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Sultan N, Foyster M, Tonkovic M, Noon D, Burton-Murray H, Biesiekierski JR, Tuck CJ. Presence and characteristics of disordered eating and orthorexia in irritable bowel syndrome. Neurogastroenterol Motil 2024:e14797. [PMID: 38606723 DOI: 10.1111/nmo.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Orthorexia, a harmful obsession with eating healthily, may develop from illnesses characterized by dietary restriction, including irritable bowel syndrome (IBS) and eating disorders (ED). Evidence of disordered eating in IBS exists, but orthorexia has not been assessed. This cross-sectional study in adults (≥18 years) assessed presence and characteristics of disordered eating and orthorexia in IBS, compared to control subjects (CS) and ED. METHODS IBS participants met Rome IV, and ED participants met DSM-5 criteria. Disordered eating was assessed using "sick, control, one-stone, fat, food" (SCOFF, ≥2 indicating disordered eating), and orthorexia by the eating habits questionnaire (EHQ). Secondary measures included stress (PSS); anxiety (HADS-A); food-related quality of life (Fr-QoL), and dietary intake (CNAQ). KEY RESULTS In 202 IBS (192 female), 34 ED (34 female), and 109 CS (90 female), more IBS (33%) and ED (47%) scored SCOFF≥2 compared to CS (16%, p < 0.001, chi-square). IBS and ED had higher orthorexia symptom severity compared to CS (EHQ IBS 82.9 ± 18.1, ED 90.1 ± 19.6, and CS 73.5 ± 16.9, p < 0.001, one-way ANOVA). IBS and ED did not differ for SCOFF or EHQ (p > 0.05). Those with IBS and disordered eating had higher orthorexia symptom severity (EHQ 78.2 ± 16.6 vs. 92.4 ± 17.5, p < 0.001, independent t-test), worse symptoms (IBS-SSS 211.0 ± 78.4 vs. 244.4 ± 62.5, p = 0.008, Mann-Whitney U test), higher stress (p < 0.001, independent t-test), higher anxiety (p = 0.002, independent t-test), and worse FR-QoL (p < 0.001, independent t-test). CONCLUSIONS AND INFERENCES Disordered eating and orthorexia symptoms occur frequently in IBS, particularly in those with worse gastrointestinal symptoms, higher stress, and anxiety. Clinicians could consider these characteristics when prescribing dietary therapies.
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Affiliation(s)
- Nessmah Sultan
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Mandy Foyster
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
| | - Matilda Tonkovic
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
| | - Danielle Noon
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, Victoria, Australia
| | - Helen Burton-Murray
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jessica R Biesiekierski
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Caroline J Tuck
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, Victoria, Australia
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Foyster M, Sultan N, Tonkovic M, Govus A, Burton-Murray H, Tuck CJ, Biesiekierski JR. Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study. Eat Weight Disord 2023; 28:101. [PMID: 38070009 PMCID: PMC10710386 DOI: 10.1007/s40519-023-01631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. METHODS Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). RESULTS ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [- 2.24, - 0.34], p = 0.008; r = 0.26, 95% CI [- 2.11, - 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). CONCLUSION Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. LEVEL OF EVIDENCE III: Evidence obtained from cohort studies.
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Affiliation(s)
- Mandy Foyster
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Nessmah Sultan
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Matilda Tonkovic
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Andrew Govus
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Helen Burton-Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Caroline J Tuck
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, VIC, Australia
| | - Jessica R Biesiekierski
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia.
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.
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Tuck CJ, Sultan N, Tonkovic M, Biesiekierski JR. Orthorexia nervosa is a concern in gastroenterology: A scoping review. Neurogastroenterol Motil 2022; 34:e14427. [PMID: 35811419 PMCID: PMC9541631 DOI: 10.1111/nmo.14427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
There is concern that use of restrictive therapeutic diets, such as those used in disorders of the gut-brain interaction (DGBI), may increase disordered eating. In this issue of Neurogastroenterology and Motility, Burton Murray et al. and Peters et al. both demonstrate a high prevalence of disordered eating in patients with gastrointestinal conditions, particularly those with DGBI. Given these findings, it is likely that orthorexia is common in this patient group, although this was not directly examined in these studies. Orthorexia nervosa is described as an obsessive and unsafe focus on eating foods perceived as healthy. This mini-review therefore focuses on orthorexia by conducting a scoping review, as per the PRISMA extension for scoping reviews, aimed to assess the prevalence of orthorexia, and associations between orthorexia and restrictive eating practices. While a wide range of orthorexia prevalence has been reported (0%-97%) across the 57 studies included, no studies assessed prevalence specifically in gastrointestinal conditions. Four of eight studies describing diseases associated with specific dietary patterns suggested that participants who followed a diet for "digestive issues" or "food intolerances" were at higher orthorexia risk. These results suggest that dietary modifications may be a factor contributing to orthorexia. Additionally, we provide a commentary on the clinical implications of the findings for gastrointestinal conditions including a clinical flow chart. Clinicians should consider if a restrictive diet is appropriate for individuals with DGBI and include screening for disordered eating prior to implementation of dietary modifications. Future prospective studies should evaluate orthorexia within this patient group.
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Affiliation(s)
- Caroline J. Tuck
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Nessmah Sultan
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Matilda Tonkovic
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Jessica R. Biesiekierski
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia,Department of Nutrition, Dietetics and FoodMonash UniversityNotting HillVictoriaAustralia
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Affiliation(s)
- N. Brajenovic
- a The Ruder Boskovic Institute , P. O. Box 180, Zagreb, 10002, Croatia
| | - M. Tonkovic
- a The Ruder Boskovic Institute , P. O. Box 180, Zagreb, 10002, Croatia
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Andrásyová D, Regecová V, Kellerová E, Tonkovic M. [Effect of adrenergic stimuli on electrocardiographic and vectorcardiographic characteristics of ventricular repolarization]. Vnitr Lek 2002; 48 Suppl 1:164-9. [PMID: 12744040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Autonomic effect of various stimuli on haemodynamic variables is usually tested by changes in blood pressure (BP) and/or heart rate (HR). It is known that increased sympathetic drive of ventricles can interfere with repolarization process. This study was focused on reactive changes of maximal spatial T vector (sTmax), R-R and QTc intervals, in relation to BP changes in 79 boys and men, averaged age 17 +/- 2 years, 36 from them were adolescents with elevated BP (high normal or hypertension I according to WHO/ISH 1999) (ZTK), 19 normotensives (NTK), and 24 normotensive sportsmen. R-R, QTc intervals and maximal spatial T vector were recorded by a PC (Cardiag METE, Prague) with Frank lead system while sitting in mid-respiratory position, during mental arithmetic (MA), after handgrip and during passive head-up tilting to 60 degrees. BP was measured simultaneously by a cuff sphygmomanometer, using phases 1 and 5 of Korotkoff sounds. MA resulted in significant BP increase in all subgroups, however the reactive changes of systolic BP as well as magnitude of R-R shortening, sTmax decline were about two times higher, and in the case of QTc lengthening three times higher in sportsmen. Handgrip provoked in all subgroups in average the less reactive changes of diastolic BP, sTmax, R-R, and QTc intervals. Head-up tilting evoked in all subgroups a significant increase of diastolic BP that was again higher in sportsmen vs. ZTK and NTK. R-R intervals became significantly (p < or = 0.02) and more often shortened in sportsmen vs. ZTK and NTK. Relatively more evident decline of sTmax (more than 20%) in ZTK was the highest change from all observed parameters to all tested stimuli. Our results indicate that for analysis of effect stimuli, which modulate balance in autonomic nervous system, it is helpful to pay attention also to the parameters of repolarization process that may represent a sensitive indicator of sympathetic tonization in myocardial ventricles.
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Affiliation(s)
- D Andrásyová
- Ustav normálnej a patologickej fyziológie Slovenskej akadémie vied, Bratislava, Slovenská republika
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Andrasyova D, Regecova V, Tonkovic M, Kellerova E, Krc-Turbova Z, Novotna E. Sensitive markers of the repolarization alterations in systemic hypertension. BRATISL MED J 2002; 102:530-5. [PMID: 11901712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION The early phase of essential hypertension has been associated with changes in cardiovascular regulation caused by imbalance in some parts of autonomic nervous system. Autonomic effect of various stimuli on haemodynamic variables is usually tested by changes in blood pressure (BP) and/or heart rate (HR). It is known that increased sympathetic drive of ventricles can interfere with repolarization process. THE AIM This study was focused on reactive changes of maximal spatial T vector (sTmax) and R-R intervals, in relation to BP changes in 79 boys and men, averaged age 17 +/- 2 yrs. 36 from them where adolescents with elevated BP (high normal or hypertension I according to WHO/ISH1999) (EBP), 19 normotensives (NBP), and 24 normotensive sportsmen. R-R intervals and maximal spatial T vector were recorded by a PC (Cardiag METE, Prague) with Frank lead system while sitting in mid-respiratory position, during mental arithmetic (MA) and during passive head-up tilting to 60 degrees. BP was measured simultaneously by a cuff sphygmomanometer, using phases 1 and 5 of Korotkoff sounds. RESULTS MA resulted in significant BP increase in all subgroups, however the reactive changes of systolic BP as well as magnitude of R-R shortening, and sTmax decline were about two times higher in sportsmen. Head-up tilting evoked in all subgroups a significant increase of diastolic BP that was again higher in sportsmen vs. EBP and NBP. R-R interval became significantly (p < 0.02) and more often shortened in sportsmen than in EBP and NBP. Relatively more evident decline of sTmax (more than 20%) in EBP was the highest change from all observed parameters to both tested stimuli. CONCLUSION Our results indicate that for analysis of the effect of stimuli, which modulate balance in autonomic nervous system, it is helpful to pay attention also to the parameters of repolarization process that may represent a sensitive indicator of sympathetic tonization in myocardial ventricles. (Tab. 4, Fig. 2, Ref. 27.)
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Affiliation(s)
- D Andrasyova
- Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia.
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Hadzija O, Tonkovic M, Iskric S. Thin Layer Chromatography of Some Metals on Silica Gel Layers Impregnated with Phenolic Acids. J LIQ CHROMATOGR R T 1987. [DOI: 10.1080/01483918708077823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hubka M, Ruttkay-Nedecký I, Rippa S, Styk J, Tonkovic M. [Vectorcardiographic study of orthotopically transplanted heart in dogs]. BRATISL MED J 1972; 57:393-400. [PMID: 4553162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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