Role of Endogenous Opioids in the Pathophysiology of Obesity and Eating Disorders.

This second chapter in our trilogy reviews and critically appraises the scientific evidence for the role of endogenous opioid system (EOS) activity in the onset and progression of both obesity and eating disorders. Defining features of normative eating and maladaptive eating behaviors are discussed as a foundation. We review the scientific literature pertaining to the predisposing risk factors and pathophysiology for obesity and eating disorders. Research targeting the association between obesity, disordered eating, and psychiatric comorbidities is reviewed. We conclude by discussing the involvement of endogenous opioids in neurobiological and behavior traits, and the clinical evidence for the role of the EOS in obesity and eating disorders.

Endogenous Opioids in the Homeostatic Regulation of Hunger, Satiety, and Hedonic Eating: Neurobiological Foundations.

This chapter (part one of a trilogy) summarizes the neurobiological foundations of endogenous opioids in the regulation of energy balance and eating behavior, dysregulation of which translates to maladaptive dietary responses in individuals with obesity and eating disorders, including anorexia, bulimia, and binge eating disorder. Knowledge of these neurobiological foundations is vital to researchers' and clinicians' understanding of pathophysiology as well as the science-based development of multidisciplinary diagnoses and treatments for obesity and eating disorders. We highlight mechanisms of endogenous opioids in both homeostatic and hedonic feeding behavior, review research on the dysregulation of food reward that plays a role in a wide array of obesity and disordered eating, and the clinical implications of neurobiological responses to food for current science-based treatments for obesity and eating disorders.

Relationship between Anthropometric Parameters and Sensory Processing in Typically Developing Brazilian Children with a Pediatric Feeding Disorder.

In this study, we aimed to relate anthropometric parameters and sensory processing in typically developing Brazilian children diagnosed with a pediatric feeding disorder (PFD). This was a retrospective study of typically developing children with a PFD. Anthropometric data were collected and indices of weight-for-age, length/height-for-age, and body mass index-for-age (BMI-for-age) were analyzed as z-scores. Sensory profile data were collected for auditory, visual, tactile, vestibular, and oral sensory processing. We included 79 medical records of children with a PFD. There were no statistically significant (p > 0.05) relationships between the anthropometric variables (weight-, length/height-, or BMI-for-age) and the sensory variables (auditory, visual, tactile, vestibular, or oral sensory processing). In conclusion, we found no relationship between anthropometric parameters and sensory processing in the sample of typically developing Brazilian children diagnosed with a PFD under study.

Eating behaviours related to psychological stress are associated with functional hypothalamic amenorrhoea in exercising women.

Functional hypothalamic amenorrhoea (FHA) can occur due to the independent or combined effects of psychogenic and energetic stressors. In exercising women, research has primarily focused on energy deficiency as the cause of FHA while psychological stressors have been ignored. To assess both psychological and metabolic factors associated with FHA in exercising women, we performed across-sectional comparison of 61 exercising women (≥2 hours/week, age 18-35 years, BMI 16-25kg/m2), who were eumenorrheic or amenorrhoeic confirmed by daily urine samples assayed for reproductive hormone metabolites. Psychological factors and eating behaviours were assessed by self-report questionnaires. Exercising women with FHA had lower resting metabolic rate (p=0.023), T3 (p<0.001), T4 (p=0.013), leptin (p=0.002), higher peptide YY (p<0.001), greater drive for thinness (p=0.017), greater dietary cognitive restraint (p<0.001), and displayed dysfunctional attitudes, i.e., need for social approval (p=0.047) compared to eumenorrheic women. Amenorrhoeic women displayed asignificant positive correlation between the need for social approval and drive for thinness with indicators of stress, depression, and mood, which was not apparent in eumenorrheic women. In exercising women with FHA, eating behaviours are positively related to indicators of psychological stress and depression.

[Eating behavior disorders in patients hospitalized in a Mental Health Service]. / Trastornos de la alimentación en pacientes hospitalizados en un Servicio de Salud Mental Pediátrico.

INTRODUCTION: Eating disorders (ED) have a high prevalence during adolescence, associated with high morbidity and mortality. In our country, there are no data that characterize adolescent inpatients with ED. OBJECTIVE: To describe and analyze hospitalizations of children and adolescents due to ED admitted in a Pediatric Mental Health Service (PMHS). PATIENTS AND METHOD: Data were collected from the clinical record of patients with ED hospitalized in the PMHS of the Hospital Roberto del Río during 2005-2015. The following admission variables were studied: cause for hospitalization, ED type, nu tritional status, systemic involvement, and psychosocial variables (psychiatric comorbidities, family functioning, abuse, and suicide ideation/attempt). The t-Student test was used for quantitative varia bles and the chi-square or Fisher Test for qualitative variables for the comparison between groups. RESULTS: 93 patients were included, with an average age of 14.6 years, 84% of them were women. The most frequent diagnosis was anorexia nervosa (AN) (71%) and the most frequent cause for hospita lization was the failure of outpatient treatment, followed by suicide ideation/attempt. At admission, 40% of the patients had malnutrition, 96% psychiatric comorbidity, and 88% family dysfunction. CONCLUSION: AN was the most frequent ED among inpatients and the failure of outpatient treatment was the main cause for hospitalization. The latter could be explained, in part, by the high prevalence of family dysfunction and psychiatric comorbidity of patients and their families which would com plicate outpatient treatment.

Trastornos de la alimentación en pacientes hospitalizados en un Servicio de Salud Mental Pediátrico / Eating behavior disorders in patients hospitalized in a Mental Health Service

INTRODUCTION: Los trastornos de la alimentación e ingesta (TAI) tienen una elevada prevalencia durante la adolescencia, asociándose a alta morbimortalidad. En nuestro país no existen datos que caractericen a los adolescentes con TAI que requieren hospitalización. OBJETIVO: Describir y analizar las hospitaliza ciones debidas a TAI en niños y adolescentes en un Servicio de Salud Mental Pediátrico (SSMP). PACIENTES Y MÉTODO: Se recolectaron los datos de los registros clínicos de pacientes con TAI hospitalizados en el SSMP del Hospital Roberto del Río entre 2005-2015. Se estudiaron las variables de ingreso: motivo de hospitalización, tipo de TAI, estado nutricional, repercusión sistémica y variables sicosociales (comorbilidades siquiátricas, funcionamiento de la familia, abuso e ideación/intento suicida). Para la comparación de variables cuantitativas entre grupos se utilizó el test t-Student y para variables categóricas chi-cuadrado o Test Fisher. RESULTADOS: Se incluyeron 93 pacientes, me diana de edad 14,6 años, 84% género femenino. El diagnóstico más frecuente fue anorexia nerviosa (AN) (71%) y la causa más frecuente de hospitalización fue el fracaso del tratamiento ambulatorio, seguido por ideación/intento suicida. Al ingreso, 40% de los pacientes presentaban déficit nutricio nal, 96% comorbilidad psiquiátrica y 88% disfunción familiar. CONCLUSIÓN: La AN fue el TAI más frecuente dentro de los pacientes hospitalizados y el fracaso del tratamiento ambulatorio el principal motivo de ingreso. Esto último podría ser explicado, en parte, por la alta prevalencia de disfunción familiar y comorbilidad psiquiátrica de los pacientes y su familia, que estaría complicando el trata miento ambulatorio.

INTRODUCTION: Eating disorders (ED) have a high prevalence during adolescence, associated with high morbidity and mortality. In our country, there are no data that characterize adolescent inpatients with ED. OBJECTIVE: To describe and analyze hospitalizations of children and adolescents due to ED admitted in a Pediatric Mental Health Service (PMHS). PATIENTS AND METHOD: Data were collected from the clinical record of patients with ED hospitalized in the PMHS of the Hospital Roberto del Río during 2005-2015. The following admission variables were studied: cause for hospitalization, ED type, nu tritional status, systemic involvement, and psychosocial variables (psychiatric comorbidities, family functioning, abuse, and suicide ideation/attempt). The t-Student test was used for quantitative varia bles and the chi-square or Fisher Test for qualitative variables for the comparison between groups. RESULTS: 93 patients were included, with an average age of 14.6 years, 84% of them were women. The most frequent diagnosis was anorexia nervosa (AN) (71%) and the most frequent cause for hospita lization was the failure of outpatient treatment, followed by suicide ideation/attempt. At admission, 40% of the patients had malnutrition, 96% psychiatric comorbidity, and 88% family dysfunction. CONCLUSION: AN was the most frequent ED among inpatients and the failure of outpatient treatment was the main cause for hospitalization. The latter could be explained, in part, by the high prevalence of family dysfunction and psychiatric comorbidity of patients and their families which would com plicate outpatient treatment.

[Female adolescents with eating disordes: cardiac abnormalities]. / Trastornos de la conducta alimentaria: alteraciones cardiovasculares al ingreso y evolución a 3 meses.

BACKGROUND: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. AIM: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. PATIENTS AND METHODS: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. RESULTS: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. CONCLUSIONS: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.

Worse Metabolic Control and Dynamics of Weight Status in Adolescent Girls Point to Eating Disorders in the First Years after Manifestation of Type 1 Diabetes Mellitus: Findings from the Diabetes Patienten Verlaufsdokumentation Registry.

OBJECTIVE: To assess indications of eating disorders in girls with type 1 diabetes mellitus (T1DM). STUDY DESIGN: In total 31 556 girls aged >6 months and <23 years of age with T1DM from the Diabetes Patienten Verlaufsdokumentation (DPV) cohort were analyzed including 155 (0.49%) girls with anorexia nervosa, 85 (0.27%) girls with bulimia nervosa, 45 (0.14%) girls with binge eating disorder, and 229 (0.73%) girls with eating disorders not otherwise specified. Patient characteristics, weight changes, numbers of patients with severe hypoglycemia and diabetic ketoacidosis (DKA), changes of glycosylated hemoglobin A1c (HbA1c) levels, use of pumps, and prevalence of celiac disease and autoimmune thyroiditis were compared between girls with and without eating disorders. Multiple logistic regression analyses were performed. RESULTS: Eating disorders were significantly associated with late pubertal age, nonusage of pumps, no migration background, increased HbA1c levels, increased frequencies of DKA and severe hypoglycemia, and celiac disease were not related to eating disorders. Significant differences in HbA1c levels, prevalence of DKA and severe hypoglycemia between girls with and without eating disorders were already detectable in the first years after onset of T1DM. A decrease of body mass index (BMI)-SDS increased the risk for comorbid anorexia nervosa (7.1-fold [95% CI 3.6-14.3] compared with stable BMI-SDS, 6.9-fold [95%CI 3.4-14.1] compared with increase of BMI-SDS). CONCLUSIONS: Poor metabolic control and increased rates of DKA and severe hypoglycemia in the first years after manifestation of T1DM can be hints for eating disorders in girls with T1DM, and weight loss is specific for anorexia nervosa. These clinical features should lead to screening for eating disorders especially at a late pubertal age.

Trastornos de la conducta alimentaria: alteraciones cardiovasculares al ingreso y evolución a 3 meses / Female adolescents with eating disordes: cardiac abnormalities

Background: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. Aim: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. Patients and Methods: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. Results: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. Conclusions: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.

Perfil neuropsicológico de las pacientes con trastornos de la conducta alimentaria / Neuropsychological profile of patients with eating disorders

Los trastornos de la conducta alimentaria (TCA), entre los que se encuentran la anorexia nerviosa (AN) y la bulimia nerviosa (BN), presentan una gran relevancia social, económica y sanitaria. Recientemente se ha observado que las alteraciones conductuales típicas de estas pacientes podrían ser explicadas, al menos en parte, por determinados déficits cognitivos. Es por ello que la evaluación neuropsicológica parece ser necesaria para obtener una mayor comprensión de esta clase de trastornos. El objetivo de este estudio fue evaluar si existían diferencias en el funcionamiento neuropsicológico de un grupo de mujeres jóvenes con AN y BN en comparación con otro grupo de mujeres sanas sin TCA (grupo control). Los resultados obtenidos pusieron de manifiesto que las pacientes con TCA presentaron una peor ejecución en la memoria audio-verbal y episódica, una menor flexibilidad cognitiva y una peor capacidad de planificación, en comparación con un grupo de mujeres normativas. No obstante, las pacientes de este estudio se encontraban dentro de los parámetros de normalidad en la memoria visoespacial, en la atención, en la velocidad de procesamiento, en la memoria de trabajo, en la capacidad de inhibición de respuestas automáticas, en la fluidez verbal y en la cognición social. En conclusión, la identificación y caracterización de estas alteraciones cognitivas podría ayudar a identificar nuevos objetivos terapéuticos y desarrollar estrategias de tratamiento más específicas para los pacientes con TCA. De hecho, sería importante desarrollar e implementar programas de rehabilitación cognitiva coadyuvantes a la psicoterapia para este tipo de pacientes.

Eating disorders (ED) such as anorexia nervosa (AN) and bulimia nervosa (BN) have great social, economic, and healthcare relevance. It was recently observed that the typical behavioral alterations of these patients could be explained, at least partly, by certain cognitive deficits. For this reason, neuropsychological evaluations might contribute to better understanding these types of disorders. This study aims to evaluate whether there were differences in the neuropsychological functioning of a group of young women with AN and BN, compared to another group of healthy women without eating disorders (control group). The results obtained showed that patients with eating disorders had worse performance on audio-verbal and episodic memory, less cognitive flexibility, and worse planning capacity than the control group. However, cognitive functioning was unimpaired for visuospatial memory, attention, processing speed, working memory, ability to inhibit automatic responses, verbal fluency, and social cognition. In conclusion, the identification and characterization of these cognitive alterations could help to identify new therapeutic objectives and develop more specific treatment strategies for patients with ED. In fact, it would be important to develop and implement adjuvant cognitive rehabilitation programs alongside the current psychotherapy for these patients.

Night eating syndrome: How to treat it?

Night eating syndrome (NES) is characterized by caloric intake ≥ 25% of total daily after dinner and/or by two or more weekly nocturnal awakenings accompanied by food ingestion. Causes of NES are not entirely clear and seem to involve a desynchronization between the circadian rhythms of food ingestion and sleep, resulting in a delayed pattern of food intake. Estimates of the prevalence of NES in the general population are around 1.5%, and although much higher frequencies have been described in obese individuals, a causal relationship between NES and obesity is not clearly established. Since the first NES reports, several treatment modalities have been proposed, although, in many cases, the evidence is still insufficient and there is no consensus on the ideal approach. In order to conduct a critical review of proposed treatments for NES since its original description, a systematic search of articles published in journals indexed in Medline/Pubmed database in the period 1955-2015 was performed. Seventeen articles addressing non-pharmacological and pharmacological therapies met the selection criteria. Based on the articles analyzed, we conclude that serotonergic agents and psychological interventions, particularly cognitive behavioral therapy, have been shown to be effective for the treatment of NES. A combination of non-pharmacological and pharmacological therapies must be considered in future studies on the treatment of these patients.

Night eating syndrome: How to treat it? / Síndrome do comer noturno: como tratar?

Summary Night eating syndrome (NES) is characterized by caloric intake ≥ 25% of total daily after dinner and/or by two or more weekly nocturnal awakenings accompanied by food ingestion. Causes of NES are not entirely clear and seem to involve a desynchronization between the circadian rhythms of food ingestion and sleep, resulting in a delayed pattern of food intake. Estimates of the prevalence of NES in the general population are around 1.5%, and although much higher frequencies have been described in obese individuals, a causal relationship between NES and obesity is not clearly established. Since the first NES reports, several treatment modalities have been proposed, although, in many cases, the evidence is still insufficient and there is no consensus on the ideal approach. In order to conduct a critical review of proposed treatments for NES since its original description, a systematic search of articles published in journals indexed in Medline/Pubmed database in the period 1955-2015 was performed. Seventeen articles addressing non-pharmacological and pharmacological therapies met the selection criteria. Based on the articles analyzed, we conclude that serotonergic agents and psychological interventions, particularly cognitive behavioral therapy, have been shown to be effective for the treatment of NES. A combination of non-pharmacological and pharmacological therapies must be considered in future studies on the treatment of these patients.

Resumo A síndrome do comer noturno (SCN) caracteriza-se por ingestão calórica ≥ 25% do total diário após o jantar e/ou por dois ou mais despertares noturnos semanais acompanhados de alimentação. As causas da SCN não estão totalmente esclarecidas e parecem envolver uma dessincronização entre os ritmos circadianos de alimentação e sono, resultando em um atraso do padrão alimentar. Estimativas da prevalência de SCN na população geral estão em torno de 1,5% e, embora frequências bem mais elevadas tenham sido descritas em obesos, uma relação de causalidade entre SCN e obesidade não está claramente estabelecida. Desde os primeiros relatos da SCN, várias modalidades de tratamento têm sido propostas, embora, em muitos casos, a evidência ainda seja insuficiente e não exista um consenso sobre a abordagem ideal. Com o objetivo de realizar uma revisão crítica dos tratamentos propostos para a SCN, desde sua descrição original, foi realizada uma busca sistemática de artigos publicados nos periódicos indexados na base de dados MedLine / Pubmed entre 1955 e 2015. Dezessete artigos, abordando terapias não farmacológicas ou farmacológicas, preencheram os critérios de seleção. Com base nos artigos analisados, conclui-se que os agentes serotonérgicos e intervenções psicológicas, particularmente, a terapia cognitivo-comportamental, têm mostrado eficácia no tratamento da SCN. Uma combinação de terapias não farmacológicas e farmacológicas precisa ser considerada em estudos futuros sobre o tratamento desses pacientes.

Trastornos de la alimentación y deglución en niños con parálisis cerebral: condiciones clínicas acompañantes / Feeding and swallowing disorders in children with cerebral palsy: co-occurring clinical conditions

Introduction: Cerebral Palsy (CP) is frequently accompanied by other cooccurring clinical conditions (CCC). Feeding and swallowing disorders (FSD) are a common problem among CP population and tend to be more complex when associated to certain CCC. Objective: To quantify the frequency of CCC in a group of children with CP and FSD, of both genders, GMFCS I to V, between the age of 3 to 6 years. Patients and Methods: 49 patients diagnosed with CP and FSD underwent 5 assessments: 1) physiatric evaluation; 2) Gross Motor Functional Classification System (GMFCS); 3) Eating and Drinking Ability Classification System (EDACS); 4) videofluoroscopic swallowing study; and 5) sensory processing test.Results: All 49 patients had at least one of the CCC usually present in CP, with an average of 3,8 (from 1 to 6). All GFMCS and EDACS levels were affected, including mild ones. Some of the CCC showed high frequencies: intellectual disability (ID) (83,7 percent), sensory processing disorder (SPD) (75,5 percent), sialorrhea (71,4 percent), malnutrition (67,4 percent), altered alertness (67,4 percent) and constipation (61,2 percent).There was a high frequency of association between CCC. In more than 50 percent of the cases, the association of ID with most of the other conditions was the commonest.Conclusions: Children diagnosed with CP and FSD present with multiple CCC able to worsen their prognosis. All GMFCS and EDACS levels are affected. ID is the most frequent CCC, being also the most associated with the others.

Introducción: La Parálisis Cerebral (PC) cursa junto a numerosas condiciones clínicas acompañantes (CCA), destacando los trastornos de la alimentación y deglución (TAD). En PC numerosas CCA pueden interactuar con los TAD y complicarlos. Objetivo: Cuantificar la frecuencia de determinadas CCA en niños con PC, GMFCS I a V, de 3 a 6 años, portadores de TAD. Pacientes y Métodos: 49 pacientes con PC y TAD fueron sometidos a 5 evaluaciones: 1) valoración fisiátrica; 2) Gross Motor Functional Classification System (GMFCS); 3) Eating and Drinking Ability Classification System (EDACS); 4) videofluoroscopía (VFC); y 5) pauta de integración sensorial. Resultados: Todos los pacientes con PC y TAD presentaron alguna de las CCA consideradas, con un promedio de 3,8 por niño (rango 1-6), afectando a todos los niveles GMFCS y EDACS, incluidos los leves. Algunas tuvieron elevada frecuencia: déficit cognitivo (DC) (83,7 por ciento), trastorno de la integración sensorial (TIS) (75,5 por ciento), sialorrea (71,4 por ciento), desnutrición (67,4 por ciento), alerta alterada (67,4 por ciento) y constipación (61,2 por ciento). Hubo una alta frecuencia de asociación de CCA, siendo más común la asociación de DC con varias de las otras condiciones, en más del 50 por ciento de los casos. Conclusiones: Los niños con PC y TAD cursan con CCA múltiples que complican su cuadro clínico. Todos los niveles GMFCS y EDACS se ven afectados. El DC es la condición más frecuente y muestra más asociación con las otras.

Trastornos de la alimentación y deglución en niños con parálisis cerebral: presencia y severidad / Feeding and swallowing disorders in children with cerebral palsy: presence and severity

Introduction: Feeding and swallowing disorders (FSD) are common among children with cerebral palsy (CP) and have a high potential for morbidity related complications and death. Objective: To determine presence, severity and characteristics of FSD in a group of children with CP, of both genders, GMFCS I to V, between 3 and 6 years. Patients and Methods: 50 patients underwent 4 assessments: 1) description of clinical characteristics of CP; 2) clinical swallowing evaluation; 3) videofluoroscopic swallowing study; and 4) determination of presence and severity of FSD. Results: There was male predominance, with an average age of 5 years, 78 percent GMFCS III to V. Bilateral motor involvement, mixed motor symptoms and signs, and hypotonic axial muscles predominated. The presence of a FSD was high, either considered in general (98 percent of children) or considered only for solid food (98 percent) or liquids (96 percent). In all cases, FSD was most common in children with more motor involvement. All swallowing phases were affected in different proportions, especially with solid food. Recognizing normal cases from affected ones is best when using several assessing tools (5 percent of children were normal when Campora scale was used, 1 percent according to EDACS and 5 percent using videofluoroscopy).The perception of FSD was reduced in both the caregiver and the medical team. Conclusions: FSD are frequent in CP. All GMFCS levels can be affected, especially those including more motor involvement. Swallowing phases were all altered, mainly pre-oral stage for solid food. Complementing several assessing tools seems to be the best way when approaching to CP children with FSD.

Introducción: Los trastornos de la alimentación y deglución (TAD) son frecuentes en niños con Parálisis Cerebral (PC), mostrando elevados potenciales de morbimortalidad. Objetivo: Establecer la presencia, severidad y características de los TAD, en un grupo de niños y niñas con PC, GMFCS I a V, entre 3 años y 6 años. Pacientes y Métodos: 50 pacientes seleccionados fueron sometidos a 4 evaluaciones: 1) características clínicas de la PC; 2) valoración de la deglución; 3) videofluoroscopía; y 4) determinación de presencia y severidad del TAD. Resultados: Población predominantemente masculina, con edad promedio de 5 años, 78 por ciento GMFCS III a V. Predominaron la topografía bilateral, la semiología motora mixta y el hipotono axial. La presencia de TAD fue muy alta, considerada en general (98 por ciento de los casos), o sólo para sólidos (98 por ciento) o líquidos (96 por ciento), siendo más frecuente a mayor compromiso motor. Todas las fases deglutorias estuvieron alteradas en diversa proporción, especialmente con sólidos. Hubo diferencias en la detección de casos normales y alterados al aplicar distintos métodos evaluativos (5 por ciento de niños normales según escala de Campora, 1 por ciento por EDACS y 5 por ciento por videofluoroscopía).La sospecha de TAD estuvo reducida en cuidadores y profesionales rehabilitadores. Conclusiones: Los TAD son frecuentes en PC. Todos los niveles GMFCS pueden estar afectados, con más frecuencia los de mayor compromiso motor. Todas las fases deglutorias aparecen comprometidas, sobretodo la preoral para sólidos. El complemento de herramientas de evaluación parece ser lo ideal al enfrentar un paciente con TAD.

Personality prototype as a risk factor for eating disorders

Objective: To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups. Method: The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created. Results: Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group. Conclusions: Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.

Personality prototype as a risk factor for eating disorders.

OBJECTIVE: To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups. METHOD: The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created. RESULTS: Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group. CONCLUSIONS: Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.

Feeding dysfunction in children with single ventricle following staged palliation.

OBJECTIVE: To determine the prevalence of feeding dysfunction in children with single ventricle defects and identify associated risk factors. STUDY DESIGN: Patients aged 2-6 years with single ventricle physiology presenting for routine cardiology follow-up at the Children's Hospital of Wisconsin were prospectively identified. Parents of the patients completed 2 validated instruments for assessment of feeding dysfunction. Chart review was performed to retrospectively obtain demographic and diagnostic data. RESULTS: Instruments were completed for 56 patients; median age was 39 months. Overall, 28 (50%) patients had some form of feeding dysfunction. Compared with a normal reference population, patients with single ventricle had statistically significant differences in dysfunctional food manipulation (P < .001), mealtime aggression (P = .002), choking/gagging/vomiting (P < .001), resistance to eating (P < .001), and parental aversion to mealtime (P < .001). Weight and height for age z-scores were significantly lower in subjects with feeding dysfunction (-0.84 vs -0.33; P < .05 and -1.46 vs -0.56; P = .001, respectively). Multivariable analysis identified current gastrostomy tube use (P = .02) and a single parent household (P = .01) as risk factors for feeding dysfunction. CONCLUSION: Feeding dysfunction is common in children with single ventricle defects, occurring in 50% of our cohort. Feeding dysfunction is associated with worse growth measures. Current gastrostomy tube use and a single parent household were identified as independent risk factors for feeding dysfunction.

[Evaluation of bone mineral density in female adolescents with eating disorders]. / Avaliação da densidade mineral óssea em adolescentes do sexo feminino com transtorno alimentar.

OBJECTIVE: To evaluate lumbar bone mineral density (BMD) in girls with eating disorders in the beginning of the treatment, at six months, and after one year of treatment. SUBJECTS AND METHODS: This prospective study involved 35 female adolescents with AN or EDNOS treated during one year. Lumbar (L1-L4) bone mineral density by DXA was performed in the beginning of treatment, at six months, and after one year of treatment. RESULTS: There was improvement in weight, length, BMI, bone age (p < 0.001), and 70% of the adolescents with secondary amenorrhea had their menstrual cycles restored. However, the Z-score of lumbar BMD did not show differences during one year of follow-up (p = 0.76). CONCLUSION: The recovery of BMD does not occur together with the restoration of hypothalamic-pituitary-gonadal axis.

Avaliação da densidade mineral óssea em adolescentes do sexo feminino com transtorno alimentar / Evaluation of bone mineral density in female adolescents with eating disorders

OBJETIVO: Avaliar a densidade mineral óssea (DMO) lombar em meninas com transtorno alimentar no diagnóstico e após seis meses e um ano de tratamento. SUJEITOS E MÉTODOS: Estudo prospectivo com 35 adolescentes do sexo feminino, portadoras de AN ou TANE acompanhadas por um ano. A densitometria óssea (DO) da coluna lombar L1-L4 pelo método de absorciometria com raios X de dupla energia (DXA) foi realizada no início, após seis meses e um ano de tratamento. RESULTADOS: Houve aumento do peso, da altura e do índice de massa corporal (IMC), progressão da idade óssea (p < 0,001), e 70% das adolescentes com amenorreia secundária restabeleceram os ciclos menstruais. No entanto, não houve diferença significativa do escore Z da DO lombar ao longo de um ano (p = 0,76). CONCLUSÃO: A recuperação da DMO não ocorre ao mesmo tempo em que a restauração do eixo hipotalâmico-hipofisário-gonadal.

OBJECTIVE: To evaluate lumbar bone mineral density (BMD) in girls with eating disorders in the beginning of the treatment, at six months, and after one year of treatment. SUBJECTS AND METHODS: This prospective study involved 35 female adolescents with AN or EDNOS treated during one year. Lumbar (L1-L4) bone mineral density by DXA was performed in the beginning of treatment, at six months, and after one year of treatment. RESULTS: There was improvement in weight, length, BMI, bone age (p < 0.001), and 70% of the adolescents with secondary amenorrhea had their menstrual cycles restored. However, the Z-score of lumbar BMD did not show differences during one year of follow-up (p = 0.76). CONCLUSION: The recovery of BMD does not occur together with the restoration of hypothalamic-pituitary-gonadal axis.

Risk behaviors for eating disorder in adolescents and adults with type 1 diabetes.

OBJECTIVE: To evaluate the frequency of risk behaviors for eating disorder (ED) in patients with type 1 diabetes (T1D) and their association with gender, nutritional status, variables related to T1D, and body satisfaction. METHOD: 189 individuals with T1D (12-56 years old) answered the Bulimic Investigation Test (BITE), the Eating Attitude Test (EAT), the Binge Eating Scale (BES), Stunkard's Figure Rating Scale, and questions regarding control of T1D. Association between ED risk behaviors and the selected variables was assessed with the chi-square test and Student's t-test; factors that influenced the risk of ED were identified by means of logistic regression. RESULTS: Of the patients with T1D, 58.7% were at risk of ED (45, 40, and 16% according to the EAT, BITE and BES, respectively). There were significant differences between groups with and without risk for ED related to BMI (p = 0.009), gender (p = 0.001), insulin omission (p = 0.003), use of the carbohydrate counting method (p = 0.019), and body dissatisfaction (p = 0.001). The risk of ED was nine times higher in patients who reduced or omitted insulin (p = 0.036). CONCLUSIONS: Patients with T1D demonstrated a high frequency of body dissatisfaction and ED risk behaviors; the omission or reduction of insulin was an important risk factor.