Outcomes of a higher calorie inpatient refeeding protocol in Asian adolescents with anorexia nervosa.

OBJECTIVE: This study aims to compare the outcomes of higher calorie refeeding (HCR) and a lower calorie refeeding (LCR) methods among a diverse sample of young Asian adolescents admitted to a tertiary institution in Asia for management of anorexia nervosa (AN). METHOD: This is a retrospective case control study of Asian adolescents who were managed using an inpatient HCR protocol (2016-2017) and an LCR protocol (2010-2014). Baseline characteristics, daily change in percent median body mass index (%mBMI), and rates of refeeding hypophosphatemia were analyzed between groups. RESULTS: A total of 125 adolescents with AN were analyzed with 61 (52%) patients in the HCR group. Mean age was 14.0 years (SD =1.5) and mean presenting %mBMI was 73.2 (SD =6.9) with mean length of stay of 11.9 days (SD = 6.6). Patients in the HCR group had significantly increased rate of change of %mBMI (M = 0.39, SD = 0.31) than patients in the LCR group (M = 0.12, SD = 0.43) (p < .001). There was an increased rate of mild hypophosphatemia in the HCR group (HCR: 46%, LCR: 22%, p = .007) but no difference in rates of moderate hypophosphatemia and no cases of severe hypophosphataemia. Lower presenting %mBMI significantly predicted the phosphate levels (p = .004). DISCUSSION: In a sample of Asian adolescents with AN, use of an HCR protocol was associated with improved rate of inpatient weight gain. There was increased risk of mild hypophosphataemia, but not moderate to severe hypophosphataemia, suggesting that an HCR protocol can be used safely with close monitoring of phosphate levels.

Vitamin D status in young Swedish women with anorexia nervosa during intensive weight gain therapy.

PURPOSE: Anorexia nervosa (AN) is associated with reduced bone mass and an increased fracture risk. The aim was to evaluate the vitamin D status and the association with body mass index (BMI), fat mass and bone mineral density (BMD) in patients with severe AN during a prospective intervention study of intensive nutrition therapy. METHODS: This study comprised 25 Swedish female AN patients (20.1 ± 2.3 years), who were treated as inpatients for 12 weeks with a high-energy diet. Serum 25-hydroxyvitamin D (25(OH)D), calcium, phosphate and parathyroid hormone (PTH) were measured. BMD and body composition were assessed by dual-energy X-ray absorptiometry at study start and after 12 weeks. RESULTS: Twenty-two patients completed the study. The mean weight gain was 9.9 kg and BMI (mean ± SD) increased from 15.5 ± 0.9 to 19.0 ± 0.9 kg/m2, P < 0.0001. Fat mass increased from median 12 to 27 %. The median serum 25(OH)D level was 84 nmol/L at baseline, which decreased to 76 nmol/L, P < 0.05. PTH increased from median 21.9 to 30.0 ng/L, P < 0.0001. BMC increased during the study period, P < 0.001. CONCLUSIONS: Serum 25(OH)D levels were adequate both at study start and completion, however, nominally decreased after the 12-week nutritional intervention. PTH increased subsequently, which coincide with the decreased 25(OH)D levels. The reduction in 25(OH)D could be due to an increased storage of vitamin D related to the increase in fat mass since vitamin D is sequestered in adipose tissue.

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.

Angiopoietin-like protein 6 in patients with obesity, type 2 diabetes mellitus, and anorexia nervosa: The influence of very low-calorie diet, bariatric surgery, and partial realimentation.

AIM OF THE STUDY: Angiopoietin-like protein 6 (ANGPTL6) is a circulating protein with a potential role in energy homeostasis. The aim of the study was to explore the changes in ANGPTL6 levels in patients with obesity (Body mass index, BMI > 40 kg/m2) with and without type 2 diabetes mellitus (T2DM) undergoing dietary intervention (very low calorie diet - VLCD) and in a subgroup of T2DM patients after bariatric surgery. Additionally, we examined changes in ANGPTL6 in anorexia nervosa (AN) patients at baseline and after partial realimentation. We also explored the changes in ANGPTL6 mRNA expression in subcutaneous adipose tissue (SAT) of obese subjects. MATERIALS AND METHODS: The study included 23 non-diabetic obese patients, 40 obese patients with T2DM (27 underwent VLCD and 13 underwent bariatric surgery), 22 patients with AN, and 37 healthy control subjects. RESULTS: ANGPTL6 levels of AN patients were increased relative to the control group (68.6 ± 9.9 ng/ml) and decreased from 110.2 ± 13.3 to 73.6 ± 7.1 ng/ml (p = 0.004) after partial realimentation. Baseline ANGPTL6 levels in patients with obesity and T2DM did not differ from the control group. VLCD decreased ANGPTL6 levels only in obese patients with T2DM. Bariatric surgery induced a transient elevation of ANGPTL6 levels with a subsequent decrease to baseline levels. ANGPTL6 mRNA expression transiently increased after bariatric surgery and returned to baseline levels after 12 months. CONCLUSIONS: Collectively, our data suggest that serum ANGPTL6 levels and ANGPTL6 mRNA expression in SAT are affected by metabolic disorders and their treatment but do not appear to directly reflect nutritional status.

Weight restoration therapy rapidly reverses cortical thinning in anorexia nervosa: A longitudinal study.

Structural magnetic resonance imaging studies have documented reduced gray matter in acutely ill patients with anorexia nervosa to be at least partially reversible following weight restoration. However, few longitudinal studies exist and the underlying mechanisms of these structural changes are elusive. In particular, the relative speed and completeness of brain structure normalization during realimentation remain unknown. Here we report from a structural neuroimaging study including a sample of adolescent/young adult female patients with acute anorexia nervosa (n=47), long-term recovered patients (n=34), and healthy controls (n=75). The majority of acutely ill patients were scanned longitudinally (n=35): at the beginning of standardized weight restoration therapy and again after partial weight normalization (>10% body mass index increase). High-resolution structural images were processed and analyzed with the longitudinal stream of FreeSurfer software to test for changes in cortical thickness and volumes of select subcortical regions of interest. We found globally reduced cortical thickness in acutely ill patients to increase rapidly (0.06 mm/month) during brief weight restoration therapy (≈3 months). This significant increase was predicted by weight restoration alone and could not be ascribed to potentially mediating factors such as duration of illness, hydration status, or symptom improvements. By comparing cortical thickness in partially weight-restored patients with that measured in healthy controls, we confirmed that cortical thickness had normalized already at follow-up. This pattern of thinning in illness and rapid normalization during weight rehabilitation was largely mirrored in subcortical volumes. Together, our findings indicate that structural brain insults inflicted by starvation in anorexia nervosa may be reversed at a rate much faster than previously thought if interventions are successful before the disorder becomes chronic. This provides evidence drawing previously speculated mechanisms such as (de-)hydration and neurogenesis into question and suggests that neuronal and/or glial remodeling including changes in macromolecular content may underlie the gray matter alterations observed in anorexia nervosa.

Increased Bone Mineral Content During Rapid Weight Gain Therapy in Anorexia Nervosa.

Patients with anorexia nervosa (AN) are at high risk of reduced bone mass. Osteocalcin (OC), a bone formation marker, has been proposed to act as a link between bone and energy metabolism. We investigated how the 3 forms of OC respond during a 12-week intensive nutrition therapy in AN patients, in whom large changes in energy metabolism are expected.Twenty-two female AN patients, mean 20.9 years of age, with a starting mean body mass index (BMI) 15.5 kg/m2 (minimum-maximum) (13.4-17.3 kg/m2) completed the study. Biochemical markers, body composition, bone mass by DXA, and pQCT were assessed. Subjects gained in median 9.9 kg (5.5-17.0 kg), and BMI increased from median 15.4 kg/m2 (13.4-17.3 kg/m2) to 19.0 kg/m2 (16.2-20.6 kg/m2), p<0.0001. Fat mass increased from median 11.4% (4.4-24.8%) to 26.7% (16.9-39.8%). Total OC, carboxylated OC (cOC), undercarboxylated OC (ucOC), and bone-specific alkaline phosphatase (BALP) increased during the study period. No change was observed for the resorption marker carboxy-terminal cross-linking telopeptide of type I collagen (CTX). Total body bone mineral content (BMC) increased, but no changes were found for whole body or lumbar spine bone mineral density. Tibial trabecular density measured by pQCT decreased. Total OC, cOC, and ucOC were not associated with BMI, insulin or body composition parameters. This prospective study demonstrates that all 3 forms of OC (total OC, cOC, ucOC) increase during rapid weight gain. BALP increased while the resorption marker CTX was unchanged, which corroborate with the increased total body BMC.

Impact of short-term refeeding on appetite and meal experiences in new onset adolescent eating disorders.

Restrictive eating disorders (ED) are increasing and represent a serious risk to the health of adolescent females. Restrictive ED in youth are often treated through aggressive short-term refeeding. Although evidence supports that this intervention is the "gold standard" for improving ED outcomes in youth, little research has specifically probed appetite and meal-related responses to this type of intensive, short-term refeeding in newly diagnosed individuals. Information about appetite and meal-related dysfunction could provide valuable insights regarding treatment-interfering features of ED in both acute inpatient and longer-term outpatient treatment. The purpose of this study was to evaluate the hunger, fullness, olfactory, and gustatory responses of adolescents with newly-diagnosed restrictive ED and to probe how and when these responses are altered by refeeding. Using a quasi-experimental ecologically valid methodology, this study described and compared profiles of hunger, fullness, olfactory, and gustatory responses in adolescent females (n = 15) with newly diagnosed restrictive ED at hospital admission (i.e., severe malnutrition) and after medical refeeding, in comparison to healthy controls (n = 15). Results showed that newly diagnosed (i.e., malnourished) adolescents with ED showed significantly different meal-related experiences than controls. Refeeding improved some of these differences, but not all. Following refeeding, females with ED continued to show lower hunger, greater fullness, and lower pleasantness of smell ratings compared to controls. Unpleasantness of taste ratings maladaptively increased, such that females who were re-fed reported more aversive scents than pre-treatment. Profiles of meal-related responses were also identified and compared between groups. The applicability of these findings are discussed within the context of critical periods of change during refeeding treatment and potentially promising intervention targets that might enhance treatment outcomes for adolescents with newly onset, restrictive ED.

Body fat and menstrual resumption in adult females with anorexia nervosa: a 1-year longitudinal study.

BACKGROUND: The variables predicting the resumption of menses in anorexia nervosa (AN) after weight restoration have not yet been fully established. We therefore aimed to investigate the association between several clinical parameters at inpatient discharge and the resumption of menses at 1-year follow-up in weight-restored adults with AN. METHODS: Demographic, anthropometric, body composition and eating disorder features were assessed in 54 adult females with AN who had restored normal body weight [body mass index (BMI) ≥ 18.5 kg m(-) ²] at the end of specialist inpatient treatment. These variables were compared between participants who had resumed menses and those who were still amenorrheic 1 year after inpatient discharge. RESULTS: At 1-year follow-up, 35.2% of patients had resumed menstruation. No significant association was found between the resumption of menses and either age, duration of illness or BMI at inpatient admission, nor for BMI, global Eating Disorder Examination score or trunk fat percentage at inpatient discharge. Only total body fat percentage at inpatient discharge was significantly higher in patients who resumed menstruation, as confirmed by combined logistic regression analysis (odds ratio = 1.14, 95% confidence interval = 1.001-1.303, P = 0.049). CONCLUSIONS: A higher total body fat percentage at inpatient discharge is associated with the resumption of menses at 1-year follow-up in weight-restored adult females with AN.

Best nutrition counseling practices for the treatment of anorexia nervosa: a Delphi study.

OBJECTIVE: To use Delphi methodology to evaluate the extent to which a panel of registered dietitians (RDs) who treat anorexia nervosa (AN) concur on parameters related to nutrition counseling for AN. METHOD: The twenty-one panelists who participated in this study: (i) were RDs (ii) had specialized in nutritional counseling for eating disorders for 5 years or more, and (iii) had Internet access at home or work. Over a 10-week period (between 8/2013 and 11/2013), panelists completed three iterative questionnaires. Questionnaire 1 included 12 open-ended questions regarding nutrition counseling for patients with AN. Subsequent questionnaires were developed based on a content analysis of responses to the first questionnaire, and panelists were asked to rank their level of agreement with these items. RESULTS: Consensus was defined as 85% agreement and was achieved for 47 (35.3%) of the 133 items included in the third questionnaire. Items achieving consensus described nutrition counseling approaches that are applicable to all patients with AN, and their wording typically allowed for consideration of individual needs. Some items that did not achieve consensus reflected approaches for which individual tailoring may be necessary depending on age, stage of illness, and other patient factors. Consensus was also not shown for approaches for which there is little evidence. DISCUSSION: Nutritional counseling intervention for AN has some consensus features, but the need for individualization was apparent. A stronger evidence-base for nutritional counseling interventions for AN would provide guidance and facilitate greater consistency among RDs regarding how to best care for this patient population.

Automatic approach/avoidance tendencies towards food and the course of anorexia nervosa.

OBJECTIVE: The aim of the present study was to investigate the role of automatic approach/avoidance tendencies for food in Anorexia Nervosa (AN). We used a longitudinal approach and tested whether a reduction in eating disorder symptoms is associated with enhanced approach tendencies towards food and whether approach tendencies towards food at baseline are predictive for treatment outcome after one year follow up. METHOD: The Affective Simon Task-manikin version (AST-manikin) was administered to measure automatic approach/avoidance tendencies towards high-caloric and low-caloric food in young AN patients. Percentage underweight and eating disorder symptoms as indexed by the EDE-Q were determined both during baseline and at one year follow up. RESULTS: At baseline anorexia patients showed an approach tendency for low caloric food, but not for high caloric food, whereas at 1 year follow up, they have an approach tendency for both high and low caloric food. Change in approach bias was neither associated with change in underweight nor with change in eating disorder symptoms. Strength of approach/avoidance tendencies was not predictive for percentage underweight. DISCUSSION: Although approach tendencies increased after one year, approach tendencies were neither associated with concurrent change in eating disorder symptoms nor predictive for treatment success as indexed by EDE-Q. This implicates that, so far, there is no reason to add a method designed to directly target approach/avoidance tendencies to the conventional approach to treat patients with a method designed to influence the more deliberate processes in AN.

Anorexia nervosa complicated by diabetes mellitus: the case for permissive hyperglycemia.

The coexistence of Type 1 Diabetes Mellitus and anorexia nervosa results in an increased incidence of known diabetic complications such as retinopathy and nephropathy, presumably because blood glucose is difficult to control within the throes of comorbid anorexia nervosa. In addition, even when a diabetic patient with anorexia nervosa has committed to resolving his or her eating disorder, glucose control is again difficult and fraught with complexity and peril as will be highlighted in the following case report. Prudence dictates that strict glucose control is not indicated for the relatively short period of time that constitutes the early stage of refeeding in a patient with severe anorexia nervosa. Rather, "permissive hyperglycemia" may be the more optimal course to pursue, as a clinical strategy which is considerate of both the criticality of the refeeding treatment plan and of the long-term nature of the diabetic illness.

[Contemporary criteria of the diagnosis and current recommendations for nutritional therapy in anorexia nervosa]. / Wspólczesne kryteria rozpoznania i aktualne rekomendacje leczenia zywieniowego w anoreksji.

The basic criterion for the diagnosis of anorexia (AN - anorexia nervosa) by ICD-10 (International Classification of Diseases, version 10) is the body weight less than 15% of the expected normal body weight. According to DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, version IV) the basic feature of AN is a refusal to maintain body weight equal or greater than the minimal normal weight. The prevalence of anorexia nervosa is 0.3-0.5% or even 1.3-3.7% if include pre-anorexic states (eg. the phenomenon of pro-ana). The main feature of anorexia is a reduction of caloric intake. According to the recommendations of the American Psychiatric Association (APA) for nutritional treatment of patients with AN the main goals in therapy of AN are: restoration of body weight, normalization of eating patterns, achievement a normal feeling of hunger and satiety and correction of the consequences of improper nutrition. APA suggests that achievable weight gain is about 0.9-1.4 kg per week in the case of hospitalized patients and approximately 0.23-0.45 kg per week in the case of outpatients. During the nutritional treatment of AN numerous side effects including anxiety, phobia, occurrence of obsessive thoughts and compulsive behavior, suicidal thoughts and intentions may occur. According to National Institute for Clinical Excellence (NICE) the most important goal of AN therapy is weight gain in the range of 0.5-1 kg per week in hospitalized patients and 0.5 kg per week for outpatients. A person suffering from anorexia in the initial period of nutritional treatment spends twice more energy to maintain elevated body temperature, which significantly increases during the night rest. This phenomenon is called nocturnal hyperthermia and has a negative effect on the healing process. "Refeeding syndrome" is an adverse effect of nutritional treatment in anorexia. It is caused by too rapid nutrition in a patient suffering from chronic starvation. It can endanger the patient's life.

High-calorie refeeding in adolescents with anorexia nervosa: a narrative review.

Background and objectives: Recent studies about refeeding in anorexia nervosa (AN) suggest starting with a high calorie diet. This narrative review aims to understand the initial refeeding management in hospitalized children and adolescents with AN and to develop a practical protocol. Methods: We performed a comprehensive database search in June 2023 for abstracts published between January 2010 and May 2023 in different databases: Pubmed, The Cochrane Library and Embase with the terms refeeding syndrome, energy intake, diet therapy, weight restoration, hypophosphatemia, nutritional rehabilitation, anorexia nervosa, restrictive eating disorders, child, adolescent and young adult. Results: Fifteen papers were included in this review. Twelve studies were retrospective or observational. Only 3 randomized controlled trials were found. Initial energy intake varies within a wide range between 500 and 2800 kcal per day but generally begins with higher calories than current recommendations. Only hypophosphatemia was often described without clinical refeeding syndrome. Initial weight restoration was better with high calorie refeeding (HCR). Length of stay was shorter with HCR in some studies. Long term outcomes were unknown. Only two studied severely malnourished patients (< 70 % mBMI). Conclusion: In adolescents with AN and with a low risk of RS, high calorie refeeding is possible under close medical monitoring and with prompt electrolyte correction. Robust studies with a unified protocol are needed to confirm the safety of high calorie refeeding especially in severely malnourished adolescents with AN.

Characteristics and outcome of patients with anorexia nervosa on medical nutritional therapy: an institutional study with review of literature.

INTRODUCTION: Eating disorders (EDs) are debilitating mental illnesses that can lead to significant medical complications from malnutrition. Eating disorders are on the rise in Asia and the prevalence is expected to increase. The aim of this study was to understand the characteristics of local patients and evaluate our current inpatient nutritional rehabilitation protocol for anorexia nervosa (AN). METHODS: Retrospective descriptive data were gathered from 47 patients diagnosed with AN. Patients with admissions were further stratified according to their nutritional management based on whether they were on the AN protocol or standard hospital care. Data on their rate of weight gain, length of stay and calorie prescription were collected. RESULTS: Similar to previous studies, the majority of AN patients were female (96.7%). However, the age at presentation of AN in this study, as compared with previous local studies, had decreased (14 vs. 16 years). We also found that patients on the AN protocol were prescribed a higher amount of calories than those given standard care (2,700 vs. 2,317 calories). Patients on the AN protocol achieved a higher rate of weight gain per week (1.15 vs. 0.29 kg) and had a shorter length of hospital stay (23 vs. 36 days). CONCLUSION: Patients with AN appear to be presenting at a younger age. Medical stabilisation of AN patients can be achieved more quickly through a higher calorie inpatient AN treatment protocol. Future local studies examining actual calorie consumption, its effect on weight gain trajectory, severity of refeeding syndrome and time to remission will be beneficial.

Effect of nutritional rehabilitation on gastric motility and somatization in adolescents with anorexia.

OBJECTIVE: To examine gastric function, as well as the presence of somatic complaints, anxiety symptoms, and functional gastrointestinal disorders (FGIDs), in adolescents with anorexia nervosa (AN) before and after nutritional rehabilitation. STUDY DESIGN: Sixteen females with AN and 22 healthy controls with similar demographic profiles were included. Gastric emptying (measured as residual gastric volume) and gastric accommodation (measured as postprandial antral diameter) were assessed with abdominal ultrasonography. Participants completed the Children's Somatization Inventory (CSI), the Screen for Child Anxiety-Related Emotional Disorders, and the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version. All testing was repeated 3-4 months later. RESULTS: Body mass index in the AN group improved over time (P = .012). Fasting gastric parameters were similar in the 2 groups. Maximum postprandial antral diameter was significantly greater in controls compared with the AN group (P = .008). Only adolescents with AN demonstrated a significant increase in maximum postprandial diameter at repeat testing (P = .009). There was no difference in residual gastric volume between the 2 groups. Initial CSI scores were higher in adolescents with AN (P < .0001), including higher scores for nausea and abdominal pain. CSI scores were significantly lower in adolescents with AN (P = .035). Initial scores on the Screen for Child Anxiety-Related Emotional Disorders were significantly higher in adolescents with AN (P = .0005), but did not change over time. Adolescents with AN met significantly more criteria for FGIDs (P = .003). CONCLUSION: Adolescents with AN have impaired gastric accommodation that improves after nutritional rehabilitation, have significantly more somatic complaints, and meet more criteria for anxiety disorders and FGIDs. After nutritional rehabilitation, somatization improves and FGIDs become less common, but symptoms of anxiety persist.

Examining supervised meals in patients with restrictive eating disorders.

OBJECTIVES: Anorexia nervosa is a chronic, life-threatening illness affecting adolescents with increasing incidence. Previous research has demonstrated that, although weight gain is a key to medical stabilization, there is wide and significant variability in treatment practices. Meal supervision in hospitalized patients involves the use of clinical staff as active and supportive observers during meal time. No studies to date have examined the effects of meal supervision in medically hospitalized patients with anorexia nervosa. The primary aim of this study was to examine the effect of meal supervision on outcomes during inpatient medical hospitalization. METHODS: A retrospective record review of 52 patients with restrictive eating disorders admitted to a tertiary pediatric hospital from July 2008 to July 2009 was conducted. RESULTS: The data revealed higher average weights and improved overnight heart rate trends for patients who received at least 1 supervised meal during hospitalization compared with those who received no supervised meals. CONCLUSIONS: The findings warrant further investigation of meal supervision as a possible treatment modality.

Serotonin neurotransmission in anorexia nervosa.

Patients with anorexia nervosa (AN) show extreme dieting weight loss, hyperactivity, depression/anxiety, self-control, and behavioral impulsivity. 5-Hydroxytryptamine (5-HT; serotonin) is involved in almost all the behavioral changes observed in AN patients. Both genetic and environmental factors contribute toward the pathogenesis of AN. It is a frequent disorder among adolescent girls and young women and starts as an attempt to lose weight to look beautiful and attractive. Failure to see the turning point when fasting becomes unreasonable leads to malnutrition and AN. Tryptophan, the precursor of serotonin and an essential amino acid, is only available in the diet. It is therefore likely that excessive diet restriction and malnutrition decrease brain serotonin stores because the precursor is less available to the rate-limiting enzyme of 5-HT biosynthesis, which normally exists unsaturated with its substrate. Evidence shows that diet restriction-induced exaggerated feedback control over 5-HT synthesis and the smaller availability of tryptophan decreases serotonin neurotransmission at postsynaptic sites, leading to hyperactivity, depression, and behavioral impulsivity. A compensatory upregulation of postsynaptic 5-HT-1A receptors and hypophagic serotonin receptors may be involved in anxiety and suppression of appetite. It is suggested that tryptophan supplementation may improve pharmacotherapy in AN.

Nutritional intake and dietary patterns in pregnancy: a longitudinal study of women with lifetime eating disorders.

There is limited knowledge about dietary patterns and nutrient/food intake during pregnancy in women with lifetime eating disorders (ED). The objective of the present study was to determine patterns of food and nutrient intake in women with lifetime ED as part of an existing longitudinal population-based cohort: the Avon Longitudinal Study of Parents and Children. Women with singleton pregnancies and no lifetime psychiatric disorders other than ED (n 9723) were compared with women who reported lifetime (ever) ED: (anorexia nervosa (AN, n 151), bulimia nervosa (BN, n 186) or both (AN+BN, n 77)). Women reported usual food consumption using a FFQ at 32 weeks of gestation. Nutrient intakes, frequency of consumption of food groups and overall dietary patterns were examined. Women with lifetime ED were compared with control women using linear regression and logistic regression (as appropriate) after adjustment for relevant covariates, and for multiple comparisons. Women with lifetime ED scored higher on the 'vegetarian' dietary pattern; they had a lower intake of meat, which was compensated by a higher consumption of soya products and pulses compared with the controls. Lifetime AN increased the risk for a high ( ≥ 2500 g/week) caffeine consumption in pregnancy. No deficiencies in mineral and vitamin intake were evident across the groups, although small differences were observed in macronutrient intakes. In conclusion, despite some differences in food group consumption, women with lifetime ED had similar patterns of nutrient intake to healthy controls. Important differences in relation to meat eating and vegetarianism were highlighted, as well as high caffeine consumption. These differences might have an important impact on fetal development.

Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery.

Anorexia nervosa (AN) is an eating disorder with somatic complications. The aim of the study was to analyse echocardiographic abnormalities in patients with AN at initial examination and after weight restoration. A total of 173 consecutively admitted adolescents (aged 12-17 years), diagnosed with DSM-IV AN (307.1) were evaluated in a child and adolescent psychiatric department of a major university hospital from December 1997 to August 2008. In addition, 40 healthy adolescents of the same age with normal weight were examined. In patients with AN, 34.7% had a pericardial effusion (PE) which was clinically silent. In contrast, none of the controls presented with PE (p < 0.001). No differences across AN subtypes were observed. Patients with PE showed significantly lower body mass index (BMI) (p = 0.016) than patients without PE. They had more prominent low-T3 syndrome (p = 0.003) and longer duration of hospitalisation (p = 0.008) after controlling for BMI at admission. Remission of PE was observed in 88% of the patients after weight restoration. Left ventricular end-diastolic and end-systolic dimensions in AN were significantly lower than in controls (p < 0.001). There were no differences in interventricular septum thickness, posterior wall thickness and fractional shortening. This report indicates that adolescents with AN show cardiac abnormalities in comparison to healthy young women. Furthermore, PE is a frequent cardiac complication in patients with AN and it is associated with BMI, low T3 serum levels and duration of hospitalisation.