Proposal for increasing diagnostic clarity in research and clinical practice by renaming and reframing atypical anorexia nervosa as "Restrictive Eating Disorder" (RED)

Atypical anorexia nervosa (AAN) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is characterized by meeting all criteria for anorexia nervosa (AN) except for weight being within or above the "normal" range despite significant weight loss. The current definition is plagued by several problems, resulting in widely heterogeneous operationalizations in research and clinical practice. As such, the poorly defined diagnosis of AAN negatively impacts affected individuals and frustrates research attempts to better understand the syndrome. We consider conceptual flaws in the AAN description and contend that the undefined weight range and nature of weight loss renders these two factors functionally inapplicable in research and practice. They also represent a departure from the originally intended use of the AAN category, i.e., arresting a negative weight trajectory likely to result in AN, making the target population, and the application of the label, unclear. We propose revised criteria and a new name, restrictive eating disorder (RED), intended to reduce stigma and encompass a wide but better-defined range of presentations. The RED criteria focus on clinically significant restrictive behavior that disrupts normal living (i.e., impairment), and cognitive symptoms of overevaluation, disturbed experience, and lack of recognition of illness seriousness. We believe that RED may enable more appropriate clinical application, but also inspire coordinated research toward a more valid psychiatric nosology in the eating disorders field.

Weight increase in people with cystic fibrosis on CFTR modulator therapy is mainly due to increase in fat mass

Background: Ivacaftor, the first CFTR modulator drug, leads to significant long-term improvement in lung function and weight gain. The mechanism as well as the long-term impact of ivacaftor on weight, resting energy expenditure (REE) and body composition remains to be explored. Methods: This prospective observational study included 18 people with CF (pwCF) (age: median (range) 20 (6-58) years) carrying at least one CFTR gating mutation commencing ivacaftor. Assessments of body composition, REE and laboratory investigations were performed at baseline and 6, 12 and 24 months after treatment initiation. Results: Treatment with ivacaftor was associated with a significantly positive change in BMI z-score at 24 months. Fat mass (mean (95% CL) of 6.5 kg (4.0; 9.0) from baseline, p = 0.0001), but not fat-free mass changed under ivacaftor treatment. There was a significant positive correlation between weight and fat mass change. Overall, there was no significant change in measured REE from baseline (mean (95% CL) of 108 kcal/d (-12; 228), p = 0.07) in our cohort. Pancreatic function and other nutritional markers did not change with treatment, with the exception of an increase in serum vitamin A levels (p = 0.006). Conclusion: The weight gain observed in ivacaftor treated pwCF is predominantly secondary to increases in fat mass warranting early counseling of people starting on CFTR-modulating treatment with respect to healthy diet and physical exercise.

Association between body fat percentage and H-type hypertension in postmenopausal women

Background

Previous studies have explored the relationship between body fat percentage (BFP) and hypertension or homocysteine. However, evidence on the constancy of the association remains inconclusive in postmenopausal women. The aim of this study was to investigate the association between BFP and H-type hypertension in postmenopausal women.

Methods

This cross-sectional study included 1,597 eligible female patients with hypertension. Homocysteine levels ≥10 mmol/L were defined as H-type hypertension. BFP was calculated by measuring patients' physical parameters. Subjects were divided into 4 groups according to quartiles of BFP (Q1: 33.4% or lower, Q2: 33.4–36.1%, Q3: 36.1–39.1%, Q4: >39.1%). We used restricted cubic spline regression models and logistic regression analysis to assess the relationship between BFP and H-type hypertension. Additional subgroup analysis was performed for this study.

Results

Among 1,597 hypertensive patients, 955 (59.8%) participants had H-type hypertension. There were significant differences between the two groups in age, BMI, educational background, marital status, exercise status, drinking history, WC, TG, LDL, Scr, BUN, and eGFR (P < 0.05). The prevalence of H-type hypertension in the Q1 to Q4 groups was 24.9, 25.1, 24.9, and 25.1%, respectively. After adjusting for relevant factors, we found that the risk of H-type hypertension in the Q4 group had a significantly higher than the Q1 group (OR = 3.2, 95% CI: 1.3–7.5).

Conclusion

BFP was positively associated with the risk of H-type hypertension in postmenopausal women. Postmenopausal women should control body fat to prevent hypertension.

The Correlation of Total Percent Fat With Alterations in Cholesterol and Triglycerides in Adults

Background

To evaluate the detailed relationship between total percent fat (TPF) and cardiovascular disease (CVD)-related lipid biomarkers among adults and find a non-invasive indicator for screening and monitoring of the high CVD risk population.

Methods

Data of 13,160 adults were obtained from the National Health and Examination Survey (NHANES) from 1999 to 2018. TPF was assessed by dual-energy x-ray absorptiometry (DXA), and CVD-related lipid biomarkers included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Multivariable linear regression models were used to examine associations between TPF with four kinds of lipid biomarkers, and smooth curve fittings and generalized additive models were used to address the non-linear relationship between them. The inflection points were calculated by the recursive algorithm when non-linearities were detected and then weighted two-piecewise linear regression models were constructed.

Results

In multivariable regression, increasing TPF was positively associated with TC, TG, and LDL-C and negatively with HDL-C (all p < 0.001). In addition, the non-linear relationships between them were also identified by generalized additive models and smooth curve fittings. When further stratified TPF by sex, the fitted smooth curves were nearly inverted U-shaped and U-shaped curves, the inflection points were calculated, and the weighted two-piecewise linear regression models were constructed, respectively. The same results existed between android percent fat and these four lipid biomarkers.

Conclusions

Total percent fat was significantly associated with CVD-related lipid biomarkers in adults, positively with TC, TG, and LDL-C and negatively with HDL-C. It could be used as a non-invasive screener and monitor of high CVD risk population when their TPF values were less than the inflection points.

Fat percentage cutoff values to define obesity and prevalence of sarcopenic obesity in community-dwelling older adults in Turkey

PURPOSE

Sarcopenic-obesity (SO) is associated with low-functional-status and mortality. Few studies evaluated the definition and prevalence of SO. We aimed to investigate the fat-percentage cut-off values for obesity and prevalences of obesity, SO in community-dwelling older adults in Turkey.

METHODS

Body-composition was measured using bioimpedance-analysis. Sarcopenia was defined by European-Working-Group-on-Sarcopenia-in-Older-People criteria. Obesity was defined by two different methods, a fat-percentile above 60th percentile (Zoico-method) or a BMI of ≥30 kg/m² (WHO-definition).

RESULTS

We enrolled 992 subjects (308 men, 684 women). Body fat-percentage thresholds for obesity were 27.3% for men and 40.7% for women according to Zoico-method. The rates of obesity were about 40% in both genders by Zoico-method; 29.2% versus 53.7% for men and women by WHO definition. Prevalences-of-sarcopenia was 3.1% versus 0.4%; SO was 0.3% versus 0.1% when obesity was assessed with Zoico-method in men and women, respectively. No case of SO was defined when obesity was assessed using WHO-definition.

CONCLUSION

The threshold for obesity definition according to Zoico-method was similar to other European-populations. While obesity-prevalences were considerably high, SO prevalences were low but comparable to other populations. This low-prevalence seems to be due to underestimation of sarcopenia in obese subjects when skeletal-muscle-mass was adjusted by height² to recognize low-muscle-mass.

Exploring Physical Self-Perceptions Among Survivors of Adolescent and Young Adult Cancer

This study explored the factor structure of four subscales from the Physical Self-Description Questionnaire-Short Form (PSDQ-S). Associations between subscales and personal and medical factors were also examined. The analytic sample consisted of 89 survivors of adolescent and young adult cancer (M_{age at time of study} = 32.96 ± 4.37 years; M_{age at diagnosis} = 31.16 ± 4.84 years; 75.3% female). Confirmatory factor analysis suggested a reasonable fit to the data, indicating that the PSDQ-S subscales examined could be used in future investigations with this population [χ²(38) = 46.9, p = 0.15; Root Mean Square Error of Approximation = 0.05, 90% confidence interval = 0-0.10; Comparative Fit Index = 0.97; Standardized Root Mean Square of the Residuals = 0.07]. Multiple linear regressions showed that personal and medical factors accounted for a significant amount of variance in the body fat subscale, with female sex and higher body mass index being significantly associated with lower positive perceptions about the amount of one's body fat. More research examining the factor structure of the PSDQ-S subscales is warranted, and future investigations exploring personal, medical, and modifiable factors associated with physical self-perceptions should be conducted.