A Scoping Review on the Association between Night Eating Syndrome and Physical Health, Health-Related Quality of Life, Sleep and Weight Status in Adults

Night eating and night eating syndrome: associations with dysfunctional eating behaviors, mental health and quality-of-life measures in Australian adults

PURPOSE

The association of night eating (NE) and NE syndrome (NES) with dysfunctional eating behaviors, mental health and quality-of-life outcomes has been little explored in the general population. The objective of this study was to explore this for dysfunctional eating behaviors: binge-eating, use of purging, dietary restriction, use of medication to control weight; mental health: anxiety/depression; and quality-of-life outcomes: mental and physical health-related quality of life (M/PHRQoL). NE captured whether in the past 3 months, the respondents had any episodes of waking from sleep and eating, or episodes of eating a very large amount of food after evening meal excluding any such events at social gatherings or travelling overseas on a night flight or because of work shifts. NES was defined by at least weekly episodes of NE with 'a lot' of distress.

METHODS

In 2017, 2977 adults from randomly selected households in South Australia were interviewed. Analyses for bivariate association were conducted using weighted tetrachoric and weighted polychoric correlations, and ordinal and binary logistic models, to determine the association between current (3 months) NE or NES as an outcome, and binge-eating, use of purging, dietary restriction, use of medication to control weight, anxiety/depression, mental and physical health-related quality of life (M/PHRQoL) as predictors after controlling for age, sex, and body weight. All analyses adjusted for design effect by stratified cluster sampling.

RESULTS

Ordinal logistic regression found significantly higher odds of episodes of NE with binge-eating (OR = 1.756, 95% CI 1.527-2.020, p < 0.001), and significantly lower odds with increased MHRQoL (OR = 0.948, 95% 0.921-0.975, p < 0.001) and increased PHRQoL (OR = 0.976, 95% CI 0.966-0.986, p < 0.001). Binary logistic regression found significantly higher odds of NES with binge-eating (OR = 2.62, p < 0.001), and restrictive dieting (OR = 2.491, 95% CI 1.647-3.769, p < 0.01), and significantly lower odds with MHRQoL (OR = 0.913, 95% CI 0.879-0.948, p < 0.001).

CONCLUSIONS

Those with a history of binge-eating have higher likelihood of having both NE and NES which are also increased for the former in those with poorer MHRQoL and PHRQoL, and for the latter in only those with poorer MHRQoL. Revisions of diagnostic schemes may consider these findings in the context of delineation of boundaries between eating disorder syndromes.

LEVELS OF EVIDENCE

Multivariate binary logistic regression analyses found there were significantly higher odds of having night eating syndrome in association with binge eating and restrictive dieting and significantly lower odds of night eating syndrome in association with increases in MHRQoL. These results support the Muscatello et al. (Aust N Z J Psychiatry 56:120-1362022, 2022) review noting associations and overlap between night eating syndrome and other eating disorders characterized by recurrent binge-eating, and the reported associations with disorders of restrictive eating. As both night eating and binge-eating are symptoms of over or excessive eating this was not unexpected. However, the findings at a diagnostic level in this study did also support research that has found overlap between night eating syndrome and disorders characterized by restrictive eating and/or purging behaviors. By "at a diagnostic level" what we meant was when at a level associated with marked distress, as the DSM requires either functional impairment or psychological distress to be present as a defining feature of any mental health disorder and distress is a defining feature of NES (American Psychiatric Association 2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, American Psychiatric Publishing Inc.). MHRQoL rather than PHRQoL was associated with night eating syndrome. More research is required to confirm this result and it does not negate the clinical importance of consideration of physical health status of people with night eating syndrome (Muscatello et al. Aust N Z J Psychiatry 56:120-136, 2022; Sakthivel et al. Eat Weight Disorders-Stud Anorexia Bulimia Obes 28:77, 2023). This study did not find that those who have perceived subjective anxiety/depression have significantly higher odds of NE as well as NES. This may have been because the present study did not have an assessment of depression or anxiety using a validated instrument, but rather a broad self-reported experience of current perceived anxiety and/or depression. Other studies have been also more often conduced in clinical populations which may be expected to have higher rates of mental health comorbidities (Muscatello et al. Aust N Z J Psychiatry 56:120-136, 2022) than this general population sample.

PUBLIC SIGNIFICANCE STATEMENT

To our knowledge this is the first study in a representative adult general population examining the relationships between night eating (NE), NE syndrome (NES) and binge eating, purging, strict dieting and general anxiety or general depression. Those with a history of binge eating and having poorer MHRQoL and PHRQoL have higher likelihoods of experiencing NE. The same associations of these factors except for that of PHRQoL were found with NES. Revisions of diagnostic schemes may consider these findings in the context of delineation of boundaries between eating disorder syndromes. As the nature of overeating is defined more broadly in NES than in other eating disorders it is important to explore all forms of overeating when undertaking estimates of the population prevalence and burden of eating disorder.

Investigating the prevalence of probable night eating syndrome among preclinical medical students and the mediating role of impulsivity in its relationship with chronotype

The aim of the current study was to determine the prevalence of night eating syndrome (NES) among preclinical medical students. All participants were asked to complete a socio-demographic form, Night Eating Questionnaire (NEQ), Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales (PHQ-SADS), and the Adult Attention Deficit Hyperactivity Disorder Self-report Scale (ASRS). The participants were categorised according to their NEQ scores, and statistical analyses were carried out between the groups. The mean NEQ score of the participants was 16.31 ± 5.48, and 8.8% were diagnosed with probable NES. Those with probable NES had higher MEQ, PSQI, BIS-11, PHQ-15, GAD-7, PHQ-9, ASRS-A and ASRS-B scores. A moderate positive association was identified between the NEQ score and PSQI and PHQ-9. ASRS-B and BIS-11 were found to have a mediating role in the relationship between NES and MEQ. The findings of our study suggest that the prevalence of probable NES in preclinical medical students is higher than the general population, and that NES symptomatology is associated with many psychiatric clinical entities in addition to depressive and sleep disorders included in the diagnostic criteria.

The current clinical approach to feeding and eating disorders aimed to increase personalization of management

Feeding and eating disorders (FEDs) are a heterogeneous grouping of disorders at the mind-body interface, with typical onset from childhood into emerging adulthood. They occur along a spectrum of disordered eating and compensatory weight management behaviors, and from low to high body weight. Psychiatric comorbidities are the norm. In contrast to other major psychiatric disorders, first-line treatments for FEDs are mainly psychological and/or nutrition-focused, with medications playing a minor adjunctive role. Patients, carers and clinicians all have identified personalization of treatment as a priority. Yet, for all FEDs, the evidence base supporting this personalization is limited. Importantly, disordered eating and related behaviors can have serious physical consequences and may put the patient's life at risk. In these cases, immediate safety and risk management considerations may at least for a period need to be prioritized over other efforts at personalization of care. This paper systematically reviews several key domains that may be relevant to the characterization of the individual patient with a FED aimed at personalization of management. These domains include symptom profile, clinical subtypes, severity, clinical staging, physical complications and consequences, antecedent and concomitant psychiatric conditions, social functioning and quality of life, neurocognition, social cognition and emotion, dysfunctional cognitive schemata, personality traits, family history, early environmental exposures, recent environmental exposures, stigma, and protective factors. Where possible, validated assessment measures for use in clinical practice are identified. The limitations of the current evidence are pointed out, and possible directions for future research are highlighted. These also include novel and emerging approaches aimed at providing more fine-grained and sophisticated ways to personalize treatment of FEDs, such as those that utilize neurobiological markers. We additionally outline remote measurement technologies designed to delineate patients' illness and recovery trajectories and facilitate development of novel intervention approaches.

Associations of night eating with body mass index and waist circumference among health sciences students living in a post-conflict region

BACKGROUND

Stressors associated with the ongoing ethnic tensions may be the drivers of more frequent night eating, and subsequently, a higher body mass index.

AIM

To examine the association of night eating with body mass index (BMI) and waist circumference among health sciences students in Northern Kosovo.

METHODS

A cross-sectional study was carried out at the University of Prishtina in Kosovska Mitrovica from November 2018 to March 2019. Participants completed a socio-demographic questionnaire, the Night Eating Questionnaire (NEQ), the Beck's Anxiety Inventory (BAI) and the Perceived Stress Scale (PSS). Body weight, height, and waist circumference were measured by the research team.

RESULTS

The study sample consisted of 534 students. The night eating score was 14.4 ± 4.5 out of 52 (prevalence of night eating syndrome was 3.0%). Overall, the average BMI was 23.7 ± 4.5 kg/m2 (27.2% of students were overweight and 7.5% were obese). Moderate level of stress as measured by the PSS was observed 61.8% and high level of stress was recorded among 5.8%. Also, 9.2% students reported moderate BAI score and 6.0% students reported severe BAI score. After adjustment for socio-demographic characteristics, health behaviors, sleep, stress and anxiety levels, no association of night eating with BMI and waist circumference was observed.

CONCLUSION

These findings showed that there is an absence of the association between night eating, BMI and waist circumference among students who live in a post-conflict setting. There may be other factors that mediate the relationship between food intake at night and body mass index.

Taking Steps Toward a Consensus on Night Eating Syndrome Diagnostic Criteria

BACKGROUND

Night eating syndrome (NES) is included in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, as an example of "Other Specified Feeding or Eating Disorders" with minimal guidance about how to define and operationalize NES. The literature suggests that research practices vary widely, making it difficult to draw conclusions about the public health burden of, effective interventions for, or policy implications relevant to NES. This Forum article seeks to illustrate the lack of definitional agreement to underscore the need for a consensus about NES diagnostic criteria, and to propose steps toward closing knowledge gaps and achieving consensus.

METHOD

We searched PubMed and PsycINFO titles and abstracts, using "NES" as the search term, for research articles published in English between January 1, 2013 to August 12, 2024 with sample sizes of NES > 10 and ages 18 or older. Eligible articles were coded for NES definitions and assessment method used to diagnose participants with NES and for information about comorbidity of NES and any other eating disorder (ED).

RESULTS

Seventy-three articles met inclusion criteria. Most commonly, NES was diagnosed using a diagnostic criteria set (35/73) or a symptom score threshold (34/73); among the former, only eight studies employed DSM-5 NES criteria. Thirteen studies, varying widely in methodology, examined comorbidity with other EDs, most commonly binge-eating disorder where comorbidity was high.

CONCLUSION

Heterogeneity of definitions and assessment impede progress in the study of NES. We propose strategies for developing a consensus definition and addressing research gaps.

Night Eating Syndrome Among University Students in Bangladesh: Investigation of Prevalence and Associated Factors

OBJECTIVE

Night eating syndrome (NES) has been associated with psychological issues and academic performance among university students in several countries, yet research on NES in Bangladesh remains limited. Therefore, the purpose of the study was to examine the prevalence and factors associated with NES among university students in the country.

METHODS

This cross-sectional study included 500 students from five public universities in Bangladesh. A validated 14-item night eating questionnaire was used to assess NES as the outcome variable. Demographic factors, depressive symptoms measured via the Patient Health Questionnaire (PHQ-9), and internet addiction levels measured via Orman's Internet Addiction Survey (OIAS) were explored as predictor variables. A multiple binary logistic regression model was fitted to identify the correlation of NES and its associated factors, with results presented as adjusted odds ratio (AOR) and level of significance set at p values < 0.05.

RESULTS

The prevalence of NES among participants was 16.6% (mean age = 21.6 years, 53.6% male). Adjusted binary logistic regression revealed that male participants (AOR = 2.03, 95% CI = 1.09-3.74, p = 0.024), smoking (AOR = 1.92, 95% CI = 1.02-4.44, p = 0.044), depressive symptoms (AOR = 2.17, 95% CI = 1.26-3.72, p = 0.005), and severe internet addiction (AOR = 2.69, 95% CI = 1.28-5.62, p = 0.009) were significantly associated with increased odds of experiencing NES.

CONCLUSIONS

These findings underscore the need for heightened healthy eating awareness programs along with targeted mental health interventions with students attending Bangladeshi universities. Further research that explores longitudinal patterns of NES and the risk factors addressed in this study is warranted to better understand and inform the development of future interventions to benefit the Bangladeshi university student population.

The Bidirectional Association between Internet Use, Sleep Quality and Eating Behavior: A Cross-Sectional Study in Northwestern Thrace Region in Türkiye

OBJECTIVE

This study aimed to examine the complex associations between Internet addiction, sleep disturbances, and disordered eating behaviors.

METHODS

This cross-sectional study included 646 students from 17 high schools in Edirne, Türkiye between December 2023 and May 2024. A face-to-face questionnaire was administered to assess demographic characteristics, Internet addiction (YIAT), sleep quality (PSQI), and eating behavior (TFEQ-R21).

RESULTS

In total, 644 students completed the study. The prevalence of Internet addiction among adolescents was 16.3%, with a similar prevalence among male and female adolescents. The prevalence of poor sleep quality among adolescents was 6.4%, and this trend was more pronounced in male adolescents, with an incidence of 13.0%. A weak positive correlation was observed between Internet addiction and disordered eating behavior. Additionally, a moderate positive correlation was observed between poor sleep quality and disordered eating behavior. Gender, maternal education level, Internet addiction, and poor sleep quality were significant predictors of eating disorders in adolescents.

CONCLUSION

The findings of our study are of significant value in providing insights into the development of programs designed to prevent undesired eating behaviors.

Circadian disruption, clock genes, and metabolic health

A growing body of research has identified circadian-rhythm disruption as a risk factor for metabolic health. However, the underlying biological basis remains complex, and complete molecular mechanisms are unknown. There is emerging evidence from animal and human research to suggest that the expression of core circadian genes, such as circadian locomotor output cycles kaput gene (CLOCK), brain and muscle ARNT-Like 1 gene (BMAL1), period (PER), and cyptochrome (CRY), and the consequent expression of hundreds of circadian output genes are integral to the regulation of cellular metabolism. These circadian mechanisms represent potential pathophysiological pathways linking circadian disruption to adverse metabolic health outcomes, including obesity, metabolic syndrome, and type 2 diabetes. Here, we aim to summarize select evidence from in vivo animal models and compare these results with epidemiologic research findings to advance understanding of existing foundational evidence and potential mechanistic links between circadian disruption and altered clock gene expression contributions to metabolic health-related pathologies. Findings have important implications for the treatment, prevention, and control of metabolic pathologies underlying leading causes of death and disability, including diabetes, cardiovascular disease, and cancer.

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study

BACKGROUND

Performing bariatric surgery on patients with a BMI of over 50 kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China.

MATERIALS AND METHODS

A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted.

RESULTS

Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44 702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50 kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly.

CONCLUSION

Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

Beat the Clock: Assessment of Night Eating Syndrome and Circadian Rhythm in a Sample of Greek Adults

The night eating syndrome (NES) is characterized by excessive food intake during the evening and night hours, with 25% of the daily intake being consumed post-dinner, paired with ep-isodes of nocturnal food intake, at a frequency of more than twice weekly. The NES has been associated with a misaligned circadian rhythm related to a delay in overall food intake, increased energy and fat consumption. The present cross-sectional study aimed to assess NES in a Greek population and evaluate possible links between NES and chronotype. NES was assessed using the Night Eating Questionnaire (NEQ), and circadian rhythm, sleep and mood were evaluated with the Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire. A total of 533 adults participated in the study. A relatively high prevalence of NES was revealed, with more than 8.1% (NEQ ≥ 30) of the participants reporting experiencing NES symptoms, depending on the NEQ threshold used. Most participants had the intermediate chronotype. NEQ score was positively associated with the morning chronotype, and SCRAM was negatively related to "Good Sleep". Each point increment in the depression score was associated with 6% higher odds of NES. The early identification of NES gains importance in clinical practice, in a collective effort aiming to reduce NES symptomatology and its detrimental health effects.

Association of participants who screened positive for night eating syndrome with physical health, sleep problems, and weight status in an Australian adult population

BACKGROUND

Night eating syndrome (NES) is a unique eating disorder characterised by evening hyperphagia and nocturnal ingestions which cause significant distress and/or impairment in functioning. Despite the growing literature, NES remains poorly understood and under diagnosed. As such, this study aims to compare the prevalence of physical health conditions in participants with NES when compared to participants without an eating disorder (ED) and participants with other eating disorders (including anorexia nervosa (AN), binge eating disorder (BED) and bulimia nervosa (BN)) in a general population Australian sample of adults.

METHODS

The data for this study were obtained from the 2017 Health Omnibus Survey (HOS) a multi-stage, cross-sectional survey, conducted by Harrison Research in South Australia. This current study focused on 2547 participants over 18 years of age and specific questions from this population survey including those related to participant demographics and health.

RESULTS

This study identified that participants who screened positive for night eating syndrome (spNES) when compared to participants with other eating disorders (ED) or no ED diagnosis, were significantly more likely to have an increased age, be female, have lower levels of education and have lower household income. Additionally, the spNES group was significantly associated with sleep apnoea (p = 0.031), insomnia or other sleep problems (p < 0.0001), increased BMI (p < 0.0001), increased levels of pain/discomfort and lower physical health-related quality of life. Hypertension, hypercholesterolemia, and diabetes were not significantly associated with the spNES group or the "other ED" group which included participants with AN, BED, BN.

CONCLUSIONS

Several physical health problems were found to be significantly associated with the spNES group including sleep problems, increased BMI, increased levels of pain and lower self-reported physical health-related quality of life. Consequently, future research exploring the complex interaction between NES and these medical conditions may provide further insight into the diagnosis, screening tools and management of NES. Additionally, this study highlights the need for future studies which use larger population-based samples.

LEVEL OF EVIDENCE

Level III. Evidence obtained from well-designed cohort or case-control analytic studies.