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Jenkins ZM, Chait LM, Cistullo L, Castle DJ. A comparison of eating disorder symptomatology, psychological distress and psychosocial function between early, typical and later onset anorexia nervosa. J Eat Disord 2020; 8:56. [PMID: 33292580 PMCID: PMC7640671 DOI: 10.1186/s40337-020-00337-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Epidemiological studies suggest that the incidence of anorexia nervosa (AN) is increasing in younger populations, with some evidence that clinical differences occur according to age of onset (AOO), which may impact prognostic outcomes. The current study sought to compare eating disorder (ED) symptomatology, psychological distress and psychosocial function between early onset (EO), typical onset (TO) and later onset (LO) AN in a large sample of treatment-seeking patients with a diagnosis of AN. METHODS Participants included 249 individuals with a diagnosis of AN who were assessed at an outpatient ED service. The sample was divided into three groups based on AOO; those with an AOO ≤14 years (N = 58) were termed 'EO-AN', those with an AOO between 15 and 18 years (N = 113) were termed 'TO-AN' and those with an AOO of > 18 years (N = 78) were termed 'LO-AN'. Comparisons were made between AOO groups on assessments of ED symptomatology, psychological distress and psychosocial function. RESULTS EO-AN patients reported a significantly longer illness duration than both TO-AN and LO-AN groups. After controlling for effect of illness duration, the EO-AN group demonstrated significantly higher ED symptomatology and dysmorphic concern compared to the LO-AN group. The EO-AN group demonstrated significantly decreased cognitive flexibility compared to both the TO-AN and LO-AN groups. DISCUSSION These findings suggest that clinical differences do occur according to AOO in AN whereby EO-AN may represent a more severe form of illness that is not attributable to increased illness duration. Treatment strategies which specifically address patients with EO-AN may improve long term health outcomes and recovery.
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Affiliation(s)
- Zoe M Jenkins
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia. .,Department of Psychiatry, University of Melbourne, Melbourne, Australia.
| | - Lior M Chait
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | | | - David J Castle
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Hübel C, Yilmaz Z, Schaumberg KE, Breithaupt L, Hunjan A, Horne E, García‐González J, O'Reilly PF, Bulik CM, Breen G. Body composition in anorexia nervosa: Meta-analysis and meta-regression of cross-sectional and longitudinal studies. Int J Eat Disord 2019; 52:1205-1223. [PMID: 31512774 PMCID: PMC6899925 DOI: 10.1002/eat.23158] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Clinically, anorexia nervosa (AN) presents with altered body composition. We quantified these alterations and evaluated their relationships with metabolites and hormones in patients with AN longitudinally. METHOD In accordance with PRISMA guidelines, we conducted 94 meta-analyses on 62 samples published during 1996-2019, comparing up to 2,319 pretreatment, posttreatment, and weight-recovered female patients with AN with up to 1,879 controls. Primary outcomes were fat mass, fat-free mass, body fat percentage, and their regional distribution. Secondary outcomes were bone mineral density, metabolites, and hormones. Meta-regressions examined relationships among those measures and moderators. RESULTS Pretreatment female patients with AN evidenced 50% lower fat mass (mean difference [MD]: -8.80 kg, 95% CI: -9.81, -7.79, Q = 1.01 × 10-63 ) and 4.98 kg (95% CI: -5.85, -4.12, Q = 1.99 × 10-28 ) lower fat-free mass, with fat mass preferentially stored in the trunk region during early weight restoration (4.2%, 95% CI: -2.1, -6.2, Q = 2.30 × 10-4 ). While the majority of traits returned to levels seen in healthy controls after weight restoration, fat-free mass (MD: -1.27 kg, 95% CI: -1.79, -0.75, Q = 5.49 × 10-6 ) and bone mineral density (MD: -0.10 kg, 95% CI: -0.18, -0.03, Q = 0.01) remained significantly altered. DISCUSSION Body composition is markedly altered in AN, warranting research into these phenotypes as clinical risk or relapse predictors. Notably, the long-term altered levels of fat-free mass and bone mineral density suggest that these parameters should be investigated as potential AN trait markers. RESUMENOBJETIVO Clínicamente, la anorexia nervosa (AN) se presenta con alteraciones en la composición corporal. Cuantificamos estas alteraciones y evaluamos longitudinalmente su relación con metabolitos y hormonas en pacientes con AN. MÉTODO: De acuerdo con las pautas PRISMA, realizamos 94 meta-análisis en 62 muestras publicadas entre 1996-2019, comparando hasta 2,319 pacientes mujeres en pre-tratamiento, post-tratamiento, y recuperadas en base al peso con hasta 1,879 controles. Las principales medidas fueron masa grasa, masa libre de grasa, porcentaje de grasa corporal y su distribución regional. Las medidas secundarias fueron densidad mineral ósea, metabolitos y hormonas. Las meta-regresiones examinaron las relaciones entre esas medidas y moderadores. RESULTADOS Las pacientes femeninas con AN pre-tratamiento mostraron un 50% menos de masa grasa (MD: -8.80 kg, CI 95%: -9.81, -7.79, Q = 1.01 × 10-63 ) y 4.98 kg (CI 95%: -5.85, -4.12, Q = 1.99 × 10-28 ) menos de masa libre de grasa, con masa grasa preferentemente almacenada en la región del tronco durante la recuperación temprana del peso (4.2%, CI 95%: -2.1, -6.2, Q = 2.30 × 10-4 ). Aunque la mayoría de los rasgos regresaron a los niveles vistos en los controles sanos después de la restauración del peso, la masa libre de grasa (MD: -1.27 kg, CI 95%: -1.79, -0.75, Q = 5.49 × 10-6 ) y la densidad mineral ósea (MD: -0.10 kg, CI 95%: -0.18, -0.03, Q = 0.01) permanecieron significativamente alteradas. DISCUSIÓN: La composición corporal es marcadamente alterada en la AN, lo que garantiza la investigación en estos fenotipos como predictores de riesgo clínico o de recaída. Notablemente, la alteración a largo plazo de los niveles de masa libre de grasa y densidad mineral ósea sugieren que estos parámetros debe ser investigados como potenciales rasgos indicadores de AN.
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Affiliation(s)
- Christopher Hübel
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUK
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Zeynep Yilmaz
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Department of GeneticsUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Katherine E. Schaumberg
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Department of PsychiatryUniversity of Wisconsin—MadisonMadisonWisconsin
| | - Lauren Breithaupt
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusetts
- Department of PsychiatryHarvard Medical SchoolBostonMassachusetts
| | - Avina Hunjan
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUK
| | - Eleanor Horne
- Department of Genetics, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | | | - Paul F. O'Reilly
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Gerome Breen
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUK
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van Noort BM, Lohmar SK, Pfeiffer E, Lehmkuhl U, Winter SM, Kappel V. Clinical characteristics of early onset anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2018; 26:519-525. [PMID: 29943460 DOI: 10.1002/erv.2614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/04/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022]
Abstract
The aim of the current paper is to evaluate clinical characteristics of 30 children with early onset anorexia nervosa (EO-AN; age = 12.2 ± 1.6 years) compared with 30 patients with adolescent onset AN (AO-AN; age = 15.9 ± 0.7 years) and 60 age-matched healthy controls. Statistical analyses included one-way analyses of variance with three planned comparisons and chi-square tests. Compared with AO-AN, EO-AN patients displayed more restrictive eating behaviour (p = 0.038), received more tube-feeding (p = 0.024), and had less problems with self-esteem (p < 0.001) and perfectionism (p = 0.001). EO-AN patients have similar eating disorder pathology (p = 0.183), body-image distortion (p = 0.060), and number of hospitalizations (p = 0.358) as AO-AN. Only a third of EO-AN patients suffer from low self-esteem. Overall, core AN pathology seems similar in EO-AN and AO-AN. However, EO-AN patients show differences in their pathological eating behaviour and the need for tube-feeding.
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Affiliation(s)
- Betteke Maria van Noort
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sylvie Katharina Lohmar
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ernst Pfeiffer
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrike Lehmkuhl
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Maria Winter
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Viola Kappel
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Solmi M, Veronese N, Correll CU, Favaro A, Santonastaso P, Caregaro L, Vancampfort D, Luchini C, De Hert M, Stubbs B. Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2016; 133:341-51. [PMID: 26763350 DOI: 10.1111/acps.12556] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs). METHOD Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures. RESULTS Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC. CONCLUSION People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.
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Affiliation(s)
- M Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - N Veronese
- Department of Medicine, Geriatrics Section, University of Padova, Italy
| | - C U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA.,Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - A Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - P Santonastaso
- Department of Neurosciences, University of Padova, Padova, Italy
| | - L Caregaro
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - D Vancampfort
- Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium.,Z.org Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - C Luchini
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - M De Hert
- Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department, Institute of Psychiatry King's College London, London, UK
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Wells JCK, Haroun D, Williams JE, Nicholls D, Darch T, Eaton S, Fewtrell MS. Body composition in young female eating-disorder patients with severe weight loss and controls: evidence from the four-component model and evaluation of DXA. Eur J Clin Nutr 2015; 69:1330-5. [PMID: 26173868 PMCID: PMC4672328 DOI: 10.1038/ejcn.2015.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/04/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
Abstract
Background/Objectives: Whether fat-free mass (FFM) and its components are depleted in eating-disorder (ED) patients is uncertain. Dual energy X-ray absorptiometry (DXA) is widely used to assess body composition in pediatric ED patients; however, its accuracy in underweight populations remains unknown. We aimed (1) to assess body composition of young females with ED involving substantial weight loss, relative to healthy controls using the four-component (4C) model, and (2) to explore the validity of DXA body composition assessment in ED patients. Subjects/Methods: Body composition of 13 females with ED and 117 controls, aged 10–18 years, was investigated using the 4C model. Accuracy of DXA for estimation of FFM and fat mass (FM) was tested using the approach of Bland and Altman. Results: Adjusting for age, height and pubertal stage, ED patients had significantly lower whole-body FM, FFM, protein mass (PM) and mineral mass (MM) compared with controls. Trunk and limb FM and limb lean soft tissue were significantly lower in ED patients. However, no significant difference in the hydration of FFM was detected. Compared with the 4C model, DXA overestimated FM by 5±36% and underestimated FFM by 1±9% in ED patients. Conclusion: Our study confirms that ED patients are depleted not only in FM but also in FFM, PM and MM. DXA has limitations for estimating body composition in individual young female ED patients.
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Affiliation(s)
- J C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - D Haroun
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - J E Williams
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - D Nicholls
- Department of Psychological Medicine, Child and Adolescent Mental Health, Great Ormond Street Hospital, London, UK
| | - T Darch
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - S Eaton
- Developmental Biology and Cancer Programme, UCL Institute of Child Health, London, UK
| | - M S Fewtrell
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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Abstract
Anorexia nervosa is a serious psychiatric disorder accompanied by high morbidity and mortality. It is characterized by emaciation due to self-starvation and displays a unique hormonal profile. Alterations in gonadal axis, growth hormone resistance with low insulin-like growth factor I levels, hypercortisolemia and low triiodothyronine levels are almost universally present and constitute an adaptive response to malnutrition. Bone metabolism is likewise affected resulting in low bone mineral density, reduced bone accrual and increased fracture risk. Skeletal deficits often persist even after recovery from the disease with serious implications for future skeletal health. The pathogenetic mechanisms underlying bone disease are quite complicated and treatment is a particularly challenging task.
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Affiliation(s)
- Anastasia D Dede
- Department of Endocrinology and Metabolism, Hippokrateion General Hospital, Athens, Greece
| | | | - Symeon Tournis
- Laboratory for Research of Musculoskeletal System "Theodoros Garofalidis", University of Athens, KAT Hospital; Athens, Greece
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Bruni V, Dei M, Morelli C, Schettino MT, Balzi D, Nuvolone D. Body composition variables and leptin levels in functional hypothalamic amenorrhea and amenorrhea related to eating disorders. J Pediatr Adolesc Gynecol 2011; 24:347-52. [PMID: 21906977 DOI: 10.1016/j.jpag.2011.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/08/2011] [Accepted: 06/08/2011] [Indexed: 01/19/2023]
Abstract
The purpose of the study was to identify diagnostic criteria that can distinguish between subjects with functional hypothalamic amenorrhea largely related to minimal energy deficiency and those in whom failure of adaptive response to stress prevails. We studied 59 young women with secondary amenorrhea related to modest eating disorders and 58 who complained of stressful events in their history. We assessed anthropometric measurements, body composition using dual energy X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA), and basal endocrine profile. Subjects with disordered eating had lower body mass index (BMI), fat mass (FM) measured with both techniques, lumbar mineral density and direct and indirect measures of lean mass. Leptin and free tri-iodothyronine(FT(3)) concentrations also proved lower in the group of subjects with eating disorders, although there was no significant difference in cortisol between the two groups. Leptin levels were positively associated not only with fat mass, but also with body cell mass indexed to height and phase angle, parameters studied with BIA as expression of active lean compartment. A multivariate model confirmed the utility of integrating endocrine data with the study of body composition. The use of bioelectrical impedance analysis proved to be, in clinical use, a valid diagnostic alternative to DEXA, especially considering body cell mass and phase angle.
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Affiliation(s)
- Vincenzina Bruni
- Pediatric and Adolescent Gynecology Unit, University of Florence, Florence, Italy
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Waugh EJ, Woodside DB, Beaton DE, Coté P, Hawker GA. Effects of exercise on bone mass in young women with anorexia nervosa. Med Sci Sports Exerc 2011; 43:755-63. [PMID: 20962688 DOI: 10.1249/mss.0b013e3181ff3961] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The response of bone to exercise in women with anorexia nervosa (AN) is unclear. We investigated the associations between bone mineral density (BMD) and exercise performed while ill and while recovered in women with a history of AN. METHODS A cross-sectional study was conducted with 141 women with AN (85 ill; 56 recovered), aged 17-40 yr. BMD at the lumbar spine (LS), femoral neck (FN), and total body (TB) was measured by dual-energy x-ray absorptiometry. Life History Calendar and Minnesota Leisure Time Physical Activity interviews were used to collect lifetime illness and exercise histories (amount and bone loading type). Average hours per week of each of moderate (MOD) and high (HI) bone loading exercise were determined for three illness phases: "before ill," "while ill," and "while recovered." Participants were categorized into four exercise groups for each phase: MOD-ONLY, HI-ONLY, BOTH, and NEITHER (reference group). Weight-adjusted BMD z-scores were compared in the exercise groups by multivariable linear regression, adjusting for illness duration and severity, and exercise during the other illness phases. RESULTS In ill participants, MOD-ONLY "while ill" had lower BMD at LS (β = -0.69, 95% confidence interval (CI) = -1.02 to -0.05) and TB (β = -0.73, 95% CI = -1.31 to -0.15) than the NEITHER group. In recovered participants, HI-ONLY "while recovered" had higher BMD at FN (β = 0.95, 95% CI = 0.15-1.75) and TB (β = 0.79, 95% CI = 0.07-1.51) than the NEITHER group. CONCLUSIONS The effect of exercise on bone in AN patients is dependent on both the type of mechanical loading and the phase of illness during which it was performed. Excessive moderate loading exercise while ill may put patients at higher risk of low bone mass, but high bone loading activities may provoke bone accrual during recovery.
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Affiliation(s)
- Esther J Waugh
- Osteoporosis Research Program, Women’s College Hospital, 76 Grenville St., 8th Floor E, Room 812B, Toronto, Ontario, Canada M5S 2B2.
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Garcia FD, Grigioni S, Allais E, Houy-Durand E, Thibaut F, Déchelotte P. Detection of eating disorders in patients: validity and reliability of the French version of the SCOFF questionnaire. Clin Nutr 2010; 30:178-81. [PMID: 20971536 DOI: 10.1016/j.clnu.2010.09.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 09/15/2010] [Accepted: 09/20/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Although eating disorders prevalence is increasing, they are often under diagnosed in cases of unspecific signs of malnutrition. Screening scales may allow earlier diagnosis and nutritional intervention. This study aimed to evaluate the validity of the French version (SCOFF-F) of the SCOFF questionnaire for the detection of eating disorders among a female patient population referred to a clinical nutrition unit. METHODS After answering the 5 dichotomous questions of the paper version of SCOFF-F, patients were evaluated by one eating disorders specialist blinded to questionnaire results, using the MINI and Diagnosis and Statistical Manual for Mental diseases (DSM-IV) criteria as a gold standard. RESULTS Patients with anorexia nervosa (n = 67) and with bulimia nervosa (n = 45) were assessed. Age-matched healthy female students (n = 114) served as control group. At a cut-off of two positive responses, the sensibility, specificity and the area under the curve of SCOFF-F were 94.6%, 94.7% and 97.9% respectively. Cohen's kappa coefficient between SCOFF-F and MINI results was 89%. CONCLUSIONS The results of this study confirm the reliability of SCOFF-F as a screening and diagnostic-facilitating test for eating disorders in a French-speaking female patient population. SCOFF-F should help professionals in clinical nutrition to achieve earlier diagnosis and care of eating disorder patients.
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Affiliation(s)
- Frederico Duarte Garcia
- Nutrition Unit and EA 4311, Biomedical Research Institute & IFR23, University Hospital of Rouen, 76031 Rouen, Cedex, France.
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10
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Schulze UME, Schuler S, Schlamp D, Schneider P, Mehler-Wex C. Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation. Child Adolesc Psychiatry Ment Health 2010; 4:20. [PMID: 20615217 PMCID: PMC2914652 DOI: 10.1186/1753-2000-4-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 07/08/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS There still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). Therefore we assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. In addition to an expected influence of regular physical activity and hormone replacement therapy, we explored correlations with nutritionally dependent hormones. METHODS 3-9 years (mean 5.2 +/- 1.7) after hospital discharge, we re-investigated 52 female subjects with a history of early onset AN. By means of a standardized approach, we evaluated the general outcome of AN. Moreover, bone mineral content (BMC) and bone mineral density (BMD) as well as lean and fat mass were measured by dual-energy x-ray absorptiometry (DXA). In a substudy, we measured the serum concentrations of leptin and insulin-like growth factor-I (IGF-I). RESULTS The general outcome of anorexia nervosa was good in 50% of the subjects (BMI >/= 17.5 kg/m2, resumption of menses). Clinical improvement was correlated with BMC and BMD accrual (chi2 = 5.62/chi2 = 6.65, p = 0.06 / p = 0.036). The duration of amenorrhea had a negative correlation with BMD (r = -.362; p < 0.01), but not with BMC. Regular physical activity tended to show a positive effect on bone recovery, but the effect of hormone replacement therapy was not significant. Using age-related standards, the post-discharge sample for the substudy presented IGF-I levels below the 5th percentile. IGF-I serum concentrations corresponded to the general outcome of AN. By contrast, leptin serum concentrations showed great variability. They correlated with BMC and current body composition parameters. CONCLUSIONS Our results from the main study indicate a certain adaptability of bone mineral accrual which is dependent on a speedy and ongoing recovery. While leptin levels in the substudy tended to respond immediately to current nutritional status, IGF-I serum concentrations corresponded to the individual's age and general outcome of AN.
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Affiliation(s)
- Ulrike ME Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
| | - Simone Schuler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Germany
| | - Dieter Schlamp
- Heckscher Clinic for Child and Adolescent Psychiatry, Munich, Germany
| | - Peter Schneider
- Clinic for Nuclear Medicine, University of Würzburg, Germany
| | - Claudia Mehler-Wex
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
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Diamanti A, Bizzarri C, Basso MS, Gambarara M, Cappa M, Daniele A, Noto C, Castro M. How does long-term parenteral nutrition impact the bone mineral status of children with intestinal failure? J Bone Miner Metab 2010; 28:351-8. [PMID: 20033239 DOI: 10.1007/s00774-009-0140-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 10/30/2009] [Indexed: 02/07/2023]
Abstract
Patients on long-term parenteral nutrition (PN) are at significantly increased risk for the development of metabolic bone disease (MBD); this condition is characterized by incomplete mineralization of osteoid with consequent disturbances ranging from osteopenia to severe bone disease with fractures. The aim of the study was: (1) to evaluate the prevalence of MBD, (2) to identify the PN- or intestinal failure (IF)-related factors and (3) to assess annual changes of bone mineral status. Since September 2005 all patients affected by IF and treated with PN started a BMD evaluation program using dual-energy X-ray absorptiometry (DXA). Twenty-four IF patients were included [15 with short bowel syndrome (SBS), 5 with severe protracted diarrhea and 4 with chronic intestinal pseudostruction]. The bone mineral density (BMD) Z-score was significantly lower in patients than in the control group. In our series SBS patients showed a BMD Z-score significantly higher in comparison with the medical causes of IF. No significant correlations were found between bone mineral status and PN duration and nutrient intake. Nine IF patients were submitted to a second DXA evaluation after 1 year from the baseline. All bone mineral variables were significantly increased at the second DXA evaluation. The high prevalence of MBD in IF patients undergoing long-term treatment with PN requires that these patients undergo careful and periodic monitoring of their bone mineral status; patients with congenital gut dysfunctions, such as epithelium defects and motility anomalies, are at major risk of developing this complication, probably due to the association with extra-intestinal causes of bone loss.
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Affiliation(s)
- Antonella Diamanti
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, Rome, Italy
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