Disordered eating in three different age groups in Cyprus: a comparative cross-sectional study

Eating Disorder Risk Among Adolescents: The Influence of Dietary Patterns, Physical Activity, and BMI

BACKGROUND/OBJECTIVES

Eating disorders (EDs) are rising among adolescents. BMI, diet, and physical activity influence ED risk, but their interactions are complex and vary by population. Considering sociocultural changes, this study investigated the prevalence and risk factors for EDs in Romanian adolescents. We evaluated demographic factors, BMI, dietary behaviors, physical activity (PA), and previous specialist consultations using the Eating Attitudes Test-26 (EAT-26) and assessed the psychometric properties of the EAT-26 in this population.

METHODS

A cross-sectional study included 423 youths aged 13 to 20 from Cluj-Napoca. Participants completed an online survey on demographics, BMI, diet, physical activity, and previous health consultations. ED risk was assessed using the EAT-26. Confirmatory and exploratory factor analyses were conducted on the EAT-26, and binary logistic regression identified predictors of ED risk.

RESULTS

The prevalence of ED risk was 26.5%, with females having 1.61 times higher odds than males. Consulting a weight or mental health specialist increased the odds of increased ED risk (OR = 3.76). Higher BMI showed a trend in the unadjusted model (OR = 1.06). An initial CFA of the EAT-26 showed a suboptimal fit. Over 60% of the sample reported frequent consumption of ultra-processed foods.

CONCLUSIONS

Our findings highlight a significant ED risk in Romanian youth, filling a critical gap in regional public health evidence. Despite limitations due to the cross-sectional design and self-reported data, the results stress the need for measures promoting balanced diets, positive body image, and improved mental health access to reduce the growing prevalence of adolescent ED risk in Romania.

[Effectiveness of interventions to help mitigate the influence of social networks on anorexia and bulimia nervosa: a systematic review]

BACKGROUND

The study aim to analyze the impact of interventions to help mitigate the influence of social networks on anorexia and bulimia nervosa.

METHODOLOGY

A systematic review was conducted using PubMed, Scopus, PsycINFO and Web of Science. The inclusion criteria were: randomized clinical trials, published between 2013 and 2023 with a score = 5 points on the Van Tulder methodological quality scale.

RESULTS

Eight studies were selected, most carried out in secondary education centers or universities; one was online. The study sample consisted of 5,084 participants mainly young women and adolescents with an average age between 12 and 32 years. As for the social networks, some studies described their impact at a general level, while others focused on Instagram, Facebook, Tik-Tok, Twitter, and Snapchat. A positive correlation was found between the exposure to unrealistic beauty ideals found in social networks with greater concern and dissatisfaction with body image. All studies used instruments to assess the effectiveness of the interventions. The interventions helped reduce the influence of the media and social networks, improve self-perception and self-esteem assessments, reduce anxiety levels and internalization of the thin beauty ideal, reduce dietary restrictions, and make use of social networks differently.

CONCLUSIONS

Longer-lasting interventions can improve body satisfaction (one year) and depressive symptoms (six months), especially in women. Interventions should include attention to self-criticism, self-perception, self-esteem, body image, nutritional management, and media literacy skills.

Male eating disorders in midlife-possible links between excessive sports and hormones

Although eating disorders were long considered a typical female disorder, it is now clear that men are also affected. However, the literature on eating disorders in men is still very limited, and the actual extent is not known. Even less is known about the epidemiology of eating disorders in older individuals. In this focused review, we will present an update of the available data on disordered eating and eating disorders in middle-aged and older males. In addition, we will highlight the relationship of eating disorders with excessive sports as a purging method of choice for this age group and discuss the impact of age-related hormonal imbalances in aging men.

Update on the epidemiology and treatment of eating disorders among older people

PURPOSE OF REVIEW

We reviewed the recent literature on the epidemiology and treatment of eating disorders among middle-aged and older women and men.

RECENT FINDINGS

Recent studies show that among older female persons, the prevalence rates with full diagnoses of eating disorders based on DSM-IV or DSM-5 criteria are between 2.1 and 7.7%, and among older men less than 1%. These studies show that the prevalence of eating disorders decreases by age in women, but it does not get towards zero even in very high age. Middle age, with a peak around 50, is also a critical time for the occurrence of eating disorders in men. Women who reported severe menopausal symptoms showed more eating disorder pathology compared with those with low symptoms during menopausal transition.

SUMMARY

Eating disorders do occur in middle and older age of both sexes. Shame and stigmatization have decreased, and medical awareness and explicit assessment of eating behavior in all age groups have developed. What puberty is for eating disorders in adolescence and young age is menopausal transition for midlife women. Also in men, associations with hormonal disturbances are possible. Treatment approaches should consider treatment strategies tailored to older women and men, addressing the context of midlife and aging.

Social media and disordered eating among middle-aged women: Not just an adolescent concern

Evidence suggests social media use is strongly linked to disordered eating (e.g., binge eating and dietary restraint) among adolescent and young adult women, in part because it promotes engagement in social comparison (the tendency to evaluate one's own standing or ability by comparing it to another's). Yet no study has examined the impact of social media use and comparison on disordered eating among middle-aged women. Participants (N = 347), ages 40-63, completed an online survey about their social media use, social comparison, and disordered eating (bulimic symptoms, dietary restraint, and broad eating pathology). Results indicated that 89 % (n = 310) of middle-aged women used social media in the past year. Most participants (n = 260; 75 %) used Facebook, and at least a quarter used Instagram or Pinterest. Approximately 65 % (n = 225) used social media at least daily. Controlling for age and body mass index, social media-specific social comparison was positively associated with bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001). Multiple regression models evaluating frequency of social media use and social media-specific social comparison together revealed that social comparison explained a significant amount of unique variance in bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001) above and beyond frequency of social media use. Instagram explained a significant proportion of variance of dietary restraint compared to other social media platforms (p = .001). Findings suggest a large percentage of middle-aged women frequently engage with some type of social media. Further, social media-specific social comparison, rather than frequency of social media use, may be driving disordered eating in this age group of women.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression

PURPOSE

The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world.

METHODS

An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex.

RESULTS

Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased.

CONCLUSIONS

These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment.

LEVEL OF EVIDENCE

I, systematic review and meta-analysis.

Psychometric properties of a Greek translation of the Intuitive Eating Scale-2 (IES-2) in adults from Cyprus

The construct of intuitive eating is commonly assessed using the 23-item, 4-factor Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013). In this study, we assessed the psychometric properties of a novel Greek translation of the IES-2 in adults from Cyprus. In Study 1 (N = 626), an exploratory factor analysis indicated that the IES-2 should be conceptualized as consisting of six factors that showed complete invariance across women and men. Study 2 (N = 793), using exploratory structural equation modelling (ESEM) and beifactor analysis (B-ESEM), indicated that the 6-factor B-ESEM model had adequate fit and evidenced complete invariance across sex once the correlated uniqueness of negatively worded IES-2 items was accounted for. This final model evidenced adequate composite reliability, and a global G-factor evidenced adequate convergent, concurrent, and discriminant validity. In contrast, the IES-2 S-factors showed more equivocal patterns of validity, with some S-factors showing less-than-adequate associations with body image variables, self-esteem, symptoms of disordered eating, and fruit and vegetable intake. In general, these results provide satisfactory evidence of the psychometric properties of the Greek IES-2 in adults from Cyprus, but also suggest that models of IES-2 scores may vary across national or cultural contexts.

Validation of the inflexible eating questionnaire in a large sample of Chinese adolescents: psychometric properties and gender-related differential item functioning

PURPOSE

The aim of this study was to provide preliminary psychometric evidence for the Chinese version of the Inflexible Eating Questionnaire (C-IEQ) among a large sample of Chinese adolescents.

METHODS

For testing the psychometric properties of the C-IEQ, a total of 2241 (M_age = 13.91 years; 46.4% boys) adolescents from mainland China responded to the survey. Confirmatory factor analysis (CFA) was used to examine the factor structure of the C-IEQ. Measurement invariance by gender was examined by both multi-group CFA and differential item functioning (DIF). Convergent validity of the C-IEQ was assessed via examining the correlations between the C-IEQ scores and theoretically related constructs (e.g., orthorexia nervosa symptomatology, eating disorder symptomatology, and body image inflexibility).

RESULTS

The unidimensional structure with correlated errors of the C-IEQ showed good model fit (χ² = 1674.05, df = 44, p < 0.001; CFI = 0.93; TLI = 0.91; RMSEA = 0.13; SRMR = 0.06). The C-IEQ had an adequate internal consistency (α = 0.89) and demonstrated strong measurement invariance across genders. Moreover, the scores of the C-IEQ showed significant correlations with theoretically correlated constructs: orthorexia nervosa symptomatology (girls; r = 0.53 p < 0.001, boys; r = 0.45 p < 0.001), eating disorder symptomatology (girls; r = 0.32 p < 0.001, boys; r = 0.25 p < 0.001) body image inflexibility (girls; r = 0.41 p < 0.001, boys; r = 0.36 p < 0.001), suggesting good convergent validity of the C-IEQ.

CONCLUSION

The C-IEQ showed good psychometric properties in a sample of Chinese adolescents and can be used in future studies to assess eating-specific psychological inflexibility among Chinese adolescents.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

[Early detection and prevalence of risk of eating disorders in Primary Care in Guadalajara city]

OBJECTIVES

To know the percentage of adolescent patients at risk of developing an eating disorder (ED); to identify the prevalence of risk for Anorexia Nervosa, Bulimia Nervosa and Unspecified Eating Disorders (NERD) according to age, sex, health centers, nationality and family data; determine the percentage of young people with subclinical forms and study the feasibility of using tools for the early detection of this pathology in Primary Care.

MATERIAL AND METHODS

Observational, cross-sectional and multicentre study developed in the five health centers of the city of Guadalajara. Sample of 291 adolescents (124 males and 167 females) obtained through stratified, multi-stage and proportional random sampling according to age, sex and health centers. Sociodemographic, anthropometric and family variables were studied and the EAT-26, SCOFF and EDE-Q6.0 tests were applied in the first round and the EDE-12 interview in the second round.

RESULTS

The global prevalence of risk of eating disorders was 17.5% (95% CI: 13.7%-19.4%). The variables, having siblings, being single-parent and having obesity were statistically significant. Among the various types of EDs, the NERD were statistically significant with respect to Anorexia and Bulimia. The subscale concern for the silhouette was statistically significant with respect to the others. The SCOFF questionnaire showed a sensitivity of 91.6% and a specificity of 91.0% and the EDE-Q, 99.3% and 91.7% respectively.

CONCLUSIONS

High percentage of adolescents at risk of developing an eating disorder. The unspecified type of eating disorders and the concern for the silhouette subscale predominate. The SCOFF test proves to be a good screening instrument in Primary Care.

25-Hydroxyvitamin D levels and its relation to muscle strength, maximal oxygen consumption, and body mass index in young and middle adulthood women

Introduction

Vitamin D is a potent secosteroid hormone that provides many health benefits. The ubiquitous nature of vitamin D receptor (VDR) suggests widespread effect.

Purpose

The purpose of this study was to investigate the relationship between 25-hydroxyvitamin D (25OHD) levels and muscle strength, maximal oxygen consumption (VO₂max), and body mass index (BMI) in Iranian young and middle adulthood women.

Participants and methods

A cross-sectional descriptive study was conducted in 182 healthy Iranian women within the age range of 26–60 years. Body weight and height were measured, and BMI was calculated. VO₂max was determined by the Rockport test. Muscle strength was determined by the chest press, leg press, and hand grip test. Also, circulating levels of 25OHD were evaluated.

Results

Results showed a significant relationship between 25OHD levels and BMI, VO₂max, and muscle strength (chest press, leg press, hand grip dominant hand [HGDH], and hand grip nondominant hand [HGNDH]) in young and middle adulthood women (BMI in young and middle adulthood: r=−0.48, P<0.001 and r=−0.27, P=0.01, respectively; VO₂max in young and middle adulthood women: r=0.69, P<0.001 and r=0.57, P<0.001, respectively; chest press, leg press, HGDH, and HGNDH in young adulthood: r=0.58, r=0.59, r=0.65, and r=0.42, respectively, P<0.001; and in middle adulthood: r=0.73, r=0.34, r=0.66, and r=0.55, respectively, P≤0.001). Multiple linear regression analysis showed that higher levels of VO₂max, HGDH, and chest press predicted higher 25OHD levels in the young adulthood women (R²=0.75; β=0.39, β=0.35, and β=0.30, respectively; P<0.001). Moreover, VO₂max and HGDH were the strongest predictor of 25OHD levels in the middle adulthood women (R²=0.71; β=0.35, β=0.40, respectively; P<0.001).

Conclusion

Based on the results, it could be concluded that VO₂max and strength are useful indirect marker for 25OHD levels in the young and middle adulthood women. It also seems that VO₂max and HGDH strength had stronger associations with 25OHD levels in the young adulthood women, and chest press and HGDH had stronger associations with 25OHD levels in the middle adulthood women.