Educational attainment in eating disorders: What can we learn from visualising data.

BACKGROUND: Educational attainment is an understudied outcome in eating disorders (ED). We compared the educational attainment of individuals with and without ED. METHODS: This study is a nationwide, register-based, observational epidemiological study using record linkage. The studied cohorts were (1) all persons treated psychiatrically for ED from 1970 to 2014, and (2) a control population matched for sex, age, and place of residence. The International Standard Classification of Education 2011 was used to classify educational attainment. We employed ineqord, a series of graphical and analytical tools that are appropriate for comparing the distributions of ordinal data (Jenkins, 2020). RESULTS: Females with ED attained higher educational levels than males with ED. Males with ED had lower average educational levels than controls. On average, female controls attained higher educational levels than patients with ED in the eating disorders not otherwise specified or overeating groups. Females with anorexia nervosa, differed from matched controls: While their median was the same, too many participants were in the lower and higher levels of educational attainment. Females with bulimia nervosa had higher educational levels than matched controls on average. CONCLUSIONS: Educational attainment differs between individuals with and without out ED for all ED diagnoses and in both sexes.

Gut-Brain Interaction Disorders and Anorexia Nervosa: Psychopathological Asset, Disgust, and Gastrointestinal Symptoms.

BACKGROUND: Gastrointestinal (GI) symptoms are very common in subjects with eating disorders (EDs). This study aimed to (a) investigate the prevalence of gut-brain interaction disorders (DGBIs) in anorexia nervosa (AN) patients, according to ROME IV criteria; and (b) explore AN psychopathological assets and disgust that might impact GI symptoms. METHODS: Thirty-eight female patients consecutively diagnosed with untreated AN (age 19.32 ± 5.59) in an outpatient clinic devoted to EDs underwent Eating Disorder Inventory-3 (EDI-3), Hospital Anxiety and Depression Scale (HADS), Social Phobia Anxiety Scale (SPAS), Body Uneasiness Test (BUT), and Disgust Scale (DS) questionnaires. The presence of DGBIs was evaluated and GI symptoms were assessed using a standardized intensity-frequency questionnaire. RESULTS: A total of 94.7% of our sample met the diagnostic criteria for functional dyspepsia (FD), of which 88.8% presented the postprandial distress syndrome (PDS) subtype and 41.6% presented the epigastric pain syndrome (EPS) subtype. In addition, 52.6% of the sample met the diagnostic criteria for irritable bowel syndrome (IBS), while for functional constipation (FC), prevalence reached 7.9%. All participants presented a pathological score on the disgust scale. Significant correlations were found between several GI symptoms and psychopathological asset and disgust. CONCLUSIONS: AN is a multifactorial disorder. It is necessary to implement studies with an integrated approach, taking into account DGBIs, as well as to monitor the emotional-cognitive structure that acts as a factor in maintaining the disorder.

Low risk of some common cancers in women with anorexia nervosa: Evidence from a national record-linkage study.

BACKGROUND: Some studies report that women with anorexia nervosa (AN) have lower risk than others of breast cancer, but increased risk of cancers of other sites. No work has been done to quantify the risk in the English population. METHODS: Retrospective cohort study using a national linked dataset of Hospital Episode Statistics for 1999-2021. We selected individuals with a hospital admission for AN, and compared their relative risk (RR) of developing site-specific cancers, with that in a reference cohort. RESULTS: We identified 75 cancers in 15,029 women hospitalised with AN. There was a low RR of all cancers combined at 0.75 (95%CI 0.59-0.94), and, notably, low RR for breast cancer 0.43 (0.20-0.81), cancers of secondary and ill-defined sites 0.52 (0.26-0.93). The RR for parotid gland cancer was 4.4 (1.4-10.6) within a year of first recorded diagnosis of AN. In men, we found 12 cancers in 1413 individuals hospitalised with AN, but no increased risks beyond the first year of diagnosis of AN. CONCLUSIONS: This is the first report on the association between AN and cancers in the all-England population. The study showed low rates of breast cancer, and of all cancers combined, in women hospitalised with AN. It is possible that some of the metabolic or hormonal changes observed in AN could work as a protective factor for breast cancer. More experimental work is needed to identify and explain these factors. The new finding on the higher risk of salivary gland tumours could inform clinicians caring for patients with AN.

Atypical anorexia nervosa after bariatric surgery and the DSM-5 diagnostic criteria: Commentary on Walsh et al. (2023).

The applicability of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for anorexia nervosa (AN) and atypical AN to individuals having undergone bariatric surgery poses several challenges due to the atypical presentation of AN-like symptoms in this population. We describe these challenges, propose modifications to the corresponding diagnostic criteria, and delineate areas of research to inform possible adaptations of atypical AN criteria with applicability to postbariatric surgery populations. We discuss the utility of a strict definition of "significantly low weight" and "significant weight loss" as part of DSM-5 Criterion A for AN and atypical AN, highlighting the importance of clinical judgment. We also question the clinical distinction between AN and atypical AN based solely on weight and argue that the hallmark feature of both diagnoses in postbariatric surgery populations should be persistent energy intake restriction coupled with persistent weight-control behaviors. Finally, criteria B and C need to allow the distinction between common concerns of bariatric surgery patients regarding weight and eating, and clinically relevant symptoms of atypical AN and AN. Knowing the rates, the specificities, and the impact of atypical AN on postsurgical weight loss has important implications for the clinical attention of these often-overlooked patients.

The absence of association between anorexia nervosa and smoking: converging evidence across two studies.

Previous studies have found increased smoking prevalence amongst adults with anorexia nervosa (AN) compared to the general population. The current investigation explored bidirectional associations between AN and smoking behaviour (initiation and heaviness), to address questions surrounding causation. In Study One, logistic regression models with variance robust standard errors assessed longitudinal associations between AN and smoking, using data from adolescent participants of the Avon Longitudinal Study of Parents and Children (N = 5100). In Study Two, two-sample Mendelian randomisation (MR) tested possible causal effects using summary statistics from publicly available genome-wide association studies (GWAS). Study One provided no clear evidence for a predictive effect of AN on subsequent smoking behaviour, or for smoking heaviness/initiation predicting later AN. MR findings did not support causal effects between AN and smoking behaviour, in either direction. Findings do not support predictive or causal effects between AN and smoking behaviour. Previously reported associations may have been vulnerable to confounding, highlighting the possibility of smoking and AN sharing causal risk factors.

Eating disorders: A neglected group of mental disorders in patients requesting aesthetic surgery.

BACKGROUND: There is a lack of data concerning the prevalence of eating disorders in patients requesting aesthetic surgery in spite of a large body of literature on the psychopathology of these patients. This may mostly be due to insufficient diagnostic assessment instruments. Therefore, the aim of this study was to determine the prevalence of eating disorders and their comorbidities in patients undergoing aesthetic surgery. METHODS: The assessment of prevalence of the eating disorders as anorexia nervosa, bulimia nervosa and binge eating disorder as well as other mental disorders was performed with the Structured Clinical Interview for DSM-IV mental disorders (SCID), axis 1. RESULTS: 212 patients (198 females, 14 males), requesting different types of aesthetic surgery, were included in this study. Eating disorders had a current prevalence of 8.0% (17/212) and a lifetime prevalence of 11.3% (24/212). Anorexia nervosa was predominantly found in patients with breast augmentation [current: 7.4% (2/27); lifetime: 11.1% (3/27)] and rhinoplasty [6.3 (1/16); 12.6% (2/16)]. Bulimia nervosa dominated in patients with liposuction [10% (3/30); 13.3% (4/30)] and binge eating disorder in patients with abdominoplasty [current/lifetime: 10.8% (4/37)]. Levels of significance (p ≤ 0.002) were reached for prevalence of the eating disorders in above mentioned types of surgery, when compared to prevalence data of the general population (two proportion Z test for SPSS). CONCLUSION: Eating disorders are distributed according to a certain pattern in the different types of aesthetic surgery. Interestingly, the current prevalence of eating disorders (17/212) was comparable to that of body dysmorphic disorder (26/212).

Self-disgust and disgust sensitivity are increased in anorexia nervosa inpatients, but only self-disgust mediates between comorbid and core psychopathology.

OBJECTIVE: The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics. METHOD: Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory-3, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Disgust Scale-Revised and Self-Disgust Scale. RESULTS: AN patients manifested higher self-disgust and disgust sensitivity than HCs. In addition, self-disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups. DISCUSSION: Our findings imply the putative role of self-disgust in the development of EDs psychopathology in HCs and in its maintenance in AN patients.

Evolución y tratamiento de los trastornos de la conducta alimentaria en adolescentes: serie de casos / Treatment of eating disorders in adolescents: case series

Los trastornos de la conducta alimentaria son enfermedades de elevada prevalencia en la adolescencia y tienen repercusión en la salud integral. El objetivo fue describir su evolución y tratamiento en un grupo de adolescentes. Se estudiaron adolescentes menores de 18 años con al menos 6 meses de seguimiento y tratados por un equipo interdisciplinario. Se incluyeron 41 adolescentes: 23 presentaron anorexia nerviosa; 9, trastornos alimentarios no especificados; 7, bulimia nerviosa y 2, trastorno por atracones. El 35 % de pacientes con anorexia nerviosa requirió internación por complicaciones de la desnutrición. El 69 % de las pacientes con anorexia nerviosa, el 57 % de quienes tenían bulimia nerviosa y el 78 % de quienes tenían un trastorno alimentario no especificado presentaron remisión total o parcial, y no hubo pacientes fallecidos. La mayoría presentó una evolución favorable con el tratamiento.

Eating disorders are highly prevalent diseases in adolescence and have an impact on overall health. The objective was to describe the evolution and treatment of eating disorders in adolescents. Adolescents under 18 years of age with at least 6 months of follow-up and treated by an interdisciplinary team were studied. Forty one adolescents were included, 23 presented anorexia nervosa, 9 unspecified eating disorders, 7 bulimia nervosa and 2 binge eating disorders. Thirty five percent of patients with anorexia nervosa required hospitalization for complications of malnutrition. Sixty nine percent of the patients with anorexia nervosa, 57 % with bulimia nervosa, and 78 % with unspecified eating disorders had total or partial remission and there were no deceased patients. The majority presented a favorable evolution with the treatment.

Risk factors for eating disorders: an umbrella review of published meta-analyses

Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

[Anorexia nervosa: Abnormalities in hematological and biochemical parameters]. / Anorexie mentale : anomalies des paramètres hématologiques et biochimiques.

Abnormalities of hematological and biochemical parameters are various and frequent during anorexia nervosa, and are mainly related to malnutrition, weight loss, and compensatory purgative behaviors. They are most often moderate and reversible through appropriate nutritional and weight rehabilitation, as well as well-conducted symptomatic treatment. Severe abnormalities are rarer, but are potentially serious or even fatal. Isolated moderate anemia and leukopenia are frequently noted, with thrombocytopenia being less frequent. Severe, bi-cytopenic, pancytopenic, and spinal cord injury are less common. They can be explained by the gelatinous transformation of the bone marrow caused by malnutrition. Biochemical abnormalities are typically hydroelectrolytic disorders (hypokalemia, hyponatremia, metabolic alkalosis), acute or chronic renal failure, elevated transaminases, risk of potentially severe hypoglycemia, and elevated lipid parameters. During the refeeding syndrome, hypophosphatemia is characteristic and may be associated with hypomagnesemia and hypocalcemia, and thiamine deficiency. Malnutrition can also lead to alterations in hormone status, including hypothyroidism, hypercorticism and hypogonadism, which may be involved in the development of serious bone conditions such as osteoporosis. These abnormalities should be routinely investigated, monitored, and corrected during anorexia nervosa. Early and multidisciplinary management of this eating disorder is essential to prevent chronicity of the disorder and the potential severity of these abnormalities.

Risk of anorexia and bulimia nervosa and its associated factors in undergraduate students / Risco de anorexia e bulimia nervosa e seus fatores associados em estudantes de graduação

ABSTRACT Objective To quantify the prevalence and related factors to the risk of anorexia and bulimia nervosa in undergraduate students at a private university in Bogotá, Colombia. Methods A cross-sectional study, which evaluated the frequency of food consumption, physical activity (International Physical Activity Questionnaire, short form), the risk of anorexia and bulimia nervosa (Sick, Control, One, Fat, and Food questionnaire) and demographic variables. The statistical analysis used a multivariate logistic regression model, where the outcome was the yes/no risk of anorexia or bulimia nervosa. Results A total of 1,545 university students participated. The average age was 19.2 years (+/-2.5), 65.7% were women, and 63.9% came from Bogotá. The risk of anorexia and bulimia nervosa was 27.6%. In the logistic regression, the risk was associated with female sex (OR 1.6 CI95% 1.2 to 2.1), daily consumption of cereals (OR 0.7 CI95% 0.6 to 0.9), daily fat consumption (OR 1.5 CI95% 1.1 to 2.1), eat light products (OR 1.8 CI95% 1.1 to 2.9), consume protein supplements (OR 0.4 CI95% 0.2 to 0.8), being in disagreement with physical activity for fun (OR 1.8 CI95% 1.1 to 3.1), and physical activity by appearance (OR 2.2 CI95% 1.6 to 2.9). Conclusions The prevalence of risk to anorexia and bulimia nervosa in the study sample is high. The associated factors were the consumption of cereals, fat, light products, and protein supplements. Physical activity by appearance and disagreement to do exercise by fun were associated with the risk of anorexia and bulimia nervosa. So it is recommended that universities implement awareness and education interventions to address this problem.

RESUMO Objetivo Quantificar a prevalência e os fatores relacionados ao risco de anorexia e bulimia nervosa em estudantes de graduação de uma universidade particular de Bogotá, Colômbia. Métodos Estudo transversal, que avaliou a frequência de consumo alimentar, atividade física (ferramenta (Questionário Internacional de Atividade Física, versão curta), risco de anorexia e bulimia nervosa (Questionário de doença, controle, um, gordura e comida) e variáveis demográficas. A análise estatística utilizou um modelo de regressão logística multivariada, em que o resultado foi o risco sim / não de anorexia ou bulimia nervosa. Resultados Participaram 1.545 estudantes universitários. A idade média era de 19,2 anos (+/- 2,5), 65,7% eram mulheres e 63,9% eram de Bogotá. O risco de anorexia e bulimia nervosa foi de 27,6%. Na regressão logística, o risco foi associado ao sexo feminino (OR 1,6 IC95% 1,2 a 2,1), consumo diário de cereais (OR 0,7 IC95% 0,6 a 0,9), consumo diário de gordura (OR 1,5 IC95% 1,1 a 2,1), comer produtos leves (OR 1,8 IC95% 1,1 a 2,9), consomem suplementos proteicos (OR 0,4 IC95% 0,2 a 0,8), discordam de atividade física para se divertir (OR 1,8 IC95% 1,1 a 3,1) e atividade física pela aparência (OR 2,2 CI95% 1,6 a 2,9). Conclusão A prevalência de risco para anorexia e bulimia nervosa na amostra do estudo é alta. Os fatores associados foram o consumo de cereais, gorduras, produtos light e suplementos proteicos. A atividade física pela aparência e a discordância para fazer exercício pela diversão estiveram associadas ao risco de anorexia e bulimia nervosa. Portanto, é recomendado que as universidades implementem intervenções de conscientização e educação para resolver esse problema.

Eating disorders and psychosis: a review and case report

SUMMARY INTRODUCTION: The interplay between eating disorders and psychosis is a challenging field to which little attention has been paid. Its study raises conceptual and methodological questions in both areas, making the diagnosis and management of patients difficult. Such questions are addressed and illustrated with a review and case report. METHODS: The authors present the case of a woman with Anorexia Nervosa and with comorbid Shared Psychotic Disorder, based on a literature review regarding the comorbidity between eating disorders and psychosis. The authors conducted a non-systematic review by searching the PubMed database, using the Mesh Terms "anorexia nervosa", "bulimia nervosa", "comorbidity" and "psychotic disorders". RESULTS: The findings suggest that studies on the subject are limited by issues regarding data on the prevalence of comorbidities, phenomenological aspects of eating disorders, and the interface and integration with psychotic symptoms. CONCLUSIONS: The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. In order to ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.

RESUMO INTRODUÇÃO: A interface entre perturbação do comportamento alimentar e psicose é um campo desafiador para o qual pouca atenção foi direcionada. O seu estudo levanta algumas questões conceituais e metodológicas em ambas as áreas, dificultando o diagnóstico e o manejo dos pacientes. Essas questões são abordadas e ilustradas neste trabalho com uma revisão e um relato de caso. MÉTODOS: Os autores apresentam o caso de uma mulher com anorexia nervosa e perturbação psicótica partilhada comórbida, com base numa revisão da literatura sobre a comorbilidade entre perturbação do comportamento alimentar e psicose. Os autores realizaram uma revisão não sistemática, por meio de pesquisa no banco de dados PubMed, utilizando os termos "anorexia nervosa", "bulimia nervosa", "comorbilidade" e "perturbações psicóticas". RESULTADOS: Os resultados sugerem que os estudos sobre o tema são limitados por questões inerentes a escassos dados sobre prevalência de comorbilidades, aspectos fenomenológicos das perturbações alimentares, e sua interface e integração com sintomas psicóticos. CONCLUSÕES: O caso apresentado ilustra as dificuldades no manejo de uma paciente com perturbação alimentar e psicose. A fim de garantir uma abordagem rigorosa dos sintomas psicóticos e alimentares, a avaliação do paciente deve focar o padrão de emergência dos sintomas, a sua fenomenologia, antecedentes clínicos e familiares e o seu status clínico.

Bone density status in a large population of patients with anorexia nervosa.

Anorexia nervosa (AN) is associated with multiple medical complications. One of the rare permanent complications of AN is the deleterious effect that it has on a patient's bone mineral density (BMD). We report on the Dual-Energy X-ray Absorptiometry (DXA) findings of 336 consecutive patients with AN. Also, we investigated the effects of different factors on these DXA results. These factors included age, body mass index (BMI), percentage of ideal body weight (IBW), duration of illness, duration of amenorrhea, medications such as proton pump inhibitors (PPI) or selective serotonin reuptake inhibitors (SSRI), tobacco use and 25-hydroxy vitamin D levels. This study demonstrated a concerning high prevalence of reduced bone mineral density in patients with AN. Thus, the implication being that those involved in the care of patients with AN need to be cognizant of this serious complication and not be assuaged by the young age of this patient population.

Eating Disorder Screening: a Systematic Review and Meta-analysis of Diagnostic Test Characteristics of the SCOFF.

BACKGROUND: Eating disorders affect upwards of 30 million people worldwide and often go undertreated and underdiagnosed. The purpose of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the Sick, Control, One, Fat and Food (SCOFF) questionnaire for DSM-5 eating disorders in the general population. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed. A PubMed search was conducted among peer-reviewed articles. Information regarding validation of the SCOFF was required for inclusion. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS: The final analysis included 25 studies. The validity of the SCOFF was high across samples with a pooled sensitivity of 0.86 (95% CI, 0.78-0.91) and specificity of 0.83 (95% CI, 0.77-0.88). Subgroup analyses were conducted to examine the impact of methodology, study quality, and clinical characteristics on diagnostic accuracy. Studies with the highest sensitivity tended to be case-control studies of young women with anorexia nervosa (AN) and bulimia nervosa (BN). Studies which included more men, included those diagnosed with binge eating disorder, and recruited from large community samples tended to have lower sensitivity. Few studies reported on BMI and race/ethnicity; thus, subgroups for these factors could not be examined. No studies used reference standards which assessed all DSM-5 eating disorders. CONCLUSION: This meta-analysis of 25 validation studies demonstrates that the SCOFF is a simple and useful screening tool for young women at risk for AN and BN. However, there is not enough evidence to support utilizing the SCOFF for screening for the range of DSM-5 eating disorders in primary care and community-based settings. Further examination of the validity of the SCOFF or development of a new screening tool, or multiple tools, to screen for the range of DSM-5 eating disorders heterogenous populations is warranted. TRIAL REGISTRATION: This study is registered online with PROSPERO (CRD42018089906).

Anorexia nerviosa en población pediátrica / Anorexia nervosa in pediatrics

Resumen La anorexia nerviosa se caracteriza por una sobreestimación del volumen y forma del cuerpo, que conlleva a una búsqueda de la delgadez mediante dietas rígidas. Esta se presenta en 0.6% de la población mundial, siendo las mujeres adolescentes quienes más la padecen y ocurriendo en pacientes cada vez más jóvenes. Con respecto a los criterios diagnósticos, actualmente no se cuenta con rubros o guías específicas para la población pediátrica, lo que dificulta su valoración. En cuanto al tratamiento, se recomienda la realimentación progresiva alcanzar el peso esperado para el sexo y edad del paciente, en conjunto con terapia psicológica individual y familiar. Se concluye que es fundamental para el abordaje de la anorexia nerviosa ampliar la investigación para asegurar que las particularidades de esta en la población pediátrica, en su diagnóstico, tratamiento y prevención, sean contempladas. Asimismo, se insiste en la necesidad del trabajo interdisciplinario para lograr una recuperación integral.

Abstract Anorexia nervosa is a disorder characterized by an overestimation of the volume and shape of the body, which leads them to seek excessive thinness through rigid diets. It occurs in 0.6% of the world population, mostly affecting teenage girls and increasingly occurring in young patients. Nowadays, there are no specific guidelines for anorexia nervosa in pediatric patients which complicates its assessment. The recommended treatment is progressive feeding until the patient gains the expected weight for the patient, according to his sex and age, alongside individual and family therapy. It is concluded that further research is key to assure that the particularities of diagnosis, treatment and prevention of the disorder in pediatric patients are contemplated. Likewise, interdisciplinary work is necessary to achieve an integral approach.

Effects of vitamin D and estrogen receptor polymorphisms on bone mineral density in adolescents with anorexia nervosa.

Background Anorexia nervosa (AN) is a serious eating disorder that is associated with decreased bone mineral density (BMD) and greater lifetime risk for fractures. The aim of this study was to determine the correlation between BMD and genetic polymorphisms in AN. Methods This case-control study analyzed vitamin D receptor (VDR) (VDRBsml, VDRFokl) and estrogen receptor (ESR) (ESR1Xbal, ESR1Pvull) polymorphisms in 45 adolescents diagnosed with AN and 46 age-matched healthy controls. BMD values of the AN group were classified as low or normal, and polymorphisms were compared between cases and controls. The effects of body mass index (BMI), duration of disease and amenorrhea on BMD were also evaluated. Results In girls with AN, a positive effect of the bb genotype of VDRBsmI polymorphism on femur Z-scores (p = 0.103) and of the Ff genotype of VDRFokI polymorphism on vertebra Z-scores (p = 0.097) was observed. In boys with AN, a positive effect of the Ff genotype of VDRFokI polymorphism on vertebra BMD (g/cm2) was detected (p = 0.061). No association was detected between ESR polymorphisms. An inverse relationship was observed between BMD and duration of illness and amenorrhea. A direct relationship was detected between BMD and BMI. Conclusions Specific VDR gene polymorphism genotypes may have positive effects on BMD in patients with AN. Additionally, the lack of association between ESR gene polymorphisms on BMD could be attributed to the low estrogen status of the patient.

Pain and temporomandibular disorders in patients with eating disorders

Abstract Orofacial pain and temporomandibular dysfunction may cause chronic facial pain, which may interfere with the emotional state and food intake of patients with eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). Sixty-four patients were assigned to four groups: Group A (AN - restricting subtype): 07; Group B (AN - purging subtype ): 19; Group C (BN): 16; and Group D (control): 22. Complaints of pain are more prevalent in individuals with eating disorders (p<0.004). There are differences between the presence of myofascial pain and the number of hospitalizations (p = 0.046) and the presence of sore throat (p=0.05). There was a higher prevalence of masticatory myofascial pain and complaints of pain in other parts of the body in ED patients; however, there was no difference between ED subgroups. There was no difference in the number of self-induced vomiting between ED patients with and without myofascial pain.

Trastornos de la conducta alimentaria en estudiantes de medicina de una universidad de Perú / Eating disorders in medical students of a Peruvian university

Introducción: Los trastornos de la conducta alimentaria afectan con mayor frecuencia a jóvenes, y pueden llegar a tener importantes consecuencias en su salud mental y física. Objetivo: Determinar la prevalencia de probable diagnóstico de trastornos de conducta alimentaria en estudiantes de medicina y sus factores asociados. Métodos: Estudio descriptivo transversal realizado en estudiantes de medicina del primer año de una universidad de Lima, Perú. Se aplicó un cuestionario virtual para recolectar los datos de interés. Aquellos con un puntaje ≥20 en elEatingAttitudes Test-26, se consideronconprobable diagnóstico de trastornos de conducta alimentaria.Para evaluar los factores se calcularon razones de prevalencia y intervalos de confianza al 95% usando regresiones de Poissoncrudas con varianza robusta. Resultados: Del total de 440 estudiantes de primer año, 375 (85,2 por ciento) completaron la encuesta. La prevalencia de probable diagnóstico de trastornos de conducta alimentaria fue de 10,1 por ciento (11,3 en mujeres y 8,6 en varones).Los factores asociados a esta variable fueron: rechazo escolar por trastornos nutricionales, rechazo laboral por la delgadez, rechazo social cercano por la imagen corporal, influencia familiar sobre la imagen corporal, influencia de la imagen corporal de modelos de pasarela e influencia de los anuncios televisivos de productos para adelgazar. Los dos últimos con los mayores valores de la razón de prevalencias. Conclusiones: Aproximadamente uno de cada diez estudiantes presentaprobable diagnóstico de trastornos de conducta alimentaria que se asocian con factores familiares, sociales,laborales y otros relacionados con los medios de comunicación(AU)

Introduction: Eating disorders affect mostly young persons, and may have important consequences on their mental and physical health. Objectives: To determine the probable diagnosis of eating disorders in medical students and to evaluate their associated factors. Methods: Descriptive and cross-sectional study performed in first-year medical students of a private university in Lima, Peru. An electronic survey was administrated to collect data of interest. Those students with a score ≥20 in the Eating Attitudes Test-26 were considered to have probable diagnosis of eating disorders. For assessment of associated factors, we calculated prevalence ratios and 95 percent confidence intervals using Poisson crude regressions with robust variance. Results: Of 440 first-year medical students, 375 (85.2 percent) completed our survey. The prevalence of probable diagnosis of eating disorders in the study population was 10.1 percent (11.3for females and 8.6for males). Associated factors to this variable were: school rejection due to nutritional disorders, job rejection due to thinness, social rejection of body image, family influence on body image, influence of fashion show models' body image and influence of TV advertisement of slimming products. The two latter reached the highest prevalence ratio values. Conclusions: Around one in ten students has a probable diagnosis of eating disorders associated with family, social, work and mass media-related factors(AU)

Hepatic Complications of Anorexia Nervosa.

Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases. Acute liver failure associated with coagulopathy and encephalopathy can rarely occur. Liver enzymes may also less commonly increase as part of the refeeding process due to hepatic steatosis and can be distinguished from starvation hepatitis by the finding of a fatty liver on ultrasonography. Individuals with AN and starvation-induced hepatitis are at increased risk of hypoglycemia due to depleted glycogen stores and impaired gluconeogenesis. Gastroenterology and hepatology consultations are often requested when patients with AN and signs of hepatitis are hospitalized. It should be noted that additional laboratory testing, imaging, or liver biopsy all have low diagnostic yield, are costly, and potentially invasive, therefore, not generally recommended for diagnostic purposes. While the hepatitis of AN can reach severe levels, a supervised increase in caloric intake and a return to a healthy body weight often quickly lead to normalization of elevated aminotransferases caused by starvation.

[Prevalence of eating disorders among women with polycystic ovary syndrome]. / Evészavarok prevalenciája policisztás ováriumszindrómás nok körében.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. Symptomes and complications of PCOS have adverse effect on quality of life among concerned women. Most research findings suggest that PCOS is associated with eating disorders, but there are inconsistent results in connection with their relationship in the published literature. OBJECTIVE: The aim of this study was to determine the prevalence of eating disorders among women with PCOS. METHOD: Body mass index (BMI), Eating Attitudes Test (EAT) and Eating Behaviour Severity Scale (EBSS) were used to measure eating attitudes and behaviors. Furthermore PCOS symptomes were measured by Ferriman-Gallwey Score, Global Acne Grading Score, Savin Scale and other pcos symptoms were also accessed. A total of 318 women were included in this analysis. The sample consists of a PCOS group (N=95), a control group (N=100) and a hyperandrogen group (N=123). The Prevalence of clinical bulimia nervosa was 5.3%, subclinical anorexia nervosa 1.1% and subclinical bulimia nervosa was 10.5% among PCOS women. 1.6% subclinical bulimia nervosa was detected in the hyperandrogen group. CONCLUSIONS: The results of the study indicate that the prevalence of clinical and subclinical bulimia nervosa is increased among women with PCOS compared to healthy women. Eating disorders can have significant negative influence on the outcome of the treatment of PCOS. To sum up, these findings suggest that it should be necessary to pay attention to the screening of eating disorders, and the findings also reveals that psychological treatment of eating disorders among women with PCOS is relevant.