Validation of the Night Eating Diagnostic Questionnaire (NEDQ) and its relationship with depression, sleep quality, “food addiction”, and body mass index

Taking Steps Toward a Consensus on Night Eating Syndrome Diagnostic Criteria

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Examining the evidence between screen time and night eating behaviour with dietary intake related to metabolic syndrome: A narrative review

Screen time (ST) on digital devices has increased in recent decades due to digital development. Furthermore, constant engagement with digital devices alters sleep patterns, leading to nocturnal eating behaviour among users. These phenomena are therefore of great concern, as digital device addiction and night eating are associated with unhealthy food intake, increasing the metabolic syndrome (MetS) risks. The purpose of this review was to examine the evidence of the influence of ST and night eating behaviour (NEB) on dietary intake and its association with MetS based on previous literature. Prolonged ST and NEB have an association with excessive intake of energy from overconsumption of high-sugar and high-fat foods. However, the relationship between digital content and its influence on food intake is inconsistent. A higher MetS risk was found in individuals with longer ST due to a sedentary lifestyle, while positive energy balance and a shift in circadian rhythm contributed to night eaters. ST and NEB presented with a significant influence on food intake in adults. Additionally, unhealthy food intake due to excessive consumption of empty-calorie foods such as sweet and fatty foods due to addiction to electronic devices and eating at night has a detrimental effect on metabolic function. Therefore, improving food intake by reducing ST and night binges is essential to reduce the risk of MetS.

Associations of Food Addiction Symptomatology and Disordered Eating Behaviors in a Pre-Surgical Bariatric Population

The construct of food addiction (FA) has been highly debated in recent years particularly in the fields of disordered eating, medical weight management, and bariatric surgery. Some researchers have argued that FA symptoms are distinct, highly prevalent, and present a barrier for patients seeking medical treatment for obesity. The purpose of this study is to evaluate the cross-sectional associations between FA symptomatology, binge eating disorder (BED) and other appetitive traits, as well as dietary quality in a sample of adults with obesity seeking bariatric surgery. This post hoc analysis was conducted on a prospectively collected dataset from August 2020 to August 2022 at a single academic medical center. Descriptive statistics were used to characterize the sample. Additional analyses included: correlation coefficients, multivariable linear regression, and analysis of variance. A total of 587 patients were included in this analysis with low average scores for FA symptoms (mean: 1.48; standard deviation (SD): 2.15). Those with no BED symptoms had the lowest average FA symptoms scores (mean: 0.87; SD: 1.52) and those with both bingeing and LOCE had the highest average scores (mean: 3.35; SD: 2.81). This finding supports the hypothesis that, while related, FA and BED may represent different cognitions and behaviors.

Correlates of Food Addiction and Eating Behaviours in Patients with Morbid Obesity

INTRODUCTION

Food addiction (FA) is a promising construct regarding the multifactorial aetiology of obesity and the search for therapeutic approaches. However, there is an ongoing debate regarding the overlap/differentiation with eating disorders and the classification as a substance- or behaviour-related addiction. Energy-dense foods, especially those combining carbohydrates and fat, are associated with addictive eating and suspected of playing a role in the genesis of FA. This study aims to further understand the clinical significance of FA and to identify possible therapeutic targets. A special focus is set on potentially addictive foods (combination of carbohydrates and fat).

METHODS

Based on the Yale Food Addiction Scale 2.0, a cohort of 112 German adults with morbid obesity was divided into two sub-samples (patients with and without FA), which were examined for differences in the variables listed below.

RESULTS

The prevalence of FA was 25%. Patients meeting criteria for FA showed higher degrees of hunger, emotional, binge, and night eating than patients without FA. In addition, hunger and disinhibition were found to be significant predictors of FA. FA was not associated with sex, age, body mass index (BMI), cognitive restraint, rigid and flexible control, prevalence of substance use, age of onset of obesity, stress level, level of social support, reduction of BMI during a weight loss programme, or programme withdrawal rate. There was no significant difference in the consumption of foods rich in both carbohydrates and fat, nor of fat or carbohydrates alone.

CONCLUSION

FA can be considered as a sub-phenotype of obesity, occurring in approximately 25% of obesity cases. Dysfunctional emotional coping mechanisms associated with low distress tolerance showed to be significantly related to FA and should be targeted therapeutically. Behavioural interventions should include a bio-psycho-social model. Binge eating episodes were found to be characteristic for FA and the already stated overlap between FA and binge eating behaviour can be confirmed. The results do not support a decisive difference due to a substance-related component of FA. Despite this, the existence of FA as a distinct entity cannot be excluded, as not all patients with FA exhibit binges.

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

Night eating syndrome (NES) is characterised by recurrent episodes of night eating, evident through excessive food consumption after the evening meal or eating after awakening from sleep, often associated with significant distress and/or impairment in functioning. This scoping review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines. The search was conducted through the use of PubMed, Medline (OVID) and SCOPUS, to identify relevant articles published within the last 10 years. Search terms including "Night eating*" OR "NES" and Boolean phrases were used to refine the search. Additionally, the age of participants was restricted to 18 years and above, to ensure only adult participants were included. The abstracts of the remaining articles were used to screen for those that were relevant. From a total of 663 citations, 30 studies assessing night eating syndrome met the inclusion criteria to be included in the review. We found inconsistent associations of NES with higher body mass index (BMI), less physical activity, type 2 diabetes mellitus (T2DM) and poorer quality of sleep. These inconsistencies may have been due to the use of different measurement methods, lack of power from small sample sizes of NES in some studies and varying ages of participants, with associations being more likely to be found in higher-quality, representative populations than in university student samples. There were no associations of NES with T2DM in clinical populations and with hypertension, OSA and metabolic syndrome, but sample sizes were small. The impacts of NES on these medical conditions should be addressed in future, using well-sized and long-term studies involving representative populations of adults. In conclusion, NES likely has negative impacts on BMI, T2DM, physical activity, and sleep quality, which in turn may increase cardio-metabolic risk. However, further research is needed to elucidate the interaction between NES and its associated features.

Night eating syndrome subtypes: differences in binge eating and food addiction symptoms

PURPOSE

The purpose of the current study was to examine differences in binge eating and food addiction symptoms between Night Eating Syndrome (NES) latent subtypes: evening hyperphagia with nocturnal ingestions (EHNI), evening hyperphagia-only (EHO), and nocturnal ingestions-only (NIO). It was hypothesized that the EHNI group would report more binge eating behaviors and more food addiction symptoms than both the EHO and NIO groups. Further, it was hypothesized that the EHO and NIO groups would differ with the EHO group reporting more binge eating behaviors and the NIO group reporting more food addiction symptoms.

METHODS

Participants completed measures online relating to night eating, binge eating, and food addiction. Average age of the final sample was 34.3 (SD = 10.5) and 62.0% were men. Responses to the Night Eating Questionnaire (NEQ; Allison et al., 2008) were used to create an EHNI group (n = 65), an EHO group (n = 32), and a NIO group (n = 69). ANOVAs were conducted to examine between-group differences on disordered eating symptoms.

RESULTS

Participants in the EHNI group reported more severe binge eating and food addiction symptoms than those in the EHO and NIO groups. However, there were no significant differences in binge eating or food addiction between the EHO and NIO groups.

CONCLUSION

Individuals who meet both NES core criteria (evening hyperphagia and nocturnal ingestions) are likely at a higher risk for experiencing other, more severe disordered eating pathologies. Implications concerning assessment and future research on NES typology are discussed.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Daytime sleepiness, addictive-like eating, and obesity sequelae in Black and African American youth with obesity

OBJECTIVES

The purpose of the current study was to examine the association between poor sleep health (ie, excessive daytime sleepiness), obesity sequelae (ie, percent overweight and serum leptin levels), and addictive-like eating behaviors, an obesity phenotype, in a sample of Black/African American (B/AA) adolescents.

DESIGN

The current study analyzed archival baseline data from a sample of B/AA adolescents with obesity enrolled in a sequential randomized clinical trial.

SETTING

Data were collected in the participants' homes by trained research assistants unaware of treatment condition.

PARTICIPANTS

A sample of 181 B/AA adolescents with obesity between the ages of 12 and 16 years (M = 14.26, SD = 1.46) and having a body mass index (BMI) above the 95th percentile for age and gender were sampled.

MEASUREMENTS

Self-report measures included the Cleveland Adolescent Sleepiness Questionnaire and the Yale Food Addiction Scale-Children (YFAS-C). Anthropomorphic data and blood samples were used to determine BMI and serum leptin levels, respectively.

RESULTS

Excessive daytime sleepiness was positively correlated with YFAS-C symptom count, r = 0.295, P < .001. Serum leptin levels and percent overweight were both positively correlated with each other, r = 0.445, P < .001 and with YFAS-C symptom count, r = 0.215, P = .006. After controlling for age and gender, results supported an indirect effect from daytime sleepiness to both serum leptin levels (estimate = 2.210, SE = 0.932, P = .018) and percent overweight (estimate = 2.817, SE = 1.415, P = .046) through YFAS-C symptom count.

CONCLUSIONS

Culturally informed interventions on eating behaviors (ie, addictive-like eating) when excessive daytime sleepiness is reported are needed. Early intervention may help prevent the onset or worsening of obesity among adolescents.

Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age.

Conclusions

This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Converging vulnerability factors for compulsive food and drug use

Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Addiction-like response in brain and behavior in a rat experimental model of night-eating syndrome

STUDY OBJECTIVES

Individuals ailing from night eating syndrome (NES) consume more than 25% of their daily food intake during the normal sleep time, delaying their sleep or waking up in the middle of the night to eat. This study explored two experimental conditions resembling NES in Wistar rats by offering palatable food during the sleep phase, alone or combined with sleep delay. Also we explored their impact on addiction-like changes in the brain and behavior.

METHODS

Experiment 1 explored the brain response after a first NES-like event; experiment 2 and 3 explored addiction-like behaviors c-Fos and FosB/ΔFosB in corticolimbic regions after 4 weeks exposition to NES-like conditions and after one week of withdrawal, respectively. For all 3 experiments 6 experimental groups were used: 1. Control; 2. Restricted access (1 h) to high-sugar diet (HSD) or to 3. high-fat diet (HFD); 4., Sleep delay for 4 h (SD) (from ZT0-ZT4, rats using slow rotating wheels); 5. SD + HSD; 6. SD + HFD.

RESULTS

A first event of eating a palatable diet with or without SD was sufficient to stimulate c-Fos and ΔFosB. Along 4 weeks of exposure to the palatable diets rats exhibited escalation and binge eating, which was highest for the HFD. At this stage, SD did not influence behavioral changes nor the neuronal response. After one-week in withdrawal, rats exhibited craving and effort to obtain their palatable diet. The brains of rats previously exposed to sleep delay maintained high levels of FosB/ΔFosB in the accumbens shell and high c-Fos activation in the insular cortex.

CONCLUSIONS

In our experimental models of NES-like a HFD in the sleep phase and SD are risk factors to develop binge eating and addiction-like behaviors.

Depression symptoms and night eating in young adulthood

PURPOSE

We estimated cross-sectional and longitudinal associations between depression symptoms and night eating in young adults.

METHODS

Data were drawn from a longitudinal investigation of students age 12-13 years at inception in 1999-2000, in Montreal, Canada. Depression symptoms were measured with the Depressive Symptoms Scale (DSS) 20 times from age 12 to 17, and with the Major Depression Inventory (MDI) post-high school at ages 20 and 24. Night eating was measured at age 24. The association between depression symptoms and night eating was estimated in multivariable logistic regression models adjusted for sex, age and mother university-educated.

RESULTS

9% of 829 participants (n = 77) reported night eating. In cross-sectional analysis, the adjusted odds ratio (OR) estimate for MDI scores (range 0-50) was 1.04 (1.01, 1.07). In longitudinal analyses, the OR estimates were 1.75 (1.20, 2.55) for DSS scores (range 1-4) and 1.03 (1.002, 1.06) for the MDI.

CONCLUSIONS

Depression symptoms are associated with night eating in young adults cross-sectionally and possibly longitudinally. Treatment of depression symptoms may be important in preventing night eating, a core symptom of the Night Eating Syndrome.

LEVEL OF EVIDENCE

Level III, cohort analytic study.

Determinants of sleep quality in college students: A literature review

PURPOSE

To review the various determinants of sleep quality among college students.

METHODS

The PubMed, Web of Science and Cochrane Library databases were searched with the search string "sleep quality" AND "college students" for articles published between January 2007 and October 2017. Articles were excluded if they (1) examined sleep quality as a risk factor for other outcomes or (2) involved inpatients or participants under medical care.

RESULTS

The 112 identified studies were classified into categories according to the investigated determinants and their effect on sleep quality. Physical activity and healthy social relations improved sleep quality, while caffeine intake, stress and irregular sleep-wake patterns decreased sleep quality. Less consistent results were reported regarding eating habits and sleep knowledge, while proper napping during the day might improve overall sleep quality.

CONCLUSIONS

College students are vulnerable to different risk factors for sleep quality. When designing interventions to improve sleep quality among college students, the main determinants need to be taken into consideration.

Linking What We Eat to Our Mood: A Review of Diet, Dietary Antioxidants, and Depression

Studies have shown that diet and nutrition play significant roles in the prevention of depression and its clinical treatment. The present review aims to provide a clear understanding of the associations between diet patterns, specific foods, nutrients such as antioxidants, and depression. As a result, balanced dietary patterns such as the Mediterranean diet and certain foods such as fish, fresh vegetables, and fruits have been associated with a lower risk of depression or depressive symptoms, while high-fat Western diets and sugar-sweetened beverages have been associated with higher risk of depression or depressive symptoms. Dietary antioxidants such as green tea polyphenols or isoflavonoid intake have been negatively associated with depression or depressive symptoms. It is concluded that diet patterns, specific foods, and antioxidants play important roles in the prevention and clinical treatment of depression.

Night eating syndrome: a psychiatric disease, a sleep disorder, a delayed circadian eating rhythm, and/or a metabolic condition?

Introduction: Night Eating Syndrome (NES) refers to an abnormal eating behavior which presents as evening hyperphagia consuming >25% calorie intake and/or nocturnal awaking with food ingestion which occurs ≥2 times per week. Although the syndrome has been described more than seven decades ago, the literature has been growing slowly on its etiology, diagnosis, and treatment. Areas covered: The proposed treatment options for NES are all at a case-study level. Moreover, our understanding of its etiology, comorbidities, and diagnosis is still premature. We performed a literature review in Medline/PubMed to identify all the studies proposing a management plan for NES and summarized all the existing data on its diagnosis and treatment. Expert opinion: To date, none of the proposed treatment options for NES have been promising and long-term data on its efficacy is lacking. The slow growth of evidence on this debilitating but underreported condition may be due to unawareness among clinicians, under-reporting by patients, and unrecognized diagnostic criteria. Objective screening of symptoms during office visits especially for patients at a high-risk for NES will identify more patients suffering from the syndrome.

Dysfunctional eating in type 2 diabetes mellitus: A multicenter Italian study of socio-demographic and clinical associations

BACKGROUND AND AIMS

Dysfunctional eating might impact on the management and metabolic control of type 2 diabetes (T2DM), modifying adherence to healthy diet and food choices.

METHODS AND RESULTS

In a multicenter study, we assessed the prevalence of dysfunctional eating in 895 adult outpatients with T2DM (51% males, median age 67, median BMI 30.3 kg/m²). Socio-demographic and clinical characteristics were recorded; dysfunctional eating was tested by validated questionnaires (Eating Attitude Test-EAT-26, Binge Eating Scale-BES; Night Eating Questionnaire-NEQ); food intake and adherence to Mediterranean diet were also measured (in-house developed questionnaire and Mediterranean Diet Score-MDS). Obesity was present in 52% of cases (10% obesity class III), with higher rates in women; 22% had HbA1c ≥ 8%. The EAT-26 was positive in 19.6% of women vs. 10.2% of men; BES scores outside the normal range were recorded in 9.4% of women and 4.4% of men, with 3.0% and 1.5% suggestive of binge eating disorder, respectively. Night eating (NEQ) was only present in 3.2% of women and 0.4% of men. Critical EAT and BES values were associated with higher BMI, and all NEQ + ve cases, but one, were clustered among BES + ve individuals. Calorie intake increased with BES, NEQ, and BMI, and decreased with age and with higher adherence to Mediterranean diet. In multivariable logistic regression analysis, female sex, and younger age were associated with increase risk of dysfunctional eating.

CONCLUSION

Dysfunctional eating is present across the whole spectrum of T2DM and significantly impacts on adherence to dietary restriction and food choices.

A Review of the Relationship between Night Eating Syndrome and Body Mass Index

PURPOSE OF THE REVIEW

To review literature on night eating syndrome (NES) and body mass index (BMI, kg/m²) published in the last 5 years.

RECENT FINDINGS

Since December, 2013, 11 studies examined the association between NES and BMI. Five of these studies reported a positive relationship, five showed no relationship, and one produced mixed findings. Emotional eating and age were moderators. Twelve studies examined whether there was a difference in BMI between those with and without NES with only five of these finding differences. A primary weakness of the recent literature base is that it is almost entirely cross-sectional. Recent findings regarding the relationship between NES and BMI are mixed. Future research should examine the relationship between these variables longitudinally and continue to examine moderating variables that explain why some individuals manifest excess weight with NES and others do not.

Prevalence of food addiction and association with stress, sleep quality and chronotype: A cross-sectional survey among university students

AIMS

Food addiction (FA) is defined as an insatiable desire for the consumption of specific high-fat, high-sugar foods beyond the required energy needs for sustenance. The aims of this study were to determine FA prevalence and to assess associations between FA, stress, sleep quality and chronotype among university students.

DESIGN AND SETTING

A cross-sectional questionnaire-based survey conducted among students from 8 major Lebanese universities. Students were randomly selected and requested to fill the questionnaire. 644 agreed to participate. Data were collected via a face-to-face interview conducted by 2 trained research assistants.

PARTICIPANTS

University students above 18 years old and not presenting any cognitive or chronic illnesses, after signing a written consent form.

MEASUREMENTS

In addition to sociodemographic data, all participants filled the following self-administered standardized and validated questionnaires: Yale Food Addiction Scale (YFAS), Perceived Stress Scale (PSS), Morningness-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index (PSQI).

FINDINGS

FA prevalence was 10.1% with a 95% confidence interval of 7.8-12.4%. 56.5% of all the participants had a poor quality of sleep, whereas 81.2% of the participants presenting FA experienced a poor sleep quality (versus 57.2% when no FA is present). 70.2% of the students presented an intermediate chronotype, 20.5% an evening chronotype and 8.7% a morning chronotype. Age, smoking status, BMI, PSS and PSQI remained significantly correlated to the continuous YFAS score in multivariate analysis.

CONCLUSIONS

Our findings denote the importance of identifying and offering help to individuals presenting a FA because it is frequent among youth, associated to higher BMI and to smoking, seems to be a very intertwined and complex phenomenon coexisting with other neuropsychiatric problems, such as stress and poor sleep quality and therefore can have serious health implications.

Psychometric properties and gender invariance of the simplified Chinese version of Night Eating Questionnaire in a large sample of mainland Chinese college students

PURPOSE

The Night Eating Questionnaire (NEQ) is the most frequently used instrument for assessing night eating syndrome (NES), and it has been translated to many languages, including a traditional Chinese version in Taiwan. However, significant differences exist in the social, linguistic, and cultural contexts between mainland China and Taiwan. For its use in mainland China, a simplified Chinese version is needed and its psychometric properties should be further evaluated. Thus, the current study aimed to obtain a simplified Chinese NEQ (SC-NEQ) and validate its psychometric properties.

METHODS

According to standard procedures, the SC-NEQ was obtained by language transformation from the traditional Chinese version of NEQ. The SC-NEQ was then administered to 1273 mainland Chinese college students recruited from three provinces in mainland China.

RESULTS

The four-factor structure of the original English NEQ (morning anorexia, evening hyperphagia, mood/sleep, and nocturnal ingestions) was confirmed in the current sample. Moreover, a second-order model also fitted the data well. The SC-NEQ showed good reliability with a Cronbach's alpha and omega of 0.70 and 0.83, respectively. The total score of the SC-NEQ was significantly and moderately correlated with eating pathology (r = .35, p < .01). Strong measurement invariance across gender groups was also supported.

CONCLUSIONS

These findings suggest that the SC-NEQ can be a useful tool to assess NES in mainland China.

LEVEL OF EVIDENCE

V, descriptive (cross-sectional) study.

Factor structure of the Night Eating Diagnostic Questionnaire (NEDQ) and an evaluation of the diagnostic criteria of the night eating syndrome

BACKGROUND

The Night Eating Diagnostic Questionnaire (NEDQ) is a validated assessment of the night eating syndrome (NES) based on the proposed diagnostic criteria. While past results show that NEDQ is associated with psychopathology and body mass index (BMI), the relationships between the proposed NES diagnostic criteria and psychopathology and BMI have not been investigated. Thus, the relationships between the proposed NES diagnostic criteria and factors previously associated with NES, namely depression, "food addiction" (FA), sleep quality, and BMI were examined. Finally, the NEDQ factor structure was examined for the first time in order to determine whether the NEDQ is assessing NES appropriately.

METHODS

The NEDQ, depression, sleep quality, and FA questionnaires were administered to a sample of older community members (n = 468) and a student sample (n = 254). Principal Components Analysis (PCA) was performed to examine the factor structure of the NEDQ. The relationships between the proposed diagnostic criteria and depression, sleep quality, FA, and BMI were examined using multiple regression.

RESULTS

The proposed NES criteria were highly intercorrelated. PCA revealed a single factor solution for the NEDQ. In the community sample, depression was associated with the presence of five of nine proposed diagnostic criteria while poor sleep quality and FA were associated with the presence of seven and six criteria respectively. In the community sample, only the sleep problems and impairment/distress criteria were positively associated with BMI. In the student sample, fewer criteria were associated with psychopathology, and no criteria were associated with BMI.

CONCLUSIONS

These findings support the proposed criteria for diagnosis of NES. All proposed criteria were associated with at least one psychopathology measure. BMI was only associated with the sleep problems and impairment/distress criteria in the community sample. The PCA finding of a single factor indicates that the NEDQ is a cohesive assessment of NES, and that the NEDQ is a good measure of NES criteria.

Preliminary Validation of the Italian Night Eating Questionnaire (I-NEQ-16): Item Analysis and Factor Structure

Night eating syndrome (NES) severity is usually assessed with the Night Eating Questionnaire (NEQ). Although the most common version of the NEQ is composed of 14 items (NEQ-14), two additional items measuring distress associated with the night eating have been proposed, but they have never been included in past psychometric studies. The aim of the present study was to create an Italian version of the NEQ-16 (I-NEQ-16), with the inclusion of the proposed items for assessing the distress associated with night eating. A major objective of the study was to propose a unidimensional version of the I-NEQ-16 and investigate its psychometric properties. 482 Italian adults (380 women and 102 men; mean age = 25.5, SD = 10.9 years old) were administered the Italian versions of the NEQ, the Night Eating Diagnostic Questionnaire (NEDQ), and questionnaires measuring binge eating, emotional and external eating, diurnal chronotype, insomnia, and anxiety and depression severity. In order to improve the unidimensionality of the I-NEQ-16, we removed from further analyses items 1, 4, and 7, because they increased the heterogeneity of the measure. Confirmatory factor analysis, indicated the fit of a modified one-factor model, allowing correlated errors between three pairs of items. I-NEQ-16 scores were significantly associated with all concurrent questionnaire scores and were able to categorize individuals according to their diagnosis of NES according to the NEDQ. Thus, the I-NEQ-16 is a valid measure that is potentially useful for investigating correlates of night eating in the general population.

Night eating syndrome and its association with weight status, physical activity, eating habits, smoking status, and sleep patterns among college students

BACKGROUND

Night eating syndrome (NES) is characterized by evening hyperphagia and/or nocturnal ingestion.

OBJECTIVE

The main objective of this study was to assess the percentage of students complying with symptoms and behaviors consistent with the diagnostic criteria for NES, and explore its association with body mass index (BMI), dietary habits, physical activity, smoking status, and sleep patterns, among a sample of college students.

METHODS

A cross-sectional survey was conducted among a sample of 413 undergraduate students, mean age of 20.6 ± 1.68 SD, at Central Michigan University. Students completed an online survey including demographic information and the Night Eating Diagnostic Questionnaire (NEDQ) and Pittsburgh Sleep Quality Index Questionnaire (PSQI). Participants were grouped based on self-reporting of the presence and frequency of night eating-related symptoms and behaviors related to the diagnostic criteria for NES as follows: normal, mild night eater, moderate night eater, and full-syndrome night eater. Pearson's Chi-squared, Student's t test, and Wilcoxon rank-sum test were used to test the association between students with and without any night eating behavior in relation to BMI, lifestyle variables, and sleep duration/quality.

RESULTS

Results showed that the proportion of students complying with symptoms and behaviors consistent with full-syndrome of NES was 1.2%. There were no significant differences between students complying with symptoms and behaviors consistent with any level of NES and those without any night eating behavior regarding BMI, eating habits, physical activity, and smoking status. NES was significantly related to sleep duration (P = 0.023). Students complying with symptoms consistent with any level of NES reported shorter sleep time and had higher total PSQI score (6.73 ± 4.06) than students without the syndrome (5.61 ± 2.61) (P = 0.007).

CONCLUSION

Although the percentage of students complying with full-syndrome NES was relatively low in our student sample, those students had shorter sleep time and poorer sleep quality than the other groups. However, it is unclear whether evening hyperphagia is a response to a lack of sleep or vice versa, and further research is needed.

LEVEL OF EVIDENCE

Level III, case-control analytic study.