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Eating and Feeding Disorders with Restrictive Food Intake

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Policies and Education for Health Promotion".

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 27656

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Special Issue Editor

Dr. Ricarda Schmidt

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Guest Editor

University of Leipzig Medical Center, Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Unit, Department of Psychosomatic and Psychotherapy, Leipzig, Germany
Interests: avoidant/restrictive food intake disorder; feeding practices; assessment; neuropsychology; childhood; adolescence; binge-eating disorder

Special Issue Information

Dear Colleagues,

Restrictive eating disorders are considered serious mental disorders in childhood and adolescence due to their substantial effects on physical and mental health. Although the common feature of restrictive eating disorders is the avoidance or restriction of food intake, a variety of different motives underlie these disorders, and different cognitive, neurobiological, and emotional characteristics are assumed to be involved. While research on anorexia nervosa is increasingly elucidating its etiological factors, there is still a great need to optimize existing prevention approaches and treatments. For avoidant/restrictive food intake disorder (ARFID), research is still in its early stages. Little is known about the precise nature of ARFID, its phenotypes, as well as the mechanisms involved in its development and maintenance. Since ARFID originated from early feeding disorders, it is especially essential to consider both feeding and eating disorder perspectives.

In this Special Issue of Nutrients, we aim to present a collection of the latest research on different specified restrictive eating disorders. In addition to systematic reviews, clinical or experimental studies on the assessment, epidemiology, nosology, etiology, and treatment of these disorders are welcome.

Dr. Ricarda Schmidt
Guest Editor

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Keywords

avoidant/restrictive food intake disorder
anorexia nervosa
atypical anorexia nervosa
food intake
picky eating
food neophobia

Published Papers (6 papers)

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Research

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9 pages, 246 KiB

Open AccessArticle

Weight Gain in Adults with Avoidant/Restrictive Food Intake Disorder Compared to Restrictive Anorexia Nervosa—Pilot Findings from a Longitudinal Study

by Magnus Fjeldstad, Torben Kvist and Magnus Sjögren

Nutrients 2021, 13(3), 871; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030871 - 07 Mar 2021

Cited by 6 | Viewed by 2879

Abstract

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by persistent failure to meet nutritional needs, absence of body image distortion and often low body weight. Weight restorative treatment in ARFID-adults is provided for as in Anorexia Nervosa (AN), while the effect is unknown. The aim was to compare weight gain between ARFID and restrictive subtype of AN (AN-R), including exploring impact of medical factors and psychopathology. Methods: Individuals with ARFID (n = 7; all cases enrolled over 5 years) and AN-R (n = 80) were recruited from the Prospective Longitudinal All-comers inclusion study in Eating Disorders (PROLED) during 5 years. All underwent weight restorative inpatient treatment. Clinical characteristics at baseline and weekly weight gain were recorded and compared. Results: There were no significant differences at baseline weight, nor in weight gain between groups. Anxiety was statistically significantly higher in AN-R at baseline. Conclusions: Although there were differences in several clinical measures at baseline (Autism Quotient, symptom checklist, mood scores and Morgan Russel Outcome Scale), only anxiety was higher in AN-R. No differences in weight gain were observed, although mean values indicate a faster weight gain in the ARFID group. Standard weight restorative treatment in this study in adults with ARFID has similar weight gaining effect as in AN-R. Full article

(This article belongs to the Special Issue Eating and Feeding Disorders with Restrictive Food Intake)

11 pages, 299 KiB

Open AccessArticle

Cognitive Function in Adults with Enduring Anorexia Nervosa

by Maria Seidel, Helen Brooker, Kamilla Lauenborg, Keith Wesnes and Magnus Sjögren

Nutrients 2021, 13(3), 859; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030859 - 05 Mar 2021

Cited by 11 | Viewed by 4201

Abstract

Anorexia Nervosa (AN) is a severe and often enduring disorder characterized by restriction of food intake, low body weight, fear of weight gain, and distorted body image. Investigations on cognition performance in AN patients have yielded conflicting results. Using an established and sensitive computerized cognitive test battery, we aimed to assess core aspects of cognitive function, including attention span, information processing, reasoning, working and episodic memory, in AN patients and controls. Patients were recruited from the Danish Prospective Longitudinal all-comer inclusion study in Eating Disorders (PROLED). Included were 26 individuals with AN and 36 healthy volunteers (HV). All were tested with CogTrack (an online cognitive assessment system) at baseline, and AN patients were tested again at a follow-up time point after weight increase (n = 13). At baseline, AN patients showed faster reaction times in the attention tasks, as well as increased accuracy in grammatical reasoning compared to HV. There were no differences in cognitive function between AN patients and HV in the other cognitive domains measured (sustained attention, working and episodic memory, speed of retrieval, and speed of grammatical reasoning). No differences were visible in the AN sample between baseline and follow-up. Performance did not correlate with any clinical variables in the AN sample. These findings supplement results from other studies suggesting increased concentration and reasoning accuracy in patients suffering from AN, who showed increased performance in cognitive tasks despite their illness. Full article

(This article belongs to the Special Issue Eating and Feeding Disorders with Restrictive Food Intake)

15 pages, 772 KiB

Open AccessArticle

Is Serum BDNF Altered in Acute, Short- and Long-Term Recovered Restrictive Type Anorexia Nervosa?

by Jonas L. Steinhäuser, Joseph A. King, Friederike I. Tam, Maria Seidel, Ronald Biemann, Marie-Louis Wronski, Daniel Geisler, Veit Roessner and Stefan Ehrlich

Nutrients 2021, 13(2), 432; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020432 - 29 Jan 2021

Cited by 8 | Viewed by 3599

Abstract

Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in the regulation of food intake and body weight, has been implicated in the development and maintenance of Anorexia nervosa (AN). The majority of previous studies reported lower BDNF levels in acutely underweight AN patients (acAN) and increasing levels after weight rehabilitation. Here, we investigated serum BDNF concentrations in the largest known AN sample to date, both before and after weight restoration therapy. Serum BDNF was measured in 259 female volunteers: 77 in-patient acAN participants of the restrictive type (47 reassessed after short-term weight rehabilitation), 62 individuals long-term recovered from AN, and 120 healthy controls. We validated our findings in a post-hoc mega-analysis in which we reanalyzed combined data from the current sample and those from our previous study on BDNF in AN (combined sample: 389 participants). All analyses carefully accounted for known determinants of BDNF (age, sex, storage time of blood samples). We further assessed relationships with relevant clinical variables (body-mass-index, physical activity, symptoms). Contrary to our hypotheses, we found zero significant differences in either cross-sectional or longitudinal comparisons and no significant relationships with clinical variables. Together, our study suggests that BDNF may not be a reliable state- or trait-marker in AN after all. Full article

(This article belongs to the Special Issue Eating and Feeding Disorders with Restrictive Food Intake)

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11 pages, 583 KiB

Open AccessArticle

Macro- and Micronutrient Intake in Children with Avoidant/Restrictive Food Intake Disorder

by Ricarda Schmidt, Andreas Hiemisch, Wieland Kiess, Kai von Klitzing, Franziska Schlensog-Schuster and Anja Hilbert

Nutrients 2021, 13(2), 400; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020400 - 27 Jan 2021

Cited by 23 | Viewed by 3575

Abstract

Although case studies in avoidant/restrictive food intake disorder (ARFID) indicate severe nutritional deficiencies in those with a highly limited amount or variety of food intake, systematic analyses on food intake in treatment-seeking children and adolescents with ARFID are lacking. Within this study, n = 20 patients with an interview-based diagnosis of ARFID (0–17 years) were included and compared to n = 20 healthy controls individually matched for age and sex. Children or parents completed three-day food diaries and a food list. Macronutrient, vitamin, and mineral supply was determined based on the percentage of their recommended intake. The results showed a significantly lower total energy and protein intake in ARFID versus controls, with trends for lower fat and carbohydrate intake. ARFID subtypes of limited amount versus variety of food intake significantly differed in macro-, but not micronutrient intake. Those with ARFID met only 20–30% of the recommended intake for most vitamins and minerals, with significantly lower intake relative to controls for vitamin B1, B2, C, K, zinc, iron, and potassium. Variety of food intake was significantly reduced in ARFID versus controls in all food groups except carbohydrates. This study demonstrated that ARFID goes along with reduced everyday life macro- and micronutrient intake, which may increase the risk for developmental and health problems. Future studies additionally assessing serum nutrient levels in a larger sample may further explore differences in food intake across diverse ARFID presentations. Full article

(This article belongs to the Special Issue Eating and Feeding Disorders with Restrictive Food Intake)

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Review

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10 pages, 284 KiB

Open AccessReview

Intensive Treatments in Adolescent Anorexia Nervosa

by Beate Herpertz-Dahlmann

Nutrients 2021, 13(4), 1265; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13041265 - 13 Apr 2021

Cited by 21 | Viewed by 7637

Abstract

Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care. Full article

(This article belongs to the Special Issue Eating and Feeding Disorders with Restrictive Food Intake)

17 pages, 3796 KiB

Open AccessReview

A Systematic Review and Meta-Analysis Finds Increased Blood Levels of All Forms of Ghrelin in Both Restricting and Binge-Eating/Purging Subtypes of Anorexia Nervosa

by Maria Seidel, Signe Markmann Jensen, Darren Healy, Aakriti Dureja, Hunna J. Watson, Birgitte Holst, Cynthia M. Bulik and Jan Magnus Sjögren

Nutrients 2021, 13(2), 709; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020709 - 23 Feb 2021

Cited by 13 | Viewed by 4383

Abstract

Anorexia nervosa (AN) is a severe psychiatric condition associated with high mortality and chronicity. The hunt for state, trait, subtyping, and prognostic biomarkers is ongoing and the orexigenic hormone ghrelin and its different forms, acyl ghrelin and desacyl ghrelin, have been proposed to be increased in AN, especially in the restrictive subtype. A systematic literature search was performed using established databases up to 30 November 2020. Forty-nine studies met inclusion criteria for cross-sectional and longitudinal meta-analyses on total ghrelin, acyl ghrelin, and desacyl ghrelin. All forms of ghrelin were increased in the acute stage of anorexia nervosa during fasting compared to healthy controls. Previous notions on differences in ghrelin levels between AN subtypes were not supported by current data. In addition, a significant decrease in total ghrelin was observed pre-treatment to follow-up. However, total ghrelin levels at follow-up were still marginally elevated compared to healthy controls, whereas for acyl ghrelin, no overall effect of treatment was observed. Due to heterogeneity in follow-up designs and only few data on long-term recovered patients, longitudinal results should be interpreted with caution. While the first steps towards a biomarker in acute AN have been completed, the value of ghrelin as a potential indicator of treatment success or recovery status or its use in subtype differentiation are yet to be established. Full article

(This article belongs to the Special Issue Eating and Feeding Disorders with Restrictive Food Intake)

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