Eating disorders and dietary patterns : a cross-sectional study among students of a Lebanese private university

Abstract

Background -- Eating disorders (EDs) and related risk factors have become an area of interest for researchers, and a challenge to manage for health care practitioners. EDs were considered mainly as western culture disorders; however recent studies showed a comparable raise of EDs in the Middle Eastern countries. Objective -- The purpose of this study was to estimate the proportion of Notre Dame University students (NDU) who are at risk of developing EDs, and examine the association of ED’s risk with socio-demographic, lifestyle, dietary factors and dietary patterns Methods -- This was a cross-sectional study, conducted a sample of 457 NDU students of both genders. Informed consent form was obtained prior to participation from study applicants. Data on socio-demographic and lifestyle factors were collected using a background questionnaire, along with data on physical activity collected using the International Physical Activity Questionnaire (IPAQ)- short form. Dietary intake of participants was assessed using a 61-item food frequency questionnaire (FFQ-61 item). The risk of developing EDs was assessed using the SCOFF questionnaire (The Sick Control, One stone, Fat, Food). Anthropometric, body composition and blood pressure measurements of all subjects were obtained, using standard protocols and bioelectrical impedance analysis, respectively. Statistical Analysis -- Quantitative and qualitative measurements were summarized as mean ‡ standard deviation/ Median (Interquartile range) and n (%). Comparisons of continuous and categorical variables were performed using independent two-sample T- Test/ Mann Whitney- U-Test/ analysis of variance and the chi square test/ Fisher’s exact test respectively. Dietary patterns were identified by exploratory factor analysis, Spearman’s correlation coefficients were calculated between dietary patterns and energy adjusted nutrient intakes. Multiple linear regression was used to assess socio-demographic and lifestyle determinants of the various dietary patterns. Multivariate linear regressions were used to assess associations between each of the identified dietary patterns and being at risk of EDs, after controlling for confounders. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 22 for Windows. A p-value<0.05 will be considered statistically significant. Results -- The mean age of the sample was 21.3‡1.9 years (63% males). Five dietary patterns were identified: ‘Traditional Lebanese’, ‘Western fast food’, ‘Diary’, ‘Lebanese fast food’ and ‘Fruits’. Using the SCOFF questionnaire, 146 (32.4%) students were found to be at a high risk of developing EDs with a significantly higher proportion of females than males (F: 40% vs. M: 28.1%, P<0.05). Significant associations were observed between high risk of EDs and: frequency of eating meals while watching television/week (often (37%), occasionally (25%), rarely (36%)), physical activity level (low level 39%, moderate 24% and high 37%), family history of mental illness (positive: 52% vs. negative: 31%), higher depression score (42% vs. 28%, P=0.014), risky waist circumference (49% vs. 31%, P=0.038), higher percentage of body fat ( 26.3 vs. 19.6, P=0.004), higher BMI (Obese: 49%, Overweight: 41%, Normal: 28%, Underweight:4%, P=0.000), risky waist to height (44% vs. 26%, P=0.000), chronic morbidity (Yes:46%; No:31%, P=0.046), unhealthy eating behavior for the past 3 months (Yes: 48%; No:30%, P=0.008), lower energy intake (4172.5 vs. 4860.1, P=0.004) and higher dietary intake of: potassium ( 14324 vs. 1313 mg, P=0.000), magnesium (151.5 vs. 143.0 mg, P=0.007), fiber (9.1 vs. 8.6 g, P=0.015), copper (0.67 vs. 0.65 mg, P=0.026), fluoride (1259 vs. 1037 mcg, P=0.036), phosphorous (649 vs. 630 mg, P=0.044), Vitamin C ( 53 vs. 48 mg, P=0.043), B5(1.95 vs. 1.81 mg, P=0.008), B6(0.87 vs. 0.81 mg, P=0.011) and B7 (11.09 vs. 10.36 mcg, P=0.046). Students at high risk of EDs had a 0.111 lower score from the “Dairy” pattern (P=0.035), with no associations with the other dietary patterns. Conclusion -- Early detection and treatment of EDs may be improved by routinely evaluation of several specific risk factors in adolescence.