Overlap of orthorexia,eating attitude and psychological distress in some Italian and Spanish university students

BACKGROUND Orthorexia nervosa(ON)is the persistent concern of maintaining the self-imposed diet to improve one's health.Many factors have been associated to ON in university students.AIM To assess the prevalence of ON in Italian and Spanish university students in relation to eating attitude and psychological distress,and the possible overlaps between ON(evaluated with different scored questionnaires from the originally proposed ORTO-15),distress and risk of eating disorders.METHODS This study was carried out on 160 students recruited at La Sapienza University of Rome and at the Catholic University of Murcia.Questionnaires were administered to evaluate ON(ORTO-15 and sub-scores),body concerns(Multidimensional Body-Self Relations Questionnaire,MBSRQ,and Body Uneasiness test,BUT),psychological distress(Kessler Psychological Distress Scale,K10),physical activity(International Physical Activity Questionnaire,IPAQ),eating attitude(Eating Attitudes Test,EAT-26)and malnutrition(Starvation Symptom Inventory,SSI).Sex differences,within the same country,and differences between Italian and Spanish students,within the same sex,were evaluated.RESULTS The ORTO-15 positive subjects,assessed with the originally proposed cut-off,were above 70%in both Italian and Spanish students,with a higher prevalence in the Spanish sample(Italian females 76.3%,Italian males 70.7%;Spanish females 97.0%,Spanish males 96.3%).According to ORTO-7,about 30%of Italian and 48%of Spanish students were positive to ON with no significant sex differences.When excluding students underweight(UW),overweight(OW)or obese(OB),as well as those potentially at risk of eating disorders or presenting mild,moderate and severe distress,in the resultant normal weight(NW)-K10neg-EAT-26neg subgroup,we did not find many correlations observed in the whole sample,including those between ORTO scores and BUT,SSI,Total MBSRQ and some of its components.Moreover,ORTO-7 resulted in the only ON score unrelated with Body Mass Index,MBSRQ components and IPAQassessed intense activity,in the NW-K10neg-EAT-26neg subgroup.After this sort of“exclusion diagnosis”,the prevalence of ON of these students on the overall sample resulted in 16.9%,12.2%,15.2%and 25.9%for Italian females,Italian males,Spanish females and Spanish males,respectively.CONCLUSION In some university students ON could be a symptom of other conditions related to body image concerns and distress,as well as to high physical activity and appearance,fitness,health or illness orientation(from MBSRQ).However,ORTO-7 became independent from these confounding variables,after the exclusion of UW,OW,OB and students positive to EAT-26 and K10,suggesting the possibility of identifying orthorexic subjects with this specific questionnaire.

Diet in neurogenic bowel management:A viewpoint on spinal cord injury

The aim of this review is to offer dietary advice for individuals with spinal cord injury(SCI)and neurogenic bowel dysfunction.With this in mind,we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy,autonomic dysreflexia and neurogenic bladder.In addition,SCI is often associated with a sedentary lifestyle,which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation,including cardiovascular and chronic kidney diseases.The Mediterranean diet,along with exercise and dietary supplements,has been suggested as an anti-inflammatory intervention in individuals with SCI.However,individuals with chronic SCI have a daily intake of whole fruit,vegetables and whole grains lower than the recommended dietary allowance for the general population.Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake;therefore,this finding could explain the low consumption of plant foods.Low consumption of fibre induces dysbiosis,which is associated with bothendotoxemia and inflammation.Dysbiosis can be reduced by exercise and diet in individuals with SCI.Therefore,to summarize our viewpoint,we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines.Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI,chronic kidney diseases,chronic pain and irritable bowel syndrome.We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength,flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits.Finally,dietary advice for Paralympic athletes is suggested.