Anorexia Nervosa And Bulimia Nervosa

Although not included within the category of nutritionally related chronic diseases, the eating disorders anorexia nervosa and bulimia nervosa are important. These diseases are primarily disorders of perception of body image and are characterized by an excessive concern over being fat. They

Table 8. Dietary Factors and Cancer Etiology

Carcinogenic dietary factors

Energy excess associated with increased cancer mortality in men and women

Amount and type of fat in the diet also related to increased cancer risk; high saturated fat, cholesterol, and low polyunsaturated fat are risk factors

High protein intake associated with increased risk of enhanced tumorigenesis

Zinc deficiency associated with increased risk of tumors

Excess alcohol intake

High intake of coffee is a possible risk factor

Artificial sweeteners such as saccharin increase risk of bladder cancer

Nitrates, nitrites, and nitrosamines may be causative factors of gastric cancer

Methods of food preparation, such as charcoal broiling, smoking food, and frying, may increase risk

Anticarcinogenic factors

Energy deficit inhibits tumor growth

High levels of monounsaturated fat in the diet show decreased incidence of certain cancers

High levels of fiber from fruits and vegetables are associated with low levels of colon and rectal cancer.

Vitamin A and its analogues and precursor (carotenids) are possible inhibitors of carcinogenesis; /?-carotene may be protective in a mechanism independent of its role as a vitamin A precursor

Vitamin C has antioxidant properties that may influence tumorigenesis

Vitamin E as an intracellular antioxidant may protect against carcinogens

Calcium intake has a inverse association with colon cancer risk

Selenium intake has been associated with decreased tumor growth in animal models are often regarded as modern disorders despite the fact that similar conditions have been recognized in medicine for more than a century.

Anorexia nervosa is a condition of self-engendered weight loss whose occurrence was originally thought to be restricted to young women. It also occurs in young men who are concerned with their body image such as dancers and models. The diseases appear to be largely confined to affluent societies that espouse Western cultural ideals.

Diagnostic criteria include: refusal to maintain minimally normal body weight for age and height; intense fear of gaining weight or becoming fat, even though already underweight; undue influence of body weight or shape on self-evaluation; and denial of the seriousness of the current low body weight with amennorhea often occurring in postmen-archal females (41). Associated symptoms include: depressed mood, irritability, social withdrawal, loss of sexual libido, preoccupation with food and rituals, as well as reduced alertness and concentration (42).

One form of the disease invokes restrictive feeding behavior commonly associated with normal dieting, such as undereating, refusal to take high-energy foods, and strenuous exercise. This behavior is abnormal only in the degree to which it is pursued. Restlessness is very common once emaciation sets in and continues until physical deterioration leads to weakness and lassitude. The "purging" form involves more dangerous behaviors, such as self-induced vomiting, and laxative or diuretic use.

Bulimia nervosa is a variant of anorexia nervosa and shares many of its clinical and demographic features. It is closely related to the purging form of anorexia nervosa. One of the major differences is that bulimic patients maintain normal weight. The condition generally involves persistent dietary restriction that is eventually interrupted by episodes of binge eating with compensatory behaviors such as vomiting and laxative abuse. Behavioral disturbances often become the focus of intense guilt feelings. In the early stages of the disease, all patients attempt to control their weight by dieting and abstaining from high-energy foods.

They are constantly preoccupied by thoughts of food, but their pattern of eating alternates between fasting and gorging. Patients are extremely secretive about their bulimic episodes. It is this secrecy that makes the condition difficult to diagnose.

Both conditions occur predominantly in industrialized, developed countries and are rare elsewhere (43). Immigrants are more likely to develop eating disorders than their peers in their country of origin, probably indicating the importance of sociocultural factors in the etiology and distribution of these disorders (43).

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