Attitudes toward weight gain during pregnancy: results from the Norwegian mother and child cohort study (MoBa).

OBJECTIVE: To explore attitudes toward weight gain during pregnancy in women with and without eating disorders and across eating disorder subtypes, and to examine associations among weight-gain attitudes and actual gestational weight gain, infant birth weight, and infant size-for-gestational-age. METHOD: Pregnant women (35,929) enrolled in the prospective population-based Norwegian mother and child cohort study (MoBa) provided information at approximately week 18 of gestation regarding eating disorders and weight gain attitudes. We explored these variables in women with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, purging type, and binge eating disorder (BED). RESULTS: The presence of an eating disorderly was associated with greater worry over gestational weight gain. In women without eating disorders, greater worry was associated with higher gestational weight gain, higher infant weights, greater likelihood of a large-for-gestational-age infant, and reduced likelihood of a small-for-gestational-age infant. Women with BED who reported greater worry also experienced higher weight gains during pregnancy. DISCUSSION: Women with eating disorders tend to experience weight-gain-related worry during pregnancy. Early worry about gestational weight-gain may be a harbinger of high gestational gain.

Maternal eating disorders influence sex ratio at birth.

We explored sex ratio at birth, defined as the proportion of male live births, in women with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified-purging type (EDNOS-P) relative to a referent group in a large population-based sample of 38,340 pregnant women in Norway. Poisson regressions were adjusted for mother's age, pre-pregnancy BMI, lifetime smoking status, maternal education, income, marital status, gestational age, and parity. Lower proportions of male live births were observed in the anorexia and bulimia groups, while binge eating disorder and EDNOS-P were associated with a higher proportion of male births. These data suggest that maternal eating disorders may influence offspring sex and that the direction of effect may vary by eating disorder subtype. If confirmed, this finding could provide evidence in formulating hypotheses regarding the consequences of eating disorders and determinants of sex ratio at birth.

The impact of obesity on outcome after major colorectal surgery.

PURPOSE: There is an epidemic of obesity in the Western world and its associated substantial morbidity and mortality. This review examines the data on the impact of obesity on perioperative morbidity and mortality specifically in the context of colorectal surgery. METHODS: MEDLINE, PUBMED, and the Cochrane library were searched for relevant articles. A manual search for other pertinent papers also was performed. RESULTS: There is good evidence that obesity is a risk factor for wound infection after colorectal surgery. Obesity may increase the risk of wound dehiscence, incisional site herniation, and stoma complications. Obesity is linked to anastomotic leak, and obese patient undergoing rectal resections may be at particular risk. There is little data on the impact of obesity on pulmonary and cardiovascular complications after colorectal surgery. Operation times are longer for rectal procedures in obese patients, but hospital stay is not prolonged. Obese patients undergoing laparoscopic colorectal surgery are at increased risk of conversion to an open procedure. CONCLUSIONS: Obesity has a negative impact on outcome after colorectal surgery. To further clarify the impact of obesity on surgical outcome, it is recommended that future studies examine grades of obesity and include measures of abdominal obesity.

The psychobiology and diagnostic significance of amenorrhea in patients with anorexia nervosa.

Amenorrhea is a diagnostic criterion for anorexia nervosa (AN), although menstrual cycles have been found to persist in some women with all the other features of AN. This study sought to determine factors that are associated with amenorrhea in 39 women with current primary spectrum AN. The use of exercise to control weight (odds ratio (OR) = 3.5; 95% confidence interval (CI) = 1.3-9.9; P = .02), low novelty seeking scores (OR = 0.7; 95% CI = 0.58-0.94; P = .02), and low systolic blood pressure (OR = 0.9; 95% CI = 0.84-0.99; P = .046) were predictors of amenorrhea independent of body mass index.

Childhood gastrointestinal complaints in women with bulimia nervosa.

OBJECTIVE: The current study describes childhood gastrointestinal (GI) complaints in adult women presenting for a treatment trial for bulimia nervosa (BN) and examines the correlates of BN symptomatology. METHOD: The sample comprised 135 women with BN who underwent an assessment including questions regarding childhood GI complaints. Individuals were grouped into one of three categories: no GI complaints, GI complaints with/without constipation (GI complaints), and constipation only. Eating disorder psychopathology was compared across these groups. RESULTS: One third of participants reported GI complaints or constipation only in childhood. Women with GI complaints were younger, and had an earlier onset of BN and self-induced vomiting compared with women with no GI complaints. Trends existed for a younger age of first binge, and a higher frequency of binge eating in this group. DISCUSSION: These findings suggest that individuals with childhood GI complaints and other risk factors for BN may be at greater risk of developing a more severe eating disorder at an earlier age.

Patterns of weight change after treatment for bulimia nervosa.

OBJECTIVE: The current study examined changes in weight and body mass index (BMI) at 5-year follow-up among women treated for bulimia nervosa. METHOD: The study comprised 80 women who had participated in a randomized clinical trial evaluating cognitive-behavior therapy for bulimia nervosa. The women had attended assessments at posttreatment and at 5-year follow-up while not pregnant. RESULTS: Changes in mean weight and BMI between posttreatment and 5-year follow-up were small in absolute terms and were not statistically significant. However, by the 5-year follow-up, approximately one half of the participants had either lost (31%) or gained (18%) 5 or more kilograms or were underweight (31%) or overweight (24%) as defined by BMI. Univariate analyses suggest that it is the patients who gain weight over the follow-up that are distinctive. Patients who gained weight over the follow-up were more likely to have commenced menstruation at a younger age, to have a lifetime history of being heavier, and to have been heavier and more dissatisfied with their body at pretreatment, posttreatment, and at 5-year follow-up. CONCLUSION: Five years after treatment for bulimia nervosa, approximately one half of the participants had changed substantially in weight. For those who had changed, weight loss was more common than weight gain.

Use of nutritional supplements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa.

OBJECTIVE: Selective serotonin reuptake inhibitor (SSRI) medication does not appear to be effective in ill, malnourished anorexia nervosa (AN) patients. However, it may be effective in preventing relapse after weight restoration. The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects. METHOD: Twenty-six subjects with AN participated in a trial of fluoxetine. In a double-blind, placebo-controlled manner, subjects received either nutritional supplements or a nutritional placebo. The nutritional supplement included tryptophan (the precursor of serotonin), vitamins, minerals, and essential fatty acids believed to influence serotonin pathway function. RESULTS: There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo. Moreover, there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms. DISCUSSION: The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects.

Anxiolytic effects of acute tryptophan depletion in anorexia nervosa.

OBJECTIVE: Recent studies have raised the question as to whether a dysregulation of the neurotransmitter serotonin may contribute to the alterations in mood seen in anorexia nervosa (AN). People with AN tend to be anxious, obsessional, perfectionistic, and harm avoidant. These traits are premorbid and persist after recovery. It has been suggested that increased activity of brain serotonin systems could contribute to this pathologic condition. Dieting in AN, which serves to reduce plasma levels of tryptophan (TRP), may serve to reduce symptoms of dysphoric mood. METHOD: Fourteen women currently symptomatic with AN (ILL AN), 14 women recovered from AN (REC AN), and 15 healthy control women (CW) underwent acute tryptophan depletion (ATD). Measures of psychological state were self-assessed at baseline and hourly after ATD to determine whether ATD would reduce negative mood. RESULTS: ILL AN and REC AN had significantly higher mean baseline TRP/LNAA (tryptophan/large neutral amino acids) ratios compared with CW. In contrast to placebo, the ATD challenge demonstrated a significantly greater reduction in the TRP/LNAA ratio for ILL AN (-95%) and REC AN (-84%) compared with CW (-70 %). Both the ILL AN and REC AN had a significant reduction in anxiety on the ATD day compared with the placebo day. DISCUSSION: These data demonstrate that a dietary-induced reduction of TRP, the precursor of serotonin, is associated with decreased anxiety in people with AN. Restricting dietary intake may represent a mechanism through which individuals with AN modulate a dysphoric mood.

Thyroid indices and response to fluoxetine and nortriptyline in major depression.

We investigated: (i) the status of thyroid hormones and their clinical correlates in patients with major depression; (ii) changes in thyroid hormone status after treatment with fluoxetine versus nortriptyline; and (iii) whether blunted thyrotropin-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) challenge predicts improvement after 6 weeks of fluoxetine versus nortriptyline treatment. Patients with major depression entering a treatment trial were assessed with the Structured Clinical Interview for DSM-III-R and were rated on the Montgomery-Asberg Depression Rating Scale (MADRS). Blood samples were taken for TSH, thyroxine (T4) and free thyroxine (FT4) measurement, and the maximum TSH response (deltamaxTSH) to a TRH challenge test was undertaken. Patients were then randomly assigned to receive fluoxetine or nortriptyline for six weeks. At 6 weeks, patients repeated the thyroid hormone assessment and completed the MADRS. Mean concentrations of TSH, T4, FT4 and deltamaxTSH were within reference ranges. T4 and FT4 levels decreased significantly after treatment in responders, but not in nonresponders. After treatment, deltamaxTSH concentrations decreased significantly in patients who responded to fluoxetine, and increased in patients who responded to nortriptyline. Patients with deltamaxTSH blunting at pretreatment were more likely to be male, to have higher MADRS scores and have a history of alcohol and drug dependence. Patients with a pretreatment deltamaxTSH of < 3.0 microm/ml showed greater improvement on the MADRS when treated with fluoxetine than if treated with nortriptyline. We observed a decrease in T4 and FT4 in responders to treatment with fluoxetine or nortriptyline. Positive relationships between deltamaxTSH blunting and alcohol and drug abuse and severity of depression were found. Patients with blunted deltamaxTSH responded better to fluoxetine than to nortriptyline. It is suggested that a blunted DmaxTSH may reflect a predominantly serotonergic disturbance in this group of patients with major depression.

The effect of bulimia nervosa on plasma glucose and lipids.

This analysis examined changes in plasma lipids and glucose after 3 years in women treated for bulimia nervosa (BN). One hundred and thirty-five women aged 17-45 years with DSM-III-R BN entered a 12-week cognitive behavioral therapy treatment programme. Prior to and 3 years after treatment, patients completed psychiatric and behavioral assessments and fasting blood samples were drawn. At 3-year follow-up, 105 women were available, 67.6% of whom had no eating disorder and 32.4% of whom had any eating disorder (16.2% with eating disorder not otherwise specified and 16.2% with BN). Women with no eating disorder diagnosis at 3-year follow-up experienced a significant mean decrease in plasma glucose from pretreatment to 3-year follow-up compared to those with any eating disorder diagnosis. Eating disorder diagnosis at 3-year follow-up was independently associated with change in plasma glucose when potential confounders were adjusted for. Plasma triglyceride concentrations did not change in the group as a whole. Plasma HDL-cholesterol increased and total cholesterol decreased significantly from pretreatment to 3-year follow-up in the group as a whole. The decrease in serum cholesterol was significant in women with no eating disorder, but not in the women with any eating disorder diagnosis at 3-year follow-up. We conclude that a protracted course of BN may result in clinically insignificant increases in glucose concentrations and may attenuate the decrease in total cholesterol that is observed in women who recover from BN.