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Wilcox H, Paz V, Saxena R, Winkelman JW, Garfield V, Dashti HS. The Role of Circadian Rhythms and Sleep in Anorexia Nervosa. JAMA Netw Open 2024; 7:e2350358. [PMID: 38175645 PMCID: PMC10767597 DOI: 10.1001/jamanetworkopen.2023.50358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Importance Observational studies have associated anorexia nervosa with circadian rhythms and sleep traits. However, the direction of causality and the extent of confounding by psychosocial comorbidities in these associations are unknown. Objectives To investigate the association between anorexia nervosa and circadian and sleep traits through mendelian randomization and to test the associations between a polygenic risk score (PRS) for anorexia nervosa and sleep disorders in a clinical biobank. Design, Setting, and Participants This genetic association study used bidirectional 2-sample mendelian randomization with summary-level genetic associations between anorexia nervosa (from the Psychiatric Genomics Consortium) and chronotype and sleep traits (primarily from the UK Biobank). The inverse-variance weighted method, in addition to other sensitivity approaches, was used. From the clinical Mass General Brigham (MGB) Biobank (n = 47 082), a PRS for anorexia nervosa was calculated for each patient and associations were tested with prevalent sleep disorders derived from electronic health records. Patients were of European ancestry. All analyses were performed between February and August 2023. Exposures Genetic instruments for anorexia nervosa, chronotype, daytime napping, daytime sleepiness, insomnia, and sleep duration. Main Outcomes and Measures Chronotype, sleep traits, risk of anorexia nervosa, and sleep disorders derived from a clinical biobank. Results The anorexia nervosa genome-wide association study included 16 992 cases (87.7%-97.4% female) and 55 525 controls (49.6%-63.4% female). Genetic liability for anorexia nervosa was associated with a more morning chronotype (β = 0.039; 95% CI, 0.006-0.072), and conversely, genetic liability for morning chronotype was associated with increased risk of anorexia nervosa (β = 0.178; 95% CI, 0.042-0.315). Associations were robust in sensitivity and secondary analyses. Genetic liability for insomnia was associated with increased risk of anorexia nervosa (β = 0.369; 95% CI, 0.073-0.666); however, sensitivity analyses indicated bias due to horizontal pleiotropy. The MGB Biobank analysis included 47 082 participants with a mean (SD) age of 60.4 (17.0) years and 25 318 (53.8%) were female. A PRS for anorexia nervosa was associated with organic or persistent insomnia in the MGB Biobank (odds ratio, 1.10; 95% CI, 1.03-1.17). No associations were evident for anorexia nervosa with other sleep traits. Conclusions and Relevance The results of this study suggest that in contrast to other metabo-psychiatric diseases, anorexia nervosa is a morningness eating disorder and further corroborate findings implicating insomnia in anorexia nervosa. Future studies in diverse populations and with subtypes of anorexia nervosa are warranted.
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Affiliation(s)
- Hannah Wilcox
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Valentina Paz
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Instituto de Psicología Clínica, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
- MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Richa Saxena
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
| | - John W. Winkelman
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Sleep Disorders Clinical Research Program, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Victoria Garfield
- MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hassan S. Dashti
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
- Division of Nutrition, Harvard Medical School, Boston, Massachusetts
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Raque TL, Lamphere B, Motzny C, Kauffmann J, Ziemer K, Haywood S. Pathways by Which Self-Compassion Improves Positive Body Image: A Qualitative Analysis. Behav Sci (Basel) 2023; 13:939. [PMID: 37998685 PMCID: PMC10669661 DOI: 10.3390/bs13110939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
The current study applied consensual qualitative research-modified to essays written by 51 college women completing an expressive writing intervention over three time points for a total of 153 essays to identify how increases in self-compassion improve body image. A qualitative coding team tracked changes in affect and cognition over three time points. The results demonstrated that college women consistently expressed body acceptance and psychological flexibility. Additionally, the participants expressed important increases in mindfulness as well as decreases in social influences, feelings of separation, negative health behaviors, and attention to media messages. Decreases were found in their expressions of body functionality, love and kindness toward their body, and internal locus of control. These findings suggest pathways through which self-compassion may improve women's body image by increasing mindfulness and decreasing the negative ways of relating to one's body, specifically in the areas of media, clothing, make-up, and negative social interactions.
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Affiliation(s)
- Trisha L. Raque
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Brooke Lamphere
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Christine Motzny
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Julia Kauffmann
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Kathryn Ziemer
- Old Town Psychology, 1221 King Street, Alexandria, VA 22314, USA;
| | - Shaakira Haywood
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
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Mutti C, Malagutti G, Maraglino V, Misirocchi F, Zilioli A, Rausa F, Pizzarotti S, Spallazzi M, Rosenzweig I, Parrino L. Sleep Pathologies and Eating Disorders: A Crossroad for Neurology, Psychiatry and Nutrition. Nutrients 2023; 15:4488. [PMID: 37892563 PMCID: PMC10610508 DOI: 10.3390/nu15204488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
The intricate connection between eating behaviors and sleep habits is often overlooked in clinical practice, despite their profound interdependence. Sleep plays a key role in modulating psychological, hormonal and metabolic balance and exerting an influence on food choices. Conversely, various eating disorders may affect sleep continuity, sometimes promoting the development of sleep pathologies. Neurologists, nutritionists and psychiatrists tend to focus on these issues separately, resulting in a failure to recognize the full extent of the clinical conditions. This detrimental separation can lead to underestimation, misdiagnosis and inappropriate therapeutic interventions. In this review, we aim to provide a comprehensive understanding of the tangled relationship between sleep, sleep pathologies and eating disorders, by incorporating the perspective of sleep experts, psychologists and psychiatrists. Our goal is to identify a practical crossroad integrating the expertise of all the involved specialists.
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Affiliation(s)
- Carlotta Mutti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, 43125 Parma, Italy
| | - Giulia Malagutti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, 43125 Parma, Italy
| | - Valentina Maraglino
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, 43125 Parma, Italy
| | - Francesco Misirocchi
- Neurology Unit, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy (A.Z.)
| | - Alessandro Zilioli
- Neurology Unit, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy (A.Z.)
| | - Francesco Rausa
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, 43125 Parma, Italy
| | - Silvia Pizzarotti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, 43125 Parma, Italy
| | - Marco Spallazzi
- Neurology Unit, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy (A.Z.)
| | - Ivana Rosenzweig
- Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London WC2R 2LS, UK
| | - Liborio Parrino
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, 43125 Parma, Italy
- Neurology Unit, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy (A.Z.)
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Bazo Perez M, Hayes TB, Frazier LD. Beyond generalized anxiety: the association of anxiety sensitivity with disordered eating. J Eat Disord 2023; 11:173. [PMID: 37784155 PMCID: PMC10544544 DOI: 10.1186/s40337-023-00890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Anxiety and eating disorders (EDs) are rising at alarming rates. These mental health disorders are often comorbid, yet the factors associated with their comorbidity are not well understood. The present study examined a theoretical model of the pathways and relative associations of anxiety sensitivity (AS) with different dimensions of ED risk, controlling for generalized anxiety. METHODS Participants (N = 795) were undergraduate students with an average age of 21 (SD = 4.02), predominantly female (71%), and Hispanic (71.8%). Participants completed an online survey with established measures of AS (i.e., Anxiety Sensitivity Index-3; ASI-3), general anxiety (i.e., Beck Anxiety Inventory; BAI), and eating behaviors (i.e., Eating Attitudes Test-26; EAT-26). RESULTS The results of our structural equation models indicated that AS subscales were significantly associated with dimensions of the EAT-26, even when controlling for generalized anxiety. Specifically, the ASI-3 factors reflecting cognitive and social concerns provided the most consistent significant associations with EDs. Whereas reporting higher cognitive concerns was associated with higher ED symptoms (e.g., reporting the urge to vomit after a meal), reporting higher social concerns was associated with fewer ED symptoms. These differential results may suggest risk and resilience pathways and potential protective or buffering effects of social concerns on ED risk. DISCUSSION Findings advance understanding of the role of AS in the comorbidity of anxiety and EDs, demonstrating the strong association of AS with ED pathology. These findings provide cognitive indicators for transdiagnostic therapeutic intervention in order to reduce the risk of EDs.
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Affiliation(s)
- Maria Bazo Perez
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Timothy B Hayes
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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Abanobi AN, Itacy S, Coleman CM, Harlow BL. Association between eating disorders and sleep duration among college students: Findings from the National Healthy Minds study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-7. [PMID: 37463502 DOI: 10.1080/07448481.2023.2225616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Explore associations between eating disorders (EDs) and sleep duration and the impact of depression symptoms (DSs) in American college students. PARTICIPANTS College students from 2018 to 2019 Healthy Minds Study. METHODS Multivariate logistic regression evaluated associations between EDs (bulimia, anorexia, binge eating [BED]) and sleep duration. Stratified analyses assessed effect modification by DSs and gender. RESULTS Students reporting any eating disorder had no greater risk of not recommended sleep duration during weekdays compared to those with no eating disorder history (Adjusted OR = 0.99, 95% CI: 0.89-1.13). However, subjects reporting BED were at greater risk of deficient sleep during weekends compared to those with no EDs (Adjusted OR = 1.26, 95% CI: 1.01-1.58). This association was not impacted by DSs. However, all EDs were associated with not-recommended sleep duration among those who identified as other gender identity in comparison to those with no EDs. CONCLUSION Health educators should monitor academic performance in students with EDs for adequate sleep duration.
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Affiliation(s)
- Amarachi N Abanobi
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sarah Itacy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Chad M Coleman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Sahlan RN, Kinkel-Ram SS, Uzoegwu K, Smith A. Fear of COVID-19, insomnia, and eating disorder symptoms among Iranian college students. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 13:100601. [PMID: 37234278 PMCID: PMC10198744 DOI: 10.1016/j.jadr.2023.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/10/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
Objective Eating disorders (EDs), fear of COVID-19, and insomnia have all increased during the COVID-19 pandemic in Western societies. Additionally, fear of COVID-19 and sleep disturbances relate to ED symptoms in Western societies. However, it is unknown whether fear of COVID-19 and insomnia relate to ED symptoms in non-Western countries, such as Iran. Thus, this study examined the relation between fear of COVID-19, insomnia, and ED symptoms among Iranian college students. Specifically, we hypothesized that insomnia and fear of COVID-19 would each uniquely relate to ED symptoms and the interaction between insomnia and fear of COVID-19 would also associate with increased ED symptoms. Method College students (N =1,043) filled out measures assessing fear of COVID-19, insomnia, and ED symptoms. We ran moderation analyses using linear regression for global ED symptoms and negative binomial regressions for binge eating and purging. Results Fear of COVID-19 and insomnia had unique effects on global ED symptoms and binge eating. Insomnia, but not fear of COVID-19, had a unique effect on purging. No significant interaction effect was found. Discussion This study was the first to examine the association between fear of COVID-19 and insomnia on ED symptoms in Iran. Fear of COVID-19 and insomnia should be incorporated into novel assessments and treatments for EDs.
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Affiliation(s)
- Reza N Sahlan
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo-SUNY, Buffalo, NY, United States
| | | | - Kelechi Uzoegwu
- Miami University, Department of Psychology, Oxford, Ohio, United States
| | - April Smith
- Auburn University, Department of Psychology, Auburn, AL, United States
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Xie X, Cheng H, Chen Z. Anxiety predicts internet addiction, which predicts depression among male college students: A cross-lagged comparison by sex. Front Psychol 2023; 13:1102066. [PMID: 36726503 PMCID: PMC9885532 DOI: 10.3389/fpsyg.2022.1102066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives Internet addiction has become an increasingly serious public health issue, putting young people at particular risk of psychological harm. This study aimed to analyze the interactions between college students' depression, anxiety, and Internet addiction and explore how these interactions differ between men and women. Methods A 6-month follow-up study was conducted on 234 college students using the Self-Rating Depression Scale, Self-rating Anxiety Scale, and Revised Chen Internet Addiction Scale. Results Depression, anxiety, and Internet addiction were positively correlated (p < 0.01). Anxiety can predict Internet addiction and that Internet addiction can predict depression. Moreover, anxiety had a significant predictive effect on Internet addiction among men. Conclusion Anxiety predicts Internet addiction, and Internet addiction predicts depression among male college students. These findings may better inform future Internet addiction intervention strategies. Particularly, interventions may better address Internet addiction by focusing on the role of anxiety, especially among men.
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Integrative review on psychological and social risk and prevention factors of eating disorders including anorexia nervosa and bulimia nervosa: seven major theories. Heliyon 2022; 8:e11422. [DOI: 10.1016/j.heliyon.2022.e11422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/16/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
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Gómez-García G, Ramos-Navas-Parejo M, de la Cruz-Campos JC, Rodríguez-Jiménez C. Impact of COVID-19 on University Students: An Analysis of Its Influence on Psychological and Academic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610433. [PMID: 36012067 PMCID: PMC9407859 DOI: 10.3390/ijerph191610433] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 05/04/2023]
Abstract
The irruption of COVID-19 has had different consequences on mental health in the youth population. Specifically, the sector made up of university students has suffered an abrupt change of teaching modality because of the pandemic. As such, this paper aims to analyze the impact that COVID-19 has had on different personal factors of students: (i) satisfaction with life; (ii) lived uncertainty; (iii) depression, anxiety, and stress, as well as factors related to academic development; (iv) motivation and the creation of teaching and learning strategies during this period; and (v) the perception of the degree of adaptability to the new scenario brought about by the university system. For this purpose, a cross-sectional quantitative design was advocated through the elaboration of an SEM model, which included 1873 university students from Andalusian Universities (Spain). The results reflected the strong negative impact that the pandemic had, especially on the levels of life satisfaction and the indices of depression, anxiety, and stress of the students. Likewise, the findings reflected the relevance of the correct adaptability on the part of the university to these new circumstances. It is necessary for university institutions to focus their efforts on quality attention to students, in order to establish fluid communication with them and to adapt to their academic and personal needs.
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Affiliation(s)
- Gerardo Gómez-García
- Department of Didactics and School Organisation, Faculty of Education Science, Campus Universitario de Cartuja, University of Granada, 18071 Granada, Spain
| | - Magdalena Ramos-Navas-Parejo
- Department of Didactics and School Organization, Faculty of Education and Sport Sciences, Campus Universitario de Melilla, University of Granada, 52071 Melilla, Spain
| | - Juan-Carlos de la Cruz-Campos
- Department of Didactics and School Organization, Faculty of Education and Sport Sciences, Campus Universitario de Melilla, University of Granada, 52071 Melilla, Spain
- Correspondence:
| | - Carmen Rodríguez-Jiménez
- Department of Didactics and School Organization, Faculty of Education and Sport Sciences, Campus Universitario de Melilla, University of Granada, 52071 Melilla, Spain
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Li S, Cui G, Yin Y, Tang K, Chen L, Liu X. Prospective Association Between Problematic Mobile Phone Use and Eating Disorder Symptoms and the Mediating Effect of Resilience in Chinese College Students: A 1-Year Longitudinal Study. Front Public Health 2022; 10:857246. [PMID: 35570941 PMCID: PMC9092370 DOI: 10.3389/fpubh.2022.857246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 12/19/2022] Open
Abstract
A previous cross-sectional study found that problematic mobile phone use (PMPU) was associated with students' eating disorder symptoms. However, since the cross-sectional study cannot infer the causality and the direction of effect, the longitudinal relationship between the two and the mechanism behind this relationship are unclear. Therefore, the present study explores the prospective association between PMPU and eating disorder symptoms and related mediation mechanisms using a 1-year longitudinal study of 1,181 college students (from December 2019 [T1] to December 2020 [T2]). Survey tools used include the Mobile Phone Addiction Tendency Scale, the 10-item Connor-Davidson resilience scale, and the 12 item Short Form of the Eating Disorder Examination Questionnaire. The longitudinal relationship between PMPU and eating disorder symptoms and the mediating effect of resilience was analyzed using a cross-lagged model. The results showed that PMPU (β = 0.086, P < 0.01) and resilience (β = -0.145, P < 0.01) at T1 predicted eating disorder symptoms at T2, but not vice versa. PMPU was bidirectionally associated with resilience, and the prediction effect of PMPU at T1 to resilience at T2 (β = -0.151, P < 0.001) was higher than the prediction effect of resilience at T1 to PMPU at T2 (β = -0.134, P < 0.001). The standardized indirect effect of PMPU at T1 on eating disorder symptoms at T2 via resilience was significant (β = 0.022, 95% CI = 0.010~0.040, P < 0.001). Therefore, PMPU and resilience were predictive for eating disorder symptoms in college students, and resilience may play a mediating role in the prospective association between PMPU and eating disorder symptoms. This study provides new ideas and higher-level evidence for the development of prevention and intervention measures for college students' eating disorder symptoms.
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Affiliation(s)
- Shaojie Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Guanghui Cui
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongtian Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kaixuan Tang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lei Chen
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xinyao Liu
- Shandong University of Traditional Chinese Medicine, Jinan, China
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Liu J, Teng Z, Chen Z, Wei Z, Zou T, Qin Y, Yuan H, Liu M, Chen J, Tang H, Xiang H, Wu H, Wu R, Huang J. Exploring the associations between behavioral health risk factors, abnormal eating attitudes and socio-demographic factors among Chinese youth: Survey of 7,984 vocational high school students in Hunan in 2020. Front Psychiatry 2022; 13:1000821. [PMID: 36419983 PMCID: PMC9676643 DOI: 10.3389/fpsyt.2022.1000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study investigated the associations between behavioral health risk factors (anxiety, depression, stress, insomnia, drinking, smoking) and abnormal eating attitudes among Chinese vocational high school students (CVHSS). Potential moderating relationships were also explored with relevant socio-demographic factors of the student's age, sex, rural or urban community, household income, family type and educational level of the father and mother. METHODS A total of 7,984 students from three vocational high schools in Hunan, China completed a questionnaire about their socio-demographic characteristics, alcohol use, smoking, and symptoms of depression, anxiety, stress (21-item version of the Depression Anxiety Stress Scale), insomnia (8-item Athens Insomnia Scale), and abnormal eating attitudes (19-item Chinese version of Eating Attitudes Test). RESULTS The prevalence rates for behavioral health problems among these students ranged widely depending on the risk factor: 42.5% insomnia, 41.3% anxiety, 26.2% depression, 14.4% stress, 13.7% drinking, and 8.3% smoking. Additionally, 61.7% of students were at-risk for at least one of these six behavioral health disorders. Abnormal eating attitudes were associated with depression (r = 0.422), anxiety (r = 0.490), stress (r = 0.490), and insomnia (r = 0.375), with all of these relationships being significant (p < 0.01) and large size statistical effects. However, other analyzes found that none of the socio-demographic background factors had meaningful associations with the behavioral health risk factors (0 of 28 tests) and very few background factors were associated with the abnormal eating attitude measures (only 3 of 35 tests). Females had higher levels than males on dieting and bulimia but not on the other two eating attitude components. CONCLUSIONS This study determined that behavioral health risk factors (sleep problems and anxiety in particular) were common among high school students in China and that mental health and sleep disorder risks also tended to co-occur in some students with abnormal eating attitudes. Therefore, prevention and early identification programs for behavioral risk factors are needed for this population. It is important to pay more attention to students with abnormal eating attitude-related symptoms, who may have also underlying mental health problems and need further evaluation.
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Affiliation(s)
- Jieyu Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ziwei Teng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zirong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zirou Wei
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tianxiang Zou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yue Qin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Yuan
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Xiang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Haishan Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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Differences in severity of eating disorder symptoms between adults with depression and adults with anxiety. Eat Weight Disord 2021; 26:1409-1416. [PMID: 32592138 PMCID: PMC7906044 DOI: 10.1007/s40519-020-00947-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Anxiety and depression are both considered maintaining factors for eating disorders (ED) but it is still unclear if one is more strongly associated with ED symptoms than the other. We examined differences in severity of ED symptoms among adults with either, both, or neither depression and anxiety. METHODS Volunteers (N = 3,780) to the project implicit mental health website ( https://implicit.harvard.edu/ ) self-reported their ED status (current ED: n = 374, past ED: n = 436; no ED: n = 2,970), their current depression/anxiety status, and their ED symptoms (using the Eating Attitudes Test). ANOVAs with post hoc comparisons were used to examine relationships between ED symptoms and comorbid depression/anxiety status among currently ill, recovered, and never ill individuals. RESULTS Participants without comorbidities had the least and participants with both comorbidities had the most severe ED symptoms (p = .021). Participants with anxiety alone had more severe ED symptoms relative to those with depression alone across groups (current ED: p = .024; past ED: p = .019; no EDs: p = .021). DISCUSSION These findings demonstrate, in contrast with an earlier study among youth with EDs (Hughes et al., 2013), that comorbid anxiety may be linked with more severe ED symptoms relative to comorbid depression. It is possible that anxiety serves as a maintaining factor for ED symptoms such that dieting and other ED-related behaviors may function to modulate symptoms of anxiety. LEVEL OF EVIDENCE Level III, case-control analytic study.
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13
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Christensen KA, Short NA. The case for investigating a bidirectional association between insomnia symptoms and eating disorder pathology. Int J Eat Disord 2021; 54:701-707. [PMID: 33665877 PMCID: PMC9434493 DOI: 10.1002/eat.23498] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/22/2022]
Abstract
Many people with eating disorders (EDs) report symptoms of insomnia (i.e., frequent difficulty falling asleep, staying asleep, and/or early morning wakening) and sleep problems have been linked to alterations in eating behaviors; however, mechanisms of these bidirectional associations remain poorly understood and under researched. This is a problem because higher insomnia symptom severity is a risk factor for the onset and perpetuation of anxiety, mood, trauma, and substance use disorders and, potentially, ED symptoms. Furthermore, insomnia symptoms may hinder recovery and increase relapse rates following successful psychotherapy. In this article, we describe potential mechanisms underlying bidirectional associations between insomnia and eating psychopathology that may contribute to the etiology and maintenance of both disorders. We suggest novel directions for future research to characterize the association between dysregulated sleep and ED symptoms and to evaluate impacts of insomnia symptoms on relapse and recovery for people with co-occurring pathology. Finally, we discuss options for testing the incorporation of existing evidence-based treatments for insomnia disorder (e.g., Cognitive-Behavioral Therapy for Insomnia) with ED care. Overall, insomnia symptoms present a promising intervention point for ED treatment that has not been systematically tested, yet would be highly feasible to address in routine clinical care.
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Affiliation(s)
| | - Nicole A. Short
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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14
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Christensen KA, Forbush KT, Elliott BT, Jarmolowicz DP. A single-case multiple baseline design for treating insomnia in eating disorders: The TIRED study. Int J Eat Disord 2021; 54:652-659. [PMID: 33336848 PMCID: PMC8428790 DOI: 10.1002/eat.23450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The purpose of this trial is to evaluate the novel use of an empirically supported treatment for sleep problems for people with residual insomnia disorder following ED treatment. METHOD Participants (N = 6) will complete a single-case multiple baseline study using Brief Behavioral Treatment for Insomnia (Buysse et al., Archives of Internal Medicine, 171, 2011, 887-895; Troxel et al., Behavioral Sleep Medicine, 10, 2012, 266-279). Participants will complete pre- and post-treatment evaluations of insomnia severity, sleep efficiency, daytime fatigue, ED symptoms, depressive symptoms, and anxiety symptoms. Throughout treatment, participants will complete daily diaries of sleep indices (sleep latency, wake after sleep onset, total sleep time, and sleep efficiency). RESULTS The primary outcome will be treatment effects on insomnia severity, measured by the Insomnia Severity Index. Secondary outcomes include sleep efficiency and daytime fatigue. Exploratory outcomes include ED-related impairment and symptoms, anxiety symptoms, and depression symptoms. We will provide subject-level graphs of sleep indices and ED symptoms throughout treatment. Additionally, treatment effects will be examined at one- and three-month follow-up. DISCUSSION Although insomnia treatments have been evaluated in other psychiatric disorders, there has yet to be a study examining behavioral interventions for insomnia in EDs. Results of this study will inform the development and application of interventions for residual insomnia symptoms in this population.
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Affiliation(s)
| | | | | | - David P. Jarmolowicz
- Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas
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15
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Nagata JM, Thurston IB, Karazsia BT, Woolridge D, Buckelew SM, Murray SB, Calzo JP. Self-reported eating disorders and sleep disturbances in young adults: a prospective cohort study. Eat Weight Disord 2021; 26:695-702. [PMID: 32222955 PMCID: PMC7529665 DOI: 10.1007/s40519-020-00888-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/05/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the prospective association between eating disorders, disordered eating behaviors, and sleep disturbances in young adults. METHODS We used prospective cohort data of young adults aged 18-26 from the National Longitudinal Study of Adolescent to Adult Health (N = 12,082). Self-reported exposures of interest (at 18-26 years) included (1) an eating disorder diagnosis proxy; disordered eating behaviors such as (2) restrictive eating behaviors including fasting/skipping meals, (3) compensatory behaviors including vomiting, laxatives/diuretics, or weight loss pills; and (4) loss of control/overeating. Self-reported sleep disturbances at 7-year follow-up included trouble falling or staying asleep. RESULTS In negative binomial regression models, all four exposures predicted both sleep disturbance outcomes at 7-year follow-up, when adjusting for demographic covariates and baseline sleep disturbances. When additionally adjusting for baseline depressive symptoms, the associations between eating disorder diagnosis proxies and trouble falling (incidence rate ratio [IRR] 1.24; 95% CI 1.05-1.46) and staying (IRR 1.16; 95% CI 1.01-1.35) asleep remained statistically significant; however, the associations between eating behaviors and sleep disturbances were attenuated. CONCLUSIONS Eating disorders in young adulthood predict sleep disturbances at 7-year follow-up. Young adults with eating disorders or who engage in disordered eating behaviors may be assessed for sleep disturbances. LEVEL III Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
| | - Idia B Thurston
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Bryan T Karazsia
- Department of Psychology, The College of Wooster, Wooster, OH, USA
| | - Daniel Woolridge
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Sara M Buckelew
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jerel P Calzo
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA, USA
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16
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Austin A, Potterton R, Flynn M, Richards K, Allen K, Grant N, Glennon D, Mountford VA, Franklin‐Smith M, Schelhase M, Jones WR, Serpell L, Mahoney K, Brady G, Nunes N, Kali K, Connan F, Schmidt U. Exploring the use of individualised patient‐reported outcome measures in eating disorders: Validation of the Psychological Outcome Profiles. EUROPEAN EATING DISORDERS REVIEW 2021; 29:281-291. [DOI: 10.1002/erv.2819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Amelia Austin
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Rachel Potterton
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Michaela Flynn
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Katie Richards
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Karina Allen
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
- South London and Maudsley NHS Foundation Trust London UK
- School of Psychological Sciences The University of Western Australia Western Australia Australia
| | - Nina Grant
- South London and Maudsley NHS Foundation Trust London UK
| | | | - Victoria A. Mountford
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
- South London and Maudsley NHS Foundation Trust London UK
- Maudsley Health Abu Dhabi United Arab Emirates
| | | | | | | | - Lucy Serpell
- North East London NHS Foundation Trust London UK
- Division of Psychology and Language Sciences University College London London UK
| | - Kate Mahoney
- North East London NHS Foundation Trust London UK
| | - Gaby Brady
- Central and North West London NHS Foundation Trust London UK
| | - Nicole Nunes
- Central and North West London NHS Foundation Trust London UK
| | - Kuda Kali
- Central and North West London NHS Foundation Trust London UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust London UK
| | - Ulrike Schmidt
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
- South London and Maudsley NHS Foundation Trust London UK
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17
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Wu R, Guo L, Rong H, Shi J, Li W, Zhu M, He Y, Wang W, Lu C. The Role of Problematic Smartphone Uses and Psychological Distress in the Relationship Between Sleep Quality and Disordered Eating Behaviors Among Chinese College Students. Front Psychiatry 2021; 12:793506. [PMID: 34966312 PMCID: PMC8710586 DOI: 10.3389/fpsyt.2021.793506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Sleep problems and eating disorders (EDs) are both serious public health concerns often seen in young adults. Yet, the underlying mechanisms for such associations are largely unknown. This study aims to examine potential serial multiple mediation effects of problematic smartphone use (PSU) and psychological distress (i.e., depressive and anxiety symptoms) in the relationship between sleep quality and disordered eating behaviors/attitudes (DEBs). Methods: A total of 4,325 students from two Tibet universities in China (2,657 females and 1,668 males) completed an online survey that included the following measurements: Eating Attitude Test-26 for disordered eating behaviors/attitudes, the Chinese Version of Pittsburgh Sleep Quality Index (CPSQI), Smartphone Addiction Scale-Short Version (SAS-SV) for problematic smartphone use, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for psychological distress. Results: While the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = -0.0667~0.0970), both PSU (Standardized β = 0.016, 95% CI = 0.0256~0.0591) and anxiety symptoms (Standardized β = 0.014, 95% CI = 0.0203~0.0526) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of "sleep quality -> PSU -> anxiety symptoms -> DEBs" existed(Standardized β = 0.001, 95% CI = 0.0002~0.0012). Similarly, while the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = -0.0667~0.0970), both PSU (Standardized β = 0.020, 95% CI = 0.0337~0.0692) and depressive symptoms (Standardized β = 0.015, 95% CI = 0.0139~0.0652) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of "sleep quality -> PSU -> depressive symptoms -> DEBs" existed (Standardized β = 0.001, 95% CI = 0.0006~0.0038). Conclusions: Psychological and behavioral factors may comprehensively work together, leading to flow-on effects from sleep problems to disordered eating behaviors among university students. Appropriate interventions that target problematic smartphone use could thus potentially reduce anxiety and depression levels, which in turn will provide a buffer against the negative impact of poor sleep quality on eating disorder symptoms.
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Affiliation(s)
- Ruipeng Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang, China.,Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Hao Rong
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang, China
| | - Jingming Shi
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang, China.,Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, China
| | - Wenyan Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Minxia Zhu
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang, China
| | - Yongjun He
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
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