sixty students with normal weight during a flicker paradigm with neutral, hypercaloric and hypocaloric food pictures. Both groups of participants showed an attentional bias for food-related pictures as compared to neutral pictures. However, the bias was larger in individuals with overweight than in individuals with normal weight when changes were of marginal interest, suggesting a stronger avoidance of the food-related picture. This study showed that food-related stimuli influence attention allocation processes in both participants with overweight and normal weight. In particular, as compared to individuals with normal weight, those with overweight seem to be characterised by a stronger attentional avoidance of (or smaller attention maintenance on) food-related stimuli that could be considered as a voluntary strategy to resist food consumption

Binge‐watching: development and validation of the Binge‐Watching Addiction Questionnaire

The approach to the vision of TV series has deeply changed in the last years, and watching multiple episodes of TV content in a single session becomes a popular viewing pattern referred as binge‐watching. Early studies defined binge‐watching as a potentially addictive behavior showing characteristics similar to other behavioral addictions, such as loss of control and pleasure anticipation. This study aims to validate a short self‐report questionnaire focused on assessing binge‐watching behavior and determining whether it shows characteristics similar to addictive behavior, the Binge‐Watching Addiction Questionnaire (BWAQ). An online survey was adopted to administer the questionnaire in the general population (N = 1277). Exploratory and confirmatory factor analyses assessed both the validity and the structure of the scale in two independent samples. The statistical analyses confirmed a four‐factor model (i.e., “Craving”, “Dependency”, “Anticipation”, “Avoidance”) of the BWAQ with good psychometric properties. The BWAQ can differentiate between people who adopt maladaptive watching activities from those who use TVseries as leisure and entertainment activities. Therefore, this questionnaire may enable researchers to improve this emerging field of research significantly

The coronavirus pandemic: a possible model of the direct and indirect impact of the pandemic on sleep quality in Italians

Purpose: This study aimed to assess the direct and indirect impact of COVID-19 related aspects on self-reported sleep quality, considering the moderator role of some psychological variables. Methods: during the first weeks of the lockdown in Italy, 2286 respondents (1706 females and 580 males; age range: 18-74 years) completed an online survey that collected sociodemographic information and data related to the experience with the COVID-19 pandemic. Some questionnaires assessed sleep quality, psychological well-being, general psychopathology, Post-Traumatic Stress Disorders symptoms, and anxiety. The path analysis was adopted. Results: The study confirms a direct effect of some aspects ascribable to the pandemic, with a mediator role of the psychological variables. Lower sleep quality was directly related to the days spent at home in confinement and the knowledge of people affected by the COVID-19. All the other aspects related to the COVID-19 pandemic influenced sleep quality through the mediator effect of psychological variables. Conclusion: This study highlighted that the psychological condition of the population has been influenced by the COVID-19 pandemic and the government actions taken to contain it, but it has also played an important role in mediating the quality of sleep, creating a vicious circle on people's health. The results suggest that a health emergency must be accompanied by adequate social support programs to mitigate the fear of infection and promote adequate resilience to accept confinement and social distancing. Such measures would moderate psychological distress and improve sleep quality

Anxiety and Attentional Processes: The Role of Resting Heart Rate Variability

Individuals with high anxiety preferentially focus attention on emotional information. The autonomic nervous system (ANS) plays an important role in modulating both anxiety and attentional processes. Despite many studies having evaluated attentional bias in anxious people, few of them have investigated the change blindness phenomenon associated with the attentional response toward salient stimuli, considering the role of the ANS. This study aimed to examine the role of heart rate variability (HRV) in trait anxiety and top-down and bottom-up attentional processes toward emotional stimuli. Seventy-five healthy university students were divided into high (N = 39) and low (N = 36) trait anxiety groups and completed a change detection flicker task with neutral, positive, and negative stimuli. The results evidenced a different attentional pattern between people with high and low anxiety considering both the two attentional processes and the valence of the stimuli. Specifically, individuals with high anxiety showed a bias in elaborating emotional stimuli related to their salience (i.e., negative stimuli were faster elaborated than neutral and positive stimuli when top-down attentional mechanisms were involved, while slower performances were highlighted considering bottom-up attentional mechanisms in response to emotional stimuli compared to neutral stimuli). Moreover, an association between HRV, trait anxiety levels, and change blindness phenomenon was confirmed. These results underline the role of HRV as a possible predictor of the alteration of attentional mechanism in anxiety

Alexithymia. a facet of uncontrolled hypertension

Introduction: Proper control of blood pressure reduces the risk of developing cardiovascular and cerebrovascular complications in hypertensive people. However, this control remains mostly unsatisfactory. Although alexithymia has been associated with essential hypertension, no study has analysed the relationship between alexithymia and blood pressure control in drug-treated hypertension. This research aimed to analyse the presence and the characteristics of this relationship, considering both the pharmacological treatment and the achievement of adequate maintenance of blood pressure in a physiological range. Method: One thousand two hundred and forty-one people participated in the study. Eight hundred and ten were hypertensive patients, and four hundred and thirty-one were normotensive people. The Toronto Alexithymia Scale-20 was used to assess alexithymia. Results: Results show that hypertensive people are more alexithymic than normotensive people. According to the presence of pharmacological treatment, treated hypertensive patients are more alexithymic than normotensive and not treated hypertensive patients. Considering the blood pressure control associated with the drug-therapy, people with uncontrolled hypertension are more alexithymic than normotensive and untreated hypertensive people. Conclusions: These findings confirm a relationship between alexithymia and essential arterial hypertension, but they also highlight that alexithymia appears to be associated with higher severity of hypertension. Alexithymia could be a facet of uncontrolled hypertension

The night effect of anger: relationship with nocturnal blood pressure dipping

Introduction: The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. Methods: We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State–Trait Anger Expression Inventory was used to assess anger. Results: Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. Conclusions: These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon

The night side of blood pressure: nocturnal blood pressure dipping and emotional (dys)regulation

Introduction: The dipping phenomenon is a physiological drop in blood pressure (around 10–20%) during sleep and represents an event related to the circadian blood pressure trend. This phenomenon, in some cases, is characterized by some alterations that can be expressed by an increase (extreme dipping), a decrease (non-dipping), or a reverse (i.e., higher blood pressure during sleep compared to awake state; reverse-dipping) physiological decline of blood pressure. Few studies focused on the association between the circadian variation of blood pressure and psychological variables, although this information could help understanding how psychological characteristics (e.g., emotional regulation or dysregulation) interact with individuals’ physiological processes. Given the association between emotional dysregulation and essential hypertension, this study aimed to investigate the relationship between alexithymia and dipping status in a sample of healthy and hypertensive adults in the absence of other medical conditions. Methods: Two hundred and ten adults took part in the study and were classified, according to ambulatorial blood pressure measure (ABPM), into three groups: dippers (n = 70), non-dippers (n = 70), and extreme dippers (n = 70). The participants completed a socio-demographic and anamnestic interview and the Toronto Alexithymia Scale-20 (TAS-20). Results: The ANOVAs on the TAS-20 subscales showed that the groups differed in the difficulty identifying feelings and difficulty describing feelings. In both the subscales, dippers showed lower scores than non-dippers and extreme dippers. The ANOVA on the global score of TAS-20 confirmed that dippers were less alexithymic than both extreme dippers and non-dippers. Conclusions: This study confirms that some psychological factors, like alexithymia, could represent a characteristic of patients who fail to exhibit an adaptive dipping phenomenon. Moreover, an association between an excessive reduction of BP (extreme dipping) or a lack of the decrease of BP during sleep (non-dipping) and a worse emotional regulation, considering alexithymia construct, was highlighted for the first time, confirming the relevant role of the emotional process in the modulation of an essential psychophysiological process such as the circadian variation of BP