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Almeida MN, Atkins M, Garcia-Fischer I, Weeks IE, Silvernale CJ, Samad A, Rao F, Burton-Murray H, Staller K. Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010-2020. Neurogastroenterol Motil 2024; 36:e14782. [PMID: 38488182 PMCID: PMC11147706 DOI: 10.1111/nmo.14782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/10/2024] [Accepted: 03/04/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND AND AIMS Gastrointestinal (GI) disorders are common in patients with eating disorders. However, the temporal relationship between GI and eating disorder symptoms has not been explored. We aimed to evaluate GI disorders among patients with eating disorders, their relative timing, and the relationship between GI diagnoses and eating disorder remission. METHODS We conducted a retrospective analysis of patients with an eating disorder diagnosis who had a GI encounter from 2010 to 2020. GI diagnoses and timing of eating disorder onset were abstracted from chart review. Coders applied DSM-5 criteria for eating disorders at the time of GI consult to determine eating disorder remission status. RESULTS Of 344 patients with an eating disorder diagnosis and GI consult, the majority (255/344, 74.2%) were diagnosed with an eating disorder prior to GI consult (preexisting eating disorder). GI diagnoses categorized as functional/motility disorders were most common among the cohort (57.3%), particularly in those with preexisting eating disorders (62.5%). 113 (44.3%) patients with preexisting eating disorders were not in remission at GI consult, which was associated with being underweight (OR 0.13, 95% CI 0.04-0.46, p < 0.001) and increasing number of GI diagnoses (OR 0.47 per diagnosis, 95% CI 0.26-0.85, p = 0.01). CONCLUSIONS Eating disorder symptoms precede GI consult for most patients, particularly in functional/motility disorders. As almost half of eating disorder patients are not in remission at GI consult. GI providers have an important role in screening for eating disorders. Further prospective research is needed to understand the complex relationship between eating disorders and GI symptoms.
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Affiliation(s)
- Mariana N Almeida
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Micaela Atkins
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isabelle Garcia-Fischer
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Imani E Weeks
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Casey J Silvernale
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ahmad Samad
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fatima Rao
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Helen Burton-Murray
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle Staller
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Wronski ML, Kuja-Halkola R, Hedlund E, Martini MI, Lichtenstein P, Lundström S, Larsson H, Taylor MJ, Micali N, Bulik CM, Dinkler L. Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.10.24304003. [PMID: 38558975 PMCID: PMC10980122 DOI: 10.1101/2024.03.10.24304003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder, characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with a range of psychiatric and somatic symptoms, and therefore consult various pediatric subspecialties; large-scale studies mapping comorbidities are however lacking. To characterize health care needs of people with ARFID, we systematically investigated ARFID-related mental and somatic conditions in 616 children with ARFID and >30,000 children without ARFID. Methods In a Swedish twin cohort, we identified the ARFID phenotype in 6-12-year-old children based on parent-reports and register data. From >1,000 diagnostic ICD-codes, we specified mental and somatic conditions within/across ICD-chapters, number of distinct per-person diagnoses, and inpatient treatment days between birth and 18th birthday (90 outcomes). Hazard ratios (HR) and incidence rate ratios (IRR) were calculated. Findings Relative risks of neurodevelopmental, gastrointestinal, endocrine/metabolic, respiratory, neurological, and allergic disorders were substantially increased in ARFID (e.g., autism HR[CI95%]=9.7[7.5-12.5], intellectual disability 10.3[7.6-13.9], gastroesophageal reflux disease 6.7[4.6-9.9], pituitary conditions 5.6[2.7-11.3], chronic lower respiratory diseases 4.9[2.4-10.1], epilepsy 5.8[4.1-8.2]). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had a significantly higher number of distinct mental diagnoses (IRR[CI95%]=4.7[4.0-5.4]) and longer duration of hospitalizations (IRR[CI95%]=5.5[1.7-17.6]) compared with children without ARFID. Children with ARFID were diagnosed earlier with a mental condition than children without ARFID. No sex-specific differences emerged. Interpretation This study yields the broadest and most detailed evidence of co-existing mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties. Funding Fredrik and Ingrid Thurings Foundation, Mental Health Foundation.
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Affiliation(s)
- Marie-Louis Wronski
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elin Hedlund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Miriam I. Martini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nadia Micali
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital – Mental Health Services CPH, Denmark
- Institute for Biological Psychiatry, Mental Health Centre Sct Hans, Copenhagen University Hospital – Mental Health Services, Copenhagen, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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3
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Gibson D, Mehler PS. A new conceptual model for anorexia nervosa: A role for connective tissue? Int J Eat Disord 2024; 57:537-542. [PMID: 38372082 DOI: 10.1002/eat.24172] [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: 01/23/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra-articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN. Therefore, a better understanding is needed to elucidate: (1) the relationship between abnormal connective tissue and AN, (2) the impact of starvation toward the development of abnormal connective tissue and how this manifests clinically, (3) the etiology of autonomic nervous system changes contributing to the dysautonomia in AN, and (4) how the sensory signals sent from potentially abnormal connective tissue to the central nervous system impact interoception in AN. A conceptual model incorporating abnormal connective tissue is provided. PUBLIC SIGNIFICANCE: The etiology of AN remains poorly understood and current theories fail to account for the direct impact of starvation on the health of the organs and tissues of the body. There is significant clinical overlap between AN and hereditary connective tissue disorders. This paper attempts to provide a new conceptual model for AN in which abnormal connective tissue contributes to the underlying pathogenesis.
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Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Eating Recovery Center, Denver, Colorado, USA
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4
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Perry TR, Cai K, Freestone D, Steinberg DM, Bohon C, Menzel JE, Baker JH. Early weight gain as a predictor of weight restoration in avoidant/restrictive food intake disorder. J Eat Disord 2024; 12:27. [PMID: 38360833 PMCID: PMC10870495 DOI: 10.1186/s40337-024-00977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/21/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Previous research has demonstrated that early weight gain in family-based treatment (FBT) is predictive of remission for adolescents with anorexia nervosa (AN). However, no published data has addressed if early weight gain is also predictive of reaching weight restoration (i.e., 95% EBW) in patients with avoidant/restrictive food intake disorder (ARFID). Furthermore, no studies have evaluated the performance of the statistical models used to predict weight restoration at the end of treatment. This study sought to examine whether early weight gain in ARFID is predictive of weight restoration at 20 weeks using ROC analysis. Additionally, this study assessed how accurately the model classified patients and what types of misclassifications occurred. METHODS Participants (n = 130, 57.7% cisgender female 70.0% white) received virtual outpatient FBT. Receiver operating characteristics (ROC) were used to predict successful weight restoration at end of treatment, using early weight gain as the predictor. Twenty weeks was considered as the end of treatment, to align with the definition of end of treatment in FBT clinical trials. ROC analyses demonstrated that gaining at least 6.2 pounds by week 5 of treatment was the strongest predictor of achieving 95% EBW at 20 weeks (AUC = 0.72 [0.63, 0.81]). ROC analyses misclassified 35% of patients; the most common misclassification was predicting that a patient would not achieve 95% EBW when they actually did (61.6%). A logistical regression model, which included the patients' %EBW at admission in addition to early weight gain as a predictor, outperformed the ROC analyses (AUC = 0.90 [0.85, 0.95]) and provided additional context by showing the probability that a patient would succeed. CONCLUSION Taken together, research demonstrates that early weight gain is a useful predictor of 95% EBW at 20 weeks of treatment for patients with ARFID who require weight restoration. Furthermore, results suggest that statistical models need to take into account additional information, such as %EBW at admission, along with early weight gain in order to more accurately predict which patients will reach weight restoration at week 20.
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Affiliation(s)
- Taylor R Perry
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA.
- State University of New York at Albany, Albany, NY, USA.
| | - Kelly Cai
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - David Freestone
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Dori M Steinberg
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
- Duke University, Durham, NC, USA
| | - Cara Bohon
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
- Stanford University, Stanford, CA, USA
| | - Jessie E Menzel
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Jessica H Baker
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
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5
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Yin T, Ye R, Wang Q, Wang L, Xu W, Tu W, Xu G. Difficulties in eating out of home while diagnosed with inflammatory bowel disease: A qualitative interview study from China. PLoS One 2023; 18:e0288908. [PMID: 38051719 DOI: 10.1371/journal.pone.0288908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/06/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Meeting healthy dietary needs while eating out can be a challenging experience for adults with inflammatory bowel disease. This study examined the barriers experienced by adults with inflammatory bowel disease (IBD) when eating out. OBJECTIVE This study aimed to explore the perceptions of people with IBD on eating out barriers. DESIGN A qualitative study among individuals affected by IBD was conducted through semi-structured interviews. RESULTS Sixteen adults from China were diagnosed with IBD between 6 months and 20 years prior to the study. They were recruited from four tertiary care hospitals in Nanjing, China. The participants completed a semi-structured interview between April and September 2022. Self-perceived difficulties with eating and drinking when eating out were varied. After thematic analysis of the data, five main themes emerged: limited access to healthy and hygiene food; no pleasure of food enjoyment; financial strain; not feeling loved, supported or understood; and coping strategies for not meeting demand. CONCLUSIONS This study highlights the various barriers encountered by patients with inflammatory bowel disease when eating out. These findings will help people with IBD to encourage the formation of targeted health and well-being-related interventions. Knowledge of nutrition and diet should be provided in education and training programs administered to IBD.
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Affiliation(s)
- Tingting Yin
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Ran Ye
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiuqin Wang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Lulu Wang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenjing Xu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenjing Tu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Guihua Xu
- Nanjing University of Chinese Medicine, Nanjing, China
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6
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Smith L, López Sánchez GF, Fernandez-Egea E, Ford T, Parris C, Underwood BR, Butler L, Barnett Y, Trott M, Koyanagi A. Eating disorders and physical multimorbidity in the English general population. Eat Weight Disord 2023; 28:72. [PMID: 37676625 PMCID: PMC10485116 DOI: 10.1007/s40519-023-01600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
PURPOSE People with eating disorders may be at increased risk for physical health problems, but there are no data on the relationship between eating disorders and physical multimorbidity (i.e., ≥ 2 physical conditions) and its potential mediators. Thus, we investigated this association in a representative sample of adults from the UK, and quantified the extent to which this can be explained by various psychological and physical conditions, and lifestyle factors. METHODS Cross-sectional data of the 2007 Adult Psychiatric Morbidity Survey were analyzed. Questions from the five-item SCOFF screening instrument were used to identify possible eating disorder. Respondents were asked about 20 physical health conditions. Multivariable logistic regression and mediation analysis were conducted. RESULTS Data on 7403 individuals aged ≥ 16 years were analyzed [mean (SD) age 46.3 (18.6) years; 48.6% males]. After adjustment, possible eating disorder was associated with 2.11 (95%CI = 1.67-2.67) times higher odds for physical multimorbidity. Anxiety disorder explained the largest proportion this association (mediated percentage 26.3%), followed by insomnia (21.8%), perceived stress (13.4%), depression (13.1%), obesity (13.0%), and alcohol dependence (4.3%). CONCLUSION Future longitudinal studies are warranted to understand potential causality and the underlying mechanisms in the association between eating disorder and multimorbidity, and whether addressing the identified potential mediators in people with eating disorders can reduce multimorbidity.
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Affiliation(s)
- Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Christopher Parris
- Medical Technology Research Centre, School of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, Cambridge, UK
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Mike Trott
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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7
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Torstveit MK, Ackerman KE, Constantini N, Holtzman B, Koehler K, Mountjoy ML, Sundgot-Borgen J, Melin A. Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med 2023; 57:1119-1126. [PMID: 37752004 DOI: 10.1136/bjsports-2023-106932] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines targeting the athlete health and performance team, athlete entourage (eg, coaches, parents, managers) and sport organisations. Primary prevention of REDs seeks to minimise exposure to and reduce behaviours associated with problematic LEA. Some of the important strategies are educational initiatives and de-emphasising body weight and leanness, particularly in young and subelite athletes. Secondary prevention encourages the early identification and management of REDs signs or symptoms to facilitate early treatment to prevent development of more serious REDs outcomes. Recommended strategies for identifying athletes at risk are self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers. Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of REDs. The cornerstone of tertiary prevention is identifying the source of and treating problematic LEA. Best practice guidelines to prevent REDs and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of REDs.
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Affiliation(s)
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naama Constantini
- Sport Medicine, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Bryan Holtzman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Anna Melin
- Department of Sport Science, Linnaeus University, Vaxjo/Kalmar, Sweden
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Aulinas A, Muhammed M, Becker KR, Asanza E, Hauser K, Stern C, Gydus J, Holmes T, Murray HB, Breithaupt L, Micali N, Misra M, Eddy KT, Thomas JJ, Lawson EA. Oxytocin response to food intake in avoidant/restrictive food intake disorder. Eur J Endocrinol 2023; 189:149-155. [PMID: 37474111 PMCID: PMC10396082 DOI: 10.1093/ejendo/lvad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the response of anorexigenic oxytocin to food intake among adolescents and young adults with avoidant/restrictive food intake disorder (ARFID), a restrictive eating disorder characterized by lack of interest in food or eating, sensory sensitivity to food, and/or fear of aversive consequences of eating, compared with healthy controls (HC). DESIGN Cross-sectional. METHODS A total of 109 participants (54 with ARFID spectrum and 55 HC) were instructed to eat a ∼400-kcal standardized mixed meal. We sampled serum oxytocin at fasting and at 30-, 60-, and 120-min postmeal. We tested the hypothesis that ARFID would show higher mean oxytocin levels across time points compared with HC using a mixed model ANOVA. We then used multivariate regression analysis to identify the impact of clinical characteristics (sex, age, and body mass index [BMI] percentile) on oxytocin levels in individuals with ARFID. RESULTS Participants with ARFID exhibited greater mean oxytocin levels at all time points compared with HC, and these differences remained significant even after controlling for sex and BMI percentile (P = .004). Clinical variables (sex, age, and BMI percentile) did not show any impact on fasting and postprandial oxytocin levels among individuals with ARFID. CONCLUSIONS Consistently high oxytocin levels might be involved in low appetite and sensory aversions to food, contributing to food avoidance in individuals with ARFID.
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Affiliation(s)
- Anna Aulinas
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER Unidad 747), ISCIII, 08025 Barcelona, Spain
- Department of Medicine, University of Vic—Central University of Catalonia, 08500 Vic, Barcelona, Spain
| | - Maged Muhammed
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Kendra R Becker
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Elisa Asanza
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Kristine Hauser
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Casey Stern
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Julia Gydus
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Tara Holmes
- Translational and Clinical Research Center, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Helen Burton Murray
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Lauren Breithaupt
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Nadia Micali
- Eating Disorders Research Unit, Mental Health Services of the Capital Region of Denmark, Psychiatric Centre Ballerup, 2750 Ballerup, Denmark
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, WC1N 1EH, London, United Kingdom
| | - Madhusmita Misra
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Division of Pediatric Endocrinology, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Kamryn T Eddy
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Jennifer J Thomas
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
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9
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Weeks I, Abber SR, Thomas JJ, Calabrese S, Kuo B, Staller K, Murray HB. The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder. J Clin Gastroenterol 2023; 57:651-662. [PMID: 37079861 PMCID: PMC10623385 DOI: 10.1097/mcg.0000000000001853] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.
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Affiliation(s)
- Imani Weeks
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Sophie R. Abber
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Jennifer J. Thomas
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Samantha Calabrese
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Helen Burton Murray
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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10
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Liu BD, Starkey M, Virani A, Pichette SL, Fass S, Song G. Review article: Functional dyspepsia and pregnancy-Effects and management in a special population. Aliment Pharmacol Ther 2023; 57:1375-1396. [PMID: 37129241 DOI: 10.1111/apt.17534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Around 10% of Americans meet the Rome IV criteria for functional dyspepsia (FD), with a significantly higher rate in women. FD also has a higher prevalence in women below the age of 50, suggesting that women who are affected are likely to be of reproductive age. Unfortunately, there is a lack of research or evidence-based guidelines on managing FD in pregnancy. AIMS AND METHODS To address this issue, we aimed to perform a systematic review of the interactions between FD and pregnancy and managing pre-existing FD in the peripartum and post-partum phases using current lifestyle, pharmacological, non-pharmacological and alternative medicine interventions. RESULTS Due to the lack of Rome IV FD-specific data in pregnancy, we instead performed a narrative review on how existing FD interventions could be extrapolated to the pregnant population. Where possible we use the highest level of available evidence or official guidelines to answer these questions, which often involves synthesising treatment and safety evidence of these interventions in other diseases during pregnancy. Finally, we highlight current substantial knowledge gaps requiring further research for the safe management of a pregnant patient with pre-existing FD. CONCLUSIONS Overall, despite the paucity of knowledge of treating FD during pregnancy, providers can mitigate this uncertainty by planning ahead with the patient. Patients should ideally minimise treatment until after breastfeeding. However, interdisciplinary resources are available to ensure that minimal-risk interventions are maximised, while interventions with more risks, if necessary, are justifiable by both the patient and the care team. Future investigations should continue to elicit the mechanistic relationship between FD and pregnancy while cautiously expanding prospective research on promising and safe therapies in pregnant patients with pre-existing FD.
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Affiliation(s)
- Benjamin D Liu
- Department of Medicine, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio, USA
| | - Morgan Starkey
- Department of Medicine, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio, USA
| | - Aleena Virani
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Sandra L Pichette
- Department of Obstetrics and Gynecology, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio, USA
| | - Shira Fass
- Department of Psychiatry, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio, USA
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11
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Staller K, Abber SR, Burton Murray H. The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide. Lancet Gastroenterol Hepatol 2023; 8:565-578. [PMID: 36868254 DOI: 10.1016/s2468-1253(22)00351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 03/04/2023]
Abstract
Eating disorders include a spectrum of disordered thinking patterns and behaviours around eating. There is increasing recognition of the bi-directional relationship between eating disorders and gastrointestinal disease. Gastrointestinal symptoms and structural issues might arise from eating disorders, and gastrointestinal disease might be a risk factor for eating disorder development. Cross-sectional research suggests that individuals with eating disorders are disproportionately represented among people seeking care for gastrointestinal symptoms, with avoidant-restrictive food intake disorder in particular garnering attention for high rates among individuals with functional gastrointestinal disorders. This Review aims to describe the research to date on the relationship between gastrointestinal disorders and eating disorders, highlight research gaps, and provide brief, practical guidance for the gastroenterology provider in detecting, potentially preventing, and treating gastrointestinal symptoms in eating disorders.
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Affiliation(s)
- Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Helen Burton Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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12
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Atkins M, Burton Murray H, Staller K. Assessment and management of disorders of gut-brain interaction in patients with eating disorders. J Eat Disord 2023; 11:20. [PMID: 36782302 PMCID: PMC9926752 DOI: 10.1186/s40337-022-00731-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/28/2022] [Indexed: 02/15/2023] Open
Abstract
Disorders of gut-brain interaction (DBGI), also known as functional gastrointestinal disorders, are common in individuals with eating disorders, and may precede or perpetuate disordered eating. Understanding the pathophysiology of common gastrointestinal symptoms in DGBI can be important for the care of many patients with eating disorders. In this review, we summarize the literature to date on the complex relationship between DBGI and eating disorders and provide guidance on the assessment and management of the most common symptoms of DBGI by anatomic region: esophageal symptoms (globus and functional dysphagia), gastroduodenal symptoms (functional dyspepsia and nausea), and bowel symptoms (abdominal pain, bloating and constipation).
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Affiliation(s)
- Micaela Atkins
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. .,Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.
| | - Helen Burton Murray
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, 02215, USA
| | - Kyle Staller
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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13
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Dhopatkar N, Keeler JL, Mutwalli H, Whelan K, Treasure J, Himmerich H. Gastrointestinal symptoms, gut microbiome, probiotics and prebiotics in anorexia nervosa: A review of mechanistic rationale and clinical evidence. Psychoneuroendocrinology 2023; 147:105959. [PMID: 36327759 DOI: 10.1016/j.psyneuen.2022.105959] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
Recent research has revealed the pivotal role that the gut microbiota might play in psychiatric disorders. In anorexia nervosa (AN), the gut microbiota may be involved in pathophysiology as well as in the gastrointestinal (GI) symptoms commonly experienced. This review collates evidence for the potential role of gut microbiota in AN, including modulation of the immune system, the gut-brain axis and GI function. We examined studies comparing gut microbiota in AN with healthy controls as well as those looking at modifications in gut microbiota with nutritional treatment. Changes in energy intake and nutritional composition influence gut microbiota and may play a role in the evolution of the gut microbial picture in AN. Additionally, some evidence indicates that pre-morbid gut microbiota may influence risk of developing AN. There appear to be similarities in gut microbial composition, mechanisms of interaction and GI symptoms experienced in AN and other GI disorders such as inflammatory bowel disease and functional GI disorders. Probiotics and prebiotics have been studied in these disorders showing therapeutic effects of probiotics in some cases. Additionally, some evidence exists for the therapeutic benefits of probiotics in depression and anxiety, commonly seen as co-morbidities in AN. Moreover, preliminary evidence for the use of probiotics in AN has shown positive effects on immune modulation. Based on these findings, we discuss the potential therapeutic role for probiotics in ameliorating symptoms in AN.
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Affiliation(s)
- Namrata Dhopatkar
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK.
| | - Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Hiba Mutwalli
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London SE1 9NH, UK.
| | - Janet Treasure
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK; Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Hubertus Himmerich
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK; Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
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14
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Gibson D, Watters A, Dee E, Mehler PS. Gastric dilatation in patients with restrictive eating disorders. Int J Eat Disord 2022; 55:1853-1858. [PMID: 36285773 DOI: 10.1002/eat.23839] [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: 06/29/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To better understand gastric dimensions in patients diagnosed with restrictive eating disorders (EDs). METHOD In this retrospective study, 56 patients, with restrictive EDs, and 60 gender/age/race-matched patients from an outpatient clinic, were studied. Difference in stomach size, between cohorts, was ascertained, and regression analyses were used to examine associations with stomach size in the ED cohort. RESULTS Patients with EDs were found to have significantly enlarged gastric dimensions when compared to the control group (M:14.8 cm [SD: 3.2] vs. 11.4 cm [SD: 2.9], p < .0001). Among the ED cohort, blood urea nitrogen (BUN), on the day of imaging, positively correlated with gastric dimensions (r = .43, p = .0009), while hypoalbuminemia negatively correlated with gastric dimensions (r = -.37, p = .005). BUN and albumin nadir were also significantly associated with stomach size (r2 = .26, F[2,53] = 9.46, p = .0003). There was no significant correlation between gastric dimensions and ED diagnosis, percent ideal body weight, gender, duration of illness, engagement in vomiting behaviors, diagnosis of superior mesenteric artery syndrome, or use of promotility agents. DISCUSSION Findings in this study suggest that malnutrition, secondary to EDs, may be associated with an enlarged stomach. The relationship between the gastric dimensions and reported GI symptoms in this population remain to be determined. PUBLIC SIGNIFICANCE There are many physiologic changes to the gastrointestinal system that develop with malnutrition but the contribution of these physiologic changes toward the reported GI symptoms and refeeding difficulties is unclear. This is the first study to suggest that patients with malnutrition, secondary to EDs, may be associated with an enlarged stomach, and this potential relationship requires further investigation.
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Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elizabeth Dee
- Department of Radiology, Denver Health Hospital Authority, Denver, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Eating Recovery Center, Denver, Colorado, USA
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15
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Burton Murray H, Calabrese S. Identification and Management of Eating Disorders (including ARFID) in GI Patients. Gastroenterol Clin North Am 2022; 51:765-783. [PMID: 36375995 DOI: 10.1016/j.gtc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Eating disorders are characterized by cognitions (eg, fear of gastrointestinal symptoms around eating, overvaluation of body shape/weight) and behaviors (eg, dietary restriction, binge eating) associated with medical (eg, weight loss), and/or psychosocial impairments (eg, high distress around eating). With growing evidence for bidirectional relationships between eating disorders and gastrointestinal disorders, gastroenterology providers' awareness of historical, concurrent, and potential risk for eating disorders is imperative. In this conceptual review, we highlight risk and maintenance pathways in the eating disorder-gastrointestinal disorder intersection, delineate different types of eating disorders, and provide recommendations for the gastroenterology provider in assessing and preventing eating disorder symptoms..
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Affiliation(s)
- Helen Burton Murray
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Samantha Calabrese
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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16
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Diet, Digestion, and the Dietitian: A Survey of Clinicians' Knowledge, Attitudes and Practices to Advance the Treatment of Gastrointestinal Disturbances in Individuals with Anorexia Nervosa. J Clin Med 2022; 11:jcm11195833. [PMID: 36233700 PMCID: PMC9573322 DOI: 10.3390/jcm11195833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Despite advances in treatment of anorexia nervosa (AN), current therapeutic approaches do not fully consider gastrointestinal disturbances (GID), often present in AN. Addressing GID, both symptoms and disorders, is likely to improve treatment adherence and outcomes in people with AN. GID are complex and are linked to a range of factors related to eating disorder symptomology and can be impacted by nutritional treatment. It is not known which dietetic practices are currently used to address GID in AN. Therefore, this survey aimed to explore the perceived knowledge, attitudes, and practices (KAP) of Australian dietitians treating AN and co-occurring GID. Seventy dietitians participated by completing an online survey. Knowledge scores were calculated based on correct responses to knowledge items (total: 12 points); and two groups were generated: higher knowledge (≥10 points, n = 31) and lower knowledge (≤9 points, n = 39). A greater proportion of dietitians with higher knowledge recognized the role of GID in pathogenesis of AN (p = 0.002) and its impact on quality of life (p = 0.013) and screened for GID (p ≤ 0.001), compared with those with lower knowledge. These results suggest that attitudes and practices toward patients presenting with AN and GID differ depending on level of knowledge. This may have important implications for treatment outcomes for individuals with AN and GID.
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17
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Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S. Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord 2022; 10:132. [PMID: 36064606 PMCID: PMC9442924 DOI: 10.1186/s40337-022-00654-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. METHODS This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. RESULTS A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. CONCLUSIONS This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.
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Affiliation(s)
- Ashlea Hambleton
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Genevieve Pepin
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
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18
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Gibson D, Watters A, Pieracci F, Reiss R, Mehler PS. Pneumatosis Intestinalis and Anorexia Nervosa. Surg Infect (Larchmt) 2022; 23:661-666. [PMID: 35969259 DOI: 10.1089/sur.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a condition historically associated with many diagnoses and can be life-threatening. The purpose of this article is to understand PI better in the setting of malnutrition secondary to anorexia nervosa (AN), a condition not historically affiliated with PI. Patients and Methods: In this retrospective study, the clinical findings of seven patients with AN are reported. Results: The patients were all found to have PI involving the right colon, with only a single patient also found to have PI involving additional colonic areas. No patients had small intestine involvement, and most of the patients were also diagnosed with the binge-purge subtype of AN, were receiving tube feeds, and had tenderness on abdominal examination. All seven patients were managed non-operatively. Conclusions: The authors propose that there may be an association between AN and PI. Given the surgical risks associated with malnutrition, the decision to pursue surgery, in the absence of the discussed pathologic risk factors, should be made in a very thoughtful manner. Future studies are warranted to better understand this potential association between PI and AN.
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Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Fredric Pieracci
- Department of Surgery, Denver Health Hospital Authority, Denver, Colorado, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rebecca Reiss
- Department of Pharmacy, Denver Health Hospital Authority, Denver, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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19
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Family-Empowered Treatment in Higher Levels of Care for Adolescent Eating Disorders: The Role of the Dietitian. J Acad Nutr Diet 2022; 122:1825-1832. [PMID: 35738535 DOI: 10.1016/j.jand.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022]
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20
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Li S, Cui G, Yin Y, Tang K, Chen L, Liu X. Prospective Association Between Problematic Mobile Phone Use and Eating Disorder Symptoms and the Mediating Effect of Resilience in Chinese College Students: A 1-Year Longitudinal Study. Front Public Health 2022; 10:857246. [PMID: 35570941 PMCID: PMC9092370 DOI: 10.3389/fpubh.2022.857246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 12/19/2022] Open
Abstract
A previous cross-sectional study found that problematic mobile phone use (PMPU) was associated with students' eating disorder symptoms. However, since the cross-sectional study cannot infer the causality and the direction of effect, the longitudinal relationship between the two and the mechanism behind this relationship are unclear. Therefore, the present study explores the prospective association between PMPU and eating disorder symptoms and related mediation mechanisms using a 1-year longitudinal study of 1,181 college students (from December 2019 [T1] to December 2020 [T2]). Survey tools used include the Mobile Phone Addiction Tendency Scale, the 10-item Connor-Davidson resilience scale, and the 12 item Short Form of the Eating Disorder Examination Questionnaire. The longitudinal relationship between PMPU and eating disorder symptoms and the mediating effect of resilience was analyzed using a cross-lagged model. The results showed that PMPU (β = 0.086, P < 0.01) and resilience (β = -0.145, P < 0.01) at T1 predicted eating disorder symptoms at T2, but not vice versa. PMPU was bidirectionally associated with resilience, and the prediction effect of PMPU at T1 to resilience at T2 (β = -0.151, P < 0.001) was higher than the prediction effect of resilience at T1 to PMPU at T2 (β = -0.134, P < 0.001). The standardized indirect effect of PMPU at T1 on eating disorder symptoms at T2 via resilience was significant (β = 0.022, 95% CI = 0.010~0.040, P < 0.001). Therefore, PMPU and resilience were predictive for eating disorder symptoms in college students, and resilience may play a mediating role in the prospective association between PMPU and eating disorder symptoms. This study provides new ideas and higher-level evidence for the development of prevention and intervention measures for college students' eating disorder symptoms.
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Affiliation(s)
- Shaojie Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Guanghui Cui
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongtian Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kaixuan Tang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lei Chen
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xinyao Liu
- Shandong University of Traditional Chinese Medicine, Jinan, China
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