A prospective observational study comparing rates of medical instability between adolescents with typical and atypical anorexia nervosa

doi:10.1111/jhn.13328

Observational Study

. 2024 Aug;37(4):1100-1108.

doi: 10.1111/jhn.13328. Epub 2024 Jun 24.

A prospective observational study comparing rates of medical instability between adolescents with typical and atypical anorexia nervosa

Cliona Brennan¹, Erica Cini², Sarah Illingworth³, Simon Chapman⁴, Mima Simic⁵, Dasha Nicholls⁶, Victoria Chapman⁷, Conor Simms⁸, Ellen Hayes⁷, Sarah Fuller⁹, Jade Orpwood¹⁰, Nicola Tweedy⁷, Tahmida Baksh¹¹, Emma Astaire¹², Dee Bhakta³, Eloise Saglio¹³, Annie Stevenson¹⁴, Melissa Buchbinder

Affiliations

¹ South London and Maudsley NHS Trust, London Metropolitan University, London, UK.
² East London NHS Foundation Trust, Kings College London, University College London, London, UK.
³ London Metropolitan University, London, UK.
⁴ South London and Maudsley NHS Trust, Kings College Hospital London, London, UK.
⁵ South London and Maudsley NHS Trust, London, UK.
⁶ Central North West London NHS Trust, Imperial College London, London, UK.
⁷ Royal Free Hospital NHS Trust, London, UK.
⁸ West London NHS Trust, London, UK.
⁹ East London Foundation Trust, London, UK.
¹⁰ Northeast London Foundation Trust, London, UK.
¹¹ East London NHS Foundation Trust, London, UK.
¹² Central Northwest London NHS Trust, London, UK.
¹³ West London NHS Mental Health Trust, London, UK.
¹⁴ North East London Foundation Tryst, London, UK.

PMID: 38923043
DOI: 10.1111/jhn.13328

Observational Study

A prospective observational study comparing rates of medical instability between adolescents with typical and atypical anorexia nervosa

Cliona Brennan et al. J Hum Nutr Diet. 2024 Aug.

. 2024 Aug;37(4):1100-1108.

doi: 10.1111/jhn.13328. Epub 2024 Jun 24.

Authors

Affiliations

¹ South London and Maudsley NHS Trust, London Metropolitan University, London, UK.
² East London NHS Foundation Trust, Kings College London, University College London, London, UK.
³ London Metropolitan University, London, UK.
⁴ South London and Maudsley NHS Trust, Kings College Hospital London, London, UK.
⁵ South London and Maudsley NHS Trust, London, UK.
⁶ Central North West London NHS Trust, Imperial College London, London, UK.
⁷ Royal Free Hospital NHS Trust, London, UK.
⁸ West London NHS Trust, London, UK.
⁹ East London Foundation Trust, London, UK.
¹⁰ Northeast London Foundation Trust, London, UK.
¹¹ East London NHS Foundation Trust, London, UK.
¹² Central Northwest London NHS Trust, London, UK.
¹³ West London NHS Mental Health Trust, London, UK.
¹⁴ North East London Foundation Tryst, London, UK.

PMID: 38923043
DOI: 10.1111/jhn.13328

Abstract

Background: Recognition of atypical anorexia nervosa (AAN) has challenged underweight as a defining factor of illness severity in anorexia nervosa (AN). The present study aimed to compare rates of medical instability in adolescents with underweight (AN) and non-underweight (AAN) anorexia nervosa.

Methods: The study examined assessment data from specialist eating disorder services in the UK between January and December 2022. Participants (n = 205) aged 11-18 years were recruited across eight eating disorder clinics and diagnosed with AN (n = 113) or AAN (n = 92) after clinical assessment. Parameters associated with risk of medical instability were compared between AN and AAN groups, using t tests and regression analysis.

Results: Rates of bradycardia and hypotension did not differ significantly between AN and AAN groups (p = 0.239 and p = 0.289). Although white blood cell counts were lower in the AN group, rates of leukopaenia could not be statistically compared as a result of there being too few counts in at least one group. No incidences of hypophosphataemia were found in the sample. A significant regression equation was found for percentage median body mass index, but not rate of weight loss, as a predictor of blood pressure, serum phosphorous and magnesium.

Conclusions: Our findings indicate that medical instability occurs across a range of body weights in young people with AN and AAN. Although certain parameters of risk such as blood pressure, serum phosphorous and magnesium may be worsened at lower weight, both AN and AAN are serious mental health conditions that can lead to medical instability.

Keywords: anorexia nervosa; eating disorders; malnutrition; medical instability; mental health.

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Cited by

Two identical twin pairs discordant for longstanding anorexia nervosa and OSFED: lived experience accounts of eating disorder and recovery processes.
Elwyn R, Williams M, Smith E, Smith S. Elwyn R, et al. J Eat Disord. 2024 Sep 2;12(1):127. doi: 10.1186/s40337-024-01078-w. J Eat Disord. 2024. PMID: 39223672 Free PMC article.

References

REFERENCES

1. Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020;50(1):24–29.
1. The American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 5th ed. 2013. pp. 307.
1. Dell'Osso L, Abelli M, Carpita B, Pini S, Castellini G, Carmassi C, et al. Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive‐compulsive spectrum. Neuropsychiatr Dis Treat. 2016;12:1651–1660.
1. Vo M, Golden N. Medical complications and management of atypical anorexia nervosa. J Eat Disord. 2022;10(1):4–9. https://doi.org/10.1186/s40337-022-00720-9
1. Brennan C, Illingworth S, Cini E, Bhakta D. Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta‐analysis. J Eat Disord. 2023;11(1):58.

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[1] Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020;50(1):24–29.

[2] Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020;50(1):24–29.

[3] The American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 5th ed. 2013. pp. 307.

[4] The American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 5th ed. 2013. pp. 307.

[5] Dell'Osso L, Abelli M, Carpita B, Pini S, Castellini G, Carmassi C, et al. Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive‐compulsive spectrum. Neuropsychiatr Dis Treat. 2016;12:1651–1660.

[6] Dell'Osso L, Abelli M, Carpita B, Pini S, Castellini G, Carmassi C, et al. Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive‐compulsive spectrum. Neuropsychiatr Dis Treat. 2016;12:1651–1660.

[7] Vo M, Golden N. Medical complications and management of atypical anorexia nervosa. J Eat Disord. 2022;10(1):4–9. https://doi.org/10.1186/s40337-022-00720-9

[8] Vo M, Golden N. Medical complications and management of atypical anorexia nervosa. J Eat Disord. 2022;10(1):4–9. https://doi.org/10.1186/s40337-022-00720-9

[9] Brennan C, Illingworth S, Cini E, Bhakta D. Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta‐analysis. J Eat Disord. 2023;11(1):58.

[10] Brennan C, Illingworth S, Cini E, Bhakta D. Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta‐analysis. J Eat Disord. 2023;11(1):58.

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A prospective observational study comparing rates of medical instability between adolescents with typical and atypical anorexia nervosa

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A prospective observational study comparing rates of medical instability between adolescents with typical and atypical anorexia nervosa

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