Eating Disorder Symptomatology Among Young Adult Cigarette and E-Cigarette Users.

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research.

Prevalence of night eating syndrome among inbound call centre employees in Kuala Lumpur, Malaysia.

Background: Night eating syndrome (NES) is described as a disordered eating pattern relative to sleep, where consumption of food occurs in the evening and night. Numerous studies had been conducted in various populations but studies on (NES) among call centre employees are limited. Aim: This study aimed to determine the prevalence of NES and its determinants among selected inbound call centre employees in Kuala Lumpur, Malaysia. Methods: In this cross-sectional study, a total of 217 inbound call centre employees were recruited through random sampling. A self-administered socio-demographic and work-related questionnaire was used to collect data on the background of the respondents. Information on NES and well-being was obtained by using the Night Eating Questionnaire (NEQ) and World Health Organisation-Five Well-Being Index (WHO-5) respectively. Data on dietary intakes, smoking habits, alcohol intakes and life stress were acquired using a Simple Lifestyle Indicator Questionnaire (SLIQ) while eating behaviour of the respondents was studied using the Three-Factor Eating Questionnaire (TFEQ-18). Results: The mean age of the respondents was 24.1 ± 6.0 years. The prevalence of NES was 12.0% (95% CI = 8.12-17.24). The binary logistic regression identified that NES is significantly associated with adequate exercise (AOR = 4.250, p = 0.012) and emotional eating (AOR = 6.510, p = 0.014). Conclusion: This study showed that the prevalence of NES was high in the call centre and repeated nocturnal eating can have multiple adverse health effects. Therefore, promoting healthy eating habits are crucial to reduce the impacts of NES.

Adult attachment anxiety is associated with night eating syndrome in UK and US-based samples: Two cross-sectional studies.

Previous research has shown that "attachment anxiety" is a robust predictor of disinhibited eating behaviours and that this relationship is underpinned by difficulties in managing emotion. Night eating syndrome (NES), a proposed eating disorder characterized by evening hyperphagia, nocturnal awakenings to eat, and morning anorexia, is also associated with eating to manage emotion. Across two studies (N = 276 & N = 486), we considered a relationship between attachment anxiety and NES. In Study 1, we hypothesised (pre-registered) that attachment anxiety would predict NES score and that this relationship would be mediated by disinhibited eating. Participants were asked to complete questionnaire measures of attachment orientation, disinhibited eating (emotional and uncontrolled eating) and NES. Our parallel mediation model confirmed a direct relationship between attachment anxiety and NES (p < .001) and showed an indirect path via both emotional (95% CI: 0.15-0.63) and uncontrolled eating (95% CI: 0.001-0.36). In Study 2, we showed that fear of negative evaluation of eating significantly mediated a reversed relationship between attachment anxiety and NES (95% CI: 0.02-0.04). Finally, across both studies we used a novel tool to assess "eating to cope". We showed a relationship with emotional eating but failed to show a robust relationship with NES. Attachment orientation may represent a potential intervention target for night eating syndrome. Future research should consider a longitudinal approach to strengthen our understanding of directionality amongst these factors.

'In the night kitchen': A scoping review on the night eating syndrome.

BACKGROUND: First described in 1955, night eating syndrome refers to an abnormal eating behavior clinically defined by the presence of evening hyperphagia (>25% of daily caloric intake) and/or nocturnal awaking with food ingestion occurring ⩾ 2 times per week. AIMS: Although the syndrome is frequently comorbid with obesity, metabolic and psychiatric disorders, its etiopathogenesis, diagnosis, assessment and treatment still remain not fully understood. METHODS: This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; PubMed database was searched until 31 October 2020, using the key terms: 'Night Eating Syndrome' AND 'complications' OR 'diagnosis' OR 'drug therapy' OR 'epidemiology' OR 'etiology' OR 'physiology' OR 'physiopathology' OR 'psychology' OR 'therapy'. RESULTS: From a total of 239 citations, 120 studies assessing night eating syndrome met the inclusion criteria to be included in the review. CONCLUSION: The inclusion of night eating syndrome into the Diagnostic and Statistical Manual of Mental Disorders-5 'Other Specified Feeding or Eating Disorders' category should drive the attention of clinician and researchers toward this syndrome that is still defined by evolving diagnostic criteria. The correct identification and assessment of NES could facilitate the detection and the diagnosis of this disorder, whose bio-psycho-social roots support its multifactorial nature. The significant rates of comorbid illnesses associated with NES and the overlapping symptoms with other eating disorders require a focused clinical attention. Treatment options for night eating syndrome include both pharmacological (selective serotonin reuptake inhibitors, topiramate and melatonergic drugs) and non-pharmachological approaches; the combination of such strategies within a multidisciplinary approach should be addressed in future, well-sized and long-term studies.

A Cross-Sectional Study of Evening Hyperphagia and Nocturnal Ingestion: Core Constituents of Night Eating Syndrome with Different Background Factors.

This web-based cross-sectional survey aimed to elucidate the differences between the two core symptoms of night eating syndrome (NES): evening hyperphagia and nocturnal ingestion in the general Japanese population aged 16-79 years. Participants who consumed at least 25% of daily calories after dinner were defined as having evening hyperphagia. Those who consumed food after sleep initiation at least twice a week were determined to have nocturnal ingestion. Of the 8348 participants, 119 (1.5%) were categorized in the evening hyperphagia group, 208 (2.6%) in the nocturnal ingestion group, and 8024 in the non-NES group. Participants with evening hyperphagia and nocturnal ingestion had significantly higher anxiety scores (p < 0.05 and p < 0.001, respectively) and depression (p < 0.001 for both) than those without NES. Multiple logistic regression analysis revealed that evening hyperphagia was significantly and independently associated with higher body mass index, shorter sleep duration, later sleep-wake schedule, and higher insomnia score, while nocturnal ingestion was significantly and independently associated with younger age, smoking habit, living alone, earlier sleep-wake schedule, and higher insomnia score. Sleep duration and sleep-wake schedule characteristics in the two groups were opposite, suggesting differences in the sleep pathophysiology mechanisms.

Evaluation of night eating syndrome in individuals with and without obesity.

INTRODUCTION: There are publications with contrasting results on the relationship between night eating syndrome and obesity. The aim of this study was to investigate the frequency and relationship between night eating syndrome (NES) in obese and non-obese participants. MATERIAL AND METHODS: Between 1 January 2018 and 1 May 2018, 420 people ages 18-65 years who applied to Izmir Katip Çelebi University Atatürk Training and Research Hospital Family Medicine and Endocrinology outpatient clinics for any reason enrolled in this study. Body mass index (BMI = weight [kg]/height² [m²]) was calculated by measuring participants' height and weight. BMI values between 18.50 and 24.99 were normal weight, between 25.0 and 29.99 were overweight, between 30.0 and 39.99 were obese, and 40.0 and above were considered morbidly obese. Participants' sociodemographic data, the Night Eating Questionnaire (NEQ), and the Beck Depression Inventory (BDI) were administered by face-to-face interview technique. RESULTS: The average age of the participants was 42 ± 13 years and 68.6% were female. The mean body mass index (BMI) of the participants was 31.8 ± 8.2. The prevalence of NES was determined: 10% of the participants had NES. The higher frequency of NES in patients with morbid obesity was found to be statistically significant compared to those without morbid obesity (p < 0.05). The mean BDS score was 23.5 ± 10.86 (min: 0, max: 46) in the NES group and 12.18 ± 88.95 (min: 0, max: 49) in the non-NES group. There was a significant difference between the two groups in terms of BDS scores (p < 0.001). CONCLUSIONS: Because obesity has an important place in primary health care services, it is important to know the relationship between NES and depression. Recognition of NES and consideration of planned follow-up and treatment in the applicants will help to treat obesity more effectively.

Dietary patterns of patients with binge eating disorders with and without night eating.

OBJECTIVE: This study aimed to compare dietary patterns (timing and frequency of binge episodes, caloric intake and macronutrient composition) of patients with binge eating disorders (BE) with and without night eating syndrome (NES). DESIGN: The study includes 59 women (18-60) who sought treatment for Eating Disorders (EDs) and were diagnosed with BED or BN (BE) with or without NES. They were divided into two groups: NES-BE and BE-only. The participants kept 7-day, 24-h food diaries and completed demographic and depression questionnaires. RESULTS: NES-BE reported significantly a higher frequency of binge days and binge episodes during the week, and more energy and fat consumption than BE-only. CONCLUSIONS: Individuals with NES-BE exhibit higher levels of eating pathology than individuals with BE-only. Thus, NES-BE may not be simply a variant of BED or BN but rather a separate entity that may lead to a more severe disorder and require early assessment and more intensive and suitable treatment. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Night eating syndrome: a psychiatric disease, a sleep disorder, a delayed circadian eating rhythm, and/or a metabolic condition?

Introduction: Night Eating Syndrome (NES) refers to an abnormal eating behavior which presents as evening hyperphagia consuming >25% calorie intake and/or nocturnal awaking with food ingestion which occurs ≥2 times per week. Although the syndrome has been described more than seven decades ago, the literature has been growing slowly on its etiology, diagnosis, and treatment. Areas covered: The proposed treatment options for NES are all at a case-study level. Moreover, our understanding of its etiology, comorbidities, and diagnosis is still premature. We performed a literature review in Medline/PubMed to identify all the studies proposing a management plan for NES and summarized all the existing data on its diagnosis and treatment. Expert opinion: To date, none of the proposed treatment options for NES have been promising and long-term data on its efficacy is lacking. The slow growth of evidence on this debilitating but underreported condition may be due to unawareness among clinicians, under-reporting by patients, and unrecognized diagnostic criteria. Objective screening of symptoms during office visits especially for patients at a high-risk for NES will identify more patients suffering from the syndrome.

Brain-Behavior-Immune Interaction: Serum Cytokines and Growth Factors in Patients with Eating Disorders at Extremes of the Body Mass Index (BMI) Spectrum.

Alterations of the immune system are known in eating disorders (EDs), however the importance of cytokine balance in this context has not been clarified. We compared cytokines and growth factors at opposite ends of BMI ranges, in 90 patients classified in relation to BMI, depressive and EDs comorbidities. Serum concentrations of interleukin (IL)-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were determined by a biochip analyzer (Randox Labs). Differences were calculated through ANOVA. Possible predictors of higher cytokine levels were evaluated through regression analysis. IL-1α, IL-10, EGF, and IFN-γ were altered individuals with anorexia nervosa (AN) and binge eating disorder (BED). Night-eating was associated with IL-8 and EGF levels, IL-10 concentrations with post-dinner eating and negatively with sweet-eating, long fasting with higher IFN-γ levels. IL-2 increase was not linked to EDs, but to the interaction of depression and BMI. Altogether, for the first time, IL-1α, IL-10, EGF, and IFN-γ were shown to differ between AN and HCs, and between AN and individuals with obesity with or without BED. Only IL-2 was influenced by depression. Dysfunctional eating behaviors predicted abnormal concentrations of IL-10, EGF, IL-8 and IFN-γ.

The relationship between food insecurity and binge and night eating symptoms in prebariatric surgery patients is mediated by depressive symptoms.

BACKGROUND: Eleven percent of households in the United States experience food insecurity, which is a lack of access to adequate, desirable food for a healthy lifestyle. Although food insecurity is associated with increased risk of obesity and nonadherence to dietary management of chronic diseases such as diabetes, the correlates of food insecurity have not yet been studied in a bariatric surgery population. OBJECTIVES: To replicate, in a bariatric sample, previous findings that food insecurity is related to eating pathology and to test the hypothesis that this relationship is mediated by depressive symptoms. SETTING: University hospital, United States. METHODS: Two hundred forty bariatric surgery candidates responded to self-report measures of food insecurity and mood, night-eating, and binge-eating symptoms. The sample was 74% female and 71% white, with a mean age of 41.09 (11.84) years. Based on responses to the United States Department of Agriculture Adult Food Security Survey Model, 15.8% were categorized as food insecure and 25.8% as marginally food secure. Multiple regression models with bootstrapping for confidence interval estimates were used to explore mediation hypotheses. RESULTS: Food insecurity was positively associated with symptoms of night eating and binge eating, and these relationships were cross-sectionally mediated by depressive symptoms. CONCLUSIONS: Food insecure bariatric candidates may be at increased risk of poorer postoperative outcomes because of lack of access to needed food and the detrimental mental health impact of this lack of access.

A Review of the Relationship between Night Eating Syndrome and Body Mass Index.

PURPOSE OF THE REVIEW: To review literature on night eating syndrome (NES) and body mass index (BMI, kg/m2) published in the last 5 years. RECENT FINDINGS: Since December, 2013, 11 studies examined the association between NES and BMI. Five of these studies reported a positive relationship, five showed no relationship, and one produced mixed findings. Emotional eating and age were moderators. Twelve studies examined whether there was a difference in BMI between those with and without NES with only five of these finding differences. A primary weakness of the recent literature base is that it is almost entirely cross-sectional. Recent findings regarding the relationship between NES and BMI are mixed. Future research should examine the relationship between these variables longitudinally and continue to examine moderating variables that explain why some individuals manifest excess weight with NES and others do not.

Night Eating Syndrome and Its Relationship with Emotional Eating, Sleep Quality and Nutritional Status Among Adolescents' Boys.

Current study was aimed to evaluate the relationship between emotional eating and night eating syndrome (NES) with sleep quality among adolescents in Tabriz-Iran. The current study was conducted among eighty adolescent boys aged 12-16 years old from Tabriz-Iran. Night eating syndrome and Emotional eating were measured by validated specific questionnaires. Pittsburgh Sleep Quality Index questionnaire (PSQI) was used for assessment of sleep quality. Emotional and very emotional eaters had significantly higher protein and fat intake. Among components of PSQI, subjective sleep quality, sleep disturbances and daytime dysfunction scores among emotional and very emotional eaters were significantly higher. Moreover, adolescents with NES, had higher PSQI score and lower carbohydrate intake; whereas, intake of fat among NES group was significantly higher (P < 0.05). Our results indicated poor sleep quality and higher dietary fat intake among adolescents with emotional eating disorder and NES. Therefore, it is necessary to consider healthy nutritional pattern including low fat intake in prevention of developing emotional eating and NES among adolescents.

Psychometric properties and gender invariance of the simplified Chinese version of Night Eating Questionnaire in a large sample of mainland Chinese college students.

PURPOSE: The Night Eating Questionnaire (NEQ) is the most frequently used instrument for assessing night eating syndrome (NES), and it has been translated to many languages, including a traditional Chinese version in Taiwan. However, significant differences exist in the social, linguistic, and cultural contexts between mainland China and Taiwan. For its use in mainland China, a simplified Chinese version is needed and its psychometric properties should be further evaluated. Thus, the current study aimed to obtain a simplified Chinese NEQ (SC-NEQ) and validate its psychometric properties. METHODS: According to standard procedures, the SC-NEQ was obtained by language transformation from the traditional Chinese version of NEQ. The SC-NEQ was then administered to 1273 mainland Chinese college students recruited from three provinces in mainland China. RESULTS: The four-factor structure of the original English NEQ (morning anorexia, evening hyperphagia, mood/sleep, and nocturnal ingestions) was confirmed in the current sample. Moreover, a second-order model also fitted the data well. The SC-NEQ showed good reliability with a Cronbach's alpha and omega of 0.70 and 0.83, respectively. The total score of the SC-NEQ was significantly and moderately correlated with eating pathology (r = .35, p < .01). Strong measurement invariance across gender groups was also supported. CONCLUSIONS: These findings suggest that the SC-NEQ can be a useful tool to assess NES in mainland China. LEVEL OF EVIDENCE: V, descriptive (cross-sectional) study.

Night eating syndrome in patients with eating disorders: Is night eating syndrome distinct from bulimia nervosa?

BACKGROUND/PURPOSE: Night eating syndrome (NES) is a diagnosis newly introduced in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders. This study investigated the characteristics of NES in individuals with eating disorders and the clinical significance of NES in individuals with bulimia nervosa (BN). METHODS: We recruited participants with eating problems at psychiatric outpatient clinics and from Internet referrals and age, sex, and educational level-comparable controls from September 2013 to April 2017. All participants received in-face structured clinical interviews to establish their eating disorder and NES diagnoses and completed questionnaires assessing NES, eating attitudes/behaviors, depression, sleep disturbances, morningness/eveningness preference, and functional impairment. Comparisons of measurements were made across patients with eating disorder subtypes and across patients with NES-only, BN-only, comorbid BN and NES, and controls. RESULTS: NES was identified in 10.3%, 34.9%, and 51.7% of the individuals with anorexia nervosa, BN, and binge-eating disorder, respectively. NES-only group had more frequent binge-eating, higher degrees of eating pathology, depression, sleep disturbances, and functional impairment compared to controls; however, NES-only group shared similar levels of disordered eating, depression, sleep disturbances, and functional impairment with BN-only group. BN-NES group had no difference from BN-only group on most eating pathology, psychopathology, and functional impairment, except for the presence of greater eating and weight concerns. CONCLUSION: NES has its clinical significance; however, it overlaps with BN in several dimensions of psychopathology. Presence of night eating in a BN group may not contribute clinically meaningful psychopathology.

The relationship between night eating symptoms and disordered eating attitudes via insomnia and chronotype differences.

Humans' sleep timing and the psychological construct "diurnal preference" determines their "chronotype" (i.e., morning or evening type). Diurnal preferences can affect sleep-awake rhythms and eating behaviors. Our aim in this study was to examine the relationship between night eating symptoms and disordered eating attitudes by evaluating insomnia and chronotype differences in university students. The participants, 383 university students, filled out a package of psychological tools, including the Morningness-Eveningness Questionnaire, the Insomnia Severity Index, the Night Eating Questionnaire, and the Eating Attitude Test. One way analysis of variance was used to investigate the relationship of chronotypes with scale scores, and mediation regression analysis was used to investigate the indirect effects of night eating symptoms on disordered eating attitudes. Insomnia and night eating scores of the participants varied statistically according to chronotypes, and both insomnia and night eating scores were associated with the evening type. Findings show that night eating symptoms have a direct effect on the chronotype differences and insomnia and an indirect effect on disordered eating attitudes, by increasing insomnia scores. In conclusion, night eating syndrome may represent the misalignment of food intake and may shift the circadian rhythm to delayed sleep phase, acting as a peripheral oscillator in human.

Why I eat at night: A qualitative exploration of the development, maintenance and consequences of Night Eating Syndrome.

Night Eating Syndrome (NES), as a diagnosis, presents as a combination of disordered eating, sleep and mood. Patients identified as having both NES and obesity demonstrate poorer outcomes in terms of weight loss compared to those with NES only. However, research focusing on psychological factors associated with NES remains relatively underdeveloped. This study aimed to explore the relationship between NES and the experience of emotion from the perspective of patients accessing a weight management service. Ten adults who met diagnostic criteria for moderate or full NES took part in a semi-structured interview. Data were analysed using a constructivist approach to grounded theory. A core concept to emerge from the analysis was termed 'emotional hunger'; reflecting an urge or need to satiate a set of underlying unmet emotional needs. It was underpinned by the following interrelated themes: (1) Cultivating a dependency on food; (2) Relying on food to regulate emotions; (3) Understanding the significance of night-time; (4) Acknowledging the consequences of night eating. This study provides an in-depth understanding of the relationship between NES and the experience of emotion from the perspective of patients attending a weight management service. Results have potential to inform future service development, particularly around the adoption of a more holistic approach to night eating behaviours.

Prevalence, demographic correlates, and association with psychological distress of night eating syndrome among Chinese college students.

Night eating syndrome (NES) has primarily been studied in Western societies, and the prevalence and associated factors of NES in China still remain unknown. This study examined the prevalence, demographic correlates, and association with psychological distress of NES among Chinese college students. By using the Chinese version of Night Eating Questionnaire (C-NEQ), data were collected from 909 university students sampled from three provinces in China. Results showed that the prevalence of NES was 2.8% (2.4% after excluding students with binge eating); the occurrence of NES was correlated with gender ([Formula: see text]) and the higher night eating scores were significantly correlated with higher psychological distress (rs = .396-.471, ps < .001). Because of the huge population base in China, there could be a large number of Chinese college students with NES. Therefore, more attention is needed for prevention, detection, and treatment of NES for Chinese college students.

Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities.

Binge-eating disorder (BED) and night-eating syndrome (NES) are two forms of disordered eating associated with overweight and obesity. While these disorders also occur in nonobese persons, they seem to be associated with weight gain over time and higher risk of diabetes and other metabolic dysfunction. BED and NES are also associated with higher risk of psychopathology, including mood, anxiety, and sleep problems, than those of similar weight status without disordered eating. Treatments are available, including cognitive behavior therapy (CBT), interpersonal psychotherapy, lisdexamfetamine, and selective serotonin reuptake inhibitors (SSRIs) for BED; and CBT, SSRIs, progressive muscle relaxation, and bright light therapy for NES.

The effect of agomelatine and melatonin on sleep-related eating: a case report.

BACKGROUND: Sleep-related eating may occur in the context of mental illness, sleep disorders, or psychopharmacological treatment. Frequently, sleep-related eating leads to severe weight gain and, so far, there are no treatment options for the condition. CASE PRESENTATION: We report the case of a 54-year-old white woman with depression, panic disorder, and sleep apnea under treatment with various antidepressants who developed severe sleep-related eating. Her sleep-related eating completely vanished after addition of agomelatine, it reoccurred after cessation of agomelatine, and vanished again after her re-exposure to another melatonergic drug, extended melatonin. CONCLUSIONS: This case suggests that melatonergic drugs lead to relief from sleep-related eating, even when the condition occurs in the context of physical and mental disorders as well as psychopharmacological treatment.

Night eating among veterans with obesity.

The obesity rate is higher among veterans than the general population, yet few studies have examined their eating behaviors, and none have examined the presence of night eating and related comorbidities. This study examines night eating syndrome (NES) among veterans seeking weight management treatment, and relationships between NES and weight, insomnia, disordered eating, and psychological variables. The sample consisted of 110 veterans referred to a weight management program at VA Connecticut Healthcare System. More than one out of ten veterans screened positive for NES, and one-third screened positive for insomnia. Most individuals screening positive for NES also screened positive for insomnia. Night eating was associated with higher BMI, and with higher scores on measures of binge eating, emotional overeating, and eating disorder symptomatology. Veterans screening positive for NES were also significantly more likely to screen positive for depression and PTSD. When controlling for insomnia, only the relationships between night eating and binge and emotional eating remained significant. Those screening positive for PTSD were more likely to endorse needing to eat to return to sleep. Findings suggest that both NES and insomnia are common among veterans seeking weight management services, and that NES is a marker for additional disordered eating behavior, specifically binge eating and overeating in response to emotions. Additional studies are needed to further delineate the relationships among NES, insomnia, and psychological variables, as well as to examine whether specifically addressing NES within behavioral weight management interventions can improve weight outcomes and problematic eating behaviors.