Intestinal barrier integrity in anorexia nervosa (a pilot study)

Objective There is no conclusive evidence for involvement of intestinal barrier alteration in the etiology of anorexia nervosa (AN). The aims of this pilot study were to identify serum markers of intestinal barrier integrity in patients with AN and to determine the relationships between those markers and body mass index (BMI), eating disorder symptoms, gastrointestinal complaints, and liver synthesis function (international normalized ratio [INR]). Method Twenty-five outpatients with AN prior to starting treatment and 28 healthy controls (HC) were assessed. BMI and serum markers of intestinal barrier integrity were measured, including zonulin family peptides (ZFP), lipopolysaccharide-binding protein (LBP), and intestinal fatty-acid-binding protein (i-FABP). Eating disorder symptoms and gastrointestinal complaints were evaluated via questionnaires. Results The serum ZFP concentration was significantly lower in patients with AN than in HC (44.2 [7.4] vs. 49.2 [5.6] ng/ml, mean [standard deviation], p = .008). LBP and i-FABP did not differ between the two groups. In patients with AN, serum ZFP was significantly predicted by BMI (β = 0.479, p = .009), age (β = 0.411, p = .020), and INR (β = −0.388, p = .028). No such associations were found for either gastrointestinal complaints or eating disorder symptoms. Discussion Abnormal levels of serum ZFP were observed in patients with AN. Further studies with other assessment methods are warranted to examine intestinal barrier function in AN.publishedVersio

Objectively measured physical activity among treatment seeking children and adolescents with severe obesity and normal weight peers

Background: Treatment seeking children and adolescents with severe obesity often experience barriers to physical activity. Studies objectively measuring physical activity in this group and investigating explanatory factors for physical activity levels could inform clinical practice. Objectives: This study aimed to compare objectively measured physical activity levels among treatment seeking children and adolescents with severe obesity and normal weight peers, and to investigate explanatory factors for time spent in moderate physical activity and vigorous physical activity among children and adolescents with severe obesity. Methods: Children with severe obesity (n = 85) were matched 1:1 by age, gender, and the season for accelerometer measurements with normal weight peers (n = 85). Children wore accelerometers for seven consecutive days, yielding measures of physical activity, sleep duration and timing. Parents reported on screen time, parental body mass index and participation in organized sports. Results: Children and adolescents with severe obesity spent significantly less time in moderate physical activity (12 min, p < 0.001) and vigorous physical activity (21 min, p < 0.001) per day compared to normal weight peers. No difference for time spent in sedentary activity was found between groups. For participants with severe obesity, age ≤12 years (p = 0.009) and participation in organized sports (p = 0.023) were related to more moderate physical activity, while age ≤12 years (p = 0.038) and early sleep timing (p = 0.019) were related to more vigorous physical activity. Conclusion: Children and adolescents with severe obesity were less physically active than their normal weight peers. Factors related to more moderate and vigorous physical activity in children with severe obesity were lower age, participation in organized sports and earlier sleep timing.publishedVersio

Cadmium, Inorganic Arsenic and Iodine in Farmed and Wildgrowing Winged Kelp (Alaria Esculenta) and Sugar Kelp (Saccharina Latissima)

Dyrking av tare er en ny kystnæring i Norge. Ettersom etterspørsel øker, øker også behovet for mer utfyllende og grunnleggende informasjon om hva tare inneholder. I denne oppgaven fokuseres det på to brunalger Alaria esculenta og Saccharina latissima som er dyrket i nærheten av et oppdrettsanlegg ved Rongøy. Hovedfokuset er på kvantifisering av mengden kadmium, uorganisk arsen og jod, siden disse elementene vil være at spesiell interesse i forhold til mattrygghetsperspektiv. Det er totalt analysert 154 prøver av dyrket og viltvoksende butare og sukkertare hovedsakelig fra lokaliteten Rongøy, men også noen prøver fra Flatøyflu. All dyrket tare er en del av et integrert multitrofisk akvakultursystem (IMTA-system). Oppgaven gir informasjon om hvordan konsentrasjonene av uorganiske stoff endrer seg i tare i forhold til størrelser, ulikt vev, ulike lokaliteter, sesong og forskjeller i viltvoksende og dyrket tare. Taren er vurdert i et mattrygghetsperspektiv i forhold til innhold av kadmium, uorganisk arsen og jod. I tillegg til at næringsmessige bidrag er vurdert. Dyrket butare inneholder lavere konsentrasjoner av kadmium, men høyere konsentrasjoner av jod enn viltvoksende butare. Dyrket sukkertare inneholder noe mer kadmium og uorganisk arsen enn viltvoksende sukkertare. Butare og sukkertare fra oppdrettsanlegg ved Rongøy viser en økning i kadmium gjennom sesongen, dyrket sukkertare fra Flatøyflu viser motsatt trend. Det forekommer ikke en tydelig sesongvariasjon for uorganisk arsen. Sesongbildet for jodinnholdet i butare kan tyde på en økning sent i sesongen. For dyrket tare vil kadmiumkonsentrasjonen minke for tareplanter med rask veksthastighet, og konsentrasjonen er størst i vekstsonen. Svært mange uorganiske stoff hadde en negativ korrelasjon til størrelsen på taren, med unntak av total arsen. Konsentrasjonen av jod ser ut til å øke fra stilk til tuppen av butare. Påvekst av epibiota kan potensielt føre til bidrag av uorganiske grunnstoff og mosdyret (Membranipora membranacea) vil trolig føre til en økning av kadmiuminnholdet i tare. Konsentrasjonene av kadmium og uorganisk arsen utgjør ikke en trussel for konsum av butare og sukkertare. Jodkonsentrasjonen vil være begrensende element for konsum av butare og sukkertare, men ulike prosesseringsmetoder vil kunne redusere jodkonsentrasjonen.Masteroppgave i kjemiKJEM39

Kadmium, uorganisk arsen og jod i dyrket og viltvoksende butare (Alaria esculenta) og sukkertare (Saccharina latissima)

Dyrking av tare er en ny kystnæring i Norge. Ettersom etterspørsel øker, øker også behovet for mer utfyllende og grunnleggende informasjon om hva tare inneholder. I denne oppgaven fokuseres det på to brunalger Alaria esculenta og Saccharina latissima som er dyrket i nærheten av et oppdrettsanlegg ved Rongøy. Hovedfokuset er på kvantifisering av mengden kadmium, uorganisk arsen og jod, siden disse elementene vil være at spesiell interesse i forhold til mattrygghetsperspektiv. Det er totalt analysert 154 prøver av dyrket og viltvoksende butare og sukkertare hovedsakelig fra lokaliteten Rongøy, men også noen prøver fra Flatøyflu. All dyrket tare er en del av et integrert multitrofisk akvakultursystem (IMTA-system). Oppgaven gir informasjon om hvordan konsentrasjonene av uorganiske stoff endrer seg i tare i forhold til størrelser, ulikt vev, ulike lokaliteter, sesong og forskjeller i viltvoksende og dyrket tare. Taren er vurdert i et mattrygghetsperspektiv i forhold til innhold av kadmium, uorganisk arsen og jod. I tillegg til at næringsmessige bidrag er vurdert. Dyrket butare inneholder lavere konsentrasjoner av kadmium, men høyere konsentrasjoner av jod enn viltvoksende butare. Dyrket sukkertare inneholder noe mer kadmium og uorganisk arsen enn viltvoksende sukkertare. Butare og sukkertare fra oppdrettsanlegg ved Rongøy viser en økning i kadmium gjennom sesongen, dyrket sukkertare fra Flatøyflu viser motsatt trend. Det forekommer ikke en tydelig sesongvariasjon for uorganisk arsen. Sesongbildet for jodinnholdet i butare kan tyde på en økning sent i sesongen. For dyrket tare vil kadmiumkonsentrasjonen minke for tareplanter med rask veksthastighet, og konsentrasjonen er størst i vekstsonen. Svært mange uorganiske stoff hadde en negativ korrelasjon til størrelsen på taren, med unntak av total arsen. Konsentrasjonen av jod ser ut til å øke fra stilk til tuppen av butare. Påvekst av epibiota kan potensielt føre til bidrag av uorganiske grunnstoff og mosdyret (Membranipora membranacea) vil trolig føre til en økning av kadmiuminnholdet i tare. Konsentrasjonene av kadmium og uorganisk arsen utgjør ikke en trussel for konsum av butare og sukkertare. Jodkonsentrasjonen vil være begrensende element for konsum av butare og sukkertare, men ulike prosesseringsmetoder vil kunne redusere jodkonsentrasjonen

"De snakker og snakker om asylsøkere, men de kjenner oss ikke". Historier fra asylsøkere i London

Denne oppgaven tar utgangspunkt i historier som er fortalt meg fra mennesker som er i, eller har gjennomgått en asylprosess i London. Mine informanter synes å være begrenset hvordan i hvordan de kan komme til uttrykk. Jeg lurer på hvor de begrensningene kommer fra. Gjennom oppgaven argumenterer jeg for at hvordan asylsøkere kan uttrykke seg påvirkes av strukturelle og erfaringsbaserte forhold. Det synes å være en forestilling av hvordan en flyktning er', som får konsekvenser for hvordan mine informanter kan presentere seg selv i asylprosessen, og i dagliglivet utenfor. Dypest sett synes det at forestillingen mine informanter blir møtt med, får konsekvenser for hvem de kan være. Jeg presiserer at verken jeg eller andre som alltid har levd i trygge omgivelser fullt ut forstå hva mennesker på flukt har levd gjennom. For asylsøkere er virkeligheten mer brutal. Radikale forskjeller i erfaring av livet, betyr ikke at jeg og andre utenforstående ikke kan relatere oss til mennesker som søker asyl. Jeg argumenterer for en økt sosial anerkjennelse av asylsøkere, som mennesker med en verdi inn i våre fellesskap

Experiences when implementing enhanced cognitive behavioral therapy as a standard treatment for anorexia nervosa in outpatients at a public specialized eating-disorder treatment unit

Background Enhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area. Methods This study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment. Results A high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered. Conclusions Patients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate. Trial registration ClinicalTrials.gov. Identifier: NCT02745067. Registered: April 20, 2016. https://clinicaltrials.gov/ct2/showNCT0274506

Experiences when implementing enhanced cognitive behavioral therapy as a standard treatment for anorexia nervosa in outpatients at a public specialized eating-disorder treatment unit

Background Enhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area. Methods This study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment. Results A high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered. Conclusions Patients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate

Differences in sleep patterns between patients with anorexia nervosa and healthy controls: a cross-sectional study

Abstract Background Sleep difficulties are common in patients with anorexia nervosa (AN), but objective assessments have mostly been performed in hospital and laboratory settings. We aimed to identify differences in sleep patterns between patients with AN and healthy controls (HC) in their free-living environments, and potential associations between sleep patterns and clinical symptoms in patients with AN. Methods This cross-sectional study analyzed 20 patients with AN prior to them starting outpatient treatment and 23 HC. Sleep patterns were measured objectively using an accelerometer (Philips Actiwatch 2) for 7 consecutive days. Average sleep onset, sleep offset, total sleep time, sleep efficiency, wake after sleep onset (WASO) and mid-sleep awakenings lasting ≥ 5 min were compared between patients with AN and HC using nonparametric statistical analyses. Associations of sleep patterns with body mass index, eating-disorder symptoms, eating-disorder-associated impairment, and symptoms of depression were assessed in the patient group. Results Compared with HC, patients with AN had shorter WASO [median (interquartile range(IQR)): 33 vs. 42 min], but a longer average duration of mid-sleep awakenings lasting ≥ 5 min [median (IQR): 9 vs. 6 min, p = 0.006] and had more nights with no sleep (six nights in four patients with AN vs. zero nights in HC). There were no differences between patients with AN and HC regarding other sleep parameters and no significant correlations between sleep patterns and clinical parameters in patients with AN. However, HC presented a Intraindividual variability pattern that was closer to a normal distribution, whereas patients with AN tended to either have very regular or large variability in sleep onset time (AN; n = 7  75th percentile vs. HC; n = 4  75th percentile) during the week of sleep recordings. Conclusion Patients with AN seem to spend more time awake during the night and have more nights without sleep than do HC, even though their average weekly sleep duration did not differ from that in HC. The intraindividual variability in sleep pattern seems to be an important parameter that should be assessed when studying sleep in patients with AN. Trial registration ClinicalTroals.gov. Identifier: NCT02745067. Registered: April 20, 2016

Association between habitual sleep duration/quality and appetite markers in individuals with obesity

Study Objectives: To assess if habitual sleep duration/quality was associated with appetite in individuals with obesity, and if the association was modulated by sex. Methods: Sleep duration/quality was measured with Pittsburgh Sleep Quality Index score in 95 healthy adults with obesity (BMI: 36.6 ± 4.2 kg/m2). Subjective feelings of appetite were assessed using visual analogue scales, and plasma concentrations of active ghrelin, total peptide YY, active glucagon-like peptide 1, cholecystokinin (CCK) and insulin were measured in fasting and every 30 min up to 2.5 h after a meal. Results: No significant associations were found between sleep duration, or overall quality, and appetite in all participants. However, a worse sleep efficiency was associated with lower postprandial CCK, a shorter habitual sleep was associated with lower postprandial desire to eat and a lower daytime dysfunction was associated with higher prospective food consumption in fasting (P<0.05, for all). In males, a shorter habitual sleep duration and a worse subjective sleep quality were associated with increased basal and postprandial active ghrelin (P<0.05, P<0.01, P<0.01 and P<0.05, respectively). Also, a shorter habitual sleep was associated with lower basal and postprandial insulin (P<0.05 for both) and a worse overall sleep quality with lower postprandial insulin (P<0.05). In females, a worse overall sleep quality was associated with lower postprandial active ghrelin (P<0.05), and short habitual sleep with higher postprandial insulin (P<0.05). Conclusion: A worse habitual sleep efficiency is associated with blunted postprandial CCK secretion in individuals with obesity. The association between habitual sleep duration/quality and insulin and active ghrelin seems to be modulated by sex, but more studies are needed to confirm these finding

Intestinal barrier integrity in anorexia nervosa (a pilot study)

Objective There is no conclusive evidence for involvement of intestinal barrier alteration in the etiology of anorexia nervosa (AN). The aims of this pilot study were to identify serum markers of intestinal barrier integrity in patients with AN and to determine the relationships between those markers and body mass index (BMI), eating disorder symptoms, gastrointestinal complaints, and liver synthesis function (international normalized ratio [INR]). Method Twenty-five outpatients with AN prior to starting treatment and 28 healthy controls (HC) were assessed. BMI and serum markers of intestinal barrier integrity were measured, including zonulin family peptides (ZFP), lipopolysaccharide-binding protein (LBP), and intestinal fatty-acid-binding protein (i-FABP). Eating disorder symptoms and gastrointestinal complaints were evaluated via questionnaires. Results The serum ZFP concentration was significantly lower in patients with AN than in HC (44.2 [7.4] vs. 49.2 [5.6] ng/ml, mean [standard deviation], p = .008). LBP and i-FABP did not differ between the two groups. In patients with AN, serum ZFP was significantly predicted by BMI (β = 0.479, p = .009), age (β = 0.411, p = .020), and INR (β = −0.388, p = .028). No such associations were found for either gastrointestinal complaints or eating disorder symptoms. Discussion Abnormal levels of serum ZFP were observed in patients with AN. Further studies with other assessment methods are warranted to examine intestinal barrier function in AN