Anorexia nervosa and bulimia nervosa: sibling sex ratio and birth rank--a catchment area study

Clinical profile of children and adolescents diagnosed with anorexia nervosa in Indian context

OBJECTIVE

This study was conducted to assess the trends observed in the prevalence pattern, clinical presentation, psychosocial profile and treatment profile of anorexia nervosa in children and adolescents who presented to a tertiary care child and adolescent psychiatry centre over a period of ten years.

METHODS

Case records of children and adolescents diagnosed with anorexia nervosa at the department of child and adolescent psychiatry from 1st April 2009-31 st March 2019 were obtained from the medical records department of the National Institute of Mental Health and Neurosciences (NIMHANS). Standardized data abstraction forms were developed and used for the purpose of this study. Pseudo-anonymization was done to ensure confidentiality and clinical characteristics of the sample were studied using frequency analysis and central tendencies.

RESULTS

Prevalence of anorexia nervosa in a clinic-based population is estimated to be 0.07% over the 10-year period. The mean age at presentation was 13.96 years (SD-2.3) and the male to female ratio was 1:12. The majority (80.8%) were admitted and only one patient (3.8%) received treatment on an outpatient basis. Two or more psychosocial stressors were associated with the onset of illness in 88.5% (n = 23) of the patients and dysfunctional family dynamics was noted to be a significant issue in the majority of cases. All the patients received pharmacotherapy and CBT-based individual therapy. The overall outcome was favourable based on the CGI-I scores.

CONCLUSIONS

Prevalence of anorexia nervosa in the clinic-based setting is rising in the Indian context. Sample characteristics are similar to those seen in the west. There is a huge demand-supply gap that calls for creating a service provider network to ensure community-based care.

Do disordered eating behaviours in girls vary by school characteristics? A UK cohort study

Previous research on eating disorders, disordered eating behaviours, and whether their prevalence varies across schools, has produced inconsistent results. Our previous work using Swedish record-linkage data found that rates of diagnosed eating disorders vary between schools, with higher proportions of girls and higher proportions of highly educated parents within a school being associated with greater numbers of diagnosed eating disorders. We aimed to extend these findings to a UK population-based sample and hypothesised that a similar association would be evident when studying disordered eating behaviours. We used data from the Avon Longitudinal Study of Parents and Children to test the hypothesis that prevalence of self- and parent-reported disordered eating behaviours (binge eating, purging, fasting, restrictive eating, and fear of weight gain), and body dissatisfaction cluster by school. We had complete data on body dissatisfaction, school attended, and other possible risk factors for 2146 girls in 263 schools at age 14 and on disordered eating behaviours for 1769 girls in 273 schools at age 16. We used multilevel logistic regression modelling to assess whether prevalence varied between and within schools, and logistic regression to investigate the association between specific school characteristics and prevalence of disordered eating behaviours and body dissatisfaction. At age 14, there was no evidence for body dissatisfaction clustering by school, or for specific school characteristics being associated with body dissatisfaction. At age 16, there was no evidence for clustering, but higher rates of disordered eating behaviours were associated with attending all-girl schools and lower levels with attending schools with higher academic results. We found no evidence for clustering of disordered eating behaviours in individual schools, possibly because of the small cluster sizes. However, we found evidence for higher levels of disordered eating behaviours in 16 years in all-girl schools, and in schools with lower academic performance.

Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort

OBJECTIVE

We investigated whether parental eating disorders (ED) predict ED in children, using a large multigeneration register-based sample.

METHOD

We used a subset of the Stockholm Youth Cohort born 1984-1995 and resident in Stockholm County in 2001-2007 (N = 286,232), The exposure was a diagnosed eating disorder in a parent; the outcome was any eating disorder diagnosis in their offspring, given by a specialist clinician, or inferred from an appointment at a specialist eating disorder clinic. A final study sample of 158,697 (55.4%) had data on these variables and confounding factors and contributed a total of 886,241 person years to the analysis.

RESULTS

We found good evidence in support of the hypothesis that ED in either parent are independently associated with ED in their female children (HR 1.97 (95% CI: 1.17-3.33), P = 0.01) and that ED in mothers are independently associated with ED in their female children (HR 2.35 (95% CI: 1.39-3.97) P = 0.001). Numbers were too low to permit separate analysis of ED in parents and their male children.

CONCLUSION

Eating disorders in parents were associated with ED in children. This study adds to our knowledge about the intergenerational transmission of ED, which will help identify high-risk groups and brings about the possibility of targeted prevention.

Parental mental illness and eating disorders in offspring

OBJECTIVE

To investigate which parental mental illnesses are associated with eating disorders in their offspring.

METHOD

We used data from a record-linkage cohort study of 158,679 children aged 12-24 years at the end of follow-up, resident in Stockholm County from 2001 to 2007, to investigate whether different parental mental illnesses are risk factors for eating disorders in their offspring. The outcome measure was diagnosis of any eating disorder, either from an ICD or DSM-IV code, or inferred from an appointment at a specialist eating disorder clinic.

RESULTS

Mental illness in parents is a risk factor for eating disorders in female offspring (Adjusted Hazard Ratio (AHR) 1.57 (95% CI 1.42, 1.92), p < 0.0001). Risk of eating disorders is increased if there is a parental diagnosis of bipolar affective disorder (AHR 2.28 (95% CI 1.39, 3.72), p = 0.004), personality disorder (AHR 1.57 (95% CI 1.01, 2.44), p = 0.043) or anxiety/depression (AHR 1.57 (95% CI 1.32, 1.86), p < 0.0001). There is a lack of statistical evidence for an association with parental schizophrenia (AHR 1.41 (95% CI 0.96, 2.07), p = 0.08), and somatoform disorder (AHR 1.25 (95% CI 0.74, 2.13), p = 0.40). There is no support for a relationship between parental substance misuse and eating disorders in children (AHR 1.08 (95% CI 0.82, 1.43), p = 0.57).

DISCUSSION

Parental mental illness, specifically parental anxiety, depression, bipolar affective disorder, and personality disorders, are risk factors for eating disorders in their offspring.

We are family--parents, siblings, and eating disorders in a prospective total-population study of 250,000 Swedish males and females

OBJECTIVE

We examined how parental characteristics and other aspects of family background were associated with the development of eating disorders (ED) in males and females.

METHOD

We used register data and record linkage to create the prospective, total-population study the Stockholm Youth Cohort. This cohort comprises all children and adolescents who were ever residents in Stockholm County between 2001 and 2007, plus their parents and siblings. Individuals born between 1984 and 1995 (N = 249, 884) were followed up for ED from age 12 to end of 2007. We used Cox regression modeling to investigate how ED incidence was associated with family socioeconomic position, parental age, and family composition.

RESULTS

In total, 3,251 cases of ED (2,971 females; 280 males) were recorded. Higher parental education independently predicted a higher rate of ED in females [e.g., adjusted hazard ratio (HR) 1.69 (95% CI: 1.42, 2.02) for degree-level vs. elementary-level maternal education], but not in males [HR 0.73 (95% CI: 0.42, 1.28), p < 0.001 for gender interaction]. In females, an increasing number of full-siblings was associated with lower rate of ED [e.g., fully adjusted HR 0.92 (95% CI: 0.88, 0.97) per sibling], whereas an increasing number of half-siblings was associated with a higher rate [HR 1.05 (95% CI: 1.01, 1.09) per sibling].

DISCUSSION

The effect of parental education on ED rate varies between males and females, whereas the effect of number of siblings varies according to whether they are full or half-siblings. A deeper understanding of these associations and their underlying mechanisms may provide etiological insights and inform the design of preventive interventions.

Anorexia nervosa, autoimmunity and the hygiene hypothesis

The hypothesis proposed is that anorexia nervosa (AN) is an autoimmune disease caused by delayed exposure to common micro-organisms in which auto-antibodies to regulatory peptides and hypothalamic neurons, which cross react with microbial antigens, disturb appetite and lead to decreased intake of food. IgG, IgA and IgM auto-antibodies to a range of regulatory peptides concerned with appetite and mood are found in patients with AN. The regulatory peptides show sequence homology with common micro-organisms of the microbial flora. Auto-antibodies to α melanocyte stimulating hormone (αMSH) are positively correlated with AN psychopathology. But patients with bulimia nervosa (BN) and normal healthy controls also have a similar range of auto-antibodies at comparable levels. The incidence of AN is rising in developed countries, the disease is more common in females than in males, the peak incidence is in the teenage years, there is seasonal variation in the month of birth and the disease is more common in higher socio-economic groups. These are all features which are consistent with the hygiene hypothesis. But there is no evidence that the disease is more common in first born than in later born children. There is a paucity of data on early life events such as attendance at nursery and exposure to pets. Genetic factors are important but the data on major histocompatibility complex (MHC) gene polymorphisms are contradictory. The epidemiological and serological data are consistent with the hypothesis under investigation but key questions in relation to the hygiene hypothesis have not been posed. A large case control study of AN epidemiology is indicated. MHC gene polymorphisms should be assessed. There is, however, sufficient evidence to justify a trial of pooled immunoglobulin therapy in patients with life threatening AN.

Age of onset has limited association with body mass index at time of presentation for anorexia nervosa: comparison of peak-onset and late-onset anorexia nervosa groups

The clinical characteristics differentiating late-onset anorexia nervosa (AN) from typical pubertal onset AN remain unclear. The purpose of the present study was to examine these differences in a retrospective analysis. A total of 149 female AN patients was divided into two groups: a peak-onset AN group (n = 125) in which onset occurred between the ages of 15 and 24 years, and a late-onset AN group (n = 24) in which onset occurred at the age of > or =25 years. A logistic regression analysis was conducted with this classification as the target variable and five clinical factors as explanatory variables for the clinical characteristics at the time of initial examination. Body mass index (BMI) at the time of presentation was identified as a possible factor affecting classification as peak-onset or late-onset AN. In addition, a negative linear correlation was detected between age of onset and BMI at the time of initial examination. The results suggest that BMI at the time of the initial examination is an important clinical characteristic to differentiate peak-onset AN and late-onset AN.

Perceived body size and desire for thinness of young Japanese women: a population-based survey

The present study describes findings in relation to perceived body size and 'desire for thinness' by age and residential areas ('metropolitan areas', 'large cities', 'small cities' and 'towns') among young Japanese women. Data on 1731 non-pregnant, non-lactating women aged 15-39 years from the 1998 National Nutrition Survey of Japan were used. Current body size was evaluated by BMI percentiles (lean, <5th; underweight, 5th or = BMI <25th; normal, 25th< or = BMI< 75th; overweight, 75th < or =BMI <95th; obese, > or =95th), calculated for 5-year age groups. Perceived body size was obtained by self-report. We defined 'overestimation' as non-overweight, non-obese women who perceived themselves as being 'overweight' or 'obese'. Desired body size was evaluated by applying the desired BMI to these cut-off points. Of all the women, 48.4% perceived themselves as being 'overweight' or 'obese', and 43.7% desired a 'lean' or 'underweight' body size. Adjusted for the current BMI, the OR for 'overestimation' calculated by a logistic regression model was significantly elevated in the 15-19-year age group (OR 2.79; 95% CI 1.76, 4.43), compared with the 25-29-year age group. The OR for 'desire for thinness' was significantly high in the 35-39-year age group (OR 2.74; 95% CI 1.93, 3.89) and the 15-19-year age group (OR 2.26; 95% CI 1.57, 3.24). Women living in metropolitan areas had higher OR for 'desire for thinness' (but not for 'overestimation') than did women in towns (OR 1.47; 95% CI 1.05, 2.07). The findings suggest the nature of excessive weight concerns of young women in Japan; thus efforts to control such health-risk behaviours at a national level are urgent.

A case-control study of family composition in anorexia nervosa

OBJECTIVES

The family compositions of patients with anorexia nervosa may inform consideration of the etiology of the disorder, and previous studies in this area have had methodologic weaknesses which we sought to address in a case-control design.

METHODS

The family composition of 259 females with anorexia nervosa was compared with that of 200 control subjects. Birth order and numbers of brothers and sisters were compared in unmatched and matched analyses using both univariate and multivariate statistical techniques.

RESULTS

In both the unpaired univariate and the matched conditional logistic regression analyses, the anorexic females were both significantly later in the birth order and had significantly fewer brothers than control subjects.

DISCUSSION

Although it is possible that these findings were affected by response bias among control subjects, it is more likely that they are informative with regard to the etiology of anorexia nervosa. Possible etiologic links are discussed in relation to biologic, family, and sociocultural factors.