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PubMed1984

The influence of ready-to-eat cereal consumption at breakfast on nutrient intakes of individuals 62 years and older.

From 7-day food diaries of a cross-sectional sample of American elderly individuals (n = 561), breakfast consumption patterns were assessed and related to average daily nutrient intake patterns. Results indicated that, in general, breakfast consumption made a significant contribution to the average elderly individual's daily nutrient intake and, in particular, breakfasts containing ready-to-eat cereal had a greater impact on nutrient intake levels than did breakfasts not containing ready-to-eat cereal. More specifically, elderly individuals who had ready-to-eat cereal at breakfast 4-7 times during the week surveyed consumed significantly less (P less than or equal to 0.05) fat and cholesterol and significantly more fiber, carbohydrate, total sugar, protein, thiamin, niacin, riboflavin, vitamins B6, B12, and A, iron, calcium, phosphorus, potassium, magnesium, copper, and zinc at the breakfast meal than those who had no ready-to-eat cereal at breakfast. Fewer statistically significant differences between the two groups were evidenced when vitamin/mineral supplement usage was included in the analysis. Average daily intake levels of frequent consumers of ready-to-eat cereal were significantly (P less than or equal to 0.05) greater than those of nonconsumers for all dietary components except protein, fat, cholesterol, vitamin E, and sodium when supplement usage was excluded from the calculations. When supplements were included, significant differences between the two groups decreased to nine dietary components. Comparison of the average nutrient composition of breakfasts containing ready-to-eat cereal and those not containing ready-to-eat cereal revealed those including ready-to-eat cereal contained significantly greater quantities of all nutrients assessed regardless of whether or not vitamin/mineral supplements were included in the calculations.

Aged↗

PubMed2002

Eating difficulties in relation to gender, length of stay, and discharge to institutional care, among patients in stroke rehabilitation.

PURPOSE: To describe and compare eating difficulties from admission to discharge, with regard to length of stay (LOS) and discharge to institutional care, as well as in relation to gender. METHOD: Patients, aged 65 or above, admitted for stroke rehabilitation, having at least one eating difficulty were observed (n =108) as regards to eating on admission and at discharge. Analysis followed earlier findings in which eating difficulties had been found to have three components, i.e. ingestion, deglutition and energy. RESULTS: Of the components, ingestion difficulties were the most common, followed by low energy. The most common single difficulties were low food consumption, difficulties in manipulating food on the plate and transporting it to the mouth. Ingestion difficulties especially decreased during the rehabilitation period. Women were older and ate less on admission and at discharge than men, improved less than men, and also a higher proportion had a low food intake at the time of discharge if having longer LOS and/or being discharged to institutional care. Patients with longer LOS and those discharged to institutional care had more eating difficulties on admission and were more dependent in activities of daily living (ADL) than those with shorter LOS and those who returned home. LOS was mainly explained by ingestion difficulties on admission and low age. Discharge to institutional care was explained by living alone before admission, ingestion difficulties at discharge, male gender and high age. CONCLUSIONS: Ingestion difficulties on admission indicate a longer in-hospital stay and decrease to a greater extent than other types of eating difficulties. If these difficulties persist at the time of discharge the patients are more likely to need institutional care. It is important to assess and take systematic measures for each of the three variants of eating difficulties, i.e. ingestion, deglutition, and energy, to improve eating abilities. Women in particular need attention with regard to low food intake.

Activities of Daily Living↗

PubMed2006

Quality of life: eating disorders.

OBJECTIVE: There is a lack of measurements with predictive validity that are specific for quality of life (QOL) in patients with eating disorders. METHOD: A total of 306 eating disorder patients treated as inpatients completed the Quality of Life for Eating Disorders (QOL ED): 109 at both admission and discharge from hospital, 65 at both admission and after 12 months. Patients also completed well-validated measures of eating disorders, psychological dysfunction and general physical and mental QOL. QOL ED consists of 20 self-report questions that provide scores for the domains of behaviour, eating disorder feelings, psychological feelings, effects on daily life, effects on acute medical status and body weight, and a global score. RESULTS: QOL ED domain scores correlated appropriately with previously validated well-known measures of eating disorders, psychological dysfunction, general QOL and behaviour and body weight (p < 0.001). The QOL ED shows high reliability (Cronbach's alpha = 0.93). All scores changed significantly and appropriately during inpatient hospital treatment and between admission and 12 months after discharge from hospital (p < 0.001). The scores differed for anorexia nervosa, bulimia, eating disorder not specified (EDNOS) and no diagnosis. All no diagnosis (recovered) domain and global scores were significantly different from all diagnoses scores (p < 0.001). CONCLUSION: This quick, simple instrument fulfils all potential uses for QOL assessments in the clinical and research settings associated with eating disorders, including outcome.

Adult↗

PubMed1999

Genetic and environmental influences on eating patterns of twins aged >/=50 y.

BACKGROUND: Clinicians and researchers could benefit from a greater understanding of the role of genetic and environmental factors in human eating behavior. OBJECTIVE: Our aim was to estimate the relative influence of genetic and environmental factors on habitual eating patterns in middle-aged and elderly men and women. DESIGN: Male and female twins (n = 4640) aged >/=50 y completed a mailed version of the National Cancer Institute food-frequency questionnaire. Factor analysis was performed to identify eating patterns among respondents. Estimates of genetic, common environmental (shared by family members), and specific environmental (unique to an individual) influences were obtained for food use, serving size, and consumption frequency by comparing monozygotic and dizygotic twin-pair groups with structural equation analysis. RESULTS: Two independent eating patterns were identified: the first consisted of items high in fat, salt, and sugar, and the second reflected healthful eating habits. Although the influence of environmental factors was larger, between 15% and 38% of the total variation in pattern 1 and between 33% and 40% in pattern 2 were explained by genetic influences. Models accounting for sex differences in genetic and environmental estimates fit the data significantly better for food use and serving size of foods in eating pattern 1 and for food use in eating pattern 2. CONCLUSION: Although 60-85% of the variability in eating patterns was associated with environmental factors, genetic influences were also apparent and there was some evidence of sex specificity. These findings may be important in crafting dietary interventions and predicting adherence to these interventions.

Aged↗

PubMed2003

Association between eating patterns and obesity in a free-living US adult population.

Some studies have suggested that eating patterns, which describe eating frequency, the temporal distribution of eating events across the day, breakfast skipping, and the frequency of eating meals away from home, may be related to obesity. Data from the Seasonal Variation of Blood Cholesterol Study (1994-1998) were used to evaluate the relation between eating patterns and obesity. Three 24-hour dietary recalls and a body weight measurement were collected at five equally spaced time points over a 1-year period from 499 participants. Data were averaged for five time periods, and a cross-sectional analysis was conducted. Odds ratios were adjusted for other obesity risk factors including age, sex, physical activity, and total energy intake. Results indicate that a greater number of eating episodes each day was associated with a lower risk of obesity (odds ratio for four or more eating episodes vs. three or fewer = 0.55, 95% confidence interval: 0.33, 0.91). In contrast, skipping breakfast was associated with increased prevalence of obesity (odds ratio = 4.5, 95% confidence interval: 1.57, 12.90), as was greater frequency of eating breakfast or dinner away from home. Further investigation of these associations in prospective studies is warranted.

Adult↗

PubMed1995

Eating disorders and maladaptive dietary/insulin management among youths with childhood-onset insulin-dependent diabetes mellitus.

OBJECTIVE: To determine the prevalence of DSM-III eating disorder and the conjoint symptoms of maladaptive dietary/insulin management (irrespective of eating disorder) and their psychiatric and biomedical correlates among youths with childhood-onset insulin-dependent diabetes mellitus (IDDM). METHOD: Forty-four girls and 35 boys, 8 to 13 years old at IDDM onset, were repeatedly interviewed during an interval of up to 14 years (mean = 9 years) to ascertain psychiatric disorders and behaviors related to diabetes care. Metabolic control and IDDM-related hospitalizations also were monitored. RESULTS: By the mean age of approximately 21 years, 3.8% of the sample had DSM-III eating disorders and 11.4% had "eating problems," defined as the conjoint symptoms of severe dietary indiscretion and repeated insulin omission (irrespective of eating disorders). Youths with "eating problems" were nine times more likely to have had a psychiatric disorder than the rest of the patients, and they had a significantly higher rate of pervasive noncompliance with medical treatment. No between-group differences were found in metabolic control and rates of multiple hospitalizations. CONCLUSIONS: The diabetes-specific symptom-pair of serious dietary indiscretion and repeated insulin omission appears to identify youths who have had other problems as well. The association of eating problems with psychiatric disorders (other than eating disorders) suggests that a subgroup of diabetic youths have various difficulties in coping with the medical illness and require close monitoring and psychosocial intervention.

Adolescent↗

PubMed2001

Predicting children's reported eating disturbances at 8 years of age.

OBJECTIVES: To examine differential parental influences on eating attitudes and behaviors of 8-year-old children with a specific focus on gender effects and to assess the specificity of this relationship. METHOD: One hundred eight infants were monitored from birth and interviewed at age 8 for eating disturbances and negative affect with an adaptation of the McKnight Risk Factor Survey. Parental measures included the Three Factor Eating Questionnaire subscales Disinhibition and Restraint as well as body mass index, assessed at study entry. RESULTS: No gender differences were found for frequencies of children's self-reported eating disturbances. Higher maternal restraint scores predicted worries about being too fat in girls but not in boys. Higher maternal disinhibition scores also differentially predicted weight control behaviors in their daughters. Negative affect in the child was (weakly) predicted by higher maternal body mass index. No association between paternal predictors of disturbed eating and the child's eating disturbances and negative emotionality was found. CONCLUSIONS: The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters. The clinical importance of these disturbances in terms of precursors of adolescent eating disorders has to be determined by monitoring the sample through puberty.

Adult↗

PubMed2004

Childhood abuse and risk of eating disorders in women.

BACKGROUND: Eating disorders are one of the most common psychiatric disorders among women. Little is known about underlying causes. METHODS: To assess the association between childhood violence victimization and eating disorders, we performed a case-control study of women participating in the Harvard Study of Moods and Cycles, a population-based sample of women 36 to 44 years of age. Cases were women who met the diagnostic criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder after a structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). A self-administered questionnaire was used to assess a history of abuse as a child. RESULTS: Compared with women who reported no abuse, women who reported childhood physical abuse had twice the odds of suffering from subclinical eating disorder symptoms (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.3-3.3) or meeting DSM-IV criteria for an eating disorder (2.1; 1.1-4.2). Women who reported both physical and sexual abuse during childhood had 3 times the odds of developing eating disorder symptoms (3.0; 1.3-6.8) and nearly 4 times the odds of meeting DSM-IV criteria for an eating disorder (3.9; 1.3-11.5). These associations persisted within the subgroup of women with no depression antecedent to first onset of an eating disorder. CONCLUSIONS: The present study provides additional evidence of an association between preadolescent trauma and psychiatric morbidity.

Adult↗

PubMed2003

Eating disorders and suicide risk factors in adolescents: an Italian community-based study.

In a mixed male-female sample of 1000 adolescents age 15 to 19 years in a northeastern area of Italy, we investigated the links between eating disorders and suicidal tendencies by means of self-compiled measures, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Test (BAT), and the SCL-90-R. More females than males reported abnormal eating patterns suggesting eating disorders: we found that 100 females (15.8%) and 8 males (2.8%) achieved scores above the suggested cutoff on EAT (cutoff = 30), 26 females (4.1%) and 1 male (.3%) achieved scores above the suggested cutoff on BITE (cutoff = 20), and 287 females (45.5%) and 24 males (8.6%) achieved scores above the suggested cutoff on BAT (cutoff = 36). More females than males also reported symptoms of hopelessness (44.3% vs. 30.5%) and suicidal ideation (30.8% vs. 25.3%). Both males and females reporting suicidal ideation achieved significantly higher scores on the eating disorders inventories, with no independent contribution by age, socioeconomic status, or body mass index. Although caution is required when drawing conclusions from self-reported measures, studies on mood disorders and suicidality in youth clearly need to include measures of eating disorders.

Adolescent↗

PubMed2006

Attributional style in the eating disorders.

Previous research has shown that patients with eating disorders have a characteristic cognitive bias, making internal attributions when evaluating negative events. However, there is less clarity about their attributions for positive events. There are suggestions that this cognitive style might be influenced by depressed mood. This study examines attributional style in the eating disorders for positive and negative events, independent of covariant effects of depression. Twenty-five eating-disordered women and 26 nonclinical women each completed measures of attributional style, depressed mood, and eating pathology. They also completed a measure of verbal intelligence (to ensure comparability of groups). Women with an eating disorder had a greater tendency to attribute negative situations to the self when compared with nonclinical women, even when differences in depressed mood were controlled for. There were no comparable differences in positive attributional biases. Women with an eating disorder adopt a self-blaming style when evaluating negative events, and such self-blame is likely to contribute to the maintenance of an eating disorder. This suggests that therapy for the eating disorders should include an element that focuses on highlighting and re-evaluating such interpretations.

Adult↗

PubMed2007

Eating disorders and substance abuse in Canadian women: a national study.

AIMS: This study aimed to examine the comorbidity between eating disorders and substance use in a large nationally representative sample of Canadian adult women. Recent as well as life-time measures of substance use were used. DESIGN: The research was based on secondary analyses of data collected, using multi-stage stratified probability sampling, by Statistics Canada in the Mental Health and Well-being cycle 1.2 of the Canadian Community Health Survey (CCHS). MEASUREMENTS: The Eating Attitude Test (EAT-26) was used to measure risk of eating disorders. Alcohol use, dependence and interference, and illicit drug use, dependence and interference were measured using relevant modules from the short form of the Composite International Diagnostic Interview (CIDI-SF). PARTICIPANTS: Data on a nationally representative sample of Canadian adult women, grouped into three age groups, were used for this research. FINDINGS: Alcohol dependence and alcohol interference were associated significantly with the risk for an eating disorder in the three adult age groups. Significant associations were also found in the three age groups between risk for an eating disorder and the life-time abuse of and dependence on illicit drugs. Significant associations were found in the 15-24 and 25-44-year age groups when the 12-month time-frame was used. CONCLUSIONS: The study findings support the call for the development of short screening instruments for adult women with eating disorders and substance abuse, as well as for the development of treatment strategies that address the co-occurrence of eating disorders and substance use

Adolescent↗

PubMed2006

Detection of eating difficulties after stroke: a systematic review.

BACKGROUND: It is highly important in nursing care for persons with stroke to screen for, assess and manage eating difficulties. The impact on eating after stroke can be of different types, comprising dysphagia as well as eating difficulties in a larger perspective. Eating difficulties can cause complications such as malnutrition, dehydration, aspiration, suffocation, pneumonia and death. There is a lack of systematic reviews about methods to be used by nurses in their screening for eating difficulties. AIM: This review aims at systematically capturing and evaluating current peer-reviewed published literature about non-instrumental (besides pulse oximetry) and non-invasive screening methods for bedside detection of eating difficulties among persons with stroke. METHODS: A search was performed in Medline and 234 articles were obtained. After a selection process 17 articles remained, covering seven screening methods and including about 2,000 patients. CONCLUSION: Best nursing practice for detecting eating difficulties includes as the first step the Standardized Bedside Swallowing Assessment (SSA) to detect dysphagia (strong evidence). As the second step an observation should be made of eating including ingestion, deglutition and energy (moderate evidence). Applying pulse oximetry simultaneously to SSA can possibly add to the accuracy of aspiration detection, especially silent aspiration (limited evidence). The methods should be used as a complement to interviews.

Benchmarking↗

PubMed1998

Prevention of disturbed eating behaviour: a prospective intervention study in 14- to 19-year-old Swiss students.

Subsequent to an epidemiological study on eating behaviour in adolescents, a prospective study was carried out to examine the effect of health promotion lessons on disturbed eating behaviour. From the original sample (t1, n = 1944), a subgroup of 314 students of both sexes, 14-19 years of age, was selected. Participants came from a total of 20 classes in which a high percentage of students exhibited disturbed eating behaviour. Ten classes were then randomly selected to receive health promotion lessons (intervention group, high-risk; IGHR), while the other 10 classes served as controls (control group, high-risk; CGHR). The Eating Attitudes Test (EAT-26), the Giessen Physical Complaint List for Children and Adolescents (GSCL-C) and the Self-Report Symptom Check-List (SCL-90-R) were administered shortly before (t2) and 3 months after (t3) the interventions. The three health promotion lessons dealt with issues concerning beauty ideals, gender differences in psychosexual maturation and body awareness, healthy eating behaviour, physiology of nutrition, early symptoms of eating disorders and therapeutic approaches. The data analyses revealed an improvement on all three symptom scales for both groups between t2 and t3, but there were no significant differences between the IGHR and CGHR groups. When data from high-scoring female participants only were analysed (HRf-IGHR and HRf-CGHR), the multivariate analysis revealed a significant interaction between time and group (15.2% of variance explained). Our experiences in implementing health promotion lessons that conveyed knowledge about eating disorders and addressed physical and psychological issues in a more general way indicated that these interventions can be carried out in schools, and may contribute to increases in physical and psychological well-being in a high-risk population of adolescents.

Adolescent↗

PubMed2005

Children with early refusal to eat: follow-up in adolescence.

AIM: To describe the adolescent outcome of infant refusal to eat (RTE) and to investigate early predictors of adolescent outcomes. METHODS: 19 of 25 children with RTE and 35 of 42 controls were assessed at age 16. The participants rated eating attitudes and self-perceptions with a Swedish version of the Children's Eating Attitudes Test (ChEAT) and a Swedish self-perception measure. Weight and height were assessed through self-reports, and body mass index (BMI) was computed. Child and family variables measured from infancy through age 4 were used as predictors. RESULTS: RTE and controls did not differ with regard to disturbed eating attitudes, BMI or self-perceptions. There were no relations between early predictors and adolescent disturbed eating for the whole sample, but breastfeeding problems and social adversity in the early years predicted negative self-perceptions, and weight at 4 y predicted adolescent BMI. For the RTE group, low birthweight predicted higher levels of disturbed eating attitudes and less positive self-perceptions. For the control group, social adversity predicted high BMI. CONCLUSION: RTE does not seem to constitute a risk factor for adolescent disturbed eating. Further, there may be different risk factors for adolescent disturbed eating for children with and without RTE.

Adolescent↗

PubMed1999

The impact of oral health on stated ability to eat certain foods; findings from the National Diet and Nutrition Survey of Older People in Great Britain.

OBJECTIVES: To assess how the dental status of older people's mouths affected their stated ability to eat common foods. DESIGN: Cross sectional study. SUBJECTS: Survey was part of the oral health component of the nationwide British National Diet and Nutrition Survey: people aged 65 years and older. Two separate representative samples aged 65 and over: a free-living and an institutional sample. 881 free-living and 275 institution subjects had a dental exam and were interviewed about ability to eat key foods. RESULTS: Significant percentages of free-living people had difficulty or could not eat at least 4 of 16 foods, and about 1 in 5 dentate stated they had difficulty eating or could not eat raw carrots, apples, well-done steak or nuts. More of the edentate subjects stated that they had difficulty eating than the dentate. Perceived chewing ability increased with increasing numbers of natural teeth and pairs of opposing posterior teeth. Subjects reporting a sociodental impact were more likely to consider that they were unable to eat foods that required more chewing. Associations remained valid after correction for the effects of age, sex, social class and denture wearing status and region. Perceived dryness did not affect significantly the stated ease of eating most foods. There were more dietary restrictions reported by the institution sample. Some foods, such as nuts, apples and raw carrots could not be eaten easily by over half of edentate people in the institution sample. CONCLUSIONS: The stated selection of foods are substantially affected by numbers of teeth and occluding pairs of posterior teeth and presence of full dentures in significant percentages of older people.

Aged↗

PubMed1996

Eating attitudes in young females with diabetes: insulin omission identifies a vulnerable subgroup.

Eating attitudes were investigated in young females with diabetes (YFDs) and healthy age-matched female controls. Results from the Eating Disorder Inventory confirmed that YFDs had higher scores for drive for thinness, body dissatisfaction and bulimia. In addition, YFDs who omitted insulin injections had high scores for ineffectiveness and interoceptive awareness and had increased sensitivity to external eating cues (as measured by the Dutch Eating Behaviour Questionnaire). It is suggested that dieting and weight gain associated with diabetes treatment precipitate a deterioration in eating attitudes. Furthermore, omission of insulin and increased sensitivity to external eating cues serve as markers for a group of YFDs who are at increased risk of developing an eating disorder. The present results provide support for the spiral model of eating disorders (Heatherton & Polivy, 1992) and its emphasis on the importance of self-esteem and self-awareness.

Adolescent↗

PubMed1997

The role of social physique anxiety and other variables in predicting eating behaviors in college students.

Early identification of potentially harmful eating patterns is critical in the effective remediation of such behaviors. The purpose of this investigation was to examine the degree to which various factors including gender, family history, and athletic status predict disordered eating behavior; social physique anxiety and percent body fat were added as potential predictor variables. The eating behaviors of student-athletes and nonathlete students were also compared. One hundred eighty undergraduate students (males = 49, females = 131) provided demographic information and completed the Eating Attitudes Test (EAT) and the Social Physique Anxiety Scale (SPAS). Stepwise multiple-regression analysis indicated that social physique anxiety, gender, and body fat (%Fat) combined to predict 34% of disordered eating behaviors: EAT = 0.921 SPA - 1.05 %Fat + 10.95 Gender (1 = M, 2 = F) - 17.82 (R2 = .34, SE = 4.68). A one-way ANOVA comparing the eating behaviors of athletes and nonathletes revealed no significant difference between these groups.

Adolescent↗

PubMed1999

Eating problems and related weight control behaviour in adult Japanese women.

BACKGROUND: Fewer studies concerning eating problems have been conducted in adult than in adolescent female populations. The aims of this study are to ascertain the proportion of eating problems and clarify weight control behaviour in adult Japanese women. METHODS: This study employed a questionnaire survey with a cross-sectional design. Subjects were adult females aged 20-39 years, working in a computer factory. Four hundred and six women agreed to participate in the study. The questionnaire elicited self-reported age, body height, body weight and various histories of dieting, fasting and purging behaviour. The Eating Attitudes Test 26-item version (EAT-26) was also administered. Subjects showing an EAT-26 score equal to or greater than 20 were identified as having eating problems. RESULTS: Among the subjects, 172 women (42.4%) had some history of dieting behaviour and 24 (5.9%) had some history of fasting behaviour. Regarding misuse of laxatives, diet pills and diuretics for the purpose of weight loss, 50 (14.3%) were past or current users of diet pills, followed by 42 (10.3%) laxative abusers and 15 (3.7%) diuretic abusers. Six (1.5%) subjects had an EAT-26 score of 20 or greater, 5 (1.9%) in their 20s, and 1 (0.8%) in her 30s, the difference not being statistically significant. CONCLUSIONS: Although dieting behaviour is common in adult Japanese working women, the proportion of eating problems is low in comparison with Western adult populations.

Adult↗