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1.
Prevention of eating disorders at universities: A systematic review and meta-analysis.
Harrer, M, Adam, SH, Messner, EM, Baumeister, H, Cuijpers, P, Bruffaerts, R, Auerbach, RP, Kessler, RC, Jacobi, C, Taylor, CB, et al
The International journal of eating disorders. 2020;(6):813-833
Abstract
BACKGROUND Eating problems are highly prevalent among young adults. Universities could be an optimal setting to prevent the onset of eating disorders through psychological intervention. As part of the World Mental Health-International College Student initiative, this systematic review and meta-analysis synthesizes data on the efficacy of eating disorder prevention programs targeting university students. METHOD A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, PsycINFO) for randomized trials comparing psychological preventive interventions for eating disorders targeting university students with psychoeducation or inactive controls was performed on October 22, 2019. RESULTS Twenty-seven studies were included. Thirteen (48.1%) were rated to have a low risk of bias. The relative risk of developing a subthreshold or full-blown eating disorder was incidence rate ratio = 0.62 (95% CI [0.44, 0.87], n c = 8, numbers-needed-to-treat [NNT] = 26.08; standardized clinical interviews only), indicating a 38% decrease in incidence in the intervention groups compared to controls. Small to moderate between-group effects at posttest were found on eating disorder symptoms (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, n c = 26), dieting (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, n c = 21), body dissatisfaction (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, n c = 25), drive for thinness (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, n c = 12), weight concerns (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, n c = 13), and affective symptoms (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, n c = 18). The effects on bulimia nervosa symptoms were not significant. Heterogeneity was moderate across comparisons. DISCUSSION Eating disorder prevention on campus can have significant, small-to-moderate effects on eating disorder symptoms and risk factors. Results also suggest that the prevention of subthreshold and full-syndrome eating disorders is feasible using such interventions. More research is needed to identify ways to motivate students to use preventive eating disorder interventions. ANTECEDENTES Los trastornos de la conducta alimentaria son altamente prevalentes entre los adultos jóvenes. Las universidades podrían ser un entorno óptimo para prevenir la aparición de trastornos alimentarios a través de la intervención psicológica. Como parte de la iniciativa World Mental Health-International College Student, esta revisión sistemática y meta-análisis sintetiza datos sobre la eficacia de los programas de prevención de trastornos alimentarios dirigidos a estudiantes universitarios. MÉTODO: Una búsqueda bibliográfica sistemática de datos bibliográficas (CENTRAL, MEDLINE, PsycINFO) para ensayos aleatorios que comparaban intervenciones preventivas psicológicas para trastornos alimentarios dirigidos a estudiantes universitarios con psicoeducación o controles inactivos fue realizada hasta el 22 de octubre de 2019. RESULTADOS Se incluyeron 27 estudios. Trece (48,1%) fueron calificados como de bajo riesgo de sesgo. El riesgo relativo de desarrollar un trastorno de la conducta alimentaria subclínico (parcial) o completo fue IRR = 0.62 (95% CI [0.44, 0.87], nc = 8, NNT = 26.08; sólo entrevistas clínicas estandarizadas), lo que indica una disminución del 38% en la incidencia en los grupos de intervención en comparación con los controles. Se encontraron efectos pequeños a moderados entre los grupos en la post-prueba en los síntomas del trastorno alimentario (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, nc = 26), dieta (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, nc = 21), insatisfacción corporal (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, nc = 25), impulso por delgadez (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, nc = 12), problemas de peso (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, nc = 13) y síntomas afectivos (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, nc = 18). Los efectos sobre los síntomas de la bulimia nervosa no fueron significativos. La heterogeneidad fue moderada en las comparaciones. DISCUSIÓN: La prevención de los trastornos de la conducta alimentaria en el campus universitario puede tener efectos significativos, de pequeños a moderados, sobre los síntomas del trastorno alimentario y los factores de riesgo. Los resultados también sugieren que la prevención de los trastornos alimentarios subclínicos o parciales y síndromes completos es factible utilizando tales intervenciones. Se necesita más investigación para identificar formas de motivar a los estudiantes a usar intervenciones preventivas para los trastornos de la conducta alimentaria.
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2.
Changes in disordered eating behaviors over 10 or more years: A meta-analysis.
Romano, KA, Heron, KE, Amerson, R, Howard, LM, MacIntyre, RI, Mason, TB
The International journal of eating disorders. 2020;(7):1034-1055
Abstract
OBJECTIVE The present meta-analysis evaluated changes in individuals' risk of engaging in distinct disordered eating behaviors (DEBs) in the long-term. METHOD Longitudinal studies assessing changes in DEBs via ≥2 assessments with a time lag of ≥10 years were included. Risk ratios were calculated for baseline to 10-14.9-year (M = 11.04) follow-up and baseline to ≥15-year (M = 18.62) follow-up changes in the use of binge eating, multiple purging, self-induced vomiting, laxatives, diuretics, diet pills, compensatory exercising, fasting/dieting, and multiple DEBs; Cohen's d was used for continuous binge-eating plus purging variable changes. Subgroup and meta-regression analyses tested whether eating disorder (ED) clinical sample versus nonclinical sample status, female versus male sex/gender, higher versus lower study bias, and baseline mean age and body mass index influenced overall effect magnitude for analyses with sufficient data. RESULTS Seventeen studies (26 [sub]samples) were included. Overall, individuals' risk of engaging in various restrictive eating and other compensatory behaviors decreased over time and the magnitudes of risk reductions for the use of certain compensatory DEBs were larger over longer follow-up durations. Specifically, for significant DEB change models, risk reductions spanned from 20.0-39.8% for 10-year follow-up and 24.7-74.8% for ≥15-year follow-up. However, nuances were found in the nature of these DEB changes as a function of DEB type, follow-up length, ED versus nonclinical sample composition, and baseline mean age. CONCLUSIONS These findings provide important information that can help identify treatment priorities and suggest that targeted and tailored preventative ED treatments warrant consistent implementation at the community-level, particularly for youth.
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3.
Eating disorders risk among medical students: a global systematic review and meta-analysis.
Jahrami, H, Sater, M, Abdulla, A, Faris, MA, AlAnsari, A
Eating and weight disorders : EWD. 2019;(3):397-410
Abstract
PURPOSE Medical students appear to be a high-risk group to develop psychological problems including eating disorders (ED). The prevalence estimates of ED risk vary greatly between studies. This systematic review and meta-analysis was done to estimate the prevalence of ED risk among medical students. METHODS An electronic search of EMBASE, MEDLINE, ProQuest and Google Scholar was conducted. Studies that reported the prevalence of ED risk among medical students and were published in English peer-reviewed journals between 1982 and 2017 were included. Information about study characteristics and the prevalence of ED risk were extracted by four investigators. Each article was reviewed independently by at least two investigators. Estimates were pooled using random-effects meta-analysis using the DerSimonian-Laird method. The main outcome of interest was the prevalence of ED risk in medical students. RESULTS The prevalence of ED risk among medical students was extracted from nineteen cross-sectional studies across nine countries (total participants n = 5722). The overall pooled prevalence rate of ED risk was 10.4% (497/5722 students, 95% CI 7.8-13.0%), with statistically significant evidence between-study heterogeneity (Q = 295, τ2 = 0.003, I2 = 94.0%, P < 0.001). Prevalence estimates between studies ranged from 2.2 to 29.1%. CONCLUSION In this systematic review and meta-analysis, the summary prevalence of ED risk among medical students was 10.4%. Further research is needed to identify and prevent ED in this population. Studies are also needed to investigate concurrent pathologies associated with ED risk. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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4.
Problematic Internet Use as a Predictor of Eating Disorders in Students: A Systematic Review and Meta-Analysis Study.
Hinojo-Lucena, FJ, Aznar-Díaz, I, Cáceres-Reche, MP, Trujillo-Torres, JM, Romero-Rodríguez, JM
Nutrients. 2019;(9)
Abstract
Problematic Internet use (PIU) has begun to be linked to the development of certain eating disorders. This uncontrolled use of the Internet is mainly found in the student population. The purposes of this paper were to determine PIU-related eating disorders in students from a systematic review of the literature and to analyze the incidence of PIU in eating disorders through a meta-analysis of the literature. We used two electronic databases (Web of Science and Scopus) from inception to June 2019. The systematic literature review was based on fixed inclusion and exclusion criteria. A total of 12 studies were identified (systematic review) and 10 studies for meta-analysis, which included 16,520 students. Different eating disorders were associated with PIU: anorexia nervosa, bulimia nervosa, binge-eating disorder, food preoccupation, loss of control eating, and dieting. Furthermore, meta-analysis confirmed that PIU is a predictor of eating disorders in students. The groups of students with PIU presented a higher rate in the presence of eating disorders, these differences being significant. Finally, this study showed empirical evidence on the link between PIU and eating disorders. The need for prevention in childhood and adolescence is highlighted.
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5.
Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis.
Trindade, AP, Appolinario, JC, Mattos, P, Treasure, J, Nazar, BP
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;(2):179-187
Abstract
OBJECTIVE To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED. METHODS The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO). RESULTS Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively). CONCLUSION Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.
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6.
Relationship between polyunsaturated fatty acid and eating disorders: Systematic review and meta-analysis.
Satogami, K, Tseng, PT, Su, KP, Takahashi, S, Ukai, S, Li, DJ, Chen, TY, Lin, PY, Chen, YW, Matsuoka, YJ
Prostaglandins, leukotrienes, and essential fatty acids. 2019;:11-19
Abstract
OBJECTIVES Eating disorders result in poor nutrition, poor physical conditions and even suicidality and mortality. Although polyunsaturated fatty acids (PUFAs) have attracted attention in the emerging field of nutritional psychiatry, their role in eating disorders remains unknown. This meta-analysis investigates the differences of PUFA levels between patients with eating disorders and healthy controls, and the potentially beneficial effects of PUFAs in such patients. METHODS We conducted a systematic literature search and meta-analysis under the random effects model. RESULT Eleven studies were included in the current meta-analysis. Compared with controls, 379 patients with eating disorders had significantly higher plasma levels of alpha-linolenic acid, eicosapentaenoic acid, stearidonic acid, osbond acid, palmitoleic acid, oleic acid, and total omega-3 fatty acids; and lower levels of total omega-6 fatty acids and omega-6/omega-3 ratio. Eating disorders were associated with significantly higher red blood cell membrane levels of palmitoleic acid and oleic acid and lower levels of adrenic acid, arachidonic acid, and total omega-6 fatty acids. In addition, PUFA supplements were associated with a benefit to body weight outcomes but not disease severity and mood symptoms in interventional trials. DISCUSSION This meta-analysis indicates abnormal levels of PUFAs in peripheral blood tissues in patients with eating disorders. The relationship between PUFAs and eating disorders should be interpreted cautiously considering the specific lipid metabolism under starvation state. To investigate the role of PUFAs on psychopathological and therapeutic effects in eating disorders, further larger clinical studies are warranted.
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7.
Prevention of eating disorders: A systematic review and meta-analysis.
Le, LK, Barendregt, JJ, Hay, P, Mihalopoulos, C
Clinical psychology review. 2017;:46-58
Abstract
OBJECTIVE To systematically review and quantify the effectiveness of Eating Disorder (ED) prevention interventions. METHODS Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsychInfo, EMBASE, and Scopus) were searched for published randomized controlled trials of ED prevention interventions from 2009 to 2015. Trials prior to 2009 were retrieved from prior reviews. RESULTS One hundred and twelve articles were included. Fifty-eight percent of trials had high risk of bias. Findings indicated small to moderate effect sizes on reduction of ED risk factors or symptoms which occurred up to three-year post-intervention. For universal prevention, media literacy (ML) interventions significantly reduced shape and weight concerns for both females (-0.69, confidence interval (CI): -1.17 to -0.22) and males (-0.32, 95% CI -0.57 to -0.07). For selective prevention, cognitive dissonance (CD) interventions were superior to control interventions in reducing ED symptoms (-0.32, 95% CI -0.52 to -0.13). Cognitive behavioural therapy (CBT) interventions had the largest effect size (-0.40, 95% CI -0.55 to -0.26) on dieting outcome at 9-month follow-up while the healthy weight intervention reduced ED risk factors and body mass index. No indicated prevention interventions were found to be effective in reducing ED risk factors. CONCLUSIONS There are a number of promising preventive interventions for ED risk factors including CD, CBT and ML. Whether these actually lower ED incidence is, however, uncertain. Combined ED and obesity prevention interventions require further research.
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8.
A Meta-Analysis Examining the Influence of Pro-Eating Disorder Websites on Body Image and Eating Pathology.
Rodgers, RF, Lowy, AS, Halperin, DM, Franko, DL
European eating disorders review : the journal of the Eating Disorders Association. 2016;(1):3-8
Abstract
Previous research has indicated that exposure to pro-eating disorder websites might increase eating pathology; however, the magnitude of this effect is unknown. This study aimed to conduct a systematic review and meta-analysis to examine the effect of exposure to pro-eating disorder websites on body image and eating pathology. Studies examining the relationship between exposure to pro-eating disorder websites and eating pathology-related outcomes were included. The systematic review identified nine studies. Findings revealed significant effect sizes of exposure to pro-eating disorder websites on body image dissatisfaction (five studies), d = .41, p = .003; dieting (six studies), d = .68, p < .001, and negative affect (three studies), d = 1.00, p < .001. No effect emerged for bulimic symptoms (four studies), d = .22, p = .73. Findings confirmed the effect of pro-eating disorder websites on body image and eating pathology, highlighting the need for enforceable regulation of these websites.
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9.
Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis.
Deshmukh, M, Balasubramanian, H, Patole, S
Neonatology. 2016;(1):55-65
Abstract
BACKGROUND A delayed passage of meconium is considered as a risk factor for feed intolerance in preterm neonates. OBJECTIVES The aim of this study was to review the effects of different therapeutic agents for meconium evacuation on feed tolerance in preterm neonates. METHODS A systematic review of randomised controlled trials (RCTs) of different therapeutic agents for meconium evacuation in preterm neonates (gestation <32 weeks and/or birth weight <1,500 g) using the Cochrane systematic review methodology was undertaken. Databases including Google Scholar were searched in January 2016. The primary outcome was the time to reach full feeds (TFF; ≥120 ml/kg feeds with stoppage of parenteral nutrition >24 h). Secondary outcomes included necrotising enterocolitis (NEC), weight at discharge and adverse effects. The results were summarised as per the GRADE guidelines. RESULTS Six RCTs (2 each of glycerine suppository and enema, 1 normal saline enema and 1 oral osmotic contrast agent; n = 442) with a low or unclear risk of bias were included. The pooled estimate (random effects model) showed no reduction in TFF [mean difference (MD) -0.03, 95% CI -2.47, 2.41, p = 0.98; level of evidence: low]. No differences in NEC [risk ratio (RR) 1.71, 95% CI 0.63, 4.65, p = 0.30; level of evidence: low] and weight at discharge (MD -0.08, 95% CI -0.30, 0.15, p = 0.50; level of evidence: low) were found. The trial assessing oral osmotic contrast agents reported a trend towards a higher incidence of NEC ≥ stage II. There were no other adverse effects. CONCLUSION Limited low-quality evidence indicates that prophylactic glycerine suppository, small volume glycerine/normal saline enema or oral osmotic contrast agents to evacuate meconium did not reduce TFF in preterm neonates. Large, well-designed trials are essential to study this clinically significant issue.
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10.
Reducing eating disorder symptoms and risk factors using the internet: A meta-analytic review.
Melioli, T, Bauer, S, Franko, DL, Moessner, M, Ozer, F, Chabrol, H, Rodgers, RF
The International journal of eating disorders. 2016;(1):19-31
Abstract
OBJECTIVE The purpose of this meta-analytic review was, first, to evaluate the efficacy of Internet-based programs in decreasing eating disorder (ED) symptoms, and, second, to identify moderator variables these effects. METHOD Twenty studies were identified and between-group effect sizes were calculated for ED symptoms and risk factors. RESULTS Compared with control conditions, Internet-based programs successfully decreased body dissatisfaction (d = 0.28, 95% CI [0.15-0.41], p < .001), internalization of the thin ideal (d = 0.36, 95% CI [0.07-0.65], p < .05), shape and weight concern (d = 0.42, 95% CI [0.13-0.71], p < .05), dietary restriction (d = 0.36, 95% CI [0.23-0.49], p < .001), drive for thinness (d = 0.47, 95% CI [0.33-0.60], p < .001), bulimic symptoms (d = 0.31, 95% CI [0.20-0.41], p < .001), purging frequency (d = 0.30, 95% CI [0.02-0.57], p < .05), and negative affect (d = 0.32, 95% CI [0.12-0.52], p < .001). Moderator analyses revealed no impact of data analytic strategy on intervention effects. Similarly, participant risk status was not a moderator for most outcomes. DISCUSSION Internet-based programs are successful in decreasing ED symptoms and risk factors with small to moderate between-group effect sizes.