A Cross-Sectional Study of Evening Hyperphagia and Nocturnal Ingestion: Core Constituents of Night Eating Syndrome with Different Background Factors

This web-based cross-sectional survey aimed to elucidate the differences between the two core symptoms of night eating syndrome (NES): evening hyperphagia and nocturnal ingestion in the general Japanese population aged 16–79 years. Participants who consumed at least 25% of daily calories after dinner were defined as having evening hyperphagia. Those who consumed food after sleep initiation at least twice a week were determined to have nocturnal ingestion. Of the 8348 participants, 119 (1.5%) were categorized in the evening hyperphagia group, 208 (2.6%) in the nocturnal ingestion group, and 8024 in the non-NES group. Participants with evening hyperphagia and nocturnal ingestion had significantly higher anxiety scores (p < 0.05 and p < 0.001, respectively) and depression (p < 0.001 for both) than those without NES. Multiple logistic regression analysis revealed that evening hyperphagia was significantly and independently associated with higher body mass index, shorter sleep duration, later sleep-wake schedule, and higher insomnia score, while nocturnal ingestion was significantly and independently associated with younger age, smoking habit, living alone, earlier sleep-wake schedule, and higher insomnia score. Sleep duration and sleep-wake schedule characteristics in the two groups were opposite, suggesting differences in the sleep pathophysiology mechanisms.

Prevalence and psychiatric comorbidities of night-eating behavior in obese bariatric patients: preliminary evidence for a connection between night-eating and bipolar spectrum disorders

Purpose The co-occurrence of obesity, eating and mood disorders has been frequently reported in clinical and epidemiological settings. This study aimed to explore the prevalence of night-eating obese patients referred for bariatric surgery and to identify associated psychopathology and psychiatric comorbidity. Methods The sample was composed of 121 obese patients consecutively enrolled between November 2010 and May 2012 during psychiatric evaluations for bariatric intervention. Clinical features and psychiatric diagnoses were collected. Night-eating was investigated through the administration of the Night-eating Questionnaires (NEQ) and was defined as the presence of self-reported evening hyperphagia and/or nocturnal ingestions. Binge-eating and purging behaviors and general psychopathology were respectively assessed using the Bulimic Investigatory Test, Edinburgh and the Symptom Checklist-90-Revised. Results Night-eating was reported by twenty subjects (16.5%). Patients with night-eating behavior were significantly more frequently diagnosed with bipolar spectrum disorders and with comorbid eating and mood disorders in comparison with other patients. Night-eating patients showed significantly more binging/purging behaviors and greater severity of somatization, obsessive–compulsive symptoms, phobic anxiety, psychoticism and sleep disorders. Patients with bipolar disorder type 1 or 2 scored significantly higher than those without mood disorders at NEQ total score, mood/sleep and nocturnal ingestions subscales, but also scored significantly higher than other patients with mood disorders at the latter subscale. Conclusion Patients with evening hyperphagia and/or nocturnal ingestions should be carefully evaluated to detect possible bipolar spectrum disorders and other eating disorders. Prompt management of these conditions should be provided before bariatric interventions. Level of evidence V, cross-sectional descriptive study.

Metabolic Fates of Evening Crop-Stored Sugar in Ruby-Throated Hummingbirds (Archilochus colubris)

During the day, hummingbirds quickly metabolize floral nectar to fuel high metabolic demands, but are unable to feed at night. Though stored fat is the primary nocturnal metabolic fuel, it has been suggested that hummingbirds store nectar in their crop to offset fat expenditure in the night or to directly fuel their first foraging trip in the morning. We examine the use of crop-stored sugar in the nocturnal energy budget of ruby-throated hummingbirds (Archilochus colubris) using respirometry and 13C stable isotope analysis. Hummingbirds were fed a 13C-enriched sugar solution before lights-out and held in respirometry chambers overnight without food. Respirometry results indicate that the hummingbirds metabolized the sugar in the evening meal in less than 2 h, and subsequently primarily catabolized fat. Breath stable isotope signatures provide the key insight that the hummingbirds converted a substantial portion of an evening meal to fats, which they later catabolized to support their overnight metabolism and spare endogenous energy stores. These results show that the value of a hummingbird’s evening meal depends on how much of this energy was converted to fat. Furthermore, this suggests that evening hyperphagia is an important energy maximization strategy, especially during energetically expensive periods such as migration or incubation.

Evidence-Based Treatment Approaches for Night Eating Disorders

Night eating syndrome (NES) is characterized by evening hyperphagia and nocturnal ingestions. This chapter presents criteria for NES diagnosis, considerations for differential diagnosis, recommended diagnostic assessment tools, and current estimates of NES prevalence. Evidence in support of pharmacological interventions, behavioral stress management, behavioral weight loss treatment, and phototherapy for NES is reviewed. A clinical case example and detailed overview of cognitive–behavioral therapy for NES are also provided, and the potential impact of weight status on NES treatment outcome is discussed. Results from initial treatment outcome studies with small sample sizes are promising, but larger, randomized controlled trials of behavioral, pharmacological, and combination treatments for NES are needed.

Current and emerging drugs treatment for night eating syndrome

IntroductionThe night eating syndrome (NES) is a categorized in the diagnostic and statistic manual (DSM-5) as an “Other Specified Feeding or Eating Disorder” and it is characterized by a reduced feeding during the day, evening hyperphagia accompagned by frequent nocturnal awakenings associated with conscious episodes of compulsive ingestion of food and abnormal circadian rhythms of food and other neuroendocrine factors. Frequently it is associated with obesity and depressed mood.ObjectivesThe purpose of this review is to investigate the state of art concerning the psychopharmacological treatment of NES.MethodsA Medline enquiry of published articles from 2005 to October 2015 was performed using the following keywords: “NES, pharmacological treatment, SSRI, antidepressants, antipsychotic, sertraline, citalopram, escitalopram, duloxetine, venlafaxine, paroxetine, fluoxetine, fluvoxamine, topiramate”. Reviews, single case studies and RCT were also analyzed.ResultsOnly few studies met the selection criteria. A recent 8-week double-blind placebo controlled study, in 34 patients with NES, has confirmed the efficacy of sertraline. Sertraline was associated with significantly greater improvement than placebo in overall symptomatology.ConclusionsSSRIs should be considered the drug of choice for the treatment of NES not only because of evidence in the literature but also since they display the best pharmacological profiles with fewer adverse events. More evidence of efficacy is shown for some SSRIs such us paroxetine, fluvoxamine and especially sertraline. Topiramate should be reserved for cases resistant to treatment with SSRIs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Agomelatine Efficacy in the Night Eating Syndrome

Night eating syndrome (NES) is a nosographic entity included among the forms not otherwise specified (EDNOS) in eating disorders (ED) of the DSM IV. It is characterized by a reduced food intake during the day, evening hyperphagia, and nocturnal awakenings associated with conscious episodes of compulsive ingestion of food. Frequently, NES patients show significant psychopathology comorbidity with affective disorders. This paper describes a case report of an NES patient treated with agomelatine, an antidepressant analogue of melatonin, which acts by improving not only the mood but also by regulating sleep cycles and appetite. After three months of observation, the use of Agomelatine not only improved the mood of our NES patient (assessed in the HAM-D scores) but it was also able to reduce the night eating questionnaire, by both reducing the number of nocturnal awakenings with food intake, the time of snoring, the minutes of movement during night sleep (assessed at polysomnography), and the weight (−5.5 kg) and optimizing blood glucose and lipid profile. In our clinical case report, agomelatine was able both to reduce the NES symptoms and to significantly improve the mood of our NES patient without adverse side effects during the duration of treatment. Therefore, our case report supports the rationale for further studies on the use of Agomelatine in the NES treatment.