Adherence to a Mediterranean Diet, Body Composition and Energy Expenditure in Outpatients Adolescents Diagnosed with Anorexia Nervosa: A Pilot Study.

Weight restoration is the primary goal of treatment for patients with Anorexia Nervosa (AN). This observational pilot study aims to describe adherence to the Mediterranean Diet (MD) and the consequent process of weight and functional recovery in outpatient adolescents diagnosed with AN. Eight patients with a median age of 15.1 (14.0-17.1) years were seen at baseline and after six months. Anthropometrics, body composition, and resting energy expenditure (REE) were assessed. The KIDMED questionnaire, the 24 h recall, and a quantitative food frequency questionnaire were used to evaluate adherence to the MD. The median KIDMED score increased from 5.5 (T0) to 10 (T1), which was not significant. Intakes of grams of carbohydrates, lipids, mono-unsaturated fatty acids, and fiber increased (p = 0.012, p = 0.036, p = 0.036, p = 0.025). Weight significantly increased (p = 0.012) as well as lean body mass (p = 0.036), with a resulting improvement of the REE (p = 0.012). No association between anthropometrics and body composition and the KIDMED score was found. The MD could represent an optimal dietary pattern for weight gain and nutritional restoration in patients with AN, and it could lead to an improvement in body composition and resting energy expenditure.

Psychopathological Profile Associated with Food Addiction Symptoms in Adolescents with Eating Disorders.

Eating disorders are considered one of the psychiatric disorders with a higher risk of death. Food addiction, related to some food addictive-like behaviours, is often in comorbidity with eating disorders and is associated with worse psychopathology. The present study aims to outline the food addiction profile, investigated using the Yale Food Addiction Scale 2.0 (YFAS 2.0), in 122 adolescents (median age: 15.6 years) suffering from eating disorders and to investigate its association with psychopathology. Patients filled out the Youth Self Report, the Multidimensional Anxiety Scale for Children 2, The Children Depression Inventory 2, and the Eating Disorder Inventory 3 (EDI-3). Pearson's chi-square test and multiple correspondence analysis were used to identify profiles. The mean symptom count was 2.8 ± 2.7. The "withdrawal" symptom was the most frequent (51%) and the most associated with clinical scores. The diagnosis of bulimia nervosa and the EDI-3 bulimia scale resulted to be the only variables to be associated with positive YFAS 2.0 symptoms. Conversely, anorexia nervosa, restrictive and atypical, was not associated with YFAS 2.0 symptoms. In conclusion, outlining the food addiction profile of eating disorders may give information about a patient's phenotype and could help to identify specific treatment models.

Corrigendum: Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study.

[This corrects the article DOI: 10.3389/fpsyt.2021.653482.].

Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study.

Introduction: Medical and psychiatric complications and treatment compliance are important considerations in determining the treatment program for patients with severe anorexia nervosa (AN). Clinical practice guidelines agree that an outpatient program is the first choice for the treatment of most eating disorders, but vary in supporting these programs for AN. However, inpatient care is known to be costly and the risk of relapse and readmission is high. This pilot study aimed to describe the first data on an Italian partial hospitalization care program for AN adolescents [high-level care treatment (HLCT)], evaluating its impact on patients' clinical status, average hospitalization time, and the hospital costs compared to inpatient treatment (IP). Methods: For this retrospective pilot study, we have selected a group of 34 females with AN aged 11-18 years, divided between those who followed inpatient treatment and those who received HLCT treatment; they were matched for age and severity. We investigated the differences in treatment and outcomes between the two groups in terms of heart rate, length of treatment, weight gain, psychological characteristics, and hospital costs. Statistics for non-parametric distributions were used to compare the two groups. Results: No differences between the two groups were found at admission. At discharge, patients in the HLCT group presented a lower number of in-hospital treatment days, a higher increase of weight, and a significant improvement in outcomes compared to the inpatient group. No significant differences were found in heart rate and hospital costs. Conclusions: This study represents a first comparison between inpatient care and the HLCT treatment program, which suggests that day hospital treatment could represent a meeting point between inpatient and outpatient treatment, combining the merits of both forms of treatment. Further studies are needed in order to better investigate the different treatment programs for severe AN in adolescence.

Restrictive eating disorders in children and adolescents: a comparison between clinical and psychopathological profiles.

PURPOSE: DSM-5 describe three forms of restrictive and selective eating: Anorexia Nervosa-Restrictive (AN-R), Anorexia Nervosa-Atypical (AN-A), and Avoidant/Restrictive Food Intake Disorder (ARFID). While AN is widely studied, the psychopathological differences among these three diseases are not clear. The aim of this study was to (i) compare the clinical features of AN-R, AN-A, and ARFID, in a clinical sample recruited from a specialized EDs program within a tertiary care children's Hospital; (ii) identifying three specific symptom profiles, to better understand if restrictive ED share a common psychopathological basis. METHODS: Data were collected retrospectively. Psychometric assessment included: the Children's Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Child Behavior Checklist (CBCL), and the Eating Disorder Inventory-3 (EDI-3). RESULTS: A final sample of 346 children and adolescent patients were analyzed: AN-R was the most frequent subtype (55.8%), followed by ARFID (27.2%) and AN-A (17%). Patients with ARFID presented different features from AN-R and AN-A, characterized by lower weight and medical impairment, younger age at onset, and a frequent association with separation anxiety and ADHD symptoms. EDI-3 profiles showed specific different impairment for both AN groups compared to ARFID. However, no differences was detected for items: 'Interpersonal Insecurity', "Interoceptive Deficits", "Emotional Dysregulation", and "Maturity Fears". CONCLUSIONS: Different ED profiles was found for the three groups, but they share the same general psychopathological vulnerability, which could be at the core of EDs in adolescence. LEVEL OF EVIDENCE: III. Evidence obtained from case-control analytic studies.

Family functioning, coparenting, and parents' ability to manage conflict in adolescent anorexia nervosa subtypes.

INTRODUCTION: Studies about family functioning in adolescent anorexia nervosa (AN) are conflicting and often do not consider the possible differences between the restricting and binge/purging subtypes (AN-R and AN-B/P). Moreover, an underestimated element is the quality of the coparenting relationship, that is, the level of coordination and agreement between parents, as well as the methods of managing parental conflict. METHOD: The study aims to explore family functioning, coparenting and conflict management in a sample of 60 adolescents with AN-R and AN-B/P and their relations with AN severity in terms of body mass index (BMI). Patients and parents completed the following questionnaires: Family Adaptability and Cohesion Evaluation Scales, Coparenting Scale-Revised, and Conflict Management Questionnaire. RESULTS: No differences are found in general family functioning between the two groups, but mothers in the AN-R group show a higher coparental conflict and a tendency to use negative-passive ways of conflict management than mothers of the AN-B/P group. Moreover, the presence of a coparental conflict is associated to lower BMI and to more dysfunctional family functioning. DISCUSSION: These findings underline the importance of increasing knowledge on specific aspects of general family functioning. In particular, it seems that the way parents manage conflict between themselves as partners can have a role in the maintenance of AN. Clinical implications of these results are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Food Addiction in a Group of Italian Adolescents Diagnosed for Eating Disorder.

Research in patients with Eating Disorders (EDs) showed high rates of Food Addiction (FA) even in restrictive subtypes. The majority of studies were conducted on adult population. The present work aimed to describe and compared FA in adolescents diagnosed for different EDs and to evaluate its association with patients' psychopathology. Patients aged 12-18 y were included in the analysis. FA was assessed using the Yale Food Addiction Scale 2.0. The rate of FA was of 49.4% in the whole sample (n = 87, F = 90.8%) and of 53.7% in patients diagnosed with restrictive anorexia nervosa. No difference in FA frequency was detected between EDs. A worse psychopathological picture was found in patients diagnosed with FA. Higher age, higher score to the Eating Attitudes Test-26 and to the Eating Disorder Inventory-3's Interoceptive Deficits scale have been detected as the major predictors of FA in our sample. FA may be considered a transnosographic construct, not linked to the subtype of ED but to patients' personal characteristics and, in particular, to age and interoceptive deficits. A worse psychopathology might be considered a risk factor for the presence of FA in EDs.

Autonomic response to the Adult Attachment Projective in anorexia nervosa.

PURPOSE: Cardiovascular complications associated with anorexia nervosa (AN) are well recognized. Whether a wide array of studies has investigated autonomic nervous system (ANS) functioning at rest in people with AN, few is yet known on their reactivity ability during stress conditions. The aim of the current study is testing ANS reactivity to a stressful task activating attachment system among adolescents with AN. METHODS: Heart rate (HR) and its variability, as derived by high-frequency-heart rate variability (HF-HRV), were continuously assessed while 13 AN patients and 12 healthy controls (HCs) responded to a set of attachment-related drawings (Adult Attachment Projective, AAP). RESULTS: Findings showed that patients with AN displayed a stronger parasympathetic activity, as indicated by generally a lower heart rate (HR) during the entire task and a higher HF-HRV for drawings eliciting dyadic interactions compared to HCs. CONCLUSION: The study findings suggest a novel understanding of cardiovascular functioning in AN. LEVEL OF EVIDENCE: Level V, descriptive study.

How adolescents with anorexia nervosa and their parents perceive family functioning?

This study aims at examining whether adolescent girls diagnosed with anorexia nervosa and their parents differ in perceiving the different aspects of family functioning. Moreover, the discrepancy between adolescent girls and healthy controls on Family Adaptability and Cohesion Evaluation Scales dimensions, family communication, and family satisfaction is investigated. The study includes 36 female anorexia patients and their parents and 36 healthy controls. The results showed a different view between mothers and their daughters with regard to the dimension of rigidity. In addition, girls with anorexia nervosa were less satisfied about family environment and rated their families as less communicative, flexible, cohesive, and more disengaged, compared to controls.

Are adolescents with anorexia nervosa better at reading minds?

INTRODUCTION: The present study aimed to investigate mindreading abilities in female adolescent patients with AN compared to healthy controls (HCs), analysing differences for emotional valence of facial stimuli. METHODS: The Eating Disorder Inventory) for evaluating psychological traits associated with eating disorders and the Children's version of the Reading the Mind in the Eyes Test for evaluating mindreading abilities were administered to 40 Italian female patients (mean age = 14.93; SD = 1.48) with restrictive diagnosis of anorexia nervosa (AN) and 40 healthy females (mean age = 14.88; SD = 0.56). RESULTS: No significant differences between the AN group and HCs for the Eyes Total score were found. Even when analysing emotional valence of the items, the two groups were equally successful in the facial recognition of positive, negative and neutral emotions. A significant difference was revealed for the percentage of correct responses of item 10 and item 15, where the AN group was less able to correctly identify the target descriptor (Not believing) over the foils than HCs. A significant difference was revealed in discriminating for affective emotions versus cognitive states; only for affective but not for cognitive states, patients with AN were found to perform better than controls on the mindreading task. CONCLUSIONS: Our study highlighted the importance of analysing and discriminating for different valences of facial stimuli when assessing mindreading abilities in adolescents with AN, so that more precise and specific treatment approaches could be developed for female adolescents with AN.