Clinical Characteristics of Inpatients with Childhood vs. Adolescent Anorexia Nervosa

We aimed to compare the clinical data at first presentation to inpatient treatment of children (<14 years) vs. adolescents (≥14 years) with anorexia nervosa (AN), focusing on duration of illness before hospital admission and body mass index (BMI) at admission and discharge, proven predictors of the outcomes of adolescent AN. Clinical data at first admission and at discharge in 289 inpatients with AN (children: n = 72; adolescents: n = 217) from a German multicenter, web-based registry for consecutively enrolled patients with childhood and adolescent AN were analyzed. Inclusion criteria were a maximum age of 18 years, first inpatient treatment due to AN, and a BMI <10th BMI percentile at admission. Compared to adolescents, children with AN had a shorter duration of illness before admission (median: 6.0 months vs. 8.0 months, p = 0.004) and higher BMI percentiles at admission (median: 0.7 vs. 0.2, p = 0.004) as well as at discharge (median: 19.3 vs. 15.1, p = 0.011). Thus, in our study, children with AN exhibited clinical characteristics that have been associated with better outcomes, including higher admission and discharge BMI percentile. Future studies should examine whether these factors are actually associated with positive long-term outcomes in children

Seasonal variation of BMI at admission in German adolescents with anorexia nervosa

Objective Recent preliminary studies indicated a seasonal association of BMI at admission to inpatient treatment for anorexia nervosa (AN), indicating lower BMI in the cold season for restrictive AN. An impaired thermoregulation was proposed as the causal factor, based on findings in animal models of AN. However, findings regarding seasonality of BMI and physical activity levels in the general population indicate lower BMI and higher physical activity in summer than in winter. Therefore, we aimed to thoroughly replicate the findings regarding seasonality of BMI at admission in patients with AN in this study. Method AN subtype, age- and gender-standardized BMI scores (BMI-SDS) at admission, mean daily sunshine duration and ambient temperature at the residency of 304 adolescent inpatients with AN of the multi-center German AN registry were analyzed. Results A main effect of DSM-5 AN subtype was found (F(2,298) = 6.630, p = .002), indicating differences in BMI-SDS at admission between restrictive, binge/purge and subclinical AN. No main effect of season on BMI-SDS at admission was found (F(1,298) = 4.723, p = .025), but an interaction effect of DSM-5 subtype and season was obtained (F(2,298) = 6.625, p = .001). Post-hoc group analyses revealed a lower BMI-SDS in the warm season for restrictive AN with a non-significant small effect size (t(203.16) = 2.140, p = .033; Hedges′g = 0.28). Small correlations of mean ambient temperature (r = −.16) and daily sunshine duration (r = −.22) with BMI-SDS in restrictive AN were found. However, the data were widely scattered. Conclusions Our findings are contrary to previous studies and question the thermoregulatory hypothesis, indicating that seasonality in AN is more complex and might be subject to other biological or psychological factors, for example physical activity or body dissatisfaction. Our results indicate only a small clinical relevance of seasonal associations of BMI-SDS merely at admission. Longitudinal studies investigating within-subject seasonal changes might be more promising to assess seasonality in AN and of higher clinical relevance

Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder.

OBJECTIVE For adolescents, DSM-5 differentiates anorexia nervosa (AN) and atypical AN with the 5th BMI-centile-for-age. We hypothesized that the diagnostic weight cut-off yields (i) lower weight loss in atypical AN and (ii) discrepant premorbid BMI distributions between the two disorders. Prior studies demonstrate that premorbid BMI predicts admission BMI and weight loss in patients with AN. We explore these relationships in atypical AN. METHOD Based on admission BMI-centile < or ≥5th, participants included 411 female adolescent inpatients with AN and 49 with atypical AN from our registry study. Regression analysis and t-tests statistically addressed our hypotheses and exploratory correlation analyses compared interrelationships between weight loss, admission BMI, and premorbid BMI in both disorders. RESULTS Weight loss in atypical AN was 5.6 kg lower than in AN upon adjustment for admission age, admission height, premorbid weight and duration of illness. Premorbid BMI-standard deviation scores differed by almost one between both disorders. Premorbid BMI and weight loss were strongly correlated in both AN and atypical AN. DISCUSSION Whereas the weight cut-off induces discrepancies in premorbid weight and adjusted weight loss, AN and atypical AN overall share strong weight-specific interrelationships that merit etiological consideration. Epidemiological and genetic associations between AN and low body weight may reflect a skewed premorbid BMI distribution. In combination with prior findings for similar psychological and medical characteristics in AN and atypical AN, our findings support a homogenous illness conceptualization. We propose that diagnostic subcategorization based on premorbid BMI, rather than admission BMI, may improve clinical validity. PUBLIC SIGNIFICANCE Because body weights of patients with AN must drop below the 5th BMI-centile per DSM-5, they will inherently require greater weight loss than their counterparts with atypical AN of the same sex, age, height and premorbid weight. Indeed, patients with atypical AN had a 5.6 kg lower weight loss after controlling for these variables. In comparison to the reference population, we found a lower and higher mean premorbid weight in patients with AN and atypical AN, respectively. Considering previous psychological and medical comparisons showing little differences between AN and atypical AN, we view a single disorder as the most parsimonious explanation. Etiological models need to particularly account for the strong relationship between weight loss and premorbid body weight

How to foster collaborative active lifestyles among youngsters and seniors?

TFG del programa Erasmus EPS elaborat a Politechnika LódzkaIn today’s world people are suffering from a lack of a healthy lifestyle. The goal is to promote a healthy lifestyle by encouraging youngsters and seniors to do more activities together. The Design Thinking method is used to find the solution. This is a solution-based type of workflow in which the team starts with the goal instead of the problem. This leads to discovering the real cause of the problem and, in result, finding many alternative solutions. Findings and analysis show that there are a lot of reasons behind the problem. Without the obvious ones like an unhealthy diet it was stated that technology and lack of social life are also big factors that should be taken into account while creating the solution. In result the term healthy lifestyle has been redefined so that it includes physical health as well as mental and social. Between seniors and youngsters there exists a technological gap that has to be reduced. Both groups can benefit from each other by sharing experiences. An active lifestyle can be achieved not only by doing physical activities but also mental ones. The proposed solution includes all mentioned observations. The paper is recommended above those who wish to learn the concepts of Design Thinking as well as for everyone concerned about the problem of children’s and senior's lack of healthy lifestyle

How to foster collaborative active lifestyles among youngsters and seniors?

TFG del programa Erasmus EPS elaborat a Politechnika LódzkaIn today’s world people are suffering from a lack of a healthy lifestyle. The goal is to promote a healthy lifestyle by encouraging youngsters and seniors to do more activities together. The Design Thinking method is used to find the solution. This is a solution-based type of workflow in which the team starts with the goal instead of the problem. This leads to discovering the real cause of the problem and, in result, finding many alternative solutions. Findings and analysis show that there are a lot of reasons behind the problem. Without the obvious ones like an unhealthy diet it was stated that technology and lack of social life are also big factors that should be taken into account while creating the solution. In result the term healthy lifestyle has been redefined so that it includes physical health as well as mental and social. Between seniors and youngsters there exists a technological gap that has to be reduced. Both groups can benefit from each other by sharing experiences. An active lifestyle can be achieved not only by doing physical activities but also mental ones. The proposed solution includes all mentioned observations. The paper is recommended above those who wish to learn the concepts of Design Thinking as well as for everyone concerned about the problem of children’s and senior's lack of healthy lifestyle

Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers

Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m2), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9-18.9 years) with a diagnosis of AN (n = 404) or atypical AN (n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity

First Sociodemographic, Pretreatment and Clinical Data from a German Web-Based Registry for Child and Adolescent Anorexia Nervosa

Objective: The first web-based registry for childhood and adolescent anorexia nervosa (AN) in Germany was established to systematically collect demographic and clinical data. These data as well as information on how young individuals with AN can find access to healthcare services are presented. Method: Patients ́ data from child and adolescent psychiatry departments of 12 university hospitals and two major nonuniversity hospitals in Germany were collected between January 2015 and December 2016. All patients met the ICD-10 diagnostic criteria for (atypical) AN. Sociodemographic data, type and amount of healthcare utilization before admission, and clinical data at admission and discharge were compiled. Results: 258 patients with a mean age of 14.7 years and a mean BMI at admission of 15.3 kg/m2 were included. The parents and patients had a higher educational level than the general German population. More than 80 % of the patients reported having uti- lized healthcare before hospitalization. The mean duration of outpatient treatment before hospitalization was 7 months. Conclusions: There seem to be major barriers to specialist treatment for young patients with AN in Germany, which should be analyzed in future studies

Die Versorgung von Kindern und Jugendlichen mit Anorexia nervosa in deutschen Kliniken

Fragestellung: Die stationäre Behandlung von Patientinnen mit Anorexia nervosa (AN) wird in Bezug auf ihre mittel- und langfristigen Wirkungen und Nebenwirkungen kontrovers diskutiert. In der deutschen S3-Leitlinie zur Diagnostik und Behandlung der Essstörungen wird die Notwendigkeit eines auf Essstörungen spezialisierten Therapeutenteams betont. Die Versorgung von Kindern und Jugendlichen mit AN in deutschen Kliniken wurde im Hinblick auf aktuelle Diagnostik- und Behandlungskonzepte untersucht. Methodik: Ein Fragebogen wurde an 163 deutsche kinder- und jugendpsychiatrische/-psychosomatische Kliniken versandt, der die Versorgungsstrukturen im Hinblick auf allgemeine Charakteristika der Kliniken sowie Diagnostik und Therapie von Kindern und Jugendlichen mit AN erfasst. Ergebnisse: Alle Kliniken, die Patientinnen mit Essstörungen behandeln (N = 84), bieten Einzeltherapie, familienbasierte Interventionen und Psychoedukation an. Nahezu alle Kliniken definieren ein Zielgewicht. Die angestrebte vorgegebene Gewichtszunahme pro Woche beträgt im Mittel 486 g/Woche (von 200 g bis 700 g/Woche; SD = 117). Alle weiteren diagnostischen und therapeutischen Maßnahmen werden nicht von allen Kliniken durchgeführt. Schlussfolgerungen: In dieser ersten Untersuchung der Versorgungsstrukturen von Kindern und Jugendlichen mit der Diagnose AN in Deutschland konnte gezeigt wer- den, dass trotz einheitlich integrierter leitliniengerechter Basisbehandlung die Versorgung von Patientinnen mit der Diagnose AN in Bezug auf Diagnostik, Gewichtsrestitution und spezifischer einzel- und gruppentherapeutischer Interventionen deutlich unterschiedlich gehandhabt wird

Seasonal variation of BMI at admission in German adolescents with anorexia nervosa

Objective Recent preliminary studies indicated a seasonal association of BMI at admission to inpatient treatment for anorexia nervosa (AN), indicating lower BMI in the cold season for restrictive AN. An impaired thermoregulation was proposed as the causal factor, based on findings in animal models of AN. However, findings regarding seasonality of BMI and physical activity levels in the general population indicate lower BMI and higher physical activity in summer than in winter. Therefore, we aimed to thoroughly replicate the findings regarding seasonality of BMI at admission in patients with AN in this study. Method AN subtype, age- and gender-standardized BMI scores (BMI-SDS) at admission, mean daily sunshine duration and ambient temperature at the residency of 304 adolescent inpatients with AN of the multi-center German AN registry were analyzed. Results A main effect of DSM-5 AN subtype was found (F(2,298) = 6.630, p = .002), indicating differences in BMI-SDS at admission between restrictive, binge/purge and subclinical AN. No main effect of season on BMI-SDS at admission was found (F(1,298) = 4.723, p = .025), but an interaction effect of DSM-5 subtype and season was obtained (F(2,298) = 6.625, p = .001). Post-hoc group analyses revealed a lower BMI-SDS in the warm season for restrictive AN with a non-significant small effect size (t(203.16) = 2.140, p = .033; Hedges′g = 0.28). Small correlations of mean ambient temperature (r = −.16) and daily sunshine duration (r = −.22) with BMI-SDS in restrictive AN were found. However, the data were widely scattered. Conclusions Our findings are contrary to previous studies and question the thermoregulatory hypothesis, indicating that seasonality in AN is more complex and might be subject to other biological or psychological factors, for example physical activity or body dissatisfaction. Our results indicate only a small clinical relevance of seasonal associations of BMI-SDS merely at admission. Longitudinal studies investigating within-subject seasonal changes might be more promising to assess seasonality in AN and of higher clinical relevance