Global prevalence of eating disorders in children: a comprehensive systematic review and meta-analysis | Italian Journal of Pediatrics

The present systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to assess the global prevalence of EDs in children. A protocol has not been prepared for this study. For this purpose, a systematic search was conducted in databases including PubMed, Web of Science, Scopus, ScienceDirect, Embase, and Google Scholar using relevant keywords (“prevalence,””eating disorder,””feeding disorder,””eating problem,””appetite disorder,”combined with Boolean operators OR and AND) on July 23, 2024, without any restrictions on the year of publication. All the related studies published by the mentioned date, including those identified through manual searches, were added into information management software, EndNote, for further evaluation.

Relevant keywords were considered based on the PICO criteria. Population (P) was children in the world, Intervention (I): no intervention, Comparison (C): comparison with children who did not report eating disorders. Outcome (O) was: prevalence of eating disorders in children.

Search strategies for all databases: PubMed: (((((eating disorder [MeSH Terms]) OR (“Appetite Disorders”)) OR (“Eating and Feeding Disorders”)) OR (“Feeding Disorders”)) AND (“Children”)) AND (Prevalence).

Web of science: ALL = (eating disorder OR Appetite Disorders OR”Eating and Feeding Disorders”OR”Feeding Disorders”AND”Children”AND”Prevalence”).

Scopus: TITLE-ABS- (eating disorder OR Appetite Disorders OR”Eating and Feeding Disorders”OR”Feeding Disorders”AND”Children”AND”Prevalence”).

Embase: eating disorder: ti,ab,kw OR Appetite Disorders’:ti,ab,kw OR’Eating and Feeding Disorders’:ti,ab,kw OR’Feeding Disorders’:ab,kw AND’Children’:ti,ab,kw AND Prevalece:ti,ab,kw.

ScienceDirect: Title, abstract or author-specified keywords (eating disorder OR Appetite Disorders OR”Eating and Feeding Disorders”OR”Feeding Disorders”AND”Children”AND”Prevalence”).

Table of Contents

Identification of articles

Inclusion criteria

Studies were included in this research if they met the following criteria:

1.

Studies that reported the prevalence of ED (EDs) or their subsets in children (according to the World Health Organization (WHO), individuals under the age of 10 are considered children; however, some related studies have considered different age ranges for children [12, 13]; and some have not specifically defined a particular age group as a child, in such cases, we used the WHO definition.
2.

Studies published in English.
3.

Cross-sectional and Longitudinal studies.
4.

Case–control studies.
5.

Cohort studies.

Exclusion criteria

The following studies were excluded:

1.

Case report studies.
2.

Case series studies.
3.

Interventional studies.
4.

Review studies.
5.

Animal studies.

Study selection

In the present research, in the first stage, to obtain studies related to the title, all duplicate studies were removed, and the title and abstract of the remaining studies were examined and studied. According to the inclusion and exclusion criteria, all unrelated studies were excluded from the research process. In the next step, the researchers reviewed the full text of the remaining studies, and the studies that did not meet the necessary criteria for entering the research at this stage were also excluded from the research. Finally, the information obtained from the remaining studies was measured and extracted. To minimize errors and bias, all the above steps and also evaluate the methodological quality of each paper were carried out separately by two independent researchers, and if the two researchers disagreed, a third researcher performed the related evaluations.

Qualitative evaluation of studies

The STORBE checklist is a validated tool to measure the quality of observational studies, and it has been commonly used in meta-analysis studies for quality assessment. This checklist was employed in the present study to assess the quality of the selected studies. This checklist consists of 6 scales and 32 subscales and generally evaluates the title, abstract, introduction, methods, results, and discussion of the studies. According to the mentioned checklist, the minimum and maximum points that the studies can get are 0 and 32, respectively. Studies that have scored at least 16 points were considered of good quality, and those scoring below 16 points were excluded from the research [15].

Data extraction

Two researchers extracted the required data for the checklist designed to conduct the research. Information such as the names of the authors, year of publication, location, type of study, sample size, the prevalence of EDs or their subtypes in children, mean or age range of participants, and the tools necessary to measure the status of EDs in different studies were extracted and entered into the designed checklist.

Statistical analysis

Data analysis was conducted using the Comprehensive Meta-Analysis software, Version 2 (Biostat, Englewood, NJ 07631, USA). The I² index was used to evaluate the heterogeneity, and publication bias was evaluated using the Funnel plot and Egger test (at a significance level of 0.05).

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