97 Active Surveillance of Early-Onset Eating Disorders, Prader-Willi Syndrome and Vitamin D Deficiency Rickets

Abstract

Objective: CPSP undertook 2-year surveillance of three nutrition and growth-related conditions: early-onset eating disorders (EOED), Prader-Willi syndrome (PWS) and vitamin D deficiency rickets (VDDR). Canadian incidence estimates were needed to test hypotheses that EOED cases are being missed because current diagnostic criteria do not apply to children aged 5–12 years, that early identification of PWS and related-obesity as well as increasing cases of VDDR are public health issues. Methods: Over 2400 paediatricians reported cases of uncommon high morbidity/mortality diseases by mailing a check off form monthly. For each report, a detailed questionnaire was completed. The response rates were 83% for initial reports and 96% for questionnaires. Results: The EOED study confirmed 138 cases in children aged 5–12 years. The female to male ratio was 8:1 compared to 10:1 in older age groups. Food avoidance was a predominant clinical feature. Children displayed preoccupation with food and fear of gaining weight. The mean weight loss was 7.8 kg. The majority had no comorbid psychiatric diagnosis; however, 44% had a positive psychiatric family history and 54% experienced changes in social situations. Bradycardia was the most common medical complication. The PWS study identified 35 genetically confirmed cases, diagnosed at a mean age of three years. Of the 28 with available data, 25 had infantile feeding problems and 43% had gained excess weight between 1–6 years of age. The VDDR study confirmed 104 cases. Ninety were infants and toddlers with intermediate and dark skin who had been exclusively breastfed without appropriate vitamin D supplementation. The most frequent signs and symptoms at diagnosis were: skeletal deformity, seizures, failure to thrive, fractures, and delayed milestones. Conclusions: The findings indicate a need for creating developmentally appropriate EOED diagnostic criteria, for identifying PWS early and for heightened awareness of rickets prevention among health care providers