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Eating Disorders: A Review

Author/s: 
Evelyn Attia, B Timothy Walsh

Importance: Eating disorders are characterized by disturbances in eating behavior and occur worldwide, with a lifetime prevalence of 2% to 5%. They are more common among females than males and may be associated with medical and psychiatric complications, impaired functioning, and decreased quality of life.

Observations: Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food intake disorder. These disorders may be associated with changes in weight, electrolyte abnormalities (eg, hyponatremia, hypokalemia), bradycardia, disturbances in reproductive hormones (eg, decreased estradiol levels in females), and decreased bone density. Individuals with anorexia nervosa, bulimia nervosa, and binge-eating disorder have high lifetime rates of depression (76.3% for bulimia nervosa, 65.5% for binge-eating disorder, and 49.5% for anorexia nervosa) and higher rates of suicide attempts than those without eating disorders. Anorexia nervosa is associated with a mortality rate of 5.1 deaths per 1000 person-years (95% CI, 4.0-6.1), nearly 6 times higher than that of individuals of the same age without anorexia nervosa; 25% of deaths among individuals with anorexia nervosa are from suicide. First-line treatments for eating disorders include nutritional support, psychotherapy, and pharmacotherapy. Behaviorally focused therapies, including cognitive behavioral therapy, may be effective, especially for bulimia nervosa and binge-eating disorder. Youth with anorexia nervosa benefit from family-based treatment with parental oversight of eating, resulting in a remission rate at 6 to 12 months of 48.6% vs 34.3% with individual treatment (odds ratio, 2.08; 95% CI, 1.07-4.03; P = .03). Fluoxetine and other antidepressants decrease episodes of binge eating in individuals with bulimia nervosa, even in those without depression (fluoxetine vs placebo, standardized mean difference = -0.24 [small effect size; 95% CI, -0.41 to -0.08]). Antidepressants and the central nervous system stimulant lisdexamfetamine reduce binge frequency in binge-eating disorder compared with placebo (antidepressants vs placebo, standardized mean difference = -0.29 [small effect size; 95% CI, -0.51 to -0.06]; lisdexamfetamine vs placebo, Hedges g = 0.57 [medium effect size; 95% CI, 0.28-0.86]). There are currently no effective medications for treatment of anorexia nervosa. Individuals with serious medical or psychiatric complications of eating disorders such as bradycardia or suicidality should be hospitalized for treatment.

Conclusions and relevance: Globally, eating disorders affect 2% to 5% of individuals during their lifetime and are more common in females than males. In addition to weight changes, eating disorders may cause electrolyte abnormalities, bradycardia, disturbances in reproductive hormones, and decreased bone density, and are associated with increased risk of depression, anxiety, and suicide attempts. First-line treatments of eating disorders include nutritional support, psychotherapy, and pharmacotherapy.

Keywords 
eating disorder

Diets

Author/s: 
Mary Yannakoulia, Nikolaos Scarmeas

Food consumption provides essential and nonessential nutrients in the human body and thereby promotes growth and health. Individual food choice and the potential modification of eating habits are complex issues, influenced by the availability and acceptability of foods.1 The availability of foods depends on physical, political, and economic factors. From the myriad foods that are available or potentially available for consumption, the selection is based on socioeconomic, cultural, and individual factors. Individual foods are parts of diets; diets are characterized by nutrient content, clustering of foods, and temporal consumption patterns. The plethora of diets continually expands, and some diets have been extensively investigated.
We review the underlying rationale for and constituents of the most widely recognized, scientifically explored, and broadly promoted diets (Figure 1). We do not review diets for specific nutritional or metabolic deficiencies or many of the constructed dietary indexes. This review is not intended to detail the clinical efficacy of each diet presented, although we briefly outline some of the well-known potential effects on health and the underlying mechanisms. Even though most (but not all) of the dietary modifications have been driven by the desire to control body weight, we consider important health effects independently of adiposity.

Keywords 
diet

Influence of changes in diet quality on unhealthy aging: the Seniors-ENRICA cohort

Author/s: 
Ortolá, Rosario, García-Esquinas, Esther, García-Varela, Giselle, Struijkab, Ellen A., Rodríguez-Artalejo, Fernando, Lopez-Garcia, Esther

Background

Whether adopting a better diet in late life influences the aging process is still uncertain. Thus, we examined the association between changes in diet quality and unhealthy aging.

Methods

Data came from 2042 individuals aged ≥ 60 years recruited in the Seniors-ENRICA cohort in 2008–2010 (wave 0) and followed-up in 2012 (wave 1) and 2015 (wave 2). Diet quality was assessed with the Mediterranean Diet Adherence Screener (MEDAS), the Mediterranean Diet Score (MDS) and the Alternate Healthy Eating Index-2010 (AHEI-2010) at waves 0 and 1. Unhealthy ageing was measured using a 52-item health deficit accumulation index with 4 domains (functional, self-rated health/vitality, mental health, and morbidity/health services use) at each wave. An increase in dietary indices represents a diet improvement, and a lower deficit accumulation index indicates a health improvement.

Results

Compared with participants with a > 1-point decrease in MEDAS or MDS, those with a > 1-point increase showed lower deficit accumulation from wave 0 to wave 2 (multivariate β [95% CI]: –1.49 [− 2.88 to − 0.10], p-trend = 0.04 for MEDAS; and − 2.20 [− 3.56 to − 0.84], p-trend = 0.002 for MDS) and from wave 1 to wave 2 (− 1.34 [− 2.60 to − 0.09], p-trend = 0.04 for MEDAS). Also, participants with a > 5-point increase in AHEI-2010 showed lower deficit accumulation from wave 0 to wave 1 (− 1.15 [− 2.01 to − 0.28], p-trend = 0.009) and from wave 0 to wave 2 (− 1.21 [− 2.31 to − 0.10], p-trend = 0.03) than those with a > 5-point decrease. These results were mostly due to a strong association between improved diet quality and less functional deterioration.

Conclusions

In older adults, adopting a better diet was associated with less deficit accumulation, particularly functional deterioration. Improving dietary habits may delay unhealthy ageing. Our results have clinical relevance since we have observed that the deficit accumulation index decreases an average of 0.74 annually.

Keywords 
cohort study dietary patterns aging

The Mediterranean Diet: What You Need to Know About Eating the Mediterranean Way

Author/s: 
Smith, Melinda, Segal, Robert

When you think about Mediterranean food, your mind may go to pizza and pasta from Italy, or lamb chops from Greece, but these dishes don’t fit into the healthy dietary plans advertised as “Mediterranean.” A true Mediterranean diet consists mainly of fruits and vegetables, seafood, olive oil, hearty grains, and other foods that help fight against heart disease, certain cancers, diabetes, and cognitive decline. It’s a diet worth chasing; making the switch from pepperoni and pasta to fish and avocados may take some effort, but you could soon be on a path to a healthier and longer life.

Keywords 
mediterranean diet health benefits
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