Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity最新文献

Purpose: Anorexia nervosa (AN) is a major concern in adolescents. Attachment problems contribute to its pathogenesis and maintenance. This research explores the relationship between parent-daughter emotional dyssynchrony and the psychopathology of AN daughters.

Methods: One hundred and fourteen female adolescents with AN and their parents participated in this study. The daughters completed the youth self-report (YSR) and other self-report measures of personality, eating, and general psychopathology. The parents completed the Child Behavior Checklist (CBCL). The YSR and CBCL ratings were compared and the difference was considered a measure of emotional dyssynchrony. Dyssynchrony scores were correlated with daughters' personality and psychopathology.

Results: Mothers scored lower on 15/21 (71%), and fathers scored lower on 11/21 (52%). Mothers scored higher than fathers did in thought problems. Mothers' dyssynchrony was positively related to their daughters' harm avoidance and negatively related to their self-directedness. Both parents' dyssynchrony correlated with their daughters' eating habits and general psychopathology. Dyssynchrony in each psychopathological measure of YSR was positively correlated with specific daughters' psychopathological traits.

Conclusions: Parents' perceptions underestimate the suffering of adolescents with AN. Mothers' perception was worse than that of fathers, possibly because of greater overinvolvement. Parent-daughter dyssynchrony is largely related to daughters' psychopathology. This cross-sectional study could not confirm whether dyssynchrony contributed to the onset of AN or follows it. Interventions that promote emotional synchronization may aid in the treatment of adolescents with AN.

Level of evidence: III.

Purpose: To determine the prospective associations between sleep disturbance and binge-eating disorder and behaviors in a national sample of early adolescents in the United States (US).

Methods: We analyzed prospective cohort data from the Adolescent Brain Cognitive Development Study (N = 9428). Logistic regression analyses were used to determine the associations between several sleep variables (e.g., overall sleep disturbance, disorders of initiating and maintaining sleep [insomnia], duration; Year 2) and binge-eating disorder and behaviors (Year 3), adjusting for sociodemographic Year 2 binge-eating covariates.

Results: Overall sleep disturbance was prospectively associated with higher odds of binge-eating disorder (OR = 3.62, 95% CI 1.87-6.98) and binge-eating behaviors (OR = 1.59, 95% CI 1.17-2.16) 1 year later. Disorders of initiating and maintaining sleep were prospectively associated with higher odds of binge-eating disorder (OR = 1.12, 95% CI 1.05-1.19) and binge-eating behaviors (OR = 1.06, 95% CI 1.03-1.10). Sleep duration under 9 h was prospectively associated with greater binge-eating behaviors.

Conclusions: Sleep disturbance, insomnia symptoms, and shorter sleep duration were prospectively associated with binge eating in early adolescence. Healthcare providers should consider screening for binge-eating symptoms among early adolescents with sleep disturbance.

Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Purpose: Individuals with obesity and binge eating face weight stigma, which can lead to internalized weight bias (IWB), reinforce eating disorder (ED) pathology, and promote unrealistic weight loss expectations (WLE). Greater understanding of pathways between IWB, ED pathology, and WLE could inform interventions to promote healthy WLE and reduce IWB. This study explored pathways through which IWB directly and indirectly relates to eating pathology and WLE in treatment-seeking adults with obesity and recurrent binge eating.

Methods: Participants (N = 199, Mage = 40.3, SD = 14.3) completed the Eating Disorder Examination interview (EDE) and questionnaire (EDE-Q), Modified Weight Bias Internalization Scale, and Positive and Negative Affect Scale. WLE were calculated based on participants' expected weight loss divided by current weight. We hypothesized that greater IWB would be associated with greater eating pathology and higher WLE. Pearson correlations were examined to identify possible pathways, followed by exploring direct and indirect associations for pathways with significant correlations.

Results: IWB was positively correlated with Eating and Shape Concerns, as well as negative affect (p < 0.05), but not with WLE. Negative affect was positively correlated with WLE. In the pathway model, IWB was directly, negatively associated with WLE (b = - 0.02, p < 0.05). Negative affect was a significant indirect pathway between IWB and WLE (b = 0.01).

Conclusions: Our results align with previous literature showing that IWB reinforces eating pathology. Interventions targeting negative affect might promote more reasonable WLE.

Level of evidence: Level V, cross-sectional descriptive study.

Background: Anxiety due to a phobia of normal body weight is a core feature and maintenance factor of anorexia nervosa (AN). This is the first study to explore the efficacy and acceptability of using a novel imaginal exposure response prevention group to target fears associated with being a normal body weight to reduce anxiety in adolescents with AN.

Methods: The lead author adapted an I-ERP manual used to treat AN in adults in 1-1 therapy. Content was adapted for an adolescent population, sessions reduced from 10 to 4 and was delivered in a group format with audio recordings to be more accessible for patients. Nineteen patients with AN completed the group and the group therapist collected outcome measures before and after the intervention. A paired samples t-test was used to assess change in eating disorder psychopathology (EDEQ), anxiety and depression (RCAD) and fear of food (FOFM). Qualitative feedback to assess acceptability was also gathered.

Results: Statistically significant reduction in anxiety in a variety of situations pertaining to weight and shape was found after completion of the group. There were no significant changes shown in eating disorder psychopathology. Adolescents provided qualitative feedback which suggested the intervention was acceptable for users.

Conclusions: I-ERP which has been adapted for adolescents with AN in a group format seems to improve eating disorder psychopathology and reduce weight, shape, social and separation anxiety and phobias when used as an adjuvant to inpatient treatment. Further controlled research is advised.

Level of evidence: Level III.

Objective: The weight-adjusted-waist index (WWI) is a novel measure of central adiposity, potentially linked to various sleep disturbances. This study explores the relationship between WWI and sleep outcomes, such as trouble sleeping, sleep disorder, and sleep duration.

Methods: Data from the National Health and Nutrition Examination Survey 2007-2012 were analyzed, including 13,494 participants. The analysis focused on individuals aged 20 years and older who provided information on WWI and sleep. Sleep status was determined based on responses to the following questions: (1) "How many hours do you sleep?"; (2) if they reported trouble sleeping; and (3) if they had physician-diagnosed sleep disorders. Regression models assessed the association between WWI and sleep outcomes across the entire population and within subgroups. Restricted cubic spline (RCS) analysis was conducted to examine potential non-linear relationships between WWI and sleep outcomes.

Results: A higher WWI was significantly correlated with an increased likelihood of trouble sleeping (OR = 1.26, 95% CI: 1.16, 1.36; p < 0.001) and sleep disorder (OR = 1.71, 95% CI: 1.50, 1.95; p < 0.001) in the overall population. RCS analysis indicated a linear relationship between WWI and these sleep outcomes. Subgroup analysis identified that the connection between WWI and trouble sleeping was most pronounced among Non-Hispanic Blacks and individuals with lower educational levels. For sleep disorder, the association was stronger in males and Non-Hispanic Blacks. A slight negative association between WWI and sleep duration was found, especially among non-drinkers (β = - 0.13, 95% CI: - 0.24, - 0.02; p = 0.028).

Conclusion: The findings highlight a significant and linear relationship between elevated WWI and an increased likelihood of experiencing trouble sleeping and sleep disorder, with variations observed across different demographic and lifestyle subgroups. These results imply that central adiposity, as measured by WWI, plays an important role in sleep health.

Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Anorexia nervosa (AN) and depression are complex conditions with high comorbidity, impacting mental and physical health. Recent research suggests gut microbiota plays a significant role in their development and progression. This correspondence highlights the critical gaps in understanding the gut-brain axis in AN and depression, emphasizing the need for comprehensive research. We discuss recent findings, including altered gut microbiota profiles and inflammatory factors, and identify key areas for future investigation. These include large-scale, multi-center studies to quantify microbiota profiles, mechanistic understanding of gut microbiota alterations, and diagnostic and therapeutic advances using microbiota as biomarkers. Addressing these gaps is crucial for developing effective treatment strategies and improving patient outcomes. By exploring the underlying mechanisms, validating biomarkers, and developing targeted therapies, we can enhance diagnostic accuracy, improve treatment outcomes, and better support patients with AN and depression. This research has the potential to transform the management of these conditions and improve quality of life for those affected.Level of evidence Low level of evidence as it is a personal opinion.

Purpose: This study examines the connection between infections and the abrupt onset or exacerbation of anorexia nervosa (AN) in the context of PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).

Methods: The authors conducted a literature review and present a case study of a 17-year-old girl treated at the University of Turin Eating Disorder Unit, whose AN presented with an abrupt onset following an infection and was characterized by a rapid and favorable course.

Results: The review includes 30 cases derived from six studies, suggesting that AN can manifest as PANS/PANDAS, with subjects, mainly adolescents, experiencing sudden or exacerbated eating restrictions alongside obsessive-compulsive behaviors. Some cases improved with antibiotics or standard psychiatric treatments, although age, symptom severity, and diagnostic markers like D8/17 varied across studies. Data on treatment follow-up also varied. The report refers to the case of V., a 17-year-old girl who developed AN following an intestinal infection. After significant weight loss and amenorrhea, she was hospitalized for 29 days, receiving psychiatric care, nutritional rehabilitation, and pharmacological treatment. Over 2 months of residential care and ongoing outpatient therapy, she improved notably, though mild body dysmorphophobia persisted.

Conclusions: While evidence suggests a possible link between infections and AN, research is still limited and inconsistent. Infections may trigger AN through autoimmune mechanisms or by initiating weight loss, particularly in younger patients. Although further studies are needed to clarify this relationship, infections should be considered in AN diagnosis, especially in pediatric cases.

Level of evidence: Level V, a narrative review and a case report.

Purpose: Intuitive exercise may foster healthier engagement in physical activity, leading to enhanced well-being and more intuitive eating habits. The Intuitive Exercise Scale (IEXS) was originally developed to assess this construct in English speakers. The IEXS is composed of four scales addressing distinct facets of intuitive exercise: emotional exercise, body trust, exercise rigidity, mindful exercise. The present study aimed to validate an Italian translation of the IEXS, exploring its factorial structure, invariance, internal consistency, and convergent validity.

Methods: A sample of 1140 women and men (age: M = 45.25, SD = 11.64, range 22-76 years) was recruited from the Italian general population; 61.8% were physically active. Inclusion criteria were being an Italian native speaker and being at least 18 years. The sample was randomly split in two equal halves for the Exploratory Factor Analysis (n = 570; women: 50%; physically active: 61.8%) and the Confirmatory Factor Analysis (n = 570; women: 50%; physically active: 61.8%). Multi-group confirmatory factor analyses were performed to assess invariance among women and men and physically and non-physically active individuals. McDonald's omega was used to assess internal consistency. Pearson's correlations were utilized to assess convergent validity.

Results: The Italian IEXS replicated a four-factor structure and showed good invariance among women and men. Invariance among physically and non-physically active individuals was only partially supported. Excellent internal consistency and adequate convergent validity were achieved.

Conclusions: The IEXS demonstrated to be a valid measure to examine intuitive exercise in the Italian population, replicating and expanding the findings of the English version. Level of evidence Level V, Cross-sectional, Psychometric study.

Purpose: Exploring novel mediators affecting the relationship between obesity and sleep-disordered breathing (SDB) is necessary. This study aimed to explore the mediating role of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) in the association between body mass index (BMI) and SDB using data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) cycles.

Methods: Total 7639 participants were included. SDB was defined based on the self-reported frequency of snoring, snorting, or excessive daytime sleepiness. The BMI and NHHR were calculated based on height and weight measurements and laboratory data, respectively. Weighted multivariate logistic and linear regression analyses were conducted to examine the associations, and restricted cubic spline (RCS) analysis was used to assess dose-response relationships. Mediation analysis was performed to evaluate the NHHR's role in the BMI-SDB association. Subgroup analyses were performed to assess differences across various populations.

Results: SDB symptoms were observed in 51.05% of participants. Higher BMI was significantly associated with increased SDB risk. RCS analysis revealed a nonlinear relationship between BMI and SDB. Subgroup analyses indicated a positive correlation between BMI and SDB was stronger among nonhypertensive participants. NHHR was positively associated with BMI and SDB. Mediation analysis showed that the NHHR explained 5.44-8.12% of the BMI-SDB association.

Conclusions: BMI is a critical factor in the risk of SDB, and the NHHR partially mediates this relationship. BMI and cholesterol levels should be managed to mitigate the SDB risk.

Level of evidence: Level V-cross-sectional observational study.