Characterization of refeeding protocols for under 18 years old hospitalized patients with anorexia nervosa: A systematic review

PURPOSE

To characterize and compare, through descriptive analysis, existing refeeding protocols for under 18 years old hospitalized patients with anorexia nervosa (AN).

METHODS

This is a systematic review of PubMed, Cochrane, SciELO, Lilacs and BVS databases, without search period restriction. Studies were selected in accordance with pre-defined eligibility criteria and according to the Population, Intervention, Comparator, Outcome and Study Design (PICOS).

RESULTS

Twenty articles out of 412 found complied with PICOS eligibility criteria and were included in the final review. Most of the studies were observational or retrospective and 80% were published in the last decade. Large variability in relation to sample size, refeeding protocols and length of stay were observed between studies.

CONCLUSION

All included studies had several methodological limitations and heterogeneous designs, making it difficult to establish conclusive guidelines regarding the most adequate and effective refeeding protocol for under 18 years old hospitalized patients with AN. Prospective trials are necessary to straight compare standard refeeding protocols for this population.

Is binge eating associated with poor weight loss outcomes in people with a high body weight? A systematic review with meta-analyses

OBJECTIVES

This systematic review aimed to compare the weight change in people with or without binge eating who underwent various weight loss treatments.

METHODS

We searched for studies in PubMed, American Psychological Association, and Embase from inception to January 2022. The studies selected included assessment of binge eating and body weight before and after weight loss treatment in people of any age. The meta-analyses were conducted using Comprehensive Meta-Analysis (CMA). We used Egger's regression test, the funnel plot, and the Trim and Fill test to assess the risk of publication bias.

RESULTS

Thirty-four studies were included in the systematic review, with a total of 10.184 participants. The included studies were divided into three categories according to types of weight loss treatments, namely, (1) bariatric surgery; (2) pharmacotherapy isolated or combined with behavioral interventions; and (3) behavioral and/or nutritional interventions. The meta-analyses showed no significant difference in weight loss between people with or without binge eating engaged in weight loss treatments, with an overall effect size of - 0.117 (95% CI - 0.405 to 0.171; P = 0.426).

CONCLUSIONS

Our findings showed no difference in weight loss in people with or without pre-treatment binge eating who received various weight loss treatments. Weight loss treatments should not be withheld on the basis that they will not be effective in people with pre-treatment binge eating, albeit their safety and longer term impacts are unclear.

LEVEL OF EVIDENCE

Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.

Craving for carbs: food craving and disordered eating in low-carb dieters and its association with intermittent fasting

Studies point to positive outcomes in a diet with reduction of carbohydrates and that the associated practice of intermittent fasting (IF) might increase weight loss. Although dieting might be related to disordered eating, little evidence is available about the role of restrictive carbohydrates diets on disordered eating. This study aimed to explore if doing low-carb (LC) diets was related to disordered eating and if IF would increase these symptoms. The sample comprised university students (n = 682), with a mean age of 22 years old and average BMI of 23.6 kg/m2 (SD = 4.3). Twenty-seven percent (n = 188) of respondents reported doing LC diet in the last three months. Of those, 31% (n = 58) reported doing LC diet combined with periods of IF. Mean scores were compared using parametric tests, and effects size and correlations between variables were calculated. Dieters showed higher levels of binge eating, food cravings, cognitive restraint, cognitive restraint toward carbohydrates when compared to non-dieters. The association of LC and IF was related to an increase in disordered eating, especially binge eating and food cravings, specifically 'Lack of control', 'Thoughts or preoccupation with food,' and 'Guilt from cravings and/or for giving in to them'. These results provide evidence that restrictive carbohydrate diets and IF may increase cognitive restraint and, consequently, food cravings.Level III: Evidence obtained from cohort or case-control analytic studies.

The manifestation of emotional distress: Correlations between self-compassion and self-mutilation in Brazilian women with disordered eating behavior

BACKGROUND

The functions or motives for self-mutilation behavior (SMB) in Eating Disorders are diverse, and the relationship with self-compassion is unclear. Objectives This study aims to evaluate the relationship between SMB and Self-compassion.

METHODS

251 women aged 25.8 years (SD=5.94) and 73.54kg (SD=19.33) completed measures for Binge Eating (BE), Self-Compassion, and SMB.

RESULTS

In the total evaluated, 83.27% (n=209) presented BE and 94.02% (n=236) presented at least 1 type of SMB. In comparison between groups, the BE-purging one's reached higher values for BE, and less self-compassion, while BE group presented higher self-compassion values. For the BE-purging group, the behaviors "Cut or carving skin", "Hitting self", "Pulling out one's hair", "Burning skin" and "Picking areas of the body to the point of drawing blood" showed inverse correlations with self-compassion.

CONCLUSION

There is an inverse correlation between self-compassion and SMB, and SMB seems to have different functions between BE-purging group vs. BE group.

Cognitive restraint directed at carbohydrates in individuals on low-carb diet with binge eating: the role of guilt about food cravings

OBJECTIVE

To evaluate whether the carbohydrate-restricted diet leads to higher levels of food cravings in individuals with binge eating.

METHODS

A total of 146 individuals with binge eating participated in the Low-Carb Diet Group (n=48) and Control Group (n=98). The Binge Eating Scale, Hay's questionnaire, Food Cravings Questionnaire - Trait and State, Cognitive restraint subscale and its adapted version for the cognitive restraint toward carbohydrates, were used as measures. Parametric tests were used for comparison between groups (Student's t test), and Pearson's correlation test to verify correlations between variables of interest.

RESULTS

No differences were found between groups with and without diet concerning the level of binge eating or food craving total score. The differences found were the higher levels of cognitive restraint (p=0.01), cognitive restraint for carbohydrates (p=0.01) and subscales of 'guilt about food craving' (p=0.04) in the Low-Carb Diet Group.

CONCLUSION

Individuals with binge eating and a history of low-carb diet have greater cognitive restraint toward carbohydrates and association with altered eating attitudes (guilt about food craving).

Existe uma relação entre autocompaixão e adição à comida em mulheres com comportamentos alimentares disfuncionais?

RESUMO Objetivo: Verificar a relação entre autocompaixão e adição à comida em mulheres com comportamento alimentar disfuncional. Métodos: Mulheres de um grupo de apoio completaram as escalas de compulsão alimentar, restrição cognitiva, autocompaixão, Escala de Adição à Comida de Yale versão modificada 2.0 (YFAS 2.0) e questionário de Hay para práticas compensatórias. Foram identificados a prevalência de adição à comida e sintomas segundo a YFAS. Para serem incluídas, as participantes deveriam atingir pontuação para compulsão alimentar e, para análises, foram divididas em função da presença de práticas compensatórias. O grupo foi analisado por meio de testes de correlação de Pearson entre variáveis de interesse, e os grupos bulímico e compulsivo foram comparados com teste t de Student (p < 0,05; software JASP). Resultados: Participaram do estudo 190 mulheres. De acordo com a YFAS, 95,3% (n = 181) tinham adição à comida, e os escores da escala apresentaram correlação negativa com a autocompaixão e com a compulsão alimentar (p = 0,014 em ambas). Os níveis de autocompaixão apresentaram correlação negativa com as questões #3, #5, #6, #8 e #9 da YFAS (p < 0,05). Conclusões: Este estudo traz dados para a discussão da necessidade de analisar como a autocrítica atrelada ao sofrimento de quem apresenta comportamento alimentar disfuncional afeta o preenchimento da escala, trazendo identificação com a noção de vício, já que esta é culturalmente aceita.

Eating behavior, non-food substance consumption and negative urgency in women

Objective

To evaluate aspects of eating behavior, presence of non-food substance consumption and negative urgency in women from an on-line support group for eating disorders.

Methods

Participants (n=147) completed questionnaires for binge eating assessment, Intuitive Eating, negative urgency, cognitive restraint and a question of non-food substance consumption. Participants were separated according to criteria for bulimic symptoms and compulsive symptoms.

Results

The consumption of non-food substances was 4.8% (n=7). The Bulimic Group (n=61) showed higher values for binge eating (p=0.01), cognitive restraint (p=0.01) and negative urgency (p=0.01) compared with the Compulsive Group (n=86). Only the Compulsive Group showed an inverse correlation between scores for binge eating and Intuitive Eating (p=0.01). In both groups, binge eating was inversely correlated with the subscale of body-food choice congruence of Intuitive Eating scale. As expected, the Bulimic Group reached higher values for measures of disordered behaviors such as cognitive restraint and binge eating, and lower scores for Intuitive Eating.

Conclusion

The aspects of Intuitive Eating are inversely associated with compulsive and bulimic symptoms and the correlation analyses for binge eating and negative urgency agreed with models reported in published literature about negative urgency.

Prevalência de comportamentos de risco para transtornos alimentares e uso de dieta “low-carb” em estudantes universitários

RESUMO Objetivos Identificar a presença de compulsão alimentar associada ou não a práticas compensatórias em praticantes de dieta low-carb. Métodos Foram utilizadas a Escala de Compulsão Alimentar Periódica (ECAP) e o Questionário de Hay para avaliar a frequência de compulsão alimentar e práticas compensatórias, além de um questionário de frequência do consumo de chocolate, pão e arroz. A intensidade de restrição de carboidratos foi avaliada com escala de 1 a 8 pontos. Os participantes foram divididos nos grupos (i) dieta low-carb e (ii) controle. Foram realizadas comparações entre grupos, além de correlações entre variáveis de interesse no grupo dieta (p < 0,05). Resultados Participaram 853 universitários, sendo 75,97% mulheres com média de 22,04 anos (DP = 3,33) e índice de massa corporal (IMC) com média de 23,56 kg/m2 (DP = 4,38). Do total, 214 fizeram dieta low-carb e 639 não. A prevalência de um alto escore sugestivo de compulsão alimentar sem práticas compensatórias foi de 17,94% (n = 153) e a presença de compulsão alimentar associada com compensação foi de 2,23% (n = 19). No grupo dieta, 35,05% (n = 75) também realizaram jejum intermitente. O grupo dieta atingiu maiores valores para ECAP e IMC e menores para frequência de consumo de arroz e pão francês. Ainda, os escores da ECAP se correlacionaram positivamente com o consumo de chocolate (r = + 0,14 ; p = 0,0377) e valores de IMC (r = + 0,19; p = 0,0042), enquanto a restrição de carboidratos apresentou correlação negativa com o consumo de chocolate (r = - 0,13; p = 0,041), pão francês (r = - 0,20; p = 0,0024) e arroz (r = - 0,36; p = <0,0001). Conclusões Destacam-se a alta prevalência da prática de dieta (25,09%) e os maiores níveis de compulsão alimentar neste grupo, além de menor consumo de arroz e pão francês em relação aos que não fizeram dieta.

Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty

BACKGROUND

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery, and body contouring surgery is most frequently sought by patients with BDD.

OBJECTIVES

To estimate the prevalence and severity of BDD symptoms in patients seeking abdominoplasty.

METHODS

Ninety patients of both sexes were preoperatively divided into two groups: patients with BDD symptoms (n = 51) and those without BDD symptoms (n = 39) based both on the Body Dysmorphic Disorder Examination (BDDE) and clinical assessment. Patients in the BDD group were classified as having mild to moderate or severe symptoms, according to the BDDE. Body weight and shape concerns were assessed using the Body Shape Questionnaire (BSQ).

RESULTS

The prevalence of BDD symptoms was 57%. There were significant associations between BDD symptoms and degree of body dissatisfaction, level of preoccupation with physical appearance, and avoidance behaviors. Mild to moderate and severe symptoms of BDD were present in 41% and 59% of patients, respectively, in the BDD group. It was found that the more severe the symptoms of BDD, the higher the level of concern with body weight and shape (P < .001). Patients having distorted self-perception of body shape, or distorted comparative perception of body image were respectively 3.67 or 5.93 times more likely to show more severe symptoms of BDD than those with a more accurate perception.

CONCLUSIONS

Candidates for abdominoplasty had a high prevalence of BDD symptoms, and body weight and shape concerns were associated with increased symptom severity.

Body checking and eating cognitions in Brazilian outpatients with eating disorders and non psychiatric controls

OBJECTIVE

Compare inadequate eating behaviors and their relationship to body checking in three groups: patients with anorexia nervosa (AN), patients with bulimia nervosa (BN) and a control group (C).

METHODS

Eighty three outpatients with eating disorders (ED) and 40 controls completed eating attitudes and body checking questionnaires.

RESULTS

The overall relationship between the eating attitude and body checking was statistically significant in all three groups. The worse the eating attitude, the greater the body checking behavior. However, when we look at each group individually, the relationship was only statistically significant in the AN group (r=.354, p=0.020).

DISCUSSION

The lower the desired weight and the worse the eating attitude, the more people check themselves, although in the presence of an ED the relationship between body checking and food restrictions is greater. In patients displaying the AN subgroup, body checking is also related to continued dietary control.

Cognitive Behavioral Therapies in older adults with depression and cognitive deficits: a systematic review

OBJECTIVES

The objective of this study is to investigate the effectiveness of cognitive behavioral therapies (CBTs) in improving depressive symptoms, disability, and cognition in older adults with depression and cognitive deficits.

DESIGN

It was performed a systematic search for articles published between 1994 and February 2014 in the MEDLINE/Pubmed, PsycINFO, and SCIELO. The studies should have provided information about benefits after CBTs to older adults with depression and cognitive deficits.

RESULTS

Cognitive behavioral therapy focused on problem solving is the main approach studied, having better effectiveness than supportive therapy in randomized clinical trials. Significant improvements in mood and disability were consistent, although evidence of changes in cognitive measures is controversial, less studied, and limited. Nevertheless, improvements in executive functions, processing speed, and changes in patients' perspectives of problem solving skills, such as generating alternatives and decision-making, were described. Also, it would be necessary that future studies more often evaluate cognitive status of depressed elders, as well as cognitive changes after psychotherapy. It should be emphasized that there is a lack of studies in this field, and more approaches in CBTs need to be investigated to this population.

CONCLUSION

Older adults with depression and cognitive deficits can benefit from CBTs. Improvements in mood and disability are more consistent than changes in cognition, which are little studied after CBTs. It is necessary more studies in the field, as well as, to investigate more approaches in CBTs to older adults with depression and cognitive deficits.

Body checking and obsessive-compulsive symptoms in Brazilian outpatients with eating disorders

OBJECTIVE

Compare obsessive-compulsive symptoms in patients with anorexia nervosa (AN) and bulimia nervosa (BN), and assess the association of these symptoms and body checking in each of these groups of patients.

METHODS

Eighty-five female outpatients with eating disorders (ED) completed body checking and obsessive-compulsive questionnaires.

RESULTS

Body checking was more prevalent in the BN group. Among patients with AN, the highest mean body-checking scores were found in patients with somatic obsessions related to body areas and eating rituals (p = 0.003 and 0.018, respectively).

DISCUSSION

Patients with eating disorders are believed to be included in the obsessive-compulsive spectrum, and may experience intrusive thoughts about behavior. The results of our work suggest that obsessive symptoms and body checking should be further investigated and properly managed in patients with ED.

Atitudes em relação ao corpo e à alimentação de pacientes com anorexia e bulimia nervosa

Objetivo: Avaliar como se relacionam as atitudes alimentares e corporais de pacientes com anorexia ou bulimia nervosa. Métodos: Pacientes adultas de um ambulatório especializado, com diagnóstico de anorexia (n = 48) ou bulimia nervosa (n = 58), responderam à Disordered Eating Attitude Scale (DEAS) para avaliação das atitudes alimentares e ao Body Attitude Questionnaire (BAQ) para atitudes corporais – ambos traduzidos e validados para mulheres jovens do Brasil. A correlação entre os escores da DEAS e do BAQ foi avaliada utilizando o coeficiente de Pearson. Modelos de regressão linear testaram preditores para atitudes alimentares e corporais. Resultados: Pacientes com bulimia apresentam relação com o alimento mais disfuncional – subescala 1 da DEAS (p < 0,001) e piores atitudes corporais (BAQ total e cinco fatores). Correlações entre a DEAS e BAQ foram mais fortes para a anorexia do que para bulimia e houve forte correlação (r > 0,6) para ambas apenas quando se analisou a relação com o alimento e o sentir-se gorda e entre atitudes corporais como um todo e a relação com o alimento. O escore total da DEAS foi preditor da BAQ total: cada um ponto na DEAS aumenta 0,788 na BAQ (R2 = 0,628). Conclusão: Pacientes com bulimia apresentam pior relação com o alimento e piores atitudes corporais. As atitudes corporais se correlacionaram com as atitudes alimentares, de maneira mais forte para pacientes com anorexia; atitudes alimentares mais disfuncionais predizem pior relação com o corpo para ambos os diagnósticos.

Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery. BDD is also a challenge for plastic surgeons because it is still an underdiagnosed mental disorder. The aims of this study were to prospectively investigate whether patients with mild to moderate BDD are suitable for rhinoplasty, and to assess BDD severity and patient satisfaction with the surgical outcome 1 year after the intervention. All women (n = 116) seeking rhinoplasty at a university hospital between September 2009 and August 2010 were recruited for the study and assessed for BDD. The final sample consisted of 31 patients aged 32 (standard deviation (SD), 10) years with mild to moderate BDD who underwent rhinoplasty. The participants were assessed preoperatively (baseline) and 1 year postoperatively with the Body Dysmorphic Disorder Examination (BDDE). Most patients (22/31, 71%) were of African descent. Socio-demographic variables and the extent of the nasal deformities had no effect on the severity of BDD symptoms and patient satisfaction with surgery outcome. At the 1-year postoperative follow-up, there was a significant decrease from baseline in BDDE scores and time spent by patients worrying about their appearance; 25 (25/31, 81%) patients experienced complete remission from BDD and 28 (28/31, 90%) were satisfied with the results of surgery. Rhinoplasty may be indicated in the treatment of female patients with mild to moderate BDD.

Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders

Background

Eating disorder (ED) patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship between ED and bipolar disorder (BD), the study on a broader bipolar spectrum definition has not been done in this population. We aimed to study the occurrence of bipolar spectrum (BS) and comorbidities in eating disorder patients of a tertiary service provider.

Methods

Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified were evaluated. The assessment comprised the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), clinical criteria for diagnosis of the Zurich bipolar spectrum. Mann–Whitney tests compared means of continuous variables. The association between categorical variables and the groups was described using contingency tables and analyzed using the chi-square or Fisher's exact test. The level of significance alpha was set at 5%.

Results

The results showed that 68.1% of patients had comorbidity with bipolar spectrum, and this was associated with higher family income, proportion of married people, and comorbidity with substance use. The ED with BS group showed higher rates of substance use comorbidity (40.4%) than the ED without BS group (13.6%).

Discussion

These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated, the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions. Further studies are necessary to evaluate the association of other clinical correlates and its possible causal association.

Stunkard Figure Rating Scale for Brazilian men

PURPOSE

To evaluate psychometric assessment of Stunkard Figure Rating Scale (FRS) for Brazilian male population.

METHODS

The sample was composed of a control group (94 students) and a clinical group (20 eating disordered patients). Two questionnaires were applied: the FRS and the Eating Attitudes Questionnaire-26. Weight, height, and body mass index (BMI) were collected in the control group (self-reported) and clinical group (measured). Body dissatisfaction (BD) was calculated by subtraction of ideal body (IB) from the current body (CB) score. The concurrent validity was assessed through the analysis of the correlation between the CB and BD scores and the BMI and the body weight. The discriminant validity was achieved by measurements of association between the groups studied and the scales CB, IB and BD. Reliability was assessed by the comparison of the score averages at two moments and by the intraclass coefficient correlation.

RESULTS

The questionnaire had a correlation higher than 0.67 for the measures of weight and BMI. Regarding the CB, IB and BD scores, a significant difference was not observed between the clinical and the control group. There was no difference between the scores for BD at the two moments analyzed.

CONCLUSIONS

The FRS is stable and capable of correlating with anthropometric measures. Nevertheless, for this population the questionnaire was unable to distinguish between the two groups analyzed.

Support system for decision making in the identification of risk for body dysmorphic disorder: a fuzzy model

PURPOSE

To develop a fuzzy linguistic model to quantify the level of distress of patients seeking cosmetic surgery. Body dysmorphic disorder (BDD) is a mental condition related to body image relatively common among cosmetic surgery patients; it is difficult to diagnose and is a significant cause of morbidity and mortality. Fuzzy cognitive maps are an efficient tool based on human knowledge and experience that can handle uncertainty in identifying or grading BDD symptoms and the degree of body image dissatisfaction. Individuals who seek cosmetic procedures suffer from some degree of dissatisfaction with appearance.

METHODS

A fuzzy model was developed to measure distress levels in cosmetic surgery patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostic criterion B for BDD. We studied 288 patients of both sexes seeking abdominoplasty, rhinoplasty, or rhytidoplasty in a university hospital.

RESULTS

Patient distress ranged from "none" to "severe" (range=7.5-31.6; cutoff point=18; area under the ROC curve=0.923). There was a significant agreement between the fuzzy model and DSM-IV criterion B (kappa=0.805; p<0.001).

CONCLUSION

The fuzzy model measured distress levels with good accuracy, indicating that it can be used as a screening tool in cosmetic surgery and psychiatric practice.

Effects of eating disorders on oral fungal diversity

BACKGROUND

The eating disorders anorexia and bulimia nervosa can cause several systemic and oral alterations related to poor nutrition and induced vomiting; however, the oral microflora of these patients is poorly studied.

OBJECTIVE

The aim of this study was to evaluate fungal microflora in the oral cavity of these patients by culture-dependent and culture-independent methods.

STUDY DESIGN

Oral rinse samples were cultured to assess the prevalence of Candida species, and the isolates were identified by API system. Microorganism counts were compared by the Mann-Whitney test (5%). Ribotyping, a type of molecular analysis, was performed by sequencing the D1/D2 regions of 28S rRNA.

RESULTS

Our results demonstrated that the eating disorder group showed higher oral Candida spp. prevalence with culture-dependent methods and higher species diversity with culture-independent methods.

CONCLUSIONS

Eating disorders can lead to an increased oral Candida carriage. Culture-independent identification found greater fungal diversity than culture-dependent methods.

Psychometric Evaluation of the Body Checking Cognitions Scale (BCCS) Portuguese Version

The aim of this study is evaluate the psychometric results and validity of the Brazilian Portuguese language version of the Body Checking Cognitions Scale (BCCS). Factor analysis and concurrent validity were checked on assessments from participants with and without eating disorders. The scale had good internal consistency. Factor analysis confirmed four components. Control and Eating Disorders groups were discriminated, and results correlated well with the Eating Attitudes Test and Body Shape Questionnaire. The results for the Portuguese version of the BCCS were similar to the original version, and its use is recommended for evaluation of body-checking cognitions in the Brazilian population with or without eating disorders.

O que é comportamento de risco para transtornos alimentares em adolescentes?

OBJETIVO: Caracterizar comportamento de risco para transtornos alimentares (TA) e sua frequência entre adolescentes em uma revisão da literatura nacional e internacional. MÉTODOS: Foi realizada uma busca bibliográfica por meio de uma revisão integrativa nas bases de dados PubMed (US National Library of Medicine)e Lilacs e no portal SciELO,utilizando-se os descritores relacionados à "eating disorder risk behavior". Foram selecionados artigos publicados nos últimos 10 anos, nos idiomas português, espanhol e inglês, e especificamente com adolescentes. Foram avaliados 76 artigos e analisados a nomenclatura e os instrumentos utilizados para avaliar comportamento de risco para TA e sua prevalência. RESULTADOS: Encontrou-se uma série de termos para avaliar risco para TA. A metodologia mais utilizada foi a de questionários e escalas, destacando-se o EAT-26 ou 40 e o BITE, dentre os mais frequentes; a prevalência de risco variou de 0,24% a 58,4%. CONCLUSÃO: Diferentes nomenclaturas e instrumentos são utilizados para avaliar comportamento de risco para TA entre adolescentes, com grande amplitude nos resultados de prevalência. Maior padronização de termos e metodologia de avaliação permitiriam melhor comparação entre estudos epidemiológicos em diferentes localidades.

Equivalência Semântica da versão em português do "Body Change Inventory"

Com o crescimento das pesquisas acerca dos componentes da imagem corporal, fazem-se necessários instrumentos válidos que avaliem suas dimensões. O Body Change Inventory (BCI) avalia as estratégias adotadas para modificação do corpo entre adolescentes. O objetivo deste estudo foi descrever o processo de tradução e avaliação da equivalência semântica do BCI para a língua portuguesa. O processo envolveu as etapas de (1) tradução do questionário para o idioma português; (2) retrotradução para o inglês; (3) avaliação da equivalência semântica; e, (4) análise da compreensão verbal por especialistas e jovens brasileiros. As seis subescalas que compõem o instrumento foram traduzidas para o português. Foram realizadas adaptações na linguagem a fim de tornar o instrumento adequado à realidade brasileira. As questões foram interpretadas como de fácil compreensão tanto por especialistas quanto pelos jovens. O Questionário de Mudança Corporal encontra-se traduzido e adaptado para o idioma português, sendo ainda necessária a avaliação das equivalências operacional, de mensuração e funcional.

Psychometric evaluation of the "Body Checking and Avoidance Questionnaire--BCAQ" adapted to Brazilian Portuguese

OBJECTIVE

Adapt and validate the Brazilian Portuguese version of the Body Checking and Avoidance Questionnaire (BCAQ).

METHODS

The study consisted of: translation and back translation; technical review and assessment of semantic equivalences, factor analysis and discriminant and concurrent validity in a sample of subjects with and without eating disorders.

RESULTS

The instrument was adapted and was found to be easy to understand (mean scores higher than 3.4; maximum score: 5.0) and showed excellent concordance (Cronbach's alpha: 0.94). Factor analysis identified five components with eigenvalues greater than 1. It was able to discriminate the two groups (p<0.001) and correlated with the Eating Attitudes Test (EAT) (r=0.50), body shape questionnaire (BSQ) (r=0.68) and Beck Depression Inventory (BDI) scales (0.51).

DISCUSSION

The Brazilian Language version showed suitable internal consistency and external validation, and was easy to understand. The results were similar to the original version and its use is recommended for evaluation of body checking in the Brazilian population in subjects with or without eating disorders.

Equivalência semântica e avaliação da consistência interna da versão em português do Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3)

O objetivo do estudo foi descrever o processo de adaptação transcultural do Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) para a língua portuguesa. A metodologia foi baseada nas etapas de (1) tradução do questionário para o português; (2) retrotradução para o inglês; (3) comitê de peritos para construção da primeira versão; (4) avaliação da compreensão verbal por especialistas e por uma amostra da população-alvo; (5) análise da consistência interna do instrumento a partir do alfa de Cronbach. O instrumento foi traduzido para o português e a versão final contou com os 30 itens do instrumento original. Todos os itens foram interpretados como de fácil compreensão, tanto por especialistas quanto pela população-alvo. Os valores de consistência interna foram satisfatórios, sendo de 0,91 para toda a escala. O instrumento encontra-se traduzido e adaptado para o português, com evidências de boa compreensão e consistência interna, sendo ainda necessária a avaliação de sua equivalência de mensuração, validade externa e reprodutibilidade.

Posture and body image in individuals with major depressive disorder: a controlled study

OBJECTIVE

In this study, we aimed to quantify posture and body image in patients with major depressive disorder during episodes and after drug treatment, comparing the results with those obtained for healthy volunteers.

METHOD

Over a 10-week period, we evaluated 34 individuals with depression and 37 healthy volunteers. Posture was assessed based on digital photos of the subjects; CorelDRAW software guidelines and body landmarks were employed. Body image was evaluated using the Body Shape Questionnaire.

RESULTS

During depressive episodes (in comparison with the post-treatment period), patients showed increased head flexion (p<0.001), increased thoracic kyphosis (p<0.001), a trend toward left pelvic retroversion (p=0.012) and abduction of the left scapula (p=0.046). During remission, patient posture was similar to that of the controls. At week 1 (during the episode), there were significant differences between the patients and the controls in terms of head flexion (p<0.001) and thoracic kyphosis (p<0.001); at weeks 8-10 (after treatment), such differences were seen only for shoulder position. The mean score on the Body Shape Questionnaire was 90.03 during the depressive episode, compared with 75.82 during remission (p=0.012) and 62.57 for the controls.

CONCLUSION

During episodes of depression, individuals with major depressive disorder experience changes in posture and mild dissatisfaction with body image. The findings demonstrate that the negative impact of depression includes emotional and physical factors.

[Cross-cultural adaptation: translation and Portuguese language content validation of the Tripartite Influence Scale for body dissatisfaction]

The aim of this study was to translate and adapt the Tripartite Influence Scale to the Portuguese language and evaluate its content validity and internal consistency. Six steps included: (1) translation; (2) back-translation; (3) technique revision and semantic evaluation; (4) conduct validation by professional experts (judges); (5) assessment of comprehensibility by the target population, using a verbal rating scale; and (6) evaluation of the internal consistency using Cronbach's alpha coefficient. The 43 questions were translated and adapted to the Portuguese language. The final version consisted of 39 items, with content validity for three constructs (media, family, and friends), clarity and easy understanding, and good internal agreement (Cronbach's alpha coefficients > 0.80). The instrument was successfully translated and adapted to Portuguese and showed good content validity, verbal comprehensibility, and internal consistency. Further analysis of external validity, equivalence of measurement, and reproducibility are necessary.

Nutritional knowledge, eating attitudes and chronic dietary restraint among men with eating disorders

We compared nutritional knowledge, eating attitudes and chronic dietary restraint scores among 17 men (10 with bulimia nervosa and 7 with anorexia nervosa) and 50 women (20 with bulimia nervosa and 30 with anorexia nervosa), who were consecutive patients at a major treatment center in Brazil. There were no differences in nutritional knowledge and concern with food between men and women. For both genders, chronic dietary restraint scores were higher among bulimics. Men with eating disorders had better eating attitudes scores than women. Anorexic men tended to have worse eating attitudes scores than bulimic men, while the opposite was observed for women, suggesting an interaction between gender and diagnosis.

A study of the validity and reliability of the Brazilian version of the Body Shape Questionnaire (BSQ) among adolescents

OBJECTIVES: to produce evidence of the validity and reliability of the Body Shape Questionnaire (BSQ) - a tool for measuring an individual's attitude towards his or her body image. METHODS: the study covered 386 young people of both sexes aged between 10 and 18 from a private school and used self-applied questionnaires and anthropometric evaluation. It evaluated the internal consistency, the discriminant validity for differences from the means, according to nutritional status (underweight, eutrophic, overweight and obese), the concurrent validity by way of Spearman's correlation coefficient between the scale and the Body Mass Index (BMI), the waist-hip circumference ratio (WHR) and the waist circumference (WC). Reliability was tested using Wilcoxon's Test, the intraclass correlation coefficient and the Bland-Altman figures. RESULTS: the BSQ displayed good internal consistency (±=0.96) and was capable of discriminating among the total population, boys and girls, according to nutritional status (p<0.001). It correlated with the BMI (r=0.41; p<0.001), WHR (r=-0.10; p=0.043) and WC (r=0.24; p<0.001) and its reliability was confirmed by intraclass correlation (r=0.91; p<0.001) for the total population. The questionnaire was easy to understand and could be completed quickly. CONCLUSIONS: the BSQ presented good results, thereby providing evidence of its validity and reliability. It is therefore recommended for evaluation of body image attitudes among adolescents.

Tradução, adaptação e avaliação psicométrica da Escala de Conhecimento Nutricional do National Health Interview Survey Cancer Epidemiology

OBJETIVO: O estudo objetivou traduzir e adaptar, para a língua portuguesa, a escala de conhecimento nutricional aplicada no National Health Interview Survey Cancer Epidemiology e avaliar sua validade e precisão. MÉTODOS: Após sua tradução e retro-tradução, a escala foi adaptada, substituindo-se alimentos tipicamente americanos por outros típicos do Brasil. Ela foi aplicada em 39 mulheres com transtornos alimentares e 57 estudantes de Nutrição. Esperava-se uma maior pontuação destas últimas, atestando a validade discriminatória do questionário. O instrumento foi reaplicado em 50 estudantes e obteve-se o coeficiente de correlação entre as duas aplicações. RESULTADOS: As estudantes fizeram 10,5 pontos, com desvio-padrão de 1,7 pontos, enquanto as pacientes fizeram 7,4, com desvio-padrão de 2,6 pontos (p=0,0000001). Apenas 1,75% das estudantes apresentou baixo conhecimento, versus 34,21% das pacientes (p<0,005). Encontrou-se alto conhecimento em 57,90% das estudantes e em 13,16% das pacientes (p<0,005). O coeficiente de correlação de Spearman foi 0,52 (p=0,00009). CONCLUSÃO: O teste preencheu os critérios psicométricos para validade, mas sua precisão deve ser reavaliada. Sugere-se que o reteste seja feito em menor intervalo de tempo. Dado que as estudantes ainda estão no processo aprendizado, seria interessante aplicar a escala em nutricionistas, com conhecimento mais sedimentado.

Concurrent and discriminant validity of the Stunkard's figure rating scale adapted into Portuguese

This study examined the concurrent and discriminant validity of the Figure Rating Scale adapted into Portuguese. The sample was composed of a control group (98 students without eating disorders) and a clinical group (16 women diagnosed with Bulimia Nervosa). Respondents chose schematic figures representing their current and ideal body sizes. The difference between the two choices was calculated to give an ideal discrepancy score. There were high correlations between body mass index and current body size or ideal discrepancy score. The ideal discrepancy scores were greater among the clinical group, indicating that the scale could discriminate between the two groups. The results of this preliminary work indicate that the scale is a valid measure of body image when used in Brazil.

Psychometric testing and applications of the Body Attitudes Questionnaire translated into Portuguese

Although many body attitudes scales have been developed, none have been translated into Portuguese. This study aimed to translate the Ben-Tovim and Walker Body Attitudes Questionnaire and assess validity and reliability for a Brazilian sample. Women with (n = 39) and without (n = 57) eating disorders completed the scale, to assess discriminant validity. Convergent validity was assessed by the correlations between the scores and a measure of body dissatisfaction. The questionnaire was applied twice to controls after 1 mo. to evaluate reliability. Eating-disordered women had significantly higher mean scores on Feeling Fat, Disparagement, Salience and Lower Body Fatness, and lower scores on Attractiveness. No mean difference on Strength and Fitness was found. Most subscales were significantly correlated with the body-dissatisfaction measure. Test-retest coefficients ranged from .57 to .85. The translated version of the Body Attitudes Questionnaire seems to be a valid and reliable measure of body attitudes.

The Eating Disorders Section of the Development and Well-Being Assessment (DAWBA): development and validation

OBJECTIVE: Development and validation of the Eating Disorders Section of the Development and Well-Being Assessment (DAWBA). It is a package of questionnaires, interviews and evaluation techniques, designed to generate DSM-IV and ICD-10 based diagnoses of anorexia, bulimia nervosa and the respective partial syndromes in epidemiological studies, in subjects who are 7 to 17 years old. The parents are interviewed in all cases, as are young people aged 11 or more. METHODS: 174 girls, divided into three groups, were assessed with the Eating Disorders Section of the Development and Well-Being Assessment: 48 with eating disorders, 55 clinical controls (with depression, obsessive-compulsive disorder or gastrointestinal disease) and 71 community controls. The sensitivity, specificity and predictive values of the assessment were investigated by comparing the Development and Well-Being Assessment diagnoses with independent psychiatric diagnoses. The test-retest reliability was investigated by reapplying the measure on 55 subjects after 2 or 3 weeks. RESULTS: For the detection of any DSM-IV and ICD-10 eating disorder, the final Development and Well-Being Assessment diagnosis had a sensitivity of 100%, specificity of 94%, positive predictive value of 88%, and a negative predictive value of 100%; there was 95% agreement between the initial and repeat diagnoses (a kappa of 0.81). CONCLUSION: The Eating Disorders Section of the Development and Well-Being Assessment has suitable psychometric properties for use in clinical and epidemiological studies.