Altered insula resting-state functional connectivity correlates with impaired cognitive control in children with emotional undereating.

Eating less in response to negative emotions, called emotional undereating (EUE), is common in children, but research on the etiology of these behaviors is in its infancy. 91 children (aged 9-12, 46 females) completed EUE subscale of Children Eating Behavior Questionnaire and underwent resting-state fMRI. Of these, 43 participants also completed arrow task and 78 were followed up one year later. Compared to children with low-EUE, those with high-EUE exhibited fewer errors but longer reaction times, indicating over-control and reduced flexibility. Additionally, children with high-EUE revealed decreased resting-state functional connectivity (rsFC) within the prefrontal cortex and altered connectivity of insula. Notably, rsFC between the insula and the temporal lobe mediate the relationship between EUE and arrow-task performance at baseline and positively predicted the arrow-task performance one year later. These findings identify a potential stable neural marker of impaired cognitive control in children with EUE and provide new insights into the neurobiological basis of emotional undereating in childhood.