Swedish population reference standards for height, weight and body mass index attained at 6 to 16 years (girls) or 19 years (boys)

Functional connectivity underlying hedonic response to food in female adolescents with atypical AN: the role of somatosensory and salience networks

Atypical anorexia nervosa (AN) usually occurs during adolescence. Patients are often in the normal-weight range at diagnosis; however, they often present with signs of medical complications and severe restraint over eating, body dissatisfaction, and low self-esteem. We investigated functional circuitry underlying the hedonic response in 28 female adolescent patients diagnosed with atypical AN and 33 healthy controls. Participants were shown images of food with high (HC) or low (LC) caloric content in alternating blocks during functional MRI. The HC > LC contrast was calculated. Based on the previous literature on full-threshold AN, we hypothesized that patients would exhibit increased connectivity in areas involved in sensory processing and bottom-up responses, coupled to increased connectivity from areas related to top-down inhibitory control, compared with controls. Patients showed increased connectivity in pathways related to multimodal somatosensory processing and memory retrieval. The connectivity was on the other hand decreased in patients in salience and attentional networks, and in a wide cerebello-occipital network. Our study was the first investigation of food-related neural response in atypical AN. Our findings support higher somatosensory processing in patients in response to HC food images compared with controls, however HC food was less efficient than LC food in engaging patients' bottom-up salient responses, and was not associated with connectivity increases in inhibitory control regions. These findings suggest that the psychopathological mechanisms underlying food restriction in atypical AN differ from full-threshold AN. Elucidating the mechanisms underlying the development and maintenance of eating behavior in atypical AN might help designing specific treatment strategies.

Reduced resting-state connectivity in areas involved in processing of face-related social cues in female adolescents with atypical anorexia nervosa

Atypical anorexia nervosa (AN) has a high incidence in adolescents and can result in significant morbidity and mortality. Neuroimaging could improve our knowledge regarding the pathogenesis of eating disorders (EDs), however research on adolescents with EDs is limited. To date no neuroimaging studies have been conducted to investigate brain functional connectivity in atypical AN. We investigated resting-state functional connectivity using 3 T MRI in 22 drug-naïve adolescent patients with atypical AN, and 24 healthy controls. Psychological traits related to the ED and depressive symptoms have been assessed using the Eating Disorders Examination Questionnaire (EDE-Q) and the Montgomery-Åsberg Depression Rating Scale self-reported (MADRS-S) respectively. Reduced connectivity was found in patients in brain areas involved in face-processing and social cognition, such as the left putamen, the left occipital fusiform gyrus, and specific cerebellar lobules. The connectivity was, on the other hand, increased in patients compared with controls from the right inferior temporal gyrus to the superior parietal lobule and superior lateral occipital cortex. These areas are involved in multimodal stimuli integration, social rejection and anxiety. Patients scored higher on the EDE-Q and MADRS-S questionnaires, and the MADRS-S correlated with connectivity from the right inferior temporal gyrus to the superior parietal lobule in patients. Our findings point toward a role for an altered development of socio-emotional skills in the pathogenesis of atypical AN. Nonetheless, longitudinal studies will be needed to assess whether these connectivity alterations might be a neural marker of the pathology.

Changes and predictive value for treatment outcome of the compulsive exercise test (CET) during a family-based intervention for adolescents eating disorders

Background

The aim of this study was to explore changes in the Compulsive Exercise Test (CET) following a family-based intervention in adolescents with restrictive eating disorders (ED). It was hypothesized that compulsive exercise would improve with successful intervention against the ED but also that a high level of compulsive exercise at presentation would be associated with a less favourable outcome.

Method

The CET, the Eating Disorders Examination-Questionnaire (EDE-Q), and body mass index were available for 170 adolescents at presentation and at a one-year follow-up. Treatment was a family-based intervention and included that all exercise was stopped at start of treatment. Recovery was defined as EDE-Q score < 2.0 or absence of an ED at an interview.

Results

Exercise for weight control and for avoiding low mood, which are related to ED cognitions, decreased in recovered patients. Exercise for improving mood did not change in either recovered or not recovered patients. The CET subscale scores at presentation did not independently predict recovery.

Conclusion

Compulsive exercise is one of several ED related behaviours which needs to be targeted at the start of treatment. With successful treatment it decreases in parallel with other ED related cognitions and behaviours but without a loss of the ability to enjoy exercise.

Insulin resistance and lung function in obese asthmatic pre-pubertal children

BACKGROUND

Recent findings have supposed that the underlying association between the increased prevalence of both asthma and obesity may be insulin resistance (IR).

METHODS

Insulin and glucose serum levels were analyzed to calculate the homeostatic model assessment of insulin resistance (HOMA-IR) for IR in 98 pre-pubertal children. Lung function and allergy status evaluation were performed. The study population was divided into four groups: (1) obese asthmatic children (ObA); (2) normal-weight asthmatic children (NwA); (3) normal-weight non-asthmatic children (Nw) and (4) obese non-asthmatic children (Ob).

RESULTS

Forced expiratory volume in 1 s (FEV1) was slightly lower in obese subjects compared with normal-weight subjects and forced vital capacity (FVC) appeared lower in asthmatics, whereas between non-asthmatics subjects, it was lower in the obese group than in the normal-weight one. The post hoc analysis revealed a statistically significant reduction in FEV1, peak expiratory flow (PEF), forced expiratory flows (FEF) between 50% and 25% of the FVC (FEF50 and FEF25) between ObA and Nw and in FEV1, FVC, PEF, FEF50 and FEF25 between NwA and Nw, but no statistically significant differences of lung function parameters were observed between ObA and NwA. We found an inverse relationship between HOMA-IR and all spirometric parameters, although without any statistical significance. We also observed a significantly lower FVC in insulin-resistant children (HOMA-IR>95th percentile) (p=0.03).

CONCLUSIONS

This study suggests that lung function could be early altered in obese children, already in pre-pubertal age. Although IR should not manifest its effects on lungs in pre-pubertal obese children, the prevention or treatment of obesity in the pre-pubertal period may prevent definitive negative effects on lungs.

Low weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission

AIM

This study examined predictors of emergency hospitalisation of adolescent girls with restrictive eating disorders and weight loss treated by a family-based intervention programme.

METHODS

We studied 339 girls aged 10-17 years treated in a specialist unit at Uppsala University Children's Hospital, Sweden, from August 2010 to December 2015. Historical weight data were obtained from school health services, and other weight data were determined at presentation. Weight controlling behaviour was recorded, and patients were evaluated using the Eating Disorder Examination Questionnaire. A family-based intervention started after assessment and the early weight gain after one week, one month and three months was assessed.

RESULTS

There were 17 emergency admissions of 15 patients for refusing food, progressive weight loss and medical instability. Logistic regression analysis showed that emergency admissions were predicted by a low body mass index standard deviation score at presentation (odds ratio 2.57), a high rate of weight loss before presentation (odds ratio 4.38) and a low rate of weight gain at the start of treatment (odds ratio 4.59).

CONCLUSION

Poor weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission.

Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome

BACKGROUND

Family-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. We have investigated the one-year outcome of a family-based intervention programme with defined and decisive interventions at the start of treatment.

METHOD

Data pertaining 201 adolescents with restrictive ED with features of anorexia nervosa but not fulfilling the weight criterion starting treatment 2010-2015, had a wide range of body mass index (BMI) and of weight loss at presentation, and completed a one-year follow-up was analysed. Recovery from the ED was defined as an Eating Disorder Examination-questionnaire (EDE-Q) score < 2.0 or as not fulfilling criteria for an ED at a clinical interview.

RESULTS

By EDE-Q 130 (65%) had recovered at 1 year and by clinical interview 106 (53%). According to the EDE-Q criterion recovery was independently associated with lower EDE-Q score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current BMI. Not fulfilling criteria for an ED was associated with the same factors and also by higher BMI at presentation.

CONCLUSION

The observations that low weight and high ED cognitions confer a poor prognosis but that rapid weight gain at the start of treatment predicts a better prognosis are presently extended to adolescents with restrictive ED with a wide range of BMI at presentation. High weight suppression at follow-up is associated with a poor prognosis and indicates the importance of taking premorbid BMI into account when setting weight targets for treatment.

Using different growth references to measure thinness and overweight among Swedish primary school children showed considerable variations

AIM

The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.

METHODS

The height and weight measurements of 4518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight was calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.

RESULTS

Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5% to 16.9% for the boys and 6.9% to 13.7% for the girls, while the prevalence of overweight, including obesity and severe obesity, varied from 16.5% to 25.7% for the boys and 18.2 to 25.2% for the girls. There were also significant gender differences depending on the growth reference we used.

CONCLUSION

Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references.

Influence of premorbid BMI on clinical characteristics at presentation of adolescent girls with eating disorders

BACKGROUND

Considering the prevalence of obesity in society it can be expected that some adolescents with an eating disorder (ED) start weight loss from an overweight and present at a near-normal weight. Presently, the influence of premorbid BMI on clinical characteristics of adolescent girls presenting with an ED has ben studied.

METHOD

Premorbid growth charts were available for 275 postmenarcheal adolescent girls presenting with an ED (anorexia nervosa = 27, (subthreshold) bulimia nervosa = 9, restrictive EDNOS = 239). Initial assessment included measurement of weight and length, physical examination, blood sampling and administration of the Eating Disorder Examination-Questionnaire youth version (EDE-Q).

RESULTS

Despite greater weight loss girls with a high premorbid body mass index (BMI) had a higher BMI at presentation compared to those with a lower premorbid BMI. Although not underweight some presented with clinical and laboratory signs of starvation. These signs were related to not only low BMI but also to rapid and large weight loss. Their EDE-Q scores did not differ from those of girls who presented with an underweight.

CONCLUSION

Girls with a restrictive ED and premorbid overweight may present with a near-normal BMI. They can nevertheless be medically compromised and have eating disturbed cognitions at the level of underweight girls. They should not be regarded as having a less severe ED but merit full assessment and a start of treatment.

Plasma cholesterol is related to menstrual status in adolescent girls with eating disorders and weight loss

AIM

This study examined the relationship between plasma cholesterol and circulating triiodothyronine and oestradiol in 561 adolescent girls aged 11-17 with eating disorders.

METHODS

Plasma total cholesterol, high-density lipoprotein cholesterol, serum triodothyronine and oestradiol were measured at assessment, and historical weight data were obtained from growth charts provided by the school health services. Cholesterol levels were related to weight change, menstrual status and serum hormones.

RESULTS

Plasma total cholesterol levels of >5.0 mmol/L were found in 38% of the 77 girls who were premenarcheal, 32% of the 199 with secondary amenorrhoea and 17% of those who were still menstruating. These cholesterol levels were inversely related to serum oestradiol and triiodothyronine concentrations, but not weight change, in amenorrhoic girls and were positively related to body mass index and inversely related to weight loss and serum triiodothyronine in girls who were still menstruating.

CONCLUSION

Increased plasma total cholesterol was related to amenorrhoea in adolescent girls with eating disorders and weight loss. Oestrogens appeared to mediate the effect of starvation on cholesterol, most effectively in premenarcheal girls. Re-establishing menstruation is an important goal in the treatment of eating disorders, to avoid dyslipidaemia and the risk of future cardiovascular disease.

Evaluation of the Compulsive Exercise Test (CET) in Adolescents with Eating Disorders: Factor Structure and Relation to Eating Disordered Psychopathology

OBJECTIVE

The aims of this study were to explore the factor structure of the Compulsive Exercise Test (CET) in a clinical sample of Swedish adolescents with eating disorders (ED) and to study the relationship of CET with ED cognitions, body weight and exercise frequency.

METHODS

The compulsive Exercise Test, the Eating Disorders Examination-Questionnaire, body mass index (BMI) and exercise frequency were available at assessment of 210 adolescents (age 14.4 ± 1.6 years) with ED.

RESULTS

Factor analysis generated four factors with close similarity to factors previously obtained in a community sample of adolescents samples and supported the use of the original version of CET. Exercise for weight control was strongly related to ED cognitions but less to exercise frequency and BMI. Exercise for regulation of mood was related to ED cognitions and exercise frequency but not to BMI.

DISCUSSION

In adolescents with ED, different aspects of exercise are related to ED cognitions. This needs addressing in the treatment of adolescents with ED. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Favorable effects of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating disorders

OBJECTIVE

To study the effect of clearly defined and decisive parental interventions at the start of treatment of restrictive eating disorders (ED) in adolescents.

METHOD

Forty-seven adolescents with ED (anorexia nervosa = 6, bulimia nervosa = 1, EDNOS = 40) and their families participated. Parents were advised to (1) keep the adolescent home from school, (2) eat all meals together with the adolescent, (3) prevent any form of exercise, and (4) prevent vomiting during the first week of treatment. Weight change was followed up to three months and EDE-Q administered at start of treatment and at three months.

RESULTS

Thirty (64%) of the families accomplished all four interventions during the first week of treatment. Their adolescents gained ∼ 1 kg of weight at one week, 2 kg at one month, and 4 kg at three months while adolescents in families who did not accomplish all four interventions gained only 1.4 kg up to three months. Scores on the EDE-Q decreased during treatment and in adolescents of families who accomplished all four interventions they were in the range of a reference population.

DISCUSSION

Decisive parental management of eating disturbed behaviors at the start of treatment of adolescents with ED promotes later clinical outcome. The finding supports the view that family based therapies are effective in adolescent ED. Results has to be followed up for evaluation of the long term effects of this type of intervention.

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.

A comparison of clinical characteristics between adolescent males and females with eating disorders

BACKGROUND

Eating disorders (ED) are serious disorders that have a negative impact on both the psychological and the physiological well-being of the afflicted. Despite the fact that ED affect both genders, males are often underrepresented in research and when included the sample sizes are often too small for separate analyses. Consequently we have an unclear and sometimes contradictory picture of the clinical characteristics of males with ED. The aim of the present study was to improve our understanding of the clinical features of adolescent males with eating disorders.

METHODS

We compared age at presentation, weight at presentation, history of significantly different premorbid weight and psychiatric (Attention Deficit Hyperactivity Disorder (ADHD)) and somatic comorbidity (celiac disease and diabetes) of 58 males to 606 females seeking medical care for eating disorders at the Children's Hospital in Uppsala, Sweden during the years 1999-2012. As all boys were diagnosed with either AN or Other Specified Feeding or Eating Disorder (OSFED) atypical AN, the age and weight comparisons were limited to those girls fulfilling the diagnostic criteria for AN or OSFED atypical AN.

RESULTS

There was no significant difference in age at presentation. Differences in weight at presentation and premorbid weight history were mixed. A significantly higher percentage of males had a history of a BMI greater than two standard deviations above the mean for their corresponding age group. As well, there was a higher prevalence of ADHD among the males whereas celiac disease and diabetes only was found among the females.

CONCLUSIONS

A better understanding of the clinical characteristics of males with ED at presentation should improve our ability to identify males with ED and thereby aid in tailoring the best treatment alternatives.

Bone metabolism in adolescent girls with eating disorders and weight loss: independent effects of weight change, insulin-like growth factor-1 and oestradiol

Adolescents with eating disorders (ED) are at risk of developing osteoporosis if weight is not recovered. Previous investigations do not separate the effects of weight change per se from those of concomitant hormonal changes. In this investigation serum osteocalcin (OC), C-terminal telopeptide of collagen (CTX), insulin-like growth factor-1 (IGF-1) and oestradiol were measured at assessment of 498 girls with ED and during weight gain of 59 girls. At assessment, OC concentrations were associated independently with weight (change), IGF-1 and oestradiol. Low weight, a high rate of weight loss and the hormone concentrations were associated with low OC. Low weight and high rate of weight loss were associated with high CTX concentrations but there were no associations independent of weight (change) with the hormones. During weight recovery, OC and CTX were independently and positively associated with weight, weight gain, IGF-1 and oestradiol. Bone metabolism markers are related to weight change independently of IGF-1 and oestradiol during both weight loss and weight gain. During weight gain, when pubertal development and growth are resumed there is an additional independent positive association between the markers and IGF-1 and oestradiol. These relationships are strongest in premenarcheal girls.

Z-score reference values for height in Turkish children aged 6 to 18 years

OBJECTIVE

Standard deviation score or Z-score reference charts are used in some countries in preference to percentile charts and are considered as better tools in assessing children with measurements outside the accepted limits of normality. Growth data for Istanbul children have previously been reported as percentiles; hence, the aim of this study is to present these data in Z-score reference tables. Data on secular trend in height in Turkish children will also be presented.

METHODS

Height and weight data based on a total of 11 664 height and 11 655 weight measurements in 1100 boys and 1020 girls between 6 and 18 years of age obtained by biannual visits to schools were analyzed. All children came from well-to-do families and were all healthy. All measurements were made by two trained technicians. The LMS method was used in the analyses. The results were expressed as Z-score values for age.

RESULTS

Heights of the boys and girls in all age groups were close to the updated USA growth references and showed an upward trend from previous data on Turkish children.

CONCLUSIONS

Height growth in Turkish school-age children of high socioeconomic level conforms to the updated growth data for USA children and also shows a secular trend. The data also point to the importance of updating local growth data periodically.

Pediatric Crohn's disease from onset to adulthood: granulomas are associated with an early need for immunomodulation

OBJECTIVE

Childhood onset Crohn's disease (CD) is considered more aggressive than adult onset disease. Epithelioid cell granulomas in intestinal biopsies are one, non-obligate, criterion of CD. We investigated granulomas as markers of CD severity in children followed to adulthood.

MATERIAL AND METHODS

Forty-five individuals with childhood onset CD were studied from diagnosis until attainment of final height, with data on disease location, medical and surgical management and with detailed growth data analyses. A blinded review of diagnostic biopsies was also performed.

RESULTS

We found granulomas in 22/45 (49%) children at diagnosis, altogether in 28/45 (62%) patients during the disease course (median overall follow-up - 12.3 years, range 9.3-18). Granulomas were found in 9/11 (82%) with upper gastrointestinal involvement (cumulatively 17/20, 85%) (p = 0.017 and p = 0.006, respectively). The time from diagnosis to initiating immune modulating treatment (median 4.5 months, range 0-75) was shorter in the granuloma-positive group (16/22) compared to the granuloma-negative group (18/23) (median 33 months, range 2-105; p = 0.01). The median standard deviation score height at diagnosis and final adult height (both adjusted for target height) did not correlate to findings of granulomas.

CONCLUSIONS

Epithelioid cell granulomas were associated with a shorter time to initiating immune modulating drugs, as a possible sign of more severe disease, but growth was not affected.

Methodologies to assess paediatric adiposity

INTRODUCTION

Childhood obesity is associated with increased risk of adult obesity, cardiovascular disease, diabetes and cancer. Appropriate techniques for assessment of childhood adiposity are required to identify children at risk. The aim of this review was to examine core clinical measurements and more technical tools to assess paediatric adiposity.

METHODS

The online databases PubMed, CINALH and EMBASE were searched and the abstracts identified were reviewed to determine appropriate studies. Their reference lists were also searched to identify further eligible studies. Publications were included if they described childhood measurement techniques or involved validation.

RESULTS AND DISCUSSION

There are many body composition assessment tools available, none of which are direct. Each technique has limitations and a combination of methods may be used. The main clinical techniques are weight, height, body mass index (BMI) and circumferences which provide sufficient information to enable classification of overweight or obesity when growth centile charts and ratios are employed. Further investigation depends on resources available and examiner skill. Skinfold thicknesses are cost-effective but require technical training and only measure subcutaneous fat. Dual energy X-ray absorptiometry (DEXA), air displacement plethysmography (ADP), magnetic resonance imaging (MRI) and computed tomography (CT) are more costly and intensive, requiring the child to remain still for longer periods. DEXA and ADP are capable of accurately measuring adiposity but are unable to distinguish between fat depots. MRI and CT can distinguish intra-abdominal from subcutaneous adiposity and are considered gold standards, but CT is unsuitable for adiposity measurement in children due to high levels of radiation exposure. Ultrasound is a promising technique capable of measuring intra-abdominal adiposity in children but requires further validation.

CONCLUSION

The core clinical measurements of weight, height, BMI and circumferences are sufficient to enable diagnosis of paediatric overweight and obesity while more technical tools provide further insight.

Poor catch-up growth in late adolescent boys with eating disorders, weight loss and stunting of growth

OBJECTIVE

The study aims to investigate the catch-up growth of boys presenting with an eating disorder (ED) and a stunting of growth.

METHOD

Weight gain and growth of 46 boys with ED were followed up for 1-3 years.

RESULTS

A total of 13 boys who had not started their pubertal growth spurt at presentation started catch-up growth immediately following nutritional rehabilitation and weight gain. After 3 years, they had returned to their premorbid growth curve. Thirty-three boys who had started their pubertal growth spurt prior to presentation never caught up in height but continued to catch down despite weight gain. After 3 years, they had lost 0.64 ± 0.55 height standard deviation scores corresponding to approximately 4.5 cm of potential height.

CONCLUSIONS

In prepubertal boys with EDs, catch-up growth is possible. Pubertal boys are at a disadvantage in that catch-up growth may not occur despite weight gain.

Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child

BACKGROUND

A routine pediatric clinical assessment of body composition is increasingly recommended but has long been hampered by the following 2 factors: a lack of appropriate techniques and a lack of reference data with which to interpret individual measurements. Several techniques have become available, but reference data are needed.

OBJECTIVE

We aimed to provide body-composition reference data for use in clinical practice and research.

DESIGN

Body composition was measured by using a gold standard 4-component model, along with various widely used reference and bedside methods, in a large, representative sample of British children aged from 4 to ≥20 y. Measurements were made of anthropometric variables (weight, height, 4 skinfold thicknesses, and waist girth), dual-energy X-ray absorptiometry, body density, bioelectrical impedance, and total body water, and 4-component fat and fat-free masses were calculated. Reference charts and SD scores (SDSs) were constructed for each outcome by using the lambda-mu-sigma method. The same outcomes were generated for the fat-free mass index and fat mass index.

RESULTS

Body-composition growth charts and SDSs for 5-20 y were based on a final sample of 533 individuals. Correlations between SDSs by using different techniques were ≥0.68 for adiposity outcomes and ≥0.80 for fat-free mass outcomes.

CONCLUSIONS

These comprehensive reference data for pediatric body composition can be used across a variety of techniques. Together with advances in measurement technologies, the data should greatly enhance the ability of clinicians to assess and monitor body composition in routine clinical practice and should facilitate the use of body-composition measurements in research studies.

Bone metabolism markers in adolescent girls with eating disorders and weight loss: effects of growth, weight trend, developmental and menstrual status

Serum concentrations of osteocalcin (OC) decrease and those of C-terminal telopeptide of type 1 collagen (CTX) increase during weight loss in adolescent girls with eating disorders (ED). The impact of weight loss on bone metabolism markers is greatest in premenarcheal girls.

INTRODUCTION

Adolescents with ED stand a risk of not reaching optimal peak bone mass and develop osteoporosis. Previous investigations are contradictory as to how markers of bone formation and resorption change during weight loss and nutritional rehabilitation.

METHODS

Serum OC and CTX were measured at assessment of 461 adolescent girls with ED and during treatment of 55 girls with anorexia nervosa. Bone metabolism was related to weight, weight change and growth rate.

RESULTS

At assessment, OC concentrations were positively correlated with growth rate and inversely with age and (rate of) weight loss. Growth rate was the only predictor of CTX concentrations in premenarcheal girls. In postmenarcheal girls, CTX concentrations were inversely correlated with age and rate of weight loss. During weight gain, there was an increase of OC concentrations. CTX concentrations decreased at the onset of weight gain and increased when near normal weight was reached.

CONCLUSIONS

Bone formation markers decrease and resorption markers increase during weight loss. The effects are independent of menstrual status but the impact on bone formation markers is greater in young, premenarcheal girls. Markers are normalised during weight gain but it is conceivable that repeated and/or prolonged weight loss in adolescents reduces peak bone mass.

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.

Growth in Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency

Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is an inborn error of fatty acid metabolism that affects the degradation of long chain fatty acids and causes insufficient energy production and accumulation of toxic intermediates. The treatment consists of a diet low in fat, with supplementation of medium-chain triglycerides that bypass the metabolic block. In addition, frequent feeds and extra carbohydrates are given during febrile illnesses to reduce lipolysis. Hence, this diet differs from the general dietary recommendations for growing children. Furthermore, the Swedish dietary instructions for fat intake in LCHAD deficiency are given in grams, which differ from most guidelines that recommend fat intake as percentage shares of total caloric intake.

AIMS

To assess growth in patients with LCHAD deficiency, in relation to dietary treatment and to evaluate if overweight/obesity is more common than in the normal population.

RESULTS

The growth velocity showed acceleration after diagnosis and the start of treatment, followed by a period of stable or decelerated growth. The majority of the patients developed overweight to a greater extent than children without LCHAD deficiency. Several patients also went through a phase of obesity. Data on final height (FH) showed that three out of five patients had grown according to their genetic potential.

CONCLUSIONS

Regular and frequent follow-up and careful monitoring of weight are essential to avoid the development of overweight and obesity. The Swedish dietary instructions defining fat intake in total grams per day may be an alternative approach to achieve a moderate total caloric intake.

Post-term birth is associated with greater risk of obesity in adolescent males

OBJECTIVE

To test the hypothesise that post-term birth (>42 weeks gestation) adversely affects longitudinal growth and weight gain throughout childhood.

STUDY DESIGN

A total of 525 children (including 17 boys and 20 girls born post-term) were followed from birth to age 16 years. Weight and height were recorded prospectively throughout childhood, and respective velocities from birth to end of puberty were calculated using a mathematical model.

RESULTS

At birth, post-term girls were slimmer than term girls (ponderal index, 27.7 ± 2.6 kg/m(3) vs 26.3 ± 2.8 kg/m(3); P<.05). At age 16 years, post-term boys were 11.8 kg heavier than term subjects (body mass index [BMI], 25.4 ± 5.5 kg/m(2) vs 21.7 ± 3.1 kg/m(2); P<.01). The rate of obesity was 29% in post-term boys and 7% in term boys (P<.01), and the combined rate of overweight and obesity was 47% in post-term boys and 13% in term boys (P<.01). Weight velocity, but not height velocity, was higher in post-term boys at age 1.5-7 years (P<.05) and again at age 11.5-16 years (P<.05). BMI was higher in post-term boys at age 3 years, with the difference increasing thereafter. BMI and growth were similar in post-term and term girls.

CONCLUSION

In this post-term birth cohort, boys, but not girls, demonstrated accelerated weight gain during childhood, leading to greater risk of obesity in adolescence.

Harmonizing national growth references for multi-centre surveys, drug monitoring and international postmarketing surveillance

AIM

National European growth references differ. We aimed to convert (harmonize) currently used charts into a single unified interchangeable LMS format for each European nation.

METHODS

Nine currently used national European growth references from Belgium (2009), France (1979), Poland (2001), Sweden (2002), Switzerland (1989), the UK (1990), Italy (2006) and Germany (1979 and 1997) were harmonized and compared with the international WHO child growth standards and WHO growth reference data for 5-19 years.

RESULTS

European growth charts can be harmonized. The approach appears useful as height, and body mass index (BMI) is inappropriately represented by WHO references. European height references exhibit warping when plotted against the WHO reference. The French appears too short, the other Europeans too tall. Also, the BMI is not appropriately represented by the WHO references.

CONCLUSIONS

Harmonizing references is a novel, convenient and cost-effective approach for converting historic and/or incomplete local or national growth reference charts into a unified interchangeable LMS format. Harmonizing facilitates producing growth references 'on demand', for limited regional purposes, for ethnically, socio-economically or politically defined minorities, but also for matching geographically different groups of children and adolescents for international growth and registry studies.

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.

Family climate and recovery in adolescent onset eating disorders: a prospective study

OBJECTIVE

This prospective study investigated the self-assessed family climate of adolescent patients and their parents during treatment of and recovery from eating disorders.

METHOD

One hundred two girls aged 13-17 years with eating disorders, answered the self-report Family Climate Scale (FCS) and Eating Disorders Inventory for Children at initial assessment and after 18 and 36 months. The FCS was also answered by their parents at the same time points.

RESULTS

Self-assessed family climate and eating disorder symptoms were similar for recovered (R) and nonrecovered (NR) adolescents at initial assessment and at 18 months. At 36 months, FCS Closeness was higher for R, and FCS Distance was lower for R compared with NR. Parents of R adolescents had higher scores on FCS Closeness and lower scores on FCS Chaos compared with parents of NR adolescents at the 36-month follow-up.

CONCLUSION

Self-reported family climate was associated with recovery. Changes in eating disorder symptoms preceded changes in family climate.

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.

The reciprocal influences of asthma and obesity on lung function testing, AHR, and airway inflammation in prepubertal children

Although asthma and obesity are among the major chronic disorders their reciprocal or independent influences on lung function testing, airways hyperresponsiveness (AHR) and bronchial inflammation has not been completely elucidated. In 118 pre-pubertal Caucasian children anthropometric measurements functional respiratory parameters (flow/volume curves at baseline and after 6-minute walk test [6MWT]) together with bronchial inflammatory index (FeNO) were assessed. The study population was divided into four groups according to BMI and the presence or absence of asthma: Obese asthmatic (ObA) Normal-weight asthmatic (NwA), Obese non-asthmatic (Ob), non-asthmatic normal-weight children (Nw). Baseline PEF and MEF(75) (%-expected) were significantly different across the four groups with significantly lower values of MEF(75) in ObA and Ob children when compared to Nw children (P = 0.004 and P = .0001, respectively) and this independent role of obesity on upper respiratory flows was confirmed by multiple analysis of covariance. After 6 MWT respiratory parameters decreased only in ObA and NwA children and 12 children presented a positive fall in FEV(1), in contrast no changes of respiratory function testing were detected in Ob and Nw children, and only 2 Ob children presented a significant fall in FEV(1). FeNO analysis demonstrated significantly higher values in ObA and NwA children when compared to Ob (P = 0.008 and P = 0.0002, respectively) and Nw children (P = 0.0001 and P = 0.0003, respectively), although a significant difference was found between Ob and Nw children (P = 0.0004). Multiple analysis of covariance confirmed an independent role of asthma on this parameter. In conclusion while AHR and airway inflammation are clearly associated with an asthmatic status, obesity seems to induce reduction of upper airways flows associated with a certain degree of pro-inflammatory changes.

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.

Body mass index percentiles for children and adolescents in Germany based on a nationally representative sample (KiGGS 2003-2006)

OBJECTIVE

To present body mass index (BMI) percentiles representative for children in Germany and to compare them with the currently used percentiles by Kromeyer-Hauschild (KH) and international percentiles of the World Health Organisation (WHO) and the International Obesity Task Force (IOTF).

METHODS

Representative examination survey of 17 641 children and adolescents aged 0-17 years living in Germany (KiGGS 2003-2006 study, response rate 67%) with standardized measurement of height and weight.

RESULTS

Generally, BMI in KiGGS was higher than in the reference populations from previous decades. KiGGS shows an asymmetric upward shift of the BMI distribution from about age 6 years and an earlier adiposity rebound compared with KH. The BMI peak in the first year of life is shown by KiGGS and WHO, but much less by KH. The cut-offs for overweight and obesity determined with the IOTF methodology in KiGGS (percentiles corresponding to BMI 25 and 30 kg/m(2) at 18 years of age) were similar to IOTF cut-offs from age 18 to 10 years but systematically lower for younger children.

CONCLUSIONS

The KiGGS BMI percentiles appear more valid for Germany than present alternatives and should be used for population monitoring. Despite their methodological limitations, the general shape of the older German KH references is confirmed by KiGGS for the ages 2-17 years. In order not to obscure the increase in obesity rates in the last decades, we therefore propose to continue using KH for individual diagnosis and estimation of the prevalence of overweight and obesity in this age range.

Improved treatment satisfaction but no difference in metabolic control when using continuous subcutaneous insulin infusion vs. multiple daily injections in children at onset of type 1 diabetes mellitus

OBJECTIVE

The aim of this study was to compare safety, metabolic control, and treatment satisfaction in children/adolescents at onset of type 1 diabetes mellitus who were treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI).

RESEARCH DESIGN AND METHODS

Seventy-two children/adolescents (7-17 yr of age) were enrolled in this open, randomized, parallel, multicenter study. Approximately half of the patients were treated with MDI (natural protamine hagedorn [NPH] insulin twice daily and rapid-acting insulin three to -four times daily, n = 38) by pen, and the other half received CSII (n = 34). The patients were followed for 24 months with clinical visits at the entry of the study and after 1, 6, 12, and 24 months. During these visits, hemoglobin A1c, insulin doses, weight, and height were registered. Severe episodes of hypoglycemia and ketoacidosis as well as technical problems were recorded. In addition, the patients/parents answered the Diabetes Treatment Satisfaction Questionnaire.

RESULTS

There was no significant difference in metabolic control between the treatment groups. Treatment satisfaction was significantly higher in the group treated with CSII compared with the MDI group (p <or= 0.01 at all screening visits). There were no episodes of ketoacidosis and there was no significant difference regarding severe hypoglycemia between the treatment groups.

CONCLUSIONS

CSII treatment proved to be a safe therapy in children/adolescents followed for 24 months after onset of their diabetes. Treatment satisfaction was higher in the CSII group, although there was no difference in metabolic control compared with the MDI group.

Cardiovascular risk factors in overweight and obese Chinese children: a comparison of weight-for-height index and BMI as the screening criterion

BACKGROUND

Childhood obesity is a widespread and growing problem in the world. Body mass index (BMI) and weight-for-height criterion have been used to determine childhood obesity. No data was available to evaluate cardiovascular risk factors in overweight and obese Chinese children screened by weight-for-height index and Chinese newly developed BMI criterion.

AIM OF THE STUDY

To evaluate cardiovascular risk factors in overweight and obese Chinese children by using Chinese BMI and weight-for-height index as screening criterion.

METHODS

A total of 215 children aged 7.5-13 years were recruited from 3 primary schools in Guangzhou, PR China. Measurements included body weight, height, waist and hip circumference, fasting serum glucose, insulin, total triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A (apo A), apolipoprotein B (apo B). Chinese BMI and weight-for- height criterion were used to classify overweight and obesity.

RESULTS

According to Chinese BMI criterion, 65 from 108 obese children originally identified by weight-for-height were reclassified as obese and other 41 children were classified as overweight. Compared with non-obese children, obese children screened by Chinese BMI and weight-for-height index had increased levels of TG, LDL-C, apo B, insulin; decreased levels of HDL-C, apo A; and significantly higher prevalence of hypertriglyceridemia and high LDL-C. Children identified as overweight by Chinese BMI criterion had also shown high TG, LDL-C, apo B, insulin levels, low HDL-C, apo A levels, and significantly higher prevalence of hypertriglyceridemia than the normal weight children.

CONCLUSIONS

Our study reveals that overweight and/or obesity screened by both Chinese new BMI and weight-for-height criterion are associated with increased levels of cardiovascular risk factors (e.g., elevated serum TG, LDL, apo B, and reduced HDL-C, apo A levels). Using Chinese BMI criterion may underestimate the prevalence of childhood obesity but it could be adopted as a unique tool for screening children's overweight in population-based screening programs.

Weight and growth requirements for menarche in teenage girls with eating disorders, weight loss and primary amenorrhea

BACKGROUND/AIM

To investigate weight and growth requirements for menarche in girls with eating disorders (ED), weight loss and primary amenorrhea.

METHODS

Growth charts from school health services and measurements of weight and stature throughout treatment were obtained for 47 such girls.

RESULTS

Weight loss started at an age of 12.4 +/- 1.6 years from a top weight of 41.7 +/- 7.1 kg. Approximately a year later they had lost 5.1 +/- 4.3 kg and grown only 2.8 +/- 3.5 cm. Following treatment and weight gain, growth accelerated and the girls reached a peak growth velocity of 4.3 +/- 2.6 cm/year 2 years before menarche which occurred at an age of 15.5 +/- 1.6 years at a weight of 52.2 +/- 5.3 kg. Menarche occurred within a wide range of weights but could be predicted by a linear regression on prepubertal weight (R(2) = 0.39; p < 0.001).

CONCLUSIONS

Following treatment, girls with ED and primary amenorrhea progress through puberty at a slowed rate. The weight required for menarche can be predicted by the prepubertal weight which may represent the individual's normal growth track unaffected by the ED.

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.

Dietary intake among under-, normal- and overweight 9- and 15-year-old Estonian and Swedish schoolchildren

OBJECTIVES

To determine the differences in macronutrient and food group contribution to total food and energy intakes between Estonian and Swedish under-, normal- and overweight schoolchildren, and to estimate the association between diet and body mass index (BMI).

DESIGN

Cross-sectional comparison between Estonian and Swedish children and adolescents of different BMI groups.

SETTING

Twenty-five schools from one region in Estonia and 42 in two regions of central Sweden.

SUBJECTS

In total 2308 participants (1176 from Estonia and 1132 from Sweden), including 1141 children with a mean age of 9.6 +/- 0.5 years and 1167 adolescents with a mean age of 15.5 +/- 0.6 years.

RESULTS

Overweight was more prevalent among younger girls in Sweden (17.0 vs. 8.9%) and underweight among girls of both age groups in Estonia (7.9 vs. 3.5% in younger and 10.5 vs. 5.1% in older age group of girls). Compared with that of normal- and underweight peers, the diet of overweight Estonian children contained more energy as fat (36.8 vs. 31.7%) but less as carbohydrates, and they consumed more milk and meat products. Absolute BMI of Estonian participants was associated positively with energy consumption from eggs and negatively with energy consumption from sweets and sugar. Swedish overweight adolescents tended to consume more energy from protein and milk products. Risk of being overweight was positively associated with total energy intake and energy from fish or meat products. In both countries the association of overweight and biological factors (pubertal maturation, parental BMI) was stronger than with diet.

CONCLUSION

The finding that differences in dietary intake between under-, normal- and overweight schoolchildren are country-specific suggests that local dietary habits should be considered in intervention projects addressing overweight.

Limitations of the current world health organization growth references for children and adolescents

Since the 1970s, the World Health Organization (WHO) has recommended the use of the growth references developed by the United States National Center for Health Statistics (NCHS) based on national survey data collected in the 1960s and 1970s. These references are known as the WHO or NCHS/WHO growth references. Over the past three decades, the WHO or NCHS/WHO growth references have played an important role internationally in the assessment of child and adolescent growth and nutritional status. However, the references have a number of weaknesses. The limitations of the infant portion of the references were thoroughly assessed in WHO's effort to develop a new international growth reference for infants and preschool children. The present report discusses the limitations of the NCHS/WHO references for school-aged children and adolescents, including a number of conceptual, methodological, and practical problems. The global obesity epidemic poses another challenge that the NCHS/WHO reference cannot appropriately meet. There is a need for a single international reference to assess the nutritional status and growth of school-aged children and adolescents across different countries.

Haematological changes and iron status in teenage girls with eating disorders and weight loss-the importance of menstrual status

AIM

To study haematological changes and iron stores in teenage girls with eating disorders and weight loss.

METHODS

Blood haemoglobin concentration, white blood cell and thrombocyte count and serum ferritin concentration were measured at assessments of 446 subjects.

RESULTS

Haemoglobin concentrations, leukocyte and thrombocyte counts were related to weight and rate of weight loss but were largely within reference ranges. Serum ferritin concentrations were high in girls with amenorrhea and related to weight and rate of weight loss. Girls who retained menstruations had low serum ferritin concentrations and 37% had depleted iron stores (serum ferritin<16 microg/L).

CONCLUSION

Anaemia, leukopenia and thrombocytopenia are uncommon in teenage girls with eating disorders and weight loss. When present, other diseases causing haematological changes should be considered. In amenorrhoic girls muscle catabolism increases serum ferritin concentrations which may give a false impression of an adequate iron status. This is unmasked in girls with retained menstruations who often have depleted iron stores.

Nutritional state of Polish prepubertal children assessed by population-specific and international standards

OBJECTIVE

To assess the frequency of obesity, overweight and underweight (thinness) in Polish 7-9-year-old children using a population specific definition as compared to the French, US and IOTF references based on body mass index (BMI).

DESIGN

Height and weight were measured and BMI was calculated in a randomly selected representative sample of 7-9-year-old Polish children (N = 2916; 1445 girls; 1471 boys) to define their nutritional status. Overweight (including obesity) was estimated according to four and underweight (thinness) according to three definitions Polish national references; French references; United States references and International Obesity Task Force references.

RESULTS

According to Polish, French, U.S. and IOTF references overweight (including obesity) was found in 12.1, 14.3, 20.7 and 15.4% of children, respectively; 3.5, 9.4 and 3.6% of children were obese according to national, U.S. and IOTF references, respectively while underweight (thinness) was present in 6.9, 2.6 and 4.2% of children according to Polish, French and U.S. references, respectively. A trend of decreasing overweight and increasing underweight through age classes was observed.

CONCLUSION

The rates of underweight (thinness), overweight and obesity in Polish 7-9-year-old children calculated according to the national, French, U.S. and IOTF references were significantly different. Therefore even if the IOTF reference is considered superior for international epidemiological studies, population specific standards should probably coexist for clinical practice.

Prevalence of overweight and obesity in school-aged children

PURPOSE

Childhood obesity is a public health concern in Canada. Few published anthropometric data are available to indicate obesity prevalence in Canadian children. Obesity prevalence is reported for school-aged children in 11 London, Ontario, schools.

METHODS

Data on body weight and height were obtained using standardized procedures. United States Centers for Disease Control and Prevention (CDC) body mass index (BMI)-for-age references and Cole's international BMI reference were used to classify the children's weight categories.

RESULTS

The study included 1,570 pupils aged six to 13. The CDC BMI references categorized 16.6% and 11.8% of children as overweight and obese, respectively. In comparison, when the Cole BMI reference and cut-off points were used, 17.5% and 7.6% of children were classified as overweight and obese, respectively.

CONCLUSION

Overweight is prevalent in the study population. Public health interventions are warranted to curb the obesity epidemic in school-aged children.

Perceptions of gender ideals predict outcome of eating disorders in adolescent girls

Clinical features have low predictive value for the outcome of eating disorders. This study focuses on the possible predictive value of gender ideals. Data was from adolescent girls thoroughly assessed both at presentation and at a three-year follow up. Few variables differed between the outcome groups. However, perceptions of gender ideals, as measured by the Three Questions of Ideals, were found to contribute to the prediction of outcome. A discriminant analysis showed that gender ideals, maturity fears, sexual debut, and vomiting were significant discriminators in a set of factors, which correctly classified the outcome for 75.3% of the sample.

ExpoFacts--an overview of European exposure factors data

European exposure factor data have been collected in one centrally available, freely accessible site on the Internet: the ExpoFacts database (http://www.ktl.fi/expofacts/). The process of compiling the database required locating the exposure factor data and evaluating its general applicability and public availability. The scope of the ExpoFacts database covers 30 European countries, often each with its own approach for data generation and publication. The database includes information on food intake, time use, physiology, housing, and demographic parameters, as available. Information included in the database, as well as the challenges in collecting and compiling this information, are summarized. Data were found to be unavailable for ExpoFacts for a number of reasons: (1) data have not been collected, (2) collected data are not published, (3) the publishing format or language makes the data hard to locate and use, (4) copyright restrictions prevent presenting the data in an open access website, or (5) data exist, but are too expensive to acquire. Improving accessibility and harmonization of existing data would enhance the information base for exposure and risk assessments. In addition, the ExpoFacts project demonstrates a successful process for acquiring, storing, and sharing exposure factors data.

High prevalence of overweight and obesity in 11-15-year-old children from Sicily

BACKGROUND AND AIM

To evaluate the prevalence of overweight and obesity in children and adolescents from Sicily, we carried out a cross-sectional study in a large cohort of 48,897 (24,119 males and 24,778 females) randomly selected 11-15-year-old Sicilian schoolchildren.

METHODS AND RESULTS

Anthropometric data (weight and height) were obtained in all children. Urban vs. rural areas were taken into account. Centiles were obtained using the LMS method. Obesity and overweight prevalence were defined using as references both the values of the National Center for Disease Control (CDC 2000) in the United States and those of the International Obesity Task Force (IOTF). Median body mass index (BMI) values in Sicily were comparable to values observed in South and Center-North Italy. BMI cut-off values in Sicilian children were higher than reference values established in the U.S. CDC growth chart 2000. Using both the IOTF or the U.S. CDC 2000 cut-off values the prevalence of overweight and obesity in 11-15-year-old Sicilian children was very high: nearly 40% at age 11 and, although progressively decreasing with age increase, still over 25% at age 15.

CONCLUSIONS

The prevalence of overweight and obesity in 11-15-year-old Sicilian schoolchildren is one of the highest ever reported. The prevalence is much higher at a younger age; thereafter it progressively decreases and values tend to reconcile with those observed in other geographical areas at age 14-15.

Long-term clinical outcome in patients with congenital chloride diarrhea

OBJECTIVES

Congenital chloride diarrhea (CLD) is a rare, autosomal recessive disorder of intestinal Cl/HCO3 exchange caused by mutations in the SLC26A3 gene and characterized by persistent Cl rich diarrhea from birth. Treatment is symptomatic and replacement therapy with NaCl and KCl has been shown to be effective in children, but the long-term prognosis remains unclear. We studied the largest known cohort of patients to evaluate the long-term outcome of CLD and to search for extraintestinal manifestations.

METHODS

This is a cross-sectional clinical evaluation and retrospective analysis of medical history of 36 Finnish patients with CLD, born in the 1960s (n = 8), 1970s (n = 7) and 1980s (n = 21).

RESULTS

Early diagnosis and aggressive salt replacement therapy were associated with normal growth and development, in addition to significantly reduced mortality rates among the groups of patients born in the different decades, respectively (P = 0.001). No deaths due to CLD were observed after 1972. Enuresis, slight soiling and hospitalizations for gastroenteritis were common, especially in childhood, but 92% of the patients found their health excellent or good. Complications documented were end-stage renal disease (n = 1) and hyperuricemia (n = 4), novel findings possibly associated with CLD being male subfertility (n = 3), spermatoceles (n = 3), intestinal inflammation (n = 2), inguinal hernias (n = 4) and increased concentrations of sweat Cl in 12% of the patients.

CONCLUSIONS

When early diagnosed and adequately treated, the long-term prognosis of CLD is favorable. A putative role of a primary anion exchange defect of SLC26A3 in male subfertility and the decline of renal function due to chronic dehydration deserve further characterization.

Growth of Estonian seventeen-year-old boys during the last two centuries

Between 1811 and 2003, the mean height of 17-year-old Estonian boys increased 18.4 cm (0.97 cm per decade). The increase was 5.2 cm (0.7 cm per decade) between 1811 and 1886, 12.3 cm (2.2 cm per decade) between 1922 and 1978, and 0.5 cm per decade between 1978 and 2003. Between 1922 and 2003, mean height increased 8.2% and mean weight increased 27.2%. Between 1956 and 2003, biacromial (shoulder) breadth increased more than bicristal (hip) breadth; relative chest depth diminished; chest circumference and upper thigh circumference both increased. A multidimensional body structure model is constructed from 1998 to 2003 data.

Body mass index cutoffs for underweight, overweight, and obesity in South Korean schoolgirls

OBJECTIVES

To establish BMI percentiles and cutoffs for underweight, overweight, and obesity in South Korean schoolgirls.

RESEARCH METHODS AND PROCEDURES

A total of 1229 South Korean schoolgirls aged 8 to 18 years were randomly selected to complete a self-administered questionnaire. BMI charts and cutoffs were constructed after analyzing data from 1107 subjects. Percentile curves were established by the modified LMS method.

RESULTS

The percentiles for underweight, overweight, and obesity corresponding to BMI of 18.5, 23.0, and 25.0 kg/m2 at age 18 were the 13.0th percentile, the 77.8th percentile, and the 91.2nd percentile, respectively. The corresponding prevalences of underweight, overweight, and obesity were 12.1, 12.5, and 9.8%, respectively.

DISCUSSION

We established for the first time, to our knowledge, new BMI cutoffs for ages 8 to 18 that corresponded to BMIs of 18.5, 23.0, and 25.0 kg/m2 for Asian adults designated by the International Obesity Task Force. These newly established BMI cutoffs might help to estimate the prevalence of overweight and obesity in Asian children.

Medical assessment of adolescent girls with eating disorders: an evaluation of symptoms and signs of starvation

AIM

To investigate the prevalence of symptoms and signs related to starvation at the initial examination of adolescent girls with eating disorders (ED).

METHODS

Two hundred and eleven girls with eating disorders recruited for a multicentre research and evaluation programme of six specialist eating disorder services in Sweden have been studied. The presence or absence of 12 symptoms, reported by the patients, and 16 signs, observed by the examiners, were registered and related to body weight.

RESULTS

Eleven observed signs--loss of subcutaneous fat, loss of muscle mass, loss of muscular force, dry and scaly skin, brittle nails, dry and brittle hair, lanugo hair, resting pulse <60, systolic blood pressure <110, peripheral hypothermia, and peripheral cyanosis--were related to body weight expressed in standard deviation scores (SDS). When the number of observed signs for each patient was calculated, there was a strong relationship with weight. The odds ratio for having more than two signs was 4.35 (95% CI 2.67-7.04; p = 2.8 x 10(-9) for every one-unit change in weight SDS. Of the symptoms reported by the patients, only three were related to weight. When the number of reported symptoms for each patient was calculated, a relationship with weight was not observed.

CONCLUSION

In adolescent girls with ED, physical signs observed at medical examination can be related to weight. However, reported symptoms are poorly related to weight and may be influenced by other factors. The finding emphasizes the importance of medical assessment at presentation of patients with ED.