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Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

We aimed to identify the risk of eating disorders (ED) in women with polycystic ovary syndrome (PCOS) compared to controls.

Methods

We performed a systematic review and meta-analysis of studies that included women with well-defined PCOS and controls and used validated ED screening/diagnostic tools to measure mean ED score, prevalence of abnormal ED scores, and/or prevalence of specific ED diagnoses such as bulimia nervosa and binge eating disorder.

Results

Eight studies, including 470 women with PCOS and 390 controls, met inclusion criteria for the systematic review. Meta-analysis of seven of those studies found that the odds of an abnormal ED score (OR 3.05; 95% CI 1.33, 6.99; four studies) and the odds of any ED diagnosis (OR 3.87; 95% CI 1.43, 10.49; four studies) were higher in women with PCOS compared to controls.

Conclusions

Our study suggests that women with PCOS are at increased odds of having abnormal ED scores and specific ED diagnoses. Given the potential implications of an ED on weight management strategies, our findings support routine screening for ED in this population.

Level of evidence

Level I, systematic review and meta-analysis.

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References

  1. Lizneva D, Suturna L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R (2016) Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril 106:6–15. https://doi.org/10.23736/S0391-1977.18.02824-9

    Article  PubMed  Google Scholar 

  2. Rotterdam ESHRE/ASRM-Sponsored PCOS, Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004

    Article  Google Scholar 

  3. Zawadski JK, Dunaif A (1992) Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine F (eds) polycystic ovary syndrome. Blackwell Scientific, Boston, pp 377–384

    Google Scholar 

  4. Dokras A (2013) Cardiovascular disease risk in women with PCOS. Steroids 78:773–776. https://doi.org/10.1016/j.steroids.2013.04.009

    Article  CAS  PubMed  Google Scholar 

  5. Cesta CE, Månsson M, Palm C, Lichtenstein P, Iliadou AN, Landén M (2016) Polycystic ovary syndrome and psychiatric disorders: co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology 73:196–203. https://doi.org/10.1016/j.psyneuen.2016.08.005

    Article  PubMed  Google Scholar 

  6. Lee I, Cooney LG, Saini S, Smith ME, Sammel MD, Allison KC, Dokras A (2017) Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril 107:796–802. https://doi.org/10.1016/j.fertnstert.2016.12.014

    Article  PubMed  Google Scholar 

  7. Dokras A, Clifton S, Futterweit W, Wild R (2011) Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and metaanalysis. Obstet Gynecol 117:145–152. https://doi.org/10.1097/AOG.0b013e318202b0a4

    Article  PubMed  Google Scholar 

  8. Grucza RA, Przybeck TR, Cloninger CR (2007) Prevalence and correlates of binge eating disorder in a community sample. Compr Psychiatry 48:124–131. https://doi.org/10.1016/j.comppsych.2006.08.002

    Article  PubMed  Google Scholar 

  9. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiat 1:348–358. https://doi.org/10.1016/j.biopsych.2006.03.040

    Article  Google Scholar 

  10. Hudson JI, Coit CE, Lalonde JK, Pope HG Jr (2012) By how much will the proposed new DSM-5 criteria increase the prevalence of binge eating disorder? Int J Eat Disord 45:139–141. https://doi.org/10.1002/eat.20890

    Article  PubMed  Google Scholar 

  11. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Book  Google Scholar 

  12. Brechan I, Kvalem IL (2015) Relationship between body dissatisfaction and disordered eating: mediating role of self-esteem and depression. Eat Behav 17:49–58. https://doi.org/10.1016/j.eatbeh.2014.12.008

    Article  PubMed  Google Scholar 

  13. Himelein MJ, Thatcher SS (2006) Depression and body image among women with polycystic ovary syndrome. Journal of Health Psychology 11:613–625. https://doi.org/10.1177/1359105306065021

    Article  PubMed  Google Scholar 

  14. Stice E, Shaw HE (2002) Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. J Psychosom Res 53:985–993. https://doi.org/10.1016/S0022-3999(02)00488-9

    Article  PubMed  Google Scholar 

  15. Cooney LG, Lee I, Sammel MD, Dokras A (2017) High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 32:1075–1091. https://doi.org/10.1093/humrep/dex044

    Article  PubMed  Google Scholar 

  16. de la Rie SM, Noordenbos G, van Furth EF (2005) Quality of life and eating disorders. Qual Life Res 14:1511–1522. https://doi.org/10.1007/s11136-005-0585-0

    Article  PubMed  Google Scholar 

  17. Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, Xavier M (2013) The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiat 1:904–914. https://doi.org/10.1016/j.biopsych.2012.11.020

    Article  Google Scholar 

  18. Palavras MA, Hay P, Touyz S, Sainsbury A, da Luz F, Swinbourne J, Estella NM, Claudino A (2015) Comparing cognitive behavioural therapy for eating disorders integrated with behavioural weight loss therapy to cognitive behavioural therapy-enhanced alone in overweight or obese people with bulimia nervosa or binge eating disorder: study protocol for a randomised controlled trial. Trials 16:578. https://doi.org/10.1186/s13063-015-1079-1

    Article  PubMed  PubMed Central  Google Scholar 

  19. Moran L, Gibson-Helm M, Teede H, Deeks A (2010) Polycystic ovary syndrome: a biopsychosocial understanding in young women to improve knowledge and treatment options. J Psychosom Obstet Gynecol 31:24–31. https://doi.org/10.3109/01674820903477593

    Article  Google Scholar 

  20. McCuen-Wurst CM, Culnan E, Stewart NL, Allison KC (2018) Weight and eating concerns in women’s reproductive health. Curr Psychiatry Rep. https://doi.org/10.1007/s11920-017-0828-0 (in press)

    Article  Google Scholar 

  21. Karacan E, Caglar GS, Gürsoy AY, Yilmaz MB (2014) Body satisfaction and eating attitudes among girls and young women with and without polycystic ovary syndrome. J Pediatr Adolesc Gynecol 27:72–77. https://doi.org/10.1016/j.jpag.2013.08.003

    Article  PubMed  Google Scholar 

  22. Allison KC, Lundgren JD, O’Reardon JP, Geliebter A, Gluck ME, Vinai P, Stunkard AJ (2010) Proposed diagnostic criteria for night eating syndrome. Int J Eat Disord 43:241–247. https://doi.org/10.1002/eat.20693

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wells GA, Shea B, Connell D, Peterson J, Welch V, Losos M et al (1999) The Newcastle- Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Health Research Institute, Ottawa. Retrieved from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  24. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341. https://doi.org/10.1016/j.ijsu.2010.02.007

    Article  PubMed  Google Scholar 

  25. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al (2010) Meta-analysis of observational studies in epidemiology: a proposal for reporting. J Am Med Assoc 283:2008–2012. https://doi.org/10.1001/jama.283.15.2008

    Article  Google Scholar 

  26. Morgan J, Scholtz S, Lacey H, Conway G (2008) The prevalence of eating disorders in women with facial hirsutism: an epidemiological cohort study. Int J Eat Disord 41:427–431. https://doi.org/10.1002/eat.20527

    Article  PubMed  Google Scholar 

  27. Pinhas-Hamiel O, Pilpel N, Carel C, Singer S (2006) Clinical and laboratory characteristics of adolescents with both polycystic ovary disease and anorexia nervosa. Fertil Steril 85:1849–1851. https://doi.org/10.1016/j.fertnstert.2005.11.041

    Article  PubMed  Google Scholar 

  28. Rodino IS, Byrne S, Sanders KA (2016) Disordered eating attitudes and exercise in women undergoing fertility treatment. Aust N Z J Obstet Gynaecol 56:82–87. https://doi.org/10.1111/ajo.12407

    Article  PubMed  Google Scholar 

  29. Rodino IS, Byrne S, Sanders KA (2016) Obesity and psychological wellbeing in patients undergoing fertility treatment. Reprod BioMed Online 32:104–112. https://doi.org/10.1016/j.rbmo.2015.10.002

    Article  PubMed  Google Scholar 

  30. Resch M, Szendei G, Haász P (2004) Bulimia from a gynecological view: hormonal changes. J Obstet Gynaecol 24:907–910. https://doi.org/10.1080/01443610400018924

    Article  CAS  PubMed  Google Scholar 

  31. Morgan JF, McCluskey SE, Brunton JN, Lacey JH (2002) Polycystic ovarian morphology and bulimia nervosa: a 9-year follow-up study. Fertil Steril 77:928–931. https://doi.org/10.1016/S0015-0282(02)03063-7

    Article  PubMed  Google Scholar 

  32. McCluskey S, Evans C, Lacey JH, Pearce JM, Jacobs H (1991) Polycystic ovary syndrome and bulimia. Fertil Steril 55:287–291. https://doi.org/10.1016/S0015-0282(16)54117-X

    Article  CAS  PubMed  Google Scholar 

  33. Michelmore KF, Balen AH, Dunger DB, Vessey MP (1999) Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol 51:779–786. https://doi.org/10.1046/j.1365-2265.1999.00886.x

    Article  CAS  Google Scholar 

  34. Jahanfar SH, Maleki H, Mosavi AR (2005) Subclinical eating disorder, polycystic ovary syndrome—is there any connection between these two conditions through leptin—a twin study. Med J Malaysia 60:441–446

    PubMed  Google Scholar 

  35. Jeanes YM, Reeves S, Gibson EL, Piggott C, May VA, Hart KH (2017) Binge eating behaviours and food cravings in women with polycystic ovary syndrome. Appetite 109:24–32. https://doi.org/10.1016/j.appet.2016.11.010

    Article  CAS  PubMed  Google Scholar 

  36. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878

    Article  CAS  PubMed  Google Scholar 

  37. Garner DM, Garfinkel PE (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med 9:273–279

    Article  CAS  PubMed  Google Scholar 

  38. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, … Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33

    PubMed  Google Scholar 

  39. Fairburn CG, Cooper Z, O’Connor M (2008) Eating disorder examination, 16th edn. In: Fairburn CG (ed) Cognitive behavior therapy and eating disorders. Guildford Press, New York

    Google Scholar 

  40. Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J (2000) Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol 183:759–769. https://doi.org/10.1067/mob.2000.106580

    Article  CAS  PubMed  Google Scholar 

  41. Henderson M, Freeman CP (1987) A self-rating scale for bulimia. The ‘BITE’. Br J Psychiatry 150:18–24

    Article  CAS  PubMed  Google Scholar 

  42. Allison KC, Lundgren JD, O’Reardon JP, Martino NS, Sarwer DB, Wadden TA, Stunkard AJ (2008) The Night Eating Questionnaire (NEQ): psychometric properties of a measure of severity of the night eating syndrome. Eat Behav 9:62–72. https://doi.org/10.1016/j.eatbeh.2007.03.007

    Article  PubMed  Google Scholar 

  43. Stunkard AJ, Messick S (1985) The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 29:71–83

    Article  CAS  PubMed  Google Scholar 

  44. Mann AH, Wakeling A, Wood K, Monck E, Dobbs R, Szmukler G (1983) Screening for abnormal eating attitudes and psychiatric morbidity in an unselected population of 15-year-old schoolgirls. Psychol Med 13:573–580

    Article  CAS  PubMed  Google Scholar 

  45. Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJ (2004) Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behav Res Ther 42:551–567. https://doi.org/10.1016/S0005-7967(03)00161-X

    Article  CAS  PubMed  Google Scholar 

  46. Batcheller AE, Ressler IB, Sroga JM, Martinez AM, Thomas MA, DiPaola KB (2013) Binge eating disorder in the infertile polycystic ovary syndrome patient. Fertil Steril 100(Suppl 3):S413

    Article  Google Scholar 

  47. Bernadett M, Szemán-N A (2016) Prevalence of eating disorders among women with polycystic ovary syndrome. [Article in Hungarian]. Psychiatria Hungarica 31:136–145

    PubMed  Google Scholar 

  48. Hollinrake E, Abreu A, Maifeld M, Van Voorhis BJ, Dokras A (2007) Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 87:1369–1376. https://doi.org/10.1016/j.fertnstert.2006.11.039

    Article  PubMed  Google Scholar 

  49. Månsson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landén M (2008) Women with polycystic ovary syndrome are often depressed or anxious—a case control study. Psychoneuroendocrinology 33:1132–1138. https://doi.org/10.1016/j.psyneuen.2008.06.003

    Article  PubMed  Google Scholar 

  50. Larsson I, Hulthén L, Landén M, Pålsson E, Janson P, Stener-Victorin E (2016) Dietary intake, resting energy expenditure, and eating behavior in women with and without polycystic ovary syndrome. Clin Nutr 35:213–218. https://doi.org/10.1016/j.clnu.2015.02.006

    Article  PubMed  Google Scholar 

  51. Sundblad C, Bergman L, Eriksson E (1994) High levels of free testosterone in women with bulimia nervosa. Acta Psychiatr Scand 90:397–398

    Article  CAS  PubMed  Google Scholar 

  52. Kerchner A, Lester W, Stuart SP, Dokras A (2009) Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertil Steril 91:207–212. https://doi.org/10.1016/j.fertnstert.2007.11.022

    Article  PubMed  Google Scholar 

  53. Gibson-Helm M, Teede H, Dunaif A, Dokras A (2016) Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 102:604–612. https://doi.org/10.1210/jc.2016-2963

    Article  PubMed Central  Google Scholar 

  54. Pagoto S, Bodenlos JS, Kantor L, Gitkind M, Curtin C, Ma Y (2007) Association of major depression and binge eating disorder with weight loss in a clinical setting. Obesity 15:2557–2559. https://doi.org/10.1038/oby.2007.307

    Article  PubMed  Google Scholar 

  55. Agras WS, Telch CF, Arnow B, Eldredge, KWilfley, DE, Raeburn SD… Marnell M (1994) Weight loss, cognitive-behavioral, and despiramine treatments in binge eating disorder. An additive design. Behav Ther 25:225–238

    Article  Google Scholar 

  56. Cooney L, Milman LW, Sammel M, Allison KC, Epperson A, Dokras A (2016) Cognitive behavioral therapy improves weight loss and quality of life in women with polycystic ovary syndrome (PCOS). Fertil Steril 106:e252–e253. https://doi.org/10.1016/j.fertnstert.2016.07.729

    Article  Google Scholar 

  57. Rosen DS (2010) Identification and management of eating disorders in children and adolescents. Pediatrics 126:1240–1253. https://doi.org/10.1542/peds.2010-2821

    Article  PubMed  Google Scholar 

  58. Stice E, Schupak-Neuberg E, Shaw HE, Stein RI (1994) Relation of media exposure to eating disorder symptomatology: an examination of mediating mechanisms. J Abnorm Psychol 103:836–840

    Article  CAS  PubMed  Google Scholar 

  59. Dokras A, Stener-Victorin E, Yildiz BO, Li R, Ottey S, Teede H (2018) Androgen excess-polycystic ovary syndrome: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 109:888–899

    Article  PubMed  Google Scholar 

  60. Cotton M, Ball C, Robinson P (2003) Four simple questions can help screen for eating disorders. J Gen Intern Med 18:53–56. https://doi.org/10.1046/j.1525-1497.2003.20374.x

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

No specific funding was provided for this project. Laura Cooney was supported by a T32 Reproductive Training Grant.

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Correspondence to Anuja Dokras.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Informed consent was obtained from each of the individual participants included in the study.

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40519_2018_533_MOESM1_ESM.tiff

Supplementary material 1: Supp. Figure 1 Evaluation of publication bias. 1a: funnel plot for studies reporting prevalence of any eating disorder to; 1b: funnel plot for studies reporting prevalence of disordered eating (Created using Stata). (TIFF 32874 KB)

Supplementary material 2 (DOCX 14 KB)

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Lee, I., Cooney, L.G., Saini, S. et al. Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis. Eat Weight Disord 24, 787–797 (2019). https://doi.org/10.1007/s40519-018-0533-y

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