Dermatologic signs in patients with eating disorders

Orthorexia and eating attitudes in health sciences students

Background

The prevalence of eating disorders and orthorexia nervosa has steadily increased and this situation may lead to severe physical, psychological, and social disorders.

Aim

The aim of this study was to investigate the prevalence of disordered eating attitudes and orthorexia tendencies among university students studying in various Health Sciences departments in Turkey.

Subjects and Methods

The study subjects were selected from Health Sciences Faculty students. Among the students who accepted the study, 639 people were reached by simple random sampling method. The EAT-40 and ORTO-15 which are validated instruments for the screening of abnormal eating behaviors and orthorexia nervosa respectively, were used as measurement tools.

Results

The majority of the students who participated in the study were found to exhibit orthorexic tendencies, and male students had a higher orthorexic tendency in comparison to female students (p = 0.022). More specifically, the students studying in the Department of Nutrition and Dietetics had lower orthorexic tendencies compared with the students from other departments. There was no significant relationship between BMI values and the mean ORTO-15 scores, whereas the mean EAT-40 score was found to increase statistically significantly with increased BMI (p = 0.038). There was a statistically significant difference between the departments and classes in terms of mean EAT-40 scores, whereas no difference was found regarding gender.

Conclusion

Orthorexia nervosa is a common problem for university students studying in health-related departments. Interestingly, the orthorexic tendencies of girls and students studying in the Nutrition and Dietetics department were found to be lower in this study. It was determined that all students except the Nutrition and Dietetics department had orthorexia tendencies. More comprehensive studies are needed to better understand orthorexia nervosa and healthy lifestyle interaction.

Preparing Patients for Cosmetic Surgery and Aesthetic Procedures: Ensuring an Optimal Nutritional Status for Successful Results

Aesthetic and cosmetic medical practices have attracted considerable consumer attention globally. However, possible complications vary and range from mild, self-resolving ecchymoses or edema to more persistent complications. The aim of this review is to identify the nutritional deficits or excesses associated with the major complications of reconstructive surgery, aesthetic surgery, and mini-invasive aesthetic procedures. An additional goal is to provide a bundle of actions for professionals working in the industry in order to reduce the risks of aesthetic procedures and improve the clinical outcomes. Granulomas, hypertrophic scars and keloids, seromas, infections and xerosis, hyperpigmentation, petechiae, livedo reticularis, slower wound healing, and other poor outcomes are frequently associated with nutritional deficiencies. Nutritional status can markedly affect wound healing and tissue repair following surgical interventions, as well as the outcomes of aesthetic and cosmetic medical practices. Professionals working in this industry, therefore, need to consider the nutritional aspects of their patients to obtain the best results.

Hair-Based Assessment of Sex Steroid Hormones in Patients with Anorexia Nervosa

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.

Risk of somatic diseases in patients with eating disorders: the role of comorbid substance use disorders

AIMS

Eating disorders (EDs) and substance use disorders (SUDs) often co-occur, and both involve somatic diseases. So far, no study has considered whether comorbid SUDs may impact somatic disease risk in patients with EDs. Therefore, this study aimed to examine the impact of comorbid SUDs on the risk of 11 somatic disease categories in patients with anorexia nervosa (AN), bulimia nervosa (BN) and unspecified eating disorder (USED) compared to matched controls.

METHODS

A retrospective cohort study was conducted using Danish nationwide registries. The study population included 20 759 patients with EDs and 83 036 controls matched on month and year of birth, sex and ethnicity. Hazard ratios (HRs) were calculated to compare the risk of being diagnosed with a somatic disease (within 11 categories defined by the ICD-10) following first ED diagnosis (index date) between ED patients and controls both with and without SUDs (alcohol, cannabis or hard drugs).

RESULTS

The ED cohort and matched controls were followed for 227 538 and 939 628 person-years, respectively. For ED patients with SUDs, the risk pattern for being diagnosed with different somatic diseases (relative to controls without SUDs) varied according to type of ED and SUD [adjusted HRs ranged from 0.95 (99% CI = 0.57; 1.59) to 4.17 (2.68, 6.47)]. The risk estimates observed among ED patients with SUDs were generally higher than those observed among ED patients without SUDs [adjusted HRs ranged from 1.08 (99% CI = 0.95, 1.22) to 2.56 (2.31, 2.84)]. Abuse of alcohol only had a non-synergistic effect on six disease categories in AN patients and five in BN and USED patients. Abuse of cannabis (with/without alcohol) had a non-synergistic effect on five disease categories in AN and BN patients and two in USED patients. Abuse of hard drugs (with/without alcohol or cannabis) had a non-synergistic effect on nine disease categories in AN patients, eight in BN patients and seven in USED patients.

CONCLUSIONS

The present study documents non-synergistic but not synergistic harmful somatic consequences of SUDs among patients with different EDs, with AN and hard drugs being the most predominant factors. Hence, EDs and SUDs did not interact and result in greater somatic disease risk than that caused by the independent effects. Since EDs and SUDs have independent effects on many somatic diseases, it is important to monitor and treat ED patients for SUD comorbidity to prevent exacerbated physical damage in this vulnerable population.

Eating Disorders

Eating disorders are common behavioral disorders associated with substantial psychological and physical morbidity and mortality. Persons with eating disorders frequently present to primary care providers, who may also be responsible for their general medical management. This article reviews the diagnosis, medical assessment, and treatment of the most common eating disorders.

Striae distensae as a diagnostic indicator for eating disorder pathologies

OBJECTIVE

This manuscript provides a review of the relationship between patients with an underlying eating disorder (ED) and the presence of striae distensae (SD). Researchers and clinicians have recognized many different skin manifestations associated with EDs. According to the Diagnostic and Statistical Manual of Mental Disorders, EDs include, but are not limited to, anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). The presence of specific skin findings often helps clinicians conclude whether or not a patient may have an underlying ED and require further evaluation. One skin finding associated with an ED with little current literature focus is SD. SD arises from a combination of hormonal imbalances and stretching of the dermis, triggering a local inflammatory response. The presence of SD leaves patients with diminished quality of life. There is no single guideline treatment for SD; however, topical and/or light and laser therapies can be utilized.

METHOD

Using online medical literature databases and the PRISMA guidelines, 11 out of 574 articles met the acceptable criteria to be analyzed, emphasizing the lack of current literature on this subject.

RESULTS

Anxiety and depression were comorbidities demonstrated to be strongly related to AN and obesity, secondary to BED, in patients who developed SD. Higher degrees of suicidal ideation and insomnia, along with lower self-esteem levels, were more likely to be present in these patients.

CONCLUSION

Altogether, this review highlights the importance of continued evaluation of SD and its overall impact on patient's mental health, emphasizing an underlying ED.

Skin signs in eating disorders: a literature review

PURPOSE

To summarize and describe the available knowledge on dermatological manifestation of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders IV-TR and 5th edition.

METHODS

We searched in PubMed, Scopus and Web of Science databases from January 1, 1980 through May 1, 2020 for papers in English language on the skin manifestation of eating disorders. Results were screened using the PRISMA tool.

RESULTS

The study yielded 207 results. According with PRISMA guidelines, 26 papers were included in the review. More than 73% of screened papers (19/26) were case reports. Cross-sectional studies represented the 19.2% of screened papers (5/26). Each eligible study has been screened and analyzed.

CONCLUSION

Huge heterogeneity of skin signs of eating disorders were identified. The number of controlled studies available is very limited, and most papers of interest are case reports or narrative review articles. Larger, more methodologically rigorous studies to evaluate the presence of dermatological issue in eating disorder patients are needed.

LEVEL OF EVIDENCE

Level IV. Evidence obtained from multiple time series analysis such as case studies.

Understanding treatment delay: Perceived barriers preventing treatment-seeking for eating disorders

OBJECTIVE

Only a small proportion of individuals with an eating disorder will receive targeted treatment for their illness. The aim of this study was to examine the length of delay to treatment-seeking and determine the barriers preventing earlier access and utilisation of eating disorder treatment for each diagnostic group - anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorder.

METHOD

Participants were recruited as part of the TrEAT multi-phase consortium study. One hundred and nineteen Australians (13-60 years; 96.9% female) with eating disorders currently accessing outpatient treatment for their illness completed an online survey comprised of self-report measures of eating disorder severity, treatment delay and perceived barriers to treatment-seeking. The treating clinician for each participant also provided additional information (e.g. body mass index and diagnosis).

RESULTS

Overall, the average length of delay between onset of eating disorder symptoms and treatment-seeking was 5.28 years. Controlling for age, latency to treatment-seeking was significantly longer for individuals with bulimia nervosa and binge eating disorder compared to anorexia nervosa. However, when perceived barriers to treatment-seeking were investigated, there were no significant differences between the diagnostic groups in regard to the perceived barriers they experienced. Stigma was rated as the most impactful barrier for each diagnostic group.

CONCLUSION

Findings suggest that individuals with eating disorders face substantial delays in accessing appropriate treatment and that latency to treatment-seeking is often magnified for counter-stereotypical eating disorder presentations. Further research is required to investigate other factors contributing to this delay.

Eating Disorders: An Analysis of Self-Induced Vomiting, Binge Eating, and Oral Hygiene Behavior

BACKGROUND

Self-induced vomiting (SIV) is often present in patients with eating disorders (ED) and potentially damaging for oral health. Related behaviors, such as binge eating and oral hygiene habits, may equally increase the risk for dental damage. This study aimed to investigate behaviors and habits in patients with ED and SIV in relation to oral health.

METHODS

All patients enlisting for treatment in an ED clinic for 1 year were offered to take part in the study. Fifty-four of 65 patients were accepted to participate, and a questionnaire included questions on dietary and oral hygiene habits was included. A subgroup consisting of only those 17 ED patients who reported SIV during the previous six months comprised the sample for this study and received additional questions related to other compensatory behaviors and oral hygiene habits in relation to oral health.

RESULTS

Binge eating before SIV was common (14/17 patients). Time point for SIV after binge eating and the procedures performed after vomiting varied. Tooth brushing after vomiting was common (7/17). Food and drinks during binge eating included mainly items rich in calories (sugar/fat) or acid. All 17 patients believed that vomiting could damage their teeth, but only one of them had informed the dentist about having an ED. A number of oral symptoms were reported. Ten patients considered their oral health to be good/fairly good, while the remaining seven patients reported their oral health as not so good/bad/very bad. Information on how ED could affect their teeth was commonly received from the media.

CONCLUSIONS

The dental team should be made aware of the likely detrimental effects of binge eating and vomiting on oral health in patients with eating disorders. The team should also be aware of the cyclical nature of the disease and the similarities and diversities that exist within this group of ED patients. Since ED patients hide their disease from the dental team, this stresses the importance of open and trustful communication between patients and health workers. An organized collaboration between ED clinics and dental professionals is suggested as well as a development of avenues for information about ED and oral health.

Nutrition and hair

Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.

Could acne be a risk factor for developing eating disorders? Acne vulgaris and eating disorders

INTRODUCTION

Skin findings such as acne, hypertrichosis, and hyperpigmentation may be a clue for the diagnosis of eating disorders. There are studies on skin findings in eating disorders, but there is no study evaluating eating disorders in acne patients. We aimed to investigate eating disorders in acne patients and evaluate the effect of acne severity, quality of life, and body mass index (BMI) on eating disorders.

METHODS

Two hundred thirty-two acne patients and 314 healthy controls were enrolled. Acne severity was detected according to Grading Acne Severity Scale (GAGS) by the dermatologists. Eating Attitude Test-40 (EAT) and Acne Quality of Life Scale (AQLS) were filled out by patients. The controls filled out EAT. Individuals scoring EAT≥30 points were considered at risk for eating disorders.

RESULTS

The median EAT score (15 vs. 13) and the number of patients scoring EAT ≥30 (14.2% vs. 2.2%) were found to be significantly higher in the patients' group compared with control group (p: 0.005, p < 0.001). There was a significant positive correlation between EAT score and AQLS score but no significant relationship between acne severity and EAT score. A significant positive correlation was found between EAT scores and BMI.

CONCLUSION

Eating disorders and acne are mostly seen in adolescence, and both have high biopsychosocial morbidity. Also eating disorders can even be mortal sometimes. There are common psychopathological mechanisms in eating disorders and acne.

Nutraceuticals

Hair loss has a multifactorial etiology that includes internal and external triggers. These include poor diet and nutrition (extrinsic), as well as the natural aging process (intrinsic). Other external factors include pollution, hair products, hair styling, and ultraviolet exposure, which can cause free radical formation, oxidative stress, and microinflammation at the site of the hair follicles. Botanic substances have demonstrated antioxidant, anti-inflammatory, and immune-enhancing properties. Vitamins and minerals are needed when deficiencies are apparent or demonstrate efficacy at higher doses than normally found in one's diet. The safety and efficacy of oral nutraceuticals have been demonstrated in clinical trials.

Diffuse reticulate purpura in two adolescents with anorexia nervosa and severe malnutrition

Anorexia nervosa is an eating disorder frequently associated with cutaneous manifestations. A rare type of purpura, known as diffuse reticulate purpura, has been described in patients with anorexia nervosa and severe malnutrition. Typical characteristics of this condition include a purpuric reticulate rash predominantly affecting the trunk that rapidly resolves with adequate feeding. We report two male adolescent patients with anorexia nervosa and severe malnutrition who developed diffuse reticulate purpura.

Hair endocannabinoid concentrations in individuals with acute and weight-recovered anorexia nervosa

BACKGROUND

The endocannabinoid system has been suggested to modulate energy metabolism and stress response and could be an important factor in the pathophysiology of anorexia nervosa (AN). In the context of AN, excessive physical activity may influence endocannabinoid concentrations. The objective of this study was to investigate hair endocannabinoid concentrations at different stages of the disorder. Measurement in hair allows for a cumulative assessment of endocannabinoid concentrations independent of circadian rhythms.

METHODS

In a combined cross-sectional and longitudinal design, we measured hair concentrations of the endocannabinoids anandamide and 2-arachidonoylglycerol and the endocannabinoid-related compounds palmitoylethanolamide, oleoylethanolamide, and stearoylethanolamide in female underweight patients with acute AN (n = 67, reassessment of n = 47 after short-term weight restoration with a body mass index increase of at least 14%), individuals long-term recovered from AN (n = 27), and healthy control participants (n = 84).

RESULTS

Hair concentrations of anandamide and all endocannabinoid-related compounds were elevated in acute AN and decreased over the course of short-term weight restoration. Anandamide concentrations remained elevated in long-term recovered AN patients. In long-term recovered patients, physical activity correlated positively with the concentrations of all endocannabinoid-related compounds.

CONCLUSION

The current study provides evidence for a significant alteration of the endocannabinoid system in acute AN, which may partly persist into long-term recovery. The endocannabinoid system may be a possible target for pharmaceutical interventions in AN, which should be explored in further preclinical and subsequently clinical randomized controlled trials.

Eating disorders and the orthodontist: Diagnosis, considerations and referral

BACKGROUND

Eating disorders are relatively common mental health disorders in Western European and North American populations. The peak incidence occurs within the adolescent years, which correlates with the largest orthodontic patient population. The morbidity associated with these psychological conditions is significant, and has a direct impact upon patient well-being, orthodontic outcomes and the success of treatment. Therefore, it is of relevance to the orthodontist to be aware of potential presenting features of these conditions, when and where to seek advice, and how such disorders may impact upon orthodontic outcomes.

METHODS

Articles published on PUBMED and MEDLINE relevant to orthodontics and eating disorders were reviewed. Key information was extracted, and the relevant evidence for the orthodontist summarised.

RESULTS

Eating disorders may present to the orthodontist in specialist or hospital practice, either undiagnosed or as a co-morbidity. Orthodontists may benefit from an appreciation of these potential diagnoses, the orthodontic implications and to have the confidence to refer their patients to the necessary services.

LIMITATIONS

There is little existing research in this area.

CONCLUSIONS

These conditions have a significant impact on patient morbidity and mortality. This cohort of patients is not suitable for orthodontic treatment while their disease is active. The impact of a developing eating disorder can adversely affect orthodontic treatment.

Cutaneous signs in dermatological diseases; An overview

Cutaneous signs in dermatology are pathognomonic or diagnostic for certain conditions. A knowledge of these signs is a useful skill, which must not be forgotten in the recent trend towards relying on molecular biology and other investigative tools including histological findings to make a diagnosis. The aim of this review is to summarize all cutaneous signs in dermatology in a systematic way that would benefit dermatologists, trainee or experienced, in identifying diseases and sharpening their clinical skills. A keyword search for the terms “cutaneous signs,” “sign” AND “dermatology” was conducted through PUBMED, Google, and the major textbooks in dermatology (i.e., Rooks Textbook of Dermatology; Fitzpatrick's Dermatology in General Medicine and Dermatology). References were searched thoroughly for all cutaneous signs described. One hundred and nineteen signs were noted and summarized under the following categories: autoimmune, infective, inflammatory, neoplastic, genetic, trauma/miscellaneous. This review would serve as a good reference for those wanting to improve their clinical acumen in diagnosing dermatological disease.

Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences

The pharmacological treatment of patients with an eating disorder (ED) often includes medications to treat their ED, comorbid mental health problems, malnutrition and the physical health problems resulting from it. The currently approved pharmacological treatment options for EDs are limited to fluoxetine for bulimia nervosa (BN) and - in some countries - lisdexamfetamine for binge eating disorder (BED). Thus, there are no approved pharmacological options for anorexia nervosa (AN), even though study results for olanzapine and dronabinol are promising. Topiramate might be an additional future option for the treatment of BN and BED. Selective serotonin reuptake inhibitors (SSRI), mirtazapine and bupropion could be considered for the treatment of comorbid unipolar depression. However, AN and BN are contraindications for bupropion. For ED patients with a manic episode, we recommend olanzapine in AN and risperidone in BN and BED; whereas for bipolar depression, olanzapine (plus fluoxetine) seems appropriate in AN and lamotrigine in BN and BED. Acute anxiety or suicidality may warrant benzodiazepine treatment with lorazepam. Proton-pump inhibitors, gastroprokinetic drugs, laxatives and hormones can alleviate certain physical health problems caused by EDs. Therapeutic drug monitoring, pharmacogenomic testing, a more restrictive use of "pro re nata" (PRN) medication, an interdisciplinary treatment approach, shared decision making (SDM) and the formulation of common treatment goals by the patients, their family or carers and clinicians could improve treatment success and safety. Novel genetic, immunological, microbiome and brain imaging research as well as new pharmacological developments like the use of psychedelics, stimulants, novel monoaminergic drugs, hormone analogues and drugs which enhance the effects of psychotherapy may extend our therapeutic options in the near future.

Pernio as the clinical presentation of celiac disease: A case report

We present the case of a 12-year-old girl with severe pernio as the sole clinical presentation of celiac disease (CD), without associated gastrointestinal symptoms. Lesions greatly improved once a gluten free diet was initiated. At 5-year follow-up, she remains in clinical remission throughout the year with no pharmacological treatment, without skin lesions flare-up in the winter months.

Medical Complications of Anorexia Nervosa and Bulimia Nervosa

Anorexia nervosa and bulimia nervosa are mental illnesses with associated complications affecting all body systems with arguably the highest mortality of all mental health disorders. A comprehensive medical evaluation is an essential first step in the treatment of anorexia nervosa and bulimia nervosa. Weight restoration and cessation of purging behaviors are often essential components in the management of medical complications of these illnesses.

Eating disorders in musicians: a survey investigating self-reported eating disorders of musicians

PURPOSE

This study aimed to estimate the prevalence of eating disorders (EDs) in musicians, and to evaluate their relation to perfectionism, stress, anxiety and depression.

METHODS

It examined: (1) the prevalence of EDs using the Eating Disorder Examination Questionnaire (EDE-Q), body mass index (BMI) and self-reports, (2) psychological risk factors using the Depression Anxiety Stress Scale (DASS-21) and perfectionism inventory and (3) demographic details, information about musical and career development, lifestyle, eating habits and health. A survey was distributed worldwide and a total of 301 English-speaking musicians aged 18 years and older participated.

RESULTS

Our screening tools for EDs showed a high prevalence of EDs in musicians: the EDE-Q Global Score (EDE-QGS) showed pathological values in 18.66% of the musicians and when questioned about lifetime prevalence, 32.3% of the musicians answered positively. The median BMI was within the normal range. Regarding general mental health, the DASS-21 showed that depression and stress were severe, anxiety was extremely severe and the perfectionism inventory composite score was 26.53. There was no significant difference on the EDE-QGS between musicians who perform different types of music, but music students, professionals, soloists and musicians travelling overseas had a higher percentage of pathological EDE-QGS. Perfectionism was higher in classical musicians and there was a low positive correlation between EDE-QGS and the risk factors: perfectionism, depression, anxiety, stress, peer pressure and social isolation.

CONCLUSION

EDs are prevalent in musicians and possible risk factors are their increased perfectionism, depression, anxiety and stress due to the demands of their job.

Acipimox Administration With Exercise Induces a Co-feedback Action of the GH, PP, and PYY on Ghrelin Associated With a Reduction of Peripheral Lipolysis in Bulimic and Healthy-Weight Czech Women: A Randomized Study

Objective: Anti-lipolytic drugs and exercise are enhancers of growth hormone (GH) secretion. Decreased circulating free fatty acids (FFA) have been proposed to exert ghrelin-GH feedback loop after administration of an anti-lipolytic longer-acting analog of nicotinic acid, Acipimox (OLB, 5-Methylpyrazine-2-carboxylic acid 4-oxide, molecular weight of 154.1 Da). OLB administration strongly suppresses plasma FFA during exercise. Neuroendocrine perturbations of the adipose tissue (AT), gut, and brain peptides may be involved in the etiopathogenesis of eating disorders including bulimia nervosa (BN) and anorexia nervosa. BN is characterized by binge eating, self-induced vomiting or excessive exercise. Approach: To test the hypothesis that treatment with OLB together with exercise vs. exercise alone would induce feedback action of GH, pancreatic polypeptide (PP), peptide tyrosine tyrosine (PYY), and leptin on ghrelin in Czech women with BN and in healthy-weight Czech women (HW). The lipolysis rate (as glycerol release) in subcutaneous abdominal AT was assessed with microdialysis. At an academic medical center, 12 BN and 12 HW (the control group) were randomized to OLB 500 mg 1 h before a single exercise bout (45 min, 2 W/kg of lean body mass [LBM]) once a week vs. identical placebo over a total of 2 weeks. Blood plasma concentrations of GH, PP, PYY, leptin, ghrelin, FFA, glycerol, and concentrations of AT interstitial glycerol were estimated during the test by RIA utilizing ¹²⁵I-labeled tracer, the electrochemiluminescence technique (ECLIA) or colorimetric kits. Results: OLB administration together with short-term exercise significantly increased plasma GH (P < 0.0001), PP (P < 0.0001), PYY, and leptin concentrations and significantly decreased plasma ghrelin (P < 0.01) concentrations in both groups, whereas short-term exercise with placebo resulted in plasma ghrelin (P < 0.05) decrease exclusively in BN. OLB administration together with short-term exercise significantly lowered local subcutaneous abdominal AT interstitial glycerol (P < 0.0001) to a greater extent in BN. Conclusion: OLB-induced suppression of plasma ghrelin concentrations together with short-term exercise and after the post-exercise recovering phase suggests a potential negative co-feedback of GH, PP, PYY, and leptin on ghrelin secretion to a greater extent in BN. Simultaneously, the exercise-induced elevation in AT interstitial glycerol leading to a higher inhibition of peripheral lipolysis by OLB in BN. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03338387.

Comparison of cutaneous manifestations in diabetic and nondiabetic obese patients: A prospective, controlled study

OBJECTIVE

Obesity is known to be a risk factor for many diseases including dermatological problems. Here, we aimed to determine the cutaneous manifestations in obese patients and the frequency of the accompanying dermatoses and to investigate the effect of diabetes mellitus in obese patients on cutaneous manifestations compared with the control group.

METHODS

Our study included a total of 600 adults: 450 obese volunteers and 150 healthy volunteers. The number of diabetic obese patients was 138 (30%), whereas that of nondiabetic obese patients was 312 (70%). A detailed dermatological examination was performed for each case, and accompanying dermatoses were compared.

RESULTS

The mean body mass index (BMI) in the obese patients and control group was 37.22 kg/m2 and 22.23 kg/m2, respectively. The most common dermatoses in the obese patients were, according to their frequency: striae distensae (291 patients, 64.7%), acrochordon (236 patients, 52.4%), acanthosis nigricans (213 patients, 47.3%), plantar hyperkeratosis (209 patients, 46.4%), and venous insufficiency (202 patients, 44.9%). Although hirsutism was more frequently observed in the nondiabetic obese group than in the diabetic obese group, stasis dermatitis was less frequently observed (p<0.05).

CONCLUSION

We found that many dermatoses are more frequently observed in the obese patients than in the controls. We observed that the effect of obesity on skin is different from that of diabetes mellitus and that cutaneous manifestations of obesity occur more frequently. More extensive, comprehensive, and advanced studies on this subject are required.

Acne and nutrition: hypotheses, myths and facts

Acne is an inflammatory and multifactorial skin disease. Different external and internal factors, including air pollution, aggressive skincare products, medication, mechanical, hormonal and familial factors and, more recently, lifestyle and stress, have been suggested as having an impact on acne. Moreover, for many years nutrition was believed to cause or worsen acne. Over the last decades, however, it has become a dermatological doctrine that there is no direct association between diet and acne. Even if recent research has allowed to identify certain nutritional elements and behaviour that may impact on acne, including the excessive intake of dairy products and hyperglycaemic food, modern lifestyle nutrition, obesity and eating disorders, knowledge about the role of nutrition in the physiopathology of acne still remains sparse and hypotheses and myths continue to dominate the debate. Thus, further clinical and translational research is necessary to investigate and confirm the association between nutrition and acne.

Growing evidence of the beneficial effects of a marine protein-based dietary supplement for treating hair loss

BACKGROUND

Hair loss is a common condition among women with a range of causes including nutritional deficiencies.

AIMS

To review the clinical data supporting the use of an oral marine supplement designed to promote hair growth.

PATIENTS/METHODS

Adult women with temporary thinning hair. Following an initial pilot study, five randomized, double-blind studies assessed the effectiveness of the oral marine supplement for promoting hair growth. Each study was approved by one or more institutional review boards.

RESULTS

Together, these studies demonstrated the ability of oral marine supplements to increase the growth of terminal and vellus hairs, increase the diameter of terminal and vellus hairs, and decrease hair loss. This product is beneficial for men as well as women.

CONCLUSIONS

A dietary supplement containing a marine complex and other natural ingredients can safely and effectively promote hair growth and decrease hair shedding in women and men with thinning hair.

Characteristics of seeking treatment among U.S. adolescents with eating disorders

OBJECTIVE

The majority of persons with eating disorders (EDs) do not seek ED treatment, yet little is known about treatment-seeking barriers or facilitators. The aim of the study is to describe the characteristics associated with seeking ED treatment among U.S. adolescents with EDs.

METHOD

Data from a nationally representative cross-sectional study of U.S. adolescents ages 13-18 years were used for these analyses. Specifically, adolescents who met criteria for lifetime EDs (N = 281) were included. Sociodemographic information, characteristics of EDs, psychiatric comorbidities, and other mental health service use were assessed via interview.

RESULTS

Only 20% of adolescents sought ED treatment. Females were 2.2 (95% CI 0.8, 6.4) times more likely to seek treatment than males (19.9% vs. 8.9%). Adolescents who met criteria for anorexia nervosa or bulimia nervosa were 2.4 (95% CI 0.9, 6.3) and 1.9 (95% CI 1.0, 3.8) times more likely to seek treatment than adolescents who met criteria for binge-eating disorder (27.5% and 22.3% vs. 11.6%). Specific ED behaviors (restriction and purging), ED-related impairment, and any mental health service use were also associated with adolescent treatment seeking.

DISCUSSION

Adolescent treatment seeking was infrequent overall, with individuals with counter-stereotypic ED presentations least likely to have sought treatment. Adolescent treatment seeking could be promoted through increasing awareness among the public and healthcare professionals that EDs affect a heterogeneous group of people. More generally, research involving both treatment-seeking and non-treatment-seeking individuals holds great potential to refine the field's knowledge of ED etiology, prevalence, treatment, and prevention.

Dermatological aspects influencing the practice of physical activities by obese individuals

Abstract Objective : The aim of this study was to perform a systematic review of the major skin diseases affecting obese individuals and their influence on physical activity. Methods : Relevant articles were identified by systematically searching PubMed from 2000 to 2014, using the descriptors "skin diseases" and "obesity", "skin disease" and "obesity", "skin diseases" and "physical activity", "skin disease" and "physical activity". The PEDro Scale (in Brazilian Portuguese) was used to rate the methodological quality of the studies. Results : A total of 320 articles were examined in the first phase. In the end, 11 articles met the proposed criteria and were included for analysis in the systematic review. We investigated cutaneous manifestations of diseases and classified them according to their effects under 5 categories: metabolic (n = 10), aesthetic (n = 7), inflammatory (n = 6), mechanical (n = 5) and infectious (n = 3). The most frequent dermatoses among obese were acanthosis nigricans, acrochordon (skin tags), stretch marks, plantar keratodermia, intertrigo, bacterial and fungal infections. Acanthosis nigricans was found to be the most important metabolic implication of obesity. Conclusion : Although neglected, skin lesions are common in obesity and have implications for physical activity because they cause pain, discomfort, friction, infection, inflammation, embarrassment, limitation or difficulty of movement. Strategies to promote skin health may result in a better integration of physical activity into routine therapy and improve the quality of life of obese individuals.

The Relationship of Disordered Eating Attitudes With Body Composition and Anthropometric Indices in Physical Education Students

Background:

Abnormal eating behavior, unhealthy weight control methods, and eating disordered symptoms have risen among college students.

Objectives:

The aim of this study was to examine disordered eating attitudes and their relationship with anthropometric and body composition indices in physical education students in Tabriz, the capital of East Azerbaijan province, Iran.

Patients and Methods:

This cross-sectional study was conducted on 210 physical education students, 105 males and 105 females aged 18 to 25, who were selected by systematic random sampling from physical education faculty of Tabriz University in Tabriz, Iran, in 2013. Eating attitude test (EAT-26) was used for the assessment of disordered eating attitudes. In addition, anthropometric and body composition indices were assessed.

Results:

About 10% of the studied subject had disturbed eating attitudes; significantly more males (15.4%) reported an EAT-26 ≥ 20 (disordered eating attitudes) than females (4.8%) (P < 0.05). In males, the EAT-26 score was positively correlated with weist perimeter (WP) (r = 0.21, P < 0.05) and the waist-to-hip ratio (r = 0.26, P < 0.01). In females, the EAT-26 score was positively correlated with weight (r = 0.19, P < 0.05) and the WP (r = 0.28, P < 0.01). In females, weight (P < 0.05), body mass index (BMI) (P < 0.05), WP (P < 0.01), and waist-to-hip ratio (P < 0.05) were significantly different between disordered eating attitude and healthy subjects, while in males there was no significant difference between the two groups regarding the anthropometric and body composition indices.

Conclusions:

Abnormal eating attitude was notable among physical education students in Tabriz, Iran. It seems that some anthropometric indices such as BMI and central obesity indices were related to the increase of disordered eating attitude.

Anorexia nervosa - medical complications

In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications which are commonly present as part of their eating disorders. Almost every body system can be adversely, affected by this state of progressive malnutrition. Moreover, some of the complications can have permanent adverse effects even after there is a successful program of nutritional rehabilitation and weight restoration. Within this article we will review all body systems affected by AN. There is also salient information about both, how to diagnose these medical complications and which are the likely ones to result in permanent sequelae if not diagnosed and addressed early in the course of AN. In a subsequent article, the definitive medical treatment for these complications will be presented in a clinically practical manner.

Eating disorders and the skin

Eating disorders, which include anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified, are psychiatric disorders with physical complications. Several factors may contribute to the onset of anorexia nervosa and bulimia nervosa, including a familial predisposition to these disorders as well as individual personality characteristics. Dissatisfaction with body shape and an overwhelming desire to be thin are considered as risk factors for the development of eating disorders. Skin signs are the expression of the medical consequences of starvation, vomiting, abuse of drugs, such as laxatives and diuretics, and psychiatric morbidity. They include xerosis, lanugolike body hair, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticularis, interdigital intertrigo, paronychia, acquired striae distensae, and acral coldness. The most characteristic cutaneous sign of vomiting is Russell sign (knuckle calluses). Symptoms due to laxative or diuretic abuse include adverse reactions to drugs. Symptoms due to psychiatric morbidity (artefacta) include the consequences of self-induced trauma. The role of the dermatologist in the management of eating disorders is to make an early diagnosis of the "hidden" signs of eating disorders in patients who tend to minimize or deny their disorder.

Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

Dietary behaviors and oral-systemic health in women

The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed.

Nutrition and hair: deficiencies and supplements

Hair follicle cells have a high turnover. A caloric deprivation or deficiency of several components, such as proteins, minerals, essential fatty acids, and vitamins, caused by inborn errors or reduced uptake, can lead to structural abnormalities, pigmentation changes, or hair loss, although exact data are often lacking. The diagnosis is established through a careful history, clinical examination of hair loss activity, and hair quality and confirmed through targeted laboratory tests. Examples of genetic hair disorders caused by reduced nutritional components are zinc deficiency in acrodermatitis enteropathica and copper deficiency in Menkes kinky hair syndrome.

[Epidemiology of anorexia nervosa: a review]

A critical review of the literature was conducted to provide answers to three questions: firstly, are we facing a national and/or international epidemic of anorexia nervosa (AN) as claimed in the media by certain professionals? Secondly, is AN simply an ordinary crisis of adolescence? Thirdly, is it a pathology that solely affects the higher socio-professional categories?

METHOD

A Medline search was conducted and backed up by a manual search to find all the studies or literature reviews published on prevalence, incidence rates, outcomes, morbidity and mortality in AN and its links with social class, covering the period 2000-2011.

RESULTS

The differing methodologies of the studies on these themes have a considerable impact on the interpretation of results. For each indicator retained, the results observed in the different studies are detailed and commented in the light of these differences. The prevalence of AN in women aged 11 to 65 in non-clinical population ranges from 0 to 2.2 %. It varies in particular with the age of the studied subjects, the measurements used, and the definition criteria for AN. Among men, the lifetime prevalence is around 0.3%. The marked disparities in incidence rates observed are related to the nature of the samples considered: subjects consulting in hospital, whether in a specialised department or in any department, those consulting general practitioners (GPs), or subjects from general population samples recruited in different surveys (girls in schools for example). The incidence of female cases is low in general medicine or specialised consultation in town (whatever the speciality): from 4.2 and 8.3/100,000 individuals per year. It is much higher in the general population, ranging from 109 to 270/100,000 individuals per year. In fact, the studies reporting variations in the incidence of AN were conducted on samples from clinical populations in certain countries (United States and United Kingdom). They are probably more a reflection of variations in detection rates and use of healthcare, than of variations in the incidence in the general population. The mean duration of AN appears shorter in the general population than in clinical populations. On average, 47% of the individuals treated for AN recovered, 34% improved, 21% had a chronic eating disorder, and 5% died. The outcome is better for subjects treated during adolescence. Mortality is frequently expressed in crude mortality rate (CMR), which is not very informative on account of the heterogeneous natures of the cohorts followed; only the studies reporting standardised mortality rate (SMR) are informative. AN appears as having one of the highest mortality rates among psychiatric pathologies. Mortality varies according to the population considered. Rates observed are 6.2 to 10.6 times greater than that observed in the general population for a follow-up duration ranging respectively from 13 to 10 years. It is lower for longer follow-up periods, only 3.7 times more frequent than in the general population for follow-up periods of 20 to 40 years. It appears lower for subjects treated before the age of 20. The main causes of death are eating disorder complications, suicide and cancer. One review of the literature concluded in the absence of any significant link between this pathology and social class.

DISCUSSION

There is nothing in the incidence and prevalence data to back up the notion of a recent "epidemic" of AN. AN is not simply a crisis of adolescence: morbidity and mortality are considerable in this pathology. The relationship between AN and social class is not established.

Skin manifestations of obesity: a comparative study

BACKGROUND

Obesity is one of the world's biggest health problems nowadays. Little research has been done on the skin diseases that affect obese patients.

OBJECTIVE

To study the prevalence of skin manifestations in obese patients compared with a control group of normal-weight patients.

METHODS

A total of 76 obese patients [body mass index (BMI) ≥30 kg/m(2) ] and 73 with normal-weight volunteers (BMI 18.5-24.9 kg/m(2) ) were included in the study and had their complete medical history and skin examination evaluated by the same examiner. All patients were investigated for the presence of metabolic syndrome.

RESULTS

The dermatoses that showed a statistically significant relationship with obesity, compared with the control group were: striae (P < 0.001), plantar hyperkeratosis (P < 0.001), acrochordons (P = 0.007), intertrigo (P < 0.001), pseudoacanthosis nigricans (P < 0.001), keratosis pilaris (P = 0.006), lymphedema (P = 0.002) and bacterial infections (P = 0.05). The presence of striae, pseudoacanthosis nigricans and bacterial infections were also found to be correlated with the degree of obesity.

CONCLUSIONS

Obesity is strongly related to several skin alterations that could be considered as markers of excessive weight. Skin care of obese patients deserves particular attention, not only because of the high prevalence of cutaneous alteration but mainly because many of these disorders are preventable and could be treated, improving patient's quality of life.

Livedo reticularis and related disorders

OPINION STATEMENT

Livedo reticularis is a violaceous mottling of the skin with a "fishnet" reticular appearance. Primary and secondary etiologies exist, including a pathologic variant termed livedo racemosa. No evidence-based medicine exists to guide therapy for this disorder, but most patients with primary and secondary livedo reticularis are asymptomatic and do not require treatment. In the rare instance that a patient with primary livedo reticularis experiences mild symptoms such as episodic numbness and tingling, avoidance of cold and vasoconstricting substances should be encouraged. Lastly, judicious dosing of a vasodilator such as a calcium channel blocker can be prescribed. Patients with secondary livedo reticularis or livedo racemosa may benefit from these same therapeutic suggestions; however, treating the proximate cause of livedo with a systemic association is encouraged and is most likely to yield cutaneous improvement. Although antiplatelet and/or anticoagulant therapy is often required when treating a patient with the antiphospholipid antibody syndrome or Sneddon's syndrome, the attendant livedo racemosa typically remains unchanged or progresses despite this treatment.