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Ayrolles A, Clarke J, Dechaux M, Lefebvre A, Cohen A, Stordeur C, Peyre H, Bargiacchi A, Godart N, Watson H, Delorme R. Inpatient target discharge weight for early-onset anorexia nervosa: Restoring premorbid BMI percentile to improve height prognosis. Clin Nutr ESPEN 2023; 54:150-156. [PMID: 36963857 DOI: 10.1016/j.clnesp.2023.01.025] [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: 06/01/2022] [Revised: 10/11/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Early-onset anorexia nervosa (EO-AN) is characterized by restricted food intake leading to low body weight, emerging before 14 years old. Most patients reaching a target body mass index (BMI) around the 25th percentile at hospitalization discharge display an incomplete prospective height catch-up. A better understanding of height prognosis determinants is required. METHODS In 74 children with an EO-AN, we collected height and weight premorbidly, at hospitalization, and at discharge, 6 months, 12 months, and at longer-term follow-up of 36 months. We defined a height prognosis parameter (HPP) as the difference between the height percentile at follow-up times and the premorbid height percentile. We explored the relationship between weight parameters and height catch-up at follow-up with linear regression analyses. RESULTS A higher weight suppression (WS) - i.e., difference between premorbid and current BMI - at admission and discharge was associated with lower HPP - i.e., a greater loss of height - at 12 months and 36 months follow-up. Similarly, a higher premorbid BMI percentile was associated with a lower HPP at 12 and 36 months. CONCLUSION Target discharge weight for EO-AN patients should be tailored and based on premorbid BMI trajectory to improve height prognosis.
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Affiliation(s)
- A Ayrolles
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Human Genetics & Cognitive Functions, Institut Pasteur, Paris, France.
| | - J Clarke
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Centre of Psychiatry and Neuroscience, INSERM UMR 894, Paris, France
| | - M Dechaux
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - A Lefebvre
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Human Genetics & Cognitive Functions, Institut Pasteur, Paris, France
| | - A Cohen
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - C Stordeur
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - H Peyre
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; INSERM UMRS 1141, Paris, France; Paris University, Paris, France
| | - A Bargiacchi
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - N Godart
- Fondation Santé des Etudiants de France, Paris, France; CESP, U1018, INSERM, Villejuif, France; UFR of Health Sciences, UVSQ, Versailles, France
| | - H Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA; School of Psychology, Curtin University, Perth, Australia; School of Paediatrics, Division of Medicine, The University of Western Australia, Perth, Australia
| | - R Delorme
- Assistance Publique - Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Human Genetics & Cognitive Functions, Institut Pasteur, Paris, France; Paris University, Paris, France
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Downey AE, Richards A, Tanner AB. Linear growth in young people with restrictive eating disorders: "Inching" toward consensus. Front Psychiatry 2023; 14:1094222. [PMID: 36937727 PMCID: PMC10020618 DOI: 10.3389/fpsyt.2023.1094222] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Background While the assessment of acute medical stability in patients with eating disorders should never be minimized, careful attention toward other specific age-related consequences of malnutrition can improve psychological outcomes and reduce long-term, potentially irreversible medical complications, like linear growth impairment. Review While the impact of malnutrition on linear growth is widely recognized, emerging data highlight consensus in several key areas: the time from onset to time of diagnosis, age at illness onset, pubertal stage at illness onset, and adequacy of weight restoration to achieve catch-up growth. This review provides concrete and actionable steps to help providers identify and explore deviations in expected growth and development while prioritizing early and aggressive weight restoration to provide the best opportunity for catch-up linear growth in patients with eating disorders. Conclusion The impact of restrictive eating disorders on growth and development cannot be overstated, particularly in pre- and peripubertal patients. While many consequences of malnutrition are reversible, the loss of genetic height potential may prove irreversible without early and aggressive weight restoration.
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Affiliation(s)
- Amanda E. Downey
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Amanda E. Downey,
| | - Alexis Richards
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Anna B. Tanner
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Accanto Health Perimeter Center East, Dunwoody, GA, United States
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Modan-Moses D, Yaroslavsky A, Pinhas-Hamiel O, Levy-Shraga Y, Kochavi B, Iron-Segev S, Enoch-Levy A, Toledano A, Stein D. Prospective Longitudinal Assessment of Linear Growth and Adult Height in Female Adolescents With Anorexia Nervosa. J Clin Endocrinol Metab 2021; 106:e1-e10. [PMID: 32816013 DOI: 10.1210/clinem/dgaa510] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Growth retardation is an established complication of anorexia nervosa (AN); however, findings concerning the adult height of AN patients are inconsistent. OBJECTIVE The objective of this work was to assess linear growth and adult height in female adolescents with AN. DESIGN AND SETTING A prospective observational study was conducted in a tertiary university hospital. PARTICIPANTS Participants included all 255 female adolescent AN patients hospitalized in the pediatric psychosomatic department between January 1, 2000 and May 31, 2015. INTERVENTIONS Height and weight were assessed at admission and during hospitalization. Patients were subsequently invited for measurement of adult height. Additional data collected included premorbid height data, menstrual history, skeletal age, pertinent laboratory studies, and parental heights. MAIN OUTCOME MEASURE The main outcome measure of this study was adult height. RESULTS Mean age at admission was 15.4 ± 1.75 years, mean body mass index (BMI) was 15.7 ± 1.8 kg/m2 (BMI SDS = -2.3 ± 1.45 kg/m2). Premorbid height SD scores (SDS) were not significantly different from those expected in normal adolescents (0.005 ± 0.96). However, height SDS at admission (-0.36 ± 0.99), discharge (-0.34 ± 0.96), and at adult height (-0.29 ± 0.95), were significantly (P < .001) lower than expected. Furthermore, adult height was significantly (P = .006) shorter compared to the midparental target height. Stepwise forward linear regression analysis identified age (r = 0.32, P = .002) and bone age (r = -0.29, P = .006) on admission, linear growth during hospitalization (r = 0.47, P < .001), and change in luteinizing hormone during hospitalization (r = -0.265, P = .021) as independent predictors of improvement in height SDS from the time of admission to adult height. CONCLUSIONS Whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yael Levy-Shraga
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Brigitte Kochavi
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sharon Iron-Segev
- Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
- School of Nutrition, Peres Academic Center, Rehovot, Israel
| | - Adi Enoch-Levy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Toledano
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Swenne I. Poor catch-up growth in late adolescent boys with eating disorders, weight loss and stunting of growth. EUROPEAN EATING DISORDERS REVIEW 2013; 21:395-8. [PMID: 23733412 DOI: 10.1002/erv.2237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/12/2013] [Accepted: 04/24/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The study aims to investigate the catch-up growth of boys presenting with an eating disorder (ED) and a stunting of growth. METHOD Weight gain and growth of 46 boys with ED were followed up for 1-3 years. RESULTS A total of 13 boys who had not started their pubertal growth spurt at presentation started catch-up growth immediately following nutritional rehabilitation and weight gain. After 3 years, they had returned to their premorbid growth curve. Thirty-three boys who had started their pubertal growth spurt prior to presentation never caught up in height but continued to catch down despite weight gain. After 3 years, they had lost 0.64 ± 0.55 height standard deviation scores corresponding to approximately 4.5 cm of potential height. CONCLUSIONS In prepubertal boys with EDs, catch-up growth is possible. Pubertal boys are at a disadvantage in that catch-up growth may not occur despite weight gain.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Sweden.
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Modan-Moses D, Yaroslavsky A, Kochavi B, Toledano A, Segev S, Balawi F, Mitrany E, Stein D. Linear growth and final height characteristics in adolescent females with anorexia nervosa. PLoS One 2012; 7:e45504. [PMID: 23029058 PMCID: PMC3445517 DOI: 10.1371/journal.pone.0045504] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 08/21/2012] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Growth retardation is an established complication of anorexia nervosa (AN). However, findings concerning final height of AN patients are inconsistent. The aim of this study was to assess these phenomena in female adolescent inpatients with AN. METHODS We retrospectively studied all 211 female adolescent AN patients hospitalized in an inpatient eating disorders department from 1/1/1987 to 31/12/99. Height and weight were assessed at admission and thereafter routinely during hospitalization and follow-up. Final height was measured in 69 patients 2-10 years after discharge. Pre-morbid height data was available in 29 patients. RESULTS Patients' height standard deviation scores (SDS) on admission (-0.285±1.0) and discharge (-0.271±1.02) were significantly (p<0.001) lower than expected in normal adolescents. Patients admitted at age ≤13 years, or less than 1 year after menarche, were more severely growth-impaired than patients admitted at an older age, (p = 0.03). Final height SDS, available for 69 patients, was -0.258±1.04, significantly lower than expected in a normal population (p = 0.04), and was more severely compromised in patients who were admitted less than 1 year from their menarche. In a subgroup of 29 patients with complete growth data (pre-morbid, admission, discharge, and final adult height), the pre-morbid height SDS was not significantly different from the expected (-0.11±1.1), whereas heights at the other time points were significantly (p = 0.001) lower (-0.56±1.2, -0.52±1.2, and -0.6±1.2, respectively). CONCLUSIONS Our findings suggest that whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
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Abstract
OBJECTIVE This study examines the risks of disordered eating among Hong Kong adolescents. SUBJECTS A total of 893 students (12-18 years old) participated in a cross-sectional study in 2007. METHODS Students' height and weight were measured and the Eating Attitudes Test (EAT-26) was completed. The risks of disordered eating were assessed by EAT-26 results and weight status. Sex differences in the risks of disordered eating were examined by logistic regression models with adjustment for age. RESULTS Based on the EAT-26 results, 18.5% of boys and 26.6% of girls were at risk of disordered eating with a significant adjusted odds ratio (OR) of 1.58 [95% confidence interval (CI) 1.15-2.18] for sex. A significant OR of 1.60 (95%CI 1.21-2.13) for sex was also obtained when both EAT-26 results and weight status were used for the screening. CONCLUSIONS Hong Kong adolescent girls have a higher risk of disordered eating than boys. EAT-26 results together with measured weight status are useful criteria for screening disordered eating attitudes and behaviors in adolescents.
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Affiliation(s)
- K-K Mak
- Department of Community Medicine and School of Public Health, Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
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Winston AP, Paul M, Juanola-Borrat Y. The same but different? Treatment of anorexia nervosa in adolescents and adults. EUROPEAN EATING DISORDERS REVIEW 2011; 20:89-93. [PMID: 21913286 DOI: 10.1002/erv.1137] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 05/12/2011] [Indexed: 11/11/2022]
Abstract
A significant number of patients with anorexia nervosa have to be transferred from child and adolescent mental health services (CAMHS) to adult services. CAMHS and adult services differ in terms of therapeutic approach and the availability of specialist treatment. CAMHS treatment is often based around family interventions, which aim to help parents take control of their child's eating, and patients are often encouraged to 'externalise' the illness. Adult treatment tends to be based around individual therapy, and the patient is encouraged to take personal responsibility for change. The place of inpatient treatment is generally accepted for adults but there is uncertainty about its effectiveness for adolescents. Young people may find it difficult to negotiate the transition between services, and CAMHS and adult services need to work more closely together. Transitions should be carefully planned, with thorough preparation of both patients and their families.
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Affiliation(s)
- Anthony P Winston
- Eating Disorders Unit, Woodleigh Beeches Centre, Coventry and Warwickshire Partnership Trust, Warwick, UK.
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8
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Shi L, Wudy SA, Buyken AE, Maser-Gluth C, Hartmann MF, Remer T. Prepubertal glucocorticoid status and pubertal timing. J Clin Endocrinol Metab 2011; 96:E891-8. [PMID: 21450991 DOI: 10.1210/jc.2010-2935] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Whether prepubertal glucocorticoid status impacts on the timing of puberty is not clear. OBJECTIVE The objective of the study was to examine the relationship between prepubertal glucocorticoid status and early or late pubertal markers, independent of adrenarchal and nutritional status. DESIGN AND PARTICIPANTS Prospective cohort study of healthy Caucasian children (n = 111, 56 boys) who provided both 24-h urine samples and weighed dietary records 1 and 2 yr before the start of pubertal growth spurt [age at take-off (ATO)]. MEASUREMENTS Major urinary glucocorticoid and androgen metabolites determined by gas chromatography-mass spectrometry analysis were summed to assess daily overall cortisol (ΣC21) and adrenal androgen secretion; urinary free cortisol and cortisone measured by RIA were summed (UFF+UFE) as an indicator of potentially bioactive free glucocorticoids. MAIN OUTCOMES The main outcomes included ATO, age at peak height velocity, age at menarche/voice break, ages at Tanner stage 2 for breast (girls) and genital (boys) development, and pubic hair. RESULTS In girls ΣC21, but not UFF+UFE, was associated with pubertal markers after adjusting for overall adrenal androgen, urinary nitrogen, and body fat. Girls with higher ΣC21 (fourth quartile) reached ATO 0.7 yr (P = 0.01) and menarche 0.9 yr later (P = 0.006) than girls with lower ΣC21 (first quartile). The ΣC21 tended to be also positively associated with age at Tanner stage 2 for breast (P = 0.1), Tanner stage 2 for pubic hair (P = 0.1), and age at peak height velocity (P = 0.06). In boys, neither the ΣC21 nor UFF+UFE was related to pubertal timing. CONCLUSION An individually higher prepubertal glucocorticoid secretion level, even in physiological range, appears to delay early and late pubertal timing of healthy girls, particularly their onset of pubertal growth spurt and menarche.
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Affiliation(s)
- Lijie Shi
- Research Institute of Child Nutrition, Department of Nutrition and Health, Heinstueck 11, 44225, Dortmund, Germany.
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Misra M, Katzman DK, Cord J, Manning SJ, Mendes N, Herzog DB, Miller KK, Klibanski A. Bone metabolism in adolescent boys with anorexia nervosa. J Clin Endocrinol Metab 2008; 93:3029-36. [PMID: 18544623 PMCID: PMC2515086 DOI: 10.1210/jc.2008-0170] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is a condition of severe undernutrition associated with low bone mineral density (BMD) in adolescent females with this disorder. Although primarily a disease in females, AN is increasingly being recognized in males. However, there are few or no data regarding BMD, bone turnover markers or their predictors in adolescent AN boys. HYPOTHESES We hypothesized that BMD would be low in adolescent boys with AN compared with controls associated with a decrease in bone turnover markers, and that the gonadal steroids, testosterone and estradiol, and levels of IGF-I and the appetite regulatory hormones leptin, ghrelin, and peptide YY would predict BMD and bone turnover markers. METHODS We assessed BMD using dual-energy x-ray absorptiometry and measured fasting testosterone, estradiol, IGF-I, leptin, ghrelin, and peptide YY and a bone formation (aminoterminal propeptide of type 1 procollagen) and bone resorption (N-telopeptide of type 1 collagen) marker in 17 AN boys and 17 controls 12-19 yr old. RESULTS Boys with AN had lower BMD and corresponding Z-scores at the spine, hip, femoral neck, trochanter, intertrochanteric region, and whole body, compared with controls. Height-adjusted measures (lumbar bone mineral apparent density and whole body bone mineral content/height) were also lower. Bone formation and resorption markers were reduced in AN, indicating decreased bone turnover. Testosterone and lean mass predicted BMD. IGF-I was an important predictor of bone turnover markers. CONCLUSION AN boys have low BMD at multiple sites associated with decreased bone turnover markers at a time when bone mass accrual is critical for attainment of peak bone mass.
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Affiliation(s)
- Madhusmita Misra
- BUL 457, Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA.
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Misra M. Long-Term Skeletal Effects of Eating Disorders with Onset in Adolescence. Ann N Y Acad Sci 2008; 1135:212-8. [DOI: 10.1196/annals.1429.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Prabhakaran R, Misra M, Miller KK, Kruczek K, Sundaralingam S, Herzog DB, Katzman DK, Klibanski A. Determinants of height in adolescent girls with anorexia nervosa. Pediatrics 2008; 121:e1517-23. [PMID: 18519455 DOI: 10.1542/peds.2007-2820] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Anorexia nervosa, a condition characterized by marked caloric restriction and low insulin like growth factor-1 levels, would be expected to cause short stature. However, this disorder is also associated with hypogonadotropic hypogonadism and high growth hormone levels. Delays in growth-plate closure from associated hypogonadism may result in a longer period of time available for statural growth with protective effects on stature. In addition, growth hormone may have direct effects on the growth plate independent of insulin-like growth factor 1 to increase statural growth. OBJECTIVES AND METHODS To determine the impact of undernutrition, hypogonadism, and acquired growth hormone resistance on height in adolescents with anorexia nervosa (aged 12-18 years), we examined 208 girls: 110 with anorexia nervosa and 98 controls of comparable chronological age. Sixty-three girls with anorexia nervosa and 79 controls were followed prospectively over 1 year. Mean duration of illness was 11.6 +/- 13.2 months. In a subset, overnight growth hormone sampling was performed every 30 minutes for 12 hours, and fasting insulin-like growth factor 1 levels were obtained. RESULTS The difference between height and target height and between predicted adult height and target height did not differ between the groups, indicating preservation of height potential. The groups had comparable bone age, but bone age was lower than chronological age in girls with anorexia nervosa. Girls with anorexia nervosa had lower insulin-like growth factor 1 levels and higher nadir growth hormone levels than those of controls. Nadir growth hormone levels predicted height SD scores and predicted adult-height SD scores in controls but not in the girls with anorexia nervosa. In girls with anorexia nervosa, insulin-like growth factor 1 and duration of illness predicted height measures. Height SD scores of <0 were more likely after 32 months of illness and at insulin-like growth factor 1 levels of <134 ng/mL. Delayed baseline bone age predicted subsequent increases in height SD scores in immature girls with anorexia nervosa. CONCLUSIONS Our data suggest that preservation of height potential in this cohort of girls with anorexia nervosa may be a consequence of delayed bone age. Hypogonadism may negate the deleterious effects of undernutrition on stature by allowing for a longer duration of growth.
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Affiliation(s)
- Rajani Prabhakaran
- BUL 457, MassGeneral Hospital, Neuroendocrine Unit, 55 Fruit St, Boston, MA 02114, USA
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13
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Swenne I. Weight and growth requirements for menarche in teenage girls with eating disorders, weight loss and primary amenorrhea. HORMONE RESEARCH 2008; 69:146-51. [PMID: 18219217 DOI: 10.1159/000112587] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 12/01/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM To investigate weight and growth requirements for menarche in girls with eating disorders (ED), weight loss and primary amenorrhea. METHODS Growth charts from school health services and measurements of weight and stature throughout treatment were obtained for 47 such girls. RESULTS Weight loss started at an age of 12.4 +/- 1.6 years from a top weight of 41.7 +/- 7.1 kg. Approximately a year later they had lost 5.1 +/- 4.3 kg and grown only 2.8 +/- 3.5 cm. Following treatment and weight gain, growth accelerated and the girls reached a peak growth velocity of 4.3 +/- 2.6 cm/year 2 years before menarche which occurred at an age of 15.5 +/- 1.6 years at a weight of 52.2 +/- 5.3 kg. Menarche occurred within a wide range of weights but could be predicted by a linear regression on prepubertal weight (R(2) = 0.39; p < 0.001). CONCLUSIONS Following treatment, girls with ED and primary amenorrhea progress through puberty at a slowed rate. The weight required for menarche can be predicted by the prepubertal weight which may represent the individual's normal growth track unaffected by the ED.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Rozé C, Doyen C, Le Heuzey MF, Armoogum P, Mouren MC, Léger J. Predictors of late menarche and adult height in children with anorexia nervosa. Clin Endocrinol (Oxf) 2007; 67:462-7. [PMID: 17561975 DOI: 10.1111/j.1365-2265.2007.02912.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The onset of anorexia nervosa (AN) during childhood can affect the timing of puberty and adult height. The aim of the study was to evaluate the determinants of late menarche and adult height in children with AN. PATIENTS AND METHODS We carried out a retrospective, longitudinal, university hospital-based study. All prepubertal or early pubertal girls diagnosed with AN between 1998 and 2002 were selected for the study. Participants (n = 33) were studied at a median age of 21 (19.8-24.3) years. AN was diagnosed at 11.8 (10.7-12.3) years. RESULTS Patients with AN reached menarche at significantly greater ages than their mothers [15.4 (13.5-16.8) vs. 13.2 (12.0-14.5) years, P < 0.01]. Chronological age at onset of AN and lowest body mass index (BMI) were important independent predictive factors for delayed menarche (P < 0.01). Adult height was 165.0 (163.0-172.0) cm, 2.5 (-1.5 to 5.0) cm above target height. Twelve patients (36%) did not reach their target height and had a median height deficit of -3.9 cm with respect to their target height. The duration of hospitalization, a marker of disease severity and chronicity, was an independent predictor of the difference between adult height and target height for a given individual (beta coefficient = -0.07; P = 0.01). The other factors studied (i.e. age at onset of AN, pubertal stage at diagnosis of AN, lowest BMI reached, associated comorbidity if any, type of AN, age at menarche) had no significant effect on adult height. CONCLUSION The intensity of the disease affects the timing of menarche but not adult height in most patients. Hospitalization, despite often being an effective means of managing AN, does not reduce the impact of AN on growth.
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Affiliation(s)
- Catherine Rozé
- Paediatric Endocrinology Department, Centre de Référence Maladies Endocriniennes Rares de la Croissance and Inserm U 690, Robert Debré Hospital, Université Paris VII, Paris, France
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Abstract
The onset of eating disorder psychopathology is most common in the adolescent age group. Acute psychopathology or subsyndromal eating disorders are perhaps less intractable in these young patients. Subsyndromal eating disorders in children and adolescents are not only clinically significant in their present state, but may represent legitimate candidates for preventive efforts in light of: (i) a risk of progression from subthreshold anorexia nervosa (SAN) to AN or subthreshold bulimia nervosa (SBN) to BN; (ii) the detrimental effects on outcome of delaying treatment; and (iii) the refractory, severe nature of eating disorders once the diagnostic threshold is crossed. Moreover, children and adolescents with SAN and SBN may in fact be exhibiting early 'caseness' of these disorders. Given that AN is notoriously difficult to treat, and there are limited efficacy data for adolescent BN, attempts to disrupt these disorders in what is arguably their early phases is an important goal in preventing more chronic and treatment-resistant forms of these disorders. Future research should address whether the best interventions for SAN and SBN should be derived from the prevention or intervention fields.
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Affiliation(s)
- Daniel Le Grange
- Department of Psychiatry, The University of Chicago, Chicago, IL, USA.
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16
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Swenne I. Weight requirements for catch-up growth in girls with eating disorders and onset of weight loss before menarche. Int J Eat Disord 2005; 38:340-5. [PMID: 16231359 DOI: 10.1002/eat.20182] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The current study investigated catch-up in stature in girls with eating disorders and onset of weight loss and stunting of growth before menarche. METHOD Forty-six girls were followed with measurements of weight and stature for 2-5 years after presentation. RESULTS At presentation, the girls were stunted by 0.48 +/- 0.57 standard deviation scores (SDS) for height compared with their prepubertal growth track. Maximal stunting of 0.72 +/- 0.68 SDS was reached after 1 year of treatment despite weight gain. Catch-up growth, that is, increase in height SDS, was achieved during the second to fourth years. Thirty-four girls who reached menarche had normalized weight and reached their prepubertal growth track. In a regression analysis, growth in stature during a year of treatment could be predicted to 50% by age, the weight gain that year, the weight gain the preceding year, and by the weight level at the start of the year. Catch-up growth during a year could be predicted to 26% by the weight gain that year and the weight gain the preceding year. CONCLUSION Catch-up growth is possible in girls with eating disorders of premenarcheal onset. Weight gain is necessary for catch-up growth and must start before the ability to grow is lost with age. Once weight gain starts, the full effect on growth in stature takes several years to evolve.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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17
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Katzman DK. Medical complications in adolescents with anorexia nervosa: a review of the literature. Int J Eat Disord 2005; 37 Suppl:S52-9; discussion S87-9. [PMID: 15852321 DOI: 10.1002/eat.20118] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the current article is to summarize the evidence-based medical complications and treatments that are both common and unique to adolescents with anorexia nervosa (AN). Recent literature relating to the cardiovascular complications, refeeding syndrome, alterations in linear growth, impaired bone mineral accretion, and structural and functional brain changes was reviewed. The literature suggests that the medical complications in adolescents with AN are different from those reported in adults. The unique clinical presentation, the early onset, and the unknown impact of these complications underscore the need for early identification and treatment of AN in adolescents. AN is a serious disorder with significant and often life-threatening medical complications. The increasing growth of evidence highlights the importance of early identification and treatment by an interdisciplinary team of health care providers who have expertise in managing adolescents with AN and their medical sequelae.
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Affiliation(s)
- Debra K Katzman
- Division of Adolescent Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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18
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Kinoshita Y, Kizaki Z, Matsuo K, Ishihara Y, Adachi S, Kosaka K, Kinugasa A, Sugimoto T. A Case of 17 Years Old Male with Short Stature and Delayed Adolescence due to Distorted Body Image. Clin Pediatr Endocrinol 2005. [DOI: 10.1297/cpe.14.s24_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yumiko Kinoshita
- Department of Pediatrics, Kyoto Prefectural University of Medicine
| | | | - Kensuke Matsuo
- Department of Pediatrics, Kyoto Prefectural University of Medicine
| | | | - Shinsuke Adachi
- Department of Pediatrics, Kyoto Prefectural University of Medicine
| | - Kitaro Kosaka
- Department of Pediatrics, Kyoto Prefectural University of Medicine
| | - Akihiko Kinugasa
- Department of Pediatrics, Kyoto Prefectural University of Medicine
| | - Tohru Sugimoto
- Department of Pediatrics, Kyoto Prefectural University of Medicine
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19
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Modan-Moses D, Yaroslavsky A, Novikov I, Segev S, Toledano A, Miterany E, Stein D. Stunting of growth as a major feature of anorexia nervosa in male adolescents. Pediatrics 2003; 111:270-6. [PMID: 12563050 DOI: 10.1542/peds.111.2.270] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess growth retardation in male adolescent patients who have a diagnosis of anorexia nervosa (AN) and the effect of weight restoration on catch-up growth. METHODS Medical charts of all male adolescent AN patients (n = 12) who were admitted to the Pediatric Psychosomatic Department at the Sheba Medical Center from January 1, 1994, to December 31, 1998, were reviewed. Height and weight measurements were obtained before the onset of AN, at admission, and thereafter routinely during hospitalization and follow-up. RESULTS Eleven patients exhibited growth retardation during the course of their illness, as evident in a decrease in their height standard deviation score (SDS). The mean height SDS at the time of admission (-0.81 +/- 0.93) was significantly lower than the premorbid SDS (-0.21 +/- 0.91). Weight restoration resulted in accelerated linear growth (up to 2 cm/mo) in all patients. Positive weight gain (weight gain rate >1 kg/y) was associated with a mean height gain of 6.97 +/- 6.48 cm/y, whereas weight loss or failure to gain weight (weight gain rate <or=1 kg/y) was associated with a mean of 2.7 +/- 3.9 cm/y. This between-group difference was highly significant. Complete catch-up growth was not achieved in 9 of 12 patients. There was a trend for the mean adult final height SDS (-0.52 +/- 0.84) to be higher than the admission height SDS but lower than both the premorbid height SDS and the midparental target height SDS (-0.21 +/- 0.79). CONCLUSIONS Linear growth retardation was a prominent feature of AN in our sample of male adolescent patients, preceding, in some cases, the reported detection of the eating disorder. Weight restoration, particularly when target weight is based on the premorbid height percentile, may be associated with significant catch-up growth, but complete catch-up growth may not be achieved.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology Service, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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20
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Abstract
Anorexia nervosa and bulimia nervosa are expressed differently in children and adolescents than in adults. Consequently, diagnostic procedures and multidisciplinary treatments need to be tailored to the unique developmental, medical, nutritional, and psychological needs of children and adolescents with eating disorders. This paper reviews current research outlining the differences between child, adolescent, and adult eating disorders. Research is then reviewed concerning the effectiveness of hospitalization, partial hospitalization, individual dynamic therapy, cognitive-behavioral therapy, interpersonal therapy, family therapy, and medication for treating anorexia nervosa, bulimia nervosa, and related eating disorders in children and adolescents. Specific recommendations are made for practitioners to tailor these treatments to their eating-disordered child and adolescent patients, following a stepped-care, decision-tree model of intervention that takes into account the effectiveness, cost, and intrusiveness of the interventions.
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21
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Fisher M, Golden NH, Katzman DK, Kreipe RE, Rees J, Schebendach J, Sigman G, Ammerman S, Hoberman HM. Eating disorders in adolescents: a background paper. J Adolesc Health 1995; 16:420-37. [PMID: 7669792 DOI: 10.1016/1054-139x(95)00069-5] [Citation(s) in RCA: 205] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M Fisher
- Division of Adolescent Medicine, North Shore University Hospital, Cornell University Medical College, Manhasset, New York 11030, USA
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22
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Abstract
PURPOSE Medical information on male anorectics is scant. We present data on 10 males with anorexia nervosa, who were treated at our Eating Disorders Center during a twelve-year period. METHODS Retrospective chart review. RESULTS All patients were malnourished weighing 80% or less of their ideal body weight with a mean B.M.I. of 13.5 +/- 2.0. Height below the 50th percentile was evident in 80% of the patients, and was below the 10th percentile in 30% of the patients. Structural brain changes on brain computerized tomography scans were noted in seven out of nine patients and more than 50% had mild anemia relative to the Tanner stage. Other findings included a mean presenting heart rate of 68.3 +/- 17: four out of ten patients had presenting heart rates of 80 or greater and of these, three had serious medical problems and were severely malnourished. Two patients had cardiac complications and one had a life-threatening electrolyte disturbance. CONCLUSION Despite the small number of patients, the proportion of male adolescent anorectics with medical abnormalities seems high, and may be due to difficulties in establishing the diagnosis and delay in seeking medical attention. Patients who had heart rates of 80 or greater were perhaps sicker and further along in their development of congestive heart failure, thus explaining their initial relative tachycardia. We suggest a higher index of suspicion for congestive heart failure and closer medical monitoring when a malnourished adolescent with anorexia nervosa presents with relatively elevated heart rates.
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Affiliation(s)
- J H Siegel
- Division of Adolescent Medicine, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA
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23
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Golden NH, Kreitzer P, Jacobson MS, Chasalow FI, Schebendach J, Freedman SM, Shenker IR. Disturbances in growth hormone secretion and action in adolescents with anorexia nervosa. J Pediatr 1994; 125:655-60. [PMID: 7523649 DOI: 10.1016/s0022-3476(94)70030-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Women in whom anorexia nervosa develops during adolescence have failure of linear growth associated with low levels of insulin-like growth factor I (IGF-1). To investigate the pathophysiology of growth retardation in adolescents with anorexia nervosa, we measured basal growth hormone (GH), growth hormone-binding protein (GHBP), IGF-1, and insulin-like growth factor binding protein-3 (IGFBP-3) in three groups of patients: (1) 28 recently hospitalized female adolescents with anorexia nervosa, (2) 23 of the same patients after partial weight restoration, and (3) 28 healthy control subjects matched for age, sex, and pubertal stage. Fasting GH levels in group 1 did not differ significantly from those in group 3. In contrast, serum GHBP (p < 0.001), IGF-1 (p < 0.001), and IGFBP-3 (p < 0.01) were significantly lower in group 1 than in group 3. Serum GHBP and IGFBP-3 levels were positively correlated with body mass index. Serum GHBP levels were low in patients in all five pubertal stages and even in those shown to have adequate GH secretion. In group 2 (after refeeding) the serum IGF-1 concentration increased significantly and GHBP and IGFBP-3 returned to normal. We conclude that patients with anorexia nervosa have diminished GH action resulting in decreased secretion of IGF-1. The positive correlation with body mass index and the reversibility with refeeding suggest that these changes are secondary to malnutrition. Altered GH function that occurs during the years of active growth can explain the growth retardation seen in anorexia nervosa.
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Affiliation(s)
- N H Golden
- Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York
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24
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Kotler L, Katz L, Anyan W, Comite F. Case study of the effects of prolonged and severe anorexia nervosa on bone mineral density. Int J Eat Disord 1994; 15:395-9. [PMID: 8032354 DOI: 10.1002/eat.2260150410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Among the most severe sequelae of anorexia nervosa (AN) are its skeletal complications. Young women who have AN during adolescence may not attain their expected peak skeletal mass, and may enter adulthood with reduced bone mineral density (BMD) and an increased risk of fracture. This case history describes a young woman with severe AN that included prolonged exposure to both low body weight and amenorrhea. BMD measurement during the acute stage of her illness revealed severe osteopenia. Six years after recovery from AN, follow-up studies demonstrated only modest gains in BMD, with measurements for the hip and lumbar spine that are greater than 2 SDs below the age-matched mean.
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Affiliation(s)
- L Kotler
- Yale University School of Medicine, New Haven, Connecticut
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25
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Abstract
In this report, three cases of eating-disordered women in their thirties are presented to document the occurrence of eating disorders in this age group. The clinical characteristics and associated features are described. Clinicians are reminded to consider the possibility of an eating disorder in patients who present with weight loss regardless of their age.
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Affiliation(s)
- V Fornari
- Department of Psychiatry, North Shore University Hospital-Cornell University Medical College, Manhasset, New York
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26
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Abstract
Menstrual dysfunction is common in adolescents who are involved in intensive athletic activity or who are limiting their nutritional intake excessively. The mechanism for hypothalamic amenorrhea in athletes and dieters is not yet fully understood. Other causes of menstrual dysfunction due to pregnancy, central lesions, hormone imbalance, or ovarian failure should be excluded in the athlete with amenorrhea. Amenorrheic patients who have sufficient estrogen effect on their endometrium to have withdrawal bleeding following exposure to progestins should be cycled with progestins on a regular basis to prevent endometrial hyperplasia. Estrogen replacement with cyclic progestin should be considered in the hypoestrogenic adolescent with prolonged amenorrhea. The long-term consequences of hypothalamic amenorrhea in adolescents remain to be determined.
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Affiliation(s)
- M J Mansfield
- Division of Adolescent and Young Adult Medicine, Children's Hospital, Boston, Massachusetts
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27
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Abstract
Many theories have been advanced in an attempt to understand and treat anorexia nervosa, an eating disorder primarily affecting adolescent females. A description of clinical signs and symptoms and the criteria for diagnosis is provided. A current review of the literature summarizes the major theories of etiology and treatment. A case study is presented, and nursing goals, as part of a multidisciplinary team, are discussed.
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28
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Abstract
The demographic features, clinical picture, antecedent events and family background in 13 male patients with anorexia nervosa are compared with those in a control group of 39 adolescent female anorectics; the general picture of the illness in males is similar to that in females. Focusing on a group of males, usually less vulnerable to anorexia nervosa, can highlight possible predisposing factors.
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Affiliation(s)
- J L Margo
- Oxford Higher Training Scheme in Psychiatry, Warenford Hospital
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29
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Salmons PH. Anorexia nervosa and related conditions in schoolchildren. Nutr Health 1987; 4:217-25. [PMID: 3554045 DOI: 10.1177/026010608700400405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The clinical features of anorexia nervosa and the prevalence of the eating orders in different societies is described. The role of physiological, cultural and biological factors in the aetiology of eating are reviewed. Finally ways of preventing eating disorders are considered.
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30
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Abstract
To study the effect of severe undernutrition on linear growth during adolescence, a report was obtained on the ultimate adult height of 71 patients who had had anorexia nervosa at or before age 16 years. At time of diagnosis (ages 9-16 years) median height percentile was 49; at adult follow-up (ages 18-29 years) the median height percentile was 55. This change favoring growth was statistically significant (p less than 0.01). Height percentile was maintained or increased in 45 patients and decreased in 26 patients. In only four patients did it change by more than 20 percentile points downward; in 12 patients height percentile increased by more than 20 points. We conclude that, despite weight loss of up to 45 percent at or before age 16 years, most patients with anorexia nervosa continue to grow in stature according to expected norms.
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31
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Nussbaum M, Baird D, Sonnenblick M, Cowan K, Shenker IR. Short stature in anorexia nervosa patients. JOURNAL OF ADOLESCENT HEALTH CARE : OFFICIAL PUBLICATION OF THE SOCIETY FOR ADOLESCENT MEDICINE 1985; 6:453-5. [PMID: 4055466 DOI: 10.1016/s0197-0070(85)80052-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the treatment of many anorexia nervosa (AN) patients, we observed clinically that these girls were short in stature. In order to test this hypothesis, we reviewed the height records of all patients seen with a previous diagnosis of AN in an eight-year period. Of 104 patients, 85 were suitable for study and were compared to a control group of 85 age-matched subjects. Seventy-six percent of the AN patients (mean age 15.8 years) were below the 50th height percentile for age; 14.1% were below the 5th percentile; and 25.8% were between the 25th and 49th percentile. Parental height was available for 35 subjects. The AN patients were significantly shorter than their parents, and comparison suggests an impairment of growth rather than a familial etiology. As 80% of subjects developed AN after menarche, malnutrition does not appear to be responsible for the observed height deficits.
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