Marcie Schneider

Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?

Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.

Eating attitudes, health-risk behaviors, self-esteem, and anxiety among adolescent females in a suburban high school

In order to determine whether adolescent females with abnormal eating attitudes display lower levels of self-esteem and higher levels of anxiety than their peers, and whether these adolescents participate in health-risk behaviors to a greater or lesser degree than their peers, we administered a series of questionnaires to the females attending a suburban high school in New York State. The questionnaires, completed by 268 students (mean age, 16.2 years), included data on health-risk behaviors and weight attitudes, an Eating Attitudes Test, a self-esteem scale, and an anxiety inventory. Results indicated that almost two-thirds of the students described themselves as overweight, almost three-quarters felt they were above the healthiest weight for their age and height, and almost four-fifths were above the weight at which they would be most happy; 18% of the students scored 30 or more on the Eating Attitudes Test, a score suggestive of an eating disorder. Use of Spearman-rank correlation coefficients and multiple linear regression analysis revealed that those with more unhappiness with their weight and higher scores on the eating attitudes test were more likely to have lower self-esteem and higher anxiety and to participate more in health-risk behaviors, including cigarette smoking, alcohol use, drug use, and sexual activity with more total partners. The data from this study further corroborate the growing belief that health-risk behaviors tend to cluster together in vulnerable adolescents and demonstrate that abnormal eating attitudes and behaviors may be part of this cluster, especially in females with low self-esteem and high levels of anxiety.

Hypophosphatemia secondary to oral refeeding in anorexia nervosa

OBJECTIVE Hypophosphatemia is a well-known complication of the refeeding syndrome in severe cases of anorexia nervosa, described mostly as a result of refeeding with total parenteral nutrition. Few cases have been reported secondary to either nasogastric or oral refeeding. METHOD The authors present three cases in which hypophosphatemia developed secondary to oral refeeding in severe anorexia nervosa. RESULTS All 3 patients developed significant hypophosphatemia, to a low of 0.9 mg/dl in two cases and a low of 1. 7 mg/dl in the third. The first patient received close to 3,000 calories per day, along with intravenous fluids, in the hospital; the other 2 patients ate large amounts for several days at home. Caloric restriction and replenishment with phosphorous resulted in a rapid return of phosphorous values to normal levels. DISCUSSION Those who treat severely malnourished patients with eating disorders, whether as inpatients or outpatients, need to be vigilant for the development of the refeeding syndrome, even in patients receiving oral refeeding alone.

Eating attitudes in urban and suburban adolescents

We administered the Eating Attitudes Test (EAT), Rosenberg Self-Esteem Scale, and Spielberger Trait Anxiety Inventory to two populations of high school students. The first group, 268 suburban females (mean age 16.2 years), completed their questionnaires in May 1988. The second population, 389 females and 281 males (mean age 16.0 years) in a city school with 92% black of Hispanic students, completed their questionnaires in February 1990 and were also measured for height and weight as part of a health screening. Scores of 21 or higher on the EAT-26 were achieved by 17.5% of the suburban females, 15.0% of the urban females, and 6.0% of the urban males. Significantly more suburban females (63%) considered themselves overweight, compared with both urban females (35%) and males (19%), yet only 14% of suburban females were calculated to be > 10% over ideal body weight, compared with 45% of urban females and 39% of urban males. Contrary to expectations, self-esteem was higher and anxiety lower in the urban students than the suburban students; self-esteem and anxiety were each significantly correlated with higher EAT scores in both populations, but believing oneself overweight was correlated with higher EAT scores in only the suburban students. These data indicate that abnormal eating attitudes are present among both urban and suburban students but with important differences in their manifestations and implications.

Marfan syndrome in adolescents and young adults: psychosocial functioning and knowledge.

Twenty-two subjects with Marfan syndrome (age range 11–24 years, mean 15.7 years) were studied to evaluate the impact of Marfan syndrome on their lives, level of psychosocial adaptation, concerns about their disorder, compliance with medical regimens, and knowledge of Marfan syndrome. Subjects were interviewed and then completed the Offer Self-Image Questionnaire and two questionnaires designed for the study. Parents also were interviewed. Subjects demonstrated normal psychosocial adaptation on the Offer Self-Image Questionnaire. Nevertheless, the subjects perceived that their lives would be significantly better without Marfan syndrome, especially in the areas of physical activities and self-image. They expressed concerns about their illness most often to their parents, less frequently to their doctors. Their compliance with medical regimens were suboptimal and similar to the published description of compliance among teenagers with other chronic illnesses. Their knowledge base was weakest in the areas pertaining to future childbearing. Thus, althogh these subjects showed normal psychosocial adaptation, doctors caring for them may foster bette coping with Marfan syndrome by discussing self-image issues and Marfan syndrome-related concerns, and by encouraging compliance and imparting knowledge. J Dev Behav Pediatr 11:122–127, 1990. Index terms: Marfan syndrome, adolescents, psychosocial adaptation, medical compliance, chronic illness.

Correlates of low bone density in females with anorexia nervosa.

UNLABELLED The objectives were to delineate those factors which correlate with low bone density in patients with anorexia nervosa and in turn to predict those at greatest risk for osteopenia. DESIGN Bone density was evaluated by dual energy x-ray absorptiometry in 28 postmenarchal females with anorexia nervosa who had never received hormonal therapy. Bone density results were correlated with specific historical and physical factors utilizing descriptive statistics, scatter plots, and the Spearman correlation coefficient. RESULTS Mean age was 18.6 years, mean age at menarche was 12.9 yrs, mean length of illness was 19.8 months and mean duration of amenorrhea was 13.4 months. Mean % ideal body weight was 84% at the time of bone density, 75% at minimum weight and 100% at maximum weight. Mean lumbar spine bone density was -1.69 standard deviations from the norm; mean lateral spine bone density was -1.45 standard deviations from the norm; mean femoral neck of the hip bone density was -1.18 standard deviations from the norm. There was a strong negative correlation between duration of amenorrhea and bone density at the lumbar spine (r = -0.50, p < .01) and a mild correlation at the lateral spine (r = -0.49, p < 0.05) and femoral neck (r = -0.41, p < 0.05). There was also a strong negative correlation between length of illness and bone density at the lumbar spine (r = -0.53, p < 0.01) and lateral spine (r = -0.77, p < 0.0001), and a mild correlation with the femoral neck (r = -0.48, p < 0.05). Scatter plots of lumbar bone density versus duration of amenorrhea, and versus length of illness clearly showed not only that longer duration of amenorrhea and longer length illness correlated to bone loss, but also strikingly that within a short time of being ill and amenorrheic, significant bone loss was seen. Age, and age at menarche correlated mildly with osteopenia at the lateral spine; age correlated mildly with osteopenia at the femoral neck as well. There was a trend for minimum BMI to correlate with osteopenia at the lateral spine. There were no correlations of bone density with % IBW at bone density, minimum % IBW, maximum % IBW, change in % IBW, BMI at the time of the bone density, maximum BMI or change in BMI. CONCLUSIONS Low bone density, especially in the lumbar spine, correlated with both a longer duration of amenorrhea and longer length of illness, but not with other factors, in our patients with anorexia nervosa. As many of these patients, even those with a short duration of illness and amenorrhea, were osteopenic, it is advisable to continue to perform bone density studies in all patients with anorexia nervosa, on both a clinical and research basis.

Correlates of low bone density in females with anorexia nervosa

UNLABELLED The objectives were to delineate those factors which correlate with low bone density in patients with anorexia nervosa and in turn to predict those at greatest risk for osteopenia. DESIGN Bone density was evaluated by dual energy x-ray absorptiometry in 28 postmenarchal females with anorexia nervosa who had never received hormonal therapy. Bone density results were correlated with specific historical and physical factors utilizing descriptive statistics, scatter plots, and the Spearman correlation coefficient. RESULTS Mean age was 18.6 years, mean age at menarche was 12.9 yrs, mean length of illness was 19.8 months and mean duration of amenorrhea was 13.4 months. Mean % ideal body weight was 84% at the time of bone density, 75% at minimum weight and 100% at maximum weight. Mean lumbar spine bone density was -1.69 standard deviations from the norm; mean lateral spine bone density was -1.45 standard deviations from the norm; mean femoral neck of the hip bone density was -1.18 standard deviations from the norm. There was a strong negative correlation between duration of amenorrhea and bone density at the lumbar spine (r = -0.50, p < .01) and a mild correlation at the lateral spine (r = -0.49, p < 0.05) and femoral neck (r = -0.41, p < 0.05). There was also a strong negative correlation between length of illness and bone density at the lumbar spine (r = -0.53, p < 0.01) and lateral spine (r = -0.77, p < 0.0001), and a mild correlation with the femoral neck (r = -0.48, p < 0.05). Scatter plots of lumbar bone density versus duration of amenorrhea, and versus length of illness clearly showed not only that longer duration of amenorrhea and longer length illness correlated to bone loss, but also strikingly that within a short time of being ill and amenorrheic, significant bone loss was seen. Age, and age at menarche correlated mildly with osteopenia at the lateral spine; age correlated mildly with osteopenia at the femoral neck as well. There was a trend for minimum BMI to correlate with osteopenia at the lateral spine. There were no correlations of bone density with % IBW at bone density, minimum % IBW, maximum % IBW, change in % IBW, BMI at the time of the bone density, maximum BMI or change in BMI. CONCLUSIONS Low bone density, especially in the lumbar spine, correlated with both a longer duration of amenorrhea and longer length of illness, but not with other factors, in our patients with anorexia nervosa. As many of these patients, even those with a short duration of illness and amenorrhea, were osteopenic, it is advisable to continue to perform bone density studies in all patients with anorexia nervosa, on both a clinical and research basis.