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O'Brien M, Quirke R, Gowan R, McNicholas F. Prevalence of thiamine deficiency in anorexia nervosa: a systematic review and narrative synthesis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02576-7. [PMID: 39240360 DOI: 10.1007/s00787-024-02576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
Thiamine is an essential vitamin that plays a crucial role in many biochemical processes in the body. Anorexia nervosa (AN) is one potential cause of a state of deficiency which can result in grave medical sequelae. There is limited available evidence of the prevalence of thiamine deficiency in patients who suffer from AN. The current study aimed to systematically review all available evidence on the prevalence of thiamine deficiency in cohorts with AN. Studies were included where thiamine status in a group of participants with AN was measured, either through self-reporting or objective measurement. Eight databases (Scopus, CINAHL complete, Medline complete, EMBASE, WEB OF SCIENCE, PROSPERO, COCHRANE DATABASE OF SYSTEMATIC REVIEWS and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. PRISMA guidelines were followed. The study was registered on PROSPERO. A minimum of two researchers conducted each part of the review. The search identified 42 articles whose full texts were screened for eligibility, with 17 retained for qualitative synthesis. The prevalence rates of thiamine deficiency in AN varied from 5.9% to 100% when based on self-report dietary intake. When objective measurements were taken, rates ranged from 0% to 56.7%. The review suggested that age, body mass index (BMI), duration of illness and subtype of AN were not associated with thiamine status. The limited available evidence suggested that the use of supplements, prior treatment and higher energy intakes were associated with a reduced risk of developing a thiamine deficiency among individuals with AN. Poor study methodology including small sample size, inconsistent deficiency definition and study heterogeneity limits the conclusions that can be drawn. Ultimately, there is insufficient strength of evidence to draw definitive clinical recommendations. This review highlights the need for further studies with more robust methodology to help further inform clinical practice.
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Affiliation(s)
- Michael O'Brien
- Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Rachael Quirke
- Department of Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Roisin Gowan
- National Maternity Hospital, Holles Street, Dublin, Ireland
| | - Fiona McNicholas
- Department of Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
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2
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Jenkins PE, Proctor K, Snuggs S. Dietary intake of adults with eating disorders: A systematic review and meta-analysis. J Psychiatr Res 2024; 175:393-404. [PMID: 38772131 DOI: 10.1016/j.jpsychires.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Studies have confirmed the link between altered dietary intake and eating disorders (EDs), although no systematic assessment of this research exists. Rigorous synthesis of dietary intake in anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and similar EDs is needed to explore similarities and differences. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we conducted a systematic review and quantitative synthesis of studies of dietary intake. Searches of three electronic databases resulted in thirty-nine included studies. Meta-analyses of subsets of these studies were undertaken to summarise macronutrient intake across AN, BN, and BED. Study quality was assessed using the American Academy of Nutrition and Dietetics Quality Criteria Checklist, with ratings either Positive (k = 27) or Neutral (k = 12). Adults with AN had low energy intake and those with BED reported elevated macronutrient intake. Individuals with BN reported wide variation in energy intake, including some of the highest estimates. Individuals with AN were likely to under-consume key micronutrients, with sodium potentially over-consumed in BN and BED. Vitamin D was under-consumed across all disorders. This meta-analysis highlights important diagnostic differences and synthesises dietary intake in EDs, with particular relevance to risk assessment and treatment.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom.
| | - Katy Proctor
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
| | - Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
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3
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Frigaard J, Hynne H, Randsborg K, Mellin-Olsen T, Young A, Rykke M, Singh PB, Hove LH, Hofgaard AK, Jensen JL. Exploring oral health indicators, oral health-related quality of life and nutritional aspects in 23 medicated patients from a short-term psychiatric ward. Front Public Health 2023; 11:1083256. [PMID: 37124774 PMCID: PMC10130439 DOI: 10.3389/fpubh.2023.1083256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Background Patients suffering from psychiatric disorders face many difficulties due to their condition, medications and lifestyle. Oral health and nutrition may be affected, further complicating their lives. Our aim was to provide in-depth information on oral health and nutritional factors in a small group of patients in short-term psychiatric ward. Methods Twenty-three patients (mean age 36, average medications five) were recruited during short-term hospitalization in a psychiatric ward. Inclusion criteria: anxiety, psychosis and/or depression, and use of at least one antidepressant or anxiolytic/antipsychotic drug with xerostomia as a known side effect. Subjective oral dryness was evaluated using the Shortened Xerostomia Inventory (SXI). Oral examination included Clinical Oral Dryness Score (CODS), secretion of unstimulated (UWS) and stimulated whole saliva (SWS), and evaluation of dental, gingival, and periodontal status. Self-reported complaints of oral disorders were recorded. The Oral Health Impact Profile-14 (OHIP-14) was used to explore oral health-related quality of life. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and diet quality was assessed using the Mediterranean diet score (KIDMED). Results Compared to healthy controls, the patients had significantly higher SXI scores and CODS, and SWS secretion was lower. Complaints of dysgeusia and halitosis were significantly more frequent among patients. Gingivitis was more common in patients. OHIP-14 scores were much higher in the patients, and they reported significantly poorer oral and general health. Most patients lacked a regular meal pattern. Very low diet quality was observed in five patients, while improvements were needed in twelve. "Dry mouth" and "No appetite, just did not feel like eating" were the most common symptoms preventing patients from eating enough. The PG-SGA-SF symptoms component score showed a strong negative correlation with self-reported oral health, and a strong positive correlation with OHIP-14. Conclusion This relatively small group of patients in short-term psychiatric ward had both reduced oral health and poor oral health-related quality of life. Furthermore, their nutritional intake was affected by their oral health problems. Although larger groups need to be studied, these findings indicate that oral health and nutrition should be evaluated and adjusted in these patients to improve their overall care.
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Affiliation(s)
- Julie Frigaard
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Håvard Hynne
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | | | | | - Alix Young
- Department of Cariology and Gerodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Morten Rykke
- Department of Cariology and Gerodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Preet Bano Singh
- Department of Cariology and Gerodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | | | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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Linnaranta O, Bourguignon C, Crescenzi O, Sibthorpe D, Buyukkurt A, Steiger H, Storch KF. Late and Instable Sleep Phasing is Associated With Irregular Eating Patterns in Eating Disorders. Ann Behav Med 2020; 54:680-690. [PMID: 32211873 PMCID: PMC7459186 DOI: 10.1093/abm/kaaa012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sleep problems are common in eating disorders (EDs). PURPOSE We evaluated whether sleep-phasing regularity associates with the regularity of daily eating events. METHODS ED patients (n = 29) completed hourly charts of mood and eating occasions for 2 weeks. Locomotor activity was recorded continuously by wrist actigraphy for a minimum of 10 days, and sleep was calculated based on periods of inactivity. We computed the center of daily inactivity (CenDI) as a measure of sleep phasing and consolidation of the daily inactivity (ConDI) as a measure of daily sleep rhythm strength. We assessed interday irregularities in the temporal structure of food intake using the standard deviation (SD) of frequency (IFRQ), timing (ITIM), and interval (IINT) of food intake. A self-evaluation of other characteristics included mood, anxiety, and early trauma. RESULTS A later phasing of sleep associated with a lower frequency of eating (eating frequency with the CenDI rho = -0.49, p = .007). The phasing and rhythmic strength of sleep correlated with the degree of eating irregularity (CenDI with ITIM rho = 0.48, p = .008 and with IINT rho = 0.56, p = .002; SD of CenDI with ITIM rho = 0.47, p = .010, and SD of ConDI with IINT rho = 0.37, p = .048). Childhood Trauma Questionnaire showed associations with variation of sleep onset (rho = -0.51, p = .005) and with IFRQ (rho = 0.43, p = .023). CONCLUSIONS Late and variable phasing of sleep associated robustly with irregular pattern of eating. Larger data sets are warranted to enable the analysis of diagnostic subgroups, current medication, and current symptomatology and to confirm the likely bidirectional association between eating pattern stability and the timing of sleep.
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Affiliation(s)
- Outi Linnaranta
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Clément Bourguignon
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Olivia Crescenzi
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | | | - Asli Buyukkurt
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Howard Steiger
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Eating Disorders Continuum, Douglas University Institute, Montreal, QC, Canada
| | - Kai-Florian Storch
- Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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5
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Gormez A, Kurtulmus A, Kirpinar I. Iron metabolism and haematological changes in anorexia nervosa: an adult case report. Eat Weight Disord 2018; 23:395-398. [PMID: 28378272 DOI: 10.1007/s40519-017-0377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/27/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Aynur Gormez
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Kurtulmus
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.
| | - Ismet Kirpinar
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
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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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Pettersson C, Tubic B, Svedlund A, Magnusson P, Ellegård L, Swolin-Eide D, Forslund HB. Description of an intensive nutrition therapy in hospitalized adolescents with anorexia nervosa. Eat Behav 2016; 21:172-8. [PMID: 26970731 DOI: 10.1016/j.eatbeh.2016.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe an intensive nutrition therapy for hospitalized adolescents and young adults with anorexia nervosa (AN) in terms of body weight, body composition, energy balance and food related anxiety. METHOD Twenty-six young females, 16-24years of age, with AN were invited to participate at admission to a specialized eating disorder unit in Göteborg, Sweden. Intensive nutrition therapy comprised 12weeks on a structured meal plan. Six meals were served daily, in combination with high-energy liquid nutritional supplements from start. Energy and nutrient intakes, energy expenditure, body composition and food related anxiety were measured during the study. A 3-month follow-up of body weight and food related anxiety was conducted. RESULTS Twenty-one patients participated. The total daily energy intake was, during the first week of treatment, (mean±SD) 3264±196kcal (74kcal/kg), and decreased gradually during treatment to 2622±331kcal (49kcal/kg). Total daily energy expenditure was initially 1568±149kcal and increased gradually to 2034±194kcal. Patients gained on average 9.8±2.1kg and body mass index increased from 15.5±0.9 to 19.0±0.9kg/m(2). Body fat increased from 13±6% to 26±6%. Fat free mass remained unchanged, but skeletal muscle mass increased from 16.7±2.0 to 17.6±2.4kg, p=0.009. Patients' food related anxiety decreased significantly during treatment and was still unchanged 3months later. CONCLUSION The presented intensive nutrition therapy with initially high energy and nutrient intakes produced substantial weight gain, increased fat and muscle mass and decreased food related anxiety in AN patients, without any clinical side effects.
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Affiliation(s)
- Cecilia Pettersson
- Anorexia-Bulimia Unit, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden.
| | - Bojan Tubic
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Anna Svedlund
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Per Magnusson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
| | - Lars Ellegård
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Diana Swolin-Eide
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Heléne Bertéus Forslund
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
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8
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Veronese N, Solmi M, Rizza W, Manzato E, Sergi G, Santonastaso P, Caregaro L, Favaro A, Correll CU. Vitamin D status in anorexia nervosa: A meta-analysis. Int J Eat Disord 2015; 48:803-13. [PMID: 25445242 DOI: 10.1002/eat.22370] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In anorexia nervosa (AN), osteoporosis and osteopenia are common, which have been associated with low circulating levels of vitamin D (VitD) in other settings. We aimed to meta-analyze cross-sectional studies reporting on VitD parameters in patients with AN and healthy controls (HCs). METHOD Electronic PubMed search from database inception until December 31, 2013 and meta-analysis of cross-sectional studies comparing serum levels of 25-hydroxyvitamin D (25OH-D), 1,25-dihydroxyvitamin D (1,25OH-D) and dietary VitD between patients with AN and HCs, before or after VitD supplementation. We calculated random effects standardized mean differences (SMDs) ±95% confidence intervals (CIs) as effect size measures. RESULTS Out of 1,739 initial hits, 15 studies with a total of 927 participants (AN = 408 and HCs = 519) were meta-analyzed. In the unsupplemented state, both serum 25OH-D (studies = 4; n = 168; SMD = -0.43; 95%CI: -0.83 to -0.03; p = .03) and 1,25OH-D levels (studies = 4; n = 113; SMD = -1.06; 95%CI: -1.47 to -0.66; p < .00001) were significantly lower in AN than HCs. In AN patients treated with cholecalciferol supplementation, serum 25OH-D levels were significantly higher than in HCs (studies = 5; n = 449; SMD = 0.66; 95%CI: 0.01-1.31; p = .05). Paradoxically, despite lower 25OH-D and 1,25OH-D levels, AN patients reported similar intake of VitD compared to HCs (studies = 6; n = 314; SMD = 0.33; 95%CI: -0.16, 0.81; p = .19). DISCUSSION Although AN patients reported similar dietary VitD intake compared to HCs, AN patients had significantly lower 25OH-D and 1,25OH-D levels without supplementation. Conversely, supplementation with cholecalciferol fully normalized VitD serum levels. Future studies are needed to clarify the role of VitD supplementation in AN for improving bone health.
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Affiliation(s)
- Nicola Veronese
- Department of Medicine, DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Wanda Rizza
- Department of Food and Human Nutrition Science, University Campus Bio-Medico, Rome, Italy
| | - Enzo Manzato
- Department of Medicine, DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine, DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | | | - Lorenza Caregaro
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA.,Hofstra North Shore LIJ School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, New York, USA.,Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, New York, USA
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9
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Elran-Barak R, Sztainer M, Goldschmidt AB, Crow SJ, Peterson CB, Hill LL, Crosby RD, Powers P, Mitchell JE, Le Grange D. Dietary Restriction Behaviors and Binge Eating in Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder: Trans-diagnostic Examination of the Restraint Model. Eat Behav 2015; 18:192-6. [PMID: 26122390 PMCID: PMC8686697 DOI: 10.1016/j.eatbeh.2015.05.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/16/2015] [Accepted: 05/13/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare dietary restriction behaviors among adults with eating disorders involving binge eating, including anorexia nervosa-binge/purge subtype (AN-BE/P), bulimia nervosa (BN), and binge eating disorder (BED), and to examine whether dietary restriction behaviors impact binge eating frequency across diagnoses. METHOD Participants included 845 treatment seeking adults (M=30.42+10.76years) who met criteria for DSM-5 AN-BE/P (7.3%;n=62), BN (59.7%;n=504), and BED (33.0%;n=279). All participants self-reported their past and current eating disorder symptoms on the Eating Disorder Questionnaire. RESULTS Adults with AN-BE/P and BN reported significantly more dietary restriction behaviors (e.g. eating fewer meals per day, higher frequency of fasting, consuming small and low calorie meals) in comparison to adults with BED. Adults with AN-BE/P and BN who reported restricting food intake via eating fewer meals per day had more frequent binge eating episodes. However, adults with BN who reported restricting food intake via eating small meals and low calorie meals had less frequent binge eating episodes. DISCUSSION This study provides mixed support for the restraint model by suggesting that not all dietary restriction behaviors are associated with higher levels of binge eating. It may be that adults with BN who report a higher frequency of eating small and low calorie meals display more control over their eating in general, and therefore also have lower frequency of binge eating. Clinicians should assess for dietary restriction behaviors at the start of treatment prior to assuming that all forms of strict dieting and weight control behaviors similarly impact binge eating.
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Affiliation(s)
- Roni Elran-Barak
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.
| | - Maya Sztainer
- Department of Psychiatry, University of Chicago, Chicago,
IL, USA
| | | | - Scott J. Crow
- Department of Psychiatry, University of Minnesota School of
Medicine, Minneapolis, MN, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota School of
Medicine, Minneapolis, MN, USA
| | - Laura L. Hill
- The Center for Balanced Living, Worthington, OH, USA
| | - Ross D. Crosby
- Department of Clinical Neuroscience, University of North
Dakota School of Medicine and Health Sciences, and the Neuropsychiatric Research
Institute, Fargo, ND, USA
| | - Pauline Powers
- Clinical and Translational Science Institute, Health
Sciences Center University of South Florida, Tampa, FL, USA
| | - James E. Mitchell
- Department of Clinical Neuroscience, University of North
Dakota School of Medicine and Health Sciences, and the Neuropsychiatric Research
Institute, Fargo, ND, USA
| | - Daniel Le Grange
- Department of Psychiatry and Department of Pediatrics,
University of California, San Francisco, CA, USA
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10
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Elran-Barak R, Accurso EC, Goldschmidt AB, Sztainer M, Byrne C, Le Grange D. Eating patterns in youth with restricting and binge eating/purging type anorexia nervosa. Int J Eat Disord 2014; 47:878-83. [PMID: 24777645 PMCID: PMC4337799 DOI: 10.1002/eat.22289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe eating patterns in youth with restricting and binge/purge type anorexia nervosa (AN) and to examine whether eating patterns are associated with binge eating or purging behaviors. METHOD Participants included 160 children and adolescents (M = 15.14 ± 2.17 years) evaluated at The University of Chicago Eating Disorders Program who met criteria for DSM-5 restrictive type AN (AN-R; 75%; n = 120) or binge eating/purging type AN (AN-BE/P; 25%; n = 40). All participants completed the eating disorder examination on initial evaluation. RESULTS Youth with AN-R and AN-BE/P differed in their eating patterns, such that youth with AN-R consumed meals and snacks more regularly relative to youth with AN-BE/P. Among youth with AN-BE/P, skipping dinner was associated with a greater number of binge eating episodes (r = -.379, p < .05), while skipping breakfast was associated with a greater number of purging episodes (r = -.309, p < .05). DISCUSSION Youth with AN-R generally follow a regular meal schedule, but are likely consuming insufficient amounts of food across meals and snacks. In contrast, youth with AN-BE/P tend to have more irregular eating patterns, which may play a role in binge eating and purging behaviors. Adults monitoring of meals may be beneficial for youth with AN, and particularly those with AN-BE/P who engage in irregular eating patterns.
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Affiliation(s)
- Roni Elran-Barak
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Erin C. Accurso
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Andrea B. Goldschmidt
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Maya Sztainer
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Catherine Byrne
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
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11
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Rigaud D, Jiang T, Pennacchio H, Brémont M, Perrin D. [Triggers of bulimia and compulsion attacks: validation of the "Start" questionnaire]. Encephale 2013; 40:323-9. [PMID: 24091068 DOI: 10.1016/j.encep.2013.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/27/2013] [Indexed: 11/27/2022]
Abstract
AIM There are few published studies on the triggers of binge eating in anorexia nervosa of binge/purging subtype (BPAN), bulimia nervosa (BN) and binge eating disorder (BED). PATIENTS AND METHODS We validated in 29 patients (10 BPAN, 10 BN and 9 BED) the perspicuity, the clarity and the intra- (doubles) and inter- (test-retest) reproducibility of a 24-item Start questionnaire on the triggers of binge eating. Then the Start questionnaire was administered to 176 patients (65 BPAN, 62 BN and 59 BED patients) being 27.5+9.1 yr old, having 15+9 binge eating (BE) episodes/week, with a mean binge duration of 1 hr 36min (+ 38min)/day. RESULTS BE episodes occurred mainly during the second part of the day: afternoon after work (67% of the patients), "tea" time (55%), evening after dinner (42%) and at night (22%). The principal place for BE episodes was at home (96%). The BED patients avoided binges at the parents' home (89%) more often than the BPAN (62%, P<0.02). The binges occurred mainly in the living room (44%), in the kitchen (43%), and less in the bedroom (31%). Hunger pangs seemed to be a trigger of binges in 31% of the patients, and a stronger trigger in BED (42%) than in the BPAN and BN patients (24%; P=0.04). Binge eating episodes could occur despite a high satiety level (just after lunch or dinner) in 29% of the BN and in 16% of the BED patients (P<0.02). Concerning food, the major triggers were high energy-density food (77%) and comfort food (60%), such as chocolate, cakes, bread and pasta. The food consumed for binge episodes (in-binge food) was more often a strong trigger than the other food (not used for binges): olfaction (19% versus 10%), sight (52% versus 25%) and placing in the mouth (71% versus 26%; P<0.02 for all, in the 3 groups). Being tired could be a strong trigger in 37% of the patients, but "being aroused" in the other 38 % of the patients. Stressful events (65%), anxiety (74%), "being under pressure" or irritated (51% and 55%) were of course major triggers in a majority of the patients, as well as sadness (61%), feeling of powerlessness (62%), inefficiency (73%) and depressive state (71%). Flashback from traumatism (sexual trauma in 17% of the patients) was a strong trigger of binges more often in BPAN and BED (44%) than in BN (23%; P<0.05). The binge eating was painful (and "not at all a pleasure") in 69% of the patients, but could also be a relaxing behavior in 31% of the patients, more often in the BED (43%) than in the BPAN patients (20%; P<0.05). The binge eating behavior was quoted as obsessive in 63% of BPAN, 92% of BN and only 34% of BED patients (P<0.001). The patients said that they were unable to avoid the binge (76% of the patients), more often in BPAN and BN than in BED patients (P<0.01). As a whole, 62% of BPAN, 89% of BN and only 4 % of BED patients (P<0.05) were unable to avoid purging (vomiting). In 12% of the cases, there was a pleasure felt when binging. For the other patients, shame, filth and incapacity were the feelings related to binges in 58% of the BPAN, 45% of BN and 43% of BED patients (P<0.04). The global score of addiction (zero=not addicted, 10=very addicted) was 8.56+1.2 in BPAN, 8.42+1.5 in BN and 6.74+1.1 in BED patients (NS between BPAN and BN; P<0.01 between BPAN and BN on the one hand and BED on the other). CONCLUSION The present study has demonstrated the usefulness of the Start questionnaire. It also evidences the key role of intrinsic factors, both metabolic and emotional, as strong triggers for binge eating episodes in BPAN, BN and BED. It has also demonstrated the role of environmental determinants.
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Affiliation(s)
- D Rigaud
- CHU Le Bocage, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France.
| | - T Jiang
- Centre des sciences du goût, 9E, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - H Pennacchio
- Association Autrement, 9, rue de Metz, 21000 Dijon, France.
| | - M Brémont
- Association Autrement, 9, rue de Metz, 21000 Dijon, France.
| | - D Perrin
- Association Autrement, 9, rue de Metz, 21000 Dijon, France
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Higgins J, Hagman J, Pan Z, MacLean P. Increased physical activity not decreased energy intake is associated with inpatient medical treatment for anorexia nervosa in adolescent females. PLoS One 2013; 8:e61559. [PMID: 23637854 PMCID: PMC3630220 DOI: 10.1371/journal.pone.0061559] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/11/2013] [Indexed: 11/18/2022] Open
Abstract
There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN). Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11–19 years (14.3±1.8 years), with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall) and 1 week prior (24 hour food recall, modifiable activity questionnaire). Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability.
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Affiliation(s)
- Janine Higgins
- School of Medicine, Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
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13
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Schebendach JE, Porter KJ, Wolper C, Walsh BT, Mayer LE. Accuracy of self-reported energy intake in weight-restored patients with anorexia nervosa compared with obese and normal weight individuals. Int J Eat Disord 2012; 45:570-4. [PMID: 22271488 PMCID: PMC4469285 DOI: 10.1002/eat.20973] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare self-reported and measured energy intake in weight-restored patients with anorexia nervosa (AN), weight-stable obese individuals (OB), and normal weight controls (NC). METHOD Forty participants (18 AN, 10 OB, and 12 NC) in a laboratory meal study simultaneously completed a prospective food record. RESULTS AN patients significantly (p = .018) over-reported energy intake (16%, 50 kcal) and Bland-Altman (B-A) analysis indicated bias toward over-reporting at increasing levels of intake. OB participants significantly (p = .016) under-reported intake (19%, 160 kcal) and B-A analysis indicated bias toward under-reporting at increasing levels of intake. In NC participants, NS (p = .752) difference between reported and measured intake was found and B-A analysis indicated good agreement between methods at all intake levels. DISCUSSION Self-reported intake should be cautiously interpreted in AN and OB. Future studies are warranted to determine if over-reporting is related to poor outcome and relapse in AN, or under-reporting interferes with weight loss efforts in OB.
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Affiliation(s)
- Janet E. Schebendach
- Correspondence to: Janet E. Schebendach, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032.
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14
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Papillard-Marechal S, Sznajder M, Hurtado-Nedelec M, Alibay Y, Martin-Schmitt C, Dehoux M, Westerman M, Beaumont C, Chevallier B, Puy H, Stheneur C. Iron metabolism in patients with anorexia nervosa: elevated serum hepcidin concentrations in the absence of inflammation. Am J Clin Nutr 2012; 95:548-54. [PMID: 22301927 DOI: 10.3945/ajcn.111.025817] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Only a few studies based on small cohorts have been carried out on iron status in anorexia nervosa (AN) patients. OBJECTIVE The aim of this study was to evaluate the role of hepcidin in hyperferritinemia in AN adolescents. DESIGN Twenty-seven adolescents hospitalized for AN in the pediatric inpatient unit of Ambroise Paré Academic Hospital were enrolled in the study. The control group comprised 11 patients. Hematologic variables and markers of iron status, including serum hepcidin, were measured before and after nutritional rehabilitation. RESULTS The mean age of patients was 14.4 y. Except for 2 AN patients and 1 control patient, all patients presented normal hemoglobin, vitamin B-12, and folate concentrations. Markers of inflammation and cytokines were normal throughout the study. None of the muscular lysis markers were elevated. Most AN patients had normal serum iron concentrations on admission. Serum ferritin concentrations were significantly higher in patients than in control subjects (198 compared with 49 μg/L, respectively; P < 0.001). The median hepcidin concentration was significantly higher in AN patients than in the control group (186.5 compared with 39.5 μg/L, respectively; P = 0.002). There was a highly significant correlation between ferritinemia and serum hepcidin concentrations (P < 0.0001). After nutritional rehabilitation, a significant reduction was observed (P = 0.004) in serum ferritin. Serum hepcidin analyzed in a smaller number of patients also returned to within the normal range. CONCLUSIONS Hepcidin and ferritin concentrations were higher in the serum of AN patients, without any evidence of iron overload or inflammation. These concentrations returned to normal after nutritional rehabilitation. These results suggest that nutritional stress induced by malnourishment in the hepatocyte could be yet another mechanism that regulates hepcidin.
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15
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Schebendach J, Mayer LES, Devlin MJ, Attia E, Walsh BT. Dietary energy density and diet variety as risk factors for relapse in anorexia nervosa: a replication. Int J Eat Disord 2012; 45:79-84. [PMID: 21448937 PMCID: PMC4469286 DOI: 10.1002/eat.20922] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To replicate our previous findings of an association between energy density and diet variety in recently weight-restored patients with anorexia nervosa (AN) and clinical outcome in the year following treatment. METHOD Nineteen hospitalized, weight-restored women with AN completed a food record, from which a diet energy density score (DEDS) and a diet variety score (DVS) were calculated. After hospital discharge, patients were contacted regularly; at the end of one year, clinical outcome was determined using modified Morgan-Russell criteria. As in our previous study, outcome was dichotomized into "full, good, or fair" and "poor" groups. RESULTS Data from 16 subjects were available. The DEDS was significantly lower (p < .05) in the poor outcome group (0.7 ± 1) compared with the "full, good, or fair" outcome group (0.9 ± 1). Although the DVS was also lower in the poor outcome group (13.9 ± 2) compared with the "full, good or fair" outcome group (15.7 ± 1.8), this difference was not statistically significant. DISCUSSION In recently weight-restored patients with AN, a lower DEDS, but not DVS, is associated with poor clinical outcome after inpatient treatment. This finding may be important in the assessment of risk for relapse in patients with AN.
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Affiliation(s)
- Janet Schebendach
- Eating Disorders Research Unit, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, New York, USA.
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16
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Schebendach JE, Mayer LE, Devlin MJ, Attia E, Contento IR, Wolf RL, Walsh BT. Food choice and diet variety in weight-restored patients with anorexia nervosa. ACTA ACUST UNITED AC 2011; 111:732-6. [PMID: 21515121 DOI: 10.1016/j.jada.2011.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 11/12/2010] [Indexed: 11/25/2022]
Abstract
Anorexia nervosa is a serious psychiatric illness associated with substantial morbidity and mortality. Weight-restored females with anorexia nervosa with limited diet variety, assessed by a diet variety score, have been reported to have poor outcomes. Using the same patient cohort, the objective of the current study was to provide a detailed description of the types of foods from which patients restrict variety in their diets. Forty-one weight-restored patients, hospitalized between June 2000 and July 2005, who completed a 4-day food record before discharge were followed for up to 1 year. Patient outcomes were categorized as a success (n=29) or failure (n=12) using Morgan-Russell criteria. Although the total number of foods selected did not differ between the success and failure groups (73±14 vs 74±13, respectively; P=0.741), a significant difference in the total number of different foods was observed: the failure group selected fewer and the success group selected more (43±9 vs 51±7; P=0.005). Outcomes groups also differed significantly in the variety of foods selected from 5 of 17 food groups. Results suggest that a diet limited in total variety and specifically limited in variety from five food groups may be associated with relapse in patients with anorexia nervosa.
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Affiliation(s)
- Janet E Schebendach
- Columbia University Medical Center, New York State Psychiatric Institute, Eating Disorders Research Unit, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA.
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17
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Wolfe BE, Baker CW, Smith AT, Kelly-Weeder S. Validity and utility of the current definition of binge eating. Int J Eat Disord 2009; 42:674-86. [PMID: 19610126 DOI: 10.1002/eat.20728] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Binge eating, a cardinal symptom of bulimia nervosa (BN) and binge eating disorder (BED), continues to pose challenges in terms of its definition and thus construct validity and clinical utility. This article reviews the available empirical data that support or refute the current DSM-IV-TR defined characteristics of a binge episode. METHOD A systematic literature review was conducted using Medline/PubMed electronic database on DSM-IV-TR defined binge characteristics and associated attributes. RESULTS Data support the current DSM guidelines indicating that binge episodes typically occur in less than 2 h. Size of binge episodes has variability across BN and BED diagnostic groups. Loss of control (LOC) continues to be a core feature of binge eating. Negative affect is the most widely reported antecedent. Strikingly, little is known about binge episodes among individuals with anorexia nervosa-binge/purge subtype. DISCUSSION Available empirical evidence supports the current DSM duration and LOC attributes of a binge episode in BN and BED. However, a more controversial issues is the extent to which size is important in the definition of a binge episode (e.g., subjective vs. objective episodes) across diagnostic categories and the extent to which binge size informs prognosis, treatment, and clinical outcomes. Further study of binge eating attributes in AN is needed.
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Affiliation(s)
- Barbara E Wolfe
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, Massachusetts 02467, USA.
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18
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Soh NLW, Touyz S, Dobbins T, Surgenor L, Clarke S, Kohn M, Lee EL, Leow V, Rieger E, Ung KEK, Walter G. Cross-cultural differences in the macronutrient intakes of women with anorexia nervosa in Australia and Singapore. EUROPEAN EATING DISORDERS REVIEW 2008; 16:427-35. [PMID: 18567064 DOI: 10.1002/erv.876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM To compare the macronutrient intakes of women with and without anorexia nervosa (AN) across cultures. METHOD Participants were women with AN (n = 39) and without AN (n = 89) of North European and East Asian backgrounds recruited in Australia and Singapore. Energy and the percentage energy contributed by protein (%protein), fat (%fat) and carbohydrate (%CHO) were assessed from participant's diet histories and analysed in terms of cultural group, acculturation, socio-economic status (SES) and education level. RESULTS AN status was associated with lower energy and higher %CHO. Greater %protein was associated with greater acculturation to Western culture and lower SES, but not AN. Greater %fat was associated with lower SES and lower acculturation in women with AN, but with higher acculturation in controls. Greater %CHO was also associated with higher SES. CONCLUSION The findings may represent Western diets' higher protein and fat contents, 'Western' knowledge of weight-loss diets, and affordability of low fat foods.
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Affiliation(s)
- Nerissa Li-Wey Soh
- Child and Adolescent Mental Health Services, Northern Sydney Central Coast Area Health Service, New South Wales, Australia.
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19
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Schebendach JE, Mayer LE, Devlin MJ, Attia E, Contento IR, Wolf RL, Walsh BT. Dietary energy density and diet variety as predictors of outcome in anorexia nervosa. Am J Clin Nutr 2008; 87:810-6. [PMID: 18400701 DOI: 10.1093/ajcn/87.4.810] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric illness associated with significant morbidity and mortality. Successful treatment results in weight restoration, but recidivism is common, and the rate of relapse is estimated to be as high as 50%. Maintenance of a healthy diet is central to the recovery process, but the relation between diet and relapse has not been investigated in AN patients. OBJECTIVE The objective of the study was to determine whether diet energy density and diet variety in recently weight-restored women with AN predict outcome. DESIGN After gaining weight to a body mass index (BMI; in kg/m(2)) of > or = 20, 47 hospitalized women completed 4-d food records, from which a mean diet energy density score (DEDS) and a mean diet variety score (DVS) were calculated. Outcome was determined at study end by using modified Morgan-Russell criteria, and it was dichotomized as "treatment success" or "treatment failure." Data were analyzed by using Student's t test. A logistic regression model was constructed to evaluate the effects of DEDS, DVS, and caloric intake on outcome. RESULTS Groups did not differ significantly in mean measures of age, admission and weight-restored BMI, or caloric intake. However, DEDS and DVS were significantly higher in the success group than in the failure group. The success and failure groups were followed for a mean of 240 and 170 d, respectively. In the logistic regression model, DEDS (P = 0.016) and DVS (P = 0.048) but not caloric intake (P = 0.585) significantly predicted outcome. CONCLUSION In recently weight-restored women with AN, lower DEDS and DVS but not caloric intake were associated with poor outcome.
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Affiliation(s)
- Janet E Schebendach
- Eating Disorders Research Unit, New York State Psychiatric Institute, Columbia College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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20
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Abstract
Energy deprivation and malnutrition are often thought to be key factors in the maintenance of bulimia nervosa (BN). Our review shows that it is unclear how much energy is actually available to BN patients' metabolism because the contribution of food consumed during binge eating is generally neglected. Also, there is little evidence for another key hypothesis that binge-eating episodes are triggered by carbohydrate craving. This study examined energy consumption and macronutrient composition of meals and binge-eating episodes in food diaries. Forty female BN patients, 40 female panic disorder (PD) patients, and 40 healthy women recorded their food intake while in their natural environment during two consecutive days. We did not find the expected evidence for chronic energy deprivation and malnutrition in BN patients. Also, there was no evidence that carbohydrate craving drives binge eating. The implications for models of BN and for treatments targeting eating behavior are discussed.
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Affiliation(s)
- Georg W Alpers
- Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians Universität Würzburg, Marcusstrasse 9-11, Wuerzburg D-97070, Germany.
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21
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Alvarenga MS, Negrão AB, Philippi ST. Nutritional aspects of eating episodes followed by vomiting in Brazilian patients with bulimia nervosa. Eat Weight Disord 2003; 8:150-6. [PMID: 12880193 DOI: 10.1007/bf03325005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The clinical aspects of bulimia nervosa (BN) are similar in countries with different sociocultural backgrounds, but less is known about dietary composition in patients from developing countries. Little is also known about the role that nutritional aspects may play in behaviours aimed at counteracting the effects of binge eating. OBJECTIVES To describe the daily energy intake and eating behaviour of BN patients in Brazil and compare the dietary patterns of the patients who terminated eating episodes by vomiting and those patients who did not. METHODS Thirty patients from an eating disorders programme in a university-affiliated hospital completed a 14-day dietetic diary; the data were analysed using nutritional software. RESULTS Mean age and BMI of the patients were respectively 27.2 +/- 9.6 years and 25.5 +/- 6.7 Kg/m2. The patients in the vomiting subgroup ate more irregularly and consumed a more variable number of meals per day than those in the non-vomiting subgroup. The daily energy intake of the patients as a whole was 2,202 kcal, with a macronutrient composition of 53% carbohydrates, 31% fats and 17% proteins. The mean energy intake of the eating episodes followed by vomiting was 1,331 kcal with a macronutrient profile of 51% carbohydrates, 36% fat and 14% protein. Intake and eating patterns were characterised by between- and within- individual variability, and so no significant differences were found in the subgroup comparisons. Foods with a high energy density were preferred during the eating episodes followed by vomiting. CONCLUSIONS The results indicate that patients who vomit have a more irregular and variable eating pattern than those who do not vomit, but their daily nutrient content is comparable.
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Affiliation(s)
- M S Alvarenga
- Eating Disorders Program, Psychiatric Institute and Department, University of São Paulo, Brazil.
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22
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Alvarenga M, Larino MA. Terapia nutricional na anorexia e bulimia nervosas. REVISTA BRASILEIRA DE PSIQUIATRIA 2002. [DOI: 10.1590/s1516-44462002000700009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A alimentação e a dieta têm um importante papel no desenvolvimento e manutenção dos transtornos alimentares. Portanto, devem ser levados em consideração nos programas de tratamento dessas condições clínicas. Pacientes com transtornos alimentares apresentam importantes restrições dietéticas, padrões alimentares inadequados e hábitos errôneos devido a uma série de falsos mitos e crenças e a uma sensação de incompetência para lidar com o alimento. Tais alterações podem levar a mudanças em seu estado nutricional, que necessita de cuidados dietéticos específicos, como reabilitação nutricional e orientação sobre dieta adequada. Além disto, o aconselhamento nutricional é necessário para esclarecer e desmistificar crenças inadequadas e para estabelecer uma adequada relação com o alimento.
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Affenito SG, Dohm FA, Crawford PB, Daniels SR, Striegel-Moore RH. Macronutrient intake in anorexia nervosa: The National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr 2002; 141:701-5. [PMID: 12410201 DOI: 10.1067/mpd.2002.129840] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the macronutrient intake of females with or without a history of anorexia nervosa (AN) at three times: two years and one year before the onset of AN, and during the first year of the illness. STUDY DESIGN Prospective cohort study with 3-day food intake records collected over 10 years. Subjects were 154 white females (aged 9 or 10 years at study entry), of whom 14 had AN and 140 were healthy females matched for age at study entry and parental education. RESULTS Compared with the healthy girls, girls with AN reported significantly lower total energy intake and fat intake during the first year of the illness; the lower total energy intake was evident already at the 1-year (but not the 2-year) pre-onset assessment. CONCLUSIONS To identify AN early on, health practitioners caring for adolescent girls should inquire about food intake and reluctance to eat certain foods, especially those containing fat.
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Affiliation(s)
- Sandra G Affenito
- Department of Nutrition and Family Studies, Saint Joseph College, West Hartford, Connecticut 06457, USA
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24
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Hadigan CM, Anderson EJ, Miller KK, Hubbard JL, Herzog DB, Klibanski A, Grinspoon SK. Assessment of macronutrient and micronutrient intake in women with anorexia nervosa. Int J Eat Disord 2000; 28:284-92. [PMID: 10942914 DOI: 10.1002/1098-108x(200011)28:3<284::aid-eat5>3.0.co;2-g] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the accuracy of diet history compared to observed food intake in the nutritional assessment of women with anorexia nervosa (AN) and healthy age-matched controls. METHOD One-month diet history was compared to 1-day observed food intake in 30 women with AN and 28 control subjects. RESULTS Reported intake by diet history was similar to observed intake for macronutrient composition and fat intake for patients with AN. Reported energy intake was higher than observed intake (1,602 +/- 200 kcal vs. 1,289 +/- 150 kcal, p <.05), but was in agreement with predicted energy expenditure by the Harris-Benedict equation (1,594 +/- 18 kcal, p =.97) in patients with AN. Micronutrient intake by diet history was highly correlated with observed intake in patients with AN. More than one half of the patients with AN failed to meet the recommended dietary allowance (RDA) for vitamin D, calcium, folate, vitamin B12, zinc, magnesium, and copper when assessed by diet history. In contrast to patients with AN, diet history did not correlate with observed intake of energy, macronutrients, or most micronutrients among the controls. DISCUSSION Diet history is an accurate tool to assess fat intake and macronutrient composition in patients with AN and demonstrates significant micronutrient deficiencies in this population. The agreement between total energy intake and predicted energy expenditure supports the overall utility of the diet history in the nutritional assessment of patients with AN.
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Affiliation(s)
- C M Hadigan
- Combined Program in Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Guertin TL. Eating behavior of bulimics, self-identified binge eaters, and non-eating-disordered individuals: what differentiates these populations? Clin Psychol Rev 1999; 19:1-23. [PMID: 9987581 DOI: 10.1016/s0272-7358(98)00017-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This article reviews and critiques the eating behavior literature comparing the binge and non-binge-eating episodes of three populations of normal-weight women: bulimics, self-identified binge eaters, and non-eating-disordered women. The specific behaviors evaluated are number of calories consumed during different types of eating episodes, frequency of binge eating, number of eating episodes, rate of food consumption, the macronutrient composition of the food ingested, and context and duration of eating. Differences in these populations' eating behavior are analyzed in terms of their theoretical contribution. It is concluded that differences in the observed behavior of these groups are consistent with restraint theory, purge opportunity, and the forbidden foods hypothesis. Conversely, results do not support carbohydrate craving theory or a deficit in the satiety mechanisms of bulimics. Suggestions for future research are presented.
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Affiliation(s)
- T L Guertin
- Purdue University, West Lafayette, IN 47907, USA.
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van der Ster Wallin G, Hambraeus L. An anthropometrical and biochemical assessment of nutritional status in eating disordered patients: Is there a problem of interpretation? Nutr Res 1996. [DOI: 10.1016/0271-5317(96)00114-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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