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Nighttime eating disorders

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    1. Nighttime eating disorders ????? ???

    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.

    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 > 31), although 20% of subjects had a BMI <25. 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 Before/After Meal, Day/NightBefore/After Meal, Day/Night

    14. Endocrine system regulating appetite Before/After Meal, Day/NightBefore/After Meal, Day/Night

    15. Endocrine system regulating appetite Before/After Meal, Day/NightBefore/After Meal, Day/Night

    20. Dissociation between ghrelin & leptin Night hyperphagia Melatonin is still synchronized w/ Leptin Morning Anorexia Leptin relative high (cos delay) & Ghrelin relative low (cos advance)Night hyperphagia Melatonin is still synchronized w/ Leptin Morning Anorexia Leptin relative high (cos delay) & Ghrelin relative low (cos advance)

    21. Dissociation between glucose & insulin High risk at DiabeteHigh risk at Diabete

    22. Amplitude shifts Up ? TSH: because of night awakenings Down ? Ghrelin, Insulin, Cortisol, Food intake Amplitude of ghrelin & insulin may be reduced by night awakenings. (REM) Amplitude influences effectiveness.Amplitude of ghrelin & insulin may be reduced by night awakenings. (REM) Amplitude influences effectiveness.

    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.

    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