1
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Wong VZ, Lowe MR. Is there a basis for a weight cut-off point? A large-scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre. EUROPEAN EATING DISORDERS REVIEW 2024; 32:641-651. [PMID: 38383957 DOI: 10.1002/erv.3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE There is debate surrounding how to differentiate between anorexia nervosa (AN) and atypical AN (atypAN) as diagnostic entities, and whether a distinction based on BMI is warranted. Better understanding eating disorder (ED) and emotional symptoms across atypAN and AN subtypes [AN-restricting (AN-R), AN-binge/purge (AN-BP)], with and without controlling for BMI, can elucidate how atypAN differs from AN subtypes and whether there is a basis for a BMI cut-off. METHODS 1810 female patients at an ED treatment centre completed intake surveys. ANCOVAs assessed differences across AN-R (n = 853), AN-BP (n = 726), and atypAN (n = 231) groups on ED, depressive, and anxiety symptoms, anxiety sensitivity, experiential avoidance, and mindfulness, with and without controlling for BMI. RESULTS Relative to AN-R, atypAN and AN-BP groups endorsed significantly higher ED and depressive symptoms, anxiety sensitivity, experiential avoidance, and significantly lower mindfulness (all p < 0.001), but atypAN and AN-BP groups did not differ from one another. When controlling for BMI, all previously significant differences between atypAN and AN-R did not remain significant. CONCLUSION Individuals with atypAN who have a higher BMI experience more pronounced ED and emotional symptoms, suggesting that relying solely on BMI as a marker of illness severity may be problematic.
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Affiliation(s)
- Valerie Z Wong
- Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, New Jersey, USA
| | - Michael R Lowe
- Drexel University, Department of Psychological & Brain Sciences, Philadelphia, Pennsylvania, USA
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2
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Nohara N, Hiraide M, Horie T, Takakura S, Hata T, Sudo N, Yoshiuchi K. The optimal cut-off score of the Eating Attitude Test-26 for screening eating disorders in Japan. Eat Weight Disord 2024; 29:42. [PMID: 38850379 PMCID: PMC11162384 DOI: 10.1007/s40519-024-01669-1] [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: 03/08/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024] Open
Abstract
PURPOSE The Eating Attitude Test-26 (EAT-26) is a screening tool for eating disorders (EDs) in clinical and non-clinical samples. The cut-off score was suggested to be varied according to target population. However, no studies have examined the appropriateness of the originally proposed score of 20 for screening DSM-5 eating disorders in Japan. This study aimed to identify an appropriate cut-off score to better differentiate clinical and non-clinical samples in Japan for EDs. METHODS The participants consisted of 54 patients with anorexia nervosa restricting type, 58 patients with anorexia nervosa binge-eating/purging type, 37 patients with bulimia nervosa diagnosed according to DSM-5 criteria, and 190 healthy controls (HCs). Welch's t test was used to assess differences in age, body mass index (BMI), and total EAT-26 scores between HCs and patients with EDs. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal cut-off score. RESULTS The HCs had significantly higher BMI and lower total EAT-26 mean scores than patients with EDs. The area under the ROC curve was 0.925, indicating that EAT-26 had excellent performance in discriminating patients with EDs from HCs. An optimal cut-off score of 17 was identified, with sensitivity and specificity values of 0.866 and 0.868, respectively. CONCLUSIONS The result supports the suggestions that optimal cut-off score should be different according to target populations. The newly identified cut-off score of 17 would enable the identification of patients with EDs who have been previously classified as non-clinical samples in the EAT-26 test. LEVEL OF EVIDENCE III: evidence obtained from case-control analytic study.
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Affiliation(s)
- Nobuhiro Nohara
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Maiko Hiraide
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takeshi Horie
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Shu Takakura
- Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tomokazu Hata
- Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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3
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Beard J, Waller G. Atypical anorexia nervosa: A scoping review to determine priorities in research and clinical practice. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38590285 DOI: 10.1002/erv.3092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND There is currently a limited understanding of the identification, nature, and treatment of Atypical Anorexia Nervosa (AAN). Recent systematic reviews have identified only small numbers of candidate papers, and some areas lack any meaningful review so far - particularly treatment outcomes. A key issue is the lack of clarity in the literature regarding the definition of weight loss criteria. OBJECTIVES This scoping review aimed to determine the nature and extent of our knowledge of AAN, in order to assist in the development of future systematic reviews and meta-analyses, as well as indicating what further research is needed. METHOD Following the identification of 6747 records, 317 records using the term AAN or a defined equivalent were identified from six databases, including the 'grey' literature. RESULTS Of the 317 studies, 111 provided participant characteristics, and only 10 provided discrete treatment outcomes. Each of these subsets of the data are tabulated and supported with supplementary material, so that future systematic reviewers can access this resource. DISCUSSION The pattern and content of the existing studies allows recommendations to be made regarding future reviews, research and clinical practice. There is a particular need for clear weight/weight loss criteria and adequate interventions.
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Affiliation(s)
- Jessica Beard
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
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4
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Billman Miller MG, Gioia AN, Essayli JH, Forrest LN. Few differences in psychiatric comorbidities and treatment response among people with anorexia nervosa and atypical anorexia nervosa. Int J Eat Disord 2024; 57:809-818. [PMID: 37737487 DOI: 10.1002/eat.24046] [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] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Little is known about how individuals with atypical anorexia nervosa (AN) respond to eating disorder (ED) treatment in a partial hospitalization program (PHP), nor how certain factors such as trauma, childhood abuse, psychiatric comorbidity, and suicidal thoughts and behaviors might contribute to poor treatment outcomes. Thus, the current study (1) compares prevalence of these factors between individuals with AN and atypical AN upon admission to an ED PHP, (2) compares PHP treatment response between groups, and (3) investigates whether experiencing these factors impacts treatment outcomes. METHOD We conducted a retrospective chart review of young adults admitted to a PHP with AN (n = 95) and atypical AN (n = 59). Histories of psychiatric comorbidities and adverse childhood experiences were obtained from initial psychiatric evaluations. ED symptoms were assessed at intake and discharge with the Eating Disorder Examination-Questionnaire (EDE-Q). RESULTS No significant differences were found at intake in ED symptom severity or prevalence of lifetime trauma, childhood abuse, number of psychiatric diagnoses, or suicidal thoughts and behavior. Symptomatology at discharge also did not differ between groups. Emotional abuse was significantly related to discharge shape and weight overvaluation. No other intake characteristics were significantly related to discharge symptomatology. DISCUSSION To our knowledge, this is the first study to compare the prevalence of comorbidities for both AN and atypical AN, as well as differential treatment outcomes for these individuals in a PHP. Results add to growing literature suggesting that, other than weight, AN and atypical AN have few properties that reliably distinguish them from one another. PUBLIC SIGNIFICANCE This study adds to a growing body of literature that raises questions about whether anorexia nervosa (AN) and atypical AN are truly different diagnoses. Our findings suggest these two groups present to treatment in a partial hospitalization program (PHP) with similar ED symptoms, as well as prevalence of lifetime trauma, childhood abuse, suicidal thoughts and behavior, and number of psychiatric comorbidities, and demonstrate similar treatment trajectories in PHP.
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Affiliation(s)
| | - Ayla N Gioia
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Jamal H Essayli
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
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5
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Golden NH, Kapphahn CJ, Cheng J, Kreiter A, Downey AE, Accurso EC, Machen VI, Adams SH, Buckelew SM, Moscicki AB, Le Grange D, Garber AK. Course and outcome in individuals with atypical anorexia nervosa: Findings from the Study of Refeeding to Optimize iNpatient Gains (StRONG). Int J Eat Disord 2024; 57:799-808. [PMID: 37507351 PMCID: PMC10822019 DOI: 10.1002/eat.24029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We previously reported that participants with atypical anorexia nervosa (atypical AN) had higher historical and admission weights, greater eating disorder psychopathology, but similar rates of amenorrhea and weight suppression at baseline as compared to anorexia nervosa (AN); here, we compare 1-year outcomes. METHOD Weight, % median body mass index (%mBMI), Eating Disorder Examination Questionnaire (EDE-Q) scores, resumption of menses, and rehospitalizations were examined at 3, 6, and 12 months post-discharge. Analyses (N = 111) compared changes in %mBMI, weight suppression, and EDE-Q scores over time between atypical AN and AN. RESULTS Among the participants (48 atypical AN, 63 AN), both groups gained weight but those with atypical AN had lower gains than those with AN in %mBMI (p = .02) and greater weight suppression (p = .002) over time. EDE-Q scores improved over time, independent of weight suppression, with no significant difference between atypical AN and AN. Groups did not differ by rates of resumption of menses (80% atypical AN, 76.9% AN) or rehospitalization (29.2% atypical AN, 37.9% AN). Greater weight suppression predicted longer time to restore menses and more days of rehospitalization. DISCUSSION Individuals with atypical AN regained a smaller proportion of body mass and were more weight suppressed over time. Change in eating disorder cognitions, resumption of menses, and rehospitalization rates at 1-year follow-up did not differ between groups. There was no significant difference in weight suppression between groups for those who were psychologically improved at 12 months. Findings highlight limitations in our understanding of weight recovery in atypical AN. New metrics for recovery are urgently needed. PUBLIC SIGNIFICANCE Little is known about outcome in atypical anorexia nervosa (atypical AN). We examined recovery metrics in young people with atypical AN and anorexia nervosa (AN) 1 year after medical hospitalization. Individuals with atypical AN showed slower weight gain and remained further from their pre-illness weight. There were no differences in the rates of psychological recovery, resumption of menses, or rehospitalization. New metrics are needed to assess recovery in atypical AN.
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Affiliation(s)
- Neville H Golden
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
| | - Cynthia J Kapphahn
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
| | - Jing Cheng
- Department of Preventive & Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Anna Kreiter
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
| | - Amanda E Downey
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Vanessa I Machen
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Sally H Adams
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Sara M Buckelew
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Andrea K Garber
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
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6
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Fitterman-Harris HF, Han Y, Osborn KD, Faulkner LM, Williams BM, Pennesi JL, Levinson CA. Comparisons between atypical anorexia nervosa and anorexia nervosa: Psychological and comorbidity patterns. Int J Eat Disord 2024; 57:903-915. [PMID: 38288579 PMCID: PMC11018480 DOI: 10.1002/eat.24147] [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: 09/13/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Literature comparing "atypical" anorexia nervosa (atypical AN) and anorexia nervosa (AN) suggests these diagnoses share significant similarities in eating disorder (ED) pathology and psychiatric comorbidities. This study evaluated potential differences in ED pathology, psychiatric comorbidity, associated mechanisms (i.e., ED fears and perfectionism), and demographic factors (i.e., ethnicity and age) between individuals with atypical AN and AN. METHOD Data from seven protocols were combined for a total 464 individuals diagnosed with atypical AN (n = 215) or AN (n = 249). Between-group differences in ED severity and behaviors, psychiatric comorbidities, ED fears, perfectionism, and demographic factors were assessed using t-tests, Wilcoxon rank-sum tests, and Fisher's exact test. RESULTS Participants with atypical AN reported higher levels of overvaluation of weight and shape than those with AN. Participants with AN scored higher on food-related fears (anxiety about eating, food avoidance behaviors, and feared concerns) and fears of social eating, as well as obsessive-compulsive symptoms. Participants with AN were more likely to identify as Asian or Pacific Islander. No other statistically significant differences were found between groups for overall ED severity, ED behaviors, psychiatric comorbidities, general ED fears, perfectionism, or demographic factors. DISCUSSION Overall, results support previous literature indicating limited differences between individuals with atypical AN and AN, though individuals with atypical AN reported more overvaluation of weight and shape and those with AN reported higher food and social eating fears and obsessive-compulsive symptoms. Relatively few overall differences between atypical AN and AN highlight the importance of exploring dimensional conceptualizations of AN as an alternative to the current categorical conceptualization. PUBLIC SIGNIFICANCE This study assessed differences among individuals with atypical anorexia nervosa and anorexia nervosa in eating disorder severity and behaviors, comorbid psychiatric diagnoses, associated mechanisms, and demographic factors. Few differences emerged, though participants with atypical anorexia nervosa reported more overvaluation of weight and shape, while those with anorexia nervosa reported more food and social eating fears and higher obsessive-compulsive symptoms. Results support exploration of these diagnoses as a spectrum disorder.
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Affiliation(s)
| | - Yuchen Han
- Department of Bioinformatics and Biostatistics, University of Louisville
| | - Kimberly D. Osborn
- Department of Psychological and Brain Sciences, University of Louisville
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University
| | - Loie M. Faulkner
- Department of Psychological and Brain Sciences, University of Louisville
| | - Brenna M. Williams
- Department of Psychological and Brain Sciences, University of Louisville
| | - Jamie-Lee Pennesi
- Department of Psychological and Brain Sciences, University of Louisville
| | - Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville
- Department of Pediatrics – Division of Child and Adolescent Psychiatry, University of Louisville
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7
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Brennan C, Cini E, Illingworth S, Chapman S, Simic M, Nicholls D, Chapman V, Simms C, Hayes E, Fuller S, Orpwood J, Tweedy N, Baksh T, Astaire E, Bhakta D. Greater rate of weight loss predicts paediatric hospital admission in adolescent typical and atypical anorexia nervosa. Eur J Pediatr 2024; 183:1789-1799. [PMID: 38252309 DOI: 10.1007/s00431-024-05436-3] [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: 11/19/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
Hospital admissions for eating disorders (ED) are rapidly increasing. Limited research exists evidencing the factors that lead to hospital admissions or their outcomes. The current study aimed to identify predictors of hospital admission in adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN). Prospective observational study including participants (n = 205) aged 11-18 and diagnosed with AN or AAN at initial ED assessment, across eight London clinics. Physical health parameters at assessment, including heart rate, blood pressure, temperature and rate of weight loss, were compared between adolescents who were admitted to a paediatric ward following assessment and those who were not admitted. The mean rate of weight loss prior to assessment was significantly higher, and mean energy intake significantly lower, in the admitted vs not admitted groups (1.2 vs 0.6kg/week, p < 0.001 and 565 kcal/day vs 857 kcal/day, p < 0.001), independent of degree of underweight. No significant differences were identified between groups in all other parameters of physical risk. Underweight adolescents with AN were equally likely to be admitted as non-underweight adolescents with AAN. Conclusion: This study provides evidence on predictors of hospital admission, from a sample representing the London area. The assessment of weight loss speed, duration and magnitude are recommended as priority parameters that inform the risk of deterioration and the likelihood of hospital admission in adolescent AN and AAN. Further research investigating outcomes of these hospital admission is needed. What is Known: • Hospital admissions for eating disorders (ED) are rapidly increasing. • Limited research exists evidencing the factors that lead to hospital admissions, or their outcomes. What is New: • This study provides evidence on predictors of hospital admission in young people with typical and atypical anorexia nervosa. • Weight loss speed, duration, and magnitude are recommended as priority parameters that inform the risk of deterioration and the likelihood of hospital admission in this patient group.
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Affiliation(s)
- Cliona Brennan
- South London and Maudsley NHS Trust, London Metropolitan University, London, UK.
- The Michael Rutter Centre, De Crespigny Park, Camberwell, London, SE5 8AZ, UK.
| | - Erica Cini
- East London NHS Foundation Trust, Kings College London, University College London, London, UK
| | | | - Simon Chapman
- South London and Maudsley NHS Trust, Kings College Hospital London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Trust, London, UK
| | - Dasha Nicholls
- Central Northwest London NHS Trust, Imperial College London, London, UK
| | | | | | | | - Sarah Fuller
- Northamptonshire NHS Trust, Northamptonshire, UK
| | | | | | | | | | - Dee Bhakta
- London Metropolitan University, London, UK
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8
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Kons K, Essayli J, Shook J. Comparing the knowledge, attitudes, and practices of pediatric and family medicine clinicians toward atypical anorexia nervosa versus anorexia nervosa. Int J Eat Disord 2024; 57:993-1001. [PMID: 38082458 PMCID: PMC11018502 DOI: 10.1002/eat.24095] [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: 07/19/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To investigate the knowledge, attitudes, and current practices of adolescent primary care providers regarding the epidemiology, clinical features, and diagnosis of atypical anorexia nervosa (AN) compared to AN. METHODS An online survey was sent to the Pediatric and Family Medicine clinicians who provide medical care to adolescents. Statistical analyses compared differences in responses to questions about atypical AN versus AN. RESULTS Relative to AN, participants (n = 67) were significantly less familiar with atypical AN, less likely to consider a diagnosis of atypical AN, less comfortable identifying atypical AN, less likely to counsel patients with atypical AN on health risks, less likely to refer patients with atypical AN to a specialist, and less likely to correctly identify atypical AN. Clinicians with more years in medical practice reported a significantly larger gap in familiarity between AN and atypical AN than clinicians with less than 5 years of practice. CONCLUSIONS Providers who care for adolescents appear to be less familiar with and less likely to identify atypical AN compared to AN. This knowledge gap may be more pronounced among clinicians with more years practicing medicine due to the novelty of atypical AN as a diagnosis. Lack of knowledge surrounding atypical AN risk factors may result in delayed diagnosis and associated poor health outcomes. Future research should investigate strategies that improve knowledge and screening of atypical AN in medical and other settings. PUBLIC SIGNIFICANCE Pediatric and Family Medicine clinicians are less familiar with atypical anorexia nervosa (AN) and less likely to diagnose a patient with atypical AN relative to AN. Insufficient knowledge about atypical AN may place these individuals at increased risk for worsening restrictive eating and the physical and psychological consequences of malnutrition.
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Affiliation(s)
- Kelly Kons
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jamal Essayli
- Department of Pediatrics, Division of Adolescent Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer Shook
- Department of Pediatrics, Division of Adolescent Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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9
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Rajcsanyi LS, Zheng Y, Herpertz-Dahlmann B, Seitz J, de Zwaan M, Herzog W, Ehrlich S, Zipfel S, Giel K, Egberts K, Burghardt R, Föcker M, Antel J, Fischer-Posovszky P, Hebebrand J, Hinney A. Unexpected identification of obesity-associated mutations in LEP and MC4R genes in patients with anorexia nervosa. Sci Rep 2024; 14:7067. [PMID: 38528040 PMCID: PMC10963783 DOI: 10.1038/s41598-024-57517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024] Open
Abstract
Mutations leading to a reduced or loss of function in genes of the leptin-melanocortin system confer a risk for monogenic forms of obesity. Yet, gain of function variants in the melanocortin-4-receptor (MC4R) gene predispose to a lower BMI. In individuals with reduced body weight, we thus expected mutations leading to an enhanced function in the respective genes, like leptin (LEP) and MC4R. Therefore, we have Sanger sequenced the coding regions of LEP and MC4R in 462 female patients with anorexia nervosa (AN), and 445 healthy-lean controls. In total, we have observed four and eight variants in LEP and MC4R, respectively. Previous studies showed different functional in vitro effects for the detected frameshift and non-synonymous variants: (1) LEP: reduced/loss of function (p.Val94Met), (2) MC4R: gain of function (p.Val103Ile, p.Ile251Leu), reduced or loss of function (p.Thr112Met, p.Ser127Leu, p.Leu211fsX) and without functional in vitro data (p.Val50Leut). In LEP, the variant p.Val94Met was detected in one patient with AN. For MC4R variants, one patient with AN carried the frameshift variant p.Leu211fsX. One patient with AN was heterozygous for two variants at the MC4R (p.Val103Ile and p.Ser127Leu). All other functionally relevant variants were detected in similar frequencies in patients with AN and lean individuals.
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Affiliation(s)
- Luisa Sophie Rajcsanyi
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, 45147, Essen, Germany.
- Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, Essen, Germany.
- Section for Molecular Genetics of Mental Disorders, University Hospital Essen, Essen, Germany.
- Institute of Sex- and Gender-Sensitive Medicine, University Hospital Essen, Essen, Germany.
| | - Yiran Zheng
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, Essen, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, 45147, Essen, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Wolfgang Herzog
- Department of Internal Medicine II, General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany
| | - Stefan Ehrlich
- Eating Disorders Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence in Eating Disorders KOMET, Tübingen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence in Eating Disorders KOMET, Tübingen, Germany
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Roland Burghardt
- Oberberg Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Fasanenkiez, Berlin, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Munster, Germany
- LWL-University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Jochen Antel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, Essen, Germany
| | | | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, Essen, Germany
- Section for Molecular Genetics of Mental Disorders, University Hospital Essen, Essen, Germany
- Institute of Sex- and Gender-Sensitive Medicine, University Hospital Essen, Essen, Germany
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Marchili MR, Bozzola E, Guolo S, Marchesani S, Spina G, Mascolo C, Vicari S, De Jacobis IT, Raponi M, Villani A. Pediatric acute hospitalization for anorexia nervosa: an economic evaluation. Ital J Pediatr 2024; 50:33. [PMID: 38413993 PMCID: PMC10900686 DOI: 10.1186/s13052-024-01605-0] [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: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a psychiatric disorders which may potentially led to a high risk of health medical complications, suicide and self-harming behaviour. Since Covid-19 pandemic onset in March 2020, evidence suggested an increase occurrence of AN. The main aim of the retrospective analysis is to define the cost of hospitalization in the acute phase (HAP) at IRCCS Bambino Gesù Children Hospital, Rome, Italy, over 2 years study. Secondary purposes are defining the main risk factors for a prolonged hospitalization (including age, sex and comorbidities) and the possible influence of Covid-19 pandemic on AN admission and hospital stay. METHODS for the purpose of the study, we included children and adolescents aged less than 18 years, admitted to IRCCS Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of AN. Medical costs were calculated consulting the Lazio Regional Health Service Tariffs. Basing on the date of hospital admission, patients were later divided into two subgroups: subgroup A included patients hospitalized prior than Covid-19 onset (from March 2019 to February 2020) and subgroup B those admitted after (from March 2020 to October 2022). RESULTS a total of 260 patients has been included in the study with a median age of 15 years (range 6-18 years). The total health care cost of AN hospitalized patients was of EUR 3,352,333 with a median cost of EUR 11,124 for each admission (range EUR 930 - 45,739) and a median daily cost of EUR 593 (range EUR 557-930). Median cost was higher in case of comorbidities, guarded patients, enteral feeding. A prolonged hospitalization has been documented in subgroup A with a higher economic burden. CONCLUSIONS the economic burden of eating disorders is of note. Adequate sanitary policies as well as health economic analyses are required to gain insight into the cost-effectiveness of AN management. TRIAL REGISTRATION 2526-OPBG-2021.
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Affiliation(s)
| | - Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- Child Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvio Marchesani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Mascolo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Springall GAC, Goldsmith G, Zannino D, Cheong J, Mynard JP, Yeo M, Cheung MMH. Carotid wave analysis in young adults with a history of adolescent anorexia nervosa: a case control study. J Eat Disord 2024; 12:21. [PMID: 38308371 PMCID: PMC10835867 DOI: 10.1186/s40337-023-00963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with abnormalities that may increase the risk of future cardiovascular disease. This study assessed the cardiovascular health of individuals who recovered from AN during adolescence by conducting wave power analysis. METHODS Former AN patients discharged from the Royal Children's and Monash Children's Hospitals (N = 17) in Melbourne, Australia underwent ultrasound imaging of the right carotid artery. Wave power analysis was conducted to assess biomechanical interactions of the cardiovascular system. Patient measures were compared to healthy controls (N = 51). RESULTS Eighty-eight percent of the former AN patients and controls were female, aged approximately 25 years, with a healthy body mass index. Mean carotid flow and pulsatility index were not different between groups. Carotid arterial strain and distensibility were lower, and the wave speed and beta stiffness index higher in the former AN patients. Characteristic impedance was not different nor were the forward and backward wave amplitudes. However, wave reflection indices (ratios of backward-to-forward compression wave area, and wave-related effect on pressure and hydraulic power) were 12-18% lower in the former AN patients (p < 0.05). CONCLUSIONS Increased carotid artery stiffness and reduced wave reflection are evident in young adults who recovered from adolescent AN. This may relate to an adaptive process that helps to maintain or restore flow and characteristic impedance despite increased vessel stiffness, with this warranting future investigation.
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Affiliation(s)
- Gabriella A C Springall
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Greta Goldsmith
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jeanie Cheong
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
- Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
| | - Jonathan P Mynard
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Michele Yeo
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, VIC, Australia
| | - Michael M H Cheung
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia
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12
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Toigo S, Katzman DK, Vyver E, McFaull SR, Iynkkaran I, Thompson W. Eating disorder hospitalizations among children and youth in Canada from 2010 to 2022: a population-based surveillance study using administrative data. J Eat Disord 2024; 12:3. [PMID: 38167164 PMCID: PMC10763198 DOI: 10.1186/s40337-023-00957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are severe mental illnesses associated with significant morbidity and mortality. EDs are more prevalent among females and adolescents. Limited research has investigated Canadian trends of ED hospitalizations prior to the COVID-19 pandemic, however during the pandemic, rates of ED hospitalizations have increased. This study examined rates of ED hospitalizations among children and youth in Canada from 2010 to 2022, by sex, age, province/territory, length of stay, discharge disposition and ED diagnosis. METHODS Cases of ED hospitalizations among children and youth, ages 5 to 17 years, were identified using available ICD-10 codes in the Discharge Abstract Database from the 2010/11 to 2022/23 fiscal years. The EDs examined in this study were anorexia nervosa (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa (F50.2), other EDs (F50.3, F50.8) and unspecified EDs (F50.9). Both cases of total and first-time ED hospitalizations were examined. Descriptive statistics and trend analyses were performed. RESULTS Between 2010/11 and 2022/23, 18,740 children and youth were hospitalized for an ED, 65.9% of which were first-time hospitalizations. The most frequent diagnosis was anorexia nervosa (51.3%). Females had significantly higher rates of ED hospitalization compared to males (66.7/100,000 vs. 5.9/100,000). Youth had significantly higher rates compared to children. The average age of ED hospitalization was 14.7 years. Rates of ED hospitalizations were relatively stable pre-pandemic, however during the pandemic (2020-2021), rates increased. INTERPRETATION Rates of pediatric ED hospitalizations in Canada increased significantly during the pandemic, suggesting that there may have been limited access to alternative care for EDs or that ED cases became more severe and required hospitalization. This emphasizes the need for continued surveillance to monitor how rates of ED hospitalizations evolve post-pandemic.
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Affiliation(s)
- Stephanie Toigo
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada.
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ellie Vyver
- Section of Adolescent Medicine, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Steven R McFaull
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Ithayavani Iynkkaran
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
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13
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Wilcox H, Paz V, Saxena R, Winkelman JW, Garfield V, Dashti HS. The Role of Circadian Rhythms and Sleep in Anorexia Nervosa. JAMA Netw Open 2024; 7:e2350358. [PMID: 38175645 PMCID: PMC10767597 DOI: 10.1001/jamanetworkopen.2023.50358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Importance Observational studies have associated anorexia nervosa with circadian rhythms and sleep traits. However, the direction of causality and the extent of confounding by psychosocial comorbidities in these associations are unknown. Objectives To investigate the association between anorexia nervosa and circadian and sleep traits through mendelian randomization and to test the associations between a polygenic risk score (PRS) for anorexia nervosa and sleep disorders in a clinical biobank. Design, Setting, and Participants This genetic association study used bidirectional 2-sample mendelian randomization with summary-level genetic associations between anorexia nervosa (from the Psychiatric Genomics Consortium) and chronotype and sleep traits (primarily from the UK Biobank). The inverse-variance weighted method, in addition to other sensitivity approaches, was used. From the clinical Mass General Brigham (MGB) Biobank (n = 47 082), a PRS for anorexia nervosa was calculated for each patient and associations were tested with prevalent sleep disorders derived from electronic health records. Patients were of European ancestry. All analyses were performed between February and August 2023. Exposures Genetic instruments for anorexia nervosa, chronotype, daytime napping, daytime sleepiness, insomnia, and sleep duration. Main Outcomes and Measures Chronotype, sleep traits, risk of anorexia nervosa, and sleep disorders derived from a clinical biobank. Results The anorexia nervosa genome-wide association study included 16 992 cases (87.7%-97.4% female) and 55 525 controls (49.6%-63.4% female). Genetic liability for anorexia nervosa was associated with a more morning chronotype (β = 0.039; 95% CI, 0.006-0.072), and conversely, genetic liability for morning chronotype was associated with increased risk of anorexia nervosa (β = 0.178; 95% CI, 0.042-0.315). Associations were robust in sensitivity and secondary analyses. Genetic liability for insomnia was associated with increased risk of anorexia nervosa (β = 0.369; 95% CI, 0.073-0.666); however, sensitivity analyses indicated bias due to horizontal pleiotropy. The MGB Biobank analysis included 47 082 participants with a mean (SD) age of 60.4 (17.0) years and 25 318 (53.8%) were female. A PRS for anorexia nervosa was associated with organic or persistent insomnia in the MGB Biobank (odds ratio, 1.10; 95% CI, 1.03-1.17). No associations were evident for anorexia nervosa with other sleep traits. Conclusions and Relevance The results of this study suggest that in contrast to other metabo-psychiatric diseases, anorexia nervosa is a morningness eating disorder and further corroborate findings implicating insomnia in anorexia nervosa. Future studies in diverse populations and with subtypes of anorexia nervosa are warranted.
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Affiliation(s)
- Hannah Wilcox
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Valentina Paz
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Instituto de Psicología Clínica, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
- MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Richa Saxena
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
| | - John W. Winkelman
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Sleep Disorders Clinical Research Program, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Victoria Garfield
- MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hassan S. Dashti
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
- Division of Nutrition, Harvard Medical School, Boston, Massachusetts
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14
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Rometsch C, Guthoff M, Zipfel S, Stengel A. Renal failure following insulin purging in atypical anorexia nervosa and type 1 diabetes mellitus. Front Psychiatry 2023; 14:1325021. [PMID: 38152359 PMCID: PMC10752605 DOI: 10.3389/fpsyt.2023.1325021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
Objective Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are severe and complex eating disorders that can be prevalent among individuals with type 1 diabetes mellitus (T1DM). Insulin purging, characterized by the intentional underuse / omission of insulin to control weight, is under-recognized in medicine and is a purging strategy of patients with AN or AAN and comorbid T1DM. Often, this can lead to renal failure, necessitating a (pancreas-) kidney transplantation. This article presents a comprehensive overview of the interplay between AN/AAN and T1DM and summarizes the evidence in literature. Methods A narrative review is presented on basis of a detailed case study of a 32-year-old female with end-stage renal failure seeking (pancreas-) kidney transplantation displaying etiology, diagnosis, comorbidities, complications, and treatment of AN and AAN with emphasis on those patients with T1DM. Results Insulin purging in patients with AN/AAN and coexisting T1DM can exacerbate T1DM complications, including accelerating the onset of end-stage renal failure. A multidisciplinary approach including nutrition treatment and psychotherapeutic techniques was considered necessary for treatment, focusing on psychosomatic in-patient care before and after organ transplantation. Conclusion Insulin purging in patients with AAN and T1DM poses severe health risks, including accelerated renal complications. For those considering transplantation, insulin purging has explicitly to be diagnosed and a holistic treatment addressing both the renal condition and psychosomatic symptoms/disorders is crucial for successful post-transplant outcomes.
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Affiliation(s)
- Caroline Rometsch
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Internal Medicine IV, Diabetology, Endocrinology, Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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15
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Patel N, Tyagi R, Biswas D, Birjees A, Rajesh C, Khan S. Anorexia Nervosa: Evaluating Disparities in Places of Death in the United States Over 22 Years Using the CDC WONDER Database. Cureus 2023; 15:e51245. [PMID: 38288199 PMCID: PMC10823200 DOI: 10.7759/cureus.51245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Anorexia nervosa is a severe and occasionally fatal eating disorder characterized by extreme weight loss and a distorted body image in which the affected individuals typically exhibit a strong fear of gaining weight, leading to rigid dietary restrictions and excessive activity. This condition can cause severe health problems, such as hunger, cardiovascular issues, and organ destruction. Anorexia nervosa is a key subject for research in the context of end-of-life care disparities due to its psychological and physical challenges. Aims: This study examines differences in the places of death for people with anorexia nervosa during a 22-year period in the USA, taking into account four important factors: age group, gender, race, and U.S. census region. METHODOLOGY Data were collected from the CDC WONDER website on August 31, 2023, and spans years 1999 to 2020, using the particular ICD-11 code F50.0 for anorexia nervosa. The study aims to uncover the important determinants impacting the location of death within this specific population using sophisticated statistical methods, including univariate logistic regression. RESULTS The analysis of aggregate data yielded notable findings. The patient's principal site of death was at home or in hospice care. Other sites were less prevalent, with medical facilities or nursing homes ranking second. The place of death was highly influenced by age groups with diverse patterns. Gender had no significant impact; however, geographical inequalities were noticeable. Individuals in the Northeast, Midwest, and South were less likely than those in the West to die at home or in hospice care. The location of death was unaffected by race. CONCLUSIONS In conclusion, this study found that death in home and hospice was more common than in medical or hospital nursing facilities in all four analyzed groups. These findings highlight the critical need for significant advancements in end-of-life care, particularly in home and hospice settings.
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Affiliation(s)
- Nirmal Patel
- Internal Medicine, St. George's University School of Medicine, West Indies, GRD
| | - Rahul Tyagi
- Family Medicine, Leeds General Practitioner Confederation, Leeds, GBR
- Family Medicine, Royal College of General Practitioners, London, GBR
| | | | - Ayesha Birjees
- Internal Medicine, Fathima Institute of Medical Sciences, Kadapa, IND
| | - Chetana Rajesh
- Pediatrics and Child Health, Sri Ramachandra Medical College and Research Institute, Chennai, IND
| | - Sadia Khan
- Internal Medicine, Karachi University, Karachi, PAK
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Suliman O, Alrazehi AA, Alsafar BA, Kaki AA, Alsafar AA, E Alharbi MK, M Alharbi MK, Abed FA, Almohammadi AA, Alsaedi EA. How Does an Eating Disorder Affect Your Physical and Mental Health and How It Is Related to Sleeve Gastrectomy? Cureus 2023; 15:e50832. [PMID: 38155980 PMCID: PMC10753139 DOI: 10.7759/cureus.50832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 12/30/2023] Open
Abstract
Background Obesity is the pandemic of this era. At the same time, the commercialisation of thinness has also increased its adversity. Dissatisfaction with body shape is leading to many eating disorders. These disorders further cause several health problems. It has been found that individuals with eating disorders experience insomnia, depression, and anxiety. It also affects the endocrine system and digestive systems of the body. The surgical approach provides a more efficient treatment of obesity with sustainable results. Sleeve gastrectomy is the most popular surgical treatment. Sleeve gastrectomy is one of the prominent bariatric surgeries. Patients going through sleeve gastrectomy not only lose weight but also improve their mental health. Objective This study assesses the relationship between obesity, eating disorders, and physical health. It also focuses on the prevalence of sleeve gastrectomy procedures in such individuals and their outcomes. Methods This study used a cross-sectional design and a convenient sampling technique. The obese individuals who had eating disorders residing in Medina Al-Munawara and Riyadh city were taken as the samples. Online questionnaires were shared with participants to collect their perspectives on their weight, eating disorders, and their impact on physical health. The study collected both retrospective and present data. Results A total sample of 335 participants was taken, of which 181 (54%) were females and 154 (46%) were males, with a mean BMI of 28.85±2.57. The fear of weight gain was found among 265 (79%) of participants, 151 (45%) were feeling guilt while eating, 275 (82%) were weighing themselves daily, 325 (97%) were unable to stop eating even when complete, and 117 (35%) were unable to control themselves when they have food. As per the methods of avoiding weight gain, 166 (49.6%) were skipping a meal, 157 (47%) were following a diet, 17 (5%) were inducing vomiting, and 16 (4.8%) reused laxatives and diuretics. A total of 158 (47.2%) were involved in sports, but it was reduced to 61 (18.25%) upon sickness. Only 24 (7%) participants had undergone sleeve gastrostomy, and 181 (54%) believed that their cravings had increased, 238 (71%) complained of dizziness, and 151 (45%) believed that fast food caused gut unrest. Conclusion Obese individuals who are going through eating disorders are psychologically and physically compromised. They consider skipping meals to be the most efficient means of weight loss, and only a small percentage prefer to go for sleeve gastrectomy.
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Affiliation(s)
- Osman Suliman
- College of Clinical Sciences, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Ammar A Alrazehi
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Badr A Alsafar
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Abdullah A Kaki
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Alwaleed A Alsafar
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Mazen K E Alharbi
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Mazen K M Alharbi
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Fares A Abed
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Asim A Almohammadi
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
| | - Emad A Alsaedi
- College of Medicine, Faculty of Medicine, Al-Rayan Colleges, Madinah, SAU
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Costa D, Charvin I, Da Fonseca D, Bat-Pitault F. Day hospital program for anorexia nervosa in children and adolescents: Assessment, management and specific focus on early onset anorexia nervosa. L'ENCEPHALE 2023; 49:557-563. [PMID: 36253185 DOI: 10.1016/j.encep.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The French day hospital program specialized in eating disorders (ED) opened in January 2018. Our study presents preliminary data on clinical profiles of patients with anorexia nervosa (AN). We describe more specifically clinical characteristics of patients with early onset AN and according to their therapeutics orientations. Then, we compare the weight gain of patients managed only in day-patient (DP) treatment with those managed initially inpatient (IP) treatment and relays in DP. METHODS Ninety-two patients with AN, aged between 8 and 18 years, were evaluated with several questionnaires (EDI-2, EDE-Q, BSQ, EDS-R, CDI, STAI-Y, VSP-A, EPN-13). RESULTS Patients with early onset AN, n = 23 (25.3%), presented more restrictive behaviors, less marked dietary symptomatology, a lower degree of clinical perfectionism and a less marked feeling of ineffectiveness than adolescent patients with AN. Regarding the choice of hospitalization modality (DP alone or IP-DP), the only difference highlighted was the severity of patient undernutrition. Among the patients who were treated (IP-DP n = 27 vs DP alone n = 25), the weight evolution after one month and at discharge was favorable for both groups. CONCLUSION These preliminary data suggest the effectiveness of DP in the care of AN in children and adolescents.
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Affiliation(s)
- D Costa
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.
| | - I Charvin
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - D Da Fonseca
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France; Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
| | - F Bat-Pitault
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France; Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
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Lim J, White J, Withington T, Catania S, Wilson D, Knight P, Rees B, Middeldorp C, Krishnamoorthy G. Family-based treatment takes longer for adolescents with mental health comorbidities: findings from a community mental health service. Eat Disord 2023; 31:588-609. [PMID: 37066723 DOI: 10.1080/10640266.2023.2201995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Children and adolescents diagnosed with an eating disorder often meet the diagnosis of another mental health disorder. In addition to eating disorders, individuals with comorbid disorders have higher suicide rates and more severe and chronic eating disorder symptoms. The present research aimed to investigate the influence of comorbid conditions on the treatment outcomes of children and adolescents that attended a public community mental health service. It was hypothesised that the patients with comorbidities would have a more extended treatment duration, slower rates of weight restoration, more hospital admissions for medical compromise, and poorer functioning than those without comorbidities. Data from 78 past patients at the Eating Disorder Program in Queensland, Australia, were analysed. Patients with comorbidities demonstrated similar recovery rates to those without comorbidities. However, those with comorbid conditions had longer episodes of treatment. The study's results support using Family Based Treatment for patients with and without comorbidities. The implications of the findings for public mental health services and directions for future research are discussed.
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Affiliation(s)
- Jacqueline Lim
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Jacinda White
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | - Tania Withington
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Salvatore Catania
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | - Daniel Wilson
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Penny Knight
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | | | - Christel Middeldorp
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Govind Krishnamoorthy
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
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Alsheweir A, Goyder E, Alnooh G, Caton SJ. Prevalence of Eating Disorders and Disordered Eating Behaviours amongst Adolescents and Young Adults in Saudi Arabia: A Systematic Review. Nutrients 2023; 15:4643. [PMID: 37960296 PMCID: PMC10649920 DOI: 10.3390/nu15214643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Eating disorders (EDs) and disordered eating behaviours (DEBs) are significant health problems related to body image and weight dissatisfaction among adolescents and young adults worldwide. During this stage of sensitive development, these behaviours may hinder the optimal growth process and can consequently lead to wasting, stunting, and micronutrient deficiencies. However, there is a limited amount of literature on DEB among Arab populations, particularly in Saudi Arabia. This review aims to assess the prevalence of EDs/DEB and to develop a clear understanding of the epidemiology of such conditions among adolescents and youth in Saudi Arabia. Five databases were systematically searched and 14 papers met the inclusion criteria. The Eating Attitudes Test (EAT-26) was the predominant tool used for evaluating aberrant eating behaviours, indicating a high prevalence of EDs/DEB ranging from 10.2% to 48.1%. The highest prevalence of EDs/DEB was reported in the eastern region ranging from 29.4% to 65.5%. In terms of age and sex, the prevalence was higher among older students compared to younger school students and males reported more Eds/DEB compared to female students. These disorders are found to be prevalent in Saudi Arabia, and the risk of developing such conditions is high across the whole age range.
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Affiliation(s)
- Azzah Alsheweir
- Sheffield Centre for Health & Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, Sheffield S1 4DA, UK; (E.G.); (S.J.C.)
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 145111, Saudi Arabia
| | - Elizabeth Goyder
- Sheffield Centre for Health & Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, Sheffield S1 4DA, UK; (E.G.); (S.J.C.)
| | - Ghadah Alnooh
- Centre for Assistive Technology and Connected Healthcare, Sheffield Centre for Health & Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, Sheffield S1 4DA, UK;
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Samantha J. Caton
- Sheffield Centre for Health & Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, Sheffield S1 4DA, UK; (E.G.); (S.J.C.)
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20
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Vogel M, Gil A, Galaz C, Urrejola P, Lacalle L, Jara R, Irribarra V, Letelier M, Costa D, Espinoza G. Virtually Accompanied Eating in the Outpatient Therapy of Anorexia Nervosa. Nutrients 2023; 15:3783. [PMID: 37686815 PMCID: PMC10489725 DOI: 10.3390/nu15173783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Normalizing the eating pattern and weight recovery are the main objectives in treating anorexia nervosa (AN). Eating accompaniment through shared mealtimes is a common strategy in eating disorder management programs. This study aims to examine the impact on weight gain of an internet-delivered meal support group on patients with AN who were under ambulatory treatment with the Eating Disorders Unit of the UC Christus Health Network, Chile. METHODS An observational study of 54 female patients with AN diagnosis who participated in Online Meal Support Groups (OMSGs) three times a week was performed. Their weight, BMI and BMI%, was reviewed at the beginning of the sessions and at 45- and 90-day follow-up. RESULTS Patients showed significant weight gain during follow-up. At the 90-day follow-up, patients had gained 4.41 (SD ± 2.82) kg with an effect size of -1.563. CONCLUSIONS Statistically significant differences were found between the weight at the beginning of the intervention and at the 45- and 90-day follow-up, meaning that eating support online groups may be an effective intervention for weight gain and maintenance in patients with AN. These findings highlight the viability of developing cost-effective and more accessible interventions for AN and thus help reduce the duration of untreated disease and its consequences.
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Affiliation(s)
- Melina Vogel
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
- Psychiatry Department, Faculty of Medicine, Pontificia Universidad Catolica, Santiago 8330077, Chile
| | - Aurora Gil
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Camila Galaz
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Pascuala Urrejola
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
- Adolescent Unit, Pediatrics Department, Faculty of Medicine, Pontificia Universidad Catolica, Santiago 8330077, Chile
| | - Lucas Lacalle
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Raúl Jara
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Verónica Irribarra
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
- Nutrition and Diabetes Department, Faculty of Medicine, Pontificia Universidad Catolica, Santiago 8330077, Chile
| | - Matias Letelier
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Daniela Costa
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Gabriela Espinoza
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
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21
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Hay P, Mohsin M, Liu L, Touyz S, Meyer C, Arcelus J, Madden S, Attia E, Pike KM, Conti J. Impact of LEAP and CBT-AN Therapy on Improving Outcomes in Women with Anorexia Nervosa. Behav Sci (Basel) 2023; 13:651. [PMID: 37622791 PMCID: PMC10451721 DOI: 10.3390/bs13080651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Anorexia nervosa (AN) is a mental health disorder that has serious physical, emotional and social consequences. Whilst cognitive behavioural therapy for AN (CBT-AN) has demonstrated efficacy, there remains a global need to improve AN treatment. Compulsive exercise activity therapy (LEAP) is an active therapy consisting of the addition to CBT-AN of eight specific sessions that focus on exercise and motivation for behavioural change. This paper presents a secondary analysis of 74 female participants in a randomised control trial of LEAP plus CBT-AN versus CBT-AN alone. The main aim of this study was to explore putative predictors and to estimate the magnitude of changes due to LEAP for specific outcome measures. Participants (LEAP: n = 36; CBT-AN: n = 38) were assessed at three successive surveys: baseline, end of therapy, and 6 months post-therapy. The overall effect sizes for changes between baseline to end of therapy and baseline to 6-month follow-up assessment showed large effect sizes (Cohen's d > = 0.80) for mental-health-related quality of life (MHRQoL), weight concern, dietary restraint, eating concern, AN stage change, and psychological distress (all p < 0.05). The results also indicated that several pre-treatment characteristics, including body mass index (BMI), level of eating disorder (ED) symptoms, and MHRQoL are important for identifying whether a treatment is likely to be effective. Future treatment programs should aim to optimise early improvements in BMI, ED symptoms, and MHRQoL.
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Affiliation(s)
- Phillipa Hay
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Faculty of Medicine & Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Liquan Liu
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW 2560, Australia
| | - Stephen Touyz
- Inside Out Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
- Psychoneurobiology of Eating and Addictive Behaviors Group, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, University of Barcelona, 08908 Barcelona, Spain
| | - Sloane Madden
- The Sydney Children’s Hospitals Network, Westmead, Sydney, NSW 2145, Australia
| | - Evelyn Attia
- The New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
| | - Kathleen M. Pike
- World Health Organization Collaborating Centre for Capacity Building and Training in Global Mental Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
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22
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Li Z, Leppanen J, Webb J, Croft P, Byford S, Tchanturia K. Analysis of symptom clusters amongst adults with anorexia nervosa: Key severity indicators. Psychiatry Res 2023; 326:115272. [PMID: 37276647 PMCID: PMC10790244 DOI: 10.1016/j.psychres.2023.115272] [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: 12/14/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
This study used cluster analysis to explore clinically relevant subgroups of adult patients with anorexia nervosa (AN). Patients were clustered based on their body mass index (BMI), eating disorder symptomatology, anxiety and depression symptoms and autistic characteristics. The difference between clusters in work and social functioning, duration of illness, bingeing and purging behaviour, previous hospitalisations and number of comorbidities was also investigated. Two meaningful clusters emerged: a higher symptoms cluster with more severe eating pathology, anxiety, depression, and more autistic traits, and a second cluster with lower symptoms. BMI did not make major contributions to cluster formation. The higher symptoms cluster also reported lower self-efficacy to change, more previous hospitalisations, comorbid diagnoses, binge eating and purging behaviours and use of psychotropic medication. Our findings suggest that weight alone may not be a significant severity indicator amongst inpatients with AN, and targeted treatment of AN should consider a broader range of symptom severity indicators.
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Affiliation(s)
- Zhuo Li
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Croft
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK; National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK; Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia.
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23
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Birgegård A, Mantilla EF, Breithaupt LE, Borg S, Sanzari CM, Padalecki S, Hedlund E, Bulik CM. Proposal for increasing diagnostic clarity in research and clinical practice by renaming and reframing atypical anorexia nervosa as "Restrictive Eating Disorder" (RED). Eat Behav 2023; 50:101750. [PMID: 37263139 DOI: 10.1016/j.eatbeh.2023.101750] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Atypical anorexia nervosa (AAN) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is characterized by meeting all criteria for anorexia nervosa (AN) except for weight being within or above the "normal" range despite significant weight loss. The current definition is plagued by several problems, resulting in widely heterogeneous operationalizations in research and clinical practice. As such, the poorly defined diagnosis of AAN negatively impacts affected individuals and frustrates research attempts to better understand the syndrome. We consider conceptual flaws in the AAN description and contend that the undefined weight range and nature of weight loss renders these two factors functionally inapplicable in research and practice. They also represent a departure from the originally intended use of the AAN category, i.e., arresting a negative weight trajectory likely to result in AN, making the target population, and the application of the label, unclear. We propose revised criteria and a new name, restrictive eating disorder (RED), intended to reduce stigma and encompass a wide but better-defined range of presentations. The RED criteria focus on clinically significant restrictive behavior that disrupts normal living (i.e., impairment), and cognitive symptoms of overevaluation, disturbed experience, and lack of recognition of illness seriousness. We believe that RED may enable more appropriate clinical application, but also inspire coordinated research toward a more valid psychiatric nosology in the eating disorders field.
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Affiliation(s)
- Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Emma Forsén Mantilla
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lauren E Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stina Borg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christina M Sanzari
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sophie Padalecki
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Public Health, College of Arts and Sciences, Elon University, NC, USA
| | - Elin Hedlund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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24
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Schlissel AC, Richmond TK, Eliasziw M, Leonberg K, Skeer MR. Anorexia nervosa and the COVID-19 pandemic among young people: a scoping review. J Eat Disord 2023; 11:122. [PMID: 37474976 PMCID: PMC10360262 DOI: 10.1186/s40337-023-00843-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The extent to which the recent global COVID-19 Pandemic has impacted young people with restrictive eating disorders [i.e., anorexia nervosa (AN) and atypical anorexia nervosa (AAN)] is unclear. We conducted a scoping review of the literature to identify how the pandemic has impacted this population and to identify gaps in the current literature to inform future research efforts. MAIN BODY We searched PubMed, EMBASE, the Web of Science, The Cochrane Library, PsycInfo, ProQuest Dissertations and Theses Global, LitCovid, Google Scholar, and relevant agency websites from 2019 to 2022. We included studies that focused on young people with AN/AAN globally. Of the 916 unduplicated articles screened, 17 articles met the inclusion criteria, reporting on 17 unique studies including 4,379 individuals. Three key findings were identified. First, an increase in hospitalizations related to eating disorders was found during COVID-19 among young people with AN and AAN. Multiple studies cited increased medical instability, even though the overall duration of disease was shorter compared to pre-pandemic levels. Second, changes in eating disorder-related symptomology during the pandemic were reported in this population, as well as poorer overall behavioral and mental health. Suggested reasons behind changes included boredom or minimal distraction from pathological thoughts, increased social isolation, increased social media and online use (e.g., reading blogs or watching YouTube), gym and school closures, changes in routines due to lockdowns and quarantines, and worries over gaining the "Quarantine 15". Third, there was an increase in the use of telemedicine as a treatment modality for the treatment of AN. Challenges were reported by both clinicians and patients regardless of past experience using telemedicine. When compared to no treatment, telemedicine was recognized as the best option during COVID-19 lockdowns; however some individuals expressed the preference for in-person treatment and planned to return to it once it became available. CONCLUSION The pandemic significantly impacted young people with restrictive eating disorders as seen by increased hospitalizations and requests for outpatient care. A primary driver of the changes in eating disorder symptomatology may be lockdowns and quarantines. Further research investigating how the series of lockdowns and re-openings impacted individuals with AN/AAN is warranted.
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Affiliation(s)
- Anna C. Schlissel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Tracy K. Richmond
- Division of Adolescent Medicine, Boston Children’s Hospital, 6th Floor, 333 Longwood Avenue, Boston, MA 02115 USA
- Harvard Medical School, Pediatrics, 25 Shattuck Street, Boston, MA 02115 USA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Kristin Leonberg
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Jaharis Family Center for Biomedical and Nutrition Sciences, Tufts University, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Margie R. Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
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25
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Bracké KFM, Steegers CPM, van der Harst T, Dremmen MHG, Vernooij MW, White TJH, Dieleman GC. Can neuroimaging measures differentiate the disease course of anorexia nervosa? A systematic review. J Psychiatr Res 2023; 163:337-349. [PMID: 37263169 DOI: 10.1016/j.jpsychires.2023.05.059] [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: 02/24/2023] [Revised: 04/20/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
Anorexia nervosa (AN) entails many uncertainties regarding the clinical outcome, due to large heterogeneity in the disease course. AN is associated with global decrease in brain volumes and altered brain functioning during acute illness. However, it is unclear whether structural and functional brain alterations can predict clinical outcome. We aimed to systematically review the predictive value of volumetric and functional brain outcome measures of structural and functional brain magnetic resonance imaging (MRI) on the disease course of AN. Four databases (Embase, Medline, Psycinfo, and Cochrane Central Register) were systematically searched. A total of 15 studies (structural MRI: n = 6, functional MRI: n = 9) were reviewed. In total 464 unique AN patients, and 328 controls were included. Follow-up time ranged between 1 and 43 months. Structural neuroimaging studies showed that lower brain volumes of the cerebellum, subcortical grey matter, and cortical white matter at admission predicted a worse clinical outcome. A smaller increase of the anterior cingulate cortex volume in the early phase of the disease predicted a worse clinical outcome. Lower overall gyrification, and a higher clustering coefficient predicted a worse clinical outcome. Functional MRI studies showed that frontal, parietal and temporal activity during task-based algorithms predicted follow-up body mass index, although results were bidirectional possibly due to the large heterogeneity in methodological approaches. Neuroimaging measures may predict the clinical outcome of AN. However, there is a lack of replication studies. Future studies are needed to validate the prognostic utility of neuroimaging measures in AN patients, and should harmonize demographic, clinical and neuroimaging features in order to enhance comparability.
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Affiliation(s)
- Katrien F M Bracké
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Cathelijne P M Steegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Tess van der Harst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marjolein H G Dremmen
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Tonya J H White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Section of Social and Cognitive Developmental Neuroscience, National Institutes of Health, Bethesda, MD, USA
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
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26
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Chiang CP, Hayes D, Panagiotopoulou E. Apps targeting anorexia nervosa in young people: a systematic review of active ingredients. Transl Behav Med 2023; 13:406-417. [PMID: 36753537 PMCID: PMC10255767 DOI: 10.1093/tbm/ibad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Evaluating the presence of behavior change techniques (BCTs) in mHealth apps could be used to better understand what "active ingredients" contribute to outcomes. Despite the early onset of Anorexia Nervosa (AN) and the increasing use of mobile apps to seek mental healthcare among young people, BCTs underpinning mHealth apps targeting AN have never been systematically examined. This review systematically identified and analyzed BCTs underpinning apps targeted at reducing AN in young people in an attempt to understand their active components. Apps were searched and screened in Apple Store and Google Play. Six apps that met the inclusion criteria and were coded by trained researchers against the BCT Taxonomy V1. Overall, 22 of 93 possible BCTs were identified. The most common were "Information about health consequences," "Social support (unspecified)," and "Information about antecedents". Identified BCTs suggested potential overlaps with traditional clinical treatments for AN, such as cognitive behavioral therapy and family-based therapy. Further investigation is required to evaluate the apps' usability and effectiveness.
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Affiliation(s)
- Clara P Chiang
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
| | - Daniel Hayes
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Evidence Based Practice Unit, UCL and the Anna Freud National Centre for Children and Families (AFNCCF), London, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London WC1E 7HB, UK
| | - Elena Panagiotopoulou
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
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27
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Pruccoli J, Pugliano R, Pranzetti B, Parmeggiani A. Premenarchal anorexia nervosa: clinical features, psychopharmacological interventions, and rehospitalization analysis in a 1-year follow-up, controlled study. Eur J Pediatr 2023:10.1007/s00431-023-04960-y. [PMID: 37052674 PMCID: PMC10257596 DOI: 10.1007/s00431-023-04960-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
Premenarchal anorexia nervosa (AN) represents a specific subtype of AN, defined by an onset before the menarche in females, involving unique endocrine and prognostic features. The scarce data on this condition lack case-control and follow-up studies. This is a case-control, observational, naturalistic study, involving participants with premenarchal AN (premenarchal girls presenting to the study center newly diagnosed with AN) treated with a multidisciplinary hospital intervention, compared to postmenarchal AN individuals on clinical, endocrine, psychopathological, and treatment variables. The rate of rehospitalizations on a 1-year follow-up after discharge and respective prognostic factors were assessed with a Kaplan-Meier analysis and Cox regression model. The sample included 234 AN participants (43, 18.4% with premenarchal and 191, 81.6% with postmenarchal AN). When compared to postmenarchal, premenarchal AN individuals presented with lower depressive scores (Self-Administered Psychiatric Scales for Children and Adolescents (SAFA)) (U = 1387.0, p = 0.010) and lower luteinizing hormone (LH) levels (U = 3056.0, p = 0.009) and were less frequently treated with antidepressants (X2 = 5.927, p = 0.015). A significant predictive model of the risk of rehospitalization (X2 = 19.192, p = 0.004) identified a higher age at admission (B = 0.522, p = 0.020) and a day-hospital (vs inpatient) treatment (B = 3957, p = 0.007) as predictive factors for rehospitalization at 1-year, independent from the menarchal status. Conclusion: This study reports the clinical and treatment characteristics of premenarchal AN in one of the largest samples available in the current literature. Specific clinical features and prognostic factors for rehospitalization at 1-year follow-up were identified. Future studies should longitudinally investigate treatment-dependent modifications in endocrine and psychopathological measures in this population. What is Known: • Premenarchal Anorexia Nervosa (AN) is a subtype of AN characterized by its onset before menarche in females and is associated with unique endocrine and prognostic features. What is New: • Individuals with premenarchal AN may display specific clinical profiles, with lower depressive symptoms and luteinizing hormone levels than postmenarchal controls.
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Affiliation(s)
- Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in Età Evolutiva, UO Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Via Massarenti 9, 40138, Università di Bologna, Bologna, Italy
| | - Rosa Pugliano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in Età Evolutiva, UO Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Via Massarenti 9, 40138, Università di Bologna, Bologna, Italy
| | - Beatrice Pranzetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in Età Evolutiva, UO Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Via Massarenti 9, 40138, Università di Bologna, Bologna, Italy
| | - Antonia Parmeggiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in Età Evolutiva, UO Neuropsichiatria dell'Età Pediatrica, Bologna, Italy.
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Via Massarenti 9, 40138, Università di Bologna, Bologna, Italy.
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Brennan C, Illingworth S, Cini E, Bhakta D. Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta-analysis. J Eat Disord 2023; 11:58. [PMID: 37024943 PMCID: PMC10080852 DOI: 10.1186/s40337-023-00779-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
This review investigates the relationship between weight and risk of medical instability (specifically bradycardia, hypotension, hypothermia, and hypophosphatemia) in adolescents with typical and atypical anorexia nervosa. Atypical anorexia nervosa, listed as an example under the DSM-5 category of Other Specified Feeding and Eating Disorders (OSFED), describes patients who are not clinically underweight but otherwise meet criteria for anorexia nervosa. There is a lack of empirical evidence exploring medical complications in adolescents presenting with atypical anorexia nervosa. The small number of studies that do exist in this area indicate that medical instability exists across a range of weights, with weight loss being associated with increased medical risk, independent of underweight. The aim of this review was to collate and analyse results from available studies and identify indicators of medical risk in these two groups of adolescents with restrictive eating disorders. Studies were identified by systematic electronic search of medical databases, including PubMed and EMBASE. All studies investigated the relationship between weight and medical instability and included adolescents diagnosed with anorexia nervosa or atypical anorexia nervosa. One randomised controlled trial, five cohort studies and three chart reviews were included, with a total sample size of 2331 participants. Between 29 and 42% of participants presented with medical instability requiring hospitalisation, in the absence of underweight. Underweight adolescents were significantly more likely to have lower blood pressures (p < 0.0001) and bradycardia was significantly associated with greater weight loss (p < 0.05). There were no statistically significant associations found between degree of underweight and heart rate, temperature, or rate of weight loss (p = 0.31, p = 0.46 and p = 0.16, respectively). Adolescents that were less than 70% median body mass index were significantly more likely to have hypophosphatemia (p < 0.05). The findings of this review support the hypothesis that medical instability can occur across a range of weights in adolescent eating disorders, with rapid weight loss being an important indicator of increasing medical risk. Results were limited by the small number of existing studies that contained data for statistical analysis. Rapid weight loss should be considered as an important indicator of medical instability in adolescents presenting with both typical and atypical anorexia nervosa.
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Affiliation(s)
- Cliona Brennan
- South London and Maudsley NHS Trust, Maudsley Hospital, De Crespigny Park, London, SE5 8AZ, UK.
- London Metropolitan University, 166-220 Holloway Road, London, N7 8DB, UK.
| | - Sarah Illingworth
- London Metropolitan University, 166-220 Holloway Road, London, N7 8DB, UK
| | - Erica Cini
- East London NHS Foundation Trust, Emmanuel Miller Centre, 11 Gill Street, London, E14 8HQ, UK
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK
- University College London, London, UK
| | - Dee Bhakta
- London Metropolitan University, 166-220 Holloway Road, London, N7 8DB, UK
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Salatto A, Riccio MP, Garotti R, Bravaccio C, Spagnuolo MI. Pitfalls and Risks of “New Eating Disorders”: Let the Expert Speak! Nutrients 2023; 15:nu15061307. [PMID: 36986036 PMCID: PMC10051931 DOI: 10.3390/nu15061307] [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: 02/04/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
Since the post-pandemic period, there has been an increase in the incidence of eating disorders (EADs) and a lowering of the age of onset. In addition to the ‘classic’ forms, there has also been an increase in new forms of EADs. This article proposes a brief review of the literature concerning mainly two of these new disorders: atypical anorexia and avoidant/restrictive food intake disorder. In addition, a brief overview is proposed of the most frequently raised questions that clinicians may face when dealing with EADs. The answers are provided by doctors from the Federico II University of Naples, who additionally offer the most common red flags on the topic derived from long clinical experience. This article is proposed to be a brief operational guide for all clinicians working in the pediatric area in order to provide diagnostic clues and useful elements to refer patients to specialists for a correct and multidisciplinary treatment.
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Affiliation(s)
- Alessia Salatto
- Department of Pediatrics, University Federico II of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Maria Pia Riccio
- U.O.S.D. of Child Neuropsychiatry, Department of Translational Medical Sciences, 80131 Naples, Italy
- Correspondence:
| | - Raffaele Garotti
- U.O.S.D. of Child Neuropsychiatry, Department of Translational Medical Sciences, 80131 Naples, Italy
| | - Carmela Bravaccio
- U.O.S.D. of Child Neuropsychiatry, Department of Translational Medical Sciences, 80131 Naples, Italy
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Eating disorders in 11–17 year old schoolgirls: Prevalence, features of clinical manifestations, psychosomatic comorbidity. ACTA BIOMEDICA SCIENTIFICA 2023. [DOI: 10.29413/abs.2023-8.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background. Eating disorders are an urgent public health problem due to their high prevalence and mortality. The disease prognosis depends on timely diagnosis; however, these conditions are sure to be underestimated.The aim. To study the prevalence, features of clinical manifestations and psychosomatic comorbidity of eating disorder (ED) and subthreshold eating disorder (SED) in schoolgirls aged 11–17 years.Materials and methods. We examined 917 schoolgirls aged 11–17 years. The screening questionnaire including 11questions combined into three pools named “Thoughts about one’s own body” was used. The first pool (A) – assessed body dissatisfaction, the second one (B) – eating disorders, the third one (C) – food intake disorders. The answers were encoded as “1”, “2”, “3” (“false”, “rather true”, “true”). Schoolgirls who scored the maximum number of points (12) in the pool A were regarded as dissatisfied with their body and were further divided into two groups: the first group (ED) included girls who scored more than 10 points in the pool B; girls who scored less than 10 points were in the second group (SED), respectively. Body mass index (BMI) was determined by the weight-height coefficient correlated with centile tables. Psychosomatic comorbidity was assessed by the presence of recurrent headache and abdominal pain in the last six months.Results. The overall prevalence of eating disorders was 11.7 %, where ED made 2.1 %, SED – 9.6 %. All schoolgirls had abnormal eating behavior; however, those with SED used less aggressive weight-loss methods. BMI ˂ 5th percentile was observed in 10 % of girls with ED and 4.5 % – with SED. 60 % of girls with ED and 40.9 % with SED complained about frequent headaches; 30 % of girls with ED and 20.4 % with SED were suffering from frequent abdominal pain.Conclusion. In schoolgirls, subthreshold eating disorder is 4.6 times more common than threshold eating disorder. Characteristics of clinical manifestations are the absence of underweight for most schoolgirls and comorbidity with pain syndrome.
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Dąbkowska-Mika A, Steiger R, Gander M, Haid-Stecher N, Fuchs M, Sevecke K, Gizewski ER. Evaluation of visual food stimuli paradigms on healthy adolescents for future use in fMRI studies in anorexia nervosa. J Eat Disord 2023; 11:35. [PMID: 36879292 PMCID: PMC9987124 DOI: 10.1186/s40337-023-00761-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Mostly, visual food stimuli paradigms for functional Magnetic Resonance Imaging are used in studies of eating disorders. However, the optimal contrasts and presentation modes are still under discussion. Therefore, we aimed to create and analyse a visual stimulation paradigm with defined contrast. METHODS In this prospective study, a block-design fMRI paradigm with conditions of randomly altering blocks of high- and low-calorie food images and images of fixation cross was established. Food pictures were rated in advance by a group of patients diagnosed with anorexia nervosa to address the dedicated perception of patients with eating disorders. To optimize the scanning procedure and fMRI contrasts we have analysed neural activity differences between high-calorie stimuli versus baseline (H vs. X), low-calorie stimuli versus baseline (L vs. X) and high- versus low-calorie stimuli (H vs. L). RESULTS By employing the developed paradigm, we were able to obtain results comparable to other studies and analysed them with different contrasts. Implementation of the contrast H versus X led to increased blood-oxygen-level-dependent signal (BOLD) mainly in unspecific areas, such as the visual cortex, the Broca´s area, bilaterally in the premotor cortex and the supplementary motor area, but also in thalami, insulae, the right dorsolateral prefrontal cortex, the left amygdala, the left putamen (p < .05). When applying the contrast L versus X, an enhancement of the BOLD signal was detected similarly within the visual area, the right temporal pole, the right precentral gyrus, Broca´s area, left insula, left hippocampus, the left parahippocampal gyrus, bilaterally premotor cortex and thalami (p < .05). Comparison of brain reactions regarding visual stimuli (high- versus low-calorie food), assumed to be more relevant in eating disorders, resulted in bilateral enhancement of the BOLD signal in primary, secondary and associative visual cortex (including fusiform gyri), as well as angular gyri (p < .05). CONCLUSIONS A carefully designed paradigm, based on the subject's characteristics, can increase the reliability of the fMRI study, and may reveal specific brain activations elicited by this custom-built stimuli. However, a putative disadvantage of implementing the contrast of high- versus low-calorie stimuli might be the omission of some interesting outcomes due to lower statistical power. Trial registration NCT02980120.
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Affiliation(s)
- Agnieszka Dąbkowska-Mika
- Department of Neuroradiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Neuroimaging Research Core Facility, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Manuela Gander
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Tirol Kliniken, Milserstrasse 10, 6060, Hall in Tirol, Austria
| | - Nina Haid-Stecher
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Tirol Kliniken, Milserstrasse 10, 6060, Hall in Tirol, Austria
| | - Martin Fuchs
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Tirol Kliniken, Milserstrasse 10, 6060, Hall in Tirol, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Tirol Kliniken, Milserstrasse 10, 6060, Hall in Tirol, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Jhe GB, Lin J, Freizinger M, Richmond T. Adolescents with anorexia nervosa or atypical anorexia nervosa with premorbid overweight/obesity: What should we do about their weight loss? JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:55-58. [PMID: 36121167 DOI: 10.1111/jcap.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/25/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
Traditionally, anorexia nervosa (AN) was understood to exist exclusively among underweight individuals and weight was used to assess level of severity and course of treatment. Recent trends have found a growing number of individuals presenting with AN or atypical AN (AAN) (i.e., those who remain with weight in a "normal" or "healthy" range despite significant weight loss) have a premorbid history of overweight/obesity. Individuals with AN/AAN and premorbid overweight/obesity represent an especially metabolically vulnerable population as with either AN or AAN, there is marked weight loss. Patients with AAN present a specific challenge as healthcare professionals must identify a clinically significant eating disorder in adolescents of potentially "normal" weights and then must balance their knowledge and training of traditional treatment of AN with obesity treatment and prevention. Currently, there are no evidence-based treatments to guide medical and mental health professionals regarding weight restoration, medical stabilization, and psychological treatment in patients with AN/AAN with a history of overweight/obesity while also addressing risk prevention for obesity.
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Affiliation(s)
- Grace B Jhe
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Lin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Melissa Freizinger
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy Richmond
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Barko EB, Moorman SM. Weighing in: qualitative explorations of weight restoration as recovery in anorexia nervosa. J Eat Disord 2023; 11:14. [PMID: 36721222 PMCID: PMC9887881 DOI: 10.1186/s40337-023-00736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) continues to capture the public's imagination, centered around physical appearance, particularly weight. Clinical conceptions of AN also emphasize weight. The objective of this study was to explore how individuals with lived AN experience thought about the role of weight in illness and recovery. METHODS The current study employed a grounded theory approach through qualitative inductive inquiry and analysis of 150 anonymous narratives, exploring firsthand experience of AN and recovery of adult individuals, based in the United States of America. RESULTS Individuals with AN histories contested intersecting popular cultural and medical presumptions of their health and illness positioned in weight. Respondents indicated that while weight does not measure recovery, it matters to recovery in unanticipated ways. Others' expectations for a low weight served as a gatekeeper to various forms of social and institutional support. Respondents felt that the weight obsessions of other people made it difficult to earn the illness legitimacy to access sufficient care. CONCLUSIONS Research findings bear implications for future AN research, advocacy, and clinical practice, as respondents pivot research emphasis from weight as a sociocultural motivation for AN, to weight as a sociocultural obstacle to AN recovery.
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Affiliation(s)
- Emily B Barko
- Department of Sociology, Boston College, 140 Commonwealth Avenue, McGuinn Hall 426, Chestnut Hill, MA, 02467, USA.
| | - Sara M Moorman
- Department of Sociology, Boston College, 140 Commonwealth Avenue, McGuinn Hall 426, Chestnut Hill, MA, 02467, USA
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35
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Kramer R. Considerations in Evidence-Based Treatment of Adolescents With Atypical Anorexia Nervosa. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2023; 49:41-51. [PMID: 36811063 PMCID: PMC9933807 DOI: 10.1007/s42843-023-00080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
There is emerging evidence suggesting atypical anorexia nervosa (AAN), an eating disorder (ED) introduced in the DSM-5, is as serious an ED as anorexia nervosa (AN) in terms of medical risk and ED pathology. Medical hospitalizations among individuals with AAN have significantly increased over the years and individuals with AAN are noted to have longer illness durations and greater weight loss prior to receiving care than individuals with AN. Additionally, AAN is noted to be two to three times more common than AN in community samples of adolescents. Given that AAN is a newer diagnosis, research knowledge and evidence-based treatment guidelines are emerging, yet pivotal. Thus, this article discusses specific considerations during assessment and treatment using Family Based Treatment (FBT) among adolescents diagnosed with AAN and clinical and ethical concerns involved while providing effective care and mitigating any weight bias or stigma related to historical and current weight status.
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Davén J, Hellzen O, Häggström M. Encountering patients with anorexia nervosa - An emotional roller coaster. nurses’ lived experiences of encounters in psychiatric inpatient care. Int J Qual Stud Health Well-being 2022; 17:2069651. [PMID: 35481811 PMCID: PMC9068011 DOI: 10.1080/17482631.2022.2069651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of this study was to illuminate the meaning of nurses’ lived experiences of encounters with adult patients with anorexia nervosa in psychiatric inpatient care. Methods A qualitative phenomenological hermeneutical design was used. Personal interviews with a narrative approach were conducted with 11 nurses with experience of encountering patients with anorexia nervosa in psychiatric inpatient care. Results Three key themes were revealed: Being overwhelmed by emotions consisting of three subthemes: Bearing feelings of incomprehension, Navigating emotions, and Being disappointed and frustrated; Seeking strength to cope consisting of three subthemes: Relying on colleagues and routines, Feeling hope and motivation, and Building inner security; and Trying to build relations consisting of two subthemes: Getting closer to the patient and Relating to relatives. Conclusion Our findings illuminate the “emotional roller-coaster” which nurses are embedded in during their daily work experiences. Being able to balance one’s professional role, seeing the person behind the patient, and the illness is important in all nurse-patient encounters. An examination of nurses’ lived experiences can contribute new and important knowledge, an in-depth understanding of the nurses’ work situation, and can help identify any need for increased knowledge.
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Affiliation(s)
- Josefine Davén
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Ove Hellzen
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Marie Häggström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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37
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Vo M, Golden N. Medical complications and management of atypical anorexia nervosa. J Eat Disord 2022; 10:196. [PMID: 36522787 PMCID: PMC9756584 DOI: 10.1186/s40337-022-00720-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Atypical anorexia nervosa (AAN) is a new diagnosis in the 5th edition of the Diagnostic and Statistical Manual. Patients with AAN have been recognized to have similar, if not more severe, medical and psychological complications compared with patients with typical Anorexia Nervosa; yet studies on medical complications and optimal treatment of AAN are lacking. Here we review what is known regarding medical presentation and management of patients with AAN.
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Affiliation(s)
- Megen Vo
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Road Suite 210, Palo Alto, CA, 94304, USA.
| | - Neville Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Road Suite 210, Palo Alto, CA, 94304, USA
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Mereu A, Fantoni T, Caini S, Monzali F, Roselli E, Taddei S, Lucarelli S, Pisano T. Suicidality in adolescents with onset of anorexia nervosa. Eat Weight Disord 2022; 27:2447-2457. [PMID: 35277848 DOI: 10.1007/s40519-022-01384-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The mortality rate in patients with anorexia nervosa (AN) is 5 to 10 times higher than in general population and, suicide is one of the main causes of death. We evaluated the prevalence of suicidality (ideation, self-injurious behaviour, suicidal attempts) in 100 adolescents with onset of AN and we explored the correlation between suicidality, severity of AN symptoms and psychiatric comorbidity. METHODS We subdivided AN patients into restrictive (R-AN; n = 66) and restrictive atypical (A-AN; n = 34), according to the European Guidelines criteria. Assessment was performed using the eating disorder inventory 3rd version, the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version interview, and the Columbia-suicide severity rating scale. Fisher's exact test and Mann-Whitney test (with correction for multiple testing) were used to compare the distribution of categorical and continuous variables between R-AN and A-AN patients, and between patients with vs. without suicidal behaviours. RESULTS Twenty-seven patients (27%) presented suicidality as clinical feature, expressed as at least one of the following: suicidal ideation (24%), self-cutting (19%), and suicidal attempt (6%). Patients with suicidality showed greater severity of psychiatric symptoms related to AN psychopathology and presented psychiatric comorbidity, especially depression, more often than patients who did not reported suicidality (70,4% vs 29,6%). No significant differences in terms of suicidal behaviours and AN-specific psychopathology were found between R-AN and A-AN. CONCLUSIONS Suicidality in adolescent patients with R-AN and A-AN seems to be related to ED symptoms. These data highlight the importance of screening for suicidality among adolescents at onset of AN, and confirms that A-AN should not be considered a milder disease. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).
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Affiliation(s)
- Alberta Mereu
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Teresa Fantoni
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Francesca Monzali
- Dietetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Elena Roselli
- Dietetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Silvia Taddei
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | | | - Tiziana Pisano
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
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Huckins LM, Signer R, Johnson J, Wu YK, Mitchell KS, Bulik CM. What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding. Mol Psychiatry 2022; 27:3929-3938. [PMID: 35595976 PMCID: PMC9718676 DOI: 10.1038/s41380-022-01601-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
Substantial progress has been made in the understanding of anorexia nervosa (AN) and eating disorder (ED) genetics through the efforts of large-scale collaborative consortia, yielding the first genome-wide significant loci, AN-associated genes, and insights into metabo-psychiatric underpinnings of the disorders. However, the translatability, generalizability, and reach of these insights are hampered by an overly narrow focus in our research. In particular, stereotypes, myths, assumptions and misconceptions have resulted in incomplete or incorrect understandings of ED presentations and trajectories, and exclusion of certain patient groups from our studies. In this review, we aim to counteract these historical imbalances. Taking as our starting point the Academy for Eating Disorders (AED) Truth #5 "Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses", we discuss what we do and do not know about the genetic underpinnings of EDs among people in each of these groups, and suggest strategies to design more inclusive studies. In the second half of our review, we outline broad strategic goals whereby ED researchers can expand the diversity, insights, and clinical translatability of their studies.
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Affiliation(s)
- Laura M Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Mental Illness Research, Education and Clinical Centers, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, 14068, USA
| | - Rebecca Signer
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jessica Johnson
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ya-Ke Wu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Tan P, Shah R, Hassouna T, Murphy R, McNally S. The role of biodegradable temporizing matrix in the management of a patient with major burns and anorexia nervosa. J Surg Case Rep 2022; 2022:rjac410. [PMID: 36177380 PMCID: PMC9514796 DOI: 10.1093/jscr/rjac410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Severe malnutrition secondary to anorexia nervosa results in deeper burns and significantly impacts wound healing, which represents a major challenge to burn management. The use of acellular dermal matrices, such as biodegradable temporizing matrix (BTM), is a valuable tool to overcome the surgical limitations. We describe a case of a 36-year-old female with a background of anorexia nervosa (body mass index of 12.3) presenting with a 30% total burns surface area (TBSA) burn. All of her burns were excised down to fascia due to the absence of subcutaneous fat. Her thin skin and depleted nutritional status significantly impacted reconstructive options. BTM was utilized to create a neodermis and provide adequate time to optimize the nutritional status before autologous skin resurfacing 3 weeks later, which yielded robust coverage with minimal donor site morbidity. Despite initial surgical and nutritional challenges, excellent outcomes were achieved in terms of wound healing, scar contractures and mobility.
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Affiliation(s)
- Poh Tan
- Department of Burns and Plastic Surgery, Wythenshawe Hospital , Southmoor Road, Manchester M23 9LT , UK
| | - Rushabh Shah
- Department of Burns and Plastic Surgery, Wythenshawe Hospital , Southmoor Road, Manchester M23 9LT , UK
| | - Tarek Hassouna
- Department of Burns and Plastic Surgery, Wythenshawe Hospital , Southmoor Road, Manchester M23 9LT , UK
| | - Ralph Murphy
- Department of Burns and Plastic Surgery, Wythenshawe Hospital , Southmoor Road, Manchester M23 9LT , UK
| | - Samantha McNally
- Department of Burns and Plastic Surgery, Wythenshawe Hospital , Southmoor Road, Manchester M23 9LT , UK
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Shachar-Lavie I, Segal H, Oryan Z, Halifa-Kurtzman I, Bar-Eyal A, Hadas A, Tamar T, Benaroya-Milshtein N, Fennig S. Atypical anorexia nervosa: Rethinking the association between target weight and rehospitalization. Eat Behav 2022; 46:101649. [PMID: 35777105 DOI: 10.1016/j.eatbeh.2022.101649] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 05/07/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Bodyweight restoration is one of the most important targets in adolescent inpatient treatment of anorexia nervosa (AN). This study examined the association between achieving target weight and rehospitalization in two groups of adolescents with AN and atypical anorexia nervosa (AAN) admitted to a specialized inpatient unit. METHOD Included were 202 adolescent patients hospitalized in a specialized eating disorder unit, 10-18 years old. One hundred fifty-four adolescents were diagnosed with AN, and 48 with AAN. We examined the patients' demographic and clinical characteristics, the achievement of treatment goals, and their rehospitalization history within a year of discharge from the unit. RESULTS Log-linear regression indicated a significant association between achieving target weight during the inpatient program and rehospitalization at one-year follow-up in the AN group; this association was not significant in the AAN group. DISCUSSION This study emphasizes the importance of differentiating patients with AAN from those with classical AN. Specifically, it raises questions about the predictive power of target weight at discharge in preventing relapse and its centrality in determining AAN patients' treatment plans.
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Affiliation(s)
| | - Hila Segal
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Zohar Oryan
- Schneider Children's Medical Center, Petah Tikva, Israel
| | | | - Adi Bar-Eyal
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Arik Hadas
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Tahar Tamar
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Noa Benaroya-Milshtein
- Schneider Children's Medical Center, Petah Tikva, Israel; Sackler Medical School, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Silvana Fennig
- Schneider Children's Medical Center, Petah Tikva, Israel; Sackler Medical School, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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42
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Bou Khalil R, Sultan A, Seneque M, Richa S, Lefebvre P, Renard E, Courtet P, Maimoun L, Guillaume S. Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study. Nutrients 2022; 14:2727. [PMID: 35807906 PMCID: PMC9269154 DOI: 10.3390/nu14132727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REEIC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REEIC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.
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Affiliation(s)
- Rami Bou Khalil
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Ariane Sultan
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Maude Seneque
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Sami Richa
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France
| | - Philippe Courtet
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Laurent Maimoun
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier, 34295 Montpellier, France
| | - Sebastien Guillaume
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
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Freizinger M, Recto M, Jhe G, Lin J. Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap. CHILDREN 2022; 9:children9060837. [PMID: 35740774 PMCID: PMC9221982 DOI: 10.3390/children9060837] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Atypical anorexia nervosa (AAN) is a restrictive eating disorder (ED) that describes individuals who may be normal weighted or overweight; many have a premorbid history of obesity. Pediatric care providers are trained to identify and provide best practices for youth with pediatric obesity; however, most pediatric care providers are not trained to assess and treat restrictive EDs which typically present in youth aged 10 and 14 years. Although individuals with AAN may appear to be within a ‘healthy weight’, many experience malnutrition, psychological symptoms, and severe physiological complications after weight loss. These individuals are presenting to pediatric services at an increasing rate and exhibit acute medical instability along with severe ED psychopathology. One complicating factor is youth with AAN may take longer to be identified by pediatric providers and may be reluctant to engage in treatment. Delayed treatment for AAN, along with all EDs often results in poorer treatment outcomes. A greater understanding of this complex illness is essential to inform medical decisions, such as labs, vitals, hospital admissions, and psychological therapy. Currently, there are no standardized guidelines for treating AAN in youths. This review is designed to present evidence-based treatment to inform and guide best treatment practices.
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Affiliation(s)
- Melissa Freizinger
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - Michelle Recto
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Grace Jhe
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Lin
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
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Ceccarini MR, Precone V, Manara E, Paolacci S, Maltese PE, Benfatti V, Dhuli K, Donato K, Guerri G, Marceddu G, Chiurazzi P, Dalla Ragione L, Beccari T, Bertelli M. A next generation sequencing gene panel for use in the diagnosis of anorexia nervosa. Eat Weight Disord 2022; 27:1869-1880. [PMID: 34822136 DOI: 10.1007/s40519-021-01331-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of this study was to increase knowledge of genes associated with anorexia nervosa (AN) and their diagnostic offer, using a next generation sequencing (NGS) panel for the identification of genetic variants. The rationale underlying this test is that we first analyze the genes associated with syndromic forms of AN, then genes that were found to carry rare variants in AN patients who had undergone segregation analysis, and finally candidate genes intervening in the same molecular pathways or identified by GWAS or in mouse models. METHODS We developed an NGS gene panel and used it to screen 68 Italian AN patients (63 females, 5 males). The panel included 162 genes. Family segregation study was conducted on available relatives of probands who reported significant genetic variants. RESULTS In our analysis, we found potentially deleterious variants in 2 genes (PDE11A and SLC25A13) associated with syndromic forms of anorexia and predicted deleterious variants in the following 12 genes: CD36, CACNA1C, DRD4, EPHX2, ESR1, GRIN2A, GRIN3B, LRP2, NPY4R, PTGS2, PTPN22 and SGPP2. Furthermore, by Sanger sequencing of the promoter region of NNAT, we confirmed the involvement of this gene in the pathogenesis of AN. Family segregation studies further strengthened the possible causative role of CACNA1C, DRD4, GRIN2A, PTGS2, SGPP2, SLC25A13 and NNAT genes in AN etiology. CONCLUSION The major finding of our study is the confirmation of the involvement of the NNAT gene in the pathogenesis of AN; furthermore, this study suggests that NGS-based testing can play an important role in the diagnostic evaluation of AN, excluding syndromic forms and increasing knowledge of the genetic etiology of AN. LEVEL OF EVIDENCE Level I, experimental study.
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Affiliation(s)
- Maria Rachele Ceccarini
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy.
- C.I.B., Consorzio Interuniversitario per le Biotecnologie, Trieste, Italy.
| | | | | | | | | | - Valentina Benfatti
- Department of Eating Disorder, Palazzo Francisci Todi, USL 1 Umbria, Todi, PG, Italy
| | | | | | | | | | - Pietro Chiurazzi
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Medicina Genomica, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Genetica Medica, 00168, Roma, Italy
| | - Laura Dalla Ragione
- Department of Eating Disorder, Palazzo Francisci Todi, USL 1 Umbria, Todi, PG, Italy
- Food Science and Human Nutrition Unit, University Campus Biomedico of Rome, Rome, Italy
| | - Tommaso Beccari
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
- C.I.B., Consorzio Interuniversitario per le Biotecnologie, Trieste, Italy
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Draffin K, Hamilton J, Godsil S, Rudolph S, Crowe T, Newton R. Comparison of a low carbohydrate intake and standard carbohydrate intake on refeeding hypophosphatemia in children and adolescents with anorexia nervosa: a pilot randomised controlled trial. J Eat Disord 2022; 10:50. [PMID: 35413883 PMCID: PMC9006566 DOI: 10.1186/s40337-021-00519-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutritional rehabilitation for patients with anorexia nervosa involves balancing the need for weight gain whilst mitigating the risk of refeeding syndrome. Graded caloric increases and restriction of calories from carbohydrate have been used to minimise the risk of developing refeeding hypophosphatemia. There is little evidence to support the recommended nutrient composition, specifically the recommended carbohydrate intake that is safe in this population. The aim of this pilot study was to compare the effect of a low and a standard carbohydrate feeding protocol on serum phosphate levels in children and adolescents with anorexia nervosa. METHODS A pilot study of 23 children and adolescents with anorexia nervosa admitted for medical stabilisation to the adolescent ward of a tertiary hospital was undertaken. Participants were commenced on an oral feeding protocol and were randomly allocated to isocaloric meal plans that were either low carbohydrate (< 40% total energy from carbohydrate) or standard carbohydrate (50-60% total energy from carbohydrate). Serum phosphate levels were monitored daily across the first week and twice weekly thereafter. Clinical status, including weight gain, was monitored throughout admission. RESULTS 52% (n = 12) of participants were allocated to the low carbohydrate group and 48% (n = 11) were allocated to the standard carbohydrate group. No patients in either of the diet groups developed refeeding hypophosphatemia in the first seven days of admission. Weight gain during the first week was significantly higher in the standard carbohydrate diet (1.4 kg/wk ± 0.5) compared to the low carbohydrate diet (0.6 kg/wk ± 0.9), p value 0.03. Participants from both diet groups were largely orally fed with less than 10% of the total number of meals and/or snacks across both groups provided as nutrition supplement drinks, either orally or enterally. CONCLUSION This pilot study supports that a standard carbohydrate intake (providing 50-60% of total energy from carbohydrate) optimises nutritional rehabilitation without increasing the risk of refeeding hypophosphatemia in adolescent inpatients with anorexia nervosa. CTN: ACTRN12621000300875. Plain English Summary: People with eating disorders who are underweight or malnourished, such as patients with anorexia nervosa, are at risk of refeeding syndrome when they receive treatment and return to regular eating. Refeeding syndrome may cause fluid and electrolyte shifts. This can occur as a result of the reintroduction of carbohydrates, and can have potentially life-threatening consequences if not managed appropriately. Refeeding hypophosphatemia is one of the early markers of refeeding syndrome. This study compared patients who were provided a low carbohydrate diet (40% total energy from carbohydrate) to those who were provided a standard carbohydrate diet (50-60% total energy from carbohydrate) to see if patients from either group were more at risk of developing refeeding syndrome. No patients in either of the diet groups developed refeeding hypophosphatemia. This pilot study may help to ensure that when patients get treated for their eating disorder in hospital, they can return to a normal diet as soon as possible with close medical monitoring.
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Rodgers RF, Fischer LE, Laveway K, Laws K, Bui E. Fear of fatness and desire for thinness as distinct experiences: A qualitative exploration. Int J Eat Disord 2022; 55:530-540. [PMID: 35150010 DOI: 10.1002/eat.23689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The pursuit of thinness and fear of gaining weight have been found to play an important role in eating disorder symptomatology. While these dimensions have typically been considered conjointly, emerging evidence suggests they may be distinct dimensions. The aim of this study was to explore the subjective experiences of fear of fatness and drive for thinness in young women with body image concerns. METHOD Young women endorsing weight concerns (N = 29, mean age = 20.86, SD = 2.70 years) were interviewed and asked to describe an experience of fear of fat and drive for thinness, respectively. RESULTS Qualitative analysis was conducted and identified four themes: (1) precipitating events; (2) physiological, emotional, cognitive, and proprioceptive experiences; (3) coping strategies; and (4) sociocultural influences. While similarities emerged, the experiences of fear of fatness, and of drive for thinness also evidenced clear differences situating the former in the context of fear-based avoidance patterns, and the latter in approach-based reward models. DISCUSSION These findings provide additional support for the usefulness of considering fear of fat and drive for thinness as distinct constructs. Further research examining the contributions of each of these constructs to eating pathology is warranted.
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Affiliation(s)
- Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Laura E Fischer
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Katherine Laveway
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Kristen Laws
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Caen University Hospital & Caen University, Caen, France.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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47
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Nizami H, Su L, Jain R, Jain R. Effects of chronically skipping meals on atrial fibrillation risk. Future Cardiol 2022; 18:497-506. [PMID: 35360935 DOI: 10.2217/fca-2021-0086] [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: 11/21/2022] Open
Abstract
Atrial fibrillation is the most common form of arrhythmia and can result in significant morbidity and mortality. While there are many potential causes of atrial fibrillation that have been well studied, this work considers the potential effect of chronically skipping meals on the development of atrial fibrillation. The authors discuss the various processes that skipping meals initiates in the body that may ultimately result in atrial fibrillation. Through a better understanding of the various disease pathophysiologies that can contribute to the development of atrial fibrillation, this narrative review may help lead to more advanced therapeutic and preventive approaches.
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Affiliation(s)
- Hamasah Nizami
- School of Medicine, American University of Integrative Sciences, #9 5th Avenue Belleville, St. Michael, Barbados
| | - Lilly Su
- School of Medicine, Pennsylvania State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Rahul Jain
- University Hospital, 1 Hospital drive, Columbia, MO 65212, USA
| | - Rohit Jain
- Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
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48
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Pauls A, Dimitropoulos G, Marcoux-Louie G, Singh M, Patten SB. Psychological characteristics and childhood adversity of adolescents with atypical anorexia nervosa versus anorexia nervosa. Eat Disord 2022; 30:210-222. [PMID: 33103622 DOI: 10.1080/10640266.2020.1836907] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The assessment and diagnosis of atypical anorexia nervosa (AAN) is an ongoing challenge for clinicians. This study aims to examine psychological morbidity and exposure to childhood adversity in adolescents with AAN compared to adolescents with anorexia nervosa, restricting type (AN-R). This registry-based study compared 42 adolescents with AAN to 79 adolescents with AN-R on a variety of psychosocial measures at the time of presentation to a specialized eating disorder program. In contrast to AN-R, adolescents with AAN had more severe drive for thinness (p =.011), body dissatisfaction (p =.038), and lower quality of life (p =.047), but had better global functioning (p =.032). Adolescents who had high Adverse Childhood Experiences (ACE) Questionnaire scores (ACE score ≥ 4) had over 5 times higher odds of having AAN than those who did not have high ACE scores (p =.008). There was no significant difference between groups on measures of low self-esteem and non-accidental self-injury. Adolescents with AAN presented with similar or more severe psychosocial distress compared to their peers with AN-R across a majority of the measures. The findings highlight the need to address trauma, body-related difficulties, and quality of life in the assessment and treatment of adolescents with AAN.
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Affiliation(s)
- Ashley Pauls
- Departments of Psychiatry, University of Calgary, Calgary, Canada
| | | | - Gisele Marcoux-Louie
- Calgary Eating Disorder Program, Alberta Children's Hospital, Alberta Health Services
| | - Manya Singh
- Mathison Centre for Mental Health Research & Education,Department of Psychiatry, University of Calgary
| | - Scott B Patten
- Departments of Psychiatry, University of Calgary, Calgary, Canada.,Departments of Psychiatry & Community Health Sciences, University of Calgary
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49
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Riva A, Falbo M, Passoni P, Polizzi S, Cattoni A, Nacinovich R. High levels of physical activity in female adolescents with anorexia nervosa: medical and psychopathological correlates. Eat Weight Disord 2022; 27:151-162. [PMID: 33704692 DOI: 10.1007/s40519-021-01126-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE While overexercise is commonly described in patients who experience anorexia nervosa (AN), it represents a condition still underestimated, especially in the paediatric population. METHOD The present study aims at assessing the possible associations between levels of physical activity (PA) and clinical features, endocrinological data and psychopathological traits in a sample of 244 female adolescents hospitalised for AN subdivided into two groups according to PA levels (high PA vs. no/low PA). The two groups were compared through multivariate analyses, while multiple regression analysis was conducted to determine whether physical activity predict specific outcomes. RESULTS No significant differences were found between the two groups in terms of last Body Mass Index (BMI) before illness, BMI at admission and disease duration, while a difference emerged in delta BMI(rapidity of weight loss), significantly higher in high-PA group (p = 0.021). Significant differences were observed in Free triiodothyronine- (p < 0.001), Free thyroxine (p = 0.046), Follicle-stimulating hormone (p = 0.019), Luteinising hormone (p = 0.002) levels, with values remarkably lower in high-PA group. Concerning psychopathological scales, the high-PA group showed worst Children's Global Assessment Scale (CGAS) scores (p = 0.035). Regression analyses revealed that higher PA predicts higher delta BMI (p = 0.021), presence of amenorrhea (p = 0.003), lower heart rate (p = 0.012), lower thyroid (Free triiodothyronine p < 0.001, Free thyroxine p = 0.029) and gynaecological hormones' levels (Follicle-stimulating hormone p = 0.023, Luteinising hormone p = 0.003, 17-Beta estradiol p = 0.041). Concerning psychiatric measures, HPA predicts worst scores at CGAS (p = 0.019), and at scales for evaluation of alexithymia (p = 0.028) and depression (p = 0.004). CONCLUSIONS Results suggest that high levels of physical activity in acute AN associate with worst clinical conditions at admission, especially in terms of endocrinological and medical features. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Mariella Falbo
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Paolo Passoni
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Serena Polizzi
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, University of Milan Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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Hecht LM, Hadwiger A, Patel S, Hecht BR, Loree A, Ahmedani BK, Miller-Matero LR. Disordered eating and eating disorders among women seeking fertility treatment: A systematic review. Arch Womens Ment Health 2022; 25:21-32. [PMID: 34175997 DOI: 10.1007/s00737-021-01156-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.
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Affiliation(s)
- Leah M Hecht
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.
| | - Ashley Hadwiger
- Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Shivali Patel
- Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Bryan R Hecht
- MetroHealth Medical Center, Division of Reproductive Endocrinology, 2500 Metrohealth Dr, Cleveland, OH, 44109, USA
| | - Amy Loree
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.,Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
| | - Lisa R Miller-Matero
- Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA.,Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA
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