Everyday eating behavior and menstrual function in young women.

OBJECTIVE: To examine the association of different types of everyday eating behavior with disturbances of menstrual function. DESIGN: Prospective cohort study with two groups, low dietary restraint (n = 13) and high dietary restraint (n = 9), identified with the Three-Factor Eating Questionnaire by Stunkard and Messick. SETTING: Research clinic. PARTICIPANTS: Normal volunteers (students and young professionals). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Frequent serum and urine samples for determination of estradiol (E2), progesterone (P), and metabolites. Food and behavioral diaries. RESULTS: Eleven of the 13 women with low dietary restraint had menstrual cycles that fulfilled the following standard criteria: Serum E2 maximum of 440 pmol/L or more, P maximum of 19 nmol/L or more, and luteal phase length of 9 days or more. Only 2 of the 9 women with high dietary restraint had cycles that satisfied these criteria. Of the remaining 7, 1 had an anovulatory cycle and 6 had decreased P concentrations (P less than 0.05) and/or a shortened luteal phase (P less than 0.02). CONCLUSIONS: High cognitive restraint in everyday eating behavior may be a risk factor for the development of menstrual disturbance in young women.

Circadian pattern of large neutral amino acids, glucose, insulin, and food intake in anorexia nervosa and bulimia nervosa.

Insulin, glucose, and large neutral amino acids (LNAA) were studied in 10 patients with anorexia nervosa, 13 patients with bulimia nervosa, and 15 healthy controls. Blood samples were collected at hourly intervals during the day and at two-hour intervals during the night over a 24-hour period. Ad libitum caloric and relative carbohydrate intake was significantly reduced in the anorectic and bulimic patients. Elevated concentrations of beta-hydroxybutyric acid (BHBA) were seen in the bulimic group, and low triiodothyronine (T3) concentrations in the anorectic group. Mean plasma glucose and insulin concentrations were significantly lowered in both groups. The tryptophan (Trp) to LNAA ratio was reduced in anorectic, but not in bulimic patients. These findings suggest that Trp influx into the brain is reduced in anorectic patients, possibly impairing central serotonergic function.

Luteinizing hormone and follicle stimulating hormone secretion patterns in female athletes with and without menstrual disturbances.

Thirty-one young female athletes and 13 age-matched sedentary controls were studied throughout one menstrual cycle or over a 6 week period. Blood was sampled on 5 days per week. Episodic gonadotrophin secretion was measured in the early follicular phase and in the late luteal phase by blood sampling over a 12-h period at 15-min intervals. Eight athletes had anovulatory cycles, nine had impaired progesterone (P4) secretion during the luteal phase and 14 had normal cycles as judged from oestradiol (E2) and P4 plasma levels. Athletes with normal cycles had shorter cycles, lower E2 maxima at midcycle, and lower E2 and P4 concentrations during the luteal phase than had sedentary controls. Episodic luteinizing hormone (LH) secretion in the early follicular phase was significantly impaired in the anovulatory athletes: the average LH values over 12 h and the number of secretion episodes were significantly reduced. No significant changes were seen in follicle stimulating hormone secretion.

Energy expenditure and everyday eating behavior in healthy young women.

The doubly labeled water method was used to measure average daily total energy expenditure (EE) in 23 healthy normal-weight women classified as restrained or unrestrained eaters. Although the relative weight of restrained eaters was found to be higher (BMI 21.1 +/- 1.3 vs 20.0 +/- 1.3 kg/m2, p less than 0.03), the self-reported energy consumption of the restrained eaters, when adjusted for body composition and height, totaled approximately 410 kcal/d less energy than that of the unrestrained group (p less than 0.002). Correspondingly, the adjusted EE was found to be lower by 620 kcal/d in restrained eaters (p less than 0.005). In both groups metabolic indices of starvation (beta-hydroxybutyric acid and triiodothyronine) were in the normal range. Neither these nor weight changed from the beginning to the end of the 14-d observation period. Thus, the lower EE of the restrained group reflects diminished caloric requirements and is not an adaptive response to a temporary decrease in food intake.

Cyclic ovarian function in recreational athletes.

In 17 female recreational athletes, ovarian function was monitored using daily hormone measurements and serial ultrasound determinations. Whereas 11 out of 13 women of a control group showed estradiol (E2) maxima beyond 470 pmol/l, progesterone (P4) maxima of 19 nmol/l or more, and a luteal phase length of 9 days or more, only 10 out of 17 athletes satisfied these criteria. Six athletes showed disturbed follicular development, and one athlete showed luteal phase disturbance. Both athletes with disturbed menstrual function (n = 7) and athletes fulfilling the above-mentioned minimal criteria (n = 10) had lower E2 concentrations in all phases of the menstrual cycle (P less than 0.05). P4 concentrations were significantly decreased in the group with disturbed menstrual function (P less than 0.05). Maximal aerobic capacity in the two athlete groups was similar. Neither athlete group showed the expected increase in caloric intake compared with the sedentary controls. It is concluded that recreational running is associated with altered ovarian function. Inadequate nutritional adaptation may be a contributing factor.

Endocrine findings in restrained eaters.

Restrained (n = 9) and unrestrained eaters (n = 13) were selected from a group of healthy young women. Blood samples were collected overnight at half-hour intervals. Levels of cortisol, growth hormone, and glucose in both groups did not differ, while restrained eaters had significantly lower insulin values. After a standardized test meal of 500 kcal, restrained eaters had significantly lower norepinephrine values while insulin and glucose values did not differ from those of the unrestrained group. These findings indicate that restrained eating may have a biological basis.

From dietary restraint to binge eating: some theoretical considerations.

A correlation between dietary restraint and the occurrence of binge eating has been convincingly shown in several investigations. However, the mediating mechanisms have not yet been elaborated in detail nor linked to empirical evidence. This theoretical gap is addressed in the following. After a short review of behavioral and metabolic correlates of dietary restraint, potential effects of restrained eating on the psychophysiological regulation of food intake are described. These effects may lead to the disruption of intake regulation and therefore can be regarded as direct causes of binge eating.

Differences in food-choice frequencies between restrained and unrestrained eaters.

Reported frequency of consumption for certain food items was studied in young normal-weight women, classified into 19 unrestrained and 20 restrained eaters by the Three-Factor Eating Questionnaire of Stunkard & Messick (1985). Neither group differed in the consumption of basic foods and snacks but restrained eaters showed a strong tendency to avoid fat. A large percentage of this group was used to consuming artificial sweeteners and other calorie-reduced foodstuffs. These qualitative alterations in the everyday eating behavior of restrained eaters may be one of the links between dietary restraint and binge eating.

Mood changes and physical complaints during the normal menstrual cycle in healthy young women.

Significant emotional and physical symptoms have been linked to hormonal changes during the menstrual cycle. A critical evaluation of the available studies questions the commonly held belief in menstrual-cycle-related complaints in the majority of normal women. The present study investigated changes in mood, somatic complaints and vegetative variables during the menstrual cycle in 30 healthy young women. Normal cycle function was evaluated and cycle phases were defined according to endocrine data. For all subjects, blood samples were taken at least three times a week to measure estradiol and progesterone. Daily ratings of psychological variables revealed no significant changes in global mood or depression over the cycle. Somatic complaints such as abdominal pain and breast tenderness were significantly related to the luteal, premenstrual, and menstrual phases. Appetite increased in the periovulatory and premenstrual phases. There was a tendency for sexual interest to be highest in the post-menstrual period. Affect and vegetative variables showed no association with hormone levels but were significantly correlated with subjective stress ratings. We conclude that in most healthy young women, cycle-related hormone fluctuations are not accompanied by marked affective changes. Specific physical complaints, however, do occur, particularly in the luteal, premenstrual, and menstrual phases.

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, depression, 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.

A comparison of the validity of three scales for the assessment of dietary restraint.

The construct validity of Herman and Polivy's Restraint Scale (RS), the restraint factor of the Three Factor Eating Questionnaire (TFEQ-R), and the restraint scale of the Dutch Eating Behavior Questionnaire (DEBQ-R) were investigated by relating these scales to self-reported mean caloric intake per day and to other measures associated with disordered eating and figure consciousness. A factor analysis showed that the three restraint scales measure different components of the restraint construct. A high score on the RS was closely related to consequences of mostly unsuccessful dieting, such as disinhibited eating and weight fluctuations, but not to successful overall caloric restriction in everyday life. High scores on the TFEQ-R and the DEBQ-R represented the more successful dieting behavior component of restraint. The three scales have in common a motivational component of restrained eating, including concerns about shape and weight, and desire for thinness.

Decreased follicular phase gonadotropin secretion is associated with impaired estradiol and progesterone secretion during the follicular and luteal phases in normally menstruating women.

We tested the hypothesis that disturbed follicular development and disturbed luteal progesterone (P4) secretion are associated with reduced gonadotropin secretion in the early follicular phase by measuring pulsatile LH and FSH secretion at that time in 53 normally menstruating women. Three groups of women were identified on the basis of serum sex steroid concentrations (measured daily throughout the cycle) and luteal phase length. Group A (n = 27) had normal ovarian hormone secretion with peak serum estradiol (E2) concentrations of 440 pmol/L or more, peak serum P4 concentrations of 19 nmol/L or more, and luteal phase length of 9 days or more. Group B (n = 16) had normal peak serum E2 values, but peak serum P4 values less than 19 nmol/L and/or luteal phase length less than 9 days. Group C (n = 10) had peak serum E2 values below 440 pmol/L. Risk factors for the disturbances found in groups B and C were exercise and/or intermittent dieting. Compared to group A, both groups B and C had reduced mean serum LH concentrations (3.1 +/- 1.5 vs. 2.3 +/- 1.4 and 2.0 +/- 1.0 IU/L; P less than 0.05) and reduced LH pulse frequencies (5.2 +/- 2.1 vs. 3.5 +/- 1.8 and 3.3 +/- 2.3 pulses/12 h; P less than 0.02). LH amplitude was similar in all 3 groups. Mean serum FSH concentrations were slightly but not significantly lower in group C. We conclude that reduced gonadotropin secretion during the follicular phase may indeed affect E2 and P4 secretion at later stages of the menstrual cycle. The patterns of alteration associated with disturbed E2 and P4 secretion in normally menstruating women are similar to those that occur in women with hypothalamic amenorrhea.

Behavioral and biological correlates of dietary restraint in normal life.

Based on laboratory results, restrained eating has been linked to the development of binge eating and eating disorder syndromes such as bulimia nervosa. This study was designed to extend the scope of investigation of the concept of restrained eating beyond the laboratory. Eating behavior and biochemical indices of nutritional state were investigated in 60 young women, who were divided in restrained and unrestrained eaters by questionnaire. Seven-day records of food intake showed that the high-restraint group ate around 400 kcal a day fewer than the low-restraint group. Group differences in actual macronutrient intake and long-term food preferences pointed to a qualitatively altered eating pattern in restrained eaters. Actual protein portion was higher in restrained eaters. They tried to avoid calorie dense food items of high carbohydrate and fat content. Instead, they preferred food regarded as low-caloric and healthy. Plasma levels of triiodothyronine and glucose, which could be taken as indices of long-term adaptation to starvation, were not decreased in the high-restraint group. However, significantly higher levels of triglycerides in restrained eaters may reflect a biological state due to short-term starvation. The results indicate that the concept of dietary restraint predicts eating behavior not only under experimental conditions, but also in normal life. As a consequence of altered eating patterns, psychological and physiological deprivation can be hypothesized in restrained eaters, making them prone to the occurrence of overeating.

Dieting causes menstrual irregularities in normal weight young women through impairment of episodic luteinizing hormone secretion.

Thirteen healthy, normal weight young women were studied throughout a control cycle and a diet cycle, during which they lost 1 kg per week on a vegetarian 800 kcal diet. Blood was sampled daily in the morning, and at weekly intervals, collected at 10-minute intervals for 6 hours. Follicle growth was monitored by ultrasonic measurement. All subjects showed normal cyclic gonadal function during the control cycle. Cyclic gonadal function remained unaltered in two subjects during the diet cycle. No dominant follicle developed in seven others, while another four showed apparently normal follicular development but impaired progesterone secretion by the corpus luteum. Comparison of both cycles revealed that episodic luteinizing hormone (LH) secretion during the follicular phase was altered by dieting. Average LH concentrations and the frequency of episodic secretions were significantly reduced during the follicular phase but not during the luteal phase. Follicle-stimulating hormone was unaltered.

Serotonin turnover in rat brain during semistarvation with high-protein and high-carbohydrate diets.

Serotonin (5-HT) and 5-hydroxyindolacetic acid (5-HIAA) were determined in seven brain regions of semistarved and control male rats. After semistarvation on a high carbohydrate diet serotonin turnover, as indicated by 5-HIAA/5-HT ratio, was increased in the total brain and several regions both three and 24 hours after the last meal. In contrast, after semistarvation on a high-protein diet serotonin turnover was decreased three hours after ingestion of the final meal, but increased 24 hours thereafter. Compulsary running wheel activity for one hour did not influence diet induce changes in serotonin turnover. Alterations in plasma corticosterone during semistarvation were not related to changes in central serotonin turnover. Data suggest that the interaction of caloric restriction and diet composition determines serotonin turnover during semi-starvation.

Gonadotrophins, oestradiol and progesterone during the menstrual cycle in bulimia nervosa.

Gonadotrophins and gonadal hormones were studied during the menstrual cycle or during 5 weeks when no cycles occurred in 15 patients who were diagnosed as having bulimia by DSM III criteria. Nine healthy age-matched women served as controls. Based on plasma oestradiol (E2) values patients were divided into two groups. Group I (n = 8) did not show E2 increases greater than 444 pmol/l indicating that no follicular development took place. Group II showed normal follicular hormone production during the follicular phase but impaired progesterone (P4) levels during the luteal phase. Studies of episodic gonadotrophin secretion during the follicular phase revealed low average LH and FSH values and reduced amplitude but no significant changes of frequency in group I. Our data indicate that impaired follicular maturation as seen in about half of the bulimic patients is caused by impaired gonadotrophin secretion.