Gastrointestinal and eating problems in women with Ehlers-Danlos syndromes.

PURPOSE: Ehlers-Danlos syndromes (EDS) are a group of heritable conditions in which abnormal collagen synthesis leads to features such as joint hypermobility, skin abnormalities, and tissue fragility. Gastrointestinal (GI) symptoms are common among those affected. These may negatively impact eating behaviors, leading to weight/nutritional problems. We aimed to compare GI symptoms, disordered eating, and body mass index (BMI) between EDS patients and healthy controls, and to explore the link between these variables in EDS patients. METHOD: In this cross-sectional study, women with EDS and healthy controls responded to an online survey assessing GI symptoms (heartburn/regurgitations, early satiety, nausea/vomiting, bloating, abdominal pain, dysphagia), food allergies/intolerances, disordered eating, history of eating disorders (ED), and BMI. We performed intergroup comparisons as well as multivariate analyses to explore the associations between disordered eating, GI symptoms, and BMI in the EDS group. RESULTS: Sixty-six women with EDS and 39 healthy controls were included in the study. The EDS patients showed significantly more GI symptoms and food allergies/intolerances, increased prevalence of ED history, higher risk of current ED, and lower BMI than the controls. In the EDS group, the risk for ED was associated with GI symptoms; restricted eating was associated with GI symptoms, food allergies/intolerances, and dysphagia; uncontrolled eating was associated with GI symptoms; and BMI was associated with GI symptoms and food allergies/intolerances. DISCUSSION: Our results are concordant with that of previous reports highlighting the high level of GI problems and disordered eating in women with EDS. In addition, and for the first-time, the association between both is evidenced in this specific population. LEVEL OF EVIDENCE III: Case-control analytic study.

Joint Hypermobility and Clinical Correlates in a Group of Patients With Eating Disorders.

Background: The ability to move joints beyond the normal range of motion is called Joint Hypermobility (JHM). JHM has been associated with a plethora of physical problems and is a frequent sign of hereditary disorders of connective tissue. Neuropsychiatric conditions such as eating disorders (ED) have also been related to JHM. However, little is known about the clinical profile of people with ED and JHM. The aim of this study was to explore JHM in patients with ED and to compare the clinical characteristics of hypermobile ED patients with non-hypermobile ED patients. Method: Fifty-three outpatients diagnosed with ED were assessed using the Beighton score for JHM, the Eating Disorders Inventory 2, the Eating Disorder Examination, and the Detail and Flexibility Questionnaire. Information relating to patients' psychiatric and somatic comorbidities/symptoms was also collected. Results: Using the traditional Beighton score's cutoff of ≥4, 41.5% of the sample presented with JHM. Our results indicate that compared with non-hypermobile ED patients, those with JHM are significantly younger, suffer at a greater extent from joint pain and easy bruising, have a shorter duration of the ED, and have lower scores for cognitive rigidity. In addition, for those with anorexia nervosa, the restricting subtype represents a significantly lower proportion of hypermobile ED patients compared to non-hypermobile ED patients. Multivariate analyses showed that cognitive rigidity, age, and duration of the ED could predict the JHM status in this sample. Conclusion: These results suggest that JHM is frequent in patients with ED and is accompanied by signs of tissue fragility. Patients with ED and JHM seem to present a specific profile characterized by less cognitive rigidity and restricting behavior in the case of anorexia nervosa. Further research is needed in order to confirm these results.

Body dissatisfaction and disordered eating attitudes among adolescents from Portugal and Spain / Insatisfacción corporal y actitudes alimentarias alteradas en adolescentes de Portugal y España

Cross-cultural studies comparing eating attitudes among adolescents from southern-European countries are scarce. We aimed to compare body dissatisfaction, disordered-eating attitudes, awareness and internalisation of the unrealistic-body-ideal, self-esteem, perfectionism and impulsivity among adolescents from Spain and Portugal. Participants were 249 Spanish and 206 Portuguese adolescents (51.2% girls) aged 12-15 (M= 13.3 years, SD= 0.6). A 2 × 2 (country × sex) MANOVA was conducted for each self-reported measure. Girls scored higher on awareness and internalisation of the unrealistic-body-ideal, body-dissatisfaction, disordered-eating attitudes and lower on self-esteem than boys did. Regarding the country, Portuguese adolescents scored higher than Spaniards on eating disorder attitudes, impulsivity and perfectionism. Our findings show significant differences between country and gender, highlighting the importance of specific gender-oriented prevention strategies

Las diferencias transculturales en la insatisfacción corporal y las actitudes alimentarias de riesgo en adolescentes han sido escasamente estudiadas en el sur de Europa. El objetivo de este estudio fue comparar la insatisfacción corporal, las actitudes alimentarias alteradas, la interiorización del ideal estético, la autoestima, el perfeccionismo y la impulsividad de adolescentes de Espana y Portugal. Participaron 249 adolescentes españoles y 206 portugueses (51,2% de chicas) de entre 12 y 15 años (M= 13,3 años; DT= 0,6). Se realizó un MANOVA considerando un diseño 2 × 2 (país × sexo) para cada medida autoinformada. Las chicas obtuvieron puntuaciones más altas en interiorización del ideal estético, insatisfacción corporal, conductas alimentarias alteradas y menor autoestima que los chicos. En cuanto al país, los adolescentes portugueses puntuaron más alto que los españoles en actitudes alimentarias alteradas, impulsividad y perfeccionismo. Nuestros hallazgos muestran diferencias significativas entre país y sexo, destacando la importancia de las estrategias de prevención específicas para cada sexo

Tumor de Frantz. presentacion de 2 casos / Frantz´s tumor. a two cases presentation

La neoplasia sólida pseudopapilar de páncreas es una neoplasia maligna de bajo grado, relativamente poco frecuente, que representa entre 0.9 y 2.7 % de todas las neoplasias malignas pancreáticas. Afecta principalmente mujeres jóvenes (89 % de los casos), con una edad promedio al diagnóstico de 28 años. La mayoría presentan sintomatología inespecífica relacionada a una masa intrabdominal y más de un tercio suelen ser descubiertas incidentalmente. Presentamos dos casos (una paciente de 19 años de edad diagnosticada de una neoplasia localizada en cuerpo de páncreas y una paciente de 28 años con tumor en la cabeza, que correspondían a tumor de Frantz. Analizamos las características biológicas de estos tumores, sus formas de presentación y las pruebas complementarias recomendadas para su diagnóstico, así como una búsqueda en la literatura.

The solid pseudopapillary neoplasm of the pancreas is a low-grade malignancy, relatively rare, representing between 0.9 and 2.7% of all pancreatic malignancies. It mainly affects young women (89% of cases), with a mean age at diagnosis of 28 years. Most have specific symptoms related to intra-abdominal mass and more than one third are usually discovered incidentally. We report two cases ( a 19-years-old woman diagnosed of a neoplasm in the tail and another 28 years old woman , with neoplasm in the head of the pancreas which could be classified as Frantz’s tumor. We analyze the biological characteristics of these tumors, their forms of presentation and the recommended explorations for the diagnostic.

Pilot assessment of two disordered eating prevention programs. Preliminary findings on maladaptive beliefs related to eating disorders.

AIMS: As eating disorders have severe consequences, they require prevention. We aimed to compare maladaptive beliefs related to eating disorders by following two programs based on media literacy in adolescents at post-test intervention, and after 6 and 12month-follow-ups. The Male and Female Nutrition and Media Literacy Model preventive program (NUT+MEF+MEM+ML in Spanish) and the Theater Alive program are both based on the same contents, the former being presented in a multimedia and interactive format and the latter in a drama format. Both were compared to a control group without intervention, whose participants received usual classes before the assessments. METHOD: Participants were 178 adolescents in the second year of compulsory secondary education from fours schools of Terrassa (Catalonia, Spain). All participants in each school were assigned to the same group, depending on school schedules. A mixed 3 (group: Theater Alive, NUT+MEF+MEM+ML, control)×3 (time: post-test, 6-month-follow-up, 12-month-follow-up) factorial design was used to evaluate the effect on maladaptive beliefs measured using a CE-TCA tool. RESULTS: When compared to the control group, both Theater Alive (d=0.88) and NUT+MEM+MEF+ML (d=0.60) obtained lower scores over time, the latter being not statistically significant. DISCUSSION: The Theater Alive program may produce an effect of cognitive dissonance that might eliminate the discrepancy between the contents of the play and those that are internalized, thus modifying maladaptive beliefs. Participants in the Theater Alive program, as actors in front of an audience, had to defend certain content that was rehearsed over and over again to the point until it became internalized.

Association of biological, psychological and lifestyle risk factors for eating disturbances in adolescents.

We aimed to assess the association of several risk factors for eating disturbances in adolescents. Participants were 448 girls and boys aged 12-15 years. Being female, higher body mass index, internalisation of standard of appearance, perfectionism, body dissatisfaction, number of lifetime addictive behaviours and lower self-esteem were associated with higher eating disturbance scores, whereas frequency of sedentary behaviours and physical activity were not (R(2) ⩾ 41%). Findings suggest the need to guide prevention efforts towards the broad spectrum of individual potentially modifiable factors. A non-specific comprehensive perspective may be adequate to prevent problems related to weight, body image and drug use.

Body dissatisfaction and disordered eating among Portuguese and Spanish adolescents: The role of individual characteristics and internalisation of sociocultural ideals.

The aim of this study was to explore the differences in patterns of risk factors for body dissatisfaction and disordered eating attitudes in both female and male adolescents from Portugal and Spain. The sample included 455 adolescents aged 12-16 years (M = 13.28, SD = 0.65) from two urban areas of each country. Body mass index, self-reported self-esteem, perfectionism, internalisation of sociocultural ideals, body dissatisfaction and disordered eating attitudes were assessed. Path analyses provided partial support for a cross-cultural model of body dissatisfaction and disordered eating in Western countries due to the presence of certain differences in the patterns of relationships across sex and country. The findings suggest the importance not only of identifying cultural specificities, even in "neighbouring" countries, but also of developing a global and comprehensive preventive approach that focuses on the influence of the ideal of beauty transmitted by Western societies.

Assessment of two school-based programs to prevent universal eating disorders: media literacy and theatre-based methodology in Spanish adolescent boys and girls.

AIMS: To evaluate the long-term effects of two school-based prevention programs administered to a universal mixed-sex sample of school-going adolescents on disturbed eating attitudes, aesthetic ideal internalization, and other eating disorder risk factors, when compared to a control group. METHODS: Participants were 200 adolescents aged 12-15 selected by means of incidental sampling from second-year compulsory secondary education at schools. An interactive multimedia media literacy program (ML + NUT, Media Literacy and Nutrition) and a program focused on the same topics using dramatic arts (Theatre Alive) were applied and compared with a control group. Pretest, posttest (1 month later), and 5- and 13-month follow-up measurements were taken. Analyses were conducted with two-way mixed 3 × 3 ANCOVA (group × phase) adjusted by baseline levels, body mass index, and sex. RESULTS: Participants in both experimental groups showed significantly higher self-esteem scores than the control group over time. The ML + NUT group also presented lower aesthetic ideal internalization scores than the control group. DISCUSSION: Both programs can benefit students' self-esteem. Moreover, ML + NUT program was useful in reducing thin-ideal internalization. However, differences in body dissatisfaction and disordered eating attitudes were not found. The programs may be protective on the core psychological variables, which are essential to adaptive adolescent development.

Prevention programme for eating disturbances in adolescents. Is their effect on body image maintained at 30 months later?

We assessed changes in the body image of Spanish adolescents who participated in a programme aimed at preventing disordered eating, with a 30-month follow-up. 254 girls and 189 boys aged 12-14 were assigned to a control group (n=201) or one of two possible experimental conditions: media literacy programme (ML, n=143) and media literacy plus nutrition awareness programme (ML+NUT, n=99). Body image was assessed with the Body Image Questionnaire (Qüestionari d'Imatge Corporal; QÜIC). Pre-test, post-test, 7- and 30-month follow-up measurements were taken. Linear model analyses were carried out with a 2×3×3 ANOVA (sex×group×phase), adjusted by the baseline level. At 30-month follow-up, ML and ML+NUT participants showed fewer body problems and more body satisfaction than the control group. There is a need for prevention programmes addressing eating and body image disturbances that involve both boys and girls.

Assessment of body image: psychometric properties of the Body Image Questionnaire.

This study investigated the psychometric properties of the Body Image Questionnaire (QÜIC) in Spanish adolescents. The sample comprised 254 girls and 189 boys, aged 12-15. Principal component analyses showed that the 18 satisfaction items could be summarized using two moderately interrelated dimensions, torso and head/limbs, with satisfaction with chest/breast and genitals loading on a different factor for boys (torso) and girls (head/limbs). The QÜIC measures of body satisfaction, body problems, general physical appearance and conformity with weight and height presented satisfactory test-retest reliability, internal consistency and convergent validity. Our findings support the use of the QÜIC when assessing body image.

Disordered eating behaviors and body image in a longitudinal pilot study of adolescent girls: what happens 2 years later?

We assessed the prospective association of risk factors for eating and body image disturbances after a 2-year follow-up in a community sample of Spanish adolescent girls. The participants included 128 Spanish girls aged 12-14, who took part in a 28-month prospective study. Aspects assessed were eating attitudes (Eating Attitudes Test), influence of the body shape model (questionnaire on influences of the aesthetic body shape model), extreme weight-control behaviors (Eating Disorder Examination-Questionnaire), body image (Body Image Questionnaire) and Body Mass Index (BMI). BMI, extreme weight-control behaviors and body image problems emerged as potential predictors of an increase in eating disturbances. An increased influence of the thinness model was significantly associated with reduced body satisfaction and body image problems. Preventive programs are needed to contribute reducing the impact of sociocultural influences with regard to thinness, the use of extreme weight-control behaviors and overweight in adolescents.

Factores de riesgo de alteraciones alimentarias en adolescentes españoles y chilenos / Risk factors of altered eating behaviors in Spanish and Chilean adolescents

El objetivo del estudio fue comparar factores de riesgo individual, familiar y sociocultural de alteraciones alimentarias en adolescentes españoles y chilenos. Participaron 172 españoles y 106 chilenos de ambos sexos, de 12 a 14 años. Se evaluó el índice de masa corporal, dieta, interiorización del modelo estético corporal (“Cuestionario de influencias del modelo estético corporal”), actitudes alimentarias (“Test de actitudes hacia la comida”) y satisfacción corporal (“Cuestionario de imagen corporal”), en función del país y sexo. En función del país no se observan diferencias en la interiorización del modelo estético corporal, actitudes alimentarias y riesgo de desarrollar alteraciones alimentarias, mientras que la satisfacción corporal (p< 0,01) y la realización de dieta (p= 0,03) son superiores en la muestra chilena. En función del sexo no se hallan diferencias en actitudes alimentarias y niveles de dieta, en cambio las chicas presentan mayor interiorización del modelo estético corporal (p< 0,05) y menor satisfacción corporal (p= 0,02). Estos resultados sugieren que los adolescentes evaluados comparten influencias socioculturales hacia la delgadez y actitudes alimentarias orientadas al control del peso (AU)

The aim of the study was to compare individual, family, and cultural risk factors of eating disturbance in Spanish and Chilean adolescents. The sample comprised 172 Spanish and 106 Chilean adolescents of both genders, aged from 12 to 14 years, who participated in a cross section descriptive study. Body Mass Index, diet, internalization of body shape model (“Cuestionario de Influencias del modelo estético corporal”), eating attitudes (Eating Attitudes Test) and body satisfaction (“Cuestionario de imagen corporal”), were evaluated taking into account country and gender. No differences are observed on internalization of the body shape model, eating attitudes and eating disturbance risk across countries, whereas body satisfaction (p< .01) and making diet (p= .03) are higher in the Chilean sample. No differences are found on eating attitudes and diet level across genders, but girls show more internalization of the body shape model (p< .05) and less body satisfaction (p= .02). These results suggest that the adolescents evaluated share sociocultural influences towards thinness and eating attitudes oriented the weight control