Population at risk for eating disorders in a Spanish region

A Scoping Review of the Prevalence of Eating Disorders in Spain

INTRODUCTION

Eating disorders (EDs) are mental health illnesses with a multifactorial origin. At present, no review of indexed publications studying their prevalence in Spain is available.

MATERIAL AND METHODS

A scoping review (PROSPERO -CRD42019140884-) was carried out through systematic searches (MEDLINE, EMBASE and PsycINFO) until January 2022. Papers published in Spanish/English analysing the prevalence of EDs in Spain (population < 65 years) were selected.

RESULTS

A total of 766 articles were identified (186 eliminated as duplicates). A total of 580 articles were analysed on the basis of title and abstract, and 67 articles were selected for full-text analysis. A total of 37 studies analysed the prevalence of EDs in Spain.

CONCLUSIONS

This is the first scoping review to analyse the prevalence of EDs in Spain. Puberty and adolescence are the most extensively studied stages. There is a high heterogeneity in the use of ED screening tools and a paucity of information on diagnostic tools.

The prevalence of feeding and eating disorders symptomology in medical students: an updated systematic review, meta-analysis, and meta-regression

PURPOSE

Medical students have a higher risk of developing psychological issues, such as feeding and eating disorders (FEDs). In the past few years, a major increase was observed in the number of studies on the topic. The goal of this review was to estimate the prevalence risk of FEDs and its associated risk factors in medical students.

METHODS

Nine electronic databases were used to conduct an electronic search from the inception of the databases until 15th September 2021. The DerSimonian-Laird technique was used to pool the estimates using random-effects meta-analysis. The prevalence of FEDs risk in medical students was the major outcome of interest. Data were analyzed globally, by country, by research measure and by culture. Sex, age, and body mass index were examined as potential confounders using meta-regression analysis.

RESULTS

A random-effects meta-analysis evaluating the prevalence of FEDs in medical students (K = 35, N = 21,383) generated a pooled prevalence rate of 17.35% (95% CI 14.15-21.10%), heterogeneity [Q = 1528 (34), P = 0.001], τ2 = 0.51 (95% CI 0.36-1.05), τ = 0.71 (95% CI 0.59-1.02), I2 = 97.8%; H = 6.70 (95% CI 6.19-7.26). Age and sex were not significant predictors. Body mass index, culture and used research tool were significant confounders.

CONCLUSION

The prevalence of FEDs symptoms in medical students was estimated to be 17.35%. Future prospective studies are urgently needed to construct prevention and treatment programs to provide better outcomes for students at risk of or suffering from FEDs.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Risk of Eating Disorders in Patients With Celiac Disease

OBJECTIVES

Several cases of eating disorders (EDs) have been reported in patients with celiac disease (CD), suggesting that ED could be a comorbidity associated with CD. Few epidemiological studies have, however, assessed this potential association. We aimed to evaluate the risk of EDs in individuals diagnosed with CD in comparison to healthy controls.

METHODS

A total of 98 cases and 98 controls matched for sex, age, and body mass index between 10 and 23 years old were studied. A questionnaire was completed on medical history and sociodemographic as well as anthropometric characteristics. Various ED screening self-reported tests were administered.

RESULTS

A total of 61.2% of the study population were girls with a mean age of 15.3 ± 3.7 years old. Patients with CD scored nonsignificantly higher on all the ED screening tests than control participants. No differences were observed between study groups in terms of the frequency of individuals who exceeded the clinical cutoff identifying those at risk of ED. Patients with CD above 13 years old were associated with a 2.15-point increase in the Eating Attitude Test score compared with controls [β-coefficient = 2.15 SE 1.04; P = 0.04] after adjusting for various confounders.

CONCLUSIONS

Although being a patient with CD was associated with a significantly higher Eating Attitude Test score in individuals older than 13 years old, no clear differences were observed between individuals with CD and controls in terms of risk of ED when other screening tests were used. More studies with larger samples and prospective designs are warranted to confirm these findings.

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.

Abnormal eating attitudes in Mexican female students: a study of prevalence and sociodemographic-clinical associated factors

The objective of the study was to determine the prevalence of abnormal eating attitudes (AEA) in Mexican high school and university students in the city of San Luis Potosí, Mexico. By means of a transversal study with a weighted, random and multistage sampling process, we analyzed a representative sample of female students (N= 2006). The instrument was the Eating Disorder Inventory-2 (EDI-2), validated in Mexican population and a questionnaire of sociodemographic data. The prevalence of AEA was 12.6% and its frequency was significantly higher in high school than in university students. AEA cases were uniformly distributed among public and private institutions and a highly significant relationship between substances consumption and AEA was observed. A logistic regression model for AEA was obtained. Therefore, a profile of highly AEA was built based on sociodemographic data and a solid instrument validated in Mexican population, which can be employed as a screening and secondary prevention tool to design public health programs.

Gender, school and academic year differences among Spanish university students at high-risk for developing an eating disorder: an epidemiologic study

BACKGROUND

The aim of this study was to assess the magnitude of the university population at high-risk of developing an eating disorder and the prevalence of unhealthy eating attitudes and behaviours amongst groups at risk; gender, school or academic year differences were also explored.

METHODS

A cross-sectional study based on self-report was used to screen university students at high-risk for an eating disorder. The sample size was of 2551 university students enrolled in 13 schools between the ages of 18 and 26 years. The instruments included: a social-demographic questionnaire, the Eating Disorders Inventory (EDI), the Body Shape Questionnaire (BSQ), the Symptom Check List 90-R (SCL-90-R), and the Self-Esteem Scale (RSE). The sample design is a non-proportional stratified sample by academic year and school. The prevalence rate was estimated controlling academic year and school. Logistic regression analysis was used to investigate adjusted associations between gender, school and academic year.

RESULTS

Female students presented unhealthy weight-control behaviours as dieting, laxatives use or self-induced vomiting to lose weight than males. A total of 6% of the females had a BMI of 17.5 or less or 2.5% had amenorrhea for 3 or more months. In contrast, a higher proportion of males (11.6%) reported binge eating behaviour. The prevalence rate of students at high-risk for an eating disorder was 14.9% (11.6-18) for males and 20.8% (18.7-22.8) for females, according to an overall cut-off point on the EDI questionnaire. Prevalence rates presented statistically significant differences by gender (p < 0.001) but not by school or academic year.

CONCLUSION

The prevalence of eating disorder risk in university students is high and is associated with unhealthy weight-control practices, similar results have been found in previous studies using cut-off points in questionnaires. These results may be taken into account to encourage early detection and a greater awareness for seeking treatment in order to improve the diagnosis, among students on university campuses.

Prevalence of eating disorders in a Spanish community adolescent sample

OBJECTIVE

To describe the prevalence of eating disorders (ED) among Spanish adolescents and to present the reliability of the Catalan version of the EDE-12.

METHOD

A community sample of 1155 participants, and a risk sample of 93 participants, aged between 10.9 and 17.3 years old, from the city of Barcelona participated in the study. The study involved two stages: first, an initial screening with the Eating Disorder Inventory-2 (EDI-2), and second, a structured clinical interview (EDE-12). Three scales of the EDI-2 (Drive for thinness, Body dissatisfaction and Bulimia) were used to select the at risk sample; the Eating Disorders Examination-12 (EDE-12) was only administered to the at-risk sample.

RESULTS

A 1.28% of the total sample was detected as ED (2.31% of girls and 0.17% of boys). Reliability coefficients of EDE-12 ranged from medium to high.

DISCUSSION

Symptoms of anorexia and bulimia nervosa were higher among girls than boys. Preoccupation with maintained low weight, with body image and shape, and taking excessive exercise in order to loose weight, are increasing among Spanish adolescents. Prevalence rate of ED is lower than other studies with Spanish' adolescents sample, and could be related to the sample age (13.16% of the sample is smaller than 12 years old), and to the non response bias to the interview because the assessment was carried out in the school setting.

Prevalence and correlates of chronic dieting in a multi-ethnic U.S. community sample

Despite the increasing rates of obesity in the U.S. and corresponding rise in weight-related concerns among men and women in all ethnic groups, most research in the U.S. has been conducted using white female samples. This study explored the prevalence and correlates of chronic dieting (high levels of dietary restraint) among a U.S. communitybased sample of Hispanic, Asian, Black, and White women and men (N=1257). Chronic dieting was more common among women than men, and less common among Asians than other ethnic groups. Across the total sample, dietary restraint was positively correlated with weight history, disordered eating attitudes, distorted body experiences, and depression, and was negatively correlated with self-esteem. Female chronic dieters showed the highest degree of disturbance; compared with female non-dieters (and male chronic dieters), they reported lower self-esteem, higher depression, and more disordered eating attitudes. As hypothesized, they also exhibited a higher degree of acculturation to Anglo-American society. Male chronic dieters had more disordered eating attitudes and experienced greater body distortion than male non-dieters. Interestingly, these results were not moderated by ethnicity. Although the prevalence of chronic dieting differs among ethnic groups living in the U.S., the psychological characteristics related to eating and weight appear similar for individuals who diet, irrespective of ethnicity.

Factor structure of Eating Disorders Inventory-2 in a Spanish sample

OBJECTIVE

To present basic statistics and analyze factor structure of EDI-2 in an adolescent non-clinical sample from Spain.

METHOD

An Exploratory Factor Analysis (EFA) was carried out with Principal Axis Factoring (PAF) and oblimin rotation, using raw scores.

RESULTS

EFA presented a 21-factor structure with eigenvalues greater than 1. It was then forced into 11 and 5-factor solutions.

DISCUSSION

The eleven-factor structure does not correspond with the 11 scales. A five-factor structure seems to be better suited than other factor solutions and presented higher reliability coefficients.