Prevalence and Etiology of Eating Disorders in Polycystic Ovary Syndrome: A Scoping Review.

Polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disorder affecting females across the lifespan. Eating disorders (EDs) are psychiatric conditions that may impact the development of PCOS and comorbidities including obesity, metabolic syndrome, and type 2 diabetes. The aim of this scoping review was to determine the prevalence of EDs and disordered eating, and to review the etiology of EDs in PCOS. The review was conducted using search terms addressing PCOS, EDs, and disordered eating in databases, including PubMed, Scopus, PsycINFO, and CINAHL. Structured interviews, self-administered questionnaires, chart review, or self-reported diagnosis were used to identify EDs in 38 studies included in the review. The prevalence of any ED in those with PCOS ranged from 0% to 62%. Those with PCOS were 3-6-fold more likely to have an ED and higher odds ratios (ORs) of an elevated ED score compared with controls. In those with PCOS, 30% had a higher OR of bulimia nervosa and binge ED was 3-fold higher compared with controls. Studies were limited on anorexia nervosa and other specified feeding or ED (such as night eating syndrome) and these were not reported to be higher in PCOS. To our knowledge, no studies reported on avoidant/restrictive food intake disorder, rumination disorder, or pica in PCOS. Studies showed strong associations between overweight, body dissatisfaction, and disordered eating in PCOS. The etiologic development of EDs in PCOS remains unclear; however, psychological, metabolic, hypothalamic, and genetic factors are implicated. The prevalence of any ED in PCOS varied because of the use of different diagnostic and screening tools. Screening of all individuals with PCOS for EDs is recommended and high-quality studies on the prevalence, pathogenesis of specific EDs, relationship to comorbidities, and effective interventions to treat ED in those with PCOS are needed.

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.

Prevalence of eating disorder symptomatology among outpatients referred to health promotion from somatic hospital departments.

BACKGROUND AND AIMS: All eating disorders (EDs) lead to a significant decrease of health status, psychosocial functioning and quality of life (QoL). Individuals with untreated binge eating disorder (BED) tend to gain weight over time, which may contribute to serious health issues. In somatic hospital departments, some outpatients have reduced compliance with lifestyle changes. This may, to some extent, be due to patients with an undiagnosed ED receiving the incorrect treatment. In this cross-sectional study, we aimed to investigate the prevalence of EDs among patients referred to lifestyle courses. RESULTS: A total of 136 patients referred from somatic hospital departments to lifestyle changes in a specialized hospital unit were included in the study. The response rate was 69.4%. Self-reported ED or sub-clinical symptoms of ED according to the Eating Disorder Examination Questionnaire (EDE-Q) were found in 17.65%. Of these, 11.03% fulfilled the self-reported criteria for an ED (BED, 7.35%; bulimia nervosa, 3.68%). Patients with an ED or subclinical ED symptoms had elevated grazing behaviour compared to those without ED symptomatology. A statistically significant difference in QoL was also found. DISCUSSION AND CONCLUSIONS: The prevalence of self-reported ED or subclinical ED symptoms in patients referred to a lifestyle course is substantial. This ED group had reduced QoL and larger grazing behaviour compared to patients without ED symptomatology. Thus, the prevalence of undiagnosed EDs among patients within somatic hospital departments may be substantial, underlining the importance of screening and further research within this topic. LEVEL OF EVIDENCE: Level III, well-designed cohort study. SIGNIFICANCE: What is already known on this subject? In a review including populations from Scandinavia, the USA and South America, the estimated BED prevalence in individuals with higher body weight seeking help to lose weight is 13-27% [22]. Dawes et al. (2016) conducted a meta-analysis investigating the prevalence of mental health conditions among bariatric surgery candidates and recipients. They included 25 studies with a total of 13,769 patients and found that the prevalence of BED was 17% (13-21%) [10]. What this study adds? We have identified a group of patients who may be receiving inappropriate treatment with weight loss intervention instead of specialized ED intervention. It appears that this issue is valid in various somatic hospital departments. Thus, this is a field that requires further attention and investigation.

Relações de amizade nos transtornos alimentares: revisão integrativa da literatura / Friendship relationships in eating disorders: an integrative literature review / Relaciones de amistad en los trastornos alimentarios: revisión integradora

Ainda é desconhecido o papel da amizade enquanto constitutiva da rede de apoio social nos transtornos alimentares (TAs). Esta revisão integrativa teve por objetivo analisar a produção científica sobre relações de amizade em pessoas com TAs. Foram consultadas as bases PubMed/MEDLINE, LILACS, PsycINFO, Web of Science e EMBASE, de 2010 a 2020. Dos 1126 artigos recuperados, 15 preencheram os critérios de elegibilidade. A maioria tem abordagem qualitativa e delineamento transversal, sem indicar referencial teórico. Aspectos qualitativos das relações de amizade foram associados com redução da frequência e intensidade de sintomas quando o vínculo era considerado de boa qualidade. Já amizades que envolviam comentários depreciativos e influências negativas acerca do corpo e hábitos alimentares foram considerados fatores de risco para desencadeamento dos transtornos. Investir na qualidade dos relacionamentos entre pares pode contribuir para fortalecer a rede de proteção social e reduzir a vulnerabilidade psicossocial de adolescentes com risco para desenvolver TAs. (AU)

There is still little knowledge about the role of friendship within the social support network in eating disorders (EDs). This integrative review aimed to analyze the scientific production about friendship relationships in people with EDs. The literature review was conducted using the PubMed/MEDLINE, LILACS, PsycINFO, Web of Science, and EMBASE databases in the period from 2010 to 2020. Among the 1126 articles retrieved, 15 met the eligibility criteria, most with a qualitative approach and cross-sectional design, without indicating a theoretical framework. The qualitative aspects of friendship were associated with a reduced frequency and intensity of symptoms when the bond was considered to be of good quality. On the other hand, friendships that involved derogatory comments and negative influences related to body image and eating habits emerged as potential risk factors for triggering disorders. Investing in the quality of peer relationships can contribute to strengthening the social safety net and reducing the psychosocial vulnerability of adolescents at higher risk for developing EDs. (AU)

El papel de la amistad como constitutiva de la red de apoyo social en los trastornos alimentarios (TAs) es aún desconocido. Este estudio tiene como objetivo analizar la producción científica sobre las relaciones de amistad en personas con TAs. Se consultaron las bases PubMed/MEDLINE, LILACS, PsycINFO, Web of Science e EMBASE, entre 2010 y 2020. De los 1126 artículos recuperados, 15 cumplían los criterios de elegibilidad. La mayoría tiene enfoque cualitativo y diseño transversal, sin indicar el marco teórico. Los aspectos cualitativos de las relaciones de amistad se asociaron con una menor frecuencia/intensidad de los síntomas cuando el vínculo se consideraba de buena calidad. Amistades que implicaban comentarios despectivos e influencias negativas sobre el cuerpo y los hábitos alimentarios se consideraron factores de riesgo. Invertir en la calidad de las relaciones entre pares puede contribuir a reforzar la red de protección social y reducir la vulnerabilidad de adolescentes con riesgo de desarrollar TAs. (AU)

Exposures during pregnancy and at birth are associated with the risk of offspring eating disorders.

BACKGROUND: Eating disorders (ED) are severe psychiatric disorders, commonly debuting early. Aberrances in the intrauterine environment and at birth have been associated with risk of ED. Here, we explore if, and at what effect size, a variety of such exposures associate with offspring ED, that is, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). METHODS: This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses. RESULTS: A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found. CONCLUSIONS: Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED. PUBLIC SIGNIFICANCE: We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.

Efficacy of educational interventions in adolescent population with feeding and eating disorders: a systematic review.

BACKGROUND: Educational interventions are a key element in the care of young patients with feeding and eating disorders, forming part of the majority of therapeutic approaches. The aim of this review is to evaluate the impact of educational interventions in adolescents with feeding and eating disorders. METHODS: Following the PRISMA recommendations electronic databases were searched up to 29 June 2023. Studies related to educational interventions in young population diagnosed with feeding and eating disorders (anorexia nervosa, avoidant/restrictive food intake disorder, bulimia nervosa, pica and ruminative disorders and binge- eating disorder) in Spanish and English language, without temporal limitation, were located in the databases: PubMed, Scopus, CINAHL, Cochrane Library, PsycINFO, CUIDEN, DIALNET, and ENFISPO. A search in the databases of grey literature was performed in OpenGrey and Teseo. The review protocol was registered in PROSPERO (CRD42020167736). RESULTS: A total of 191 articles were selected from the 9744 citations screened. Ten publications were included. The results indicated variability between educational programs, including individual and group interventions, learning techniques and various research methodologies. Variables such as learning, attitudinal and perceptual changes, anthropometric parameters, symptom improvement, normalization of eating patterns, evaluation of the program and cognitive flexibility were identified. The risk of bias was high due to the low methodological quality of a large number of studies analyzed. CONCLUSION: The results indicate that educational interventions can influence the improvement of knowledge level and have a positive effect on health outcomes. Although education is a common practice in the treatment of these pathologies, high-quality studies were not identified. Thus, this review concludes that additional evidence is needed to evaluate the effectiveness of educational programs, with further research studies, especially randomized controlled trials, to confirm these results. LEVEL OF EVIDENCE: Level I: Systematic review.

How to address physical activity and exercise during treatment from eating disorders: a scoping review.

PURPOSE OF REVIEW: This scoping review aimed to provide a recent update on how to address dysfunctional physical activity and exercise (DEx), and on effects and experiences from including supervised and adapted physical activity or exercise (PAE), during treatment of eating disorders. RECENT FINDINGS: A systematic search for peer-reviewed publications in the period 2021-2023 generated 10 original studies and 6 reviews, including one meta-analysis (reporting according to PRISMA and SWiM). Findings showed that DEx was effectively managed by use of psychoeducation and/or PAE. Inclusion of PAE as part of treatment showed low-to-moderate impact on health and positive or neutral effects on eating disorder psychopathology. There were no reports of adverse events. For individuals with anorexia nervosa, PAE improved physical fitness with no influence on body weight or body composition unless progressive resistance training was conducted. For individuals with bulimia nervosa, DEx was reduced simultaneously with increased functional exercise and successful implementation of physical activity recommendations during treatment. Experiences by individuals with eating disorders and clinicians, including accredited exercise physiologists, pointed to positive benefits by including PAE in treatment. SUMMARY: Lack of consensus about DEx and of recommendations for PAE in official treatment guidelines hinder adequate approaches to these issues in eating disorder treatment.

Loss of control in binge-eating disorder: Fear and resignation.

OBJECTIVE: Binge-eating disorder involves overeating while feeling a loss of control (LOC). Emotions around LOC appear to vary; some patients fear LOC whereas others feel powerless or "resigned" to LOC. This study examined differences in psychopathology among treatment-seeking patients with binge-eating disorder categorized with fear of LOC, resignation to LOC, and no fear/resignation of LOC. METHOD: Doctoral research clinicians administered diagnostic and semistructured interviews to characterize psychopathology and establish a diagnosis of binge-eating disorder in participants (N = 382). The interview assessed fear of LOC in the past month. Further queries assessed whether, in the absence of fear of LOC, patients were resigned to LOC or had no fear/resignation. RESULTS: Patients with fear of LOC and resigned to LOC endorsed significantly greater global eating-disorder psychopathology than patients with no fear/resignation. Patients with fear of LOC reported greater distress about binge eating and greater depression than those with no fear/resignation. Patients resigned to LOC reported significantly more frequent binge-eating episodes than those with fear of LOC and no fear/resignation. Black individuals and men were more likely to report no fear/resignation than other demographic groups. DISCUSSION: This study describes a novel clinical aspect of binge-eating disorder: resignation to LOC. Findings highlight the importance of including anticipatory cognitive-affective experiences in treatment formulations and planning. Future research should examine co-occurrence of these experiences and their association with impairment. Future research should also examine how fear of LOC and resignation to LOC change during treatment and whether they predict or moderate treatment outcomes. PUBLIC SIGNIFICANCE: Adults with binge-eating disorder have anticipatory cognitive-affective experiences about loss of control (LOC) over eating (i.e., fear of LOC, resigned to LOC, no fear nor resignation of LOC). Individuals who experience fear of LOC and those who are resigned to LOC had more severe psychopathology than those without fear/resignation. Binge-eating disorder has the highest prevalence of the eating disorders; thus, findings have high public significance in guiding clinicians' treatment planning.

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.

Sintomas de transtornos alimentares em acadêmicos de medicina / Symptoms of eating disorders in medical students

Objetivo: avaliar os sintomas de transtornos alimentares em estudantes do Curso de Medicina do Centro Universitário Christus. Métodos: o estudo foi realizado com acadêmicos do quarto semestre do curso de Medicina. Utilizou-se um questionário sociodemográfico e antropométrico e os instrumentos Eating Atitudes Test (EAT-26); Binge Eating Scale (BES); e Sick Control One Stone Fat Food Questionnaire (SCOFF). Resultados: participaram do estudo 78 alunos, sendo 54 pessoas do sexo feminino (69,23%). A média de idade dos participantes foi de 22 (±4,7) anos, e o IMC médio foi de 24,33 (±4,11) kg/m2. Quanto ao SCOFF, 38,46% dos participantes apresentaram elevada probabilidade de transtorno alimentar, 14,10% apresentaram alto risco para desenvolverem transtornos alimentares segundo o EAT-26, e 12,82% apresentaram escores sugestivos de presença de compulsão alimentar moderada mediante o uso da BES. Conclusão: os transtornos alimentares e os comportamentos alimentares alterados foram identificados entre os acadêmicos de medicina. Assim, são necessárias intervenções de educação em saúde e de apoio psicológico para esta população, objetivando reduzir o risco de desenvolvimento de transtornos alimentares.

Objective: this study aimed to evaluate the symptoms of eating disorders in medical students at Centro Universitário Christus. Methods: the study was carried out with fourth-semester medical students. A sociodemographic and anthropometric questionnaire was used, the Eating Attitudes Test (EAT-26) instruments; Binge Eating Scale (BES); and Sick Control One Stone Fat Food Questionnaire (SCOFF). Results: 78 students participated in the study, 54 of whom were female (69.23%). The mean age of the participants was 22 (±4.7) years and the mean BMI was 24.33 (±4.11) kg/m2. As for the SCOFF, 38.46% of the participants had a high probability of having an eating disorder, 14.10% had a high risk of developing eating disorders according to the EAT-26, and 12.82% had scores suggestive of the presence of moderate binge eating using BES. Conclusion: eating disorders and altered eating behaviors were identified among medical students. Thus, health education and psychological support interventions are needed for this population, aiming to reduce the risk of developing eating disorders.

Transtornos alimentares: vivências de mulheres acima de 30 anos / Eating disorders: experiences of women aged over 30 years / Trastornos alimentarios: experiencias de mujeres de más de 30 años

O objetivo deste estudo foi compreender como mulheres adultas (acima de 30 anos) diagnosticadas com transtornos alimentares (TAs) vivenciam o adoecer. Trata-se de um estudo qualitativo, descritivo e exploratório, desenvolvido com base no referencial teórico-metodológico da Análise Fenomenológica Interpretativa (AFI). Participaram seis mulheres, com idades entre 34 e 65 anos, atendidas em um serviço especializado. Os dados foram coletados por meio de entrevista aberta, de inspiração fenomenológica, na modalidade remota. As entrevistas foram audiogravadas, transcritas e analisadas seguindo os passos da AFI. Duas categorias temáticas foram identificadas: "Vivendo antes do adoecer" e "Encontrando-se doente." Constatou-se que os sintomas tiveram início anteriormente à vida adulta e que houve dificuldade na confirmação do diagnóstico. Na perspectiva das participantes, conviver com a sintomatologia ficou mais complicado em função de particularidades de manejo dos sintomas na vida adulta, e a idade é percebida como um fator que impacta e dificulta ainda mais a recuperação. As participantes relataram desesperança em relação ao futuro, apesar de a maioria reconhecer melhoras no quadro clínico ao longo do tempo e de valorizar a relação de confiança estabelecida com a equipe multiprofissional.(AU)

This study aimed to understand the experience of illness of adult women (over 30 years) diagnosed with eating disorders (ED). This is a qualitative, descriptive, and exploratory study, using Interpretative Phenomenological Analysis (IPA) as theoretical and methodological framework. A sample of six women aged 34-64 years, assisted in a specialized service, were recruited to complete a phenomenological in-depth open interview. The data were remotely collected. Interviews were audio-recorded, transcribed and analyzed following the IPA. Two thematic categories were identified: "Living before the illness" and "Finding about the illness." It was found that the symptoms started before adulthood and that there was difficulty establishing the diagnosis. Living with the symptoms became more complicated due to particularities of symptom management in adulthood and age is perceived as a factor that impacts recovery and makes it even more difficult. The participants reported hopelessness about the future, although most recognized improvements in the clinical condition over time and valued the trusting relationship they established with the multiprofessional team.(AU)

El objetivo de este estudio fue comprender las experiencias de las mujeres adultas (mayores de 30 años) diagnosticadas con trastornos alimentarios (TA) respecto a la enfermedad. Se trata de un estudio cualitativo, descriptivo y exploratorio, desarrollado a partir del marco teórico y metodológico del Análisis Fenomenológico Interpretativo (AFI). Participaron seis mujeres, con edades de entre 34 y 65 años, atendidas en un servicio especializado. Los datos se recogieron mediante entrevistas abiertas, de inspiración fenomenológica, en la modalidad a distancia. Las entrevistas fueron grabadas en audio, transcritas y analizadas siguiendo los pasos del AFI. Se identificaron dos categorías temáticas: "Vivir antes de enfermar" y "Encontrarse enfermo." Se constató que los síntomas comenzaron antes de la edad adulta y que hubo dificultades de establecer el diagnóstico. La convivencia con síntomas se complicó debido a las particularidades del manejo de los síntomas en la vida adulta y la edad se percibe como un factor que influye y dificulta aún más la recuperación. Los participantes manifestaron desesperanza sobre el futuro, aunque reconocieron mejoras en el cuadro clínico con el paso del tiempo y valoraron la relación de confianza establecida con el equipo multiprofesional.(AU)

Grupo multifamiliar em transtornos alimentares durante a primeira onda da pandemia de covid-19: transição para a modalidade online / Multifamily group on eating disorders during the first wave of the covid-19 pandemic: transitioning to the online modality / Grupo multifamiliar de trastornos alimentarios durante la primera ola de la pandemia de la covid-19: transición a la modalidad en línea

As restrições impostas pela pandemia de covid-19 levaram os serviços de saúde a reorganizarem seu funcionamento, ajustando-se à modalidade remota. A transição repentina e sem o devido preparo técnico impôs desafios adicionais para usuários e profissionais. Para aprimorar as estratégias assistenciais, torna-se imprescindível dar voz aos usuários dos serviços, para que narrem suas experiências e possam manifestar suas facilidades e dificuldades com essa passagem. Este estudo tem como objetivo investigar como os principais cuidadores familiares de pessoas com transtornos alimentares vivenciaram a transição do grupo de apoio para o formato remoto e identificar vantagens e desvantagens percebidas nesse modelo. Estudo clínico-qualitativo, exploratório, realizado em um serviço de atendimento especializado de um hospital terciário. O cenário investigado foi o grupo de apoio psicológico aberto a familiares que, desde o início da pandemia de covid-19, passou a ser oferecido na modalidade online. Participaram do estudo cinco mães e três pais presentes em 13 sessões grupais consecutivas. Entrevistas individuais foram aplicadas com a Técnica do Incidente Crítico logo após o término de cada encontro grupal, totalizando 26 entrevistas audiogravadas, transcritas e submetidas à análise temática. A transição para o online foi vivenciada pelos participantes como um recurso válido para permitir que o grupo funcionasse em tempos de grave crise sanitária. Como vantagens, foram mencionadas: a continuidade do cuidado, maior acessibilidade e facilidade em relação à logística da participação. Como limitações do formato online, foram destacadas: nem todos os familiares contam com conexão de internet de qualidade e possível dificuldade para manusear a tecnologia digital. Apesar dos desafios impostos pela súbita mudança para a modalidade online, na perspectiva dos usuários do serviço os esforços de adaptação foram bem-sucedidos, possibilitando a continuidade do cuidado à saúde mental.(AU)

The constraints imposed by the COVID-19 pandemic led health services to reorganize their operation, adjusting to the online modality. The sudden and unprepared technical transition has imposed additional challenges for both users and professionals. To improve care strategies, it is essential to give voice to services users, so that they can narrate their experiences and express their facilities and difficulties with this transition. This study aims to investigate how main family caregivers of people with eating disorders experienced the transition of the support group to the remote modality and to identify perceived advantages and disadvantages in this model. This is a clinical-qualitative, exploratory study carried out in a specialized care service of a tertiary hospital. The investigated setting was the psychological support group open to family members, which since the beginning of the COVID-19 pandemic has been offered online. Five mothers and three fathers who attended 13 consecutive group sessions participated in the study. Individual interviews were carried out with the Critical Incident Technique shortly after the end of each group meeting with all members, totaling 26 audio-recorded interviews. Data were subjected to thematic analysis. Transition was experienced as a valid resource to maintain the group active in times of a severe health crisis. As advantages of the remote modality were mentioned: continuity of care, greater accessibility, and ease in relation to the logistics of participation. As limitations of the online format were highlighted: not everyone has a good-quality connection to the internet, and difficulty in handling the digital technology. Despite the challenges imposed by the sudden shift to the online modality, from the service users' perspective the adaptation efforts were successful, enabling continuity of mental health care.(AU)

Las limitaciones que impuso la pandemia de la COVID-19 llevaron a los servicios sanitarios a reorganizar su funcionamiento adaptándose a la modalidad remota. El súbito cambio y sin la preparación técnica adecuada implicó retos adicionales a los usuarios y profesionales. Para mejorar las estrategias de atención es fundamental dar voz a los usuarios de los servicios, para que puedan narrar sus experiencias y expresar sus facilidades y dificultades con esta transición. Este estudio pretende investigar cómo han vivido los cuidadores de personas con trastornos alimentarios la transición del grupo de apoyo presencial al formato remoto e identificar las ventajas y desventajas percibidas en este modelo. Se trata de un estudio clínicocualitativo, exploratorio. El escenario investigado fue el grupo de apoyo psicológico abierto a los familiares en la modalidad en línea. Cinco madres y tres padres participaron en 13 sesiones de grupo consecutivas. Se realizaron entrevistas individuales con la técnica de incidentes críticos inmediatamente después de cada reunión del grupo, con un total de 26 entrevistas grabadas en audio, transcritas y sometidas a análisis temático. La transición a la red fue experimentada como un recurso válido para permitir que el grupo funcione en tiempos de crisis sanitaria grave. Las ventajas de la modalidad remota fueron conexión segura en tiempos de confinamiento físico, continuidad, mayor accesibilidad y facilidad en relación con la logística de la participación. Las limitaciones del formato en línea fueron la falta de una conexión de calidad a Internet y la posible dificultad de manejo de la tecnología digital. A pesar de las dificultades impuestas por el cambio repentino a la modalidad en línea, desde la perspectiva de los usuarios del servicio los esfuerzos de adaptación fueron un éxito, lo que permitió seguir con la atención de salud mental.(AU)

Evaluation of a one-hour asynchronous video training for eating disorder screening and referral in U.S. Pediatric Primary Care: A pilot study.

OBJECTIVE: Develop and pilot-test the efficacy of an online training in improving comfort, knowledge, and behaviors related to eating disorders (EDs) screening among U.S.-based pediatric primary care providers (PCPs). METHODS: PCPs (N = 84) completed a baseline survey assessing comfort, knowledge, and behaviors regarding ED screening and referral, then watched a 1-h training video followed by a post-video survey. Half of the participants were randomly assigned to complete spaced-education questions in the following 2 months. All participants completed a 2-month follow-up survey. We used McNemar's and McNemar-Bowker tests to assess differences from baseline to post-video and post-video to follow-up, and logistic models to assess differences by spaced-education condition. RESULTS: From baseline to post-video, there were significant improvements in PCPs' knowledge about and comfort in screening and making referrals for EDs (p < .05). There were no differences between spaced-education conditions in knowledge and behaviors from baseline or post-video to follow-up, but spaced-education participants reported significantly greater comfort in screening for BN (p < .01) and BED (p < .01) compared to non-spaced-education participants. DISCUSSION: Findings suggest that a 1-h asynchronous training can improve PCP comfort, knowledge, and behavior in screening for EDs; spaced-education may provide slight additional benefits in PCP comfort. PUBLIC SIGNIFICANCE: The delivery of an 1-h asynchronous online video training helped to improve PCPs' comfort, knowledge, and behavior in screening and referral for EDs among pediatric populations. This has implications for future evaluations of brief trainings among this provider population, which could ultimately help to improve early identification of EDs and referrals to appropriate treatment.

Increased plasma asprosin levels are associated with overeating and loss of control in drug-free bulimia nervosa.

PURPOSE: Abnormalities in appetite hormones have been implicated in bulimia nervosa (BN). Orexigenic hormone asprosin has been reported to be associated with food intake and weight gain, but no relevant studies have yet been reported in BN. This study investigated asprosin concentrations and their association with eating disorder symptoms in patients with BN. METHODS: This study recruited a total of 26 BN patients and 23 healthy controls (HC). Symptom severity for eating disorders, depression, and anxiety was determined by the Eating Disorder Examination Questionnaire 6.0, Beck Depression Inventory, Version 2, and Beck Anxiety Inventory, respectively. In addition, the study employed sandwich enzyme-linked immunoassay technology to determine plasma asprosin and glucose concentrations in all participants. RESULTS: The results revealed that plasma asprosin concentrations were significantly higher in BN patients than in HC (P = 0.037), but the difference disappeared after adjusting for the covariate BMI (F = 2.685, P = 0.108). Correlation analysis showed that asprosin concentration was positively correlated with overeating (r = 0.451, P = 0.021) and eating loss of control (r = 0.483, P = 0.012) in BN patients. Linear regression analysis indicated that an increase in asprosin concentration was associated with an increase in the times of overeating (F = 6.303, P = 0.019, R2 = 0.208). Multiple linear regression showed that increases in asprosin concentration and BDI-II total score could explain the frequent eating loss of control (F = 5.766, P = 0.009, R2 = 0.334). CONCLUSIONS: The present study is the first report of plasma asprosin concentration in BN patients and found that overeating and eating loss of control increased with the increase of asprosin concentration. Additionally, asprosin level and degree of depression may explain the frequency of loss of control. LEVEL OF EVIDENCE: Level III: Evidence obtained from case-control studies.

Comorbid Eating Disorders in a Sample of Youth With Bipolar Disorder: Elevated Burden of Dimensional and Categorical Psychopathology.

Objective: There is growing recognition of the importance of comorbid eating disorders (ED) among individuals with bipolar disorder (BD). However, most studies on this topic have focused on adult samples, and little is known regarding comorbid ED among youth with BD.Methods: The sample included 197 youth with DSM-IV BD (BD-I, BD-II, or BD-NOS [not otherwise specified]), aged 13-20 years and recruited from a subspecialized clinic within a tertiary academic health sciences center from 2009 to 2017. Univariate analyses examined demographic and clinical variables among participants with versus without lifetime DSM-IV ED. Variables significant at P < .10 were entered into a backward stepwise regression.Results: Fifty-six participants (28.4%) had lifetime DSM-IV ED (3.6% anorexia nervosa, 8.1% bulimia nervosa, 16.8% ED not otherwise specified). Significant correlates of lifetime ED were female sex (P < .001), BD-II subtype (P = .03), suicidal ideation (P = .006), suicide attempts (P = .004), non-suicidal self-injury (P < .001), sexual abuse (P = .02), cigarette smoking (P = .001), anxiety disorders (P = .004), posttraumatic stress disorder (P = .004), substance use disorders (P = .006), history of individual therapy (P = .01), and family history of anxiety (P = .01). Significant correlates of no lifetime ED were BD-I subtype (P < .001) and lifetime lithium use (P = .01). The ED group had significantly more severe lifetime depression (P < .001) and significantly more self-reported affective lability (P < .001) and borderline personality traits (P < .001). In multivariate analysis, the most robust predictors of lifetime ED were female sex (odds ratio [OR] = 4.61, P = .004), BD-I subtype (OR = 0.21, P = .03), cigarette smoking (OR = 2.78, P = .02), individual therapy (OR = 3.92, P = .03), family history of anxiety (OR = 2.86, P = .02), and borderline personality traits (OR = 1.01, P = .009).Conclusions: ED are common among youth with BD and associated with adverse clinical characteristics, many of which converge with prior adult literature. Future studies evaluating specific ED subtypes are warranted, as are treatment studies targeting comorbid ED in youth with BD.

Ejercicio físico y terapia nutricional en el tratamiento de los trastornos de la conducta alimentaria. Revisión Sistemática / Physical exercise and nutritional therapy in the treatment of eating disorders

Los Trastornos de la Conducta Alimentaria (TCA) son una enfermedad mental grave, causante de morbilidad física y psicosocial. Esta enfermedad tiene una mayor prevalencia entre mujeres jóvenes, y en población deportista. La terapia cognitiva conductual (TCC) es el tratamiento actual más adecuado para este tipo de trastornos, no obstante, cada vez son más los programas que incluyen pautas de ejercicio físico (EF) y Terapia Nutricional (TN) para el tratamiento de los TCA. Objetivo. Realizar una revisión sistemática exploratoria de la literatura que permita conocer el estado actual de los programas de intervención a través del EF y la TN para el tratamiento de los TCA. Materiales y métodos. Se realizó una búsqueda y recopilación de documentos científicos mediante un modelo de acumulación de datos y selección de estudios, en la que se utilizaron las bases de datos informatizadas SCOPUS, Web of Science, y PubMed. En todas las bases de datos consultadas, se empleó la misma frase de búsqueda. Para acotar los resultados, se introdujeron una serie de criterios de inclusión y exclusión. Resultados. La revisión contó con cinco documentos relacionados con la temática de estudio, que cumplían los criterios de inclusión. Conclusión. Las intervenciones con EF y TN para el tratamiento de los TCA suponen una reducción en la severidad de la sintomatología de los pacientes. Estos programas se muestran como una herramienta terapéutica alternativa o complementariaa la terapia convencional. Se requieren más estudios que combinen programas de intervención de EF y TN dirigidos a pacientes con TCA(AU)

Eating Disorders (ED) are a severe mental illness that causes physical and psychosocial problems. This illness has a higher prevalence among young women, and between athletes. cognitive behavioural therapy (CBT) is the current treatment for this type of disorder. However, more and more programs are including physical exercise (PE) and nutritional therapy (TN) for eating disorders treatment. Objective. To carry out an exploratory systematic review of the literature that allows us to know the current state of intervention programs through physical exercise and nutritional therapy for the treatment of eating disorders. Materials and methods. For the reference search thesame search phrase was used. The terms were entered in English in the following computerized databases: SCOPUS, Web of Science, and PubMed. To limit the search, four inclusion criteria were introduced. Results. The review included five scientific articles related to the study topic, which met the inclusion criteria. Conclusion. Intervention programs for the treatment of eating disorders that include physical exercise and nutritional therapy are shown as an alternative or complementary tool to conventional therapy. These programs involve a reduction in the severity of ED symptoms and an improvement in anthropometric parameters and physical condition. More studies that combine PE and TN programs for people with ED are required(AU)

Déficits neuropsicológicos en mujeres con trastornos de la conducta alimentaria / Neuropsychological impairment in women with eating disorders

RESUMEN Introducción Antecedentes: La anorexia nerviosa (AN) y la bulimia nerviosa (BN) son enfermedades mentales graves y crónicas que afectan a un alto porcentaje de la población. Un número creciente de estudios han informado de alteraciones neuropsicológicas en esta población, que aparentemente contribuyen a la aparición y progresión del trastorno, y que repercuten en la eficacia del tratamiento y la recuperación. Metodología: El objetivo de esta Revisión Narrativa es resumir los hallazgos relativos al perfil neuropsicológico de las mujeres con AN y BN en diferentes fases de tratamiento. Resultados: La evidencia disponible sugiere que las mujeres con AN y BN presentan un perfil de déficits de cognición ejecutiva y social. Estos resultados son consistentes con la evidencia de los hallazgos de neuroimagen de alteraciones cerebrales estructurales en las áreas frontales y en los circuitos frontales-subcorticales. Conclusiones: El conocimiento de los perfiles neuropsicológicos de las mujeres con AN y BN ofrece información clave para entender la presentación clínica de esta población y los retos en la adherencia y beneficio del tratamiento. Los estudios futuros deberían explorar la eficacia de las intervenciones dirigidas a las deficiencias neuropsicológicas y cómo contribuyen al tratamiento habitual.

Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are severe and chronic mental health illnesses that affect a high percentage of the population. A growing number of studies have reported neuropsychological impairments in this population, apparently contributing to the onset and progression of the disorder, and impacting on treatment efficacy and recovery. Methodology: This Narrative Review aimed to summarize findings regarding the neuropsychological profile of women with AN and BN at different treatment phases. Results: Available evidence suggests that women with AN and BN present a profile of executive and social cognition deficits. These results are consistent with evidence from neuroimaging findings of structural brain alterations in frontal areas and frontal-subcortical circuits. Conclusions: Knowledge about the neuropsychological profiles of AN and BN women offers key information to understand the clinical presentation of this population and challenges in adhering and benefiting from treatment. Future studies should explore the efficacy of interventions targeting neuropsychological impairments and how they contribute to treatment as usual.

Low levels of proinflammatory cytokines in a transdiagnostic sample of young male and female early onset eating disorders without any previous treatment: A case control study.

Growing interest exists in the association of the immune system and its role in the development and maintenance of eating disorders (ED). Current evidence suggests that serum cytokine levels seem to be elevated in females with anorexia nervosa (AN). However, less is known in bulimia nervosa (BN) and other specified feeding and eating disorders (OSFED), specially in males. We aimed to perform a case-control study in a sample of forty eight young patients (38 females and 10 males) with early diagnosis of AN, BN or OSFED and without any previous treatment, compared with twenty nine healthy controls (19 females and 10 males) matched by age, sex and socioeconomic status. We evaluated eating-related psychopathology and depressive symptoms and measured serum concentration of proinflammatory cytokines IL-1ß, IL-6, and TNF-α and anti-inflammatory cytokine IL-10. Contrary to expectations, levels of IL-1ß and IL-6 were significantly lower in ED patients, compared with healthy controls. Comparing the different groups of females, we found elevated levels of IL-10 among ED patients therefore supporting the idea of an immunosuppressive status in the early stages. This could indicate that early onset patients without any previous treatment could remain in a reward-dependent state with a lower immune response.

Perfil e curso do tratamento de pacientes atendidos em um serviço especializado em transtornos alimentares / Profile and course of treatment of patients with eating disorders treated in a specialized service

O curso do tratamento dos transtornos alimentares (TA) tende a evoluir com minoria dos pacientes atingindo remissão do quadro clínico e mantendo a recuperação ao longo da vida. Fatores de diversas naturezas impactam no prognóstico dessas situações, sem consenso sobre os indicadores mais favoráveis, além da inexistência de dados nacionais sobre essa temática. Sendo assim, o objetivo deste estudo foi avaliar o perfil dos pacientes com TA atendidos por um serviço especializado e investigar os fatores associados ao desfecho do tratamento. Trata-se de um estudo de natureza transversal, de caráter retrospectivo, descritivo, exploratório com delineamento quantitativo realizado com dados de todos os pacientes com TA que fizeram seguimento pelo Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo (GRATA-HC-FMRP-USP) desde a sua criação, em 1982, até 2019. Foram coletadas informações, nos prontuários médicos, referentes ao primeiro atendimento, de natureza sociodemográfica, clínica, antropométrica e bioquímica, e o desfecho do tratamento. Os dados foram analisados de forma descritiva pelo programa SPSS versão 22.0. Para verificar a associação entre as variáveis categóricas, foi utilizado o teste Qui-Quadrado ou o teste exato de Fisher; para relacionar as variáveis numéricas, o teste de Kruskal-Wallis e para os testes de regressão logística de Poisson com variância robusta, foi utilizado o R Core Team versão 4.0.1, cujo nível de significância foi de 0.05. Como resultados, foram localizados 271 prontuários elegíveis para a pesquisa, cuja amostra foi predominantemente feminina (89,7%), considerada jovem (21,5±9 anos), solteira (86,9%%), com diagnóstico de anorexia nervosa (AN) (65,7%), seguido por BN (21,4%), que apresentava magreza (56,3%), e com média de Índice de Massa Corporal-IMC no limite mínimo da normalidade (18,5±5,3Kg/m²), com hipercolesterolemia (45,9%), e níveis inadequados de albumina e vitamina C (46,8% e 73,1%, respectivamente). A metade dos indivíduos tinha comorbidades psiquiátricas (50,6%) e 88,5% (n=100) dos 113 prontuários com essa informação, realizaram tratamento anterior. O tempo médio de tratamento foi de 26,8±39,1 meses (1 a 480 meses). O abandono foi o desfecho terapêutico mais prevalente na amostra (68,3%), seguido de alta hospitalar (22,5%). O menor tempo de tratamento e não ter realizado tratamento anterior influenciaram significativamente o abandono (p=0,0001 e p=0,0101, respectivamente). Para aqueles pacientes que foram encaminhados para outros serviços ou receberam alta por não seguirem as orientações (inassistência), houve relação com ferro sérico baixo (p=0,0398) e o diagnóstico de transtorno de personalidade (p=0,0003). Como conclusão, o perfil dos pacientes atendidos pelo serviço representa características sociodemográficas, clinicas e nutricionais da AN. A taxa de abandono foi elevada e os preditores associados a esse desfecho foram o tempo de tratamento e a realização de tratamento anterior para o TA. Espera-se que esses achados possam subsidiar o aprimoramento da prática clínica com a sugestão de alvos terapêuticos específicos na busca de melhor prognóstico para essas graves doenças mentais

The course of treatment for eating disorders (ED) tends to evolve with a minority of patients reaching remission of the clinical condition and maintaining recovery throughout life. Factors of different natures impact the prognosis of these situations, with no consensus on the most favorable indicators, besides the lack of national data on this topic. Therefore, the aim of this study was to assess the profile of patients with ED treated by a specialized service and investigate the factors associated with the treatment outcome. This is a cross-sectional, retrospective, descriptive, exploratory study with a quantitative design performed with data from all patients with ED who were followed up by the Assistance Group for Eating Disorders of the Clinical Hospital from Medical School of Ribeirão Preto, University of São Paulo (GRATA-HC-FMRP-USP) since its creation, 1982, until 2019. Sociodemographic, clinical, anthropometric, biochemical and the treatment outcome information was collected from the medical records concerning the first appointment. Data were descriptively analyzed using SPSS version 22.0. To verify the association between categorical variables, the Chi-Square test or Fisher's exact test was used; to relate the numerical variables, the Kruskal-Wallis test and for the Poisson logistic regression tests with robust variance, the R Core Team version 4.0.1 was used, whose significance level was 0.05. The data on the 271 eligible medical records located, indicated a sample predominantly female (89.7%), considered young (21.5±9 years), single (86.9%), diagnosed with AN (65 .7%), followed by BN (21.4%), who was thin (56.3%), and with an average body mass index-BMI at the minimum limit of normality (18.5±5.3Kg/m²), with hypercholesterolemia (45.9%), and inadequate levels of Albumin and Vitamin C (46.8% and 73.1%, respectively). Half of the individuals had psychiatric comorbidities (50.6%) and 88.5% (n=100) of the 113 records with this data, had undergone previous treatment. Mean treatment time was 26.8±39.1 months (1 to 480 months). Dropout was the most prevalent therapeutic outcome the sample (68.3%), followed by hospital discharge (22.5%). The results suggest that the shorter duration of treatment and not having undergone previous treatment significantly influenced dropout (p=0.0001 and p=0.0101, respectively). For those patients who were referred to other services or were discharged for not following the orientations (non-attendance), there was a relationship with low serum iron (p=0.0398) and a diagnosis of personality disorder (p=0.0003). In conclusion, the profile of patients assisted by the service represents AN's sociodemographic, clinical and nutritional characteristics. The dropout rate was high and the predictors associated with this outcome were the length of treatment and previous treatment for ED. It is expected that these findings may support the improvement of clinical practice with the suggestion of specific therapeutic targets in the pursuit for a better prognosis for these serious mental illnesses