Pugliese M T, Lifshitz F, Grad G, Fort P, Marks-Katz M
N Engl J Med. 1983 Sep 1;309(9):513-8. doi: 10.1056/NEJM198309013090901.
We evaluated 201 children for short stature or delayed puberty or both. Fourteen of them (nine boys and five girls, aged 9 to 17 years) fit a pattern of growth failure due to malnutrition, which was the result of a self-imposed restriction of caloric intake arising from a fear of becoming obese. All 14 patients underwent a complete history, physical examination, diagnostic laboratory evaluation, and psychiatric assessment. They were all below the fifth percentile for weight, and 11 of them were also below the fifth percentile for height. The deficit of weight for height ranged from 5 to 23 per cent. Seven of the older patients also had delayed puberty. All 14 patients had deteriorating linear growth, which was preceded by at least one to two years of inadequate weight gain. They ingested only 32 to 91 per cent of the recommended caloric intake for their age and frequently skipped meals. No gross psychiatric disease or anorexia nervosa was found; on the whole, they were good students with rather compulsive, shy personalities observed in an open-ended interview. The Diagnostic Interview for Children and Adolescents, which was conducted with seven patients, also revealed no psychiatric disease. After nutritional and psychiatric counseling, the patients resumed an adequate caloric intake for their age, and recovery occurred, as demonstrated by increased linear growth and sexual development.
我们对201名身材矮小或青春期发育延迟或两者皆有的儿童进行了评估。其中14名儿童（9名男孩和5名女孩，年龄在9至17岁之间）符合因营养不良导致生长发育迟缓的模式，这是由于害怕肥胖而自行限制热量摄入所致。所有14名患者均接受了全面的病史询问、体格检查、诊断性实验室评估和精神评估。他们的体重均低于第5百分位数，其中11人的身高也低于第5百分位数。身高对应的体重不足范围为5%至23%。7名年龄较大的患者还存在青春期发育延迟。所有14名患者的线性生长均出现恶化，在这之前至少有一到两年体重增加不足。他们摄入的热量仅为其年龄推荐热量摄入的32%至91%，且经常不吃饭。未发现明显的精神疾病或神经性厌食症；总体而言，在开放式访谈中观察到他们都是好学生，性格相当强迫、害羞。对7名患者进行的儿童及青少年诊断访谈也未发现精神疾病。经过营养和心理辅导后，患者恢复了适合其年龄的充足热量摄入，并出现了恢复情况，表现为线性生长增加和性发育。
