Predicting onset and maintenance of men's eating disorders | International Journal of Clinical and Health Psychology

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Vílchez, Ángel Vales" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "De Francisco" ] 1 => array:2 [ "nombre" => "Constantino" "apellidos" => "Arce" ] 2 => array:2 [ "nombre" => "María del Pilar" "apellidos" => "Vílchez" ] 3 => array:2 [ "nombre" => "Ángel" "apellidos" => "Vales" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1697260016300229?idApp=UINPBA00004N" "url" => "/16972600/0000001600000003/v1_201609110025/S1697260016300229/v1_201609110025/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Predicting onset and maintenance of men's eating disorders" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "255" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonios Dakanalis, Joana Pla-Sanjuanelo, Manuela Caslini, Chiara Volpato, Giuseppe Riva, Massimo Clerici, Giuseppe Carrà" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Antonios" "apellidos" => "Dakanalis" "email" => array:2 [ 0 => "antonios.dakanalis@unipv.it" 1 => "antonios.dakanalis@unimib.it" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Joana" "apellidos" => "Pla-Sanjuanelo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Manuela" "apellidos" => "Caslini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Chiara" "apellidos" => "Volpato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Giuseppe" "apellidos" => "Riva" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Massimo" "apellidos" => "Clerici" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Giuseppe" "apellidos" => "Carrà" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "University of Pavia, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "University of Milano-Bicocca, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad de Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Catholic University of Milan, Italty" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Istituto Auxologico Italiano, Italy" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "University College of London, United Kingdom" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author: Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Predictores de inicio y desarrollo de patología alimentaria en hombres" ] ] "textoCompleto" => "Threshold eating disorders (EDs), i.e., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), but also other specified feeding and EDs (OSFEDs) recognized in DSM-5, i.e., atypical AN, BN and BED of low frequency and/or limited duration, and purging disorder (<a class="elsevierStyleCrossRef" href="#bib0015">American Psychiatric Association [APA], 2013</a>), are all marked by chronicity, functional impairment, emotional distress, and physical morbidity (e.g., <a class="elsevierStyleCrossRefs" href="#bib0005">Allen, Byrne, Oddy, & Crosby, 2013; Raevuori, Keski-Rahkonen, & Hoek, 2014</a>). They represent serious yet understudied mental health issues, particularly amongst young men attending colleges, who are at the average age of onset (<a class="elsevierStyleCrossRef" href="#bib0115">Raevuori et al., 2014</a>). For instance, according to recent prospective data from community-recruited male samples (<a class="elsevierStyleCrossRef" href="#bib0005">Allen et al., 2013</a>), the peak onset age is 18-20 years for any ED and OSFED. College has been identified as a possible precipitating factor of the initiation and/or deterioration of the component symptoms of EDs, i.e., behavioural features shared across ED/OSFED diagnoses such as binge-eating, laxative/diuretic misuse, fasting, excessive exercise, and self-induced vomiting (e.g., <a class="elsevierStyleCrossRefs" href="#bib0020">Cain, Epler, Steinley, & Sher, 2012; Dakanalis, Clerici et al., 2016; Dakanalis, Timko et al., 2016</a>). Contemporaneous research with young adult men also showed that the aforementioned component symptoms of EDs are prevalent (<a class="elsevierStyleCrossRef" href="#bib0050">Dakanalis, Clerici et al., 2016</a>) but also relatively stable over the four traditional years of college (<a class="elsevierStyleCrossRef" href="#bib0020">Cain et al., 2012</a>). Consistently, DSM-5 (<a class="elsevierStyleCrossRef" href="#bib0015">APA, 2013</a>), that outlined more sex-neutral diagnostic criteria for threshold EDs and their OSFED variants, provided opportunities for improved recognition and diagnosis of EDs in young adult men (<a class="elsevierStyleCrossRef" href="#bib0115">Raevuori et al., 2014</a>). Nonetheless, our knowledge regarding the course and the factors mainly associated with both the onset and maintenance of diagnosable EDs in this population is limited.The dual-pathway model of eating pathology (e.g., <a class="elsevierStyleCrossRef" href="#bib0130">Stice, Marti, & Durant, 2011</a>) has emerged as a key framework for explaining the development and persistence of EDs (<a class="elsevierStyleCrossRef" href="#bib0035">Culbert, Racine, & Klump, 2015</a>). It posits that body dissatisfaction, resulting from appearance-ideal internalization (i.e., endorsement of unattainable societal body shape ideals as own ideals and standards for comparison) promotes unhealthy dieting behaviours that may progress to AN (<a class="elsevierStyleCrossRef" href="#bib0130">Stice et al., 2011</a>). Further, people may think the restriction of food intake for limited periods allows them to binge eat but not gain weight/body fat “which might promote a cycle of acute restriction punctuated by overeating” (p. 623). Body dissatisfaction is also thought to promote negative affectivity (i.e., shame, anxiety, sadness) because of the importance of physical appearance in western culture, which in turn may trigger binge-eating as a means of coping with aversive feelings. In some individuals binge-eating (i.e., eating unusually large quantities of food accompanied by subjective feelings of loss of control) may be followed by a range of compensatory behaviours (i.e., self-induced vomiting, excessive exercise) aimed at counteracting the effects of calories consumed and avoiding weight/body fat gain, which can “turn into a vicious cycle” (p. 623). Indeed, longitudinal studies with adolescent girls have shown that body dissatisfaction and dieting increase risk for any threshold ED and OSFED, with appearance-ideal internalization and negative affectivity predicting onset of any OSFED and threshold BN and BED (e.g., <a class="elsevierStyleCrossRefs" href="#bib0035">Culbert et al., 2015; Stice et al., 2011</a>). Furthermore, elevated body dissatisfaction, appearance-ideal internalization, dieting, and negative affectivity are all associated with the development and persistence of clinically significant ED pathology amongst initially asymptomatic and symptomatic college-aged women (<a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis, Timko et al., 2016</a>).Amongst young adult men, strong concurrent relationships between body dissatisfaction, appearance-ideal internalization, negative affectivity, and component symptoms of EDs have long been observed (<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis & Riva, 2013a</a>), with symptoms remaining relatively stable over the college period (<a class="elsevierStyleCrossRef" href="#bib0020">Cain et al., 2012</a>). Additionally, recent longitudinal research with late adolescent boys and young adult men indicated that body discontent motivates later dieting attempts as a means of losing subcutaneous body fat (that can hide musculature) and appearing more consistent with the male lean-muscular ideal standard, which in turn predict binge-eating (<a class="elsevierStyleCrossRef" href="#bib0040">Dakanalis, Carrà, Calogero et al., 2015</a>), followed by compensatory behaviours (<a class="elsevierStyleCrossRef" href="#bib0050">Dakanalis, Clerici et al., 2016</a>). Whether body dissatisfaction, appearance-ideal internalization, dieting, and negative affectivity predict future onset and/or maintenance of diagnosable EDs in male samples, as in female samples, remains uncertain (<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al., 2015</a>). Nonetheless, the reviewed evidence (<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis & Riva, 2013a</a>) that (a) only a subset of young adult men meet diagnostic criteria for EDs, even though the majority of this population report high appearance-ideal internalization, dieting and body dissatisfaction rates, and (b) negative affectivity also predates and maintains other psychopathological conditions (i.e., substance abuse) highlight the importance to identify additional specific factors that distinguish between men who do and do not develop and/or maintain an ED. Identification of new risk factors could be useful for improving the effectiveness of prevention programmes by enabling clinicians to gear them toward and address needs of young men who are at particularly high risk (<a class="elsevierStyleCrossRef" href="#bib0115">Raevuori et al., 2014</a>). Identification of new maintenance factors to be targeted in existing treatment approaches for improving recovery rates or to guide the design of novel interventions in men, which account for up to 25% of all eating disordered cases (<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis & Riva, 2013a</a>), is also important. It is arguably more important to identify men at increased risk for the onset and maintenance of any ED (including OSFEDs) since a substantial amount of those who do seek treatment have OSFEDs, and prevention programmes should ideally target all EDs, rather than just one type of ED/OSFED (<a class="elsevierStyleCrossRefs" href="#bib0115">Raevuori et al., 2014; Stice et al., 2011</a>).The tendency to experience one's body from an outside observer's (or third-person) perspective (i.e., principally as an object, to be evaluated for its appearance rather than for its effectiveness) is a major target of such investigation (<a class="elsevierStyleCrossRefs" href="#bib0055">Dakanalis & Riva, 2013a; Tiggemann, 2013</a>). This experience, i.e., self-objectification, describes a particular perspective on the (bodily) self - a form of self-consciousness characterised by habitual and constant monitoring of the body and thinking of it in terms of how it looks (<a class="elsevierStyleCrossRef" href="#bib0125">Riva, Gaudio, & Dakanalis, 2015</a>). Though traditionally studied in relation to women's ED pathology, accumulated reviewed evidence from research involving young adult men (<a class="elsevierStyleCrossRefs" href="#bib0055">Dakanalis & Riva, 2013a, 2013b; Hausenblas et al., 2013; Tiggemann, 2013</a>) indicates that (a) they are preoccupied with how their body appears from a third-person perspective, (b) opportunities for self-objectification (i.e., experimental or daily exposure to media idealized-images or appearance-focused comments/conversations) result in increased body dissatisfaction, dieting, and negative affectivity, and (c) experimental manipulations of self-objectification increased self-reported component symptoms of EDs. In addition, to reliably distinguish individuals (also males) with any type of ED (OSFEDs included) from healthy controls, the degree of self-objectification influences the severity of ED pathology and comprehensive recovery from any type of ED is associated with reduced levels of this variable (e.g., <a class="elsevierStyleCrossRefs" href="#bib0045">Dakanalis, Carrà, Timko et al., 2015; Dakanalis, Timko, Clerici, Riva, & Carrà, 2015; Fitzsimmons-Craft, Bardone-Cone, & Kelly, 2011; Riva et al., 2015; Tiggemann, 2013</a>). Nevertheless, little is currently known about the role of self-objectification as a prospective predictor of the onset and/or maintenance of diagnosable EDs.Using data from an on-going longitudinal study on men's eating and mental health issues, we sought to examine the influence and utility of self-objectification and another four traditionally accepted vulnerability factors (body dissatisfaction, appearance-ideal internalization, dieting, negative affectivity; <a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al., 2015</a>) in predicting the onset and maintenance of men's (DSM-5) EDs at 4-year follow-up. The relative variance explained by each of the emerged predictors was examined to identify the most salient contributor to both ED onset and maintenance.MethodDesign and participantsAs part of an on-going longitudinal study on men's eating and mental health issues (from college entrance to after graduation) all first-year male students identified through the registrar's database of one of the largest Italian universities were contacted via e-mail and invited to respond voluntarily to an online survey in autumn 2010 [first college year; Time 1 (T1)/baseline] and 2014 [last college year; Time 2 (T2)/follow-up]. Of those who were initially contacted (N=3,303), 2,689 men responded to the survey at T1. The participation rate (81.4%) is quite close to that reported by other studies involving the same recruitment methodology (i.e., 80.4% for <a class="elsevierStyleCrossRef" href="#bib0050">Dakanalis, Clerici et al., 2016</a>). Additionally, based on the information provided by the registrar (at T1) regarding age, diversity of family socio-economic status and region of residence before university, and ethnic composition of all first-year male students, analyses (i.e., two-tailed t-test for age and χ2 test for the remaining category variables; <a class="elsevierStyleCrossRef" href="#bib0120">Reid, 2014</a>), not shown but available on request, revealed no significant differences in any of these demographic variables between non-participants and participants. Thus, according to the registrar's database of the university from which the sample was recruited, the geographical region of residence before university (33% Northern Italy, 31% Central Italy, 32% Southern Italy, and 4% out of Italy), family socio-economic status (60% middle class, 20.5% lower-middle class, and 19.5% upper-middle class), ethnic composition (78.5% Caucasian, 8.5% Hispanic/Latino, 7% Asian, and 6% other or mixed ethnic heritage), and age (M=18.5, SD=1.41 years) of male first-year college participants was representative. At T1, participants had a mean body mass index (BMI) of 23.48 (SD=5.89) kg/m2; the majority of them were identified as heterosexual (92.5%) and reported they did not reside with their parents (90%). Of the 2,689 participants who responded to the T1 survey, 2,507 (93.2%) men (final analytic sample) responded to the survey at T2. Attrition analyses verified that participants who provided data at both time points did not significantly differ from those who only provided data at T1 on all aforementioned continuous (i.e., age, BMI) and categorical (i.e., ethnic composition) demographic variables, and also on mean scores of all measures of putative factors (described in instruments subsection that follow) and survey-based ED diagnostic rates determined through algorithms applied to the responses on Eating Disorder Diagnostic Scale (EDDS) items (as detailed in the instruments subsection). Due to the space constrictions, the results of the aforementioned attrition analyses (performed through two-tailed t-test and χ2 test for continuous and categorical variables, respectively; <a class="elsevierStyleCrossRef" href="#bib0120">Reid, 2014</a>) are available on request.Using a two-stage design (<a class="elsevierStyleCrossRef" href="#bib0105">Holland, Bodell, & Keel, 2013</a>), men whose survey responses on EDDS items indicated they met DSM-5 criteria for any ED (OSFEDs included) at T1/baseline or T2/follow-up (“cases”, N=184) and “controls” (matched on demographics and BMI; N=185) were invited to participate in a face-to face interview assessment in a case-control design in which interviewers/clinicians were blind to survey-based (EDDS) diagnoses; further details are embedded in the instruments and procedure subsections below. A total of 333 men (91% and 90% of the invited cases and controls) volunteered for interview assessments, conducted up to two months after the time frame on which survey-based diagnoses were made; the overall participation rate is quite close to that reported by other studies using the same design (i.e., 89.9% for <a class="elsevierStyleCrossRef" href="#bib0105">Holland et al., 2013</a>) and comparisons (available on request) of survey- or interview-based diagnostic rates (through χ2 test) and mean scores of all measures of putative factors (through t-test), described below, revealed no significant differences between participants and non-participants with and without EDs/OSFEDs.InstrumentsSelective standardized questionnaires and clinical interviews with well-established psychometric properties among Italian ED patients (men included) and community-based male samples were used to assess EDs and all putative factors in this study.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-EDs. The Italian EDDS (<a class="elsevierStyleCrossRef" href="#bib0030">Conti, 2009</a>) is a 22-item questionnaire (combination of Likert, dichotomous and frequency scores, and open-ended questions about weight and height, allowing BMI calculation) that assesses the DSM-IV criteria for EDs and generates both a symptom composite scale (reflecting the overall level of disordered eating symptoms) and a diagnostic scale. As detailed elsewhere (<a class="elsevierStyleCrossRef" href="#bib0095">Flament et al., 2015</a>), the EDDS also provides all relevant information to assess the DSM-5 criteria for EDs with the exception that items assessing criteria for BED referred to the past 6 months (i.e., duration stipulation of the DSM-IV). In our study, these items were adapted to cover the past 3 months (i.e., duration stipulation of the DSM-5) consistent with the adaption made by prior research, which also provided accompanying (adapted) computer algorithms to generate DSM-5 diagnoses (<a class="elsevierStyleCrossRef" href="#bib0095">Flament et al., 2015</a>). By applying these algorithms to the survey data, participants were classified as meeting (or not) DSM-5 criteria for threshold EDs or OSFEDs at T1 and T2. EDs were collapsed across diagnoses and thus measured as a dichotomous variable (present v. absent) in line with prior community-based studies noticing that the prevalence of diagnosable EDs is not in favour of an examination of associations of vulnerability factors with specific threshold ED and OSFED entities (<a class="elsevierStyleCrossRef" href="#bib0130">Stice et al., 2011</a>), particularly in men (<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al., 2013</a>). Employing the Italian Eating Disorder Examination (EDE) 17.0D (<a class="elsevierStyleCrossRef" href="#bib0025">Calugi et al., 2015</a>) as a gold-standard interview for assessing DSM-5 EDs in our case-control design (described above), sensitivity (ranging from .91 to .93) and specificity (ranging from .99 to 1.00) of the survey-based diagnoses (based on the EDDS) were excellent at each time point. Since survey data was available for the full sample (N=2,507), and in consideration of the high level of agreement between survey-based and interview-based diagnoses (κ=.90-.93), survey-based diagnoses were used in this study to allow diagnostic status of a larger sample to be determined, crucial for examining predictors of ED onset and maintenance separately (<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al., 2013</a>).</li><li class="elsevierStyleListItem" id="lsti0010">-Putative factors. The 8-item Body Surveillance subscale of the Italian Objectified Body Consciousness Scale (<a class="elsevierStyleCrossRef" href="#bib0065">Dakanalis, Timko, Clerici et al., 2015</a>), which measures the extent to which people consistently think and monitor their own body's outward appearance from an external observer's (third-person) perspective, was included as the gold-standard measure of self-objectification (<a class="elsevierStyleCrossRef" href="#bib0140">Tiggemann, 2013</a>). Following relevant recommendations (<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis & Riva, 2013a</a>), the Italian 10-item Male Body Dissatisfaction Scale (<a class="elsevierStyleCrossRef" href="#bib0070">Dakanalis, Timko, Madeddu et al., 2015</a>) was included as the gold-standard measure of men's levels of body dissatisfaction. The 9-item General Internalization subscale of the Italian Sociocultural Attitudes Towards Appearance Questionnaire-3 (<a class="elsevierStyleCrossRefs" href="#bib0030">Conti, 2009; Dakanalis, Zanetti et al., 2015</a>) and the 10-item Negative Affect subscale of the Italian Positive and Negative Affect Schedule (<a class="elsevierStyleCrossRef" href="#bib0135">Terracciano, McCrae, & Costa, 2003</a>) were used to assess appearance-ideal internalization and negative affectivity, respectively. Finally, and consistent with prior ED research (e.g., <a class="elsevierStyleCrossRef" href="#bib0130">Stice et al., 2011</a>), the 10-item Restrained Eating subscale of the Italian Dutch Eating Behaviour Questionnaire (<a class="elsevierStyleCrossRef" href="#bib0080">Dakanalis et al., 2013</a>) was used to measure dieting. In our final analytic sample (N=2,507), just as in subgroups of participants with and without EDs, the internal reliability (α) estimates of each measure were ≥.91 at each time point.</li></ul>ProcedureData for this study was collected following the methodology we have already used successfully in the past and fully detailed elsewhere (<a class="elsevierStyleCrossRefs" href="#bib0050">Dakanalis, Clerici et al., 2016; Dakanalis, Timko et al., 2016</a>). Briefly, students were contacted through the university's academic information technology centre at each time point. The e-mail message informed students about the study (including the possibility of being contacted, if selected, for a face-to-face interview) and efforts taken to ensure confidentiality of the online data, and directed volunteers to an online survey where they gave electronic informed consent and completed the study measures. The measures were identical at both time points, presented in a counterbalanced order, and formatted so that participants could not skip individual items. Men's surveys from the two waves were matched (100%) through the university ID (last five digits) and no duplicate or erroneous data suggesting inattentive or random responding to T1 and/or T2 surveys were identified. To allow for independent assessment of ED diagnosis, clinicians with at least 10 years’ experience in assessing and treating men's EDs conducted all interviews (κ=1.0 at both time points) in the case-control design described above and detailed elsewhere (<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al., 2013</a>). All consenting participants provided written informed consent and assessments took place on the college campus (89%) or in participants’ houses. The ethics review board of the co-ordinating body of the project (UniPV) approved the study.Data analysisDescriptive statistics on changes in (DSM-5) ED diagnostic status from T1 to T2 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) are provided. Differences in T1/baseline putative factors/predictors among four groups of participants (described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) classified based on the presence or absence of an ED at each wave of assessment (e.g., <a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis, Timko et al., 2016</a>) were assessed in SPSS 21.0 (IBM, NY) through MANOVA, preceded by checking that the data met all assumptions associated with this statistical technique (i.e., homogeneity of the variance-covariance), and followed by post-hoc tests (Tukey's B) (<a class="elsevierStyleCrossRef" href="#bib0120">Reid, 2014</a>). Subsequently, logistic regression models examined the association between each baseline putative predictor (T1) and change in the predictor (T2 - T1) with T2 ED status: “onset” (v. onset-free) or “maintenance” (v. cessation) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Each predictor (baseline/T1 value and change value) was entered in a separate/individual model that was adjusted for BMI and disordered eating symptom levels at study entry and changes in BMI between assessments, as recommended (e.g., <a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis, Timko et al., 2016</a>); because of the results of pre-analyses demographic variables (other than BMI), described above, were not entered as covariates in the planned analyses. Using SAS 9.3 (Cary, NC) software, one set of these (five) individual models examined the impact of each putative predictor on T2 “onset” amongst individuals without an ED at T1, and the second set of models examined the impact of each putative predictor on T2 “maintenance” amongst individuals with an ED at T1. Consistent with the study goals, Max-rescaled R2, i.e., the only measure of predictive power offered by SAS 9.3 (Cary, NC) for binary logistic regressions (<a class="elsevierStyleCrossRef" href="#bib0010">Allison, 2012</a>), examining the explanatory, predictive, value of a model, was calculated for each individual predictor model and for (logistic regression) combined models examining all statistically significant individual predictors and adjustment variables entered together and adjustment variables only.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>ResultsDescriptive statistics on changes in ED diagnostic status from T1 to T2 appear in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. At T1, 4% of the sample (n=101) met DSM-5 criteria for an ED. At 4-year follow-up/T2, 3.3% of the sample (n=83) met DSM-5 criteria for an ED, with 48.2% (n=40) of these cases representing new onset EDs, and 51.8% (n=43) of these cases representing men who had maintained an ED from baseline to 4-year follow-up).As shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, the MANOVA indicated differences on all T1/baseline putative factors across the four groups of participants classified based on the presence or absence of an ED at each wave of assessment, with subsequent post-hoc tests revealing that the groups differed significantly from each other in mean baseline scores of all putative factors. The significant differences between groups that were equivalent in terms of presence or absence of an ED at baseline/T1 but showing different outcomes at follow-up/T2 were of interest. Specifically, the “onset” group (i.e., without an ED at T1 and with an ED at T2) reported greater baseline scores on all putative factors as compared to the “stable no-ED”, or onset-free, group (i.e., without an ED at both time points). Likewise the “maintenance” group (with an ED at both time points) reported greater baseline scores on all putative factors as compared to the “cessation” group (i.e., with an ED at T1 and without an ED at T2).Odds ratios (ORs) from individual predictor models for associations of predictors with T2 “onset” (v. onset-free) and “maintenance” (v. cessation) are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Amongst individuals without an ED at baseline/T1 assessment, higher levels of self-objectification, body dissatisfaction, appearance-ideal internalization, dieting, and negative affectivity at T1 were significantly associated with the “onset” of an ED at T2/follow-up. Amongst those with an ED at T1, higher levels of self-objectification, body dissatisfaction, appearance-ideal internalization, dieting, and negative affectivity at T1 were significantly associated with ED “maintenance” at T2/follow-up. Changes in all individual predictor variables between assessments (i.e., from T1 to T2) were also significantly associated with both the “onset” and “maintenance” of an ED at T2/follow-up; ORs were comparable in magnitude to those for the individual predictor values at T1 (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Importantly, we also confirmed significant findings when restricting analyses to those for whom ED diagnosis was checked/confirmed by the clinical interview in the case-control design.<a class="elsevierStyleCrossRef" href="#fn0005">1</a>Examination of max-rescaled R2 values, also reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, indicated that the individual predictor model with the greatest explanatory/predictive value in explaining either “onset” (R2=.41) or “maintenance” (R2=.40) ED was the self-objectification model. In each individual predictor model, the remaining predictors (body dissatisfaction, appearance-ideal internalization, dieting, negative affectivity) had only half (or less) of the explanatory strength for either “onset” or “maintenance” ED. The explanatory value of the combined model, including all statistically significant individual predictors and adjusted variables/covariates (BMI and disordered eating levels at study entry, and changes in BMI between assessments) entered, was high (R2=.68 for onset, .67 for maintenance); the only covariates explained 10% and 11% of the variance in the “onset” and “maintenance ED, respectively.DiscussionUsing longitudinal data we examined the influence of relevant factors in predicting the onset and maintenance of men's (DSM-5) EDs at 4-year follow-up. Our findings showed that elevated self-objectification, body dissatisfaction, appearance-ideal internalization, dieting, and negative affectivity at baseline as well as changes in these factors between assessments were significantly associated with future ED onset. Interestingly, greater initial levels in the aforementioned five factors as well as changes in these factors between assessments also predicted ED maintenance, with ORs comparable to those for individual predictor variables contributing to the ED onset (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). However, examination of the variance explained by each of the examined factors indicates that men's self-objectification tendency emerged as the strongest predictor of both ED onset and maintenance.Our findings regarding body dissatisfaction, appearance-ideal internalization, dieting, and negative affectivity converged with those found in prior studies investigating their role on ED onset amongst adolescent girls (e.g., <a class="elsevierStyleCrossRefs" href="#bib0035">Culbert et al., 2015; Stice et al., 2011</a>) and on the development and persistence of college women's clinically significant ED pathology (e.g., <a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis, Timko et al., 2016</a>). This implies that the effects of these variables are moderately robust and potentially not gender specific. The findings regarding self-objectification are novel and should inform preventive and treatment research. Hyper-focused attention on, and constant monitoring of, the body's appearance (characterizing self-objectification) has been consistently found to be an outcome of the appearance-ideal internalization in both sexes (<a class="elsevierStyleCrossRef" href="#bib0140">Tiggemann, 2013</a>). It has also been found to magnify the discrepancy between actual and ideal body attributes and/or perceived body imperfections (<a class="elsevierStyleCrossRefs" href="#bib0100">Hausenblas et al., 2013; Riva et al., 2015</a>). Thus, self-objectification and its cumulative effect may play a key role in the acceleration of body dissatisfaction, associated affective distress and/or dieting attempts, thereby potentiating meaningful increases in the risk of ED pathology (<a class="elsevierStyleCrossRefs" href="#bib0045">Dakanalis, Carrà, Timko et al., 2015; Fitzsimmons-Craft et al., 2011</a>). Although support for this suggestion came from a recent study that followed (initially) asymptomatic adolescents of both sexes for four years (<a class="elsevierStyleCrossRef" href="#bib0040">Dakanalis, Carrà, Calogero et al., 2015</a>), self-objectification might also be involved in the maintenance process of ED pathology (<a class="elsevierStyleCrossRef" href="#bib0140">Tiggemann, 2013</a>). According to ED scholars, when patients with any ED continue to think and monitor their own body “from a third-person perspective, factors that contribute significantly to EDs (i.e., body dissatisfaction, dieting, negative affectivity) remain untouched” (<a class="elsevierStyleCrossRef" href="#bib0090">Fitzsimmons-Craft et al., 2011</a>, p. 303). Research needs to validate this process and clarify the temporal sequence of the potential intervening experiences linking self-objectification to both the onset and persistence of ED pathology (<a class="elsevierStyleCrossRef" href="#bib0125">Riva et al., 2015</a>).Even with longitudinal data and statistical control of several factors, unmeasured third variables (i.e., genetic factors) could account for the relationships observed (<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al., 2015</a>). The prevalence estimates of any DSM-5 EDs obtained in our sample at baseline/T1 (4%) and 4-year follow-up/T2 (3.3%) are consistent with those reported in comparable community surveys of young adult men (<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al., 2013</a>) and the existing literature on the general population of college-aged men (<a class="elsevierStyleCrossRefs" href="#bib0055">Dakanalis & Riva, 2013a; Raevuori et al., 2014</a>). The sample size of symptomatic and asymptomatic participants was also appropriate (i.e., above the recommended 10:1 cases-to-variable ratio, <a class="elsevierStyleCrossRef" href="#bib0010">Allison, 2012</a>) for individual and combined logistic regression models conducted for examining the impact of each predictor and all five predictors on “onset” and “maintenance” of any ED (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), respectively. Yet the prevalence of specific DSM-5 ED diagnoses (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) was too low to allow examination of associations of putative factors with specific threshold ED and OSFED entities. Although considerably larger prospective studies will be necessary to address this issue, it is worth noting that prior research supports the “trans-diagnostic” relevance of the variables considered in this study (e.g., <a class="elsevierStyleCrossRefs" href="#bib0035">Culbert et al., 2015; Dakanalis, Timko, Clerici et al., 2015; Fitzsimmons-Craft et al., 2011; Stice et al., 2011; Tiggemann, 2013</a>). Additional descriptive data (not shown) indicating that none of T1 or T2 symptomatic participants reported receiving ED treatment before the T1 and between T1 and T2 assessments may suggest that our findings reflect a naturalistic progression of EDs and the vulnerability factors considered in this study. Despite evidence that the presentation format of measures (paper-and-pencil vs. online) did not change the quality of results (e.g., <a class="elsevierStyleCrossRef" href="#bib0070">Dakanalis, Timko, Madeddu et al., 2015</a>), all study variables embedded in online surveys were based on self-report data that is potentially susceptible to self-deceptive responding and assessment error (in the case of survey-based diagnoses). Importantly, survey-based diagnoses demonstrated concurrent validity with interview-based ED diagnoses in our sample, increasing confidence in the reported results. Moreover, we could confirm significant findings also when restricting analyses to those for whom ED diagnosis was checked/confirmed by the clinical interview in the case-control design. Although our analytic sample was representative (as mentioned in methods), men in the current study came from a selective northern Italian university; thus findings may not generalize to populations of dissimilar demographics, including inpatient samples. However, few available studies also involving men, and examining the stability of ED diagnoses in both community-based (<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al., 2013</a>) and inpatient (<a class="elsevierStyleCrossRef" href="#bib0110">Keel & Brown, 2010</a>) samples reported rates of remission (57-58%) quite close to those observed in this study (57.4%, i.e., 58 of 101 men with an ED at T1 did not retain diagnosis at T2), thereby supporting the representativeness of longitudinal patterns observed in our sample. Additionally, although the duration between T1 and T2 assessment (4 years) was a strength of our study, we were not able to examine potential fluctuations or changes in ED status over the course of illness (i.e., between T1 and T2), and the examined factors may have demonstrated important associations with remission and relapse that we were unable to evaluate. In addition, future research should also test for interactions between the examined factors suggestive of qualitatively distinct risk/maintenance pathways (<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis & Riva, 2013a</a>). This could benefit from, for example, classification tree analyses that are also able to empirically derive cut-points for continuous measures (such as those used in this study for assessing the putative factors) and allowing optimal identification of young adult men at elevated risk for the onset and maintenance of DSM-5 EDs (<a class="elsevierStyleCrossRef" href="#bib0130">Stice et al., 2011</a>).Despite the aforementioned limitations, our findings revealing that self-objectification, body dissatisfaction, appearance-ideal internalization, dieting, and negative affectivity were all predictors of both ED onset and maintenance highlight potentially similar psychological foci for prevention and treatment efforts. Importantly, self-objectification had greater explanatory value with regard to both ED onset and maintenance, as compared to the remaining four traditionally accepted risk/maintenance factors (<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al., 2015</a>). Thus, a focus on reducing self-objectification might be considered as a potential intervention strategy to prevent and treat young men's ED pathology. Indeed, recent research revealed that the addition of self-objectification as a target variable within traditional (evidenced-based) cognitive dissonance prevention programmes targeting appearance-ideal internalization, increased the reduction of undergraduate eating and body-related disturbances as well as the small-to medium effect sizes of these traditional programmes (<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al., 2015</a>). The leading empirically supported cognitive-behaviour (CB) treatment for BN, which has been successfully adapted with the goal of making it “trans-diagnostic” appears “more effective in reducing ED behavioural symptoms rather than producing changes in body image disturbance” (<a class="elsevierStyleCrossRef" href="#bib0045">Dakanalis, Carrà, Timko et al., 2015</a>, p.102). Hence, the use of CB or other interventions of proven efficacy in combination with promising approaches (i.e., virtual reality) designed to decrease the hyper-focus on, and scrutiny of, body appearance (characterizing self-objectification), and to address body dissatisfaction and negative reactions to one's image, might be helpful to decrease ED pathology and improve treatment outcomes (<a class="elsevierStyleCrossRefs" href="#bib0040">Dakanalis, Carrà, Calogero, Fida et al., 2015; Dakanalis, Carrà, Calogero, Zanetti et al., 2015; Dakanalis et al., 2014; Riva, Gaggioli, & Dakanalis, 2013; Riva et al., 2015</a>).FundingThe work was supported by a grant from the Onassis Foundation (O/RG 2010/G/A212). The authors report no declarations of financial interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres729052" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec733125" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres729051" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec733126" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Method" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Design and participants" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Instruments" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedure" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Data analysis" ] ] ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-12-12" "fechaAceptado" => "2016-05-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec733125" "palabras" => array:5 [ 0 => "Eating disorders" 1 => "Onset" 2 => "Maintenance" 3 => "DSM-5" 4 => "Ex post facto study" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec733126" "palabras" => array:5 [ 0 => "Trastornos de la conducta alimentaria" 1 => "inicio" 2 => "mantenimiento" 3 => "DSM-5" 4 => "estudio ex post facto" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Background/Objective: Eating disorders (EDs) represent serious yet understudied mental health issues, particularly amongst young adult men attending colleges, who are at the average age of onset. Despite this and recent evidence that in young adult men the core ED symptoms are prevalent and remain relatively stable over the college period, little is known about factors associated with both the onset and maintenance of diagnosable EDs in this population. This work sought to address these research gaps. Method: Logistic regression analyses were conducted using data from an on-going longitudinal study of eating and mental health issues to examine the influence of theoretically relevant factors in predicting the onset and maintenance of men's (DSM-5) EDs at 4-year follow-up (N=2,507). Results: Body dissatisfaction, self-objectification, appearance-ideal internalization, dieting, and negative affectivity were all predictors of ED onset and maintenance. Self-objectification was the largest contributor to both ED onset and maintenance. Conclusions: The findings highlight potentially similar psychosocial foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are discussed." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Antecedentes/Objetivo: Los trastornos de la conducta alimentaria (TCAs) representan graves, aunque poco estudiados, problemas de salud mental en las universidades, especialmente en hombres jóvenes, quienes se encuentran en la edad media de inicio. A pesar de la evidencia de que en hombres adultos jóvenes los principales síntomas de TCA son frecuentes y se mantienen relativamente estables durante el período universitario, poco se sabe sobre los factores asociados con la aparición y el mantenimiento de los TCAs en esta población. Este trabajo trata de abordar estas lagunas de investigación. Método: Se realizaron análisis de regresión logística utilizando datos de un estudio longitudinal en curso sobre alimentación y salud mental para examinar la influencia de factores teóricamente relevantes para predecir la aparición y el mantenimiento de los TCAs (DSM-5) en hombres durante 4 años de seguimiento (N=2.507). Resultados: La insatisfacción corporal, la auto-objetivación, la internalización de la apariencia ideal, las dietas, y la afectividad negativa fueron predictores de inicio y mantenimiento de TCA. La auto-objetivación fue el mayor contribuyente a la aparición y mantenimiento de TCA. Conclusiones: Los resultados destacan focos similares para su prevención y tratamiento. Se discuten las implicaciones para mejorar los enfoques preventivos y de tratamiento existentes." ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "Specifically, additional restricting analyses (available on request from the corresponding author due to space constrictions) of those individuals for whom ED diagnosis was confirmed by the clinical interview (i.e., EDE) in the case-control design (described in the methods/design and participants subsections) produced the same pattern of results, with ORs comparable to results described in Table 3 from analyses of survey-based data." "identificador" => "fn0005" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ED Status</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">At 4-year follow-up/Time 2</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">At baseline/Time 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No ED n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ED n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No ED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2,406 (96%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2,366 (94.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 (4.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anorexia Nervosa (AN) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (0.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bulimia Nervosa (BN) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (0.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (0.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Binge Eating Disordera (BED) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (1.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (0.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atypical AN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BN of low frequency and/or limited duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BED of low frequency and/or limited duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Purging Disorder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1201594.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes in DSM-5 eating disorder (ED) status from baseline to 4-year follow-up (N=2,507)." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Definition \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stable no-ED (n=2,366) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Participants without an ED at baseline and 4-year follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onset (n=40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Participants without an ED at baseline and with an ED at 4-year follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maintenance (n=43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Participants with an ED at baseline and 4-year follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cessation (n=58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Participants with an ED at baseline and without an ED at 4-year follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1201596.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline putative factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stable no-ED \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onset \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maintenance \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cessation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Self-objectification (possible score range: 1-7)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.88 (1.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.00 (0.55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.89 (0.40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.44 (0.36) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body dissatisfaction (possible score range: 9-54)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.49 (6.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.99 (6.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.05 (5.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.04 (11.99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appearance-ideal internalization (possible score range: 9-45)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.55 (5.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.02 (6.55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.69 (8.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.99 (3.05) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dieting (possible score range: 1-5)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.85 (1.46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.11 (0.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.83 (0.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.50 (1.04) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative affectivity (possible score range: 10-50)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.51 (7.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.16 (4.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.96 (5.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.99 (5.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1201592.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Variables are expressed as means (standard deviation)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Multivariate F-value (Wilk's lambda)=106.47, p<.001, ηp2=.56 (large effect size); post-hoc tests (Tukey's B) revealed that each group significantly differed from each other in all putative factors." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "*" "nota" => "p<.001 (univariate significance)." ] ] ] "descripcion" => array:1 [ "en" => "Differences on baseline putative factors across groups of participants with and without an eating disorder (ED) at baseline and 4-year follow-up." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note. All models are adjusted for body mass index (BMI) and disordered eating levels at study entry, and BMI changes between assessments. All odds ratios are statistically significant (p<.05). R2 reflects the percentage of variance (R2value x 100) explained by separate (individual) and combined predictor models. Each of the five single (individual) predictor models includes baseline predictor, change in predictor and adjusted variables/covariates. The combined model includes all baseline predictors as well as change in predictor and adjusted variables/covariates." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col">Association of putative factors with ED onset (N=2,406)</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Individual Predictor Model \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratios \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% Confidence Interval \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Max-rescaled R2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline self-objectification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.00-5.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in self-objectification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.00-5.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline body dissatisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78-3.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in body dissatisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.69-3.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline appearance-ideal internalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.51-2.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in appearance-ideal internalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.42-2.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline dieting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04-1.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in dieting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.16-1.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline negative affectivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.41-2.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in negative affectivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.33-2.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combined models: All significant predictors and covariates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Covariates only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1201593.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col">Association of putative factors with ED maintenance (n=101)</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Individual Predictor Model \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratios \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% Confidence Interval \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Max-rescaled R2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline self-objectification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.98-5.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in self-objectification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.49-4.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline body dissatisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.68-2.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in body dissatisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.62-2.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline appearance-ideal internalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.52-2.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in appearance-ideal internalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.29-2.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline dieting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.15-1.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in dieting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.11-1.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline negative affectivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.20-1.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in negative affectivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.19-2.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combined models: All significant predictors and covariates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Covariates only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1201595.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Logistic regression analyses predicting eating disorder (ED) onset and maintenance at 4-year follow-up." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "Allen et al., 2013" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "DSM–IV–TR and DSM-5 eating disorders in adolescents: Prevalence, stability, and psychosocial correlates in a population-based sample of male and female adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.L. 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Predicting onset and maintenance of men's eating disorders

Predictores de inicio y desarrollo de patología alimentaria en hombres

Antonios Dakanalisa,b,

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antonios.dakanalis@unipv.it
antonios.dakanalis@unimib.it

Corresponding author: Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy.

, Joana Pla-Sanjuaneloc, Manuela Caslinib, Chiara Volpatob, Giuseppe Rivad,e, Massimo Clericib, Giuseppe Carràf

a University of Pavia, Italy

b University of Milano-Bicocca, Italy

c Universidad de Barcelona, Spain

d Catholic University of Milan, Italty

e Istituto Auxologico Italiano, Italy

f University College of London, United Kingdom

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Threshold eating disorders &#40;EDs&#41;&#44; i&#46;e&#46;&#44; anorexia nervosa &#40;AN&#41;&#44; bulimia nervosa &#40;BN&#41;&#44; and binge eating disorder &#40;BED&#41;&#44; but also other specified feeding and EDs &#40;OSFEDs&#41; recognized in DSM-5&#44; i&#46;e&#46;&#44; atypical AN&#44; BN and BED of low frequency and&#47;or limited duration&#44; and purging disorder &#40;<a class="elsevierStyleCrossRef" href="#bib0015">American Psychiatric Association &#91;APA&#93;&#44; 2013</a>&#41;&#44; are all marked by chronicity&#44; functional impairment&#44; emotional distress&#44; and physical morbidity &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRefs" href="#bib0005">Allen&#44; Byrne&#44; Oddy&#44; &#38; Crosby&#44; 2013&#59; Raevuori&#44; Keski-Rahkonen&#44; &#38; Hoek&#44; 2014</a>&#41;&#46; They represent serious yet understudied mental health issues&#44; particularly amongst young men attending colleges&#44; who are at the average age of onset &#40;<a class="elsevierStyleCrossRef" href="#bib0115">Raevuori et al&#46;&#44; 2014</a>&#41;&#46; For instance&#44; according to recent prospective data from community-recruited male samples &#40;<a class="elsevierStyleCrossRef" href="#bib0005">Allen et al&#46;&#44; 2013</a>&#41;&#44; the peak onset age is 18-20 years for any ED and OSFED&#46; College has been identified as a possible precipitating factor of the initiation and&#47;or deterioration of the component symptoms of EDs&#44; i&#46;e&#46;&#44; behavioural features shared across ED&#47;OSFED diagnoses such as binge-eating&#44; laxative&#47;diuretic misuse&#44; fasting&#44; excessive exercise&#44; and self-induced vomiting &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRefs" href="#bib0020">Cain&#44; Epler&#44; Steinley&#44; &#38; Sher&#44; 2012&#59; Dakanalis&#44; Clerici et al&#46;&#44; 2016&#59; Dakanalis&#44; Timko et al&#46;&#44; 2016</a>&#41;&#46; Contemporaneous research with young adult men also showed that the aforementioned component symptoms of EDs are prevalent &#40;<a class="elsevierStyleCrossRef" href="#bib0050">Dakanalis&#44; Clerici et al&#46;&#44; 2016</a>&#41; but also relatively stable over the four traditional years of college &#40;<a class="elsevierStyleCrossRef" href="#bib0020">Cain et al&#46;&#44; 2012</a>&#41;&#46; Consistently&#44; DSM-5 &#40;<a class="elsevierStyleCrossRef" href="#bib0015">APA&#44; 2013</a>&#41;&#44; that outlined more sex-neutral diagnostic criteria for threshold EDs and their OSFED variants&#44; provided opportunities for improved recognition and diagnosis of EDs in young adult men &#40;<a class="elsevierStyleCrossRef" href="#bib0115">Raevuori et al&#46;&#44; 2014</a>&#41;&#46; Nonetheless&#44; our knowledge regarding the course and the factors mainly associated with both the onset and maintenance of diagnosable EDs in this population is limited&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The dual-pathway model of eating pathology &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0130">Stice&#44; Marti&#44; &#38; Durant&#44; 2011</a>&#41; has emerged as a key framework for explaining the development and persistence of EDs &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Culbert&#44; Racine&#44; &#38; Klump&#44; 2015</a>&#41;&#46; It posits that body dissatisfaction&#44; resulting from appearance-ideal internalization &#40;i&#46;e&#46;&#44; endorsement of unattainable societal body shape ideals as own ideals and standards for comparison&#41; promotes unhealthy dieting behaviours that may progress to AN &#40;<a class="elsevierStyleCrossRef" href="#bib0130">Stice et al&#46;&#44; 2011</a>&#41;&#46; Further&#44; people may think the restriction of food intake for limited periods allows them to binge eat but not gain weight&#47;body fat &#8220;which might promote a cycle of acute restriction punctuated by overeating&#8221; &#40;p&#46; 623&#41;&#46; Body dissatisfaction is also thought to promote negative affectivity &#40;i&#46;e&#46;&#44; shame&#44; anxiety&#44; sadness&#41; because of the importance of physical appearance in western culture&#44; which in turn may trigger binge-eating as a means of coping with aversive feelings&#46; In some individuals binge-eating &#40;i&#46;e&#46;&#44; eating unusually large quantities of food accompanied by subjective feelings of loss of control&#41; may be followed by a range of compensatory behaviours &#40;i&#46;e&#46;&#44; self-induced vomiting&#44; excessive exercise&#41; aimed at counteracting the effects of calories consumed and avoiding weight&#47;body fat gain&#44; which can &#8220;turn into a vicious cycle&#8221; &#40;p&#46; 623&#41;&#46; Indeed&#44; longitudinal studies with adolescent girls have shown that body dissatisfaction and dieting increase risk for any threshold ED and OSFED&#44; with appearance-ideal internalization and negative affectivity predicting onset of any OSFED and threshold BN and BED &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRefs" href="#bib0035">Culbert et al&#46;&#44; 2015&#59; Stice et al&#46;&#44; 2011</a>&#41;&#46; Furthermore&#44; elevated body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity are all associated with the development and persistence of clinically significant ED pathology amongst initially asymptomatic and symptomatic college-aged women &#40;<a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis&#44; Timko et al&#46;&#44; 2016</a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Amongst young adult men&#44; strong concurrent relationships between body dissatisfaction&#44; appearance-ideal internalization&#44; negative affectivity&#44; and component symptoms of EDs have long been observed &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a</a>&#41;&#44; with symptoms remaining relatively stable over the college period &#40;<a class="elsevierStyleCrossRef" href="#bib0020">Cain et al&#46;&#44; 2012</a>&#41;&#46; Additionally&#44; recent longitudinal research with late adolescent boys and young adult men indicated that body discontent motivates later dieting attempts as a means of losing subcutaneous body fat &#40;that can hide musculature&#41; and appearing more consistent with the male lean-muscular ideal standard&#44; which in turn predict binge-eating &#40;<a class="elsevierStyleCrossRef" href="#bib0040">Dakanalis&#44; Carr&#224;&#44; Calogero et al&#46;&#44; 2015</a>&#41;&#44; followed by compensatory behaviours &#40;<a class="elsevierStyleCrossRef" href="#bib0050">Dakanalis&#44; Clerici et al&#46;&#44; 2016</a>&#41;&#46; Whether body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity predict future onset and&#47;or maintenance of diagnosable EDs in male samples&#44; as in female samples&#44; remains uncertain &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al&#46;&#44; 2015</a>&#41;&#46; Nonetheless&#44; the reviewed evidence &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a</a>&#41; that &#40;a&#41; only a subset of young adult men meet diagnostic criteria for EDs&#44; even though the majority of this population report high appearance-ideal internalization&#44; dieting and body dissatisfaction rates&#44; and &#40;b&#41; negative affectivity also predates and maintains other psychopathological conditions &#40;i&#46;e&#46;&#44; substance abuse&#41; highlight the importance to identify additional specific factors that distinguish between men who do and do not develop and&#47;or maintain an ED&#46; Identification of new risk factors could be useful for improving the effectiveness of prevention programmes by enabling clinicians to gear them toward and address needs of young men who are at particularly high risk &#40;<a class="elsevierStyleCrossRef" href="#bib0115">Raevuori et al&#46;&#44; 2014</a>&#41;&#46; Identification of new maintenance factors to be targeted in existing treatment approaches for improving recovery rates or to guide the design of novel interventions in men&#44; which account for up to 25&#37; of all eating disordered cases &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a</a>&#41;&#44; is also important&#46; It is arguably more important to identify men at increased risk for the onset and maintenance of any ED &#40;including OSFEDs&#41; since a substantial amount of those who do seek treatment have OSFEDs&#44; and prevention programmes should ideally target all EDs&#44; rather than just one type of ED&#47;OSFED &#40;<a class="elsevierStyleCrossRefs" href="#bib0115">Raevuori et al&#46;&#44; 2014&#59; Stice et al&#46;&#44; 2011</a>&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The tendency to experience one&#39;s body from an outside observer&#39;s &#40;or third-person&#41; perspective &#40;i&#46;e&#46;&#44; principally as an object&#44; to be evaluated for its appearance rather than for its effectiveness&#41; is a major target of such investigation &#40;<a class="elsevierStyleCrossRefs" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a&#59; Tiggemann&#44; 2013</a>&#41;&#46; This experience&#44; i&#46;e&#46;&#44; self-objectification&#44; describes a particular perspective on the &#40;bodily&#41; self - a form of self-consciousness characterised by habitual and constant monitoring of the body and thinking of it in terms of how it looks &#40;<a class="elsevierStyleCrossRef" href="#bib0125">Riva&#44; Gaudio&#44; &#38; Dakanalis&#44; 2015</a>&#41;&#46; Though traditionally studied in relation to women&#39;s ED pathology&#44; accumulated reviewed evidence from research involving young adult men &#40;<a class="elsevierStyleCrossRefs" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a&#44; 2013b&#59; Hausenblas et al&#46;&#44; 2013&#59; Tiggemann&#44; 2013</a>&#41; indicates that &#40;a&#41; they are preoccupied with how their body appears from a third-person perspective&#44; &#40;b&#41; opportunities for self-objectification &#40;i&#46;e&#46;&#44; experimental or daily exposure to media idealized-images or appearance-focused comments&#47;conversations&#41; result in increased body dissatisfaction&#44; dieting&#44; and negative affectivity&#44; and &#40;c&#41; experimental manipulations of self-objectification increased self-reported component symptoms of EDs&#46; In addition&#44; to reliably distinguish individuals &#40;also males&#41; with any type of ED &#40;OSFEDs included&#41; from healthy controls&#44; the degree of self-objectification influences the severity of ED pathology and comprehensive recovery from any type of ED is associated with reduced levels of this variable &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRefs" href="#bib0045">Dakanalis&#44; Carr&#224;&#44; Timko et al&#46;&#44; 2015&#59; Dakanalis&#44; Timko&#44; Clerici&#44; Riva&#44; &#38; Carr&#224;&#44; 2015&#59; Fitzsimmons-Craft&#44; Bardone-Cone&#44; &#38; Kelly&#44; 2011&#59; Riva et al&#46;&#44; 2015&#59; Tiggemann&#44; 2013</a>&#41;&#46; Nevertheless&#44; little is currently known about the role of self-objectification as a prospective predictor of the onset and&#47;or maintenance of diagnosable EDs&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Using data from an on-going longitudinal study on men&#39;s eating and mental health issues&#44; we sought to examine the influence and utility of self-objectification and another four traditionally accepted vulnerability factors &#40;body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; negative affectivity&#59; <a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al&#46;&#44; 2015</a>&#41; in predicting the onset and maintenance of men&#39;s &#40;DSM-5&#41; EDs at 4-year follow-up&#46; The relative variance explained by each of the emerged predictors was examined to identify the most salient contributor to both ED onset and maintenance&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Method</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Design and participants</span><p id="par0030" class="elsevierStylePara elsevierViewall">As part of an on-going longitudinal study on men&#39;s eating and mental health issues &#40;from college entrance to after graduation&#41; all first-year male students identified through the registrar&#39;s database of one of the largest Italian universities were contacted via e-mail and invited to respond voluntarily to an online survey in autumn 2010 &#91;first college year&#59; 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<a class="elsevierStyleCrossRef" href="#bib0120">Reid&#44; 2014</a>&#41;&#44; not shown but available on request&#44; revealed no significant differences in any of these demographic variables between non-participants and participants&#46; Thus&#44; according to the registrar&#39;s database of the university from which the sample was recruited&#44; the geographical region of residence before university &#40;33&#37; Northern Italy&#44; 31&#37; Central Italy&#44; 32&#37; Southern Italy&#44; and 4&#37; out of Italy&#41;&#44; family socio-economic status &#40;60&#37; middle class&#44; 20&#46;5&#37; lower-middle class&#44; and 19&#46;5&#37; upper-middle class&#41;&#44; ethnic composition &#40;78&#46;5&#37; Caucasian&#44; 8&#46;5&#37; Hispanic&#47;Latino&#44; 7&#37; Asian&#44; and 6&#37; other or mixed ethnic heritage&#41;&#44; and age &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#46;5&#44; <span class="elsevierStyleItalic">SD</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;41 years&#41; of male first-year college participants was representative&#46; At T1&#44; participants had a mean body mass index &#40;BMI&#41; of 23&#46;48 &#40;<span class="elsevierStyleItalic">SD</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;89&#41; kg&#47;m<span class="elsevierStyleSup">2</span>&#59; the majority of them were identified as heterosexual &#40;92&#46;5&#37;&#41; and reported they did not reside with their parents &#40;90&#37;&#41;&#46; Of the 2&#44;689 participants who responded to the T1 survey&#44; 2&#44;507 &#40;93&#46;2&#37;&#41; men &#40;final analytic sample&#41; responded to the survey at T2&#46; Attrition analyses verified that participants who provided data at both time points did not significantly differ from those who only provided data at T1 on all aforementioned continuous &#40;i&#46;e&#46;&#44; age&#44; BMI&#41; and categorical &#40;i&#46;e&#46;&#44; ethnic composition&#41; demographic variables&#44; and also on mean scores of all measures of putative factors &#40;described in instruments subsection that follow&#41; and survey-based ED diagnostic rates determined through algorithms applied to the responses on Eating Disorder Diagnostic Scale &#40;EDDS&#41; items &#40;as detailed in the instruments subsection&#41;&#46; Due to the space constrictions&#44; the results of the aforementioned attrition analyses &#40;performed through two-tailed <span class="elsevierStyleItalic">t</span>-test and <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> test for continuous and categorical variables&#44; respectively&#59; <a class="elsevierStyleCrossRef" href="#bib0120">Reid&#44; 2014</a>&#41; are available on request&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Using a two-stage design &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Holland&#44; Bodell&#44; &#38; Keel&#44; 2013</a>&#41;&#44; men whose survey responses on EDDS items indicated they met DSM-5 criteria for any ED &#40;OSFEDs included&#41; at T1&#47;baseline or T2&#47;follow-up &#40;&#8220;cases&#8221;&#44; <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>184&#41; and &#8220;controls&#8221; &#40;matched on demographics and BMI&#59; <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>185&#41; were invited to participate in a face-to face interview assessment in a case-control design in which interviewers&#47;clinicians were blind to survey-based &#40;EDDS&#41; diagnoses&#59; further details are embedded in the instruments and procedure subsections below&#46; A total of 333 men &#40;91&#37; and 90&#37; of the invited cases and controls&#41; volunteered for interview assessments&#44; conducted up to two months after the time frame on which survey-based diagnoses were made&#59; the overall participation rate is quite close to that reported by other studies using the same design &#40;i&#46;e&#46;&#44; 89&#46;9&#37; for <a class="elsevierStyleCrossRef" href="#bib0105">Holland et al&#46;&#44; 2013</a>&#41; and comparisons &#40;available on request&#41; of survey- or interview-based diagnostic rates &#40;through <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> test&#41; and mean scores of all measures of putative factors &#40;through <span class="elsevierStyleItalic">t</span>-test&#41;&#44; described below&#44; revealed no significant differences between participants and non-participants with and without EDs&#47;OSFEDs&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Instruments</span><p id="par0040" class="elsevierStylePara elsevierViewall">Selective standardized questionnaires and clinical interviews with well-established psychometric properties among Italian ED patients &#40;men included&#41; and community-based male samples were used to assess EDs and all putative factors in this study&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">EDs&#46; The Italian EDDS &#40;<a class="elsevierStyleCrossRef" href="#bib0030">Conti&#44; 2009</a>&#41; is a 22-item questionnaire &#40;combination of Likert&#44; dichotomous and frequency scores&#44; and open-ended questions about weight and height&#44; allowing BMI calculation&#41; that assesses the DSM-IV criteria for EDs and generates both a symptom composite scale &#40;reflecting the overall level of disordered eating symptoms&#41; and a diagnostic scale&#46; As detailed elsewhere &#40;<a class="elsevierStyleCrossRef" href="#bib0095">Flament et al&#46;&#44; 2015</a>&#41;&#44; the EDDS also provides all relevant information to assess the DSM-5 criteria for EDs with the exception that items assessing criteria for BED referred to the past 6 months &#40;i&#46;e&#46;&#44; duration stipulation of the DSM-IV&#41;&#46; In our study&#44; these items were adapted to cover the past 3 months &#40;i&#46;e&#46;&#44; duration stipulation of the DSM-5&#41; consistent with the adaption made by prior research&#44; which also provided accompanying &#40;adapted&#41; computer algorithms to generate DSM-5 diagnoses &#40;<a class="elsevierStyleCrossRef" href="#bib0095">Flament et al&#46;&#44; 2015</a>&#41;&#46; By applying these algorithms to the survey data&#44; participants were classified as meeting &#40;or not&#41; DSM-5 criteria for threshold EDs or OSFEDs at T1 and T2&#46; EDs were collapsed across diagnoses and thus measured as a dichotomous variable &#40;present v&#46; absent&#41; in line with prior community-based studies noticing that the prevalence of diagnosable EDs is not in favour of an examination of associations of vulnerability factors with specific threshold ED and OSFED entities &#40;<a class="elsevierStyleCrossRef" href="#bib0130">Stice et al&#46;&#44; 2011</a>&#41;&#44; particularly in men &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al&#46;&#44; 2013</a>&#41;&#46; Employing the Italian Eating Disorder Examination &#40;EDE&#41; 17&#46;0D &#40;<a class="elsevierStyleCrossRef" href="#bib0025">Calugi et al&#46;&#44; 2015</a>&#41; as a gold-standard interview for assessing DSM-5 EDs in our case-control design &#40;described above&#41;&#44; sensitivity &#40;ranging from &#46;91 to &#46;93&#41; and specificity &#40;ranging from &#46;99 to 1&#46;00&#41; of the survey-based diagnoses &#40;based on the EDDS&#41; were excellent at each time point&#46; Since survey data was available for the full sample &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;507&#41;&#44; and in consideration of the high level of agreement between survey-based and interview-based diagnoses &#40;<span class="elsevierStyleItalic">&#954;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;90-&#46;93&#41;&#44; survey-based diagnoses were used in this study to allow diagnostic status of a larger sample to be determined&#44; crucial for examining predictors of ED onset and maintenance separately &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al&#46;&#44; 2013</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Putative factors&#46; The 8-item Body Surveillance subscale of the Italian Objectified Body Consciousness Scale &#40;<a class="elsevierStyleCrossRef" href="#bib0065">Dakanalis&#44; Timko&#44; Clerici et al&#46;&#44; 2015</a>&#41;&#44; which measures the extent to which people consistently think and monitor their own body&#39;s outward appearance from an external observer&#39;s &#40;third-person&#41; perspective&#44; was included as the gold-standard measure of <span class="elsevierStyleItalic">self-objectification</span> &#40;<a class="elsevierStyleCrossRef" href="#bib0140">Tiggemann&#44; 2013</a>&#41;&#46; Following relevant recommendations &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a</a>&#41;&#44; the Italian 10-item Male Body Dissatisfaction Scale &#40;<a class="elsevierStyleCrossRef" href="#bib0070">Dakanalis&#44; Timko&#44; Madeddu et al&#46;&#44; 2015</a>&#41; was included as the gold-standard measure of men&#39;s levels of <span class="elsevierStyleItalic">body dissatisfaction</span>&#46; The 9-item General Internalization subscale of the Italian Sociocultural Attitudes Towards Appearance Questionnaire-3 &#40;<a class="elsevierStyleCrossRefs" href="#bib0030">Conti&#44; 2009&#59; Dakanalis&#44; Zanetti et al&#46;&#44; 2015</a>&#41; and the 10-item Negative Affect subscale of the Italian Positive and Negative Affect Schedule &#40;<a class="elsevierStyleCrossRef" href="#bib0135">Terracciano&#44; McCrae&#44; &#38; Costa&#44; 2003</a>&#41; were used to assess <span class="elsevierStyleItalic">appearance-ideal internalization</span> and <span class="elsevierStyleItalic">negative affectivity</span>&#44; respectively&#46; Finally&#44; and consistent with prior ED research &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0130">Stice et al&#46;&#44; 2011</a>&#41;&#44; the 10-item Restrained Eating subscale of the Italian Dutch Eating Behaviour Questionnaire &#40;<a class="elsevierStyleCrossRef" href="#bib0080">Dakanalis et al&#46;&#44; 2013</a>&#41; was used to measure <span class="elsevierStyleItalic">dieting</span>&#46; In our final analytic sample &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;507&#41;&#44; just as in subgroups of participants with and without EDs&#44; the internal reliability &#40;<span class="elsevierStyleItalic">&#945;</span>&#41; estimates of each measure were &#8805;&#46;91 at each time point&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Procedure</span><p id="par0055" class="elsevierStylePara elsevierViewall">Data for this study was collected following the methodology we have already used successfully in the past and fully detailed elsewhere &#40;<a class="elsevierStyleCrossRefs" href="#bib0050">Dakanalis&#44; Clerici et al&#46;&#44; 2016&#59; Dakanalis&#44; Timko et al&#46;&#44; 2016</a>&#41;&#46; Briefly&#44; students were contacted through the university&#39;s academic information technology centre at each time point&#46; The e-mail message informed students about the study &#40;including the possibility of being contacted&#44; if selected&#44; for a face-to-face interview&#41; and efforts taken to ensure confidentiality of the online data&#44; and directed volunteers to an online survey where they gave electronic informed consent and completed the study measures&#46; The measures were identical at both time points&#44; presented in a counterbalanced order&#44; and formatted so that participants could not skip individual items&#46; Men&#39;s surveys from the two waves were matched &#40;100&#37;&#41; through the university ID &#40;last five digits&#41; and no duplicate or erroneous data suggesting inattentive or random responding to T1 and&#47;or T2 surveys were identified&#46; To allow for independent assessment of ED diagnosis&#44; clinicians with at least 10 years&#8217; experience in assessing and treating men&#39;s EDs conducted all interviews &#40;<span class="elsevierStyleItalic">&#954;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;0 at both time points&#41; in the case-control design described above and detailed elsewhere &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al&#46;&#44; 2013</a>&#41;&#46; All consenting participants provided written informed consent and assessments took place on the college campus &#40;89&#37;&#41; or in participants&#8217; houses&#46; The ethics review board of the co-ordinating body of the project &#40;UniPV&#41; approved the study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Data analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Descriptive statistics on changes in &#40;DSM-5&#41; ED diagnostic status from T1 to T2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; are provided&#46; Differences in T1&#47;baseline putative factors&#47;predictors among four groups of participants &#40;described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; classified based on the presence or absence of an ED at each wave of assessment &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis&#44; Timko et al&#46;&#44; 2016</a>&#41; were assessed in SPSS 21&#46;0 &#40;IBM&#44; NY&#41; through MANOVA&#44; preceded by checking that the data met all assumptions associated with this statistical technique &#40;i&#46;e&#46;&#44; homogeneity of the variance-covariance&#41;&#44; and followed by post-hoc tests &#40;Tukey&#39;s B&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0120">Reid&#44; 2014</a>&#41;&#46; Subsequently&#44; logistic regression models examined the association between each baseline putative predictor &#40;T1&#41; and change in the predictor &#40;T2 - T1&#41; with T2 ED status&#58; &#8220;onset&#8221; &#40;v&#46; onset-free&#41; or &#8220;maintenance&#8221; &#40;v&#46; cessation&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Each predictor &#40;baseline&#47;T1 value and change value&#41; was entered in a separate&#47;individual model that was adjusted for BMI and disordered eating symptom levels at study entry and changes in BMI between assessments&#44; as recommended &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis&#44; Timko et al&#46;&#44; 2016</a>&#41;&#59; because of the results of pre-analyses demographic variables &#40;other than BMI&#41;&#44; described above&#44; were not entered as covariates in the planned analyses&#46; Using SAS 9&#46;3 &#40;Cary&#44; NC&#41; software&#44; one set of these &#40;five&#41; individual models examined the impact of each putative predictor on T2 &#8220;onset&#8221; amongst individuals without an ED at T1&#44; and the second set of models examined the impact of each putative predictor on T2 &#8220;maintenance&#8221; amongst individuals with an ED at T1&#46; Consistent with the study goals&#44; Max-rescaled <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#44; i&#46;e&#46;&#44; the only measure of predictive power offered by SAS 9&#46;3 &#40;Cary&#44; NC&#41; for binary logistic regressions &#40;<a class="elsevierStyleCrossRef" href="#bib0010">Allison&#44; 2012</a>&#41;&#44; examining the <span class="elsevierStyleItalic">explanatory</span>&#44; predictive&#44; <span class="elsevierStyleItalic">value</span> of a model&#44; was calculated for each individual predictor model and for &#40;logistic regression&#41; combined models examining all statistically significant individual predictors and adjustment variables entered together and adjustment variables only&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Descriptive statistics on changes in ED diagnostic status from T1 to T2 appear in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; At T1&#44; 4&#37; of the sample &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41; met DSM-5 criteria for an ED&#46; At 4-year follow-up&#47;T2&#44; 3&#46;3&#37; of the sample &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>83&#41; met DSM-5 criteria for an ED&#44; with 48&#46;2&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; of these cases representing new onset EDs&#44; and 51&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41; of these cases representing men who had maintained an ED from baseline to 4-year follow-up&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; the MANOVA indicated differences on all T1&#47;baseline putative factors across the four groups of participants classified based on the presence or absence of an ED at each wave of assessment&#44; with subsequent post-hoc tests revealing that the groups differed significantly from each other in mean baseline scores of all putative factors&#46; The significant differences between groups that were equivalent in terms of presence or absence of an ED at baseline&#47;T1 but showing different outcomes at follow-up&#47;T2 were of interest&#46; Specifically&#44; the &#8220;onset&#8221; group &#40;i&#46;e&#46;&#44; without an ED at T1 and with an ED at T2&#41; reported greater baseline scores on all putative factors as compared to the &#8220;stable no-ED&#8221;&#44; or onset-free&#44; group &#40;i&#46;e&#46;&#44; without an ED at both time points&#41;&#46; Likewise the &#8220;maintenance&#8221; group &#40;with an ED at both time points&#41; reported greater baseline scores on all putative factors as compared to the &#8220;cessation&#8221; group &#40;i&#46;e&#46;&#44; with an ED at T1 and without an ED at T2&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Odds ratios &#40;<span class="elsevierStyleItalic">OR</span>s&#41; from individual predictor models for associations of predictors with T2 &#8220;onset&#8221; &#40;v&#46; onset-free&#41; and &#8220;maintenance&#8221; &#40;v&#46; cessation&#41; are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Amongst individuals without an ED at baseline&#47;T1 assessment&#44; higher levels of self-objectification&#44; body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity at T1 were significantly associated with the &#8220;onset&#8221; of an ED at T2&#47;follow-up&#46; Amongst those with an ED at T1&#44; higher levels of self-objectification&#44; body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity at T1 were significantly associated with ED &#8220;maintenance&#8221; at T2&#47;follow-up&#46; Changes in all individual predictor variables between assessments &#40;i&#46;e&#46;&#44; from T1 to T2&#41; were also significantly associated with both the &#8220;onset&#8221; and &#8220;maintenance&#8221; of an ED at T2&#47;follow-up&#59; <span class="elsevierStyleItalic">OR</span>s were comparable in magnitude to those for the individual predictor values at T1 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Importantly&#44; we also confirmed significant findings when restricting analyses to those for whom ED diagnosis was checked&#47;confirmed by the clinical interview in the case-control design&#46;<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Examination of max-rescaled <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> values&#44; also reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; indicated that the individual predictor model with the greatest explanatory&#47;predictive value in explaining either &#8220;onset&#8221; &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;41&#41; or &#8220;maintenance&#8221; &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;40&#41; ED was the self-objectification model&#46; In each individual predictor model&#44; the remaining predictors &#40;body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; negative affectivity&#41; had only half &#40;or less&#41; of the explanatory strength for either &#8220;onset&#8221; or &#8220;maintenance&#8221; ED&#46; The explanatory value of the combined model&#44; including all statistically significant individual predictors and adjusted variables&#47;covariates &#40;BMI and disordered eating levels at study entry&#44; and changes in BMI between assessments&#41; entered&#44; was high &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;68 for onset&#44; &#46;67 for maintenance&#41;&#59; the only covariates explained 10&#37; and 11&#37; of the variance in the &#8220;onset&#8221; and &#8220;maintenance ED&#44; respectively&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Using longitudinal data we examined the influence of relevant factors in predicting the onset and maintenance of men&#39;s &#40;DSM-5&#41; EDs at 4-year follow-up&#46; Our findings showed that elevated self-objectification&#44; body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity at baseline as well as changes in these factors between assessments were significantly associated with future ED onset&#46; Interestingly&#44; greater initial levels in the aforementioned five factors as well as changes in these factors between assessments also predicted ED maintenance&#44; with <span class="elsevierStyleItalic">OR</span>s comparable to those for individual predictor variables contributing to the ED onset &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; However&#44; examination of the variance explained by each of the examined factors indicates that men&#39;s self-objectification tendency emerged as the strongest predictor of both ED onset and maintenance&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Our findings regarding body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity converged with those found in prior studies investigating their role on ED onset amongst adolescent girls &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRefs" href="#bib0035">Culbert et al&#46;&#44; 2015&#59; Stice et al&#46;&#44; 2011</a>&#41; and on the development and persistence of college women&#39;s clinically significant ED pathology &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0075">Dakanalis&#44; Timko et al&#46;&#44; 2016</a>&#41;&#46; This implies that the effects of these variables are moderately robust and potentially not gender specific&#46; The findings regarding self-objectification are novel and should inform preventive and treatment research&#46; Hyper-focused attention on&#44; and constant monitoring of&#44; the body&#39;s appearance &#40;characterizing self-objectification&#41; has been consistently found to be an outcome of the appearance-ideal internalization in both sexes &#40;<a class="elsevierStyleCrossRef" href="#bib0140">Tiggemann&#44; 2013</a>&#41;&#46; It has also been found to magnify the discrepancy between actual and ideal body attributes and&#47;or perceived body imperfections &#40;<a class="elsevierStyleCrossRefs" href="#bib0100">Hausenblas et al&#46;&#44; 2013&#59; Riva et al&#46;&#44; 2015</a>&#41;&#46; Thus&#44; self-objectification and its cumulative effect may play a key role in the acceleration of body dissatisfaction&#44; associated affective distress and&#47;or dieting attempts&#44; thereby potentiating meaningful increases in the risk of ED pathology &#40;<a class="elsevierStyleCrossRefs" href="#bib0045">Dakanalis&#44; Carr&#224;&#44; Timko et al&#46;&#44; 2015&#59; Fitzsimmons-Craft et al&#46;&#44; 2011</a>&#41;&#46; Although support for this suggestion came from a recent study that followed &#40;initially&#41; asymptomatic adolescents of both sexes for four years &#40;<a class="elsevierStyleCrossRef" href="#bib0040">Dakanalis&#44; Carr&#224;&#44; Calogero et al&#46;&#44; 2015</a>&#41;&#44; self-objectification might also be involved in the maintenance process of ED pathology &#40;<a class="elsevierStyleCrossRef" href="#bib0140">Tiggemann&#44; 2013</a>&#41;&#46; According to ED scholars&#44; when patients with any ED continue to think and monitor their own body &#8220;from a third-person perspective&#44; factors that contribute significantly to EDs &#40;i&#46;e&#46;&#44; body dissatisfaction&#44; dieting&#44; negative affectivity&#41; remain untouched&#8221; &#40;<a class="elsevierStyleCrossRef" href="#bib0090">Fitzsimmons-Craft et al&#46;&#44; 2011</a>&#44; p&#46; 303&#41;&#46; Research needs to validate this process and clarify the temporal sequence of the potential intervening experiences linking self-objectification to both the onset and persistence of ED pathology &#40;<a class="elsevierStyleCrossRef" href="#bib0125">Riva et al&#46;&#44; 2015</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Even with longitudinal data and statistical control of several factors&#44; unmeasured third variables &#40;i&#46;e&#46;&#44; genetic factors&#41; could account for the relationships observed &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al&#46;&#44; 2015</a>&#41;&#46; The prevalence estimates of any DSM-5 EDs obtained in our sample at baseline&#47;T1 &#40;4&#37;&#41; and 4-year follow-up&#47;T2 &#40;3&#46;3&#37;&#41; are consistent with those reported in comparable community surveys of young adult men &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al&#46;&#44; 2013</a>&#41; and the existing literature on the general population of college-aged men &#40;<a class="elsevierStyleCrossRefs" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a&#59; Raevuori et al&#46;&#44; 2014</a>&#41;&#46; The sample size of symptomatic and asymptomatic participants was also appropriate &#40;i&#46;e&#46;&#44; above the recommended 10&#58;1 cases-to-variable ratio&#44; <a class="elsevierStyleCrossRef" href="#bib0010">Allison&#44; 2012</a>&#41; for individual and combined logistic regression models conducted for examining the impact of each predictor and all five predictors on &#8220;onset&#8221; and &#8220;maintenance&#8221; of any ED &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; respectively&#46; Yet the prevalence of specific DSM-5 ED diagnoses &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; was too low to allow examination of associations of putative factors with specific threshold ED and OSFED entities&#46; Although considerably larger prospective studies will be necessary to address this issue&#44; it is worth noting that prior research supports the &#8220;trans-diagnostic&#8221; relevance of the variables considered in this study &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRefs" href="#bib0035">Culbert et al&#46;&#44; 2015&#59; Dakanalis&#44; Timko&#44; Clerici et al&#46;&#44; 2015&#59; Fitzsimmons-Craft et al&#46;&#44; 2011&#59; Stice et al&#46;&#44; 2011&#59; Tiggemann&#44; 2013</a>&#41;&#46; Additional descriptive data &#40;not shown&#41; indicating that none of T1 or T2 symptomatic participants reported receiving ED treatment before the T1 and between T1 and T2 assessments may suggest that our findings reflect a naturalistic progression of EDs and the vulnerability factors considered in this study&#46; Despite evidence that the presentation format of measures &#40;paper-and-pencil vs&#46; online&#41; did not change the quality of results &#40;e&#46;g&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0070">Dakanalis&#44; Timko&#44; Madeddu et al&#46;&#44; 2015</a>&#41;&#44; all study variables embedded in online surveys were based on self-report data that is potentially susceptible to self-deceptive responding and assessment error &#40;in the case of survey-based diagnoses&#41;&#46; Importantly&#44; survey-based diagnoses demonstrated concurrent validity with interview-based ED diagnoses in our sample&#44; increasing confidence in the reported results&#46; Moreover&#44; we could confirm significant findings also when restricting analyses to those for whom ED diagnosis was checked&#47;confirmed by the clinical interview in the case-control design&#46; Although our analytic sample was representative &#40;as mentioned in methods&#41;&#44; men in the current study came from a selective northern Italian university&#59; thus findings may not generalize to populations of dissimilar demographics&#44; including inpatient samples&#46; However&#44; few available studies also involving men&#44; and examining the stability of ED diagnoses in both community-based &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Holland et al&#46;&#44; 2013</a>&#41; and inpatient &#40;<a class="elsevierStyleCrossRef" href="#bib0110">Keel &#38; Brown&#44; 2010</a>&#41; samples reported rates of remission &#40;57-58&#37;&#41; quite close to those observed in this study &#40;57&#46;4&#37;&#44; i&#46;e&#46;&#44; 58 of 101 men with an ED at T1 did not retain diagnosis at T2&#41;&#44; thereby supporting the representativeness of longitudinal patterns observed in our sample&#46; Additionally&#44; although the duration between T1 and T2 assessment &#40;4 years&#41; was a strength of our study&#44; we were not able to examine potential fluctuations or changes in ED status over the course of illness &#40;i&#46;e&#46;&#44; between T1 and T2&#41;&#44; and the examined factors may have demonstrated important associations with remission and relapse that we were unable to evaluate&#46; In addition&#44; future research should also test for interactions between the examined factors suggestive of qualitatively distinct risk&#47;maintenance pathways &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dakanalis &#38; Riva&#44; 2013a</a>&#41;&#46; This could benefit from&#44; for example&#44; classification tree analyses that are also able to empirically derive cut-points for continuous measures &#40;such as those used in this study for assessing the putative factors&#41; and allowing optimal identification of young adult men at elevated risk for the onset and maintenance of DSM-5 EDs &#40;<a class="elsevierStyleCrossRef" href="#bib0130">Stice et al&#46;&#44; 2011</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Despite the aforementioned limitations&#44; our findings revealing that self-objectification&#44; body dissatisfaction&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity were all predictors of both ED onset and maintenance highlight potentially similar psychological foci for prevention and treatment efforts&#46; Importantly&#44; self-objectification had greater explanatory value with regard to both ED onset and maintenance&#44; as compared to the remaining four traditionally accepted risk&#47;maintenance factors &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al&#46;&#44; 2015</a>&#41;&#46; Thus&#44; a focus on reducing self-objectification might be considered as a potential intervention strategy to prevent and treat young men&#39;s ED pathology&#46; Indeed&#44; recent research revealed that the addition of self-objectification as a target variable within traditional &#40;evidenced-based&#41; cognitive dissonance prevention programmes targeting appearance-ideal internalization&#44; increased the reduction of undergraduate eating and body-related disturbances as well as the small-to medium effect sizes of these traditional programmes &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Culbert et al&#46;&#44; 2015</a>&#41;&#46; The leading empirically supported cognitive-behaviour &#40;CB&#41; treatment for BN&#44; which has been successfully adapted with the goal of making it&#160;&#8220;trans-diagnostic&#8221;&#160;appears &#8220;more effective in reducing ED behavioural symptoms rather than producing changes in body image disturbance&#8221; &#40;<a class="elsevierStyleCrossRef" href="#bib0045">Dakanalis&#44; Carr&#224;&#44; Timko et al&#46;&#44; 2015</a>&#44; p&#46;102&#41;&#46; Hence&#44; the use of CB or other interventions of proven efficacy in combination with promising approaches &#40;i&#46;e&#46;&#44; virtual reality&#41; designed to decrease the hyper-focus on&#44; and scrutiny of&#44; body appearance &#40;characterizing self-objectification&#41;&#44; and to address body dissatisfaction and negative reactions to one&#39;s image&#44; might be helpful to decrease ED pathology and improve treatment outcomes &#40;<a class="elsevierStyleCrossRefs" href="#bib0040">Dakanalis&#44; Carr&#224;&#44; Calogero&#44; Fida et al&#46;&#44; 2015&#59; Dakanalis&#44; Carr&#224;&#44; Calogero&#44; Zanetti et al&#46;&#44; 2015&#59; Dakanalis et al&#46;&#44; 2014&#59; Riva&#44; Gaggioli&#44; &#38; Dakanalis&#44; 2013&#59; Riva et al&#46;&#44; 2015</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">The work was supported by a grant from the Onassis Foundation &#40;O&#47;RG 2010&#47;G&#47;A212&#41;&#46; The authors report no declarations of financial interest&#46;</p></span></span>"
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          "identificador" => "xres729052"
          "titulo" => "Abstract"
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        1 => array:2 [
          "identificador" => "xpalclavsec733125"
          "titulo" => "Keywords"
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          "titulo" => "Resumen"
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          "titulo" => "Palabras clave"
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          "titulo" => "Method"
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            0 => array:2 [
              "identificador" => "sec0010"
              "titulo" => "Design and participants"
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              "identificador" => "sec0020"
              "titulo" => "Procedure"
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              "titulo" => "Data analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Funding"
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        8 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-12-12"
    "fechaAceptado" => "2016-05-09"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec733125"
          "palabras" => array:5 [
            0 => "Eating disorders"
            1 => "Onset"
            2 => "Maintenance"
            3 => "DSM-5"
            4 => "Ex post facto study"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec733126"
          "palabras" => array:5 [
            0 => "Trastornos de la conducta alimentaria"
            1 => "inicio"
            2 => "mantenimiento"
            3 => "DSM-5"
            4 => "estudio ex post facto"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Background&#47;Objective&#58; Eating disorders &#40;EDs&#41; represent serious yet understudied mental health issues&#44; particularly amongst young adult men attending colleges&#44; who are at the average age of onset&#46; Despite this and recent evidence that in young adult men the core ED symptoms are prevalent and remain relatively stable over the college period&#44; little is known about factors associated with both the onset and maintenance of diagnosable EDs in this population&#46; This work sought to address these research gaps&#46; Method&#58; Logistic regression analyses were conducted using data from an on-going longitudinal study of eating and mental health issues to examine the influence of theoretically relevant factors in predicting the onset and maintenance of men&#39;s &#40;DSM-5&#41; EDs at 4-year follow-up &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;507&#41;&#46; Results&#58; Body dissatisfaction&#44; self-objectification&#44; appearance-ideal internalization&#44; dieting&#44; and negative affectivity were all predictors of ED onset and maintenance&#46; Self-objectification was the largest contributor to both ED onset and maintenance&#46; Conclusions&#58; The findings highlight potentially similar psychosocial foci for prevention and treatment efforts&#46; Implications for improving existing preventive and treatment approaches are discussed&#46;</p></span>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Antecedentes&#47;Objetivo&#58; Los trastornos de la conducta alimentaria &#40;TCAs&#41; representan graves&#44; aunque poco estudiados&#44; problemas de salud mental en las universidades&#44; especialmente en hombres j&#243;venes&#44; quienes se encuentran en la edad media de inicio&#46; A pesar de la evidencia de que en hombres adultos j&#243;venes los principales s&#237;ntomas de TCA son frecuentes y se mantienen relativamente estables durante el per&#237;odo universitario&#44; poco se sabe sobre los factores asociados con la aparici&#243;n y el mantenimiento de los TCAs en esta poblaci&#243;n&#46; Este trabajo trata de abordar estas lagunas de investigaci&#243;n&#46; M&#233;todo&#58; Se realizaron an&#225;lisis de regresi&#243;n log&#237;stica utilizando datos de un estudio longitudinal en curso sobre alimentaci&#243;n y salud mental para examinar la influencia de factores te&#243;ricamente relevantes para predecir la aparici&#243;n y el mantenimiento de los TCAs &#40;DSM-5&#41; en hombres durante 4 a&#241;os de seguimiento &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;507&#41;&#46; Resultados&#58; La insatisfacci&#243;n corporal&#44; la auto-objetivaci&#243;n&#44; la internalizaci&#243;n de la apariencia ideal&#44; las dietas&#44; y la afectividad negativa fueron predictores de inicio y mantenimiento de TCA&#46; La auto-objetivaci&#243;n fue el mayor contribuyente a la aparici&#243;n y mantenimiento de TCA&#46; Conclusiones&#58; Los resultados destacan focos similares para su prevenci&#243;n y tratamiento&#46; Se discuten las implicaciones para mejorar los enfoques preventivos y de tratamiento existentes&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Specifically&#44; additional restricting analyses &#40;available on request from the corresponding author due to space constrictions&#41; of those individuals for whom ED diagnosis was confirmed by the clinical interview &#40;i&#46;e&#46;&#44; EDE&#41; in the case-control design &#40;described in the methods&#47;design and participants subsections&#41; produced the same pattern of results&#44; with ORs comparable to results described in Table 3 from analyses of survey-based data&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ED Status</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">At 4-year follow-up&#47;Time 2</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">At baseline&#47;Time 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No ED<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ED<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No ED&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;406 &#40;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;366 &#40;94&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;1&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ED&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;4&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;1&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anorexia Nervosa &#40;AN&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;0&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bulimia Nervosa &#40;BN&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;0&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;0&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;0&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Binge Eating Disorder<span class="elsevierStyleSup">a</span> &#40;BED&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;1&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;0&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;0&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atypical AN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BN of low frequency and&#47;or limited duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;0&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;0&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BED of low frequency and&#47;or limited duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;1&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;0&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Purging Disorder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Changes in DSM-5 eating disorder &#40;ED&#41; status from baseline to 4-year follow-up &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;507&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Definition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stable no-ED &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;366&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Participants without an ED at baseline and 4-year follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onset &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Participants without an ED at baseline and with an ED at 4-year follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maintenance &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Participants with an ED at baseline and 4-year follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cessation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Participants with an ED at baseline and without an ED at 4-year follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline putative factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stable no-ED&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maintenance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cessation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Self-objectification &#40;possible score range&#58; 1-7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;88 &#40;1&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;00 &#40;0&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;89 &#40;0&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;44 &#40;0&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body dissatisfaction &#40;possible score range&#58; 9-54&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;49 &#40;6&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;99 &#40;6&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;05 &#40;5&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;04 &#40;11&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appearance-ideal internalization &#40;possible score range&#58; 9-45&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;55 &#40;5&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;02 &#40;6&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;69 &#40;8&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;99 &#40;3&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dieting &#40;possible score range&#58; 1-5&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;85 &#40;1&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;11 &#40;0&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;83 &#40;0&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;50 &#40;1&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative affectivity &#40;possible score range&#58; 10-50&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;51 &#40;7&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;16 &#40;4&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;96 &#40;5&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;99 &#40;5&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1201592.png"
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          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Variables are expressed as means &#40;standard deviation&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Multivariate <span class="elsevierStyleItalic">F</span>-value &#40;Wilk&#39;s lambda&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#46;47&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#44; <span class="elsevierStyleItalic">&#951;</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">p</span></span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;56 &#40;large effect size&#41;&#59; post-hoc tests &#40;Tukey&#39;s B&#41; revealed that each group significantly differed from each other in all putative factors&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001 &#40;univariate significance&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Differences on baseline putative factors across groups of participants with and without an eating disorder &#40;ED&#41; at baseline and 4-year follow-up&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note&#46;</span> All models are adjusted for body mass index &#40;BMI&#41; and disordered eating levels at study entry&#44; and BMI changes between assessments&#46; All odds ratios are statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> reflects the percentage of variance &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">value</span> x 100&#41; explained by separate &#40;individual&#41; and combined predictor models&#46; Each of the five single &#40;individual&#41; predictor models includes baseline predictor&#44; change in predictor and adjusted variables&#47;covariates&#46; The combined model includes all baseline predictors as well as change in predictor and adjusted variables&#47;covariates&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col">Association of putative factors with ED onset &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;406&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Individual Predictor Model&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; Confidence Interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Max-rescaled <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline self-objectification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;00-5&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in self-objectification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;00-5&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline body dissatisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;78-3&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in body dissatisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;69-3&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline appearance-ideal internalization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;51-2&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in appearance-ideal internalization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;42-2&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline dieting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;04-1&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in dieting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;16-1&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline negative affectivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;41-2&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change in negative affectivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;33-2&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combined models&#58; All significant predictors and covariates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Covariates only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col">Association of putative factors with ED maintenance &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Individual Predictor Model&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Max-rescaled <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline self-objectification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;94&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline body dissatisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Logistic regression analyses predicting eating disorder &#40;ED&#41; onset and maintenance at 4-year follow-up&#46;</p>"
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      "titulo" => "References"
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "Allen et al&#46;&#44; 2013"
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                    0 => array:2 [
                      "titulo" => "DSM&#8211;IV&#8211;TR and DSM-5 eating disorders in adolescents&#58; Prevalence&#44; stability&#44; and psychosocial correlates in a population-based sample of male and female adolescents"
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            1 => array:3 [
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              "etiqueta" => "Allison&#44; 2012"
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                    0 => array:2 [
                      "titulo" => "Logistic Regression Using SAS&#58; Theory and Application"
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                      "titulo" => "Diagnostic and Statistical manual of Mental Disorders &#40;DSM-5&#41;"
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                      "doi" => "10.1002/eat.20945"
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Article information

ISSN: 16972600
Original language: English

DOI:10.1016/j.ijchp.2016.05.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	12	11	23
2024 September	25	14	39
2024 August	29	16	45
2024 July	21	15	36
2024 June	27	15	42
2024 May	13	13	26
2024 April	23	11	34
2024 March	31	12	43
2024 February	19	7	26
2024 January	16	18	34
2023 December	24	14	38
2023 November	26	12	38
2023 October	32	20	52
2023 September	40	7	47
2023 August	15	14	29
2023 July	20	20	40
2023 June	9	11	20
2023 May	22	30	52
2023 April	11	3	14
2023 March	15	6	21
2023 February	18	1	19
2023 January	28	8	36
2022 December	22	14	36
2022 November	26	16	42
2022 October	24	25	49
2022 September	26	30	56
2022 August	22	18	40
2022 July	20	20	40
2022 June	22	12	34
2022 May	23	10	33
2022 April	16	22	38
2022 March	42	12	54
2022 February	26	8	34
2022 January	51	9	60
2021 December	16	11	27
2021 November	17	21	38
2021 October	28	31	59
2021 September	17	21	38
2021 August	26	16	42
2021 July	14	14	28
2021 June	16	14	30
2021 May	29	17	46
2021 April	64	16	80
2021 March	45	12	57
2021 February	23	16	39
2021 January	43	27	70
2020 December	28	35	63
2020 November	24	23	47
2020 October	27	11	38
2020 September	31	16	47
2020 August	27	8	35
2020 July	18	6	24
2020 June	22	14	36
2020 May	26	13	39
2020 April	14	13	27
2020 March	24	7	31
2020 February	25	7	32
2020 January	15	16	31
2019 December	21	14	35
2019 November	18	16	34
2019 October	25	6	31
2019 September	21	9	30
2019 August	16	3	19
2019 July	33	24	57
2019 June	43	22	65
2019 May	70	21	91
2019 April	39	31	70
2019 March	18	11	29
2019 February	23	10	33
2019 January	22	15	37
2018 December	18	14	32
2018 November	31	18	49
2018 October	39	10	49
2018 September	39	9	48
2018 August	8	10	18
2018 July	14	9	23
2018 June	13	0	13
2018 May	6	9	15
2018 April	7	5	12
2018 March	8	3	11
2018 February	8	2	10
2018 January	14	13	27
2017 December	15	1	16
2017 November	18	5	23
2017 October	21	5	26
2017 September	14	13	27
2017 August	18	13	31
2017 July	15	9	24
2017 June	15	15	30
2017 May	20	13	33
2017 April	21	11	32
2017 March	27	27	54
2017 February	18	7	25
2017 January	16	9	25
2016 December	42	13	55
2016 November	54	23	77
2016 October	58	18	76
2016 September	64	23	87
2016 August	5	1	6
2016 July	4	3	7

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