With eating disorders on the rise among boys, minorities and younger children, doctors need to keep an eye out for unexpected cases, according to the author of a new report. The stereotype that eating disorders affect only affluent, white teenage girls no longer applies, said David S. Rosen, MD, MPH, who wrote a clinical report on the topic that was published in the December issue of Pediatrics. “It’s also happening to boys, young children, people of color and middle-aged women. It’s more of an equal opportunity disorder,” said Dr. Rosen, a professor of pediatrics, internal medicine and psychiatry at the University of Michigan.
Males, for example, now represent up to 10% of all cases of eating disorders. The number of children younger than 12 who are hospitalized for eating disorders increased 119% from 1999 to 2006, according to an analysis by the Agency for Healthcare Research and Quality cited in the report (www.ncbi.nlm.nih.gov/pubmed/21115584/). Young children who develop eating disorders are more susceptible to serious medical consequences such as stunted growth and organ damage, Dr. Rosen said.
Early intervention recommended
He urges physicians, nurses, parents, school social workers and others to intervene early. Health care professionals should take note when patients, particularly young ones, make derogatory comments about their appearance or talk about going on a diet. The report said screening questions about eating patterns and body image should be asked of all preteens and adolescents.
Fewer than 1% of adolescent girls in the U.S. have anorexia, and 1% to 2% percent have bulimia. Experts estimate that between 1% and 14% of Americans exhibit some physical and psychological symptoms of an eating disorder. Male and female athletes, including gymnasts, runners and wrestlers, and performers, such as dancers and models, may be more at risk.
The report said eating disorders may have more of a genetic link, similar to alcoholism and depression, than previously thought. The discovery that some children may be genetically predisposed to the condition may “help to take away some of the blame or stigma,” Dr. Rosen said. With more children obese, physicians should choose their words carefully when counseling a child about his or her weight, Dr. Rosen said. He sees young patients with eating disorders who claim their problems with food began when their doctor told them to lose weight.
Dr. Rosen recommends that physicians discuss healthy eating practices, not dieting, with patients and focus on a healthy lifestyle, not losing weight. “There’s a perception that, like alcoholism, [an eating disorder] never goes away and that the best you can do is keep it under control,” he said. But if caught early, “most children and teens can expect to recover completely.”
The idea that disease-causing genes can be beneficial is not new. The most clear-cut case involves a gene variant that, when present in two copies, causes sickle cell anaemia, which can result in severe pain, organ damage and death. Although it seems that natural selection would work to eliminate the disorder, the variant remains prevalent in some areas of Africa because people with just a single copy are less susceptible to malaria. Evolutionarily the trade-off is worth it: Far more people are protected from malaria than ever develop sickle cell anaemia even in today’s environment.
Unlike sickle cell anaemia, which is caused by a mutation in just one gene, many complex diseases are associated with several variants – specific locations in the DNA where the nucleotide ‘letters’ vary between individuals. These locations are known as SNPs, for single nucleotide polymorphisms. Some of these SNPs are associated with an increased disease risk, while others protect against developing the disease. When calculating an individual’s overall genetic risk, it’s necessary to consider the net effect of all of his or her variants.
Researchers at Stanford University picked seven well-known conditions to study: type-1 and type-2 diabetes, rheumatoid arthritis, hypertension, Crohn’s disease, coronary artery disease and bipolar disorder. Previous genome wide association studies have identified several hundred SNPs associated with each disorder. Corona found that of the top SNPs associated with type-1 diabetes, 80 have been recently increasing in prevalence, meaning that they underwent positive selection. Of these, a surprising 58 are associated with an increased risk of the disorder, while 22 appear protective. Similarly, SNPs associated with an increased risk for rheumatoid arthritis were found to be positively selected. In contrast to type-1 diabetes and rheumatoid arthritis, Corona found that we’re evolving away from a tendency to develop Crohn’s disease (that is, more protective SNPs than risky SNPs have been positively selected).
Results for the other three disorders – type-2 diabetes, coronary artery disease and bipolar disorder – showed that protective and risky SNPs were positively selected in about equal proportions. ‘Now we’re starting to see little hints as to why this might be the case,’ said Butte. For example, a recent study in another lab showed that genetic variations in an antiviral response gene called IFIH1 that improve its ability to protect against enterovirus infection (and the resulting severe, potentially deadly, abdominal distress) also increase a carrier’s risk for type-1 diabetes. And scientists who study global disease patterns have long noted that the prevalence of tuberculosis varies inversely with that of rheumatoid arthritis.
‘It’s possible that, in areas of the world where associated triggers for some of these complex conditions are lacking, carriers would experience only the protective effect against some types of infectious disease,’ said Butte, who pointed out that the cumulative effect of many SNPs in a person’s genome may buffer the effect of any one variant, even if it did raise a person’s risk for a particular condition.
Regardless of the reason, some evolutionary tenets still apply. Healthier people are, presumably, more likely to reproduce and pass those same genes – be they protective or risky – to their offspring. When conditions changed because of differences in diet, exposures or location as populations move around the globe, carriers of the risky SNPs began to develop the conditions we struggle with today.
Corona and Butte are now expanding their investigation to include even more SNPs and diseases. They are also looking at the genetic profile of various types of tumours to see if there’s evidence for positive evolutionary pressure there as well.
‘Even though we’ve been finding more and more genetic contributions to disease risk,’ said Butte, ‘that’s not really an appealing answer. There have got to be some other reasons why we have these conditions.’
Source: Stanford University Medical Centre
Researchers employed imaging techniques to examine and analyze brain anatomical differences between 55 female IBS patients and 48 female control subjects. Patients had moderate IBS severity, with disease duration from one to 34 years (average 11 years). The average age of the participants was 31.
Investigators found both increases and decreases of brain grey matter in specific cortical brain regions.
Even after accounting for additional factors such as anxiety and depression, researchers still discovered differences between IBS patients and control subjects in areas of the brain involved in cognitive and evaluative functions, including the prefrontal and posterior parietal cortices, and in the posterior insula, which represents the primary viscerosensory cortex receiving sensory information from the gastrointestinal tract.
“The grey-matter changes in the posterior insula are particularly interesting since they may play a role in central pain amplification for IBS patients,” said study author David A. Seminowicz, Ph.D., of the Alan Edwards Centre for Research on Pain at McGill University. “This particular finding may point to a specific brain difference or abnormality that plays a role in heightening pain signals that reach the brain from the gut.”
Decreases in grey matter in IBS patients occurred in several regions involved in attentional brain processes, which decide what the body should pay attention to. The thalamus and midbrain also showed reductions, including a region – the periaqueductal grey – that plays a major role in suppressing pain.
“Reductions of grey matter in these key areas may demonstrate an inability of the brain to effectively inhibit pain responses,” Seminowicz said.
The observed decreases in brain grey matter were consistent across IBS patient sub-groups, such as those experiencing more diarrhea-like symptoms than constipation.
“We noticed that the structural brain changes varied between patients who characterized their symptoms primarily as pain, rather than non-painful discomfort,” said Mayer, director of the UCLA Center for Neurobiology of Stress. “In contrast, the length of time a patient has had IBS was not related to these structural brain changes.”
Mayer added that the next steps in the research will include exploring whether genes can be identified that are related to these structural brain changes. In addition, there is a need to increase the study sample size to address male-female differences and to determine if these brain changes are a cause or consequence of having IBS.
The study was funded by the National Institutes of Health.
Additional authors include M. Catherine Bushnell, Ph.D., of McGill University, and Jennifer B. Labus, Joshua A. Bueller, Kirsten Tillisch and Bruce D. Naliboff, Ph.D., all of UCLA.
As an example of a picky eater who would not be classified as having an eating disorder, Marcus referenced a woman who spoke on a radio program recently. The woman declared herself “the pickiest eater I've ever met” and explained that the thought of eating any cooked vegetable made her sick, though she didn't mind them raw.
“That is not a disorder,” said Marcus. “She has plenty of other foods to choose from and it's not affecting her health or well-being.”
In her practice at Western Psych, Marcus doesn't see many adults that she would classify as having such a disorder. “I think people don't identify themselves as having an eating disorder and it hasn't been considered an eating disorder,” she said. “They don't come to us.”
At Duke, Zucker encounters adult picky eaters mainly as the parents of children that she is treating for picky eating or other eating disorders.
Adults who are picky tend to like bland foods that are comfortable and colorless, said Marcus, such as plain pasta or french fries.
In both children and adults, picky eating can be caused by “food neophobia,” otherwise known as the fear of new foods, by sensory sensitivity to particular textures, or by traumatic experiences such as forced eating.
Still, the vast universe of picky eaters is poorly defined, Zucker said.
“It's been a pretty poorly operationalized construct — what it means to be a picky eater,” she said. “There's a lot of different definitions floating around. What we'll find is a huge continuum — we all have food quirks.”
Source: Pittsburgh Post-Gazette
The team set out to examine levels of depression and anxiety between adults with celiac disease following a gluten-free diet and in control subjects drawn from the general population.
For their study, the team used the Hospital Anxiety and Depression Scale to measure levels of anxiety, depression, and likely anxiety or depressive disorder, in 441 adult patients with celiac disease recruited by the German Celiac Society. They then conducted the same assessments on 235 comparable patients with inflammatory bowel disease (IBD), either in remission or with slight disease activity. They did the same for the cross-sample control group of 441 adults from the general population.
The team used regression analysis to test possible demographic and disease-related predictors of anxiety and depression in celiac disease. Demographic predictors included age, sex, social class, and family status. Disease-related predictors included Latency to diagnosis, duration of GFD, compliance with GFD, thyroid disease.
The team found that female gender (P = 0.01) was the main predictor (R(2) = 0.07) of anxiety levels in patients with celiac disease. Female patients had a higher risk for a probable anxiety disorder (OR = 3.6, 95% CI: 1.3-9.4, P = 0.01) Patients who lived alone (OR = 0.5, 95% CI: 0.2-0.9, P = 0.05) enjoyed a lower risk of anxiety disorder. None of the demographic and medical variables for which the team screened predicted either depression levels or risk for a probable depressive disorders.
Patients with celiac disease showed anxiety levels of 6.6 +/- 3.4, and those with IBD, anxiety levels of 6.9 +/- 3.7, both higher than the general population's level of 4.6 +/- 3.3 – (both P < 0.001). Depression levels were similar for people with celiac disease (4.2 +/- 3.4), IBD (4.6 +/- 3.4) and the general population (4.2 +/- 3.8) (P = 0.3). Rates of likely anxiety disorders in people with celiac disease were 16.8%, and 14.0% for IBD, both higher than the rates of 5.7% in the general population (P < 0.001). All three groups showed similar rates of probable depressive disorder (P = 0.1).
Their results provide strong indications that adult women with celiac disease on a gluten-free diet suffer higher rates of anxiety than persons of the general population. They encourage clinicians to provide anxiety screens for adult women with celiac disease on a gluten-free diet.
“Once we know the exact causes of type 2 diabetes, we can develop more effective prevention and therapy strategies,” said Dr. Thomas Illig, research group leader at the Institute of Epidemiology of Helmholtz Zentrum München and one of the corresponding authors of the study. Dr. Cornelia Huth, who played a key role in the selection of the study participants and the analyses of Helmholtz Zentrum München, added: “What enabled us to identify these factors with a high level of confidence is the large number of investigated subjects in this collaborative study. Each factor by itself contributes only slightly to the entire diabetes risk. But to find out more about the pathogenic mechanisms of the disease, even these slight contributions are important.” Dr. Christian Herder and Dr. Wolfgang Rathmann, both of whom are research group leaders at the German Diabetes Center, pointed out: “One important finding of the new study is that some of the gene loci associated with increased type 2 diabetes risk are also risk variants for other diseases such as coronary heart disease, autoimmune diseases and cancer. This suggests that specific proteins could be relevant for several diseases at the same time.”
Type 2 diabetes is a disorder of glucose homeostasis. Characteristic features of this disorder are that the effect and sufficient production of the hormone insulin become lost. The pathogenic mechanisms of this disease are not yet fully understood. It is known, however, that the combination of genetic susceptibility and lifestyle factors leads to diabetes. In Germany alone, not less than seven percent of the population has been diagnosed with the disease – altogether almost six million people. Additionally, studies show that several million men and women in Germany suffer from as yet undiagnosed and thus untreated diabetes.
To this end, the following emotional variables have been specified: those relative to emotional experience —the frequency of positive and negative emotions, anxiety, low self-esteem and the influence of diet, weight and the body shape on the emotional state—; negative perception of emotions, negative attitude to emotional expression, alexithymia —the inability to identify own emotions and to express them verbally— and the manner of controlling negative emotions.
Moreover, another variable has also been taken into account: the need for control. This variable is not strictly emotional, but has a clear emotional component, given that people with a high need for control, experience anxiety and unwellness when perceiving lack of control.
Study of women
In order to undertake the study, 433 women took part; 143 of these suffered from some kind of eating disorder and 145 in risk of contracting one. The results of the study show that, in general, the majority of the variables put forward can be used as predictive of suffering an eating disorder. The variables which, above all, alert to greater risk of developing an eating disorder are when the emotional state of the person is excessively influenced by diet, weight and body shape, when self-esteem is low, and when, in anxiety situations, emotions are not expressed and the person tends to act in an impulsive manner.
These results have important implications, above all when drawing up prevention programmes for eating disorders. With the data obtained, it can be said that many of the emotional variables dealt with in Ms Pascual's work should be taken into account when drawing up these prevention programmes.
Eating disorders are very serious illnesses that have dire consequences for the sufferer, both physically as well as psychologically and socially, and there are disorders that are evermore widespread. Much research has been undertaken in order to find out the factors involved in their development, but the role played by the various emotional variables at the onset of these disorders has hardly been investigated. This thesis presented at the UPV/EHU focused on this matter more deeply.
Dietitians and other health professionals have long recognized the importance of establishing healthful nutrition practices during teenage years. Diet and exercise patterns adopted during these prime developmental years set the stage for life-long habits that can mean the difference between vitality and infirmity in later years.
Your calorie needs vary depending on your growth rate, degree of physical maturation, body composition, and activity level. However, you do need extra nutrients to support the adolescent growth spurt, which, for girls, begins at ages 10 or 11, reaches its peak at age 12, and is completed by about age 15. In boys, it begins at 12 or 13 years of age, peaks at age 14, and ends by about age 19.
In addition to other nutrients, adequate amounts of iron and calcium are particularly important as your body undergoes this intensive growth period. From ages nine to 18 years, both males and females are encouraged to consume a calcium-rich diet (1,300 milligrams daily) in order to ensure adequate calcium deposits in the bones. This may help reduce the incidence of osteoporosis in later years. The recommended calcium intake can be achieved by getting at least three cups of fat-free or low-fat milk daily or the equivalent amount of low-fat yogurt and/or low-fat cheese. For those who don’t wish to consume dairy products, a variety of other calcium sources are available such as green, leafy vegetables, calcium-fortified soy products, and other calcium-fortified foods and beverages.
To meet energy needs, teenagers should eat at least three meals a day, beginning with breakfast. Studies show eating breakfast affects both cognitive and physical performance; that is, if you eat breakfast, you may be more alert in school and better able to learn and to perform sports or other physical activities.
Snacks also form an integral part of meal patterns for teenagers. You often cannot eat large quantities of food at one sitting and often feel hungry before the next regular mealtime.Healthy mid-morning and midafternoon snacks may be appropriate for you you.
Fast-growing, active teenagers may have tremendous energy needs. Although your regular meals can be substantial, you may need snacks to supply energy between meals and to meet your daily nutrient needs. If you are less active or who have already gone through the growth spurt, you may need to cut out the snacking.
Teenager’s food choices are often influenced by social pressure to achieve cultural ideals of thinness, gain peer acceptance, or assert independence from parental authority. These factors may increase your risk for developing eating disorders. An eating disorder is an emotional and physical problem that is associated with an obsession with food, body weight, or body shape. A teenager with an eating disorder diets, exercises, and/or eats excessively as a way of coping with the physical and emotional changes of adolescence. The three most common types of eating disorders are anorexia, bulimia, and binge eating. Each type has its own symptoms and diagnosis.
According to the National Mental Health Information Center, as many as 10 million girls and women and one million boys and men are struggling with eating disorders such as anorexia nervosa (a disorder causing people to severely limit their food intake) or bulimia (a disorder in which people binge and purge by vomiting or using laxatives). Both anorexia and bulimia can lead to convulsions, kidney failure, irregular heartbeats, osteoporosis, and dental erosion. Those suffering from compulsive overeating or binge-eating disorder are at risk for heart attack, developing high blood pressure and high cholesterol, kidney disease and/or failure, arthritis, bone deterioration, and stroke.
Seeing a dietitian like Nastaran for medical nutrition therapy as well as seeing a medical specialist for psychotherapy are two integral components in the treatment of eating disorders. These are such complex illnesses that the expertise of multidisciplinary healthcare professionals is required.
Overweight and Obesity
Adults are not alone in the concern about weight management. In addition to the increase in the prevalence of adults who are obese or overweight, adolescent and childhood obesity and overweight are also on the rise.
Data from the US National Health and Nutrition Examination Survey (NHANES 2003-2004), indicate that 14 percent of two to five year olds and 17 percent of children and adolescents ages 12-19 years in the United States are overweight. The prevalence of overweight children and adolescents has quadrupled and tripled, respectively, in the last 30 years. Only a small percentage of overweight children may attribute their problem to endocrine disorder or other underlying physical problems. Overweight and obesity can be determined by Body Mass Index (BMI).
If you are overweight, you need to reduce the rate of weight gain while still allowing for growth and development. Overweight children and adolescents are more likely to be overweight or obese as adults. Therefore, health professionals emphasize healthful eating and the importance of physical activity as a life-long approach to weight management and to overall good health and quality of life. Before going on a diet, a healthcare provider and/or dietitian like Nastaran should always be consulted.
Strong bones, good muscle tone, and lower risk of developing chronic diseases are some of the key benefits derived from regular physical activity. Furthermore, being physically active promotes psychological well-being and reduces feelings of depression and anxiety. According to the Centers for Disease Control and Prevention/Division of Adolescent and School Health, 77 percent of children aged nine to 13 years participate in free-time physical activity and only 39 percent engage in organized physical activity. Among high school students, 63 percent participate in vigorous physical activity and just 25 percent engage in sufficient moderate physical activity. Twelve percent engage in little or no physical activity at all.
Participation in physical activity tends to decline as you get older. The long-term consequences of physical inactivity include an increased risk of type 2 diabetes, high blood pressure, high blood cholesterol, asthma, arthritis, and premature death. To maintain good health status you should engage in at least 60 minutes of physical activity on most, preferably all, days of the week
Source: International Food Information Council
Researchers aren't sure why there could be a link between the mode of delivery and celiac disease, but one possible explanation is that children born via C-section don't pick up the same microbes from their mothers as babies that pass through the vaginal canal, Hornef said. This alters the infant's colonization with gut microflora, or “good” microbes, that aid in digestion and fending off pathogens.
Previous research suggests there are differences in the intestinal bacterial flora between children born vaginally or by C-section.
“We are only beginning to understand the complexity of the host-microbial interaction at the intestinal mucosa, and it is difficult to make firm conclusions at this stage,” Hornef said.
Does any of this suggest that women with a personal or family history of celiac disease avoid C-sections? According to both Green and Hornef, it's too early to make firm recommendations.
“I think our data are not evidence enough to already make a medical recommendation, but rather they shed light on a possibly ill-studied issue,” Hornef said. “The data first need to be confirmed.”