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

Associations of fibroblast growth factor-23 with markers of inflammation, insulin resistance and obesity in adults.

Elevated fibroblast growth factor-23 (FGF23) is an established marker of cardiovascular disease. The underlying reason(s) for the rise accompanying cardiovascular health decline are unclear. Prior studies have shown that FGF23 concentrations are associated with markers of inflammation and insulin resistance but they have been limited by a focus on persons with chronic kidney disease (CKD) and lack of race and sex diversity. The objective of this study was to examine the associations of FGF23 and markers of inflammation, insulin resistance, and anthropometrics in a large cohort of community-dwelling adults.Associations of FGF23 with markers of inflammation [interleukin-6 (IL-6), IL-10, high sensitivity-CRP (hsCRP)], insulin utilization [resistin, adiponectin, homeostatic model assessment of insulin resistance (HOMA-IR)] and anthropometrics [BMI and waist circumference (WC)] were examined cross-sectionally in a 1,040 participants randomly selected from the Reason for Geographic and Racial Differences in Stroke (REGARDS) Study, a national study of black and white adults ≥45 years. Effect modification by race and CKD status was tested, and stratified models were analyzed accordingly.Median FGF23 concentration was 69.6 RU/ml (IQR: 53.2, 102.7). Higher quartiles of FGF23 were associated with higher mean concentrations of IL-6, IL-10, hsCRP and resistin (Ptrend<0.001 for all). There were no significant differences in HOMA-IR, adiponectin concentrations, BMI, or WC across FGF23 quartiles in the crude analyses. CKD significantly modified the relationships between FGF23 and inflammatory markers, HOMA-IR, BMI and WC (P ≤ 0.01 for all). In linear regression models adjusted for sociodemographic and clinical variables, FGF23 was positively associated with IL-6, hsCRP, IL-10, HOMA-IR, BMI and WC in individuals without CKD, but not among individuals with CKD. Additionally, FGF23 was positively associated with resistin irrespective of CKD status.Elevated FGF23 concentrations may be considered a biomarker for decline in metabolic function among individuals with normal kidney function

Circulating levels of fibroblast growth factor-21 increase with age independently of body composition indices among healthy individuals

Background: Circulating FGF21 levels are commonly elevated in disease states. There is limited information regarding concentrations of circulating FGF21 in the absence of disease, as well as age-related differences in body composition that may contribute to FGF21 regulation across groups. Objective: The objectives of this study were to assess FGF21 levels across age groups (childhood to elder adulthood), and investigate whether body composition indices are associated with age-related differences in circulating FGF21. Materials and methods: We cross-sectionally analyzed serum concentrations of FGF21 in 184 healthy subjects aged 5–80 y (45% male). Multiple linear regression was performed to assess the independent association of categorical age (children: 5–12 y, young adults: 20–29 y, adults: 30–50 y, older adults: 55–64 y, elder adults: 65–80 y) with FGF21 concentration taking into account DXA-measured body composition indices [bone mineral density (BMD) and percent lean, trunk, and fat mass]. We also stratified analysis by tertile of FGF21. Results: Incremental increases in FGF21 levels were observed across age groups (youngest to highest). Age group was positively associated with FGF21 level independent of body composition indices (age group variable: β = 0.25, 0.24, 0.24, 0.23, all P < 0.0001, controlling for percent lean, BMD, percent fat, and percent trunk fat, respectively). By FGF21 tertile, age group was associated with FGF21 in the lowest tertile only (β = 13.1, 0.19, 0.18, all P ≤ 0.01, accounting for percent lean, fat and trunk fat, respectively), but not when accounting for BMD. Conclusions: Our findings in a healthy population display an age-related increase in serum FGF21, highlighting a potential age effect in response to metabolic demand over the lifecourse. FGF21 levels increase with age independently of body composition. At lower levels of FGF21, BMD, but not other body composition parameters, attenuates the association between FGF21 level and age, suggesting the metabolic demand of the skeleton may provide a link between FGF21 and energy metabolism

Markers of inflammation, insulin utilization and anthropometrics overall and by quartile of FGF23.

<p>The first column represents the overall sample, and the subsequent columns represent FGF23 quartiles 1–4, respectively, in each panel. Values are presented as geometric means, 95% confidence intervals (interleukin-6, high sensitivity C-Reactive protein, interleukin-10, resistin, adiponectin, HOMA-IR)) or mean ± standard deviation (body mass index, waist circumference).</p

Associations between vascular health indices and serum total, free and bioavailable 25-hydroxyvitamin D in adolescents.

The role of vitamin D in cardiovascular health remains debated as results have been inconsistent. Previous studies have not considered the bioavailability of 25-hydroxy vitamin D [25(OH)D]. Objectives of our study were to investigate the association between serum concentrations of total, free and bioavailable 25(OH)D and independent predictors of cardiovascular risk such as flow mediated dilatation (FMD) and augmentation index (AIx).This cross-sectional study included 47 post-menarchal, adolescent females [31 African American (AA) and 16 European American (EA)].AIx was standardized to a heart rate of 75 beats/min (AIx75). Free and bioavailable 25(OH)D concentrations were calculated from standard formulas.Mean age of the participants was 15.8 ± 1.4 years and mean body mass index was 23.1 ± 4.0 kg/m2. Serum total 25(OH)D was not associated with FMD, but was positively associated with AIx75 in the adjusted model (rho = 0.4, P = 0.03). AIx75 was positively associated with bioavailable 25(OH)D (rho = 0.4, P = 0.004) and free 25(OH)D (rho = 0.4, P = 0.009) and the associations persisted after adjusting for covariates. In race-specific analyses, total, free and bioavailable 25(OH)D were strongly positively associated with AIx75 in AA (rho = 0.5, 0.4, 0.4, respectively), which persisted even after adjusting for covariates. Whereas in EA there was an inverse association between total 25(OH)D and AIx75 in EA (rho = -0.6), which attenuated after adjusting for covariates.Circulating total, free and bioavailable 25(OH)D were associated with arterial stiffness in adolescent girls, and these associations were race dependent. Notwithstanding, the implications of associations between vascular function indices and 25(OH)D remains unclear

Multivariable-adjusted associations between natural log-transformed fibroblast growth factor-23 and natural log-transformed markers of inflammation in the overall sample and by chronic kidney disease (CKD) status.

<p>Model 1 is adjusted for age, sex, race, region of residence. Model 2 is adjusted for variables in Model 1 plus indices of socioeconomic status, history of diabetes, coronary heart disease, stroke, lifestyle habits (tobacco usage, alcohol consumption, physical activity), serum calcium, serum phosphorus, eGFR and UACR. In models stratified by CKD status, Model 2 was not adjusted for eGFR and UACR. IL-6 = interleukin-6, hsCRP = high-sensitivity c-reactive protein, IL-10 = interleukin-10.</p><p>Multivariable-adjusted associations between natural log-transformed fibroblast growth factor-23 and natural log-transformed markers of inflammation in the overall sample and by chronic kidney disease (CKD) status.</p

Participant characteristics overall and by quartile of fibroblast growth factor-23 level.

<p>Data are given as mean (standard error), median [interquartile range] or frequencies.</p><p>Abbreviations: UACR, urinary albumin to creatinine ratio; eGFR, estimated glomerular filtration rate.</p><p>* (≤7 and 14 drinks/d for women and men, respectively)</p><p>**(>7 and 14 drinks/d for women and men, respectively)</p><p>***In answer to “How many times per week do you engage in intense physical activity, enough to work up a sweat?”</p><p>Participant characteristics overall and by quartile of fibroblast growth factor-23 level.</p

Multivariable-adjusted associations between natural log-transformed fibroblast growth factor-23 and anthropometrics (BMI and WC, waist circumference) in the overall sample and by chronic kidney disease (CKD) status.

<p>Model 1 is adjusted for age, sex, race, and region of residence. Model 2 is adjusted for indices of socioeconomic status, history of coronary heart disease and/or stroke, lifestyle habits (tobacco usage, alcohol consumption, physical activity), serum calcium, phosphorus, eGFR and UACR. In models stratified by CKD status, Model 2 was not adjusted for eGFR and UACR.</p><p>Multivariable-adjusted associations between natural log-transformed fibroblast growth factor-23 and anthropometrics (BMI and WC, waist circumference) in the overall sample and by chronic kidney disease (CKD) status.</p

Crude and partial Spearman correlations for the association between 25(OH)D measures and vascular outcomes.

<p>*All correlations after adjusting for age, race and percent body fat.</p>‡<p>Correlations also adjusted fasting insulin for all outcomes (i.e., AIx75, FMD, SBP and DBP), and, also adjusted for height for outcome variables AIx75, SBP, DBP.</p><p>Bolded values represent those that are statistically significant (<i>P</i>≤0.05). Abbreviations: 25(OH)D, 25-hydroxyvitamin D; AIx75, augmentation index standardized to a heart rate of 75 beats/min; FMD, flow-mediated dilation; SBP, systolic blood pressure; DBP, diastolic blood pressure.</p><p>Crude and partial Spearman correlations for the association between 25(OH)D measures and vascular outcomes.</p