Night eating syndrome: Implications for severe obesity

Department of Obesity & Endocrinology, University of Liverpool, Liverpool, UK.
Nutrition & Diabetes (Impact Factor: 2.65). 09/2012; 2(9):e44. DOI: 10.1038/nutd.2012.16
Source: PubMed


Night eating syndrome (NES) was first identified in 1955 by Stunkard, a psychiatrist specialising in eating disorders (ED). Over the last 20 years considerable progress has been made in defining NES as a significant clinical entity in its own right and it has now been accepted for inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) due for publication in 2013. NES is considered a dysfunction of circadian rhythm with a disassociation between eating and sleeping. Core criteria include a daily pattern of eating with a significantly increased intake in the evening and/or night time, as manifested by one or both of the following: at least 25% of food intake is consumed after the evening meal or at least two episodes of nocturnal eating per week. An important recent addition to core criteria includes the presence of significant distress and/or impairment in functioning. Stunkard's team recommend further investigation on the pathogenesis of NES, in particular its relationship with traumatic life events, psychiatric comorbidity, the age of onset of NES and course of NES over time. The relationship between NES and other ED also requires further clarification as night-eaters exhibit some features of other ED; previous guidance to separate NES from other ED may have hindered earlier characterisation of NES. Evidence from European and American studies suggests NES features strongly in populations with severe obesity. The complex interplay between depression, impaired sleep and obesity-related comorbidity in severely obese individuals makes understanding NES in this context even more difficult. This review examines evidence to date on the characterisation of NES and concludes by examining the applicability of current NES criteria to individuals with severe obesity.

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    • "The impact of NES on daily functioning is of current research interest [13]; in particular, its impact on the pathogenesis and maintenance of impaired sleep in severe obesity and obesity-related comorbidity is unclear. Eating and sleep behavior in obese NES populations often are studied in isolation, without consideration of their interrelationships [15]. Our cross-sectional study sought to explore these associations using validated tools to measure sleep quality using the Pittsburgh Sleep Quality Index (PSQI) [16], EDS (as a surrogate marker for suspected OSA) using the Epworth Sleepiness Scale (ESS) [17], and night-eating behavior using the Night Eating Questionnaire (NEQ) [18].The primary objective of our study was to identify the prevalence of poor sleep quality, EDS, and night-eating behavior in consecutive patients with severe obesity attending a Specialist Weight Management Service based in Liverpool, United Kingdom. "
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    ABSTRACT: The relationships between night eating, poor sleep quality, and obesity-related comorbidity in a severely obese UK clinic population is unknown. We used validated tools to identify prevalence and to explore this relationship. Consecutive consenting clinic attendees completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS), and Night Eating Questionnaire (NEQ) to identify sleep quality, excessive daytime sleepiness (EDS) (a surrogate marker for suspected obstructive sleep apnea [OSA]), and night eating, respectively. Proportions of individuals above and below tool cutoff points were compared. Pearson product moment correlation coefficients examined relationships between total scores. Reported prevalence from 144 participants (mean body mass index [BMI] 46.9 [9.5]kg/m(2); age 44.6 [12.1]years; 68% women) had poor sleep quality (73.0%), suspected OSA (30.8%), and night-eating behavior (2.8%). The strongest correlation between PSQI and NEQ scores (r=0.54; P<.001) was undiminished after controlling for EDS. Although significantly correlated, PSQI and ESS scores (r=0.31; P<.001) reduced after controlling for night eating (r=0.21; P=.02). Correlation between NEQ and ESS scores (r=0.26; P=.002) was smaller and nonsignificant after controlling for sleep quality (r=0.12; P=.18). Poor sleep quality is common in severe obesity, though night eating is rare. The association between poor sleep quality and night eating is not influenced by the presence of EDS.
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