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Presseller EK, Parker MN, Zhang F, Manasse S, Juarascio AS. Continuous glucose monitoring as an objective measure of meal consumption in individuals with binge-spectrum eating disorders: A proof-of-concept study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:828-837. [PMID: 38568882 DOI: 10.1002/erv.3094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/26/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Going extended periods of time without eating increases risk for binge eating and is a primary target of leading interventions for binge-spectrum eating disorders (B-EDs). However, existing treatments for B-EDs yield insufficient improvements in regular eating and subsequently, binge eating. These unsatisfactory clinical outcomes may result from limitations in assessment and promotion of regular eating in therapy. Detecting the absence of eating using passive sensing may improve clinical outcomes by facilitating more accurate monitoring of eating behaviours and powering just-in-time adaptive interventions. We developed an algorithm for detecting meal consumption (and extended periods without eating) using continuous glucose monitor (CGM) data and machine learning. METHOD Adults with B-EDs (N = 22) wore CGMs and reported eating episodes on self-monitoring surveys for 2 weeks. Random forest models were run on CGM data to distinguish between eating and non-eating episodes. RESULTS The optimal model distinguished eating and non-eating episodes with high accuracy (0.82), sensitivity (0.71), and specificity (0.94). CONCLUSIONS These findings suggest that meal consumption and extended periods without eating can be detected from CGM data with high accuracy among individuals with B-EDs, which may improve clinical efforts to target dietary restriction and improve the field's understanding of its antecedents and consequences.
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Affiliation(s)
- Emily K Presseller
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Megan N Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Fengqing Zhang
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephanie Manasse
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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2
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St Clair L, Grady A, Mahmut MK. Investigating the Link between Eating Attitudes, Taste and Odour Preferences and the Chemical Senses. BIOLOGY 2023; 12:1415. [PMID: 37998014 PMCID: PMC10669679 DOI: 10.3390/biology12111415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To examine if higher degrees of pathological eating attitudes in a non-clinical sample are associated with odour and taste perception and preferences based on psychophysical ratings. PARTICIPANTS AND METHODS A total of 80 female university students completed the eating attitudes test (EAT-26), followed by four chemosensory measures including olfactory and gustatory perception plus perceptual ratings and preferences for food odours and tastes. RESULTS There were no significant correlations between EAT-26 scores and measures of olfactory and gustatory perception. However, a significant interaction effect indicated higher degrees of pathological eating attitudes may be associated with differential sensitivity to sweet and fatty food odours compared to those with lower levels of pathological eating attitudes. CONCLUSIONS This was the first study to examine pathological eating attitudes using food stimuli with a non-clinical sample. The results remain preliminary until replication. However, the findings highlight the need for development of measures of disordered eating attitudes and behaviours that go beyond caloric restriction.
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Affiliation(s)
| | | | - Mehmet K. Mahmut
- Food, Flavour and Fragrance Lab, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
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3
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Ishitsuka K, Yamamoto-Hanada K, Mezawa H, Saito-Abe M, Sasaki H, Nishizato M, Sato M, Ohya Y. Association between pre-pregnancy weight status and dietary patterns during pregnancy: results from the Japan Environment and Children's Study. Public Health Nutr 2023; 26:1807-1814. [PMID: 37129016 PMCID: PMC10478052 DOI: 10.1017/s1368980023000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Pre-pregnancy weight status is related to offspring health and may influence dietary patterns during pregnancy. We aimed to evaluate the link between pre-pregnancy weight status and dietary patterns during pregnancy. DESIGN Dietary data were collected using a FFQ during middle or late pregnancy. Dietary patterns were identified using principal component analysis. Anthropometric data were extracted from medical charts. Multiple linear regression was used to assess associations between pre-pregnancy weight status (severely or moderately underweight, mildly underweight, normal weight, overweight and obese) and dietary patterns during pregnancy after adjusting for socio-demographic characteristics. SETTING Nationwide Japan. PARTICIPANTS Pregnant Japanese women enrolled in the Japan Environment and Children's Study, a prospective birth cohort study (n 90 765). RESULTS We identified three dietary patterns. Compared with women with pre-pregnancy normal weight, those with pre-pregnancy obesity were less likely to habitually consume 'fruits and vegetables' pattern (coefficient, -0·18; 95 % CI, -0·21, -0·14) and 'confectionery' pattern (coefficient, -0·18; 95 % CI, -0·21, -0·14) and more likely to consume 'white rice and soy products' pattern (coefficient, 0·08; 95 % CI, 0·04, 0·11), and those with severely or moderately pre-pregnancy underweight were more likely to consume 'confectionery' pattern (coefficient, 0·06; 95 % CI, 0·03, 0·09) during pregnancy, after adjusting for confounders. CONCLUSION We found that moderately and severely pre-pregnancy underweight women and those with obesity had unhealthy dietary patterns compared to those with pre-pregnancy normal weight. Our findings suggest that prenatal dietary advice is important and should be based on the pre-pregnancy weight status.
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Affiliation(s)
- Kazue Ishitsuka
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Kiwako Yamamoto-Hanada
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Hidetoshi Mezawa
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Mayako Saito-Abe
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Hatoko Sasaki
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Minaho Nishizato
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Miori Sato
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Yukihiro Ohya
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
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4
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Figueiredo N, Kose J, Srour B, Julia C, Kesse-Guyot E, Péneau S, Allès B, Paz Graniel I, Chazelas E, Deschasaux-Tanguy M, Debras C, Hercberg S, Galan P, Monteiro CA, Touvier M, Andreeva VA. Ultra-processed food intake and eating disorders: Cross-sectional associations among French adults. J Behav Addict 2022; 11:588-599. [PMID: 35380986 PMCID: PMC9295249 DOI: 10.1556/2006.2022.00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background and aims Data regarding the association between ultra-processed food (UPF) consumption and eating disorders (ED) are scarce. Our aim was to investigate whether UPF intake was associated with different ED types in a large population-based study. Methods 43,993 participants (mean age = 51.0 years; 76.1% women) of the French NutriNet-Santé web-cohort who were screened for ED in 2014 via the Sick-Control-One stone-Fat-Food (SCOFF) questionnaire, were included in the analysis. The clinical algorithm Expali TM tool was used to identify four ED types: restrictive, bulimic, binge eating, and other (not otherwise specified). Mean dietary intake was evaluated from at least 2 self-administered 24-h dietary records (2013-2015); categorization of food as ultra-processed or not relied on the NOVA classification. The associations between UPF intake (as percent and reflecting mean daily UPF quantity (g/d) within the dietary intake, %UPF) and ED types were evaluated using polytomous logistic regression models. Results 5,967 participants (13.6%) were categorized as likely ED (restrictive n = 444; bulimic n = 1,575; binge eating n = 3,124; other ED n = 824). The fully-adjusted analyses revealed a positive association between UPF intake and bulimic, binge eating, and other ED: ED risk (odds ratio, OR) for an absolute 10-percentage point incremental increase in %UPF intake were 1.08 (1.01-1.14; P = 0.02), 1.21 (1.16-1.26; P < 0.0001), and 1.11 (1.02-1.20; P = 0.02), respectively. No significant association was detected for restrictive ED. Discussion and Conclusion This study revealed an association of UPF intake with different ED types among French adults. Future research is needed to elucidate the direction of the observed associations.
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Affiliation(s)
- Natasha Figueiredo
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- Health Services Research Group (RESHAPE), INSERM U1290, Claude Bernard University - Lyon 1, Lyon, France
| | - Junko Kose
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
| | - Bernard Srour
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
| | - Chantal Julia
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- Department of Public Health, AP-HP Paris Seine-Saint-Denis Hospital System, Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
| | - Sandrine Péneau
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
| | - Benjamin Allès
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
| | - Indira Paz Graniel
- Human Nutrition Research Group, Department of Biochemistry and Biotechnology, Rovira i Virgili University, Tarragona, Spain
| | - Eloi Chazelas
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
| | - Mélanie Deschasaux-Tanguy
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
| | - Charlotte Debras
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
- Department of Public Health, AP-HP Paris Seine-Saint-Denis Hospital System, Bobigny, France
| | - Pilar Galan
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
| | - Carlos A. Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Mathilde Touvier
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
- National Nutrition and Cancer Research Network (NACRE), Jouy-en-Josas, France
| | - Valentina A. Andreeva
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) – University of Paris, Bobigny, France
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Post-traumatic stress disorder may set the neurobiological stage for eating disorders: A focus on glutamatergic dysfunction. Appetite 2021; 167:105599. [PMID: 34271078 DOI: 10.1016/j.appet.2021.105599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a trauma and stress-related disorder which has been shown to be highly comorbid with, and commonly a precedent of, the eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder. The objective of this review is to discuss a potential overlapping neurobiological mechanism for this comorbidity. Alterations in glutamatergic neurotransmission have been observed in all four of the aforementioned disorders. Excessive excitation via glutamate contributes to excitotoxicity, and over-activation of the hypothalamic-pituitary-adrenal axis, both of which have implications for the deterioration of various brain structures. Prominent structures impacted include the hippocampus, hypothalamus, and prefrontal cortex, all of which are integral to the regulation of stress and eating. The current review suggests that altered glutamate function by trauma or extreme stress may facilitate PTSD and subsequent eating disorder onset, and that glutamatergic modulation may be a key treatment for individuals suffering from these conditions. This overlapping mechanism may help inform future research on individuals with comorbid PTSD and eating disorders, and it could also help inform ways to potentially prevent the onset of these conditions.
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6
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Hermont AP, Pordeus IA, Ramos-Jorge J, Paiva SM, Auad SM. Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear? Eat Weight Disord 2021; 26:1119-1127. [PMID: 32929621 DOI: 10.1007/s40519-020-01008-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology. METHODS An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained. RESULTS The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029). CONCLUSION It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW. LEVEL OF EVIDENCE III case-control analytic study.
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Affiliation(s)
- Ana Paula Hermont
- Department of Pediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Isabela Almeida Pordeus
- Department of Pediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joana Ramos-Jorge
- Department of Pediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Saul Martins Paiva
- Department of Pediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sheyla Márcia Auad
- Department of Pediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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7
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McMaster CM, Fong M, Franklin J, Hart S. Dietetic intervention for adult outpatients with an eating disorder: a systematic review and assessment of evidence quality. Nutr Rev 2021; 79:914-930. [PMID: 33544862 DOI: 10.1093/nutrit/nuaa105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Eating disorders (EDs) are complex mental illnesses that require medical, psychological, and dietetic intervention to assist patients achieve recovery. OBJECTIVE Available evidence was reviewed regarding dietetic intervention for adult outpatients with an ED and the quality of this evidence was assessed. DATA SOURCES Systematic literature searches were conducted using 5 databases (MEDLINE, PreMEDLINE, EMBASE, CINAHL, PsycINFO) for studies comparing adults with an ED receiving a dietetic intervention with those receiving a psychological intervention alone, those receiving a combined dietetic and psychological intervention, or a control group. DATA EXTRACTION Literature searches returned 3078 results, with 10 articles reporting on 9 randomized controlled trials meeting the inclusion criteria. The quality of evidence was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. DATA ANALYSIS GRADE assessments for studies involving individuals with anorexia nervosa indicated very low quality of evidence for outcomes including weight, ED psychopathology and ED behaviors , and no studies measured nutritional changes. For studies conducted with participants with bulimia nervosa or binge eating disorder, only 1 study included a group receiving combined evidence-based psychological and dietetic intervention. A combined intervention produced moderate-quality evidence for lower attrition, greater abstinence from ED behaviors, and more meals eaten per week in comparison with a stand-alone psychological or dietetic intervention. CONCLUSIONS There is currently limited evidence to sufficiently assess the impact of incorporating dietetic interventions into outpatient treatment for adults with an ED; however, available evidence supports clinical practice guidelines that dietetic intervention should not be delivered as a stand-alone treatment. Additional methodologically sound studies in larger samples are required to fully inform dietetic treatment in EDs and incorporation of such interventions as part of a multidisciplinary treatment approach.
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Affiliation(s)
- Caitlin M McMaster
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - Mackenzie Fong
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| | - Janet Franklin
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Susan Hart
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.,Nutrition and Dietetics Department, St Vincent's Hospital, Sydney, New South Wales, Australia
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8
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Ayton A, Ibrahim A. The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research. Nutr Rev 2020; 78:579-596. [PMID: 31846028 PMCID: PMC7682725 DOI: 10.1093/nutrit/nuz089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Over the last 50 years, in parallel with the obesity epidemic, the prevalence of eating disorders has increased and presentations have changed. In this narrative review, we consider recent research exploring the implications of changing patterns of food consumption on metabolic and neurobiological pathways, a hitherto neglected area in eating disorder research. One of the major changes over this time has been the introduction of ultra-processed (NOVA-4) foods, which are gradually replacing unprocessed and minimally processed foods. This has resulted in the increased intake of various sugars and food additives worldwide, which has important metabolic consequences: triggering insulin and glucose response, stimulating appetite, and affecting multiple endocrine and neurobiological pathways, as well as the microbiome. A paradigm shift is needed in the conceptual framework by which the vulnerability to, and maintenance of, different eating disorders may be understood, by integrating recent knowledge of the individual metabolic responses to modern highly processed foods into existing psychological models. This could stimulate research and improve treatment outcomes.
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Affiliation(s)
- Agnes Ayton
- University of Oxford, Oxford, United Kingdom
| | - Ali Ibrahim
- South London and Maudsley NHS Foundation Trust, Snowsfields Adolescent Unit, Mapother House, Maudsley Hospital, London
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9
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Mattheus HK, Wagner C, Becker K, Bühren K, Correll CU, Egberts KM, Ehrlich S, Fleischhaker C, Föcker M, Hahn F, Hebebrand J, Herpertz-Dahlmann B, Jaite C, Jenetzky E, Kaess M, Legenbauer PhD T, Pfeiffer PhD JP, Renner Md TJ, Roessner V, Schulze U, Sinzig J, Wessing I, von Gontard A. Incontinence and constipation in adolescent patients with anorexia nervosa-Results of a multicenter study from a German web-based registry for children and adolescents with anorexia nervosa. Int J Eat Disord 2020; 53:219-228. [PMID: 31617610 DOI: 10.1002/eat.23182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are common disorders in childhood and are frequently accompanied by comorbid psychiatric disorders. Despite a high association between urinary and fecal incontinence with psychiatric and neurodevelopmental disorders, research on comorbidity between incontinence and anorexia nervosa (AN) remains scarce. Yet, it is well known that somatic consequences of AN include metabolic and gastrointestinal disorders. The study sought to assess the prevalence of incontinence and constipation in children and adolescents with AN and to examine associations of these two symptoms with body weight at admission and with BMI changes during inpatient treatment. METHODS Data collected between 2015 and 2017 by a multicenter German web-based registry for AN were analyzed. Three hundred and forty-eight patients with AN (96.3% female, mean age = 15.1 ± 1.8 years) were assessed regarding AN subtype, psychiatric comorbidity, body weight, incontinence, and constipation. RESULTS Overall, 27.6% of patients had constipation, 1.8% had NE and 1.8% DUI. Prevalence of constipation did not significantly differ between AN subtypes. Constipation did not lead to any significant differences in weight/BMI changes during inpatient treatment. DISCUSSION This is the largest study of incontinence and constipation in patients with AN, so far. Our results indicate that constipation is highly prevalent in adolescent patients with AN and reflects a clinically relevant condition. Despite, patients with AN do not have an increased prevalence of incontinence compared with the general population. Future studies should include medical examinations like ultrasound and physical examination of the lower abdomen to evaluate the severity of constipation.
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Affiliation(s)
- Hannah K Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Catharina Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg and University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Karin M Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Freia Hahn
- Department of Child an Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR - Hospital Viersen, Viersen, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ekkehart Jenetzky
- Department of Child and Adolescent Psychiatry, University Medicine of the Johannes Gutenberg-University, Mainz, Germany.,Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tanja Legenbauer PhD
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr University Bochum, Bochum, Germany
| | - Jens P Pfeiffer PhD
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg and University Hospital Marburg, Marburg, Germany
| | - Tobias J Renner Md
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital, University of Ulm, Ulm, Germany
| | - Judith Sinzig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Ida Wessing
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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10
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Johansson AK, Norring C, Unell L, Johansson A. Diet and behavioral habits related to oral health in eating disorder patients: a matched case-control study. J Eat Disord 2020; 8:7. [PMID: 32128206 PMCID: PMC7045484 DOI: 10.1186/s40337-020-0281-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients suffering from eating disorders (ED) have a substantially increased risk for developing poor oral health. In this regard, dietary habits in combination with obsessive behavior as well as the expression and intensity of the disease are of utmost importance. This study aimed to investigate diet and behavioral habits in patients with ED compared to healthy controls. METHODS All patients who initiated treatment in an ED clinic during 1 year were invited to participate in the study. Sixty-five patients were admitted out of which 54 agreed to participate: 50 women and 4 men, mean age 21.5 years, range 10-50 years. From a public dental health clinic, 54 sex-and age-matched controls where selected. In all participants a comprehensive questionnaire was completed. ED patients were analyzed with respect to their self-perceived disease state: when they felt "relatively good" (ED-good) and "bad" (ED-bad) as well as if they reported vomiting or not. RESULTS The ED-good patients reported significantly higher intake of caffeine-containing and cola light soft drinks and both study groups reported a lower intake of regularly sweetened carbonated drinks compared to controls. ED-bad reported significantly lower intake of number of meal and sweet intake while both study groups brushed their teeth more frequently than controls. As regards awareness of detrimental dietary intake and the possible risk for oral health complications did not differ between patients and controls except that the ED groups were more aware that vomiting and brushing thereafter could damage their teeth. ED patients went less often to the dentist for regular checkups than controls. Vomiting ED patients differed in several of the parameters related to dietary and other behaviors compared to no vomiting subjects. According to regression analyses and compared to healthy controls, predictive variables for ED-good were: higher intake of caffeine containing drinks (OR 1.34, CI 1.10-1.64) and lower intake of regular soft drinks (OR 0.57, CI 0.35-0.94). For ED-bad, lower frequency intake of lunch meals (OR 0.59, CI 0.39-0.88) and sweet biscuits were predictive (OR 0.15, CI 0.05-0.48). CONCLUSIONS ED patients present a number of dietary and other types of behavior that are potentially harmful for oral health. It is important to retrieve reports on the ED behaviors in both relatively good and bad disease state in order for the medical team to prescribe adequate advice and treatment.
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Affiliation(s)
- Ann-Katrin Johansson
- 1Department of Clinical Dentistry-Cariology, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009 Bergen, Norway
| | - Claes Norring
- 2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Unell
- 3School of Health and Medical Sciences, Örebro University and Region Örebro County Council, Örebro, Sweden
| | - Anders Johansson
- 4Department of Clinical Dentistry-Prosthodontics, Faculty of Medicine, University of Bergen, Bergen, Norway
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11
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Effects of Sucralose Ingestion versus Sucralose Taste on Metabolic Responses to an Oral Glucose Tolerance Test in Participants with Normal Weight and Obesity: A Randomized Crossover Trial. Nutrients 2019; 12:nu12010029. [PMID: 31877631 PMCID: PMC7019725 DOI: 10.3390/nu12010029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022] Open
Abstract
Here, we tested the hypothesis that sucralose differentially affects metabolic responses to labeled oral glucose tolerance tests (OGTTs) in participants with normal weight and obesity. Participants (10 with normal weight and 11 with obesity) without diabetes underwent three dual-tracer OGTTs preceded, in a randomized order, by consuming sucralose or water, or by tasting and expectorating sucralose (e.g., sham-fed; sweetness control). Indices of β-cell function and insulin sensitivity (SI) were estimated using oral minimal models of glucose, insulin, and C-peptide kinetics. Compared with water, sucralose ingested (but not sham-fed) resulted in a 30 ± 10% increased glucose area under the curve in both weight groups. In contrast, the insulin response to sucralose ingestion differed depending on the presence of obesity: decreased within 20–40 min of the OGTT in normal-weight participants but increased within 90–120 min in participants with obesity. Sham-fed sucralose similarly decreased insulin concentrations within 60 min of the OGTT in both weight groups. Sucralose ingested (but not sham-fed) increased SI in normal-weight participants by 52 ± 20% but did not affect SI in participants with obesity. Sucralose did not affect glucose rates of appearance or β-cell function in either weight group. Our data underscore a physiological role for taste perception in postprandial glucose responses, suggesting sweeteners should be consumed in moderation.
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12
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Geer B, Gibson D, Grayeb D, Benabe J, Victory S, Mehler S, Mehler P. Metformin abuse: A novel and dangerous purging behavior in anorexia nervosa. Int J Eat Disord 2019; 52:319-321. [PMID: 30629296 DOI: 10.1002/eat.23010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To report a case of severe multisystem illness, near death and permanent kidney failure in a woman with a history of anorexia nervosa-binge purge type due to abuse of prescription metformin, an approved oral diabetes medication obtained surreptitiously via the internet. METHOD Psychiatric and medical records were reviewed from the medical care of this patient. A literature search was also performed on prescription medication abuse as a mode of purging. DISCUSSION Metformin abuse in a patient with an eating disorder as a purging behavior is a rarely reported, albeit very dangerous entity. Clinicians treating eating disorders should increasingly be aware of the potential abuse of prescription medications, unapproved for weight loss but which have weight loss, as a reported side effect. This is particularly important as the ability to obtain prescription medications via the internet, without a prescription, becomes more ubiquitous.
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Affiliation(s)
- Bashir Geer
- Department of Medicine, ACUTE, Denver Health, Denver, Colorado.,Department of Medicine, University of Colorado, Denver, Colorado
| | - Dennis Gibson
- Department of Medicine, ACUTE, Denver Health, Denver, Colorado.,Department of Medicine, University of Colorado, Denver, Colorado
| | - Daniela Grayeb
- Department of Medicine, ACUTE, Denver Health, Denver, Colorado.,Department of Medicine, University of Colorado, Denver, Colorado
| | - Jodie Benabe
- Department of Medicine, ACUTE, Denver Health, Denver, Colorado
| | - Shelby Victory
- Department of Medicine, ACUTE, Denver Health, Denver, Colorado
| | | | - Philip Mehler
- Department of Medicine, ACUTE, Denver Health, Denver, Colorado.,Department of Medicine, University of Colorado, Denver, Colorado.,Eating Recovery Center, Denver, Colorado
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13
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Abstract
Anorexia nervosa and bulimia nervosa are characterized by severely restricted intake, binge eating, and compensatory behaviors like self-induced vomiting. The neurobiological underpinnings of these maladaptive behaviors are poorly understood, but the application of cognitive neuroscience and neuroimaging to eating disorders has begun to elucidate their pathophysiology. Specifically, this review focuses on 3 areas that suggest paths forward: reward, cognitive and behavioral control, and decision making. Understanding the brain-based mechanisms that promote and maintain these often chronic symptoms could guide the development of new and more effective treatments.
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14
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Garcia-Burgos D, Maglieri S, Vögele C, Munsch S. How Does Food Taste in Anorexia and Bulimia Nervosa? A Protocol for a Quasi-Experimental, Cross-Sectional Design to Investigate Taste Aversion or Increased Hedonic Valence of Food in Eating Disorders. Front Psychol 2018; 9:264. [PMID: 29593595 PMCID: PMC5859071 DOI: 10.3389/fpsyg.2018.00264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Despite on-going efforts to better understand dysregulated eating, the olfactory-gustatory deficits and food preferences in eating disorders (ED), and the mechanisms underlying the perception of and responses to food properties in anorexia nervosa (AN) and bulimia nervosa (BN) remain largely unknown; both during the course of the illness and compared to healthy populations. It is, therefore, necessary to systematically investigate the gustatory perception and hedonics of taste in patients with AN and BN. To this end, we will examine whether aversions to the taste of high-calorie food is related to the suppression of energy intake in restricting-type AN, and whether an increased hedonic valence of sweet, caloric-dense foods may be part of the mechanisms triggering binge-eating episodes in BN. In addition, the role of cognitions influencing these mechanisms will be examined. Method: In study 1, four mixtures of sweet-fat stimuli will be presented in a sensory two-alternative forced-choice test involving signal detection analysis. In study 2, a full-scale taste reactivity test will be carried out, including psychophysiological and behavioral measures to assess subtle and covert hedonic changes. We will compare the responses of currently-ill AN and BN patients to those who have recovered from AN and BN, and also to those of healthy normal-weight and underweight individuals without any eating disorder pathology. Discussion: If taste response profiles are differentially linked to ED types, then future studies should investigate whether taste responsiveness represents a useful diagnostic measure in the prevention, assessment and treatment of EDs. The expected results on cognitive mechanisms in the top-down processes of food hedonics will complement current models and contribute to the refinement of interventions to change cognitive aspects of taste aversions, to establish functional food preferences and to better manage food cravings associated with binge-eating episodes. No trial registration was required for this protocol, which was approved by the Swiss ethics committee (CER-VD, n° 2016-02150) and the Ethics Review Panel of the University of Luxembourg.
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Affiliation(s)
| | - Sabine Maglieri
- School of Agricultural, Forest and Food Sciences HAFL, Bern University of Applied Sciences, Bern, Switzerland
| | - Claus Vögele
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Simone Munsch
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
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15
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Hart S, Marnane C, McMaster C, Thomas A. Development of the "Recovery from Eating Disorders for Life" Food Guide (REAL Food Guide) - a food pyramid for adults with an eating disorder. J Eat Disord 2018; 6:6. [PMID: 29619220 PMCID: PMC5878939 DOI: 10.1186/s40337-018-0192-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/08/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is limited evidence to inform nutrition and dietetic interventions for individuals with eating disorders even though it is recommended as an essential part of multidisciplinary management. There is minimal guidance, an absence of standardised nutrition educational material, and no research on how best to educate patients on healthy eating and how to achieve nutrition adequacy. Therefore the REAL Food Guide was developed. METHODS The REAL Food Guide is a pyramid with four layers and key nutrition messages beside each layer that was conceived to address gaps in nutrition education and intervention for individuals with eating disorders. Written and verbal consumer feedback was obtained from consumers receiving treatment regarding the acceptability and usefulness of the REAL Food Guide. A unique database was developed to reflect the types of foods and realistic portion sizes that patients are likely to select. This database was used for nutrition modelling to assess the nutrition adequacy of three meal patterns (meat containing, vegetarian and semi-vegan) for both weight maintenance and weight regain. Each meal pattern was compared to the Nutrient Reference Values for Australia and New Zealand. RESULTS Nutritional analysis demonstrated nutritional adequacy of meal patterns for energy, macronutrients and most micronutrients when the recommended number of serves from the REAL Food Guide were assessed. All meal patterns were adequate in micronutrients except for the semi-vegan meal pattern that was inadequate in vitamin D. Feedback from individuals with eating disorders demonstrates the nutrition education tool was acceptable to them as they felt it was more helpful for their recovery than general nutrition guidelines. CONCLUSION The REAL Food Guide is a comprehensive and user-friendly guide that clinicians can use to educate patients about components of a balanced and healthy diet. The guide can educate all eating disorder clinicians, including those who are new to the field, about the basics of nutrition. Clinicians using the guide can be confident that, if followed, patient's energy and nutritional requirements will be met and important nutrition education messages are reinforced, that are tailored to the beliefs and concerns of individuals with eating disorders.
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Affiliation(s)
- Susan Hart
- Nutrition Services, St Vincent's Health Network, Darlinghurst, 2010 Australia.,2The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, 2006 Australia
| | - Claire Marnane
- Newtown Nutrition, Suite 1, 33 King St, Newtown, 2042 Australia.,4Nutrition and Dietetics Program, The University of Sydney, Camperdown, 2006 Australia
| | - Caitlin McMaster
- 2The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, 2006 Australia.,5Weight Management Service, The Children's Hospital at Westmead, Westmead, 2145 Australia
| | - Angela Thomas
- Central Coast Eating Disorders Outpatient Service, Toukley, 2263 Australia
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16
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Setsu R, Hirano Y, Tokunaga M, Takahashi T, Numata N, Matsumoto K, Masuda Y, Matsuzawa D, Iyo M, Shimizu E, Nakazato M. Increased Subjective Distaste and Altered Insula Activity to Umami Tastant in Patients with Bulimia Nervosa. Front Psychiatry 2017; 8:172. [PMID: 28993739 PMCID: PMC5622337 DOI: 10.3389/fpsyt.2017.00172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/31/2017] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to examine differences in brain neural activation in response to monosodium glutamate (MSG), the representative component of umami, between patients with bulimia nervosa (BN) and healthy women (HW) controls. We analyzed brain activity after ingestion of an MSG solution using functional magnetic resonance imaging (fMRI) in a group of women with BN (n = 18) and a group of HW participants (n = 18). Both groups also provided a subjective assessment of the MSG solution via a numerical rating scale. The BN group subjectively rated the MSG solution lower in pleasantness and liking than the control group, although no difference in subjective intensity was noted. The fMRI results demonstrated greater activation of the right insula in the BN group versus the control group. Compared with the HW controls, the BN patients demonstrated both altered taste perception-related brain activity and more negative hedonic scores in response to MSG stimuli. Different hedonic evaluation, expressed as the relative low pleasing taste of umami tastant and associated with altered insula function, may explain disturbed eating behaviors, including the imbalance in food choices, in BN patients.
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Affiliation(s)
- Rikukage Setsu
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Miki Tokunaga
- School of Nutrition and Dietetics, Kanagawa University of Human Services, Yokosuka, Japan
| | - Toru Takahashi
- Department of Nutrition and Health Sciences, Fukuoka Women's University, Fukuoka, Japan
| | - Noriko Numata
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Daisuke Matsuzawa
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Michiko Nakazato
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
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17
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Schebendach J, Klein DA, Mayer LES, Attia E, Devlin MJ, Foltin RW, Walsh BT. Assessment of the motivation to use artificial sweetener among individuals with an eating disorder. Appetite 2016; 109:131-136. [PMID: 27884761 DOI: 10.1016/j.appet.2016.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 11/04/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
Eating disorders are associated with a range of abnormalities in eating behavior. Some individuals consume large amounts of non-caloric artificial sweeteners, suggesting abnormalities in appetitive responding. The current study aimed to quantify hedonic and motivating effects of artificial sweetener in individuals with and without an eating disorder. Two laboratory studies were conducted. Hedonic preference was estimated using the number of artificial sweetener packets (0-10) added to unsweetened cherry flavored Kool-Aid (study 1). Motivation to obtain sweetener was assessed by a progressive ratio (PR) work task (study 2). Ninety-three participants (25 anorexia nervosa restricting type (AN-R), 23 AN binge/purge type (AN-B/P), 20 bulimia nervosa (BN), and 25 normal controls (NC)) completed the study. No significant difference in hedonic preference was found among participant groups. Work completed at the PR task ranged from 0 to 9500 key-board presses. The AN-B/P group had a significantly higher breakpoint and performed significantly more work for sweetener compared to the BN and NC groups. Among AN-B/P and AN-R participants, the preferred number of Equal packets was significantly correlated with the breakpoint and total work. The increased amount of work for sweetener among individuals with AN-B/P supports an enhanced reward value of sweet taste in this population, and suggests that the characteristic food avoidance in AN cannot be accounted for by decreased reward value of all taste-related stimuli. This study also supports the novel application of a PR ratio task to quantify the motivating effect of sweet taste among individuals with an eating disorder.
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Affiliation(s)
- Janet Schebendach
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA.
| | - Diane A Klein
- New York University, Langone Medical Center, Department of Psychiatry, USA
| | - Laurel E S Mayer
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - Evelyn Attia
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - Michael J Devlin
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - Richard W Foltin
- Division on Substance Abuse, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - B Timothy Walsh
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
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18
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Characterization of eating patterns among individuals with eating disorders: What is the state of the plate? Physiol Behav 2014; 134:92-109. [DOI: 10.1016/j.physbeh.2014.02.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 12/28/2022]
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19
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Pepino MY, Tiemann CD, Patterson BW, Wice BM, Klein S. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care 2013; 36:2530-5. [PMID: 23633524 PMCID: PMC3747933 DOI: 10.2337/dc12-2221] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Nonnutritive sweeteners (NNS), such as sucralose, have been reported to have metabolic effects in animal models. However, the relevance of these findings to human subjects is not clear. We evaluated the acute effects of sucralose ingestion on the metabolic response to an oral glucose load in obese subjects. RESEARCH DESIGN AND METHODS Seventeen obese subjects (BMI 42.3 ± 1.6 kg/m(2)) who did not use NNS and were insulin sensitive (based on a homeostasis model assessment of insulin resistance score ≤ 2.6) underwent a 5-h modified oral glucose tolerance test on two separate occasions preceded by consuming either sucralose (experimental condition) or water (control condition) 10 min before the glucose load in a randomized crossover design. Indices of β-cell function, insulin sensitivity (SI), and insulin clearance rates were estimated by using minimal models of glucose, insulin, and C-peptide kinetics. RESULTS Compared with the control condition, sucralose ingestion caused 1) a greater incremental increase in peak plasma glucose concentrations (4.2 ± 0.2 vs. 4.8 ± 0.3 mmol/L; P = 0.03), 2) a 20 ± 8% greater incremental increase in insulin area under the curve (AUC) (P < 0.03), 3) a 22 ± 7% greater peak insulin secretion rate (P < 0.02), 4) a 7 ± 4% decrease in insulin clearance (P = 0.04), and 5) a 23 ± 20% decrease in SI (P = 0.01). There were no significant differences between conditions in active glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, glucagon incremental AUC, or indices of the sensitivity of the β-cell response to glucose. CONCLUSIONS These data demonstrate that sucralose affects the glycemic and insulin responses to an oral glucose load in obese people who do not normally consume NNS.
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Affiliation(s)
- M Yanina Pepino
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA.
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20
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Oral processing effort, appetite and acute energy intake in lean and obese adults. Physiol Behav 2013; 120:173-81. [PMID: 23954409 DOI: 10.1016/j.physbeh.2013.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 06/02/2013] [Accepted: 08/07/2013] [Indexed: 11/23/2022]
Abstract
Chewing reportedly contributes to satiation and satiety signals. Attempts to document and quantify this have led to small and inconsistent effects. The present trial manipulated oral processing effort though required chewing of gums of different hardness and measured appetitive sensations, energy intake, gastric emptying, GI transit time, and concentrations of glucose, insulin, GLP-1, ghrelin and pancreatic polypeptide. Sixty adults classified by sex and BMI (15 each of lean females, obese females, lean males and obese males) were tested in a randomized, controlled, cross-over trial with three arms. They chewed nothing, soft gum or hard gum for 15 min while sipping grape juice (10% of individual energy needs) containing acetaminophen and lactulose on one day each separated by 7 days. Electromyographic recordings and self-reports were obtained during and after chewing to quantify oral processing effort. Blood was sampled through an indwelling catheter and appetite ratings were obtained at baseline and at 0, 15, 30, 45, 60, 90, 120, 180 and 240 min after chewing initiation. Breath samples were collected at 10 min intervals for the first 2h and at 30 min intervals for the next 2h. No effects of chewing were observed for appetitive sensations or gut peptide concentrations. Energy intake tended to decline in lean and increase in obese participants so that daily energy intake differed significantly between the two groups when chewing either gum, while no difference was observed on the non-chewing day. Serum glucose and insulin were significantly lower at selected time points 90-240 min after chewing compared to baseline and the non-chewing day. These data indicate chewing effort does not affect appetitive sensations or gut peptide secretion, but may exert a small differential effect on acute energy intake in lean and obese individuals and lead to greater post-prandial declines of serum glucose and insulin. The efficacy of gum chewing as a substitute for eating for weight management remains uncertain.
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21
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Brown TA, Keel PK. What contributes to excessive diet soda intake in eating disorders: appetitive drive, weight concerns, or both? Eat Disord 2013; 21:265-74. [PMID: 23600556 PMCID: PMC3670085 DOI: 10.1080/10640266.2013.779190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Excessive diet soda intake is common in eating disorders. The present study examined factors contributing to excessive intake in a sample of individuals with lifetime eating disorders based on proposed DSM-5 criteria (n = 240) and non-eating disorder controls (n = 157). Individuals with eating disorders, particularly bulimia nervosa, consumed more diet soda than controls. Eating disorder symptoms that reflect increased appetitive drive or increased weight concerns were associated with increased diet soda intake. Increased weight concerns were associated with increased diet soda intake when levels of appetitive drive were high, but not when they were low. Results highlight the importance of monitoring diet soda intake in individuals with eating disorders and may have implications for the maintenance of dysregulated taste reward processing in bulimia nervosa.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychology, Florida State University, Tallahassee, Florida 32306, USA.
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22
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Abstract
AIM To review the main psychological and mental conditions that are manifested dentally in the form of tooth wear. These conditions include depression, eating disorders, and alcohol and drug use disorders. The paper will also review the comorbidity of these conditions and the relevance of other medical conditions and lifestyle factors, such as gastroesophageal reflux disorder, smoking and diet, in the expression of tooth wear. CONCLUSION A holistic, multidisciplinary, healthcare approach is required in management of tooth wear patients with underlying mental health disorders. Dentists and Dental Care Professionals can have an important role in identifying these mental disorders through the observed tooth wear. They can also play a key role in monitoring patients' response and compliance to medical treatment through the monitoring of tooth wear progression and expression.
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Affiliation(s)
- Khaled E Ahmed
- Clinical Academic Fellow, Restorative Dentistry Group, University of Glasgow Dental School, Glasgow, UK.
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23
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Avena NM, Bocarsly ME. Dysregulation of brain reward systems in eating disorders: neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa. Neuropharmacology 2012; 63:87-96. [PMID: 22138162 PMCID: PMC3366171 DOI: 10.1016/j.neuropharm.2011.11.010] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 10/28/2011] [Accepted: 11/18/2011] [Indexed: 01/18/2023]
Abstract
Food intake is mediated, in part, through brain pathways for motivation and reinforcement. Dysregulation of these pathways may underlay some of the behaviors exhibited by patients with eating disorders. Research using animal models of eating disorders has greatly contributed to the detailed study of potential brain mechanisms that many underlie the causes or consequences of aberrant eating behaviors. This review focuses on neurochemical evidence of reward-related brain dysfunctions obtained through animal models of binge eating, bulimia nervosa, or anorexia nervosa. The findings suggest that alterations in dopamine (DA), acetylcholine (ACh) and opioid systems in reward-related brain areas occur in response to binge eating of palatable foods. Moreover, animal models of bulimia nervosa suggest that while bingeing on palatable food releases DA, purging attenuates the release of ACh that might otherwise signal satiety. Animal models of anorexia nervosa suggest that restricted access to food enhances the reinforcing effects of DA when the animal does eat. The activity-based anorexia model suggests alterations in mesolimbic DA and serotonin occur as a result of restricted eating coupled with excessive wheel running. These findings with animal models complement data obtained through neuroimaging and pharmacotherapy studies of clinical populations. Information on the neurochemical consequences of the behaviors associated with these eating disorders will be useful in understanding these complex disorders and may inform future therapeutic approaches, as discussed here. This article is part of a Special Issue entitled 'Central Control of Food Intake'.
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Affiliation(s)
- Nicole M Avena
- University of Florida, College of Medicine, Department of Psychiatry, Gainesville, FL 32608, USA.
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Fetissov SO, Crook MA. What increased consumption of licorice may reveal in anorexia nervosa. Nutrition 2011; 27:853-4. [PMID: 21679880 DOI: 10.1016/j.nut.2011.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
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Klein DA, Schebendach JE, Gershkovich M, Smith GP, Walsh BT. Modified sham feeding of sweet solutions in women with anorexia nervosa. Physiol Behav 2010; 101:132-40. [PMID: 20438741 DOI: 10.1016/j.physbeh.2010.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 04/26/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
Anorexia Nervosa (AN) is a disorder of self-starvation characterized by decreased meal size and food intake. While it is possible that reduced food intake in AN reflects an excess of inhibitory factors, e.g., cognitive inhibition related to fear of weight gain or abnormal postingestive negative feedback, it is also possible that decreased intake reflects diminished orosensory stimulation of food intake. This has been difficult to test directly because the amount of food ingested during a test meal by patients with AN reflects an integration of orosensory excitatory, and cognitive, learned, and postingestive inhibitory controls of eating. To begin to dissociate these controls, we adapted the modified sham feeding technique (MSF) to measure the intake of a series of sweetened solutions in the absence of postingestive stimulation. Subjects with AN (n=24) and normal controls (NC, n=10) were randomly presented with cherry Kool Aid solutions sweetened with five concentrations of aspartame (0, 0.01, 0.03, 0.08 and 0.28%) in a closed opaque container fitted with a straw. They were instructed to sip as much as they wanted of the solution during 15 1-minute trials and to spit the fluid out into another opaque container. Subjects with AN sipped less unsweetened solution than NC (p<0.05). Because this difference appeared to account completely for the smaller intakes of sweetened solutions by AN, responsiveness of intake to sweet taste per se was not different in AN and NC. Since MSF eliminated postingestive and presumably cognitive inhibitory controls, and the orosensory response to sweet taste was not different in AN than NC, we conclude that decreased intake by AN subjects under these conditions reflects the increased inhibition characteristic of this disorder that is presumably learned, with a possible contribution of decreased potency of orosensory stimulation by the sipped solutions.
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Affiliation(s)
- D A Klein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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26
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Marino JM, Ertelt TE, Wonderlich SA, Crosby RD, Lancaster K, Mitchell JE, Fischer S, Doyle P, le Grange D, Peterson CB, Crow S. Caffeine, artificial sweetener, and fluid intake in anorexia nervosa. Int J Eat Disord 2009; 42:540-5. [PMID: 19189405 PMCID: PMC3022267 DOI: 10.1002/eat.20633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This article provides an analysis of the use of artificial sweeteners, caffeine, and excess fluids in patients diagnosed with anorexia nervosa (AN). METHOD Seventy participants with AN were recruited to participate in an ecologic momentary assessment study which included nutritional analysis using the Nutrition Data Systems for Research, a computer based dietary recall system. RESULTS When subtypes were compared, participants with AN-restricting subtype (AN-R) and participants with AN-Binge-Purge (AN-B/P) did not differ in quantity of aspartame, caffeine, or water consumed. Daily water consumption was related to daily vomiting frequency in AN-B/P but not to daily exercise frequency in either participants with AN-R or AN-B/P. DISCUSSION Caffeine, water, and aspartame consumption can be variable in patients with AN and the consumption of these substances seems to be only modestly related to purging behavior.
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Affiliation(s)
- Joanna M. Marino
- University of North Dakota Department of Psychology, Grand Forks, North Dakota
| | - Troy E. Ertelt
- University of North Dakota Department of Psychology, Grand Forks, North Dakota
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | | | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Sarah Fischer
- University of Georgia, Department of Psychology, Athens, Georgia
| | - Peter Doyle
- University of Chicago, Department of Psychiatry, Chicago, Illinois
| | - Daniel le Grange
- University of Chicago, Department of Psychiatry, Chicago, Illinois
| | - Carol B. Peterson
- University of Minnesota, Department of Psychiatry, Minneapolis, Minnesota
| | - Scott Crow
- University of Minnesota, Department of Psychiatry, Minneapolis, Minnesota
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Aschenbrenner K, Scholze N, Joraschky P, Hummel T. Gustatory and olfactory sensitivity in patients with anorexia and bulimia in the course of treatment. J Psychiatr Res 2008; 43:129-37. [PMID: 18423668 DOI: 10.1016/j.jpsychires.2008.03.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 02/26/2008] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The majority of studies on taste and smell in eating disorders have revealed several alterations of olfactory or gustatory functions. Aim of this prospective study was to employ detailed olfactory and gustatory testing in female subjects of three homogenous groups - anorexia nervosa, bulimia nervosa and healthy controls - and to look at the effects of treatment on these measures. METHODS Sixteen hospitalized female patients with anorexia (restricting type, mean age [M]=24.5 years), 24 female patients with bulimia (purging type, M=24.3 years) as well as 23 healthy controls (M=24.5 years) received olfactory ("Sniffin' Sticks") and gustatory testing ("Taste Strips"). Group differences in olfactory and gustatory sensitivity, body mass index (BMI), the Beck depression inventory, the eating attitudes test (EAT), and the influence of therapy on gustatory and olfactory function were investigated. RESULTS (1) Group differences were present for odor discrimination and overall olfactory function with anorexic patients having the lowest scores. (2) Regarding taste function, controls scored higher than patients with anorexia. (3) At admission small but significant correlations were found between overall olfactory function and body weight (r(63)=0.35), BMI (r(63) = 0.37), and EAT score (r(63) = -0.27). Similarly, (4) the taste test score correlated significantly with body weight (r(63)= 0.48), and BMI (r(63) = 0.45). Finally, (5) at discharge overall olfactory and gustatory function were significantly higher compared to admission in anorexic patients. CONCLUSIONS As compared to healthy controls and bulimic patients our results show lowered olfactory and gustatory sensitivities in anorexic patients that improved with increasing BMI and decreasing eating pathology in the course of treatment.
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Affiliation(s)
- Katja Aschenbrenner
- Department for Psychosomatic Medicine, University of Dresden Medical School, Fetscherstrasse 74, 01307 Dresden, Germany.
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Modified sham feeding of sweet solutions in women with and without bulimia nervosa. Physiol Behav 2008; 96:44-50. [PMID: 18773914 DOI: 10.1016/j.physbeh.2008.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 07/25/2008] [Accepted: 08/11/2008] [Indexed: 11/22/2022]
Abstract
Although it is possible that binge eating in humans is due to increased responsiveness of orosensory excitatory controls of eating, there is no direct evidence for this because food ingested during a test meal stimulates both orosensory excitatory and postingestive inhibitory controls. To overcome this problem, we adapted the modified sham feeding technique (MSF) to measure the orosensory excitatory control of intake of a series of sweetened solutions. Previously published data showed the feasibility of a "sip-and-spit" procedure in nine healthy control women using solutions flavored with cherry Kool Aid and sweetened with sucrose (0-20%). The current study extended this technique to measure the intake of artificially sweetened solutions in women with bulimia nervosa (BN) and in women with no history of eating disorders. Ten healthy women and 11 women with BN were randomly presented with cherry Kool Aid solutions sweetened with five concentrations of aspartame (0, 0.01, 0.03, 0.08 and 0.28%) in a closed opaque container fitted with a straw. They were instructed to sip as much as they wanted of the solution during 1-minute trials and to spit the fluid out into another opaque container. Across all subjects, presence of sweetener increased intake (p<0.001). Women with BN sipped 40.5-53.1% more of all solutions than controls (p=0.03 for total intake across all solutions). Self-report ratings of liking, wanting and sweetness of solutions did not differ between groups. These results support the feasibility of a MSF procedure using artificially sweetened solutions, and the hypothesis that the orosensory stimulation of MSF provokes larger intake in women with BN than controls.
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Siega-Riz AM, Haugen M, Meltzer HM, Von Holle A, Hamer R, Torgersen L, Knopf-Berg C, Reichborn-Kjennerud T, Bulik CM. Nutrient and food group intakes of women with and without bulimia nervosa and binge eating disorder during pregnancy. Am J Clin Nutr 2008; 87:1346-55. [PMID: 18469258 PMCID: PMC2663958 DOI: 10.1093/ajcn/87.5.1346] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known concerning the dietary habits during pregnancy of women with eating disorders that may lie in the causal pathway of adverse birth outcomes. OBJECTIVE We examined the nutrient and food group intakes of women with bulimia nervosa and binge-eating disorder during pregnancy and compared these with intakes of women with no eating disorders. DESIGN Data on 30,040 mother-child pairs from the prospective Norwegian Mother and Child Cohort Study were used in cross-sectional analyses. Dietary information was collected by using a food-frequency questionnaire during the first half of pregnancy. Statistical testing by eating disorder categories with the non-eating-disorder category as the referent group was conducted by using log means adjusted for confounding and multiple comparisons. Food group differences were analyzed by using a Wilcoxon's two-sided normal approximation test that was also adjusted for multiple comparisons. RESULTS Women with binge-eating disorder before and during pregnancy had higher intakes of total energy, total fat, monounsaturated fat, and saturated fat, and lower intakes of folate, potassium, and vitamin C than the referent (P < 0.02). Women with incident binge-eating disorder during pregnancy had higher intakes of total energy and saturated fat than the referent (P = 0.01). Several differences emerged in food group consumption between women with and without eating disorders, including intakes of artificial sweeteners, sweets, juice, fruit, and fats. CONCLUSION Women with bulimia nervosa before and during pregnancy and those with binge-eating disorder before pregnancy exhibit dietary patterns that differ from those in women without eating disorders, that are reflective of their symptomatology, and that may influence pregnancy outcomes.
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Affiliation(s)
- Anna Maria Siega-Riz
- Department of Epidemiology and Nutrition, School of Public Health, University of North Carolina at Chapel Hill, 27516, USA.
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Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev 2007; 32:20-39. [PMID: 17617461 PMCID: PMC2235907 DOI: 10.1016/j.neubiorev.2007.04.019] [Citation(s) in RCA: 767] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Revised: 04/19/2007] [Accepted: 04/28/2007] [Indexed: 02/07/2023]
Abstract
[Avena, N.M., Rada, P., Hoebel B.G., 2007. Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews XX(X), XXX-XXX]. The experimental question is whether or not sugar can be a substance of abuse and lead to a natural form of addiction. "Food addiction" seems plausible because brain pathways that evolved to respond to natural rewards are also activated by addictive drugs. Sugar is noteworthy as a substance that releases opioids and dopamine and thus might be expected to have addictive potential. This review summarizes evidence of sugar dependence in an animal model. Four components of addiction are analyzed. "Bingeing," "withdrawal," "craving" and "cross-sensitization" are each given operational definitions and demonstrated behaviorally with sugar bingeing as the reinforcer. These behaviors are then related to neurochemical changes in the brain that also occur with addictive drugs. Neural adaptations include changes in dopamine and opioid receptor binding, enkephalin mRNA expression and dopamine and acetylcholine release in the nucleus accumbens. The evidence supports the hypothesis that under certain circumstances rats can become sugar dependent. This may translate to some human conditions as suggested by the literature on eating disorders and obesity.
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Affiliation(s)
- Nicole M. Avena
- Department of Psychology, Princeton University, Princeton, NJ 08540 USA
| | - Pedro Rada
- Department of Psychology, Princeton University, Princeton, NJ 08540 USA
| | - Bartley G. Hoebel
- Department of Psychology, Princeton University, Princeton, NJ 08540 USA
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Hetherington MM, Boyland E. Short-term effects of chewing gum on snack intake and appetite. Appetite 2006; 48:397-401. [PMID: 17118491 DOI: 10.1016/j.appet.2006.10.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 09/12/2006] [Accepted: 10/04/2006] [Indexed: 11/22/2022]
Abstract
Consumers report that chewing gum can reduce cravings and the likelihood of snacking. The present study set out to examine the effects of chewing gum on subjective appetite and snack energy intake (EI) in 60 participants (40 females, 20 males, 21.7+/-4 years; BMI=22.7+/-3.4) who came to the laboratory four times for lunch and then returned 3 h later for a snack. Participants consumed salty or sweet snacks after chewing gum (sugar-free or regular) for 15 min hourly after lunch or had no-gum. Hunger, desire to eat and fullness were rated immediately after lunch (T0) and hourly post-lunch (T1 and T2) until just before snack (T3). Chewing gum reduced EI by 36 cal (401.8+/-22 kcal) compared to no-gum (437.7+/-23 kcal; p=0.04). Rated hunger increased from T0 to T3 (p<0.001); however, this was less after gum compared to no-gum (p<0.01). Desire to consume salty and sweet snacks also increased. However, desire to eat sweet snacks (but not salty) increased less after gum compared to no-gum (p=0.004). Therefore, chewing gum suppressed appetite, specifically desire for sweets and reduced snack intake. This supports anecdotal reports by consumers and could inform weight control strategies.
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Affiliation(s)
- Marion M Hetherington
- Department of Psychology, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
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