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Prevalence of Night Eating in Obese and Nonobese Twins Sanna Tholin1,2, Annakarin Lindroos3, Per Tynelius2, Torbjörn Åkerstedt1, Albert J

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Prevalence of Night Eating in Obese and Nonobese Twins Sanna Tholin1,2, Annakarin Lindroos3, Per Tynelius2, Torbjörn Åkerstedt1, Albert J ARTICLES nature publishing group EPIDEMIOLOGY Prevalence of Night Eating in Obese and Nonobese Twins Sanna Tholin1,2, AnnaKarin Lindroos3, Per Tynelius2, Torbjörn Åkerstedt1, Albert J. Stunkard4, Cynthia M. Bulik5,6 and Finn Rasmussen1 The aim of this study was to assess the prevalence of night eating (NE) and associated symptoms in a population- based sample of Swedish twins. A total of 21,741 individuals aged 20–47 years completed a questionnaire in 2005/2006. NE was defined as ≥25% of daily food intake after the evening meal and/or awakening at least once per week with eating episodes. The prevalence of NE was 4.6% in men and 3.4% in women. Among obese men and women, the prevalence was 8.4 and 7.5%, respectively. Men and women with NE had 3.4 and 3.6 times higher risk of binge eating compared to individuals without NE. The risk of sleep-related problems was 1.6–3.4 times higher in men and 2.5–3.3 times higher in women with NE compared to those without NE. This epidemiological study has estimated the prevalence of NE in a twin population. It revealed that NE is 2.5 and 2.8 times more common in obese men and women compared to normal weight men and women. Furthermore that NE is associated with binge eating and sleep-related problems. Obesity (2009) 17, 1050–1055. doi:10.1038/oby.2008.676 INTRODUCTION conceptualization defines NES as present when >25% of daily Given the increasing prevalence of obesity worldwide (1), caloric intake takes place after the evening meal and/or when and the documented association between sleep-related prob- nocturnal ingestions of food occur ≥3 times per week (15). lems and obesity (2–4), it is of considerable scientific inter- The causes for the suggested, disturbed circadian pattern of est to explore how symptoms of night eating (NE) relate food intake in NES are not clear. The evening hyperphagia and to both of these public health problems. As early as 1955, NE may be related to total overeating and obesity (16). However, Stunkard described the night-eating syndrome (NES) in a O’Reardon et al. studied the eating patterns and food intake in study of severely obese women (5). NES was initially defined those with NE and controls and found that despite large differ- as nocturnal hyperphagia, insomnia, and morning anorexia ences in the timing of the eating between those with NE and (i.e., loss of appetite). In the decades following this report, only controls, total energy intake did not differ (17). The causes for a limited number of studies have been conducted to determine the delayed circadian pattern of food intake in NES are not clear; the prevalence and nature of NES. As described under Methods however, neuroendocrine differences between individuals with section, NE is a more broadly defined condition than NES, NES and controls seem to be consequences rather than causes of making it essential to distinguish between these conditions. the altered pattern and timing of food intake (15). The use of varying diagnostic criteria applied to rela- With reference to the relation between binge eating tively small convenience or clinical samples has resulted in a and NES, Allison et al. studied three groups of individuals wide range of prevalence estimates with low precision (6,7). recruited by advertisements in Pennsylvania, USA: 177 par- Moreover, the highly select nature of study samples has lim- ticipants with binge eating disorder (BED), 68 individuals ited the ability to assess accurately the relation between NE with NES, and 45 overweight/obese comparison individuals and associated symptoms such as obesity, binge eating, and without BED or NES (9). The BED group had more episodes sleep-related problems (8–14). Therefore, research on large of binge eating and episode days of binge eating than the NES and population-based samples is needed. group which reported having more episodes of binge eating NES is not included in the current version of the Diagnostic and episode days of binge eating than the control group. and Statistical Manual of Mental Disorders (DSM-IV), but Similarly overeating episodes were more frequent among the provisional diagnostic criteria are available. The current BED group than the NES and comparison groups, although 1Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; 2Division of Epidemiology, Stockholm Centre of Public Health, Stockholm, Sweden; 3MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; 4Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA; 5Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; 6Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Correspondence: Finn Rasmussen ([email protected]) Received 25 February 2008; accepted 29 December 2008; published online 19 February 2009. doi:10.1038/oby.2008.676 1050 VOLUME 17 NUMBER 5 | MAY 2009 | www.obesityjournal.org ARTICLES EPIDEMIOLOGY the two later groups did not differ. Based on these and other Questions about NE, binge eating, BMI, findings the authors concluded that NES and BED are differ- and sleep-related problems ent entities (9). In a recent study from Australia, Colles et al. We applied both a broad and a narrow definition of NE. Broad NE was defined as awakenings with food intake during the night at least once a compared a NES only group, a binge eating only group and week and/or ≥25% of daily food intake after the evening meal. Narrow a comorbid NES and binge eating group (18). In the NES NE was defined as awakenings with food intake at least once a week and/ group, 40% reported binge eating and in the binge eating or ≥50% of daily food intake after the evening meal. Intake of water or group, 37% also reported NES. The authors also compared other beverages only did not count as food intake. Our definitions and these groups with respect to psychological distress and BMI. categories of NE were based on the following two questions: (i) “How often do you get up at night to eat?” with response alternatives never, The comorbid NES/binge eating group and the binge eating once or twice, weekly, nightly, and don’t know/don’t wish to answer; only group showed similar patterns of psychological distress, and (ii) “What proportion of your daily food intake takes place after while the NES only group revealed lower psychological dis- the evening meal?” with response alternatives 0, 1–24, 25–49, 50–74, tress than the comorbid NES/binge eating group. Mean BMI 75–100, and don’t know/don’t wish to answer. values were similar in the NES only group (40.2 kg/m2), binge Men and women with present or past symptoms of binge eating were 2 identified through the following two questions: “Have you ever had eating only group (43.7 kg/m ), and the comorbid NES/binge binges when you ate what most people would regard as an unusually eating group (43.7 kg/m2) (18). large amount of food in a short period of time?” with response alterna- Exploring the relation between BMI and NE, previous stud- tives yes, no, and don’t know/refuse; and “When you were having eating ies have yielded inconsistent results (14,19–24). Several reports binges, did you feel that your eating was out of control?” with response have shown positive associations between NES and BMI alternatives not at all, slightly, moderately, very much, extremely, and don’t know/don’t wish to answer. Those who answered “yes” to the first (20,21,25,26). In contrast, Striegel-Moore et al. (14) and also question and “very much” or “extremely” to the second question were Rand et al. (23) found no association between NE and BMI defined as binge eaters. in two different and large random samples of adults from the BMI (kg)/height (m2) was calculated from self-reported height and United States. In samples of 682 black and 659 white young weight and participants were categorized as normal weight (BMI 18.5– 2 2 ≥ 2 women from the United States who participated in a follow-up 24.9 kg/m ), overweight (BMI 25.0–29.9 kg/m ), or obese (BMI 30 kg/m ) according to the World Health Organization criteria (28). study of risk factors for cardiovascular diseases, Striegel- Participants with missing data on both NE questions were excluded Moore et al. found no association between NE and BMI (7). (n = 1,928) as were individuals who did not endorse one NE question Based on analyses of National Health Nutrition Examination and had missing data on the other (n = 605). As described above the final Survey-III data from the United States, Striegel-Moore et al. main study population comprised 21,741 individuals with complete data reported a weak inverse association between NE, defined as on NE symptoms and BMI. Nonresponse to questions about sleep-related problems, located in eating ≥25% after 7 pm, and BMI in adolescents and adults (24). an “elective” section of the questionnaire, was higher and results requir- However, analyses according to other definitions, e.g., eating ing access to this information were thus calculated for a subsample 50% or more after 7 pm, revealed no associations. (n = 6,208) as described below. In light of the inconsistencies in previous research and the Information on sleep-related problems was obtained through the dearth of population-based studies, the objectives of the current following questions: “Have you had difficulty falling asleep (during the past 3 months)?”, “Have you had feelings of not having had enough sleep study were: (i) to determine the prevalence of NE in a large pop- on awakening (during the last 6 months)?”, “Have you had disturbed ulation of Swedish men and women; (ii) to assess the relation of or restless sleep (during the last 6 months)?” For each question, those NE to BMI, sleep-related problems, and binge eating.
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