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Yang K, Kwon S, Burton-Murray H, Kuo B, Chan AT, Field AE, Staller K. Maladaptive weight control and eating behaviours in female adolescents/young adults are associated with increased risk of irritable bowel syndrome in adulthood: Results from the Growing Up Today Study (GUTS). Aliment Pharmacol Ther 2024. [PMID: 39102895 DOI: 10.1111/apt.18197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/09/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is common among individuals with eating disorders. The relationship between these conditions is likely bidirectional. However, data on the risk of IBS among those with prior eating disorders is largely limited to cross-sectional studies. AIM To prospectively evaluate the association between maladaptive weight control/eating behaviours in females during adolescence/young adulthood with subsequent IBS using the Growing Up Today Study (GUTS). METHODS Starting in 1996 (age: 9-14) and during follow-up, participants reported frequency of maladaptive eating/weight control behaviours during the past year to lose weight: self-induced vomiting (n = 5740), laxative use (n = 5438), and fasting (n = 5522) in addition to reporting binge eating (n = 4459). Starting in 2001 and during follow-up, participants reported if they had ever been diagnosed with an eating disorder (n = 5316). Incident IBS cases were identified from four questionnaire cycles (2013, 2014, 2016, 2019), with participants specifying the year of diagnosis if occurring before the questionnaire date. Multivariable logistic regressions adjusting for age, body mass index, and depressive symptoms estimated the associations of interest. RESULTS Maladaptive weight control/eating behaviours were associated with increased IBS risk [ORs (95% CIs) for laxatives to lose weight = 3.67 (2.52-5.35), vomiting to lose weight = 1.83 (1.29-2.60), fasting to lose weight = 2.62 (1.86-3.70), and bingeing = 2.25 (1.54-3.28)] as was history of eating disorder diagnosis [OR (95% CI) = 3.42 (2.38-4.90)]. The magnitude of IBS risk increased with the frequency of maladaptive behaviours. CONCLUSIONS There is evidence for the potential role of early maladaptive weight control/eating behaviours in the development of adult IBS among females.
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Affiliation(s)
- Keming Yang
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sohee Kwon
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen Burton-Murray
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Braden Kuo
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alison E Field
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kyle Staller
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abed MT, Sayyed E, Yamak O, Abdoh Q, Badrasawi M. The association between night eating syndrome and GERD symptoms among university students at An-Najah National University in Palestine: a cross-sectional study. BMC Gastroenterol 2024; 24:169. [PMID: 38760691 PMCID: PMC11100070 DOI: 10.1186/s12876-024-03259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Night eating syndrome (NES) is a kind of eating disorder. NES association with gastroesophageal reflux disease (GERD) symptoms among university students is still not fully understood. We aimed to determine the relationship between NES and the presence of GERD symptoms among university students at An-Najah National University in Palestine. METHODS This study involved undergraduate students from An-Najah National University. The data were collected through online surveys from November to December 2023. The sampling frame involved voluntary sampling, as the data were collected using a structured questionnaire to collect data on sociodemographic variables, medical history, lifestyle habits, nutritional status, GERD risk, and NES. The GERD questionnaire (GerdQ) was used to assess symptoms, while the Arabic version of the validated Night Eating Questionnaire (NEQ) was used to assess night eating. Physical activity was assessed using the short form of the International Physical Activity Questionnaire (SF-IPAQ), and adherence to a Mediterranean diet was assessed using the validated Arabic version of the MEDAS. Both univariate and multivariate analyses were also conducted to assess the study hypotheses. RESULTS The study involved 554 participants, 59.9% female. A total of 33.4% reported GERD symptoms, with 10.3% having NES. A strong association was observed between GERD and NES and between GERD and physical activity. Night eating syndrome (AOR = 2.84, CI = 1.07-3.19), high physical activity (AOR = 0.473, CI = 1.05-3.19), and non-smoking (AOR = 0.586, CI = 1.27-7.89) were identified as independent predictors of GERD symptoms. CONCLUSION This study revealed that 33.4% of undergraduate students were at risk of GERD, with night eaters having a greater risk. GERD risk was negatively associated with physical activity level and smoking status. No associations were found between GERD risk and weight status, Mediterranean diet adherence, sociodemographic factors, or sleep disturbances.
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Affiliation(s)
- Mohammad Taleb Abed
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Eyad Sayyed
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Obada Yamak
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Qusay Abdoh
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Internal Medicine, GI and Endoscopy Unit, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Manal Badrasawi
- Department of Nutrition and Food Technology, College of Medicine and Health Sciences, An- Najah National University, Nablus, 44839, Palestine.
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Igudesman D, Abbaspour A, Reed KK, Flatt RE, Becken B, Thornton LM, Bulik CM, Carroll IM. Laxative Abuse Is Associated With a Depleted Gut Microbial Community Structure Among Women and Men With Binge-Eating Disorder or Bulimia Nervosa: The Binge Eating Genetics Initiative. Psychosom Med 2023; 85:727-735. [PMID: 37363967 PMCID: PMC10543565 DOI: 10.1097/psy.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study assessed the associations of binge eating, compensatory behaviors, and dietary restraint with the composition and diversity of the intestinal microbiota among participants with binge-eating disorder or bulimia nervosa. METHODS We analyzed data from 265 participants aged 18 to 45 years with current binge-eating disorder or bulimia nervosa enrolled in the Binge Eating Genetics Initiative study. We evaluated the associations of binge-eating frequency; presence/absence and frequency of vomiting, laxative use, and compulsive exercise; and dietary restraint with abundances of gut microbial genera, species, and diversity (Shannon diversity, Faith phylogenetic diversity, and Peilou's evenness) from 16S rRNA gene sequencing. General linear regression models adjusted for potential confounders, including age and current body mass index, were used to test associations; p values were corrected for the false discovery rate. RESULTS The normalized abundance of four genus- and species-level gut microbes and three diversity indices were lower among Binge Eating Genetics Initiative participants who reported any laxative use compared with those who reported no laxative use. Vomiting frequency was positively associated with the normalized abundance of the genus Escherichia-Shigella , a potential pathobiont, although the association was attenuated to nonsignificance after adjustment for age, body mass index, and binge-eating episodes. CONCLUSIONS Laxative use was highly and uniformly predictive of a reduced gut microbial diversity including potential commensals and pathobionts, and should be assessed and accounted for in all future studies of eating disorders and the gut microbiota. Future studies should collect data on specific medications-particularly laxatives-and dietary intake to obtain unbiased estimates of the effect of eating disorders on the gut microbiota and identify potential downstream clinical implications.Trial Registration:ClinicalTrials.gov identifier: NCT04162574 .
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Affiliation(s)
- Daria Igudesman
- From the Department of Nutrition (Igudesman, Reed, Bulik, Carroll), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Medical Epidemiology and Biostatistics (Abbaspour, Bulik) Karolinska Institutet, Stockholm, Sweden; Department of Psychology and Neuroscience (Flatt), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Pediatric Infectious Diseases (Becken), University of Nebraska Medical Center, Omaha, Nebraska; and Department of Psychiatry, University of North Carolina at Chapel Hill (Thornton, Bulik), Chapel Hill, North Carolina
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Evans KM, Averill MM, Harris CL. Disordered eating and eating competence in members of online irritable bowel syndrome support groups. Neurogastroenterol Motil 2023; 35:e14584. [PMID: 36989182 PMCID: PMC10524246 DOI: 10.1111/nmo.14584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND This study seeks to evaluate eating competence and disordered eating likelihood among members of online support groups for irritable bowel syndrome (IBS) and determine whether eating competence and disordered eating likelihood varies according to IBS symptom severity and subtype. METHODS This cross-sectional study is based on an anonymous survey conducted from August to September 2021. Adults with IBS (N = 225) were recruited from online and social media IBS support forums. IBS symptom severity was assessed using the validated IBS Severity Scoring System (IBS-SSS), likelihood of disordered eating was assessed using the validated Eating Attitudes Test (EAT-26), and eating competence was assessed using the validated Satter Eating Competence Inventory (ecSI 2.0™). Multiple linear regression was used to predict EAT-26 total score from IBS-SSS score, age, and IBS subtype. ANOVAs were used to examine the relationships between IBS severity level, IBS subtype, and ecSI 2.0™ total score. KEY RESULTS Eating competence among the sample was low at 17% while 27% was classified as likely or very likely disordered eating. IBS severity was positively associated with EAT-26 score (p = 0.011) and ecSI 2.0™ score was significantly lower in the severe IBS group compared to the moderate IBS group (p = 0.016). No relationship was detected between IBS subtype and EAT-26 or ecSI 2.0™ scores. CONCLUSIONS & INFERENCES IBS severity was positively associated with disordered eating likelihood and negatively associated with eating competence. This sheds light on the importance of assessing eating competence and screening for disordered eating prior to selecting therapies for patients with IBS, particularly in females with severe symptoms.
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Affiliation(s)
- Kate M Evans
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Michelle M Averill
- Nutritional Sciences Program, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Cristen L Harris
- Nutritional Sciences Program, Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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5
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Hafstad SM, Bauer J, Harris A, Pallesen S. The prevalence of orthorexia in exercising populations: a systematic review and meta-analysis. J Eat Disord 2023; 11:15. [PMID: 36747235 PMCID: PMC9903632 DOI: 10.1186/s40337-023-00739-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
AIM Orthorexia Nervosa (ON) describes a pathological obsession with proper and high-quality nutrition that is necessary to research further in order to elucidate its prevalence and correlates which may bear implications for prevention and treatment. The aim of this study was to review studies that report the prevalence of ON in people who exercise, calculate an overall prevalence through a random-effects meta-analysis approach and investigate the association of ON prevalence using a random-effects meta-regression. In addition, a sub-group-analysis based on ON-instruments and a sensitivity analysis excluding students samples, were conducted. METHOD Systematic searches were conducted in the following online databases: PubMed, Embase, Web of Science, PsychInfo, CINAHL, Google Scholar and OpenNet. The following search terms were used: Orthore* AND (prevalenc* OR incidenc* OR frequen* OR cut-off OR epidem*). A total of 613 unique hits were reviewed by two blinded authors, and 24 studies were coded and assessed for risk of bias (Holy et.al). The meta-regression included three independent variables (sex, type of sport, and sample size). RESULTS The overall prevalence of ON in the exercising population was 55.3% (95% CI 43.2-66.8). Cochran's Q was 11,436.38 (df = 23, p < 0.0000), and the I2 was 98.4%, indicating high heterogeneity across studies. The sensitivity showed an overall prevalence of 51.3% (95% CI 51.3-70.0). There was a significant difference in prevalence estimates based on the instruments used (Qbet = 33.6, df = 2, p < 0.01). DISCUSSION The overall prevalence of ON in exercising populations was very high. The between-study disparity was large and was partly explained by the ON-instrument administered. One fourth of the studies had a moderate risk of bias. The majority of the studies did not specify relevant demographic information about the sample, and information about the type of sport was frequently missing.
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Affiliation(s)
- Stine Marie Hafstad
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway.
| | - Jonas Bauer
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway
| | - Anette Harris
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway.,Optentia, the Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
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Peters JE, Basnayake C, Hebbard GS, Salzberg MR, Kamm MA. Prevalence of disordered eating in adults with gastrointestinal disorders: A systematic review. Neurogastroenterol Motil 2022; 34:e14278. [PMID: 34618988 DOI: 10.1111/nmo.14278] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/16/2021] [Accepted: 09/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with gastrointestinal disorders are prone to heightened awareness of dietary intake. When diet-related thoughts or behaviors are excessive, they may lead to psychological distress, nutritional compromise, and impair medical treatment. Identification of disordered eating behavior and eating disorders is crucial for effective management, but data on their prevalence within this population remain scarce. We conducted a systematic review of the prevalence of disordered eating behavior and eating disorders in adults with gastrointestinal disorders. METHODS MEDLINE, PubMed, and PsycInfo databases were searched up to June 2021. Studies examining disordered eating in adult patients with a primary gastrointestinal diagnosis were included. KEY RESULTS A total of 17 studies met the inclusion criteria for the review. The range of gastrointestinal disorders examined included disorders of gut-brain interaction (DGBI), coeliac disease, and inflammatory bowel disease (IBD). The methods for examining disordered eating were highly variable. The prevalence of disordered eating ranged from 13-55%. The prevalence was higher in patients with disorders of gut-brain interaction (DGBI) than in those with organic gastrointestinal disorders. Factors associated with disordered eating included female sex, younger age, gastrointestinal symptom severity, anxiety and depression, and lower quality of life. CONCLUSIONS & INFERENCES Disordered eating is highly prevalent in adult patients with gastrointestinal illness, particularly those with DGBI. Understanding whether a patient's primary underlying diagnosis is that of an eating disorder or gastroenterological disorder remains a challenge for clinicians. There is an unmet need to identify at-risk patients so that psychological intervention can be included in the therapeutic strategy.
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Affiliation(s)
- Jessica E Peters
- The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Chamara Basnayake
- The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Geoffrey S Hebbard
- The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Michael R Salzberg
- The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Michael A Kamm
- The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
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Associations between Abnormal Eating Styles and Irritable Bowel Syndrome: A Cross-Sectional Study among Medical School Students. Nutrients 2022; 14:nu14142828. [PMID: 35889787 PMCID: PMC9319336 DOI: 10.3390/nu14142828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Few studies have investigated the association between eating styles and IBS. This study aimed to explore the association between abnormal eating styles and irritable bowel syndrome (IBS). (2) Methods: This cross-sectional study investigated students in China Medical University and Shenyang Medical College. Eating styles were evaluated by the Dutch Eating Behavior Questionnaire (DEBQ), and IBS was diagnosed according to Rome III criteria. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). (3) Results: A total of 335 students were diagnosed with IBS. Students with the total scores in tertile 2 and 3 had 1.29 times and 2.75 times higher risk of IBS than students with the total scores in tertile 1, respectively. Simultaneously, the risk of IBS in the tertile 3 of external eating, emotional eating, and restraint eating trends was 3.87 times, 2.71 times, and 3.82 times higher than that of tertile 1, respectively. (4) Conclusions: this study showed that a high score in both total eating styles and each eating style was associated with the odds of having IBS and suggested that the psychological factors behind eating styles may play a critical role in controlling the IBS.
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Gouda A, El-Kassas M. Barrett’s esophagus in a patient with bulimia nervosa: A case report. World J Clin Cases 2022; 10:5841-5845. [PMID: 35979135 PMCID: PMC9258367 DOI: 10.12998/wjcc.v10.i17.5841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/18/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Barrett’s esophagus is a known complication of long-standing gastroesophageal reflux disease, and it is a potential risk factor of developing esophageal adenocarcinoma.
CASE SUMMARY Here, we present a case of a 47-year-old male patient referred to the gastroenterology clinic for upper endoscopy because he has a long-standing history of heartburn and vomiting after meals. On examination, he had characteristic findings of self-induced vomiting as abrasions and callosities on the dorsum of the right hand and dental erosions. A detailed history revealed that he had 17 years of binge eating with self-induced vomiting. His upper endoscopy showed gastroesophageal reflux grade D with salmon-red mucosal projections, and the biopsy revealed intestinal mucosal metaplasia.
CONCLUSION This case emphasized the importance of considering upper endoscopy screening for Barrett’s esophagus in patients with eating disorders, especially those with self-induced vomiting, as in bulimia nervosa.
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Affiliation(s)
- Ahmed Gouda
- Department of Gastroenterology NMC, Ruwais Hospital, Abu Dhabi 14638, United Arab Emirates
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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9
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Johansson AK, Mjanger Øvretvedt T, Reinholtsen KK, Johansson A. Eating Disorders: An Analysis of Self-Induced Vomiting, Binge Eating, and Oral Hygiene Behavior. Int J Clin Pract 2022; 2022:6210372. [PMID: 35685564 PMCID: PMC9159179 DOI: 10.1155/2022/6210372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Self-induced vomiting (SIV) is often present in patients with eating disorders (ED) and potentially damaging for oral health. Related behaviors, such as binge eating and oral hygiene habits, may equally increase the risk for dental damage. This study aimed to investigate behaviors and habits in patients with ED and SIV in relation to oral health. METHODS All patients enlisting for treatment in an ED clinic for 1 year were offered to take part in the study. Fifty-four of 65 patients were accepted to participate, and a questionnaire included questions on dietary and oral hygiene habits was included. A subgroup consisting of only those 17 ED patients who reported SIV during the previous six months comprised the sample for this study and received additional questions related to other compensatory behaviors and oral hygiene habits in relation to oral health. RESULTS Binge eating before SIV was common (14/17 patients). Time point for SIV after binge eating and the procedures performed after vomiting varied. Tooth brushing after vomiting was common (7/17). Food and drinks during binge eating included mainly items rich in calories (sugar/fat) or acid. All 17 patients believed that vomiting could damage their teeth, but only one of them had informed the dentist about having an ED. A number of oral symptoms were reported. Ten patients considered their oral health to be good/fairly good, while the remaining seven patients reported their oral health as not so good/bad/very bad. Information on how ED could affect their teeth was commonly received from the media. CONCLUSIONS The dental team should be made aware of the likely detrimental effects of binge eating and vomiting on oral health in patients with eating disorders. The team should also be aware of the cyclical nature of the disease and the similarities and diversities that exist within this group of ED patients. Since ED patients hide their disease from the dental team, this stresses the importance of open and trustful communication between patients and health workers. An organized collaboration between ED clinics and dental professionals is suggested as well as a development of avenues for information about ED and oral health.
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Affiliation(s)
- Ann-Katrin Johansson
- Department of Clinical Dentistry-Cariology, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Tonje Mjanger Øvretvedt
- Department of Clinical Dentistry-Cariology, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Karen Knudsen Reinholtsen
- Department of Clinical Dentistry-Cariology, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anders Johansson
- Department of Clinical Dentistry-Prosthodontics, Faculty of Medicine, University of Bergen, Bergen, Norway
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10
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McGowan A, Harer KN. Irritable Bowel Syndrome and Eating Disorders: A Burgeoning Concern in Gastrointestinal Clinics. Gastroenterol Clin North Am 2021; 50:595-610. [PMID: 34304790 DOI: 10.1016/j.gtc.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome affects 10% to 15% of the population, and up to 90% of patients with irritable bowel syndrome exclude certain foods to improve their gastrointestinal symptoms. Although focused dietary restrictions are a normal, adaptive response, restrictions can spiral out of control and result in maladaptive restriction. Dietary therapies are rapidly becoming first-line treatment of irritable bowel syndrome, and gastroenterologists need to be aware of red flag symptoms of maladaptive eating patterns and the negative effects of prescribing restrictive diets. There is also growing awareness of the association between eating disorders and gastrointestinal symptoms, including irritable bowel syndrome symptoms.
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Affiliation(s)
- Andrea McGowan
- University of Michigan School of Public Health, c/o Kimberly Harer, 1500 East Medical Center Drive, 3912 TC SPC 5362, Ann Arbor, MI 48109, USA
| | - Kimberly N Harer
- University of Michigan, Division of Gastroenterology, Department of Internal Medicine, 1500 East Medical Center Drive, 3912 TC SPC 5362, Ann Arbor, MI 48109, USA.
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11
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Wiklund CA, Rania M, Kuja-Halkola R, Thornton LM, Bulik CM. Evaluating disorders of gut-brain interaction in eating disorders. Int J Eat Disord 2021; 54:925-935. [PMID: 33955041 PMCID: PMC10751984 DOI: 10.1002/eat.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/18/2021] [Accepted: 04/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders commonly co-occur with gastrointestinal problems. This case-control study aimed to (a) document the prevalence of disorders of gut-brain interaction (DGBI) in eating disorders, (b) examine the specific impact of disordered eating behaviors on the risk of DGBI, and (c) explore the impact of current eating disorder psychopathology on DGBI. METHOD We included 765 cases with eating disorders and 1,240 controls. DGBI were assessed via the ROME III questionnaire. Prevalences of DGBI were calculated across eating disorder diagnoses (anorexia nervosa, bulimia nervosa, and multiple eating disorders) and in controls. The association between disordered eating behaviors and DGBI was examined using logistic regression models. Lastly, we compared the total number of DGBI in individuals with high versus low current eating disorder symptoms. RESULTS A large majority (88.2-95.5%) of individuals with eating disorders reported at least one DGBI and 34.8-48.7% reported three or more DGBI. Of the DGBI categories, functional bowel disorders were the most commonly endorsed category, and of the individual DGBI, irritable bowel syndrome was the most frequently reported (43.9-58.8%). All investigated disordered eating behaviors showed a positive association with most DGBI categories. Finally, individuals reporting high current eating disorder symptoms reported higher mean number of DGBI (3.03-3.34) than those with low current symptoms (1.60-1.84). DISCUSSION The directionality and mechanisms underlying the nature of the relationship between gastrointestinal and eating disorder symptoms is worthy of further study and clinicians should adopt an integrated approach by attending to both gastrointestinal and eating disorder symptoms in their patients.
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Affiliation(s)
- Camilla A Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marianna Rania
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, Mater Domini University Hospital, Catanzaro, Italy
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Lin JA, Woods ER, Bern EM. Common and Emergent Oral and Gastrointestinal Manifestations of Eating Disorders. Gastroenterol Hepatol (N Y) 2021; 17:157-167. [PMID: 34035776 PMCID: PMC8132634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Eating disorders (EDs) such as anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder are associated with restricted diets and abnormal compensatory behaviors, frequently leading to malnutrition and oral and gastrointestinal manifestations. Dental and oral complications are generally caused by malnutrition, micro-nutrient deficiency, and chronic acid exposure; hence, treatment of the ED and frequent dental examinations are essential to reduce morbidity. Gastrointestinal manifestations are multifactorial in origin, and may be caused by disordered behaviors, malnutrition, anxiety, and/or may be a function of the ED itself. This article reviews the most common oral and gastrointestinal manifestations of EDs and describes emergent complications such as acute gastric dilation and superior mesenteric artery syndrome. It is important for providers to recognize complications associated with EDs to provide the best treatment possible.
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Affiliation(s)
- Jessica A. Lin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth R. Woods
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elana M. Bern
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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Goldschmidt AB, Khoury JC, Mitchell JE, Jenkins TM, Bond DS, Zeller MH, Michalsky MP, Inge TH. Loss of Control Eating and Health Indicators Over 6 Years in Adolescents Undergoing Metabolic and Bariatric Surgery. Obesity (Silver Spring) 2021; 29:740-747. [PMID: 33759383 PMCID: PMC8474017 DOI: 10.1002/oby.23126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess associations between loss of control (LOC) eating and health outcomes among adolescents undergoing metabolic and bariatric surgery. METHODS A total of 234 adolescents were studied before and up to 6 years after surgery in a prospective, observational cohort design. Adolescents provided self-reports of LOC eating, pain severity, sleep quality, polycystic ovary syndrome, gastroesophageal reflux disease, and medication usage and objective measures of fasting glucose, serum insulin, glycohemoglobin A1c , cholesterol, triglycerides, and blood pressure. χ2 tests, Wilcoxon rank sums, and generalized linear mixed models were used to assess concurrent and prospective associations between LOC eating and health indicators. RESULTS LOC eating presented in 32.5% of adolescents before surgery and was positively associated with sleep disturbances and psychiatric medication usage. After surgery, LOC eating presented in 7.9% to 14.6% of participants and was correlated with improved low- and high-density lipoprotein cholesterol levels and greater back pain. LOC eating was inversely associated with low-density lipoprotein cholesterol at the next consecutive time point. CONCLUSIONS LOC eating was unexpectedly associated with improved low- and high-density lipoprotein cholesterol in adolescents undergoing metabolic and bariatric surgery. Deleterious effects of LOC eating on obesity-related health conditions, aside from back pain, were not detected. Metabolic and other weight-independent health benefits of surgery may persist postoperatively despite LOC eating and associated weight regain.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Todd M. Jenkins
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dale S. Bond
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Meg H. Zeller
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marc P. Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Thomas H. Inge
- Department of Surgery, University of Colorado, Denver and Children’s Hospital Colorado, Aurora, CO, USA
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Frequency of Eating Disorder Pathology Among Patients With Chronic Constipation and Contribution of Gastrointestinal-Specific Anxiety. Clin Gastroenterol Hepatol 2020; 18:2471-2478. [PMID: 31923640 DOI: 10.1016/j.cgh.2019.12.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/10/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Individuals with eating disorders (EDs) frequently have constipation-related symptoms, although the mechanisms of this relationship are not clear. We examined the frequency of and relation between EDs and constipation in patients with chronic constipation referred for anorectal manometry. METHODS We analyzed data from 279 patients with chronic constipation (79.2% female) evaluated at a tertiary center from June 2017 through September 2018. Participants completed a standardized psychometric assessment (patient assessment of constipation symptoms questionnaire and hospital anxiety and depression scale and visceral sensitivity index analyses) and anorectal manometry. A subset of patients completed colonic transit testing. Participants with clinically significant ED pathology were identified based on scores of 20 or higher on the Eating Attitudes Test-26. We performed a logistic regression analysis to examine factors associated with the likelihood of having ED pathology. Odds ratios were calculated based on continuous variables. We examined the contribution of anxiety to the relationship between severity of ED pathology and symptoms of constipation (such as abdominal pain) using a regression-based bootstrapping approach. RESULTS Of the study participants, 53 (19.0%) had clinically significant ED pathology. The presence of ED pathology was associated with greater general anxiety scores, based on the hospital anxiety and depression scale (odds ratio, 1.20; 95% CI, 1.05-1.38), and greater gastrointestinal-specific anxiety scores, based on the visceral sensitivity index (odds ratio, 1.06; 95% CI, 1.03-1.09). Gastrointestinal-specific anxiety fully mediated the relationship between the severity of ED pathology and constipation (standardized β, 0.11-0.16; P = .026-.024). We found no differences in anorectal manometry or colonic transit between patients with vs without ED pathology. CONCLUSIONS In an analysis of patients with chronic constipation, we found that 19% had clinically significant ED pathology. Our preliminary finding indicated that ED pathology might contribute to constipation via gastrointestinal-specific anxiety. Clinicians should consider screening patients with chronic constipation for EDs-especially patients who report symptoms such as bloating and abdominal pain.
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Somatic symptoms and binge eating in women's daily lives. J Psychosom Res 2020; 135:110161. [PMID: 32504896 PMCID: PMC7365755 DOI: 10.1016/j.jpsychores.2020.110161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/06/2020] [Accepted: 05/20/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The present study aimed to determine whether the momentary severity of women's somatic symptoms was concurrently and prospectively associated with their engagement in binge eating in naturalistic settings. METHOD Thirty women (Mage = 34.13, SD = 13.92) who had engaged in binge eating at least once over the month prior to study entry completed a 14-day ecological momentary assessment (EMA) protocol. During each of the 14 days, participants received five semi-random surveys via text message that assessed momentary somatic symptom severity (i.e., headaches, stomachaches/pain, chest/heart pain, faintness/dizziness, shortness of breath, fatigue) and disordered eating behaviors. Generalized estimating equations were used to determine whether momentary somatic symptoms were concurrently and prospectively (i.e., by participants' next assessment) associated with the occurrence of binge eating behavior, while controlling for age and body mass index. RESULTS At the within-person level, more severe stomachaches/pain, faintness/dizziness, shortness of breath, and fatigue were concurrently associated with an increased likelihood of engaging in binge eating. Further, at the between-person level, more severe stomachaches/pain, chest/heart pain, shortness of breath, and fatigue in general were associated with binge eating across the EMA protocol. Momentary stomachache/pain severity also prospectively predicted women's engagement in binge eating behavior at the next assessment. CONCLUSIONS The present results provide initial evidence that multiple somatic symptoms may serve as momentary correlates or proximal antecedents of binge eating behavior in women's daily lives. Somatic symptoms may consequently prove useful to target in eating disorder treatments, perhaps via interoceptive exposure interventions.
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Riedlinger C, Schmidt G, Weiland A, Stengel A, Giel KE, Zipfel S, Enck P, Mack I. Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis. Front Psychiatry 2020; 11:195. [PMID: 32425816 PMCID: PMC7212454 DOI: 10.3389/fpsyt.2020.00195] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Eating disorders (ED) such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are often accompanied by a variety of psychological and physical comorbidities. Gastrointestinal (GI) symptoms are a classical feature in most patients with ED. The heterogeneity of studies on this topic is high, making it difficult to have a clear overview. The aim of this systematic review is therefore to provide an overview of subjectively and objectively measured differences and changes in the GI tract in patients with EDs, along with the occurrence of GI complications. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Google Scholar to find all relevant studies examining GI problems in AN, BN, and BED. Quantitative analyses were performed for objective GI physiology measures where applicable. RESULTS The review differentiated between ED types and also between studies that report GI outcomes of ED in (i) human studies with an ED diagnosis excluding case reports that provide an overview of GI problems in ED and (ii) case reports with an ED diagnosis describing rare GI complications in ED. GI symptoms and impaired gastric transit times were frequent features of EDs with specific differences found for the ED types. During the time course of treatment, GI symptoms changed and/or improved but not completely. GI complications extended the range of GI problems observed, including a variety of serious complications such as gastric dilatation. CONCLUSIONS Problems of the GI tract are frequent in patients with ED and it is likely that they complicate therapy, especially in patients with AN. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42019100585.
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Affiliation(s)
- Caroline Riedlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Greta Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
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Hetterich L, Mack I, Giel KE, Zipfel S, Stengel A. An update on gastrointestinal disturbances in eating disorders. Mol Cell Endocrinol 2019; 497:110318. [PMID: 30359760 DOI: 10.1016/j.mce.2018.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/27/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023]
Abstract
Eating disorders, namely anorexia nervosa, bulimia nervosa and binge eating disorder are frequent diseases and often complicated by comorbidities, e.g. psychiatric or cardiovascular comorbidities. It is to note that also gastrointestinal symptoms/complications are frequently observed in patients with eating disorders. These diseases will be presented in the current review along with - where known - possible underlying mechanisms. Lastly, gaps in knowledge will be highlighted.
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Affiliation(s)
- Larissa Hetterich
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Isa Mack
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany; Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
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18
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Wiklund CA, Kuja-Halkola R, Thornton LM, Hübel C, Leppä V, Bulik CM. Prolonged constipation and diarrhea in childhood and disordered eating in adolescence. J Psychosom Res 2019; 126:109797. [PMID: 31536865 DOI: 10.1016/j.jpsychores.2019.109797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Gastrointestinal problems are common in all eating disorders; however, the extent to which these problems predate the onset of eating disorders is not clear. We explored longitudinal associations between childhood gastrointestinal problems and adolescent disordered eating, and assessed whether observed associations are potentially causal or due to familial confounding factors. METHODS Data from a population-based Swedish twin sample were used to investigate associations between parent- and self-reported protracted constipation and diarrhea in childhood and adolescence, and later disordered eating, measured by the Eating Disorders Inventory-2 (EDI). Linear regression models were used to investigate the associations. Possible familial confounding was explored by using a within-twin pair analysis. RESULTS We found that those who reported a history of constipation at age 15 scored 5.55 and 5.04 points higher, respectively, on the EDI total score at age 15 and 18, compared with those without constipation. Those reporting a history of diarrhea at age 15 scored 5.15 points higher, and the group reporting both problems scored 9.52 points higher on the EDI total score at age 15 than those reporting no problems. We observed that the association between constipation and disordered eating was attenuated in the within-twin pair analysis, but remained positive. CONCLUSIONS Gastrointestinal problems in childhood and adolescence are significantly associated with disordered eating. Associations were partly due to familial confounding, but might also be consistent with a causal interpretation. Clinicians should be aware of the increased risk of disordered eating when following children and adolescents who present with gastrointestinal problems.
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Affiliation(s)
- Camilla A Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Hübel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Virpi Leppä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Akhondi N, Memar Montazerin S, Soltani S, Saneei P, Hassanzadeh Keshteli A, Esmaillzadeh A, Adibi P. General and abdominal obesity in relation to the prevalence of irritable bowel syndrome. Neurogastroenterol Motil 2019; 31:e13549. [PMID: 30657237 DOI: 10.1111/nmo.13549] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Earlier studies on the obesity-IBS association have mostly been reported from Western nations, and limited data are available in this regard from developing countries. This study was performed to examine the association of general and abdominal obesity with Irritable bowel syndrome (IBS) in a Middle Eastern population. METHODS In this cross-sectional study, 4763 Iranian adults participated. Data on self-reported anthropometric measurements were collected, and BMI was calculated. Overweight and obesity were defined as 25 ≤ BMI < 30 and BMI ≥ 30 kg/m2 , respectively. Also, we used WC measurements to define the three categories of normal (<94 cm in men <80 cm in women), abdominal overweight (94 ≤ WC < 102 in men and 80 ≤ WC < 88 in women), and abdominal obesity (WC ≥ 102 cm in men and WC ≥ 88 cm in women). Assessment of different GI symptoms including those related to IBS was done using a validated Persian version of the Rome III questionnaire. IBS was defined as the presence of recurrent abdominal pain or discomfort at least sometimes in the last 3 months associated with 2 or more of the following features: improvement with defecation, pain onset associated with a change in frequency of stool, and pain onset associated with a change in form (appearance) of stool. KEY RESULTS Irritable bowel syndrome was more prevalent among individuals with abdominal obesity compared with normal subjects (23.8% vs 19%). Neither in crude nor in adjusted models, we found any significant association between overweight and obesity and IBS [for overweight: OR: 0.95, 95% CI: 0.66-1.36 and for obesity: OR: 1.06, 95% CI: 0.85-1.31]. We observed a significant positive association between abdominally overweight and IBS in crude model (OR: 1.31, 95% CI: 1.09-1.60); however, this association became non-significant after adjustment for potential confounders (OR: 1.09, 95% CI: 0.82-1.44). Across BMI categories, neither in crude nor in adjusted models, we did not find any significant association between overweight (OR: 0.89, 95% CI: 0.62-1.27), obesity (OR: 1.05, 95% CI: 0.58-1.87), and abdominal pain severity. Abdominal overweight (OR: 0.96, 95% CI: 0.65-1.40) and obesity (OR: 1.61, 95% CI: 0.67-1.63) were not associated with abdominal pain severity. CONCLUSIONS AND INFERENCES It is concluded that general or abdominal obesity was not associated with odds of IBS. Future longitudinal studies are needed to clarify the association between obesity and IBS.
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Affiliation(s)
- Negin Akhondi
- Isfahan Medical Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Memar Montazerin
- Isfahan Medical Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Soltani
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Wardle RA, Thapaliya G, Nowak A, Radford S, Dalton M, Finlayson G, Moran GW. An Examination of Appetite and Disordered Eating in Active Crohn's Disease. J Crohns Colitis 2018; 12:819-825. [PMID: 29617753 DOI: 10.1093/ecco-jcc/jjy041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Crohn's disease [CD] patients suffer from nutritional deficiencies when in active disease. We aim to examine calorific intake, macronutrient choice, and disordered eating behaviour in patients with active CD. METHODS CD patients with matched healthy volunteers [HV] were recruited. Active disease was defined by faecal calprotectin >250 µg/g, C-reactive protein 83.8 ± 47.1 mg/dL, or active disease seen on endoscopy or imaging. Symptoms were quantified by Harvey‑Bradshaw Index [HBI]. Calorific intake was assessed by 24-h dietary recall. Disordered eating was assessed using validated questionnaires: Binge Eating Scale [BES]; Power of Food Scale [PFS]; Control of Eating Questionnaire [CoEQ]; Dutch Eating Behaviour Questionnaire [DEBQ]; and Three Factor Eating Questionnaire [TFEQ]. RESULTS Totals of 30 CD (18 male[M]:12 female [F], age 32.3 ± 2.19 years, body mass index [BMI] 24.9 ± 0.8) and 31 matched HV [19 M:12 F, age 32.8 ± 2.0 years, BMI 24.7 ± 0.5] were recruited. Mean faecal calprotectin was 1032.5 ± 176 µg/g, C-reactive protein 8.38 ± 4.71 mg/dL, and HBI 4.8 ± 1. There were no significant differences in calorific intake between groups. Protein intake was lower in the CD cohort [p = 0.03]. Hospital Anxiety and Depression score was higher [p = 0.01] and CoEQ-Positive Mood [p = 0.001] lower in CD. CD patients were characterised by higher BES [p = 0.01] and lower CoEQ Craving Control [p = 0.027], with greater craving for Sweet [p = 0.043] and Savoury [p = 0.021] foods. PFS food Present [p = 0.005], DEBQ Emotional [p =< 0.001], and External Eating [p = 0.022] were significantly higher than among HV. CONCLUSIONS Reduced protein consumption and more prevalent disordered eating behaviour traits were present in CD. Greater binge eating and decreased control of cravings may be attributed to lower mood and higher anxiety observed. Patients may benefit from stronger psychological support with firm dietetic advice for healthy eating.
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Affiliation(s)
- Richard Anthony Wardle
- National Institute for Health Research [NIHR] Biomedical Research Centre in Gastrointestinal and Liver Diseases. University of Nottingham, Nottingham, UK
| | - Gita Thapaliya
- National Institute for Health Research [NIHR] Biomedical Research Centre in Gastrointestinal and Liver Diseases. University of Nottingham, Nottingham, UK
| | - Adam Nowak
- National Institute for Health Research [NIHR] Biomedical Research Centre in Gastrointestinal and Liver Diseases. University of Nottingham, Nottingham, UK
| | - Shellie Radford
- National Institute for Health Research [NIHR] Biomedical Research Centre in Gastrointestinal and Liver Diseases. University of Nottingham, Nottingham, UK
| | - Michelle Dalton
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | | | - Gordon W Moran
- National Institute for Health Research [NIHR] Biomedical Research Centre in Gastrointestinal and Liver Diseases. University of Nottingham, Nottingham, UK
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Abstract
Eating disorders affect millions of children, adolescents, and their families worldwide, and the pediatric primary care provider is often the first line of evaluation for these patients. Eating disorders affect nearly every system in the body, and signs and symptoms vary depending on patient behaviors (restrictive eating, binge eating, purging). Because the diagnosis is not always straightforward, a clinician's ability to recognize the potential medical complications of eating disorders early in their course can help facilitate timely treatment and an appropriate level of support. Most of these medical complications improve or resolve with nutritional rehabilitation and cessation of eating disorder behaviors. Refeeding severely underweight patients should be approached with caution as there is potential for significant fluid and electrolyte derangement that may worsen a patient's clinical status. Prompt recognition of the medical complications of eating disorders can improve short-term and long-term health in these children and adolescents. [Pediatr Ann. 2018;47(6):e238-e243.].
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Abstract
Eating disorders are traditionally thought of as a problem specific to women, but evidence suggests the disorders also occur in men. Identifying the problem and referring patients for treatment can be difficult. Understanding the nuances of these disorders and realizing the incidence in men is important, as it is often overlooked as a differential diagnosis.
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Factors Associated with Binge Eating Behavior among Malaysian Adolescents. Nutrients 2018; 10:nu10010066. [PMID: 29320461 PMCID: PMC5793294 DOI: 10.3390/nu10010066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 02/06/2023] Open
Abstract
Although there are numerous studies on binge eating behavior in the Western countries, studies on this behavior in Malaysia are still limited. Therefore, this cross-sectional study aimed to determine the risk factors associated with binge eating behavior among adolescents in Malaysia. The study included 356 adolescents (42.7% males and 57.3% females), aged 13 to 16 years. They completed a self-administered questionnaire on demographic and socioeconomic backgrounds, frequency of family meals, family meal environments, family cohesion, perception of body size, self-esteem, depressive symptoms, perfectionistic self-presentation, and binge eating behavior. Furthermore, their weight, height, and waist circumference were measured. It was found that 14.0% of the participants engaged in binge eating behavior (15.2% in females and 12.5% in males). Additionally, it was identified that high levels of depressive symptoms, high levels of body dissatisfaction, poor family cohesion, and low self-esteem were significantly contributed to binge eating behavior after controlling for sex (adjusted R2 = 0.165, F = 15.056, p < 0.001). The findings may suggest that improving the relationships between family members, along with eliminating adolescents’ negative emotions could help in the prevention of binge eating behavior among adolescents. The identified modifiable risk factors should be incorporated into binge eating preventive programs to increase the effectiveness of the programs.
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Thornton LM, Watson HJ, Jangmo A, Welch E, Wiklund C, von Hausswolff‐Juhlin Y, Norring C, Herman BK, Larsson H, Bulik CM. Binge-eating disorder in the Swedish national registers: Somatic comorbidity. Int J Eat Disord 2017; 50:58-65. [PMID: 27642179 PMCID: PMC5215312 DOI: 10.1002/eat.22624] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate associations between binge-eating disorder (BED) and somatic illnesses and determine whether medical comorbidities are more common in individuals who present with BED and comorbid obesity. METHOD Cases (n = 850) were individuals with a BED diagnosis in the Swedish eating disorders quality registers. Ten community controls were matched to each case on sex, and year, month, and county of birth. Associations of BED status with neurologic, immune, respiratory, gastrointestinal, skin, musculoskeletal, genitourinary, circulatory, and endocrine system diseases were evaluated using conditional logistic regression models. We further examined these associations by adjusting for lifetime psychiatric comorbidity. Amongst individuals with BED, we explored whether comorbid obesity was associated with risk of somatic disorders. RESULTS BED was associated with most classes of diseases evaluated; strongest associations were with diabetes [odds ratio (95% confidence interval) = 5.7 (3.8; 8.7)] and circulatory systems [1.9 (1.3; 2.7)], likely indexing components of metabolic syndrome. Amongst individuals with BED, those with comorbid obesity were more likely to have a lifetime history of respiratory [1.5 (1.1; 2.1)] and gastrointestinal [2.6 (1.7; 4.1)] diseases than those without comorbid obesity. Increased risk of some somatic disease classes in individuals with BED was not simply due to obesity or other lifetime psychiatric comorbidity. DISCUSSION The association of BED with many somatic illnesses highlights the morbidity experienced by individuals with BED. Clinicians treating patients with BED should be vigilant for medical comorbidities. Nonpsychiatric providers may be the first clinical contact for those with BED underscoring the importance of screening in primary care. © 2016 The Authors International Journal of Eating Disorders Published by Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:58-65).
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Affiliation(s)
- Laura M. Thornton
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Hunna J. Watson
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina,Faculty of Health Sciences, School of Psychology and Speech PathologyCurtin UniversityPerthAustralia,Faculty of Medicine, Dentistry, and Health Sciences, School of Paediatrics and Child Healththe University of Western AustraliaPerthAustralia
| | - Andreas Jangmo
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Elisabeth Welch
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Camilla Wiklund
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Yvonne von Hausswolff‐Juhlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet/Stockholm Centre for Eating disordersStockholmSweden,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Claes Norring
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet/Stockholm Centre for Eating disordersStockholmSweden,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | | | - Henrik Larsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Cynthia M. Bulik
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina,Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
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Souza da Silva T, Bisi Molina MDC, Antunes Nunes MA, Perim de Faria C, Valadão Cade N. Binge eating, sociodemographic and lifestyle factors in participants of the ELSA-Brazil. J Eat Disord 2016; 4:25. [PMID: 27795829 PMCID: PMC5081934 DOI: 10.1186/s40337-016-0095-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/18/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This study investigates the relationship between recurrent binge eating episodes and nutritional and food profiles and lifestyle in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal da Saúde do Adulto - ELSA-Brazil) cohort. RESULTS Recurrent binge eating episodes were associated with obesity (OR 5.188; confidence interval [CI] 4.051-6.645), overweight (OR 2.534; CI 1.980-3.243), female sex (OR 1.918; CI 1.573-2.338), age between 34 and 54 years old (OR 1.349; CI 1.115-1.631), alcohol ingestion ≥ 5 in two hours (OR 1.397; CI 1.068-1.827), and insufficient physical activity (OR 1.290; CI 1.078-1.544). CONCLUSION Being overweight has an important association with recurrent binge eating episodes, as does demographic and lifestyle characteristics, including excessive alcohol consumption.
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Affiliation(s)
- Thamyres Souza da Silva
- Federal University of Espírito Santo (Universidade Federal do Espírito Santo), Vitória, Brazil
| | | | | | - Carolina Perim de Faria
- Federal University of Espírito Santo (Universidade Federal do Espírito Santo), Vitória, Brazil
| | - Nagela Valadão Cade
- Federal University of Espírito Santo (Universidade Federal do Espírito Santo), Vitória, Brazil
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Abstract
PURPOSE OF REVIEW This review provides an update on the new Diagnostic and Statistical Manual (DSM) diagnosis of binge-eating disorder (BED) by presenting diagnostic criteria, associated risk factors and co-morbidities, and tools for assessment. An update on the currently available evidence-based treatments for adolescent BED is provided to help with the coordination of treatment planning for identified patients with this condition. RECENT FINDINGS BED is now officially included in the DSM. Research with youth has begun to show improvement from treatments such as cognitive behavioral therapy, previously shown to be useful in adults. SUMMARY BED is common and often begins during youth. The availability of diagnostic criteria, along with increasing knowledge about the condition and available treatments, is expected to result in improved identification and management in younger patients.
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Satherley R, Howard R, Higgs S. Disordered eating practices in gastrointestinal disorders. Appetite 2014; 84:240-50. [PMID: 25312748 DOI: 10.1016/j.appet.2014.10.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE To systematically review evidence concerning disordered eating practices in dietary-controlled gastrointestinal conditions. Three key questions were examined: a) are disordered eating practices a feature of GI disorders?; b) what abnormal eating practices are present in those with GI disorders?; and c) what factors are associated with the presence of disordered eating in those with GI disorders? By exploring these questions, we aim to develop a conceptual model of disordered eating development in GI disease. METHODS Five key databases, Web of Science with Conference Proceedings (1900-2014) and MEDLINE (1950-2014), PubMed, PsycINFO (1967-2014) and Google Scholar, were searched for papers relating to disordered eating practices in those with GI disorders. All papers were quality assessed before being included in the review. RESULTS Nine papers were included in the review. The majority of papers reported that the prevalence of disordered eating behaviours is greater in populations with GI disorders than in populations of healthy controls. Disordered eating patterns in dietary-controlled GI disorders may be associated with both anxiety and GI symptoms. Evidence concerning the correlates of disordered eating was limited. CONCLUSIONS The presence of disordered eating behaviours is greater in populations with GI disorders than in populations of healthy controls, but the direction of the relationship is not clear. Implications for further research are discussed.
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Affiliation(s)
| | - R Howard
- University of Birmingham, Birmingham, UK
| | - S Higgs
- University of Birmingham, Birmingham, UK
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Reas DL, Zipfel S, Rø Ø. Is it an eating disorder or achalasia or both? A literature review and diagnostic challenges. EUROPEAN EATING DISORDERS REVIEW 2014; 22:321-30. [PMID: 25053457 DOI: 10.1002/erv.2307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/05/2014] [Accepted: 06/17/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Achalasia is a rare oesophageal motility disorder characterized by physical, behavioural and psychosocial features that are strikingly similar to eating disorders (ED). METHOD A literature search of PubMed and Google Scholar identified 36 cases of achalasia from 11 countries misdiagnosed as ED between 1980 and 2013. RESULTS On average, the typical misdiagnosed case was an 18-year-old female with an average weight loss of 16.2 kg. Vomiting behaviour in achalasia was distinguished by occurring after both solids and liquids, occurring in public, and worsening at night or while lying down, and was associated with pain relief. Manometric investigations of oesophageal functioning in clinical ED samples are few and have shown little evidence of dysmotility. DISCUSSION Achalasia and ED share numerous clinical features including weight loss and vomiting. Pain associated with swallowing difficulties may lead to an increasingly restricted pattern of eating and food avoidance. Increased awareness of achalasia in ED treatment settings can help facilitate detection of achalasia, thereby reducing treatment delay.
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Affiliation(s)
- Deborah L Reas
- Regional Eating Disorders Service, Division of Mental Health and Addiction, Oslo University Hospital, Norway
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