Department of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, MI.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
J Dev Behav Pediatr. 2023 May 1;44(4):e277-e283. doi: 10.1097/DBP.0000000000001173. Epub 2023 Apr 4.
When adolescents present with symptoms of unexplained weight loss, underweight, or poor appetite, eating disorders (EDs) are commonly on the list of differential diagnoses. However, the relationship of these symptoms to other psychiatric disorders is often less clear.
Using the Rochester Epidemiology Project database, a retrospective cohort study of adolescents (13-18 years) with billing diagnoses of weight loss, underweight, or loss of appetite was conducted between January 2005 and December 2017. Patients who presented with conditions commonly associated with weight loss, underweight, or poor appetite (e.g., cancer) were excluded. This study sought to examine the proportion of patients who received ED and psychiatric diagnoses within 5 years of the index visit and patient characteristics associated with these diagnoses.
Of 884 patients diagnosed with symptoms of unexplained weight loss, underweight, or poor appetite, 662 patients ( M age = 15.8; SD = 1.6; 66.0% female) met study criteria. Within 5 years of the index visit, the lifetime prevalence of all psychiatric disorders was 70% (n = 461) and of EDs was 21% (n = 141). For both psychiatric disorders and EDs, sex and race were significantly associated with receiving a diagnosis within 5 years. Decrease in body mass index (BMI) percentile was associated with receiving an ED diagnosis, whereas the highest historical BMI percentile was associated with receiving a psychiatric diagnosis.
Patients presenting with symptoms of unexplained weight loss, underweight, or poor appetite are at risk not only for EDs but also for other psychiatric disorders that may require further assessment and follow-up.
当青少年出现不明原因的体重减轻、体重过轻或食欲不振等症状时，饮食失调（ED）通常是鉴别诊断的重点。然而，这些症状与其他精神障碍的关系通常不太明确。
本研究使用罗切斯特流行病学项目数据库，对 2005 年 1 月至 2017 年 12 月期间出现体重减轻、体重过轻或食欲不振症状的青少年（13-18 岁）进行了回顾性队列研究。排除了出现与体重减轻、体重过轻或食欲不振相关的常见疾病（如癌症）的患者。本研究旨在调查在指数就诊后 5 年内接受 ED 和精神诊断的患者比例，以及与这些诊断相关的患者特征。
在 884 例被诊断为不明原因体重减轻、体重过轻或食欲不振的患者中，有 662 例患者（ M 年龄=15.8；SD=1.6；66.0%为女性）符合研究标准。在指数就诊后 5 年内，所有精神障碍的终身患病率为 70%（n=461），饮食失调的患病率为 21%（n=141）。对于精神障碍和 ED，性别和种族与 5 年内获得诊断显著相关。体重指数（BMI）百分位下降与 ED 诊断相关，而历史最高 BMI 百分位与精神诊断相关。
出现不明原因体重减轻、体重过轻或食欲不振症状的患者不仅有患 ED 的风险，还有其他精神障碍的风险，可能需要进一步评估和随访。
