Evolución y tratamiento de los trastornos de la conducta alimentaria en adolescentes: serie de casos / Treatment of eating disorders in adolescents: case series

Los trastornos de la conducta alimentaria son enfermedades de elevada prevalencia en la adolescencia y tienen repercusión en la salud integral. El objetivo fue describir su evolución y tratamiento en un grupo de adolescentes. Se estudiaron adolescentes menores de 18 años con al menos 6 meses de seguimiento y tratados por un equipo interdisciplinario. Se incluyeron 41 adolescentes: 23 presentaron anorexia nerviosa; 9, trastornos alimentarios no especificados; 7, bulimia nerviosa y 2, trastorno por atracones. El 35 % de pacientes con anorexia nerviosa requirió internación por complicaciones de la desnutrición. El 69 % de las pacientes con anorexia nerviosa, el 57 % de quienes tenían bulimia nerviosa y el 78 % de quienes tenían un trastorno alimentario no especificado presentaron remisión total o parcial, y no hubo pacientes fallecidos. La mayoría presentó una evolución favorable con el tratamiento.

Eating disorders are highly prevalent diseases in adolescence and have an impact on overall health. The objective was to describe the evolution and treatment of eating disorders in adolescents. Adolescents under 18 years of age with at least 6 months of follow-up and treated by an interdisciplinary team were studied. Forty one adolescents were included, 23 presented anorexia nervosa, 9 unspecified eating disorders, 7 bulimia nervosa and 2 binge eating disorders. Thirty five percent of patients with anorexia nervosa required hospitalization for complications of malnutrition. Sixty nine percent of the patients with anorexia nervosa, 57 % with bulimia nervosa, and 78 % with unspecified eating disorders had total or partial remission and there were no deceased patients. The majority presented a favorable evolution with the treatment.

Risk factors for eating disorders: an umbrella review of published meta-analyses

Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

Non-suicidal self-injury in patients with eating disorders: nuclear aspects / Autolesiones no suicidas en pacientes con trastornos de la conducta alimentaria: Aspectos nucleares

Abstract Background: Through the culture of thinness, increasingly promoted in our society as a beauty canon, it is not surprising that the number of people affected by eating disorders is increasing. Objective: This research aims to study the relationship between non-suicidal self-injuries and nuclear aspects of eating disorders specified along with this article. Methods: The sample consisted of 60 women diagnosed with anorexia and bulimia. Questionnaires assessing impulsivity, body satisfaction, alexithymia, body attitude and self-esteem were administered. Participants with non-suicidal self-harm were compared with those without it, and participants with anorexia with and without self-harm and participants with bulimia with and without self-harm were compared. Results: Differences were found in body dissatisfaction= 5.71; p ≤0.01), body attitudes= 4.80; p ≤0.02), self-esteem= 14.09; p ≤0.00) and impulsivity (t= 3.39; p ≤0.01) between participants with and without non-suicidal self-harm. Conclusions: These are key factors for the clinical area in the treatment of eating disorders to prevent the presence of self-harm, as it allows focusing the treatment target on those aspects such as dissatisfaction and impulsivity, which are key in the development of self-harm.

Resumen Introducción: A través de la cultura de la delgadez, cada vez más promovida en nuestra sociedad como canon de belleza, no es de extrañar que este aumentado el número de personas afectadas por Trastornos de Conducta alimentaria. Objetivo: Estudiar la relación entre las autolesiones no suicidas y aspectos nucleares del trastorno de conducta alimentaria que se especifican a lo largo de este artículo. Métodos: La muestra ha sido formada por 60 mujeres diagnosticadas de anorexia y bulimia. Se administraron cuestionarios que evaluaban la impulsividad, satisfacción corporal, alexitimia, actitud corporal y autoestima. Se compararon aquellas participantes que presentaban autolesiones no suicidas con las que no lo presentaban, además se compararon participantes con anorexia con y sin autolesiones y participantes con bulimia con y sin autolesiones. Resultados: Se encontraron diferencias en insatisfacción corporal = 5,71; p ≤0.01), en actitudes corporales= 4.80; p ≤0.02), autoestima= 14.09; p ≤0.00) e impulsividad, (t= 3.39; p ≤0.01) entre participantes con y sin autolesiones no suicidas. Conclusiones: Estos son factores clave para la clínica en el tratamiento de los trastornos de conducta alimentaria para prevenir la presencia de autolesiones, ya que permite enfocar el objetivo del tratamiento a aquellos aspectos como la insatisfacción e impulsividad, que son claves en el desarrollo de autolesiones.

Disordered eating and body change behaviours: support for the Tripartite Influence Model among Brazilian male university students / Comportamentos de risco para transtornos alimentares e de mudança corporal: suporte ao Modelo dos Três Fatores para adultos brasileiros

Abstract The Tripartite Influence Model posits that sociocultural influences mediated by internalization and social comparison are predictors of disordered eating and body change behaviours. This study aimed to test the Tripartite Influence Model among Brazilian male university students, which has not been tested yet. 707 undergraduate students of the five Brazilian regions, completed measures of sociocultural influences, internalization, social comparison, body and muscularity dissatisfaction, disordered eating and body change behaviours. Structural equation modelling analyses showed good model-fitting. Parental influence was related to internalization, while peer influence with social comparison. Media influences were related to both internalization and social comparison. Internalization and social comparison are mediating variables that are related to body dissatisfaction and muscularity dissatisfaction. Finally, muscularity dissatisfaction was associated with body change behaviours.

Resumo O modelo de influência dos três fatores indica que as influências socioculturais, mediadas pela internalização e a comparação social, são preditoras de comportamentos de risco para transtornos alimentares e comportamentos de mudança corporal. O estudo objetivou testar o Modelo de Influência dos Três Fatores para jovens adultos brasileiros, uma vez que o mesmo ainda não foi testado neste contexto. 707 homens, jovens universitários das cinco regiões brasileiras, responderam a instrumentos de avaliação das influências socioculturais, internalização, comparação social, insatisfação com o corpo e com a muscularidade, comportamentos de risco para transtornos alimentares e comportamentos de mudança corporal. Análise por meio de Modelagem de Equações Estruturais demonstrou adequados índices de ajustamento do modelo. As influências dos pais foram associadas com a internalização, enquanto as influências dos pares com a comparação social. Influência da mídia demonstrou associação tanto com a internalização quanto com a comparação social. A internalização e a comparação social são variáveis mediadoras que se relacionam com a insatisfação corporal e insatisfação com a muscularidade. Por fim, a insatisfação com a muscularidade esteve associada com os comportamentos de mudança corporal.

Trastornos de la conducta alimentaria en adolescentes: una mirada integral / Eating disorders in adolescents: a comprehensive approach

Los trastornos de la conducta alimentaria (TCA) son enfermedades muy serias que se inician habitualmente en la adolescencia y en general han ido en aumento en los países en desarrollo. Actualmente, diversos factores obstaculizan su prevención, pesquisa y tratamiento en el país, siendo uno importante la escasez de capacitación de los profesionales de salud en este tema emergente. El objetivo de este artículo es contribuir al conocimiento que poseen los pediatras sobre los TCA en la adolescencia, mediante una revisión actualizada de la literatura en el tema. En esta publicación se abordan la principal clasificación internacional de los TCA en uso en la literatura científica actual y la epidemiología, etiología, el impacto en la salud integral, la presentación clínica y el tratamiento de los TCA más frecuentes en la adolescencia.

Eating disorders (ED) are very serious diseases that usually begin in adolescence and have, in general, been increasing in developing countries. In the country, there are currently several fac tors that hinder their prevention, detection, and treatment, where the lack of training of health professionals in this emerging issue appears as an important one. The purpose of this article is to contribute to the knowledge that pediatricians have about ED in adolescence, through an updated review of the literature on the subject. This publication addresses the main internatio nal classification of ED in use in the current scientific literature and the epidemiology, etiology, impact on comprehensive health, clinical presentation, and treatment of the most common ED in adolescence.

Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil

Objective: To identify the frequency of disordered eating (DE) and unhealthy weight control behaviors (UWCB) among adolescents and associations with age, sex, actual weight status, perceived weight status, and body image dissatisfaction. Methods: Cross-sectional study of 1,156 adolescents. DE was assessed using a specific self-report questionnaire, UWCB by specific behaviors that were not typically recommended for weight management, and body dissatisfaction by Stunkard's silhouettes. Results: The frequency of DE was 17.3%, and that of UWCB, 31.9%; 80.1% of participants were dissatisfied with body image. Perception of oneself as overweight was associated with 1.795-fold odds of DE. Those with UWCB had 7.389-fold odds of DE, while DE increased the odds of UWCB 7.280-fold. Girls, participants who perceived themselves as overweight, and those who reported body dissatisfaction were 2.266, 2.381, and 1.752 times more likely to have UWCB, respectively. Conclusion: A high prevalence of UWCB and a moderate prevalence of DE behaviors was found in adolescents from the city of São Paulo, Brazil. Those who perceived themselves as overweight had more DE and UWCB, and both behaviors were related. UWCB was more common in girls and among those dissatisfied with their bodies.

Comportamiento clínico y enfoque terapéutico de los trastornos alimentarios en personas con diabetes mellitus tipo 1 / Clinical Behavior and Therapeutic Approach of Eating Disorders in People with Type 1 Diabetes Mellitus

Introducción: El comportamiento clínico de la diabetes mellitus tipo 1 y el enfoque terapéutico de los trastornos de la conducta alimentaria se complejizan cuando estos coinciden en una misma persona. Objetivo: Describir algunos aspectos del comportamiento clínico y enfoque terapéutico de los trastornos de la conducta alimentaria en personas con diabetes mellitus tipo 1. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema en el primer semestre de 2019. Se utilizaron como buscadores de información científica a Pubmed y a Google Académico. Como criterios iniciales de elegibilidad, se evaluaron artículos de revisión, de investigación y páginas Web que, en general, tenían menos de 10 años de publicados, en idioma español, portugués e inglés, y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 65 artículos, de los cuales 33 fueron referenciados. Conclusiones: El comportamiento clínico de los trastornos de la conducta alimentaria en pacientes con diabetes mellitus tipo 1 combina síntomas y signos propios de ambas dolencias. Ambas entidades nosológicas se deben prevenir, pesquisar, diagnosticar e intervenir desde los servicios de atención primaria de salud, a través de una perspectiva interdisciplinaria. El tratamiento endocrinológico, unido a la terapia individual, la psicoeducación relacionada con los trastornos de la conducta alimentaria, la terapia familiar y un plan de tratamiento integral para la salud mental son imprescindibles desde el primer nivel de atención(AU)

Introduction: The clinical behavior of type 1 diabetes mellitus and the therapeutic approach to eating disorders become more complex when they coincide in the same person. Objective: To describe some aspects of the clinical behavior and therapeutic approach of eating disorders in people with type 1 diabetes mellitus. Methods: A search of relevant literature on the subject was carried out in the first semester of 2019. We used, as search engines for scientific information, Pubmed and Google Scholar. As initial eligibility criteria, we evaluated review articles, research articles, and web pages which, in general, were published less than 10 years ago, in Spanish, Portuguese and English, and which made, in their titles, specific reference to the topic of the study. Articles that did not meet these conditions were excluded. This allowed the study of 65 articles, of which 33 were referenced. Conclusions: The clinical behavior of eating disorders in patients with type 1 diabetes mellitus combines symptoms and signs typical of both conditions. Both nosological entities must be prevented, screened, diagnosed and intervened, starting in primary health care services, through an interdisciplinary perspective. Endocrinological treatment, together with individual therapy, eating disorders-related psychoeducation, family therapy, and a comprehensive treatment plan for mental health are essential, starting in the first level of care(AU)

Sintomas de Transtorno Alimentar e Satisfação com Imagem Corporal em Bailarinos Profissionais de Dança Contemporânea / Symptoms of Eating Disorders and Satisfaction With Body Image in Contemporary Dancing Professional Dancers

INTRODUÇÃO: Na dança contemporânea os bailarinos se apresentam com uma diversidade de aparência corporal, podendo estar contribuindo com uma imagem corporal e com menos sintomas de transtornos alimentares. OBJETIVOS: verificar a prevalência de sintomas de transtorno alimentar em bailarinos profissionais brasileiros de dança contemporânea de ambos os gêneros, bem como averiguar possíveis associações com a satisfação com a imagem corporal. MÉTODOS: participaram do estudo 76 bailarinos com média de idade 26.72 (+/-6.88) anos de companhias de dança contemporâneas brasileiras. Foi utilizado um questionário multidimensional contendo questões sobre informações gerais e da prática, características físicas , imagem corporal e transtorno alimentar . Os dados foram analisados através da estatística descritiva e inferencial não paramétrica. RESULTADOS: os bailarinos de dança contemporânea possuem um IMC dentro da referência de normalidade. A maioria dos bailarinos encontra-se satisfeitos com a imagem corporal e diferenças significativas indicaram diferenças entre os gêneros, onde os homens estão mais satisfeitos com a imagem corporal do que as mulheres. Tem-se uma prevalência de presença sintomas para transtornos alimentares de 14,5%, e as mulheres são mais propensas a desenvolver sintomas de transtornos alimentares do que os homens. CONCLUSÃO: os bailarinos de dança contemporânea, apresentaram uma prevalência significativa de presença de sintomas de transtornos alimentares, e que o gênero pode levar a percepções diferenciadas: os bailarinos estão mais satisfeitos com a imagem corporal do que as bailarinas, mas as bailarinas são mais vulneráveis aos sintomas de transtornos alimentares do que os bailarinos. (AU)

Introduction: In contemporary dance the dancers present with a diversity of body appearance, being able to be contributing with a body image and with less symptoms of eating disorders. Objectives: to verify the prevalence of eating disorder symptoms in Brazilian contemporary dance dancers of both genders, as well as to investigate possible associations with satisfaction with body image. Methods: 76 professional dancers with a mean age of 26.72 (+/- 6.88) years of Brazilian contemporary dance companies participated in the study. A multidimensional questionnaire containing questions about general and practice information, physical characteristics, body image and eating disorder was used. The data were analyzed through the statistical descriptive and non-parametric inferential. Results: Contemporary dance dancers have a BMI within the normal range. Most dancers are satisfied with body image and significant differences indicate differences between genders, where men are more satisfied with body image than women. It has a prevalence of presence symptoms for eating disorders of 14.5%, and women are more likely to develop symptoms of eating disorders than men. Conclusion: contemporary dance dancers had a significant prevalence of eating disorders symptoms, and that gender may lead to different perceptions: dancers are more satisfied with body image than dancers, but dancers are more vulnerable to symptoms of eating disorders than the dancers. (AU)

Evolución de las conductas alimentarias de riesgo en adolescentes mexicanos, 2006-2018 / Disordered eating in Mexican adolescents, 2006-2018

Resumen: Objetivo. Analizar la evolución de la prevalencia de conductas alimentarias de riesgo (CAR) en adolescentes mexicanos entre 2006 y 2018. Material y métodos. Se utilizó información de las Ensanut 2006 y 2018-19. Se evaluaron las CAR con el Cuestionario Breve de Conductas Alimentarias de Riesgo, distinguiendo entre normativas (recomendadas en la prevención de la obesidad) y no normativas (no recomendadas). Se analizó la relación entre CAR e indicadores del medio ambiente sociocultural en que los adolescentes se desenvuelven (nivel socioeconómico, tamaño de la localidad). Resultados. La prevalencia de CAR normativas pasó de 11.9% (IC95%: 11.3-12.6) a 15.7% (IC95%: 15.0-16.5) y la de las CAR no normativas de 12.1 (IC95%: 11.4-12.9) a 21.9 (IC95% 21.0-22.9). Las CAR fueron más frecuentes en mujeres, en adolescentes con sobrepeso u obesidad, de nivel socioeconómico más alto y en localidades urbanas. Conclusión. Las CAR son un problema importante en adolescentes y es necesario implementar estrategias de prevención.

Abstract: Objective. To analyze the evolution in prevalence of risky eating behaviors (REB) in Mexican adolescents between 2006 and 2018. Materials and methods: We employed data from Ensanut 2006 and 2018-19. We evaluated REB with the Brief Questionnaire of Risky Eating Behaviors, distinguishing between normative (recommended for obesity prevention) and non-normative (not recommended) REB. We analyzed the association between REB and indicators of the sociocultural environment of adolescents (socioeconomic level, urban/rural place of living. Results: The prevalence of normative REB changed from 11.9% (95%CI: 11.3-12.6) to 15.7% (95%CI: 15.0-16.5), and the prevalence of non-normative REB from 12.1 (95%CI: 11.4-12.9) to 21.9 (95%CI: 21.0-22.9). REB were more frequent among females, those with overweight or obesity, those in the higher socioeconomic levels, and in urban areas. Conclusions: REB are an important issue among adolescents, and preventive strategies are required.

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

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

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

Feeding difficulties and eating disorders in pediatric patients with cancer / Trastornos y dificultades en la alimentación en pacientes pediátricos con cáncer

Abstract Background Feeding difficulties and disorders are a common problem in the pediatric population, which involve a series of deficient behaviors about nutrition processes that can adversely affect psychomotor, psychosocial, and physical development of children. This study aimed to describe the frequency of feeding difficulties or disorders in pediatric patients with cancer. Methods A prospective study which included 125 children from 1-19 years treated at the Department of Oncology of the Instituto Nacional de Pediatría, Mexico City, was conducted. The diagnosis of eating disorders and feeding difficulties was determined during the first 48 h since admission, and the age of the patient influenced the type of disorder and feeding difficulties. Results Children older than 11 years presented more frequently an intense resistance of feeding because of discomfort pain (fear of feeding) than younger children (11.4 ± 4.7 vs. 7.4 ± 4.9, p ≤ 0.001). The most frequent alteration associated with malnutrition was loss of appetite (odds ratio [OR]: 8.8, confidence interval [CI] 95% 2.9-26.9, p<0.001), followed by fear of feeding (OR: 3.14, CI 95% 1.24-7.9, p=0.015), and the organic causes showed the highest risk for malnutrition (OR: 3.1, CI 95% 0.98-9.7, p=0.054). Conclusions Over 90% of the studied population demonstrated at least one eating disorder or feeding difficulty. The principal effect is inadequate nutritional intake due to limited appetite and fear of feeding, which can result in undernutrition. For this reason, the identification of alterations in nutrition processes should be part of the comprehensive assessment of cancer patients.

Resumen Introducción Los trastornos y dificultades para la alimentación son problemas comunes en la edad pediátrica. Estas situaciones conllevan una serie de comportamientos inadecuados respecto de los procesos de nutrición que pueden afectar de manera adversa el desarrollo psicomotor, psicosocial y físico del niño. El objetivo de este trabajo fue describir la frecuencia de desórdenes y dificultades en la alimentación en niños con cáncer a través de un estudio prospectivo. Métodos Se incluyeron 125 niños de 1 a 19 años de edad del Servicio de Oncología del Instituto Nacional de Pediatría, Ciudad de México. El diagnóstico de desorden y dificultad en la alimentación se determinó en las primeras 48 horas del ingreso. Resultados Los niños mayores de 11 años presentan con mayor frecuencia resistencia a comer debido a dolor o malestar (miedo a comer) (11.4±4.7 años versus 7.4±4.9 años; p≤0.001). La alteración más frecuente asociada a malnutrición fue la disminución del apetito (razón de momios [RM]: 8.8; intervalo de confianza [IC] 95%: 2.9-26.9; p<0.001), seguido del miedo a comer (RM: 3.14; IC 95%: 1.24-7.9; p=0.015) y las causas con mayor riesgo de malnutrición fueron las orgánicas (RM: 3.1; IC 95%: 0.98-9.7; p=0.054). Conclusiones Se encontró que en más del 90% de esta población se presentó por lo menos un desorden alimentario o dificultad al alimentarse. El principal efecto es la ingesta nutricional inadecuada debida al apetito limitado y al miedo a alimentarse, lo que puede resultar en desnutrición. Por esta razón, la identificación de alteraciones en los procesos de nutrición deben ser parte de la valoración integral de los pacientes con cáncer.

Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis

Objective: To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED. Methods: The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO). Results: Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively). Conclusion: Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.

Dificuldades alimentares em pré-escolares, práticas alimentares pregressas e estado nutricional / Feeding difficulties in preschool children, previous feeding practices, and nutritional status

RESUMO Objetivo: Identificar a prevalência de dificuldade alimentar (DA) em pré-escolares, sua associação com fatores epidemiológicos e práticas alimentares pregressas, bem como sua repercussão sobre o estado nutricional. Métodos: Estudo transversal com aplicação de questionário às mães de 301 crianças de dois a seis anos de creches públicas e privadas em Natal, Rio Grande do Norte, em 2014 e 2015. Identificou-se DA segundo critérios de Kerzner, incluindo os perfis de "ingestão altamente seletiva", "criança agitada com baixo apetite", "fobia alimentar" e "criança com distúrbio psicológico ou negligenciada". As variáveis de associação analisadas por regressão logística foram: tempo de aleitamento materno, idade de introdução de leite de vaca e da alimentação complementar, faixa etária, renda familiar, tipo de escola, perfil das mães (responsivas ou não responsivas) e índice de massa corpórea (IMC). Resultados: DA foi encontrada em 37,2% dos casos analisados, com predomínio de "ingestão altamente seletiva" (25,4%). Não houve associação entre DA e práticas alimentares na fase de lactente, renda familiar e tipo de escola. Não houve diferença entre as médias de escore Z IMC para os grupos com e sem DA (1,0±1,5DP e 1,1±1,4DP, respectivamente). A faixa etária de cinco a seis anos apresentou maior ocorrência de DA (OR 1,8; IC95% 1,1-2,9) e filhos de mães com perfil responsivo tiveram menores chances de apresentar DAs (OR 0,4; IC95% 0,2-0,8). Conclusões: DA foi de alta prevalência. Não houve repercussão sobre o estado nutricional nem associação às práticas alimentares pregressas. O perfil responsivo das mães é fator protetor para as DAs e reforça a importância da natureza comportamental e da interação mãe-filho.

ABSTRACT Objective: To identify the prevalence of feeding difficulties in preschoolers, its association with epidemiological factors and previous eating habits, and repercussion on nutritional status. Methods: Cross-sectional study with a questionnaire given to the mothers of 301 children aged 2-6 years enrolled in public and private kindergartens in Natal, Northeast Brazil, conducted in 2014-2015. Feeding difficulty was assessed according to Kerzner's criteria, resulting in the profiles "highly selective intake", "active child with small appetite", "fear of feeding", and "child with psychological disorder or neglected". Association with the following independent variables was analyzed by logistic regression: breastfeeding time, age of cows' milk and complementary feeding introduction, age range, family income, type of school, mothers' profile (responsive or nonresponsive), and body mass index (BMI). Results: Feeding difficulty was found in 37.2% of cases, with predominance of "highly selective intake" (25.4%). It was not associated with infancy feeding practices, family income or type of school. There were no differences between the BMI Z score means for the groups with and without feeding difficulty (1.0±1.5 SD and 1.1±1.4 SD, respectively). The five-to-six age range had more occurrences (OR 1.8; 95%CI 1.1-2.9). Children of responsive mothers were less likely to have feeding difficulties (OR 0.4; 95%CI 0.2-0.8). Conclusions: Feeding difficulties were very frequent. Nutritional status was not impacted by it, and infancy eating habits were not associated with it. Responsive mothers' profile is a protective factor against eating difficulties and reinforces the importance of behavioral factors and mother-child interaction.

Trastornos de la conducta alimentaria en estudiantes de medicina de una universidad de Perú / Eating disorders in medical students of a Peruvian university

Introducción: Los trastornos de la conducta alimentaria afectan con mayor frecuencia a jóvenes, y pueden llegar a tener importantes consecuencias en su salud mental y física. Objetivo: Determinar la prevalencia de probable diagnóstico de trastornos de conducta alimentaria en estudiantes de medicina y sus factores asociados. Métodos: Estudio descriptivo transversal realizado en estudiantes de medicina del primer año de una universidad de Lima, Perú. Se aplicó un cuestionario virtual para recolectar los datos de interés. Aquellos con un puntaje ≥20 en elEatingAttitudes Test-26, se consideronconprobable diagnóstico de trastornos de conducta alimentaria.Para evaluar los factores se calcularon razones de prevalencia y intervalos de confianza al 95% usando regresiones de Poissoncrudas con varianza robusta. Resultados: Del total de 440 estudiantes de primer año, 375 (85,2 por ciento) completaron la encuesta. La prevalencia de probable diagnóstico de trastornos de conducta alimentaria fue de 10,1 por ciento (11,3 en mujeres y 8,6 en varones).Los factores asociados a esta variable fueron: rechazo escolar por trastornos nutricionales, rechazo laboral por la delgadez, rechazo social cercano por la imagen corporal, influencia familiar sobre la imagen corporal, influencia de la imagen corporal de modelos de pasarela e influencia de los anuncios televisivos de productos para adelgazar. Los dos últimos con los mayores valores de la razón de prevalencias. Conclusiones: Aproximadamente uno de cada diez estudiantes presentaprobable diagnóstico de trastornos de conducta alimentaria que se asocian con factores familiares, sociales,laborales y otros relacionados con los medios de comunicación(AU)

Introduction: Eating disorders affect mostly young persons, and may have important consequences on their mental and physical health. Objectives: To determine the probable diagnosis of eating disorders in medical students and to evaluate their associated factors. Methods: Descriptive and cross-sectional study performed in first-year medical students of a private university in Lima, Peru. An electronic survey was administrated to collect data of interest. Those students with a score ≥20 in the Eating Attitudes Test-26 were considered to have probable diagnosis of eating disorders. For assessment of associated factors, we calculated prevalence ratios and 95 percent confidence intervals using Poisson crude regressions with robust variance. Results: Of 440 first-year medical students, 375 (85.2 percent) completed our survey. The prevalence of probable diagnosis of eating disorders in the study population was 10.1 percent (11.3for females and 8.6for males). Associated factors to this variable were: school rejection due to nutritional disorders, job rejection due to thinness, social rejection of body image, family influence on body image, influence of fashion show models' body image and influence of TV advertisement of slimming products. The two latter reached the highest prevalence ratio values. Conclusions: Around one in ten students has a probable diagnosis of eating disorders associated with family, social, work and mass media-related factors(AU)

Association of weight control behaviors with body mass index and weight-based self-evaluation

Objective: To determine the frequency of weight control behaviors (WCBs) and their correlation with body mass index (BMI) and weight-based self-evaluation. Methods: Data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from 27,501 volunteers (30.4% men, mean age 28.9±8.7 years). Results: The most prevalent WCBs for men and women were exhaustive physical exercise and prolonged fasting, respectively. Frequent exhaustive physical exercise was the only behavior more often adopted by men. BMI was positively associated with WCBs, which were very frequent in obese subjects. About 15% of normal-weight women reported using diuretics and laxatives, and 12.2% reported vomiting as a WCB at least occasionally. Among subjects who regarded body weight highly in their self-evaluation, there was a strong positive association with all WCBs, at similar degrees, in both genders. Compared to those who never base their intrinsic personal value on body weight, those who frequently base intrinsic value on body weight were at 25-30 times higher risk of inducing vomiting. Conclusion: The prevalence of participants adopting WCBs was high, especially in women and obese subjects. Weight-based self-evaluation was more strongly associated with WCBs than BMI.

Variables associated with disordered eating behaviors among freshman students from Mexico City / Variables asociadas con conductas alimentarias de riesgo en estudiantes de la Ciudad de México

Abstract: Objective: To estimate the prevalence of disordered eating behaviors (DEB) and identify their associations with demographic and psychological variables among freshman students at a public university in Mexico City. Materials and methods: A sample of 892 subjects participated in the study. Bivariate and multinomial models were performed to determine associations between DEB and covariates. Results: Of those surveyed, 6.8% of the women and 4.1% of the men exhibited DEB (p<0.05). The variables increasing the risk of eating disorders (ED) for women were internalization of the aesthetic thin ideal (IATI), body mass index (BMI), self-esteem and physical activity, while for men they were IATI, drive for muscularity, and self-esteem. Conclusions: The frequency of DEB among women and men and the internalization of the thin ideal in both sexes suggest the possibility of a change in the precursor conditions for eating disorders, particularly for men, who exhibit increased risk of such behaviors.

Resumen: Objetivo: Estimar la prevalencia de conductas alimentarias de riesgo (CAR) e identificar asociaciones con variables sociodemográficas y psicológicas en estudiantes de nuevo ingreso de una universidad pública de la Ciudad de México. Material y métodos: Se aplicó una encuesta a 892 estudiantes de ambos sexos. Para analizar asociaciones entre CAR y sus covariables se emplearon modelos bivariados y multivariados. Resultados: Se estimó que 6.8% de las mujeres y 4.1% de los hombres presentaron CAR (p>0.05). Entre las mujeres las variables que aumentaron el riesgo de CAR fueron interiorización del ideal estético de la delgadez (IIED), índice de masa corporal (IMC), autoestima y actividad física. Entre los hombres, las variables que sobresalieron fueron IIED, deseo por un cuerpo musculoso y autoestima. Conclusiones: La frecuencia de CAR entre mujeres y hombres, así como la IIED en ambos sexos sugiere un cambio en las condiciones de riesgo, especialmente entre los varones.

Prevalência de sintomas para transtornos alimentares em escolares de 11 a 15 anos da rede municipal de ensino da cidade de Nova Petrópolis, RS / Prevalence of symptoms for eating disorders in schoolchildren aged 11 to 15 years of the municipal school system of the city of Nova Petrópolis

Objetivo: Verificar a prevalência de sintomas para Transtornos Alimentares (TA) em escolares de 11 a 15 anos da rede municipal de ensino da cidade de Nova Petrópolis, RS. Métodos: Foi realizado um estudo transversal com 323 escolares (população na faixa etária). Para avaliação dos sintomas para TA, utilizou-se o teste de atitudes alimentares (EAT 26). Resultados: A prevalência de sintomas para TA foi de 21,7%. A insatisfação com a imagem corporal foi de 79,3%. Os escolares insatisfeitos apresentaram quase o triplo de chances de estarem com os sintomas em relação aos satisfeitos. Conclusões: As prevalências de sintomas para TA e a insatisfação com a imagem corporal da população estudada encontram-se elevadas e devem ser motivo de preocupação dos profissionais de saúde (AU)

Aim: To determine the prevalence of symptoms for Eating Disorders (ED) in schoolchildren aged 11 to 15 years of the municipal school system of the city of Nova Petrópolis, RS. Methods: A cross-sectional study was conducted with 323 schoolchildren (population in the age group). To evaluate for ED symptoms, the Eating Attitudes Test (EAT 26) was used. Results: The prevalence of symptoms for ED was 21.7%. Dissatisfaction with body image was 79.3%. The dissatisfied schoolchildren were nearly three times more likely to have symptoms than satisfied ones. Conclusions: The prevalence of symptoms for BP and the dissatisfaction with body image in the studied population are high and should be a matter of concern to health professionals (AU)

Comportamento de risco para bulimia nervosa, hábitos alimentares e de higiene bucal como fatores associados ao desgaste dentário erosivo e cárie dentária em adolescentes / Bulimia nervosa risk behavior, dietary habits and oral hygiene practices as associated factors for erosive tooth wear and dental caries among adolescents

Os distúrbios alimentares possuem uma etiologia multifatorial, composta de predisposições socioculturais, genéticas e vulnerabilidades biológicas e psicológicas. Entre os fatores predisponentes, destacam-se os padrões de interação presentes no ambiente familiar e o contexto sociocultural, caracterizado pela extrema valorização do corpo. A presença de algumas condições bucais, como o desgaste dentário erosivo e a cárie dentária, pode estar relacionada à ocorrência de distúrbios alimentares, como a bulimia nervosa (BN). Pesquisas sobre fatores de risco favorecem a análise oportuna de possíveis sinais e sintomas e, consequentemente, o estabelecimento de condutas preventivas. Este trabalho objetivou comparar a ocorrência do desgaste dentário erosivo e da cárie dentária em adolescentes com e sem comportamento de risco para BN, e investigar a influência de hábitos alimentares e de higiene bucal na ocorrência de desgaste dentário erosivo e da cárie dentária. Aprovação ética e termos de consentimento foram obtidos. A amostra foi composta por 225 escolares do sexo feminino, na faixa etária de 15 a 18 anos, oriundas de escolas das redes pública e particular de ensino de Belo Horizonte, no sudeste do Brasil. O comportamento de risco para BN foi avaliado segundo as subescalas de sintomas e gravidade dos sintomas da versão brasileira do Teste de Investigação Bulímica de Edinburgh (BITE) sendo categorizado em: hábito alimentar normal, comportamento de risco clinicamente significante e grave comportamento de risco. Os hábitos alimentares e de higiene bucal foram avaliados através de questionários autoaplicáveis. O desgaste dentário erosivo e a cárie dentária foram avaliados através dos índices de O'Sullivan e ICDAS II, respectivamente, por uma examinadora previamente calibrada (Kappa intra-examinador: 0,90 e 0,81; Kappa inter-examinadores: 0,88 e 0,83, referentes à erosão e à cárie dentária). Os dados foram analisados de forma descritiva e inferencial, através do software SPSS 18.0 (p<0,05). Através do modelo de regressão logística constatou-se que o grave comportamento de risco para a BN foi associado com o desgaste dentário erosivo (OR = 8,31; IC 95% = 3,91-16,91), e com adolescentes provenientes de escolas privadas (OR = 3,11 IC 95% = 1,44-6,45), mas não com a cárie dentária (OR = 1,13, IC 95% = 0,72-1,73). O comportamento de risco clinicamente significante para bulimia não foi associado às condições bucais avaliadas (p>0,05). Com relação aos hábitos alimentares, o desgaste dentário erosivo foi associado ao consumo diário de frutas cítricas (p<0,009) e refrigerantes com açúcar (p<0,046), enquanto a cárie dentária foi associada ao consumo diário de biscoitos recheados (p<0,049). O hábito de escovar os dentes imediatamente após as refeições foi estatisticamente associado à ocorrência de desgaste dentário erosivo no grupo com grave comportamento de risco para BN (p=0,047). O comportamento de risco para BN, caracterizado como clinicamente significante, não foi associado com implicações dentárias, mas o grave comportamento de risco para BN foi associado com a ocorrência de desgaste dentário erosivo. Hábitos alimentares e de higiene bucal foram associados à presença de desgaste dentário erosivo e cárie dentária

Eating disorders have a multifactorial etiology, composed of sociocultural and genetic predispositions as well as biological and psychological vulnerabilities. Among the predisposing factors, it is important to highlight the interaction patterns present in the family environment and the sociocultural context characterized by the overvaluation of the body and beauty standards. The presence of some dental implications such as erosive tooth wear and dental caries may be related to the occurrence of eating disorders such as bulimia nervosa (BN). Research on eating disorders' risk factors favors the timely analysis of possible signs and symptoms and, consequently, the establishment of preventive measures. This study aimed to compare the occurrence of erosive tooth wear and dental caries in adolescents with and without risk factor for BN, and investigate the influence of dietary habits and oral hygiene practices with the occurrence of erosive tooth wear and dental caries. Ethical approval and written consent forms were obtained. The sample consisted of female students, aged 15-18 years, from private and public schools in Belo Horizonte, southeastern Brazil. Risk behavior for BN was evaluated according to the subscales of symptoms and severity of the Brazilian version of the Bulimic Investigatory Test of Edinburgh (BITE) and classified in normal eaten behavior, clinically significant bulimic risk behavior and severe bulimic risk behavior. Eating habits and oral hygiene practices were assessed using validated self-report questionnaires. Erosive tooth wear and dental caries were evaluated by the O'Sullivan index and the ICDAS-II index, respectively, by a previously calibrated examiner (intraexaminer Kappa: 0.90 and 0.81, Kappa inter-examiner: 0.88 and 0.83, related to tooth erosion and dental caries). The data were analyzed descriptively and inferentially, using SPSS 18.0 software (p <0.05). Through the logistic regression model it was found that the severe risk behavior for BN was associated with erosive tooth wear (OR = 8.31; 95% CI = 3.91-16.91), and adolescents from private schools (OR = 3.11 95% CI = 1.44- 6.45), but not with dental caries (OR = 1.13, 95% CI = 0.72-1.73). The clinically significant risk behavior for BN was not associated with the assessed oral conditions (p> 0.05). With regard to eating habits, erosive tooth wear was associated with daily consumption of citric fruits (p<0.009), and soft drinks with sugar (p<0.046), while dental caries was associated with the daily consumption of cream biscuits (p<0.049). The habit of brushing the teeth shortly after eating was statistically associated with the occurrence of erosive tooth wear in the group with severe risk behavior for BN (p = 0.047). The risk behavior for BN, classified as clinically significant, was not associated with dental implications, but the severe risk behavior for BN was associated with the occurrence of erosive tooth wear. Dietary and oral hygiene habits were associated with the presence of erosive tooth wear and dental caries.

Riesgo para trastornos de la conducta alimentaria en estudiantes secundarios y su relación con la composición por sexo del colegio / Risk for eating disorders in secondary students and their relation with the composition by sex of the school

Introduction: eating disorders(ED)are chronic mental illnesses, highly prevalent within adolescent population, affecting women more than men. Generally, ED are triggered by an unsatisfactory self body-image, which relates to several socio-cultural factors. Objective: To study the prevalence of the risk of developing ED within Chilean high school students, and to evaluate its relation with sex and the school gender composition (SGC): single-sex or coeducational. Method: A transversal-analytic study was performed using three Santiago public high schools: female-exclusive, male-exclusive and coeducational. The Eating Attitudes Test-40 was applied, considering a 30-point score to define qualitatively the risk condition. Results: The sample included 415 students, 52 percent women, with a mean age of 15,9 years (range 14 to 18). The global prevalence of risk for ED was 14,9 percent. The risk condition was significantly higher in women (25,2 percent) than men (4 percent). No differences were found when comparing the prevalence of risk according to the type of school. Discussion: The higher risk for ED among women respect to men was confirmed, and the SGC has no influence on this risk.