Current Family Functioning and Youth Cardiometabolic Health in the SOL Youth Study.

BACKGROUND: Family functioning may impact children's cardiometabolic health; however, few studies have examined multiple cardiometabolic markers among a diverse racial/ethnic cohort. The relationship between child- and caregiver-reported family functioning and the cardiometabolic health of Hispanic/Latino youth was examined. METHOD: Data were from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) (2012-2014), a population-based cohort study of children and adolescents whose parents participated in the HCHS/SOL (2008-2011). The relationship between youth- and caregiver-rated family functioning, and concordance of ratings is modeled, utilizing the general functioning subscale of the McMaster Family Assessment Device with youth objective cardiometabolic health markers (obesity, central adiposity, prediabetes/diabetes, prehypertension/hypertension, triglycerides, HDL cholesterol) adjusting for sociodemographic factors. RESULTS: Among boys, child/caregiver concordant ineffective family functioning rating was associated with higher cumulative cardiometabolic risk (adjusted B (95% CI): 0.30 (0.04, 0.56)), but no association was observed among girls (adjusted B (95% CI): 0.04 (-0.13, 0.21)). Among girls, ineffective child rating/effective caregiver rating was associated with higher cumulative cardiometabolic risk (adjusted B (95% CI): 0.27 (0.06, 0.48)), but no association was observed among boys (adjusted B (95% CI): 0.02 (-0.23, 0.27). CONCLUSION: Findings suggest that family functioning among this Hispanic/Latino population may influence cardiometabolic risk among youth. Observed differences in the associations by youth sex and concordant/discordant reports of family functioning suggest interventions at the family level, targeting both caregivers and youth, that consider differential sex effects are warranted.

The impact of open versus closed weighing on rate of weight gain and length of stay among inpatients with anorexia nervosa.

Anorexia nervosa (AN) is a serious illness associated with significant morbidity and mortality. Few data exist to guide practice regarding sharing daily weight information (open weighing) or withholding it (closed weighing) from patients. We investigated the effect of open versus closed weighing on weight-related outcomes among inpatients with AN. Data were collected during a 4-month period when 43 patients were not told their daily weight, and a consecutive 4-month period when 41 patients were told their weights during rounds. There was no significant difference in mean overall weight change (3.6 ± 2.7 kg vs. 3.5 ± 2.5 kg), hospital duration (14.3 ± 10.0 vs. 14.2 ± 7.6 days), or rate of weight gain (0.26 ± 0.11 vs. 0.25 ± 0.13 kg) between groups. It is possible that one weighing procedure may not be preferable with respect to certain clinical outcomes for inpatients with AN, suggesting there may be multiple ways to navigate the discussion of weight progress in weight restoration programs.

The impact of medically tailored meals and nutrition therapy on biometric and dietary outcomes among food-insecure patients with congestive heart failure: a matched cohort study.

BACKGROUND: To evaluate the impact of home-delivered, medically tailored meals and medical nutrition therapy among food-insecure patients following hospitalization for congestive heart failure by comparing clinical outcomes to a retrospectively matched cohort. METHODS: Patients at high risk for readmission and food insecurity received up to three months of medically tailored meals and medical nutrition therapy after discharge. Pre-intervention and post-intervention weight, body mass index, blood pressure, and dietary intake were assessed. A combination of difference-in-difference and logistic regression models were used to compare changes between cohorts and evaluate impact attributable to the program. RESULTS: Thirty-nine program participants were compared to a matched cohort of 117 unexposed patients. Participants experienced a marginal reduction in body mass index and an increase in systolic and diastolic blood pressure; however, these results were not statistically significant. To determine relevance to clinical cut-offs, logistic regressions were used, demonstrating that exposure to the intervention resulted in higher odds of a categorical reduction in blood pressure (OR: 1.85), though this did not reach statistical significance (95% CI: 0.67-5.32). Pre vs. post trends indicated that more-healthful foods and drinks increased numerically or remained similar to baseline, while less-healthful foods decreased numerically or remained similar to baseline. CONCLUSIONS AND IMPLICATIONS: These findings highlight the need for more longitudinal research on medically tailored meals and medical nutrition therapy interventions using clinical outcomes while setting realistic suggestions for program implementation. This study additionally illustrates the promise of integrating electronic medical record data and matched cohorts into medical nutrition program evaluation within the health sector.

Use of Stimulants in Patients with Comorbid Anorexia Nervosa and Attention-Deficit/Hyperactivity Disorder in a Structured Inpatient Setting.

OBJECTIVE: Clinicians may be concerned about using psychostimulant medications in patients in whom weight gain is desired because of their potential side effects of appetite suppression and weight loss. This report depicts the successful treatment of 2 adolescent patients with anorexia nervosa (AN) and attention-deficit/hyperactivity disorder (ADHD) in an inpatient eating disorders unit. METHOD: A report of 2 clinical cases (ages 19 and 20 years) was used to describe the management of comorbid AN and ADHD. Tolerance to stimulants, meal completion, and ability to restore weight were assessed over the course of hospitalization. RESULTS: Behaviorally focused refeeding combined with psychostimulants notably improved symptoms of AN and comorbid ADHD without adverse effects. CONCLUSION: Psychostimulant medications may be used successfully in patients with AN and ADHD in the context of structured behavioral treatment designed for weight restoration.

Inviting eating disorder patients to discuss the academic literature: a model program for psychoeducation.

BACKGROUND: Psychoeducation initiatives in which patients read primary scientific literature have not yet been studied as a treatment intervention for eating disorders. In this paper, we discuss and evaluate the acceptability of a novel psychoeducational journal club for individuals with anorexia and bulimia nervosa in inpatient and partial hospitalization program settings. Primary literature about eating disorders is presented and discussed with patients. By presenting scientifically-supported information, our "Psychoeducational Research Group" is designed to help patients restructure disordered thoughts and encourage adherence to evidence-based treatment. METHODS: Using a Likert scale questionnaire (0 = not at all; 5 = very much), participants provided ratings for how much they liked the group and felt that it helped them across several domains. RESULTS: Average scores from 33 participants (26 inpatient, 7 partial hospital patients) indicated they would recommend this group to others receiving eating disorder treatment (4.8 ± 0.6). Scores also suggested patients' likeability (4.6 ± 0.8), benefit regarding challenging eating disorder thoughts (4.1 ± 1.1), improved motivation for eating behavior change (4.0 ± 1.0) and completion of prescribed nutritional plan (3.6 ± 1.0), and usefulness in working towards treatment goals (4.2 ± 0.9) associated with group participation. CONCLUSIONS: Preliminary findings support the acceptability of this psychoeducational group and that it may serve as a useful adjunct to larger evidence-based programming across eating disorder treatment settings.

Measurement of fidgeting in patients with anorexia nervosa using a novel shoe-based monitor.

OBJECTIVE: To objectively assess seated non-exercise physical activity in patients with anorexia nervosa (AN) relative to healthy controls (HCs) and examine the associations between this physical activity, eating disorder pathology, and levels of anxiety and depression. METHOD: Eleven inpatients with AN and 10 HCs wore a shoe-based accelerometer (SmartShoe) at three time points: a) while eating lunch, b) filling out questionnaires, and c) watching television for 1h. RESULTS: Across all three tasks, patients with AN were significantly more active than HCs, thereby engaging in a greater degree of restless or fidgeting behavior. Degree of physical activity was positively correlated with eating disorder psychopathology in the sample with AN, and a trend towards a positive association between physical activity and levels of depression and anxiety was also found in this sample. Among individuals with AN, physical activity was not significantly correlated with BMI, duration of illness, or number of days since hospital admission. DISCUSSION: Use of a minimally invasive, shoe-based monitor revealed patients with AN engaged in a greater degree of fidgeting relative to HCs during quiet, seated tasks and this heightened activity was related to measures of pathology. Non-exercise physical activity, including fidgeting, may warrant further clinical attention in this patient population.