The Changing Face and Focus of the Adolescent with an Eating Disorder

The classic silhouette of the typical adolescent with an eating disorder (ED) is a white female with extremely low body weight; this has begun to take a new shape. The most apparent shift in the classic views are sex and weight. A trend toward a progressively decreasing age of onset in ED has also emerged. The objective of this paper is to describe the ED patients presenting to Children's of Alabama's Adolescent Eating Disorders Clinic, encompassing their age, sex, BMI percentile and muscle function. The data was examined from all first presentations to the clinic from 2013 to 2016. Between May 2013 and March 2016, 102 new patient appointments were scheduled. 88 patient's charts were reviewed from the time of each initial appointment in the Adolescent Eating Disorders Clinic to obtain the sex, age, race, height, weight, reason for referral/active problems and ED diagnosis for each patient. BMI percentile was calculated according to reference ranges for sex and age. Handgrip strength was measured by dynamometer. As is consistent with previously published data, there were significantly more females than males seen in our population. There were more females than males across all categories of ED diagnoses. The highest number of diagnoses occurred between the ages of 13-16. A positive correlation between BMI percentile and measured handgrip strength was observed. Measured handgrip strength in females was lower in ages 13-18 than expected grip strength for age. When males were grouped by "Males 14 and under" and "Males 15 and over,"a lower measured grip strength compared to the expected grip strength for age was demonstrated. The impact of ED on morbidity and mortality has been well recognized; however the most often reported association was mainly based on changes in body weight. The adverse metabolic consequences perturb nutrient sensing and ultimately delivery and utilization. A shift in the focus of energy balanced towards systemic malnourishment may allow healthy and sustained metabolic improvements

FELEing It: Developing a Rubric Through an Interdisciplinary Partnership to Support Graduate Students’ Writing Skills

Educational leadership demands that school leaders be able to communicate clearly and effectively in writing, both academically and professionally. Leaders of a Master’s in Educational Leadership (M.Ed.) program at a university in the southeast of the United States established an interdisciplinary collaboration with the university’s Faculty Writing Partners program to develop valid and reliable rubrics to assess graduate students’ writing abilities through critical task essays. The critical task essays connect required internship experience in each course with a targeted Florida Principal Leadership Standard (FPLS), coursework, and scholarly research. However, an objective performance measure for the critical task essays was lacking. Accordingly, a criterion-referenced rubric was developed to: 1) specify criteria for writing in relation to grammar, mechanics, and organization, 2) identify quality peer-reviewed research as evidence to support clinical experience, 3) effectively articulate in writing personal strengths, weaknesses, and plans for improvement towards mastery of the FPLS, and 4) provide consistency in expectations and feedback among professors and adjunct instructors. The rubric demonstrated validity and reliability, and likely led to consistently higher scores on both the critical task essays and, most importantly, the Florida Educational Leadership Examination (FELE).   Résumé: Le leadership en éducation exige que les cadres scolaires sachent communiquer clairement et efficacement sous forme écrite, tant au niveau pédagogique que professionnel. Les responsables de la maîtrise en leadership éducationnel dans une université du sud-est des États-Unis ont établi une collaboration interdisciplinaire avec les responsables du programme « Faculty Writing Partners » à la même université afin de développer des critères valables et fiables pour évaluer, au moyen de textes d’analyse critique, les aptitudes en rédaction de leurs étudiants diplômés. Ces textes ont comme objectif de relier les expériences acquises par ces étudiants lors d’un stage obligatoire dans chaque cours au Florida Principal Leadership Standard (FPLS), au travail qu’ils ont effectué dans le cours, et à leurs recherches universitaires en général. Il manquait cependant une mesure objective pour évaluer les textes d’analyse critique. On a donc conçu un tableau fondée sur des critères précis pour : 1) spécifier nos attentes en ce qui a trait à la grammaire, la syntaxe et l’organisation du texte; 2) reconnaître l’article de recherche de bonne qualité évalué par les pairs comme complément de l’expérience clinique; 3) articuler efficacement sous forme écrite les qualités, faiblesses et objectifs d’amélioration personnels relatifs à la maîtrise du FPLS; et 4) assurer une uniformité parmi les professeurs et les instructeurs associés dans leurs attentes et leurs conseils. Le tableau s’est avéré valable et fiable. D’ailleurs, en toute probabilité, il a mené à de meilleurs résultats pour les textes d’analyse critique et surtout pour le Florida Educational Leadership Examination (FELE).   Keywords / Mots clés : educational leadership, professional writing for school leaders, academic writing for school leaders, improving FELE writing scores / leadership en éducation, rédaction professionnelle pour cadres scolaires, rédaction universitaire pour cadres scolaires, amélioration des résultats en rédaction pour le FEL

Association of vitamin D-binding protein and vitamin D3 with insulin and homeostatic model assessment (HOMA-IR) in overweight and obese females

Objective: Equivocal association the contribution of 25-hydroxyvitamin D (25(OH)D) and the well-accepted role of vitamin D-binding protein (VDBP) on bioavailability of 25(OH)D or its independent roles, has led to possible association of the VDBP in glucose metabolism. This study was conducted to evaluate the relationships among 25(OH)D, VDBP, glucose/insulin metabolism and homeostatic model assessment (HOMA-IR). Blood samples were collected from 236 obese and overweight women. VDBP and 25(OH)D levels, and biochemical parameters were measured using an enzyme-linked immunosorbent assay (ELISA). An impedance fat analyzer was utilized to acquire the body composition. Results: Using the multivariate linear regression, a reverse relationship was observed between VDBP and (HOMA-IR), such that women with higher VDBP displayed lower insulin resistance. The relationship was independent of age, body mass index, standardized energy intake and physical activity (p = 0.00). No significant relationship between 25(OH)D levels, FBS, body composition or insulin resistance were observed (p > 0.2). Current study observed that higher level of VDBP may be associated with lower levels of insulin and HOMA-IR, thus the evaluation of VDBP in diverse population groups seems to have significant clinical value in evaluating the prevalence of DM or early stage of glucose intolerance

Feasibility, acceptability, and characteristics associated with adherence and completion of a culturally relevant internet-enhanced physical activity pilot intervention for overweight and obese young adult African American women enrolled in college

BACKGROUND: African American women are one of the least active demographic groups in the US, with only 36% meeting the national physical activity recommendations in comparison to 46% of White women. Physical activity begins to decline in African American women in adolescence and continues to decline into young adulthood. Yet, few interventions have been developed to promote physical activity in African American women during this critical period of life. The purpose of this article was to evaluate the acceptability and feasibility of a culturally-relevant Internet-enhanced physical activity pilot intervention for overweight/obese African American college females and to examine psychosocial and behavioral characteristics associated with intervention adherence and completion. METHODS: A 6-month single group pre-posttest design was used. Participants (n = 27) accessed a culturally-relevant Social Cognitive Theory-based physical activity promotion website while engaging in a minimum of four moderate-intensity physical activity sessions each week. Acceptability and feasibility of the intervention was assessed by participant retention and a consumer satisfaction survey completed by participants. RESULTS: Fifty-six percent of participants (n = 15) completed the intervention. Study completers were more physically active at baseline (P = 0.05) and had greater social support for exercise from family members (P = 0.04). Sixty percent of study completers (n = 9) reported the website as enjoyable or very enjoyable to use and 60% (n = 9) reported increased motivation from participation in the physical activity program. Moreover, 87% (n = 13) reported they would recommend the website to a friend. CONCLUSIONS: Results provide some preliminary support for the acceptability and feasibility of an Internet-enhanced physical activity program for overweight/obese African American women, while highlighting important limitations of the approach. Successful promotion of physical activity in college aged African American women as they emerge into adulthood may result in the development of life-long healthy physical activity patterns which may ultimately reduce physical activity-related health disparities in this high risk underserved population. Future studies with larger samples are needed to further explore the use of Internet-based programs to promote physical activity in this population

Genetic variation in a member of the laminin gene family affects variation in body composition in Drosophila and humans

<p>Abstract</p> <p>Background</p> <p>The objective of the present study was to map candidate loci influencing naturally occurring variation in triacylglycerol (TAG) storage using quantitative complementation procedures in <it>Drosophila melanogaster</it>. Based on our results from <it>Drosophila</it>, we performed a human population-based association study to investigate the effect of natural variation in <it>LAMA5 </it>gene on body composition in humans.</p> <p>Results</p> <p>We identified four candidate genes that contributed to differences in TAG storage between two strains of <it>D. melanogaster</it>, including <it>Laminin A </it>(<it>LanA</it>), which is a member of the α subfamily of laminin chains. We confirmed the effects of this gene using a viable <it>LanA </it>mutant and showed that female flies homozygous for the mutation had significantly lower TAG storage, body weight, and total protein content than control flies. <it>Drosophila LanA </it>is closely related to human <it>LAMA5 </it>gene, which maps to the well-replicated obesity-linkage region on chromosome 20q13.2-q13.3. We tested for association between three common single nucleotide polymorphisms (SNPs) in the human <it>LAMA5 </it>gene and variation in body composition and lipid profile traits in a cohort of unrelated women of European American (EA) and African American (AA) descent. In both ethnic groups, we found that SNP rs659822 was associated with weight (EA: <it>P </it>= 0.008; AA: <it>P </it>= 0.05) and lean mass (EA: <it>P= </it>0.003; AA: <it>P </it>= 0.03). We also found this SNP to be associated with height (<it>P </it>= 0.01), total fat mass (<it>P </it>= 0.01), and HDL-cholesterol (<it>P </it>= 0.003) but only in EA women. Finally, significant associations of SNP rs944895 with serum TAG levels (<it>P </it>= 0.02) and HDL-cholesterol (<it>P </it>= 0.03) were observed in AA women.</p> <p>Conclusion</p> <p>Our results suggest an evolutionarily conserved role of a member of the laminin gene family in contributing to variation in weight and body composition.</p

A Conserved Role for Syndecan Family Members in the Regulation of Whole-Body Energy Metabolism

Syndecans are a family of type-I transmembrane proteins that are involved in cell-matrix adhesion, migration, neuronal development, and inflammation. Previous quantitative genetic studies pinpointed Drosophila Syndecan (dSdc) as a positional candidate gene affecting variation in fat storage between two Drosophila melanogaster strains. Here, we first used quantitative complementation tests with dSdc mutants to confirm that natural variation in this gene affects variability in Drosophila fat storage. Next, we examined the effects of a viable dSdc mutant on Drosophila whole-body energy metabolism and associated traits. We observed that young flies homozygous for the dSdc mutation had reduced fat storage and slept longer than homozygous wild-type flies. They also displayed significantly reduced metabolic rate, lower expression of spargel (the Drosophila homologue of PGC-1), and reduced mitochondrial respiration. Compared to control flies, dSdc mutants had lower expression of brain insulin-like peptides, were less fecund, more sensitive to starvation, and had reduced life span. Finally, we tested for association between single nucleotide polymorphisms (SNPs) in the human SDC4 gene and variation in body composition, metabolism, glucose homeostasis, and sleep traits in a cohort of healthy early pubertal children. We found that SNP rs4599 was significantly associated with resting energy expenditure (P = 0.001 after Bonferroni correction) and nominally associated with fasting glucose levels (P = 0.01) and sleep duration (P = 0.044). On average, children homozygous for the minor allele had lower levels of glucose, higher resting energy expenditure, and slept shorter than children homozygous for the common allele. We also observed that SNP rs1981429 was nominally associated with lean tissue mass (P = 0.035) and intra-abdominal fat (P = 0.049), and SNP rs2267871 with insulin sensitivity (P = 0.037). Collectively, our results in Drosophila and humans argue that syndecan family members play a key role in the regulation of body metabolism

A computer based approach to improve the dietary and physical activity patterns of a diverse group of adolescents

Diet and physical activity patterns have been implicated as major factors in the increasing prevalence of childhood and adolescent obesity. It is estimated that between 16 and 33 percent of children and adolescents in the United States are overweight (CDC, 2000). Moreover, the CDC estimates that less than 50% of adolescents are physically active on a regular basis (CDC, 2003). Interventions must be focused to modify these behaviors. Facilitating the understanding of proper nutrition and need for physical activity among adolescents is the first step in preventing overweight and obesity and delaying the development of chronic diseases later in life (Dwyer, 2000). The purpose of this study was to compare the outcomes of students receiving one of two forms of education (both emphasizing diet and physical activity), to determine whether a computer based intervention (CBI) program using an interactive, animated CD-ROM would elicit a greater behavior change in comparison to a traditional didactic intervention (TDI) program. A convenience sample of 254 high school students aged 14-19 participated in the 6-month program. A pre-test post-test design was used, with follow-up measures taken at three months post-intervention. No change was noted in total fat, saturated fat, fruit/vegetables, or fiber intake for any of the groups. There was also no change in perceived self-efficacy or perceived social support. Results did, however, indicate an increase in nutrition knowledge for both intervention groups (p\u3c0.001). In addition, the CBI group demonstrated more positive and sustained behavior changes throughout the course of the study. These changes included a decrease in BMI (ppre/post\u3c0.001, ppost/follow-up\u3c0.001), number of meals skipped (ppre/post\u3c0.001), and soda consumption (ppre/post=0.003, ppost/follow-up=0.03) and an increase in nutrition knowledge (ppre/post\u3c0.001, ppre/follow-up \u3c0.001), physical activity (ppre/post\u3c0.05, p pre/follow-up\u3c0.01), frequency of label reading (ppre/follow-up \u3c0.0l) and in dairy consumption (ppre/post=0.03). The TDI group did show positive gains in some areas post intervention, however a return to baseline behavior was shown at follow-up. Findings of this study suggest that compared to traditional didactic teaching, computer-based nutrition and health education has greater potential to elicit change in knowledge and behavior as well as promote maintenance of the behavior change over time

Higher Serum Insulin Concentrations Positively Influence the Bone Mineral Density in African American Adolescents

Background: Puberty is a developmental stage of increased insulin resistance that also is a critical period for bone mass accrual. Historically, African Americans (AA) have lesser risk for osteoporotic fractures compared to European Americans (EA). AA also have higher incidence of insulin resistance. The possibility that bone health and insulin secretion or concentrations are linked has not been investigated. Aims: We aimed to examine the associations of bone mineral density (BMD) and bone mineral apparent density (BMAD) with insulin sensitivity and secretion in healthy adolescent girls and healthy female adults and to evaluate ethnic differences in these associations. Study Design: Observational cohort design. Place and Duration of the Study: University of Alabama at Birmingham, between January 2010 and September 2011. Methodology: Healthy, female, non-smoking adolescents and young adults (14-55 years) were enrolled in this observational cohort study. Results: Adolescents had significantly higher fasting insulin (P=0.0002), insulin area under the curve [AUC] (P= 0.0004) and lower insulin sensitivity (P=0.0005) compared to adults. Among adolescents, AA race was significantly associated with BMD (β=0.086, P=0.01) and BMAD (β=0.0075, P=0.002); however, adjusting for insulin AUC explained this difference. Insulin AUC (β=0.0006, P=0.029) and fasting insulin (β=0.0005, P=0.01) were positively associated with BMAD only in AA adolescents. Insulin AUC and fasting insulin were not significant predictors of BMD for adults. Conclusion: The higher insulin concentration among AA adolescents is associated with increased BMD and higher BMAD