Characterization of refeeding protocols for under 18 years old hospitalized patients with anorexia nervosa: A systematic review.

PURPOSE: To characterize and compare, through descriptive analysis, existing refeeding protocols for under 18 years old hospitalized patients with anorexia nervosa (AN). METHODS: This is a systematic review of PubMed, Cochrane, SciELO, Lilacs and BVS databases, without search period restriction. Studies were selected in accordance with pre-defined eligibility criteria and according to the Population, Intervention, Comparator, Outcome and Study Design (PICOS). RESULTS: Twenty articles out of 412 found complied with PICOS eligibility criteria and were included in the final review. Most of the studies were observational or retrospective and 80% were published in the last decade. Large variability in relation to sample size, refeeding protocols and length of stay were observed between studies. CONCLUSION: All included studies had several methodological limitations and heterogeneous designs, making it difficult to establish conclusive guidelines regarding the most adequate and effective refeeding protocol for under 18 years old hospitalized patients with AN. Prospective trials are necessary to straight compare standard refeeding protocols for this population.

Associação entre fontes de informação utilizadas por estudantes de nutrição e percepção da função da alimentação / Association between sources of information used by nutrition students and their perception of the function of food

A atuação dos nutricionistas pode ser baseada na percepção do que é alimentação saudável, por sua vez influenciada pela formação e por diversas fontes de informação. Este estudo tem como objetivo identificar as fontes de informação que os estudantes de Nutrição usam para se atualizar e sua associação com percepção da função da alimentação, fase da graduação e tipo de instituição de ensino. Participaram 497 estudantes de 41 instituições do estado de São Paulo ­ Brasil - que responderam de forma online quais as principais fontes de informação utilizadas para se atualizar, qual a principal função da alimentação e questões de caracterização da amostra. As respostas foram codificadas e a associação entre as fontes de informação com as demais variáveis foram avaliadas pelo teste qui-quadrado de Pearson. Artigos científicos foram citados por 51,7% dos estudantes como principal fonte de informação. A principal função da alimentação foi referida como exclusivamente biológica por 72,4% dos estudantes. O uso da mídia como primeira fonte de informação foi mais frequente entre aqueles que relataram apenas aspectos biológicos como função da alimentação (p=0,024). A fonte de informação esteve associada com percepção de alimentação saudável, tipo de instituição de ensino e fase da graduação. As informações provenientes da mídia devem ser discutidas de forma crítica, especialmente na atual vigência de controvérsias na Nutrição.

The performance of nutritionists can be based on their perception of what healthy eating is, which is in turn influenced by training and different sources of information. This study aims to identify the sources of information that Nutrition students use to update themselves and their association with their perception of the function of food, their academic stage, and type of educational institution. The participants were 497 students from 41 institutions in the state of São Paulo ­ Brazil ­ who answered online what the main sources of information used to update themselves are, what the main function of food is, and questions about the characterization of the sample. The answers were coded and the association between the information sources and the other variables were evaluated using Pearson's chi-squared test. Scientific articles were cited by 51.7% of students as the main source of information. The main function of food was referred to as exclusively biological by 72.4% of students. The use of the media as the primary source of information was more frequent among those who reported only biological aspects such as a function of eating (p=0.024). The source of information was associated with perception of healthy eating, type of educational institution and academic stage. Information from the media must be critically discussed, especially in the present current of controversies in nutrition.

Alimentação saudável na perspectiva dos estudantes de Nutrição do estado de São Paulo / Healthy eating in the perspective of Nutrition students of the state of São Paulo

Introdução: A alimentação é um dos fatores determinantes da saúde. Estudantes de Nutrição, quando formados, atuarão com base em sua percepção de alimentação saudável para promover, manter e recuperar a saúde por meio da alimentação. Por isso, sua percepção de alimentação saudável, que é variável e influenciada por múltiplos fatores, pode impactar a saúde e o atual cenário epidemiológico. Objetivo: explorar a percepção de alimentação saudável de estudantes de Nutrição do estado de São Paulo. Materiais e métodos: uma amostra de 625 estudantes de graduação em Nutrição de 42 instituições públicas e privadas localizadas em 25 municípios do estado de São Paulo, participantes do Estudo de Saúde dos Nutricionistas respondeu, de forma online, um questionário com abordagem quantitativa e qualitativa desenvolvido para avaliar a percepção de alimentação saudável, a Escala de Silhuetas Brasileiras, a subescala Relação com a comida da Escala de Atitudes Alimentares Transtornadas, um questionário para avaliar comportamento de risco para transtornos alimentares (TA), além de questões de caracterização da amostra. Foram investigadas a associação entre a percepção de alimentação saudável e tipo de instituição, fase da graduação, sexo, estado nutricional, comportamento de risco para TA, satisfação corporal por meio do teste qui-quadrado; a relação entre a percepção de alimentação saudável e relacionamento com a comida por meio do teste de Mann Whitney; e a predição da percepção de alimentação saudável a partir das variáveis do estudo por meio de um modelo de Árvore de Classificação e Regressão. Resultados: Dos estudantes, 82,4% eram provenientes de instituições privadas, tinham em média 23,42 anos (DP=2,96), 93,4% eram do sexo feminino, 70,2% era eutrófica, 23,2% relataram algum comportamento de risco para TA, 85,0% estavam insatisfeitos com sua imagem corporal, 71,5% entendiam alimentação saudável exclusivamente do ponto de vista biológico e 28,5% consideravam alimentação saudável como um fenômeno biopsicossociocultural. A percepção de alimentação saudável esteve associada ao tipo de instituição de ensino e fase da graduação, sendo que estudantes de instituições públicas e no final da graduação, entendiam, em maior frequência, alimentação saudável como aquela que considera aspectos biopsicossocioculturais (p<0,001, para ambos). Não foram encontradas associações entre percepção de alimentação saudável e sexo (p=0,910), estado nutricional (p=0,552), comportamento de risco para TA (0,382) e satisfação corporal (p=0,352), nem relação entre percepção de alimentação saudável e relacionamento com a comida (p=0,159). A percepção de alimentação saudável pôde ser predita, com precisão de 66,4%, principalmente a partir do tipo de instituição, da percepção da função do nutricionista, do semestre da graduação, do nível de atividade física, do uso de artigos científicos como fonte de informação, da percepção corporal e da atitude com relação à manteiga, sendo o tipo de instituição de ensino o fator mais importante para classificar os estudantes segundo a percepção biológica e biopsicossociocultural da alimentação. Conclusão: A maior parte dos estudantes entende que a percepção de alimentação saudável está relacionada, principalmente, aos aspectos biológicos. Enquanto que uma parcela menor entende a alimentação saudável como um fenômeno biopsicossociocultural. A percepção de alimentação saudável esteve associada ao tipo de instituição de ensino e fase da graduação e não esteve associada a sexo, estado nutricional, comportamento de risco para TA, satisfação corporal e relacionamento com a comida. O estudo oferece como contribuição uma ferramenta para predição da percepção de alimentação saudável dos estudantes e uma reflexão sobre a formação do nutricionista, servindo de base para a proposição de estratégias de ensino que promovam a visão biopsicossociocultural da alimentação, saúde e Nutrição.Título em inglêsHealthy eating in the perspective of Nutrition students of the state of São Paulo

Introduction: Food is one of the determinants of health. Students of Nutrition, when graduated, will act based on their perception of healthy eating to promote, maintain and restore health through foods. Therefore, their perception of healthy eating, which is variable and influenced by multiple factors, can impact health and the current epidemiological scenario. Objective: to explore the perception of healthy eating among students of Nutrition in the state of São Paulo - Brazil. Materials and methods: a sample of 625 undergraduate students of Nutrition from 42 public and private institutions located in 25 municipalities of the state of São Paulo, participants of the Health Study of Nutritionists, answered online, a questionnaire with quantitative and qualitative approach developed to evaluate the perception of healthy eating, the Figure Rating Scales for Brazilian Adults, the subscale Relation with food of the Disordered Eating Attitude Scale, a questionnaire to evaluate risk for eating disorders (ED), and questions of characterization of the sample. We investigated the association between the perception of healthy eating and type of institution, graduation phase, sex, nutritional status, risk for ED, body satisfaction through the chi-square test; the relation between the perception of healthy eating and relationship with food through the Mann Whitney test; and the prediction of healthy eating perception from the study variables through a Classification and Regression Tree model. Results: Of the students, 82.4% came from private institutions, had a mean of 23.42 years (SD = 2.96), 93.4% were female, 70.2% had normal weight, 23, 2% reported some risk behavior for ED, 85% were dissatisfied with their body image, 71.5% considered healthy eating exclusively from a biological point of view and 28.5% considered healthy eating as a biopsychosociocultural phenomenon. The perception of healthy eating was associated with the type of institution and undergraduate phase, and students from public institutions and at the end of the undergraduate course understood, more frequently, healthy eating as the one that considers biopsychosociocultural aspects (p < 0.001, for both). There were no associations between healthy eating perception and sex (p = 0.910), nutritional status (p = 0.552), risk behavior for ED (p = 0.382) and body satisfaction (p = 0.352), nor relation between healthy eating perception and relationship with food (p = 0.159). The perception of healthy eating could be predicted with an accuracy of 66.4%, mainly from the type of institution, the perception of the function of the dietitian, the graduation semester, the level of physical activity, the use of scientific articles as a source of information, body perception and attitude towards butter, and the type of institution is the most important factor to classify students according to the biological and biopsychosociocultural perception of healthy eating. Conclusion: Most students understand that the perception of healthy eating is mainly related to biological aspects. While a smaller portion understands healthy eating as a biopsychosociocultural phenomenon. The perception of healthy eating was associated with the type of institution and graduation phase and was not associated with gender, nutritional status, risk for ED, body satisfaction and relationship with food. The study offers as a contribution a tool to predict the perception of healthy eating of students and a reflection on the formation of the dietitian, serving as the basis for proposing teaching strategies that promote the biopsychosociocultural view of food, health and Nutrition

Attitudes toward health and taste of food among women with bulimia nervosa and women of a non-clinical sample.

Taste preferences and health concerns play important roles in determining eating attitudes, thus influencing food choices. Disordered eating attitudes are common among women, and can lead to the development and maintenance of eating disorders (ED). Attitudes toward health and taste of food among ED patients and its comparison with non-clinical women are not well known, and this knowledge could improve eating interventions. In this study, we compared taste preferences and health concerns in 27 women with diagnosis of bulimia nervosa (BN) and 216 women of a non-clinical sample. All participants completed the Health and Taste Attitude Scale (HTAS). Using analysis of covariance we compared the HTAS scores of the BN patients with those of the college students. Risk behaviors for ED (assessed by the Eating Attitudes Test) were identified in 54 (25%) of the non-clinical sample, all of whom were therefore excluded in comparison of BN patients. Non-clinical sample, compared to patients, scored higher on the HTAS Taste domain (p < 0.001) and its pleasure subscale (p < 0.001), whereas patients scored higher on the HTAS Health domain (p < 0.05) and its light product interest subscale (p < 0.05). Based on our data, eating attitudes of women of non-clinical sample are related to taste and pleasure, whereas women with BN are concerned with adopting a diet regarded as healthy, thus increasing their interest in "light" products. Therefore, the taste and health concerns must be considered in nutrition interventions for women in general, and prevention and treatment of ED as determinants of food choice.

Validation of the Disordered Eating Attitude Scale for adolescents / Validação da Escala de Atitudes Alimentares Transtornadas para adolescentes

ABSTRACT Objective To perform the psychometric evaluation of the Disordered Eating Attitude Scale (DEAS) for adolescents. Methods Sample consisted of 1,119 Brazilian adolescents (12-18 years old; 59.6% female) studying at technical schools in São Paulo state-Brazil, who answered an online survey with the DEAS, the Eating Attitude Test (EAT-26), and the Restraint Scale (RS). The internal consistency of the DEAS was assessed using Cronbach’s alpha. The convergent validity of DEAS was evaluated by means of Pearson’s coefficient correlation with EAT-26 and RS. The test-retest reliability was evaluated using a sub-sample of 61 adolescents. Known-groups validity was determined by comparing female student mean scores with scores of 33 female adolescents with eating disorders. Results The reliability of the DEAS was 0.79. EAT-26 and RS scores were positively correlated with DEAS scores (EAT: 0.78 for females and 0.59 for males, p < 0.001; RS: 0.63 for females and 0.48 for males, p < 0.001). The DEAS total and subscale scores differentiated students and patients with eating disorders (p < 0.001). The intra-class correlation coefficient for test-retest reliability was 0.87. Conclusion Results indicate that the DEAS adolescent version showed good internal consistency, convergent validity, known-groups validity, and test-retest reliability, suggesting its potential in identifying disordered eating attitudes among adolescents. It could also be helpful in identifying adolescents at risk from eating disorders, assisting in prevention programs.

RESUMO Objetivo Realizar a avaliação psicométrica da Escala de Atitudes Alimentares Transtornadas (EAAT) para adolescentes. Métodos A amostra foi composta por 1.119 adolescentes (12-18 anos; 59,6% do sexo feminino) estudantes de escolas técnicas do estado de São Paulo, que responderam online à EAAT, ao Teste de Atitudes Alimentares (EAT-26) e à Escala de Restrição (RS). A consistência interna da EAAT foi avaliada usando o alpha de Cronbach e a validade convergente por meio do coeficiente de correlação de Pearson com o EAT-26 e a RS. A confiabilidade teste-reteste foi avaliada usando uma subamostra de 61 adolescentes. A validade known-groups foi determinada pela comparação dos escores médios de estudantes do sexo feminino com os escores de 33 adolescentes do sexo feminino com transtornos alimentares. Resultados A consistência interna foi de 0,79, e as pontuações no EAT-26 e na RS estiveram positivamente correlacionadas com a pontuação da EAAT (EAT: 0,78 para o sexo feminino e 0,59 para o masculino, p < 0,001; RS: 0,63 para o sexo feminino e 0,48 para o masculino, p < 0,001). O escore da EAAT diferenciou estudantes e pacientes com transtornos alimentares (p < 0,001). O coeficiente de correlação intraclasse na confiabilidade teste-reteste foi de 0,87. Conclusão A versão da EAAT para adolescentes mostrou boa consistência interna, validade convergente, known-groups e confiabilidade teste-reteste, sugerindo o seu potencial na identificação de atitudes alimentares transtornadas entre adolescentes. Ela pode, portanto, ser útil na identificação de adolescentes com risco de transtornos alimentares, auxiliando em programas de prevenção.

[Cross-cultural adaptation and validation of the Health and Taste Attitude Scale (HTAS) in Portuguese]. / Adaptação transcultural e validação para o português da Escala de Atitudes em Relação ao Sabor da Health and Taste Attitude Scale (HTAS).

The scope of this study was to show the cross-cultural adaptation and validation of the Health and Taste Attitude Scale in Portuguese. The methodology included translation of the scale; evaluation of conceptual, operational and item-based equivalence by 14 experts and 51 female undergraduates; semantic equivalence and measurement assessment by 12 bilingual women by the paired t-test, the Pearson correlation coefficient and the coefficient intraclass correlation; internal consistency and test-retest reliability by Cronbach's alpha and intraclass correlation coefficient, respectively, after application on 216 female undergraduates; assessment of discriminant and concurrent validity via the t-test and Spearman's correlation coefficient, respectively, in addition to Confirmatory Factor and Exploratory Factor Analysis. The scale was considered adequate and easily understood by the experts and university students and presented good internal consistency and reliability (µ 0.86, ICC 0.84). The results show that the scale is valid and can be used in studies with women to better understand attitudes related to taste.

Adaptação transcultural e validação para o português da Escala de Atitudes em Relação ao Sabor da Health and Taste Attitude Scale (HTAS) / Cross-cultural adaptation and validation of the Health and Taste Attitude Scale (HTAS) in Portuguese

O objetivo do estudo foi apresentar a adaptação transcultural e validação da Escala de Atitudes em Relação ao Sabor da Health and Taste Attitude Scale para o Português. A metodologia contou com a tradução da escala; avaliação da equivalência conceitual, operacional e de item, por 14 experts e 51 universitárias; avaliação da equivalência semântica e mensuração, por 12 mulheres bilíngues por meio do teste t pareado, do coeficiente de correlação de Pearson e do coeficiente de correlação intraclasse; avaliação da consistência interna e confiabilidade teste-reteste por meio do Alpha de Cronbach e do Coeficiente de Correlação Intraclasse, respectivamente, após aplicação em 216 universitárias; avaliação da validade discriminante e concorrente, por meio do teste T e do Coeficiente de Correlação de Spearman, respectivamente; além de Análise Fatorial Confirmatória e Analise Fatorial Exploratória. A escala foi considerada adequada e de fácil compreensão pelos experts e universitárias e apresentou boa consistência interna e confiabilidade (µ 0,86; CCI 0,84). Os resultados apontam que a escala é válida e pode ser utilizada em estudos com mulheres, para entender melhor as atitudes em relação ao sabor.

The scope of this study was to show the cross-cultural adaptation and validation of the Health and Taste Attitude Scale in Portuguese. The methodology included translation of the scale; evaluation of conceptual, operational and item-based equivalence by 14 experts and 51 female undergraduates; semantic equivalence and measurement assessment by 12 bilingual women by the paired t-test, the Pearson correlation coefficient and the coefficient intraclass correlation; internal consistency and test-retest reliability by Cronbach's alpha and intraclass correlation coefficient, respectively, after application on 216 female undergraduates; assessment of discriminant and concurrent validity via the t-test and Spearman's correlation coefficient, respectively, in addition to Confirmatory Factor and Exploratory Factor Analysis. The scale was considered adequate and easily understood by the experts and university students and presented good internal consistency and reliability (µ 0.86, ICC 0.84). The results show that the scale is valid and can be used in studies with women to better understand attitudes related to taste.

Anorexia nervosa: differences and similarities between adolescents with and without a history of obesity / Anorexia nerviosa: diferencias y similitudes entre adolescentes con y sin antecedentes de obesidad

The aim of this study was to evaluate clinical differences and similarities between anorexia nervosa (AN) patients with and without a history of obesity. We evaluated 108 patients (10-18 years old) with the restricting or purging subtype of AN, treated at a public referral facility in Brazil. To evaluate clinical characteristics, we used a standardized psychiatric interview, the Development and Well-Being Assessment, the Children's Global Assessment Scale, the Eating Disorder Examination Questionnaire (EDE-Q), and body mass index (BMI)-for-age percentile. The mean age was 14.8±2.5 years, and 95 (88.0%) of the patients were female. Of the 108 patients evaluated, 78 (72.2%) had restrictive AN and 23 (21.3%) had a history of obesity. Patients with and without a history of obesity were similar in terms of age at onset, time from symptom onset to treatment, duration of treatment, impact of the disease on global functioning, and comorbidities. At treatment initiation, those with a history of obesity were at a higher BMI-for-age percentile and scored higher on the Weight Concern subscale of the EDE-Q. We conclude that severe cases of AN can occur in patients with and without a history of obesity with no differences in terms of the baseline characteristics and the duration of treatment. The significantly higher BMI-for-age percentiles amongst patients with a history of obesity (at treatment initiation) suggests that the urge for treatment shouldn't be based on BMI percentile only.

El objetivo de este estudio fue identificar las diferencias clínicas entre pacientes con anorexia nerviosa (AN) con y sin antecedentes de obesidad. Se evaluaron 108 pacientes (10-18 años de edad) con AN del subtipo restrictivo o purgativo, tratados en un centro público de referencia en Brasil. Para evaluar las características clínicas, se utilizaron una entrevista estandarizada psiquiátrica, el Development and Well-Being Assessment, la Children's Global Assessment Scale, el Eating Disorder Examination Questionnaire (EDE-Q), y el percentil del índice de masa corporal (IMC) para la edad. La edad media fue de 14.80±2, años, y 95 (88.00%) de los pacientes eran del sexo femenino. De los 108 pacientes, 78 (72.20%) tenían AN restrictiva y 23 (21.30%) tenían antecedentes de obesidad. Los pacientes con y sin antecedentes de obesidad eran similares en términos de edad de inicio de la enfermedad, tiempo desde el inicio de los síntomas hasta el inicio del tratamiento, duración del tratamiento, impacto de la enfermedad en el funcionamiento general y comorbilidades. Al inicio del tratamiento, los pacientes con antecedentes de obesidad estaban en un percentil más alto de IMC para la edad y puntuaron más alto en la subescala preocupación por el peso del EDE-Q. En conclusión, casos graves de AN pueden ocurrir en pacientes con y sin antecedentes de obesidad.

Risk behaviors for eating disorder in adolescents and adults with type 1 diabetes.

OBJECTIVE: To evaluate the frequency of risk behaviors for eating disorder (ED) in patients with type 1 diabetes (T1D) and their association with gender, nutritional status, variables related to T1D, and body satisfaction. METHOD: 189 individuals with T1D (12-56 years old) answered the Bulimic Investigation Test (BITE), the Eating Attitude Test (EAT), the Binge Eating Scale (BES), Stunkard's Figure Rating Scale, and questions regarding control of T1D. Association between ED risk behaviors and the selected variables was assessed with the chi-square test and Student's t-test; factors that influenced the risk of ED were identified by means of logistic regression. RESULTS: Of the patients with T1D, 58.7% were at risk of ED (45, 40, and 16% according to the EAT, BITE and BES, respectively). There were significant differences between groups with and without risk for ED related to BMI (p = 0.009), gender (p = 0.001), insulin omission (p = 0.003), use of the carbohydrate counting method (p = 0.019), and body dissatisfaction (p = 0.001). The risk of ED was nine times higher in patients who reduced or omitted insulin (p = 0.036). CONCLUSIONS: Patients with T1D demonstrated a high frequency of body dissatisfaction and ED risk behaviors; the omission or reduction of insulin was an important risk factor.

Risk behaviors for eating disorder in adolescents and adults with type 1 diabetes

Objective: To evaluate the frequency of risk behaviors for eating disorder (ED) in patients with type 1 diabetes (T1D) and their association with gender, nutritional status, variables related to T1D, and body satisfaction. Method: 189 individuals with T1D (12-56 years old) answered the Bulimic Investigation Test (BITE), the Eating Attitude Test (EAT), the Binge Eating Scale (BES), Stunkard's Figure Rating Scale, and questions regarding control of T1D. Association between ED risk behaviors and the selected variables was assessed with the chi-square test and Student's t-test; factors that influenced the risk of ED were identified by means of logistic regression. Results: Of the patients with T1D, 58.7% were at risk of ED (45, 40, and 16% according to the EAT, BITE and BES, respectively). There were significant differences between groups with and without risk for ED related to BMI (p = 0.009), gender (p = 0.001), insulin omission (p = 0.003), use of the carbohydrate counting method (p = 0.019), and body dissatisfaction (p = 0.001). The risk of ED was nine times higher in patients who reduced or omitted insulin (p = 0.036). Conclusions: Patients with T1D demonstrated a high frequency of body dissatisfaction and ED risk behaviors; the omission or reduction of insulin was an important risk factor. .

Who are the children and adolescent patients of a national referral service of eating disorders in Brazil?: a cross-sectional study of a clinical sample.

OBJECTIVES: To investigate the sociodemographic and clinical profile of patients receiving treatment at a specialized service for children and adolescents with eating disorders (ED) in São Paulo, Brazil, and to compare data with the relevant literature. METHODS: This cross-sectional study assessed male and female patients with ED up to 18 years of age. All data were collected upon admission. RESULTS: A total of 100 subjects were assessed. Mean age was 15.41±0.18 years, and mean age at ED onset was 13.5±0.19 years. Mean disease duration was 21.06 ±1.67 months. Of the total sample, 82% of the patients were female, 84% were Caucasian, 64% came from A and B economic tiers. Moreover, in 60% ED started at 14 years of age or less, and 74% had psychiatric comorbidities. Anorexia nervosa was the most prevalent diagnosis (43%). Hospitalized patients had lower body mass index, longer ED duration, and more severe scores on the Children's Global Assessment Scale than outpatients (p < 0.05). CONCLUSIONS: Our young Brazilian patients with ED present epidemiological and symptomatic characteristics very similar to those found in the scientific literature, including a high prevalence of psychiatric comorbidities. The higher frequency of full syndrome ED, the predominance of cases with an early onset, the delay in beginning specialized treatment, and the more severe state of inpatients provide grounds for concern because these factors differ from what has been reported in reference studies and indicate greater ED severity.

Atitudes em relação à saúde e sabor dos alimentos e imagem corporal entre mulheres / Attitudes regarding food health and taste and body image among women

O processo de escolha alimentar recebe múltiplas influências, sendo possível destacar a preocupação com a saúde, o prazer obtido por meio da alimentação e a satisfação corporal como importantes determinantes do consumo alimentar, podendo inclusive agir como fatores precipitantes e mantenedores de transtornos alimentares (TA). Objetivos - Avaliar como atitudes mais voltadas à saúde ou ao sabor dos alimentos diferem entre mulheres jovens de população não clínica e com TA; e a relação entre a imagem corporal e atitudes voltadas à saúde ou ao sabor entre estas mulheres. Métodos - 216 universitárias e 30 mulheres em tratamento para TA (18-40 anos; 83 por cento com diagnóstico de bulimia nervosa; 17 por cento com diagnóstico de anorexia nervosa) responderam a Escala de Atitudes em Relação à Saúde e ao Sabor (EARSS) e a Escala de Silhuetas Brasileiras. Universitárias participaram da adaptação transcultural da Escala de Sabor das EARSS e responderam ainda o Teste de Atitudes Alimentares para avaliação de risco para TA. A Escala de Sabor foi avaliada em relação à sua consistência interna, confiabilidade teste-reteste, validade discriminante e concorrente, além de análise fatorial confirmatória e exploratória. Os escores na EARSS de universitárias com e sem risco para TA e, pacientes com TA e universitárias sem risco foram comparados por meio de análise de covariância. A influência da satisfação e da percepção corporal nos escores na EARSS foi avaliada por meio do coeficiente de correlação de Pearson. Resultados - A Escala de Sabor foi considerada adequada e de fácil compreensão, 8 com boa consistência interna e confiabilidade (alpha de Crombach 0,86; Coeficiente de Correlação Intraclasse 0,84). O comportamento de risco para TA foi identificado em 25 por cento das universitárias, que não foram comparadas com pacientes. Universitárias sem risco de TA tiveram uma pontuação maior na Escala de Sabor da EARSS quando comparadas às pacientes (p=0,009). Universitárias com risco de TA tiveram pontuação maior na Escala de Saúde (p=0,022) comparadas aquelas sem risco. Pacientes apresentaram maiores níveis de insatisfação corporal (p<0,001) e pior percepção corporal (p=0,015) que a população não clínica. Em ambos os grupos, não houve correlação entre insatisfação e percepção corporal com atitudes mais voltadas à saúde ou ao prazer. Conclusão - Mulheres de população não clínica apresentaram atitudes mais voltadas ao sabor enquanto que aquelas com TA apresentaram atitudes mais voltadas à saúde, independente do grau de insatisfação e percepção corporal.

Food choice process receives multiple influences, could be highlighted the concern for health, the pleasure obtained through food and the body dissatisfaction as important determinants of food consumption, and may also act as precipitating factor and maintainers of eating disorders (ED). Objective - To assess how attitudes towards taste versus health differ between young women with eating disorders and young women from non-clinical population, and the relationship between these attitudes with their body image. Methods - 216 college students women and 30 women under treatment for ED (18-40 years; 83 per cent had a diagnosis of bulimia nervosa; 17 per cent had a diagnosis of anorexia nervosa) completed the Health and Taste Attitudes Scale (HTAS) and the Figure Rating Scales for Brazilian Adults. College students participated in the crosscultural adaptation of the Taste Scale of HTAS and answered Eating Attitudes Test - for assessing the risk for ED. The Taste Scale was assessed in terms of their internal consistency, test-retest reliability, concurrent and discriminant validity, and confirmatory factor analysis and exploratory. The scores of HTAS for students with and without risk for ED and, patients with ED and without risk for ED were compared using by means a covariance analysis. The influence of body satisfaction scores in HTAS was assessed by Pearson coefficient correlation. Results - The Taste Scale was considered adequate and easily understood, showed good internal consistency and reliability (Cronbachs alpha 0.86, Intraclass Correlation Coefficient 0.84). The risk behavior for ED was identified in 25.0 per cent of the college students, who were not 10 compared with patients. Students had a higher score on the Taste Scale when compared to the patients (p<0.009). College students with ED risk had higher score on Health Scale compared with those without ED risk (p=0.022). Patients had higher levels of body dissatisfaction (p<0.001) and worse body perception (p=0.015) than students. In both groups, there was no correlation between body dissatisfaction and perceived attitudes more focused health or taste. Conclusion - Women of non-clinical population had attitudes more focused on taste and pleasure while those with ED showed attitudes more geared towards health, regardless of the degree of dissatisfaction and body perception.

Who are the children and adolescent patients of a national referral service of eating disorders in Brazil?: a cross-sectional study of a clinical sample / Quem são os jovens pacientes de um serviço de referência nacional em transtornos alimentares no Brasil?: estudo transversal de uma amostra clínica

Objectives: To investigate the sociodemographic and clinical profile of patients receiving treatment at a specialized service for children and adolescents with eating disorders (ED) in São Paulo, Brazil, and to compare data with the relevant literature. Methods: This cross-sectional study assessed male and female patients with ED up to 18 years of age. All data were collected upon admission. Results: A total of 100 subjects were assessed. Mean age was 15.41±0.18 years, and mean age at ED onset was 13.5±0.19 years. Mean disease duration was 21.06 ±1.67 months. Of the total sample, 82% of the patients were female, 84% were Caucasian, 64% came from A and B economic tiers. Moreover, in 60% ED started at 14 years of age or less, and 74% had psychiatric comorbidities. Anorexia nervosa was the most prevalent diagnosis (43%). Hospitalized patients had lower body mass index, longer ED duration, and more severe scores on the Children's Global Assessment Scale than outpatients (p < 0.05). Conclusions: Our young Brazilian patients with ED present epidemiological and symptomatic characteristics very similar to those found in the scientific literature, including a high prevalence of psychiatric comorbidities. The higher frequency of full syndrome ED, the predominance of cases with an early onset, the delay in beginning specialized treatment, and the more severe state of inpatients provide grounds for concern because these factors differ from what has been reported in reference studies and indicate greater ED severity.

Objetivos: Investigar o perfil sociodemográfico e clínico de pacientes de um serviço especializado no tratamento de crianças e adolescentes com transtornos alimentares (TA) em São Paulo, Brasil, e comparar os dados com a literatura científica relevante. Métodos: Este estudo transversal avaliou pacientes com diagnóstico de TA de ambos os sexos, com idade até 18 anos. Os dados foram coletados na admissão dos pacientes ao serviço. Resultados: A amostra foi composta por 100 sujeitos. A idade média foi de 15,41±0,18 anos, e a média de idade ao início dos TA foi de 13,5±0,19 anos. O tempo médio de duração da doença foi de 21,06±1,67 meses. Da amostra total, 82% dos pacientes eram meninas, 84% eram brancos, 64% provinham das classes econômicas A e B. Além disso, 60% iniciaram a patologia com 14 anos ou menos e 74% tinham comorbidades psiquiátricas. A forma total da anorexia nervosa foi o diagnóstico mais prevalente (43%). Os pacientes hospitalizados tiveram menor índice de massa corporal, mais tempo de TA e escores mais graves na Escala de Avaliação Global de Crianças quando comparados com pacientes do ambulatório (p < 0,05). Conclusões: Os pacientes brasileiros jovens com TA avaliados no presente estudo apresentaram características epidemiológicas e sintomatológicas muito semelhantes aos dados da literatura científica, inclusive com relação à alta prevalência de comorbidades psiquiátricas. A maior frequência das síndromes totais dos TA, o predomínio de quadros de início precoce, o longo tempo decorrido até iniciar tratamento especializado e a maior gravidade dos pacientes hospitalizados observados nesta amostra chamam atenção por diferirem do que tem sido relatado em estudos semelhantes e também por indicarem uma maior gravidade do TA.