Epidemiological studies on adverse dieting behaviours and eating disorders among young people in Hungary

Eating psychopathology in ballet dancers: a meta-analysis of observational studies

OBJECTIVE

To assess whether ballet dancers have higher eating psychopathology mean scores than the general population.

METHODS

Meta-analysis of cross-sectional observational studies comparing the scores of one or more of the validated eating psychopathological scales between ballet dancers and any control groups.

RESULTS

Twelve studies were included in the metanalysis. Ballet dancers had a significantly higher EAT score (12 studies retrieved, SMD 0.82 [95% CI 0.44-1.19], p < 0.00001, I² = 84)]; subgroup analysis suggested a possible role of control subjects' choice in explaining heterogeneity. Scores on the EDI subscales of Drive for Thinness, Bulimia, and Body dissatisfaction were available from four studies; Drive for Thinness was higher in ballet dancers (SMD 0.62 [0.01, 1.22]), as well as the Bulimia scale (SMD 0.38 [0.02, 0.73], p = 0.04) and the Body Dissatisfaction scale (SMD 0.34 [0.15, 0.53]). Data on Perfectionism, Interpersonal problems, Ineffectiveness, and Maturity fears, were available from three studies. Higher scores in Perfectionism (SMD 0.68 [0.24, 1.12] p = 0.02), Interpersonal problems (SMD 0.24 [0.02, 0.47], in Inefficacy, (SMD 2.18 [1.31, 3.06]) were found for ballet dancers; on the other hand, Maturity fears scores were not significantly different between ballet dancers and controls (IV-MD = 0.15 [- 0.07, 0.36]). Seven studies reported tests not performed elsewhere.

DISCUSSION

Ballet dancers show a higher level of restriction and drive for thinness than controls, and they may be, therefore, at higher risk for the development of eating disorders. Available studies do not allow the discrimination of dysfunctional eating attitudes and behaviors from adaptive responses.

LEVEL OF EVIDENCE

Level I (evidence obtained from systematic reviews and meta-analyses).

Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011

BACKGROUND AND AIMS

There are contradictory findings on time changes in the prevalence of eating disorders (EDs). The first epidemiological studies in Hungary were carried out in the late 1980s. The objective of the present study was to follow the changes in the prevalence of EDs in medical students after a period of 22 years.

METHODS

A questionnaire survey was conducted in 1989 and in 2010. The sample comprised medical students: 538 subjects (248 males and 290 females) in 1989 and 969 subjects (261 males and 708 females) in 2010. The questionnaire contained sociodemographic and anthropometric items, the Eating Behaviour Severity Scale, the General Health Questionnaire, the Anorexia Nervosa Inventory for Self-Rating, and the Eating Disorder Inventory (EDI). In the second wave, three subscales of the EDI-2 and the SCOFF questionnaire were added.

RESULTS

Current and desired body mass index were significantly higher in the second study. Binge eating at least once a week was reported less frequently (2.7% vs 6.8% in males, 6.1% vs 13% in females) in 2010. The proportion of subclinical anorexia nervosa was higher among females in 2011 (2.5% vs 0.3%, P < 0.01). Among males, the proportion of counterregulatory behaviours increased significantly (from 8.9 to 14.6%).

DISCUSSION AND CONCLUSIONS

The increase of the proportion of subclinical anorexia nervosa and that of male EDs may relate to the importance of the changes in the sociocultural background. Further representative studies are proposed in other countries of Central and Eastern Europe among medical students and in the general population.

Culture Change and Eating Patterns: A Study of Georgian Women

Introduction: Immigration and culture change have been thought to affect various aspects of psychological well-being, including eating behaviors. This study aimed to examine the association between immigration, acculturation strategies and eating patterns. Materials and Methods: Acculturation was conceptualized and measured by acculturation strategies of integration (maintaining original culture and adopting the new culture), assimilation (adopting the new culture and leaving behind the old), separation (sticking with the original culture only) and marginalization (maintaining/adopting neither culture). Eating patterns were conceptualized by dietary restriction, eating concern, shape concern, and weight concern. Links between demographic variables, acculturation strategies, and eating patterns were also examined. Five hundred and six Georgian women took part in the study: 253 living abroad (UK and USA) and 253 living in Georgia. Measures included East Asian Acculturation Measure (EAAM) for acculturation strategies (assimilation, integration, separation, and marginalization subscales) and Eating Disorder Examination Questionnaire (EDEQ) for eating patterns (dietary restriction, eating concern, weight concern, shape concern subscales, and global score). Relevant demographic variables and Body Mass Index (BMI) were recorded. Results: Comparisons of immigrant and nonimmigrant groups using Multivariate Analysis of Covariance (MANCOVA) with BMI as a covariate found a difference in dietary restriction only, with immigrants yielding higher mean score than non-immigrants. The global EDEQ scores of immigrant and nonimmigrant groups were almost identical though. Correlations between separation and marginalization and four EDEQ scores were statistically significant and positive, while correlations between integration and two EDEQ subscales were marginally significant and negative. Regression analysis showed that separation and marginalization strategies of acculturation were significantly linked with EDEQ eating concern, shape concern, weight concern, and global scores thereby representing predictors of elevated eating outcomes. Discussion: Findings suggested that moving to Western countries increased dietary restriction among Georgian women. Furthermore, while living abroad, the lack of integration in a host culture, as a common denominator of separation and marginalization strategies of acculturation, may predict elevated eating, shape, and weight concerns among women relocated over six years ago. Acculturation conditions may also be linked with integration or well-being outcomes.

Identifying high-school dance students who will develop an eating disorder: a 1-year prospective study

This study examined the changes in eating disorder (ED) status over 1 year and identified risk factors for EDs among female dance students. In 2003, all students enrolled in each of the nation's 12 high schools with gifted dance programs participated in a two-phase survey. The same participants were invited to take part in a follow-up survey 1 year later. In all, 583 persons completed the phase 1 questionnaire survey, and 245 persons completed interviews twice at baseline and follow-up. Thirty-five females had a newly developed ED, and less than half of the ED cases found at baseline had recovered at follow-up. Being a grade 12 student carried a reduced risk of EDs, whereas higher baseline scores on the Bulimic Investigatory Test Edinburgh (BITE) increased risks of developing an ED after 1 year. A 10-item BITE questionnaire validly identified girl dance students who would develop EDs later in high school. EDs were more commonly developed during middle adolescence, and we suggest that prevention work against EDs begin in this period among the dance student population. The brief screening questionnaire might help detect intervention targets of a prevention program among adolescent dance students.

High prevalence of eating disorders not otherwise specified in northwestern Spain: population-based study

PURPOSE

To determine the incidence and prevalence of eating disorder and its clinical forms.

METHODS

All new ED cases of both genders, ≥15 years old, diagnosed from January 2005 to December 2009 were included. All patients who suffered from ED in December 2009 were included in the prevalence study. This is a prospective, population-based study. Cumulative incidence rates and 20-year prevalence were calculated.

RESULTS

The ED incidence was 14.1 (95% CI 11.4-16.1) cases per 100,000 inhabitants per year, for AN, BN and EDNOS 3.1 (95% CI 2.00-4.1), 4.4 (95% CI 3.0-8.00) and 6.5 (95% CI 4.8-7.9), respectively. The incidence of ED at the four age-intervals, 15-24, 25-34, 35-45 and >45 years, revealed that the 25-34-year interval had the highest incidence; moreover, new cases were observed even in the >45-year interval. The prevalence of ED was 82.8 (95% CI 69.4-94.5) per 100,000 inhabitants, being for AN, BN and EDNOS 18.6 (95% CI 12.5-24.4), 25.7 (95% CI 18.5-32.5) and 38.3 (95% CI 29.4-46.5), respectively.

CONCLUSIONS

The incidence and prevalence of EDNOS are the highest in the ED cases; furthermore, new cases of ED are observed above the age of 45, which are remarkable data.

Trends in hospital admissions for eating disorders in a country undergoing a socio-cultural transition, the Czech Republic 1981-2005

OBJECTIVE

To test the hypothesis that the socio-cultural transition in the 1990s in Eastern Europe was associated with an increase in admissions for eating disorders (ED).

METHOD

Cases of ICD-9 and ICD-10 ED in 1981, 1986 and 1992-2005 and first admissions for ICD-10 anorexia nervosa (AN) in 1994-2005 were retrieved from the Czech national register of hospital admissions. Age- and sex-adjusted admission rates (per 100,000) were calculated and time trends tested by Poisson regression.

RESULTS

The admission rate for ED in females aged 10-39 quadrupled from 2.6 (95% CI 2.1-3.0) in 1981 to 10.6 (95% CI 9.8-11.5) in 2001, and remained elevated till 2005. The rate of first-time admissions for AN in 10- to 39-old females increased from 4.5 (95% CI 3.6-5.4) in 1994 to 7.5 (95% CI 6.3-8.6) in 1999, followed by a non-significant decrease.

CONCLUSION

Temporal association of an increase in admissions with socio-cultural transition suggests that risk of severe ED including AN is culture-dependent.

A study of eating attitudes and related factors in a sample of first-year female Nutrition and Dietetics students of Harokopion University in Athens, Greece

OBJECTIVE

To investigate eating attitudes and related factors in a sample of first-year female students of Harokopion University, Nutrition and Dietetics (ND) School.

METHOD

The Eating Attitudes Test (EAT-26), a set of 12 male and female figures, and two questionnaires for demographic, clinical and nutritional data were administered to 53 ND students and 54 first-year female students of Athens Technological Institution Health Visitors (HV) School.

RESULTS

The ND group scored higher in EAT-26 total score (p=0.05) and Diet subscale (p=0.02) than the HV group. EAT-26 score in the ND group correlated significantly with dinner avoidance (correlation coefficient: 0.3, p=0.02). Logistic regression analysis showed that avoidance of dinner (p=0.03), choosing leaner ideal women figures (p=0.005) and larger self images (p=0.01) were the three factors that could predict high EAT-26 scores in the ND group (EAT-26>or=20).

CONCLUSIONS

First-year ND students might have more often disordered eating attitudes as opposed to students from other university programs.

[Prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in adolescent girls in Reus (Spain)]

INTRODUCTION

Eating disorders are characterized by changes in eating patterns associated with a series of psychosocial conflicts, low self-esteem and poor empathy, and an obsession with slimming.

OBJECTIVES

The aims of the present study were: 1. To determinate the prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in a representative sample of adolescent girls between the ages of 12 and 21 living in the city of Reus (Spain). 2. To evaluate the association between eating disorders and alterations on the Eating Attitudes Test-40 (EAT-40), Body Attitudes Test (BAT), and the Aesthetic Body Shape Questionnaire (CIMEC).

MATERIAL AND METHOD

We performed a cross-sectional observational study in a random sample of adolescent girls aged between 12 and 21 years old. Information was gathered from a structured questionnaire on demographic and anthropometric factors (age, place of birth, education, etc.), clinical examination, clinical interview, DMS-IV diagnostic criteria, and three self-administered tests: EAT-40, BAT and CIMEC.

RESULTS

A total of 551 adolescents were analyzed. The mean age was 17.6+/-2.5 years. Diagnostic criteria of anorexia nervosa were found in 0.9% (95% CI: 0.4-2.4), bulimia nervosa in 2.9% (95% CI: 1.7-4.7), and other eating disorders in 5.3% (95% CI: 3.6-7.5). The test showing the greatest alterations was the CIMEC (38%), followed by the BAT (27.1%) and EAT-40 (23.1%). All the adolescents that met the diagnostic criteria of anorexia nervosa showed alterations in all three tests.

CONCLUSIONS

The high prevalence of eating disorders indicates the need for greater direct involvement among health professionals. The EAT-40, BAT and CIMEC are effective screening instruments for these disorders.