The Association Between ABO, Rh Blood Types and Eating Behaviour

ISSN 2149-2042 e-ISSN 2149-4606 Medeniyet Medical Journal 2018;33(4):314-319 doi:10.5222/MMJ.2018.73558 Original Article/Orijinal Makale Sports Physiology / Spor Fizyolojisi The association between ABO, RH blood types and eating behaviour ABO ve RH kan tipleri ile yeme davranışı arasındaki ilişki Serpil ÇEÇEN1 , Canan EREN2 ID ID ABSTRACT ÖZ Aim: The aim of the present study is to reveal controlled eating, uncontrolled eating and emotional eating behaviours in women referred to the outpatient clinic of Sports Physiology with complaints of obesity, and to search whether an association exists between ABO blood types as well as Rh factor and these behaviours using Three-Factor eating Questionnaire (TFEQ). Amaç: Çalışmamızın amacı, Spor Fizyolojisi Polikliniğine obezite nedeniyle başvuran kadınlarda Three-Factor Eating Questionnaire (TFEQ) kullanarak kontrollü yeme, kontrolsüz yeme ve emosyonel yeme davranışını ortaya koymak ve bu davranışların ABO kan grupları ve Rh faktörü ile ilişkisininin olup olmadığını araştırmaktır. Method: The women between 18 and 65 years of age who referred because of obesity consisted the obesity group (n=197) whereas a control group (n=95) was created from non-obese women who referred to the blood bank as blood donors. Body heights of the women were measured at standing position without shoes. A complete blood analysis was performed including body weight, body mass index, fat percentage, fat weight and lean body weight through bio-impedance (Tanita-BC-418 MA III). The participants were asked to reply the three-factor Eating Questionnaire (TFEQ)-18) which is an international questionnaire evaluating controlled eating, uncontrolled eating and emotional eating behaviour. Blood type and Rh factor analyses were performed in the blood bank. The patient data collected within the scope of the study were analysed through IBM Statistical Package for the Social Sciences (SPSS) for Windows 20.0 package program. Yöntem: On sekiz-altmış beş yaş arası obezite nedeniyle başvuran kadınlardan obezite grubu (n=197), kan bankasına kan dönorü olarak başvuran obez olmayan kadınlardan kontrol grubu oluşturuldu (n= 95). Düz zeminde, çıplak ayakla boy uzunlukları ölçüldü. Daha sonra bioimpedans (Tanita-BC-418 MA III) cihazında kilo, beden kitle indeksi, yağ yüzdesi, yağ ağırlığı ve yağsız ağırlığı gösteren tüm vücut analizi yapıldı. Kontrollü yeme, kontrolsüz yeme ve emosyonel yeme davranışını ölçen uluslararası düzeyde kullanılan, ülkemizde uygunluğu gösterilmiş çalışmaları olan üç faktörlü beslenme anketini (Three-Factor Eating Questionnaire (TFEQ)-18) doldurmaları istendi. Kan grupları ve Rh faktörünün tayini kan bankasında gerçekleştirildi. Çalışma kapsamında toplanan hasta verileri IBM Statistical Package for the Social Sciences (SPSS) for Windows 20.0 paket programı ile analiz edildi. Results: Cognitive restraint was detected to be higher in the blood type A when compared with blood type O whereas uncontrolled eating and emotional eating behaviour were not affected by ABO blood types and Rh factor. Conclusion: A significant result for controlled restriction only in blood type A may guide new studies that will investigate the effect of ABO blood group antigens and Rh factors on eating behaviour. Keywords: Obesity, blood groups, eating behaviour Bulgular: Cognitive restraint (Bilişsel kısıtlama) A kan grubunda O grubuna gore daha yüksek oranda belirlenirken, kontrolsüz yeme ve emosyonel yeme davranışının ABO kan gruplarından ve Rh faktöründen etkilenmediği belirlendi. Sonuç: Bu çalışmada yalnızca A kan grubunda kontrollü kısıtlama açısından anlamlı sonuç belirlenmesi ABO kan grubu antijenlerinin ve Rh faktörünün yeme davranışı üzerine etkisini araştırmak açısından daha yeni çalışmalara yol gösterici olabilir. Anahtar kelimeler: Obesite, kan grupları, yeme davranışı Received: 17.08.2018 Accepted: 11.10.2018 1 Marmara University Pendik Training and Research Hospital, Department of Sports Physiology, İstanbul, Turkey 2 Marmara University Pendik Training and Research Hospital, Department of Blood Bank, İstanbul, Turkey Corresponding author: Serpil Çeçen, Marmara University Pendik Training and Research Hospital, Department of Sports Physiology, İstanbul, Turkey e-mail: tahirer34@gmail.com ORCID ID’s: S.Ç. 0000-0002-7908-5208, C.E. 0000-0003-4726-8840 314 S. Çeçen et al., The association between ABO, RH blood types and eating behaviour INTRODUCTION Since obesity is a significant health problem whose incidence increases rapidly all over the world; number of investigations on obesity also increase. Obesity is defined as a supraphysiological increase of adipose tissue in the body1. Increase in adipose tissue leads to an increase in the risk of development of some diseases including Type 2 diabetes mellitus, coronary heart disease and cancer2. Obesity has been known to have multifactorial etiology and also associated with the eating behaviour of the individual. Food type choice, food intake and meal time are determined by eating behaviour3. Eating behaviour may vary in certain cases such as different mood, environmental and social factors4. Therefore, it is important to understand why we eat. Three-Factor Eating Questionnaire (TFEQV) is a method used for such objective which was firstly published by Stunkard and Messick in 1985. The questionnaire includes 51 items and evaluates the desire to eat in three categories as as restraint, disinhibition and hunger5. Later, Karlsson et al.6 revised the aforesaid questionnaire and limited with 18 questions which assess cognitive restraint, uncontrolled eating and emotional eating. The three eating behaviours assessed by TFEQ-18 include cognitive restraint (questions 2, 11, 12, 15, 16, and 18), uncontrolled eating (questions 1, 4, 5, 7, 8, 9, 13, 14 and 17) and emotional eating (questions 3, 6, and 10). Cognitive restraint is defined as being consciously careful in food selection not to gain weight7. Uncontrolled eating is defined as a strong desire for food consumption without thinking its consequences, emotional eating is also defined as increased food consumption in response to negative emotional stimuli such as anxiety, depression and anger6,8. ABO blood groups were first identified by Karl Landsteiner in 1901 according to presence of A and B antigens on membrane of red blood cells. Landsteiner and Alexander Wiener identified the Rh factor together in 1940-19419,10. The antigens of the ABO blood group system are complex carbohydrate molecules on the extracellular surface of red blood cell membranes11. ABO antigens are also highly expressed on the surface of a variety of human cells and tissues including the epithelium, sensory neurons, platelets, and the vascular endothelium12. Although existence of the association between blood types and the mood is limited with previous studies, it was shown that groups O and B are active, aggressive, progressive, and positive; and groups A and AB are conservative, passive, defensive, negative personalities13. Since the association between the mood and eating behaviour is known, the aim of the present study is to show if any association exists between the blood types and eating behaviour14. MATERIAL and METHODS This study was conducted in the Sports Physiology Clinic of the Marmara University Pendik Training and Research Hospital, Istanbul, Turkey. The subjects in the obese group were the female outpatients of the clinic aged between 18 and 65 years old. A control group was created from non-obese individuals who referred to donate blood to the hospital’s blood bank. Body height was measured on a flat surface without shoes; weight, BMI, fat percentage, fat mass and fat free mass of the patients were determined using a bio-impedance device (Tanita-BC-418 MA III). After collection of 2 ml of blood from each patient into EDTA containing tubes, ABO and Rh blood groups were determined via Forward Reverse Microplack method. Statistical methods: The patient data collected within the scope of the study were analysed using IBM Statistical Package for the Social Sciences (SPSS) for Windows 20.0 package program. Frequency and percentage were used for discrete data whereas mean ± standard deviation, median, minimum and maximum values were used for continuous data. The independent sample’s T-test was used to compare averages of two groups whereas ANOVA test was utilized to compare averages of three groups. Chi-Square Test was used to compare two discrete groups. The change in questionnaire scores according to the study gro- 315 Med Med J 2018;33(4):314-319 ups was examined; ANCOVA Test was used to analyse the effect of blood type. The p value below 0.05 was accepted as statistically significant. Table 2. Distribution of Blood groups. Blood Group n % Obesity (n=197) 0 A B AB 57 84 29 27 28.9 42.6 14.7 13.7 Control (n=95) 0 A B AB 40 33 15 7 42.1 34.7 15.8 7.4 Overall (n=292) 0 A B AB 97 117 44 34 33.2 40.1 15.1 11.6 Rh Factor n % Obesity (n=197) Positive Negative 177 20 89.8 10.2 Table 2 shows the distribution of blood groups. While obese group had a higher percentage of A blood type, O blood type percentage was higher in the control group. Control (n=95) Positive Negative 78 17 82.1 17.9 Overall (n=292) Positive Negative 255 37 87.3 12.7 Table 3 illustrates the Rh factor distribution. Both obese and control groups had higher percentage of Rh positive values. The cognitive restraint was detected to be higher in blood group A than blood group O; and uncontrolled, and emotional eating behaviours were not affected by ABO blood groups and Rh factor (Tables 4, 5, 6). Approval of the Ethics Committee: The present study was approved by the Research Ethics Committee. Participants were informed that their participation is completely voluntary; and written consent was obtained from each participant. RESULTS Table 1 shows average values for age, weight, body mass index, fat percentage, fat weight and fat -free weight of obese and control individuals who took part in our study. The average body weights for the obese, and the control groups were 90, and 55.8 kg, respectively. Table 3. Distribution of Rh factor. Table 1. Distribution of demographic characteristics of the Participants. Age (year) Height (cm) Weight (kg) Body Mass Index (BMI) Body Fat Percentage Body Fat Mass Body Muscle Mass Obesity (n=197) Mean Median Std. Deviation Minimum Maximum 33.7 34.0 7.6 17.0 54.0 159.9 159.0 6.2 143.0 180.0 90.1 84.4 22.6 55.8 167.6 35.2 33.4 7.8 24.3 65.5 40.8 40.0 6.8 25.6 63.1 37.9 33. 15.7 15.6 99.0 52.2 50.8 7.6 38.4 77.6 Control (n=95) Mean Median Std. Deviation Minimum Maximum 30.7 30.0 7.6 17.0 49.0 161.0 161.0 6.2 137.0 179.0 55.8 55.0 8.9 35.1 99.3 21.4 21.1 2.7 16.6 39.8 24.0 24.0 6.6 7.8 46.9 14.0 13.5 6.1 3.7 46.6 41.6 41.6 3.6 31.4 52.8 Overall (N=292) Mean Median Std. Deviation Minimum Maximum 32.7 33.0 7.7 17.0 54.0 160.3 160.0 6.2 137.0 180.0 78.9 74.9 25.0 35.1 167.6 30.7 29.7 9.2 16.6 65.5 35.3 36.3 10.3 7.8 63.1 30.2 27.1 17.4 3.7 99.0 48.8 47.8 8.2 31.4 77.6 316 S. Çeçen et al., The association between ABO, RH blood types and eating behaviour Table 4. Comparison results of subgroups of eating questionnaire according to blood groups. Table 7. Evaluation of eating behaviours according to groups. Group Blood Group (Obesity) Cognitive restraint Uncontrolled Eating Emotional Hunger 0 A B AB 0 A B AB 0 A B AB n Mean Std. Deviation p 57 84 29 26 57 84 29 26 57 84 29 27 2.42 2.73 2.70 2.57 2.31 2.24 2.29 2.26 2.68 2.45 2.51 2.58 0.614 0.588 0.623 0.658 0.663 0.669 0.716 0.715 1.006 0.985 0.932 0.927 0.954 Cognitive Restraint Obesity Control Uncontrolled Eating Obesity Control Emotional Hunger Obesity Control 0.579 DISCUSSION p<0.05 Table 5. Results of subgroups of eating questionnaire according to Rh factor. Rh Factor (Obesity) n Mean Std. Deviation p Cognitive restraint Positive Negative Uncontrolled Eating Positive Negative Emotional Hunger Positive Negative 176 20 176 20 177 20 2.59 2.78 2.29 2.14 2.54 2.55 Rh Factor (Control) n Mean Std. Deviation P Cognitive restraint 78 17 78 17 78 17 2.31 2.28 1.99 1.96 1.93 1.86 Positive Negative Uncontrolled Eating Positive Negative Emotional Hunger Positive Negative 0.617 0.642 0.661 0.801 0.963 1.088 0.651 0.606 0.624 0.620 0.787 0.825 0.208 0.360 0.987 0.873 0.852 0.732 Table 6. Results of subgroups of eating questionnaire according to blood groups. Blood Group (Control) n Mean Std. Deviation p Cognitive restraint 0 A B AB 40 33 15 7 2.31 2.32 2.35 2.04 0.639 0.655 0.666 0.598 0.740 Uncontrolled Eating 0 A B AB 40 33 15 7 2.00 1.90 1.99 2.31 0.584 0.662 0.576 0.735 0.476 Emotional Hunger 0 A B AB 40 33 15 7 1.99 1.82 1.86 2.09 0.821 0.791 0.814 0.629 0.763 n Mean Std. Deviation p 196 95 196 95 197 95 2.61 2.30 2.27 1.99 2.54 1.92 0.620 0.640 0.676 0.620 0.973 0.790 p<00.1 p<00.5 p<00.1 The frequency of cognitive restraint was detected to be higher in obese people with blood type A when compared to those with blood type O; it was also detected that uncontrolled eating and emotional behaviours are not affected by ABO blood groups and Rh factor. The association between eating behaviours and obesity: There are studies suggesting that eating behaviour is an important factor for obesity and depends on BMI and gender. It was shown that uncontrolled eating, cognitive restraint and emotional eating behaviour increase with increasing BMI15. Restraint and Disinhibition scores were shown to be higher in females when compared with males16. In a study where TFEQ was used, it was noted that women who had higher levels of worry and anxiety more frequently displayed much higher level of emotional eating behavior17. In a study carried out with two groups including nonobese adults and teenagers, cognitive restraint (CR) and emotional eating (EE) were detected more frequently in females of both groups according to TFEQR18 scores18. The cognitive restraint scale scores were found to be significantly lower whereas uncontrolled eating and emotional eating scale scores were detected to be lower in the individuals with lower BMI when compared to overweighed individuals in a study conducted on adolescents between 17 and 19 years of age in Kırklareli University; however, the results were not statistically significant19. In the present study, uncontrolled eating, cognitive restraint and emotional eating behaviour appears to be more frequent in the obesity group when compared with the control 317 Med Med J 2018;33(4):314-319 groups (Table 7). Although there is not any significant difference between groups A and O in terms of body weight and BMI, while restriction behaviour was less frequently detected in patients with blood group A when compared with those with group O. The association between the blood groups and obesity: There are studies suggesting the possible association between obesity and blood groups. In a study conducted on Turkish seafarers, groups AB Rh (+) and AB Rh (-) were associated with the highest (13.7% and 13.6%, respectively) and B Rh (+) and B Rh (-) with the lowest percentages (11.6% and 11.3%, respectively) of obese subjects20. The individuals with B Rh (+) blood type were found to be more susceptible for obesity. This case was explained by the assertion that patients with blood group B may be more inclined to obesity21,22. However, there was not any association detected between obesity and blood groups in a study conducted in Saudi Arabia23. The association between blood groups and diseases: to be genetically associated with schizophrenia and depression, respectively29. In previous studies, dopamine-3-hydroxylase enzyme activity which induces transformation of dopamine to norepinephrine was found to be lower in blood group O; therefore the individuals with blood group O were considered as more susceptible for psychiatric diseases. Dopamine-3-hydroxylase enzyme activity was shown to be controlled by a locus dependent on ABO blood group locus30-32. Despite different incidence rates and conflicting studies, the association shown between depression and blood groups is considered to affect eating behaviour. The association between emotional eating behaviour and depression is well known33. It is also known that such eating behaviour uses the dependence mechanism34. Existence of an association between AB, Rh negative blood group and opioid addiction was considered to be related to locus of a gene on chromosome 635. However, any association between Rh factor and emotional eating behaviour could not be detected in the present study. It was considered in 1953 that the individuals with A blood group had more risk for gastric cancer24, in another study, the non-O blood groups were found to be associated with renal cell cancer, coronary artery disease, myocardial infarction, venous thrombosis2527 which was suggested as dependent to the antigens and ABO locus. The significance in controlled restriction behaviours in the blood group A in the present study supports the aforesaid studies suggesting the possible effect of antigen and gene locus. CONCLUSIONS The association between the blood groups and mood: REFERENCES Despite conflicting outcomes, there are studies suggesting the association between blood groups and psychiatric diseases. The studies have detected that psychiatric diseases are three-fold more common in individuals with AB blood groups when compared with other groups28. 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