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Ralph-Nearman C, Osborn KD, Chang RS, Barber KE. Momentary physiological indices related to eating disorders: A systematic and methodological review. EUROPEAN EATING DISORDERS REVIEW 2024; 32:700-717. [PMID: 38446505 PMCID: PMC11144111 DOI: 10.1002/erv.3062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 12/29/2023] [Indexed: 03/07/2024]
Abstract
Eating disorders (ED) are serious psychiatric illnesses, with no everyday support to intervene on the high rates of relapse. Understanding physiological indices that can be measured by wearable sensor technologies may provide new momentary interventions for individuals with ED. This systematic review, searching large databases, synthesises studies investigating peripheral physiological (PP) indices commonly included in wearable wristbands (heart rate [HR], heart rate variability [HRV], electrodermal activity [EDA], peripheral skin temperature [PST], and acceleration) in ED. Inclusion criteria included: (a) full peer-reviewed empirical articles in English; (b) human participants with active ED; and (c) containing one of five wearable physiological measures. Kmet risk of bias was assessed. Ninety-four studies were included (Anorexia nervosa [AN; N = 4418], bulimia nervosa [BN; N = 916], binge eating disorder [BED; N = 1604], other specified feeding and eating disorders [OSFED; N = 424], and transdiagnostic [N = 47]). Participants with AN displayed lower HR and EDA and higher HRV compared to healthy individuals. Those with BN showed higher HRV, and lower EDA and PST compared to healthy individuals. Other ED and Transdiagnostic samples showed mixed results. PP differences are indicated through various assessments in ED, which may suggest diagnostic associations, although more studies are needed to validate observed patterns. Results suggest important therapeutic potential for PP in ED, and larger studies including diverse participants and diagnostic groups are needed to fully uncover their role in ED.
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Affiliation(s)
- Christina Ralph-Nearman
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Kimberly D Osborn
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Rose Seoyoung Chang
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Department of Psychology, Seoul National University, Seoul, South Korea
| | - Kathryn E Barber
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
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Viaño-Nogueira P, Aparicio-López C, Prieto-Campo Á, Morón-Nozaleda G, Camarneiro-Silva R, Graell-Berna M, de Lucas-Collantes C. Hypercapnia in hospitalized children and adolescents with anorexia nervosa as a predictive marker for readmission: a prospective study. Eat Weight Disord 2023; 28:94. [PMID: 37921895 PMCID: PMC10624702 DOI: 10.1007/s40519-023-01624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/29/2023] [Indexed: 11/05/2023] Open
Abstract
PURPOSE To determine whether hypercapnia is associated with risk of hospital readmission related to anorexia nervosa (AN) in children and adolescents. METHODS We performed a prospective study of patients ≤ 18 years old admitted due to AN decompensation from November 2018 to October 2019. Both subtypes of AN, restricting subtype (AN-R) and binge-eating/purging subtype (AN-BP), were included. Study participants were evaluated upon admission, at discharge and six months after discharge. T-tests or Mann-Whitney U tests was used to compare means values. Pearson or Spearman correlations were used to measure the association between two variables. Logistic regression models were developed to evaluate the relationship between scoring methods and readmission. RESULTS Of the 154 persons admitted during the study period, 131 met the inclusion criteria. Median age was 15.1 years. At admission, 71% of participants were malnourished and 33 (25%) had been previously admitted. We observed a marked decrease in venous pH and stable pCO2 elevation during follow-up period. Hypercapnia at discharge was associated with a twofold increased likelihood of readmission and the odds of readmission increased as discharge pCO2 rose. These findings did not depend on AN subtype or participant sex. Electrolytes persisted within the normal range. CONCLUSION Hypercapnia and respiratory acidosis are common alterations in children and adolescents hospitalized due to AN decompensation. Hypercapnia persists for at least 6 months after discharge despite clinical improvement and is associated with higher odds of readmission. This is the first study to identify an abnormal laboratory finding as a potential predictor of readmission in AN. LEVEL OF EVIDENCE IV: Multiple time series without intervention.
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Affiliation(s)
| | | | - Ángela Prieto-Campo
- Statistics and Methodology Unit, Galicia Sur Health Research Institute (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
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Nitsch A, Kearns M, Mehler P. Pulmonary complications of eating disorders: a literature review. J Eat Disord 2023; 11:12. [PMID: 36717849 PMCID: PMC9887828 DOI: 10.1186/s40337-023-00735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023] Open
Abstract
The medical complications of eating disorders (EDs) have been described in the literature; however, the pulmonary system has historically been described as relatively spared from the ravages of eating disorders and thus neglected in the literature. Here we review the pulmonary complications that have been described in the literature, including the effects of starvation on the lungs of nutritionally deprived animals and patients with anorexia nervosa. There is clear evidence of weakness of respiratory muscles with starvation in both groups. However, there is discordance in the literature as to whether starvation results in "nutritional emphysema," and if so, by what mechanism and at what degree of malnutrition it develops. We also explore the growing concern for the risk of non-tuberculosis mycobacterium infection as well as risk for pneumomediastinum and pneumothorax in patients with restrictive EDs. From the limited literature, it is clear the lungs, in fact, are not spared and that further research is needed to fully understand the full extent of pulmonary complications instigated by EDs.
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Affiliation(s)
- Allison Nitsch
- ACUTE Center for Eating Disorders at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA.,Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Mark Kearns
- Department of Pulmonary and Critical Care Medicine, Denver Health, Denver, USA.,Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Philip Mehler
- ACUTE Center for Eating Disorders at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA. .,Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA. .,Eating Recovery Center, 7351 E Lowry Blvd, Denver, CO, 80230, USA.
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Mimura Y, Shimizu Y, Oi H, Kurose S, Kudo S, Takata T, Mimura M, Funayama M. "Case series: ischemic stroke associated with dehydration and arteriosclerosis in individuals with severe anorexia nervosa". J Eat Disord 2021; 9:39. [PMID: 33743808 PMCID: PMC7981924 DOI: 10.1186/s40337-021-00393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous reports have indicated that patients with anorexia nervosa (AN) are at a relatively high risk of developing vascular diseases, including cardiovascular events and venous thromboembolism. However, there have been no previous reports of the development of ischemic stroke during refeeding therapy in patients with severe AN. This report is aimed at reporting the characteristics of an ischemic stroke in patients with AN. CASE PRESENTATIONS Our study included 29 admissions by independent 19 female patients cases (19 patients), who received thorough medical, neurological, and psychiatric examinations. Two patients were diagnosed as having developed ischemic stroke; the first patient showed multiple infarctions in the brain, while the second showed symptomatic focal infarction. Our findings suggest that dehydration and arteriosclerosis, in association with severe malnutrition, could predispose to the development of ischemic stroke in patients with severe AN. CONCLUSIONS Development of ischemic stroke in patients with AN might be overlooked. Watching out for neurological signs would help in early diagnosis of ischemic stroke in patients with AN during refeeding. Specific etiology could induce ischemic stroke in patients with AN even if they have no common risk factors of ischemia.
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Affiliation(s)
- Yu Mimura
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan. .,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yusuke Shimizu
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroki Oi
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shun Kudo
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taketo Takata
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Michitaka Funayama
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Pires SAP, Soares JC, Luz AMBD, Moleiro P. OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA - THE IMPORTANCE OF VENOUS BLOOD GASES. ACTA ACUST UNITED AC 2020; 38:e2018358. [PMID: 31939517 PMCID: PMC6958540 DOI: 10.1590/1984-0462/2020/38/2018358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. METHODS Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. RESULTS A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). CONCLUSIONS Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.
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Ibrahim A, Cutinha D, Ayton A. What is the evidence for using bed rest as part of hospital treatment of severe anorexia nervosa? EVIDENCE-BASED MENTAL HEALTH 2019; 22:77-82. [PMID: 31003978 PMCID: PMC10270425 DOI: 10.1136/ebmental-2018-300064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 11/04/2022]
Abstract
Bed rest is commonly used on medical and paediatric wards as part of nursing management of the physically compromised patient with severe anorexia nervosa. The aim of this study was to review the evidence base of bed rest as an intervention in the management of severe anorexia nervosa. We searched MEDLINE, PubMed, Embase, PsychInfo, CINAHL, HMIC, AMED, HBE, BNI and guidelines written in English until April 2018 using the following terms: bed rest and anorexia nervosa. After exclusion of duplicates, three guidelines and eight articles were included. The papers were methodologically heterogeneous, and therefore, quantitative summary was not possible. There have been no randomised controlled trials to compare the benefits and harms of bed rest as the focus of intervention in the treatment of anorexia nervosa. Several papers showed that patients have a strong preference for less restrictive approaches. These are also less intensive in nursing time. Negative physical consequences were described in a number of studies: these included lower heart rate, impaired bone turn over and increased risk of infection. We found no evidence to support bed rest in hospital treatment of anorexia nervosa. The risks associated with bed rest are significant and include both physical and psychological harm, and these can be avoided by early mobilisation. Given the established complications of bed rest in other critically ill patient populations, it is difficult to recommend the enforcement of bed rest for patients with anorexia nervosa. Future research should focus on safe early mobilisation, which would reduce complications and improve patient satisfaction.
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Affiliation(s)
- Ali Ibrahim
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK
| | - Darren Cutinha
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK
| | - Agnes Ayton
- Cotswold House, Oxford Health NHS Foundation Trust Adult Mental Health Services, Oxford, Oxfordshire, UK
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