Night eating syndrome: How to treat it?

Beat the Clock: Assessment of Night Eating Syndrome and Circadian Rhythm in a Sample of Greek Adults

The night eating syndrome (NES) is characterized by excessive food intake during the evening and night hours, with 25% of the daily intake being consumed post-dinner, paired with ep-isodes of nocturnal food intake, at a frequency of more than twice weekly. The NES has been associated with a misaligned circadian rhythm related to a delay in overall food intake, increased energy and fat consumption. The present cross-sectional study aimed to assess NES in a Greek population and evaluate possible links between NES and chronotype. NES was assessed using the Night Eating Questionnaire (NEQ), and circadian rhythm, sleep and mood were evaluated with the Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire. A total of 533 adults participated in the study. A relatively high prevalence of NES was revealed, with more than 8.1% (NEQ ≥ 30) of the participants reporting experiencing NES symptoms, depending on the NEQ threshold used. Most participants had the intermediate chronotype. NEQ score was positively associated with the morning chronotype, and SCRAM was negatively related to "Good Sleep". Each point increment in the depression score was associated with 6% higher odds of NES. The early identification of NES gains importance in clinical practice, in a collective effort aiming to reduce NES symptomatology and its detrimental health effects.

An Updated Review of Night Eating Syndrome: An Under-Represented Eating Disorder

PURPOSE OF REVIEW

Night eating syndrome (NES) is an eating disorder that has historically been under-studied. The current review aims to summarize the most up-to-date research on NES to support better awareness.

RECENT FINDINGS

Since NES was recently included as a formal diagnosis, research on the prevalence of NES is ever evolving. Current studies underscore the high comorbidity between NES and other eating disorders, with additional complexities for patient with comorbid eating disorders. Recent findings also support the association between NES and sleep correlates, a relationship that has remained during the COVID-19 pandemic. Emerging research confirms correlates of distress in NES across cultures. There remain mixed findings between NES and BMI. There is also debate around whether age is a risk factor. Bariatric surgery research has focused on the re-emergence of NES post-operatively. Our understanding of the correlates of NES is increasing. However, research on the treatment for NES remains particularly under-studied and requires further attention.

Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD)

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.

'In the night kitchen': A scoping review on the night eating syndrome

BACKGROUND

First described in 1955, night eating syndrome refers to an abnormal eating behavior clinically defined by the presence of evening hyperphagia (>25% of daily caloric intake) and/or nocturnal awaking with food ingestion occurring ⩾ 2 times per week.

AIMS

Although the syndrome is frequently comorbid with obesity, metabolic and psychiatric disorders, its etiopathogenesis, diagnosis, assessment and treatment still remain not fully understood.

METHODS

This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; PubMed database was searched until 31 October 2020, using the key terms: 'Night Eating Syndrome' AND 'complications' OR 'diagnosis' OR 'drug therapy' OR 'epidemiology' OR 'etiology' OR 'physiology' OR 'physiopathology' OR 'psychology' OR 'therapy'.

RESULTS

From a total of 239 citations, 120 studies assessing night eating syndrome met the inclusion criteria to be included in the review.

CONCLUSION

The inclusion of night eating syndrome into the Diagnostic and Statistical Manual of Mental Disorders-5 'Other Specified Feeding or Eating Disorders' category should drive the attention of clinician and researchers toward this syndrome that is still defined by evolving diagnostic criteria. The correct identification and assessment of NES could facilitate the detection and the diagnosis of this disorder, whose bio-psycho-social roots support its multifactorial nature. The significant rates of comorbid illnesses associated with NES and the overlapping symptoms with other eating disorders require a focused clinical attention. Treatment options for night eating syndrome include both pharmacological (selective serotonin reuptake inhibitors, topiramate and melatonergic drugs) and non-pharmachological approaches; the combination of such strategies within a multidisciplinary approach should be addressed in future, well-sized and long-term studies.

Night eating in bipolar disorder

OBJECTIVE

Night eating syndrome (NES) involves reduced feeding during the day and evening hyperphagia sometimes accompanied by frequent nocturnal awakenings with conscious episodes of compulsive ingestion of food. Previously, NES has not been evaluated in bipolar disorder (BD). The objective of this study was to identify NES in euthymic BD patients.

PATIENTS/METHODS

Eighty BD patients and 40 controls were examined using the Night Eating Questionnaire, Hamilton Rating Scale for Depression and Anxiety, Young Mania Rating Scale, Functioning Assessment Short-Test and International Physical Activity Questionnaire. Sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), severity of insomnia (Insomnia Severity Index) and morning-evening preference (Morningness-Eveningness Questionnaire) were also evaluated.

RESULTS

BD patients presented NES in 8.8% while the controls showed no NES. Patients with and without NES were not different with respect to gender, disease duration, smoking, heavy drinking, body mass index, waist-to-hip ratio and neck circumference. BD patients with NES scored higher for functioning as well as for the following specific components: occupational functioning, financial issues, interpersonal relationships and leisure time. They also had more anxiety, higher insomnia severity and worse sleep quality. Furthermore, BD patients with NES were more evening type.

CONCLUSION

NES occurs more frequently in BD patients than in controls. BD patients with NES present more disease-related manifestations such as more anxiety, poorer functioning and worse sleep parameters. Patients with NES were more evening type. We speculate whether changing circadian preference in these patients can reduce NES.

Visual Attention to Pictorial Food Stimuli in Individuals With Night Eating Syndrome: An Eye-Tracking Study

Night eating syndrome (NES) is characterized by excessive evening and/or nocturnal eating episodes. Studies indicate an attentional bias towards food in other eating disorders. For NES, however, evidence of attentional food processing is lacking. Attention towards food and non-food stimuli was compared using eye-tracking in 19 participants with NES and 19 matched controls without eating disorders during a free exploration paradigm and a visual search task. In the free exploration paradigm, groups did not differ in initial fixation position or gaze duration. However, a significant orienting bias to food compared to non-food was found within the NES group, but not in controls. A significant attentional maintenance bias to non-food compared to food was found in both groups. Detection times did not differ between groups in the search task. Only in NES, attention to and faster detection of non-food stimuli were related to higher BMI and more evening eating episodes. The results might indicate an attentional approach-avoidance pattern towards food in NES. However, further studies should clarify the implications of attentional mechanisms for the etiology and maintenance of NES.

Risk assessment of night-eating syndrome occurrence in women in Poland, considering the obesity factor in particular

INTRODUCTION

Night-eating syndrome (NES) involves uncontrolled and most often repeated binge eating during the night. It is related with mood disorders as well as sleep disorders and it may cause obesity. Risks related to NES are obesity, binge eating disorder, bulimia nervosa, affective disorders, and sleep disorders. The objective of this study is to analyze eating habits in terms of the risk assessment of NES occurrence in the population of women in the Masovian Voivodeship (in Poland).

PATIENTS AND METHODS

Six hundred and eleven women living in the Masovian Voivodeship participated in the study. The average age of the respondents was 22.7 years (median = 23.0; interquartile range = 3.0). The Night Eating Questionnaire (NEQ) was used to assess the risk of NES.

RESULTS

In the studied group of women, 1.3% of cases (N = 12) reached a NEQ total score of ≥25, which indicates a probability of 40.7% for NES, while 0.7% (N = 4) reached a score of ≥30, which indicates a probability of 72.2% for occurrence of this syndrome. The highest average total score was observed in the group of obese people. The level of education of the participants did not significantly affect the NEQ score. A weak correlation was observed between the place of residence variable and the mood/sleep subscale (r = 0.11, P < 0.01).

CONCLUSION

NES may be one of the causes of overweight and obesity; therefore, the need for further studies on this health issue is justified. It is worth pointing out that knowing the conditions responsible for the occurrence of NES, it is possible to suggest a prevention procedure for this condition.