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Valeriani B, Pruccoli J, Chiavarino F, Petio ML, Parmeggiani A. Nutritional Assessment of Children and Adolescents with Atypical Anorexia Nervosa: A Preliminary Longitudinal Investigation Using the 24-h Dietary Recall. CHILDREN (BASEL, SWITZERLAND) 2024; 11:427. [PMID: 38671643 PMCID: PMC11048974 DOI: 10.3390/children11040427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/18/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Atypical Anorexia Nervosa (AAN) is a Feeding and Eating Disorder characterized by fear of gaining weight and body image disturbance, in the absence of significantly low body weight. AAN may present specific clinical and psychopathological features. Nonetheless, the literature lacks data concerning the nutritional characteristics and body composition of children and adolescents with AAN and their variation over time. METHODS Case series, including 17 children and adolescents with AAN. All the patients were assessed at the first evaluation (T0) with a standardized dietary assessment (24 h Dietary Recall, 24 hDR). Nutritional data were compared with European dietary reference values (DRVs). Body composition parameters (weight, fat mass, fat-free mass) and their changes over time at two (T1) and six (T2) months were collected as well, using a Bioelectrical impedance analysis (Wunder WBA300 with four poles and foot contact; impedance frequency 50 kHz 500 μA; impedance measurement range 200~1000 Ω/0.1 Ω). RESULTS The included individuals presented eating behaviors oriented towards significantly low daily energy intake (p < 0.001) compared with DRVs set by the European Food Safety Authority (EFSA) (with low carbohydrates and fats), and increased proteins (p < 0.001). A longer latency before observation (illness duration before observation) correlated with a negative change in weight. Body composition parameters were described, with no significant changes across the six-month outpatient assessment. DISCUSSION This is the first research to systematically assess the body composition and nutritional features of a group of individuals with AAN in the developmental age. Further research should assess the effect of targeted treatment interventions on body composition and nutritional features.
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Affiliation(s)
- Beatrice Valeriani
- IRCCS-Azienda Ospedaliero-Universitaria Di Bologna, Clinical Nutrition and Metabolism Unit, 40138 Bologna, Italy;
| | - Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, Child Neurology and Psychiatry Unit, 40138 Bologna, Italy; (J.P.); (F.C.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Francesca Chiavarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, Child Neurology and Psychiatry Unit, 40138 Bologna, Italy; (J.P.); (F.C.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Maria Letizia Petio
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Antonia Parmeggiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, Child Neurology and Psychiatry Unit, 40138 Bologna, Italy; (J.P.); (F.C.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
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Bachner-Melman R, Rom R, Lev-Ari L, Shachar-Lavie I, Krispin O, Tolmacz R. Relational attitudes in adolescent girls with and without a diagnosis of anorexia nervosa or atypical anorexia nervosa. J Eat Disord 2023; 11:166. [PMID: 37737193 PMCID: PMC10515418 DOI: 10.1186/s40337-023-00896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/19/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN). METHODS Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology. RESULTS Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology. CONCLUSIONS Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.
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Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel.
- School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Roni Rom
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Iris Shachar-Lavie
- Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Orit Krispin
- Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Rami Tolmacz
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
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Feferkorn I, Badeghiesh A, Baghlaf H, Dahan MH. Pregnancy outcomes in women with anorexia nervosa: a population-based study and analysis of a matched cohort. Reprod Biomed Online 2023; 46:588-596. [PMID: 36681554 DOI: 10.1016/j.rbmo.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
RESEARCH QUESTION What implications does anorexia nervosa have on pregnancy outcomes in a US population? DESIGN A retrospective, population-based study using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A dataset of all deliveries between 2004 and 2014 inclusively was created. The population was divided into women with anorexia nervosa (n = 214) and women without anorexia nervosa (n = 9,096,574), and a cohort matched 1:4 with anorexia nervosa for age, race, medical insurance type and income quartile. Delivery and neonatal outcomes were compared between the two matched groups and with the control group of deliveries. A multivariable logistic regression analysis, controlling for statistically significant baseline characteristics, explored associations between anorexia nervosa and delivery, and neonatal outcomes. RESULTS Compared with the entire group, women diagnosed with anorexia nervosa were more likely to be white, smokers, of higher income or diagnosed with another psychiatric disorder. In the unmatched comparison, women with anorexia nervosa had a higher frequency of preterm delivery (adjusted odds ratio [aOR] 2.98 CI 1.86 to 4.76, P < 0.001), placental abruption (aOR 3.41 CI 1.38 to 8.40, P = 0.008) and small for gestational age (SGA) neonates (aOR 5.32 CI 3.12 to 9.09, P < 0.001). In the matched comparison, preterm delivery (aOR 5.31, CI 3.02 to 9.32, P < 0.001) and SGA neonates were significantly higher in the anorexia nervosa group (aOR 4.69 CI 2.6 to 8.41, P < 0.001), providing results similar to the unmatched comparison. CONCLUSION Healthcare providers, specifically fertility specialists, should be aware of the magnitude of adverse outcomes related to pregnancy in women with anorexia nervosa.
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Affiliation(s)
- Ido Feferkorn
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Montreal, QC, Canada.
| | - Ahmad Badeghiesh
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Montreal, QC, Canada
| | - Haitham Baghlaf
- Maternal-Fetal Medicine Division, Obstetrics and Gynecology, University of Tabuk, Tabuk, Saudi Arabia
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Montreal, QC, Canada
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Burton Murray H, Staller K. When Food Moves From Friend to Foe: Why Avoidant/Restrictive Food Intake Matters in Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2022; 20:1223-1225. [PMID: 34555522 DOI: 10.1016/j.cgh.2021.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Helen Burton Murray
- Harvard Medical School, Boston, Massachusetts; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle Staller
- Harvard Medical School, Boston, Massachusetts; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
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Frostad S, Bentz M. Anorexia nervosa: Outpatient treatment and medical management. World J Psychiatry 2022; 12:558-579. [PMID: 35582333 PMCID: PMC9048449 DOI: 10.5498/wjp.v12.i4.558] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/20/2021] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Anorexia nervosa (AN) is a disabling, costly and potentially deadly illness. Treatment failure and relapse are common after completing treatment, and a substantial proportion of patients develop severe and enduring AN. The time from AN debut to the treatment initiation is normally unreasonably long. Over the past 20 years there has been empirical support for the efficacy of several treatments for AN. Moreover, outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients. Early intervention improves outcomes and should be a priority for all patients. Outpatient treatment is usually the best format for early intervention, and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable. Inpatient care is more disruptive, more costly, and usually has a longer waiting list than does outpatient care. The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult. The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN. The scientific essentials for outpatient treatment are described, including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated. The following aspects are discussed: early intervention, outpatient treatment of AN, including outpatient psychotherapy for severe and extreme AN, how to determine when outpatient treatment is safe, and when transfer to inpatient healthcare is indicated. Emerging treatments, ethical issues and outstanding research questions are also addressed.
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Affiliation(s)
- Stein Frostad
- Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen 5021, Norway
| | - Mette Bentz
- Child and Adolescent Mental Health Centre, Capital Region of Denmark, University of Copenhagen, Copenhagen 2400, Denmark
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Accurso EC, Mu KJ, Landsverk J, Guydish J. Adaptation to family-based treatment for Medicaid-insured youth with anorexia nervosa in publicly-funded settings: Protocol for a mixed methods implementation scale-out pilot study. J Eat Disord 2021; 9:99. [PMID: 34389052 PMCID: PMC8360814 DOI: 10.1186/s40337-021-00454-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Family-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth. Adapting FBT may facilitate "scale-out" for Medicaid-insured youth served in publicly-funded settings and potentially improve outcomes for more diverse populations. METHODS This mixed methods effectiveness-implementation Hybrid Type 3 pilot study protocol included a planning period in collaboration with the San Francisco Department of Public Health, culminating in a two-day in-person FBT training for 25 therapists in the county, followed by the opportunity to engage in one year of weekly supervision. The training incorporated FBT adaptations intended to improve fit for low-income families within community-based settings. Treatment appropriateness and acceptability will be measured immediately post-training. Following the training, cases referred for FBT will only be assigned to the trained clinicians who voluntarily opted into long-term group supervision. Clinicians treating at least one FBT case during the supervision period will report on implementation, adaptations, and patient weight gain. Finally, semi-structured interviews with clinician participants will be conducted, focused on implementation challenges and facilitators, local treatment adaptations, and overall satisfaction with FBT. DISCUSSION Learning about clinician adaptations will advance knowledge about treatment of eating disorders in publicly-funded community clinics, which serve a racially/ethnically and socioeconomically diverse group of youth. This project is designed to accelerate FBT implementation in publicly-funded mental health systems, and inform service improvements for underserved youth with eating disorders.
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Affiliation(s)
- Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Karen J Mu
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,San Francisco Department of Public, Health Behavioral Health Services, San Francisco, CA, USA
| | | | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Medical Complications of Anorexia Nervosa. PSYCHOSOMATICS 2020; 61:625-631. [PMID: 32778424 DOI: 10.1016/j.psym.2020.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the medical complications of anorexia nervosa (AN) to enable a consult-liaison psychiatrist to be familiar with these complications when involved with the care of a hospitalized patient with AN. METHODS Comprehensive PubMed search of English language publications of adult patients with AN was carried out using keywords, phrases, and medical subject headings of anorexia nervosa-medical complications, cardiac, osteoporosis, gastrointestinal, hematological, and endocrine. The database search was restricted by time of publication of studies from 2005 to 2020. RESULTS Every organ system can be adversely affected by AN. Most are fully reversible with time and informed medical care. A multidisciplinary team is needed to optimally care for patients who are hospitalized as a result of the medical complications of their AN. CONCLUSIONS Consult-liaison psychiatrists are asked to help in the care of patients with AN who are admitted to a hospital because of a medical complication of their illness. Being familiar with these complications and their treatments will optimize their hospital stays and the care provided. In addition, involving other relevant ancillary services is an important care consideration.
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