Journal of Food and Nutrition Research
ISSN (Print): 2333-1119 ISSN (Online): 2333-1240 Website: Editor-in-chief: Prabhat Kumar Mandal
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Journal of Food and Nutrition Research. 2018, 6(7), 464-470
DOI: 10.12691/jfnr-6-7-7
Open AccessArticle

Exploration of Eating Disorders, Nutritional and Health Status Based on Eating Attitude Test-26 amongst University Adolescent Girls

Ayesha Syed1, , Falak Zeb1, 2, , Saleem Khan1, Mahpara Safdar3, Iftikhar Alam4, Muhammad Shahzad5, Fazli Akbar1, Feng Qing2, Xiaoyue Wu2 and Masooma Munir6

1Department of Human Nutrition, Faculty of Nutrition Sciences, The University of Agriculture Peshawar, Pakistan

2Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University Jiangsu, China

3Department of Home and Health Sciences, Faculty of Sciences, Allama Iqbal Open University Islamabad, Pakistan

4Department of Clinical Nutrition, College of Community Health, King Saud University, Saudi Arabia

5Institute of Basic Medical Sciences, Khyber Medical University Peshawar, Pakistan

6Institute of Food Science and Nutrition, University of Sargodha, Sargodha, Pakistan

Pub. Date: July 28, 2018

Cite this paper:
Ayesha Syed, Falak Zeb, Saleem Khan, Mahpara Safdar, Iftikhar Alam, Muhammad Shahzad, Fazli Akbar, Feng Qing, Xiaoyue Wu and Masooma Munir. Exploration of Eating Disorders, Nutritional and Health Status Based on Eating Attitude Test-26 amongst University Adolescent Girls. Journal of Food and Nutrition Research. 2018; 6(7):464-470. doi: 10.12691/jfnr-6-7-7


Eating disorder causes serious disturbances in behaviors related to nutrition in adolescent. Although most of these attitudes are benign, they can bear significant psychological and health risks. A cross-sectional study was conducted on 250 university adolescent girls studying in Peshawar Pakistan to explore their eating disorder, nutritional and health status. Girls were interviewed for eating attitudes by using Eating Attitude Test (EAT-26), socio-economic status and body image. Anthropometric and biochemical indices were measured. Based on EAT-26 scale, girls with and without eating disorders were identified. In both groups the association between anemia and risk factors was evaluated. Health and nutritional risk factors for anemia in girls were identified by applying logistic regression. Mean score of EAT-26 was 18±10.5 while for Dieting, Bulimia, Oral Control and Body Image of the girls was 8.5±7, 3.20±2.59, 6.36±4.41 and 20±9 respectively. EAT-Score was found in strong association with anemia in unadjusted and adjusted analysis. Among the health factors, girls with symptoms of anxiety, depression and stress were more likely anemic than their counterpart. More anorexic girls were found overweight and obese in comparison to the rest (p<0.05). Body shape being android or gynoid as well as anemia were found similar among the groups (p>0.05). More anorexic girls showed significant difference in less freshness, disrupted sleep and low physical activity (p<0.05). It has been concluded that eating disorders (anorexia) are more prevalent in university adolescent girls and could adversely affect the health and nutritional status of the students.

eating attitude anorexia anemia gynoid bulimia body image score

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[1]  Tsai, M., Chang, Y., Lien, P. and Wong, Y, “Survey on eating disorders related thoughts behaviors and dietary intake in female junior high school students in Taiwan”, Asia Pacific Journal of Clinical Nutrition, 20. 196-205. 2011.
[2]  Costa, C., Ramos, E., Severo, M., Barros, H. and Lopes, C, “Determinants of eating disorders symptomatology in Portuguese adolescents”, Archives of Pediatrics and Adolescent Medicine, 162. 1126-1132. 2008.
[3]  Kann, L., Warren, C.W. and Harris, W.A, “Youth Risk Behavior Surveillance-United States 1995”, Journal of School Health, 66. 365-377. 1996.
[4]  Neumark-Sztainer, D., Paxton, S.J., Hannan, P.J., Haines, J. and Story, M, “Does Body Satisfaction Matter? Five-year Longitudinal Associations between Body Satisfaction and Health Behaviors in Adolescent Females and Males”, Journal of Adolescent Health, 39. 244-251. 2006.
[5]  Patton, G.C., Selzer, R., Coffey, C., Carlin, J.B. and Wolfe, R, “Onset of adolescent eating disorders: population based cohort study over 3 years”, British Medical Journal, 318. 765-768. 1999.
[6]  Fairburn, C.G. and Paul, J.H, “Eating disorders”, The Lancet, 361. 407-416. 2003.
[7]  Alfoukha, M.M., Ayman, M.H.M. and Manar, A.B, “Social and Psychological Factors Related to Risk of Eating Disorders Among High School Girls”, The Journal of School Nursing, 1-9. 2017.
[8]  Goldschmidt, A.B., Melanie, M.W., Tse-Hwei, J.C., Whitney, E., J., Nicole, L. and DianneNeumark, S, “Fifteen-year Weight and Disordered Eating Patterns Among Community-based Adolescents”, American Journal of Preventive Medicine, 54.e21-e29. 2018.
[9]  Wakeling, A, “Abnormal eating attitudes in London schoolgirls a prospective epidemiological study: outcome at twelve months”, Psychol Med, 20. 382-394. 1990.
[10]  World Health Organization. Obesity: Preventing and Managing the Global Epidemic. WHO consultation. WHO Technical Report Series no. 894. Geneva: World Health Organization, 2000.
[11]  National Institute of Nutrition. Dietary Guidelines for Indian. 2011. Available at: Finaldraft.pdf.
[12]  Centers for Disease Control and Prevention (CDC). Guidelines for school health programs to promote lifelong healthy eating. Morb Mortal Wkly Rep, 45:1-37. 1996.
[13]  Reed, Z.E., Nadia, M., Cynthia, M.B., George, D.S. and Kaitlin, H.W, “Assessing the causal role of adiposity on disordered eating in childhood, adolescence, and adulthood: a Mendelian randomization analysis”, Am J Clin Nutr, 106. 764-72. 2017.
[14]  Zipfel, S., Owe, B.L., Reas, D.L., Deter, H. and Herzog, W, “Long term prognosis in anorexia nervosa: lessons from a 21-year follow up study”, The Lancet, 355.721-722. 2000.
[15]  Nicklas, T.A., Myers, L., Reger, C., Beech, B. and Berenson, GS, “Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa Louisiana: ethnic and gender contrasts”, Journal of the American Dietetic Association, 1432-1438. 1998.
[16]  Chugh, R. and Puri, S, “Affluent adolescent girls of Delhi: eating and weight concerns”, Br J Nutr, 86.535-42. 2001.
[17]  Mallick, N., Susmita, M. and Subha, R, “Eating attitudes and its relationship with nutritional status: a micro level study on a group of adolescent girls in the city of Howrah West BengalInt”, J Adolesc Med Health, 2017.
[18]  Tosevski, D.L., Milovancevic, M.P. and Gajic, S.D, “Personality and psychopathology of university students”, Curr Opin Psychiatry, 23. 48-52. 2010.
[19]  Steiger, H., Seguin, J.R., Million, T., Blaneyu, PH. and David, R, 1999. Eating disorders: Anorexia nervosa and bulimia nervosa. Oxford textbook of psychopathology, Oxford University Press, New York. 365- 88. 1999.
[20]  Becker, A.E., Burwell, R.A., Gilman, S.E., Herzog, D.B. and Hamburg, P, “Eating behaviors and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls”, British. J. Psych, 180.509-514. 2002.
[21]  Visser, T., Notelovitz, C., Szabo, P. and Fredericks, N, “Abnormal eating attitudes and weight-loss behaviour of adolescent girls attending a traditional Jewish high school in Johannesburg South Africa”, S. Afr. J. Clin. Nutr, 4. 208-216. 2002.
[22]  Szabo, C.P. and Hollands, C, ”Abnormal eating attitudes in secondary-school girls in South Africa: a preliminary study”, S. Afr. Med. J, 87. 524-526. 1997.
[23]  Nelson, M.C., Kocos, R., Lytle, L.A. and Perry, CL, “Understanding the perceived determinants of weight-related behaviors in late adolescence: a qualitative analysis among college youth”, J. Nutr. Edu. Behvr, 4. 287-92. 2009.
[24]  French, S.A., Story, M., Neumark-Sztainer, D., Fulkerson, J.A. and Hannan P, “Fast food restaurant use among adolescents: associations with nutrient intake food choices and behavioral and psychosocial variables”, Inter. J. Obes, 12. 1823-33. 2001.
[25]  Vereecken, C.A., Inchley, J., Subramanian, S.V., Hublet, A. and Maes, L, “The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe”, Eur. J. Pub. Health, 3. 224-232. 2005.
[26]  Nicklas S, Issanchou S, Children and food choice. Understanding consumers of food products In: L. Frewer & H. van Trijp (ed.) 2007:329-358. Cambridge: CRC Press.
[27]  Mitchell, J. and Crow, S, “Medical complications of anorexia nervosa and bulimia nervosa”, Curr Opin Psychiatry, 19. 438-443. 2006.
[28]  Popkin, B, “Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases”, Am J Clin Nutr, 84. 289-98. 2006.
[29]  Golden, N.H., Jacobson, M.S., Sterling, W.M. and Hertz, S, “Treatment goal weight in adolescents with anorexia nervosa: use of BMI percentiles”, The International Journal of Eating Disorders, 41. 301-6. 2008.
[30]  Ge, X., Glen, H., Elder, J.R., Mark, R. and Christine, C, “Pubertal Transitions, Perceptions of Being Overweight, and Adolescent Psychological Maladjustment: Gender and Ethnic Differences”, Social Psychology Quarterly, 64. 363-375. 2001.
[31]  Dahl RE, Charskadon MA. Sleep and its disorders in adolescence. principles and practice of sleep medicine in the child. Philadelphia: WB Saunders, 19-27. 1995.
[32]  Judith, N., Kehi, H.N. and Jephtha, C.N, “Eating behaviours of university students in Southern Nigeria: an evaluation of sex differences”, Sci. J. Pub. Health, 1. 23-37. 2014.
[33]  Hitze, B., Bosy-Westphal, A., Bielfeldt, F., Settler, U., Plachta-Danielzik, S., Pfeuffer, M., Schrezenmeir, J., Mönig, H. and Müller, M.J, “Determinants and impact of sleep duration in children and adolescents: data of the Kiel Obesity Prevention Study”, Eur. J. Clin. Nutr, 63. 739-746. 2009.
[34]  Knutson, K.L, “The association between pubertal status and sleep duration and quality among a nationally representative sample of U. S. adolescents”, Amr. J. Human Biology, 17. 418-424. 2005.
[35]  Vonkries, R., Toschke, A.M., Wurmser, H., Sauerwald, T. and Koletzko, B, “Reduced risk for overweight and obesity in 5-and 6-y-old children by duration of sleep-a cross-sectional study”, Int. J. Obes, 26. 710-716. 2002.
[36]  Wasnik, V., Rao, B.S. and Rao, D, “A Study of the Health Status of Early adolescent Girls residing in Social Welfare Hostels in Vizianagaram district of Andhra Pradesh State India. Interl”, J. Collaborative Research on Internal Medicine & Public Health, 1. 72-83. 2012.
[37]  Kaur, S., Deshmukh, P.R. and Garg, B.S, “Epidemiological Correlates of Nutritional Anemia in Adolescent Girls of Rural Wardha”, Indian Journal of community Medicine, 31. 255-258. 2006.
[38]  Lozoff, B., Jimenez, E., Hagen, J., Mollen, E. and Wolf, A.W, “Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infanc”, Pediatrics, 4. E51. 2000.
[39]  Chen, M., Tung-Ping, S., Ying-Sheue, C., Ju-Wei, H., Kai-Lin, H., Wen-Han, H., Tzeng-Ji, H. and Ya-Mei, B, “Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study”, BMC Psychiatry, 13. 161. 2013.