Serum leptin and body weight in females with anorexia and bulimia nervosa

In this study we hypothesized that there is a correlation between serum leptin levels and body mass indices within patients with anorexia nervosa or bulimia nervosa during a twelve weeks' course of in-patient treatment. We evaluated leptin levels weekly in female in-patients with anorexia (n = 17) or bulimia nervosa (n = 18). Only patients with anorexia nervosa were therapeutically encouraged to gain weight throughout the treatment episode. For the whole cohort, body mass indices and serum leptin levels were highly correlated upon admission (r = 0.89, p < 0.001). The median intra-individual correlation in the anorexia group was higher than in the bulimia group (0.63 and 0.39, respectively). The intra-individual correlations were higher in those anorexia nervosa patients who showed increments of their body mass index within the observation span. This dynamic aspect is important specifically in patients with anorexia nervosa during therapeutically induced weight gain.     

Some aspects of the relationship between body weight and sexual behaviour with particular reference to massive obesity and anorexia nervosa

There is some evidence for the existence of a precise weight/fat threshold for puberty. Following puberty, body weight and shape take on important new psycho-social significances for both males and females. Adolescent females usually strive to reduce their 'fatness' even it is not excessive from a biological standpoint. Super-obesity and anorexia nervosa are two human disorders of weight and fatness, more common in women, and importantly related to disturbances of sexual behavior, metabolic, social and experiential. These latter aspects sometimes at least reflect the presence of several factors which have contributed to the development of the disorders. Anorexia nervosa in particular reflects the adaptive psychosocial needs of the person concerned. Attention to this aspect during treatment will often allow the patient to tolerate the major weight gain required for recovery, thereby at the same time providing a paradigm for aspects of the pubertal process which can then be studied. The results of some such investigations together with related studies of the super-obese are reported here.     

Equivalence of body image disturbances in anorexia and bulimia nervosa.

A silhouette method, the Body Image Assessment, was used to measure self-evaluation of current and ideal body size in 3 groups: Ss with anorexia nervosa (n?=?37), Ss with bulimia nervosa (n?=?59), and normal control Ss (n?=?95). Current and ideal body size measures were contrasted across the 3 groups using body mass index as a covariate to control for the Ss' actual body size. Both eating disorder groups judged current body size to be larger and ideal body size to be thinner relative to control Ss. When actual body size was not statistically controlled, Ss with anorexia nervosa judged current body size to be thinner than did control Ss and Ss with bulimia nervosa. Data illustrate the importance of controlling for actual body size when investigating the self-evaluation of body size. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implicit and explicit memory for shape, body weight, and food-related words in patients with anorexia nervosa and nondieting controls.

Twelve patients with anorexia nervosa and 12 control participants watched a series of 64 words. There were 4 word types: anorexia related, positive, negative, and neutral. The last 3 types were anorexia unrelated. Anorexia-related words had the same affective valence as the neutral control words. Next, the participants completed an explicit memory test ( cued recall ) and an implicit memory test (word stem completion). Results showed a strong explicit memory bias for anorexia-related words for patients with anorexia nervosa but not for nondieting controls. There was no evidence for a similar bias in implicit memory. Results are discussed in the context of cognitive biases in psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological consequences of extreme weight loss and dietary restriction in patients with anorexia nervosa

This study examined the effects of weight loss and nutritional status on the cognitive performance of patients with anorexia nervosa. The intellectual, memory, attentional, verbal fluency and visuospatial abilities of 34 females with anorexia were compared to that of 31 normal weight-for-height females. Group differences in anxiety and depression were found but neither variable was related to the cognitive performance of patients with anorexia. Moreover, nutritional status and weight loss bore little relationship to the cognitive scores of the patient group. Overall, patients with anorexia were found to be deficient in their ability to recall meaningful prose and visuospatial information. The failure to find many cognitive deficits in this sample may reflect the fact that few patients with anorexia exhibited frank nutritional deficiencies.     

Tolerance to amphetamine anorexia: Role of learning versus body weight settling point.

Conducted 3 experiments with male Sprague-Dawley rats to study the development of tolerance to amphetamine (AM) anorexia. In Exp I, 19 Ss that had become tolerant to the suppressant effect of AM on milk intake were anorexic when offered other foods or water. These results appear to support a conditioning interpretation. In Exps II (38 Ss) and III (24 Ss), Ss made tolerant with milk as the diet showed prolonged anorexia when switched to Purina pellets or slightly bitter milk; but when switched from pellets or adulterated milk to milk, tolerant Ss were anorexic only 1 day and then ingested significantly more of the new diet. Results are inconsistent with a conditioning interpretation. Tolerant Ss maintained their weight below the level of saline controls despite the recovery of food intake, and the level at which they maintained their weight varied with the palatability of the diet. These results suggest that AM lowers the settling point for body weight and that tolerance to this effect does not develop. Thus, the reinstatement of prolonged anorexia when apparently tolerant Ss were switched to a less palatable diet can be understood as an attempt to attain a lower weight level. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa

OBJECTIVE: The purpose of this study was to assess the course and outcome of anorexia nervosa and bulimia nervosa at 1 year in a large cohort of women with eating disorders. METHOD: A prospective, naturalistic, longitudinal design was used to map the course of 225 women with anorexia nervosa, bulimia nervosa, and mixed anorexia and bulimia nervosa. Structured interviews were conducted quarterly. Follow-up data are presented in terms of patterns of recovery, clinical features predictive of time to recovery, and the role of comorbid disorders as fixed predictors. RESULTS: The recovery rate of bulimics was significantly better than that of anorexic or mixed subjects, yet nearly half the anorexic and mixed subjects no longer met full DSM-III-R criteria for at least 8 consecutive weeks during the first year of follow-up. Percent ideal body weight and type of eating disorder were significantly associated with outcome. CONCLUSIONS: Our findings suggest that the diagnosis of anorexia nervosa has severe implications.     

Course and outcome in adolescent anorexia nervosa

OBJECTIVE: To investigate course, outcome, and psychiatric comorbidity in adolescent anorexia nervosa by repeated follow-up assessment. METHOD: Thirty-four subjects (88%) of an original sample of 39 inpatients were followed up personally 3 and 7 years after discharge and classified according to DSM-III-R eating disorder categories. Standardized psychometric instruments were used to assess specific eating disorder symptoms, concomitant general psychopathology, and comorbid psychiatric diagnoses. RESULTS: After 7 years, 1 patient (3%) had anorexia nervosa, 4 patients (12%) bulimia nervosa, and 10 patients (29%) eating disorder not otherwise specified (EDNOS). Anxiety disorders (41%) and affective disorders (18%) were the most prevalent comorbid psychiatric disorders. Concomitant general psychopathology was significantly related to the outcome of the eating disorder. CONCLUSIONS: According to our results, the majority of former adolescent anorexic inpatients had shown substantial improvement in their eating disorders symptomatology after 7 years. Patients with persisting eating disorders mostly suffered from restrictive symptoms. The prevalence and distribution of psychiatric comorbidity were similar to those of adult-onset anorexia nervosa. Subjects with a worse outcome of the eating disorder also displayed higher levels of general psychopathology.     

The prediction of total body water from bioelectrical impedance in patients with anorexia nervosa

A simple mathematical model is proposed that predicts the dynamics of chronic progressive renal disease. The model consists of coupled linear differential equations formed from three state variables, four control parameters, and three parameters related to initial conditions. All have straightforward physical interpretations. Applied to a population of nephrons, the model predicted the hypertrophic and sclerotic features of parenchyma progressing towards end-stage renal disease. Simulation results compared favorably with measurements obtained from the literature involving the subtotal nephrectomy rat model for renal disease. The time course of disease progression and treatment were considered. Also, the implications of the model for designing new diagnostic techniques using ultrasonic analysis are discussed.     

Inpatient treatment of anorexia nervosa: review and recommendations

Inpatient treatment of anorexia nervosa, difficult and at times complex, has been shown to promote enduring change. An integrated treatment approach that includes medical, psychological, nursing, and social interventions can restore patients to a healthy weight, improve abnormal eating behaviors, and ameliorate many of the central psychopathological attitudes and illness-driven behaviors characteristic of the disorder. This article reviews inpatient treatment of anorexia nervosa, evaluating empirical studies and providing a critique of their methodology and potential applicability, combining available published studies with clinical experience to suggest a comprehensive pragmatic treatment approach, and noting research needs for the future. More controlled double-blind studies are urgently needed to assess virtually every aspect of inpatient care, especially methods for promoting safe and rapid weight restoration. Comparative studies on the efficacy of behavioral, psychotherapeutic, and pharmacological approaches and determination of the optimum step-wise preparation for discharge into a weight-preoccupied society are also needed.     

Relationship of premorbid mass and energy intake to increase of body mass during the treatment of anorexia nervosa

We studied 152 healthy pregnant women and their 156 newborns for markers of hepatitis B virus (HBV) infection in Dakar, Senegal. Of these, 120 mothers (79%) had antibodies to the hepatitis B core antigen (anti-HBc), 21 (13.8%) were hepatitis B surface antigen (HBs Ag) positive, including 2/21 (9.5%) hepatitis B core-associated antigen (HBe Ag) positive and 1/21 (4.7%) HBV DNA positive. At birth, 11 (7%) infants were HBs Ag positive; 9/11 had an HBs Ag positive mother. Ten of these HBs Ag positive-born infants were investigated at 6-7 months: 5 were strongly HBs Ag positive and developed antibodies to HBs Ag, HBc Ag or HBe Ag; these 5 (3.2% of the total) probably became chronic carriers of HBV. The 5 others were HBs Ag negative and 4/5 did not develop antibodies against HBV Ag; HBs Ag positivity at birth was likely due to contamination of the mother's blood. Thirty-one of the 145 HBs Ag negative-born infants were studied at 6-7 months and remained HBs Ag negative. However, 5 (16%) showed evidence of HBV infection occurring between 0 and 6 months, as shown by the development of antibodies to HBs Ag, HBc Ag, and/or HBe Ag. Despite the low prevalence of HBV DNA and HBe Ag in HBs Ag positive African mothers, this study shows the occurrence of perinatal transmission of HBV in West Africa, in contrast with previous studies. Perinatal HBV transmission could explain the HBV vaccination failure recently reported in children in Senegal.     

Understanding the relationship between body weight and osteoarthritis

Overweight people are at high risk of developing knee osteoarthritis (OA) and may also be at increased risk of hand and hip OA. Furthermore, being overweight accelerates disease progression in knee OA. While the increased joint stress accompanying obesity may explain the strong linkage between obesity and knee OA risk, it does not necessarily explain why obese people have a high risk of disease in the hand nor why obese women are at higher comparative risk of knee disease than obese men. Unfortunately, studies of metabolic factors linked to obesity have not provided an explanation for these findings. There are a paucity of data on weight loss as a treatment for OA, but preliminary information suggests it is especially effective in knee disease and that even small amounts of weight reduction may have favourable effects.     

Current approaches to the etiology and treatment of anorexia nervosa.

Reviews the literature on the incidence, clinical findings, and outcome of anorexia nervosa. Methodological problems with outcome statistics and data on the family background of anorexic patients are discussed. The etiological and therapeutic approaches of psychodynamic, family interactional, behavioral, and medical models are evaluated. The problems inherent in viewing anorexia nervosa as either a physiological or psychological disorder are considered. The importance of continuing research into all facets of anorexia nervosa is emphasized. (5? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating in anorexia nervosa and bulimia nervosa: An application of the tripartite model of anxiety.

Investigated anxiety in 40 women before, during, and after eating, as well as during an earlier neutral activity. Ss were 10 restricting-anorexics, 10 bulimic-anorexics, 10 bulimic, and 10 normal-weight females. Anxiety was assessed by self-report (ratings of pleasure, arousal, and anxiety), psychophysiological indicators (heart rate and skin conductance), and food consumption measures. Controls reported little or no anxiety and ate almost all of the test meal. The eating-disordered Ss reported a high level of anxiety throughout the study. Bulimics and controls ate similar amounts, whereas the anorexics ate much less. Psychophysiological arousal during eating was high in all groups. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adapted to flee famine: Adding an evolutionary perspective on anorexia nervosa.

Anorexia nervosa (AN) is commonly attributed to psychological conflicts, attempts to be fashionably slender, neuroendocrine dysfunction, or some combination of these factors. Considerable research reveals these theories to be incomplete. Psychological and societal factors account for the decision to diet but not for the phenomenology of the disorder; theories of biological defects fail to explain neuroendocrine findings that suggest coordinated physiological mechanisms. This article presents evidence that AN's distinctive symptoms of restricting food, denial of starvation, and hyperactivity are likely to be evolved adaptive mechanisms that facilitated ancestral nomadic foragers leaving depleted environments; genetically susceptible individuals who lose too much weight may trigger these archaic adaptations. This hypothesis accounts for the occurrence of AN-like syndromes in both humans and animals and is consistent with changes observed in the physiology, cognitions, and behavior of patients with AN. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypoleptinemia in patients with anorexia nervosa: loss of circadian rhythm and unresponsiveness to short-term refeeding

The human neurotropic papovavirus JC, a close relative of simian virus 40, has been associated with the formation of brain tumors in humans because of its ability to induce such tumors in other primates under experimental conditions. Here we have analyzed 30 brain tumors classified as either oligodendroglioma or astrocytoma and 22 cell lines derived from human gliomas for the presence of JC viral sequences using polymerase chain reaction with two different sets of primers. None of the tumors or cell lines contained JC viral sequences. Similarly, we failed to detect expression of JC T antigen in any of 26 human glioma lines analyzed in this study. We conclude that JC virus is not a major cause of human brain tumors.