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Impact
of Bulimia Nervosa on Pregnancy
Reprinted from Eating
Disorders Review
November/December 2000 Volume 11, Number 6
©2000
Gürze Books
Find out more about Bulimia from one of the helpful links below
What is bulimia
Why do people become bulimic
How to help someone who has bulimia
Medication for bulimia
Impacts of bulimia on pregnancy
Predicting the onset of bulimia
Bulimia Nervosa: Working toward better definitions of remission and relapse
Pictures of bulimia
Active bulimia nervosa (BN) raises the risk of miscarriage,
prematurity, and postnatal depression, according to
the results of a recent study at St. George's Hospital,
London. Using a retrospective case-control study of
women treated between 1988 and 1994, Drs. John F.
Morgan and J.H. Lacey compared the course of 122 women
with active BN during pregnancy with 82 controls with
quiescent BN. Active bulimia nervosa was significantly
associated with miscarriage (26% of subjects vs. 12%
of controls, preterm delivery (23% in subjects vs.
8% of controls), and possible gestational diabetes
(16% in subjects vs. 3 % of controls. All women in
the active group were binge eating regularly, and
95% were also inducing vomiting. None of the control
patients were inducing vomiting. Although the study
did not address the relative contributions of vomiting,
binge eating, or extreme restriction of calories on
pregnancy, the authors note that it is possible that
BN precipitates these complications, for example,
through altered insulin sensitivity and the subsequent
effect on placental blood flow.The study was reported
at the Academy for Eating Disorders annual meeting
in New York in May.
Night
Eating Syndrome: A Unique Eating Disorder
Reprinted from Eating
Disorders Review
May/June 2000 Volume 11, Number 3
©2000
Gürze Books
The night-eating syndrome (NES) appears to be distinctly
different from anorexia nervosa, bulimia nervosa,
or binge eating disorder, according to results of
studies in Norway and at the University of Pennsylvania
(JAMA 1999; 282:657)
The
night-eating syndrome is associated with morning anorexia, evening hyperphagia, and insomnia. Night eating is
thought to be brought on by stress and is believed
to affect about 2% of the general population (Int
J Eat Disord 1997; 22:65), about 9% of obese patients,
and about 27% of severely obese persons (Psychiatr
Q 1959; 33:284).
Two
studies look at behavior, endocrine changes
Two studies that examined the behavioral and neuroendocrine
sides of this disorder have better defined this perplexing
condition. The behavioral study, conducted by Dr.
Albert Stunkard and his colleagues at the University
of Pennsylvania, measured timing of energy intake,
mood level, and sleep disturbances. Subjects
included 10 obese persons (8 women and 2 men) who
met the criteria for NES and 10 matched controls who
were observed in an outpatient setting. Four subjects
with bulimia nervosa were added to the protocol as
a comparison group. Twenty-four-hour food intake data
were collected for one week. The
neuroendocrine study, conducted during a 24-hr period
while subjects were inpatients at University Hospital,
Tromsš, Norway, charted circadian levels of plasma
melatonin, leptin, and cortisol. The study group included
12 night-eaters and 21 control subjects, all women.
Behavioral
study: Half of calories between midnight and 6 am
The amount of food intake by night eaters and controls
differed only moderately, but the night eaters had
9.3 eating episodes during the 24 hours, compared
with 4.2 eating episodes for the control subjects.
The subjects with bulimia nervosa averaged 6.2 eating
episodes per day. Furthermore, the patterns of day
and night intake differed dramatically for the two
groups. During
the daytime, the cumulative energy intake of the night
eaters lagged behind that of the control subjects,
so that by 6 pm they had consumed only 37% of their
total daily intake, while the controls had consumed
74% of their total daily intake. While the food intake
of the controls slowed markedly by 8 pm, the night
eaters did not decrease their eating until after midnight.
From midnight to 6 am, the night eaters ate 56% of
their energy intake, while the control group consumed
15%.
During the 24 hours, the average mood of the night
eaters was lower than that of the controls. Also,
after 4 pm, the mood of the night eaters fell hour
by hour, while that of the controls remained unchanged.
The night eaters also had far more nighttime awakenings
than the control group (3.6 vs. 0.3, respectively)
and more than half of the nighttime awakenings were
associated with food intake. They ate mostly carbohydrates
(73% of energy) during these awakenings. The ratio
of carbohydrate to proteins in their nighttime snacks
was 7:1.
Neuroendocrine
study: differences in plasma cortisol, melatonin
The Tromsš researchers divided the 12 night eaters
into 7 nonobese (mean body mass index, or BMI, 23.1)
and 5 obese (mean BMI: 36) subjects. Just as in the
behavioral study, nighttime awakenings were far more
common among the night eaters than the controls (3.1
vs. 0.1). All
the night eaters, obese and nonobese alike, had lower
plasma melatonin levels from 10 pm to 6 am than did
controls. Plasma melatonin concentrations were higher
in the obese control group than the normal-weight
control group, but the concentrations were the same
in the obese and nonobese night eaters. Plasma leptin
levels were higher among the overweight subjects than
among the normal-weight subjects in both night eaters
and controls. The highest leptin concentrations did
not differ between the obese and nonobese subjects. Plasma
cortisol was not significantly different between obese
and nonobese subjects or controls. From 8 am to 2
am, plasma cortisol levels were higher among the night
eaters than the controls. Preprandial and postprandial
blood glucose and plasma insulin levels did not differ
between the night eaters and controls in either the
obese or normal-weight groups. The
carbohydrate-rich nighttime snacks (70.3% of kilocalories)
and especially the high carbohydrate-to-protein ratio,
suggest that night eating is designed to restore the
disrupted sleep of the night eaters. The
night-eating syndrome also seems to differ from the
"nocturnal sleep-related eating disorders"
reported by sleep disorder clinics and characterized
by eating upon awakening from sleep, often due to
sleepwalking and related sleep disturbances.
If
this is a new syndrome, how can it be treated?
According to the authors, the presence of a sleep
disorder linked to attenuation of the nighttime rise
in melatonin suggests that exogenous melatonin may
be helpful to these patients. Because the subjects'
ingestion of high-carbohydrate snacks may possibly
be an attempt to improve sleep and mood by raising
serotonin levels, selective serotonin reuptake inhibitors
may also help. In addition, corticotropin-releasing
hormone (CRH) receptor antagonists might be a helpful
addition to psychotherapy. All
of these speculations will need careful clinical testing
before any recommendations for treatment can be made.
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Additional Resources:
What is Anorexia?
What is Bulimia?
When Someone with an Eating Disorder Refuses Help
Why do People Become Anorexic?
Why Do People Become Bulimic?
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