Background – Patients with anorexia nervosa (AN), a psychiatric disorder in which diet is a central issue, present from diverse cultural backgrounds but to date there have been no cross-cultural studies into diet and AN.
Objective – To investigate the energy intake and macronutrient profile of diets in women with and without AN in Sydney and Singapore with respect to socio-cultural factors.
Design – Participants were aged 14-35 y – 39 with AN and 89 controls – and of North European or East Asian ethnicity. Daily food intakes when AN was most acute or (for controls) at one month prior to the interview date were obtained through diet history interviews. The percentages of energy contributed by protein (%Pro), fat (%F) and carbohydrate (%CHO) and the natural log of energy intake were analysed with multiple linear regression in terms of AN/control status, cultural background and orientation, socio-economic status (SES), age and education. Outcomes – AN status was associated with lower energy intakes (P<0.001) and higher %CHO (P<0.001). Higher %Pro was associated with greater Western orientation (P=0.055) but %Pro was similar regarding AN/control status. Greater Western orientation was associated with lower %F (P=0.03) in women with AN but with higher %F in controls (P=0.04). Higher SES was associated with lower %Pro (P=0.001) and %F (P=0.03) but higher %CHO (P=0.01). Cultural background was not associated with energy, %Pro, %F or %CHO.
Conclusion – The relationship between %F and orientation to Western culture may reflect the higher fat and protein intakes associated with Western diets but also the increased knowledge of current weight-loss diets promoted by Western culture. The findings regarding SES may stem from the affordability of “diet foods”.