Lifetime medical and psychiatric comorbidity of night eating behavior in the Swedish Twin Study of Adults: Genes and Environment (STAGE)

Association of participants who screened positive for night eating syndrome with physical health, sleep problems, and weight status in an Australian adult population

BACKGROUND

Night eating syndrome (NES) is a unique eating disorder characterised by evening hyperphagia and nocturnal ingestions which cause significant distress and/or impairment in functioning. Despite the growing literature, NES remains poorly understood and under diagnosed. As such, this study aims to compare the prevalence of physical health conditions in participants with NES when compared to participants without an eating disorder (ED) and participants with other eating disorders (including anorexia nervosa (AN), binge eating disorder (BED) and bulimia nervosa (BN)) in a general population Australian sample of adults.

METHODS

The data for this study were obtained from the 2017 Health Omnibus Survey (HOS) a multi-stage, cross-sectional survey, conducted by Harrison Research in South Australia. This current study focused on 2547 participants over 18 years of age and specific questions from this population survey including those related to participant demographics and health.

RESULTS

This study identified that participants who screened positive for night eating syndrome (spNES) when compared to participants with other eating disorders (ED) or no ED diagnosis, were significantly more likely to have an increased age, be female, have lower levels of education and have lower household income. Additionally, the spNES group was significantly associated with sleep apnoea (p = 0.031), insomnia or other sleep problems (p < 0.0001), increased BMI (p < 0.0001), increased levels of pain/discomfort and lower physical health-related quality of life. Hypertension, hypercholesterolemia, and diabetes were not significantly associated with the spNES group or the "other ED" group which included participants with AN, BED, BN.

CONCLUSIONS

Several physical health problems were found to be significantly associated with the spNES group including sleep problems, increased BMI, increased levels of pain and lower self-reported physical health-related quality of life. Consequently, future research exploring the complex interaction between NES and these medical conditions may provide further insight into the diagnosis, screening tools and management of NES. Additionally, this study highlights the need for future studies which use larger population-based samples.

LEVEL OF EVIDENCE

Level III. Evidence obtained from well-designed cohort or case-control analytic studies.

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

BACKGROUND

Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders.

METHODS

This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised.

RESULTS

A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED.

CONCLUSIONS

This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

Depression symptoms and night eating in young adulthood

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

LEVEL OF EVIDENCE

Level III, cohort analytic study.

New data on psychological traits and sleep profiles of patients affected by nocturnal eating

OBJECTIVE

Nocturnal eating behavior is shared by patients affected by a parasomnia, sleep-related eating disorder (SRED), and several eating disorders such as night eating syndrome (NES) and binge-eating disorder (BED); however, the differential clinical features of these patients have been poorly studied, with persisting difficulties in defining the borders between these pathologies. The aim of this study was to evaluate polysomnographic and personality characteristics of nocturnal eaters to further differentiate the syndromes.

METHODS

During a period of six months, consecutive patients complaining of nocturnal eating were asked to participate to the study. Twenty-four patients who were found to eat during the polysomnographic recording (PSG) study, and gender-matched control subjects were included. All subjects underwent a full-night video-PSG study and a psychometric assessment including the Eating Disorder Inventory (EDI-2), the self-rating Bulimic Investigatory Test-Edinburgh (BITE), the Temperament and Character Inventory (TCI), and the Barratt Impulsivity Scale (BIS).

RESULTS

Nocturnal eaters showed a mild reduction in sleep efficiency and duration due to a moderate sleep fragmentation, whereas the percentage of each sleep stage was not significantly affected. Nocturnal eaters scored higher at many subscales of the EDI-2, at the BITE symptoms subscale, and at the BIS attentional impulsivity subscale.

CONCLUSION

The psychological characteristics found in our patients with NES seem to be typical for patients affected by eating disorders, and support the hypothesis that the nocturnal behavior of these individuals is due to an eating disorder; however, specific traits also allow differentiation of NES from BED.