Linear growth in young people with restrictive eating disorders: “Inching” toward consensus

Downey, Amanda; Richards, Alexis; Tanner, Anna B.

doi:10.3389/fpsyt.2023.1094222

Cited by 7 publications

(4 citation statements)

References 61 publications

(76 reference statements)

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“…Illness duration was available for 475 adult patients. In order to assess growth retardation, we included patients who developed AN before completion of puberty and the associated growth spurt (<age 16) [ 7 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…Animal models of malnutrition show a delayed epiphyseal plate senescence, when conditions are restored, thus enabling catch-up linear growth [ 9 ]. Clinical studies evaluating height and growth in patients with AN yielded conflicting results for stunting [ 10 ]. Growth and pubertal delay were commonly reported in 27 studies included in a meta-analysis [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa—A Retrospective Chart Review

Gradl-Dietsch,

Peters,

Meule

et al. 2024

Nutrients

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Background: The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been reported in adolescent inpatients aged 15 years and younger that levels off at 15 to 18 years. BMIs standardized for age and sex (standard deviation scores, SDSs) were negatively correlated with age in these inpatients aged 8 to 18 years. Methods: The aims of the current retrospective study were threefold: first, to confirm the relationships of BMI, BMI-SDS and age in adolescent inpatients in a larger sample; second, to systematically assess the relationship of BMI, BMI-SDS, body height-SDS and age in adult inpatients at the time of referral; and third, to assess body height-SDSs and age to evaluate stunting. Results: We included 1001 girls (aged 12–17.9 years) and 1371 women (aged 18–73 years) admitted to inpatient treatment between 2014 and 2021. Mean BMI at admission was 14.95 kg/m2 (SD = 1.43; range 10.67–18.47) in adolescents and 14.63 kg/m2 (SD = 2.02; range 8.28–18.47) in adults. None of the adolescent patients but 20 adults had very low BMI values below 10 kg/m2. Adolescents showed a small but significant positive correlation between age and BMI (r = 0.12; p = 2.4 × 10−4). In adults, BMI was not correlated with age (r = −0.03; p = 0.3). BMI-SDSs was negatively correlated with age in adolescents and less so in adults (r = −0.35; p < 0.001 and r = −0.09; p = 0.001). Curve fit analyses for all patients indicated that there was a quadratic (age × age) relationship between age and BMI-SDS. Height correlated positively with BMI in adult (r = 0.1; p < 0.001) and adolescent (r = 0.09 p = 0.005) patients and we detected no evidence for stunting. Conclusions: In conclusion, the BMI of inpatients seems to be relatively stable across the age span with mean values between 14 and 15 kg/m2. BMI values initially increase with age in younger patients, drop between ages 18 and 23 and then slowly decline with age.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa—A Retrospective Chart Review

Gradl-Dietsch,

Peters,

Meule

et al. 2024

Nutrients

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“…After signature of the informed consent by the holder(s) of parental authority, target weight for weight normalisation will be calculated and participants will be randomised into one of the two trial arms. Weight normalisation is individualised and will be determined at inclusion and before randomisation to return to the previous BMI growth trajectory and is calculated by two different investigators [ 15 – 18 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison between continued inpatient treatment versus day patient treatment after short inpatient care in early onset anorexia nervosa (COTIDEA trial): a study protocol for a non-inferiority randomised controlled trial

Ayrolles,

Bargiacchi,

Clarke

et al. 2023

BMC Psychiatry

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Background In children with early-onset anorexia nervosa (first symptoms before 13 years old, EO-AN), experts recommend initial outpatient treatment but in-patient treatment (IP) is frequently indicated due to acute medical instability or for those who have not improved with outpatient treatment. This IP can target either a partial weight restauration or a total weight normalization (return to the previous BMI growth trajectory). There are no evidence in the literature on which is the better therapeutic option in EOAN. But as long length of stay induce social isolation, with elevated costs, we wonder if a stepped-care model of daypatient treatment (DP) after short IP stabilisation may be a treatment option as effective as full-time IP to target weight normalization. We designed a two-arm randomised controlled trial testing the non-inferiority of a stepped-care model of DP after short IP stabilisation versus full-time IP. Methods Eighty-eight children aged 8 to 13 years suffering from EOAN with initial severe undernutrition will be randomly allocated to either IP treatment as usual or a stepped care DP model both targeting weight normalization. Assessments will be conducted at inclusion, somatic stabilization, weight normalization, 6 months and 12 months post randomisation. The primary outcome will be BMI at 12 months post-randomisation. Secondaries outcomes will included clinical (tanner stage), biological (prealbumin, leptin, total ghrelin and IGF1) and radiological (bone mineralization and maturation) outcomes, eating symptomatology and psychiatric assessments, motivation to change, treatment acceptability and quality of life assessments, cost-utility and cost-effectiveness analyses. Discussion COTIDEA will provide rigorous evaluation of treatment alternative to full-time inpatient treatment to allow a reduction of social iatrogenic link to hospital length of stay and associated costs. Trial registration Trial is registered on ClinicalTrials.gov (NCT04479683).

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“…Patients with ARFID tend to have onset at an even younger age than those with AN (10.7 years compared to 12.7 for those with AN) [5][6][7][8], further increasing risk to growth and pubertal development. Linear height gain and pubertal progression, as well as bone and brain development, hinge upon nutritional adequacy and may all be adversely affected in children and young adolescents with ARFID [9][10][11] in potentially greater degree than has been recognized in those with AN. Despite this, no specific guidelines or recommendations have been developed to guide medical providers on assessing children and young adolescents with ARFID for growth concerns.…”

Section: Introductionmentioning

confidence: 99%

Assessing growth in children and adolescents with Avoidant/Restrictive Food Intake Disorder

Tanner,

Richmond

2024

J Eat Disord

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Background Although growth delays and disruption are a well described medical complication of restrictive eating disorders in children and young adolescents, this complication has received less attention in patients with Avoidant/Restrictive Food Intake Disorder (ARFID). Patients with ARFID have challenges with adequacy of food volume and variety that are not related to body image but are instead related to lack of interest in eating, sensory concerns, and/or fears of aversive consequences. Because onset of ARFID is commonly before puberty, concerns regarding growth adequacy may present an additional treatment challenge and a unique opportunity for support. Review Child and adolescent patients with other restrictive eating disorders are at risk of irreversible deleterious impact on growth and development, particularly when onset is before or around puberty. Although faltering growth is a defining feature of ARFID, less attention has been paid to methods for examining growth concerns in young patients with ARFID and training providers to assess growth adequacy when prepubertal and peripubertal patients present with this diagnosis. Providers working with patients under 18 years of age with eating disorders will benefit from the tools discussed in this narrative review to adequately assess growth and development against genetic potential, recognize alterations in growth that are a result of nutritional deficiencies, and support and maximize catch-up growth and development when it has been impaired. Conclusion Established pediatric growth monitoring tools and techniques to assess adequacy of growth can be applied to child and adolescent patients presenting with ARFID. These tools can improve long term outcomes in linear height for these patients and allow for monitoring during and after treatment until growth and development is complete. Medical providers caring for patients presenting with ARFID will need to establish best practices for assessing and monitoring growth.

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Linear growth in young people with restrictive eating disorders: “Inching” toward consensus

Cited by 7 publications

References 61 publications

Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa—A Retrospective Chart Review

Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa—A Retrospective Chart Review

Comparison between continued inpatient treatment versus day patient treatment after short inpatient care in early onset anorexia nervosa (COTIDEA trial): a study protocol for a non-inferiority randomised controlled trial

Assessing growth in children and adolescents with Avoidant/Restrictive Food Intake Disorder

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