Night eating syndrome

NES was originally described by Albert Stunkard in 1955 and is currently included in the other specified feeding or eating disorder (OSFED) category of the DSM-5. Most of the updated literature relating to NES has been published in recent years due to its recent changes in the DSM-5. == Epidemiology ==

NES affects both men and women, between 1 and 2% of the general population, and approximately 10% of obese individuals. Newer research suggests that the overall prevalence of NES ranges from 2.8% to 15.2% in clinical patients with eating disorders, obesity, and/or bariatric surgery. with children rarely reporting NES. However, newer studies have suggested that age is not a risk factor for NES, yet this evidence is still lacking. Other social-demographic factors such as income, gender, education level, children, living with a romantic partner, and smoking levels do not have an effect on NES. Furthermore, there have been contradictory conclusions on whether a higher BMI is a risk factor of NES, or if it is simply a consequence of night eating behavior. There has been no specific statistics regarding NES and mortality. ==Comorbidities ==

NES has a substantial association with medical diagnoses such as obesity, sleep apnea, hypercholesterolemia, polycystic ovarian syndrome, and diabetes mellitus type II (T2DM), and psychiatric diagnoses such as binge eating disorder, anorexia nervosa, bulimia nervosa, generalized anxiety disorder, major depressive disorder, and substance use disorders. In contrast to eating disorders like anorexia nervosa, NES does not necessarily depend on a person's Body Mass Index (BMI). In fact, NES has been found to be a risk factor for an earlier onset of obesity. Night eating syndrome has also been associated with diabetic complications. Many people with NES also experience depressed mood, post-traumatic stress disorder, People with NES have been shown to have higher scores for depression and low self-esteem. NES may also have an association with personality traits, such as harm avoidance, self-directedness, and impulsivity. It has been demonstrated that nocturnal levels of the hormones melatonin and leptin are decreased. Individuals tend to have poorer sleep quality and higher levels of insomnia. Often times, people with NES are unaware of their condition due to it often being overshadowed by other comorbidities. == Diagnosis ==

Specific research diagnostic criteria have been proposed outside of the DSM-5 and include: (A) Evening hyperphagia (consumption of 25% or more of the total daily calories after the evening meal) and/or nocturnal awakening and ingestion of food two or more times per week. (B) Awareness of the night eating to differentiate it from the parasomnia sleep-related eating disorder (SRED). (C) Three of five associated symptoms must also be present: lack of appetite in the morning, urges to eat at night, belief that one must eat in order to fall back to sleep at night, depressed mood, and/or difficulty sleeping. (D) The eating pattern causes significant distress or interferes with daily functioning. (E) The disordered pattern of eating has been maintained for at least 3 months. (F) The pattern is not attributable to substance use, medical conditions, medication, or another psychiatric disorder. Screening Health professionals should issue screening when suspicion of an eating disorder (ED) is present. Validated screening tools include the Night Eating Questionnaire (NEQ), Night Eating Diagnostic Questionnaire (NEDQ), Eating Disorder Examination Questionnaire (EDE-Q), Night Eating Syndrome History and Inventory (NESHI), and Eating Among Teens Survey (EAT-II). == Differential diagnosis ==

BED and NES are often considered similar due to their prevalence in individuals with obesity and association with depressive symptoms. However, key distinctions are highlighted, particularly in eating patterns. While BED usually involves a loss of control over eating with large meal portions, NES is usually characterized by controlled, smaller snacks eaten at unusual times, such as late at night or after dinner. == Treatment ==

A few treatment modalities are available for NES patients. These include pharmacotherapy, bariatric surgery, bright light therapy (BLT), and progressive muscle relaxation (PMR). In randomised control trials, medications have shown mixed results in reducing night eating symptoms, with sertraline demonstrating the most significant improvements. but other research indicates that diet by itself cannot appreciably raise serotonin levels in the brain. A few foods (for example, bananas) contain serotonin, but they do not affect brain serotonin levels. Various foods contain tryptophan, but the extent to which they affect brain serotonin levels must be further explored scientifically before conclusions can be drawn. Considering the complexity of NES, treatment should be tailored to each individual, integrating psychoeducation on diet, nutrition, and sleep with psychotherapy to achieve effective outcomes. ==See also==