Transcultural adaptation of the Night Eating Questionnaire (NEQ) for its use in the Spanish population

The Night Eating Questionnaire through the lens of the Rasch model

Previous research focused on the conventional approaches to test psychometric characteristics of the Night Eating Questionnaire (NEQ). The purpose of this research was to examine the psychometric properties of the Night Eating Questionnaire using the Rasch model in a sample of university students. The study was carried out from November 2018 to March 2019 on 300 students in health sciences at the University of Pristina temporarily seated in Kosovska Mitrovica, who completed the NEQ. A confirmatory factor analysis (CFA) suggested that the Serbian version mirrored the original NEQ structure: Goodness of fit index = 0.978, Comparative fit index = 0.996, Tucker-Lewis index = 0.995, Root Mean Square Error of Approximation = 0.011 and Standardized Root Mean Square Residual = 0.057. The Cronbach's alpha coefficient for the total scale was 0.627. The Rasch analysis showed that the item separation index classified the items into six groups based on their level of difficulty. The person reliability index separated well night eaters from day eaters. Few items did not fit the adequate range for the infit/outfit statistics. Overall, there were several groups of NEQ items that have a distinctive difficulty level, but the difference was not a remarkable one. This means that most students did not have night eating syndrome (NES), despite various levels of item difficulty. The NEQ performs well in the efforts to distinguish people who eat and do not eat at night. Most students reported conventional eating patterns and only a few had NES. The properties of the NEQ warrant its use in further night eating research.

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.

Development and validation of the Chrononutrition Profile - Diary

The circadian timing of food intake (i.e., chrononutrition) has been linked to various markers of health status, such as body weight and insulin sensitivity. However, a valid assessment of day-to-day, within-person patterns in chrononutrition has not yet been developed. This paper details the development and initial validity testing of the Chrononutrition Profile - Diary (CP-D). The CP-D assesses 6 components of chrononutrition that are likely to influence health (breakfast skipping, largest meal, evening eating, evening latency, night eating, and eating window). This measure demonstrated preliminary evidence of convergent validity with the ASA24 (Automated Self-Administered 24-hour dietary assessment tool). The CP-D is designed for use by both healthcare professionals and researchers. It can serve as an independent assessment of day-to-day patterns of chrononutrition, and can also be used along with existing dietary measures to provide a comprehensive assessment of participants' and patients' daily eating behaviors and meal timing patterns.

Adaptation of the night eating questionnaire for Brazilian adolescents

Introduction

Night Eating Syndrome (NES) is characterized by a delay in the circadian rhythm of food intake and affects 1.5% of the general population, occurring more frequently in obese people. The Night Eating Questionnaire (NEQ) was originally developed for the American adult population. It is a self-administered instrument widely used in the identification and follow-up of individuals with NES. Although the NEQ has been translated and validated for Brazilian adults, there are no reports of its adaptation for use in Brazilian adolescents. The present study aimed to adapt and evaluate reliability and reproducibility of the NEQ for Brazilian adolescents.

Material and Methods

Initially, a semantic adaptation of the Portuguese version of the NEQ was performed by 3 professionals with experience with adolescents. The suggested text was analyzed and consolidated item by item by the researchers and then presented to 21 adolescents from an intermediate school in Fortaleza. The questions with low level of understanding (<90%) were modified and the questionnaire was re-applied to 23 adolescents, obtaining satisfactory understanding.

Results

The version of the NEQ for Brazilian adolescents, compared to the adult version, contains changes in items 3, 5, 6, 7 and 13. The questionnaire was administered to 463 students aged 11 to 17 years (mean ± SD = 13.7 ± 1.2), from 3 schools. The internal consistency, measured by the Cronbach's alpha coefficient, was 0.73. The reproducibility that was measured after one week in 27 adolescents was 0.92 (95% CI 0.82-0.96).

Conclusion

The new version of the NEQ for Brazilian adolescents presents excellent reproducibility and good internal consistency and is a simple and useful instrument to evaluate nocturnal eating symptoms in this age group.

Development, validation and reliability of the Chrononutrition Profile - Questionnaire

Chrononutrition, or the circadian timing of food intake, has garnered attention as a topic of study due to its associations with health (e.g. weight gain); however, a valid and reliable assessment of chrononutrition in daily life has not yet been developed. This paper details the development and initial reliability and validity testing of the Chrononutrition Profile - Questionnaire (CP-Q). The CP-Q assesses six components of chrononutrition that are likely to influence health (breakfast skipping, largest meal, evening eating, evening latency, night eating, and eating window). This questionnaire is designed to assess general chrononutrition behaviors and preferred timing of food intake. The CP-Q can be used as a sole evaluation of chrononutrition, and can also be utilized in conjunction with existing dietary measures to provide a comprehensive assessment of one's eating behaviors. This measure offers health-care professionals, researchers, and stakeholders a cost-effective and comprehensive method of evaluating chrononutrition and identifying targets for health improvement.

En_Línea. An online treatment to change lifestyle in overweight and obesity: study protocol for a randomized controlled trial

BACKGROUND

Obesity has become a major public health problem. Innovative treatments are necessary. Internet and new technologies have been reported effective results in weight control programs, especially those with personalized feedback. This paper presents the protocol for a randomized controlled trial to test the effectiveness of an online weight control program, called en_línea, comparing with a standard group therapy and a control group.

METHODS

This is a randomized controlled trial with three intervention arms: en_línea, standard group therapy and control group. To perform this study, 305 adults (18-65 years) with overweight type II (27-29.9 kg/m2) or obesity type I (30-34.9 kg/m2) will be invited to participate. Interventions will last 17 weeks with follow-ups 1, 3, 6 and 12 months after the post-treatment appointment. The primary outcome will be post-treatment weight loss and the maintenance during the follow-ups. Secondary outcomes will be adherence rates, drop outs and quality of life. Participants will be assessed before randomization and they will be sign an inform consent.

DISCUSSION

The future challenge is to design innovative obesity treatments. Internet could be a useful tool to improve traditional weight control programs. This new intervention format is appropriate for patients who prefer not to share their intimate problems with a group, and for the new generations who feel comfortable using new technologies. Besides, Internet allows reaching a large amount of people at the same time, even if they live far away.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04127201. Retrospectively registered 15th October 2019.

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.

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.

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.

Comparative validity of the Internet and paper-and-pencil versions of the Night Eating Questionnaire

OBJECTIVE

This study examined the psychometric properties of the Internet and paper-and-pencil versions of the Mandarin Chinese version of the Night Eating Questionnaire (C-NEQ) and compared these measures' validity.

METHOD

The C-NEQ was evaluated through two different media: 626 participants completed the C-NEQ on the Internet and 160 participants completed the paper-form C-NEQ at the psychiatric outpatient clinics. A subgroup completed both versions of the C-NEQ (n=50). The Night Eating Syndrome History and Inventory was used to identify individuals with night eating syndrome (NES).

RESULTS

The paper-and-pencil and Internet versions of the C-NEQ both showed good internal consistency, reliability, and concurrent validity. Reliability between the Internet and the paper-and-pencil versions of the C-NEQ was excellent (ICC=.96). Diagnostic analysis of the C-NEQ's performance using the Receiver Operation Curve method showed excellent results in both versions; the area under the curve did not differ significantly between the versions. Regarding detecting NES, the Internet version had a higher optimal cutoff point than the paper-and-pencil version (23 and 22, respectively).

CONCLUSIONS

The Internet and paper-and-pencil versions of the C-NEQ both showed strong reliability and validity; however the two versions appear to differ marginally regarding usage in NES detection.

Sleep and Eating Disorders

Insomnia is related to an increased risk of eating disorders, while eating disorders are related to more disrupted sleep. Insomnia is also linked to poorer treatment outcomes for eating disorders. However, over the last decade, studies examining sleep and eating disorders have relied on surveys, with no objective measures of sleep for anorexia nervosa or bulimia nervosa, and only actigraphy data for binge eating disorder. Sleep disturbance is better defined for night eating syndrome, where sleep efficiency is reduced and melatonin release is delayed. Studies that include objectively measured sleep and metabolic parameters combined with psychiatric comorbidity data would help identify under what circumstances eating disorders and sleep disturbance produce an additive effect for symptom severity and for whom poor sleep would increase risk for an eating disorder. Cognitive behavior therapy for insomnia may be a helpful addition to treatment of those with both eating disorder and insomnia.

Measurement properties of eating behavior self-assessment tools in adult bariatric surgery populations: a systematic review

The present study aims to identify the range of eating behavior self-assessment tools reported in the adult bariatric surgery literature and evaluate the measurement properties of these tools using pre-established criteria. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This review revealed the use of 20 distinct tools; however, evidence for measurement properties specific to bariatric surgery populations was limited to only ten of these tools, as reported in 14 papers. Validity varied extensively and there was a widespread lack of information regarding measurement of change over time and patient burden. According to the evaluation criteria, there was adequate support for two tools. Several other tools show potential but would benefit from additional investigation of their measurement properties prior to continued use with bariatric surgery patients.

Optimal management of night eating syndrome: challenges and solutions

Night Eating Syndrome (NES) is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of nocturnal eating and/or excessive food consumption occur after the evening meal. NES is a clinically important disorder due to its relationship to obesity, its association with other psychiatric disorders, and problems concerning sleep. However, NES often goes unrecognized by both health professionals and patients. The lack of knowledge regarding NES in clinical settings may lead to inadequate diagnoses and inappropriate treatment approaches. Therefore, the proper diagnosis of NES is the most important issue when identifying NES and providing treatment for this disorder. Clinical assessment tools such as the Night Eating Questionnaire may help health professionals working with populations vulnerable to NES. Although NES treatment studies are still in their infancy, antidepressant treatments and psychological therapies can be used for optimal management of patients with NES. Other treatment options such as melatonergic medications, light therapy, and the anticonvulsant topiramate also hold promise as future treatment options. The purpose of this review is to provide a summary of NES, including its diagnosis, comorbidities, and treatment approaches. Possible challenges addressing patients with NES and management options are also discussed.

A German version of the Night Eating Questionnaire (NEQ): psychometric properties and correlates in a student sample

Night eating syndrome (NES) is marked by substantial evening or nocturnal food intake, insomnia, morning anorexia, and depressed mood. The Night Eating Questionnaire (NEQ) is the most frequently used instrument for the assessment of NES and available in several languages. The current study aimed at providing and validating a German version of the NEQ using an online study among students (N=729). The German NEQ had acceptable internal consistency (α=.71) and three-week retest-reliability (r=.77). The four-factor structure of the original version (morning anorexia, evening hyperphagia, mood/sleep, nocturnal ingestions) could be replicated, except for one item. Convergent validity was supported by moderate positive correlations with eating pathology, emotional eating, and habitual food cravings. Discriminant validity was supported by small positive correlations with relevant, but not eating-related constructs (eveningness preference, impulsivity). Scores on the NEQ were also positively, but weakly, correlated with body mass index (r=.18). The German version of the NEQ appears to be a useful tool for future investigations on night eating.

The association between night eating and body mass depends on age

Night eating syndrome (NES) is marked by substantial evening or nocturnal food intake, insomnia, morning anorexia, and depressed mood. Originally, NES was described as an eating pattern among obese individuals.However, subsequent studies showed that NES also occurs among non-obese individuals, who appear to be younger than obese individuals with NES. Thus, it has been proposed that NES may lead to future weight gain,which may explain inconsistent findings about associations between NES and body mass. The current study investigated the relationships between age, body mass index (BMI), and night eating severity in a representative sample of German adults (n = 2317). It was found that age moderated the relationship between night eating severity and BMI. Specifically, night eating was positively associated with BMI in participants who were between 31 and 60 years old, but not in younger (<31 years) or older (>60 years) participants. Results indicate that age may indeed play an important role when examining the relationship between night eating and obesity. That is, weight gain may only occur after longer periods of engaging in night eating and, thus, no or only small relationships can be found in younger samples such as students. The positive association between night eating and BMI disappears in older individuals, which may be related to onset of illness associated with wasting.

Psychometric characteristics of the Night Eating Questionnaire in a Middle East population

OBJECTIVE

To translate and validate the Night Eating Questionnaire (NEQ) into Arabic and to describe the distribution of night eating in an Egyptian sample.

METHOD

The NEQ was translated into Arabic and administered to 420 university students in Cairo, Egypt. Reliability, validity, and clinical cut-scores were generated for the Arabic NEQ. Distribution and demographic information were examined.

RESULTS

Cronbach's alpha for the Arabic NEQ was 0.54. A first order confirmatory factor analysis yielded five factors: 1: Nocturnal Ingestions, Factor 2: Evening Hyperphagia, Factor 3: Morning Anorexia, Factor 4: Insomnia, and Factor 5: Mood. A total NEQ score of 26 was determined to be very high after T-score transformation. Of the students, 4.8% scored above this cut score, and no differences for total NEQ score were found for demographic variables.

DISCUSSION

The Arabic NEQ generated a lower internal consistency score as compared to previous translations, but a similar factor structure. A cut score of 26 is similar to that determined significant for screening purposes in the original English version, and the proportion of those scoring above it is also similar to those of several international community samples. More research is needed to characterize night eating syndrome, its symptoms, and clinical impact in the Arabic culture.

Validation of screening questions and symptom coherence of night eating in the Swedish Twin Registry

BACKGROUND

Screening criteria have been used to estimate the prevalence of night eating syndrome (NES), but no validation studies have been conducted.

METHOD

We examined the validity of two screening questions for NES using a structured interview with adults enrolled in the Swedish Twin Study of Adults: Genes and Environment (STAGE) study. We also examined the coherence of the proposed diagnostic criteria for NES. A total of 416 participants (men=179; women=237) completed the interview and reported complete data for study inclusion.

RESULTS

The following values were calculated for the screening items after confirmation by interview for men and women, respectively: positive predictive value=.66 and .67, negative predictive value=.52 and .45, sensitivity=.62 and .63, and specificity=.56 and .50. As increasingly stringent diagnostic criteria were applied to the sample, prevalence of NES dropped. Nocturnal ingestions were more likely to co-occur with other NES symptoms than evening hyperphagia, which occurred frequently, but often in isolation; women were more likely to report a co-occurrence of symptoms than men, who were not likely to report distress related to NES symptoms.

CONCLUSION

In sum, almost two-thirds of participants were correctly identified as having NES (without considering distress or impairment) if they answered positively on the screening questions, and about half of the participants were correctly identified as not having NES when answering negatively on the screening questions. Although self-report questions are somewhat informative, a structured interview remains the gold standard for diagnosing NES.