Bone health in eating disorders.

Eating disorders (EDs) put adolescents and young adults at risk for impaired bone health. Low bone mineral density (BMD) with ED is caused by failure to accrue peak bone mass in adolescence and bone loss in young adulthood. Although ED patients diagnosed with bone loss may be asymptomatic, some suffer bone pains and have increased incidence of fractures. Adolescents with ED are prone to increased prevalence of stress fractures, kyphoscoliosis and height loss. The clinical picture of the various EDs involves endocrinopathies that contribute to impaired bone health. Anorexia nervosa (AN) is characterized by low bone turnover, with relatively higher osteoclastic (bone resorptive) than osteoblastic (bone formation) activity. Bone loss in AN occurs in both the trabecular and cortical bones, although the former is more vulnerable. Bone loss in AN has been shown to be influenced by malnutrition and low weight, reduced fat mass, oestrogen and androgen deficiency, glucocorticoid excess, impaired growth hormone-insulin-like growth factor 1 axis, and more. Bone loss in AN may not be completely reversible despite recovery from the illness. Treatment modalities involving hormonal therapies have limited effectiveness, whereas increased caloric intake, weight gain and resumption of menses are essential to improved BMD.

Salivary and gustatory alterations among bulimia nervosa patients.

OBJECTIVE AND DESIGN: This study systematically examined salivary composition and taste perception and monitored related subjective complaints in a group of bulimia nervosa (BN) patients. SUBJECTS: Fifty-two consenting female individuals participated in the current cross-sectional study, 26 patients diagnosed with BN according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria (mean age: 24+/-7 years) and 26 healthy controls matching in age and body mass index (BMI). METHODS: All participants were given diagnostic BN-related questionnaires, had taste and salivary-composition analyses and were monitored for oral sensorial complaints. The patients were also subjected to psychological and psychiatric examinations focusing on established criteria known to be pathognomonic of the disease (including binge eating episodes, depression, impulsive traits, enhanced awareness of body image, typical compensatory behavior, and so on). RESULTS: The self-answered questionnaires of Bulimic Investigatory Test Edinburgh (BITE), Beck Depression Inventory (BDI), brief symptom inventory (BSI) and impulsivity scale (IS) revealed highly significant differences between the two groups with respect to the various BN diagnostic symptoms of the patients (P=0.0001). Subjective and objective examinations showed an overall disturbed salivary and taste profile in BN patients, who complained of xerostomia (dry mouth) and taste aberration or oral burning sensation. CONCLUSIONS: Regardless of the specific mechanism responsible for the disturbed salivary and taste profile in BN patients, these observed changes are associated with active illness. Accordingly, administration of therapeutic agents, including antioxidants, anti-inflammatory drugs and saliva substitutes, to the oral cavity (and maybe even systemically) of BN patients should be considered.

Eating attitudes in a diverse sample of Israeli adolescent females: a comparison study.

OBJECTIVES: To estimate the eating attitudes in Israeli Jewish female adolescents. METHODS: A representative sample of 1270 females in grades 7-12 from five different Israeli schools from five different residential areas were assessed by EAT-26. RESULTS: Of the total sample, 19.5% were identified as having abnormal eating attitudes. In terms of age, the 16 year olds were found to have the significantly highest rate of total and positive EAT-26 scores. As for school subgroups, the secular boarding schools had the significantly highest rate and the kibbutz had the lowest rate of positive EAT-26 scores for the total and for all subscales. DISCUSSION: EAT-26 was found to be a useful tool for screening and identifying at-risk groups in a large adolescent Israeli population.

Association study of cannabinoid receptor gene (CNR1) alleles and anorexia nervosa: differences between restricting and binging/purging subtypes.

Anorexia nervosa (AN) is a severe and disabling psychiatric disorder, characterized by profound weight loss and body image disturbance. Family and twin studies indicate a significant genetic contribution to this disorder although no genetic mutation has yet been identified. The endocannabinoid system has recently been implicated in many physiological functions including appetite regulation. We, therefore, undertook a family based study to test the hypothesis whether a polymorphism of the CNR1 gene, which encodes human CB1 receptor, a subclass of the central cannabinoid receptor, contributes to the susceptibility to AN. Fifty two families (parents with one or two affected siblings) were genotyped for the (AAT) trinucleotide repeat of CNR1 gene. Using the haplotype relative risk (HRR) method, the distribution of alleles transmitted to the patients was not found to be significantly different from the non-transmitted parental alleles. However, upon dividing the samples to restricting and binging/purging subtypes of AN, the extended transmission disequilibrium test (ETDT) revealed that there is preferential transmission of different alleles in each of the subtypes. The 14 repeat allele was preferentially transmitted in the binging/purging AN group (P = 0.05) but not in the restricting AN group, whereas the 13 repeat allele was preferentially transmitted in the restricting AN group (almost significant, P = 0.07) but not in the binging/purging AN group. Our study suggests that restricting AN and binging/purging AN may be associated with different alleles of the CNR1 gene.

Sleep-wake monitoring in women suffering from anorexia nervosa.

There is evidence that some Anorexia Nervosa (AN) patients have sleep abnormalities. No studies of their sleep-wake cycles in a natural environment have yet been reported. The purpose of this study was to evaluate an objective and subjective sleep-wake cycle of AN patients compared to a healthy age-equated control group (CON). Twenty-one AN female and sixteen CON female subjects were recruited. Sleep-wake patterns were monitored using ambulatory monitoring mini-actigraphs for one week. Each subject completed self-report questionnaires. The self-report questionnaires revealed significantly more sleep disturbances in AN than CON, whereas the ambulatory sleep data revealed no significant differences between the two groups in sleep-wake cycle.

Disturbed attitudes to weight control in female kibbutz adolescents: a preliminary study with a view to prevention.

Eating disorders have physical, emotional, social, and cultural aspects, which are manifested in the individual's preoccupation with food, physical build, and weight, and are maladjusted means of dealing with mental and emotional problems. The practice of unhealthy means of weight regulation and eating disorders affects the individual, family, community, and society at large, and affects primarily adolescent girls and young women in Western society. Thus, there exists today an urgent need to develop a comprehensive community prevention program. This preliminary study is an attempt to determine the scope of the problem among adolescent girls (n = 38) and their significant others (n = 42), in a kibbutz in northern Israel. Self-evaluation questionnaires were used to examine attitudes and characteristics related to eating and body image, in addition to a questionnaire for evaluation of knowledgeability and attitudes among the adolescents' significant others. It was found that 85% of adolescent girls were dissatisfied with their figure, 63% were considering a diet, and 60% were afraid of losing control over their weight. Fifty-five percent of significant others did not think that eating disorders were more prevalent in families with fallacious attitudes about physical build and eating, and 50% thought that pubescent girls should be encouraged to diet. In addition, a group at risk for developing eating disorders (n = 12) was found. Significant differences in all the indicators were found between the latter group and the other girls. The findings reinforce those of research studies from other Western countries, and establish the need for a community prevention program at three levels of prevention, targeting the community in general and focusing on adolescents' significant others as agents of change.

Sleep-wake cycles in women with binge eating disorder.

OBJECTIVE: Binge eating disorder (BED) is a new diagnostic category in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The majority of studies on sleep characteristics in overweight women have used nonbinging obese women. The aim of this study was to evaluate sleep characteristics in obese BED patients in comparison to non-BED obese (OB) and nonbinging normal weight (NW) women. METHOD: Eighteen females with BED, 13 OB, and 16 NW women were recruited. Sleep-wake patterns were monitored for 1 week using mini-actigraphs and self-report questionnaires. RESULTS: Their ambulatory sleep data revealed that BED and OB subjects had significantly lower sleep efficiency, had more wake during sleep, and had less zero activity than the NW group. The self-report questionnaires presented significantly more sleep disturbances in the BED and OB groups than in the NW group. DISCUSSION: The objective results support the subjective sleep disturbances reported by the two obese groups, the BED and the OB. A possible explanation for these findings could be weight-related physical discomfort or the existence of breathing disorders in sleep. Further research, for example, overnight polysomnography recordings and follow-up treatment, is required.

A case report: treatment of severe anorexia nervosa with home total parenteral hyperalimentation.

UNLABELLED: In its chronic and severe phase, anorexia nervosa (AN) carries a high morbidity and mortality rate. In the severe stage, parenteral alimentation is often required. To date, the optimal regime for parenteral refeeding has not been well documented. Most, if not all, such treatment is performed on an inpatient basis. METHOD: We report here a case of an AN patient treated at home with total parenteral hyperalimentation which is, to the best of our knowledge, the first to be carried out in Israel. RESULTS: The patient has regained 10 kg during treatment, and has maintained her weight a year after treatment. Her gastrointestinal symptoms improved, and she has reduced the amount of laxatives she ingests. DISCUSSION: In this paper we will discuss the various issues and criteria applicable to this treatment, as well as the importance of collaboration between a primary care and specialized clinic.

Naturalistic sleep monitoring in women suffering from bulimia nervosa.

OBJECTIVE: Eating disorders may be associated with alterations in sleep. There is evidence that some bulimia nervosa (BN) patients have sleep abnormalities. No studies of their sleep-wake cycles in a natural environment have as yet been reported. The purpose of this study was to evaluate an objective and subjective sleep-wake cycle of BN compared to a healthy age-equated control group (CON). METHOD: Twenty-nine BN female and eighteen CON subjects were recruited. Sleep-wake patterns were monitored using ambulatory monitoring, mini-actigraphs (Min-Act), for 1 week. Each subject completed self-report questionnaires. RESULTS: The self-reporting questionnaires revealed that BN complained of significantly more sleep disturbances than CON. The ambulatory sleep data revealed significant differences between BN and CON in sleep onset and offset time. DISCUSSION: BN had sleep onset and sleep offset of 1 hr later, which may be connected to binge-purge patterns during the day. It is suggested that future research should focus on BN after remission.

Empirical comparison of two psychological therapies. Self psychology and cognitive orientation in the treatment of anorexia and bulimia.

The authors investigated the applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. Thirty-three patients participated in this study. The bulimic patients (n = 25) were randomly assigned either to SPT, COT, or control/nutritional counseling only (C/NC). The anorexic patients (n = 8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected.