Research On The Current Status Of Food Addiction And Dietary Patterns Of Overweight/Obese Population In A Hospital In Chengdu

Research background and purposeCurrently,obesity has become one of the medical and social problems,which seriously affects people’s physical and mental health.In recent years,the topic of"food addiction（FA）as a source of obesity"has attracted academic attention,and FA has certain similarities with obesity in terms of neurobiological effects.Studies abroad have shown that most of the overweight/obese patients show symptoms of FA.However,the problem of FA has not received widespread attention in China,and there are fewer studies related to FA.But with improvement of people’s living standards,the incidence of FA has increased year by year.The harmful effects of FA are not only overweight/obesity caused by overeating,but also the psychological impact on people.Therefore,this study used a face-to-face questionnaire to investigate the current status and dietary intake of FA among overweight/obese people in a hospital in Chengdu by using the modified Yale Food Addiction Scale 2.0（m YFAS 2.0）and the semi-quantitative food frequency questionnaire（SQFFQ）to investigate the influencing factors,establish dietary patterns,explore its association with FA,and evaluate the dietary characteristics of the FA patients,so as to provide data support for FA screening in clinical settings,provide scientific basis for providing reasonable dietary guidance suggestions for FA patients,and to find new effective ideas and methods for the treatment of overweight/obesity.Subjects and MethodsA cross-sectional survey study was conducted using the general information Questionnaire,m YFAS 2.0 and SQFFQ to collect data from overweight/obese patients attending the metabolic weight loss clinic of the department of endocrinology and metabolism at a hospital in Chengdu between August 2021 and January 2022.Basic information and laboratory indices of the study subjects were collected through the hospital HIS system.The demographic data,laboratory indicators and dietary intake levels of FA and non-FA（NFA）patients were compared and the influencing factors were analyzed by binary logistic regression.Exploratory factor analysis（EFA）was used to extract dietary patterns,and binary logistic regression models were used to explore the association between dietary patterns and FA,and to evaluate the characteristics of dietary patterns in the FA population.Result1.Prevalence of FA in overweight/obese patients and its influencing factors in a hospital in ChengduA total of 126 overweight/obese patients were included in this study.The incidence of FA was 43.65%（55/126）,light 31.75%,medium 11.11%and severe 0.79%.Comparing between the two groups,the proportion of Tibetan ethnicity,residence altitude>3500m,combined fatty liver,BMI,waist circumference,hip circumference,body fat percentage,visceral fat grade,and Hb A1c were higher in the FA group than in the NFA group（P<0.05）.The proportion of BMI in the FA group was higher in both 28-30 kg/m² and≥30 kg/m²than in the NFA group（P<0.05）.Meanwhile,the intake level of potatoes was higher in the FA group than in the NFA group,while the intake level of vegetables was lower than in the NFA group（P<0.05）.Compared with the recommended daily intake of the"Balanced Diet for Chinese Residents（2022）",the intakes of potatoes,vegetables,fruits,milk and milk products,soybeans and nuts for both FA and NFA groups were lower than the recommended intake of the pagoda;the intakes of cereals,animal foods and oils were higher than the recommended intake respectively.Compared with the Chinese Dietary Reference Intakes（DRIs）,the intake levels of energy,protein,fat,carbohydrate,niacin,vitamin E,phosphorus,potassium,magnesium,iron,zinc,copper and manganese in the FA and NFA groups were higher than the DRIs.Dietary fiber,vitamin A,vitamin B₁,vitamin B₂,vitamin C,calcium,and selenium intake levels were all lower than DRIs.Sodium intake levels were higher in the FA population than in the DRIs and lower in the NFA group than in the DRIs.The FA group had higher energy,fat,carbohydrate,sodium,and manganese intake levels than the NFA group（P<0.05）.Among the energy supply distribution ratios of the three energy-producing nutrients,the energy supply ratios of protein in both groups were in accordance with the recommended ratios,while the energy supply ratios of carbohydrates in both groups were lower than the recommended ratios,and the energy supply ratios of fats were higher than the recommended ratios.The protein energy supply ratio was higher in the NFA group than in the FA group（P<0.05）.The daily diet of the NFA group was mainly based on animal food protein,and the sources of high-quality protein included animal food and soybean and its products,accounting for 53.35%and 1.63%of the total protein,respectively.The protein intake of the FA group was mainly derived from animal food,and the animal food and soybean and its products categories of high-quality protein sources accounted for 51.61%and 1.37%of the total protein,respectively.The FA group had a higher daily intake level of protein derived from other（foods other than plants and animals,legumes and their products）than the NFA group（P<0.05）.The results of binary logistic regression analysis showed that the occurrence of FA in overweight/obese patients was positively associated with BMI,potato and fat intake levels.Using a BMI of 24-28 kg/m² as the reference group,those≥30 kg/m² were more likely to develop FA（OR=5.911,95%CI:1.528-22.867,P=0.010）.Meanwhile the level of potato intake（OR=1.024,95%CI:1.002 to 1.047,P=0.034）and fat intake（OR=1.032,95%CI:1.003 to 1.062,P=0.033）were the influencing factors for the occurrence of FA in overweight/obese patients.2.Association between dietary pattern and FAThe EFA extracted four dietary patterns from the dietary data,which were high energy and high fat diet pattern（mainly cured and processed meat products,fried pasta and refined rice and noodles）,aquatic and vegetable pattern（mainly fish,shrimp and shellfish,vegetables,milk and dairy products）,coarse grains and meat pattern（mainly coarse grains and livestock and poultry meat）,and sweet tea and fried pattern（mainly sweet tea and fried pasta）.According to the score of dietary patterns from low to high,divided into Q1,Q2 and Q3,the more overweight/obese people’s dietary intake tended to"coarse grains and meat pattern",the higher the incidence of FA（P<0.05）.There was no statistical difference in the prevalence of FA in the remaining dietary pattern score groups（P>0.05）.Compared with each dietary pattern and nutritional intake,among the"high energy and high fat diet pattern",the Q3 quartile population consumed a lower proportion of protein and carbohydrate for energy supply,and a higher intake of oil,energy,fat,vitamin E,sodium and selenium（P>0.05）.In the"aquatic vegetable pattern",the intake of vegetables,fruits,animal foods,soybeans and nuts,milk and milk products,protein energy ratio,protein,cholesterol,vitamin A,vitamin B₂,vitamin C,calcium,potassium,and selenium was higher in the Q3 quartile,while the carbohydrate energy ratio was lower（P>0.05）.In the"coarse grain meat pattern",carbohydrate energy supply in the Q3quartile was relatively low,while the intake of whole grains,potatoes,animal foods,soybeans and nuts,oils,energy,protein,fat,carbohydrates,dietary fiber,ash,vitamin B₁,vitamin B₂,niacin,vitamin E,calcium,phosphorus,potassium,sodium,magnesium,iron,zinc,selenium,copper,and manganese were higher（P>0.05）.In the"sweet tea fried pasta pattern",the intake of whole grains,soybeans and nuts and oils,energy,protein,fat,cholesterol,ash,niacin,vitamin E,potassium,zinc,and selenium was higher in the Q3quartile（P>0.05）.The results of multivariate binary logistic regression analysis showed that"high energy and high fat diet pattern"was positively associated with the occurrence of FA after unadjusted model and model 2 adjustment,with the risk of FA being 2.934 and 3.495times higher in individuals with Q3 intake level than Q1 level,respectively（95%CI:1.072-8.034;95%CI:1.087-11.232）（P<0.05）,and this association disappeared after model 3 adjustment.Meanwhile,"coarse grain meat pattern"was positively associated with the occurrence of FA in overweight/obese patients after unadjusted model and model2 adjustment,with the risk of FA in individuals with Q3 intake levels being 3.954 and3.604 times（95%CI:1.497-10.440;95%CI:1.075-12.084）higher than Q1 levels,respectively（P<0.05）.After model 3 adjustment,this association disappeared.No association was found between the"aquatic vegetable pattern","sweet tea fried pasta pattern"and the occurrence of FA in overweight/obese patients（P>0.05）.There were four dietary patterns extracted from the dietary data of FA population,which were alcohol refined rice and noodle pattern（mainly alcohol and refined rice and noodles）,ghee tea coarse grains pattern（mainly ghee tea and coarse grains）,deep fried pasta processing meat pattern（mainly fried pasta and processed meat products）,and bean kimchi pattern（mainly beans and bean products and kimchi）.In the"alcohol refined rice and noodle pattern",the Q3 quartile population consumed more cereals,oils,energy,protein,fat,carbohydrates,dietary fiber,cholesterol,ash,vitamin A,vitamin B₁,vitamin B₂,niacin,vitamin E,calcium,phosphorus,potassium,magnesium,iron,zinc,selenium,copper,and manganese（P<0.05）.In the"ghee tea coarse grains pattern",the Q3 quartile population consumed more animal food,energy,protein,fat,carbohydrate,dietary fiber,ash,vitamin B₁,vitamin B₂,niacin,phosphorus,potassium,sodium,magnesium,iron,zinc,copper,and manganese,whereas（P<0.05）.In the"deep fried pasta processing meat pattern",people in the Q3 quartile consumed more oil（P<0.05）.In the"bean kimchi pattern",people in the Q3 quartile consumed less milk and milk products,vitamin B₂,and calcium（P<0.05）.Conclusions1.The prevalence of FA among overweight/obese people in a hospital in Chengdu was 43.65%.BMI,potato and fat intake levels were the influencing factors for the occurrence of FA in overweight/obese patients.Recommend that overweight/obese patients should be screened for FA as early as possible.2.In this study,four main dietary patterns were extracted:"high energy and high fat diet pattern","aquatic vegetable pattern","coarse grain meat pattern",and"sweet tea and fried pattern".The more the dietary intake of overweight/obese people tended to"coarse grain meat pattern",the higher the incidence of FA.After adjusting for the confounding factors of ethnicity,altitude of residence,history of fatty liver disease,BMI,waist circumference and hip circumference,the occurrence of FA was associated with"high energy and high fat diet pattern"and"coarse grain meat pattern".Promote more intake of beans and products,vegetables and fruits,mushrooms and algae,fish,shrimp and shellfish,milk and dairy products and other low-fat foods,while livestock and poultry meat,refined rice and flour,sweet tea and wine and other foods to moderate intake,and maintain a reasonable and balanced diet.3.The FA population extracted four main dietary patterns:"alcoholic refined rice and noodle pattern","ghee tea coarse grain pattern","deep fried pasta processing meat pattern",and"bean kimchi pattern".The dietary structure of overweight/obese FA patients is not yet reasonable,and the intake of some nutrients is not balanced.It is recommended that health promotion and targeted dietary interventions should be provided to FA patients in a timely manner.