Abstract
ABSTRACTObjective:To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease.Methods:A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders.Results:Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75th percentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85th percentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occured at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index).Conclusion:One-third of the eating disorder group had menstrual disorder – two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25–50 in anorexia nervosa, and 50–75, in eating disorder not otherwise specified.
Highlights
Eating disorders (ED) in children and adolescents continue to be a serious problem and may result in premature death or life-long medical and psychosocial morbidity.(1) ED are classified according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).(2)ED have a peak incidence in adolescence and in females
ED diagnosis criteria cannot be fully applied to children and adolescents, making it difficult to establish the rates of ED in this population.(3) EDNOS is described as the most prevalent type.(4-6) In a Portuguese study of female students aged 12 to 23, EDNOS accounted for 77.4% of ED.(6) The prevalence of AN in adolescents is 0.3 to 2.2%, and DSM-IV diagnostic criteria of BN are met by 0.1 to 2% of adolescents.(3)
There is a relationship between age of menarche and body mass index (BMI), with an earlier menarche associated with a higher BMI.(5) An hypothalamic etiology is the most prevalent cause of amenorrhea in adolescence, followed by polycistic ovary syndrome and ED.(4,5) Amenorrhea is responsible for significant morbidity, such as decreased bone mineral density or endometrial carcinoma, and is pathological.(4) Most bone acquisition occurs during early childhood and late adolescence
Summary
Eating disorders (ED) in children and adolescents continue to be a serious problem and may result in premature death or life-long medical and psychosocial morbidity.(1) ED are classified according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).(2)ED have a peak incidence in adolescence and in females. The DSM-5, released in May 2013, proposes some significant changes for the diagnosis of ED, among which the removal of amenorrhea criteria from the diagnosis of AN; a separate diagnosis of binge-eating disorders will be added, which falls under the diagnosis of EDNOS; and in BN, the number of episodes per week of binging and purging will be reduced to one. These changes in DSM 5, with less strict criteria for AN and BN and a new ED diagnosis, will reduce the prevalence of EDNOS.(6). Without normal cycling of LH and FSH, the circulating level of estrogen is very low and ovulation will not occur.(4,5) Approximately 20% of patients with AN develop amenorrhea before significant weight loss.(5) Nutritional rehabilitation and weight recovery favor the resolution of amenorrhea.(4,5)
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