Dietary intake and nutritional risk in Mediterranean adolescents in relation to the severity of the eating disorder

Nutrient intake and adequacy in children with autism spectrum disorder: EPINED epidemiological study

LAY ABSTRACT

Children with autism spectrum disorder (ASD) have a fivefold elevated risk of developing eating problems, which predisposes them to nutritional deficiencies. This study assesses nutritional intake and adequacy in children with ASD, subdiagnostic autistic symptoms and typically developing (TD) children. Preschool children with ASD and subdiagnostic symptoms had slightly lower intake of monounsaturated fatty acids (MUFA), vitamin D and vitamin B12. Primary school children with ASD and subdiagnostic symptoms had slightly higher intake of protein, cholesterol, thiamine and niacin, and a higher percentage of obesity than children with TD. All children had a high intake in sugars, fats and saturated fatty acids; a very highly inadequate intake of vitamins (vitamins D and E), fibre, b-carotene, calcium and magnesium; and a moderately inadequate intake of vitamin C, folate and iron. However, although all children need nutrition advice, children with ASD and subdiagnostic autistic symptoms had a poorer quality diet than those with TD.

Restrained eating behaviour, anorexia nervosa and food consumption between children and adolescents: a scoping review

Anorexia nervosa (AN) and restrained eating behaviour (REB) are characterised by reduced food intake to achieve body weight loss. This scope review aimed to describe the existing evidence on the association between AN, restrictive eating behaviour and food consumption. Studies with children and adolescents of both sexes of all races and ethnicities were included. Experimental and observational studies, systematic reviews, meta-analysis, case reports or series, conference abstracts, dissertations and theses were also included. The search was conducted in ten electronic databases and grey literature without language restriction on 14 November 2020. Twenty-four studies met the inclusion criteria. Most studies included girls and identified lower intake of energy content, fat and certain micronutrients. There was also a higher intake of caffeine, fibre, vegetables, legumes and fruits and a lower intake of low-quality snack, fast food, sweets and foods with high carbohydrate and fat contents. The need to improve the quality of the diet among study participants was also identified. Thus, it is recommended that the evaluation of food consumption be careful to develop effective prevention strategies for the development of AN/REB and minimise nutritional deficiencies in these individuals.

Do Children with Attention-Deficit/Hyperactivity Disorder Follow a Different Dietary Pattern than That of Their Control Peers?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents. A current area of interest is the association between ADHD and food consumption. The aim of this study was to determine the food consumption and dietary patterns of children with and without ADHD in relation to their age and ADHD presentation. The study involved 259 preschoolers aged 3 to 6 years old (57 with ADHD and 202 controls) and 475 elementary-school-age children, aged 10 to 12 years old (213 with ADHD and 262 controls) from Spain. ADHD was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (5th edition) from Schedule for Affective Disorders and Schizophrenia for School-Age Children interviews. Eating data were collected using a food consumption frequency questionnaire, and principal component analysis was carried out to analyze dietary patterns. Western-like, sweet, and healthy patterns were identified. The ADHD group was negatively associated with the healthy pattern (p < 0.001) and positively associated with the Western-like diet (p = 0.004). Children with inattentive presentation showed lower adherence (12.2%) to a healthy pattern than that of the control group (39.9%) (p < 0.001). There is an association between ADHD and dietary habits; children with inattentive presentation may particularly be at risk of unhealthy eating habits.

Low carbohydrate diets in eating disorders and type 1 diabetes

Dietary intake requires attention in the treatment of both eating disorders and type 1 diabetes (T1D) to achieve optimal outcomes. Nutritional management of both conditions involves encouraging a wide variety of healthful foods in the context of usual cultural and family traditions. In recent times, low carbohydrate diets have seen a rise in popularity, both in T1D and in the general population. Low carbohydrate diets involve dietary restriction, although the extent depends on the level of carbohydrate prescription. Although dietary restriction is a known risk factor for eating disorders, there is limited literature on the impact of following a low carbohydrate diet on the development and maintenance of eating disorders in T1D. The aim of this review is to discuss the impact of dietary restriction on the development and treatment of eating disorders and propose considerations to enable optimum health outcomes in individuals with T1D, an at risk group. In order to achieve this, clarity regarding strategies that allow both flexibility in dietary intake and facilitate healthy eating behaviours, whilst achieving glycaemic targets, are required.

Do Children with Autism Spectrum Disorders Eat Differently and Less Adequately than Those with Subclinical ASD and Typical Development? EPINED Epidemiological Study

Food consumption in children with ASD, subclinical ASD and with typical development (TD), and their adequacy to dietary recommendations was studied. A school population sample of 77 children with ASD, 40 with subclinical ASD, and 333 with TD participated. Compared to children with TD, pre-schoolers with ASD consumed fewer raw vegetables and less fish and eggs, while primary school children consumed fewer legumes, raw vegetables, citrus fruits, cheese/yogurt and olive oil, and more meat. All groups consumed an excess of sugar but those with ASD consumed even a greater amount than their peers. The higher prevalence of obesity found in primary school children with ASD may be the consequence of a less healthy eating pattern sustained over time.

[Validation of a short food frequency questionnaire in small children]

Introduction

Introduction: validated food frequency questionnaires in children are scarce, mostly long, and only provide data about food consumption. Objectives: the aim of this study was to evaluate the reproducibility and validity of a short food frequency questionnaire that estimates energy, nutritional intake, and the frequency of food consumption in children aged between 3 and 6 years. Material and methods: in 49 children (57% boys), the reproducibility and validity of a frequency questionnaire with 41 items was assessed using Spearman's and intraclass correlations, both adjusted and not adjusted for energy. A 6-day record was used as a reference method. Results: reproducibility was high in food groups with correlations > 0.70 for most of them and between 0.5 and 0.7 for meat, fish, potatoes, sweets/soft drinks, and oil. For energy and nutrients correlations were > 0.9 and > 0.7, respectively. Validity was strong to moderate for foods with correlations > 0.7 (dairy and milk) and between 0.4 and 0.7 (sausages, eggs, yogur/cheese, vegetables and oil), and for nutrients with correlations > 0.5 (lipids, AGS, AGP, phosphorus, calcium, vitamin E and vitamin C) and between 0.3 and 0.5 (energy, starches, fiber, MUFA, cholesterol, sodium, magnesium, potassium, retinol, riboflavin, niacin, pantothenic acid, vitamin B6 and folates). All correlations were significant and increased after they had been adjusted for energy. Conclusions: the short food frequency questionnaire for children between 3 and 6 years old has high reproducibility and good validity with results that are as good as those of long food frequency questionnaires.

Disordered eating behaviors and energy and nutrient intake in a regional sample of Brazilian adolescents from public schools

PURPOSE

To estimate the prevalence of disordered eating behaviors and the association with energy and nutrient intake and nutritional status in adolescents.

METHODS

A school-based cross-sectional study was performed involving a probabilistic sample of 487 teenagers (aged 15-19 years) from public schools in the Metropolitan area of Rio de Janeiro, Brazil. The Eating Attitude Test and the Bulimic Investigatory Test Edinburgh questionnaires were applied to identify abnormal eating patterns and unusual dietary patterns, respectively. Nutritional status was defined by sex- and age-specific body mass index cutoffs. Energy and nutrient intake were assessed by a 3-day food record. The association between variables was assessed by the prevalence ratio and 95% confidence intervals, Pearson's Chi-square test, and linear regression.

RESULTS

The prevalence of abnormal eating patterns was 7.4% and that of unusual dietary patterns was 18.9%. Vitamin C intake was higher among girls with abnormal dietary patterns, with a consequent lower frequency of vitamin C deficiency when compared to those with normal dietary patterns. Calcium intake was lower in boys with unusual dietary pattern than in those without this behavior. Excess weight was associated with the presence of unusual dietary pattern in girls (PR: 2.4, 95% CI 1.6-3.5).

CONCLUSIONS

The prevalence of disordered eating behaviors was high, mainly in those who were overweight. It was associated with lower calcium intake in boys and with higher Vitamin C intake in girls.

LEVEL OF EVIDENCE

Level V, descriptive studies.

Diet quality of adolescents with eating disorders

Purpose To compare the nutritional intake of adolescents with eating disorders (EDs) to recommended Daily Values of macronutrients and micronutrients, using the Nutrition Data Systems for Research (NDSR); to determine if nutritional content varied among the different sub-types of EDs; and to use the Healthy Eating Index 2010 (HEI-2010) as a measurement of diet quality in this population. Methods Forty-six adolescents referred to an ED Program were recruited for inclusion in this study. A detailed 24-h dietary recall from each participant was obtained and a detailed nutritional analysis was generated, allowing for calculation of the HEI-2010. Descriptive statistics were calculated to determine baseline characteristics of the study population and to determine associations and differences between ED subtypes. Results Average daily caloric intake was below recommended values in the study population. Despite this, the distribution of macronutrients was within the ranges recommended for older children and adolescents by the Dietary Guidelines for Americans, 2010. Micronutrient content varied considerably. The study population had a mean HEI-2010 score of 60.1, falling within the "needs improvement" category. A majority of the participants had insufficient caloric intake for the HEI to be applicable. Conclusion Results suggest that adolescents with EDs have a surprisingly normal distribution of macronutrient intake. Although using a diet quality assessment tool such as the HEI-2010 has been helpful in analyzing overall diet quality in the general population, the restrictive caloric intake which characterizes the ED population prevents the utility of such a guide for most patients with EDs.

Emotional Symptoms and Dietary Patterns in Early Adolescence: A School-Based Follow-up Study

OBJECTIVE

To examine the relationship between early emotional symptoms and dietary patterns over 3 years in a school-based sample.

DESIGN

Three-year longitudinal prospective study.

SETTING

Thirteen schools in Reus, Spain.

PARTICIPANTS

From a sample of 562 preadolescents with and without emotional symptoms, 165 were observed and were classified as either showing (n = 100) or not showing emotional symptoms (n = 65).

MAIN OUTCOME MEASURE

Emotional symptoms were assessed at baseline and after 1 and 3 years. In the third year, data were collected on food consumption, adherence to the Mediterranean diet (MD), and physical activity.

ANALYSIS

Dietary patterns were created by principal component analysis. Multivariate logistic regression was conducted with P < .05 considered significant.

RESULTS

Girls with emotional symptoms scored significantly lower in assessments for MD (score of 5.41 ± 2.19) and physical activity (score of 4.97 ± 2.05) than did girls who had no emotional symptoms (scores: MD, 6.19 ± 1.67; physical activity: 5.86 ± 1.94). Approximately 39.68% of girls with emotional symptoms showed high adherence to a sweet and fatty food pattern. After adjusted logistic regression, girls with emotional symptoms were 4 times as likely to have high adherence to a sweet and fatty food pattern (odds ratio, 4.79; 95% confidence interval, 1.55-15.10). No differences were observed among boys.

CONCLUSIONS AND IMPLICATIONS

Girls with emotional symptoms during early adolescence have high adherence to a pattern rich in sweet and fat foods and low adherence to MD, and engage in low levels of physical activity. These findings highlight the importance of managing emotional distress to prevent it from having a negative effect on eating behavior.