The relationship between meal frequency and body mass index in black and white adolescent girls: more is less.

OBJECTIVE: To document meal frequency and its relationship to body mass index (BMI) in a longitudinal sample of black and white girls from ages 9-19 years. DESIGN: Ten-year longitudinal observational study. SUBJECTS: At baseline, 1209 Black girls (539 age nine years, 670 age 10 years) and 1,166 White girls (616 age nine years, 550 age 10 years) were enrolled in the National Heart, Lung and Blood Institute Growth and Health Study (NGHS). MEASUREMENTS: Three-day food diaries, measured height and weight and self-reported physical activity and television viewing were obtained at annual in-person visits. RESULTS: Over the course of the study, the percentage of girls eating 3+ meals on all 3 days was reduced by over half (15 vs 6%). Participants who ate 3+ meals on more days had lower BMI-for-age z-scores. Black girls, but not white girls, who ate 3+ meals on more days were less likely to meet criteria for overweight. CONCLUSION: Meal frequency was related to BMI and should be considered when developing guidelines to prevent childhood overweight.

Development and validation of a screening tool to identify eating disorders in female athletes.

OBJECTIVE: To develop and validate a screening tool to identify eating pathology in women athletes. DESIGN: Three cross-sectional subject groups were established: college women athletes diagnosed with eating disorders; college women athletes without eating pathology; college women who did not participate in athletics but were diagnosed with an eating disorder. The Female Athlete Screening Tool (FAST), and 3 valid psychometric measures were administered to subjects in all groups. Internal reliability, discriminant and concurrent validity were established. SUBJECTS/SETTINGS: Women college students between the ages of 18 and 23 years (n=41) from the University of Connecticut and St Joseph College were recruited. The athletes were screened for eating disorders by a sports medicine team. STATISTICAL ANALYSIS: Cronbach's alpha, one-way analysis of variance, and correlation analyses. RESULTS: Reliability analysis indicated a high internal consistency of the FAST (Cronbach's alpha = 0.87). Athletes with eating disorders scored significantly higher on the FAST as compared with athletes without eating pathology and nonathletes with eating disorders (P<.001), which demonstrated discriminant validity. Correlation analyses showed that the FAST was strongly correlated to the Eating Disorder Examination-Questionnaire (0.60, P<.05) and Eating Disorder Inventory (0.89, P<.001). APPLICATIONS/CONCLUSIONS: Early detection of eating disorders can help prevent the onset or severity of a clinical eating disorder. By using the screening tool that has been validated for use in women athletes, dietetic professionals can quickly identify those athletes who need assistance with their aberrant eating habits.

Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered?

Although prevalence estimates vary in women with type 1 diabetes mellitus, studies suggest the occurrence of eating disorders is comparable between women with and without diabetes mellitus. A new study examined the association between eating disorders and type 1 diabetes mellitus in 12-19-year-old females with diabetes for at least 1 year. Subjects with diabetes were 2.4 times more likely than controls (without diabetes) to have a clinical eating disorder and 1.9 times more likely to have a subthreshold eating disorder. Moreover, mean glycosylated hemoglobin was higher in subjects with diabetes who had an eating disorder (9.4%) compared with those with diabetes without an eating disorder (8.6%).

Position of the American Dietetic Association and Dietitians of Canada: women's health and nutrition.

Within the past 10 years women's health has evolved to a much broader paradigm, beyond reproductive issues. From a physiological perspective, women's health now refers to the prevention, diagnosis, and management of conditions or diseases that may be unique to women, be more prevalent in women, or manifest differently in women than men. Women's health encompasses emotional, social, cultural, spiritual, and physical well-being. It is determined by the social, political, and economic context of women's lives. Nutrition is involved in the etiology or treatment of half of the 10 leading causes of death in women. The incidence of osteoporosis and extremes in body weight are approaching epidemic proportions in women. This position reviews the following health problems: cardiovascular disease, cancer, osteoporosis, weight, and diabetes mellitus. Dietetics professionals are in the perfect position to understand the issues surrounding women's health in order to deliver a message to women that will allow them to make wise decisions regarding their health. Nutrition is a critical component of risk reduction and treatment, and must be included in clinical and preventive services for women. Dietetics professionals must work to increase their knowledge about women's health issues, to promote health and education programs, to influence policy makers, to deliver the highest-quality medical nutrition therapy, and to be proactive in documenting the effectiveness of outcomes-based research.

Women with insulin-dependent diabetes mellitus (IDDM) complicated by eating disorders are at risk for exacerbated alterations in lipid metabolism.

OBJECTIVE: To examine lipid parameters that are affected in women with insulin-dependent diabetes mellitus (IDDM) who engaged in disordered eating behaviours. DESIGN: Randomized, unmatched. SETTING: Tertiary care. SUBJECTS: Ninety women (18-46 y) with IDDM. INTERVENTIONS: Classification of subjects based on severity of eating disorder: clinical (n = 14), subclinical (n = 13) and control (n = 63). Blood was analysed for glycosylated haemoglobin (HbA1c) and serum for triglycerides and cholesterol. Carotenoid and tocopherol concentrations were analysed by high performance liquid chromatography (HPLC). Dietary intake was assessed by the National Cancer Institute food frequency questionnaire. RESULTS: HbA1c was significantly increased im women demonstrating clinical and subclinical symptoms compared to control (10.4 +/- 2.6, 10.0 +/- 1.5 and 8.3 +/- 1.6%, respectively, P < 0.05). Triglycerides concentrations were significantly increased in women with subclinical eating disorders compared to controls. In women who intentionally omitted or reduced insulin, triglyceride cholesterol and HbA1c were significantly increased compared to controls. Women with IDDM and eating disorders who exhibited bulimic behaviours consumed significantly more energy, total fat and cholesterol compared to controls and women with eating disorders who were restrained eaters. CONCLUSION: While IDDM is known to perturb lipid metabolism, these data demonstrate that eating disorders, in combination with IDDM, results in additional alterations in lipid metabolism.

Subclinical and clinical eating disorders in IDDM negatively affect metabolic control.

OBJECTIVE: To characterize the relationship of subclinical and clinical eating disorders to HbA1c values in women with IDDM. RESEARCH DESIGN AND METHODS: Ninety women with IDDM (18-46 years of age) were recruited from diabetes clinics throughout Connecticut and Massachusetts. Subjects were categorized into one of three groups according to the Diagnostic Statistical Manual of Mental Disorders (DSM-III-R) criteria for eating disorders as follows: the clinical group (n = 14), the subclinical group (partially fulfilling the diagnostic criteria; n = 13), and the control group (n = 63). Group differences in the degree of dietary restraint, binge eating, and bulimic behaviors and weight, shape, and eating concerns were assessed with the Eating Disorder Examination (EDE) and the Bulimia Test Revised (BULIT-R). RESULTS: Women with subclinical and clinical eating disorders had clinically elevated HbA1c results and more diabetes-related complications, compared with the control subjects. The severity of bulimic behaviors, weight concerns, reduced BMI, and decreased frequency of blood glucose monitoring were associated with elevated HbA1c. CONCLUSIONS: HbA1c may have clinical utility in the identification of eating disorder behavior in females with IDDM. Health care professionals should be aware of the potent effect of subclinical and clinical eating behaviors including insulin misuse in weight-conscious women with IDDM who have poor glycemic control.