Nutritional Assessment of Children and Adolescents with Atypical Anorexia Nervosa: A Preliminary Longitudinal Investigation Using the 24-h Dietary Recall.

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.

Food and Development: Children and Adolescents with Neurodevelopmental and Comorbid Eating Disorders-A Case Series.

The impact of psychiatric comorbidities in the diagnosis and treatment of feeding and eating disorders (FEDs) represents an emerging research topic. The current literature, nonetheless, lacks studies investigating the developmental paths of individuals with FEDs and comorbid neurodevelopmental disorders (NDDs). Here, we report 11 cases of children and adolescents with comorbid FEDs and NDDs, as assessed along the neuropsychological, psychopathological, and nutritional developmental pathways. The onset of FED-related psychopathology was preceded, sometimes undiagnosed, by altered neurodevelopmental features leading to specific NDD diagnoses (autism spectrum disorder-ASD; attention-deficit/hyperactivity disorder-ADHD; specific learning disorder-SLD). NDDs appeared to influence the diagnoses and treatments of FEDs, frequently with an impact on socio-relational and emotional premorbid features, and on the possibility to receive and attend FED-targeted treatments. Further studies should longitudinally contribute to assessing the experiences of care and neurodevelopmental pathways of children with FEDs and specific NDD comorbidities.

Eating disorders in young patients with neurofibromatosis type 1.

AIM: We describe the association of neurofibromatosis type 1 (NF1) and feeding and eating disorders (FED) in five patients admitted to our third level centre for both FED and NF1. METHODS: Case series of five adolescent females with NF1 treated for FED. RESULTS: We collected data from five patients with NF1 aged between 14 and 22 years, all females. The onset of eating disorder symptoms occurred between 13 and 19 years of age and was characterised by food intake restriction, associated with physical hyperactivity in three out of five cases. One patient also reported self-injurious acts and episodic binges. Patients received diagnoses of anorexia nervosa (AN, n = 2), atypical AN (n = 1), bulimia nervosa (n = 1), unspecified feeding and eating disorder (n = 1). CONCLUSION: The current literature reports a single case of an adult with NF1 and comorbid AN, focusing on the dermatological features of NF1. Our article describes a case series of five patients in developmental age affected by NF1 and FED. Clinical and psychological features of NF1 may play a role in the pathogenesis of FED when these two conditions co-occur. The dermatological alterations of NF1 may contribute to body image distortion that characterises AN. Further research is required to systematically screen populations of patients with NF1 for the presence of FED.

General psychopathological symptoms in children, adolescents, and young adults with anorexia nervosa-a naturalistic study on follow-up and treatment.

Recent research has assessed the role of general psychopathological symptoms in the natural history of mental health conditions, including anorexia nervosa (AN) in adults and obesity in children. Nevertheless, literature assessing general psychopathological symptoms in young patients with AN and their potential prognostic role in long-term outcomes is lacking. Observational, naturalistic study, involving young patients hospitalized for AN. General psychopathological symptoms were assessed by administering Symptom Check List-90-R (SCL-90-R) at admission (T0) and discharge (T1). AN-specific psychopathology was assessed with Eating Disorders Inventory-3 Eating Disorder Risk (EDRC) and Body Uneasiness Test Global Severity Index (BUT-GSI). Potential T0-T1 modifications of general psychopathological symptoms and their possible associations with baseline psychopathological, weight, and psychopharmacological variables were assessed with a generalized linear model (GLM), corrected for baseline SCL-90-R scores. Then, possible associations between T0 general psychopathological symptoms and the risk of re-hospitalization at 1 year were assessed with the Kaplan-Meier method and Cox regression. This study enrolled 133 patients (mean age 16.9 ± 2.9 years, F = 91.8%). A significant T0-T1 reduction (p < 0.001) in almost all the general psychopathological symptoms (except paranoia) emerged. The GLM revealed that higher EDI-3 EDRC scores were associated with higher T1 SCL-90-R scores in multiple domains. Cox regressions revealed a predictive role of SCL-90-R interpersonal sensitivity (B = 0.113, hazard ratio = 1.119, p = 0.023) on the risk of re-hospitalization at 1 year.  Conclusion: General psychopathological symptoms in young patients with AN may be influenced by hospital treatment interventions and have a potential prognostic role on post-discharge outcomes. Further longitudinal studies are required. What is Known: • General psychopathological symptoms represent a relevant feature that clinicians should consider in the diagnosis, treatment, and prognosis of multiple psychiatric conditions. Co-occurring psychiatric comorbidities, moreover, have been documented to impact individuals diagnosed with Anorexia Nervosa (AN) in the developmental age. Despite this evidence, the literature lacks studies assessing the occurrence and impact of general psychopathological symptoms in young patients with AN. What is New: • The clinical picture of children, adolescents, and young adults with AN mays be impacted by multiple general psychopathological symptoms, including Somatization, Obsession-compulsion, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobia, Paranoia, and Psychoticism, which may improve with a multidisciplinary hospital intervention. The occurrence of these symptoms, particularly "interpersonal sensitivity", may negatively impact the prognosis of the affected patients.

Prognostic factors in epileptic encephalopathies at onset in the first 2 years of life: The experience of a tertiary healthcare center in Italy.

INTRODUCTION: The aim of this retrospective cohort study was to identify some prognostic factors in anamnestic/clinical/instrumental data at the onset of epileptic encephalopathy (EE), for multiple outcome measures. METHODS: We recruited patients diagnosed as affected by EE at Sant'Anna University Hospital, with onset in the first 24 months of life, with follow-up lasting longer than 3 years. RESULTS: At the end of the follow-up, 6 patients (14%) died within 2 years of age; 20 patient (49%) had a drug-resistant epilepsy (DRE); 9 patients (22%) had a language development delay (LDD); 12 patients (30%) had an autism spectrum disorder (ASD); 20 patients (49%) had a global psychomotor impairment (GPI); 9 patients (22%) needed palliative care; and nobody had a normal psychomotor development. Preexisting developmental delay predicts death (p = 0.009), and in survivors, it is associated with a GPI (p < 0.001); patients with normal neurological examination at the onset of EE only develop a LDD (p = 0.020). Neuroimaging structural alterations are associated with DRE (p = 0.012) and with a GPI (p = 0.013). The history of perinatal risk factors predicts the worst prognosis (death: p = 0.035, GPI: p = 0.015, and access to palliative care: p = 0.007). The absence of early response to treatment is correlated to a poor long-term prognosis (GPI, p = 0.019; DRE, p = 0.001). The multivariate analysis confirms that a normal development at onset predicts the most favorable prognosis, both in terms of survival and cognitive outcome (OR [odds ratio] = 0.1). An early response to treatment is a protective factor for DRE (OR = 0.1). A perinatal pathology is confirmed as an independent prognostic factor of severe comorbidities (access to palliative care: OR = 10.4). SIGNIFICANCE: This study was conducted to recognize possible prognostic factors among onset data of patients with EE, considering multiple outcome measures. This study design represents an innovative element compared to available papers, which were centered on isolated endpoints of prognosis, such as the prediction of neurocognitive development impairment or drug resistance. The data obtained from the study confirm that EEs prognosis is generally, but not universally, poor. Structural etiology and/or lack of response to antiepileptic drug (AED) within three months are main risk factors for DRE. Normal development at the onset of EEs and early response to treatment are the main positive prognostic factors.