Marc S. Jacobson

Subclinical versus formal eating disorders: Differentiating psychological features

Sixty referrals to a Pediatric Eating Disorder clinic were compared on a number of demographic, clinical, and psychological variables. Twelve patients met definite diagnostic criteria for anorexia nervosa and 14 met criteria for a diagnosis of bulimia nervosa. Twenty-one patients had a subclinical form of anorexia nervosa and eight had subclinical bulimia nervosa. Five patients could not be classified. The subclinical and definite diagnostic groups were compared across a number of demographic, eating pathology, and general psychological variables. The results revealed a clear pattern of difference between the two bulimia nervosa groups on variables related to the regulation of affects and impulses. There was no clear pattern of difference between the definite and subclinical anorexia nervosa groups. The results suggest that the DSM-III-R criteria for anorexia nervosa may substantially underestimate the number of individuals with a psychologically distressing eating disorder, but provide tentative support for the maintenance of strict diagnostic criteria for bulimia nervosa.

Birth weight outcomes for repeat teenage pregnancy

To investigate the outcomes for repeat teenage pregnancy and the effect of interpregnancy interval on birth weight, birth certificate data were reviewed from all mothers under 26 years delivering their second baby during 1981-1983 at an urban teaching hospital. Initially, 409 mothers who had delivered their first baby at the same hospital were identified. Mothers were divided into three groups: mothers under 20 years for both births; mothers under 20 years for the first birth, with the second birth delayed until 20 to 25 years; and mothers 20-25 years for both births. Group 1 mothers had high but identical rates of low birth weight (17.5%) for both parities, high rates of very low birth weight infants (less than 1501 g), and no change in mean birth weight between the two pregnancies. Group 2 mothers were older at first birth and had better outcomes for first and second births than group 1 mothers. For group 1 mothers, the initiation of prenatal care was delayed at second pregnancy compared to first pregnancy (46% receiving first trimester care versus 59% at first delivery). In contrast, groups 2 and 3 showed improvement in accessing prenatal care for the second pregnancy. Interpregnancy interval had no influence on the birth weight of the second infant in any group.

Blunted growth hormone responses to clonidine in adolescent girls with early anorexia nervosa: Evidence for an early hypothalamic defect

We studied growth hormone (GH) levels in 14 adolescents with anorexia nervosa (AN), 12-20 years of age. All had amenorrhea and the duration of symptoms ranged from 2-24 months. There was no difference in unstimulated GH between the girls with AN and endocrinologically normal girls. However, the GH response to the alpha-adrenergic agent clonidine was blunted (less than 10 ng/ml) in 11 of 14 girls with AN. Our results of a normal basal GH level and blunted response to stimulation is in contrast to some reports of high basal GH levels and an exaggerated response to pituitary stimulation although it agrees with other studies. Our patient population was younger and at an earlier stage of the disease (12 with symptoms for less than 1 year) than the AN patients previously reported to have elevated GH secretion. In view of studies that report an elevated GH response to growth hormone releasing factor, our results suggest that the AN patients abnormalities in GH secretion may result from an abnormal hypothalamic response to adrenergic stimuli. This hypothalamic abnormality might also contribute to the growth failure seen in adolescent girls with AN.

Preface: The Rationale for this Conference

Adolescence is a time of rapid physiologic, psychological, and social development influencing nutrient needs as well as the individual’s ability to supply those needs. Disruptions in the balance between nutrient requirements and intake during adolescence impact on such major health problems as atherosclerosis, hypertension, obesity, anorexia nervosa, bulimia nervosa, and birth of suboptimal-weight infants. Dietary and exercise habits formed as the adolescent achieves increased independence have the potential to enhance or undermine health throughout life. Dietary indiscretion as another form of risk-taking behavior is a new concept worthy of scientific inquiry. This conference proceedings examines the key issues common to these nutritionally related disorders of adolescents in terms of macroand micronutrient requirements and their effect on growth and pubertal development. The investigators present data addressing the genetic, behavioral, and environmental contributors to these nutritional disorders, including diet, exercise, habitual physical activity, body composition, dyslipidemia, and risk-taking behavior. The effects of changing roles of women and ideals in body shape on eating habits of adolescents are examined as well. The progress in research regarding the risk factors for, and the prevention of, the disorders just mentioned, including innovative new programs for young women and e h c minorities, are described. Examples of successful multidisciplinary treatment programs are presented. Future research needed to assist in the development of prevention programs to optimize adolescent nutritional health are outlined. Recent advances in our understanding of nutritional disorders in adolescents demonstrate the potential for a major impact on the future health and welfare of our population. Disorders that have their antecedents in adolescent eating patterns have lifelong effects on premature morbidity and mortality. These disorders-atherosclerosis, hypertension, obesity, anorexia nervosa, bulimia nervosa, and birth of suboptimal-weight infants to teen mothers-account for a major proportion of health expenditures, yet preventative expenditures are minimal. They also share a common origin in imbalances of diet and exercise, either in their pathophysiology, treatment, or both. Therefore increased understanding of current adolescents’ practices and of optimal means for improving them is critical to the future of adolescent health and the healthcare system in general. Atherosclerosis is the process of arterial plaque development that results in myocardial infarction, stroke, and peripheral vascular disease. In susceptible individuals the process begins in infancy and accelerates at adolescence. Risk factors for devel-

Children and Atherosclerosis: With Particular Emphasis on Dislipoproteinaemia

Coronary heart disease (CHD) is the leading cause of death in the USA. One of the risk factors for heart disease is hypercholesterolaemia. Other known risk factors are cigarette smoking, hypertension, obesity, diabetes mellitus and a sedentary lifestyle. Numerous studies have demonstrated that early diagnosis and treatment reduces the incidence of atherosclerotic heart disease. The presence of risk factors for CHD can be established early in life. The Bogalusa Heart Study revealed a correlation between total serum cholesterol level and the presence of aortic and coronary fatty streaks in the pediatric population.! The sequence of the development of atheroma that begins with isolated foam cells in infants, to more accumulations in early childhood and finally progress to fatty streaks, has been well documented.s-> Autopsy studies on soldiers killed in the Vietnam and Korean wars also showed that early coronary atherosclerosis or its precursors begin in childhood or adolescence.s-> Currently, controversy exists regarding the decision to screen children for hypercholesterolaemia.sf Much of the controversy