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Balen AH, Tamblyn J, Skorupskaite K, Munro MG. A comprehensive review of the new FIGO classification of ovulatory disorders. Hum Reprod Update 2024; 30:355-382. [PMID: 38412452 DOI: 10.1093/humupd/dmae003] [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: 06/12/2023] [Revised: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) system for the classification of disorders of ovulation was produced 50 years ago and, by international consensus, has been updated by the International Federation of Gynecology and Obstetrics (FIGO). OBJECTIVE AND RATIONALE This review outlines in detail each component of the FIGO HyPO-P (hypothalamic, pituitary, ovarian, PCOS) classification with a concise description of each cause, and thereby provides a systematic method for diagnosis and management. SEARCH METHODS We searched the published articles in the PubMed database in the English-language literature until October 2022, containing the keywords ovulatory disorders; ovulatory dysfunction; anovulation, and each subheading in the FIGO HyPO-P classification. We did not include abstracts or conference proceedings because the data are usually difficult to assess. OUTCOMES We present the most comprehensive review of all disorders of ovulation, published systematically according to the logical FIGO classification. WIDER IMPLICATIONS Improving the diagnosis of an individual's ovulatory dysfunction will significantly impact clinical practice by enabling healthcare practitioners to make a precise diagnosis and plan appropriate management.
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Affiliation(s)
- Adam H Balen
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | - Jennifer Tamblyn
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | | | - Malcolm G Munro
- Department of Obstetrics and Gynecology, The University of California, Los Angeles, Los Angeles, CA, USA
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Cacciatore C, Cangiano B, Carbone E, Spagnoli S, Cid Ramirez MP, Polli N, Bonomi M, Persani L. Body weight variation is not an independent factor in the determination of functional hypothalamic amenorrhea in anorexia nervosa. J Endocrinol Invest 2024; 47:903-911. [PMID: 37812282 DOI: 10.1007/s40618-023-02207-z] [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: 04/20/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Functional hypothalamic amenorrhea (FHA) is one of the foremost manifestations in anorexia nervosa (AN), but a subset of patients have menses despite marked weight loss and underweight. The aim of our study was to investigate parameters potentially influencing FHA in AN. DESIGN AND METHODS In this observational retrospective study, we selected 114 female patients with AN who completed a 12 months semi-residential rehabilitation program and a subsequent 12 months outpatient follow-up. We divided our sample into three groups: "Group 0" patients who experienced FHA and recovered their menses, "Group 1" persistent FHA, "Group 2" never experienced FHA, and looked for clinical and hormonal correlations. RESULTS At the enrollment, the BMI was higher in Group 2 than in Group 1 (p = 0.0202), but the last follow-up weight was higher in Group 1 (p < 0.0001) despite persistent amenorrhea. At logistic regression, the higher BMI at which patients experienced amenorrhea was the main prediction factor for persistent FHA. Notwithstanding comparable leptin levels at admission, they improved significantly at discharge only in Groups 0 and 2 (p = 0.0054 and p = 0.0104, respectively). FT3 at admission was significantly higher in Group 2 than in Group 0 (p = 0.0249). CONCLUSIONS FHA does not correlate strictly with body weight variations in AN patients, indicating a multifactorial origin, likely including an individual predisposition. Higher FT3 levels identify patients who continue having menses at extremely low BMI. AN patients with persistent FHA constitute a subgroup in whom estroprogestins should be considered after significant weight recovery to prevent prolonged tissue hypoestrogenism.
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Affiliation(s)
- C Cacciatore
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - B Cangiano
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy
| | - E Carbone
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - S Spagnoli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - M P Cid Ramirez
- Secciòn Endocrinologia y Diabetes, Hospital Clìnico Universidad del Chile, Santiago, Chile
| | - N Polli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - M Bonomi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy
| | - L Persani
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy.
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy.
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Alzaid H, Simon JJ, Brugnara G, Vollmuth P, Bendszus M, Friederich HC. Hypothalamic subregion alterations in anorexia nervosa and obesity: Association with appetite-regulating hormone levels. Int J Eat Disord 2024; 57:581-592. [PMID: 38243035 DOI: 10.1002/eat.24137] [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: 08/24/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) and obesity are weight-related disorders with imbalances in energy homeostasis that may be due to hormonal dysregulation. Given the importance of the hypothalamus in hormonal regulation, we aimed to identify morphometric alterations to hypothalamic subregions linked to these conditions and their connection to appetite-regulating hormones. METHODS Structural magnetic resonance imaging (MRI) was obtained from 78 patients with AN, 27 individuals with obesity and 100 normal-weight healthy controls. Leptin, ghrelin, and insulin blood levels were measured in a subsample of each group. An automated segmentation method was used to segment the hypothalamus and its subregions. Volumes of the hypothalamus and its subregions were compared between groups, and correlational analysis was employed to assess the relationship between morphometric measurements and appetite-regulating hormone levels. RESULTS While accounting for total brain volume, patients with AN displayed a smaller volume in the inferior-tubular subregion (ITS). Conversely, obesity was associated with a larger volume in the anterior-superior, ITS, posterior subregions (PS), and entire hypothalamus. There were no significant volumetric differences between AN subtypes. Leptin correlated positively with PS volume, whereas ghrelin correlated negatively with the whole hypothalamus volume in the entire cohort. However, appetite-regulating hormone levels did not mediate the effects of body mass index on volumetric measures. CONCLUSION Our results indicate the importance of regional structural hypothalamic alterations in AN and obesity, extending beyond global changes to brain volume. Furthermore, these alterations may be linked to changes in hormonal appetite regulation. However, given the small sample size in our correlation analysis, further analyses in a larger sample size are warranted. PUBLIC SIGNIFICANCE Using an automated segmentation method to investigate morphometric alterations of hypothalamic subregions in AN and obesity, this study provides valuable insights into the complex interplay between hypothalamic alterations, hormonal appetite regulation, and body weight, highlighting the need for further research to uncover underlying mechanisms.
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Affiliation(s)
- Haidar Alzaid
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joe J Simon
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Battipaglia C, Petrillo T, Semprini E, Ricciardiello F, Rusce ML, Prampolini G, Ambrosetti F, Sponzilli A, Genazzani AD. Low-Dose Estrogens as Neuroendocrine Modulators in Functional Hypothalamic Amenorrhea (FHA): The Putative Triggering of the Positive Feedback Mechanism(s). Biomedicines 2023; 11:1763. [PMID: 37371858 DOI: 10.3390/biomedicines11061763] [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: 04/23/2023] [Revised: 05/29/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Functional hypothalamic amenorrhea (FHA) is a non-organic reversible chronic endocrine disorder characterized by an impaired pulsatile secretion of the gonadotropin-releasing hormone (GnRH) from the hypothalamus. This impaired secretion, triggered by psychosocial and metabolic stressors, leads to an abnormal pituitary production of gonadotropins. As LH and FSH release is defective, the ovarian function is steadily reduced, inducing a systemic hypoestrogenic condition characterized by amenorrhea, vaginal atrophy, mood changes and increased risk of osteoporosis and cardiovascular disease. Diagnosis of FHA is made excluding other possible causes for secondary amenorrhea, and it is based upon the findings of low serum gonadotropins and estradiol (E2) with evidence of precipitating factors (excessive exercise, low weight, stress). Treatments of women with FHA include weight gain through an appropriate diet and physical activity reduction, psychological support, and integrative approach up to estrogen replacement therapy. If no spontaneous ovarian function is restored, assisted reproductive technologies may be used when pregnancy is desired. Because subjects with FHA are hypoestrogenic, the use of low-dose estrogens has been proposed as a putative treatment to positively modulate the spontaneous restart of gonadotropin secretion, counteracting the blockade of the reproductive axis triggered by stress acting through the neuroendocrine pathways at the basis of positive feedback of estrogens. The mechanism through which low-dose estrogens acts is still unknown, but kisspeptin-secreting neurons may be involved.
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Affiliation(s)
- Christian Battipaglia
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Tabatha Petrillo
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Elisa Semprini
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Francesco Ricciardiello
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Maria Laura Rusce
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Greta Prampolini
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Fedora Ambrosetti
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Alessandra Sponzilli
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
| | - Alessandro D Genazzani
- Center for Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 41, 41100 Modena, Italy
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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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6
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Somatische und psychische Aspekte der Anorexia nervosa. Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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7
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Batury VL, Tam FI, Hellerhoff I, Wronski ML, Borucki K, Weidner K, Roessner V, Gao W, Ehrlich S. Hair-Based Assessment of Sex Steroid Hormones in Patients with Anorexia Nervosa. Metabolites 2022; 13:metabo13010021. [PMID: 36676946 PMCID: PMC9863132 DOI: 10.3390/metabo13010021] [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] [Received: 11/10/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022] Open
Abstract
Anorexia nervosa (AN) is a complex psychiatric disorder accompanied by a variety of endocrine effects. Altered levels of the sex steroid hormones progesterone and dehydroepiandrosterone (DHEA) have been shown to occur in patients with AN using short-term hormonal measurement methods based on blood, saliva, and urine samples. However, since sex steroid hormone levels fluctuate during the menstrual cycle, these measurement methods require a great deal of effort due to the need to collect multiple samples in order to correctly determine the basal level of sex hormones. In contrast, hair-based assessments provide a marker of accumulated longer-term hormone exposure using a single, non-invasive sample. The aim of this study was to investigate sex steroid hormone levels via hair-based assessments in acutely underweight AN in comparison with healthy, age-matched, female control participants. Additionally, we compared progesterone and DHEA hair levels longitudinally during inpatient treatment in AN. Collected hair samples were analyzed using liquid chromatography-mass spectrometry (LC-MS/MS) to determine a monthly hormone level of progesterone and DHEA. Our results indicate that DHEA hair hormone levels were similar across groups but progesterone was suppressed in underweight AN compared with healthy controls. In the longitudinal design, no significant change in hair hormone levels during partial weight restoration in patients with AN was observed. Our findings suggest that hair analysis can be used to detect suppressed progesterone levels in severe AN, and that progesterone does not increase during short-term weight restoration.
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Affiliation(s)
- Victoria-Luise Batury
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Friederike I. Tam
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Inger Hellerhoff
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Marie-Louis Wronski
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Katrin Borucki
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Wei Gao
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C.G. Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-351-458-5214
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Curran KA, Pitt PD. The Reproductive Impact of Eating Disorders in Adolescents. Semin Reprod Med 2022; 40:79-86. [PMID: 35073591 DOI: 10.1055/s-0042-1742326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Eating disorders are common, chronic illnesses that frequently arise during adolescence. Because of the impact on nutrition, individuals with eating disorders have significant health consequences, including effects on reproductive health. Adolescent women with eating disorders frequently have menstrual irregularities, though the causes of these abnormalities are complex and vary depending on the type of eating disorder. Teens with eating disorders may have changes in current and future fertility, and eating disorders during pregnancy can have medical and psychologic impacts for both mother and child. Though not well researched, eating disorders in men can affect reproductive health and potentially impact fertility. Lastly, eating disorders in adolescents can have significantly deleterious, irreversible effects on bone health.
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Affiliation(s)
- Kelly A Curran
- Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Paulette D Pitt
- Department of Education and Psychology, East Central University, Ada, Oklahoma
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De Souza MJ, Mallinson RJ, Strock NCA, Koltun KJ, Olmsted MP, Ricker EA, Scheid JL, Allaway HC, Mallinson DJ, Kuruppumullage Don P, Williams NI. Randomised controlled trial of the effects of increased energy intake on menstrual recovery in exercising women with menstrual disturbances: the 'REFUEL' study. Hum Reprod 2021; 36:2285-2297. [PMID: 34164675 DOI: 10.1093/humrep/deab149] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/14/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Does increased daily energy intake lead to menstrual recovery in exercising women with oligomenorrhoea (Oligo) or amenorrhoea (Amen)? SUMMARY ANSWER A modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. WHAT IS KNOWN ALREADY Optimal energy availability is critical for normal reproductive function, but the magnitude of increased energy intake necessary for menstrual recovery in exercising women, along with the associated metabolic changes, is not known. STUDY DESIGN, SIZE, DURATION The REFUEL study (trial # NCT00392873) is the first randomised controlled trial to assess the effectiveness of 12 months of increased energy intake on menstrual function in 76 exercising women with menstrual disturbances. Participants were randomised (block method) to increase energy intake 20-40% above baseline energy needs (Oligo/Amen + Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36). The study was performed from 2006 to 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were Amen and Oligo exercising women (age = 21.0 ± 0.3 years, BMI = 20.8 ± 0.2 kg/m2, body fat = 24.7 ± 0.6%) recruited from two universities. Detailed assessment of menstrual function was performed using logs and measures of daily urinary ovarian steroids. Body composition and metabolic outcomes were assessed every 3 months. MAIN RESULTS AND THE ROLE OF CHANCE Using an intent-to-treat analysis, the Oligo/Amen + Cal group was more likely to experience menses during the intervention than the Oligo/Amen Control group (P = 0.002; hazard ratio [CI] = 1.91 [1.27, 2.89]). In the intent-to-treat analysis, the Oligo/Amen + Cal group demonstrated a greater increase in energy intake, body weight, percent body fat and total triiodothyronine (TT3) compared to the Oligo/Amen Control group (P < 0.05). In a subgroup analysis where n = 22 participants were excluded (ambiguous baseline menstrual cycle, insufficient time in intervention for menstrual recovery classification), 64% of the Oligo/Amen + Cal group exhibited improved menstrual function compared with 19% in the Oligo/Amen Control group (χ2, P = 0.001). LIMITATIONS, REASONS FOR CAUTION While we had a greater than expected dropout rate for the 12-month intervention, it was comparable to other shorter interventions of 3-6 months in duration. Menstrual recovery defined herein does not account for quality of recovery. WIDER IMPLICATIONS OF THE FINDINGS Expanding upon findings in shorter, non-randomised studies, a modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. Improved metabolism, as demonstrated by a modest increase in body weight (4.9%), percent body fat (13%) and TT3 (16%), was associated with menstrual recovery. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the U.S. Department of Defense: U.S. Army Medical Research and Material Command (Grant PR054531). Additional research assistance provided by the Penn State Clinical Research Center was supported by the National Center for Advancing Translation Sciences, National Institutes of Health, through Grant UL1 TR002014. M.P.O. was supported in part by the Loretta Anne Rogers Chair in Eating Disorders at University of Toronto and University Health Network. All authors report no conflict of interest. TRIAL REGISTRATION NUMBER NCT00392873. TRIAL REGISTRATION DATE October 2006. DATE OF FIRST PATIENT’S ENROLMENT September 2006.
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Affiliation(s)
- Mary Jane De Souza
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Rebecca J Mallinson
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA.,Department of Kinesiology, Pennsylvania State University-Harrisburg, Middletown, PA, USA
| | - Nicole C A Strock
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Kristen J Koltun
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Marion P Olmsted
- Centre for Mental Health, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Emily A Ricker
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Jennifer L Scheid
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Heather C Allaway
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Daniel J Mallinson
- School of Public Affairs, Pennsylvania State University-Harrisburg, Middletown, PA, USA
| | | | - Nancy I Williams
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
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10
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Herpertz-Dahlmann B. Intensive Treatments in Adolescent Anorexia Nervosa. Nutrients 2021; 13:1265. [PMID: 33924294 PMCID: PMC8068891 DOI: 10.3390/nu13041265] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/26/2022] Open
Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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11
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Pape J, Herbison AE, Leeners B. Recovery of menses after functional hypothalamic amenorrhoea: if, when and why. Hum Reprod Update 2020; 27:130-153. [PMID: 33067637 DOI: 10.1093/humupd/dmaa032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses. OBJECTIVE AND RATIONALE The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery. SEARCH METHODS We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies. OUTCOMES Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation. WIDER IMPLICATIONS Although knowledge on the physiology of return of menses is presently rudimentary, the available data indicate the importance of BMI/weight (gain), energy balance and mental health. The physiological processes and genetics underlying the impact of these factors on the return of menses require further research. Larger prospective studies are necessary to identify clinical parameters for accurate prediction of return of menses as well as reliable therapeutic options.
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Affiliation(s)
- J Pape
- Department of Reproductive Endocrinology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - A E Herbison
- Department of Physiology, Development and Neuroscience, University of Cambridge CB2 3EG, UK
| | - B Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, 8091 Zurich, Switzerland.,University of Zurich, 8091 Zurich, Switzerland
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12
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Boutari C, Pappas PD, Mintziori G, Nigdelis MP, Athanasiadis L, Goulis DG, Mantzoros CS. The effect of underweight on female and male reproduction. Metabolism 2020; 107:154229. [PMID: 32289345 DOI: 10.1016/j.metabol.2020.154229] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
Chronic energy deficiency can impair the hypothalamic-pituitary-gonadal (HPG) axis and lead to hypothalamic anovulation in underweight women. This review presents the syndromes related to underweight status that are associated with infertility, summarizes the underlying mechanisms, and reviews the available treatment options. Eating disorders, such as anorexia nervosa (AN), constitute the most common cause of infertility in underweight women, who, in addition, experience miscarriages, and sexual dysfunction. The relative energy deficiency in sports (RED-S; former terminology: athlete's triad) involves menstrual dysfunction due to low energy availability, which results in anovulation. Moreover, lipodystrophies, malnutrition, starvation, systematic illnesses (malignancies, endocrinopathies, infectious diseases, advanced chronic diseases, neurologic illnesses), and the utilization of drugs can cause excessive weight loss. They may result in fertility problems due to the loss of adipose tissue and the subsequent hormonal disturbances. Each of these conditions requires multidisciplinary management. Nutritional counseling should target the restoration of energy balance by increasing intake and reducing output. Medical treatment, recommended only for patients who did not respond to standard treatment, may include antipsychotics, antidepressants, or leptin administration. Finally, psychiatric treatment is considered an integral part of the standard treatment.
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Affiliation(s)
- Chrysoula Boutari
- Department of Medicine, Boston VA Healthcare System and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Panagiotis D Pappas
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Loukas Athanasiadis
- 3(rd) Department of Psychiatry, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Christos S Mantzoros
- Department of Medicine, Boston VA Healthcare System and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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13
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Rastogi R, Sieke EH, Nahra A, Sabik J, Rome ES. Return of Menses in Previously Overweight Patients with Eating Disorders. J Pediatr Adolesc Gynecol 2020; 33:133-138. [PMID: 31715368 DOI: 10.1016/j.jpag.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE Adolescents with eating disorders and a history of overweight present with higher weights, longer duration of disease, but equally severe symptomatology compared with previously normal weight patients. To better delineate treatment goals for this understudied population, we compared weight at menses resumption with premorbid maximum weight among previously overweight and normal weight patients. DESIGN Retrospective cohort study. SETTING Outpatient adolescent medicine clinic at an eating disorder referral center. PARTICIPANTS Postmenarchal patients meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition eating disorders. History of overweight was defined as a body mass index (BMI) greater than or equal to the 85th percentile or 25 or more. INTERVENTIONS AND MAIN OUTCOME MEASURES Weight characteristics at presentation and menses resumption (BMI, BMI z-score, change from maximum weight to presentation weight) RESULTS: Previously overweight patients presented with greater mean weight, longer duration of disease, and higher BMI than previously normal weight patients. No difference was found in rates of amenorrhea at presentation or menses resumption. Previously overweight patients resumed menses at a younger age and higher BMI z-scores. The difference between weight at menses resumption and premorbid maximum weight was greater for previously overweight patients. CONCLUSION Previously overweight patients with eating disorders present differently than their normal-weight peers, so reliance on weight status as a screening criterion might result in underdiagnosis. Although BMI z-scores associated with menses resumption are higher for previously overweight patients, there is no difference in weight gain between presentation and menses resumption and time to menses resumption compared with previously normal-weight patients. Moreover, menses resumption occurred at weights significantly lower than premorbid maximum weight for previously overweight patients, so restoration to highest premorbid weight is not necessary.
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Affiliation(s)
- Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
| | - Erin H Sieke
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexa Nahra
- Department of General Pediatrics and Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Julia Sabik
- Department of General Pediatrics and Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Ellen S Rome
- Department of General Pediatrics and Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
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14
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Castellini G, Lelli L, Cassioli E, Ricca V. Relationships between eating disorder psychopathology, sexual hormones and sexual behaviours. Mol Cell Endocrinol 2019; 497:110429. [PMID: 31026479 DOI: 10.1016/j.mce.2019.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022]
Abstract
A growing body of evidences demonstrated that sexuality is an important topic in the clinical research of eating disorders (EDs), due to its association with specific psychopathological features, and etiological factors. The present review took into consideration the complex relationship between sexual behaviours, hormonal alterations and EDs psychopathology. Studies pertaining sexual behaviours in EDs were divided into those focusing on sexual dysfunctions, and those related to risky sexual behaviours. The limited number of studies on sexual dysfunctions, reported a controversial association with weight status and hormonal alterations, and a clear relationship with severity of specific psychopathology (e.g. body image disturbance). Risky sexual behaviours have been associated with impulsivity and dissociation, as well as with abnormal stress response. Finally, both restriction and uncontrolled eating have been found to be responsible for several complex metabolic alterations, determining varied sexual and gynecologic problems, such as amenorrhea, hypogonadism, genital vascular problems, infertility, and miscarriage, although it is also possible that alterations in feeding and stress hormones contribute to altered eating behaviour.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Lorenzo Lelli
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy.
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15
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Abstract
While the categories of adolescence and puberty are often treated as one, the existence of two distinct terms points to different kinds of maturation in humans. Puberty refers to a period of coordinated somatic growth and reproductive maturation that shifts individuals from nonreproductive juvenility to reproductive maturity. Adolescence includes the behavioral and social assumption of adult roles. Life history theory offers powerful tools for understanding why puberty occurs later in humans than in other primates, including the benefits of delayed reproduction as part of a cooperation-intensive life history strategy. It also sheds light on the ways that pubertal timing responds to environmental variation. I review the mechanisms of maturation in humans and propose biocultural approaches to integrate life historical understandings of puberty with a broader definition of environment to encompass the concept of adolescence.
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Affiliation(s)
- Meredith W. Reiches
- Department of Anthropology, University of Massachusetts, Boston, Massachusetts 02125, USA
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16
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Abstract
Eating disorders affect a significant number of individuals across the life span and are found among all demographic groups (including all genders, socioeconomic statuses, and ethnicities). They can cause malnutrition, which can have significant effects on every organ system in the body. Cardiovascular complications are particularly dangerous and cause eating disorders to have the highest mortality rate of all mental illnesses. This article outlines the medical assessment and treatment of malnutrition due to disordered eating.
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Affiliation(s)
- Rebecka Peebles
- Eating Disorder Assessment and Treatment Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Roberts Center for Pediatric Research, 2716 South Street, Room 14360, Philadelphia, PA 19146, USA.
| | - Erin Hayley Sieke
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard 9NW55, Philadelphia, PA 19104, USA
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17
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Herpertz-Dahlmann B, Dahmen B. Children in Need-Diagnostics, Epidemiology, Treatment and Outcome of Early Onset Anorexia Nervosa. Nutrients 2019; 11:E1932. [PMID: 31426409 PMCID: PMC6722835 DOI: 10.3390/nu11081932] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022] Open
Abstract
Knowledge of anorexia nervosa (AN) in childhood is scarce. This review gives a state-of-the-art overview on the definition, classification, epidemiology and etiology of this serious disorder. The typical features of childhood AN in comparison to adolescent AN and avoidant restrictive eating disorder (ARFID) are described. Other important issues discussed in this article are somatic and psychiatric comorbidity, differential diagnoses and medical and psychological assessment of young patients with AN. Special problems in the medical and psychological treatment of AN in children are listed, although very few studies have investigated age-specific treatment strategies. The physical and mental outcomes of childhood AN appear to be worse than those of adolescent AN, although the causes for these outcomes are unclear. There is an urgent need for ongoing intensive research to reduce the consequences of this debilitating disorder of childhood and to help patients recover.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany.
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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18
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Abstract
PURPOSE OF REVIEW The diagnosis of anorexia nervosa is associated with the highest mortality rate of any psychiatric disorder, mainly caused by medical complications.The purpose of this article is to review the common medical consequences of anorexia nervosa focusing on the special considerations related to children and adolescents and recent updates on the pathophysiology of these complications and their prognosis significance. RECENT FINDINGS The main findings were related to the diagnostic and prognostic value of hypokalaemia, QTc prolongation, hypoglycaemia and orthostatic changes. A new modality to evaluate the heart in anorexia nervosa was explored (2DSTE) as well. Bone mineral density (BMD) loss is one of the few nonreversible consequences of anorexia nervosa. BMD loss does not seem to be significantly related to sex or to cut-off low-weight parameters in teenagers with anorexia nervosa, but rather to the amount of weight loss they have experienced. Brain volume deficits might be another irreversible complication in adolescents with anorexia nervosa. SUMMARY It is crucial for any healthcare provider to be informed about the medical consequences of anorexia nervosa, not only because they can be devastating, but also because they can play an essential role in motivating patients to get treated.
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19
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IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META-ANALYSIS. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2019; 26:e25-e37. [PMID: 31577083 DOI: 10.15586/jptcp.v26i2.601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/11/2019] [Indexed: 01/11/2023]
Abstract
The resumption of menses (ROM) is an important outcome in anorexia nervosa treatment and is considered as a sign of recovery. Identification of relevant factors in its prediction is important in clinical practice. Therefore we aimed to conduct a systematic review and exploratory meta-analysis of the association between total body fat percentage (%BF) and ROM after weight restoration in adolescents and young adults with anorexia nervosa. The study was conducted by adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 604 articles retrieved, only seven studies comprising a total of 366 adolescent and young adult females with anorexia nervosa met the inclusion criteria and were reviewed, and preliminary results revealed three main findings. Firstly, patients who resumed their menstrual cycle had a significantly higher mean %BF when compared to those who did not, an overall effect confirmed by the meta-analysis (SMD: 3.74, 95% CI: 2.26-5.22). Secondly, %BF was found to be an independent predictor of the ROM in this population and an increase of only one unit of %BF can increase the odds of menstruation by ≈15-20%. Thirdly, despite the paucity of data, a cut-off point of %BF≈21was suggested as the minimum needed for ROM. In conclusion, a higher %BF seems to be associated with the ROM in weight-restored adolescent and young adult females with anorexia nervosa. Its assessment is important in a clinical setting, especially after complete weight restoration. The PROSPERO Registry - A systematic review and meta-analysis of the factors associated with the resumption of the menstrual cycle in females with anorexia nervosa after weight restoration (CRD42019111841).
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20
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Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews. J Clin Med 2019; 8:jcm8020278. [PMID: 30823566 PMCID: PMC6406645 DOI: 10.3390/jcm8020278] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 12/12/2022] Open
Abstract
Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.
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21
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Hay PJ, Touyz S, Claudino AM, Lujic S, Smith CA, Madden S. Inpatient versus outpatient care, partial hospitalisation and waiting list for people with eating disorders. Cochrane Database Syst Rev 2019; 1:CD010827. [PMID: 30663033 PMCID: PMC6353082 DOI: 10.1002/14651858.cd010827.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clinical guidelines recommend outpatient care for the majority of people with an eating disorder. The optimal use of inpatient treatment or combination of inpatient and partial hospital care is disputed and practice varies widely. OBJECTIVES To assess the effects of treatment setting (inpatient, partial hospitalisation, or outpatient) on the reduction of symptoms and increase in remission rates in people with:1. Anorexia nervosa and atypical anorexia nervosa;2. Bulimia nervosa and other eating disorders. SEARCH METHODS We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 2 July 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to 20 November 2015). We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (6 July 2018). We ran a forward citation search on the Web of Science to identify additional reports citing any of the included studies, and screened reference lists of included studies and relevant reviews identified during our searches. SELECTION CRITERIA We included randomised controlled trials that tested the efficacy of inpatient, outpatient, or partial hospital settings for treatment of eating disorder in adults, adolescents, and children, whose diagnoses were determined according to the DSM-5, or other internationally accepted diagnostic criteria. We excluded trials of treatment setting for medical or psychiatric complications or comorbidities (e.g. hypokalaemia, depression) of an eating disorder. DATA COLLECTION AND ANALYSIS We followed standard Cochrane procedures to select studies, extract and analyse data, and interpret and present results. We extracted data according to the DSM-5 criteria. We used the Cochrane tool to assess risk of bias. We used the mean (MD) or standardised mean difference (SMD) for continuous data outcomes, and the risk ratio (RR) for binary outcomes. We included the 95% confidence interval (CI) with each result. We presented the quality of the evidence and estimate of effect for weight or body mass index (BMI) and acceptability (number who completed treatment), in a 'Summary of findings' table for the comparison for which we had sufficient data to conduct a meta-analysis. MAIN RESULTS We included five trials in our review. Four trials included a total of 511 participants with anorexia nervosa, and one trial had 55 participants with bulimia nervosa. Three trials are awaiting classification, and may be included in future versions of this review. We assessed a risk of bias from lack of blinding of participants and therapists in all trials, and unclear risk for allocation concealment and randomisation in one study.We had planned four comparisons, and had data for meta-analyses for one. For anorexia nervosa, there may be little or no difference between specialist inpatient care and active outpatient or combined brief hospital and outpatient care in weight gain at 12 months after the start of treatment (standardised mean difference (SMD) -0.22, 95% CI -0.49 to 0.05; 2 trials, 232 participants; low-quality evidence). People may be more likely to complete treatment when randomised to outpatient care settings, but this finding is very uncertain (risk ratio (RR) 0.75, 95% CI 0.64 to 0.88; 3 trials, 319 participants; very low-quality evidence). We downgraded the quality of the evidence for these outcomes because of risks of bias, small numbers of participants and events, and variable level of specialist expertise and intensity of treatment.We had no data, or data from only one trial for the primary outcomes for each of the other three comparisons.No trials measured weight or acceptance of treatment for anorexia nervosa, when comparing inpatient care provided by a specialist eating disorder service and health professionals and a waiting list, no active treatment, or treatment as usual.There was no clear difference in weight gain between settings, and only slightly more acceptance for the partial hospital setting over specialist inpatient care for weight restoration in anorexia nervosa.There was no clear difference in weight gain or acceptability of treatment between specialist inpatient care and partial hospital care for bulimia nervosa, and other binge eating disorders. AUTHORS' CONCLUSIONS There was insufficient evidence to conclude whether any treatment setting was superior for treating people with moderately severe (or less) anorexia nervosa, or other eating disorders.More research is needed for all comparisons of inpatient care versus alternate care.
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Affiliation(s)
- Phillipa J Hay
- Western Sydney UniversityTranslational Health Research InstitutePenrithNew South WalesAustralia2751
- Western Sydney UniversitySchool of MedicineLocked Bag 1797Penrith South DCNSWAustralia2751
| | - Stephen Touyz
- University of SydneySchool of Psychology and Boden Institute School of MedicineSydneyNSWAustralia2006
| | - Angélica M Claudino
- Federal University of São Paulo (UNIFESP)Department of Psychiatry and Psychological MedicineRua Borges Lagoa 570 conj. 71São PauloSão PauloBrazil04038‐000
| | - Sanja Lujic
- UNSWCentre for Big Data Research in HealthCBDRH, Lowy Building, Level 4UNSW SydneyNSWAustralia2052
| | - Caroline A Smith
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Sloane Madden
- University of SydneyThe Children's Hospital at WestmeadSydneyAustralia
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22
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van Noort BM, Lohmar SK, Pfeiffer E, Lehmkuhl U, Winter SM, Kappel V. Clinical characteristics of early onset anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2018; 26:519-525. [PMID: 29943460 DOI: 10.1002/erv.2614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/04/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022]
Abstract
The aim of the current paper is to evaluate clinical characteristics of 30 children with early onset anorexia nervosa (EO-AN; age = 12.2 ± 1.6 years) compared with 30 patients with adolescent onset AN (AO-AN; age = 15.9 ± 0.7 years) and 60 age-matched healthy controls. Statistical analyses included one-way analyses of variance with three planned comparisons and chi-square tests. Compared with AO-AN, EO-AN patients displayed more restrictive eating behaviour (p = 0.038), received more tube-feeding (p = 0.024), and had less problems with self-esteem (p < 0.001) and perfectionism (p = 0.001). EO-AN patients have similar eating disorder pathology (p = 0.183), body-image distortion (p = 0.060), and number of hospitalizations (p = 0.358) as AO-AN. Only a third of EO-AN patients suffer from low self-esteem. Overall, core AN pathology seems similar in EO-AN and AO-AN. However, EO-AN patients show differences in their pathological eating behaviour and the need for tube-feeding.
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Affiliation(s)
- Betteke Maria van Noort
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sylvie Katharina Lohmar
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ernst Pfeiffer
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrike Lehmkuhl
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Maria Winter
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Viola Kappel
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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23
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Abstract
PURPOSE OF REVIEW Recent research on the multimodal treatment of eating disorders in child and adolescent psychiatry has yielded a significant increase in randomized controlled trials and systematic reviews. This review aims to present relevant findings published during the last 2 years related to medical and psychological treatment of anorexia nervosa, bulimia nervosa and avoidant/restrictive food intake disorder (ARFID). RECENT FINDINGS For anorexia nervosa, recent reports described the efficacy of different treatment settings, lengths of hospital stay and high vs. low-calorie refeeding programmes. For both anorexia and bulimia nervosa, a number of randomized controlled trials comparing individual and family-oriented treatment approaches were published. For the newly defined ARFID, only very preliminary results on possible treatment approaches implying a multidisciplinary treatment programme were obtained. SUMMARY Although there is some evidence of the effectiveness of new child and adolescent psychiatric treatment approaches to eating disorders, the relapse rate remains very high, and there is an urgent need for ongoing intensive research.
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Southmayd EA, Hellmers AC, De Souza MJ. Food Versus Pharmacy: Assessment of Nutritional and Pharmacological Strategies to Improve Bone Health in Energy-Deficient Exercising Women. Curr Osteoporos Rep 2017; 15:459-472. [PMID: 28831686 DOI: 10.1007/s11914-017-0393-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW The review aims to summarize our current knowledge surrounding treatment strategies aimed at recovery of bone mass in energy-deficient women suffering from the Female Athlete Triad. RECENT FINDINGS The independent and interactive contributions of energy status versus estrogen status on bone density, geometry, and strength have recently been reported, highlighting the importance of addressing both energy and estrogen in treatment strategies for bone health. This is supported by reports that have identified energy-related features (low body weight and BMI) and estrogen-related features (late age of menarche, oligo/amenorrhea) to be significant risk factors for low bone mineral density and bone stress injury in female athletes and exercising women. Nutritional therapy is the recommended first line of treatment to recover bone mass in energy-deficient female athletes and exercising women. If nutritional therapy fails after 12 months or if fractures or significant worsening in BMD occurs, pharmacological therapy may be considered in the form of transdermal estradiol with cyclic oral progestin (not COC).
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Affiliation(s)
- Emily A Southmayd
- Women's Health and Exercise Laboratory, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Adelaide C Hellmers
- Women's Health and Exercise Laboratory, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Mary Jane De Souza
- Women's Health and Exercise Laboratory, 104 Noll Laboratory, Department of Kinesiology and Physiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, 16802, USA.
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Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, Murad MH, Santoro NF, Warren MP. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:1413-1439. [PMID: 28368518 DOI: 10.1210/jc.2017-00131] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/23/2017] [Indexed: 02/04/2023]
Abstract
COSPONSORING ASSOCIATIONS The American Society for Reproductive Medicine, the European Society of Endocrinology, and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE To formulate clinical practice guidelines for the diagnosis and treatment of functional hypothalamic amenorrhea (FHA). PARTICIPANTS The participants include an Endocrine Society-appointed task force of eight experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and cosponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSIONS FHA is a form of chronic anovulation, not due to identifiable organic causes, but often associated with stress, weight loss, excessive exercise, or a combination thereof. Investigations should include assessment of systemic and endocrinologic etiologies, as FHA is a diagnosis of exclusion. A multidisciplinary treatment approach is necessary, including medical, dietary, and mental health support. Medical complications include, among others, bone loss and infertility, and appropriate therapies are under debate and investigation.
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Affiliation(s)
| | - Kathryn E Ackerman
- Boston Children's Hospital, Boston, Massachusetts 02115
- Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Sarah L Berga
- Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Jay R Kaplan
- Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - George Mastorakos
- Areteio Hospital, Medical School, National and Capodistrian University of Athens, Athens, Greece 10674
| | | | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | | | - Michelle P Warren
- Center for Menopause, Hormonal Disorders, and Women's Health, Columbia University Medical Center, New York, New York 10021
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Seetharaman S, Golden NH, Halpern-Felsher B, Peebles R, Payne A, Carlson JL. Effect of a Prior History of Overweight on Return of Menses in Adolescents With Eating Disorders. J Adolesc Health 2017; 60:469-471. [PMID: 27998699 PMCID: PMC6402567 DOI: 10.1016/j.jadohealth.2016.10.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/23/2016] [Accepted: 10/22/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs). METHODS Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009. RESULTS One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight. CONCLUSIONS Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight.
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Affiliation(s)
- Sujatha Seetharaman
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, California
| | - Neville H. Golden
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, California
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, California
| | - Rebecka Peebles
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Allison Payne
- Pacific Northwest University of Health Sciences, Yakima, Washington
| | - Jennifer L. Carlson
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, California,Address correspondence to: Jennifer L. Carlson, M.D., Division of Adolescent Medicine, Stanford University Medical Center, 770 Welch Road, Suite 100, Palo Alto, CA 94304. (J.L. Carlson)
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Berner LA, Feig EH, Witt AA, Lowe MR. Menstrual cycle loss and resumption among patients with anorexia nervosa spectrum eating disorders: Is relative or absolute weight more influential? Int J Eat Disord 2017; 50:442-446. [PMID: 28263397 DOI: 10.1002/eat.22697] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Prior research suggests that both body mass index (BMI) and weight suppression (highest past weight minus current weight; WS) are important in determining adult anorexia nervosa (AN) severity. We examined associations between amenorrhea and WS, DSM-5 BMI severity category, and highest premorbid BMI among patients with AN. METHOD Participants (N = 69) were adult female AN-spectrum patients at two residential treatment facilities. At admission, height, and weight were measured, and participants completed questionnaires assessing menstrual status and weight history. RESULTS Greater WS, adjusted for BMI, was associated with menstrual function at admission. First amenorrhea onset occurred at a normal BMI for 38.5% of participants. Premorbid highest BMI positively correlated with BMI at amenorrhea onset, and higher BMI at amenorrhea onset was associated with higher BMI at menses resumption. DISCUSSION These findings add to the literature indicating that relative and absolute weight status are dual indicators of illness severity in AN, and preliminarily suggest that a large proportion of adults who present for treatment initially may have shown symptoms of starvation at a normal BMI. Results underscore the need to focus on weight loss in early detection efforts and may inform target weight setting in the treatment of AN.
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Affiliation(s)
| | | | | | - Michael R Lowe
- Drexel University, Philadelphia, Pennsylvania.,The Renfrew Center for Eating Disorders, Philadelphia, Pennsylvania
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El Ghoch M, Calugi S, Pellegrini M, Chignola E, Dalle Grave R. Physical activity, body weight, and resumption of menses in anorexia nervosa. Psychiatry Res 2016; 246:507-511. [PMID: 27821361 DOI: 10.1016/j.psychres.2016.10.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/10/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
Few data are available on long-term outcomes and increased physical activity at the end of inpatient treatment in patients with anorexia nervosa. Hence we assessed the association between physical activity, measured objectively by Sense Wear Armband (SWA), and body mass index (BMI; kg/m2) and menses resumption at one-year follow-up in 32 females with anorexia nervosa who had restored normal body weight by the end of a specialist inpatient treatment. Combined logistic regression models used to evaluate the relationship between variables at discharge, BMI and resumption of menses at one-year follow-up revealed no significant association between BMI at one-year follow-up and physical activity patterns at inpatient discharge. However, total daily steps at inpatient discharge were significantly lower in patients who had resumed menstruation, as confirmed by logistic regression analysis. A small reduction in daily steps at inpatient discharge (~1000 steps) was found to increase the probability of menses resumption at one-year follow-up by ~3%. These data provide preliminary indications as to the potential usefulness of assessing daily steps to predict the resumption of menses at one-year follow-up in patients with anorexia nervosa who restore body weight by the end of inpatient treatment, although confirmation on larger samples is urgently required.
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Affiliation(s)
- Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, I-37016 Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, I-37016 Verona, Italy
| | - Massimo Pellegrini
- Department of Diagnostic, Clinical and Public Health, University of Modena and Reggio Emilia, Italy
| | - Elisa Chignola
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, I-37016 Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, I-37016 Verona, Italy
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Allaway HCM, Southmayd EA, De Souza MJ. The physiology of functional hypothalamic amenorrhea associated with energy deficiency in exercising women and in women with anorexia nervosa. Horm Mol Biol Clin Investig 2016; 25:91-119. [PMID: 26953710 DOI: 10.1515/hmbci-2015-0053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
An energy deficiency is the result of inadequate energy intake relative to high energy expenditure. Often observed with the development of an energy deficiency is a high drive for thinness, dietary restraint, and weight and shape concerns in association with eating behaviors. At a basic physiologic level, a chronic energy deficiency promotes compensatory mechanisms to conserve fuel for vital physiologic function. Alterations have been documented in resting energy expenditure (REE) and metabolic hormones. Observed metabolic alterations include nutritionally acquired growth hormone resistance and reduced insulin-like growth factor-1 (IGF-1) concentrations; hypercortisolemia; increased ghrelin, peptide YY, and adiponectin; and decreased leptin, triiodothyronine, and kisspeptin. The cumulative effect of the energetic and metabolic alterations is a suppression of the hypothalamic-pituitary-ovarian axis. Gonadotropin releasing hormone secretion is decreased with consequent suppression of luteinizing hormone and follicle stimulating hormone release. Alterations in hypothalamic-pituitary secretion alters the production of estrogen and progesterone resulting in subclinical or clinical menstrual dysfunction.
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Paulukat L, Frintrop L, Liesbrock J, Heussen N, Johann S, Exner C, Kas MJ, Tolba R, Neulen J, Konrad K, Herpertz-Dahlmann B, Beyer C, Seitz J. Memory impairment is associated with the loss of regular oestrous cycle and plasma oestradiol levels in an activity-based anorexia animal model. World J Biol Psychiatry 2016; 17:274-84. [PMID: 27160428 DOI: 10.3109/15622975.2016.1173725] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Patients with anorexia nervosa (AN) suffer from neuropsychological deficits including memory impairments. Memory partially depends on 17β-oestradiol (E2), which is reduced in patients with AN. We assessed whether memory functions correlate with E2 plasma levels in the activity-based anorexia (ABA) rat model. METHODS Nine 4-week-old female Wistar rats were sacrificed directly after weight loss of 20-25% (acute starvation), whereas 17 animals had additional 2-week weight-holding (chronic starvation). E2 serum levels and novel object recognition tasks were tested before and after starvation and compared with 21 normally fed controls. RESULTS Starvation disrupted menstrual cycle and impaired memory function, which became statistically significant in the chronic state (oestrous cycle (P < 0.001), E2 levels (P = 0.011) and object recognition memory (P = 0.042) compared to controls). E2 reduction also correlated with the loss of memory in the chronic condition (r = 0.633, P = 0.020). CONCLUSIONS Our results demonstrate that starvation reduces the E2 levels which are associated with memory deficits in ABA rats. These effects might explain reduced memory capacity in patients with AN as a consequence of E2 deficiency and the potentially limited effectiveness of psychotherapeutic interventions in the starved state. Future studies should examine whether E2 substitution could prevent cognitive deficits and aid in earlier readiness for therapy.
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Affiliation(s)
- Lisa Paulukat
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital Aachen, RWTH Aachen University , Aachen , Germany ;,b Institute of Neuroanatomy , RWTH Aachen University , Aachen , Germany
| | - Linda Frintrop
- b Institute of Neuroanatomy , RWTH Aachen University , Aachen , Germany
| | - Johanna Liesbrock
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital Aachen, RWTH Aachen University , Aachen , Germany ;,b Institute of Neuroanatomy , RWTH Aachen University , Aachen , Germany
| | - Nicole Heussen
- c Department of Medical Statistics , University Hospital Aachen, RWTH Aachen University , Aachen , Germany
| | - Sonja Johann
- b Institute of Neuroanatomy , RWTH Aachen University , Aachen , Germany
| | - Cornelia Exner
- d Department of Animal Physiology , Philipps-University Marburg , Marburg , Germany
| | - Martien J Kas
- e Department of Translational Neuroscience, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , the Netherlands
| | - Rene Tolba
- f Institute for Laboratory Animal Science and Experimental Surgery , University Hospital Aachen, RWTH Aachen University , Aachen , Germany
| | - Joseph Neulen
- g Department of Gynecological Endocrinology and Reproductive Medicine , University Hospital, RWTH Aachen University , Aachen , Germany
| | - Kerstin Konrad
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital Aachen, RWTH Aachen University , Aachen , Germany
| | - Beate Herpertz-Dahlmann
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital Aachen, RWTH Aachen University , Aachen , Germany
| | - Cordian Beyer
- b Institute of Neuroanatomy , RWTH Aachen University , Aachen , Germany
| | - Jochen Seitz
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital Aachen, RWTH Aachen University , Aachen , Germany
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El Ghoch M, Calugi S, Chignola E, Bazzani PV, Dalle Grave R. Body fat and menstrual resumption in adult females with anorexia nervosa: a 1-year longitudinal study. J Hum Nutr Diet 2016; 29:662-6. [PMID: 27230963 DOI: 10.1111/jhn.12373] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M. El Ghoch
- Department of Eating and Weight Disorders; Villa Garda Hospital; Garda (VR) Italy
| | - S. Calugi
- Department of Eating and Weight Disorders; Villa Garda Hospital; Garda (VR) Italy
| | - E. Chignola
- Department of Eating and Weight Disorders; Villa Garda Hospital; Garda (VR) Italy
| | - P. V. Bazzani
- Department of Radiology; Villa Garda Hospital; Garda (VR) Italy
| | - R. Dalle Grave
- Department of Eating and Weight Disorders; Villa Garda Hospital; Garda (VR) Italy
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Kimmel M, Ferguson E, Zerwas S, Bulik C, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord 2016; 49:260-75. [PMID: 26711005 PMCID: PMC5683401 DOI: 10.1002/eat.22483] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This article summarizes the literature on obstetric and gynecologic complications associated with eating disorders. METHOD We performed a comprehensive search of the current literature on obstetric and gynecologic complications associated with eating disorders using PubMed. More recent randomized-controlled trials and larger data sets received priority. We also chose those that we felt would be the most relevant to providers. RESULTS Common obstetric and gynecologic complications for women with eating disorders include infertility, unplanned pregnancy, miscarriage, poor nutrition during pregnancy, having a baby with small head circumference, postpartum depression and anxiety, sexual dysfunction and complications in the treatment for gynecologic cancers. There are also unique associations by eating disorder diagnosis, such as earlier cessation of breastfeeding in anorexia nervosa; increased polycystic ovarian syndrome in bulimia nervosa; and complications of obesity as a result of binge eating disorder. DISCUSSION We focus on possible biological and psychosocial factors underpinning risk for poor obstetric and gynecological outcomes in eating disorders. Understanding these factors may improve both our understanding of the reproductive needs of women with eating disorders and their medical outcomes. We also highlight the importance of building multidisciplinary teams to provide comprehensive care to women with eating disorders during the reproductive years.
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Affiliation(s)
- M.C. Kimmel
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina,Correspondence to: M.C. Kimmel, Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina.
| | - E.H. Ferguson
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - S. Zerwas
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - C.M. Bulik
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S. Meltzer-Brody
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. An Echocardiographic Study of Left Ventricular Size and Cardiac Function in Adolescent Females with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015; 24:26-33. [DOI: 10.1002/erv.2409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - James E. Potts
- Children's Heart Centre; British Columbia Children's Hospital; Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine and Provincial Specialized Eating Disorders Program; British Columbia Children's Hospital; Canada
| | | | - Gerald J. Mugford
- Faculty of Medicine and Discipline of Psychiatry; Memorial University of Newfoundland; Canada
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Herpertz-Dahlmann B, van Elburg A, Castro-Fornieles J, Schmidt U. ESCAP Expert Paper: New developments in the diagnosis and treatment of adolescent anorexia nervosa--a European perspective. Eur Child Adolesc Psychiatry 2015; 24:1153-67. [PMID: 26226918 PMCID: PMC4592492 DOI: 10.1007/s00787-015-0748-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/15/2015] [Indexed: 01/20/2023]
Abstract
Anorexia nervosa is a potentially life-threatening disorder with a typical onset in adolescence and high rates of medical complications and psychiatric comorbidity. This article summarizes issues relating to classification in DSM-5 and presents a narrative review of key evidence-based medical and behavioral interventions for adolescent AN and subthreshold restricting eating disorders, mainly, but not exclusively published between 2012 and 2014. In addition, it systematically compares the clinical guidelines of four European countries (Germany, Spain, The Netherlands, and United Kingdom) and outlines common clinical practice, in relation to treatment settings, nutritional rehabilitation, family-oriented and individual psychotherapy, and psychopharmacological treatment. With the exception of family-based treatment, which is mainly evaluated and practiced in Anglo-American countries, the evidence base is weak, especially for medical interventions such as refeeding and pharmacological intervention. There is a need for common European research efforts, to improve the available evidence base and resulting clinical guidance.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child & Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics, RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Annemarie van Elburg
- Department of Social Sciences, Rintveld, Center for Eating Disorders, Altrecht Mental Health Institute, Utrecht University, Utrecht, The Netherlands
| | - Josefina Castro-Fornieles
- Department of Child & Adolescent Psychiatry, Neurosciences Institute, Hospital Clinic of Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Föcker M, Bühren K, Timmesfeld N, Dempfle A, Knoll S, Schwarte R, Egberts KM, Pfeiffer E, Fleischhaker C, Wewetzer C, Hebebrand J, Herpertz-Dahlmann B. The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa. Eur Child Adolesc Psychiatry 2015; 24:537-44. [PMID: 25159090 DOI: 10.1007/s00787-014-0605-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Abstract
Body mass index (BMI) is one of the most important outcome predictors in patients with anorexia nervosa (AN). A low premorbid BMI percentile calculated by the patients recalled premorbid weight and the height at first admission has been found to predict the BMI at first inpatient admission. In this study, we sought to confirm this relationship. We additionally analyze the relationship between premorbid BMI percentile and BMI percentile at discharge from the first inpatient treatment and at 1-year follow-up or alternatively if applicable upon readmission within this time period. We included 161 female patients aged 11-18 years of the multisite ANDI-trial with a DSM-IV diagnosis of AN. We used a multivariate statistical model including the independent variables age, duration of illness, duration of treatment, BMI at admission and BMI percentile at discharge. The relationship between premorbid BMI percentile and BMI at admission was solidly confirmed. In addition to premorbid BMI percentile, BMI at admission and age were significant predictors of BMI percentile at discharge. BMI percentile at discharge significantly predicted BMI percentile at 1-year follow-up. An additional analysis that merely included variables available upon referral revealed that premorbid BMI percentile predicts the 1-year follow-up BMI percentile. Further studies are required to identify the underlying biological mechanisms and to address the respective treatment strategies for AN patients with a low or high premorbid BMI percentile.
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Affiliation(s)
- Manuel Föcker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburgstr. 21, 45147, Essen, Germany,
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Lafrance Robinson A, Kosmerly S. The influence of clinician emotion on decisions in child and adolescent eating disorder treatment: a survey of self and others. Eat Disord 2015; 23:163-76. [PMID: 25401960 DOI: 10.1080/10640266.2014.976107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Eating disorder clinicians from various disciplines participated in one of two surveys: the "self" group (n = 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the "other" group (n = 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent.
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