Consumo alimentar, anorexia nervosa e determinantes do comportamento de risco para transtornos alimentares em adolescentes.

Abstract

Introduction: Anorexia nervosa (AN) and risk behavior for eating disorders are considered important health problems in adolescents due to their emotional, psychosocial and physical consequences, which can be perpetuated until adulthood. Objective: To evaluate the relationship between food consumption, anorexia nervosa and risky behavior for eating disorders, as well as to describe the factors associated with this risky behavior in adolescents. Methodological considerations: This thesis comprises studies obtained from secondary and primary data. The secondary study is a scope review reported in accordance with the recommendations of the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and evaluated the association between anorexia nervosa, restrictive eating behavior (REB) and food consumption in children and adolescents. For the primary studies, a cross-sectional design carried out in Salvador-Bahia was adopted. The primary study sample was obtained using the simple random sampling without replacement (AASs) selection technique. The selection of schools was carried out using the conglomerate sampling procedure in two stages (1) schools and (2) classrooms. The sample size was 1,494 students, of both sexes, from the state public education system in Salvador. Data were collected in the school environment from July to December 2009. The Eating Attitudes Test-26 (EAT-26) was used to investigate risk behavior for eating disorders. The Body Image Questionnaire (BSQ) assessed satisfaction with body image. Dietary data were obtained using the Food Frequency Questionnaire (FFQ). Demographic, socioeconomic, anthropometric status, omission of breakfast, adoption of fasting, and extreme weight control behavior (self-induced vomiting, use of laxatives, diuretics, and weight loss medications) were collected. Descriptive data analysis was performed to characterize the study population and structural equation analysis was adopted to assess factors associated with risk behavior for eating disorders. For analysis of food consumption, dietary data were submitted to the principal components method and subsequently performed generalized Poisson model adjusted for covariates (gender, anthropometric status, body image and sexual maturation) to analyze the association between dietary pattern and risk behavior for eating disorders. Analyzes were conducted using Mplus 8.5 and R version 4.1.1 software. Results: Three manuscripts were developed. The first article refers to the scope review that included 24 studies. Similarities in food consumption in children and adolescents with AN/REB were identified: lower intake of calories and macronutrients, especially fats and certain micronutrients, as well as lower intake of low-quality snacks, fast food, sweets and foods with high carbohydrate and fat content. Greater intake of caffeine, fiber, vegetables and fruits was also recorded. Also, the intake of meat, poultry, fish and eggs groups was related to adolescents with REB. When evaluating the healthy eating index, it was detected the need to improve the quality of the diet among the participants. The results of the second manuscript recorded a prevalence of 15.2% of risk behavior for eating disorders and a direct association between anthropometry, extreme weight control behavior, adoption of fasting, skipping breakfast and sex, and risk behavior for eating disorders. No association was identified between age, body image, economic status and EAT-26. The third manuscript retained three I food pattern (sweets, carbonated drinks, soft drinks, fast food, other dairy products, cheeses, typical dishes and bakery); II food pattern (noodles, vegetables/vegetables, cereals, roots, fruits, meat/eggs and beans) and III food pattern (oils/fats, sugar, milk, rice and bread) which together explained 48.06% of the total variance in food consumption. Adherence to the highest tertiles of these patterns was associated with an increase in the final risk behavior score for eating disorders, while adherence to the moderate tertile of the II food pattern was inversely associated with the EAT-26 score. Conclusion: Children and adolescents with AN/REB reduce the intake of calories, nutrients and foods that are sources of fat and carbohydrates, in addition to increasing the intake of fruits, vegetables/vegetables, fiber and caffeine. Also, a relationship between intake of protein-rich food groups and REB was identified. The analysis of the a priori dietary pattern found an intermediate score of diet quality among adolescents. Still, an important prevalence of risk behavior for eating disorders was recorded and sex, anthropometry and behavioral factors are directly associated with the EAT-26, but no relationship was detected between age, body image and economic status and dysfunctional behaviors. Furthermore, adolescents who adhere to I, II, III food patterns in the highest tertiles increase the final score of risk behavior for eating disorders, except for adherence to the moderate tertile of the II food pattern. Thus, it is expected to contribute to the development of prevention strategies for risky behaviors for eating disorders and promote the adoption of healthier eating practices in adolescence.