Anorexia nervosa and nutritional assessment: contribution of body composition measurements

The psychiatric condition of patients suffering from anorexia nervosa (AN) is affected by their nutritional status. An optimal assessment of the nutritional status of patients is fundamental in understanding the relationship between malnutrition and the psychological symptoms. The present review evaluates some of the available methods for measuring body composition in patients with AN. We searched literature in Medline using several key terms relevant to the present review in order to identify papers. Only articles in English or French were reviewed. A brief description is provided for each body composition technique, with its applicability in AN as well as its limitation. All methods of measuring body composition are not yet validated and/or feasible in patients with AN. The present review article proposes a practical approach for selecting the most appropriate methods depending on the setting, (i.e. clinical v. research) and the goal of the assessment (initial v. follow-up) in order to have a more personalised treatment for patients suffering from A

Predictive factors of length of inpatient treatment in anorexia nervosa

International audienc

Predictive factors of length of inpatient treatment in anorexia nervosa

Objective: To identify clinical variables influencing the length of stay (LOS) of inpatient treatment for anorexia nervosa (AN). Method: We analyzed structured clinical charts of 300 consecutive hospitalizations for AN in a specialized eating disorder unit. The sample included patients from 12 to 22 years old. Factors related to the patient and events occurring during the stay were investigated as possible predictors of LOS. Results: Mean LOS was 135 days. The best model of linear regression revealed that the following factors were significantly related to LOS: duration of AN at admission, use of tube feeding during the stay, accomplishment of the therapeutic weight contract and presence of a comorbid disorder. Conclusions: The identification of factors influencing duration of stay, both at the outset and during the hospitalization, could help clinicians to optimize and individualize treatments, as well as increase patient and family compliance

Training Symbol-Based Equalization for Quadrature Duobinary PDM-FTN Systems

A training symbol-based equalization algorithm is proposed for polarization de-multiplexing in quadrature duobinary (QDB) modulated polarization division multiplexedfaster-than-Nyquist (FTN) coherent optical systems. The proposed algorithm is based on the least mean square algorithm, and multiple location candidates of a symbol are considered in order to make use of the training symbols with QDB modulation.Results show that an excellent convergence performance is obtained using the proposed algorithm under different polarization alignment scenarios. The optical signal-to-noise ratio required to attain a bit error rate of 2*10-2 is reduced by 1.7 and 1.8 dB using the proposed algorithm, compared to systems using the constant modulus algorithm with differential coding for 4-ary quadrature amplitude modulation(4-QAM) and 16-QAM systems with symbol-by-symbol detection, respectively.Furthermore, comparisons with the Tomlinson-Harashima precoding-based FTN systems illustrate that QDB is preferable when 4-QAM is utilized

Anorexia nervosa and nutritional assessment: contribution of body composition measurements

article aims at reviewing present knowledge on these topics in order to determine energy requirements for maintaining a neutral energy balance in ALS patients. Maintaining a neutral energy balance prevents malnutrition and its complications and may improve physical functioning, quality of life and survival. Prevalence of malnutrition varies between 16 and 55% in ALS patients. Energy intakes are below recommended dietary allowances in 70% of ALS patients at least. These elements suggest a chronic negative energy balance with an imbalance between requirements and intakes. While insufficient intakes can be compensated with nutritional support, the energy requirements are unclear. Studies generally report hypermetabolism in ALS patients. Estimation of total energy expenditure and as a corollary energy needs, necessitates taking into account this hypermetabolism, physical activity and possibly mechanical ventilation. The review suggests a flow chart for optimal nutritional follow-up in clinics. Further studies are required to assess whether optimal nutritional follow-up improves outcome

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.This manuscript and research was supported by grants from the Ministeriode Economía y Competitividad (PSI2015-68701-R), Instituto de Salud Carlos III (ISCIII) (FIS PI14/00290/ INT19/00046nd PI17/01167) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe. CIBERobn, CIBERsam and CIBERDEM are all initiatives of ISCIII. GMB is supported by a postdoctoral grant from FUNCIVA. This initiative is supported by Generalitat de Catalunya. LM is supported by a postdoctoral grant of the mexican institution Consejo Nacional de Ciencia y Tecnología (CONACYT). PPM was supported, in part, by a Portuguese Foundation for Science and Technology grant (POCI-01-0145-FEDER-028145). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study

Background. The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. Aims. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. Methods. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Results. Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. Conclusions. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients

DOIT-ON TRAITER LA DEPRESSION DANS L'ANOREXIE MENTALE ? ETUDE PROSPECTIVE SUR LES CRITERES DE PRESCRIPTION D'UN TRAITEMENT ANTIDEPRESSEUR LORS DE L'HOSPITALISATION DE PATIENTES ANOREXIQUES A L'ADOLESCENCE

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Déterminants de l'évolution à court terme des soins hospitaliers et du devenir à long terme dans l'anorexie mentale sévère

L anorexie mentale est une pathologie affectant à la fois la santé mentale et la santé physique. Les formes les plus sévères alors qu elles nécessitent des soins hospitaliers longs, ont un taux d échappement aux soins très élevé (20% des adolescents et 60% des adultes) et sont celles présentant le plus mauvais pronostic. Or cet échappement aux soins (ou sortie prématurée) génère à la fois des rechutes et une chronicisation. Si le devenir à long terme de ces patients est documenté, les études centrées sur les formes les plus sévères sont peu nombreuses, et parmi elles, celles prenant en compte simultanément les aspects somatiques et psychiques de leur évolution sont quasi inexistantes. C est pourquoi, après une mise au point sur les données épidémiologiques, concernant l anorexie mentale, nous avons choisi de centrer notre travail de thèse sur d une part la recherche de facteurs expliquant l échappement aux soins, et pouvant devenir des cibles thérapeutiques, et d autre part le devenir physique et psychique de ces sujets dix ans après une hospitalisation.La première étude portant sur 180 patients issus de dix centres français prenant en charge des patients anorexiques sévères, s est appuyé sur une étude d épidémiologie clinique prospective multicentrique appelée EVALHOSPITAM. Notre objectif était d identifier des facteurs prédictifs de l échappement prématuré aux soins lors d une hospitalisation pour anorexie mentale. En effet, la prise en compte de tels facteurs dès l admission permettrait peut-être de diminuer l échappement prématuré aux soins en cours d hospitalisation, et par là contribuerait à améliorer le pronostic de ces sujets. La seconde étude expose les résultats d une étude de devenir de ces patients hospitalisés à l adolescence neuf années en moyenne après une hospitalisation. Notre travail se centre sur le devenir somatique à long terme de patients ayant souffert d anorexie mentale, son lien avec le devenir psychique et une comparaison avec un échantillon issu de la population générale de même âge et de même sexe.Anorexia nervosa is a disease that affects both mental and physical health. The most severe forms as they require long hospital care, with a drop-out rate very high (20% of adolescents and 60% of adults) are those with the worst prognosis. But this drop-out (or early exit) generates both relapse and a chronicisation. If the long-term outcome of these patients is documented, studies focusing on the most severe forms are few, and among them, those taking into account both the somatic and psychic aspects of their outcome are almost nonexistent. That s why, after focusing on epidemiological data on anorexia nervosa, we chose to focus our thesis on first the search for factors explaining the drop-out and may become therapeutic targets, and second the physical and psychological outcome of these subjects ten years after hospitalization.The first study of 180 patients from ten centers taking care of severe anorexic patients, relied on a prospective clinical multicenter epidemiological study called EVALHOSPITAM. Our objective was to identify predictors of drop-out during hospitalization for anorexia nervosa. Indeed, taking into account such factors upon admission might help reduce drop-out during hospitalization, and thus help to improve the prognosis of these subjects.The second study presents the results of an outcome study of patients hospitalized during adolescence on average nine years before. Our work focuses on the somatic outcome of long-term patients who suffered from anorexia nervosa, its link to psychiatric outcome and finally a comparison with a sample from the general population of the same age and sex.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Evaluation des liens entre les indicateurs de l'état nutritionnel et les symptômes anxio-dépressifs dans l'anorexie mentale

Bien que l intrication entre la dénutrition et la présence de symptômes anxieux ou dépressifs dans l anorexie mentale soit mentionnée largement dans la littérature, peu d auteurs ont réalisé des études sur la variation du niveau d anxiété et de dépression au cours de la renutrition des patients anorexiques. Ces études précédentes sont critiquables sur le plan méthodologiques et donnent plus des éléments préliminaires que des certitudes; en effet les effectifs sont petits mais surtout la mesure de l état nutritionnel est rudimentaire; En effet celui-ci est le plus souvent évalué seulement par l indice de masse corporel, sans aucune donnée biologique ni information sur la composition corporelle. Ce travail de thèse est désigné à confirmer le lien unissant la dépression, l anxiété et l état de dénutrition. Etude prospective multicentrique sur des sujets anorexiques mentaux issus de la population des anorexiques hospitalisées. Les patients ont été tous évalués à l entrée et à la sortie par des questionnaires d évaluation des symptômes psychologiques et par plusieurs indicateurs de l état nutritionnel. Resultats: avoir pu valider la mesure par impédancemétrie de la composition corporelle chez les anorexiques dénutries. Ceci a permis de mieux évaluer l état nutritionnel des anorexiques afin d étudier la relation avec les symptômes anxio-dépressifs. A l entrée d hospitalisation, aucun lien n a été mis en évidence, cependant, ces liens sont devenu évident à la sortie. La reprise de poids et chacune des composantes de composition corporelle ont été montré qu ils sont liés à l atténuation des symptômes de dépression chez les anorexiques hospitalisés. Il existe une relation entre l état nutritionnel et les symptômes anixo-dépressifs et la renutrition influence l amélioration de l état psychique chez les anorexiques. Ce travail de recherche n est que le début d une longue investigation sur ces liens. Des études futures seront utiles pour mettre en évidence la causalité entre état nutritionnel et symptômes anxio-dépressifs.PARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF