Nighttime eating disorders

1
Nighttime eating disorders

• ????? ???

2
Historical descriptions

• Over a 52-year period NES expanded from evening
  hyperphagia to evening hyperphagia and/ or
  conscious night eating.
• First described among cases with treatment
  resistant obesity at a specialty center.

3
Normal metabolic physiology during sleep

• Nighttime in humans is typically characterized by
  a prolonged period of fasting associated with
  sleep.
• Sleep is initiated 1-4 h after the last meal. The
  length of sleep averages between 7 and 9 h. Thus,
  there is a consecutive absence of food intake for
  approximately half of every 24-h day.

4
Glucose homeostasis

• Despite a lack of food intake, serum glucose
  levels are adequately maintained throughout the
  sleep period. This is in contrast to fasting
  during sedentary wakefulness which demonstrates a
  fall in glucose over 12 h.

5

• Changes in systemic and cerebral glucose
  utilization during the sleep period helps
  maintain stable energy stores.
• Diminished motor activity contributes to
  decreased peripheral metabolism.
• The majority of the decrease in glucose
  utilization is related to the decline in brain
  metabolism.

6
(No Transcript)
7
(No Transcript)
8
Nighttime eating disorders

• Nighttime eating is categorized as either night
  eating syndrome (NES) or sleep-related eating
  disorder (SRED).
• NES could be considered an abnormality in the
  circadian rhythm of meal timing with a normal
  circadian timing of sleep onset.
• SRED is characterized by recurrent episodes of
  eating after an arousal from nighttime sleep with
  or without amnesia.

9
Nighttime eating disorders

• Studies have suggested that central nervous
  system (CNS) serotonin modulation may lead to an
  effective treatment of NES.
• SRED is frequently associated with other sleep
  disorders, in particular parasomnias. Early
  studies have shown that the anti-seizure
  medication topiramate may be an effective
  treatment.

10
Night eating syndrome

• Clinical characteristics
• Night eating has been described in normal weight,
  overweight and obese subjects.
• The mean BMI was in the obese range (BMI gt 31),
  although 20 of subjects had a BMI lt25.
• 77 reported duration of greater than 5 years.

11
Night eating syndrome

• Clinical characteristics
• NES patients eat more frequently during the day
  than obese controls.
• NES patients consume more calories at night than
  obese patients with binge eating disorder (BED).
• NES patients consume more calories at night than
  they do earlier in the day.
• NES patients have more awakenings and more
  awakenings that involve eating compared to obese
• controls.
• Nocturnal eating (after an awakening from sleep)
  is common in NES?

12
Neuroendocrine

• Cause or effect of NES?
• Alternation in glucose, insulin and ghrelin
• No significant changes in melatonin and leptin
  (phase shift)
• Consumption of comfort foods delay circadian of
  energy intake.

13
Endocrine system regulating appetite
Introduction
(Adenohypophysis)
EAT
1.Prolactin
2.TSH
(Pineal Gland)
3.Melatonin
(Stomach)
4.Ghrelin
(Adipose tissue)
5.Leptin
(Pancreas)
6.Insulin
8.Glucose
(Adrenal Cortex)
7.Cortisol
13
14
Endocrine system regulating appetite
Introduction
EAT
(Pineal Gland)
Melatonin
(Stomach)
Ghrelin
(Adipose tissue)
Leptin
(Pancreas)
Insulin
Glucose
14
15
Endocrine system regulating appetite
Introduction
(Adenohypophysis)
EAT
Prolactin
TSH
Metabolism
(Adipose tissue)
Leptin
Glucose
(Adrenal Cortex)
Cortisol
15
16
16
17
Amplitude reduced
Phase delay
Results
increased
advance
inverted
Kcalories 31.4? 1.5hr?
Carbohyrate 33.9? 1.9hr?
Fat 34.4? 1.5hr?
Protein (16.8)? (0.5hr)?
17
18
Amplitude reduced
Phase delay
Results
increased
advance
inverted
Melatonin (15.3)? 1.1hr?
TSH 30.9? (0.7hr)?
Prolactin (28.6)? (0.3hr)?
Cortisol 25.7? (0.7hr)?
19
Amplitude reduced
Phase delay
Results
increased
advance
inverted
Ghrelin 46.9? 5.2hr?
Leptin (3.9)? 1.0hr?
Glucose (56.5)? 11.6hr? or12.4hr?
Insulin 57.7? 2.8hr?
20
Dissociation between ghrelin leptin
Discussion
Ghrelin 46.9? 5.2hr?
6hr
Leptin (3.9)? 1.0hr?
20
21
Dissociation between glucose insulin
Discussion
Glucose (56.5)? 11.6hr? or12.4hr?
Insulin 57.7? 2.8hr?
21
22
Amplitude shifts
Discussion

• Up ? TSH because of night awakenings
• Down ? Ghrelin, Insulin, Cortisol, Food intake

22
23
Neuroendocrine

• Foods eaten in NES are often very similar to
  foods eaten during the daytime although high
  carbohydrate foods, such as breads and sugars are
  preferred.
• In a behavioral study of night eaters the
  carbohydrate content of evening food intake was
  higher (70) than daytime (47).

24
Neuroendocrine

• High carbohydrate food typically consumed in
  night eaters may be related to CNS serotonin
  modulation.
• A high carbohydrate-to-protein ratio facilitates
  the availability of tryptophan which is then
  converted into serotonin that promotes the
  initiation of sleep and reversal of sleep
  disruption.

25
(No Transcript)
26
Prevalence

• Multiple definitions limited the exactness of
  prevalence.
• Adult approximately 1.5
• Morbid obesity 27
• Pediatric about 1.1 (5-6 year-old)
• Patients with NES having an affected first-degree
  relative was high (OR 4.9)

27
NES and obesity

• 60 did not develop NES until obese. Normal
  weight prior to the development of NES and
  subsequent weight gain.
• Energy did not differ between night eaters and
  control?
• 6-year follow-up study NES gained more weight.

28
NES and mental illness

• Psychosocial stressors were common and closely
  coincided.
• Among obesity patients, subjects with NES have
  higher depression scores (Zung Depression
  Inventory) and lower self-esteem (Rosenberg
  Self-Esteem Scale).
• Circadian decline of mood scores after 4 PM for
  NES.

29
NES and mental illness

• Higher prevalence among outpatient psychiatry
  patients (12.3).
• NES and binge eating disorder? Some overlap but
  separate phenomenon.

30
Night eating questionnaire (NEQ)

• How hungry are you usually in the morning?
• 2. When do you usually eat for the first time?
• 3. Do you have cravings or urges to eat snacks
  after supper but before bedtime?
• 4. How much control do you have over your eating
  between supper and bedtime?
• 5. How much of you daily food intake do you
  consume after suppertime?

31
Night eating questionnaire (NEQ)

• Are you currently feeling blue or down in the
  dumps?
• 7. When you are feeling blue, is your mood lower
  in the
• 8. How often do you have trouble getting to
  sleep?
• 9. Other than only to use the bathroom, how often
  do you get up at least once in the middle of the
  night?
• 10. Do you have cravings or urges to eat snacks
  when you wake up at night?

32
Night eating questionnaire (NEQ)

• 11. Do you need to eat in order to get back to
  sleep when you awake at night?
• 12. When you get up in the middle of the night,
  how often do you snack?
• 13. When you snack in the middle of the night,
  how aware are you of your eating?
• 14. How much control do you have over your
  night-time eating?
• 15. How long have your current difficulties with
  night eating been going on?
• 16. Does anyone else in your family have problems
  with night eating, either now or in the past?

33
Treatment

• SSRI sertraline (50-200 mg) 71 over 18
  average 3.0 Kg over 8 weeks
• Anticonvulsant topramate
• Effective in NES and SRED 11.1 Kg

34
(No Transcript)