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The Frequency of Night-Eating Syndrome in People Aged 18-65 Who Admitted to a Family Medicine Clinic of a Tertiary Hospital
Bir Üçüncü Basamak Hastanenin Aile Hekimliği Kliniğine Başvuran 18-65 Yaşındaki İnsanlarda Gece Yeme Sendromu Sıklığı
Murat Dicle, Süleyman Görpelioğlu, Cenk Aypak

Euras J Fam Med 2019;8(3):121-125. https://doi.org/10.33880/ejfm.2019080305

 

Original Research / Orijinal Araştırma


ABSTRACT

Aim: Night Eating Syndrome is thought to pose a risk for the development of cardiovascular system, endocrinological and psychiatric diseases. The aim of our study was to investigate the frequency of night-eating syndrome and risk factors related to night eating syndrome. 

Methods: This cross-sectional, descriptive study was carried out among 525 people who admitted to the Family Medicine Clinic of a tertiary hospital between 01 October and 30 November 2018. The night-eating questionnaire was applied to the partcipants using face-to-face interview. Persons with a psychiatric disorder, who have a history of chronic medication or disease, who have alcohol and drug addiction and who are working on the night shift were excluded from the study. p values < 0.05 were considered as statistically significant. 

Results: Fifty-one (9.7%) of the 525 patients admitted to our clinic met the criteria of Night Eating Syndrome. In our study, there were statistically significant difference between night eating syndrome and non-night eating syndrome groups with respect to smoking status and body mass index. 

Conclusion: Night eating syndrome is a hidden public health problem which is related to cardiovascular system diseases, diabetes mellitus and psychiatric disorders besides obesity. Because of the presence of serious health problems associated with night eating syndrome, it is very important to determine night eating syndrome in primary care. 

Keywords: Night-Eating Syndrome, obesity, smoking, body mass index

ÖZ

Amaç: Gece Yeme Sendromunun kardiyovasküler sistem, endokrinolojik ve psikiyatrik hastalıkların gelişimi açısından risk oluşturduğu düşünülmektedir. Çalışmamızın amacı, gece yeme sendromunun sıklığını ve gece yeme sendromu ile ilgili olabilecek risk faktörlerini incelemektir. 

Yöntem: Kesitsel, tanımlayıcı tipteki bu çalışma, 01 Ekim-30 Kasım 2018 tarihleri arasında üçüncü basamak bir hastanenin Aile Hekimliği Kliniğine başvuran 525 kişi arasında yapıldı. Veriler, katılımcılara yüz yüze uygulanan Gece Yeme Anketi ile elde edildi. Psikiyatrik hastalığı olan, gece vardiyasında çalışan, alkol veya madde bağımlılığı olan, kronik hastalığı ya da kronik ilaç kullanım öyküsü olanlar çalışmaya dahil edilmedi. p<0,05 istatistiksel olarak anlamlı kabul edildi. 

Bulgular: Çalışmaya alınan 525 hastanın %9,7’si (n=51) gece yeme sendromu kriterlerini karşılıyordu. Sigara içme durumu ve beden kitle indeksi ile ilgili olarak gece yeme sendromu ve gece yeme sendromu olmayan gruplar arasında istatistiksel olarak anlamlı fark bulundu. Gece yeme sendromu ile cinsiyet, eğitim durumu veya medeni durum arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. 

Sonuç: Gece yeme sendromu, obezitenin yanı sıra kardiyovasküler sistem hastalıkları, diabetes mellitus ve psikiyatrik bozukluklarla ilişkili gizli bir halk sağlığı problemidir. Gece yeme sendromuna bağlı ciddi sağlık problemlerinin oluşma riski nedeniyle, birinci basamakta gece yeme sendromunu belirlemek çok önemlidir. 

Anahtar kelimeler: gece yeme sendromu, obezite, sigara içme, beden kitle indeksi


Introduction

Night Eating Syndrome (NES) was first described by Stunkard in 1955 as a disorder in treatment-resistant obesity patients characterized by morning anorexia, evening hyperphagia and insomnia (1). Although it was first described in obese individuals, it has been proven that it can be seen in people with normal weight (2). Presence of morning anorexia, eating sparingly in breakfast (e.g., only coffee or juice) or omitting breakfast, evening hyperphagia which is described as at least having 25% of food intake after the evening meal and insomnia or sleep withdrawal at least 3 times a week are defined as diagnostic criteria of NES (3). Individuals with NES consume a significant part of their food intake after the evening meal, awaken more often during the night and spend longer time to sleep again after awakening (4). The prevalence of NES was reported to be 1.5-4.3% in the adult population (5,6). Night-eating syndrome is a health problem which is related to cardiovascular system diseases, diabetes mellitus and psychiatric disorders besides obesity. The aim of this study was to determine the frequency of night-eating syndrome and to determine the relationship between night eating syndrome and sociodemographic characteristics which may be risk factors such as smoking status, marital status, gender and body mass index (BMI).

Methods

This descriptive study was conducted among 525 patients aged between 18-65 years who were admitted to the Family Medicine Clinic of a tertiary hospital, between 01 October 2018 and 30 November 2018. Data were obtained by a questionnaire which was applied to participants face to face. This questionnaire was including socio-demographic features, weight, height, body mass index and ‘Night Eating Questionnaire’ (NEQ) (7). To evaluate NES, the NEQ was used. NEQ measures the symptoms of NES with 14 items. With these 14 items, four factors of NES were requested: nocturnal eating, evening hyperphagia, morning anorexia and sleep disturbance. The first 9 questions in the questionnaire were filled by all participants. Participants who did not wake up or make a snack for the next questions were told not to continue. Questions 10 to 12 are for participants with night waking, questions 13-14 are for participants with night snacks. Questions other than the 7th question are 5-point Likert-type scale and scored between 0-4. Participants without a mood change within the day, receive zero points from the seventh question. The first, fourth and fourteenth items are scored reversly. The thirteenth question is not scored. The clinical cut-off score used for the questionnaire was 30. The reliability and validity of Turkish version of NEQ were done by Atasoy et al (8,9). 

Persons with a psychiatric disorder, who have a history of chronic medication or disease, who have alcohol and drug addiction and who are working on the night shift were excluded from the study. 

All statistical analyses were performed using SPSS for Windows v.21 software program (SPSS Inc., Chicago, IL, USA). Descriptive statistical metods in the evaluation of demographic data; frequency, percentage, mean, standart deviation, median were used. The compatibility of data with normal distribution was examined with the Kolmogorov-Smirnov test. Quantitative variables were stated as mean ± standart deviation (SD) and median (min-max), and categorical variables as number (n) and percentage (%). The Chi Square test was applied to compare relationship between categorical outcomes. Correlation test was used to examine the relationship between numeric variables. A value of p<0.05 was considered statistically significant.

Results

A total of 525 participants, 266 females (50.66%) and 259 males (49.33%) who applied to Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital Family Medicine Clinic were enrolled in the study. The mean age of the participants was 38.50±11.95 years (39.70±11.28 for females and 37.27±12.50 for males). The mean BMI was 26.05±3.73 for males and 24.59±4.21 for females. Forty-seven of the males (18.1%) and 34 of the females (12.8%) were obese. Education level, smoking and marital status of the participants are shown in Table 1.

 

Table 1. Education level, smoking and marital status of the participants

 

 

Male 
(n=259)

Female (n=269)

Education

Level

Primary school

26    (10%)

36 (13.5%)

Middle school

37 (14.3%)

23    (8.6%)

High school

100 (38.6%)

100 (37.6%)

University

96 (37.1%)

107 (40.2%)

Marital

Status

Married

149 (57.5%)

169 (63.5%)

Single

110 (42.5%)

97 (36.5%)

Smoking

Yes

150 (57.9%)

95 (35.7%)

No

109 (42.1%)

171 (64.3%)

 

The median NEQ scores of the male participants was 13.00 (min 4.00 and max 46.00) and median NEQ scores for females was 13,00 (min 0.00 and max 40.00). Fifty-one (9.7%) of the 525 patients admitted to our clinic met the criteria of NES. Twenty-eight (10.5%) of them were female and 23 (8.9%) of them were male. In our study, there were statistically significant difference between NES and non-NES groups with respect to smoking status and BMI. A statistically significant difference was found between NES and non-NES groups in both male and female obese participants (p<0.001, r=0.258).  While there was a statistically significant relationship between smoking females and NES (p=0.012), there was no statistically relationship in males (p=0.236). Also there was no statistically significant association between NES and gender (p=0.524), educational status (p=0.201) or marital status (p=0.241) of the participants (Table 2).

Table 2. Some sociodemographic characteristics of participants with and without Nes

 

 

NES +

NES -

n

P

Smoking status

Yes

32 (13.1%)

213 (86.9%)

245 (46.7%)

0.015

No

19 (6.8%)

261 (93.2%)

280 (53.3%)

Obesity

Yes

26 (5.0%)

55 (10.5%)

81 (15.5%)

0.000

No

25 (4.8%)

419 (79.8%)

444 (84.5%)

Gender

Male

23 (8.9%)

236 (91.1%)

259 (100%)

0.524

Female

28 (10.5%)

238 (89.5%)

266 (100%)

Marital status

Single

24 (4.6%)

183 (34.9%)

207 (100%)

0.241

Married

27 (5.1%)

291 (55.4%)

318 (100%)

 

Discussion

Although NES has been firstly identified in treatment-resistant obese patients by Stunkard in 1955, NES is thought to be associated with many other diseases and personality traits. The prevalence of NES was 1.5-4.3% in studies conducted on the general population (5,6). In a study conducted with the participation of 454 adult people in Oman, it was shown that 1.5% of the respondents met the criteria of NES (10). In a study conducted with the participation of 300 females in various areas of Amritsar, it was found that 3% of the participants had NES (11). In another study conducted with the participation of 19861 university students in USA, it was shown that 1.2% of the participants had NES (12). The frequency of NES among adult people in our study was 9.7%. This was higher than other studies in the literature. This situation can be explained by the different nutritional habits and socio-cultural characteristics of our society.

In some studies of NES was found to be related with gender. In a study by Colles et al. (13) and another study by Tholin et al. (14), NES was shown to be associated with gender. In a study conducted with the participation of 1636 university students, it was shown that there were no significant differences between NES and non-NES groups in gender (15). In a study with 83 participants, it was found that there was no relationship between gender and NES (16). In a study by Sevincer et al. (17), a study by Nolan et al. (18) and another study by Adami et al. (19), it was shown that there were no significant differences between NES and non-NES groups in gender. Similarly, in our study, no relationship was found between NES and gender. 

In a study conducted with the participation of 2508 adults in Germany, it has shown that there was no relationship between NES and marital status or education (6). In another study by Ceru-Björk et al. (20), with the participation of 194 people, it has shown that there was no relationship between NES and marital status or education. Similarly, in our study, no association was found between NES and marital status or education. 

In a study conducted with the participation of 413 university students, it was shown that there were no significant differences between smoking status and NES (12). In a study by Nolan et al., in a study by Runfola et al., and in another study by Ceru-Björk et al., no relationship has found between NES and smoking status (15,16,20). Similarly, in our study, no association was found between NES and male smokers. But in contrast to the literature, we found a statistically significant relationship between smoking females and NES in our study (p=0.012). 

Colles et al. (13) were found a positive correlation between NES and BMI increase of normal weight and obese patients. In the study of Milano et al. (21), it was found that the prevalence of NES increased with weight gain and that approximately half of the patients diagnosed with NES had normal weight before the onset of the disease. In the study of Aronoff et al. (22) comparing obese patients with NES to obese patients without NES, the BMI of those with NES was found to be significantly higher. In a study by Tholin et al. (6) and in another study by Zwaan et al. (14), it was shown that there were a significant association with BMI and NES. As in other studies in the literature, in our study, we found a significant positive relationship between obesity and NES for both sexes (p<0.001, r=0.258).

Conclusion

Night-eating syndrome is a hidden public health problem which is related to cardiovascular system diseases, diabetes mellitus and psychiatric disorders besides obesity. It has been shown that night-eating syndrome is associated with obesity and smoking status.  Awareness of NES and the risks that NES cause on weight gain and psychological distress are still little known in general practice. Because of the presence of serious health problems associated with night-eating syndrome, it is very important to determine NES in primary care.

It is necessary to increase studies in primary care including different health professions such as sleep medicine, cardiology, endocrinology, etc. Future work should further define NES features of clinical importance to guide the development of agreed diagnostic criteria, and develop targeted intervention strategies.

References

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How to cite / Atıf için: Dicle M, Gorpelioglu S, Aypak C. The frequency of night-eating syndrome in people aged 18-65 who admitted to a family medicine clinic of a tertiary hospital. Euras J Fam Med 2019;8(3):121-5. doi:10.33880/ejfm.2019080305


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