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Nutrients
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Food Intake Disorders: Updates, Trends, and Challenges
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Food Intake Disorders: Updates, Trends, and Challenges

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (13 April 2023) | Viewed by 13430

Special Issue Editor

Prof. Dr. Ulrich Cuntz

E-Mail Website
Guest Editor
1. Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
2. Forschungsprogramm für Psychotherapieevaluation im komplexen Therapiesetting, PMU Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
3. Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8331150 Santiago, Chile
Interests: eating disorders; regulation of hunger and satiety; malnutrition; health risks of eating disorders; somatoform disorders; functional gastrointestinal disease; psychophysiology of the gastrointestinal tract; public health systems

Special Issue Information

Dear Colleagues,

Nutrition is the lynchpin in the treatment of eating disorders. On the one hand, the disturbed food intake in the context of eating disorders is the reason for the massive health risk that accompanies them. On the other hand, the normalisation of food intake triggers considerable psychological problems, states of anxiety, fears and resistance, so that a lasting stabilisation of health can only be achieved through psychotherapy.

Eating disorders are potentially life-threatening mental disorders. Energy deficiency, disturbances in the water balance and in the regulation of electrolytes, excessive exercise, dehydration and recurrent vomiting interfere so profoundly with the physiological regulation of the metabolism that anorexia nervosa in particular, but also other eating disorders, lead to life-threatening conditions. As a rule, threatening situations are imminent and can be recognised in advance. In these cases, therapeutic support, usually in an inpatient setting, is not only a way back to mental health, but obviously also contributes to preserving life—in this sense, it is psychotherapy for a vital indication.

Medical emergencies in eating disorders usually do not occur out of nowhere but are based on the eating disorder symptoms that have usually existed for a long time and, thus, leave behind clinical features that need to be recognised. In the vast majority of cases, there is a need to improve energy intake and prevent purging behaviours, i.e., therapeutic support for the affected patients is urgently required in addition to medical intervention. The increase in food intake, the securing of energy supply, and the cessation of vomiting and excessive exercise lead to a considerable increase in mental tension in those affected and can hardly be mastered without therapeutic support.

At present, many practitioners seem to be more afraid of the consequences of increasing food intake too quickly than the much more real fear of maintaining the lack of energy supply. Yet the signs of a 'refeeding syndrome' can be recognised with adequate medical supervision, and threatening physical conditions due to a rapid normalisation of energy intake can virtually always be avoided. In some respects, it is felt that the practitioners mirror the patients' fear of a rapid increase in nutrition.

This Special Issue of Nutrients is, therefore, dedicated to the health problems associated with eating disorders and at the same time to the ways in which those affected can be helped. We would be very pleased to receive a contribution from you.

Prof. Dr. Ulrich Cuntz
Guest Editor

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Keywords

  • nutrition
  • malnutrition
  • starvation
  • electrolyte disturbances
  • water misbalance
  • psychotherapy of eating disorders
  • health risks associated with ED
  • regulation of hunger and satiety

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Published Papers (4 papers)

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Research

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14 pages, 701 KiB  
Article
Inpatient Treatment Outcome in a Large Sample of Adolescents with Anorexia Nervosa
by Norbert Quadflieg, Silke Naab, Sandra Schlegl, Tabea Bauman and Ulrich Voderholzer
Nutrients 2023, 15(19), 4247; https://doi.org/10.3390/nu15194247 - 2 Oct 2023
Cited by 4 | Viewed by 2451
Abstract
Anorexia nervosa is an illness affecting primarily adolescent girls and young women. Clinical guidelines recommend early intervention, with inpatient treatment for more severe cases. We present an evaluation of a multi-modal cognitive–behavioral inpatient treatment (CBT-E) involving carers in specialized units for adolescents. Routine [...] Read more.
Anorexia nervosa is an illness affecting primarily adolescent girls and young women. Clinical guidelines recommend early intervention, with inpatient treatment for more severe cases. We present an evaluation of a multi-modal cognitive–behavioral inpatient treatment (CBT-E) involving carers in specialized units for adolescents. Routine data of 962 adolescent inpatients (26 boys) (mean age 15.48 [1.26]; range 12–17 years) were analyzed. Predictors of good body weight outcome (achieving a discharge BMI of at least 18.5 kg/m2) were identified by logistic regression analysis. Mean inpatient treatment lasted 96.69 (45.96) days. The BMI increased significantly from 14.93 (1.38) kg/m2 at admission to 17.53 (1.58) kg/m2 at discharge (z = 26.41; p < 0.001; d = 1.708). Drive for thinness decreased from 29.08 (9.87) to 22.63 (9.77; z = 18.41; p < 0.001; d = 0.787). All other subscores of the Eating Disorder Inventory also decreased significantly, with small to medium effect sizes. General psychopathology also showed significant decreases. The Beck Depression Inventory-II score decreased from 26.06 (11.74) to 16.35 (12.51; z = 18.41; p < 0.001; d = 0.883). A good body weight outcome was predicted by a higher BMI at admission (OR = 1.828), age at onset at 15 years or higher (OR = 1.722), and higher Somatization (OR = 1.436), Anxiety (OR = 1.320), and Bulimia (OR = 1.029) scores. CBT-E involving carers is an efficient intervention for adolescents with anorexia nervosa. Full article
(This article belongs to the Special Issue Food Intake Disorders: Updates, Trends, and Challenges)
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10 pages, 620 KiB  
Article
Virtually Accompanied Eating in the Outpatient Therapy of Anorexia Nervosa
by Melina Vogel, Aurora Gil, Camila Galaz, Pascuala Urrejola, Lucas Lacalle, Raúl Jara, Verónica Irribarra, Matias Letelier, Daniela Costa and Gabriela Espinoza
Nutrients 2023, 15(17), 3783; https://doi.org/10.3390/nu15173783 - 30 Aug 2023
Viewed by 1726
Abstract
Background: Normalizing the eating pattern and weight recovery are the main objectives in treating anorexia nervosa (AN). Eating accompaniment through shared mealtimes is a common strategy in eating disorder management programs. This study aims to examine the impact on weight gain of an [...] Read more.
Background: Normalizing the eating pattern and weight recovery are the main objectives in treating anorexia nervosa (AN). Eating accompaniment through shared mealtimes is a common strategy in eating disorder management programs. This study aims to examine the impact on weight gain of an internet-delivered meal support group on patients with AN who were under ambulatory treatment with the Eating Disorders Unit of the UC Christus Health Network, Chile. Methods: An observational study of 54 female patients with AN diagnosis who participated in Online Meal Support Groups (OMSGs) three times a week was performed. Their weight, BMI and BMI%, was reviewed at the beginning of the sessions and at 45- and 90-day follow-up. Results: Patients showed significant weight gain during follow-up. At the 90-day follow-up, patients had gained 4.41 (SD ± 2.82) kg with an effect size of −1.563. Conclusions: Statistically significant differences were found between the weight at the beginning of the intervention and at the 45- and 90-day follow-up, meaning that eating support online groups may be an effective intervention for weight gain and maintenance in patients with AN. These findings highlight the viability of developing cost-effective and more accessible interventions for AN and thus help reduce the duration of untreated disease and its consequences. Full article
(This article belongs to the Special Issue Food Intake Disorders: Updates, Trends, and Challenges)
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11 pages, 746 KiB  
Article
Health Risk and Underweight
by Ulrich Cuntz, Norbert Quadflieg and Ulrich Voderholzer
Nutrients 2023, 15(14), 3262; https://doi.org/10.3390/nu15143262 - 24 Jul 2023
Cited by 4 | Viewed by 3563
Abstract
Anorexia nervosa is associated with a significant risk of morbidity and mortality. In clinical practice, health risk is assessed and estimated using routinely collected laboratory data. This study will develop a risk score using clinically relevant laboratory parameters. The related question is how [...] Read more.
Anorexia nervosa is associated with a significant risk of morbidity and mortality. In clinical practice, health risk is assessed and estimated using routinely collected laboratory data. This study will develop a risk score using clinically relevant laboratory parameters. The related question is how to estimate the health risk associated with underweight using body weight, height and age. Methods: We used routinely collected laboratory parameters from a total of 4087 patients. The risk score was calculated on the basis of electrolytes, blood count, transaminases and LDH. The nine parameters used were summed as zlog-transformed values. Where appropriate, the scales were inverted so that high values represented higher risk. For statistical prediction of the risk score, weight/height and age reference values from the WHO, the CDC (Center of Disease Control) and representative studies of German children and adults (KIGGS and NNS) were used. Results: The score calculated from nine laboratory parameters already shows a convincing relationship with BMI. Among the weight measures used for height and age, the z-score from the CDC reference population emerged as the best estimate, explaining 34% of the variance in health risk measured by the laboratory score. The percentile rank for each age-specific median weight from the KIGGS/NNS still explained more than 31% of the variance. In contrast, percentiles explained less variance than BMI without age correction. Conclusions: The score we used from routine laboratory parameters appears to be an appropriate measure for assessing the health risk associated with underweight, as measured by the quality of the association with BMI. For estimating health risk based on weight, height and age alone, z-scores and percentages of age-specific median weight, as opposed to percentiles, are appropriate parameters. However, the study also shows that existing age-specific BMI reference values do not represent risk optimally. Improved statistical estimation methods would be desirable. Full article
(This article belongs to the Special Issue Food Intake Disorders: Updates, Trends, and Challenges)
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Review

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13 pages, 290 KiB  
Review
Endocrinology of Underweight and Anorexia Nervosa
by Christian Fricke and Ulrich Voderholzer
Nutrients 2023, 15(16), 3509; https://doi.org/10.3390/nu15163509 - 9 Aug 2023
Cited by 4 | Viewed by 5090
Abstract
More than any other mental illness, the course, prognosis, and therapy of anorexia nervosa are shaped by the physical changes associated with being underweight. This article provides an overview of the endocrine changes associated with malnutrition and underweight. This overview serves as a [...] Read more.
More than any other mental illness, the course, prognosis, and therapy of anorexia nervosa are shaped by the physical changes associated with being underweight. This article provides an overview of the endocrine changes associated with malnutrition and underweight. This overview serves as a basis for understanding the other articles in this special issue, which deal with the health risks associated with being underweight. In this context, the differences between underweight in anorexia nervosa and in constitutional thinness are of particular importance in assessing the impact of intentional weight loss. In this context, the regulation of hunger and satiety deserves special interest, as this is the area in which the intentional influence on body weight comes into play. Clinical consequences on, for example, fertility, bone metabolism, the homeostasis of, for example, serum glucose levels, or body temperature have been observed for a long time; nonetheless, the medical responses, apart from vitamin supplementations and advice to gain weight, are still limited. Therefore, emphasis was placed on the potential improvement of outcomes through the administration of central or peripheral hormones. Studies were identified on PubMed via a selection of relevant keywords; original texts that were cited in reviews were studied where it was advantageous. This review found some promising data on bone health and the administration of transdermal oestrogen, which is not yet widely used, as well as distinct hormonal markers to differentiate between CT and AN. We concluded that the continuous efforts to investigate the role of endocrinology in underweight and/or anorexia nervosa lead to outcome benefits and that more and higher-powered studies are needed. Full article
(This article belongs to the Special Issue Food Intake Disorders: Updates, Trends, and Challenges)
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