Sex-dimorphic genetic effects and novel loci for fasting glucose and insulin variability.

Differences between sexes contribute to variation in the levels of fasting glucose and insulin. Epidemiological studies established a higher prevalence of impaired fasting glucose in men and impaired glucose tolerance in women, however, the genetic component underlying this phenomenon is not established. We assess sex-dimorphic (73,089/50,404 women and 67,506/47,806 men) and sex-combined (151,188/105,056 individuals) fasting glucose/fasting insulin genetic effects via genome-wide association study meta-analyses in individuals of European descent without diabetes. Here we report sex dimorphism in allelic effects on fasting insulin at IRS1 and ZNF12 loci, the latter showing higher RNA expression in whole blood in women compared to men. We also observe sex-homogeneous effects on fasting glucose at seven novel loci. Fasting insulin in women shows stronger genetic correlations than in men with waist-to-hip ratio and anorexia nervosa. Furthermore, waist-to-hip ratio is causally related to insulin resistance in women, but not in men. These results position dissection of metabolic and glycemic health sex dimorphism as a steppingstone for understanding differences in genetic effects between women and men in related phenotypes.

[Towards a transcultural approach to eating disorders]. / Pour une approche transculturelle des troubles du comportement alimentaire.

Anorexia must not be considered as a syndrome specific to a culture but as being linked to fast-moving sociocultural changes. Its occurrence can be favoured by certain transcultural phenomena, such as globalisation and the process of acculturation. The analysis of a clinical case of a young migrant with anorexia illustrates the complexity and need for complementary transcultural psychotherapy, to improve understanding and the future.

Factors associated with self-identification of an eating disorder history among Latinas meeting criteria for past or current eating disorders.

OBJECTIVE: This paper compared Latinas who self-identified as having had an eating disorder (ED) with those who did not (despite both groups meeting criteria for an ED history) on ED pathology and mental health stigma. METHOD: Seventy-seven Latinas completed an online survey. RESULTS: All 77 participants met criteria for lifetime EDs, and 92% met current criteria for an ED; however, 47% did not report having an ED history vs. 53% did report an ED history. There was no difference on binge eating frequency. Those who endorsed an ED history engaged in more compensatory behaviors, had higher EAT-26 scores, and were less fearful of stigmatization due to seeking mental health treatment. Those reporting an ED history were more likely to have met criteria for anorexia nervosa or bulimia nervosa, generally more recognizable EDs than binge eating disorder and other specified feeding or eating disorders, than those who did not report an ED history. DISCUSSION: Latinas with certain patterns of eating pathology and those with less fear of being stigmatized due to seeking mental health treatment were more likely to endorse an ED history, which has implications for treatment seeking. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1032-1035).

Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? Correlations with gender, education, and body mass index.

Investigating eating disorders and orthorexia nervosa, especially in the young population, is an important step in taking protective precautions and identifying disease. This study was carried out to determine the relationship of eating disorders and orthorexia nervosa to gender, BMI, and field of study in a population of university students in Turkey. In all, 900 university students aged 17-23 years participated in this study. EAT-40 and ORTO-15, which are validated instruments for the screening of participants with anormal eating behaviors and orthorexia nervosa, respectively, were used. There was not a significant difference in EAT-40 scores according to gender and BMI classification. However, EAT-40 scores were high among the students in social science. The number of orthorectic participants among women is higher than that among men, and ORTO-15 scores were not associated with BMI classification and field of study. A significant negative correlation was found between EAT-40 and ORTO-15 scores.

Dopamine receptor D2 and catechol-O-methyltransferase gene polymorphisms associated with anorexia nervosa in Chinese Han population: DRD2 and COMT gene polymorphisms were associated with AN.

Dopamine receptor D2 (DRD2) and catechol-O-methyltransferase (COMT) are important in dopamine system which is proved to be associated with food-anticipatory behavior, food restriction, reward and motivation. This has made them good candidates for anorexia nervosa (AN). The aim of this work is to explore the roles of DRD2 (rs1800497) and COMT (rs4680, rs4633, rs4818) gene polymorphisms in the susceptibility of AN within the Chinese Han population. We recruited 260AN patients with DSM-IV diagnosis criteria, and 247 unrelated, normal weight controls. DRD2 (rs1800497) and COMT (rs4680, rs4633, rs4818) were genotyped in all subjects. We found rs1800497 and rs4633 were associated with the susceptibility of AN within the Chinese Han sample, and allele C of rs1800497 was a protective factor. There was a gene-gene interaction between rs1800497 of DRD2 gene and rs4633 of COMT gene. We concluded that rs1800497 and rs4633 play important roles in the AN susceptibility with respect to the Chinese Han population. The gene-gene interaction between DRD2 and COMT contributes to the risk of AN.

The clinical profile of patients with anorexia nervosa in Singapore: a follow-up descriptive study.

INTRODUCTION: The prevalence rate of anorexia nervosa is lower in Asia than in the West, although studies have found that it is on the rise in Asia. This study aims to present the clinical profile of patients presenting with anorexia nervosa in Singapore. METHODS: The present study used archival data from the Eating Disorder Programme registry of the Department of Psychiatry, Singapore General Hospital, Singapore. Patient records from 2003 to 2010 were collected and analysed. Presenting characteristics of the patients were also compared with those of another local study conducted eight years earlier. RESULTS: From 2003 to 2010, a total of 271 patients were diagnosed with anorexia nervosa by a psychiatrist in our hospital. Of these, 251 (92.6%) were female and 238 (87.8%) were Chinese. Our patients had a lower mean weight (36.83 kg, p < 0.001) and a lower mean body mass index (BMI) (14.43 kg/m(2), p < 0.001) than patients from the previous local study. Almost half of all our patients (n = 135, 49.8%) were diagnosed with at least one psychiatric comorbidity and 50 (18.5%) had a history of self-harm. CONCLUSION: The presenting characteristics of our study cohort were similar to those of the Western population. However, the lower presenting weight and BMI in our cohort indicates that cases seen today are more severe than those seen eight years ago. Therefore, it is important to put in place prevention programmes to help adolescents cultivate a healthy body image as well as early intervention programmes to improve detection rates and treatment outcomes.

The 5-HTTLPR confers susceptibility to anorexia nervosa in Han Chinese: evidence from a case-control and family-based study.

Accumulating evidence has implied that serotonin system dysfunction may be involved in the etiology of anorexia nervosa (AN). Serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism is the genetic variant coding for the serotonin transporter and has a modulatory effect on its expression. This study aimed to investigate the possible association between the 5-HTTLPR and the susceptibility and severity of AN in Han Chinese using a case-control (255 patients and 351 controls) and family based study (198 trios). Eating disorder examination was used to measure the severity of AN behavioral symptoms. For the case-control study, the 5-HTTLPR showed significant association with AN in our sample (genotypic P = 0.03). The frequency of S allele was significantly higher in patients than that in controls (OR = 1.38, 95%CI: 1.06-1.79, P = 0.017). For the family-based study, the S allele of 5-HTTLPR was preferentially transmitted rather than non-transmitted from the parents to affected offspring (P = 0.013). The results of ANCOVA test revealed no significant association between the 5-HTTLPR polymorphism and severity of AN. Our findings suggested that 5-HTTLPR is able to confer susceptibility to AN in Han Chinese.

Anorexia nervosa in a girl of Chinese origin: psychological, somatic and transcultural factors.

The increased prevalence of anorexia nervosa reported in non-Western societies inevitably raises the issue of the influence of cultural factors in the genesis and the patterns of this disorder. Anorexia nervosa is not a straightforward Western culture-bound syndrome, although an influence of Western ideals of thinness does exist. The illness seems more related to rapid cultural shifts, either societal or individual, such as those occurring in the migratory process. Migrants and their children have to face the acculturation process and may experience a culture-clash. The pathology can also fulfil a positive acculturative function. This is a case study concerning a second-generation Chinese girl born in France presenting with anorexia nervosa. This case leads us to raise the issue of the choice of diagnostic criteria in relation to cultural background. We will also discuss the impact of the family's migratory history on the construction of identity in adolescence. Finally we will explore the specific features of care provision for anorexia nervosa in a transcultural setting.

Eating disorder symptoms among Japanese female students in 1982, 1992 and 2002.

To study transcultural differences in eating disorders, we examined eating disorder symptoms and point prevalence of eating disorders among Japanese female students in 1982, 1992 and 2002. In 1982, 1992 and 2002, a total of 10,499 Japanese female students, aged 16-23 years, were asked to complete a self-administered questionnaire. Diagnosis of an eating disorder was made on the basis of DSM-IV criteria. On almost all measures, there were significant increases of a disordered attitude about fear of gaining weight, body perception disturbance and problematic eating behaviors over time. The point prevalence of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified significantly increased over time. These results suggest that the prevalence of eating disorder symptoms and the point prevalence of eating disorders were increasing among Japanese female students in 2002. Changing socio-cultural factors in Japan may explain the dramatic increase of eating disorders over time.

The inversion of the fall: on identity construction in anorexia nervosa.

Anorexia nervosa can be comprehended as an illness in the broader context of Western culture. The myth of the Fall, narrating a forbidden act of eating, provides a symbolic background of a philosophical-anthropological comprehension of the identity of man, which frames a clinically relevant point of view of anorexia nervosa. The formation of identity in its broader anthropological sense and particularly with people suffering from anorexia nervosa is subjected to a philosophical and psychological analysis consulting the relevant philosophical, sociological and psychodynamic literature. The order of eating in terms of interdiction and disobedience anthropologically constitutes the identity of men: by ignoring the divine taboo, men can reach consciousness and culture. Philosophy and psychoanalytical theory have focused on this process regarding an emerging capacity to symbolize and on its relation to emancipation and the pursuit of autonomy. Under postmodern conditions with a decline of stable cultural value systems and traditional structures the process of an emancipatory identity construction becomes critical. Surrogates replace missing values; thus, injunctions such as to enjoy substitute interdictions. This paper sheds light on the impact of these cultural conditions and their postmodern changes on the identity construction of anorexia nervosa. Moreover, implications for psychotherapeutic treatment are outlined. Besides the medico-scientific models, a multifaceted understanding of anorexia nervosa has to consider cultural contexts and symbolic processes that matter in the disorder in order to provide a broader background for the treatment approach of the anorectic patient.

Anorexia nervosa in a Thai adolescent.

In Thailand, anorexia nervosa (AN) has rarely been reported. We report a 13- year-old female adolescent with AN restrictive type, the first from Thailand to meet all Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revision (DSM IVTR) criteria for AN. The emergence of a patient with AN in Khon Kaen, a province from the region with the lowest gross domestic product, accentuates the existence of eating disorders in adolescents beyond Thailand capital. Future studies considering sociocultural issues on normal eating attitudes, eating behaviors and body image in Thailand should be conducted.

Nutrição e transtornos alimentares na adolescência / Nutrition and alimentary disorders in adolescence

Atualização dos principais aspectos relativos à nutrição na infância e adolescência, com particular enfoque nos principais distúrbios alimentares encontrados nessa faixa etária, anorexia nervosa e bulimia nervosa e abordando os recursos diagnósticos e a conduta terapêutica.

Measurement invariance of the Eating Attitudes Test-26 in Caucasian and Hispanic women.

To determine whether the EAT-26 functions similarly in Caucasian and Hispanic samples, the current study investigated the factor structure of the Eating Attitudes Test (EAT-26) in 235 undergraduate Caucasian (53.6%) and Hispanic (46.4%) women, and tested for measurement invariance across the two samples. A Confirmatory Factor Analysis (CFA) of the original 3-factor structure of the EAT resulted in a poor fit in both the Caucasian and Hispanic samples. We then performed a CFA using a previously discovered 4-factor, 16-item structure. This abbreviated measure was a good fit in both the Caucasian and Hispanic samples, and the model was invariant across all dimensions tested. The 16-item EAT is a better-fitting measure in Caucasian and Hispanic women than the commonly used EAT-26. This replicates an earlier finding and generalizes those conclusions to a Hispanic sample.

Validity and reliability of the Chinese language version of the eating disorder examination (CEDE) in mainland China: Implications for the identity and nosology of the eating disorders.

PURPOSE: To investigate the crosscultural validity and reliability of the Chinese Language version of the Eating Disorder Examination (CEDE) in Wuhan, China, and to examine the psychopathological profile of eating disorder patients in central Mainland China. PARTICIPANTS AND METHOD: We administered the CEDE to 41 eating disorder patients (anorexia nervosa and bulimia nervosa) with 43 non-eating disorder controls. Specialists in eating disorders made the clinical diagnosis according to DSM-IV criteria. CEDE data between the two groups were compared. RESULTS: The CEDE demonstrates good internal consistency, test-retest reliability, and inter-examiner reliability. All CL-EDE subscales discriminated between patients with anorexia nervosa or bulimia nervosa from non-eating disordered controls. The CEDE has satisfactory sensitivity, specificity, and positive and negative predictive values. DISCUSSION: The CEDE is a useful instrument for the study of the growing clinical problem of the eating disorders in Mainland China. The finding that the characteristic fat phobia is prominent in this population of eating disordered patients and its implication on the identity and classification of the eating disorders are discussed.

Disordered weight control behaviors in early adolescent boys and girls of color: an under-recognized factor in the epidemic of childhood overweight.

OBJECTIVES: Ethnic disparities in childhood overweight are well-documented. In addition, disordered weight control behaviors (DWCB) have been linked to overweight and weight gain in multiple ways, but little is known about DWCB in youth of color, especially boys. We examined the distribution and determinants of ethnic and gender disparities in DWCB in early adolescents. METHODS: In fall 2005, 47 Massachusetts middle schools participating in the Healthy Choices overweight prevention study administered a self-report baseline survey assessing student sociodemographics, height, weight, and DWCB (vomiting or use of laxatives or diet pills in the past month to control weight). Data from 16,978 girls and boys were used in multivariate logistic regression models to estimate the odds of DWCB in youth of color compared with their white peers, controlling for individual- and school-level factors. RESULTS: Among white youth, 2.7% of girls and 2.3% of boys reported DWCB. The odds of DWCB were elevated 2-10 times in most ethnic groups relative to whites. Disparities were attenuated but persisted after controlling for multiple individual- and school-level factors. CONCLUSIONS: Ethnic disparities in DWCB must be considered in efforts to address the epidemic of childhood overweight.

The incidence of anorexia nervosa in Netherlands Antilles immigrants in the Netherlands.

OBJECTIVE: Previously we found that the incidence of anorexia nervosa (AN) in the general population was much lower in the Netherlands Antilles than in the Netherlands. As a follow-up we compared the incidence of AN in the Netherlands in persons from the Netherlands Antilles to native Dutch. METHOD: A national register of psychiatric hospital admissions was screened for cases of AN. Incidence rates (IR) and incidence rate ratios (IRR) were computed. RESULTS: The IR of AN was 1.32 per 100 000 person years (95% confidence interval (CI): 0.53-2.71) for Netherlands Antilleans and 1.09 (95% CI: 1.04-1.15) for native Dutch. The age- and sex-adjusted IRR was 1.21 (95% CI: 0.58-2.54). CONCLUSION: Contrary to the Netherlands Antilles, in the Netherlands AN is as common among Netherlands Antilleans as among native Dutch. Exposure to the Western idealization of thinness is a risk factor for the development of AN, possibly in interaction with migration-related stress.

Cultural body shape ideals and eating disorder symptoms among White, Latina, and Black college women.

Previous studies have reported inconsistent relationships between body image, eating disorder symptoms, and acculturation-relevant variables. The current study examined these variables in a sample of White, Latina, and Black college women (N = 276). White and Latina participants selected slimmer personal body shape ideals than Black women. Among Black women, the discrepancy between perceived body shape and perceived ideal body shape for the United States was predictive of Eating Disorder Inventory Body Dissatisfaction (EDI-BD) and Drive for Thinness (EDI-DFT) scores. The discrepancy between perceived body shape and perceived ideal for their ethnic group also predicted EDI-BD scores. Among Latinas, the discrepancy between perceived body shape and perceived body shape ideal for their ethnic group was predictive of EDI-BD and EDI-DFT scores, whereas a discrepancy between perceived body shape and perceived ideal for the United States was not predictive of eating disorder symptoms. Finally, higher levels of acculturative stress, but not acculturation, were associated with EDI-BD scores among Black women and EDI-DFT scores among Latinas. Findings underscore the importance of considering cultural variables such as acculturative stress when conducting clinical work with ethnic minority women.

Childhood risk factors in Korean women with anorexia nervosa: two sets of case-control studies with retrospective comparisons.

OBJECTIVE: The aim of this study was to investigate the characteristics of the risk factors for anorexia nervosa (AN) in Korean women. METHOD: Two sets of case-control comparisons were conducted, in which 52 women with lifetime AN from Seoul, S. Korea, were compared with 108 Korean healthy controls and also with 42 women with lifetime AN from the UK in terms of their childhood risk factors. A questionnaire designed to conduct a retrospective assessment of the childhood risk factors was administered to all participants. RESULTS: The Korean AN women were more likely to report premorbid anxiety, perfectionism, and emotional undereating and were less likely to report having supportive figures in their childhood than the Korean healthy controls. There were no overall differences in the childhood risk factors between the Korean and British women with AN. DISCUSSION: Premorbid anxiety, perfectionism, less social support, and emotional undereating merit attention as risk factors in Korean AN. The current results are informative, but an epidemiologically robust prospective case-control study would be needed to validate these findings.