{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:45:16Z","timestamp":1793313916691,"version":"4.5.0"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Orthorexia nervosa (ON) has attracted increasing attention in recent years, and the Orthorexia Nervosa Inventory (ONI) is one of the most widely used instruments for assessing ON. As research on ON expands across different cultural contexts, multiple countries have conducted translation and cultural adaptation studies of the ONI. However, the methodological quality of these translation procedures and the psychometric properties of the adapted versions have not yet been systematically synthesized and compared. Guided by the COSMIN framework, this systematic review aimed to evaluate the measurement quality of cross-culturally adapted ONI versions and to provide evidence for the standardized use of the ONI in clinical and research settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review followed the COSMIN and PRISMA recommendations and was prospectively registered in PROSPERO (CRD420251218905). Using \u201cOrthorexia Nervosa Inventory\u201d and related terms, we systematically searched PubMed, Scopus, the Web of Science, Embase, and the China National Knowledge Infrastructure (CNKI) up to November 2025. We included peer-reviewed original studies published in English or Chinese that reported the translation and\/or cultural adaptation of the ONI and its psychometric properties. Furthermore, two reviewers independently performed study selection and data extraction. Translation and adaptation methods were appraised using \u201cGuidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures\u201d from Beaton et al. Measurement properties were evaluated using the quality criteria of Terwee et al. and the COSMIN Risk of Bias checklist across domains including structural validity, internal consistency, reliability, measurement error, construct validity, and responsiveness. A narrative synthesis was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The search yielded 280 records, of which five studies met the inclusion criteria, covering four countries and five language versions of the ONI (Chinese, Italian, Hungarian, and two Turkish versions). There was substantial heterogeneity in translation and cultural adaptation procedures. Only one Turkish version fully reported all five steps recommended by Beaton\u2019s guidelines. Approximately 80% of the studies fulfilled the requirements for forward\u2013backward translation and synthesis, whereas only approximately 40% reported an expert committee review and 40% reported pretesting. According to COSMIN ratings, approximately 60% of the studies were judged \u201cvery good\u201d for structural validity, with the majority of versions supported by exploratory factor analysis (EFA) and\/or confirmatory factor analysis (CFA) that broadly confirmed the intended factor structure. All five studies reported acceptable internal consistency (Cronbach\u2019s \u03b1 or\n                      <jats:italic>\u03c9<\/jats:italic>\n                      for the total scale and subscales was within the recommended ranges). However, only the Chinese version provided data on test\u2013retest reliability and measurement error\/minimal detectable change (MDC), and measurement error was primarily estimated via the standard error of measurement (SEM) derived from Cronbach\u2019s \u03b1, without interpretation against a minimal important change. Evidence for construct validity was limited: Only a subset of studies tested predefined hypotheses using correlations with related measures or known-groups comparisons, and these studies were mostly rated as \u201cadequate\u201d or \u201cdoubtful.\u201d None of the included studies conducted multi-group factor analysis or differential item functioning (DIF) to assess cross-cultural validity\/measurement invariance, and no study reported responsiveness or ROC-based cut-off determination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Existing cross-cultural versions of the ONI demonstrate generally good internal consistency and preliminary support for structural validity. Nonetheless, important gaps remain in the rigor of translation procedures, test\u2013retest reliability, measurement error, and construct validity, with a striking absence of evidence on cross-cultural validity and responsiveness. Future research should rigorously adhere to established cross-cultural adaptation guidelines and COSMIN methodological standards, incorporate multi-group CFA to examine measurement invariance, and comprehensively assess test\u2013retest reliability, measurement error, and responsiveness. In addition, clinically and functionally meaningful cut-off scores should be established to enhance the applicability and comparability of the ONI across diverse cultural contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251218905<\/jats:uri>\n                      , Identifier: CRD420251218905.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1747648","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T07:03:22Z","timestamp":1772607802000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A COSMIN-based systematic review of the measurement properties of cross-cultural versions of the orthorexia nervosa inventory"],"prefix":"10.3389","volume":"17","author":[{"given":"Hanqing","family":"Zhang","sequence":"first","affiliation":[{"name":"The Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]},{"name":"Faculty of Public Health, Mahidol University","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaolumen","family":"Bao","sequence":"additional","affiliation":[{"name":"The Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]},{"name":"Faculty of Social Sciences and Humanities, Mahidol University","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1111\/cch.13086","article-title":"Systematic review of the psychometric properties of cultural adaptations and translations of the children's assessment of participation and enjoyment (cape)","volume":"49","author":"Abid","year":"2023","journal-title":"Child Care Health Dev."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"106134","DOI":"10.1016\/j.appet.2022.106134","article-title":"Orthorexia nervosa and eating disorder behaviors: a systematic review of the literature","volume":"177","author":"Atchison","year":"2022","journal-title":"Appetite"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1016\/j.appet.2016.07.008","article-title":"Organivore or organorexic? 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