DCA: psicopatologia e fisiologia della (mal)nutrizione

Informazioni scientifiche sui Disturbi del Comportamento Alimentare (DCA) e conseguenze

Eating disorders during COVID-19 pandemic: the experience of Italian healthcare providers

Purpose: Due to COVID-19 pandemic, the Italian population lived in quarantine from March to May 2020 (lockdown phase I). Restrictions impacted individuals’ psychological health, especially in those with eating disorders (ED). Healthcare providers (HCPs) treating ED provided assistance by telemedicine and/or in walk-in clinics. We hypothesize that social restrictions represented a great stressor for ED patients and HCPs, negatively impacted their therapeutic alliance, and affected the frequency of dysfunctional behaviors. Methods: This cross-sectional study consisted of an online survey investigating the experience of HCPs involved in ED treatment, with a specific focus on difficulties concerning the therapeutic efficacy. Questionnaire (n. 18 questions) was formulated ad hoc by our research team and sent by e-mail to Italian HCPs registered on online platforms. HCPs included ED experts specialized in psychology, nutrition or medicine. Data were collected during lockdown phase I and referred to patients with Anorexia Nervosa-(AN), Bulimia Nervosa (BN)—and Binge-Eating Disorder-(BED). Results: One-hundred questionnaires were collected; 84 and 76 were included in our qualitative and quantitative analyses, respectively. Thirty-six% of HCPs felt their therapeutic intervention was unsuccessful, 37% complained compromised therapeutic alliance. Changes in frequency of compensatory behaviors (increased in 41% AN and 49,5% BN; reduced in 14,6% AN and 21,8% BN) and binge-eating episodes (increased in 53,3% BN and 30,5% BED; reduced in 30,7% BN and 24,7% BED) were experienced and ascribed to augmented patient’s anxiety. Disorders switches and variation in dysfunctional conducts frequency were both significantly related to ED category (p < 0.05 for all). Concentration techniques were recognized as useful to offset such negative outcomes. Conclusion: According to HCPs, social restrictions affected the frequency of dysfunctional behaviors in ED patients and the efficacy of their therapeutic intervention. Further long-term studies are needed to confirm our data in a larger sample size. Level IV: Novel results from a cross-sectional study

Transdiagnostic vs. disorder-focused perspective in children and adolescents with eating disorders: Findings from a large multisite exploratory study

Background: The transdiagnostic model of eating disorders (ED) proposes common cognitive mechanisms in patients with ED psychopathology. Little is known about their role in the maintenance of ED in children and adolescents. This study aimed to determine whether the relationships between key factors (low self-esteem, weight and shape control, clinical perfectionism, interpersonal problems, distress and mood instability) and core maintaining mechanisms (binge-eating and restraint) would support a transdiagnostic theory in young patients. Methods: A total of 419 patients (mean age 14.7 ± 2.14 years; age range: 7–18 years; males 13.8%) diagnosed with an ED were assessed in six Italian clinical centers in 2013. Multiple comparisons between ED diagnosis, correlation analysis and principal component analysis (PCA) were performed. Results: Of the entire collective, 51.5% of patients were diagnosed with Anorexia Nervosa (AN), 12.3% were diagnosed with Bulimia Nervosa (BN) and 36.2% with Eating Disorder Not Otherwise Specified (EDNOS). In PCA, the core ED mechanisms, dietary restraint and binge eating, acted as poles of attraction of the other variables. The AN group was particularly linked to restraint and the BN group was particularly related to “Bulimia”. Considering the diagnostic subtypes, there were no significant differences between the anorexic binge-purging group, bulimic purging group and bulimic non-purging group, which constituted a unique cluster related to affective, interpersonal problems and to perfectionism, indicating a very homogeneous subgroup. Restricting anorexic group (AN-R), related to shape concern and anxious-depressed mood, was not linked to the other subtypes. EDNOS appeared to be opposed to the AN-R group; the binge eating disorder group appeared to be independent from others. Conclusion: Our results suggest the presence of both specific and transdiagnostic mechanisms in ED subtypes, whose knowledge is of relevance for clinical practice

Many Facets of Eating Disorders: Profiling Key Psychological Features of Anorexia Nervosa and Binge Eating Disorder

Objective. The present study employs a profile analysis to identify and compare psychological features and core eating disorder (ED) symptoms in clinical samples of patients with anorexia nervosa (AN) and binge eating disorder (BED) and the general population (GP). Methods. A sample comprising 421 participants (142 patients with AN; 139 patients with BED; and 140 participants from the GP) was surveyed with the Eating Disorder Inventory-3 (EDI-3). Individuals with AN and BED were recruited and tested during their first week of a multidisciplinary inpatient program for weight loss and rehabilitation at the ‘Rete DCA USL Umbria 1′ (Eating Disorders Services), Italy. Results. The findings suggest distinct patterns of symptom presentation between the three samples across all the EDI-3 dimensions—with both the AN and BED groups scoring significantly higher than the GP. Patients with AN registered greater scores in all the psychological trait scales and the drive for thinness ED-specific dimension of the EDI-3 compared with their BED counterpart—which, instead, scored higher in the bulimia and body dissatisfaction subscales. These data support the transdiagnostic nature of the main risk factors for the onset and maintenance of EDs—which would vary in severity levels—and the existence of disease-specific pathways giving rise to AN and BED. Conclusion. This study for the first time compares patients with AN and BED with a non-clinical sample on main ED psychological features. This might inform classification approaches and could have important implications for the development of prevention and early intervention programs

Efficacy of the holistic, psychonutritional approach of Centro DAI e Obesità di Città della Pieve in the management of type 2 diabetes among patients with obesity and dysfunctional eating

Purpose Dysfunctional eating is strongly associated with obesity and worsens type 2 diabetes (T2DM) outcomes. The aim of this study was to investigate the effectiveness of the psycho-nutritional treatment (PNT) of "Centro DAI e Obesita" of Citta della Pieve on weight loss and glucose management in dysfunctional eaters with obesity and T2DM. Methods PNT includes psychotherapeutical, nutritional, physical and social activities. Subjects with obesity, T2DM and dysfunctional eating habits who completed the 8 weeks residential program between 2010 and 2019 were compared with obese, T2DM, dysfunctional eaters who underwent to a conventional, hospital-based, nutritional treatment (CT). Anthropometric variables, glucolipid panel, and body composition were assessed at baseline and at the end of the program. Weight and HbA1c were also measured after one year from the completion. Results Sixty-nine patients completed the PNT and reduced weight (-7 +/- 3.2%; p < 0.001), BMI (-7 +/- 3.1%; p < 0.001), and triglycerides, AST, GGT and ALT (p <= 0.008); glycemic control improved (HbA1c: -1.1 +/- 1.5%, mean fasting glucose: -41 +/- 46 mg/dl, p < 0.001). Eleven% of subjects requiring diabetes medications at baseline discontinued the therapy. In the insulin treated group (49%), mean daily units were halved (-32.6 +/- 26.0, p < 0.001). At one year, weight loss (-6 +/- 7.4%, p < 0.001) and HbA1c reduction (-0.52 +/- 1.4%, p = 0.029) persisted. Fifty-five patients completed the CT: HbA1c reduced (p = 0.02), but weight (-0.6 +/- 3.7%), BMI (-0.7 +/- 3.8%), and insulin units' reduction (-2.5 +/- 11.7, p = 0.20) were lower compared to the PNT. Conclusion PNT is effective in improving T2DM management in patients with obesity and dysfunctional eating

Obesity and Eating Disorders. Indications for the different levels of care.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored

Servizio di Conservazione e Ampliamento delle Banche regionali della Biodiversità annualità 2009-2010

In questo anno si celebra a livello mondiale la Biodiversità quale elemento fondamentale per il mantenimento dei delicati equilibri ambientali e quindi della stessa vita sul nostro pianeta. La Regione Umbria, consapevole del valore di questa tematica ha voluto destinare per il 2010 parte dei fondi del Piano di Sviluppo Rurale 2007-2013 ad una attività di ricerca, conservazione e valorizzazione del ricco patrimonio di varietà e razze locali che contraddistingue il territorio regionale. Patrimonio che negli ultimi decenni, dato il diffondersi di un’agricoltura intensiva e l’avvio di vasti programmi di miglioramento genetico, si è andato progressivamente depauperando con il rischio che la sua scomparsa definitiva renda oltremodo critico il settore agricolo locale da sempre caratterizzato da quell’elemento di tipicità che solo può far risaltare la nostra agricoltura nel più vasto panorama del commercio nazionale e mondiale. Alla Società 3A Parco Tecnologico Agroalimentare dell’Umbria è stato affidato il compito di coordinare il “Servizio di Conservazione e Ampliamento delle Banche regionali della Biodiversità”, avvalendosi della preziosa esperienza dei Dipartimenti di Biologia Applicata e di Scienze Agrarie e Ambientali della Facoltà di Agraria dell’Università degli Studi di Perugia. Una partnership importante che mi piacerebbe definire i “Custodi della Biodiversità regionale”. Dobbiamo fornire delle risposte alle crescenti preoccupazioni in materia di sicurezza alimentare dal momento che una agricoltura di natura intensiva e sempre più industriale sta portando alla selezione e conseguente riduzione delle varietà vegetali coltivate. Il Servizio e la nostra Banca del Germoplasma in vitro, insieme a quelle dell’Università degli Studi di Perugia vogliono essere uno strumento decisivo per la salvaguardia di questo importantissimo patrimonio. Garantendo l’accesso a diversità genetiche possiamo aiutare gli agricoltori e l’agricoltura a mantenere rigorose e produttive le colture anche in condizioni climatiche mutevoli, come sta accadendo per il nostro pianeta. Per questo, le attività che di seguito vengono ampiamente descritte sono il risultato non di un progetto come tanti ma di un “Servizio” pensato per il territorio ed per coloro che contribuiscono al suo sviluppo. L’agrobiodiversità si tutela e valorizza solo coltivandola: il nostro compito è quello di sostenere gli agricoltori interessati favorendo l’accesso al materiale genetico conservato nelle collezioni ex situ