The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa

BACKGROUND While preventive interventions for eating disorders in general have shown promise, interventions specifically targeting individuals at risk for anorexia nervosa have not been evaluated. OBJECTIVE To determine the efficacy of a guided, indicated, Internet-based prevention program for women at risk for anorexia nervosa (AN). METHODS Randomized, controlled efficacy trial for women at risk for AN. Assessments at baseline (pre), post-intervention (10 weeks after baseline), 6-, and 12-month follow-up (FU). 168 women with low body weight (17.5≤BMI≤19) and high weight concerns, or with normal body weight 19<BMI≤25, high weight concerns and high restrained eating were recruited from three German universities as well as online, and randomized to Student Bodies-AN (SB-AN) or a waiting list control group (CG). Exclusion criteria were current DSM-IV full-syndrome AN, bulimia nervosa or binge eating disorder, serious medical or mental problems, such as current substance abuse, acute or chronic organic or schizophrenic psychosis, severe suicidal ideation or behaviour, no Internet access. Interventions: 1. Cognitive-behavioural, guided, Internet-based prevention program (SB-AN) over 10 weeks (IG); 2. Waiting list control condition (CG). Primary outcomes were clinically significant changes in attitudes and behaviours of disordered eating, and change in BMI in the underweight group of participants at 12-month follow-up. Secondary outcomes are new onset of eating disorders, symptoms of disordered eating, and associated psychopathology. RESULTS Data were available at post-intervention for N=137 women, and for N=116 women at 12-month FU. At 12-month FU, IGs participants showed larger decreases in EDE Total scores (79% vs. 57%) compared to the CG, and underweight IG participants also showed larger clinically relevant increases in BMI (49% vs. 32%) compared with underweight CG participants, but these differences were not significant. In addition, at post-intervention and 12-month follow-up, we found a significant increase in continuously measured BMI for underweight participants and significant improvements in attitudes and behaviours of disordered eating (e.g., restrained eating, weight and shape concerns). At all time points, rates of newly emerging ED onset cases were (non-significantly) lower in the IG compared with the CG and reductions in DSM-5-based ED syndromes were (non-significantly) higher in the IG compared with the CG. CONCLUSIONS SB-AN is the first preventive intervention shown to significantly reduce specific risk factors and symptoms for AN and shows promise for reducing full-syndrome AN onset. CLINICALTRIAL ISRCTN70380261

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Hypovolaemia after glucose/insulin infusions in volunteers

Clinical Science ◽

10.1042/cs20080032 ◽

2008 ◽

Vol 115 (12) ◽

pp. 371-378 ◽

Cited By ~ 7

Author(s):

Dan Berndtson ◽

Joel Olsson ◽

Robert G. Hahn

Keyword(s):

Body Weight ◽

Linear Relationship ◽

Plasma Glucose ◽

Glucose Concentration ◽

Plasma Glucose Concentration ◽

High Dose ◽

Acting Insulin ◽

Insulin Solution ◽

The Relationship

High-dose intravenous infusion of 5% glucose promotes rebound hypoglycaemia and hypovolaemia in healthy volunteers. To study whether such effects occur in response to glucose/insulin, 12 healthy firemen (mean age, 39 years) received three infusions over 1–2 h that contained 20 ml of 2.5% glucose/kg of body weight, 5 ml of 10% glucose/kg of body weight with 0.05 unit of rapid-acting insulin/kg of body weight, and 4 ml of 50% glucose/kg of body weight with 1 unit of insulin/kg of body weight. The plasma glucose concentration and plasma dilution were compared at 5–10 min intervals over 4 h. Regardless of the amount of administered fluid and whether insulin was given, the plasma glucose concentration decreased to hypoglycaemic levels within 30 min of the infusion ending. The plasma dilution closely mirrored plasma glucose and became negative by approx. 5%, which indicates a reduction in the plasma volume. These alterations were only partially restored during the follow-up period. A linear relationship between plasma glucose and plasma dilution was most apparent when the infused glucose had been dissolved in only a small amount of fluid. For the strongest glucose/insulin solution, this linear relationship had a correlation coefficient of 0.77 (n=386, P<0.0001). The findings of the present study indicate that a redistribution of water due to the osmotic strength of the glucose is the chief mechanism accounting for the hypovolaemia. It is concluded that infusions of 2.5%, 10% and 50% glucose, with and without insulin, in well-trained men were consistently followed by long-standing hypoglycaemia and also by hypovolaemia, which averaged 5%. These results emphasize the relationship between metabolism and fluid balance.

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Anorexia nervosa and nutritional assessment: contribution of body composition measurements

Nutrition Research Reviews ◽

10.1017/s0954422410000284 ◽

2011 ◽

Vol 24 (1) ◽

pp. 39-45 ◽

Cited By ~ 14

Author(s):

Lama Mattar ◽

Nathalie Godart ◽

Jean Claude Melchior ◽

Claude Pichard

Keyword(s):

Body Composition ◽

Anorexia Nervosa ◽

Nutritional Status ◽

Nutritional Assessment ◽

Psychological Symptoms ◽

Present Review ◽

Personalised Treatment ◽

Key Terms ◽

The Relationship

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 AN.

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Vitamin D Level Trajectories of Adolescent Patients with Anorexia Nervosa at Inpatient Admission, during Treatment, and at One Year Follow Up: Association with Depressive Symptoms

Nutrients ◽

10.3390/nu13072356 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2356

Author(s):

Manuel Föcker ◽

Nina Timmesfeld ◽

Judith Bühlmeier ◽

Denise Zwanziger ◽

Dagmar Führer ◽

...

Keyword(s):

Vitamin D ◽

Anorexia Nervosa ◽

Depressive Symptoms ◽

Vitamin D Deficiency ◽

Serum Levels ◽

Multicenter Trial ◽

Epidemiologic Studies ◽

Adolescent Patients ◽

The Relationship

(1) Background: Evidence has accumulated that patients with anorexia nervosa (AN) are at higher risk for vitamin D deficiency than healthy controls. In epidemiologic studies, low 25(OH) vitamin D (25(OH)D) levels were associated with depression. This study analyzed the relationship between 25(OH)D serum levels in adolescent patients and AN and depressive symptoms over the course of treatment. (2) Methods: 25(OH)D levels and depressive symptoms were analyzed in 93 adolescent (in-)patients with AN from the Anorexia Nervosa Day patient versus Inpatient (ANDI) multicenter trial at clinic admission, discharge, and 1 year follow up. Mixed regression models were used to analyze the relationship between 25(OH)D levels and depressive symptoms assessed by the Beck Depression Inventory (BDI-II). (3) Results: Although mean 25(OH)D levels constantly remained in recommended ranges (≥ 50 nmol/L) during AN treatment, levels decreased from (in)patient admission to 1 year follow up. Levels of 25(OH)D were neither cross-sectionally, prospectively, nor longitudinally associated with the BDI-II score. (4) Conclusions: This study did not confirm that 25(OH)D levels are associated with depressive symptoms in patients with AN. However, increasing risks of vitamin D deficiency over the course of AN treatment indicate that clinicians should monitor 25(OH)D levels.

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