Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders (EDs) that represent important global public health concerns. We analyzed their epidemiological characteristics from 1990 to 2021 to assess differences by region, sex, age, and sociodemographic context. Using data from the Global Burden of Disease (GBD) Study 1990-2021, we calculated age-standardized incidence, prevalence, and DALYs rates (ASIR, ASPR, and ASDR) for EDs, AN, and BN; analyzed temporal trends using joinpoint regression; and quantified inequalities across geography, age, and sex by sociodemographic index (SDI). The global ASIR for EDs increased gradually from 1990 to 2021, with an average annual growth of 0.53%. High-SDI regions, had the highest ASIR, 1.98-fold that of low-SDI regions (P < 0.001). Incidence increased more rapidly among male individuals than female individuals (0.55% versus 0.49%), whereas female individuals had substantially higher prevalence and accounted for 63.7% of DALYs. The 15-24-year age group, spanning adolescence and early adulthood, accounted for 54.3% of cases. For subtypes, the ASIR for BN increased from 91.95/100,000 to 107.81/100,000 (+0.55%/year), whereas that for AN increased from 14.84/100,000 to 16.59/100,000 (+0.42%/year). High-SDI regions also had the highest subtype burdens, with ASIRs for AN and BN 2.36-fold and 1.92-fold those of low-SDI regions, respectively. From 1990 to 2021, the global burden of EDs increased, with the highest burden in high-SDI regions and the fastest growth in middle-SDI regions. Female individuals aged 15-24 years carried the largest burden, although incidence increased more rapidly among male individuals. These findings can inform region-specific, sex-sensitive, and age-targeted prevention and control strategies.
Dynamic left ventricular outflow tract (LVOT) obstruction is a common and consequential feature of hypertrophic cardiomyopathy (HCM), present in a majority of patients at rest or with provocation, and it directly influences symptom burden and eligibility for therapy. When obstruction is absent at rest it can be provoked by physiologic stimuli, including the ingestion of a meal, a phenomenon patients have reported for decades. Whether postprandial assessment improves detection of obstructive physiology over conventional provocative testing has not been systematically examined. We searched PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science from inception through June 2025. Study quality was assessed with the Newcastle-Ottawa Scale. Because of substantial heterogeneity in study protocols and outcome definitions, we performed a narrative synthesis rather than a meta-analysis. Seven studies met inclusion criteria, published between 1991 and 2024 across three countries. Across these studies, postprandial assessment consistently provoked higher LVOT gradients than fasting measurement and identified obstructive physiology in patients with no obstruction on conventional testing. In the most rigorous comparative study, postprandial echocardiography identified gradients ≥ 30 mmHg in 74
Food and alcohol disturbance (FAD) is the use of compensatory behaviors within a drinking episode to enhance alcohol's effects (FAD-AE) and/or alcohol-related caloric compensation (FAD-CC). Prior work has found that FAD-AE and FAD-CC are positively associated with eating disorder (ED) outcomes; however, it is unclear whether ED outcomes differ by the type and number of FAD motives endorsed. This study examined whether domains of ED pathology differed between those who use alcohol only and those engaging in FAD for specific motives. Participants were 2801 (Mage = 19.48; 77.6% female; 68.8% White) undergraduates from six universities who reported past-month alcohol use. Participants were categorized into four groups: Alcohol-Only, FAD-CC, FAD-AE, or FAD-Both (i.e., FAD-AE and FAD-CC). A multivariate analysis of covariance examined group differences across eight ED pathology domains (purging, restricting, excessive exercise, binge eating, muscle building, body dissatisfaction, cognitive restraint, and negative attitudes toward obesity), controlling for biological sex, age, and past-month drinking quantity. The FAD-Both group reported greater ED pathology across most domains compared to all other groups. The Alcohol-Only group reported lower binge eating and body dissatisfaction than all FAD groups. Among those reporting FAD for a single motive, the FAD-CC group reported elevated body dissatisfaction, cognitive restraint, and excessive exercise compared to the FAD-AE group, whereas the FAD-AE group reported greater restriction than the FAD-CC group. Findings underscore the heterogeneity of ED pathology among undergraduates engaging in FAD for specific motives and suggest that those endorsing FAD-Both may represent a high-risk subgroup, highlighting the need for tailored interventions.
The purpose of this study was to examine associations between weight discrimination, weight bias internalization, and disordered eating in a sample of Black adults in larger bodies. Specifically, indirect effects of weight discrimination on disordered eating through weight bias internalization were hypothesized. In this cross-sectional study, 454 Black participants living in the United States with BMIs of 25 kg/m2 or greater were recruited from Prolific. Study hypotheses and data analysis plan were preregistered on the Open Science Framework (https://osf.io/px2n5/overview). As hypothesized, indirect effects of weight discrimination on disordered eating via weight bias internalization were found. The indirect effect was observed for global eating disorder symptoms and all five eating disorder subscales (restricted eating, shape and weight overvaluation, body dissatisfaction, bingeing, and purging). Findings expand previous research with predominantly White women samples to a community sample of Black adults in larger bodies, highlighting weight discrimination and weight bias internalization as important targets for eating disorder prevention and intervention in Black adults.
Shock is the clinical state whereby the patient’s circulation fails to meet the body’s metabolic demands. Both acute illnesses that lead to shock and therapies employed to support the shocked patient (including intravenous fluids, vasoactive infusions and ventilatory support) may result in changes to the normal function of the heart. The conventional approach to interpretation of echocardiography in the steady physiological state needs modification when this test is applied to the shocked patient. In this paper we explain when and why modifications are required, and provide echocardiographers already established in outpatient practice with a practical approach to performing and reporting echocardiograms in shocked patients.
We evaluated the trajectories of echocardiographic myocardial work (MW) indices and their associations with left ventricle (LV) functional recovery, myocardial viability, and perfusion in patients with reperfused acute myocardial infarction (AMI). Thirty-one patients with a first ST-elevation AMI treated with percutaneous coronary intervention were prospectively enrolled. Transthoracic echocardiography and [15O]-water positron emission tomography (PET) were performed at a median of 7.7 ± 3.8 days post- intervention (baseline). Global and segmental absolute myocardial blood flow (MBF) were assessed using PET, and myocardial segments were graded as viable or non-viable based on perfusable tissue fraction (PTF). Echocardiographic parameters, including LV ejection fraction (LVEF), global longitudinal strain (GLS), myocardial work index (MWI), constructive work (MCW), wasted work (MWW), and work efficiency (MWE), were measured at baseline and at the 6-month follow-up. The myocardial area at risk (AAR) and the remote myocardium were defined based on the culprit coronary artery segment. LVEF and GLS remained unchanged between baseline and follow-up. However, global MWI, MCW, and MWE significantly increased, while MWW decreased at the 6 months (all p < 0.05). An increase in MWI, but not MWE, was associated with improvement of LVEF. Neither global MWI nor MWE correlated with global MBF, but were inversely associated with peak levels of troponin T and NT-proBNP. In the AAR, regional MWI and MWE were significantly correlated with regional MBF (r = 0.53, p = 0.003, and r = 0.59, p < 0.001, respectively) and PTF (r = 0.41, p = 0.03, and r = 0.65, p < 0.001, respectively). At baseline, segmental MWI and MWE were higher in viable compared to non-viable segments. At 6 months, MWI and MWE increased in viable, but not in non-viable segments. Echocardiographic myocardial work indices reflect the severity of myocardial injury early after AMI and may serve as non-invasive markers of functional recovery and myocardial viability.
Dialectical behaviour therapy (DBT) is an effective treatment for eating disorders (EDs), teaching three skills to overcome maladaptive eating behaviours - mindfulness, emotion regulation, and distress tolerance. Although research has demonstrated that each of these skills are independently protective against ED symptoms, no research has explored their interconnectedness. This limits our understanding of which facets are most strongly and uniquely related to various ED symptoms. Thus, the present study (n = 1136) employed a cross-sectional network approach to identify which DBT skills were most central (i.e. the most strongly connected to other variables in the network), and which skills acted as bridges between DBT skills and ED symptoms. Under emotion regulation, negative urgency was negatively associated with binge eating, self-compassion was negatively associated with body dissatisfaction, and psychological inflexibility was positively associated with restriction. Under mindfulness, acting with awareness was negatively associated with binge eating. Moreover, binge-eating, negative urgency, and self-compassion emerged as key bridging symptoms between DBT skills and ED symptoms. Findings suggest that emotion regulation difficulties, particularly negative urgency, psychological inflexibility, low self-compassion, and low acting with awareness, may be especially relevant to ED symptoms, whereas other mindfulness and distress tolerance skills demonstrated comparatively weaker direct associations. Self-compassion in particular emerged as an important construct in the overall network, demonstrating high centrality across strength and betweenness indices, and was identified as a bridge node between DBT skills and ED symptoms. Explicitly targeting self-compassion within DBT protocols may be useful for more reducing prominent ED symptoms.
Ultra-processed food (UPF) intake is linked to poor health, though some subgroups may offer affordable, nutritious options. Few studies have examined how UPF consumption-overall and by subgroup-relates to diet quality among populations with low income. We evaluated UPF subgroup intake and associations with diet quality among adults participating in the Supplemental Nutrition Assistance Program (SNAP). Rhode Island (RI) and Connecticut (CT) participants (n = 1244, 92% female, 58% food insecure) completed an online sociodemographic survey and food frequency questionnaire (FFQ). We categorized food codes (n = 301) using NOVA, and developed thirteen UPF subgroups within NOVA group 4. We calculated UPF intake (total %kcal and by subgroup) and evaluated diet quality using the Healthy Eating Index-2020 (HEI-2020). We performed Kruskal-Wallis and Jonckheere-Terpstra tests to compare total and UPF subgroup consumption across Total HEI-2020 tertiles. Mean Total HEI-2020 score was 63.9 ± 11.5. While higher total UPF intake was associated with lower Total HEI-2020 scores, associations between subgroups and diet quality differed. Ultra-processed refined grains, sugar-sweetened beverages, and ready-to-eat/heat mixed dishes were associated with lower Total HEI-2020 scores, whereas whole grains, yogurt, and plant-based products were associated with higher Total HEI-2020 scores. UPFs are heterogeneous, with select subgroups associated with higher diet quality in a sample of SNAP-participating adults. As policymakers consider SNAP UPF waivers and restrictions, accounting for subgroup differences will be imperative to avoid unintentionally restricting access to foods that support higher diet quality among individuals with low income.
Duchenne muscular dystrophy (DMD) is a genetically determined, neuromuscular disorder occurring predominantly in males with a prevalence of 1:3,500 to 1:5,000 live male births. It is a life limiting condition with average life expectancy of only 28.1 years in the United Kingdom. A dilated cardiomyopathy occurs in all patients with DMD, and cardio-respiratory causes now account for about 80
Financial difficulty, a social driver of health, is associated with adverse maternal outcomes; however, its relation to perinatal eating behaviors is not well understood. The present study examined associations between financial difficulty and binge eating, purging, dietary restriction, and intuitive eating during pregnancy. Data were drawn from a secondary analysis of a cross-sectional, online study conducted between December 2022 and July 2023. Participants were a U.S. community sample of pregnant adults (N = 176; Mage = 29.24; 77.8% White). Approximately 35% of participants endorsed current financial difficulty. Multiple regression analyses controlling for total number of pregnancies indicated that greater financial difficulty was significantly associated with higher levels of binge eating (B = 2.04, p < .001), purging (B = 1.53, p < .001), and dietary restriction (B = 1.67, p < .001), as well as lower intuitive eating (B = -0.11, p = .002). Findings suggest that financial difficulty is associated with greater engagement in disordered eating behaviors and reduced engagement in adaptive eating during pregnancy. Results underscore financial difficulty as an important and modifiable risk factor in the perinatal period. Interventions that address financial stressors and support intuitive eating, alongside routine screening in prenatal care, may help mitigate disordered eating risk and promote maternal and fetal health outcomes.
Disordered eating behaviors (DEBs) are common among adolescents and are associated with an increased risk for clinical eating disorders. Using 2022-2023 National Survey of Children's Health data, we examined associations between food insecurity and food insufficiency and DEBs among U.S. adolescents aged 10-17 years. We hypothesized that adolescents experiencing food insecurity and food insufficiency would have higher rates of overall DEBs, compensatory behaviors, avoidant/restrictive food intake disorder (ARFID) behaviors, and binge eating behavior. Using modified Poisson regression models on a weighted sample (n = 42,844, representing 30,303,175 adolescents), we estimated crude and adjusted risk ratios (aRR) and 95% confidence intervals (CIs) for overall DEBs, compensatory behaviors, ARFID behaviors, and binge eating behavior. The overall DEB prevalence was 29.7%. Compared to adolescents with food security, those with food insecurity had a 17% (aRR: 1.17; 95% CI, 1.09-1.24) increased risk of any DEB, a 12% increased risk of compensatory behaviors (aRR: 1.12; 95% CI, 1.01-1.25), an 18% increased risk of ARFID behaviors (aRR: 1.18; 95% CI: 1.09-1.28), and a 25% increased risk of binge eating behavior (aRR: 1.25; 95%CI, 1.04-1.52). Those with food insufficiency had a 19% (aRR: 1.19; 95% CIs: 1.06-1.35) increased risk of any DEB, a 24% increased risk of compensatory behaviors (aRR: 1.24; 95% CI, 1.01-1.51), a 23% increased risk of ARFID behaviors (aRR: 1.23; 95%CI: 1.07-1.42), and a 16% increased risk of binge eating behavior (aRR: 1.16; 95% CI, 0.88-1.54). These findings underscore the need for public health policies and clinical practice to prioritize food security among U.S. adolescents to reduce the risk of DEBs.
Echocardiography is a foundational imaging modality for assessing cardiac structure and function, with a long history of technological advancement. As artificial intelligence (AI) becomes increasingly embedded across healthcare, its potential to enhance the echocardiography workflow, from image acquisition and analysis to reporting and risk stratification, has expanded rapidly. Research activity in this field has grown substantially, yet clinical adoption remains variable and often limited by practical, technical, and governance challenges. In response, the British Society of Echocardiography has developed this position statement to provide a structured, consensus‑driven evaluation of the opportunities, limitations, and requirements for the safe, equitable, and effective integration of AI into echocardiography services. Although centred on the UK context, the principles outlined may be relevant to other healthcare systems with similar models of echocardiography delivery.
Chronotype describes differences in the timing of daily rhythms, regulated by the circadian system. These patterns are classified as morning or evening chronotypes. Studies show increased impulsivity, poorer health behaviors, and greater cardiometabolic risk among evening chronotypes. However, few studies evaluate these effects relative to circadian biomarkers. Additionally, time of day may impact how chronotype affects behaviors. Participants completed an eating in the absence of hunger task during morning and evening sessions. Participants were served oatmeal, then given access to snack foods. Calories consumed from each snack type was the primary outcome. Participants fasted for ≥8 h before a 9 AM morning task. For the evening task, participants fasted for 2 h and completed an 8 PM task. Dim light melatonin onset (DLMO) was measured the day following the morning task. Covariate-adjusted models evaluated differences in caloric intake across food types and sessions, and tested associations between caloric intake and DLMO. 113 participants completed the protocol (57 female; age: M = 35.6, SD = 9.87). Significant time-of-day effects were observed, with lower intake of bland (B = -5.67, p < 0.001) and salty foods (B = -15.53, p = 0.015) in the evening. Order effects showed greater intake during the second administration for total calories and all categories (ps < 0.01). Later DLMO was linked to greater appetite ratings. These finding suggest that those with later circadian timing may have greater hedonic interest in food. Future research should explore interactions between chronotype, circadian timing, and environmental factors shaping eating behaviors.
BACKGROUND:Self-monitoring is an effective strategy for reducing unhealthy snacking, and smartphone Ecological Momentary Assessment (EMA) may promote behavioral change through measurement reactivity. However, it remains unclear whether higher monitoring frequency enhances these effects or, instead, increases burden. METHOD:Throughout a 3-week EMA protocol, 136 healthy-BMI female participants - mostly University students - were randomly assigned to either a low (3/day), medium (6/day), or high (9/day) monitoring condition. Every day, multiple times per day, participants reported cravings (degree and amount), intake, self-control, and stress. Generalized linear mixed-effects models tested changes over time and differences between conditions. It was hypothesized that higher monitoring frequency would produce stronger reductions in craving and snacking (H1), with effects moderated by self-control (trait), dietary restraint, and hedonic hunger (H2). RESULTS:Across conditions, craving (degree and amount) and snacking decreased significantly over time, supporting a general measurement reactivity effect. Against H1, the high monitoring condition did not produce steeper reductions in craving or snacking compared to lower monitoring conditions. This effect was further supported by Bayesian analysis results. Finally, against H2, self-control (trait), dietary restraint, and hedonic hunger did not moderate the effect of monitoring frequency on craving and/or snacking. CONCLUSIONS:Smartphone EMA may be effectively used to reduce cravings and snacking through measurement reactivity. Importantly, the low monitoring conditions (3 beeps/day) emerged as the least burdensome, yet effective, approach to reduce craving and snacking over time in a non-clinical sample. Future research should test whether this EMA-induced measurement reactivity effect generalizes to clinical populations.
Research has established that experiencing weight discrimination is associated with myriad negative consequences, including disordered eating cognitions. However, it has not yet been tested whether a parent's experiences of weight discrimination affect their children's disordered eating cognitions. This paper seeks to establish a relationship between a mother's experiences with weight discrimination and her children's disordered eating cognitions. Using data from the NHLBI Growth and Health Study, we tested whether 193 mothers' weight stigma experiences are associated with their children's (N = 264) body dissatisfaction and drive for thinness, and whether maternal restricted feeding practices is a mechanism through which they are related. We found that maternal weight discrimination experiences are associated with both child body dissatisfaction and child drive for thinness through maternal restrictive feeding practices. In race-stratified models, these same patterns were evident for non-white children but not white children. Overall, these associations were sometimes, but not consistently, robust to the addition of covariates. Our results suggest that maternal experiences of weight discrimination may influence their restrictive feeding patterns, and subsequently their children's disordered eating cognitions.
Compulsive exercise is commonly observed in adolescent anorexia nervosa (AN) and relates to more severe eating disorder pathology and worse outcomes. Within higher levels of care (HLOC) for eating disorders, physical activity is often restricted in an attempt to reduce compulsive exercise; yet, the effectiveness of these restrictions across levels of care remains understudied. The current study examined how compulsive exercise presents and changes within HLOC as individuals with AN transition from settings with greater supervision to those with more autonomy over movement. Given the central role of weight restoration in HLOC, the association between change in percent of expected body weight (%EBW) and compulsive exercise frequency at discharge was also explored. Participants were 443 adolescents with AN admitted to inpatient or residential treatment and stepped down to partial hospitalization or intensive outpatient programs. At admission, stepdown, and discharge, participants reported compulsive exercise frequency using the Eating Disorder Examination-Questionnaire. Among participants who endorsed compulsive exercise at admission (58.0%, n = 257), piecewise growth curve analyses found a significant decrease in compulsive exercise frequency from admission to stepdown (β = -0.21, p < .001) and no significant change from stepdown to discharge (β = -0.02, p = .080). Change in %EBW was not associated with compulsive exercise frequency at discharge (β = 0.17, p = .941, IRR = 1.19). Eating disorder recovery in the context of HLOC settings that initially restrict access to exercise is associated with reported decreases in compulsive exercise for many adolescents with AN, irrespective of weight stabilization. Research involving measures of exercise motivation, controlled designs, and follow-up data is needed to inform the development of personalized compulsive exercise interventions.
Screen use while eating has become increasingly common, yet its emotional implications remain insufficiently understood. Although previous research has examined the effects of food consumption and screen use separately, less is known about how emotional experiences change when eating occurs during screen use, or whether these changes depend on the emotional valence of screen content. The present study used a controlled laboratory experiment to examine emotion changes during screen use while eating. We also tested whether video valence moderated the association between food intake and emotion change. A total of 88 Chinese university students (21.6% male; mean age = 20.47 years) were randomly assigned to a positive, negative, or neutral video condition while freely eating snacks. Participants rated their emotional states on the Positive and Negative Affect Schedule before and after the video-watching session. Results showed that negative emotions decreased across the three conditions. Higher food intake during screen use was associated with greater improvements in positive emotions only during negative video viewing in the full sample. Hierarchical regression analysis further revealed that, among females, positive video content strengthened the positive relationship between food intake and positive emotion change, and strengthened the negative relationship between food intake and negative emotion change. Findings align with mood congruency theory and suggest that emotional outcomes during screen use while eating may depend partly on the emotional valence of screen content, particularly among female participants.
Arterial hypertension remains the leading modifiable cause of cardiovascular morbidity and mortality resulting in characteristic changes in cardiac structure and function. Contemporary hypertension clinical guidelines increasingly emphasise prevention and early detection of hypertension-mediated organ damage, yet they differ in how blood pressure is categorised and when further investigation is recommended. Within this prevention-focused landscape and alongside a broader cardio-renal-metabolic framework, this review provides a practical overview on the role of echocardiography in arterial hypertension by integrating contemporary hypertension guidelines with imaging consensus documents. We outline when echocardiography is most likely to add value in hypertension and review echocardiographic assessment of left ventricular structure and geometry, systolic and diastolic function and filling pressures, atrial remodelling, right ventricular assessment, valvular heart disease and the aorta. Practical indications for scanning and transoesophageal echocardiography considerations are discussed. Finally, we highlight future directions including prevention-focused pathways, scalable echocardiography strategies, routine inclusion of contemporaneous blood pressure in reports, artificial intelligence-enabled quantification and selective multimodality imaging within specialist hypertension services.
Objective: Theory highlights the role of emotion regulation (ER) and impulsivity in the development and maintenance of eating disorders. Although the associations between negative ER, impulsivity features, and eating disorder symptoms are well-documented, the role of positively-valanced ER difficulties remain unclear. To address this gap, we adopted a transbehavioral approach to examine how valence-specific urgency and emotion regulation difficulties individually and interactively relate to disordered eating behaviors. Method: Our sample consisted of 181 college students with heterogeneous symptom severity presentations. Participants completed self-report measures for (1) negative and positive ER difficulties, (2) negative and positive urgency, and (3) eating disorder behaviors. Results: Positive ER difficulties were positively associated with binge eating and fasting frequency at low levels of positive urgency. Additionally, negative ER difficulties were significantly associated with purging frequency at both low and high levels of negative urgency, but a stronger positive association was observed when negative urgency was low. Furthermore, negative ER difficulties were significantly associated with binge eating frequency at low levels of negative urgency. Conclusions: Contrary to our hypotheses, disordered eating behaviors were more strongly associated with emotion regulation difficulties at lower levels of urgency. These findings suggest that emotion regulation difficulties may represent a distinct pathway to disordered eating beyond urgency-related risk and highlight the importance of considering both emotion regulation and urgency in understanding eating disorder symptomatology.
