Clinical and subthreshold eating disorders: case detection in adolescent schoolgirls

Body composition in subjects with anorexia nervosa: bioelectrical impedance analysis and dual-energy X-ray absorptiometry

OBJECTIVE

To evaluate the applicability and validity of bioelectrical impedance analysis (BIA) compared with dual-energy X-ray absorptiometry (DXA) in a population of girls with restrictive anorexia nervosa (AN).

METHODS

A total of 30 girls (11-19 years old) with AN were enrolled. DXA and BIA (BIA software and the Deurenberg equations) were used to estimate the body composition. The correlation between the methods was assessed by Pearson's correlation coefficient and the Bland-Altman method.

RESULTS

The mean FFM estimates were 33.2 kg (BIA software), 32.8 kg (BIA, Deurenberg equation) and 33.1 kg (DXA). The mean FM values were 5.6 kg (BIA software), 6.2 kg (BIA, Deurenberg equation) and 6.4 kg (DXA). There was a high correlation between the FFM values estimated with the two methods (BIA software vs DXA r=0.917, p<0.001; Deurenberg equation vs DXA r=0.931, p<0.001). For the FFM, the limits of agreement were equal to ±3.34 kg for the BIA software and ±2.96 kg for the Deurenberg equation. For the FM, the limits of agreement were equal to ±4.60 kg for the BIA software and ±3.82 kg for the Deurenberg equation.

CONCLUSION

The results show a good correlation between DXA and BIA. BIA seems to be a valid alternative for epidemiological and clinical evaluations.

Eating disorders and their correlates in high school adolescents of Northern Italy

Objective – The study investigated eating disordered behaviours and life-habits correlated in a large sample of Northern Italian adolescents of both sexes. Methods – The study had a cross-sectional design. 2595 students (2,146 responders; mean age 17.2±1.7 years) attending high schools in Savona (Italy) in April and May 2001 were sampled. To assess eating attitudes, the Inventory for the Screening of Eating Disorders (ISED) was self-administered. Inquiries regarding possible risk factors for eating disorders were also made: socio-economic status, body weight, smoking and alcohol drinking habits, illegal drugs use. Results – Females scored significantly higher than males at ISED (13.4±7.7 vs. 7.6±5.8). 28.5% of females had a total ISED score above the cut-off point (18/19). Unhealthy eating behaviours were strongly associated with higher BMI, body image disturbance and illegal drugs use in both sexes; age had significant role only in males. No significant association between disordered eating behaviours and socio-economic status, smoking habit and alcohol consumption were found. Conclusions – Symptoms of eating disorders are quite spread in the Northern Italian female adolescents and associate with illegal drugs use. These data, with not negligible frequency of unhealthy eating behaviours and attitudes in males too, suggest that primary and secondary preventive interventions for teen-agers should be got ready.

Declaration of Interest: 1) the study received the financial support by Regione Liguria and ASL 2 of Savona; 2) the study didn't receive any forms of financing by pharmaceutical company support and any honoraria for consultancies or interventions was received by each author in the last two years; 3) any other involvements that might be considered a conflict of interest in connection with the submitted article. The authors state that if and when the manuscript accepted for publication, they automatically agree to transfer the copyright to the publisher

[Development of a questionnaire for body weight associated anxiety in anorexia nervosa]

Anxiety plays a comprehensive role in the psychopathology of anorexic patients and the long-term course of the disorder. Despite the importance of the major symptoms: weight phobia, there has been no systematic documentation to date of therapeutically and prognostically meaningful weight-associated fears. Given the use of a preventative approach in the early diagnosis of specific anxiety symptoms. We developed a questionnaire (Anorexia Anxiety Scale, AAS) based on a survey of 372 girls attending different types of secondary schools and a sample of 26 former patients. The number of items was reduced from 32 to 8 by means of a factor analysis. Upon further validation, the questionnaire should then be applicable for use as a screening instrument.

Drug usage as a treat to the stability of treatment outcome: a one-year follow-up study of adolescent psychiatric patients

OBJECTIVE

To examine the stability of treatment outcome one year after discharge from an inpatient treatment programme for adolescents with severe behavioural problems combined with psychiatric disorders.

METHOD

Symptom Check List-90 Revised (SCL-90 R) ratings were obtained at admission, discharge and one-year follow-up for 75 patients. Treatment outcome was determined by calculating clinically significant change on the SCL-90 R Global Severity Index (GSI) between admission and discharge. Stability of treatment outcome was determined by comparing the clinically significant changes on the GSI between admission and discharge, and between admission and follow-up.

RESULTS

Compared to baseline, 46.7% of the patients recovered (reliable change was found and their GSI at discharge was below the cutoff point for the functional population), 20% improved (reliable change was found, but the GSI was still above the cutoff point). For the other patients no reliable change was found (12.0%) or they deteriorated (21.3%). At follow-up, compared to the base score, 52.0% recovered, 13.3% improved, 12.0% showed no reliable change, and 22.7% deteriorated. Although for the whole sample no significant change was found between discharge and follow-up, some individual patients continued to improve after discharge, while others deteriorated. Analyses show that drug usage during the follow-up period is a strong predictor for these changes.

CONCLUSION

The results indicated that the majority of the patients recovered or improved during treatment and this treatment outcome was relatively stable at one-year follow-up. However, in a minority of patients the treatment results deteriorated during the one-year follow-up period. Drug usage turned out to be an important predictor for this deterioration.

Prevalence of eating disorders in Argentine boys and girls, aged 10 to 19, who are in primary care. A two-stage community-based survey

The objective of this paper is to describe the prevalence of eating disorders (ED) in Argentina, in a randomly assigned national community-based sample of 1,231 girls and 740 boys in primary care, aged 10 to 19.9. A two-stage design was followed; subjects were screened with a self-report measure (EDE-Q4), and diagnosed with an expert-based interview (EDE-120D). Height, weight and BMI were measured and five subscales of the SCL90-R were completed. More than one quarter (a 26.4%) of the sample had a BMI greater than the 90th percentile, and these accounted for 48% of the suspected cases of ED. Only 42% returned for the EDE-12 interview; diagnosis was confirmed for 137 cases (6.9% of the total sample): 6.6% BED; 0.05% BN, and 0.3% EDNOS other than BED. Binge eating and restraint of food intake related directly to BMI and purging behaviors were very rare. More subjects than expected were found to be overweight and this related directly to the diagnosed ED. Psychological distress was directly related the presence of eating disturbances.

Management and treatment of eating disorders in an Italian region

OBJECTIVE

Eating disorders (ED) are an outstanding health problem in western countries, and bear significant mortality, e.g. anorexia nervosa (AN), and morbidity. The Liguria Region Health Department set up a study with the support of a number of specialists to investigate the number and characteristics of patients referred to institutions, how patients were managed, and the healthcare facilities and personnel involved.

METHODS

The retrospective study required that all regional institutions, except two, involved in the treatment of ED during the year 2001 filled out a special questionnaire.

RESULTS

Twenty-one institutions (n=19 public, n=2 private) followed 1,220 patients with ED in the mentioned year. The prevalence of such disorders was 6 fold higher in females (1,054 F, 166 M; age range 12-32 years). Bulimia nervosa (BN) proved to be the disorder category most frequently observed (prevalence 59%) followed by AN (26%, p<0.0001) and ED not otherwise specified (EDNOS) (15%, p<0.0001). Most (approximately 90%) of these patients were managed in outpatient settings, and a multidisciplinary team approach was used in fewer than 20% of cases. Hospitalization (complete or partial) was required in 10.5% of patients: 7.1% for mental disturbances and 3.4% for severe malnutrition/electrolyte abnormalities. Fewer than one fourth of patients was admitted to two specialty units (one public and one private) for inpatients in our region with ED. Treatment provided in these centers included a specific nutritional rehabilitation program and psychologic/psychiatric care. Patients more severely underweight underwent nasogastric or parenteral feeding whenever deemed clinically appropriate. The grade of knowledge of ED by general practitioners/pediatricians and their links with trained centers were poor.

CONCLUSIONS

Although our data were obtained from a selected population, thus preventing epidemiological conclusions, they show that ED are a significant health concern in our region, with BN representing the most common disorder diagnosed in the different settings (general or specialized medical practices). Overall, the prevalence of such disorders was assessed as six fold higher in females than in males. The emerging issues to be improved are: i) poor level of communication among different specialists and subsequent scanty use of a multidisciplinary team approach in the management of ED ii) insufficient use of guidelines for the management of such disorders iii) paucity of specialty institutions for inpatients with ED iv) inadequate knowledge of the problem by primary care physicians and the community, and poor links with the healthcare institutions that might help.

Eating Attitudes Test and culture: a study in northern and southern Italy

The EAT (Eating Attitudes Test) has been widely used to compare eating morbidity in cultural groups and variations in it have been taken as indicative of cultural differences. This study assumed the existence of cultural differences between the north and the south of Italy. The EAT scores of female students from a northern and a southern Italian high school were compared. They were both higher than in other European studies, though there were no significant differences between the two groups. The result could be due to sampling limitations, but could also indicate that the EAT is not a reliable yardstick of cultural differences.