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| 3. |
- Thurfjell, Barbro, 1951-
(author)
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Adolescent Eating Disorders in a Sociocultural Context
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Adolescence means an increased risk for eating disorders (ED) and the female gender is the most important risk factor. Empirical studies of the perceptions of gender ideals—as potential mediating factors between the socio-cultural context and ED—were this thesis’ primary goals. Further aims implied evaluating the psychometric properties of the Eating Disorders Inventory for Children (EDI-C) and providing normative data for boys and girls concerning self-assessed ED symptoms and related psychological traits.The EDI-C has satisfying psychometric properties, and normative data are now provided. The vast majority of preadolescent and adolescent boys and girls (n=4725) are not preoccupied with weight concerns, but 1–3% of the boys and 9–20% of the girls here indicate feelings of anxiety and problematic attitudes. An increase of self-reported ED symptoms occurs during female preadolescence and early adolescence. Responses to three open-ended questions—addressing perceived and personal gender ideals of adolescent boys (n=347) and girls with (n=204) and without (n=417) an ED—indicate that girls are, compared to boys, more involved in images of ideals. The perceived ideal man and ideal woman differ in body size and strength. This corresponds with different health risk behaviours reported in boys (body building) and girls (dieting). Awareness of media ideals and an ability to discriminate them from individual values was common in the normal groups and in girls who had recovered from an ED. A poor outcome was associated with thinness stated as ideals of the media, without mentioning good looks. Factors that could predict outcome at the 3-year follow-up of an ED in adolescent girls were: good looks (media ideal), maturity fears, profession (individual ideal), sexual debut, and vomiting.The addition of a gender perspective would add a dimension to programmes aiming at preventing and treating ED in adolescence.
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| 4. |
- Thurfjell, Barbro, et al.
(author)
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Perceived and individual ideals of gender in Swedish adolescents with and without an eating disorder
- 2006
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In: Eating Disorders. - : Informa UK Limited. - 1064-0266 .- 1532-530X. ; 14:1, s. 55-72
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Journal article (peer-reviewed)abstract
- Three open-ended questions based on Steiner-Adair (1986) were used to study gender concepts in relation to ideals in adolescent boys and girls and eating-disordered girls. The answers were coded according to themes emanating from the collected data and not predetermined. Dichotomous differences were found between the genders regarding perceived ideals of body size, but clinical and nonclinical girls perceived ideals of society and media similarly. Individual gender concepts differed substantially from the perceived ideals, and were most often focused on lifestyle and life conditions. However, the clinical girls were somewhat more likely to emphasize appearance and loving relationships.
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| 6. |
- Thurfjell, Barbro, et al.
(author)
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Perceptions of gender ideals predict outcome of eating disorders in adolescent girls
- 2006
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In: Eating Disorders. - : Informa UK Limited. - 1064-0266 .- 1532-530X. ; 14:4, s. 287-304
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Journal article (peer-reviewed)abstract
- Clinical features have low predictive value for the outcome of eating disorders. This study focuses on the possible predictive value of gender ideals. Data was from adolescent girls thoroughly assessed both at presentation and at a three-year follow up. Few variables differed between the outcome groups. However, perceptions of gender ideals, as measured by the Three Questions of Ideals, were found to contribute to the prediction of outcome. A discriminant analysis showed that gender ideals, maturity fears, sexual debut, and vomiting were significant discriminators in a set of factors, which correctly classified the outcome for 75.3% of the sample.
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| 7. |
- Andersson, C, et al.
(author)
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Triple specificity of ZnT8 autoantibodies in relation to HLA and other islet autoantibodies in childhood and adolescent type 1 diabetes
- 2013
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In: Pediatric Diabetes. - : Wiley-Blackwell. - 1399-543X .- 1399-5448. ; 14:2, s. 97-105
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Journal article (peer-reviewed)abstract
- Andersson C, Vaziri-Sani F, Delli AJ, Lindblad B, Carlsson A, Forsander G, Ludvigsson J, Marcus C, Samuelsson U, Ivarsson SA, Lernmark A, Elding Larsson H, the BDD Study group. Triple specificity of ZnT8 autoantibodies in relation to HLA and other islet autoantibodies in childhood and adolescent type 1 diabetes. Pediatric Diabetes 2013: 14: 97-105. Objective To establish the diagnostic sensitivity of and the relationships between autoantibodies to all three Zinc transporter 8 (Zinc transporter 8 autoantibody to either one, two, or all three amino acid variants at position 325, ZnT8A) variants to human leukocyte antigen (HLA)-DQ and to autoantibodies to glutamic acid decarboxylase (GADA), insulinoma-associated protein 2 (IA-2A), and insulin (IAA). Methods We analyzed 3165 patients with type 1 diabetes (T1D) in the Better Diabetes Diagnosis study for HLA-DQ genotypes and all six autoantibodies (ZnT8RA, arginine 325 Zinc transporter 8 autoantibody; ZnT8WA, tryptophan 325 Zinc transporter 8 autoantibody; ZnT8QA, glutamine 325 Zinc transporter 8 autoantibody; GADA, IA-2A, and IAA). Results ZnT8A was found in 65% of the patients and as many as 108 of 3165 (3.4%) had 13 ZnT8A alone. None had ZnT8QA alone. Together with GADA (56%), IA-2A (73%), and IAA (33%), 93% of the T1D patients were autoantibody positive. All three ZnT8A were less frequent in children below 2 yr of age (pandlt;0.0001). All three ZnT8A were associated with DQA1-B1*X-0604 (DQ6.4) and DQA1-B1*03-0302 (DQ8). ZnT8WA and ZnT8QA were negatively associated with DQA1-B1*05-02 (DQ2). Conclusions Analysis of ZnT8A increased the diagnostic sensitivity of islet autoantibodies for T1D as only 7% remained islet autoantibody negative. The association between DQ6.4 and all three ZnT8A may be related to ZnT8 antigen presentation by the DQ6.4 heterodimer.
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| 8. |
- Brooks, Samantha J, et al.
(author)
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Obsessive-compulsivity and working memory are associated with differential prefrontal cortex and insula activation in adolescents with a recent diagnosis of an eating disorder
- 2014
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In: Psychiatry Research. - : Elsevier BV. - 0165-1781 .- 1872-7123 .- 0925-4927. ; 224:3, s. 246-253
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Journal article (peer-reviewed)abstract
- The role of rumination at the beginning of eating disorder (ED) is not well understood. We hypothesised that impulsivity, rumination and restriction could be associated with neural activity in response to food stimuli in young individuals with eating disorders (ED). We measured neural responses with functional magnetic resonance imaging (fMRI), tested working memory (WM) and administered the eating disorders examination questionnaire (EDE-Q), Barratt impulsivity scale (BIS-11) and obsessive-compulsive inventory (OCI-R) in 15 adolescent females with eating disorder not otherwise specified (EDNOS) (mean age 15 years) and 20 age-matched healthy control females. We found that EDNOS subjects had significantly higher scores on the BIS 11, EDE-Q and OCI-R scales. Significantly increased neural responses to food images in the EDNOS group were observed in the prefrontal circuitry. OCI-R scores in the EDNOS group also significantly correlated with activity in the prefrontal circuitry and the cerebellum. Significantly slower WM responses negatively correlated with bilateral superior frontal gyrus activity in the EDNOS group. We conclude that ruminations, linked to WM, are present in adolescent females newly diagnosed with EDNOS. These may be risk factors for the development of an eating disorder and may be detectable before disease onset.
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| 10. |
- Månsson, Josefin, et al.
(author)
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Favorable effects of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating diorders
- 2016
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In: International Journal of Eating Disorders. - : Wiley. - 0276-3478 .- 1098-108X. ; 49:1, s. 92-97
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Journal article (peer-reviewed)abstract
- ObjectiveTo study the effect of clearly defined and decisive parental interventions at the start of treatment of restrictive eating disorders (ED) in adolescents.MethodForty-seven adolescents with ED (anorexia nervosa = 6, bulimia nervosa = 1, EDNOS = 40) and their families participated. Parents were advised to (1) keep the adolescent home from school, (2) eat all meals together with the adolescent, (3) prevent any form of exercise, and (4) prevent vomiting during the first week of treatment. Weight change was followed up to three months and EDE-Q administered at start of treatment and at three months.ResultsThirty (64%) of the families accomplished all four interventions during the first week of treatment. Their adolescents gained ∼1 kg of weight at one week, 2 kg at one month, and 4 kg at three months while adolescents in families who did not accomplish all four interventions gained only 1.4 kg up to three months. Scores on the EDE-Q decreased during treatment and in adolescents of families who accomplished all four interventions they were in the range of a reference population.DiscussionDecisive parental management of eating disturbed behaviors at the start of treatment of adolescents with ED promotes later clinical outcome. The finding supports the view that family based therapies are effective in adolescent ED. Results has to be followed up for evaluation of the long term effects of this type of intervention.
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| 11. |
- Nylander, Charlotte, 1979-, et al.
(author)
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Self- and parent-reported executive problems in adolescents with type 1 diabetes are associated with poor metabolic control and low physical activity.
- 2018
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In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 19:1, s. 98-105
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Journal article (peer-reviewed)abstract
- BACKGROUND: Management of diabetes is demanding and requires efficient cognitive skills, especially in the domain of executive functioning. However, the impact of impaired executive functions on diabetes control has been studied to a limited extent. The aim of the study is to investigate the association between executive problems and diabetes control in adolescents with type 1 diabetes.MATERIALS AND METHODS: Two hundred and forty-one of 477 (51%) of 12- to 18-year-old adolescents, with a diabetes duration of >2 years in Stockholm, Uppsala, and Jönköping participated. Parents and adolescents completed questionnaires, including Behavioral Rating Inventory of Executive Function (BRIEF), Attention-Deficit/Hyperactivity Disorder (ADHD)-Rating Scale (ADHD-RS) and demographic background factors. Diabetes-related data were collected from the Swedish Childhood Diabetes Registry, SWEDIABKIDS. Self-rated and parent-rated executive problems were analyzed with regard to gender, glycosylated hemoglobin (HbA1c), frequency of outpatient visits, and physical activity, using chi-square tests or Fisher's test, where P-values <.05 were considered significant. Furthermore, adjusted logistic regressions were performed with executive problems as independent variable.RESULTS: Executive problems, according to BRIEF and/or ADHD-RS were for both genders associated with mean HbA1c >70 mmol/mol (patient rating P = .000, parent rating P = .017), a large number of outpatient visits (parent rating P = .015), and low physical activity (patient rating P = .000, parent rating P = .025). Self-rated executive problems were more prevalent in girls (P = .032), while parents reported these problems to a larger extent in boys (P = .028).CONCLUSION: Executive problems are related to poor metabolic control in adolescents with type 1 diabetes. Patients with executive problems need to be recognized by the diabetes team and the diabetes care should be organized to provide adequate support for these patients.
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| 12. |
- Olivo, Gaia, et al.
(author)
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Atypical anorexia nervosa is not related to brain structural changes in newly diagnosed adolescent patients.
- 2018
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In: International Journal of Eating Disorders. - : Wiley. - 0276-3478 .- 1098-108X. ; 51:1, s. 39-45
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Patients with atypical anorexia nervosa (AN) have many features overlapping with AN in terms of genetic risk, age of onset, psychopathology and prognosis of outcome, although the weight loss may not be a core factor. While brain structural alterations have been reported in AN, there are currently no data regarding atypical AN patients.METHOD: We investigated brain structure through a voxel-based morphometry analysis in 22 adolescent females newly-diagnosed with atypical AN, and 38 age- and sex-matched healthy controls (HC). ED-related psychopathology, impulsiveness and obsessive-compulsive traits were assessed with the Eating Disorder Examination Questionnaire (EDE-Q), Barratt Impulsiveness Scale (BIS-11) and Obsessive-compulsive Inventory Revised (OCI-R), respectively. Body mass index (BMI) was also calculated.RESULTS: Patients and HC differed significantly on BMI (p < .002), EDE-Q total score (p < .000) and OCI-R total score (p < .000). No differences could be detected in grey matter (GM) regional volume between groups.DISCUSSION: The ED-related cognitions in atypical AN patients would suggest that atypical AN and AN could be part of the same spectrum of restrictive-ED. However, contrary to previous reports in AN, our atypical AN patients did not show any GM volume reduction. The different degree of weight loss might play a role in determining such discrepancy. Alternatively, the preservation of GM volume might indeed differentiate atypical AN from AN.
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| 14. |
- Olivo, Gaia, et al.
(author)
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Limbic-thalamo-cortical projections and reward-related circuitry integrity affects eating behavior : A longitudinal DTI study in adolescents with restrictive eating disorders
- 2017
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:3
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Journal article (peer-reviewed)abstract
- Few studies have used diffusion tensor imaging (DTI) to investigate the micro-structural alterations of WM in patients with restrictive eating disorders (rED), and longitudinal data are lacking. Twelve patients with rED were scanned at diagnosis and after one year of family-based treatment, and compared to twenty-four healthy controls (HCs) through DTI analysis. A tract-based spatial statistics procedure was used to investigate diffusivity parameters: fractional anisotropy (FA) and mean, radial and axial diffusivities (MD, RD and AD, respectively). Reduced FA and increased RD were found in patients at baseline in the corpus callosum, corona radiata and posterior thalamic radiation compared with controls. However, no differences were found between follow-up patients and controls, suggesting a partial normalization of the diffusivity parameters. In patients, trends for a negative correlation were found between the baseline FA of the right anterior corona radiata and the Eating Disorder Examination Questionnaire total score, while a positive trend was found between the baseline FA in the splenium of corpus callosum and the weight loss occurred between maximal documented weight and time of admission. A positive trend for correlation was also found between baseline FA in the right anterior corona radiata and the decrease in the Obsessive-Compulsive Inventory Revised total score over time. Our results suggest that the integrity of the limbic-thalamo-cortical projections and the reward-related circuitry are important for cognitive control processes and reward responsiveness in regulating eating behavior.
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| 15. |
- Olivo, Gaia, et al.
(author)
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Preserved white matter microstructure in adolescent patients with atypical anorexia nervosa
- 2019
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In: International Journal of Eating Disorders. - : Wiley. - 0276-3478 .- 1098-108X. ; 52:2, s. 166-174
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Journal article (peer-reviewed)abstract
- Objective: Patients with atypical anorexia nervosa (AN) are often in the normal-weight range at presentation; however, signs of starvation and medical instability are not rare. White matter (WM) microstructural correlates of atypical AN have not yet been investigated, leaving an important gap in our knowledge regarding the neural pathogenesis of this disorder.Method: We investigated WM microstructural integrity in 25 drug-naive adolescent patients with atypical AN and 25 healthy controls, using diffusion tensor imaging (DTI) with a tract-based spatial statistics (TBSS) approach. Psychological variables related to the eating disorder and depressive symptoms were also evaluated by administering the eating disorder examination questionnaire (EDE-Q) and the Montgomery-angstrom sberg depression rating scale (MADRS-S) respectively, to all participants.Results: Patients and controls were in the normal-weight range and did not differ from the body mass index standard deviations for their age. No between groups difference in WM microstructure could be detected.Discussion: Our findings support the hypothesis that brain structural alterations may not be associated to early-stage atypical AN. These findings also suggest that previous observations of alterations in WM microstructure in full syndrome AN may constitute state-related consequences of severe weight loss. Whether the preservation of WM structure is a pathogenetically discriminant feature of atypical AN or only an effect of a less severe nutritional disturbance, will have to be verified by future studies on larger samples, possibly directly comparing AN and atypical AN.
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| 16. |
- Olivo, Gaia, et al.
(author)
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Reduced resting-state connectivity in areas involved in processing of face-related social cues in female adolescents with atypical anorexia nervosa
- 2018
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In: Translational Psychiatry. - : Springer Science and Business Media LLC. - 2158-3188. ; 8
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Journal article (peer-reviewed)abstract
- Atypical anorexia nervosa (AN) has a high incidence in adolescents and can result in significant morbidity and mortality. Neuroimaging could improve our knowledge regarding the pathogenesis of eating disorders (EDs), however research on adolescents with EDs is limited. To date no neuroimaging studies have been conducted to investigate brain functional connectivity in atypical AN. We investigated resting-state functional connectivity using 3 T MRI in 22 drug-naive adolescent patients with atypical AN, and 24 healthy controls. Psychological traits related to the ED and depressive symptoms have been assessed using the Eating Disorders Examination Questionnaire (EDE-Q) and the Montgomery-Asberg Depression Rating Scale self-reported (MADRS-S) respectively. Reduced connectivity was found in patients in brain areas involved in face-processing and social cognition, such as the left putamen, the left occipital fusiform gyrus, and specific cerebellar lobules. The connectivity was, on the other hand, increased in patients compared with controls from the right inferior temporal gyrus to the superior parietal lobule and superior lateral occipital cortex. These areas are involved in multimodal stimuli integration, social rejection and anxiety. Patients scored higher on the EDE-Q and MADRS-S questionnaires, and the MADRS-S correlated with connectivity from the right inferior temporal gyrus to the superior parietal lobule in patients. Our findings point toward a role for an altered development of socio-emotional skills in the pathogenesis of atypical AN. Nonetheless, longitudinal studies will be needed to assess whether these connectivity alterations might be a neural marker of the pathology.
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| 17. |
- Rosling, Agneta
(author)
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Eating Disorders - Aspects of Treatment and Outcome
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults.The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression.In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death.A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation.The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.
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| 19. |
- Rosling, Agneta, et al.
(author)
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One-year outcome and incidence of anorexia nervosa and restrictive eating disorders among adolescent girls treated as out-patients in a family-based setting
- 2016
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In: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 121:1, s. 50-59
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Journal article (peer-reviewed)abstract
- Aims To study the 1-year outcome and to analyse predictors of outcome of a cohort of adolescent girls with anorexia nervosa (AN) or restrictive eating disorders not otherwise specified (EDNOSr) treated as out-patients in a family-based programme at a specialized eating disorder service. To calculate the incidence of anorexia nervosa among treatment-seeking girls younger than 18 in Uppsala County from 2004 to 2006. Methods A total of 168 female patients were offered treatment, and 141 were followed-up 1 year after starting treatment, 29 with AN and 112 with EDNOSr. Results Of the 29 girls who initially had AN, 6 (20%) had a good outcome and were free of any form of eating disorder at follow-up; only 1 (3%) had AN. Of the patients with EDNOSr, 54 (48%) had a good outcome and were free of eating disorders. Three (3%) had a poor outcome and had developed AN. The incidence of AN was 18/100,000 person-years in girls younger than 12 and 63/100,000 in girls younger than 18. Conclusion Restrictive eating disorders, including AN, in children and adolescents can be successfully treated in a family-based specialized out-patient service without in-patient care.
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| 20. |
- Solstrand Dahlberg, Linda, 1988-, et al.
(author)
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Adolescents Newly Diagnosed with Eating Disorders have Structural Differences in Brain Regions linked with Eating Disorder Symptoms
- 2017
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In: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 71:3, s. 188-196
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Journal article (peer-reviewed)abstract
- Background: Adults with eating disorders (ED) show brain volume reductions in the frontal, insular, cingulate, and parietal cortices, as well as differences in subcortical regions associated with reward processing. However, little is known about the structural differences in adolescents with behavioural indications of early stage ED.Aim: This is the first study to investigate structural brain changes in adolescents newly diagnosed with ED compared to healthy controls (HC), and to study whether ED cognitions correlate with structural changes in adolescents with ED of short duration.Methods: Fifteen adolescent females recently diagnosed with ED, and 28 age-matched HC individuals, were scanned with structural magnetic resonance imaging (MRI). Whole-brain and region-of-interest analyses were conducted using voxel-based morphometry (VBM). ED cognitions were measured with self-report questionnaires and working memory performance was measured with a neuropsychological computerized test.Results and conclusions: The left superior temporal gyrus had a smaller volume in adolescents with ED than in HC, which correlated with ED cognitions (concerns about eating, weight, and shape). Working memory reaction time correlated positively with insula volumes in ED participants, but not HC. In ED, measurements of restraint and obsession was negatively correlated with temporal gyrus volumes, and positively correlated with cerebellar and striatal volumes. Thus, adolescents with a recent diagnosis of ED had volumetric variations in brain areas linked to ED cognitions, obsessions, and working memory. The findings emphasize the importance of early identification of illness, before potential long-term effects on structure and behaviour occur.
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| 23. |
- Styrud, Johan, et al.
(author)
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Experimental intrauterine growth retardation in the rat causes a reduction of pancreatic B-cell mass which persists into adulthood
- 2005
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In: Biol Neonate. ; 88, s. 122-128
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Journal article (peer-reviewed)abstract
- Background & Objectives: The aim of this study was to investigate the possibility that intrauterine growth retardation (IUGR) causes alterations of glucose tolerance, insulin secretory response to glucose, and pancreatic B-cell growth, and if such changes may persist into adulthood.Methods: Pregnant rats were operated on day 16 of pregnancy ad modum Wigglesworth to induce IUGR. Operated rats gave birth to viable offspring but litter size was reduced. The mothers nursed their pups, which were subsequently weaned and reared to an age of three months in apparent good health.Results: At one day of age IUGR pups were 10% lighter than control newborns whose mothers had been subjected to a sham operation. Pancreatic B-cell mass and insulin content were reduced by 35-40% in newborn IUGR offspring. Postnatal growth did not differ between IUGR and control animals of either sex and the difference in body weight at birth was not apparent from one week of age and onwards. Tests performed at three months of age could not demonstrate differences in glucose tolerance between IUGR and control animals. In females, but not in males, the peak insulin secretory response to glucose was lower in IUGR animals compared to controls. In the three-month-old rats B-cell mass was reduced by 40 % in male and by 45 % in female IUGR rats compared to controls, a reduction corresponding to a similar decrease in pancreatic insulin content (male reduction 48 %, female reduction 45 %).Conclusions: In the rat IUGR causes a diminution of pancreatic B-cell mass which persists into adulthood. Normal glucose tolerance could be maintained but it is conceivable that increasing demands on insulin secretion may not be met by the reduced B-cell mass and that impaired glucose tolerance and even diabetes would hence develop.
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| 24. |
- Swenne, Ingemar, et al.
(author)
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Bone metabolism in adolescent girls with eating disorders and weight loss : independent effects of weight change, insulin-like growth factor-1 and oestradiol
- 2015
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In: Eating and Weight Disorders. - : Springer Science and Business Media LLC. - 1124-4909 .- 1590-1262. ; 20:1, s. 33-41
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Journal article (peer-reviewed)abstract
- Adolescents with eating disorders (ED) are at risk of developing osteoporosis if weight is not recovered. Previous investigations do not separate the effects of weight change per se from those of concomitant hormonal changes. In this investigation serum osteocalcin (OC), C-terminal telopeptide of collagen (CTX), insulin-like growth factor-1 (IGF-1) and oestradiol were measured at assessment of 498 girls with ED and during weight gain of 59 girls. At assessment, OC concentrations were associated independently with weight (change), IGF-1 and oestradiol. Low weight, a high rate of weight loss and the hormone concentrations were associated with low OC. Low weight and high rate of weight loss were associated with high CTX concentrations but there were no associations independent of weight (change) with the hormones. During weight recovery, OC and CTX were independently and positively associated with weight, weight gain, IGF-1 and oestradiol. Bone metabolism markers are related to weight change independently of IGF-1 and oestradiol during both weight loss and weight gain. During weight gain, when pubertal development and growth are resumed there is an additional independent positive association between the markers and IGF-1 and oestradiol. These relationships are strongest in premenarcheal girls.
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| 25. |
- Swenne, Ingemar, et al.
(author)
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Bone metabolism markers in adolescent girls with eating disorders and weight loss : effects of growth, weight trend, developmental and menstrual status
- 2012
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In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 7:1-2, s. 125-133
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Journal article (peer-reviewed)abstract
- SUMMARY:Serum concentrations of osteocalcin (OC) decrease and those of C-terminal telopeptide of type 1 collagen (CTX) increase during weight loss in adolescent girls with eating disorders (ED). The impact of weight loss on bone metabolism markers is greatest in premenarcheal girls.INTRODUCTION:Adolescents with ED stand a risk of not reaching optimal peak bone mass and develop osteoporosis. Previous investigations are contradictory as to how markers of bone formation and resorption change during weight loss and nutritional rehabilitation.METHODS:Serum OC and CTX were measured at assessment of 461 adolescent girls with ED and during treatment of 55 girls with anorexia nervosa. Bone metabolism was related to weight, weight change and growth rate.RESULTS:At assessment, OC concentrations were positively correlated with growth rate and inversely with age and (rate of) weight loss. Growth rate was the only predictor of CTX concentrations in premenarcheal girls. In postmenarcheal girls, CTX concentrations were inversely correlated with age and rate of weight loss. During weight gain, there was an increase of OC concentrations. CTX concentrations decreased at the onset of weight gain and increased when near normal weight was reached.CONCLUSIONS:Bone formation markers decrease and resorption markers increase during weight loss. The effects are independent of menstrual status but the impact on bone formation markers is greater in young, premenarcheal girls. Markers are normalised during weight gain but it is conceivable that repeated and/or prolonged weight loss in adolescents reduces peak bone mass.
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| 26. |
- Swenne, Ingemar, et al.
(author)
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Do thyroid hormones mediate the effects of starvation on mood in adolescent girls with eating disorders?
- 2010
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In: Psychoneuroendocrinology. - : Elsevier BV. - 0306-4530 .- 1873-3360. ; 35:10, s. 1517-1524
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Journal article (peer-reviewed)abstract
- In the eating disorders (ED) comorbid depression is common and clinical experience suggests that it is partly related to starvation. Starvation affects thyroid hormone status and thyroid hypofunction is in turn associated with depressed mood. We have therefore investigated the possibility that thyroid hormones and starvation are associated with mood in ED. Two-hundred and thirty-nine adolescent girls were examined at presentation of an ED. Analyses of thyroid hormones, documentation of weight and weight changes, self-reports of depressive symptomatology and clinical diagnoses of ED and depression were used in the analyses. Of the 239 girls 100 were diagnosed with depression. The girls with and without depression did not differ in age, weight, height, body mass index (BMI), weight loss or duration of disease. Plasma free thyroxine concentrations were lower in depressed girls (11.9 +/- 1.7 versus 12.8 +/- 1.9 pmol/L; p < 0.01). Plasma triodothyronine and thyroid-stimulating hormone concentrations did not differ between groups. In a logistic regression analysis the odds ratio for depression was 41.1 (95% confidence interval 4.18-405; p = 0.001) for a 10 pmol/L change of plasma free thyroxine after correction for BMI, weight loss, duration of disease, rate of weight loss, plasma triodothyronine and an interaction between BMI and plasma free thyroxine. BMI did not predict depression. Low circulating thyroxine concentrations may provide a link between starvation and depression in adolescent girls with ED.
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| 27. |
- Swenne, Ingemar, et al.
(author)
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Essential fatty acid status in teenage girls with eating disorders and weight loss
- 2011
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 100:5, s. 762-767
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Journal article (peer-reviewed)abstract
- Aim: To explore the relationship between essential fatty acids (FA) and weight changes in adolescent girls with eating disorders (ED). Methods: Blood samples were obtained from 220 girls with ED and 39 healthy controls. The girls with ED were 15.3 +/- 1.5 years of age and weighed 49.8 +/- 8.7 kg (BMI 18.3 +/- 2.8 kg/m2) after a weight loss of 6.8 +/- 6.4 kg. FA were analysed in plasma phospholipids (PPL) and erythrocyte membranes (ERY). Results: The proportions of saturated and monounsaturated FA were increased during weight loss, while linoleic acid (18:2 omega 6) was decreased. The proportions of eicosapentanoic acid (EPA) (20:5 omega 3) and docosahexanoic acid (DHA) (22:6 omega 3) in PPL and ERY did not differ from controls. The activity of stearoyl-CoA-desaturase was increased as evidenced by an increased product/precursor ratio and correlated with the rate of weight loss. The activities of delta-6-desaturase and delta-5-desaturase did not differ from controls. The rate of weight loss was inversely correlated with delta-6-desaturase and directly correlated with delta-5-desaturase. Conclusion: The FA profile indicates low-fat intake, fat mobilization from stores and an increased conversion of essential FA at the delta-5-desaturase step during weight loss in adolescent girls with ED. Normal levels of EPA and DHA were maintained.
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| 28. |
- Swenne, Ingemar
(author)
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Evaluation of the Compulsive Exercise Test (CET) in Adolescents with Eating Disorders : Factor Structure and Relation to Eating Disordered Psychopathology
- 2016
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In: European eating disorders review. - : Wiley. - 1072-4133 .- 1099-0968. ; 24:4, s. 334-340
-
Journal article (peer-reviewed)abstract
- Objective: The aims of this study were to explore the factor structure of the Compulsive Exercise Test (CET) in a clinical sample of Swedish adolescents with eating disorders (ED) and to study the relationship of CET with ED cognitions, body weight and exercise frequency. Methods: The compulsive Exercise Test, the Eating Disorders Examination-Questionnaire, body mass index (BMI) and exercise frequency were available at assessment of 210 adolescents (age 14.4 +/- 1.6 years) with ED. Results: Factor analysis generated four factors with close similarity to factors previously obtained in a community sample of adolescents samples and supported the use of the original version of CET. Exercise for weight control was strongly related to ED cognitions but less to exercise frequency and BMI. Exercise for regulation of mood was related to ED cognitions and exercise frequency but not to BMI. Discussion: In adolescents with ED, different aspects of exercise are related to ED cognitions. This needs addressing in the treatment of adolescents with ED.
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| 29. |
- Swenne, Ingemar, 1953-, et al.
(author)
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Family-based intervention in adolescent restrictive eating disorders : early treatment response and low weight suppression is associated with favourable one-year outcome
- 2017
-
In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 17
-
Journal article (peer-reviewed)abstract
- Background: Family-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. We have investigated the one-year outcome of a family-based intervention programme with defined and decisive interventions at the start of treatment.Method: Data pertaining 201 adolescents with restrictive ED with features of anorexia nervosa but not fulfilling the weight criterion starting treatment 2010-2015, had a wide range of body mass index (BMI) and of weight loss at presentation, and completed a one-year follow-up was analysed. Recovery from the ED was defined as an Eating Disorder Examination-questionnaire (EDE-Q) score < 2.0 or as not fulfilling criteria for an ED at a clinical interview.Results: By EDE-Q 130 (65%) had recovered at 1 year and by clinical interview 106 (53%). According to the EDE-Q criterion recovery was independently associated with lower EDE-Q score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current BMI. Not fulfilling criteria for an ED was associated with the same factors and also by higher BMI at presentation.Conclusion: The observations that low weight and high ED cognitions confer a poor prognosis but that rapid weight gain at the start of treatment predicts a better prognosis are presently extended to adolescents with restrictive ED with a wide range of BMI at presentation. High weight suppression at follow-up is associated with a poor prognosis and indicates the importance of taking premorbid BMI into account when setting weight targets for treatment.
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| 30. |
- Swenne, Ingemar
(author)
-
Haematological changes and iron status in teenage girls with eating disorders and weight loss-the importance of menstrual status
- 2007
-
In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 96:4, s. 530-533
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Journal article (peer-reviewed)abstract
- Aim: To study haematological changes and iron stores in teenage girls with eating disorders and weight loss. Methods: Blood haemoglobin concentration, white blood cell and thrombocyte count and serum ferritin concentration were measured at assessments of 446 subjects. Results: Haemoglobin concentrations, leukocyte and thrombocyte counts were related to weight and rate of weight loss but were largely within reference ranges. Serum ferritin concentrations were high in girls with amenorrhea and related to weight and rate of weight loss. Girls who retained menstruations had low serum ferritin concentrations and 37% had depleted iron stores (serum ferritin <16 μg/L). Conclusion: Anaemia, leukopenia and thrombocytopenia are uncommon in teenage girls with eating disorders and weight loss. When present, other diseases causing haematological changes should be considered. In amenorrhoic girls muscle catabolism increases serum ferritin concentrations which may give a false impression of an adequate iron status. This is unmasked in girls with retained menstruations who often have depleted iron stores.
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| 31. |
- Swenne, Ingemar
(author)
-
Influence of premorbid BMI on clinical characteristics at presentation of adolescent girls with eating disorders
- 2016
-
In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 16
-
Journal article (peer-reviewed)abstract
- Background: Considering the prevalence of obesity in society it can be expected that some adolescents with an eating disorder (ED) start weight loss from an overweight and present at a near-normal weight. Presently, the influence of premorbid BMI on clinical characteristics of adolescent girls presenting with an ED has ben studied.Method: Premorbid growth charts were available for 275 postmenarcheal adolescent girls presenting with an ED (anorexia nervosa = 27, (subthreshold) bulimia nervosa = 9, restrictive EDNOS = 239). Initial assessment included measurement of weight and length, physical examination, blood sampling and administration of the Eating Disorder Examination-Questionnaire youth version (EDE-Q).Results: Despite greater weight loss girls with a high premorbid body mass index (BMI) had a higher BMI at presentation compared to those with a lower premorbid BMI. Although not underweight some presented with clinical and laboratory signs of starvation. These signs were related to not only low BMI but also to rapid and large weight loss. Their EDE-Q scores did not differ from those of girls who presented with an underweight.Conclusion: Girls with a restrictive ED and premorbid overweight may present with a near-normal BMI. They can nevertheless be medically compromised and have eating disturbed cognitions at the level of underweight girls. They should not be regarded as having a less severe ED but merit full assessment and a start of treatment.
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| 32. |
- Swenne, Ingemar, et al.
(author)
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Insulin-like growth factor-1 as an indicator of nutrition during treatment of adolescent girls with eating disorders
- 2007
-
In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 96:8, s. 1203-1208
-
Journal article (peer-reviewed)abstract
- Aim: The use of serum insulin-like growth factor-1 (IGF-1) concentrations as an index of nutrition has been analysed in teenage girls with eating disorders and weight loss. Method: Blood samples for analysis of IGF-1 were obtained at 349 assessments of 302 patients and biweekly during 56 treatment periods in 46 patients. IGF-1 was related to body size, weight loss, degree of leanness (BMI standard deviation score) and rate of weight loss. Results: At assessment, when most of the girls were on a weight-losing course, serum IGF-1 concentrations were low. Weight loss immediately prior to assessment was the most important predictor of IGF-1. Together with measurements of weight, height, weight loss and BMI standard deviation score the rate of weight loss predicted IGF-1 to 32–55%. During treatment when there was net weight gain, IGF-1 increased in parallel with the BMI standard deviation score, a measure of leanness, and was also influenced by the short-term weight trend. Conclusion: The serum IGF-1 concentration is an indicator of nutritional status in adolescents with eating disorders. It is sensitive to short-term weight changes measured in a clinical setting and could be used at assessment and to monitor nutritional rehabilitation.
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| 33. |
- Swenne, Ingemar, 1953-, et al.
(author)
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Low weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission
- 2017
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In: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 106:10, s. 1624-1629
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Journal article (peer-reviewed)abstract
- Aim: This study examined predictors of emergency hospitalisation of adolescent girls with restrictive eating disorders and weight loss treated by a family-based intervention programme.Methods: We studied 339 girls aged 10-17 years treated in a specialist unit at Uppsala University Children's Hospital, Sweden, from August 2010 to December 2015. Historical weight data were obtained from school health services, and other weight data were determined at presentation. Weight controlling behaviour was recorded, and patients were evaluated using the Eating Disorder Examination Questionnaire. A family-based intervention started after assessment and the early weight gain after one week, one month and three months was assessed.Results: There were 17 emergency admissions of 15 patients for refusing food, progressive weight loss and medical instability. Logistic regression analysis showed that emergency admissions were predicted by a low body mass index standard deviation score at presentation (odds ratio 2.57), a high rate of weight loss before presentation (odds ratio 4.38) and a low rate of weight gain at the start of treatment (odds ratio 4.59).Conclusion: Poor weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission.
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| 34. |
- Swenne, Ingemar, et al.
(author)
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No Unexpected Adverse Events and Biochemical Side Effects of Olanzapine as Adjunct Treatment in Adolescent Girls with Eating Disorders
- 2011
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In: Journal of child and adolescent psychopharmacology. - : Mary Ann Liebert Inc. - 1044-5463 .- 1557-8992. ; 21:3, s. 221-227
-
Journal article (peer-reviewed)abstract
- Objective: Olanzapine has been recently tried to relieve anxiety and hyperactivity in adolescents with eating disorders (EDs). Presently, the side effects of the drug have been evaluated. Method: Forty-seven adolescents with EDs were followed up by repeated blood sampling before, during, and at 3 months after medication with olanzapine. Results: Olanzapine medication was discontinued in three patients because of galactorrhea, seizures, and raised liver enzyme activities, respectively. There was a normalization of glucose, insulin, and lipid profiles during treatment, which was related to weight gain and resumption of menstruations but not to medication. Increases in thyroid-stimulating hormone and prolactin were related to olanzapine medication and comedication with selective serotonine reuptake inhibitors. Three months after discontinuing medication, there were no persisting biochemical effects. Conclusion: The side effects observed were those previously described for olanzapine. Most biochemical changes were related to weight (change) and amenorrhea and not to medication. Placebo-controlled studies are needed to investigate the efficacy of olanzapine in adolescents with EDs.
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| 35. |
- Swenne, Ingemar, 1953-, et al.
(author)
-
Omega-3 essential fatty acid status is improved during nutritional rehabilitation of adolescent girls with eating disorders and weight loss
- 2012
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 101:8, s. 858-861
-
Journal article (peer-reviewed)abstract
- AIM:Essential fatty acid status is altered in eating disorders with weight loss, and deficiencies in polyunsaturated omega-3 essential fatty acids have been implicated in the development of depression and other psychopathologies. Presently, recovery of essential fatty status during the treatment of adolescent girls with eating disorders has been investigated.METHODS:Fatty acids were analysed in erythrocyte membranes of 24 adolescents girls with eating disorders of short duration, and on the average >10 kg weight loss at presentation. Blood samples were obtained at presentation and following weight recovery on standard diet without supplementation with essential fatty acids.RESULTS:Alterations of essential fatty status observed at presentation largely normalized during treatment. Omega-3 status improved following weight gain.CONCLUSION:Adequate nutrition, normalization of eating behaviours, weight gain and the consequent return to normalization of metabolism and endocrine function are sufficient to ensure normalization of essential fatty acid status. Supplementation with omega-3 polyunsaturated fatty acids does not appear warranted.
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| 36. |
- Swenne, Ingemar, et al.
(author)
-
Omega-3 polyunsaturated essential fatty acids are associated with depression in adolescents with eating disorders and weight loss
- 2011
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 100:12, s. 1610-1615
-
Journal article (peer-reviewed)abstract
- Aim: To study the relationship between polyunsaturated fatty acids (PUFA) status and depression in adolescents with eating disorders (ED) and weight loss.Methods: Erythrocyte membranes from 217 adolescents (209 girls, eight boys) with ED were analysed for fatty acids (FA). ED and depression were diagnosed by clinical interviews and supported by self-report instruments.Results: Adolescents with ED and depression did not differ from those with ED only in terms of age, BMI, weight loss and duration of disease. In their FA profile, depressed adolescents had lower proportions of eicosapentanoic acid (EPA) and docosahexanoic acid (DHA), the end products of the omega 3 PUFA series. The ratio of long-chain (>18 carbons) omega 6/omega 3 PUFA was therefore higher in depressed adolescents. Indices of desaturase activities did not differ between depressed and not depressed adolescents.Conclusion: Low omega 3 status is related to depression in adolescents with ED. This cannot be explained by differences in weight (loss) and duration of disease, nor by differences in PUFA processing by desaturases. Data suggest a lower dietary intake of omega 3 PUFA in those with depression. Further investigations should determine whether omega 3 PUFA status improves by refeeding only or whether supplementation with PUFA is warranted.
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| 37. |
- Swenne, Ingemar
(author)
-
Plasma cholesterol is related to menstrual status in adolescent girls with eating disorders and weight loss
- 2016
-
In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 105:3, s. 317-323
-
Journal article (peer-reviewed)abstract
- AimThis study examined the relationship between plasma cholesterol and circulating triiodothyronine and oestradiol in 561 adolescent girls aged 11-17 with eating disorders. MethodsPlasma total cholesterol, high-density lipoprotein cholesterol, serum triodothyronine and oestradiol were measured at assessment, and historical weight data were obtained from growth charts provided by the school health services. Cholesterol levels were related to weight change, menstrual status and serum hormones. ResultsPlasma total cholesterol levels of >5.0 mmol/L were found in 38% of the 77 girls who were premenarcheal, 32% of the 199 with secondary amenorrhoea and 17% of those who were still menstruating. These cholesterol levels were inversely related to serum oestradiol and triiodothyronine concentrations, but not weight change, in amenorrhoic girls and were positively related to body mass index and inversely related to weight loss and serum triiodothyronine in girls who were still menstruating. ConclusionIncreased plasma total cholesterol was related to amenorrhoea in adolescent girls with eating disorders and weight loss. Oestrogens appeared to mediate the effect of starvation on cholesterol, most effectively in premenarcheal girls. Re-establishing menstruation is an important goal in the treatment of eating disorders, to avoid dyslipidaemia and the risk of future cardiovascular disease.
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| 38. |
- Swenne, Ingemar
(author)
-
Poor Catch-up Growth in Late Adolescent Boys with Eating Disorders, Weight Loss and Stunting of Growth
- 2013
-
In: European eating disorders review. - : Wiley. - 1072-4133 .- 1099-0968. ; 21:5, s. 395-398
-
Journal article (peer-reviewed)abstract
- Objective The study aims to investigate the catch-up growth of boys presenting with an eating disorder (ED) and a stunting of growth. Method Weight gain and growth of 46 boys with ED were followed up for 1-3years. Results A total of 13 boys who had not started their pubertal growth spurt at presentation started catch-up growth immediately following nutritional rehabilitation and weight gain. After 3years, they had returned to their premorbid growth curve. Thirty-three boys who had started their pubertal growth spurt prior to presentation never caught up in height but continued to catch down despite weight gain. After 3years, they had lost 0.64 +/- 0.55 height standard deviation scores corresponding to approximately 4.5cm of potential height. Conclusions In prepubertal boys with EDs, catch-up growth is possible. Pubertal boys are at a disadvantage in that catch-up growth may not occur despite weight gain.
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| 39. |
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| 40. |
- Swenne, Ingemar, et al.
(author)
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Relationship of 6-desaturase and 5-desaturase activities with thyroid hormone status in adolescents with eating disorders and weight loss
- 2013
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 102:4, s. 416-418
-
Journal article (peer-reviewed)abstract
- Aim In starvation, there is down-regulation of metabolism and changes in essential fatty acid (FA) status, which could be related to alterations of desaturase activities. Presently, the relationship between thyroid hormones and desaturase activities has been investigated in adolescents with eating disorders and weight loss. Methods Serum triiodothyronine concentrations and proportions of polyunsaturated FA in plasma phospholipids were analysed in blood samples from 227 adolescents with ED. 6-desaturase (D6D) activity was calculated as the FA ratio 20:36/18:26 and 5-desaturase (D5D) activity as the ratio 20:46/20:36. Results Serum triiodothyronine concentrations were related to leanness and ongoing weight loss. The estimated D6D activity was positively correlated with serum triiodothyronine (R2=0.232; p<0.001). D5D activity exhibited a strong inverse correlation with serum triiodothyronine (R2=0.410; p<0.001). Conclusion Changes in desaturase activities during starvation cannot be explained by inhibition/disinhibition by essential FA only. It is possible that the effects of starvation on these enzyme activities, and hence on essential FA status, are mediated by triiodothyronine.
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| 41. |
- Swenne, Ingemar, et al.
(author)
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Triiodothyronine Is an Indicator of Nutritional Status in Adolescent Girls with Eating Disorders
- 2009
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In: Hormone Research. - : S. Karger AG. - 0301-0163 .- 1423-0046. ; 71:5, s. 268-275
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Journal article (peer-reviewed)abstract
- Aim: Circulating thyroid hormone concentrations are influenced by nonthyroidal disease and changes in nutritional status. We studied thyroid hormones as possible indicators of nutrition in adolescent girls with eating disorders. Method: Blood samples for analyses of thyroid hormones were obtained at 360 assessments of 298 patients and biweekly during 42 treatment periods in 36 patients. Results: At assessment, when most of the girls were on a weight losing course, serum triiodothyronine (T3) concentrations were low. Great weight loss and rapid rate of weight loss were the most important predictors of low T3 concentrations. Serum free thyroxine concentrations were in the lower normal range. In premenarcheal girls, weight loss was the most important predictor of free thyroxine but this relationship was weaker in postmenarcheal girls. Serum TSH concentrations were within the normal range and only weakly related to weight changes. During treatment, T3 increased in parallel with weight but was also influenced by the short-term weight trend. Conclusion: Serum T3 concentration is an indicator of nutritional status in adolescent girls with eating disorders. It is sensitive to short-term weight changes and could be used to monitor progress throughout nutritional rehabilitation.
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| 42. |
- Swenne, Ingemar
(author)
-
Weight and growth requirements for menarche in teenage girls with eating disorders, weight loss and primary amenorrhea
- 2008
-
In: Hormone Research. - : S. Karger AG. - 0301-0163 .- 1423-0046. ; 69:3, s. 146-151
-
Journal article (peer-reviewed)abstract
- BACKGROUND/AIM: To investigate weight and growth requirements for menarche in girls with eating disorders (ED), weight loss and primary amenorrhea. METHODS: Growth charts from school health services and measurements of weight and stature throughout treatment were obtained for 47 such girls. RESULTS: Weight loss started at an age of 12.4 +/- 1.6 years from a top weight of 41.7 +/- 7.1 kg. Approximately a year later they had lost 5.1 +/- 4.3 kg and grown only 2.8 +/- 3.5 cm. Following treatment and weight gain, growth accelerated and the girls reached a peak growth velocity of 4.3 +/- 2.6 cm/year 2 years before menarche which occurred at an age of 15.5 +/- 1.6 years at a weight of 52.2 +/- 5.3 kg. Menarche occurred within a wide range of weights but could be predicted by a linear regression on prepubertal weight (R(2) = 0.39; p < 0.001). CONCLUSIONS: Following treatment, girls with ED and primary amenorrhea progress through puberty at a slowed rate. The weight required for menarche can be predicted by the prepubertal weight which may represent the individual's normal growth track unaffected by the ED.
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| 43. |
- Swenne, Ingemar, 1953-
(author)
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Weight Requirements for Catch-Up Growth in Adolescent Girls with Eating Disorders
- 2012
-
In: Handbook of Growth and Growth Monitoring in Health and Disease. - New York, NY : Springer Science+Business Media B.V.. - 9781441917942 - 9781441917959 ; , s. 1015-1027
-
Book chapter (other academic/artistic)abstract
- Adolescent girls presenting with an eating disorder with onset of weight loss before menarche are at risk of being stunted by undernutrition. They have, however, considerable growth potential and will catch up in stature if adequately treated. In contrast to postmenarcheal teenagers the younger girls have an insidious onset of disease with an often long period of diminished weight gain and stunting of growth. Disturbed eating behaviour may be discrete and go unnoticed during the early stages of disease. Presentation is therefore usually delayed until weight loss makes the diagnosis evident. At presentation weight deficit may be considerable due to not only weight loss but also the absence of expected weight gain. There is a decrease in linear growth, which in some cases may have completely halted. Following start of treatment there may be considerable weight gain, especially during the first year of treatment. Resumption of linear growth is, however, delayed to the second year of treatment. Growth may then continue for several years at an age when girls usually have almost reached their final height. Catch-up growth is thus achieved by prolonging the growth period rather than growing at an increased rate. Catch-up can reach the growth trajectory of prepubertal growth, i.e. the growth channel before onset of the eating disorder. This level of catch-up growth is achieved if weight gain reaches the prepubertal weight curve. When catch-up in weight and height stabilises at this level, menarche ensues. Considerable catch-up growth is thus possible in eating disorders with onset before menarche. A prerequisite is rapid weight restoration, before growth potential is lost with age. Once weight gain is achieved full catch-up in stature and completion of puberty by menarche may take several years.
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| 44. |
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| 45. |
- Wallin, Ulf, et al.
(author)
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Tidig viktuppgång vid anorexia nervosa ger god prognos : Intensiv familjebaserad behandling ger bäst resultat
- 2016
-
In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 113
-
Journal article (peer-reviewed)abstract
- Vid anorexia nervosa orsakar svälten de allvarligaste symtomen, och risken för ett långdraget förlopp ökar ju längre patienten är i svält. Avgörande för behandlingsresultatet är att häva svälten snabbt. Viktuppgång tidigt i behandlingen ger bättre prognos.Familjebaserad behandling har bäst stöd i forskningen för att åstadkomma tidig viktuppgång för ungdomar med anorexia nervosa.Många patienter erhåller i dag inte familjebaserad behandling som är evidensbaserad och fokuserar på ätstörningen.Barnpsykiatrin måste organisera sig så att patienterna direkt får god och intensiv vård utan dröjsmål.Den initiala vården bör skötas på specialenheter för ätstörningar
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| 46. |
- Welch, Elisabeth, et al.
(author)
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A comparison of clinical characteristics between adolescent males and females with eating disorders
- 2015
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In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 15
-
Journal article (peer-reviewed)abstract
- Background: Eating disorders (ED) are serious disorders that have a negative impact on both the psychological and the physiological well-being of the afflicted. Despite the fact that ED affect both genders, males are often underrepresented in research and when included the sample sizes are often too small for separate analyses. Consequently we have an unclear and sometimes contradictory picture of the clinical characteristics of males with ED. The aim of the present study was to improve our understanding of the clinical features of adolescent males with eating disorders. Methods: We compared age at presentation, weight at presentation, history of significantly different premorbid weight and psychiatric (Attention Deficit Hyperactivity Disorder (ADHD)) and somatic comorbidity (celiac disease and diabetes) of 58 males to 606 females seeking medical care for eating disorders at the Children's Hospital in Uppsala, Sweden during the years 1999-2012. As all boys were diagnosed with either AN or Other Specified Feeding or Eating Disorder (OSFED) atypical AN, the age and weight comparisons were limited to those girls fulfilling the diagnostic criteria for AN or OSFED atypical AN. Results: There was no significant difference in age at presentation. Differences in weight at presentation and premorbid weight history were mixed. A significantly higher percentage of males had a history of a BMI greater than two standard deviations above the mean for their corresponding age group. As well, there was a higher prevalence of ADHD among the males whereas celiac disease and diabetes only was found among the females. Conclusions: A better understanding of the clinical characteristics of males with ED at presentation should improve our ability to identify males with ED and thereby aid in tailoring the best treatment alternatives.
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