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Hagan KE, Johnson A, Venables K, Makara A, Haynos AF. Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students. Int J Eat Disord 2024; 57:924-936. [PMID: 38303677 PMCID: PMC11018494 DOI: 10.1002/eat.24152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups. METHOD United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non-eating-disorder controls (NCs, n = 5876). Generalized and linear mixed-effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions. RESULTS Atypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge-eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group. DISCUSSION Findings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care. PUBLIC SIGNIFICANCE College students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge-eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students.
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Affiliation(s)
- Kelsey E. Hagan
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Women’s Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Adanya Johnson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kira Venables
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Amanda Makara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Ann F. Haynos
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
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Makara A, Howe H, Cooper M, Heckert K, Weiss S, Kellom K, Scharf D, Ubel P, Orloff N, Timko CA. Modifying an Open Science Online Grocery for parents of youth with anorexia nervosa: A proof-of-concept study. Int J Eat Disord 2023; 56:1011-1020. [PMID: 36737256 DOI: 10.1002/eat.23902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE For youth with anorexia nervosa (AN), remission requires high caloric goals to achieve weight restoration, consumption of a wide variety of calorically dense foods, and reintroduction of eliminated foods. Family-based treatment (FBT), the gold-standard treatment for youth with AN, empowers parents to renourish their child and restore them to health; yet, parents often report struggling with shifting meal planning and grocery shopping behaviors to focus on nutritional rehabilitation and weight restoration. METHODS This proof-of-concept study aimed to modify a simulated grocery store (Open Science Online Grocery [OSOG]) for parents of youth with AN and explore the acceptability and feasibility of its use as part of standard care. Study staff collaborated with six parent research partners to modify the OSOG prior to piloting it with participants. Participants were 10 parents of youth undergoing a first-time hospitalization for medical stabilization of AN or atypical AN. Parents completed a battery of measures and a semistructured interview assessing the acceptability and feasibility of OSOG. RESULTS Parents described the tool as credible and acceptable. Qualitative feedback highlighted common themes of caregiver burden, nutrition education, and acceptability of the tool. DISCUSSION Results point to the need for more work in supporting parents in Phase I of FBT. PUBLIC SIGNIFICANCE Families are instrumental in supporting youth to recover from anorexia nervosa. During treatment, parents are charged with selecting and serving their adolescent's meals, often requiring them to change grocery shopping and food preparation habits to meet their child's high caloric needs. Parents reported feeling overwhelmed by this task and noted struggling with learning different approaches to nourish their adolescent during an already stressful time. Collaboratively with parents, we modified a tool to support parents in shifting thier shopping habits, which they reported as being a helpful springboard in the early phase of treatment.
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Affiliation(s)
- Amanda Makara
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Holly Howe
- The Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - Marita Cooper
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kerri Heckert
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Samantha Weiss
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Kellom
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Danielle Scharf
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter Ubel
- The Fuqua School of Business, Duke University, Durham, North Carolina, USA.,Sanford School of Policy, Duke University, Durham, North Carolina, USA.,School of Medicine, Duke University, Durham, North Carolina, USA
| | - Natalia Orloff
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Susanin A, Cooper M, Makara A, Kuschner ES, Timko CA. Autistic characteristics in youth with anorexia nervosa before and after treatment. Eur Eat Disord Rev 2022; 30:664-670. [PMID: 35780511 PMCID: PMC10243230 DOI: 10.1002/erv.2937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cognitive characteristics common to autistic individuals are often seen in adults with anorexia nervosa (AN), raising the question of whether autistic people and people with AN may share an endophenotype. We need to examine autistic characteristics during the early stages of AN to accurately parse true symptom co-occurrence from behavioural alterations due to prolonged illness. METHODS We conducted a post-hoc analysis examining autistic characteristics in 59 youth with AN. Adolescents and parents participating in a randomised-clinical trial for AN completed questionnaires probing autistic characteristics at baseline and treatment end. We categorised participants as above or below cut-offs of clinical indicators of autism using the Autism Probability Index (API) and the Autism Spectrum Quotient-10. RESULTS Rates of high autistic characteristics ranged between 0% and 36% depending on the instrument used and how the data was obtained (i.e., by informant report or self-report). Paternal report of autistic characteristics differed across treatment completers versus non completers and maternal report indicated lower weight gain for those with elevated characteristics. CONCLUSIONS Low rates of autism and fluctuations in autistic features during treatment underscore the importance of longitudinal examinations of autistic characteristics in adolescents with AN. Future studies need to replicate findings in a larger adolescent sample. TRIAL REGISTRATION ClinicalTrails.gov Identifier NCT03928028.
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Affiliation(s)
- Annabel Susanin
- Eating and Weight Disorder Program, Department of Psychiatry, Icahn School of Medicine
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marita Cooper
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amanda Makara
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily S. Kuschner
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - C. Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
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Benau EM, Makara A, Orloff NC, Benner E, Serpell L, Timko CA. How Does Fasting Affect Cognition? An Updated Systematic Review (2013-2020). Curr Nutr Rep 2021; 10:376-390. [PMID: 34595721 DOI: 10.1007/s13668-021-00370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this review was to provide an update on the literature examining how voluntary, temporary abstention from eating impacts cognitive function. RECENT FINDINGS We evaluated peer-reviewed articles published between August 2013 and January 2021 that assessed adults, included a measure of cognitive functioning with neutral stimuli, and compared individuals in a fasted state to individuals in a fed state (either within- or between-subject designs). Nineteen articles (21 studies) met inclusion criteria. Sample sizes, fasting methods, and tasks varied across studies. Review of studies indicated that fasting was associated with deficits in cognitive functioning; few studies indicated a benefit in cognitive functioning following a single voluntary fast. The heterogeneity and rarity of available studies limits the conclusions that can be drawn. Several crucial psychosocial and sociodemographic moderators remain unexplored. Recommendations for future work are discussed.
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Affiliation(s)
| | - Amanda Makara
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Eleanor Benner
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - C Alix Timko
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- University of Pennsylvania, Philadelphia, PA, USA.
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Birosová E, Siegfried L, Kmet'ová M, Makara A, Ostró A, Gresová A, Urdzík P, Liptáková A, Molokácová M, Bártl R, Valanský L. Detection of virulence factors in alpha-haemolytic Escherichia coli strains isolated from various clinical materials. Clin Microbiol Infect 2004; 10:569-73. [PMID: 15191387 DOI: 10.1111/j.1469-0691.2004.00922.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In total, 201 alpha-haemolytic Escherichia coli isolates from various clinical materials (urine samples and vaginal and rectal swabs) were examined by PCR for the presence of genes for the virulence factors alpha-haemolysin (hly), cytotoxic necrotising factor type 1 (cnf1), P-fimbriae (pap), S/F1C-fimbriae (sfa/foc), aerobactin (aer) and afimbrial adhesin (afaI). Among vaginal isolates, 96% were positive for cnf1, compared with 80% of urine strains (p 0.02) and 63% of rectal strains (p 0.0001). Similarly, sfa/foc-specific DNA sequences were found in 97% of vaginal isolates compared with 75% of rectal strains (p 0.004). The afa1 and aer genes were associated more with rectal alpha-haemolytic E. coli strains than with extra-intestinal isolates. The results suggested that CNF1 and/or S/F1C-fimbriae contribute to colonisation and persistence of alpha-haemolytic E. coli strains in the vaginal environment.
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Affiliation(s)
- E Birosová
- Institute of Medical Microbiology, School of Medicine, P J Safárik University, Kosice, Slovakia.
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Sedová A, Posluch J, Makara A. [Urological symptoms and findings in the uterine myoma (author's transl)]. Cesk Gynekol 1975; 40:338-9. [PMID: 1137871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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