Normal bone mass in bulimic women

The aim of this study was to examine the relationship among exercise, menstrual function, and bone mineral density (BMD) in different groups of age-matched patients with eating disorders. Dieting and eating disorder history, physical activity history, and menstrual history were assessed by clinical interview in 43 bulimic and 13 anorectic young women as well as in 17 healthy control subjects (18-29 yr). BMD was assessed by dual x-ray absorptiometry. All the anorectics but only 30% of the bulimics exercised regularly from the onset of their eating disorder (P < 0.01), mainly using aerobic dancing and running. All of the anorectics had been amenorrheic since the start of their symptoms, and 68% of the bulimics had a history of menstrual dysfunction. Within the exercise subgroups of bulimic patients, there was no significant relationship between BMD and current or previous menstrual function. Anorectic patients had lower BMD than bulimics and controls in all skeletal regions studied (P < 0.01). Bulimic patients who had exercised regularly during their illness had higher total body BMD than bulimics classified as sedentary (P < 0.01). Bulimics who had exercised regularly or intermittently since the onset of their eating disorder had higher BMD than sedentary bulimics in the lumbar vertebrae, femoral neck, and legs (P < 0.05). It appears that weight-bearing exercise can prevent or attenuate bone loss at specific skeletal sites in normal weight bulimic patients, but not in anorectics.     

Oral-aboral ectoderm differentiation of sea urchin embryos is disrupted in response to calcium ionophore

Cognitive-behavioral therapy (CBT) has been shown to be a highly effective form of treatment for patients with bulimia nervosa and anorexia nervosa. Issues of satiety disturbances, food restriction, and food choice are central to this form of therapy; however, ingestive behavior research that directly addresses these issues in eating disorder patients has often been overlooked by clinicians. These areas of research are reviewed and the implications of the findings for more effective CBT therapy with anorexics and bulimics are discussed.     

Alexithymia in patients with eating disorders: an investigation using a new projective technique

The concept of alexithymia was scrutinized in a group of female patients with eating disorders: 15 anorectics and 13 bulimics (mean age of 27 yr.), plus a control group of 21 (mean age 38 yr.). Subjects were interviewed and tested. In the main test an ambiguous face was flashed briefly on a screen opposite the viewer who had to describe her impressions. To enhance the ego-involvement, subliminal words (I, I ILL, I WELL) were presented before each exposure. Contrary to expectations the present patients used more emotional words than controls. Instead, they employed alternative strategies to avoid empathizing. The results were interpreted as indicating a pronounced incapacity for emotional understanding.     

Psychological characteristics of dieters and bulimics.

Two studies examined the continuum and discontinuity models of the relation between dieting and bulimia nervosa. In Study 1, 21 dieters, 19 bulimics, and 33 nondieting controls were compared on 24 measures. Multivariate analyses revealed that each of the groups differed significantly from the other 2. Univariate analyses found 18 significant differences between bulimics and dieters and 1 significant difference between dieters and controls. In Study 2, 86 Ss completed measures of psychological functioning, dieting, and bulimia nervosa. On the basis of regression analyses using factor scores from the psychological variables as predictors, high scores on a psychopathology factor and low scores on a defensiveness factor predicted both bulimia and dieting. Low self-concept scores also predicted bulimia. These data indicate that both continuity and discontinuity characterize the relation between dieting and bulimia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of data-based semi-quantitative food frequency questionnaire for dietary studies in middle-aged Japanese

BACKGROUND: We designed a data-based semi-quantitative food frequency questionnaire to clarify the relationship between food intake and lifestyle-related diseases among middle-aged Japanese. METHODS: A total of 351 middle-aged individuals were recruited to a one-day weighed diet record survey in 1994. In all, 586 foods were consumed. Intake of 31 nutrients including energy, protein, fat, carbohydrate, vitamins, minerals and dietary fiber by food was computed by multiplying the weight of food consumed by its nutrient content. First, 252 foods with up to 90 cumulative % contribution to nutrient intake were selected. Of these, foods having apparently the same/similar nutrient content were combined into 206 foods by research dietitians. Next, 183 foods with up to 0.90 cumulative multiple regression coefficient and 90 cumulative % contribution were chosen. At this stage an additional food grouping was made. RESULTS: Finally, 102 foods/recipes were included in the questionnaire: rice (2 items), bread and noodles (11), eggs, milk and dairy products (10), soybean, soybean products and other beans (7), meat including beef, pork and chicken (12), fish (5), other fish, shellfish and fish products (10), green-yellow vegetables (8), other vegetables and mushrooms (7), edible roots (2), seaweeds (3), seeds (2), fruits (8), beverages (7) and confectioneries (8). The frequencies were classified into eight categories. Portion size was calculated for the respective foods largely from the one-day weighed diet record. CONCLUSIONS: The developed semi-quantitative food frequency questionnaire substantially covered the intake of 31 nutrients and may be competent to rank middle-aged Japanese efficiently.     

Functional and evolutionary implications of natural variation in clock genes

Stomach cancer remains the second leading cancer in incidence in Shanghai, China, despite its decline over the past 2 decades. To clarify risk factors for this common malignancy, we conducted a population-based case-control study in Shanghai, China. Included in the study were 1,124 stomach cancer patients (age 20-69) newly diagnosed in 1988-1989 and 1,451 controls randomly selected among Shanghai residents. Usual adult dietary intake was assessed using a comprehensive food frequency questionnaire. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. Risks of stomach cancer were inversely associated with high consumption of several food groups, including fresh vegetables and fruits, poultry, eggs, plant oil, and some nutrients, such as protein, fat, fiber and antioxidant vitamins. By contrast, risks increased with increasing consumption of dietary carbohydrates, with odds ratios (ORs) of 1.5 (95% confidence interval [CI] 1.1-2.1) and 1.9 (95% CI 1.3-2.9) in the highest quartile of intake among men (p for trend=0.02) and women (p=0.0007), respectively. Similar increases in risk were associated with frequent intake of noodles and bread in both men (p=0.07) and women (p=0.05) after further adjustment for fiber consumption. In addition, elevated risks were associated with frequent consumption of preserved, salty or fried foods, and hot soup/porridge, and with irregular meals, speed eating and binge eating. No major differences in risk were seen according to subsite (cardia vs. non-cardia). Our findings add to the evidence that diet plays a major role in stomach cancer risk and suggest the need for further evaluation of risks associated with carbohydrates and starchy foods as well as the mechanisms involved.     

Reduced automatic motivational orientation towards food in restricting anorexia nervosa.

A striking and characteristic feature of the restricting subtype of anorexia nervosa (AN) is that they are extremely successful in regulating their food intake in a destructive manner. A possible explanation for the persistent character of their restricted food intake could be a loss of the motivational saliency of food in restricting AN patients. The present study aimed to investigate motivational orientation for food in the restricting subtype of anorexia nervosa with an indirect performance-based measure and a self-report measure of craving. An indirect approach avoidance task was administered to measure automatic approach tendencies for high-fat and low-fat food in restricting adolescent AN-like patients (n = 89) and a group of healthy adolescents (n = 76). As predicted, restricting AN-like patients showed less automatic motivational orientation toward food than healthy controls. In a similar vein, AN-like patients reported less craving for food than the group of healthy controls. The loss of an automatic motivational orientation toward food together with the deliberate strategy to avoid food might help explain the ability of restricting AN-like patients to regulate their food intake. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Nutrient intake and dental health in school children

Diet refers to the customary allowance of food and drink taken by a person from day to day. The diet may affect dental caries by reacting with the enamel surface and by serving as a substrate for cariogenic microorganisms. This study examined the role of specific nutrients in the caries experience of elementary school children. 120 children aged between 6-11, who attended the Pedodontics Department of Marmara University, Faculty of Dentistry for routine dental treatment received a dental examination, parent interview, and a 3-day diet diary. The diary was completed adequately for 100 children (83%). The average daily intake of nutrients were computed and total sugar consumption and Ca/P ratio were calculated. Each child's gender, age, fluoride history, socio-economic state of the family, previous dental experience, brushing habit, and nutrient intake were examined as independent variables. No association was apparent between dental caries and the intake of specific nutrients or Ca/P ratio, except with total sugar consumption.     

Male/female comparison of morphine effect on food intake--relation to anorexia nervosa

We have proposed that endogenous opioids play a critical role in the etiology of anorexia nervosa by mediating an auto-addiction. A biological predisposition may result from an atypical endogenous opioid system. Morphine activation of the system increases food intake in most species, including normal humans and rats, but decreases food intake in mice. The atypical opioid system in mice may be representative of that in anorexia nervosa patients, causing the biological predisposition. Anorexia nervosa is 10 times more prevalent in females than males. In the context of this auto-addiction opioid model, it was interesting to determine if the effects of morphine on food intake were markedly different between the two sexes. Full dose-response curves were done of the effects of morphine on food intake in males and females in both rats and mice, representing the typical and atypical responses, respectively. Differences between the sexes were not found to explain the marked prevalence of anorexia nervosa for females. The marked preference is probably at some other step.     

Plasma prolactin response to D-fenfluramine is blunted in bulimic patients with frequent binge episodes

BACKGROUND: Abnormalities of brain serotonin (5-HT) transmission have been implicated in the pathophysiology of bulimia nervosa (BN), but no conclusive data have yet been provided. The purpose of this study was to assess 5-HT transmission via the measurement of the prolactin (PRL) response to the specific 5-HT releasing agent D-fenfluramine (D-FEN) in both patients with BN and comparison subjects. METHODS: According to a double-blind placebo-controlled design, plasma PRL response to D-FEN was measured in 14 drug-free bulimics and 14 matched healthy controls. In both patients and controls, eating-related psychopathology, depressive and obsessive-compulsive symptoms, and aggressiveness were measured by rating scales. RESULTS: Baseline plasma levels of PRL and 17 beta-oestradiol were significantly reduced in bulimic patients, whereas basal plasma levels of cortisol did not significantly differ from healthy controls. PRL response to D-FEN was not different between patients and controls as groups, but it was significantly blunted in bulimics with high frequency bingeing (> or = 2 binge episodes per day; N = 7) as compared to both those with low frequency bingeing (< or = 1 binge episode per day; N = 7) and matched controls. A significant negative correlation emerged between the frequency of binge episodes and the hormone response to D-FEN. Moreover, although patients scored higher than healthy subjects on rating scales assessing depressive and obsessive-compulsive symptoms and aggressiveness, no significant correlation was found between these measures and the PRL response to D-FEN. CONCLUSIONS: These results support the idea that serotonin transmission is impaired in bulimic patients with frequent binge episodes.     

Folate, vitamin D, and iron intakes are low among pregnant Finnish women

OBJECTIVE: To evaluate dietary habits and nutrient intake of Finnish pregnant women, to relate these to the use of dietary supplements, and to explore possible dietary variations according to age and education. DESIGN: A random dietary survey using two five day estimated food records. SETTING: Pregnant women from 13 maternity clinics in the city of Oulu, Finland. SUBJECTS: One hundred and eighteen pregnant women in their third trimester. MAIN RESULTS: The main sources of energy were cereal products and milk products. The consumption of fish and poultry was low. Women with a higher educational level consumed more vegetables, fruit, fruit juices, and tea and less sausages, inner organs and coffee than women with a lower educational level. Younger women (< 25 y) consumed more sugar and pork and less berries, butter and inner organs than older women. On average 15% of the total energy was supplied by protein, 33% by fats, 52% by carbohydrates, and 12% by sucrose. Compared to the Nordic nutrition recommendations, the proportion of polyunsaturated fatty acids and the intake of dietary fibre were low and the intake of sugar high. The intakes of vitamins and minerals met or exceeded the recommended allowances, except for vitamin D, folate, and iron. Of the subjects 70% used dietary supplements. With the exception of vitamin D, folate, and iron, both the supplement users and non-users had an adequate nutrient intake from their diet. CONCLUSIONS: A balanced diet covers the increased nutrient requirements during pregnancy, with the exception for vitamin D, folate, and iron. The use of dietary supplements during pregnancy is excessive and partly focused on the wrong nutrients. Young and less educated, and smoking pregnant women need more nutritional guidance.     

Effects of tobacco abstinence on food intake among cigarette smokers.

The total caloric and specific nutrient intakes of smokers who became abstinent were compared with those of a control group. Both groups were composed of volunteer inpatients housed in a research ward for 7 days. After smoking ad libitum for 3 days, the experimental group was required to abstain from tobacco for the next 4 days while the control group continued to smoke. Significant increases in total caloric intake and in grams of carbohydrates, protein, fat, and sucrose were observed in the experimental relative to the control group, whereas no significant differences were found in fructose intake. The increase in caloric intake was not specific to increases in snacking. Preliminary analyses showed gender differences in food intake as a result of tobacco abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dietary assessment in epidemiology: comparison on food frequency and a diet history questionnaire with a 7-day food record

The validity of two types of diet assessment methods, a self-administered food frequency questionnaire and and interviewer-administered detailed diet history, was assessed relative to a 7-day food record on a population- based sample of 95 men and 108 women in Toronto, Canada, between May 1989 and July 1990. Each study subject completed both questionnaire methods, a food frequency questionnaire and an interviewer-administered diet history, as well as a 7-day food record in a crossover design. Data were analyzed for both unadjusted and energy-adjusted nutrients to estimate Pearson's and intraclass correlations and agreement within the categories. Mean values for the intake of most nutrients assessed by the two questionnaire methods were similar. Average, energy-adjusted Pearson's correlation coefficients for men between a food frequency questionnaire and a 7-day food record were 0.55 for macronutrients and 0.48 for micronutrients compared with 0.47 for macro- and 0.48 for micronutrients between an interviewer-administered diet history and a 7-day food record. For women, they were 0.48 for macro- and 0.54 for micronutrients between a food frequency questionnaire and a 7-day food record and 0.46 and 0.49, respectively, between an interviewer-administered diet history and a 7-day food record. The energy-adjusted Pearson correlations were generally higher than were the energy-unadjusted Pearson correlations and the intraclass correlations. The present study suggests that a food frequency questionnaire is comparable with an interviewer-administered diet history as a predictor of nutrients as estimated form a 7-day food record.     

Estimation of the use of dietary supplements in the National Diet and Nutrition Survey: people aged 65 years and Over. An observed paradox and a recommendation

OBJECTIVE: To compare the evidence derived from blood biochemical status indices with the evidence from a questionnaire and from a 4-day weighed dietary record of micronutrient supplement use in the British National Diet and Nutrition Survey (NDNS) of People Aged 65 Years and Over; to resolve some apparent incompatibility between nutrient intake and status estimates, and to recommend an approach towards supplement recording that should improve accuracy. DESIGN: The survey procedures described in the National Diet and Nutrition Survey Report (1998) included a health-and-lifestyle questionnaire, a 4-day weighed diet record, and fasting blood and urine sample for biochemical indices, including a wide range of micronutrients. SETTING: Eighty randomly selected postcode sectors from mainland Britain during 1994-1995. SUBJECTS: Of 2060 people interviewed, 1467 provided a blood sample and 1217 provided both a blood sample, and a complete 4-day diet record. About 20% were living in institutions such as nursing homes, and the remainder were living in private households. RESULTS: After assigning the subjects to four categories by the use of dietary supplements (A, those not taking supplements (by questionnaire or by the 4-day record); B, those taking supplements (excluding prescribed ones) by questionnaire only; C, those taking supplements by 4-day record only; and D, those taking supplements by both questionnaire and 4-day record), these categories were then compared with respect to estimated total nutrient intakes and blood biochemical indices. Those in category B had estimated (4-day) nutrient intakes (from foods and supplements) that were indistinguishable from those in category A, but had biochemical indices that indicated significantly higher dietary intakes of several vitamins. CONCLUSIONS AND RECOMMENDATION: The 4-day weighed intake record may not have identified all of the subjects who were regularly taking micronutrient supplements in amounts sufficient to improve their biochemical status. Because survey respondents may use supplements irregularly or change their usual patterns of supplement use during a period of intensive diet-recording, it is important to design a dietary instrument that will minimise this potential source of inaccuracy. We therefore recommend that population surveys in which an accurate estimate of micronutrient intakes is required, from supplements as well as from food, should record supplement use for a period longer than 4-days. It is likely that a better estimate of long-term intakes can be achieved by combining a 4-day weighed diet record with a structured recall or several weeks of diary records, which focus specifically on the use of supplements.     

Alcohol consumption in relation to food intake and smoking habits in the Dutch National Food Consumption Survey

The interrelationships between alcohol consumption, energy and food intake and smoking habits were studied in 1145 men and 1171 women, aged 22-49 years, in the Dutch National Food Consumption Survey, in which a 48-h dietary record method was used. The aim of the study was to investigate the effects of alcohol consumption on dietary habits and smoking. A strong relationship between alcohol consumption and energy intake was found. The energy derived from alcohol was not compensated for by lower intake of other nutrients. There was no increase in Quetelet's index with increasing alcohol consumption, except for non-smoking men who were heavy drinking on midweek days. Possible explanations for this apparent lack of an overall effect of alcohol calories are discussed. Alcohol consumption was much higher on weekend days than on midweek days. No differences in nutrient intake were found between non-drinkers, moderate drinkers and heavy drinkers on midweek days. On weekend days, however, there was a slightly higher total fat and saturated fat intake in moderately drinking men. For women cholesterol intake was found to be higher in moderate and heavy drinkers. Finally, a strong positive relationship between alcohol consumption and smoking was observed. It is concluded that the observations with respect to energy and nutrient intake and smoking habits are not indicative of a healthier lifestyle in moderate alcohol users between 22 and 49 years of age. Consequently, the more favourable prognosis of moderate drinkers cannot be ascribed to a more healthy lifestyle.     

Sucrose intake in Germany

The present investigation reevaluated the German National Food Consumption Survey in order to obtain data on sucrose intake and food sources of sucrose intake in Germany. Moreover, it focused on the effect of sucrose intake on nutrient intake. By means of the food composition data base Bundeslebensmittelschlüssel, version II.2, 7-days dietary records of a representative sample of 15,838 persons aged 4 years and older were analyzed. The relation between sucrose and nutrients intake was investigated by variance and regression analyses. Low, moderate, and high sucrose intake categories were defined by means of sucrose density quartiles and comparisons were made for the percentages of persons meeting the German nutrient intake recommendations. Mean daily sucrose intake ranges between 43.2 g/d (f, 51-64 years) and 82.3 g/d (m, 13-14 years). The mean contribution of sucrose to total energy intake is highest with 14% in young age (4-6 years) and decreases to 9% and 7% in 51-64 year old women and men, respectively. The food groups "table sugar", "confectionery and ice cream", "biscuits, cake and pastries", "preserves", "dairy products", and "non-alcoholic beverages" are the main sucrose sources with varying importance in different age groups. The average amount of naturally occurring sucrose in the Germans' diet is estimated to 15-25% of total sucrose intake. Sucrose contributes 80-90% to total disaccharides intake in Germany. With each gram of sucrose the intake of energy rises on the average by 12.5 kcal (52.4 kJ), of protein by 0.3 g (9% of the energy increase), of fat by 0.5 g (34%), and of carbohydrates by 1.8 g (57%). Consequently, the higher the sucrose content of a diet, the lower is the contribution of fat to total energy intake. In contrast, the energy-adjusted effect of sucrose was found to be negative for energy-providing nutrients (except mono- and disaccharides) as well as for all the selected micronutrients, except calcium, vitamin E, vitamin C, and dietary fiber. Accordingly, the comparison between moderate and high sucrose consumers revealed a lower percentage of persons meeting nutrient intake recommendations in the high sucrose category under the condition of a comparable energy intake. This unfavorable effect of high sucrose intake is most prominent in 4-6 year old boys and girls as the groups with the highest sucrose intake. Since from the present data no exact figure for a sucrose or sugars intake recommendation can be deduced, it is suggested to keep on the WHO recommendation for a moderate sugar intake of 10% of energy intake.     

Evaluation of diet in a sample of Czech mothers six months after delivery

BACKGROUND: Health care of nursing mothers and their infants is an important priority of primary preventive care. The mother's diet plays an important role in this respect. The objective of the presented investigation was to assess the adequacy of the dietary intake of lactating mothers during the sixth month after delivery. METHODS AND RESULTS: Data on the education, body weight, height of the mother, dietary intake, evaluated from a three-day dietary record, were collected from 131 nursing mothers and compared with the Czech recommended dietary allowances for nursing mothers as well as with data from 265 controls, i.e. women who did no longer breastfeed their babies. From the results ensues a significantly higher calcium intake (937 mg; SD = 415, p < 0.001), vitamin B1 (1.1 mg, SD = 0.5, p < 0.001), total energy (8.7 MJ, SD = 2.6, p < 0.01), protein 75.4 g, SD = 18, p < 0.01), carbohydrates (281 g, SD = 112, p < 0.01) and riboflavin (1.3 mg, SD = 0.5, p < 0.01) in nursing women as compared with those not nursing. The nursing mothers, however, do not meet the Czech recommended dietary allowances as regards total energy, calcium, vitamin C, linoleic acid, vegetable proteins and iron. Other problematic nutrients-magnesium, zinc, folates, pyridoxine, selenium and iodine could not be assessed as they are not listed in the Czech food composition tables. In women with university education the energy and nutrient intake was in the majority more favourable than in women with elementary education. On the other hand no statistical differences were found in weight increments during the period from the beginning of gestation to the sixth month after delivery between nursing and not nursing mothers. CONCLUSIONS: The results of analysis of the dietary intake of nursing mothers indicate that the Czech recommended allowances are not met as regards energy, calcium, linoleic acid, protein and iron. Whether the intake is really inadequate or whether the recommended allowances are excessive remains an open question.     

Survey of the diet of Pima Indians using quantitative food frequency assessment and 24-hour recall. Diabetic Renal Disease Study

OBJECTIVE: A dietary survey was conducted in the Gila River Indian Community in Arizona using two methods of dietary assessment--24-hour recall and quantitative food frequency (QFF) assessment--to determine the usual intake of the population. DESIGN: Interviews were conducted by Pima women who were trained and monitored by a research dietitian. Energy and nutrient intake were calculated using a computerized dietary database that included specific Pima foods. SUBJECTS: An age- and sex-stratified sample of 575 Pima Indians (273 men, 302 women) aged 18 to 74 years participated in the study. STATISTICAL ANALYSES: Spearman correlations were used to compare the results of the two survey methods for energy and each nutrient. Intraclass correlations were used to measure reproducibility. RESULTS: According to the 24-hour recall, mean reported energy intakes within decades of age were 95% to 112% of those in the US population for Pima women, and 76% to 94% of those in the US population for Pima men. Total energy intake assessed using QFF was 30% higher in men and 33% higher in women than the intake assessed using the 24-hour recall method. CONCLUSIONS: A large dietary survey conducted using lay interviewers in a Native-American community was as reproducible as studies conducted in the general US population. The Pima diet was distributed among the major nutrients in a proportion similar to the US diet.     

The specific psychopathology of bulimia nervosa: A comparison with restrained and unrestrained (normal) eaters.

The hypothesis that patients with bulimia nervosa and restrained eaters exist on a simple continuum of psychopathology was tested in 60 Ss (20 bulimics, 20 restrained eaters, 20 unrestrained eaters). Regarding measures related to dieting behavior and physical appearance, the restrained eaters differed significantly from unrestrained eaters and were similar to bulimic patients except for level of psychopathology. The restrained eaters could not be distinguished from the unrestrained eaters with regard to measures representing interoceptive perception, self-esteem, and fears about interpersonal relationships. On these traits, bulimic patients could be clearly distinguished from the normal Ss. The results support a 2-component model of the psychopathology of bulimia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)