[Eating disorders in the light of addiction]. / Troubles du comportement alimentaire à l'aune de l'addiction.

Eating disorders (ED) are complex and damaging to health. They cause suffering similar to that of addictions. Although they share some similarities, eating disorders remain distinct from addictions. Fundamental differences emerge in binge eating and restrictive behaviors. Eating disorder treatment in adolescents relies mainly on family therapy and can incorporate a reflection on these similarities and differences. For instance, understanding the addictive nature of the illness helps parents and patients to avoid sterile negotiations around food. An individualized approach is crucial to the effective management of ED by a specialized multidisciplinary team. Clarity in explaining physiological mechanisms strengthens the therapeutic alliance.

Les troubles du comportement alimentaire (TCA) sont complexes et portent atteinte à la santé. Ils peuvent engendrer des souffrances similaires à celles des addictions. Bien qu'ils partagent des similitudes, les TCA demeurent distincts des addictions. Des différences fondamentales émergent dans les comportements d'hyperphagie et de restriction. La prise en charge des TCA, axée sur la thérapie familiale, peut intégrer une réflexion sur ces similitudes et ces différences. Par exemple, la compréhension de la nature addictive de la maladie aide parents et patients à éviter des négociations stériles autour de l'alimentation. Une approche individualisée est cruciale pour une prise en charge efficace des TCA par une équipe multidisciplinaire spécialisée. La clarté dans l'explication des mécanismes physiologiques renforce l'alliance thérapeutique.

The involvement of the adrenergic system in feeding and eating disorders. A systematic review.

BACKGROUND: Adrenergic dysregulation has been proposed as a possible underlying mechanism in feeding and eating disorders (FED). This review aims to synthesise the current evidence on the role of adrenergic dysregulation in the pathogenesis and management of FED. METHODS: A systematic review was conducted in MEDLINE, Cochrane Library, and Clinicaltrials.gov. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted. Preclinical, clinical, and pharmacological studies assessing the adrenergic system in FED were included. RESULTS: Thirty-one out of 1415 recognised studies were included. Preclinically, studies on adrenaline's anorectic impact, receptor subtypes, and effects on hepatic function in rats show that catecholamine anorexia is primarily alpha-adrenergic, whereas beta-adrenergic anorexia can be obtained only after puberty, implying an impact of sexual hormones. Clinically, catecholamine levels may be higher in FED patients than in healthy controls (HC). Individuals with anorexia nervosa (AN) may show higher epinephrine-induced platelet aggregability response than HC. Pharmacological trials suggest that the alpha-2-adrenergic medication clonidine may not lower AN symptoms, but agents regulating the adrenaline-noradrenaline neurotransmission (bupropion, reboxetine, duloxetine, sibutramine) have been found to improve binge eating symptoms. CONCLUSION: Adrenergic dysregulation may be involved in the pathophysiology of FED. More research is needed to comprehend underlying mechanisms and treatment implications.

Avoidant-restrictive food intake disorder and autism: epidemiology, etiology, complications, treatment, and outcome.

PURPOSE OF REVIEW: There is considerable overlap between the features of avoidant-restrictive food intake disorder (ARFID) and autism. The purpose of this scoping review is to provide an overview of studies published on ARFID and autism in 2022 and the first half of 2023. RECENT FINDINGS: ARFID and autism are highly heritable conditions that often co-occur. In a large autism cohort, 21% of participants and 17% of their parents presented with avoidant-restrictive features. Of children diagnosed with ARFID, 8.2-54.8% are autistic. More than half of individuals with ARFID also have other neurodevelopmental, psychiatric, or somatic diagnoses. Anxiety, depression, sleep disorders, and learning difficulties are particularly common co-occurring issues. Various strategies have been developed to support autistic children with feeding difficulties. It appears that their feeding difficulties, particularly sensory sensitivities, food preferences, and mealtime rituals and routines frequently persist into adolescence and adulthood, but research on optimal support for adults and adolescents is still scarce. Untreated ARFID in autistic individuals may lead to serious complications. SUMMARY: Individuals seeking specialist care for autism, eating disorders, or gender dysphoria should be screened for ARFID. More research is needed on how to support autistic adolescents and adults with features of ARFID.

A Cross-Sectional Study of Pediatric Feeding Disorder in Children with Cystic Fibrosis.

BACKGROUND: The exact prevalence of feeding problems in children with cystic fibrosis (CF) is unknown. Pediatric feeding disorder (PFD) encompasses poor oral intake with associated medical, nutrition, psychosocial, or feeding skill dysfunction. We hypothesized that PFD is common in CF and aimed to categorize feeding dysfunction across various domains in children with CF. METHODS: An observational cross-sectional study was conducted in children with CF. Data collected included anthropometrics, nutrition data (including need for tube feeding/enteral nutrition [EN] or high-energy beverages, dietary diversity), feeding skills (Pediatric version of the Eating Assessment tool [pEAT]), and psychosocial function (About Your Child's Eating questionnaire [AYCE] in children 2-17 years of age/Behavioral Pediatric Feeding Assessment Scale [BPFAS] in children 12-23 months of age). PFD was defined as poor oral intake with: (a) pEAT score > 5; and/or (b) AYCE or BPFAS score > 2 standard deviation of normative controls; and/or (c) nutrition dysfunction (body mass index/weight-for-length z score < -1 and/or preference of oral high energy beverages or dependence on EN and/or decreased dietary diversity). RESULTS: Of 103 children in the study, 62 (60.1%) had PFD, 7 children (6.8%) were malnourished, 10 needed EN (9.7%), and 30 (29.1%) needed oral high-energy beverages. Dietary diversity was decreased in 42 children (41.5%), 1 child had feeding skill dysfunction, and 11 (10.8%) met criteria for psychosocial dysfunction. CONCLUSION: Almost 2/3rd of children with CF have PFD and many have poor dietary diversity. A significant percentage of children rely on EN and oral supplements, but psychosocial dysfunction is less prevalent.

The risk of eating disorders following the August 4th, 2020 explosion in Beirut and its relationship with trauma exposure and PTSD symptoms.

INTRODUCTION: To date, no study has demonstrated the link between the diagnosis of provisional PTSD and ED in people exposed to the explosion of August 4th, 2020. METHODS: Online participants were classified into 4 categories according to the degree of exposure to the explosion (unexposed, slightly exposed, moderately exposed, and severely exposed). The screening for ED was done using the standardized SCOFF questionnaire and the screening for provisional PTSD using the standardized IES-R questionnaire. RESULTS: Our sample included 703 participants. In the bivariate analysis, there was a trend for an association between degree of exposure to the explosion and the risk of development of an ED (p = 0.055). The independent variables included in the multivariate analysis that were statistically associated with a risk of developing eating disorders are secondary school as the highest level of education (p = 0.029; OR = 2.15) and the risk of PTSD (p = 0.041; OR = 2.05) according to IES-R, specifically hyperarousal (p = 0.028; OR = 1.07) as a symptom cluster. Provisional PTSD played a mediating role, creating a partial and indirect relationship between the degree of exposure to the explosion and the risk of developing ED with a ß coefficient of 0.075 (p < 0.001) CONCLUSION: The risk of PTSD according to IES-R was found to be a determinant of a higher risk of developing ED among participants exposed to the explosion in addition to mediating between the effect of exposure severity and the risk of ED. It is essential to fully assess and manage PTSD symptoms and ED patients exposed to such a psychological trauma.

Are child maltreatment and intimate partner violence associated with adult disordered eating?

OBJECTIVE: Disordered eating is one of the most prevalent mental health concerns (Galmiche et al., 2019, Quick & Byrd-Bredbenner, 2013, Neumark-Sztainer et al., 2006). Studies show that child maltreatment increases the likelihood of disordered eating symptoms in adulthood (Caslini et al., 2016, Hazzard et al., 2019). However, these studies overlook abuse experiences later in life, such as intimate partner violence which may also be a significant contributing factor (Bundock et al., 2013). The proposed study will help identify whether childhood maltreatment and IPV are independent predictors and/or if the combination of the two are synergistic risk factors for adult disordered eating. METHOD: We use data from 14,332 people from Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants completed questionnaires assessing child maltreatment, intimate partner violence, and disordered eating symptoms. We will perform a series of logistic regression models to examine a) whether child maltreatment and intimate partner violence are independently associated with disordered eating and b) whether exposure to the combination of both child maltreatment and intimate partner violence is associated with worse outcomes for adult disordered eating compared to exposure to only one or none at all. We also propose a supplemental analysis to establish the robustness of these effects when accounting for the highest parental education, federal poverty percentage level, race/ethnicity, gender, and age. PUBLIC SIGNIFICANCE: Disordered eating is a serious mental health concern, especially in an emerging adult population. Child maltreatment is consistently associated with disordered eating in adulthood. However, the independent or synergistic role of more recent abuse experiences, such as intimate partner violence, remains largely unknown. The proposed study provides insight into how both childhood abuse and intimate partner violence may be associated with disordered eating independently or in combination.

Childhood maltreatment is associated with cortical thinning in people with eating disorders.

Childhood maltreatment (CM) is a non-specific risk factor for eating disorders (ED) and is associated with a greater severity in their clinical presentation and poorer treatment outcome. These data suggest that maltreated people with ED may be biologically other than clinically different from non-maltreated people. The aim of the present study was to investigate cortical thickness (CT), a possible biomarker of neurodevelopment, in people with ED with or without history of CM and in healthy women. Twenty-four healthy women, 26 with anorexia nervosa and 24 with bulimia nervosa underwent a 3T MRI scan. All participants filled in the childhood trauma questionnaire. All neuroimaging data were processed by FreeSurfer. Twenty-four participants with ED were identified as maltreated and 26 participants with ED as non-maltreated. All healthy women were non-maltreated. Compared to healthy women, maltreated people with ED showed lower CT in the left rostral anterior cingulate gyrus, while compared to people with ED without history of CM showed lower CT values in the left superior frontal and in right caudal middle frontal and superior parietal gyri. No significant differences emerged in CT measures between healthy women and people with ED without history of CM. The present findings show for the first time that in adult people with ED childhood maltreatment is associated with cortical thinning in areas implicated in the modulation of brain processes that are acknowledged to play a role in the psychopathology of ED.

Clinician perspectives on assessing for disordered eating and body image disturbance in adolescents and young adults with cystic fibrosis.

BACKGROUND: Maintaining a healthy weight is a focus of Cystic Fibrosis (CF) care. With the increased use of highly effective CFTR modulators, many people with CF are gaining weight more easily, which may affect eating habits and body image. This study investigates providers' understanding and current practices surrounding body image disturbance and disordered eating in people with CF. METHODS: We distributed a one-time web-based survey to United States (U.S.)-based CF healthcare providers via CF Foundation list servs. The survey investigated providers' understanding and perceived importance of issues surrounding disordered eating and body image disturbance in adolescent and young adults (AYA) with CF as well as current screening practices. We used descriptive statistics to analyze participants' characteristics and practices. RESULTS: A total of 232 healthcare providers completed the survey. While most participants felt that screening for both body image disturbance and disordered eating should be standardized in CF care (79% and 82%, respectively), fewer than one third felt comfortable screening, and only one quarter actually screened for various eating disordered behaviors in daily practice. Only 2.7% reported using a formal screening tool. Participants reported provider assessment tools (86%), standardized partnerships with eating disorder specialists (80%), and CFF or national guidelines (79%) would be helpful to improve screening and counseling. CONCLUSION: While most CF providers believe that body image disturbance and disordered eating are important topics in AYA with CF, few address these topics with their patients. The development of educational sessions and national guidelines may improve screening and counseling practices.

The neural correlates of socio-cognitive factors and eating disorders in young people: A systematic review.

BACKGROUND: Although the primary aetiology of Eating Disorders (ED) remains unknown, research suggests a complex interplay of biological, psychological, and cultural/environmental factors. This paper aims to systematically review the literature on neuroimaging studies that measure socio-cognitive factors, in the context of body dissatisfaction and EDs in young people. Specifically, our aim was to identify patterns in the findings linked to social media-type behaviours. METHODS: The review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. 799 papers were identified in the database search and 38 studies were selected based on exclusion and inclusion criteria. Selected studies were assessed using the National Institute of Health study quality assessment tool. RESULTS: Findings point to state-related impairments in inhibitory control and salient emotional processing. Anorexia Nervosa(AN) showed impaired set-shifting abilities, working memory and decision making, while altered activation in attention networks and associated difficulties with conflict resolution were seen for Bulimia Nervosa(BN) and Other Specified Feeding and Eating Disorders(OSFED). AN and BN also demonstrated altered sensitivity to food-related stimuli in striatal regions, suggesting aberrant top-down emotional-cognitive control. ED participants also show deficits in body representation, impaired control over social behaviours and altered integration of visual and body perception. DISCUSSION: These findings support the notion that socio-cognitive dysfunctions in ED are underpinned by a distributed network of structural and functional brain changes which influence the way young people with ED interact with and respond to social media, and ultimately places at them at increased risk for body image disturbances. This Review was registered with the PROSPERO International Register of Systematic Reviews, Registration number CRD42021270696.

[Prevention of eating disorders in obesity]. / Prevención de los trastornos de laconducta alimentaria en la obesidad.

Introduction: Obesity is a public health problem due to its high prevalence, high morbidity, and high mortality. The relationship between eating disorders (ED) and obesity is widely established. A healthcare professional that cares for people with obesity must take into account a series of best practices to minimize the risk of developing an ED in the course of treatment for weight loss. Bariatric surgery (BS) is an effective, long-term treatment in selected patients with severe obesity. During the preoperative period, it is essential to detect any ED due to its high prevalence in this group. After surgery, the presence of a post-op ED and its possible relationship in terms of poorer outcomes make screening during follow-up after surgery essential. From a preventive perspective, cognitive-behavioral therapy before BS could positively influence postoperative results, and its use after BS could improve weight loss efficacy and reduce binge eating and grazing. From a more holistic preventive perspective, many believe in an integrative approach to both obesity and ED. In order to be successful, it is essential to identify any relevant risk and protective factors for both disorders.

Introducción: La obesidad constituye un problema de salud pública por su alta prevalencia y elevada morbimortalidad. La relación entre los trastornos de la conducta alimentaria (TCA) y la obesidad está ampliamente establecida. Es importante que el profesional que atiende a personas con obesidad tenga en cuenta una serie de premisas que minimicen el riesgo de aparición de un trastorno alimentario en el transcurso del tratamiento para perder peso. La cirugía bariátrica (CB) constituye un tratamiento efectivo a largo plazo en los pacientes adecuadamente seleccionados con obesidad grave. Por un lado, la elevada prevalencia de los TCA en este colectivo hace imprescindible la detección de estos trastornos en el preoperatorio. Por otro lado, la presencia de los TCA después de la cirugía y su posible relación en cuanto a peores resultados hace fundamental el cribado durante el seguimiento tras la intervención. Desde el punto de vista preventivo, la realización de una terapia cognitivo-conductual antes de la CB podría influir positivamente en los resultados posoperatorios y su empleo después podría mejorar la eficacia en cuanto a pérdida de peso y disminuir los atracones y el "grazing". Desde una perspectiva más global en relación a la prevención, son muchos quienes apuestan por un enfoque integrador para la obesidad y los TCA. Para ello es fundamental identificar los factores de riesgo y los protectores que tengan relevancia en ambos trastornos.

MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD.

INTRODUCTION: Eating disorders (EDs) and posttraumatic stress disorder (PTSD) are highly comorbid, yet there are no proven integrative treatment modalities for ED-PTSD. In clinical trials, MDMA-assisted therapy (MDMA-AT) has shown marked success in the treatment of PTSD and may be promising for ED-PTSD. METHODS: Ninety individuals with severe PTSD received treatment in a double-blind, placebo-controlled pivotal trial of MDMA-AT. In addition to the primary (Clinician-Administered PTSD Scale) and secondary (Sheehan Disability Scale) outcome measures, the Eating Attitudes Test 26 (EAT-26) was administered for pre-specified exploratory purposes at baseline and at study termination. RESULTS: The study sample consisted of 58 females (placebo = 31, MDMA = 27) and 31 males (placebo = 12, MDMA = 19) (n = 89). Seven participants discontinued prior to study termination. At baseline, 13 (15%) of the 89 individuals with PTSD had total EAT-26 scores in the clinical range (≥20), and 28 (31.5%) had total EAT-26 scores in the high-risk range (≥11) despite the absence of active purging or low weight. In completers (n = 82), there was a significant reduction in total EAT-26 scores in the total group of PTSD participants following MDMA-AT versus placebo (p = .03). There were also significant reductions in total EAT-26 scores in women with high EAT-26 scores ≥11 and ≥ 20 following MDMA-AT versus placebo (p = .0012 and p = .0478, respectively). CONCLUSIONS: ED psychopathology is common in individuals with PTSD even in the absence of EDs with active purging and low weight. MDMA-AT significantly reduced ED symptoms compared to therapy with placebo among participants with severe PTSD. MDMA-AT for ED-PTSD appears promising and requires further study.

Eating disorders in sport. Update and proposal for an integrated approach.

Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.

Disordered eating as a repercussion of sexual assault: a consequence to consider.

PURPOSE: This study aims at clarifying the links between sexual violence and disordered eating (DE). METHODS: In a sample of 12,638 victims of self-reported sexual violence, we analyzed the situation of 546 victims that declared having developed DE. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders, etc.). RESULTS: DE prevalence was 4.3% in the victim sample. The age of the first assault in DE victims was significantly lower than that of the whole population (12 years vs 16 years for median; p < 0.001). A much higher prevalence of sexual assault consequences was present in victims developing DE with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29-15.95], p < 0.001); depression (OR = 5.7 [4.81-6.86], p < 0.001); self-medication (OR = 5.3 [3.86-7.19], p < 0.001); suicide attempts (OR = 4.5 [3.59-5.67], p < 0.001); post-traumatic stress disorder (OR = 3.8 [2.99-4.78], p < 0.001); anxiety troubles (OR = 5.2 [4.11-6.47], p < 0.001); alcoholism (OR = 4.0 [2.81-5.58], p < 0.001). CONCLUSION: This study confirms the link between DE and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, DE should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such. LEVEL OF EVIDENCE: Level IV: Evidence obtained from multiple time series analysis such as case studies.

Depressive Symptomatology and Functional Status Among Stroke Survivors: A Network Analysis.

OBJECTIVE: To (1) characterize poststroke depressive symptom network and identify the symptoms most central to depression and (2) examine the symptoms that bridge depression and functional status. DESIGN: Secondary data analysis of the Stroke Recovery in Underserved Population database. Networks were estimated using regularized partial correlation models. Topology, network stability and accuracy, node centrality and predictability, and bridge statistics were investigated. SETTING: Eleven inpatient rehabilitation facilities across 9 states of the United States. PARTICIPANTS: Patients with stroke (N=1215) who received inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Center for Epidemiologic Studies Depression Scale and FIM were administered at discharge from inpatient rehabilitation. RESULTS: Depressive symptoms were positively intercorrelated within the network, with stronger connections between symptoms within the same domain. "Sadness" (expected influence=1.94), "blues" (expected influence=1.14), and "depressed" (expected influence=0.97) were the most central depressive symptoms, whereas "talked less than normal" (bridge expected influence=-1.66) emerged as the bridge symptom between depression and functional status. Appetite (R2=0.23) and sleep disturbance (R2=0.28) were among the least predictable symptoms, whose variance was less likely explained by other symptoms in the network. CONCLUSIONS: Findings illustrate the potential of network analysis for discerning the complexity of poststroke depressive symptomology and its interplay with functional status, uncovering priority treatment targets and promoting more precise clinical practice. This study contributes to the need for expansion in the understanding of poststroke psychopathology and challenges clinicians to use targeted intervention strategies to address depression in stroke rehabilitation.

Development and external validation of a prediction model for tube feeding dependency for at least four weeks during chemoradiotherapy for head and neck cancer.

BACKGROUND & AIMS: Patients who receive chemoradiotherapy or bioradiotherapy (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often experience high toxicity rates interfering with oral intake, causing tube feeding (TF) dependency. International guidelines recommend gastrostomy insertion when the expected use of TF exceeds 4 weeks. We aimed to develop and externally validate a prediction model to identify patients who need TF ≥ 4 weeks and would benefit from prophylactic gastrostomy insertion. METHODS: A retrospective multicenter cohort study was performed in four tertiary head and neck cancer centers in the Netherlands. The prediction model was developed using data from University Medical Center Utrecht and the Netherlands Cancer Institute and externally validated using data from Maastricht University Medical Center and Radboud University Medical Center. The primary endpoint was TF dependency ≥4 weeks initiated during CRT/BRT or within 30 days after CRT/BRT completion. Potential predictors were extracted from electronic health records and radiotherapy dose-volume parameters were calculated. RESULTS: The developmental and validation cohort included 409 and 334 patients respectively. Multivariable analysis showed predictive value for pretreatment weight change, texture modified diet at baseline, ECOG performance status, tumor site, N classification, mean radiation dose to the contralateral parotid gland and oral cavity. The area under the receiver operating characteristics curve for this model was 0.73 and after external validation 0.62. Positive and negative predictive value for a risk of 90% or higher for TF dependency ≥4 weeks were 81.8% and 42.3% respectively. CONCLUSIONS: We developed and externally validated a prediction model to estimate TF-dependency ≥4 weeks in LAHNSCC patients treated with CRT/BRT. This model can be used to guide personalized decision-making on prophylactic gastrostomy insertion in clinical practice.

Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome.

BACKGROUND AND AIMS: Dietary treatments are growing in popularity as interventions for chronic digestive conditions. Patients with irritable bowel syndrome (IBS) often change their eating behaviors to mitigate symptoms. This can occur under the direction of their physician, a dietitian, or be self-directed. Poorly implemented and monitored diet treatments occur frequently with considerable risks for negative consequences. We aim to review the literature related to dietary treatments and risks associated with nutritional deficiencies and disordered eating. METHODS: Searches were conducted from June to December 2020 on PubMed, MEDLINE, EMBASE, DARE and the Cochrane Database of Systematic Reviews using relevant keywords based on the Patient, Intervention, Comparator and Outcome (PICO) format. Studies included both adult and pediatric populations. Results are synthesized into a narrative review. RESULTS: While dietary approaches are efficacious in many research studies, their translation to clinical practice has been less clear. Patients with IBS are at risk for nutritional deficiencies, disordered eating, increased anxiety, and decreases in quality of life in both adult and pediatric groups. CONCLUSIONS: Physicians prescribing dietary treatment for IBS should be aware of nutritional and psychological risks and implement mitigation measures. These include using a combination of brief, validated questionnaires and clinical history, and collaboration with registered dietitians and/or psychologists. Recommendations for clinical decisions are provided.

Evaluating Characteristics Associated with Success with Tube Weaning After Intensive Multidisciplinary Intervention.

OBJECTIVE: Evidence suggests intensive multidisciplinary intervention holds benefit for children with feeding tube dependence complicated by comorbid medical, behavioral, and/or developmental conditions; however, much remains unknown regarding factors affecting a patient achieving full oral feeding after intervention. METHODS: This retrospective review involved consecutive patients (birth to age 21 years) admitted to an intensive multidisciplinary intervention program over a 5-year period (June 2014-2019) for feeding tube dependence and food refusal. This study compared the clinical presentation and treatment outcomes for patients who successfully transitioned to full oral feeding versus patients experiencing a partial wean at the last follow-up. RESULTS: Eighty-one patients completed intervention and provided outcome data (46 male patients and 35 female patients; age range 10-230 mo). Fifty-eight patients (72%) weaned from tube feeding at the last follow-up; 23 patients (28%) experienced a partial wean. The full wean group experienced greater progress by discharge (e.g., oral intake and goals achieved) and participated in longer follow-up compared with the partial wean group. Clinical characteristics associated with lack of full wean included a history of congenital heart disease requiring surgery and a history of developmental disabilities. CONCLUSION: Improving response to intensive multidisciplinary intervention likely necessitates the development of treatment adjuncts for patients whose medical and/or developmental conditions complicate wean from tube feeding, tailoring treatment for at-risk populations. Future iterations of this model of care should also adjust the quantity and/or quality of follow-up support for patients who discharge from intervention below certain clinical benchmarks.

A Framework for Developing Translationally Relevant Animal Models of Stress-Induced Changes in Eating Behavior.

Stress often affects eating behaviors, leading to increased eating in some individuals and decreased eating in others. Identifying physiological and psychological factors that determine the direction of eating responses to stress has been a major goal of epidemiological and clinical studies. However, challenges of standardizing the stress exposure in humans hinder efforts to uncover the underlying mechanisms. The issue of what determines the direction of stress-induced feeding responses has not been directly addressed in animal models, but assays that combine stress with a feeding-related task are commonly used as readouts of other behaviors, such as anxiety. Sex, estrous cyclicity, circadian cyclicity, caloric restriction, palatable diets, elevated body weight, and properties of the stressors similarly influence feeding behavior in humans and rodent models. Yet, most rodent studies do not use conditions that are most relevant for studying feeding behavior in humans. This review proposes a conceptual framework for incorporating these influences to develop reproducible and translationally relevant assays to study effects of stress on food intake. Such paradigms have the potential to uncover links between emotional eating and obesity as well as to the etiology of eating disorders.