Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Australia; Department of Adolescent Medicine, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
J Adolesc Health. 2018 Dec;63(6):717-723. doi: 10.1016/j.jadohealth.2018.08.019.
Adolescents with atypical anorexia nervosa (AAN) can experience severe physical complications despite not being underweight, posing questions about the contribution of weight loss to complications experienced in restrictive eating disorders (EDs). This study compared total weight loss and recent weight loss with admission weight as predictors of physical and psychological complications.
Retrospective (2005-2010) and prospective (2011-2013) studies were undertaken of 12- to 19-year-old hospitalized adolescents with anorexia nervosa (AN) or AAN, defined as meeting criteria for AN except underweight (≥85% median body mass index). Predictors were total weight loss (from lifetime maximum), recent weight loss (past 3 months), and admission weight. Outcomes were hypophosphatemia, clinical, anthropometric, and psychometric markers during admission.
In 171 participants (AN, 118 [69%]; AAN, 53 [31%]), there was little evidence of an association between weight measures and hypophosphatemia. Greater total weight loss (regression coefficient [Coeff]: -1.70, 95% confidence interval [CI]: -2.77, -.63, p = .002) and greater recent weight loss (Coeff: -3.37, 95% CI: -5.77, -.97, p = .006), but not admission weight, were associated with a lower pulse rate nadir. Greater total weight loss (odds ratio [OR]: 1.70, 95% CI: 1.19, 2.24, p = .003) and greater recent weight loss (OR: 2.12, 95% CI: 1.11, 4.02, p = .02) were also associated with a higher incidence of bradycardia.
In adolescents with restrictive EDs, total weight loss and recent weight loss were better predictors than admission weight of many physical complications. This suggests that future diagnostic criteria for AN place greater emphasis on weight loss.
尽管非典型厌食症（AAN）患者体重正常或超重，但仍可能出现严重的身体并发症，这对限制型饮食障碍（ED）患者的并发症与体重减轻之间的关系提出了质疑。本研究比较了总减重和近期减重与入院时体重作为预测身体和心理并发症的指标。
对 12 至 19 岁因厌食症（AN）或 AAN 住院的青少年进行回顾性（2005-2010 年）和前瞻性（2011-2013 年）研究，定义为符合 AN 标准但体重不足（≥85%中位数体重指数）。预测因子为总减重（来自终生最高值）、近期减重（过去 3 个月）和入院时体重。结果为入院时低磷血症、临床、人体测量和心理测量标志物。
在 171 名参与者（AN，118 [69%]；AAN，53 [31%]）中，体重测量值与低磷血症之间几乎没有关联的证据。总减重越大（回归系数[Coeff]：-1.70，95%置信区间[CI]：-2.77，-.63，p=0.002）和近期减重越大（Coeff：-3.37，95%CI：-5.77，-.97，p=0.006），而入院时体重与脉搏率最低值无关。总减重越大（比值比[OR]：1.70，95%CI：1.19，2.24，p=0.003）和近期减重越大（OR：2.12，95%CI：1.11，4.02，p=0.02）也与心动过缓的发生率增加有关。
在限制型 ED 青少年中，总减重和近期减重比入院时体重更能预测许多身体并发症。这表明，未来的 AN 诊断标准将更加重视体重减轻。
