Turkish version of the 'Three-Factor Eating Questionnaire-51' for obese individuals: a validity and reliability study

The Turkish validity and reliability of the Reward-Based Eating Drive (RED-13) Scale

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (number: NCT05017506).

Investigation of Eating Behaviors in Euthyroid Patients With Hashimoto's Thyroiditis

Background Hashimoto's thyroiditis (HT) is an organ-specific autoimmune disorder. While eating disorders have been associated with other autoimmune diseases, no studies have explored this relationship in patients with HT to date. This study aimed to evaluate eating behaviors in euthyroid patients with HT. Materials and methods This case-control, cross-sectional study included a total of 107 patients diagnosed with HT, aged 18-45 years, as well as 54 healthy volunteers. Thyroid function tests, anti-thyroid peroxidase (TPO), and anti-antithyroglobulin (Tg) antibodies were measured in all participants. The Three-Factor Eating Questionnaire (TFEQ), the Night Eating Questionnaire (NEQ), and the International Physical Activity Questionnaire (IPAQ) were used to assess eating disorders and physical activity levels. Results Compared to the healthy control group, patients with HT, especially those receiving levothyroxine (LT4), had significantly higher scores on the TFEQ and NEQ. A positive correlation was detected between TFEQ and NEQ scores and anti-TPO and anti-Tg levels, LT4 treatment duration, and LT4 dose. However, there were no significant differences between the groups in terms of the IPAQ scores. A negative correlation was found between TFEQ scores and serum triiodothyronine (sT3). In patients with HT, thyroid-stimulating hormone (TSH) levels were within the higher-normal range, while sT3 levels were lower-normal compared to controls. Conclusion There is a spectrum of eating disorders among patients with HT. The underlying cause of these disorders remains unclear and may be associated with thyroid antibodies and/or hormonal status. In LT4 replacement therapy, efforts should be made to mimic true physiology as closely as possible. In the follow-up of patients with HT, while TSH is within lower-normal limits, sT3 levels may be observed to be in a higher-normal range. In selected cases, a combination of T4/T3 therapy or T3 extract may be recommended. Close monitoring of patients with HT is essential, particularly for potential eating disorder-related complications, such as obesity.

Validity and Reliability of the Arabic Version of the Three-Factor Eating Questionnaire-R18

The present study translated and validated an Arabic version of the Three-Factor Eating Questionnaire-R18 (TFEQ-R18), which assesses eating behaviour traits among Arabic speakers in the three domains: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). Three bilingual experts first translated the English questionnaire into Arabic, and the questionnaire's comprehension was tested among 298 Arabic speakers. Confirmatory factor analysis (CFA) tested the model fit and flagged four items in the questionnaire with low consistency. These items were modified, and the revised Arabic version of TFEQ-R18 was validated in a population of 513 individuals. Validity was evaluated using CFA and Pearson's correlation coefficients, internal consistency using Cronbach's α, and the reproducibility of the questionnaire was confirmed with Bland-Altman analysis and T-test. The construct validity of the Arabic TFEQ-R18 was evaluated by comparing the response score in the population based on gender, BMI and age group. CFA confirmed that the model fit is good and strongly agrees with the collected data. Except for item 15 in the CR domain, all questions showed moderate to high correlation within their respective domains. The Cronbach's α for UE, EE, and CR domains recorded was 0.778, 0.784 and 0.588, respectively. Item 15 had the lowest consistency in the Arabic-TFEQ-R18, and Cronbach's α increased to 0.608 with its removal. There was no significant difference between the first and second attempts of the Arabic TFEQ-R18, indicating good test-retest reliability. Moreover, UE and EE were positively correlated to the BMI of the participants (r = 0.159, p = 0·000; r = 0.158, p = 0·000, respectively). The study concludes that the Arabic TFEQ is a valid and reliable tool for studying the three psychometric domains of UE, EE and CR among Arabic speakers.

Demographic and psychosocial correlates of measurement error and reactivity bias in a four-day image-based mobile food record among adults with overweight and obesity

Improving dietary reporting among people living with obesity is challenging as many factors influence reporting accuracy. Reactive reporting may occur in response to dietary recording but little is known about how image-based methods influence this process. Using a 4-day image-based mobile food record (mFRTM), this study aimed to identify demographic and psychosocial correlates of measurement error and reactivity bias, among adults with BMI 25-40kg/m2. Participants (n=155, aged 18-65y) completed psychosocial questionnaires, and kept a 4-day mFRTM. Energy expenditure (EE) was estimated using ≥4 days of hip-worn accelerometer data, and energy intake (EI) was measured using mFRTM. Energy intake: energy expenditure ratios were calculated, and participants in the highest tertile were considered to have Plausible Intakes. Negative changes in EI according to regression slopes indicated Reactive Reporting. Mean EI was 72% (SD=21) of estimated EE. Among participants with Plausible Intakes, mean EI was 96% (SD=13) of estimated EE. Higher BMI (OR 0.81, 95%CI 0.72-0.92) and greater need for social approval (OR 0.31, 95% CI 0.10-0.96), were associated with lower likelihood of Plausible Intakes. Estimated EI decreased by 3% per day of recording (IQR -14%,6%) among all participants. The EI of Reactive Reporters (n=52) decreased by 17%/day (IQR -23%,-13%). A history of weight loss (>10kg) (OR 3.4, 95% CI 1.5-7.8), and higher percentage of daily energy from protein (OR 1.1, 95%CI 1.0-1.2) were associated with greater odds of Reactive Reporting. Identification of reactivity to measurement, as well as Plausible Intakes, is recommended in community-dwelling studies to highlight and address sources of bias.

Development and Validation of a Lifestyle Behavior Tool in Overweight and Obese Women through Qualitative and Quantitative Approaches

There is a paucity of effective intervention tools for overweight/obese women to assess, guide and monitor their eating behavior. This study aimed to develop a lifestyle intervention tool, assess its acceptability and usefulness, and verify its construct validity in overweight/obese women. The 6P tool (Portion, Proportion, Pleasure, Phase, Physicality, Psychology) was developed and 15 women with a body mass index (BMI) ≥ 25 kg/m2 were interviewed to assess its perceived acceptability and usefulness. Subsequently, the revised 6P tool was tested in 46 women with a BMI ≥ 25 kg/m2. The Three-Factor Eating Questionnaire (TFEQ), International Physical Activity Questionnaire-Short (IPAQ), and weight were measured at baseline and one-month. Most participants were satisfied with the presentation of the 6P tool (86.8%), and agreed it was useful in guiding healthy eating (81.6%) and raising awareness of eating behavior (97.4%). There were significant improvements in cognitive restraint (p = 0.010) and disinhibition (p = 0.030) (TFEQ), portion size (P1), pleasure behaviors (P3), and total composite 6P score (p < 0.001). However, there was no significant reduction in weight or increase in physical activity. The 6P tool is acceptable and presents with good validity for assessing lifestyle behaviors.