Body Weight Parameters at the Initial Visit for Eating Disorders in Adolescents: Are These the Markers of Serious Complications?

Yıl 2024, ERKEN GÖRÜNÜMLÜ MAKALELER, 1 - 9

Ata Yiğit Çöllü , Demet Taş , Alkım Öden Akman , Esra Çöp

https://doi.org/10.12956/tchd.1499664

Öz

Objective: Eating disorders (ED) are psychiatric disorders often accompanied by medical complications. This study aimed to identify the complications in ED patients during hospital admission and their relationship with body weight (BW).

Material and Methods: Patients diagnosed with ED per DSM-5 criteria seen at least once in the adolescent department were included. Digital medical records were used to obtain patient information. Body mass index (BMI), BMI percentile, and percentage of BW by height (IBW%) were calculated to analyze their association with medical complications.

Results: Our study included 144 patients, 140 (97.2%) females and 4 (2.8%) males. Of the patients; 94 were analysed as Anorexia Nervosa (AN), 28 as Atypical AN and 17 as Bulimia Nervosa (BN). At least one cardiac complication was detected in 29.3% (39), gastrointestinal complications in 54.2% (78), hypoglycaemia in 18.2% (26), secondary amenorrhoea in 34.5% (48) and 45.8% (66) received inpatient treatment. Patients with IBW%<75 exhibited significantly higher rates of hypoglycemia, bradycardia, low sT3, amenorrhea, and hospitalization compared to those with IBW% ≥ 75 (p<0.001). Bone mineral density (BMD) was significantly inversely associated with Z-score, time to ED diagnosis and duration of amenorrhoea (p=0.006; p=0.044; p=0.032, respectively).

Conclusion: Our findings show that at least one medical complication frequently develops in ED patients at the initial evaluation. Patients with AN and BN, which usually start in adolescence, may frequently present to paediatric outpatient clinics with medical complaints. The role of internal physicians in the early diagnosis of ED is important to prevent serious complications in these patients.

Anahtar Kelimeler

Adolescents, Medical complications, Anorexia nervosa, Eating disorder, Bulimia nervosa

Etik Beyan

Araştırmada herhangi bir çıkar çatışması bulunmamaktadır ve etik ihlal yapılmamıştır

Destekleyen Kurum

Bulunmamaktadır

Yeme Bozukluğu Tanılı Ergenlerin İlk Başvurularında Vücut Ağırlığı Parametreleri: Bunlar Ciddi Komplikasyonların Belirteçleri midir?

Öz

Amaç: Yeme bozuklukları (YB), sıklıkla tıbbi komplikasyonların eşlik ettiği psikiyatrik hastalıklardır. Bu çalışmada, YB hastalarının hastaneye başvuru sırasındaki komplikasyonları ve ilk tanısal başvuru değerlendirmesindeki vücut ağırlığı (VA) ile ilişkisi değerlendirilmiştir.

Gereç ve Yöntemler: Adolesan Sağlığı ve Çocuk Psikiyatrisi değerlendirilmesi ile DSM-5 tanı kriterlerine göre YB tanısı almış hastalar çalışmaya dahil edilmiştir. Hastaların bulguları dijital tıbbi kayıt sisteminden elde edilmiştir. Tıbbi komplikasyonlarla VA ilişkilerini analiz etmek için vücut kitle indeksi (VKİ), VKİ persentili ve boya göre ideal VA yüzdesi (%İVA) hesaplanmıştır.

Bulgular: Çalışmamıza 140’ı (%97.2) kız, 4’ü (%2.8) erkek olmak üzere 144 hasta dahil edildi. Hastaların; 94’ü Anoreksiya Nervoza (AN), 28’i Atipik AN ve 17’si Bulimia Nervoza (BN) olarak değerlendirildi. Hastaların %29.3’ünde (39) en az bir kardiyak, %54.2’sinde (78) gastrointestinal komplikasyon, %18.2’sinde (26) hipoglisemi ve %34.5’inde (48) sekonder amenore saptandı ve %45.8’i (66) ise hastaneye yatırıldı. İVA<%75 olan hastalarda hipoglisemi, bradikardi, düşük serbest triiodotironin (sT3), amenore ve hastaneye yatış oranları İVA≥ %75 olanlara göre istatistiksel anlamlı fazlaydı (p<0.001). Kemik mineral yoğunluğu (KMD) Z-skoru, YB tanısına kadar geçen süre ve amenore süresi ile ters ilişki olduğu saptandı (sırasıyla p=0.006; p=0.044; p=0.032).

Sonuç: Bulgularımız, YB hastalarında ilk değerlendirmede sıklıkla en az bir tıbbi komplikasyonun geliştiğini göstermektedir. Genellikle ergenlik döneminde başlayan AN ve BN hastaları sıklıkla medikal şikayet ile pediatri polikliniklerine başvurabilirler. Bu hastalarda ciddi komplikasyonların önlenmesi için dahili hekimlerin YB erken tanısında rolü önemlidir.

Anahtar Kelimeler

Ergen, medikal komplikasyon, yeme bozukluğu, anoreksiya nervoza, blumia nervoza

Kaynakça

• Volpe U, Tortorella A, Manchia M, Monteleone AM, Albert U, Monteleone P. Eating disorders: What age at onset? Psychiatry Res 2016;238:225-7.
• Silén Y, Keski-Rahkonen A. Worldwide prevalence of DSM-5 eating disorders among young people. Curr Opin Psychiatr 2022;35:362–71.
• Welch E, Ghaderi A. Mortality in anorexia nervosa – a look back at and beyond one of the most cited papers in the field. Advances in Eating Disorders 2015;3:221–9.
• Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician 2015;91:46-52.
• Sachs KV, Harnke B, Mehler PS, Krantz MJ. Cardiovascular complications of anorexia nervosa: A systematic review. Int J Eat Disord 2016;49:238-48.
• Hung C, Muñoz M, Shibli-Rahhal A. Anorexia Nervosa and Osteoporosis. Calcif Tissue Int 2022;110:562–75.
• Gibson D, Stein A, Khatri V, Wesselink D, Sitko S, Mehler PS. Associations between low body weight, weight loss, and medical instability in adults with eating disorders. Int J Eat Disord 2024;57:869-78.
• Sato Y, Fukudo S. Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol 2015;8:255–63.
• Campbell K, Peebles R. Eating disorders in children and adolescents: state of the art review. Pediatrics 2014;134:582-92.
• Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician 2021;103:22-32.
• Baaleman DF, Velasco-Benítez CA, Méndez-Guzmán LM, Benninga MA, Saps M. Functional gastrointestinal disorders in children: agreement between Rome III and Rome IV diagnoses. Eur J Pediatr 2021;180:2297-03. 
• Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, et al.Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002;109:45-60.
• Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, et al. ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017;14:e155-e217.
• T. C. Sağlık Bakanlığı Türkiye Beslenme Rehberi (TÜBER). 2015; 46–9.
• Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics 2006;118:2245-50. 
• Eritrosit Hastalıkları ve Hemoglobin Bozuklukları Tanı ve Tedavi Kılavuzu. 2019 [cited 2023 Oct 31];22–6. Available from: www.thd.org.tr
• Abraham MB, Karges B, Dovc K, Naranjo D, Ana Arbelaez M, Mbogo J, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2022;23:1322-40.
• Petkova H, Simic M, Nicholls D, Ford T, Prina AM, Stuart R, et al. Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study. BMJ Open 2019 1;9: e027339.
• Steinhausen HC, Grigoroiu-Serbanescu M, Boyadjieva S, Neumärker KJ, Metzke CW. Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study. Int J Eat Disord 2008;41:29–36.
• Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 2011;68:714–23.
• Singh K, Kaushik A, Johnson L, Jaganathan S, Jarhyan P, Deepa M, et al. Patient experiences and perceptions of chronic disease care during the COVID-19 pandemic in India: a qualitative study. BMJ Open 2021;11: e048926.
• Yanai H, Yoshida H, Tomono Y, Tada N. Severe hypoglycemia in a patient with anorexia nervosa. Eat Weight Disord 2008;13:e1-3.
• Gurevich E, Steiling S, Landau D. Incidence of Impaired Kidney Function Among Adolescent Patients Hospitalized With Anorexia Nervosa. JAMA Netw Open 2021;4:e2134908.
• Winston AP. The clinical biochemistry of anorexia nervosa. Ann Clin Biochem 2012;49:132-43.
• Mehler PS, Koutsavlis A. Anorexia Nervosa, Albumin, and Inflammation. Am J Med 2021 ;134:e401.
• Speranza E, Marra M, De Filippo E, De Caprio C, Sammarco R, Morlino D, Contaldo F, Pasanisi F. Nutritional indicators and metabolic alterations in outpatients with anorexia nervosa: a retrospective study. Eat Weight Disord 2021;26:2693-99. 
• Hütter G, Ganepola S, Hofmann WK. The hematology of anorexia nervosa. Int J Eat Disord 2009;42:293–300.
• Misra M, Aggarwal A, Miller KK, Almazan C, Worley M, Soyka LA, et al. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatric 2004;114:1574–83.
• Stheneur C, Bergeron S, Lapeyraque A. Renal complications in anorexia nervosa. Eating and Weight Disord 2014;19:455–60.
• Hundemer GL, Clarke A, Akbari A, Bugeja A, Massicotte-Azarniouch D, Knoll G, et al. Analysis of Electrolyte Abnormalities in Adolescents and Adults and Subsequent Diagnosis of an Eating Disorder. JAMA Netw Open 2022;5:e2240809.
• Haines MS. Endocrine complications of anorexia nervosa. J Eat Disord 2023;11:24.
• Abraham SF, Pettigrew B, Boyd C, Russell J, Taylor A. Usefulness of amenorrhoea in the diagnoses of eating disorder patients. J Psychosom Obstet Gynaecol 2005;26:211–5.
• Sachs KV, Harnke B, Mehler PS, Krantz MJ. Cardiovascular complications of anorexia nervosa: A systematic review. Int J Eat Disord 2016;49:238–48.
• Riedlinger C, Schmidt G, Weiland A, Stengel A, Giel KE, Zipfel S, et al. Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis. Front Psychiatr 2020;11:195.
• Herman A, Bajaka A. The role of the intestinal microbiota in eating disorders - bulimia nervosa and binge eating disorder. Psychiatry Res 2021;300:113923.
• Swenne I, Stridsberg M, Thurfjell B, Rosling A. Triiodothyronine is an indicator of nutritional status in adolescent girls with eating disorders. Horm Res 2009;71:268–75.
• Fazeli PK. Low bone mineral density in anorexia nervosa: Treatments and challenges. Clin Rev Bone Miner Metab 2019;17:65-76.