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Abstract
Eating disorders affect a significant number of individuals across the life span and are found among all demographic groups (including all genders, socioeconomic statuses, and ethnicities). They can cause malnutrition, which can have significant effects on every organ system in the body. Cardiovascular complications are particularly dangerous and cause eating disorders to have the highest mortality rate of all mental illnesses. This article outlines the medical assessment and treatment of malnutrition due to disordered eating.
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Affiliation(s)
- Rebecka Peebles
- Eating Disorder Assessment and Treatment Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Roberts Center for Pediatric Research, 2716 South Street, Room 14360, Philadelphia, PA 19146, USA.
| | - Erin Hayley Sieke
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard 9NW55, Philadelphia, PA 19104, USA
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Abstract
Anorexia nervosa (AN) is an eating disorder that is difficult to treat, and relapse is common. This article addresses management strategies and nursing interventions for adolescents diagnosed with AN.
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Affiliation(s)
- Kathleen Peterson
- Kathleen Peterson is a professor of nursing at The College at Brockport, State University of New York. Rebecca Fuller is a level III clinical nurse at Golisano Children's Hospital, University of Rochester in N.Y
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Vo PT, Racine SE, Burt SA, Klump KL. Convergence in maternal and child reports of impulsivity, depressive symptoms, and trait anxiety, and their predictive utility for binge-eating behaviors. Int J Eat Disord 2019; 52:1058-1064. [PMID: 31318081 PMCID: PMC7439218 DOI: 10.1002/eat.23139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Early detection of binge-eating (BE) behaviors and their risk factors is associated with better outcomes. A multi-informant approach for assessing BE psychopathology and risk factors has been emphasized to increase the probability and accuracy of early detection. Impulsivity (particularly negative and positive urgency), trait anxiety, and depressive symptoms are associated with BE behaviors. The present study examined maternal-child convergence of reports of child BE, impulsivity, trait anxiety, and depressive symptoms and examined the predictive power of maternal reports for child-reported BE behaviors. METHOD Participants included 927 female twins (aged 8-16 years) and 468 mothers from the Michigan State University Twin Registry. Risk factors and BE were assessed with self-report questionnaires. RESULTS Intraclass correlation coefficients showed fair-to-moderate inter-rater agreement (ICCs = .31-.41) between maternal and child reports of risk factors and low-to-fair agreement for BE (ICCs = .05-.29). Controlling for the effects of age, pubertal status, body mass index, and family relatedness, multilevel models showed that maternal reports of child impulsivity, anxiety, and depressive symptoms did not add predictive power above and beyond child reports. DISCUSSION Results call into question the utility and practical implications of using maternal reports to supplement child reports for BE and its risk factors.
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Affiliation(s)
- Phuong T. Vo
- Department of Psychology, Michigan State University
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Herpertz-Dahlmann B, Dahmen B. Children in Need-Diagnostics, Epidemiology, Treatment and Outcome of Early Onset Anorexia Nervosa. Nutrients 2019; 11:E1932. [PMID: 31426409 PMCID: PMC6722835 DOI: 10.3390/nu11081932] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022] Open
Abstract
Knowledge of anorexia nervosa (AN) in childhood is scarce. This review gives a state-of-the-art overview on the definition, classification, epidemiology and etiology of this serious disorder. The typical features of childhood AN in comparison to adolescent AN and avoidant restrictive eating disorder (ARFID) are described. Other important issues discussed in this article are somatic and psychiatric comorbidity, differential diagnoses and medical and psychological assessment of young patients with AN. Special problems in the medical and psychological treatment of AN in children are listed, although very few studies have investigated age-specific treatment strategies. The physical and mental outcomes of childhood AN appear to be worse than those of adolescent AN, although the causes for these outcomes are unclear. There is an urgent need for ongoing intensive research to reduce the consequences of this debilitating disorder of childhood and to help patients recover.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany.
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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Sterling W, Crosbie C, Shaw N, Martin S. The Use of the Plate-by-Plate Approach for Adolescents Undergoing Family-Based Treatment. J Acad Nutr Diet 2019; 119:1075-1084. [DOI: 10.1016/j.jand.2018.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/18/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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Luzier J, Rached K, Talley J. Relapse prevention and selective serotonin reuptake inhibitor medication in two adolescents with anorexia nervosa. Int J Eat Disord 2019; 52:863-867. [PMID: 31081553 DOI: 10.1002/eat.23092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/12/2019] [Accepted: 04/28/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Clinicians and researchers have long struggled to find effective treatments for people with anorexia nervosa (AN). Although most clinical guidance suggests that selective-serotonin reuptake inhibitor (SSRI) medication is not an effective first-line treatment for AN, in practice, these medicines continue to be frequently prescribed for comorbid diagnoses. METHOD In this case report, two adolescents who were in sustained remission from AN either relapsed or began to decline significantly once their dose of SSRI medication was tapered. RESULTS In Case A, despite a very slow and measured taper, this child dropped significant weight in a short amount of time after the medication was discontinued. Fortunately for Case B, symptoms emerged before the taper was complete, and providers could quickly increase the dose of medication early in her struggle with AN thoughts and urges. DISCUSSION A brief review of literature regarding SSRI medication use in AN is presented along with considerations for future research.
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Affiliation(s)
- Jessica Luzier
- West Virginia University Department of Behavioral Medicine and Psychiatry, WVU School of Medicine - Charleston Division, Charleston, West Virginia
| | - Kristina Rached
- Psychiatry Residency, Charleston Area Medical Center, Charleston, West Virginia
| | - Jessica Talley
- West Virginia University Department of Behavioral Medicine and Psychiatry, WVU School of Medicine - Charleston Division, Charleston, West Virginia
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Buchman S, Attia E, Dawson L, Steinglass JE. Steps of care for adolescents with anorexia nervosa-A Delphi study. Int J Eat Disord 2019; 52:777-785. [PMID: 31058331 PMCID: PMC7147487 DOI: 10.1002/eat.23088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) commonly develops during adolescence. Existing literature offers some treatment guidelines, but clear clinical criteria for initial recommendations and steps of care are needed. The aim of the present study was to develop expert consensus for a stepped-care algorithm for treatment of adolescents with AN. METHOD The Delphi approach was used to identify clinical parameters that guide initial treatment recommendations and recommendations for transitions between levels of care. The Delphi approach provides a useful expert consensus when empirical data are limited. Individuals with at least 10 years of experience in the field of adolescent AN and membership in one of three professional organizations were recruited. Twenty-five panelists participated in three rounds of iterative online questionnaires. RESULTS Consensus was achieved on several features of a treatment algorithm. Hospitalization is recommended when medical instability, suicidality, or acute food refusal are present at any point in treatment. Family-based treatment (FBT) is recommended as the first-line treatment, with a few exceptions. Consensus was not reached on when to transition from a higher level of care to a lower level of care. DISCUSSION Expert opinion was used to develop a consensus-based algorithm for care of adolescents with AN. Future research is needed to test whether these recommendations can be used to optimize outcomes for adolescents with AN.
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Affiliation(s)
- Samantha Buchman
- Weill Cornell Medicine, New York-Presbyterian Hospital, White Plains, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
| | - Lisa Dawson
- Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital Sydney, Eating Disorder Service, The Children's Hospital at Westmead, Camperdown, New South Wales, Australia
| | - Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
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Zakharova IN, Dmitrieva YA, Sugyan NG, Simakova MA. Malnutrition in pediatric practice: differential diagnosis and possibilities for nutritional support. ACTA ACUST UNITED AC 2019. [DOI: 10.21518/2079-701x-2019-2-200-208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nutrition is of great importance in maintaining normal growth and development of the child, ensuring the ability to learn and resistance to adverse environmental factors. Due to the higher need for nutrients, limited nutrient reserves, and particular characteristics of metabolic processes, children are more prone to the development of various nutritional disorders, in particular, protein and energy deficiency. The nutritional factor becomes of great importance on the background of the accompanying acute and chronic diseases in children. The studies convincingly demonstrated that malnutrition leads to a prolongation of hospital stay, increased frequency of complications and increased risk of adverse outcomes. Therefore, timely diagnosis of nutritional disorders is an essential factor in maintaining health and improving the children’s quality of life. The article presents the current classification of malnutritiion, illustrates the main stages of the anthropometric examination, identifies approaches to the differential diagnosis of protein-energy deficiency causes, and discusses the possibilities of nutritional support using specialized mixtures.
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Affiliation(s)
- I. N. Zakharova
- Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Health of the Russian Federation; State Budgetary Institution of Health Care of the City of Moscow «Children’s City Clinical Hospital named after Z.A. Bashlayeva» of the Department of Healthcare of the city of Moscow
| | - Yu. A. Dmitrieva
- Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Health of the Russian Federation; State Budgetary Institution of Health Care of the City of Moscow «Children’s City Clinical Hospital named after Z.A. Bashlayeva» of the Department of Healthcare of the city of Moscow
| | - N. G. Sugyan
- Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Health of the Russian Federation; State Budgetary Institution of Health Care of the City of Moscow «Children’s City Clinical Hospital named after Z.A. Bashlayeva» of the Department of Healthcare of the city of Moscow; State Budgetary Healthcare Institution of Moscow «Children’s City Outpatient Clinic No 133 of Moscow Health Department»
| | - M. A. Simakova
- Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Health of the Russian Federation; State Budgetary Institution of Health Care of the City of Moscow «Children’s City Clinical Hospital named after Z.A. Bashlayeva» of the Department of Healthcare of the city of Moscow
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Goldhammer HB, Maston ED, Keuroghlian AS. Addressing Eating Disorders and Body Dissatisfaction in Sexual and Gender Minority Youth. Am J Prev Med 2019; 56:318-322. [PMID: 30554976 DOI: 10.1016/j.amepre.2018.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Hilary B Goldhammer
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Essence D Maston
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Alex S Keuroghlian
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Shared Concerns and Opportunity for Joint Action in Creating a Food Environment That Supports Health. Nutrients 2018; 11:nu11010041. [PMID: 30585215 PMCID: PMC6357161 DOI: 10.3390/nu11010041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 11/21/2022] Open
Abstract
The food industry is a for-profit industry with high relevance to universal eating disorders prevention. To date, policy which targets the food industry and food environment has been underutilized in efforts to decrease the incidence of eating disorders and associated risk factors. In contrast, food policy has been extensively leveraged with the aim of reducing the incidence of obesity. While philosophical misalignments with these later efforts may have constituted an obstacle to identifying the food environment as a key target for eating disorders prevention, food policy is an area where shared interests can be found. Specifically, a shared goal of obesity and eating disorders prevention efforts is creating a food environment that supports health, while minimizing the influence of the food industry that profits from the sale of highly palatable, processed foods and “diet” foods and from increasing portions of foods served and eaten.
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Pasold TL, Woods JL, Portilla MG, Nesmith JD, Boateng BA. An examination of eating disorder education and experience in a 1-month adolescent medicine rotation: what is sufficient to foster adequate self-efficacy? Int J Adolesc Med Health 2018; 32:ijamh-2017-0212. [PMID: 29953405 DOI: 10.1515/ijamh-2017-0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/25/2018] [Indexed: 11/15/2022]
Abstract
Objective Medical students and professionals report receiving limited education/training related to treating eating disorders. Because medical professionals are the point of initial contact for these patients and are involved necessarily in their treatment, sufficient knowledge on identification and intervention are imperative. This research set out to examine the impact of the eating disorder education and experience offered through a 1-month Adolescent Medicine rotation at a medical university on medical student/resident self-efficacy. Methods The 1-month rotation includes a standardized patient (SP) simulation, 1.5 h of didactic education, and 1 day observing the MD, nutritionist and psychologist within the outpatient Multidisciplinary Child/Adolescent Eating Disorders Clinic. All residents' (n = 132) eating disorder self-efficacy was assessed before (PRE) completing simulation and didactic session and again at the end of the 1-month rotation (END). Self-efficacy was also assessed after simulation and before the didactic session for group 1 (n = 92) and after simulation and didactic session for group 2 (n = 40). Results For group 1, self-efficacy was not significantly impacted PRE to POST. For group 2, self-efficacy significantly improved PRE to POST. POST to END changes were significant for both groups; however, group 2 scored significantly better across all self-efficacy areas at END. Conclusion Resident training in eating disorders requires more than is offered in many residency programs. SP simulation is strengthened as an effective training tool in assessing and promoting resident self-efficacy if it is followed by didactic education. Clinical observation and extended practice that includes ongoing guidance/feedback on performance is recommended in fostering self-efficacy.
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Affiliation(s)
- Tracie L Pasold
- Marywood University, 2300 Adams Avenue, Scranton, PA 18509, USA, Phone: +570-348-6211, Ext: 2265; Fax: +570-340-6040
| | - Jennifer L Woods
- Department of Pediatrics, Children's Hospital Colorado, Aurora Anschutz Outpatient Pavilion, Aurora, CO, USA
| | - Maria G Portilla
- Eating Disorder Clinic, Department Student Health, University of Virginia, Charlottesville, VA, USA
| | - James D Nesmith
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Beatrice A Boateng
- Office of Education and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Nikander K, Kosola S, Kaila M, Hermanson E. Who benefit from school doctors' health checks: a prospective study of a screening method. BMC Health Serv Res 2018; 18:501. [PMID: 29945604 PMCID: PMC6020452 DOI: 10.1186/s12913-018-3295-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND School health services provide an excellent opportunity for the detection and treatment of children at risk of later health problems. However, the optimal use of school doctors' skills and expertise remains unknown. Furthermore, no validated method for screening children for school doctors' assessments exists. The aims of the study are 1) to evaluate the benefits or harm of school doctors' routine health checks in primary school grades 1 and 5 (at ages 7 and 11) and 2) to explore whether some of the school doctors' routine health checks can be omitted using study questionnaires. METHODS This is a prospective, multicenter observational study conducted in four urban municipalities in Southern Finland by comparing the need for a school doctor's assessment to the benefit gained from it. We will recruit a random sample of 1050 children from 21 schools from primary school grades 1 and 5. Before the school doctor's health check, parents, nurses and teachers fill a study questionnaire to identify any potential concerns about each child. Doctors, blinded to the questionnaire responses, complete an electronic report after the appointment, including given instructions and follow-up plans. The child, parent, doctor and researchers assess the benefit of the health check. The researchers compare the need for a doctor's appointment to the benefit gained from it. At one year after the health check, we will analyze the implementation of the doctors' interventions and follow-up plans. DISCUSSION The study will increase our knowledge of the benefits of school doctors' routine health checks and assess the developed screening method. We hypothesize that targeting the health checks to the children in greatest need would increase the quality of school health services. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03178331 , date of registration June 6 th 2017.
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Affiliation(s)
- Kirsi Nikander
- School and Student Healthcare, Department of Social Services and Healthcare, City of Helsinki, Finland
- Doctoral School in Health Sciences, Doctoral Program in Population Health, University of Helsinki, Helsinki, Finland
| | - Silja Kosola
- Medical Services for Children and Adolescents, Department of Social Services and Healthcare, City of Helsinki, Finland
- Helsinki University Hospital, Children’s Hospital and University of Helsinki, Helsinki, Finland
| | - Minna Kaila
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Hermanson
- Pikkujätti Medical Centre for Children and Youth, Helsinki, Finland
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Sonneville KR, Lipson SK. Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. Int J Eat Disord 2018; 51:518-526. [PMID: 29500865 DOI: 10.1002/eat.22846] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Eating disorders (EDs) present a significant threat to the health of adolescents and young adults, yet remain under-diagnosed and under-treated at a population-level. EDs have historically been thought to afflict "skinny, white, affluent girls" (the SWAG stereotype). As such, higher-weight individuals, racial/ethnic minorities, those from socioeconomically disadvantaged backgrounds, and males may not recognize their need for treatment, may not be properly screened for EDs, and/or may not be referred to treatment. METHOD Using large-scale survey data from the healthy bodies study, we examined variations in prevalence of perceived need for ED treatment, ED diagnosis, past-year ED treatment, and treatment barriers according to weight status, race, socioeconomic background, and sex among undergraduate and graduate students with symptoms of an ED (N = 1,747). RESULTS Among students with symptoms of an ED, 30.7% perceived a need for treatment, 10.5% had received a diagnosis, and 13.6% had received treatment in the past year. Individual characteristics were highly associated with perceived need, diagnosis, and past-year treatment. Females were more likely than males to perceive a need for treatment (OR = 1.97), to be diagnosed (OR = 4.66), and to be treated (OR = 1.64) for their ED symptoms. Socioeconomic background was associated with perceived need for treatment and past-year treatment, with students from affluent backgrounds having higher odds of perceiving need (OR = 1.52) and of receiving treatment (OR = 1.89) compared with their non-affluent peers. DISCUSSION At a population-level, the unmet need for ED treatment disproportionately affects certain groups. Stereotypes about who develops EDs could contribute to disparities in ED treatment and outcomes.
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Affiliation(s)
- K R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - S K Lipson
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
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Herpertz-Dahlmann B, Dempfle A, Egberts KM, Kappel V, Konrad K, Vloet JA, Bühren K. Outcome of childhood anorexia nervosa-The results of a five- to ten-year follow-up study. Int J Eat Disord 2018; 51:295-304. [PMID: 29451957 DOI: 10.1002/eat.22840] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although admissions of children with anorexia nervosa (AN) are increasing, there remains a dearth of up-to-date knowledge of the course and outcome of early-onset AN. The aim of the present study was to investigate the outcomes of patients with AN onset before the age of 14. METHOD Sixty-eight consecutive former patients who met the DSM-IV criteria for AN and who had been treated at one of three German university hospitals were asked to participate in a follow-up study. Body mass index, body height, outcome of the eating disorder (ED), psychiatric morbidity, and health related quality of life (HRQoL) were assessed through a personal examination after an average time span of 7.5 years (range: 4.5-11.5 years) after admission. RESULTS One patient had died. Fifty-two subjects with a mean age of 12.5 (SD 1.0) years at admission and of 20.2 (SD 2.0) years at follow-up agreed to participate in the follow-up assessment, aggregating to 77.9% of the original sample. Approximately 41% of the participants had a good outcome, while 35% and 24% had intermediate and poor outcomes, respectively. Twenty-eight percent of the sample met the DSM-IV criteria for a current non-ED psychiatric disorder, and 64% met the criteria for a past non-ED psychiatric disorder. Mental HRQoL and ED-specific psychopathology was strongly associated with the outcome of AN. Average body height was below the normal range. A higher weight at admission was the only significant positive indicator of outcome. DISCUSSION Childhood AN is a serious disorder with an unfavorable course in many patients and high rates of chronicity and psychiatric comorbidity in young adulthood. Early detection and intervention are urgently needed.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Biometry and Statistics, Christian Albrecht-University Kiel, Kiel, Germany
| | - Karin Maria Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Viola Kappel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité University Hospital Berlin, Berlin, Germany
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Jennifer Anne Vloet
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
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Alckmin-Carvalho F, Vega JB, Cobelo AW, Fabbri AD, Pinzon VD, Melo MHDS. Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0101-60830000000154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Elizathe LS, Arana FG, Rutsztein G. A cross-sectional model of eating disorders in Argentinean overweight and obese children. Eat Weight Disord 2018; 23:125-132. [PMID: 27678154 DOI: 10.1007/s40519-016-0321-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022] Open
Abstract
Despite the fact that past research identified childhood obesity as an antecedent of eating disorders, not all obese children further develop this pathology. With this regard, our first purpose was to isolate which characteristics differentiate overweight children who have an eating disorder from those who have not. Second, considering that there is little evidence collected in Latin American countries, we provided overweight children data from an Argentinean sample. Specifically, we investigated if weight-teasing, perfectionism, disturbed eating attitudes and behaviors, and body image dissatisfaction are related to the occurrence of an eating disorder in 100 school-aged overweight/obese children (37 girls and 63 boys; mean age 10.85, SD 0.88). Participants completed self-report instruments and were interviewed between 1 and 2 months later to confirm the presence of eating disorders. Seventeen percent participants confirmed to have an eating disorder. Further, the multivariate logistic analysis revealed that perfectionism (Exp β = 1.19) and disturbed eating attitudes and behaviors (Exp β = 4.78) were jointly associated with the presence of an eating disorder. These results were maintained even when the overall model was adjusted for covariates such as age, gender, body mass index, and school type. Weight-teasing and body image dissatisfaction did not contribute to the multivariate model. Prevalence rates of ED and model findings were discussed.
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Affiliation(s)
- Luciana Soledad Elizathe
- Facultad de Psicología, Universidad de Buenos Aires, Hipólito Yrigoyen 3242, C1207ABQ, Buenos Aires, Argentine Republic. .,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917, C1033AAJ, Buenos Aires, Argentine Republic.
| | - Fernán Guido Arana
- Facultad de Psicología, Universidad de Buenos Aires, Hipólito Yrigoyen 3242, C1207ABQ, Buenos Aires, Argentine Republic
| | - Guillermina Rutsztein
- Facultad de Psicología, Universidad de Buenos Aires, Hipólito Yrigoyen 3242, C1207ABQ, Buenos Aires, Argentine Republic
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Lian B, Forsberg SE, Fitzpatrick KK. Adolescent Anorexia: Guiding Principles and Skills for the Dietetic Support of Family-Based Treatment. J Acad Nutr Diet 2017; 119:17-25. [PMID: 29279265 DOI: 10.1016/j.jand.2017.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Indexed: 01/08/2023]
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Sanlier N, Navruz Varli S, Macit MS, Mortas H, Tatar T. Evaluation of disordered eating tendencies in young adults. Eat Weight Disord 2017; 22:623-631. [PMID: 28871480 DOI: 10.1007/s40519-017-0430-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE It was aimed to determine the prevalence of high disordered eating tendencies and its relationship with food addiction, emotional eating and self esteem in participants at 18 and 33 years age group. METHODS This study was planned as a cross-sectional study and conducted with 1359 young adult volunteers (M = 386, F = 973) with an average age of 22.4 ± 2.84 years. Eating Attitudes Test-26 (EAT-26), Yale Food Addiction Scale (YFAS), Emotional Appetite Questionnaire (EMAQ) and Rosenberg Self-Esteem Scale (RSES) were used. EAT-26 score above 20 was considered as eating disorders risk cutoff. RESULTS Participants with disordered eating tendencies have higher rates (22.4%) of food addiction compared to participants without high disordered eating tendencies (7.2%). There is no difference for EMAQ and YFAS scores; however, there is a significant difference for RSES and EAT-26 scores according to gender. A positive association of EAT-26 with YFAS and EMAQ-negative scores and a negative association of EAT-26 with RSES and EMAQ-positive were found. DISCUSSION There is association among EAT-26, YFAS, and Rosenberg Self-Esteem Scale, and Emotional Appetite Questionnaire scores. This study provides information for future studies about high disordered eating tendencies, food addiction and mood that are thought to be important in young adults. LEVEL OF EVIDENCE Level V (cross-sectional descriptive study).
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Affiliation(s)
- Nevin Sanlier
- Department of Nutrition and Dietetics, Health Science Faculty, Biruni University, Topkapı, Istanbul, Turkey.
| | - Semra Navruz Varli
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
| | - M Sedanur Macit
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
| | - Hande Mortas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
| | - Tugba Tatar
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
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Léger J, Fjellestad-Paulsen A, Bargiacchi A, Doyen C, Ecosse E, Carel JC, Le Heuzey MF. Can growth hormone treatment improve growth in children with severe growth failure due to anorexia nervosa? A preliminary pilot study. Endocr Connect 2017; 6:839-846. [PMID: 29038330 PMCID: PMC5682412 DOI: 10.1530/ec-17-0200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Growth failure is a difficult but key aspect of care in children with anorexia nervosa (AN). The effects of hGH therapy have not been studied. The aim was to investigate the effect of hGH treatment on height velocity (HV) in children with AN. METHODS We carried out a retrospective observational study. Ten girls diagnosed with AN at 10.0 ± 1.9 years, with prolonged severe growth failure (HV < 2.5 cm/year for at least 18 months) at the age of 13.3 ± 1.1 years and delayed puberty after nutritional rehabilitation, were treated with hGH (0.040 mg/kg/day) from a bone age of 10.9 ± 1.7 years until they reached adult height. Height and HV were measured before treatment and at 12-month intervals during treatment. RESULTS Mean body mass index SDS remained unchanged, but HV increased significantly, from a median of 1.0 (0.7-2.1) to 7.1 (6.0-9.5) cm/year after one year (P < 0.002) and 5.6 (4.8-6.2) cm/year after two years of treatment. Height SDS increased from -2.2 ± 1.3 to -1.6 ± 1.3 after one year (P < 0.002) and -1.1 ± 1.5 after two years of GH treatment. Adult height (-0.1 ± 1.0 SDS) was close to target height after 3.6 ± 1.4 years of GH treatment. Serum IGF-I levels increased significantly during treatment (P < 0.01). The treatment was well tolerated. CONCLUSIONS This proof-of-concept study shows that hGH treatment is associated with significant improvements in linear growth in adolescents with AN and severe growth failure. A randomized placebo-controlled trial is required to determine the ultimate impact of GH treatment in patients with this severe, rare condition.
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Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
- Université Paris DiderotSorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM)Unité 1141, DHU PROTECT, Paris, France
| | - Anne Fjellestad-Paulsen
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
| | - Anne Bargiacchi
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service de Psychiatrie de l'Enfant et de l'Adolescent, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
| | - Catherine Doyen
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service de Psychiatrie de l'Enfant et de l'Adolescent, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
| | - Emmanuel Ecosse
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
| | - Jean-Claude Carel
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
- Université Paris DiderotSorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM)Unité 1141, DHU PROTECT, Paris, France
| | - Marie-France Le Heuzey
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service de Psychiatrie de l'Enfant et de l'Adolescent, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, Paris, France
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Sanlier N, Baser F, Mortas H, Navruz Varli S, Macit MS, Tatar T. Structural Modeling the Relationship of Food Addiction and Eating Attitudes of Young Adults with Emotional Appetite and Self-Esteem. Ecol Food Nutr 2017; 56:514-529. [DOI: 10.1080/03670244.2017.1388232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nevin Sanlier
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Biruni University, Topkapı, İstanbul, Turkey
| | - Furkan Baser
- Faculty of Applied Sciences, Department of Insurance and Actuarial Science, Ankara University, Besevler, Ankara, Turkey
| | - Hande Mortas
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Besevler, Ankara, Turkey
| | - Semra Navruz Varli
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Besevler, Ankara, Turkey
| | - M. Sedanur Macit
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Besevler, Ankara, Turkey
| | - Tugba Tatar
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Besevler, Ankara, Turkey
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72
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Barron LJ, Barron RF, Johnson JCS, Wagner I, Ward CJB, Ward SRB, Barron FM, Ward WK. A retrospective analysis of biochemical and haematological parameters in patients with eating disorders. J Eat Disord 2017; 5:32. [PMID: 29026589 PMCID: PMC5623971 DOI: 10.1186/s40337-017-0158-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/08/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The objective of the study was to determine whether levels of biochemical and haematological parameters in patients with eating disorders (EDs) varied from the general population. Whilst dietary restrictions can lead to nutritional deficiencies, specific abnormalities may be relevant to the diagnosis, pathogenesis and treatment of EDs. METHODS With ethics approval and informed consent, a retrospective chart audit was conducted of 113 patients with EDs at a general practice in Brisbane, Australia. This was analysed first as a total group (TG) and then in 4 ED subgroups: Anorexia nervosa (AN), Bulimia nervosa (BN), ED Not Otherwise Specified (EDNOS), and AN/BN. Eighteen parameters were assessed at or near first presentation: cholesterol, folate, vitamin B12, magnesium, manganese, zinc, calcium, potassium, urate, sodium, albumin, phosphate, ferritin, vitamin D, white cell count, neutrophils, red cell count and platelets. Results were analysed using IBM SPSS 21 and Microsoft Excel 2013 by two-tailed, one-sample t-tests (TG and 4 subgroups) and chi-square tests (TG only) and compared to the population mean standards. Results for the TG and each subgroup individually were then compared with the known reference interval (RI). RESULTS For the total sample, t-tests showed significant differences for all parameters (p < 0.05) except cholesterol. Most parameters gave results below population levels, but folate, phosphate, albumin, calcium and vitamin B12 were above. More patients than expected were below the RI for most parameters in the TG and subgroups. CONCLUSIONS At diagnosis, in patients with EDs, there are often significant differences in multiple haematological and biochemical parameters. Early identification of these abnormalities may provide additional avenues of ED treatment through supplementation and dietary guidance, and may be used to reinforce negative impacts on health caused by the ED to the patient, their family and their treatment team (general practitioner, dietitian and mental health professionals). Study data would support routine measurement of a full blood count and electrolytes, phosphate, magnesium, liver function tests, ferritin, vitamin B12, red cell folate, vitamin D, manganese and zinc for all patients at first presentation with an ED.
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Affiliation(s)
- Leanne J. Barron
- Brisbane City Doctors Medical Practice, Brisbane, QLD Australia
- Eating Disorders Multidisciplinary Clinic, Queensland University of Technology, Brisbane, QLD Australia
| | - Robert F. Barron
- Riverina-Murray Institute of Higher Education, Wagga Wagga, NSW Australia
| | | | - Ingrid Wagner
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Cameron J. B. Ward
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
- University of Queensland, Brisbane, QLD Australia
- Mater Medical Research Institute, Brisbane, Australia
- Queensland Paediatric Cardiac Research Group, Queensland, Australia
| | | | | | - Warren K. Ward
- Eating Disorders Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
- School of Medicine, University of Queensland, Brisbane, QLD Australia
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73
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Cook-Cottone C, Talebkhah K, Guyker W, Keddie E. A controlled trial of a yoga-based prevention program targeting eating disorder risk factors among middle school females. Eat Disord 2017; 25:392-405. [PMID: 28929940 DOI: 10.1080/10640266.2017.1365562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study investigates outcomes of a revised version of a yoga-based, eating disorder prevention program, targeting eating disorder risk factors, among fifth grade girls (i.e., Girls Growing in Wellness and Balance: Yoga and Life Skills to Empower [GGWB]). The program is designed to decrease eating disorder risk factors and bolster self-care and includes revisions not yet studied that extend the program to 14 weeks and enhance content addressing self-care. Efficacy was assessed using a controlled, repeated measures design. Results indicate that participation in the GGWB program significantly decreases drive for thinness and body dissatisfaction while significantly increasing self-care when compared to a control group. As expected, the program did not have significant effects on eating disordered behaviour likely due to low baseline rates among participants. Implications of findings as well as directions for future research on prevention are discussed.
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Affiliation(s)
| | - Kellie Talebkhah
- a University at Buffalo, State University of New York , NY , USA
| | - Wendy Guyker
- a University at Buffalo, State University of New York , NY , USA
| | - Emily Keddie
- a University at Buffalo, State University of New York , NY , USA
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Bravender T, Elkus H, Lange H. Inpatient medical stabilization for adolescents with eating disorders: patient and parent perspectives. Eat Weight Disord 2017; 22:483-489. [PMID: 27052407 DOI: 10.1007/s40519-016-0270-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The serious physical complications of eating disorders in adolescents may necessitate inpatient medical stabilization, yet little is known about how patients and their parents perceive the hospitalization experience. METHODS We identified 82 patients admitted to a large urban hospital for medical stabilization between January 1, 2010 and June 30, 2013. Twenty-three patients and 32 parents completed directed telephone interviews. Respondents rated components of the inpatient protocol using five-point Likert scales and answered open-ended questions regarding hospitalization. Quantitative and qualitative analyses were performed. RESULTS The mean age of patients at admission was 14.9 years (range 9-21) and the average stay was 8.4 days (range 2-25). Patients rated "massage therapy" most helpful and "cell phone limits" least helpful. Parents rated "nursing staff" most helpful and "seeing other patients in the hospital" least helpful. Protocol components viewed differently by parents and patients included parents more strongly endorsing "staff supervision of meals" (4.34 vs 2.82, p < 0.001) and "limits on physical activity" (4.34 vs 3.23, p = 0.001). The two most common themes identified in open-ended questions were need for hospitalization as a signifier of eating disorder severity and desire for mental health services on the medical unit. Parents emphasized the value of dietician-directed meal planning. CONCLUSIONS Inpatient medical stabilization for adolescent eating disorders may play an important role not only in addressing acute medical complications, but also in activating the patient and family regarding the need for ongoing treatment. Parents particularly appreciate staff supervision of meals and having a respite from meal planning.
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Affiliation(s)
- Terrill Bravender
- Division of Adolescent Medicine, Department of Pediatrics, University of Michigan, 1500 E. Medical Center Drive, D2215, Ann Arbor, MI, 48109-5318, USA.
| | - Hannah Elkus
- The Ohio State University College of Medicine, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Hannah Lange
- The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43202, USA
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75
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Carl RL, Johnson MD, Martin TJ, LaBella CR, Brooks MA, Diamond A, Hennrikus W, LaBotz M, Logan K, Loud KJ, Moffatt KA, Nemeth B, Pengel B, Peterson A. Promotion of Healthy Weight-Control Practices in Young Athletes. Pediatrics 2017; 140:peds.2017-1871. [PMID: 28827381 DOI: 10.1542/peds.2017-1871] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children and adolescents may participate in sports that favor a particular body type. Some sports, such as gymnastics, dance, and distance running, emphasize a slim or lean physique for aesthetic or performance reasons. Participants in weight-class sports, such as wrestling and martial arts, may attempt weight loss so they can compete at a lower weight class. Other sports, such as football and bodybuilding, highlight a muscular physique; young athletes engaged in these sports may desire to gain weight and muscle mass. This clinical report describes unhealthy methods of weight loss and gain as well as policies and approaches used to curb these practices. The report also reviews healthy strategies for weight loss and weight gain and provides recommendations for pediatricians on how to promote healthy weight control in young athletes.
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Affiliation(s)
- Rebecca L. Carl
- Institute for Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Miriam D. Johnson
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Thomas J. Martin
- Department of Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
- Department of Pediatrics, Milton S. Hershey College of Medicine, Pennsylvania State University, Hershey, Pennsylvania; and
- Central Pennsylvania Clinic for Special Children and Adults, Belleville, Pennsylvania
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Kapphahn CJ, Graham DA, Woods ER, Hehn R, Mammel KA, Forman SF, Fisher M, Robinson KA, Rome ES, Hergenroeder A, Golden NH. Effect of Hospitalization on Percent Median Body Mass Index at One Year, in Underweight Youth With Restrictive Eating Disorders. J Adolesc Health 2017; 61:310-316. [PMID: 28587796 DOI: 10.1016/j.jadohealth.2017.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Data from low-weight patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED treatment programs were analyzed to determine whether there was an association between hospitalization and gain to at least 90% median body mass index (mBMI) at 1-year follow-up. METHODS Data were retrospectively collected for 322 low-weight (<85% mBMI at intake) patients aged 9-21 years, who presented with restrictive EDs to 14 adolescent medicine-based ED programs in 2010. Positive outcome was defined as being at least 90% mBMI (%mBMI = patient's body mass index/mBMI for age × 100) at 1-year follow-up. Association between treatment at a higher level of care and gain to at least 90% mBMI was analyzed for 140 patients who were <85% mBMI at the time of presentation, had not been previously hospitalized, and had 1-year follow-up data available. RESULTS For patients presenting at <85% mBMI, those who were hospitalized in the year following intake had 4.0 (95% confidence interval: 1.6-10.1) times the odds of gain to at least 90% mBMI, compared with patients who were not hospitalized, when controlling for baseline %mBMI. CONCLUSION In this national cohort of patients with restrictive EDs presenting to adolescent medicine-based ED programs at <85% mBMI, those who were hospitalized had greater odds of being at least 90% mBMI at 1-year follow-up.
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Affiliation(s)
- Cynthia J Kapphahn
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
| | - Dionne A Graham
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rebecca Hehn
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts
| | - Kathleen A Mammel
- Division of Adolescent Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; Formerly of Department of Adolescent Pediatrics, Beaumont Children's Hospital, Royal Oak, Michigan
| | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Martin Fisher
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York; Department of Pediatrics, Hofstra-Northwell Health School of Medicine, Hempstead, New York
| | - Kelly A Robinson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Ellen S Rome
- Department of General Pediatrics, Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Albert Hergenroeder
- Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Neville H Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Morris R, Prasad A, Asaro J, Guzman M, Sanders L, Hauck A, Singh GK, Levy PT. Markers of Cardiovascular Dysfunction in Adolescents With Anorexia Nervosa. Glob Pediatr Health 2017; 4:2333794X17727423. [PMID: 28890913 PMCID: PMC5580842 DOI: 10.1177/2333794x17727423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/14/2017] [Indexed: 12/16/2022] Open
Abstract
Background. Cardiovascular complications contribute to the high morbidity and mortality rate among children with anorexia nervosa (AN). Advances in cardiac imaging permit a more comprehensive assessment of myocardial performance in children that could not be previously obtained with conventional imaging. Myocardial strain analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in children. Objective. To assess global and regional left ventricular (LV0 function in children newly diagnosed with AN with conventional and quantitative 2-dimensional speckle tracking echocardiographic (2DSTE)–derived strain imaging. Materials. In a cross-sectional study of 30 patients with AN (DSM-5) and 14 age-, sex-, and race-matched healthy children, markers of cardiovascular risk, conventional and 2DSTE measures of LV function, and structure were evaluated and compared. The AN cohort was further stratified by behavioral patterns (restrict, exercise, or purge). Results. Conventional measures and LV global strain were similar between controls and children with AN. A subgroup of AN children with purging behavior had LV remodeling characterized by significantly decreased LV mass index. Regional ventricular function at the apex, as measured by strain, was also decreased in all AN patients. Percent change from ideal body weight, body mass index Z-score, electrolyte profiles, heart rate, and blood pressure were similar. Conclusions. Subclinical regional ventricular dysfunction is present in children with AN. Ventricular remodeling exists in a subgroup of children with AN in association with purging behavior. Future studies may utilize strain imaging to identify those AN patients who are at an increased risk for developing significant cardiac dysfunction.
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Affiliation(s)
- Reshmi Morris
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Aparna Prasad
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Joseph Asaro
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Marla Guzman
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Leslie Sanders
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Amanda Hauck
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Gautam K Singh
- Washington University, School of Medicine, Saint Louis, MO, USA
| | - Philip T Levy
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA.,Washington University, School of Medicine, Saint Louis, MO, USA
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Abstract
Mental health disorders in adolescence are a significant problem, relatively common, and amenable to treatment or intervention. Obstetrician-gynecologists who see adolescent patients are highly likely to see adolescents and young women who have one or more mental health disorders. Some of these disorders may interfere with a patient's ability to understand or articulate her health concerns and appropriately adhere to recommended treatment. Some disorders or their treatments will affect the hypothalamic-pituitary-gonadal axis, causing anovulatory cycles and various menstrual disturbances. Adolescents with psychiatric disorders may be taking psychopharmacologic agents that can cause menstrual dysfunction and galactorrhea. Adolescents with mental illness often engage in acting-out behavior or substance use, which increases their risk of unsafe sexual behavior that may result in pregnancy or sexually transmitted infections. Pregnant adolescents who take psychopharmacologic agents present a special challenge in balancing the potential risks of fetal harm with the risks of inadequate treatment. Whether providing preventive women's health care or specific obstetric or gynecologic treatment, the obstetrician-gynecologist has the opportunity to reduce morbidity and mortality from mental health disorders in adolescents by early identification, appropriate and timely referral, and care coordination. Although mental health disorders should be managed by mental health care professionals or appropriately trained primary care providers, the obstetrician-gynecologist can assist by managing the gynecologic adverse effects of psychiatric medications and providing effective contraception and regular screening for sexually transmitted infections. This Committee Opinion will provide basic information about common adolescent mental health disorders, focusing on specific implications for gynecologic and obstetric practice.
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Thomas JJ, Brigham KS, Sally ST, Hazen EP, Eddy KT. Case 18-2017 - An 11-Year-Old Girl with Difficulty Eating after a Choking Incident. N Engl J Med 2017; 376:2377-2386. [PMID: 28614676 PMCID: PMC5724771 DOI: 10.1056/nejmcpc1616394] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Jennifer J Thomas
- From the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.), Pediatrics (K.S.B.), and Speech, Language, and Swallowing Disorders and Reading Disabilities (S.T.S.), Massachusetts General Hospital, and the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.) and Pediatrics (K.S.B.), Harvard Medical School - both in Boston
| | - Kathryn S Brigham
- From the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.), Pediatrics (K.S.B.), and Speech, Language, and Swallowing Disorders and Reading Disabilities (S.T.S.), Massachusetts General Hospital, and the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.) and Pediatrics (K.S.B.), Harvard Medical School - both in Boston
| | - Sarah T Sally
- From the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.), Pediatrics (K.S.B.), and Speech, Language, and Swallowing Disorders and Reading Disabilities (S.T.S.), Massachusetts General Hospital, and the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.) and Pediatrics (K.S.B.), Harvard Medical School - both in Boston
| | - Eric P Hazen
- From the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.), Pediatrics (K.S.B.), and Speech, Language, and Swallowing Disorders and Reading Disabilities (S.T.S.), Massachusetts General Hospital, and the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.) and Pediatrics (K.S.B.), Harvard Medical School - both in Boston
| | - Kamryn T Eddy
- From the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.), Pediatrics (K.S.B.), and Speech, Language, and Swallowing Disorders and Reading Disabilities (S.T.S.), Massachusetts General Hospital, and the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.) and Pediatrics (K.S.B.), Harvard Medical School - both in Boston
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Anderson K, Accurso EC, Kinasz KR, Le Grange D. Residents' and Fellows' Knowledge and Attitudes About Eating Disorders at an Academic Medical Center. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:381-384. [PMID: 27882518 PMCID: PMC7219944 DOI: 10.1007/s40596-016-0578-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study examined physician residents' and fellows' knowledge of eating disorders and their attitudes toward patients with eating disorders. METHODS Eighty physicians across disciplines completed a survey. The response rate for this survey across disciplines was 64.5 %. RESULTS Participants demonstrated limited knowledge of eating disorders and reported minimal comfort levels treating patients with eating disorders. Psychiatry discipline (p = 0.002), eating disorder experience (p = 0.010), and having ≥4 eating disorder-continuing medical education credits (p = 0.037) predicted better knowledge of anorexia nervosa but not bulimia nervosa. Psychiatry residents (p = 0.041), and those who had treated at least one eating disorder patient (p = 0.006), reported significantly greater comfort treating patients with eating disorders. CONCLUSION These results suggest that residents and fellows from this sample may benefit from training to increase awareness and confidence necessary to treat patients with eating disorders. Sufficient knowledge and comfort are critical since physicians are often the first health care provider to have contact with patients who have undiagnosed eating disorders.
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81
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Thein-Nissenbaum J, Hammer E. Treatment strategies for the female athlete triad in the adolescent athlete: current perspectives. Open Access J Sports Med 2017; 8:85-95. [PMID: 28435337 PMCID: PMC5388220 DOI: 10.2147/oajsm.s100026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Since the passage of Title IX in 1972, female sports participation has dramatically increased. The benefits of physical activity, including decreased risk for heart disease and diabetes as well as improved body image and self-esteem, far outweigh the risks. However, a select population of adolescent and young adult females may experience symptoms related to the female athlete triad (Triad), which refers to the interrelatedness of energy availability, menstrual function, and bone mineral density (BMD). These conditions often manifest clinically as disordered eating behaviors, menstrual irregularity, and stress fractures; an individual may suffer from 1 or all of the Triad components simultaneously. Because of the complex nature of the Triad, treatment is challenging and requires a multidisciplinary approach. Team members often include a physician, psychologist or psychiatrist, nutritionist or dietitian, physical therapist, athletic trainer, coach, family members, and most importantly, the patient. A thorough physical examination by a primary care physician is essential to identify all organs/systems that may be impacted by Triad-related conditions. Laboratory tests, assessment of bone density, nutritional assessment, and behavior health evaluation guide the management of the female athlete with Triad-related conditions. Treatment of the Triad includes adequate caloric consumption to restore a positive energy balance; this is often the first step in successful management of the Triad. In addition, determining the cause of menstrual dysfunction (MD) and resumption of menses is very important. Nonpharmacologic interventions are the first choice; pharmacologic treatment for MD is reserved only for those patients with symptoms of estrogen deficiency or infertility. Lastly, adequate intake of calcium and vitamin D is critical for lifelong bone health. For this review, a comprehensive search of relevant databases from the earliest dates to July 2016 was performed. Keywords, including female athlete triad, adolescent female athlete, disordered eating, eating disorder, low energy availability, relative energy deficit, anorexia, bulimia, menstrual dysfunction, amenorrhea, oligoamenorrhea, bone mineral density, osteopenia, osteoporosis, stress fracture, and stress reaction, were utilized to search for relevant articles. Articles that directly addressed assessment and management of any 1 or all of the Triad components were included in this comprehensive review. The purpose of this narrative review is to provide the reader with the latest terms used to define the components of the female athlete triad, to discuss examination and diagnosis of the Triad, and lastly, to provide the reader with the latest evidence to successfully implement a multidisciplinary treatment approach when providing care for the adolescent female athlete who may be suffering from Triad-related components.
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Affiliation(s)
| | - Erin Hammer
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
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82
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Alckmin-Carvalho F, Cobelo AW, Melo MHDS, Zeni R, Pinzon VD. Age and gender changes in children and adolescent patients of a Brazilian eating disorder program. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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83
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Abstract
Bulimia nervosa was first described in 1979 by British psychiatrist Gerald Russell as a "chronic phase of anorexia nervosa" in which patients overeat and then use compensatory mechanisms, such as self-induced vomiting, laxatives, or prolonged periods of starvation. The characterization of bulimia nervosa continues to evolve with the introduction of the DSM-5 in 2013. In this article, the epidemiology and risk factors of bulimia nervosa are identified and reviewed, along with the medical complications and psychiatric comorbidities. The evaluation of a patient with suspected bulimia nervosa is addressed, with an emphasis on acquiring a complete and thorough history as well as discovering any comorbidities that are present. Management of the patient involves both medical interventions and behavioral counseling in order to address physical, psychological, and social needs. Lastly, a new diagnosis introduced in the DSM-5, purging disorder, is described and discussed.
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Affiliation(s)
- Marigold Castillo
- Division of Adolescent Medicine, Cohen Children׳s Medical Center, Northwell Health, New Hyde Park, New York, Hofstra-Northwell School of Medicine, Hempstead, New York
| | - Eric Weiselberg
- Division of Adolescent Medicine, Cohen Children׳s Medical Center, Northwell Health, New Hyde Park, New York, Hofstra-Northwell School of Medicine, Hempstead, New York
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84
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Developmental Trajectories of Boys' Driven Exercise and Fasting During the Middle School Years. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 44:1309-19. [PMID: 26707543 DOI: 10.1007/s10802-015-0119-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Boys appear to engage in eating disorder behavior, particularly nonpurging compensatory behaviors such as driven exercise and fasting, at higher rates than previously thought. Little is known about the development of these behaviors in adolescent boys. In a sample of 631 non-binge eating and non-purging boys studied once in 5th grade and 6 times over the 3 years of middle school (grades 6 through 8), we found that (a) for some youth, driven exercise and fasting were present from grade 6; (b) different boys progressed along different trajectories of engagement in driven exercise and fasting, with some boys engaging in no driven exercise or fasting (65.8 % and 83.5 %, respectively), some boys engaging in driven exercise and fasting throughout middle school (25.2 % and 16.5 %, respectively), and other boys discontinuing engagement in driven exercise (9 %); (c) 5th grade depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership; and (d) boys engaging in driven exercise and fasting in 8th grade remained distressed. Boys' engagement in driven exercise and fasting behavior merits the attention of researchers and clinicians.
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85
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Wade KH, Kramer MS, Oken E, Timpson NJ, Skugarevsky O, Patel R, Bogdanovich N, Vilchuck K, Davey Smith G, Thompson J, Martin RM. Prospective associations between problematic eating attitudes in midchildhood and the future onset of adolescent obesity and high blood pressure. Am J Clin Nutr 2017; 105:306-312. [PMID: 27974308 PMCID: PMC5267301 DOI: 10.3945/ajcn.116.141697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinically diagnosed eating disorders may have adverse cardiometabolic consequences, including overweight or obesity and high blood pressure. However, the link between problematic eating attitudes in early adolescence, which can lead to disordered eating behaviors, and future cardiometabolic health is, to our knowledge, unknown. OBJECTIVE We assessed whether variations in midchildhood eating attitudes influence the future development of overweight or obesity and high blood pressure. DESIGN Of 17,046 children who participated in the Promotion of Breastfeeding Intervention Trial (PROBIT), we included 13,557 participants (79.5% response rate) who completed the Children's Eating Attitudes Test (ChEAT) at age 11.5 y and in whom we measured adiposity and blood pressure at ages 6.5, 11.5, and 16 y. We assessed whether ChEAT scores ≥85th percentile (indicative of problematic eating attitudes) compared with scores <85th percentile at age 11.5 y were associated with new-onset overweight, obesity, high systolic blood pressure, or high diastolic blood pressure between midchildhood and early adolescence. RESULTS After controlling for baseline sociodemographic confounders, we observed positive associations of problematic eating attitudes at age 11.5 y with new-onset obesity (OR: 2.18; 95% CI: 1.58, 3.02), new-onset high systolic blood pressure (OR: 1.34; 95% CI: 1.05, 1.70), and new-onset high diastolic blood pressure (OR: 1.25; 95% CI: 0.99, 1.58) at age 16 y. After further controlling for body mass index at age 6.5 y, problematic eating attitudes remained positively associated with new-onset obesity (OR: 1.80; 95% CI: 1.28, 2.53); however, associations with new-onset high blood pressure were attenuated (OR: 1.14; 95% CI: 0.89, 1.45 and OR: 1.09; 95% CI: 0.86, 1.39 for new-onset systolic and diastolic blood pressure, respectively). CONCLUSIONS Problematic eating attitudes in midchildhood seem to be related to the development of obesity in adolescence, a relatively novel observation with potentially important public health implications for obesity control. PROBIT was registered at clinicaltrials.gov as NCT01561612 and isrctn.com as ISRCTN37687716.
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Affiliation(s)
- Kaitlin H Wade
- School of Social and Community Medicine, Faculty of Health Sciences, .,Medical Research Council Integrative Epidemiology Unit, and
| | - Michael S Kramer
- Departments of Pediatrics and.,Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Nicholas J Timpson
- School of Social and Community Medicine, Faculty of Health Sciences.,Medical Research Council Integrative Epidemiology Unit, and
| | - Oleg Skugarevsky
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus; and
| | - Rita Patel
- School of Social and Community Medicine, Faculty of Health Sciences
| | - Natalia Bogdanovich
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Konstantin Vilchuck
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - George Davey Smith
- School of Social and Community Medicine, Faculty of Health Sciences.,Medical Research Council Integrative Epidemiology Unit, and
| | - Jennifer Thompson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Richard M Martin
- School of Social and Community Medicine, Faculty of Health Sciences.,Medical Research Council Integrative Epidemiology Unit, and.,University Hospitals Bristol National Health Service Foundation Trust, National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, United Kingdom
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86
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Unhealthy Weight Management Practices and Non-medical Use of Prescription Drugs. Am J Prev Med 2017; 52:215-219. [PMID: 27863921 DOI: 10.1016/j.amepre.2016.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/18/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Non-medical use of prescription drugs (NMUPD) has reached epidemic proportions in the U.S. With approximately one in five high school students engaging in NMUPD, it is important to understand behavioral correlates. METHODS Data were combined from the 2011 and 2013 cycles of the Youth Risk Behavior Survey, a nationally representative, cross-sectional survey. After restricting the analytic sample to students who reported a weight loss goal of either staying the same weight or losing weight, logistic regression models were used to estimate adjusted prevalence ratios and 95% CIs for associations between unhealthy weight management practices (UWMPs) and lifetime NMUPD. Individual UWMPs-fasting; taking diet pills, powders, or liquids without a doctor's advice; and vomiting or taking laxatives-and total number of UWMPs were examined. Data were analyzed in 2016. RESULTS UWMPs were more prevalent among female students (21.1% vs 10.7% for fasting; 7.5% vs 5.2% for taking diet pills, powders, or liquids; and 7.6% vs 3.2% for vomiting or taking laxatives). Significant associations between individual UWMPs and NMUPD and between the number of UWMPs and NMUPD were observed. DISCUSSION UWMPs were associated with NMUPD. Health educators in the school setting, as well as other health professionals who provide services to an adolescent population, can focus on healthy weight management strategies, and other substance-specific messages. CONCLUSIONS The association between UWMPs and NMUPD may reflect a constellation of problem behaviors exhibited among some adolescents.
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87
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Täljemark J, Råstam M, Lichtenstein P, Anckarsäter H, Kerekes N. The coexistence of psychiatric and gastrointestinal problems in children with restrictive eating in a nationwide Swedish twin study. J Eat Disord 2017; 5:25. [PMID: 28835820 PMCID: PMC5563893 DOI: 10.1186/s40337-017-0154-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/18/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Restrictive eating problems are rare in children but overrepresented in those with neurodevelopmental problems. Comorbidities decrease wellbeing in affected individuals but research in the area is relatively scarce. This study describes phenotypes, regarding psychiatric and gastrointestinal comorbidities, in children with restrictive eating problems. METHODS A parental telephone interview was conducted in 9- or 12-year old twins (n = 19,130) in the Child and Adolescent Twin Study in Sweden. Cases of restrictive eating problems and comorbid problems were established using the Autism, Tics-AD/HD and other Comorbidities inventory, parental reports of comorbidity as well as data from a national patient register. In restrictive eating problem cases, presence of psychiatric and gastrointestinal comorbidity was mapped individually in probands and their co-twin. Two-tailed Mann-Whitney U tests were used to test differences in the mean number of coexisting disorders between boys and girls. Odds ratios were used to compare prevalence figures between individuals with or without restrictive eating problems, and Fisher exact test was used to establish significance. RESULTS Prevalence of restrictive eating problems was 0.6% (concordant in 15% monozygotic and 3% of dizygotic twins). The presence of restrictive eating problems drastically increased odds of all psychiatric problems, especially autism spectrum disorder in both sexes (odds ratio = 11.9 in boys, odds ratio = 10.1 in girls), obsessive-compulsive disorder in boys (odds ratio = 11.6) and oppositional defiant disorder in girls (odds ratio = 9.22). Comorbid gastrointestinal problems, such as lactose intolerance (odds ratio = 4.43) and constipation (odds ratio = 2.91), were the most frequent in girls. Boy co-twins to a proband with restrictive eating problems generally had more psychiatric problems than girl co-twins and more girl co-twins had neither somatic nor any psychiatric problems at all. CONCLUSIONS In children with restrictive eating problems odds of all coexisting psychiatric problems and gastrointestinal problems are significantly increased. The study shows the importance of considering comorbidities in clinical assessment of children with restrictive eating problems.
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Affiliation(s)
- Jakob Täljemark
- Lund University, Medical Faculty, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Baravägen 1, S-221 85 Lund, Sweden
| | - Maria Råstam
- Lund University, Medical Faculty, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Baravägen 1, S-221 85 Lund, Sweden.,Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Anckarsäter
- CELAM (Centre for Ethics, Law and Mental Health), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan, Sweden
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88
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Peebles R, Lesser A, Park CC, Heckert K, Timko CA, Lantzouni E, Liebman R, Weaver L. Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders. J Eat Disord 2017; 5:7. [PMID: 28265411 PMCID: PMC5331684 DOI: 10.1186/s40337-017-0134-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/26/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Medical stabilization through inpatient nutritional rehabilitation is often necessary for patients with eating disorders (EDs) but includes the inherent risk of refeeding syndrome. Here we describe our experience of implementing and sustaining an inpatient nutritional rehabilitation protocol designed to strategically prepare patients with EDs and their families for discharge to a home setting in an efficient and effective manner from a general adolescent medicine unit. We report outcomes at admission, discharge, and 4-weeks follow-up. METHODS Protocol development, implementation, and unique features of the protocol, are described. Data were collected retrospectively as part of a continuous quality improvement (QI) initiative. Safety outcomes were the clinical need for phosphorus, potassium, and magnesium supplementation, other evidence of refeeding syndrome, and unexpected readmissions within one month of discharge. The value outcome was length of stay (LOS). Treatment outcomes were the percentage median BMI (MBMI) change from admission to discharge, and from discharge to 4-weeks follow-up visit. RESULTS A total of 215 patients (88% F, 12% M) were included. Patients averaged 15.3 years old (5.8-23.2y); 64% had AN, 18% had atypical anorexia (AtAN), 6% bulimia nervosa (BN), 5% purging disorder (PD), 4% avoidant-restrictive food intake disorder (ARFID), and 3% had an unspecified food and eating disorder (UFED). Average LOS was 11 days. Initial mean calorie level for patients at admission was 1466 and at discharge 3800 kcals/day. Phosphorus supplementation for refeeding hypophosphatemia (RH) was needed in 14% of inpatients; full-threshold refeeding syndrome did not occur. Only 3.8% were rehospitalized in the thirty days after discharge. Patients averaged 86.1% of a median MBMI for age and gender, 91.4% MBMI at discharge, and 100.9% MBMI at 4-weeks follow-up. Mean percentage MBMI differences between time points were significantly different (admission-discharge: 5.3%, p <0.001; discharge-follow-up: 9.2%, p <0.001). CONCLUSIONS Implementation of the CHOP inpatient nutritional rehabilitation protocol aimed at rapid, efficient, and safe weight gain and integration of caregivers in treatment of patients with diverse ED diagnoses led to excellent QI outcomes in percentage MBMI at discharge and 4-weeks follow-up, while maintaining a short LOS and low rates of RH phosphorus supplementation.
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Affiliation(s)
- Rebecka Peebles
- The Children's Hospital of Philadelphia, Department of Pediatrics, Division of Adolescent Medicine, Philadelphia, Pennsylvania USA.,The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA
| | - Andrew Lesser
- The Children's Hospital of Philadelphia, Department of Pediatrics, Division of Adolescent Medicine, Philadelphia, Pennsylvania USA
| | - Courtney Cheek Park
- The Children's Hospital of Philadelphia, Department of Pediatrics, Division of Adolescent Medicine, Philadelphia, Pennsylvania USA
| | - Kerri Heckert
- The Children's Hospital of Philadelphia, Department of Clinical Nutrition, Philadelphia, Pennsylvania USA
| | - C Alix Timko
- The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA.,The Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, Pennsylvania USA
| | - Eleni Lantzouni
- The Children's Hospital of Philadelphia, Department of Pediatrics, Division of Adolescent Medicine, Philadelphia, Pennsylvania USA.,The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA
| | - Ronald Liebman
- The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA.,The Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, Pennsylvania USA
| | - Laurel Weaver
- The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA.,The Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, Pennsylvania USA
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89
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McClain Z, Peebles R. Body Image and Eating Disorders Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatr Clin North Am 2016; 63:1079-1090. [PMID: 27865334 PMCID: PMC6402566 DOI: 10.1016/j.pcl.2016.07.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence is a crucial period for emerging sexual orientation and gender identity and also body image disturbance and disordered eating. Body image distortion and disordered eating are important pediatric problems affecting individuals along the sexual orientation and gender identity spectrum. Lesbian, gay, bisexual, transgender (LGBT) youth are at risk for eating disorders and body dissatisfaction. Disordered eating in LGBT and gender variant youth may be associated with poorer quality of life and mental health outcomes. Pediatricians should know that these problems occur more frequently in LGBT youth. There is evidence that newer treatment paradigms involving family support are more effective than individual models of care.
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Affiliation(s)
- Zachary McClain
- Craig Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 11 Northwest Tower, Room 10, Philadelphia, PA 19104, USA.
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90
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Joy E, Kussman A, Nattiv A. 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management. Br J Sports Med 2016; 50:154-62. [PMID: 26782763 DOI: 10.1136/bjsports-2015-095735] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Eating disorders, such as anorexia nervosa and bulimia nervosa, can have devastating effects on both the health and performance of athletes. Compared to non-athletes, both female and male athletes are at higher risk of developing an eating disorder. This is especially true for athletes participating in sports where low body weight or leanness confers a competitive advantage. Screening for disordered eating behaviours, eating disorders and for related health consequences should be a standard component of preparticipation examinations, and team physicians should be knowledgeable of the updated diagnostic criteria for eating disorders in the Diagnostic and Statistical Manual-V. Athletes with eating disorders should undergo thorough evaluation and treatment by an experienced multidisciplinary team. Team physicians play a critical role in decision-making on clearance for participation and return to play. Using evidence-based guidelines for clearance and return to play encourages transparency and accountability between the sports medicine care team and the athlete. Efforts to prevent eating disorders should be aimed at athletes, coaches, parents and athletic administrators, and focused on expanding knowledge of healthy nutrition in support of sport performance and health.
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Affiliation(s)
| | - Andrea Kussman
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Aurelia Nattiv
- Departments of Family Medicine and Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
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91
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Eating disorders in children and adolescents: what does the gynecologist need to know? Curr Opin Obstet Gynecol 2016; 28:381-92. [DOI: 10.1097/gco.0000000000000317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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92
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93
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Strandjord SE, Sieke EH, Richmond M, Khadilkar A, Rome ES. Medical stabilization of adolescents with nutritional insufficiency: a clinical care path. Eat Weight Disord 2016; 21:403-410. [PMID: 26597679 DOI: 10.1007/s40519-015-0245-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Nutritional insufficiency (NI) is a potential consequence of restrictive eating disorders. NI patients often require hospitalization for refeeding to restore medical stability and prevent complications such as refeeding syndrome. Limited information is available on the optimal approach to refeeding. In this study, we describe an inpatient NI care path and compare treatment outcomes at an academic medical center and a community hospital. METHODS A retrospective chart review was conducted on inpatients treated using a standardized NI care path at either the academic site, from August 2012 to July 2013 (n = 51), or the community site, from August 2013 to July 2014 (n = 39). Demographic information, eating disorder history, and treatment variables were recorded for each patient. Data were compared using the Kruskal-Wallis test and Fisher's exact test. RESULTS Patients admitted to the community site had shorter hospital stays than patients admitted to the academic site (IQR 2-4 vs. 2-7 days, p = 0.03). All patients were discharged in <14 days with a median stay of 3 days. The median initial calorie prescription was 2200 calories for both groups. No clinical cases of refeeding syndrome occurred, with only one patient developing hypophosphatemia during refeeding. CONCLUSIONS A standardized care path with a higher-calorie intervention allows for short-term hospitalization of NI patients without increasing the risk of refeeding syndrome, regardless of treatment site. This study demonstrates the efficiency and safety of treating NI patients on a regular medical floor at a community hospital.
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Affiliation(s)
- Sarah E Strandjord
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Mail Code NA21, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Erin H Sieke
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Mail Code NA21, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Miranda Richmond
- Office of Civic Education Initiatives Internship Program, Cleveland Clinic, 25875 Science Park Drive/AC121, Beachwood, OH, 44122, USA
| | - Arjun Khadilkar
- Office of Civic Education Initiatives Internship Program, Cleveland Clinic, 25875 Science Park Drive/AC121, Beachwood, OH, 44122, USA
| | - Ellen S Rome
- Department of General Pediatrics, Cleveland Clinic Children's Hospital, 9500 Euclid Ave/A120, Cleveland, OH, 44195, USA
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94
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Abstract
Obesity and eating disorders (EDs) are both prevalent in adolescents. There are concerns that obesity prevention efforts may lead to the development of an ED. Most adolescents who develop an ED did not have obesity previously, but some teenagers, in an attempt to lose weight, may develop an ED. This clinical report addresses the interaction between obesity prevention and EDs in teenagers, provides the pediatrician with evidence-informed tools to identify behaviors that predispose to both obesity and EDs, and provides guidance about obesity and ED prevention messages. The focus should be on a healthy lifestyle rather than on weight. Evidence suggests that obesity prevention and treatment, if conducted correctly, do not predispose to EDs.
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95
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Wanby P, Berglund J, Brudin L, Hedberg D, Carlsson M. Increased ferritin levels in patients with anorexia nervosa: impact of weight gain. Eat Weight Disord 2016; 21:411-417. [PMID: 26830429 DOI: 10.1007/s40519-015-0246-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/12/2015] [Indexed: 01/12/2023] Open
Abstract
PURPOSE A few recent studies have found elevated ferritin levels in patients with anorexia nervosa (AN), indicating ferritin as a potential biomarker of disease severity. The purpose of this study was to study how body mass index (BMI) and changes in BMI affect plasma ferritin concentrations in Swedish patients with eating disorders. MATERIALS AND METHODS In a retrospective computer search from 2009 to 2014, 662 patients with an eating disorder were identified from more than 200,000 individuals with electronic medical records. Three hundred and eighty-nine patients (374 females and 15 males) were found to have at least one p-ferritin value with a corresponding BMI value. Patients with AN were compared to a combined group consisting of patients with bulimia nervosa (BN) and patients with an eating disorder not otherwise specified (EDNOS). RESULTS Patients with AN had lower BMI compared to the combined group of patients with other eating disorders (BMI = 16.5 ± 1.5, n = 77 vs. 21.0 ± 4.7, n = 312, p < 0.001). Patients with AN also had higher plasma ferritin levels (median 42 μg/L (range 3.3-310) vs. 31 μg/L (range 2.8-280); p < 0.001). As BMI increased in patients with AN, ferritin levels decreased (from a median of 40 μg/L (7-400) to 26 (4-170), n = 47; p < 0.001). DISCUSSION Measuring ferritin in patients with AN could be valuable in monitoring improvements of nutritional status, but the full clinical value of following ferritin in individual patients has yet to be determined. The study also shows how research can benefit from electronically captured clinical data using electronic health records.
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Affiliation(s)
- P Wanby
- Department of Internal Medicine, Section of Endocrinology, County Hospital of Kalmar, 391 85, Kalmar, Sweden.
| | - J Berglund
- University Hospital of Linköping, Linköping, Sweden
| | - L Brudin
- Department of Clinical Physiology, County Hospital of Kalmar, Kalmar, Sweden
| | - D Hedberg
- Department of IT-Administration, County Council of Kalmar, Kalmar, Sweden
| | - M Carlsson
- Department of Clinical Chemistry, County Hospital of Sweden, Kalmar, Sweden
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96
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Affiliation(s)
- Ellen S Rome
- Department of General Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH
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97
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Axsel J, Myburgh C, Poggenpoel M. Adolescent boys with obesity: The lived experiences. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1185915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Marie Poggenpoel
- Department of Nursing Science, University of Johannesburg, South Africa
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98
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O’Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, Gray-Donald K, Rossiter M, Adamo K, Brett K, Khatri N, Robinson N, Tumback L, Cheung A. Consensus canadien sur la nutrition féminine : adolescence, reproduction, ménopause et au-delà. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:555-609.e19. [DOI: 10.1016/j.jogc.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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99
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Leitner M, Burstein B, Agostino H. Prophylactic Phosphate Supplementation for the Inpatient Treatment of Restrictive Eating Disorders. J Adolesc Health 2016; 58:616-20. [PMID: 26774639 DOI: 10.1016/j.jadohealth.2015.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/01/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The medical stabilization of adolescent patients with restrictive eating disorders can be associated with refeeding syndrome, a potentially fatal complication preceded by refeeding hypophosphatemia (RH). Whether RH can be prevented by routine prophylactic phosphate supplementation has not been previously examined. This study sought to determine the safety and efficacy of a refeeding strategy that incorporates prophylactic phosphate supplementation to prevent RH. METHODS Retrospective chart data were collected for patients aged younger than 18 years with restrictive eating disorders admitted to a tertiary pediatric inpatient ward between January 2011 and December 2014. All patients were refed with a standardized protocol that included prophylactic oral phosphate supplementation (1.0 ± .2 mmol/kg/day). RESULTS During the 4-year study period, 75 admissions (70 patients) were included for analysis. The mean age and percent median body mass index of included patients were 15.3 years and 83.5%, respectively. Seven out of 75 (9%) had percent median body mass index of <70% and 26 out of 75 (35%) had percent body weight loss >20%. All patients were normophosphatemic at the time of admission (mean serum phosphate 1.24 ± .2 mmol/L). Serial laboratory evaluation revealed that all supplemented patients maintained serum phosphate levels >1.0 mmol/L during the initial 7 days of refeeding. Eleven patients became mildly hyperphosphatemic (range 1.81-2.17 mmol/L) with no associated clinical consequences. Additional analysis of 11 patients presenting with hypophosphatemia before refeeding revealed that with supplementation, phosphate values normalized by Day 1, and this group experienced no further RH episodes during initial refeeding. CONCLUSIONS Prophylactic oral phosphate supplementation appears safe, and no episodes of RH occurred in patients with restrictive eating disorders undergoing inpatient refeeding.
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Affiliation(s)
- Maya Leitner
- Division of Adolescent Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Holly Agostino
- Division of Adolescent Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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100
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