Familial aggregation of eating disorders: results from a controlled family study of bulimia nervosa

Preventing eating disorders and disordered eating in genetically vulnerable, high-risk families

OBJECTIVE

To close the chasm between theory about families containing a parent with an eating disorders (EDs) history and lack of selective or indicated prevention programming for such families with an older child or adolescent who is, genetically, at high risk.

METHOD

A search of four major databases for January 2000 through September 2022 yielded no publications that (a) identified genetically high-risk families with offspring ages 10 through 18; (b) devised a prevention program for the family; and (c) evaluated program effects on risk/protective factors. To rectify this gap, research on three lines of family-based prevention is reviewed: (1) programs for adolescents at genetic risk for depression or anxiety; (2) the Stanford-Dresden project for adolescents at high risk for anorexia nervosa; and (3) Sadeh-Sharvit et al.'s work concerning the Parent-Based Prevention program for mothers with an EDs history and a child under age 5.

RESULTS

The significant challenges for innovative prevention programming should be addressed by experts in effective EDs, depression, and anxiety prevention, and in family-based treatment (FBT) for EDs, collaborating with people from genetically vulnerable families. Innovative programming should focus on robust risk factors for EDs, adaptive expression of non-specific risk factors (e.g., temperament), and strengthening family functioning.

DISCUSSION

The field is overdue for development of prevention programs designed for older children or adolescents who are at risk because a parent has an ED. Evidence-based prevention programs for EDs and for depression and anxiety, as well as parent-based prevention informed by FBT, provide a springboard for addressing this gap.

PUBLIC SIGNIFICANCE

The foundation of theory and research is available for stakeholders to develop prevention programming that closes the huge gap between theory and research about families that are genetically vulnerable for eating disorders versus the complete lack of prevention programming for such families that have an older child or adolescent at high risk.

Genetic and environmental contributions to diagnostic fluctuation in anorexia nervosa and bulimia nervosa

BACKGROUND

Anorexia nervosa and bulimia nervosa are two severe eating disorders associated with high premature mortality, suicidal risk and serious medical complications. Transition between anorexia nervosa and bulimia nervosa over the illness course and familial co-aggregation of the two eating disorders imply aetiological overlap. However, genetic and environmental liabilities to the overlap are poorly understood. Quantitative genetic research using clinical diagnosis is needed.

METHODS

We acquired a clinical diagnosis of anorexia nervosa (prevalence = 0.90%) and bulimia nervosa (prevalence = 0.48%) in a large population-based sample (N = 782 938) of randomly selected full-sisters and maternal half-sisters born in Sweden between 1970 and 2005. Structural equation modelling was applied to quantify heritability of clinically diagnosed anorexia nervosa and bulimia nervosa and the contributions of genetic and environmental effects on their overlap.

RESULTS

The heritability of clinically diagnosed anorexia nervosa and bulimia nervosa was estimated at 43% [95% confidence interval (CI) (36-50%)] and 41% (31-52%), respectively, in the study population, with the remaining variance explained by variance in unique environmental effects. We found statistically significant genetic [0.66, 95% CI (0.49-0.82)] and unique environmental correlations [0.55 (0.43-0.66)] between the two clinically diagnosed eating disorders; and their overlap was about equally explained by genetic and unique environmental effects [co-heritability 47% (35-58%)].

CONCLUSIONS

Our study supports shared mechanisms for anorexia nervosa and bulimia nervosa and extends the literature from self-reported behavioural measures to clinical diagnosis. The findings encourage future molecular genetic research on both eating disorders and emphasize clinical vigilance for symptom fluctuation between them.

Siblings of Individuals With Eating Disorders: A Review of the Literature

Eating disorders (EDs) are serious psychopathologies characterized by a persistent disturbance in eating or eating-related behavior. Studies have shown EDs' detrimental consequences not only for patients, but also for their families. Nevertheless, a specific group that has so far been neglected, in both the research and clinical fields, are siblings of individuals with EDs. In an effort to identify this population's needs, and to facilitate effective prevention and treatment, this paper aims to review the existing literature on the subject, and examine siblings' personal experience, ways of coping, and levels of psychopathology. PubMed and PsycNet databases were searched with no publication date restrictions, yielding 26 relevant papers. Studies were categorized according to common themes they addressed, and subsequently summarized by highlighting common features, as well as information unique to each study. Several themes emerged, including emotional well-being, psychopathology, social consequences, family dynamics, and coping strategies. Results show that EDs experienced by one individual have significant effects on one's siblings, such as a decrease in quality of life, social isolation, and elevated familial strain. In several studies siblings were found to have elevated levels of psychopathology and EDs related symptoms. Nevertheless, findings' nature and magnitude were highly varied. The review indicates the need for further studies that will examine possible intra- and interpersonal moderating factors for EDs' impact on well-being among siblings, and take into consideration the substantial heterogeneity in studies conducted thus far. Additionally, this review highlights the need for novel and effective interventions, specifically targeting this at-risk group.

Rigor and reproducibility in genetic research on eating disorders

OBJECTIVE

We explored both within-method and between-method rigor and reproducibility in the field of eating disorders genetics.

METHOD

We present critical evaluation and commentary on component methods of genetic research (family studies, twin studies, molecular genetic studies) and discuss both successful and unsuccessful efforts in the field.

RESULTS

Eating disorders genetics has had a number of robust results that converge across component methodologies. Familial aggregation of eating disorders, twin-based heritability estimates of eating disorders, and genome-wide association studies (GWAS) all point toward a substantial role for genetics in eating disorders etiology and support the premise that genes do not act alone. Candidate gene and linkage studies have been less informative historically.

DISCUSSION

The eating disorders field has entered the GWAS era with studies of anorexia nervosa. Continued growth of sample sizes is essential for rigorous discovery of actionable variation. Molecular genetic studies of bulimia nervosa, binge-eating disorder, and other eating disorders are virtually nonexistent and lag seriously behind other major psychiatric disorders. Expanded efforts are necessary to reveal the fundamental biology of eating disorders, inform clinical practice, and deliver new therapeutic targets.

Healthy eating beliefs and intentions of mothers and their adult children: An intergenerational transmission perspective

This study examined the possible intergenerational transmission of eating beliefs and intentions between 60 mothers and their adult children. Maternal restrictive feeding practices were correlated with mothers' own healthy eating attitudes and subjective norms, and with their adult children's subjective norms. Mothers' beliefs and intentions were correlated with their adult children. Adult children's intentions to eat healthily were predicted by their attitudes and perceived behavioural control, and also by their mothers' intentions and perceived behavioural control. Mothers' own beliefs and intentions may be involved in shaping their children's beliefs and intentions into adulthood but their child feeding practices may have less of an influence.

The heritability of eating disorders: methods and current findings

Family, twin, and adoption studies of anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and the proposed purging disorder presentation (PD) have consistently demonstrated that genetic factors contribute to the variance in liability to eating disorders. In addition, endophenotypes and component phenotypes of eating disorders have been evaluated and provide further insight regarding genetic factors influencing eating disorders and eating disorder diagnostic criteria. Many of these phenotypes have demonstrated substantial heritability. This chapter reviews biometrical genetic methods and current findings from family and twin studies that investigate the role of genes and environment in the etiology of eating disorders. We review the methodology used to estimate heritability, the results of these studies, and discuss the implications of this research for the basic conceptualization of eating disorders and the future value of twin modeling in the molecular genetic era.

Schmidt M, Poustka F. Psychiatrische Erkrankungen bei Verwandten von Patienten mit Anorexia nervosa und Bulimia nervosa

Zusammenfassung: Fragestellung: Im deutschen Raum gibt es kaum Familienuntersuchungen von Patienten mit Anorexia und Bulimia nervosa. Methodik: In einer Multizenter Studie wurde das Auftreten psychiatrischer Erkrankungen bei Familienangehörigen 1., 2. und 3. Grades von 65 anorektischen (n = 746) und 21 bulimischen Patienten (n = 265) mit denen von 37 gesunden Kontrollen (n = 480) sowie 11 depressiven Patienten (n = 157) verglichen. Messinstrumente waren u.a. das Diagnostische Interview für Genetische Studien bzw. das Familien Interview für Genetische Studien. Ergebnisse: Die Prävalenz von Anorexia nervosa (signifikant) sowie von depressiven Störungen (Trend) war bei Verwandten 1. und 2. Grades von Patienten mit Essstörungen gegenüber der gesunden Gruppe erhöht. Die meisten Ergebnisse waren eher bei den Familien bulimischer Patienten ausgeprägt. Die Prävalenzraten für psychiatrische Erkrankungen waren insgesamt prozentual niedriger als in vergleichbaren US amerikanischen Stichproben. Schlussfolgerung: Die Ergebnisse könnten für eine familiäre Vulnerabilität bzw. genetisches Risiko von Patienten mit Anorexia und Bulimia nervosa sprechen. Der Zusammenhang des niedrigen Alters der Indexpatienten auf die geringeren Prävalenzraten wird diskutiert.

Patients with eating disorders and their siblings. An investigation of body image perceptions

Little is known about body images of siblings of patients with eating disorders. In this study we investigated body images of patients with anorexia or bulimia nervosa and of the patients' brothers and sisters. A computer program was employed that allows modeling perceived and desired body images of patients and family members. Patients, siblings and male and female control subjects rated their body images. The selected images were compared with anthropometric data. All subjects also filled out a body image questionnaire. Data from 30 patients, 38 siblings, and 60 control subjects are presented. Siblings did not differ from healthy control subjects. Self-ideal discrepancy was different in patients with anorexia and their sisters. Body image was more negative in patients than in their sisters. Siblings of patients with eating disorders seem to be rather unimpaired in terms of body image disturbances.

Parental psychopathology as a predictor of long-term outcome in bulimia nervosa patients

This paper sought to examine parental variables as predictors of long-term outcome in women with bulimia nervosa (BN). Participants were 94 treatment-seeking women with BN who were assessed at baseline, treatment end, and at follow-up (M=10.13 years). Participants reported rates of psychopathology and obesity in their mothers and fathers at baseline. The most frequently reported parental psychopathology was substance abuse in fathers. Chi-square analyses indicated that substance abuse in fathers was associated with poor treatment-end outcome in BN participants. Depression in mothers was associated with poor outcome at long-term follow-up, and obesity in mothers was associated with better outcome at long-term follow-up. A logistic regression analysis found that lifetime mood disorder in participants and severe depression in mothers were independent predictors of bulimic symptoms at long-term follow-up. The association between maternal severe depression and long-term outcome in BN suggests that specific parental variables may indicate longer course of BN.

Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study

OBJECTIVE

The course and clinical predictors of rehospitalization were studied in a large sample of adolescent patients with anorexia nervosa who had been treated at five European sites and been followed-up.

METHOD

Two-hundred and twelve adolescent patients first admitted for in-patient treatment, aged 10-18 (Mean 14.9) years and 94.8% female, were followed-up for an average of 8.3 years after first admission at sites in (former East and West Berlin, Zurich, Sofia, and Bucharest). Clinical history data were collected by use of standardized item-sheets at first admission. Semi-structured interviews including ratings of eating pathology and psychosocial outcome were performed at follow-up.

RESULTS

About 44.8% (95/212) of the patients required at least one readmission. Rates of rehospitalization were significantly higher at the Eastern sites (Sofia and Bucharest). Significant predictors of readmission were paternal alcoholism, history of anorexia nervosa in the family, eating disorder in infancy, periodic overactivity, lower weight increase at first admission, and lower BMI at first discharge. In a model of logistic regression analysis, five variables (paternal alcoholism, eating disorder in infancy, periodic overactivity, low weight increase during first admission, and low BMI at first discharge) correctly classified 69% of the participants into cases with single or repeated admissions. Patients with repeated admissions had a less favorable long term outcome and had higher rates of persisting psychopathology at follow-up.

CONCLUSION

Rehospitalization reflects the chronic course in a sizable proportion of adolescent patients with anorexia nervosa. Family psychopathology may have an effect both in terms of genetic vulnerability and environmental stress leading to unfavorable courses. The strong effect of insufficient weight gain during first admission and lower BMI at first discharge emphasizes the importance of adequate interventions. Readmissions carry the risk for later poor psychosocial and psychiatric outcomes.

Association of eating attitudes between teenage girls and their parents

BACKGROUND

Mothers of eating disordered adolescents were more likely to have an eating disorder. However, some contradictory findings were reported because some studies failed to find this association.

AIMS

The main objective of the study was to determine the association of eating attitudes in adolescent girls with eating attitudes in their parents.

METHODS

A sample of 969 girls from Osona County (Barcelona, Spain) and their parents participated in the study. Girls completed the Eating Attitudes Test (EAT-26) and their weight and height were measured. Parents completed questionnaire with self-reported weight and height, demographic characteristics and EAT-26.

RESULTS

10.1% of girls showed high EAT-26 scores (> 20 points), indicating abnormal eating attitudes. Female adolescents were almost three times more likely to have abnormal eating attitudes if their mothers scored high on EAT-26 (OR = 2.8; 95% CI 1.5-5.2). Other significant predictors of high EAT-26 scores were age and obesity.

CONCLUSIONS

An abnormal eating attitude of the mother was identified as a potential risk factor in the development of eating disorders in female adolescents.

Variations in the preproghrelin gene correlate with higher body mass index, fat mass, and body dissatisfaction in young Japanese women

BACKGROUND

Ghrelin is an endogenous peptide that stimulates growth hormone secretion, enhances appetite, and increases body weight and may play a role in eating disorders.

OBJECTIVE

The purpose was to determine whether any preproghrelin gene variants are associated with anthropometric measures, circulating ghrelin, lipid concentrations, insulin resistance, or psychological measures relevant to eating disorders in young women.

DESIGN

This cross-sectional study compared outcome measures between preproghrelin genotypes. The participants in the study included 264 Japanese women [university students with a mean (+/-SD) age of 20.4 +/- 0.7] with no history of eating disorders. The main outcomes were responses to the Eating Disorder Inventory-2 (EDI-2), anthropometric measures, measures of depression and anxiety, and fasting blood concentrations of acylated or desacyl ghrelin, lipids, glucose, and insulin.

RESULTS

Two single nucleotide polymorphisms (SNPs) whose minor allele frequencies were >0.05--the Leu72Met (408 C-->A) SNP in exon 2 and the 3056 T-->C SNP in intron 2--were used for association analysis. The 3056C allele was significantly associated with a higher acylated ghrelin concentration (P=0.0021), body weight (P=0.011), body mass index (P=0.007), fat mass (P=0.012), waist circumference (P=0.008), and skinfold thickness (P=0.011) and a lower HDL-cholesterol concentration (P=0.02). Interestingly, the 3056C allele was related to elevated scores in the Drive for Thinness-Body Dissatisfaction (DT-BD) subscale of the EDI-2 (P=0.003).

CONCLUSION

Our findings suggest that the preproghrelin gene 3056T-->C SNP is associated with changes in basal ghrelin concentrations and physical and psychological variables related to eating disorders and obesity.

Possible role of preproghrelin gene polymorphisms in susceptibility to bulimia nervosa

Previous investigations have suggested that ghrelin, an endogenous orexigenic peptide, is involved in the pathology of eating disorders. We conducted a study to determine whether any preproghrelin gene polymorphisms are associated with eating disorders. Three hundred thirty-six eating disorder patients, including 131 anorexia nervosa (AN)-restricting types (AN-R), 97 AN-binge eating/purging types (AN-BP) and 108 bulimia nervosa (BN)-purging types (BN-P), and 300 healthy control subjects participated in the study. Genotyping was performed to determine the polymorphisms present, and with this information, linkage disequilibrium (LD) between the markers was analyzed and the distributions of the genotypes, the allele frequencies, and the haplotype frequencies were compared between the groups. The Leu72Met (408 C > A) (rs696217) polymorphism in exon 2 and the 3056 T > C (rs2075356) polymorphism in intron 2 were in LD (D' = 0.902, r2 = 0.454). Both polymorphisms were significantly associated with BN-P (allele-wise: P = 0.0410, odds ratio (OR) = 1.48; P = 0.0035, OR = 1.63, for Leu72Met and 3056 T > C, respectively). In addition, we observed a significant increase in the frequency of the haplotype Met72-3056C in BN-P patients (P = 0.0059, OR = 1.71). Our findings suggest that the Leu72Met (408 C > A) and the 3056 T > C polymorphisms of the preproghrelin gene are associated with susceptibility to BN-P.

Genetics of food intake and eating behavior phenotypes in humans

This review summarizes the research advances of the past decade regarding the role of human genetic differences in energy and nutrient intake as well as in eating behavior phenotypes and selected eating disorders. The evidence for familial aggregation and heritability based on twin and nuclear family study designs is summarized. Genome-wide linkage scans and quantitative trait loci identified to date are discussed. DNA sequence variants in candidate genes are reviewed. Single genes associated with classical eating disorders are also incorporated. Epigenetic events will need to be incorporated in future studies designed to investigate the effects of DNA variants on dietary phenotypes. Understanding the relative contribution of global genetic variation and of DNA sequence variants in specific genes is important in the effort to influence dietary habits in a healthier direction.

Gender differences in associations of eating pathology between mothers and their adolescent offspring

OBJECTIVE

To study the association of eating pathology between mothers and their adolescent offspring in a population sample.

RESEARCH METHODS AND PROCEDURES

The participants were 481 women (mean age, 47+/-SD 5 years; BMI, 25+/-4 kg/m2) and their 481 adolescent children 16 to 17 years old (BMI, 21+/-3 kg/m2) of the Stockholm Weight Development Study. Assessment methods were the Three-Factor Eating Questionnaire Revised 18 and the Eating Disorder Inventory 2.

RESULTS

A higher body weight was most related to cognitive restraint for adolescents and to emotional eating for adult women. A mother-daughter link could be identified for eating pathology, with the strongest link found for emotional eating. No mother-son link could be identified. Age subgroup analyses revealed a stronger mother-daughter link for body attitudes in younger mothers and for cognitive restraint in older mothers.

DISCUSSION

Gender differences revealed that eating pathology was shared by mothers and daughters but not by mothers and sons. A psychological strategy such as eating as a response to negative emotions was most interrelated between mothers and daughters. Younger mothers shared more attitudes toward the body with their daughters, whereas older mothers shared more restrictive eating behaviors with their daughters. The mother-daughter links found may be due to gender-specific genetic and psychological family transmission and gender-specific environmental influences. The sons' eating behaviors seem to be more independent and would be formed by other factors than for the girls.

Uncoupling protein-2/uncoupling protein-3 gene polymorphism is not associated with anorexia nervosa

Energy expenditure abnormalities have been observed in anorexia nervosa (AN). The uncoupling proteins (UCPs) have been implicated as having a role in energy metabolism and thermogenesis, and an association between a marker flanking the UCP-2/UCP-3 gene cluster and AN has been reported. Also known are insertion/deletion and -866G/A polymorphisms in the UCP-2 gene, and the -55C/T polymorphism in the UCP-3 gene. Differences in these alleles are reportedly related to changes in energy expenditure, body mass index, fat tissue accumulation and obesity. Therefore, this case-control association analysis was done to determine whether any of these UCP-2/3 gene polymorphisms are related to a predisposition to AN. In analysis of a cohort of 106 female Japanese AN sufferers and 126 normal female controls, we found no between-group differences in the polymorphism frequencies of these groups. The hypothesis that differences in the UCP-2/3 gene influence the susceptibility to AN was not supported.

Eating disturbances in siblings of patients with eating disorders

OBJECTIVE

The purpose of this study was to investigate whether siblings of patients with eating disorders show a more disturbed eating behavior and a higher proneness to associated psychological characteristics than controls.

METHOD

84 patients with eating disorders of an outpatient clinic, their siblings (n=84) and a control group (n=84) with an age range 14-34 for the total sample were evaluated using the Eating Disorder Inventory-2.

RESULTS

There was no significant difference between the siblings and the controls in disturbed eating behavior.

DISCUSSION

The existence of an eating disorder in patients does not seem to be related to the development of eating disturbed behavior in their siblings.

Genetic analysis of bulimia nervosa: methods and sample description

OBJECTIVE

Twin and family studies suggest that genetic variants contribute to the pathogenesis of bulimia nervosa (BN) and anorexia nervosa (AN). The Price Foundation has supported an international, multisite study of families with these disorders to identify these genetic variations. The current study presents the clinical characteristics of this sample as well as a description of the study methodology.

METHOD

All probands met modified criteria for BN or bulimia nervosa with a history of AN (BAN) as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). All affected relatives met DSM-IV criteria for BN, AN, BAN, or eating disorders not otherwise specified (EDNOS). Probands and affected relatives were assessed diagnostically using both trained-rater and self-report assessments. DNA samples were collected from probands, affected relatives, and available biologic parents.

RESULTS

Assessments were obtained from 163 BN probands and 165 BAN probands. Overall, there were 365 relative pairs available for linkage analysis. Of the affected relatives of BN probands, 62 were diagnosed as BN (34.8%), 49 as BAN (27.5%), 35 as AN (19.7%), and 32 as EDNOS (18.0%). For the relatives of BAN probands, 42 were diagnosed as BN (22.5%), 67 as BAN (35.8%), 48 as AN (25.7%), and 30 as EDNOS (16.0%).

DISCUSSION

This study represents the largest genetic study of eating disorders to date. Clinical data indicate that although there are a large number of individuals with BN disorders, a range of eating pathology is represented in the sample, allowing for the examination of several different phenotypes in molecular genetic analyses.

Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy

The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.

Religiousness and disordered eating: does religiousness modify family risk?

The purpose of this study was to evaluate the role of intrinsic and extrinsic religiousness in modifying family risk on disordered eating among women. We hypothesized that intrinsic religiousness would buffer the impact of family risk whereas extrinsic religiousness would increase the risk. In a survey of 876 college women between the ages of 18 and 29, the results showed that, when intrinsic religiousness was higher, there was no relationship between family risk and disordered eating. When intrinsic religiousness was lower, there was a significant positive relationship between family risk and disordered eating. These findings support the hypothesized buffering effect of intrinsic religiousness. For extrinsic religiousness, there was a stronger relationship between family risk and disordered eating when extrinsic religiousness was higher than when it was lower, supporting the hypothesized enhanced vulnerability effect. Future research should actively explore other moderating variables as well as aspects of religiousness that may contribute to risk and resiliency in disordered eating.

5-HT2A promoter polymorphism is not associated with anorexia nervosa in Japanese patients

Genetic factors have been implicated in playing a significant role in susceptibility to anorexia nervosa (AN). Among many candidate genes for AN, an association with the A allele of the -1438G/A polymorphism in the promoter region of the 5-HT2A receptor has been reported. However, these findings are controversial and all patients studied to date have been Caucasian. This study was designed to determine whether this association is reproducible in Japanese subjects. This case-control study of a cohort of 75 female Japanese AN sufferers and 127 normal female control subjects revealed no significant association between the 5-HT2A promoter polymorphism and AN. Thus, at least for Japanese subjects, the A-allele of the -1438G/A polymorphism in the promoter region of the 5-HT2A receptor gene does not contribute to a predisposition to AN.

Predicting children's reported eating disturbances at 8 years of age

OBJECTIVES

To examine differential parental influences on eating attitudes and behaviors of 8-year-old children with a specific focus on gender effects and to assess the specificity of this relationship.

METHOD

One hundred eight infants were monitored from birth and interviewed at age 8 for eating disturbances and negative affect with an adaptation of the McKnight Risk Factor Survey. Parental measures included the Three Factor Eating Questionnaire subscales Disinhibition and Restraint as well as body mass index, assessed at study entry.

RESULTS

No gender differences were found for frequencies of children's self-reported eating disturbances. Higher maternal restraint scores predicted worries about being too fat in girls but not in boys. Higher maternal disinhibition scores also differentially predicted weight control behaviors in their daughters. Negative affect in the child was (weakly) predicted by higher maternal body mass index. No association between paternal predictors of disturbed eating and the child's eating disturbances and negative emotionality was found.

CONCLUSIONS

The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters. The clinical importance of these disturbances in terms of precursors of adolescent eating disorders has to be determined by monitoring the sample through puberty.