Empirical eating disorder classification and validation using prospective studies

使用前瞻性研究进行经验性饮食失调分类和验证

• 批准号: 8197541
• 负责人: Alison E Field
• 金额: $ 60.72万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-11 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8197541
• 关键词: Adolescence; Adolescent; Adult; Age; Alcohol consumption; Alcohol or Other Drugs use; Amenorrhea; Anorexia Nervosa; Anxiety; Behavioral; Binge Eating; Binge eating disorder; Body Weight Changes; Bulimia; Categories; Child; Classification; Classification Scheme; Cohort Studies; Comorbidity; Cross-Sectional Studies; DSM-IV; Data; Diagnosis; Diagnostic; Disease; Eating Disorders; Frequencies; Gender; Grouping; Health; Individual; Lead; Longitudinal Studies; Mental Depression; Outcome; Parents; Participant; Patients; Pattern; Prevalence; Prevention program; Prospective Studies; Recording of previous events; Sampling; Sex Characteristics; Specific qualifier value; Symptoms; System; Testing; Time; United Kingdom; United States; Validation; Weight; Weight Gain; Woman; Work; base; cohort; disease classification; early onset; follow-up; male; meetings; prospective; public health relevance; purge; purging disorder; treatment program; young adult

DESCRIPTION (provided by applicant): A non-trivial number of adolescents and young adults suffer from an eating disorder, many of which lead to serious health problems. Therefore, creating a validated classification scheme is of major importance, as it is needed to help guide treatment and prevention programs. Among adolescent and young adult women in the United States and the United Kingdom, approximately 0.1-1% have anorexia nervosa and 1-3% have bulimia nervosa. Although the Diagnostic and Statistical Manual for Mental Disorders-IV (DSM-IV) criteria are widely used to classify individuals, the eating disorder diagnoses were not empirically defined and the majority of eating disordered individuals do not meet the criteria for anorexia nervosa or bulimia nervosa. Moreover, the diagnostic criteria may not capture all early onset cases and it is unclear whether they are appropriate to use with males. We propose to collect additional data on eating disorders and treatment from two ongoing cohort studies, the Growing Up Today Study (GUTS) in the United States and the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom to empirically create an eating disorder classification scheme. We will use latent class analysis and compare the resulting classification to the existing DSM-IV classification, as well as another classification proposed from latent class analyses in two cross-sectional studies. We will use data from the 16,882 participants in GUTS who have been followed every 12-24 months since 1996 to empirically derive an eating disorder classification scheme using latent class analysis. We will determine the best groupings of eating disorder symptoms, as well as the best cut-offs (such as engaging in binge eating > once per week vs. > two times per week). We will use comorbidity and outcome (weight gain and weight status, comorbid depression, anxiety, substance and alcohol use, and persistence or worsening of symptoms) during adolescence and young adulthood as the validators. By collecting information on treatment history we can assess whether these patterns and associations vary by gender, age, or treatment history in the GUTS cohort. We will use the same eating disorder information collected at ages 14, 16, and 18 years in ALSPAC to test whether the observed results in GUTS can be replicated and are therefore generalizable. We propose to use the two largest prospective studies with frequent assessments of disordered eating during adolescence and young adulthood to empirically derive a classification scheme and compare it to the system that is already frequently used (DSM-IV), but is known to not work well for many individuals, as well as an alternative classification system that has been proposed. The size of our sample and the repeat assessments allows us not only to empirically determine the best groupings of symptoms, but also allows us to propose valid frequency cutoffs for binge eating and purging. PUBLIC HEALTH RELEVANCE: A non-trivial number of adolescents and young adults suffer from an eating disorder, but the current classification scheme (The Diagnostic and Statistical Manual for mental disorders, IV edition [DSM- IV]) is known to not work well. We propose to use the two largest prospective studies with frequent assessments of disordered eating during adolescence and young adulthood to empirically derive a classification scheme and compare it to the DSM-IV in terms of comorbidity and outcome (weight gain and weight status, comorbid depression, anxiety, substance and alcohol use, and persistence or worsening of symptoms).

描述（由申请人提供）：相当数量的青少年和年轻人患有饮食失调，其中许多会导致严重的健康问题。因此，创建经过验证的分类方案非常重要，因为需要它来帮助指导治疗和预防计划。在美国和英国的青少年和年轻成年女性中，大约 0.1-1% 患有神经性厌食症，1-3% 患有神经性贪食症。尽管精神障碍诊断和统计手册-IV (DSM-IV) 标准被广泛用于对个体进行分类，但饮食失调的诊断并未根据经验进行定义，并且大多数饮食失调个体不符合神经性厌食症或神经性贪食症的标准。此外，诊断标准可能无法涵盖所有​​早发病例，并且尚不清楚它们是否适合用于男性。我们建议从两项正在进行的队列研究（美国的今日成长研究（GUTS）和英国的雅芳父母和儿童纵向研究（ALSPAC））中收集有关饮食失调和治疗的更多数据，以凭经验创建饮食疾病分类方案。我们将使用潜在类别分析，并将所得分类与现有的 DSM-IV 分类以及两个横断面研究中的潜在类别分析提出的另一个分类进行比较。我们将使用 GUTS 中 16,882 名参与者的数据，这些参与者自 1996 年以来每 12-24 个月进行一次随访，通过潜在类别分析凭经验得出饮食失调分类方案。我们将确定饮食失调症状的最佳分组，以及最佳界限（例如暴饮暴食>每周一次与>每周两次）。我们将使用青春期和成年早期的合并症和结果（体重增加和体重状态、合并症抑郁、焦虑、物质和酒精使用以及症状持续或恶化）作为验证因素。通过收集治疗史信息，我们可以评估 GUTS 队列中这些模式和关联是否因性别、年龄或治疗史而异。我们将使用 ASPAC 中在 14、16 和 18 岁收集的相同饮食失调信息来测试 GUTS 中观察到的结果是否可以复制并因此具有普遍性。我们建议利用两项最大的前瞻性研究，对青春期和青年期的饮食失调进行频繁评估，以经验方式得出分类方案，并将其与已经经常使用的系统（DSM-IV）进行比较，但已知效果不佳对于许多人来说，以及已经提出的替代分类系统。我们的样本规模和重复评估不仅使我们能够凭经验确定最佳症状分组，而且还使我们能够提出暴食和暴饮暴食的有效频率截止值。 公共卫生相关性： 相当数量的青少年和年轻人患有饮食失调，但目前的分类方案（精神障碍诊断和统计手册，IV 版 [DSM-IV]）已知效果不佳。我们建议利用两项最大的前瞻性研究，对青春期和青年期饮食失调进行频繁评估，以经验方式得出分类方案，并将其与 DSM-IV 的共病和结果（体重增加和体重状态、共病抑郁症、焦虑、物质和酒精使用以及症状持续或恶化）。