Abstract: Aim The aim of this literature review was to identify the tools developed and used to assess orthorexia nervosa (ON). Methods A systematic search was executed in PubMed, Biomed Central, and PsycINFO. The final list included 70 articles that were critically analyzed. Results A total of six tools were reported to assess ON: the BOT, the ORTO-15, the EHQ, the DOS, the BOS, and the TOS. The tools were based upon different conceptualizations of ON and of its diagnostic criteria. Although they were different, all the conceptualizations derived from the initial definition of ON provided by Bratman in 1997. None of the methodologies adopted for tool construction considered end users or client perspectives and, when carried out, the validations of the tools were fragmented and often based on specific populations. Conclusion This study may be a starting point for the construction of a new diagnostic tool for ON. Starting from the methodological weaknesses identified by this review, it was possible to derive some suggestions for future research: (a) developing a modern re-conceptualization of ON, comprehensive of end-user perspectives; (b) adopting qualitative data collection techniques to gain insights into how to diagnose ON; and (c) actively involving diverse stakeholders for constructing a new tool. Level of evidence Level of Evidence: I, systematic review. PubDate: 2019-06-21
Abstract: Background A better understanding of the individual difficulties reported by adolescents presenting with anorexia nervosa seems like an interesting avenue to refine our understanding of their psychological functioning. Objective This study aimed to: (1) describe the behavioral and affective profile of difficulties of inpatient adolescent girls presenting a restricting type of anorexia (ANR); and (2) investigate the presence of a relationship between behavioral and affective problems and severity of the disorder. Methods The sample consisted of 52 inpatient adolescent girls presenting an ANR. The youth self report assessed the behavioral and emotional profile of difficulties of participants while the Eating Disorder Risk Composite of the Eating Disorder Inventory measured the symptomatology of the disorder. A ratio between body mass index at admission and at the end of the treatment served as an indicator of weight gain. Results The sample presented an internalized profile of problems. Individual differences were found and three profiles of difficulties were present in the sample: normative, pure internalizing and mixed (clinical on the internalizing and externalizing clusters). Conclusion This study provides information on the heterogeneity of this specific population otherwise quite similar and demonstrates how severity of the disorder can be associated with a wide range of other behavioral and affective difficulties. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2019-06-19
Abstract: Purpose This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students. Methods A total of 1630 subjects (Brazilians = 446; Portuguese = 480, Mozambicans = 360, and Italians = 344) completed the Portuguese (Brazilian, Portuguese, and Mozambican students) and the Italian versions (Italian students) of the BIQLI for measuring the effects of body image on one’s quality of life. Psychometric testing included confirmatory factor analysis (CFA), discriminant and convergent validity, internal consistency, and composite reliability. The cross-national invariance of the BIQLI was assessed by multi-group analysis using ΔCFI. Moreover, the global score of the BIQLI for all countries was calculated by an algorithm and compared using the Welch’s ANOVA and the Games–Howell post-test (α = 5%). Results CFA showed an inadequate fit of unifactorial model of the BIQLI. Therefore, an alternative model comprising nine first-order factors and one second-order factor was proposed and evaluated. This new model showed adequate fit in all samples, despite some limitations that were found with respect to its convergent and discriminant validity. The alternative BIQLI model was invariant among countries. Global scores for the influence of body image on quality of life were significantly different across countries, with the Italians presenting the lowest scores. Conclusions The BIQLI factorial model found in this study represents a reliable and valid alternative to its original structure for the assessment of the effect of body image on college students’ perceived quality of life. This model must be further tested in other populations. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2019-06-19
Abstract: Purpose The majority of those who seek treatment for binge eating disorder also have accompanying obesity or overweight. The best available psychological treatments for binge eating disorder produce good and lasting outcomes with regard to control over eating but virtually no weight loss, yet control over eating and weight loss are both important and valued goals of those who seek treatment. Methods We have devised a model of the processes maintaining both the binge eating and the overweight or obesity that occurs in many patients with binge eating disorder who seek treatment. The model draws on previous research findings to highlight and integrate the factors maintaining both the disordered eating and the accompanying overweight or obesity. Results We outline a new treatment based on the proposed model that explicitly addresses the twin goals of cessation of binge eating and weight loss in an integrated fashion. The proposed treatment incorporates and integrates elements from two previously tested evidence-based interventions, enhanced cognitive behavioural therapy for eating disorders shown to reduce binge eating and cognitive behaviour therapy of obesity, which produces weight loss. Conclusion To meet a major challenge for the treatment of binge eating disorder (BED), we have proposed that an integrated treatment with the goals of addressing both binge eating and overweight or obesity is worth researching further. Should this treatment be successful, the goals of many patients who seek treatment for BED are more likely to be met. Level of evidence This brief report proposes a new approach to clinical practice to be researched further. The evidence on the basis of which the case is made is derived from Level 1: evidence obtained from at least one properly designed randomized controlled trial; systematic reviews and meta-analyses; and experimental studies. PubDate: 2019-06-18
Abstract: Purpose The allocentric lock theory (ALT) suggests that people with eating disorders have difficulties in multisensory integration in two reference frames—egocentric and allocentric, whereby the egocentric, but not allocentric, is impaired. This leads to a distorted body image that contributes to the development and maintenance of the disorder. The current study aimed to explore a facet of the ALT, namely, the visuo-spatial aspect, and its relation to cognitive flexibility in patients with anorexia nervosa (AN). Methods Fifty-five participants took part in the study: 20 AN patients and 35 controls, matched by age and education. The object perspective taking test (OPTT) and the mental rotation test (MRT), tapping egocentric and allocentric representations, respectively, and a set-shifting task were administered. The brief symptom inventory was used to measure overall levels of distress. Results AN patients showed higher level of distress. They performed poorer on the OPTT and set-shifting task but not on the MRT. The OPTT and MRT were correlated for controls but not for AN patients, while the set-shifting task and body mass index were associated with the OPTT but not with the MRT for the AN patients. Conclusions The findings support the ALT by demonstrating impaired visual egocentric representations and intact allocentric visual functions in AN patients, with cognitive flexibility associated only with the egocentric frame. Therefore, egocentric frame impairment in AN patients may be influenced by visual perception and cognitive flexibility deficiency. Level of evidence Level III: case-control analytic study. PubDate: 2019-06-17
Abstract: Purpose According to the Cognitive-Interpersonal Maintenance Model of anorexia nervosa, social factors are involved in the maintenance and development of this disorder. Therefore, this study aimed to test whether patients with restrictive-type anorexia nervosa (AN-R) experience malicious envy (negative emotions associated with the wish that others lack their superior quality), benign envy (negative emotions associated with the desire to reach and obtain the others’ superior quality) and Schadenfreude (pleasure at the misfortunes of others) with a higher intensity than healthy controls (HC). Methods 26 AN-R patients and 32 HC completed scenarios that aimed to induce envy and Schadenfreude and completed questionnaires measuring envy, self-esteem and social comparison. Results AN-R patients reported more benign envy than HC. Interestingly, higher body mass index (BMI) was associated with less Schadenfreude, malicious and benign envy in AN-R only. Conclusions This study shows that AN-R patients present higher motivation to evolve when facing others’ superior quality (i.e., benign envy). It also underlines the importance of considering social factors in the maintenance of AN-R and the role of BMI when examining emotions related to others’ fortune. Level of evidence Level III, case-control analytic study. PubDate: 2019-06-17
Abstract: Background The Vascular endothelial growth factor (VEGF) regulates endothelial cell proliferation, migration and angiogenesis, promotes vascular and capillary permeability and also is involved in inflammation. VEGF gene has been suggested to play an important role in the pathogenesis of metabolic syndrome. The aim of this study was to investigate the association between inflammatory potential of a diet and + 405 VEGF C/G (rs2010963) polymorphism and metabolic components in patients with metabolic syndrome. Methods One hundred fifty patients with metabolic syndrome and fifty healthy individuals were enrolled. A semi-quantitative food-frequency questionnaire (FFQ) was used for dietary assessments and dietary inflammatory index (DII) calculation. Biochemical assays including fasting serum glucose (FSG), serum insulin, matrix metalloproteinase-3 (MMP-3), liver enzymes and lipid profile were measured. Polymerase chain reaction-restriction fragments length polymorphism (PCR-RFLP) method was used for the determination of gene polymorphism. Results In the current study, patients with metabolic syndrome had higher serum low density lipoprotein (LDL) and lower high density lipoprotein (HDL) concentrations compared with healthy subjects. Patients with lower DII quartiles and lower inflammatory potential of the diet had lower waist to hip ratio (WHR) and lower diastolic blood pressure (DBP) compared with patients in higher DII quartiles (P < 0.05). Moreover, patients and healthy subjects in second quartile of DII had significantly higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations compared with subjects in the first quartile; also healthy subjects in third quartile had significantly higher triglyceride (TG) and total cholesterol (TC) concentrations compared with subjects in second quartile (P < 0.05). Among different genotypes of 6 P21 rs2010963 gene variants in patients with metabolic syndrome, CC genotype indicated the highest DII compared with other genotypes (P < 0.05). Conclusion The current study revealed the association between DII and metabolic risk factors of metabolic syndrome. Level of evidence Level III, case-control analytic study. PubDate: 2019-06-13
Abstract: Purpose This study examined how fathers and mothers coparent around child feeding. Methods Father–mother pairs (N = 30) of preschool-aged children (M child age = 4.1 years old) participated in joint or group interview sessions. Results Three themes emerged from the qualitative analysis: (1) couples’ division of labor regarding feeding tasks seemed to align with stereotypical gender roles; (2) couples noted that they attempted healthier family eating habits in comparison to families of origin and recognized the influence of extended family on their attempts at healthier feeding; (3) couples agreed on the importance of family mealtime, routines, and healthy meals, yet disagreed on strategies to limit unhealthy foods and achieve harmonious family meals. Conclusions This study identified processes of coparenting and child feeding areas that were particularly challenging to manage among parents, which could be important targets for childhood obesity interventions. Level of evidence V, descriptive study. PubDate: 2019-06-12
Abstract: Objective The objective of the study was to evaluate the association between orthorexia nervosa (ON) tendencies and behaviors, eating attitudes (EAT) and anxiety among a representative sample of medical students in the Lebanese universities. Methods This cross-sectional study, conducted between May 2018 and January 2019, enrolled 627 medical students using a proportionate random sample from all seven faculties of medicine in Lebanon. The ORTO-15 scale was used to evaluate ON tendencies and behaviors among participants. Scores below 40 indicate the presence of ON. The Eating Attitude Test-26 and the Hamilton Anxiety Rating A (HAM-A) scales (yielding a psychic and a somatic subscale scores) were used to assess eating attitudes and anxiety, respectively. It is noteworthy that the sum of the EAT items 6, 7, 16 and 17 responses yielded the EAT score that would predict ON. Results The results of a linear regression, taking the ORTO-15 score (15 items) as the dependent variable and the EAT total score, the summated score of the EAT items that predict ON and the psychic and somatic anxiety subscales scores as independent variables, showed that a higher EAT score (β = − 0.094) was significantly associated with lower ORTO-15 scores (more orthorexia tendencies and behaviors); whereas, a higher psychic anxiety subscale score (β = 0.117) was significantly associated with higher ORTO-15 scores (lower orthorexia tendencies and behaviors). Conclusion This suggests a link between eating disorders and ON which is beyond ON tendencies observed in eating disorders but ON individuals simultaneously have lesser psychological distress and anxiety. Level of evidence Level 5, cross-sectional descriptive study. PubDate: 2019-06-10
Abstract: Purpose While several meta-analyses and reviews revealed a worse body image disturbance (BID) in adults with anorexia nervosa (AN) or bulimia nervosa (BN) than in controls, no systematic evidence is available on BID in children and adolescents. Since the usual onset of AN and BN is before the age of 21 years, being aware of BID in children and adolescents is crucial for preventing and treating eating disorders. This systematic review aims to provide an initial overview of differences in the BID components perception, global subjective satisfaction, affect/cognition, and behavior between children and adolescents with AN and BN and healthy controls. Methods We conducted a systematic data search in PubMed and PsycINFO based on a priori eligibility criteria (AN or BN group; gender-matched healthy control group; each group n ≥ 20; maximum age 19 years; BID outcome compared between groups; published in English or German). Results We were able to include k = 8 records. Compared to healthy controls, children and adolescents with AN and BN scored higher in the BID components perception, global subjective satisfaction, affect/cognition, and behavior. Conclusions As previously found in adults, BID in children and adolescents is associated with AN and BN. Interventions and treatments are needed to alleviate BID in children and adolescents with BN and AN. We also noted that we need more investigations on BID differences in children and adolescents to improve the database. Level of evidence Level I, Systematic review. PubDate: 2019-06-08
Abstract: Purpose This study aims at investigating prospective associations between body areas satisfaction (BAS), actual (objectively measured)–ideal body weight discrepancy, actual (self-reported)–ideal body weight discrepancy and BMI among adolescents from the general population. Methods Data were collected at three measurement points: baseline (T1), 2-month follow-up (T2), 13-month follow-up (T3) among 1011 adolescents (59.3% girls) aged 13–19 years (M = 16.30, SD = 0.82) with BMIs ranging from 15.20 to 38.78 (M = 20.01, SD = 3.33). Adolescents completed questionnaires regarding BAS (T1), actual and ideal body weight (T2). Body weight and height were measured objectively (T1 and T3). Results Adolescents satisfied with most areas of their bodies had lower levels of actual (objectively measured)–ideal body weight discrepancy, which in turn predicted higher BMI, while lower levels of actual (self-reported)–ideal body weight discrepancy predicted lower BMI. No moderating effect of gender was found. Conclusions Actual–ideal weight discrepancies may operate in complex manner prompting opposite effects on BMI. Level of evidence Level III, longitudinal study without control group. PubDate: 2019-06-07
Abstract: Purpose Depression is the most common mental disorder among subjects with HIV. The present study was conducted to determine the relationship between dietary intake and depression among male and female with HIV/AIDS. Methods 335 HIV/AIDS subjects were evaluated who referred to Behavioral Disorders Counseling Center in Kermanshah, province in Iran. Depression was assessed using Beck questionnaire. Food frequency questionnaire was used to assess dietary intake. Results Our findings indicated that 76.1% of the studied subjects had varying degrees of depression. The rate of depression in the men was significantly higher than in the women (P = 0.007). The mean of weight in the men with depression was significantly lower than of the men without depression (P = 0.01). Higher adhere to legume and vegetables in the men (OR 0.049, CI 95% 0.003–0.713 and OR 0.534, CI 95% 0.334–0.855, respectively) and dairy products in the women (OR 0.493, CI 95% 0.265–0.917) were associated with decrease risk of depression. Conclusion The results of this study were shown that the high prevalence of depression among these subjects. Higher intake of legume and vegetables and dairy products had a protective effect on the risk of depression. Level of evidence Level V, descriptive cross-sectional study. PubDate: 2019-06-07
Abstract: Purpose Anorexia nervosa (AN) is a complex medical condition affecting mainly adolescents and young adults. To monitor and prevent refeeding syndrome, current guidelines recommend daily laboratory testing in the first week of hospitalization and 2–3 times/week for the following 3 weeks. The aims of this study were to determine the proportion of abnormal results of the blood tests done during the first week of nutritional rehabilitation in adolescents with AN, the proportion of test having led to supplementation and the cost of all these tests. Method A retrospective chart review of admissions for eating disorders between May 2014 and May 2015 in a tertiary Pediatric University Hospital center was performed. Patients were included if they were younger than 18 years, admitted for protocol-based refeeding and met criteria for AN (DSM 5). Results Among the 99 hospitalizations included in the study, the mean age was 14.6 years (± 1.7), with a female predominance (97%). The mean admission BMI was 15.3 ± 2 kg/m2 (Z-score − 2.6 ± 1.4). The mean length of hospitalization was 40.3 days ± 21.8. Of the 1289 laboratory tests performed, only 1.5% revealed abnormal values and 0.85% led to supplementation. No critical value was identified. The total cost for the tests performed was 148,926.80 CAD$, 1504$/admitted patient, instead of 3890$/admitted patient had we followed the recommendations. Conclusion More precise criteria should be developed regarding the frequency of laboratory tests needed to monitor and prevent refeeding syndrome. At present, the recommendations could lead to unnecessary testing and expenses. Level of evidence Level IV: Dramatic results in uncontrolled trials. PubDate: 2019-06-05
Abstract: Purpose Eating disorders (EDs) are characterized by a persistent disturbance of eating patterns, leading to poor psychological and physical health. EDs’ symptoms are diverse, but their biochemical manifestations can be identified in biofluids, as the gingival crevicular fluid (GCF). The development of a rapid and accurate analytical diagnostic technique, able to provide a wider comprehension of established biochemical abnormalities, would greatly assist EDs’ management. Mid-infrared (MIR) spectroscopy gathers all the referred features, and is considered a fingerprint technique. In this pilot trial, the GCF discrimination of patients with EDs and controls was accessed through MIR spectroscopy, further elucidating the relevant spectral differences between both groups. Methods GCF was collected from 20 women with ED diagnosis and from age-matched controls. Principal component analysis and partial least squares discriminant analysis (PLSDA) were conducted on GCF MIR spectra. Different PLSDA models were considered to address the predictive capability regarding patient identification, sampling site, and presence of EDs. Results MIR spectroscopy was capable to discriminate GCF samples, between EDs and controls, with 84.1% of correct predictions. Regression coefficient vectors’ analyses revealed that major differences were related to higher protein content in EDs. Conclusions Whether further studies are needed to validate the attained data, GCF MIR analysis may be regarded as an innovative, fast, and low-cost technique to assist on early diagnosis and clinical follow-up of EDs’ patients. Level of evidence Level IV, case–control trial. PubDate: 2019-06-05
Abstract: Purpose Body weight restoration is a major treatment aim in juvenile inpatients with anorexia nervosa (AN) (i.e., 500–1000 g/week according to the German guidelines). Several studies suggest the early weight gain to be crucial for remission. The identification of patients at risk of a low early weight gain could enable an adequate adaptation of treatment. Thus, we aimed at detecting risk factors of a low weight gain during inpatient treatment. Methods The presented work analyzes data from a pilot study in 30 female adolescent inpatients with AN (restricting subtype; age range at admission: 12.6–17.6 years). Premorbid characteristics, history of symptomatology, anthropometric data, and eating-disorder psychopathology were compared between those who gained at least an average of 500 g/week during the first 7 weeks of treatment (high weight gainers, HWG) and those who did not (low weight gainers, LWG). Results At admission, LWG (n = 15) had a significantly higher BMI(-SDS) and scored significantly higher in the eating-disorder examination questionnaire (EDE-Q) than HWG (n = 15). A logistic regression analysis indicated both parameters to be independently associated with a low weight gain. Conclusion Higher EDE-Q scores seem to be a major risk factor for a low weight gain at the beginning of treatment. Moreover, a higher BMI(-SDS) at admission does not necessarily indicate a less severe AN symptomatic, as it was associated with a lower weight gain in our sample during the first 7 weeks of treatment. Reassessment of our results in larger studies is required to draw firm conclusions for clinical practice. Level of evidence Level V. PubDate: 2019-06-05
Abstract: Purpose A growing body of literature has established that food and alcohol disturbance (FAD: decreasing one’s caloric intake in preparation for alcohol consumption) is a specific health risk that endangers health and wellbeing. Recent research on trends in FAD has revealed ethno-racial disparities. A sociological analysis is helpful to center race and examine the role of ethnic identity in reproducing health disparities. The current study is guided by theories of socialization into ideal body types by race. Methods Study uses data from a cross-sectional survey conducted among college students. The sample includes White and Black American college students, ages 18–25, and uses ordinal logistic regression to test for the impact of race and ethnic identity on engagement in FAD using the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS). Results FAD prevalence was lower among Black Americans than among White Americans in the sample. Results from ordered logistic regression models indicate that stronger ethnic ties reduce likelihood of FAD among Black Americans but have the opposite effect among White Americans. This modification effect provides evidence that ethnic identity belonging protects against FAD for Black Americans but acts as a risk factor for FAD among White Americans. Conclusions Findings shed light on the documented racial disparities in FAD and weight control behavior more broadly. Ethnic identity modifies the relationship between race and FAD in our sample. Level of evidence Level V, cross-sectional descriptive study PubDate: 2019-06-04
Abstract: Purpose We investigated the association of anthropometric status, perceived stress, and personality traits with eating behavior in university students. Methods The participants, 1546 Japanese university students (964 males, 582 females), completed a questionnaire which asked for their current height and weight, ideal height and weight, eating behaviors, perceived stress, and personality traits. Results Restrained eating was higher in normal-weight participants compared with underweight participants in both males and females (p < 0.001, both males and females). Restrained eating in normal-weight males was significantly lower in normal-weight females (p < 0.001). In addition, normal-weight males reported less stress than normal-weight females (anxiety/uncertainty, p = 0.037; tiredness/physical responses, p < 0.001; autonomic symptoms, p < 0.001; depression/feeling, p < 0.001) and underweight males (tiredness/physical responses, p = 0.018; autonomic symptoms, p = 0.001). Moreover, among normal-weight males, neuroticism was significantly lower compared with normal-weight females (p < 0.001). In multiple regression analysis, male participants revealed positive association between restrained eating and body mass index (β = 0.199, p < 0.001) or body mass index difference (β = − 0.170, p = 0.001). In contrast, female revealed more significant associations between emotional and external eating and perceived stress or personality traits compared with males. Conclusions These results indicate that associations between eating behavior and anthropometric status or psychological factors are different by each eating behavior, which is partly influenced by gender difference. Level of evidence V, cross-sectional descriptive study. PubDate: 2019-06-01
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