Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis

Amanda P Trindade, Jose C Appolinario, Paulo Mattos, Janet Treasure, Bruno P Nazar, Amanda P Trindade, Jose C Appolinario, Paulo Mattos, Janet Treasure, Bruno P Nazar

Abstract

Objective: To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED.

Methods: The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO).

Results: Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively).

Conclusion: Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1. Systematic review flowchart.
Figure 1. Systematic review flowchart.
Figure 2. Forest plot of positive screening…
Figure 2. Forest plot of positive screening rates in studies using Eating Attitudes Test (EAT-26) (cutoff point ≥ 21).95%CI = 95% confidence interval.

References

    1. Provost JA. Eating disorders in college students. Psychiatr Med. 1989;7:47–58.
    1. Mann S, Cowburn J. Emotional labour and stress within mental health nursing. J Psychiatr Ment Health Nurs. 2005;12:154–62.
    1. Sokratous S, Merkouris A, Middleton N, Karanikola M. The association between stressful life events and depressive symptoms among Cypriot university students: a cross-sectional descriptive correlational study. BMC Public Health. 2013;13:1121.
    1. Loth K, van den Berg P, Eisenberg ME, Neumark-Sztainer D. Stressful life events and disordered eating behaviors: findings from project EAT. J Adolesc Health. 2008;43:514–6.
    1. Kolar DR, Rodriguez DL, Chams MM, Hoek HW. Epidemiology of eating disorders in Latin America: a systematic review and meta-analysis. Curr Opin Psychiatry. 2016;29:363–71.
    1. Mancilla-Diaz JM, Franco-Paredes K, Vazquez-Arevalo R, Lopez-Aguila X, Alvarez-Rayon GL, Tellez-Giron MTO. A two-stage epidemiologic study on prevalence of eating disorders in female university students in Mexico. Eur Eat Disord Rev. 2007;15:463–70.
    1. Baader MT, Rojas CC, Molina FJL, Gotelli VM, Alamo PC, Fierro FC, et al. Diagnóstico de la prevalencia de trastornos de la salud mental en estudiantes universitarios y los factores de riesgo emocionales asociados. Rev Chil Neuro-Psiquiatr. 2014;52:167–76.
    1. Rueda-Jaimes GE, Camacho López PA, Rangel-Martínez-Villalba AM. Internal consistency and validity of the BITE for the screening of bulimia nervosa in university students, Colombia. Eat Weight Disord. 2008;13:e35–9.
    1. Compte EJ, Sepulveda AR, Torrente F. A two-stage epidemiological study of eating disorders and muscle dysmorphia in male university students in Buenos Aires. Int J Eat Disord. 2015;48:1092–101.
    1. Viana MC, Teixeira MG, Beraldi F, Bassani Ide S, Andrade LH. São Paulo Megacity Mental Health Survey – a population-based epidemiological study of psychiatric morbidity in the São Paulo metropolitan area: aims, design and field implementation. Rev Bras Psiquiatr. 2009;31:375–86.
    1. Pivetta LA, Gonçalves-Silva RMV. Compulsão alimentar e fatores associados em adolescentes de Cuiabá, Mato Grosso, Brasil. Cad Saude Publica. 2010;26:337–46.
    1. de Freitas SR, Appolinario JC, Souza Ade M, Sichieri R. Prevalence of binge eating and associated factors in a Brazilian probability sample of midlife women. Int J Eat Disord. 2008;41:471–8.
    1. Pena Gralle AP, Barbosa Moreno A, Lopes Juvanhol L, Mendes da Fonseca MJ, Prates Melo EC, Antunes Nunes MA, et al. Job strain and binge eating among Brazilian workers participating in the ELSA-Brasil study: does BMI matter? J Occup Health. 2007;59:247–55.
    1. Yu J, Lu M, Tian L, Lu W, Meng F, Chen C, et al. Prevalence of disordered eating attitudes among university students in Wuhu, China. Nutr Hosp. 2015;32:1752–7.
    1. Makino M, Hashizume M, Yasushi M, Tsuboi K, Dennerstein L. Factors associated with abnormal eating attitudes among female college students in Japan. Arch Womens Ment Health. 2006;9:203–8.
    1. Nakamura K, Hoshino Y, Watanabe A, Honda K, Niwa S, Tominaga K, et al. Eating problems in female Japanese high school students: a prevalence study. Int J Eat Disord. 1999;26:91–5.
    1. Kolarzyk E, Jaglarz M. [Disordered eating attitudes in medical students of Jagiellonian University] Przegl Lek. 2003;60:48–52.
    1. Reyes-Rodríguez ML, Franko DL, Matos-Lamourt A, Bulik CM, Von Holle A, Cámara-Fuentes RL. Eating disorder symptomatology: prevalence among Latino college freshmen students. J Clin Psychol. 2010;66:666–79.
    1. Ambrosi-Randić N, Pokrajac-Bulian A. Psychometric properties of the eating attitudes test and children’s eating attitudes test in Croatia. Eat Weight Disord. 2005;10:e76–82.
    1. Sira N, Pawlak R. Prevalence of overweight and obesity, and dieting attitudes among Caucasian and African American college students in Eastern North Carolina: a cross-sectional survey. Nutr Res Pract. 2010;4:36–42.
    1. Sepulveda AR, Carrobles JA, Gandarillas AM. Gender, school and academic year differences among Spanish university students at high-risk for developing an eating disorder: an epidemiologic study. BMC Public Health. 2008;8:102.
    1. Memon AA, Adil SE, Siddiqui EU, Naeem SS, Ali SA, Mehmood K. Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study. BMC Res Notes. 2012;5:84.
    1. Şanlier N, Yabanci N, Alyakut O. An evaluation of eating disorders among a group of Turkish university students. Appetite. 2008;51:641–5.
    1. Thomas J, Khan S, Abdulrahman AA. Eating attitudes and body image concerns among female university students in the United Arab Emirates. Appetite. 2010;54:595–8.
    1. Kessler RC, Shahly V, Hudson JI, Supina D, Berglund PA, Chiu WT, et al. A comparative analysis of role attainment and impairment in binge-eating disorder and bulimia nervosa: results from the WHO World Mental Health Surveys. Epidemiol Psychiatr Sci. 2014;23:27–41.
    1. Alberton VC, Dal-Bó MJ, Piovezan AP, Silva RM. Abnormal eating behaviors among medical students at a university in southern Santa Catarina, Brazil. Rev Bras Educ Med. 2013;37:15–20.
    1. Alvarenga MS, Philippi ST, Lourenço BH, Sato PM, Scagliusi FB. Insatisfação com a imagem corporal em universitárias brasileiras. J Bras Psiquiatr. 2010;59:44–51.
    1. Alvarenga MS, Scagliusi FB, Phillippi ST. Comportamento de risco para transtorno alimentar em universitárias brasileiras. Rev Psiquiatr Clin. 2011;38:3–7.
    1. Alvarenga Mdo S, Lourenço BH, Philippi ST, Scagliusi FB. Disordered eating among Brazilian female college students. Cad Saude Publica. 2013;29:879–88.
    1. Bosi MLM, Luiz RR, Morgado CMC, Costa MLS, Carvalho RJ. Autopercepção da imagem corporal entre estudantes de nutrição: um estudo no município do Rio de Janeiro. J Bras Psiquiatr. 2006;55:108–13.
    1. Bosi MLM, Luiz RR, Uchimura KY, Oliveira FP. Comportamento alimentar e imagem corporal entre estudantes de educação física. J Bras Psiquiatr. 2008;57:28–33.
    1. Bosi MLM, Uchimura KY, Luiz RR. Eating behavior and body image among psychology students. J Bras Psiquiatr. 2009;58:150–5.
    1. Bosi MLM, Nogueira JAD, Uchimura KY, Luiz RR, Godoy MGC. Comportamento alimentar e imagem corporal entre estudantes de medicina. Rev Bras Educ Med. 2014;38:243–52.
    1. Cenci M, Peres KG, Vasconcelos FAG. Prevalência de comportamento bulímico e fatores associados em universitárias. Rev Psiquiatr Clin. 2009;36:83–8.
    1. Coqueiro RS, Petroski EL, Pelegrini A, Barbosa AR. Insatisfação com a imagem corporal: avaliação comparativa da associação com estado nutricional em universitários. Rev Psiquiatr Rio Gd Sul. 2008;30:31–8.
    1. Costa Lda C, de Vasconcelos Fde G. Influence of socioeconomic behavioral and nutritional factors on dissatisfaction with body image among female university students in Florianopolis, SC. Rev Bras Epidemiol. 2010;13:665–676.
    1. Ferrari EP, Gordia AP, Martins CR, Silva DAS, Quadros TMB, Petroski EL. Body image dissatisfaction and its relationship with physical activity and nutritional status in university students. Motri. 2012;8:52–8.
    1. Fiates GMR, Salles RK. Fatores de risco para o desenvolvimento de distúrbios alimentares: um estudo em universitárias. Rev Nutr. 2001;14:3–6.
    1. Frank R, Claumann GS, Pinto AA, Cordeiro PC, Felden EPG, Pelegrini A. Fatores associados à insatisfação com a imagem corporal em acadêmicos de Educação Física. J Bras Psiquiatr. 2016;65:161–7.
    1. Garcia L, Milagres OG, Mourão L, Assis M, Palma A. Self-perception of body image among physical education and medical science students. Rev Bras Ativ Fis Saude. 2010;16:25–30.
    1. Gonçalves TD, Barbosa MP, Rosa LCL, Rodrigues AM. Comportamento anoréxico e percepção corporal em universitários. J Bras Psiquiatr. 2008;57:166–70.
    1. Kirsten VR, Fratton F, Porta NBD. Transtornos alimentares em alunas de nutrição do Rio Grande do Sul. Rev Nutr. 2009;22:219–27.
    1. Laus MF, Moreira RCM, Costa TMB. Differences in body image perception, eating behavior and nutritional status of college students of health and human science. Rev Psiquiatr Rio Gd Sul. 2009;31:192–6.
    1. Legnani RFS, Legnani E, Pereira ÉF, Da Silva Gasparotto G, Vieira LF, De Campos W. Transtornos alimentares e imagem corporal em acadêmicos de Educação Física. Motriz. 2012;18:84–91.
    1. Martins CR, Gordia AP, Silva DAS, Quadros TMB, Ferrari EP, Teixeira DM, et al. Insatisfação com a imagem corporal e fatores associados em universitários. Estud Psicol. 2012;17:241–6.
    1. Miranda VPN, Filgueiras JF, Neves CM, Teixeira PC, Ferreira MEC. Insatisfação corporal em universitários de diferentes áreas de conhecimento. J Bras Psiquiatr. 2012;61:25–32.
    1. Nicoli MG, Junior RD. Binge eating disorder and body image perception among university students. Eat Behav. 2011;12:284–8.
    1. Penz LR, Dal Bosco SM, Vieira JM. Risco para desenvolvimento de transtornos alimentares em estudantes de nutrição. Sci Med. 2008;18:124–8.
    1. Pereira LNG, Trevisol FS, Quevedo J, Jornada LK. Eating disorders among health science students at a university in southern Brazil. Rev Psiquiatr Rio Gd Sul. 2011;33:14–9.
    1. Pinto ACM, Camargo MR, Novo NF, von Krakauer Hübner C. Transtornos alimentares em alunas da Faculdade de Medicina do Centro de Ciências Médicas e Biológicas da PUC-SP. Rev Fac Cienc Med Sorocaba. 2009;11:16–20.
    1. Quadros TMB, Gordia AP, Martins CR, Silva DAS, Ferrari EP, Petroski ÉL. Imagem corporal em universitários: associação com estado nutricional e sexo Métodos População e Amostra. Motriz. 2010;16:78–85.
    1. Rech CR, Araújo EDS, Vanat JR. Autopercepção da imagem corporal em estudantes do curso de educação física. Rev Bras Educ Fis Esporte. 2010;24:285–92.
    1. Santos M, Meneguci L, Mendonça AAF. Padrão alimentar anormal em estudantes universitárias das áreas de nutrição, enfermagem e ciências biológicas. Cien et Praxis. 2008;1:1–4.
    1. Silva JD, Silva ABJ, Oliveira AVK, Nemer ASA. Influência do estado nutricional no risco para transtornos alimentares em estudantes de nutrição. Cienc Saude Coletiva. 2008;17:3399–406.
    1. Souza FGM, Martins MCR, Monteiro FCC, Neto GCM, Ribeiro IB. Anorexia e bulimia nervosa em alunas da Faculdade de Medicina da Universidade Federal do Ceara – UFC. Rev Psiq Clin. 2002;29:172–80.
    1. Souza AA, Souza JC, Hirai ES, Luciano HA, Souza N. Estudo sobre a anorexia e bulimia nervosa em universitárias. Psicol Teor Pesq. 2011;27:195–8.
    1. Stipp LM, Oliveira MRM. Imagem corporal e atitudes alimentares: diferenças entre estudantes de nutrição e de psicologia. Saude Rev. 2003;5:47–51.
    1. Vitolo MR, Bortolini GA, Horta RL. Prevalência de compulsão alimentar entre universitárias de diferentes áreas de estudo. Rev Psiquiatr Rio Gd. Sul. 2006;28:20–6.
    1. Kassier SM, Veldman FJ. Eating behaviour, eating attitude and body mass index of dietetic students versus non-dietetic majors: a South African perspective. S Afr J Clin Nutr. 2014;27:109–13.
    1. Gonidakis F, Sigala A, Varsou E, Papadimitriou G. A study of eating attitudes and related factors in a sample of first-year female nutrition and dietetics students of Harokopion University in Athens, Greece. Eat Weight Disord. 2009;14:e121–7.
    1. Harris N, Gee D, d’Acquisto D, Ogan D, Pritchett K. Eating disorder risk, exercise dependence, and body weight dissatisfaction among female nutrition and exercise science university majors. J Behav Addict. 2015;4:206–9.
    1. Yu Z, Tan M. Disordered eating behaviors and food addiction among nutrition major college students. Nutrients. 2016 Oct 26;8(11):pii: E673.
    1. Balhara YP, Mathur S, Kataria DK. Body shape and eating attitudes among female nursing students in India. East Asian Arch Psychiatry. 2012;22:70–4.
    1. Al-Otaibi HH, Nassef SL, Raouf TA. Body shape dissatisfaction, weight status and physical activity among a sample university students in Saudi Arabia. Food Nutr Sci. 2013;4:616–25.
    1. Huerta RB, Campos SC, Cruzado L. Body dissatisfaction among medical students of the Universidad Peruana Cayetano Heredia measured with the body shape questionnaire. Rev Neuropsiquiatr. 2012;75:85–92.
    1. Marcilla-Díaz JM, López-Aguilar X, Franco-Paredes K, Alvaréz-Rayón G, Vázquez-Arévalo R, Téllez-Girón MT, et al. Rol de la influencia de pares y de la interiorización del ideal de delgadez sobre la insatisfacción corporal y alimentación no saludable en jóvenes mexicanas. Rev Colomb Psicol. 2012;21:343–53.
    1. Nunes MA, Olinto MT, Camey S, Morgan C, de Jesus Mari J. Abnormal eating behaviors in adolescent and young adult women from southern Brazil: reassessment after four years. Soc Psychiatry Psychiatr Epidemiol. 2006;41:951–6.
    1. Striegel-Moore RH, Silberstein LR, Frensch P, Rodin J. A prospective study of disordered eating among college students. Int J Eat Disord. 1989;8:499–509.
    1. Eisenberg D, Nicklett EJ, Roeder K, Kirz NE. Eating disorder symptoms among college students: prevalence, persistence, correlates, and treatment-seeking. J Am Coll Health. 2011;59:700–7.
    1. Solmi F, Hatch SL, Hotopf M, Treasure J, Micali N. Prevalence and correlates of disordered eating in a general population sample: the South East London Community Health (SELCoH) study. Soc Psychiatry Psychiatr Epidemiol. 2014;49:1335–46.

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