Preliminary identification of clinical cut-off of the vegetarian vegan eating disorder screener (V-EDS) in a community and self-reported clinical sample of vegetarians and vegans.

BACKGROUND: The vegetarian vegan eating disorder screener (V-EDS) is an 18-item self-report screening tool designed to assess the unique elements of eating disorder symptomology in vegetarians and vegans. Previous results have suggested strong initial psychometric properties in non-clinical community samples of vegetarians and vegans. The present study sought to identify a preliminary threshold cut-off score to discriminate eating disorder pathology in a self-reported clinical and community sample. METHODS: This study involved secondary analysis using data collected in McLean et al. (Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS, 2023), comprising 599 non-clinical participants and 51 self-reported clinical participants. Receiver operating characteristic (ROC) curve analysis was used to compute possible cut-off values for the V-EDS. RESULTS: ROC analysis indicated good performance of the V-EDS (area under the curve = 0.87), with integration of the Youden index demonstrating a global score of ≥ 18 to be optimal in predicting clinical caseness with good sensitivity (0.804) and specificity (0.843). CONCLUSIONS: The present study fills an important gap as the first to investigate an optimal V-EDS score to discriminate level of impairment from eating disorder pathology in a sample of vegetarian and vegan community and self-reported clinical participants. We extend the utility of the V-EDS in discovering good discrimination power in classifying clinical caseness with a cut-off score of 18 shown to optimise the trade-off between sensitivity and specificity. Future research should focus on expanding the psychometric properties of the V-EDS in larger and more diverse participant groups, including gender, age, cultural identity, and eating disorder history.

This study builds on the preliminary validation of a novel eating disorder screening tool for people adhering to a vegetarian and vegan diet called the V-EDS. In this study, we set out to develop a cut-off score for the V-EDS to distinguish people needing further evaluation for a possible eating disorder within the community. We found a global V-EDS score of ≥ 18 to be ideal in distinguishing between eating disorder symptomatic and non-eating disorder groups. In future, the V-EDS may prove useful for initial screening and symptom progression of eating disorders across both clinical and research settings.

Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS.

BACKGROUND: Eating disorders have one of the highest mortality of all mental illnesses but are associated with low rates of screening and early intervention. In addition, there remains considerable uncertainty regarding the use of current standardised screening tools in measuring eating pathology in vegetarians and vegans. With these groups presenting as potential at-risk groups for disordered eating development, the present study aimed to develop and preliminary validate a novel eating disorder screening tool, the Vegetarian Vegan Eating Disorder Screener (V-EDS). METHODS: We utilised a mixed-methods approach, comprising four phases. RESULTS: A conceptual framework was developed from 25 community, clinician, and lived experience interviews and used to derive a preliminary set of 163 items (Phase 1). Phase 2 piloted the items to establish face and content validity through cognitive debriefing interviews of 18 additional community, clinician, and lived experience participants, resulting in a reduced, revised questionnaire of 53 items. Phase 3 involved scale purification using Item Response Theory in analysis of 230 vegetarians and 230 vegans resulting in a further reduced 18-item questionnaire. Phase 4 validated the screening tool in a large community sample of 245 vegetarians and 405 vegans using traditional psychometric analysis, finding the V-EDS supports a unidimensional factor structure with excellent internal consistency (α = 0.95-0.96) and convergent validity (0.87-0.88), and moderate discriminate validity (0.45-0.55). CONCLUSIONS: This study provided strong initial support for the psychometric validity and theoretical assumptions of the novel V-EDS screening tool. The V-EDS has the potential to increase early intervention rates for vegetarians and vegans experiencing eating disorder symptoms, further supporting advocacy and treatment approaches for these expanding dietary groups.

The present study describes the development and preliminary validation of the first screening tool designed to uniquely assess eating disorder symptoms in individuals following a vegetarian or vegan diet. Following several development phases, the final version of the Vegetarian Vegan Eating Disorder Screener (V-EDS) comprises 18-items, with six dietary characteristic items and 12 eating disorder scored items. The current findings support excellent initial reliability and validity of the V-EDS. The V-EDS constitutes a promising tool that could potentially be integrated as a standalone measure for initial screening in clinical and research settings, but also for more comprehensive assessment when combined with other gold-standard eating disorder tools.

Neonatal Transport Safety Metrics and Adverse Event Reporting: A Systematic Review.

OBJECTIVE: Neonatal transports are an essential component of regionalized medical systems. Neonates who are unstable after birth require transport to a higher level of care by neonatal transport teams. Data on adverse events on neonatal transports are limited. The aim of this study was to identify, evaluate, and summarize the findings of all relevant studies on adverse events on neonatal transports. METHODS: We identified 38 studies reporting adverse events on neonatal transports from January 1, 2000, to December 31, 2019. The adverse events were distributed into 5 categories: vital sign abnormalities, laboratory value abnormalities, equipment challenges, system challenges, cardiopulmonary resuscitation, and transport-related mortality. RESULTS: Most of the evidence surrounds vital sign abnormalities during transport (n = 28 studies), with hypothermia as the most frequently reported abnormal vital sign. Fourteen studies addressed laboratory abnormalities, 12 reported on events related to equipment issues, and 4 reported on system issues that lead to adverse events on transport. Of the 38 included studies, 12 included mortality related to transport as an outcome, and 4 reported on cardiopulmonary resuscitation during transport. There were significant variations in samples, definitions of adverse events, and research quality. CONCLUSION: Adverse events during neonatal transport have been illuminated in various ways, with vital sign abnormalities most commonly explored in the literature. However, considerable variation in studies limits a clear understanding of the relative frequencies of each type of adverse event. The transport safety field would benefit from more efforts to standardize adverse event definitions, collect safety data prospectively, and pool data across larger care systems.

A new era of assessment for neonatal-perinatal medicine trainees: milestones 2.0.

To optimize post-graduate competency-based assessment for medical trainees, the Accreditation Council for Graduate Medical Education initiated a sub-specialty-specific revision of the existing Milestones 1.0 assessment framework in 2016. This effort was intended to increase both the effectiveness and accessibility of the assessment tools by incorporating specialty-specific performance expectations for medical knowledge and patient care competencies; decreasing item length and complexity; minimizing inconsistencies across specialties through the development of common "harmonized" milestones; and providing supplemental materials, including examples of expected behaviors at each developmental level, suggested assessment strategies, and relevant resources. This manuscript describes the efforts of the Neonatal-Perinatal Medicine Milestones 2.0 Working Group, outlines the overall intent of Milestones 2.0, compares the novel Milestones to the original version, and details the materials contained in the novel supplemental guide. This new tool should enhance NPM fellow assessment and professional development while maintaining consistent performance expectations across specialties.

The 26-Item Eating Attitudes Test (EAT-26): Psychometric Properties and Factor Structure in Vegetarians and Vegans.

The eating disorder screener, Eating Attitudes Test (EAT), has been used widely; however, its usability in specific dietary groups such as vegetarians and vegans remain unknown. Considering the rising popularity of vegetarianism and veganism, the current study aimed to assess the psychometric properties and theoretical assumptions of the 26-item EAT in separate groups of vegetarians (n = 278), vegans (n = 580), and omnivores (n = 413). Confirmatory factor analysis of four models from previous literature revealed inadequate fit of the data, with the exception of a 16-item four-factor model in vegetarians and vegans. Further assessment of the original three-factor model and 16-item four-factor model demonstrated poor psychometric properties. The primarily inadequate test-retest reliability discovered in this study, independent of whether a shortened version was used, raises concerns around the utility and stability of the EAT-26 in vegetarians and vegans. Future research should potentially investigate novel ways of measuring eating disorder pathology in these groups.

Psychometric properties and factor structure of the Eating Disorder Examination-Questionnaire in omnivores, vegetarians, and vegans.

The psychometric properties of the Eating Disorder Examination-Questionnaire (EDE-Q) have been widely reported, but there remains considerable uncertainty regarding the factor structure of the tool, with vegetarians and vegans remaining no exception. Due to the utility of the EDE-Q as a screening and outcome measure, we assessed the theoretical assumptions and psychometric properties of the EDE-Q in vegetarians (n = 278), vegans (n = 580), and omnivores (n = 413) separately, owing to the expectation of different structures within each dietary population given their varying degrees of restraint. We undertook confirmatory factor analysis of five models previously described demonstrating inadequate fit. Exploratory factor analysis supported unique three-factor models across dietary groups incorporating Weight and Shape Concern subscales, potentially suggesting that community samples of varying of dietary restraint consistently interpret weight/shape to be related to general body image concerns. These novel findings also suggest a shorter version of the EDE-Q may be more suitable in community samples to reduce the time burden of the tool. The predominately poor test-retest reliability raises doubt around the overall utility and stability of the EDE-Q in all dietary populations, regardless of whether a shortened version is employed. Future research is needed to validate of other eating disorder tools across dietary populations.

The impacts of COVID-19 on eating disorders and disordered eating: A mixed studies systematic review and implications.

Purpose: The unique constraints to everyday life brought about by the COVID-19 pandemic have been suggested to negatively impact those with pre-existing mental health issues such as eating disorders. While individuals with eating disorders or disordered eating behaviors likely represent a vulnerable group to the COVID-19 pandemic, the impact of the pandemic is yet to be fully established. Methods: We systematically examined the impact of the COVID-19 pandemic on eating disorders and disordered eating behaviors. We searched electronic databases MEDLINE, PsycINFO, CINAHL, and EMBASE for literature published until October 2021. Eligible studies were required to report on individuals with or without a diagnosed eating disorder or disordered eating behaviors who were exposed to the COVID-19 pandemic. Findings: Seventy-two studies met eligibility criteria with the majority reporting an increase in eating disorder or disordered eating behaviors associated with the COVID-19 pandemic. Specifically, it appears children and adolescents and individuals with a diagnosed eating disorder may present vulnerable groups to the impacts of the COVID-19 pandemic. Discussion: This mixed systematic review provides a timely insight into COVID-19 eating disorder literature and will assist in understanding possible future long-term impacts of the pandemic on eating disorder behaviors. It appears that the role of stress in the development and maintenance of eating disorders may have been intensified to cope with the uncertainty of the COVID-19 pandemic. Future research is needed among understudied and minority groups and to examine the long-term implications of the COVID-19 pandemic on eating disorders and disordered eating behaviors. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284749, PROSPERO [CRD42021284749].

Disordered eating and the meat-avoidance spectrum: a systematic review and clinical implications.

PURPOSE: Meat avoidance has long been thought to be related to eating psychopathology; however, research does not necessarily support this notion. Furthermore, commonly used eating disorder scales may be picking up on normal meat-avoiding behaviours in vegetarians and vegans. As such, we systematically reviewed the association between vegetarianism, veganism, and disordered eating, and reviewed the psychometric properties of eating disorder scales for use in these populations. METHODS: We searched electronic databases MEDLINE, PsychINFO, and CINAHL for literature published until June 2021. RESULTS: Forty-eight studies met eligibility criteria, with no consensus as to whether meat avoidance was associated with higher rates of disordered eating. Most studies reported a significant positive association with both vegetarianism and veganism, and orthorexia nervosa. Six studies provided evidence for the use of eating disorder measures in vegetarians and vegans, reporting poor psychometric fit among all scales. CONCLUSION: This systematic review highlights the extent to which vegetarians and vegans have been highly understudied, with limited research suggesting higher levels of orthorexia nervosa behaviours in vegetarians and vegans. Furthermore, our results provide tentative evidence that the factorial validity of commonly used eating disorder scales, such as the EDE-Q, may be poor in vegans. LEVEL OF EVIDENCE: Level I, systematic review.

Characteristics and clinical implications of the relationship between veganism and pathological eating behaviours.

OBJECTIVE: Veganism may serve as a socially acceptable means to restrict food intake and disguise pathological eating behaviours. Studies that include vegan participants typically group them with other meat avoiders (e.g., vegetarians), potentially masking risk factors unique to veganism. METHOD: We addressed this issue by recruiting two Amazon Mechanical Turk samples of 110 vegan and 118 omnivore participants, with comparable gender composition. We aimed to examine whether vegans showed higher disordered eating than omnivores, and if motives for pursuing a vegan diet impacted disordered eating. We assessed disordered eating using the Eating Attitudes Test, the Eating Disorder Examination-Questionnaire, and the Eating Pathology Symptom Inventory. RESULTS: Vegans displayed more pathological eating behaviours than omnivores, which was significantly predicted by cognitive restraint. However, body dissatisfaction levels were higher in omnivores than vegans. Diet motives did not influence vegans' disordered eating. CONCLUSION: We propose vegans have high levels of cognitive restraint, possibly due to their intention to avoid animal products. In turn, cognitive restraint subscales in eating disorder measures might be over-pathologising rates of eating disorders in vegans. Future research should monitor the progression of people's eating-related attitudes and behaviours before and after they transition to veganism to establish whether veganism increases the risk of disordered eating, or vice versa. LEVEL OF EVIDENCE: IV, cross-sectional study.

An Australian perspective on "clean" dietary labels: Commentary on Negowetti et al. (2021).

"Clean eating" is an increasingly popular diet trend in Western countries with links to disordered eating behaviors. However, the definition of "clean" is a highly contentious issue. Negowetti, Ambwani, Karr, Rodgers, and Austin explore this important issue from a U.S. perspective conducting a scoping review of the public health implications of the use of "clean" labels on food, including legal and policy implications. The review showed that the U.S. Food and Drug Administration (FDA) has taken little action to address regulation of the use of "clean" dietary labels. Our own brief investigations suggest that the landscape in Australia under the Food Standards Australia New Zealand authority is similar. We discuss recommendations made by Negowetti et al. to address this issue in the United States, such as the FDA providing industry guidance on the term "clean," and the issuing of warning letters to companies who contravene this guidance. However, we predict that educating consumers to be more critical of unsubstantiated food labels in public health campaigns will be the most efficient way to change consumer behavior and address the "clean eating" diet trend. We also encourage eating disorder researchers and clinicians to be an influential part of this discussion.

Interactions between different eating patterns on recurrent binge-eating behavior: A machine learning approach.

OBJECTIVE: Previous research has shown that certain eating patterns (rigid restraint, flexible restraint, intuitive eating) are differentially related to binge eating. However, despite the distinctiveness of these eating patterns, evidence suggests that they are not mutually exclusive. Using a machine learning-based decision tree classification analysis, we examined the interactions between different eating patterns in distinguishing recurrent (defined as ≥4 episodes the past month) from nonrecurrent binge eating. METHOD: Data were analyzed from 1,341 participants. Participants were classified as either with (n = 512) or without (n = 829) recurrent binge eating. RESULTS: Approximately 70% of participants could be accurately classified as with or without recurrent binge eating. Intuitive eating emerged as the most important classifier of recurrent binge eating, with 75% of those with above-average intuitive eating scores being classified without recurrent binge eating. Those with concurrently low intuitive eating and high dichotomous thinking scores were the group most likely to be classified with recurrent binge eating (84% incidence). Low intuitive eating scores were associated with low binge-eating classification rates only if both dichotomous thinking and rigid restraint scores were low (33% incidence). Low flexible restraint scores amplified the relationship between high rigid restraint and recurrent binge eating (81% incidence), and both a higher and lower BMI further interacted with these variables to increase recurrent binge-eating rates. CONCLUSION: Findings suggest that the presence versus absence of recurrent binge eating may be distinguished by the interaction among multiple eating patterns. Confirmatory studies are needed to test the interactive hypotheses generated by these exploratory analyses.

Factor structure and psychometric properties of the Inflexible Eating Questionnaire in a sample of adult women.

The Inflexible Eating Questionnaire (IEQ) is a recently developed measure that assesses an individual's inflexible adherence to rigid eating rules, along with the tendency to respectively feel empowered or distressed when such rules are or are not followed. At present, evidence supporting the unidimensional structure and psychometric properties of the IEQ is limited to one specific sample of Portuguese adults. Establishing whether the IEQ is a valid and reliable measure in a different sample and by an independent research team is needed. We sought to examine the factor structure and psychometric properties of the IEQ in large sample (n = 1000) of Australian female adults. A unidimensional structure was replicated and evidence of internal consistency (α = .89) was found. IEQ scores were significantly and moderately correlated with various eating restraint measures and intuitive eating, providing evidence of convergent validity. IEQ scores also predicted incremental variance in global eating disorder symptomatology and psychosocial impairment after controlling for intuitive eating, flexible control, and rigid dietary control. Present findings offer further support for the validity and reliability of the IEQ in a non-clinical sample of women. A brief measure that assesses the inflexible adherence to eating rules may be valuable for validating current models of eating disorder psychopathology. Furthermore, incorporating the IEQ into the assessment of future randomized trials of eating disorder prevention or treatment programs may be beneficial for elucidating these interventions mechanisms of change.