Abstract

Objective: Our aim was to evaluate the relationship between evening chronotype, a proxy marker of circadian system dysfunction, and disordered eating behavior and poor dietary habits in individuals with bipolar disorder (BD).

Methods: In this cross-sectional study, we evaluated 783 adults with BD. Chronotype was determined using Item 5 from the reduced Morningness-Eveningness Questionnaire. The Eating Disorder Diagnostic Scale (EDDS) and the Rapid Eating Assessment for Participants – Shortened Version (REAPS-S) were used to assess disordered eating behavior and dietary habits, respectively. General linear models and logistic regression models were utilized to evaluate differences between chronotype groups.

Results: Two hundred and eight (27%) BD participants self-identified as having evening chronotypes. Compared to non-evening types, evening types were younger (p<0.01), and, after controlling for age, had higher mean EDDS composite z-scores (p<0.01), higher rates of binge eating (BE) behavior (p=0.04), bulimia nervosa (p<0.01), and nocturnal eating binges (p<0.01), and a higher body mass index (p=0.04). Compared to non-evening types, evening chronotypes had a lower REAP-S overall score (p<0.01) and scored lower on the “healthy foods” and “avoidance of unhealthy food” factors. Evening types also skipped breakfast more often (p<0.01), ate less fruit (p=0.02) and vegetables (p=0.04), and consumed more fried foods (p<0.01), unhealthy snacks (p=0.02), and soft drinks (p=0.01).

Conclusions: Our findings suggest that the circadian system plays a role in the disordered eating and unhealthy dietary behaviors observed in BD patients. The circadian system may therefore represent a therapeutic target in BD-associated morbidity that warrants further investigation.

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