Annette Gallant

The night-eating syndrome and obesity

The rising prevalence of obesity is a global concern. Eating behaviour and circadian rhythm are proving to be important factors in the aetiology of obesity. The night‐eating syndrome (NES) is characterized by increased late‐night eating, insomnia, a depressed mood and distress. It is evident that prevalence is higher among weight‐related populations than the general community. The exact relationship between this syndrome and obesity remains unclear. The reasons for the discrepancies found in the literature likely include varying diagnostic criteria and a wide range of study population characteristics. NES does not always lead to weight gain in thus certain individuals may be susceptible to night‐eating‐related weight gain. Weight loss through surgical and behavioural treatments has shown success in diminishing symptoms. The increasing literature associating obesity with circadian imbalances strengthens the link between the NES and obesity. Circadian genes may play a role in this syndrome. This review will examine different aspects of obesity in the context of the NES.

The Three-Factor Eating Questionnaire and BMI in adolescents: results from the Québec family study.

Eating behaviour traits are associated with body weight variations in adults. The Three-Factor Eating Questionnaire (TFEQ) measures cognitive restraint, disinhibition and hunger, as well as their corresponding subscales, e.g. rigid and flexible control. The TFEQ has not been widely used in adolescents to investigate eating behaviour traits associated with body weight. The aim of the present study was to assess whether eating behaviour traits were associated with BMI in male and female adolescents. Sixty adolescents (thirty females and thirty males; mean age 15.0 (sd 2.4) years) from the Québec Family Study completed the TFEQ and 3 d dietary records. There were no sex differences in the TFEQ scores. Rigid control, disinhibition and emotional susceptibility (to overeat) were positively related to BMI z-scores for the entire sample (r 0.3, P < 0.05). There was a positive relationship between BMI z-scores and rigid control (r 0.39, P < 0.05) in females, while BMI z-scores were positively related to emotional susceptibility (r 0.42, P < 0.02) and disinhibition (r 0.41, P < 0.03) in males. Adolescents characterised by both high disinhibition and high rigid control had significantly higher BMI z-scores than those by both low disinhibition and low rigid control. There were no significant differences in BMI z-scores between the flexible control categories. Dietary macronutrient content was not consistently related to eating behaviour traits. These results show that the eating behaviour traits of disinhibition and rigid control are independently related to BMI z-scores in this group of adolescents.

Behavioural and metabolic characterisation of the low satiety phenotype

Some individuals report weak appetite sensations and thus, have higher susceptibility to overeating. The aim of this study was (1) to evaluate the reliability of the satiety quotient (SQ), a marker of satiety efficiency; (2) to characterize the biopsychobehavioural profiles of individual presenting low satiety efficiency, i.e. the low satiety phenotype and (3) to document the impact of a weight loss program on these profiles. Sixty-nine obese men (BMI 33.6±3.0 kg/m², age 41.5±5.7 years) participated in a 16-week, non-restrictive weight loss intervention. Visual analog scales for appetite sensations in response to a test-meal were completed twice at baseline. Blood samples were collected before and during one test-meal. Questionnaires were administered before and after the intervention. The mean SQ showed good reliability (ICC=0.67). Baseline SQ scores tended to be negatively correlated with external hunger, anxiety and night eating symptoms (p<0.10). Moreover, the low satiety phenotype showed a lower cortisol response to the test-meal (p<0.05). The SQ seems to be a reliable marker of weaker appetite sensation responses. Stress/anxiety could be involved in the low satiety phenotype but did not influence the biopsychobehavioural changes in response to the intervention.

Short sleep duration is associated with a lower mean satiety quotient in overweight and obese men.

We examined satiety quotient (SQ) and energy intake (EI) according to sleep duration, quality and timing. Seventy-five overweight/obese men (age: 41.1±5.8 years; body mass index: 33.6±2.9 kg/m2) completed visual analogue scales for appetite sensations before, immediately after and every 10 minutes for 1 hour following a standardized breakfast. The mean SQ (primary outcome of the study) was calculated from four appetite sensations. The Pittsburgh Sleep Quality Index identified short-duration (<7 h/night) and ‘recommended sleep duration’ (⩾7 h/night) sleepers, poor (score ⩾5)- and good (score <5)-quality sleepers and late (midpoint of sleep >0230 hours) and early (midpoint of sleep ⩽0230 hours) sleepers. A 3-day food record and buffet-style meal assessed the EI. Short-duration sleepers had a lower mean SQ compared with recommended sleep duration sleepers (6.5±4.9 vs 8.8±4.3 mm/100 kcal; P=0.04). The mean SQ between poor and good (6.9±4.6 vs 8.7±4.6 mm/100 kcal; P=0.11) and that between early and late (8.99±5.10 vs 9.32±4.02 mm/100 kcal; P=0.78) sleepers were not significantly different. EI did not differ between the sleep groups. Thus, short-duration sleepers had a lower mean SQ compared with recommended sleep duration sleepers. However, this did not coincide with an increased EI.

Nutritional Aspects of Late Eating and Night Eating

The timing of food intake has been investigated as a novel factor in the etiology, maintenance, and treatment of obesity. Indeed, consuming a large proportion of food later in the day and into the night has been associated with higher body weight and may even impair weight loss. The diet quality of late-eaters may be a factor involved in these relationships. Moreover, the nutritional characteristics of the foods consumed during the night may negatively affect metabolic and circadian rhythms that are required for optimal health. This review will first examine the diet quality of late-eaters and describe common foods consumed as nocturnal snacks. Second, this review will briefly acknowledge the potential adverse metabolic and circadian effects of consuming certain foods very late in the evening or during the night.

Parental eating behavior traits are related to offspring BMI in the Québec Family Study

Objective:Parental eating behavior traits have been shown to be related to the adiposity of their young children. It is unknown whether this relationship persists in older offspring or whether rigid or flexible control are involved. The objective of this study was to test the hypothesis that parental eating behavior traits, as measured by the Three-Factor Eating Questionnaire (TFEQ), are related to offspring body weight.Methods:Cross-sectional anthropometric and TFEQ data from phase 2 and 3 of the Québec Family Study generated 192 parent–offspring dyads (offspring age range: 10–37 years). Relationships were adjusted for offspring age, sex and reported physical activity, number of offspring per family and parent body mass index (BMI).Results:In all parent–offspring dyads, parental rigid control and disinhibition scores were positively related to offspring BMI (r=0.17, P=0.02; r=0.18, P<0.01, respectively). There were no significant relationships between cognitive restraint (P=0.75) or flexible control (P=0.06) with offspring BMI. Regression models revealed that parent disinhibition mediated the relationship between parent and offspring BMI, whereas rigid control of the parent moderated this relationship. The interaction effect between parental rigid control and disinhibition was a significant predictor of offspring BMI (β=0.13, P=0.05).Conclusion:Family environmental factors, such as parental eating behavior traits, are related to BMI of older offspring, and should be a focus in the prevention of obesity transmission within families.

Validity of the night eating questionnaire in children

OBJECTIVE To measure the construct validity of the Night Eating Questionnaire (NEQ) in children against a parent report of child night eating syndrome (NES) symptoms (NEQ report) and a 3-day dietary recall. METHOD NEQ of 304 children from the QUALITY (QUébec Adipose and Lifestyle InvesTigation in Youth) cohort were compared to a parent report and 3-day dietary recall. RESULTS Child NEQ scores were related to the parent NEQ report (ρ = 0.30 p < 0.0001) yet there were inconsistencies between responses concerning sleep troubles. Total child NEQ scores, but not parent NEQ report scores, were associated with dietary manifestations of NES such as increased evening (ρ = 0.20, p < .001) and reduced morning intake (ρ= -0.12, p < .05). DISCUSSION The NEQ score is related to eating patterns of NES in children and is more informative than a parent report, specifically when used in conjunction with dietary recall.

The Effectiveness of A School-Based Nutrition Intervention on Children's Fruit, Vegetables, and Dairy Product Intake.

BACKGROUND Most Canadian children do not meet daily recommendations for consumption of vegetables and fruits (V/F) and dairy products (DP). The aim of this study was to evaluate the impact of Team Nutriathlon on V/F and DP consumption of children. METHODS Participants were 404 children from grades 5 and 6 (intervention group [IG] N = 242, control group [CG] N = 162). Teams of children were guided to increase their consumption and variety of V/F and DP over an 8-week period. Daily servings of V/F and DP were compared between groups at 4 time points: baseline (week 0), during (week 6), immediately after (week 9 or 10), and a follow-up 10 weeks after (week 20) the intervention. RESULTS During and after the program and at follow-up, children in the IG consumed more servings of V/F and DP compared to the CG (group × time, p < .0001). Sex, baseline consumption levels, and school socioeconomic status did not influence the results (p > .05). CONCLUSIONS Team Nutriathlon is an innovative school-based nutrition program that can help to increase the V/F and DP consumption of children.

Night-eating symptoms and 2-year weight change in parents enrolled in the QUALITY cohort

Background/Objective:The timing of food intake may be implicated in weight gain. This study tested the hypothesis that symptoms commonly associated with night-eating syndrome are related to measures of weight gain in adults.Subjects/Methods:Parents participating in QUALITY (Québec Adipose and Lifestyle InvesTigation in Youth) completed the night eating questionnaire (NEQ) at baseline (2005–2008) and at follow-up (2008–2010). Height and weight were measured and self-report questionnaire data were available for 388 parents (59% female, mean (s.d.) age: 41.8±5.7, mean (s.d.) body mass index (BMI): 29.6±5.7). Linear regression models were used to test the associations between baseline night-eating symptoms (NEQ scores, night-eating behaviours) and percent change in each of BMI and waist circumference (WC).Results:A high NEQ score predicted a small increase in percent change in BMI in nonobese parents but a decrease among those who were severely obese. Nocturnal ingestions of food predicted an increase in percent change in BMI; however, the effect size was small. Morning anorexia predicted an increase in percent change in WC.Conclusion:Certain night-eating symptoms may predict measures of weight gain in adults but the effects seem small and the findings need to be confirmed in more symptomatic samples.

Night eating behavior and metabolic heath in mothers and fathers enrolled in the QUALITY cohort study.

BACKGROUND Desynchrony between eating and sleeping patterns and poor sleep quality have been associated with obesity and metabolic abnormalities. This study examined the metabolic health correlates of night eating syndrome in adults enrolled in the QUALITY cohort study. METHODS Night eating symptoms were assessed in 310 women (mean age = 40.3 ± 5.1 years, mean BMI = 28.8 ± 6.2 kg/m(2)) and 305 men (mean age = 42.5 ± 5.9 years, mean BMI = 30.3 ± 5.0 kg/m(2)). Anthropometric measures, fasting blood samples and blood pressure were used to diagnose metabolic syndrome (MetS) and type 2 diabetes (T2D) diagnosis was self-report. Correlational and case/control comparisons assessed night eating symptoms in persons with and without MetS and T2D. RESULTS Night eating questionnaire (NEQ) scores were positively correlated with BMI. When controlling for BMI, NEQ scores were significantly negatively correlated with blood pressure in women and positively correlated with waist circumference and triglycerides in men. MetS diagnosis was associated with morning anorexia in both women and men and urges to eat at night in women only. T2D was associated with a depressed mood in women and with insomnia in men. CONCLUSION Symptoms of night eating syndrome are associated with higher BMI and poor metabolic health. Future research is needed to determine if night eating syndrome per se is a unique causal pathway in the development of obesity and metabolic disease.