One-year outcome and incidence of anorexia nervosa and restrictive eating disorders among adolescent girls treated as out-patients in a family-based setting

Aims To study the 1-year outcome and to analyse predictors of outcome of a cohort of adolescent girls with anorexia nervosa (AN) or restrictive eating disorders not otherwise specified (EDNOSr) treated as out-patients in a family-based programme at a specialized eating disorder service. To calculate the incidence of anorexia nervosa among treatment-seeking girls younger than 18 in Uppsala County from 2004 to 2006. Methods A total of 168 female patients were offered treatment, and 141 were followed-up 1 year after starting treatment, 29 with AN and 112 with EDNOSr. Results Of the 29 girls who initially had AN, 6 (20%) had a good outcome and were free of any form of eating disorder at follow-up; only 1 (3%) had AN. Of the patients with EDNOSr, 54 (48%) had a good outcome and were free of eating disorders. Three (3%) had a poor outcome and had developed AN. The incidence of AN was 18/100,000 person-years in girls younger than 12 and 63/100,000 in girls younger than 18. Conclusion Restrictive eating disorders, including AN, in children and adolescents can be successfully treated in a family-based specialized out-patient service without in-patient care.

Obsessive-compulsivity and working memory are associated with differential prefrontal cortex and insula activation in adolescents with a recent diagnosis of an eating disorder

The role of rumination at the beginning of eating disorder (ED) is not well understood. We hypothesised that impulsivity, rumination and restriction could be associated with neural activity in response to food stimuli in young individuals with eating disorders (ED). We measured neural responses with functional magnetic resonance imaging (fMRI), tested working memory (WM) and administered the eating disorders examination questionnaire (EDE-Q), Barratt impulsivity scale (BIS-11) and obsessive-compulsive inventory (OCI-R) in 15 adolescent females with eating disorder not otherwise specified (EDNOS) (mean age 15 years) and 20 age-matched healthy control females. We found that EDNOS subjects had significantly higher scores on the BIS 11, EDE-Q and OCI-R scales. Significantly increased neural responses to food images in the EDNOS group were observed in the prefrontal circuitry. OCI-R scores in the EDNOS group also significantly correlated with activity in the prefrontal circuitry and the cerebellum. Significantly slower WM responses negatively correlated with bilateral superior frontal gyrus activity in the EDNOS group. We conclude that ruminations, linked to WM, are present in adolescent females newly diagnosed with EDNOS. These may be risk factors for the development of an eating disorder and may be detectable before disease onset.

Omega-3 essential fatty acid status is improved during nutritional rehabilitation of adolescent girls with eating disorders and weight loss

AIM

Essential fatty acid status is altered in eating disorders with weight loss, and deficiencies in polyunsaturated omega-3 essential fatty acids have been implicated in the development of depression and other psychopathologies. Presently, recovery of essential fatty status during the treatment of adolescent girls with eating disorders has been investigated.

METHODS

Fatty acids were analysed in erythrocyte membranes of 24 adolescents girls with eating disorders of short duration, and on the average >10 kg weight loss at presentation. Blood samples were obtained at presentation and following weight recovery on standard diet without supplementation with essential fatty acids.

RESULTS

Alterations of essential fatty status observed at presentation largely normalized during treatment. Omega-3 status improved following weight gain.

CONCLUSION

Adequate nutrition, normalization of eating behaviours, weight gain and the consequent return to normalization of metabolism and endocrine function are sufficient to ensure normalization of essential fatty acid status. Supplementation with omega-3 polyunsaturated fatty acids does not appear warranted.

Omega-3 polyunsaturated essential fatty acids are associated with depression in adolescents with eating disorders and weight loss

AIM

To study the relationship between polyunsaturated fatty acids (PUFA) status and depression in adolescents with eating disorders (ED) and weight loss.

METHODS

Erythrocyte membranes from 217 adolescents (209 girls, eight boys) with ED were analysed for fatty acids (FA). ED and depression were diagnosed by clinical interviews and supported by self-report instruments.

RESULTS

Adolescents with ED and depression did not differ from those with ED only in terms of age, BMI, weight loss and duration of disease. In their FA profile, depressed adolescents had lower proportions of eicosapentanoic acid (EPA) and docosahexanoic acid (DHA), the end products of the ω3 PUFA series. The ratio of long-chain (>18 carbons) ω6/ω3 PUFA was therefore higher in depressed adolescents. Indices of desaturase activities did not differ between depressed and not depressed adolescents.

CONCLUSION

Low ω3 status is related to depression in adolescents with ED. This cannot be explained by differences in weight (loss) and duration of disease, nor by differences in PUFA processing by desaturases. Data suggest a lower dietary intake of ω3 PUFA in those with depression. Further investigations should determine whether ω3 PUFA status improves by refeeding only or whether supplementation with PUFA is warranted.

No unexpected adverse events and biochemical side effects of olanzapine as adjunct treatment in adolescent girls with eating disorders

OBJECTIVE

Olanzapine has been recently tried to relieve anxiety and hyperactivity in adolescents with eating disorders (EDs). Presently, the side effects of the drug have been evaluated.

METHOD

Forty-seven adolescents with EDs were followed up by repeated blood sampling before, during, and at 3 months after medication with olanzapine.

RESULTS

Olanzapine medication was discontinued in three patients because of galactorrhea, seizures, and raised liver enzyme activities, respectively. There was a normalization of glucose, insulin, and lipid profiles during treatment, which was related to weight gain and resumption of menstruations but not to medication. Increases in thyroid-stimulating hormone and prolactin were related to olanzapine medication and comedication with selective serotonine reuptake inhibitors. Three months after discontinuing medication, there were no persisting biochemical effects.

CONCLUSION

The side effects observed were those previously described for olanzapine. Most biochemical changes were related to weight (change) and amenorrhea and not to medication. Placebo-controlled studies are needed to investigate the efficacy of olanzapine in adolescents with EDs.

Essential fatty acid status in teenage girls with eating disorders and weight loss

AIM

To explore the relationship between essential fatty acids (FA) and weight changes in adolescent girls with eating disorders (ED).

METHODS

Blood samples were obtained from 220 girls with ED and 39 healthy controls. The girls with ED were 15.3 ± 1.5 years of age and weighed 49.8 ± 8.7 kg (BMI 18.3 ± 2.8 kg/m(2)) after a weight loss of 6.8 ± 6.4 kg. FA were analysed in plasma phospholipids (PPL) and erythrocyte membranes (ERY).

RESULTS

The proportions of saturated and monounsaturated FA were increased during weight loss, while linoleic acid (18:2ω6) was decreased. The proportions of eicosapentanoic acid (EPA) (20:5ω3) and docosahexanoic acid (DHA) (22:6ω3) in PPL and ERY did not differ from controls. The activity of stearoyl-CoA-desaturase was increased as evidenced by an increased product/precursor ratio and correlated with the rate of weight loss. The activities of delta-6-desaturase and delta-5-desaturase did not differ from controls. The rate of weight loss was inversely correlated with delta-6-desaturase and directly correlated with delta-5-desaturase.

CONCLUSION

The FA profile indicates low-fat intake, fat mobilization from stores and an increased conversion of essential FA at the delta-5-desaturase step during weight loss in adolescent girls with ED. Normal levels of EPA and DHA were maintained.

Do thyroid hormones mediate the effects of starvation on mood in adolescent girls with eating disorders?

In the eating disorders (ED) comorbid depression is common and clinical experience suggests that it is partly related to starvation. Starvation affects thyroid hormone status and thyroid hypofunction is in turn associated with depressed mood. We have therefore investigated the possibility that thyroid hormones and starvation are associated with mood in ED. Two-hundred and thirty-nine adolescent girls were examined at presentation of an ED. Analyses of thyroid hormones, documentation of weight and weight changes, self-reports of depressive symptomatology and clinical diagnoses of ED and depression were used in the analyses. Of the 239 girls 100 were diagnosed with depression. The girls with and without depression did not differ in age, weight, height, body mass index (BMI), weight loss or duration of disease. Plasma free thyroxine concentrations were lower in depressed girls (11.9±1.7 versus 12.8±1.9 pmol/L; p<0.01). Plasma triodothyronine and thyroid-stimulating hormone concentrations did not differ between groups. In a logistic regression analysis the odds ratio for depression was 41.1 (95% confidence interval 4.18-405; p=0.001) for a 10 pmol/L change of plasma free thyroxine after correction for BMI, weight loss, duration of disease, rate of weight loss, plasma triodothyronine and an interaction between BMI and plasma free thyroxine. BMI did not predict depression. Low circulating thyroxine concentrations may provide a link between starvation and depression in adolescent girls with ED.

Triiodothyronine is an indicator of nutritional status in adolescent girls with eating disorders

AIM

Circulating thyroid hormone concentrations are influenced by nonthyroidal disease and changes in nutritional status. We studied thyroid hormones as possible indicators of nutrition in adolescent girls with eating disorders.

METHOD

Blood samples for analyses of thyroid hormones were obtained at 360 assessments of 298 patients and biweekly during 42 treatment periods in 36 patients.

RESULTS

At assessment, when most of the girls were on a weight losing course, serum triiodothyronine (T3) concentrations were low. Great weight loss and rapid rate of weight loss were the most important predictors of low T3 concentrations. Serum free thyroxine concentrations were in the lower normal range. In premenarcheal girls, weight loss was the most important predictor of free thyroxine but this relationship was weaker in postmenarcheal girls. Serum TSH concentrations were within the normal range and only weakly related to weight changes. During treatment, T3 increased in parallel with weight but was also influenced by the short-term weight trend.

CONCLUSION

Serum T3 concentration is an indicator of nutritional status in adolescent girls with eating disorders. It is sensitive to short-term weight changes and could be used to monitor progress throughout nutritional rehabilitation.

Localisation of phosphomonoesterase activity in ectomycorrhizal fungi grown on different phosphorus sources

Phosphorus (P) is a major limiting nutrient for plants in boreal forest ecosystems where a substantial part of the total P is sequestered in organic compounds. Some ectomycorrhizal (ECM) fungi are known to produce phosphomonoesterases, enzymes that degrade organic P sources. Here, we test 16 ECM species for this enzymatic activity by growing them on media containing orthophosphate, phytic acid or apatite. A method with an overlay gel that determined both phosphomonoesterase activity and its spatial distribution was developed. The phosphomonoesterase activity was not significantly higher when growing on organic P; conversely some isolates only produced measurable enzyme activity when grown on apatite. Species-specific variations with respect to phosphomonoesterase activity as well as growth responses to different substrates were found. The production of phosphomonoesterases was found to be widespread in ECM fungi and the enzyme activity did not need induction by organic P. The enzyme activity was highest in the central parts of the mycelia, potentially reflecting breakdown and recycling of phospholipids from old hyphae or potentially higher mycelial density.

Insulin-like growth factor-1 as an indicator of nutrition during treatment of adolescent girls with eating disorders

AIM

The use of serum insulin-like growth factor-1 (IGF-1) concentrations as an index of nutrition has been analysed in teenage girls with eating disorders and weight loss.

METHOD

Blood samples for analysis of IGF-1 were obtained at 349 assessments of 302 patients and biweekly during 56 treatment periods in 46 patients. IGF-1 was related to body size, weight loss, degree of leanness (BMI standard deviation score) and rate of weight loss.

RESULTS

At assessment, when most of the girls were on a weight-losing course, serum IGF-1 concentrations were low. Weight loss immediately prior to assessment was the most important predictor of IGF-1. Together with measurements of weight, height, weight loss and BMI standard deviation score the rate of weight loss predicted IGF-1 to 32-55%. During treatment when there was net weight gain, IGF-1 increased in parallel with the BMI standard deviation score, a measure of leanness, and was also influenced by the short-term weight trend.

CONCLUSION

The serum IGF-1 concentration is an indicator of nutritional status in adolescents with eating disorders. It is sensitive to short-term weight changes measured in a clinical setting and could be used at assessment and to monitor nutritional rehabilitation.

Vertical distribution of ectomycorrhizal fungal taxa in a podzol soil profile

•   Studies of ectomycorrhizal fungal communities in forest soils are usually restricted to the uppermost organic horizons. Boreal forest podzols are highly stratified and little is known about the vertical distribution of ectomycorrhizal communities in the underlying mineral horizons. •   Ectomycorrhizal root tips were sampled from seven horizons in three continuous columns of a 52-cm deep podzol profile. Root tips were sorted into morphological groups and the colonising fungi identified by sequencing of the rDNA ITS region. The vertical distribution of mycorrhizal taxa was examined. •   A relationship between ectomycorrhizal species composition and soil horizon was found. Tomentellopsis submollis, three Piloderma species and Dermocybe spp. were found predominantly in the upper horizons while Suillus luteus, Lactarius utilis and three undescribed Piloderma species were associated with the mineral horizons. •   Two thirds of the root tips were found in the mineral soil and half of the taxa were restricted to the mineral horizons. The results highlight the need to include the mineral soil in order to gain a more accurate representation of the ectomycorrhizal community.