A survey of anorexia nervosa using the Arabic version of the EAT-26 and "gold standard" interviews among Omani adolescents

The optimal cut-off score of the Eating Attitude Test-26 for screening eating disorders in Japan

PURPOSE

The Eating Attitude Test-26 (EAT-26) is a screening tool for eating disorders (EDs) in clinical and non-clinical samples. The cut-off score was suggested to be varied according to target population. However, no studies have examined the appropriateness of the originally proposed score of 20 for screening DSM-5 eating disorders in Japan. This study aimed to identify an appropriate cut-off score to better differentiate clinical and non-clinical samples in Japan for EDs.

METHODS

The participants consisted of 54 patients with anorexia nervosa restricting type, 58 patients with anorexia nervosa binge-eating/purging type, 37 patients with bulimia nervosa diagnosed according to DSM-5 criteria, and 190 healthy controls (HCs). Welch's t test was used to assess differences in age, body mass index (BMI), and total EAT-26 scores between HCs and patients with EDs. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal cut-off score.

RESULTS

The HCs had significantly higher BMI and lower total EAT-26 mean scores than patients with EDs. The area under the ROC curve was 0.925, indicating that EAT-26 had excellent performance in discriminating patients with EDs from HCs. An optimal cut-off score of 17 was identified, with sensitivity and specificity values of 0.866 and 0.868, respectively.

CONCLUSIONS

The result supports the suggestions that optimal cut-off score should be different according to target populations. The newly identified cut-off score of 17 would enable the identification of patients with EDs who have been previously classified as non-clinical samples in the EAT-26 test.

LEVEL OF EVIDENCE

III: evidence obtained from case-control analytic study.

Factors associated with anxiety-related symptoms in children and adolescents during COVID-19 in Oman: a cross-sectional study

Reports from different parts of the world suggest that the COVID-19 pandemic and the resultant lockdown and social distancing measures have heralded unprecedented mental health challenges among children and adolescents. To date, there is a dearth of studies emerging from the Arabian Gulf, where the majority of its population are children and adolescents. The study aims to examine the prevalence of anxiety-related symptoms and their covariates among children and adolescents in an Arabian Gulf country, Oman. This is a cross-sectional analytic study carried out over two weeks (1st to 15th of August 2020) during the COVID-19 pandemic across Oman. Parents were asked to complete the online survey, which consisted of the parent version of the Screen for Child Anxiety Related Emotional Disorders (SCARED) instrument and questions regarding basic socio-demographic information. Logistic regression was used to identify the contributing variables associated with anxiety-related symptoms. A total of 790 valid responses were received. Among the 790 children, 33.3% (n = 263) were diagnosed with anxiety-related symptoms by the SCARED instrument. Logistic regression analysis suggested that anxiety-related symptoms in children and adolescents were significantly associated with three demographic variables. The model shows that children with divorced or separated parents were 1.9 times more likely to have anxiety-related symptoms than children of married couples (OR = 1.93, p = 0.035). Children living in families with an income below USD 1000/month, were 1.8 times more likely to have anxiety-related symptoms than a family with an income of USD 4000/month (OR = 1.833, p = 0.018). Children in grades 3-6 were 1.8 times more likely to have anxiety-related symptoms than those in grades 1-2 (OR = 1.79, p = 0.024). Anxiety-related symptoms are common among Omani children and adolescents. They are more likely to be reported in middle scholastic grade levels and children from families with marital discord and low socioeconomic status. It is not clear whether the presently observed rates of anxiety exceed the prevalence that would have been observed prior to the COVID-19 pandemic. More studies are therefore warranted using children and adolescents' self-reported scales.

The Prevalence of Disordered Eating Behaviours (DEBs) among Adolescent Female School Students in Riyadh, Saudi Arabia: A Cross-Sectional Study

Adolescence is a sensitive stage of life that is particularly vulnerable to nutritional problems, including DEBs. This cross-sectional study aims to explore the prevalence of DEBs among adolescent female school students in four intermediate and secondary schools in the city of Riyadh and to examine predictors associated with DEBs, including age, BMI and school regions. A total of 416 female students aged 12-19 years took part in this study. Weight and height were measured for students before the EAT-26 test was completed. Overweight and obesity were observed among 37.7% (n = 157) of students, 50.7% (n = 211) had a normal BMI and 11.5% (n = 48) were underweight. Results indicated that 123 (29.6%) students reported an EAT-26 score of 20 or more, indicating a high risk of DEB. Age was a significant predictor of DEB risk (OR = 3.087, 95% CI = 1.228-7.760), with the older age group (16-19 years) reporting a higher risk than the younger age group (12-15 years) (p = 0.017). DEB risk partially differed by school region, but BMI was not a statistically significant predictor. The high-risk group reported more binging (p = 0.008), induced vomiting (p < 0.001), laxative consumption (p < 0.001) and exercising (p < 0.001) compared with the low-risk group. Further research is warranted to understand DEB current patterns and predictors.

Prevalence of Eating Disorders and Disordered Eating Behaviours amongst Adolescents and Young Adults in Saudi Arabia: A Systematic Review

Eating disorders (EDs) and disordered eating behaviours (DEBs) are significant health problems related to body image and weight dissatisfaction among adolescents and young adults worldwide. During this stage of sensitive development, these behaviours may hinder the optimal growth process and can consequently lead to wasting, stunting, and micronutrient deficiencies. However, there is a limited amount of literature on DEB among Arab populations, particularly in Saudi Arabia. This review aims to assess the prevalence of EDs/DEB and to develop a clear understanding of the epidemiology of such conditions among adolescents and youth in Saudi Arabia. Five databases were systematically searched and 14 papers met the inclusion criteria. The Eating Attitudes Test (EAT-26) was the predominant tool used for evaluating aberrant eating behaviours, indicating a high prevalence of EDs/DEB ranging from 10.2% to 48.1%. The highest prevalence of EDs/DEB was reported in the eastern region ranging from 29.4% to 65.5%. In terms of age and sex, the prevalence was higher among older students compared to younger school students and males reported more Eds/DEB compared to female students. These disorders are found to be prevalent in Saudi Arabia, and the risk of developing such conditions is high across the whole age range.

The global prevalence of screen-based disordered eating and associated risk factors among high school students: systematic review, meta-analysis, and meta-regression

OBJECTIVE

Estimate the prevalence, and associated risk factors, of high school students who are considered at risk for an eating disorder based on screening measures.

METHODS

An electronic search of nine databases was completed from their inception until 1st September 2022. A random-effects meta-analysis was conducted, and confounder (moderator) analyses and meta-regressions examined whether the overall prevalence estimate for of screen-based disordered eating (SBDE) was moderated by student age, BMI, or gender, as well as culture and type of SBDE assessment.

RESULTS

The mean estimate of the prevalence of SBDE among high school students (K = 42 (66 datapoints), N = 56282] in the sample of 25 countries was 13% ([95% CI] = 10.0-16.8%, I2 = 99.0%, Cochran's Q p = 0.001). This effect was not moderated by features of the samples such as gender, BMI, or age. Among cultures, non-Western countries had a higher prevalence of SBDE prevalence than Western countries, but the difference was not significant. There was considerable variability in the prevalence estimates as a function of the assessment measure, but no meaningful pattern emerged.

CONCLUSION

The estimated figure of 1 in 8 high school students with SBDE-unmoderated by gender and BMI-stands out as a problem in need of attention from public health officials, psychologists, psychiatrists, pediatricians, parents, and educators. There is a great need for innovative, integrated policy and program development all along the spectrum of health promotion and universal, selective, and indicated prevention. Further research is also needed to validate and refine this estimate by (a) conducting basic research on the accuracy of eating disorder screening measurements in samples ages 14 through 17; (b) examining representative samples in more countries in general and Latin American countries in particular; (c) clarifying the relationships between SBDE and age throughout the different phases of late childhood, adolescence, and emerging adulthood; and (d) investigating whether there are meaningful forms of disordered eating and whether these are associated with variables such as gender, ethnicity, and BMI.

Eating Disorders among Adolescent Female Students in Jeddah, Saudi Arabia

Background

Eating disorders (EDs) are characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour. This study aimed to investigate the prevalence of EDs and their associated factors among female going-school adolescents in Jeddah, Saudi Arabia.

Methods

A cross-sectional study was conducted in five schools in Jeddah, Saudi Arabia, among a representative random sample of female adolescent students aged 13 years old-18 years old. A simple random sampling method was used to select the participants. An online self-administered questionnaire, the Arabic version of eating attitude test (EAT-26) and socio-cultural attitudes toward appearance questionnaire (SATAQ-4), was used.

Results

More than half (53.6%) of adolescent girls scored at or above the cut-off point of EAT-26. Around 45% of the participants had experienced family influence on their appearance and body shape, 36.7% had experienced peer influence on these factors, and 49.4% had experienced media influence. Family influence was significantly associated with EDs (P = 0.013).

Conclusion

The high prevalence of EDs among female going-school adolescents in Jeddah, Saudi Arabia, is of great concern. To mitigate this problem, effective programmes must be designed to change their dietary habits while considering the effects of family, peer and media influence, as well as focusing on the importance of eating breakfast and practising physical activity.

The Prevalence of "at Risk" Eating Disorders among Athletes in Jordan

Eating disorders (EDs) are addressed as one of the expanding mental health problems worldwide. While an ED is a clinical psychiatric diagnosis that can only be established after a psychiatric assessment, it is important to note that "at-risk" refers to people who will exhibit aberrant eating patterns but do not fully meet the requirements for an ED diagnosis. This study was designed to address the ED symptoms (i.e., "at-risk") in Jordanian athletes and their association with age, sex, body mass index (BMI), and type of sport. A convenient, cross-sectional study was conducted among 249 athlete participants by answering the Eating Attitude Test (EAT-26). The EAT-26 results indicated an ED prevalence of 34% among Jordanian athletes. Within "at-risk" ED athletes, sex, age, and BMI had no significant differences in the rates of EDs. Outdoor sports had the least effect on EDs, while the highest was amongst gymnastics. EDs prevalence is alarming among Jordanian athletes. Gymnastics is a risk factor for increasing EDs. Our results should be taken into consideration by physicians, mental health professionals, sports nutritionists, coaches, and sport medicine specialists. We recommend establishing strategies pertaining to mental health, especially EDs in sports centers, along with screening programs for those who demand additional assessment and supervision.

Prevalence of eating disorders and disordered eating in Western Asia: a systematic review and meta-Analysis

This study aimed to systematically synthesize and appraise existing literature on the prevalence of eating disorders and disordered eating in Western Asia. A systematic literature search of major English and Arabic databases, i.e., PubMed/Medline, EMBASE, PsychInfo, Web of Science and Scopus (English), Al-Manhal (Arabic) and grey literature was done to obtain the prevalence of disordered eating and eating disorders in Western Asia. The literature search was conducted on June 12^th, 2020, and included papers from 1990-2020. Out of the 249 unduplicated original studies reviewed, 27 were included in the final meta-analysis. Data were then categorized according to the tools used to identify the presence of disordered eating or eating disorders. The pooled prevalence of disordered eating as solicited by both the Eating Attitudes Scale 26 and the Eating Attitudes Scale 40 (N = 11841) was 22.07%, the Sick, Control, One stone, Fat, Food Questionnaire (n = 3160) was 22.28% and the Eating Disorder Examination-Questionnaire (n = 425) was 7.95%. The pooled prevalence obtained from those studies using semi-structured interviews for anorexia nervosa (n = 118190) was 1.59%, bulimia nervosa (n = 118513) was 2.41% and the estimated prevalence of Eating Disorder Not Otherwise Specified (EDNOS) (n = 118087) was 3.51%. Although the prevalence rate of eating disorders solicited using semi-structured interviews appeared to parallel the international range, the overall prevalence rate of disordered eating appeared to be slightly higher than the global rates of prevalence. A significant number of the suspected/detected cases of disordered eating appear to fulfill the criteria for EDNOS. This study is classified as evidence obtained from systematic reviews and meta-analyses (i.e. Level 1).

Prevalence of High-Risk Disordered Eating Amongst Adolescents and Young Adults in the Middle East: A Scoping Review

High-risk disordered eating (HRDE) negatively affects physical, mental, and social wellbeing. This scoping review aimed to estimate the prevalence of HRDE amongst adolescents and young adults in the Middle East. MEDLINE database was searched for studies published in English or Arabic from 1 January 2000 to 30 September 2020, estimating HRDE prevalence (using the Eating Attitudes Test 26 or 40 item questionnaire) in the Middle East. Two reviewers independently screened abstracts and full texts of potentially eligible records, followed by data extraction from eligible studies. Nineteen studies (n = 16,288; 65.8% female) from Egypt, Iran, Israel, Jordan, Kuwait, Libya, Oman, Palestine, Saudi Arabia, Syria, Turkey, and the United Arab Emirates were included. Prevalence of HRDE varied considerably across countries and was lowest amongst adolescents in Israel (F 8.2%; M 2.8%) and highest amongst university students in Egypt (F 75.8%; M 69.6%). Prevalence of high-risk for anorexia nervosa ranged from 0.0% in Jordan to 9.5% in Oman; high-risk for bulimia nervosa from 0.6% in Jordan to 1.0% in the United Arab Emirates; and high-risk for binge eating disorder was 1.0% and 1.8% in Turkey and Jordan, respectively. Future studies should employ a standardized two-stage design with clinical diagnosis to verify the prevalence of abnormal eating behaviours in the Middle East.

A systematic scoping review of research on COVID-19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

OBJECTIVE

Research investigating the effects of COVID-19 on eating disorders is growing rapidly. A comprehensive evaluation of this literature is needed to identify key findings and evidence gaps to better inform policy decisions related to the management of eating disorders during and after this crisis. We conducted a systematic scoping review synthesizing and appraising this literature.

METHOD

Empirical research on COVID-19 impacts on eating disorder severity, prevalence, and demand for treatment was searched. No sample restrictions were applied. Findings (n = 70 studies) were synthesized across six themes: (a) suspected eating disorder cases during COVID-19; (b) perceived pandemic impacts on symptoms; (c) symptom severity pre versus during the pandemic; (d) pandemic-related correlates of symptom severity; (e) impacts on carers/parents; and (f) treatment experiences during COVID-19.

RESULTS

Pandemic impacts on rates of probable eating disorders, symptom deterioration, and general mental health varied substantially. Symptom escalation and mental health worsening during-and due to-the pandemic were commonly reported, and those most susceptible included confirmed eating disorder cases, at-risk populations (young women, athletes, parent/carers), and individuals highly anxious or fearful of COVID-19. Evidence emerged for increased demand for specialist eating disorder services during the pandemic. The forced transition to online treatment was challenging for many, yet telehealth alternatives seemed feasible and effective.

DISCUSSION

Evidence for COVID-19 effects is mostly limited to participant self-report or retrospective recall, cross-sectional and descriptive studies, and samples of convenience. Several novel pathways for future research that aim to better understand, monitor, and support those negatively affected by the pandemic are formulated.

A review on association and correlation of genetic variants with eating disorders and obesity

Background

Now, eating disorders and obesity and their correlations are danger signal in worldwide which is caused by multifactor and associated with significant mortality and morbidity.

Main body

Every aspect of a patient’s life is influenced by eating disorders and obesity and their correlations. Due to frequent seeing of obese patients, eating disorders have been included in the review as they can sometimes be associated with obesity. However, it should be noted that most patients having eating disorder are at risk to be obese or overweight. This research explores the risk factors for the two disorders, as well as the assessment of medical complications and treatment recommendations for the disorders. In these two disorders, there is also a correlation. The essential consideration is that eating disorders are impulse-control disorders which are similar to addictive behaviors in some aspects. So it is a crying need to treat a patient with obesity and eating disorders simultaneously to ensure success. Genome-wide association studies (GWASs) have increased our knowledge of the pathophysiology of eating disorders (EDs) and obesity and their correlation.

Conclusion

This review enlightens on the summary of eating disorder, obesity, genotypic traits, molecular relations, interaction, correlation, and effect of eating disorder and obesity which outline potential future directions and clinical implications for patients with EDs and obesity.

The risk of eating disorders among children and adolescents with attention deficit hyperactivity disorder: Results of a matched cohort study

Background and Objectives

There are some studies on the association between attention deficit and hyperactivity disorder (ADHD) and the risk of eating disorders (ED). Only few have examined the risk of ED among children and adolescents with ADHD. Previous research which included subjects with ADHD with other comorbidities used inadequate controls and did not focus on the type of ADHD or the role of pharmacological treatment.

Methods

This matched cohort study was conducted in the Child/Adolescents Psychiatry Unit (CAPU), Bahrain. Using the CAPU diagnostic frameworks, 70 subjects with ADHD were recruited and matched with their corresponding age- and sex- healthy controls at 1:2 ratio (70 cases:140 controls). The participants were children or adolescents aged between 8 and 19 years old. A brief interview was used to collect socio-demographic information and anthropometrics. The risk of ED was estimated using the eating attitude test −26 (EAT-2). Data were analyzed using cohort analysis.

Results

A total of 31.43% of the subjects with ADHD were screened using EAT-26 and found to be ‘at risk’ for ED, compared to 12.14% of the controls (OR 3.31, 95% CI 1.62–6.78). The prevalence of ED among female cases with ADHD was slightly higher than males (33.33% and 30.77%, respectively). Body weight or body mass index was a statistically significant explanatory factor for the risk of ED.

Conclusions

The present study shows that children and adolescents with ADHD have a three-fold increased risk of ED compared to healthy controls. This research raised the recommendation that children and adolescents with ADHD should be screened for disordered eating patterns.

Eating disorders and associated risk factors among Imam Abdulrahman bin Faisal university preparatory year female students in Kingdom of Saudi Arabia

Objectives:

To estimate the prevalence of eating disorders among Imam Abdulrahman bin Faisal University (IAU) in Dammam, Kingdom of Saudi Arabia, female students and to investigate the associated factors.

Methods:

A cross-sectional study was conducted at IAU, Dammam, Kingdom of Saudi Arabia, in 2016 with 670 participants. Data was collected by self-administered questionnaires, including the Eating attitude test 26 (EAT-26) and the sociocultural attitudes toward appearance questionnaire (SATAQ-4). Eating behavior questions were asked to determine whether the respondents should seek evaluation for an eating disorder (ED) from a professional.

Results:

Eating attitude test 26 results showed that 29.4% of participants were categorized at a high level of concern for an ED, and 45.5% were categorized as at risk of having problematic feeding behaviors. Of the participants who scored above 20 on the EAT-26, 60.7% demonstrated high-risk feeding behavior attitudes, and approximately 11.5% who scored a body mass index (BMI) classified as underweight or very underweight required referral to a psychologist. A significant relationship was found between family stress to lose weight and EAT-26 scores above 20. The media was also found to represent external influence to lose weight.

Conclusion:

This study concluded that early detection of EDs or problematic feeding behaviors and attitude is vital to minimize the risks to physical health and well-being of the sufferers’ experiences.

Psychiatry in the Sultanate of Oman

The Sultanate of Oman is located in the south-east of the Arabian Peninsula. It has a distinctive history and subcultures. Its seafaring tradition has endowed the country with various ethnic and linguistic groups, with Arabic being a dominant language and Ibadhi being the dominant sect of Islam (Al-Nami, 1971). Oman in the 1970s saw rapid development, triggered by the discovery of oil, which took place under enlightened new political leadership.

Assessing the factor structure and measurement invariance of the eating attitude test (EAT-26) across language and BMI in young Arab women

BACKGROUND

The objective of the study was to determine the factorial structure and test the measurement invariance of the EAT-26 in a large probability sample of young female university students in Qatar (n = 2692), a Muslim country in the Middle East.

METHODS

The maximum number of factors was derived based on results from initial exploratory factor analysis (EFA) in the first-half of the randomly split sample (Sample 1). A subsequent EFA and Exploratory Structural Equation Models (ESEM) were conducted to identify the number of valid factors. A five-factor model with 19 items was identified as the optimal factor structure. This structure was further replicated using ESEM in the second-half of the sample (Sample 2). Multi-group Confirmatory Factor Analyses (CFAs) were conducted at this stage and their fit was evaluated with and without further sub-grouping by language (Arabic and English) and BMI (underweight, normal weight, and overweight/obese). Finally, measurement invariance tests were conducted in the entire sample assessing equivalence across language and BMI within the final five-factor model.

RESULTS

The five-factor structure of the new EAT-19 [fear of getting fat (FGF), eating-related control (ERC), food preoccupation (FP), vomiting-purging behavior (VPB), and social pressure to gain weight (SP)] provided the best fit: CFI = 0.976, TLI = 0.952, RMSEA = 0.045 (90%CI 0.039-0.051), SRMR = 0.018, CD =1.000. CFAs supported metric invariance for language and for BMI. Language and BMI-based population heterogeneity comparisons provided modest and small-to-moderate evidence for differential factor means, respectively.

CONCLUSION

Although the five-factor model of the EAT-19 demonstrated good item characteristics and reliability in this young female population, the lack of scalar invariance across language and BMI-categories pose measurement challenges for use of this scale for screening purposes. Future studies should develop culture- and BMI-specific cut-offs when using the EAT as a screening instrument for disordered eating in non-clinical populations.

Psychological burden among women with polycystic ovarian syndrome in Oman: a case-control study

Purpose

Previous studies in Euro-American populations have shown that women with polycystic ovarian syndrome (PCOS) have increased levels of “psychological burden”. While PCOS has been reported in Arab countries such as Oman, there is a dearth of studies of the occurrence of psychological burden among PCOS women in the Arab region. This study aimed to compare sociodemographic and clinical characteristics of PCOS women diagnosed with non-PCOS women and prevalence of severity of depression, anxiety and stress and to explore the association between PCOS and indices of psychological disturbances after adjusting for potential confounding factors.

Patients and methods

This hospital-based case–control study was conducted among women aged 16–49 years. The study included 52 women diagnosed with PCOS (as per Rotterdam 2003 criteria) and 60 control who were PCOS-free. The presence of psychological burden – depression, anxiety and stress – was quantified using Depression, Anxiety and Stress Scale-21 (DASS-21).

Results

The crude odds ratios (ORs) generated by logistic regression models indicated an increased risk of depression, anxiety and stress among women with PCOS compared to controls. The adjusted OR also indicated an increased risk of depression (OR =1.10; 95% confidence interval [CI] 0.50, 2.43), anxiety (OR =1.09; 95% CI 0.47, 2.52) and stress (OR =1.45; 95% CI 0.68, 3.12), However, no statistical differences were observed along the three psychological distresses (p>0.05) between the two study groups.

Conclusion

The study indicates that the presence of PCOS is associated with an increased risk of psychological burden. If this study will withstand further scrutiny, meeting psychological needs of such population would need to be contemplated.

Psychometric Properties of the Chinese Version of the Eating Attitudes Test in Young Female Patients with Eating Disorders in Mainland China

The study aimed to investigate the reliability and validity of the Chinese version of the eating attitudes test (EAT-26) among female adolescents and young adults in Mainland China. This scale was administered to 396 female eating disorder patients and 406 noneating disorder healthy controls, in addition 35 healthy controls completed a retest after a 4-week intervals. Tests for reliability, convergent validity and receiver operating characteristic analysis were performed to detect the psychometric properties. The EAT-26 demonstrated good internal consistency (Cronbach's alpha = 0.822-0.922), test-retest reliability (interclass correlation coefficient = 0.817) and convergent validity(r = 0.450-0.750). The receiver operating characteristic analysis showed that the cut-off 14 for anorexia nervosa and 15 for bulimia nervosa represented good compromises with approximate sensitivity (0.66-0.68) and specificity (0.85-0.86). Our findings provided evidence that the Chinese version of the EAT-26 was a psychometrically reliable and valid self-rating instrument for identifying people suffering from an eating disorder in Mainland China. A clinical cut-off range between 14 and 15 could be used, but caution should be exercised because of the low sensitivity of the tool. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Disordered eating and body image issues and their associated factors among adolescents in urban secondary schools in Sarawak, Malaysia

Eating disorders are common health issues among the adolescents. The objective of this study was to determine the prevalence of eating disorders and their relationship with body mass index, body part satisfaction and perception on body weight among urban secondary school children. It was a cross-sectional study conducted in Kuching, Sarawak. Data was collected using a self-administered questionnaire that consist of the Eating Attitude Test-26 (EAT-26), perception on body part satisfaction and body weight, and anthropometric measurement. Data was entered and analysed using SPSS version 22. A total of 329 respondents participated in this study with 59% females and 60.5% Malays. There were 14.3% of the respondents overweight and obese, with higher percentage among males (19.3%). About 18.5% of the respondents were found to be at risk of eating disorders with higher prevalence among males (19.3%). More females reported to have higher prevalence of body part dissatisfaction (46.9%) and body weight (37.6%) compared to males (40%, 28.1%). The statistical results indicated there were significant associations between EAT-26 and body mass index (BMI) (p=0.039), body part satisfaction (p=0.004), and perception of body weight (p=0.038). Eating disorders are becoming more prevalent amongst adolescents, particularly among males. As eating disorder are strongly associated with adolescent mental and physical health, intervention programme on their developmental challenges and issues for both males and females should be in place particularly in the school education syllabus.

Disordered eating attitudes during pregnancy in mothers of newborns requiring Neonatal Intensive Care Unit admission: a case control study

OBJECTIVE

The aim of the study was to assess disordered eating attitudes and other related factors in mothers of newborns requiring Neonatal Intensive Care Unit (NICU) admission compared to those of mothers who delivered healthy infants.

METHODS

An anonymous self-report study conducted among 199 mothers of newborns hospitalized in NICU, and a control group of 127 mothers of healthy newborns. Eating Attitudes Test-26 (EAT-26) and a survey regarding other perinatal health issues were used.

RESULTS

Women in the study group (SG) gained significantly less weight during pregnancy when compared to control group (CG; p = 0.001). There were fewer women with appropriate pre-gestational BMI in the SG (p = 0.052). Women who feared weight-gain during pregnancy were younger (p < 0.001) and had higher EAT-26 scores (p < 0.001). Women with EAT-26 scores >20 smoked significantly more often during their last pregnancy in the SG (p = 0.010). Cesarean section was more frequent in the SG (p = 0.017).

CONCLUSIONS

Disordered eating attitudes in gestation may significantly influence the pregnancy outcomes and newborns' health. Hence, it is vital for perinatal counseling and obstetrical care to focus on these issues to facilitate early diagnosis and intervention.

[Diagnostic validity and usefulness of the Eating Attitudes Test-26 for the assessment of eating disorders risk in a Colombian female population]

Objetivo

Evaluar la validez y la utilidad diagnóstica de la escala EAT-26 para la evaluación del riesgo de trastornos de conducta alimentaria (TCA) en población femenina.

Diseño

Estudio observacional de validación de pruebas.

Emplazamiento

Realizado en la ciudad de Medellín en nivel de atención comunitaria de consulta psiquiátrica mixta (pública y privada).

Participantes

Veinticinco mujeres con edades entre 15 y 25 años que cumplieran criterios DSM-IV-TR para anorexia y bulimia nerviosa y 111 controles sin TCA.

Mediciones principales

La muestra de casos fue por conveniencia y en controles, aleatoria simple. Se comparó el «criterio de oro» (entrevista estructurada por psiquiatra para determinar el cumplimiento o no de criterios de inclusión de caso de TCA) con el EAT-26, y al instrumento se le hizo validación cultural y semántica, validación factorial, evaluación de confiabilidad, así como determinación del mejor punto de corte por medio de la curva ROC.

Resultados

En EAT-26 subyacen 4 dominios: bulimia, dieta, preocupación por la comida y control oral. El alfa de Cronbach fue de 92,1%, y el mejor valor de corte, el de 11 y más puntos (sensibilidad del 100% y especificidad del 85,6%).

Conclusión

El EAT-26 modificado y abreviado es un instrumento multidimensional, con excelentes valores de confiabilidad y sensibilidad, y con un adecuado valor de especificidad, apropiado para el cribado de posible TCA en población de riesgo y útil en atención primaria para su detección temprana en mujeres jóvenes.

Comparative validity of the chinese versions of the bulimic inventory test edinburgh and eating attitudes test for DSM-IV eating disorders among high school dance and nondance students in Taiwan

OBJECTIVES

To compare the validity of the Eating Attitudes Test (EAT) and the Bulimic Investigatory Test Edinburgh (BITE) as screening tools for eating disorders (EDs), and to identify a new threshold for each questionnaire to detect ED cases among dance and nondance students.

METHOD

Dance students enrolled in high schools with gifted dance programs and nondance students randomly chosen from the same or nearby schools were invited to participate in a 2-phase ED survey. Participants completed the EAT and BITE questionnaires in the first phase. All participants who screened positive and 10% of the participants who screened negative were interviewed blindly using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition.

RESULTS

The BITE had better accuracy than the EAT in detecting ED in general among both dance and non-dance students. BITE scores of 19 and 16 were the optimal cutoff values for determining ED among dance and nondance students, respectively. The optimal cutoff value for the EAT to diagnose an ED was 19 for dance students and 12 for nondance students. Both questionnaires showed higher sensitivity and lower specificity in dance students than nondance students at the same cutoff points.

DISCUSSION

The BITE had better diagnostic performance than the EAT in this nonclinical population, although its ability to detect restrictive behaviors is likely as limited as that of the EAT. Plausible explanations for these results and limitations of this study are discussed in the text.

The Eating Attitudes Test (EAT-26): Reliability and Validity in Spanish Female Samples

This paper focuses on the validation of the Spanish form of the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr & Garfinkel, 1982) across two studies. Participants in Study 1 were 778 females recruited from community settings (aged 12-21). Study 2 included 86 females recruited from clinical and 86 females from community settings (aged 12-35). Results from Principal and Simultaneous Component Analyses showed a unidimensional structure of the EAT-26 item scores. Reliability analyses supported the internal consistency of the scale. Study 1 also explores the ability of the EAT-26 to discriminate between subjects with Eating Disorder (ED), Symptomatic or Asymptomatic by means of ROC analyses and using results from the Questionnaire for Eating Disorder Diagnoses (Q-EDD; Mintz, O'Halloran, Mulholland, & Schneider, 1997) as criterion. The EAT-26 demonstrated good specificity but insufficient sensitivity to detect a full or partial ED. Study 2 explores the ability of the questionnaire to discriminate between subjects with and without ED. The EAT-26 demonstrated good specificity and moderate sensitivity to detect ED. Clinical and theoretical implications of these results are discussed.

Eating disorders and their associated risk factors among Iranian population - a community based study

Backgrounds:

Many socio cultural variables could be affect eating disorders in Asian countries. In Iran, there are few researches regarding eating disorders and their contributing factors. The aim of this study is to explore frequency of eating disorders and their risk factors in an Iranian population.

Materials and Methods:

About 1204 participants were selected aged between fourteen to 55 years. Frequency of eating disorders and effects of variables such as demographic characteristics, Body Mass Index (BMI), use of media, body dissatisfaction, self-esteem, social comparison and social pressure for thinness in individuals with and without eating disorders, were assessed.

Findings:

The prevalence of eating disorders was 11.5% that included 0.8% anorexia nervosa, 6.2% full threshold bulimia nervosa, 1.4% sub threshold anorexia nervosa and 30% sub threshold binge eating disorder. Symptoms of bulimic syndrome were greater in males.

Conclusion:

In Iran, eating disorders and related problems are new issue that could be mentioned seriously The identification of these disorders and their related contributing factors are necessity of management and preventive programs planning.

Two-phase survey to determine social anxiety and gender differences in Omani adolescents

INTRODUCTION

There is a lack of studies examining the effectiveness of some of the commonly used instruments to elicit the presence of social anxiety disorder (SAD) in Arab-speaking populations, such as those in Oman. The aim of this study was to establish the influence of social anxiety and the role of gender among Omani adolescents.

METHODS

A two-phase protocol was used, entailing the psychometric properties of the Arabic version of the Liebowitz Social Anxiety Scale (LSAS) against the gold standard, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

RESULTS

According to DSM and LSAS, the prevalence of social phobia among Omani students was generally higher compared to what has been reported in other parts of the world and the crosstabs analysis showed a significant correlation between gender and SAD.

DISCUSSION

The Arabic version of LSAS proved to be an effective tool for assessing and quantifying the presence of SAD. This study discusses the sociocultural factors affecting social phobia in Omani society.

Adolescent male with anorexia nervosa: a case report from Iraq

This is the first reported case of an adolescent male with anorexia nervosa in Iraq. This disorder is believed to be rare in males across cultures and uncommon for both genders in Arab countries. The patient met the DSM-IV diagnostic criteria for anorexia nervosa. He was hospitalized and received medical and psychiatric treatment at local facilities as discussed below and responded well to treatment.

Eating disorders in adolescents and their repercussions in oral health

OBJECTIVE

To examine the prevalence of oral alterations related to eating disorders and associated factors.

METHOD

A cross-sectional study including 650 adolescents aged from 12 to 16 was carried out through self-report questionnaires (EAT-26; BITE and self-rating hamilton depression questionnaire, SRHDQ) and dental examination.

RESULTS

Significant associations were observed in mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions. The prevalence of adolescents at risk for eating disorders was of 33.1%, according to EAT-26 and 1.7% (high scores) and 36.5% (medium scores), in BITE, higher among 13-year-old females, with brothers, parents or responsible person who are illiterate, being the youngest child, living in a residence of at most two rooms and who showed depressive symptoms. All these factors showed significant relation to eating disorders.

DISCUSSION

Presence of oral alterations is associated to symptoms of eating disorders, helping precocious detection of sub clinical cases.

Is there evidence that religion is a risk factor for eating disorders?

OBJECTIVE

Is there evidence that religion is a risk factor for eating disorders?

METHODS

A literature search was performed to examine whether there is an association between religion and eating disorders.

RESULTS

There were some cross-sectional studies, case studies, and anthropological commentaries reporting eating disorders in various cultures and religions. Religious affiliation was usually reported as an incidental finding but not analyzed. A number of prevalence studies were reported from Islamic communities. This raises the possibility that young Muslim women have a higher prevalence of elevated EAT scores compared to non-Islamic women.

CONCLUSION

This literature search raises the possibility that there is an association between Islamic affiliation and positive screening for eating disorder behaviors. This supports the hypothesis that the effect of culture on eating disorders may be religious as well as secular. Carefully designed studies of the prevalence of eating disorders in multicultural populations with multiple religious affiliations may help further clarify the relationship between religion and eating disorders.

Eating behaviour, body image, and self-esteem of adolescent girls in Malaysia

This cross-sectional study was undertaken with 489 secondary school girls, ages 15-17 years, to examine disordered eating behaviours of adolescent girls in Malaysia and to estimate associations with body weight, body-size discrepancy, and self-esteem. Dietary restraint, binge eating, body image, and self-esteem were assessed using the Restrained Eating scale of the Dutch Eating Behaviour Questionnaire, the Binge Scale Questionnaire, the Contour Drawing Rating Scale, and the Rosenberg Self-Esteem Scale, respectively. Pearson correlations estimated associations between variables. There were 3.1% underweight, 9.8% at risk of being overweight, and 8.6% overweight girls. A total of 87.3% were dissatisfied with their own body size. Dietary restraint and binge eating were reported by 36.0% and 35.4%, respectively. Body Mass Index (r = .34, p < .01) and body-size dissatisfaction (r = .24, p < .01) were significantly associated with dietary restraint and binge eating, but self-esteem (r = -.20, p < .001) was significantly associated only with binge eating.

Comparative study of attitudes to eating between male and female students in the People's Republic of China

OBJECTIVE

This study was conducted to compare eating attitudes and lifestyles of male and female college students in China (Beijing).

SUBJECTS AND METHODS

The subjects of this study consisted of 217 male and 177 female college students. They were asked to fill out the Eating Attitudes Test-26 (EAT-26) and a lifestyle questionnaire.

RESULTS

The percentages of those above the cutoff point on the EAT-26 for abnormal eating attitudes were 4.7% of male and 6.2% of female students. Body perception of being fat (distorted body image) was the factor most associated with abnormal eating attitudes.

DISCUSSION

Weight related concern was prevalent amongst the Chinese students. This suggests that the culture of the beauty of thinness is common among young students in Beijing, particularly female students.

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.