Rate of weight gain as a predictor of readmission in adolescents with eating disorders

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Meghna R. Sebastian ◽  
Constance M. Wiemann ◽  
Albert C. Hergenroeder
Keyword(s):  
Eating Disorders ◽  
Weight Gain ◽  
Ideal Body Weight ◽  
Adolescent Medicine ◽  
Readmission Rates ◽  
Rapid Weight Gain ◽  
Medicine Service ◽  
Predicted Probability ◽  
Increased Risk ◽  
Co Morbidity

Abstract Background Readmission after hospital discharge is common in adolescents with eating disorders. Studies on the association between rapidity of weight gain and readmission are inconsistent. With an emphasis on more rapid weight gain during hospitalization, the effect of this strategy on readmission rates warrants further investigation. Objective This project explored the relationship between rate of weight gain during hospitalization and medically necessitated readmissions. Subjects Eighty-two patients who: were admitted due to an eating disorder during a 5-year period; achieved weight restoration to ≥84% of ideal body weight (IBW); had a follow-up visit with the adolescent medicine service after discharge; and, had information available on rate of weight gain. Methods Data were extracted from medical records. Multiple logistic regression was used to analyze the effect of rate of weight gain on readmission. The effect of a comorbid psychiatric diagnosis was tested for an interaction. Results Of patients 20.7% required readmission. The median rate of weight gain was 118.6 g/day [interquartile range (IQR) = 91.8–150.8]. There was a 1.8 times [95% confidence interval (CI) = 0.9–3.6, p = 0.087] greater odds of readmission with each increase in weight gain quartile after adjusting for potential confounders. Patients in the lowest rate of weight gain quartile and no psychiatric co-morbidity had a significantly lower predicted probability of readmission (25.1%) compared to those with a psychiatric comorbidity and in the highest quartile of rate of weight gain (48.4%). Conclusion Patients with eating disorders who have rapid inpatient weight gain and psychiatric co-morbidities may be at increased risk for readmission.

Outcome of adolescents with eating disorders from an adolescent medicine service at a large children’s hospital

2015 ◽  
Vol 27 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Albert C. Hergenroeder ◽  
Constance M. Wiemann ◽  
Christopher Henges ◽  
Amanda Dave
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Adolescent Medicine ◽  
Initial Contact ◽  
Partial Recovery ◽  
Children's Hospital ◽  
Medicine Service ◽  
Children’S Hospital ◽  
Study Hospital

Abstract Objective: To describe outcomes of adolescents with eating disorders treated by an interdisciplinary adolescent medicine service at a large children’s hospital and to identify factors, including hospitalization, associated with outcome. Design: The study design was a retrospective chart review of patients. Setting: The setting was an inpatient and outpatient adolescent service in a large urban children’s hospital. Participants: A total of 218 adolescents diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified participated in the study. Intervention: Interdisciplinary inpatient and outpatient treatment for eating disorders was adopted for intervention. Outcome measures: Patient outcomes were categorized as fully recovered, partially recovered/improved, or poorly recovered/exhibiting chronicity. Results: Being admitted to the study hospital once and longer duration of follow-up were associated with full or partial recovery. In contrast, being readmitted to the study hospital and longer duration of illness prior to the initial contact with this service were associated with poor recovery. Premorbid obesity was unrelated to outcome. Conclusions: Earlier detection and referral of adolescents with eating disorders are needed because a high percentage of patients, especially those with anorexia nervosa, required hospitalization at initial contact. The benefits of inpatient admission may extend beyond medical stabilization of the most medically compromised patients to include improved therapeutic relationship with the treatment team and improved follow-up. Many patients prematurely terminate treatment; factors contributing to premature termination of therapy need further exploration.

scholarly journals Early nutrition programming of long-term health

2012 ◽  
Vol 71 (3) ◽  
pp. 371-378 ◽  
Author(s):  
Berthold Koletzko ◽  
Brigitte Brands ◽  
Lucilla Poston ◽  
Keith Godfrey ◽  
Hans Demmelmair
Keyword(s):  
Weight Gain ◽  
Early Life ◽  
Adverse Outcomes ◽  
Postnatal Life ◽  
Long Term Effects ◽  
Public Health Importance ◽  
Rapid Weight Gain ◽  
Early Nutrition ◽  
Increased Risk

Increasing evidence from the EU Project EARNEST and many other investigators demonstrates that early nutrition and lifestyle have long-term effects on later health and the risk of common non-communicable diseases (known as ‘developmental programming’). Because of the increasing public health importance and the transgenerational nature of the problem, obesity and associated disorders are the focus of the new EU funded project ‘EarlyNutrition’. Currently, three key hypotheses have been defined: the fuel mediated ‘in utero’ hypothesis suggests that intrauterine exposure to an excess of fuels, most notably glucose, causes permanent changes of the fetus that lead to obesity in postnatal life; the accelerated postnatal weight gain hypothesis proposes an association between rapid weight gain in infancy and an increased risk of later obesity and adverse outcomes; and the mismatch hypothesis suggests that experiencing a developmental ‘mismatch’ between a sub-optimal perinatal and an obesogenic childhood environment is related to a particular predisposition to obesity and corresponding co-morbidities. Using existing cohort studies, ongoing and novel intervention studies and a basic science programme to investigate those key hypotheses, project EarlyNutrition will provide the scientific foundations for evidence-based recommendations for optimal nutrition considering long-term health outcomes, with a focus on obesity and related disorders. Scientific and technical expertise in placental biology, epigenetics and metabolomics will provide understanding at the cellular and molecular level of the relationships between early life nutritional status and the risk of later adiposity. This will help refine strategies for intervention in early life to prevent obesity.

scholarly journals OBESITY TRENDS AND RISK FACTORS AMONG REFUGEE CHILDREN/YOUTH: A SCOPING REVIEW

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e46-e46
Author(s):  
Elmira Amirazodi ◽  
Michelle Turcotte ◽  
Andrea Hunter
Keyword(s):  
Risk Factors ◽  
Weight Gain ◽  
Scoping Review ◽  
Middle Eastern ◽  
Children And Youth ◽  
Refugee Children ◽  
Older Children ◽  
Rapid Weight Gain ◽  
Increased Risk ◽  
Health Complications

Abstract BACKGROUND Overweight and obese children are at a heightened risk of adult-onset health complications including hypertension, cardiovascular disease, type 2 diabetes, certain cancers, and psychosocial complications. These disorders can begin in childhood, which increases the likelihood of early morbidity and mortality. In parallel, over the past two decades, the global population of refugees has grown substantially. OBJECTIVES Given the rapid increase of refugee populations in Canada, it is important to understand how obesity and overweight patterns for refugee children and youth differ from those of native-born populations. To date, no review has comprehensively documented weight gain trends and risk factors in paediatric refugee populations. DESIGN/METHODS A scoping review of the literature was conducted using Medline, CINAHL, and EMBASE for publications in English from August 1991 to April 2017. A total of 11 articles were identified relating to prevalence and risk factors for becoming overweight/obese in refugee children and youth aged 0 to 18 years old after arrival in a high-income setting. RESULTS Paediatric refugees were at increased risk of rapid weight gain after migration. After living in a HIC for 1.5 to 9 years, refugee children demonstrated a prevalence of obesity that ranged from 1.4 to 21%. The prevalence of overweight children and youth ranged from 5.7 to 22.8%. Refugee children and youth had a steeper increase in their BMI compared with non-refugees (P < 0.001). Younger children (< 2 years) experienced an increase in BMI at a slower rate (P = 0.002) than older children and youth. A longer length of stay in HICs was associated with an increase in BMI percentile among refugee children. Populations of Eastern European, African, and Middle Eastern ethnic backgrounds demonstrated a higher risk of becoming overweight/obese in comparison to other paediatric refugees or non-refugee children. CONCLUSION This review demonstrates that despite methodological differences between the 11 included studies, 6 of them consistently demonstrate a direct relationship between increased BMI and length of residence in HICs among refugee children. Multiple studies (n=7) emphasize the need for culturally tailored prevention strategies including timely orientation to nutrition in HICs. Preventing the development of obesity among refugee children is crucial for reducing the short and long-term health consequences associated with childhood obesity.

Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

2017 ◽  
Vol 87 (1-2) ◽  
pp. 10-16 ◽  
Author(s):  
Salah Gariballa ◽  
Awad Alessa
Keyword(s):  
Nutritional Status ◽  
Inductively Coupled Plasma ◽  
Older Patients ◽  
Controlled Trial ◽  
Prognostic Indicators ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Impact ◽  
Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

scholarly journals Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth K. Parker ◽  
Sahrish S. Faruquie ◽  
Gail Anderson ◽  
Linette Gomes ◽  
Andrew Kennedy ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Weight Gain ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Retrospective Chart Review ◽  
Refeeding Syndrome ◽  
Restrictive Eating ◽  
Weight Restoration ◽  
The Mean

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

scholarly journals A qualitative study on the multi-level process of resilience development for adults recovering from eating disorders

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Katie Grogan ◽  
Hannah O’Daly ◽  
Jessica Bramham ◽  
Mary Scriven ◽  
Caroline Maher ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Qualitative Study ◽  
Significant Proportion ◽  
Well Being ◽  
Fundamental Aspect ◽  
Increased Risk ◽  
Resilience Process ◽  
Multi Level ◽  
Level Process

Abstract Background Resilience research to date has been criticised for its consideration of resilience as a personal trait instead of a process, and for identifying individual factors related to resilience with no consideration of the ecological context. The overall aim of the current study was to explore the multi-level process through which adults recovering from EDs develop resilience, from the perspectives of clients and clinicians. The objective of this research was to outline the stages involved in the process of developing resilience, which might help to inform families and services in how best to support adults with EDs during their recovery. Method Thirty participants (15 clients; 15 clinicians) took part in semi-structured interviews, and responded to questions relating to factors associated with resilience. Using an inductive approach, data were analysed using reflexive thematic analysis. Results The overarching theme which described the process of developing resilience was ‘Bouncing back to being me’, which involved three stages: ‘Who am I without my ED?’, ‘My eating disorder does not define me’, and ‘I no longer need my eating disorder’. Twenty sub-themes were identified as being involved in this resilience process, thirteen of which required multi-level involvement. Conclusion This qualitative study provided a multi-level resilience framework for adults recovering from eating disorders, that is based on the experiences of adults with eating disorders and their treating clinicians. This framework provided empirical evidence that resilience is an ecological process involving an interaction between internal and external factors occurring between adults with eating disorder and their most immediate environments (i.e. family and social). Plain English summary Anorexia nervosa, bulimia nervosa and binge-eating disorder demonstrate high rates of symptom persistence across time and poor prognosis for a significant proportion of individuals affected by these disorders, including health complications and increased risk of mortality. Many researchers have attempted to explore how to improve recovery outcomes for this population. Eating disorder experts have emphasised the need to focus not only on the weight indicators and eating behaviours that sustain the eating disorder during recovery, but also on the psychological well-being of the person recovering. One way to achieve this is to focus on resilience, which was identified as a fundamental aspect of eating disorder recovery in previous research. This study conceptualises resilience as a dynamic process that is influenced not only at a personal level but also through the environment in which the person lives. This study gathered data from adults with eating disorders and their treating clinicians, to devise a framework for resilience development for adults recovering from eating disorders. The paper discussed ways in which these findings and the framework identified can be easily implemented in clinical practice to facilitate a better understanding of eating disorder resilience and to enhance recovery outcomes.

scholarly journals Free Sugars Consumption in Canada

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1471
Author(s):  
Huma Rana ◽  
Marie-Claude Mallet ◽  
Alejandro Gonzalez ◽  
Marie-France Verreault ◽  
Sylvie St-Pierre
Keyword(s):  
Type 2 Diabetes ◽  
Weight Gain ◽  
Total Energy ◽  
Children And Adolescents ◽  
Overweight And Obesity ◽  
Free Sugars ◽  
Added Sugars ◽  
Increased Risk ◽  
Baked Products

Free sugars (FS) are associated with a higher risk of dental decay in children and an increased risk of weight gain, overweight and obesity and type 2 diabetes. For this reason, Canada’s Food Guide recommends limiting foods and beverages that contribute to excess free sugars consumption. Estimating FS intakes is needed to inform policies and interventions aimed at reducing Canadians’ consumption of FS. The objective of this study was to estimate FS intake of Canadians using a new method that estimated the free sugars content of foods in the Canadian Nutrient File, the database used in national nutrition surveys. We define FS as sugars present in food products in which the structure has been broken down. We found that 12% of total energy (about 56 g) comes from FS in the diet of Canadians 1 year of age and older (≥1 year). The top four sources were: (1) sugars, syrups, preserves, confectionary, desserts; (2) soft drinks; (3) baked products and (4) juice (without added sugars), and accounted for 60% of total free sugars intake. The results show that efforts need to be sustained to help Canadians, particularly children and adolescents, to reduce their FS intake.

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