Objective
Eating disorders commonly co‐occur with gastrointestinal problems. This case–control study aimed to (a) document the prevalence of disorders of gut‐brain interaction (DGBI) in eating ...disorders, (b) examine the specific impact of disordered eating behaviors on the risk of DGBI, and (c) explore the impact of current eating disorder psychopathology on DGBI.
Method
We included 765 cases with eating disorders and 1,240 controls. DGBI were assessed via the ROME III questionnaire. Prevalences of DGBI were calculated across eating disorder diagnoses (anorexia nervosa, bulimia nervosa, and multiple eating disorders) and in controls. The association between disordered eating behaviors and DGBI was examined using logistic regression models. Lastly, we compared the total number of DGBI in individuals with high versus low current eating disorder symptoms.
Results
A large majority (88.2–95.5%) of individuals with eating disorders reported at least one DGBI and 34.8–48.7% reported three or more DGBI. Of the DGBI categories, functional bowel disorders were the most commonly endorsed category, and of the individual DGBI, irritable bowel syndrome was the most frequently reported (43.9–58.8%). All investigated disordered eating behaviors showed a positive association with most DGBI categories. Finally, individuals reporting high current eating disorder symptoms reported higher mean number of DGBI (3.03–3.34) than those with low current symptoms (1.60–1.84).
Discussion
The directionality and mechanisms underlying the nature of the relationship between gastrointestinal and eating disorder symptoms is worthy of further study and clinicians should adopt an integrated approach by attending to both gastrointestinal and eating disorder symptoms in their patients.
Abstract
Background
IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) ...program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5–7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents’ risk of developing type 2 diabetes.
Methods
IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents’ feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability.
Discussion
This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools.
Trial registration
Registered prospectively at ClinicalTrials.gov ID:
NCT04984421
, registered July 30, 2021
Specific information for whom and when cardiorespiratory fitness (CRF) is associated with depression risk is lacking. We aimed to study the association between adulthood CRF and incident depression, ...long-term sickness absence, and disability pension due to depression, as well as examine moderation of sex, age, education, and occupation on associations.
A large prospective cohort study follows participants over time with Swedish occupational health screenings data. The study includes 330,247 individuals (aged 16–79 years, 46% women) without a depression diagnosis at baseline. CRF was estimated from a submaximal cycle test.
CRF was associated beneficially from low to higher levels with incident depression and long-term sickness absence due to depression. Further, CRF at high levels (≥46 ml/min/kg) was associated with a decreased risk of receiving disability pension due to depression. The associations remained after adjustment for age and sex, but not lifestyle-related factors and co-morbidity. Participants with moderate and high CRF had 16% and 21%, respectively, lower risk for incident depression, and participants with high CRF had 11% lower risk for long-term sickness absence due to depression. Associations between higher CRF and the outcomes were mainly evident in men, younger participants, and individuals with low education.
In a large sample of adults without a depression diagnosis at baseline, higher CRF was shown to be beneficially related to the risk of incident depression and, to some extent, long-term sickness absence due to depression. If causal, targeted interventions focusing on increasing CRF in these sub-groups should be prioritized.
•High cardiorespiratory fitness (CRF) lowers the risk of incident depression.•High CRF is also associated with a lower risk of sickness absence due to depression.•The effect is seen in men, younger individuals, and those with shorter education.
Gastrointestinal problems are common in all eating disorders; however, the extent to which these problems predate the onset of eating disorders is not clear. We explored longitudinal associations ...between childhood gastrointestinal problems and adolescent disordered eating, and assessed whether observed associations are potentially causal or due to familial confounding factors.
Data from a population-based Swedish twin sample were used to investigate associations between parent- and self-reported protracted constipation and diarrhea in childhood and adolescence, and later disordered eating, measured by the Eating Disorders Inventory-2 (EDI). Linear regression models were used to investigate the associations. Possible familial confounding was explored by using a within-twin pair analysis.
We found that those who reported a history of constipation at age 15 scored 5.55 and 5.04 points higher, respectively, on the EDI total score at age 15 and 18, compared with those without constipation. Those reporting a history of diarrhea at age 15 scored 5.15 points higher, and the group reporting both problems scored 9.52 points higher on the EDI total score at age 15 than those reporting no problems. We observed that the association between constipation and disordered eating was attenuated in the within-twin pair analysis, but remained positive.
Gastrointestinal problems in childhood and adolescence are significantly associated with disordered eating. Associations were partly due to familial confounding, but might also be consistent with a causal interpretation. Clinicians should be aware of the increased risk of disordered eating when following children and adolescents who present with gastrointestinal problems.
•Childhood constipation is associated with adolescent disordered eating.•Diarrhea in childhood is associated with adolescent disordered eating.•Association are partly explained by familial factors.•Clinicians should be aware of the increased risk.
Research quantifying dietary intake in individuals with bulimia nervosa and binge-eating disorder (i.e., binge-type eating disorders) is surprisingly scant. We assessed the dietary intake of women ...and men with binge-type eating disorders in a large case-control study and compared them with healthy controls. We also evaluated the extent to which their dietary intake adhered to the Nordic Nutrition Recommendations. Among cases, we assessed the relationship of binge eating frequency with energy and macronutrient intake.
We derived the total daily energy, macro-, and micronutrient intake of 430 cases with binge-type eating disorders (women: n = 391, men: n = 39) and 1227 frequency-matched controls (women: n = 1,213, men: n = 14) who completed the MiniMeal-Q, a validated food frequency questionnaire. We calculated mean intake for men and women and, in women, compared mean intake of energy and nutrients between cases and controls using linear regression. We calculated the proportion of women and men who met the recommended intake levels from the NNR, and compared these proportions in female cases and controls using logistic regression. We used linear regression to examine energy and macronutrient intake of women with varying frequencies of current binge-eating.
Female, but not male cases, had a higher mean intake of total energy/day compared with controls and higher intake than recommended. The majority in all groups (male and female cases and controls) exceeded saturated fat recommendations, and did not meet recommendations for omega-3 fatty acid intake. Among all groups, adherence was low for vitamin D, selenium, and salt. Iron and folate intake was low among the majority of women, especially controls. Female cases with ≥4 binge-eating episodes in the past 28 days had higher intake of energy and percent carbohydrates, and lower intake of percent fat, compared to cases with no binge-eating episodes in the past month.
Higher than recommended total daily energy intake among women with binge-type eating disorders may lead to weight gain and downstream health complications, if persistent. In most women, iron and folate intake was insufficient, which may have negative consequences for reproductive health. We found suboptimal adherence for key nutrients that are important to limit (saturated fat and salt) or meet (omega-3 fatty acids) for cardiovascular and overall health in all groups. Nutrition counseling should form an important pillar of treatment to assist with normalization of eating patterns and may also benefit individuals without eating disorders to optimize nutrient intake for long term health promotion.
Objective
Understanding the role of premorbid body mass index (BMI) in the emergence of eating disorders may be key to identifying effective prevention strategies. We explore relations between BMI ...and eating disorders traits in young twins.
Method
The effect of BMI at age 9/12 and 15 on eating disorder traits measured using the Eating Disorders Inventory‐2 (EDI) at ages 15 and 18 was examined using bivariate modelling in a longitudinal population sample of Swedish twins.
Results
The correlation between BMI and EDI within individuals was stable across all ages and remained significant after adjusting for later BMI. Bivariate analysis indicated significant positive genetic correlations between BMI ages 9/12 and 15 and subsequent EDI scores. The relationship remained significant for BMI age 9/12 and EDI age 15 in the adjusted model, indicating a longitudinal association.
Conclusion
Our results have implications for conceptualizing the interrelation of BMI and eating disorders across childhood and adolescence.
Anorexia nervosa (AN) is a severe disorder, for which genetic evidence suggests psychiatric as well as metabolic origins. AN has high somatic and psychiatric comorbidities, broad impact on quality of ...life, and elevated mortality. Risk factor studies of AN have focused on differences between acutely ill and recovered individuals. Such comparisons often yield ambiguous conclusions, as alterations could reflect different effects depending on the comparison. Whereas differences found in acutely ill patients could reflect state effects that are due to acute starvation or acute disease-specific factors, they could also reflect underlying traits. Observations in recovered individuals could reflect either an underlying trait or a "scar" due to lasting effects of sustained undernutrition and illness. The co-twin control design (i.e., monozygotic MZ twins who are discordant for AN and MZ concordant control twin pairs) affords at least partial disambiguation of these effects.
Comprehensive Risk Evaluation for Anorexia nervosa in Twins (CREAT) will be the largest and most comprehensive investigation of twins who are discordant for AN to date. CREAT utilizes a co-twin control design that includes endocrinological, neurocognitive, neuroimaging, genomic, and multi-omic approaches coupled with an experimental component that explores the impact of an overnight fast on most measured parameters.
The multimodal longitudinal twin assessment of the CREAT study will help to disambiguate state, trait, and "scar" effects, and thereby enable a deeper understanding of the contribution of genetics, epigenetics, cognitive functions, brain structure and function, metabolism, endocrinology, microbiology, and immunology to the etiology and maintenance of AN.
Eating disorders are severe psychiatric illnesses, characterized by dysregulated eating and distorted attitudes toward weight and body shape, causing enormous suffering for patients and their ...families. Although great progress has been made in eating disorders research during the past decades, many questions still remain regarding the etiology and consequences of eating disorders.The aim of this thesis was to extend the knowledge about the relationship among body mass index (BMI), gastrointestinal complaints, and diet, and how these factors contribute to the emergence and maintenance of eating disorders.In Study I, we investigated the role of childhood BMI in later disordered eating behaviors across adolescence using a large, longitudinal twin cohort. BMI was reported at three timepoints (age 9/12, age 15, and age 18) and eating disorder symptoms were measured at two timepoints (age 15 and 18). We found a positive phenotypic correlation, meaning a correlation between BMI and eating disorders within the individual, that was stable across the ages. Further, we found a positive genetic correlation between the traits, indicating a common etiological pathway between BMI and disordered eating.In Study II, we explored the effect of childhood gastrointestinal problems on later eating disorder symptoms, in the same twin cohort as in Study I. We first estimated the association inthe full cohort, finding those who reported having had gastrointestinal problems in childhood scoring higher on an eating disorder symptom scale. In a second step we conditioned the analysis on twin pairs who were discordantly exposed to gastrointestinal problems during childhood, meaning that only twin pairs where one twin was affected and the other one was not contributed to the analysis. We found a decreased positive, however not null, association between gastrointestinal problems reported at age 15 and disordered eating symptoms reported at the same age, which suggests that the relationship between gastrointestinal problems and disordered eating can in part be explained by shared familial confounding factors.In Study III, we evaluated the prevalence of functional gastrointestinal disorders (FGID) indifferent eating disorder diagnoses, as well as the association between specific eating disorder behaviors (binge eating, purging, laxative misuse, and fasting) and FGID, and lastly, we compared the total burden of FGID in individuals with high versus low current eating disorder symptoms, as well as controls. We found high prevalence of FGID in all eating disorders with up to half of the individuals with eating disorders reporting having three or more individuals FGID. We found all eating disorder behaviors to be positively associated with most FGID categories. Lastly, we found those with lower current eating disorder symptoms to have lower total burden of FGID, although still higher than healthy controls, indicating a lingering effect of gastrointestinal problems.In Study IV, we aimed to explore the energy and nutrient intake in individuals with binge-type eating disorder (namely bulimia nervosa and binge-eating disorder) compared to healthy controls, and to the Nordic Nutrition Recommendations (NNR). We found women with binge types eating disorders to have adequate intake of macronutrients (protein, fat, and carbohydrates), and most micronutrients (vitamins and minerals). However, women with binge-type eating disorders had a mean intake of energy per day that was significantly higher than controls, and higher than the recommended daily intake. In addition, women with binge types eating disorders reported low adherence to folate, iron, vitamin D, and salt recommendations from the NNR. Although the number of men with binge-type eating disorders in the study was inadequate for statistical analysis, they did report a descriptively adequate dietary intake for most macro- and micronutrients.The work presented in this thesis provides additional knowledge concerning the role that BMI and gastrointestinal problems play across childhood and adolescence in relation to the development of eating disorders. These insights, in combination with previous knowledge, can help develop new effective prevention strategies. This thesis also increases the understanding of the comorbidity between FGID and eating disorders, and clarifies the bidirectional relationship in the development of the two classes of disorders. Lastly, this thesis maps the energy and nutrient intake in individuals with binge-type eating disorders in relation to healthy controls, and to recommendations, and suggests a need for greater attention toward ensuring recommended daily intake of energy as well as of specific vitamins and minerals.
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