Sunday, 1 December 2013

Anorexia nervosa - The Diet and nutritional supplements

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Diet and nutritional supplements to prevent anorexia nervosa

The aim of the diet and nutritional supplements is to provide enough nutrients as for people with anorexia nervosa are more likely to have vitamin and mineral deficiencies which can lead to certain symptoms of the diseases.
1. Caffeine
Caffeine intake increased over time between ages 9 and 19 years across all groups and this trend was not moderated by diagnostic status. For anorexia nervosa, relative to the non-eating disorder group, the proportional intake of caffeine from soda increased significantly before onset to onset to after onset and ingestion of chocolate-containing foods decreased sharply over time(42).

2. Alcohol
While the rate of anorexia was not elevated in alcoholics after controlling for other disorders, bulimia did occur at a greater than expected rate. However, both eating disorders were relatively rare, and much of the association with alcoholism occurred in the context of additional preexisting or secondary psychiatric disorders(43).

3. Tobacco
Although malnutrition may be expected to reduce DNA methylation through its effects on one-carbon metabolism, our negative results are in line with several in vitro and clinical studies that did not show a direct relation between gene-specific DNA methylation and folate levels. In contrast, smoking has been repeatedly reported to alter DNA methylation of specific genes and should be controlled for in future epigenetic studies(44)
.
4.  Drink 6 - 8 glasses of filtered water daily as water can decrease the risk of dehydration.
Caffeine, water, and aspartame consumption can be variable in patients with AN and the consumption of these substances seems to be only modestly related to purging behavior(45).

5. Promote healthy diet for maximum nutrients absorption.
6. The important of nutritional supplements
Some researchers suggested that conservation mechanisms resulting from starvation and/or self-prescribed nutrient supplements can result in laboratory values that appear within normal limits. These artificially inflated values drop to dangerous levels in some patients once rehydration and refeeding begin. Electrolyte status must be closely monitored during this time to prevent complications. Other micronutrient deficiencies can be corrected with adequate dietary intake, but patients with eating disorders are unlikely to consume such an adequate diet immediately upon entering treatment, so they may benefit from supplementation. Depleted nutrient stores require longer supplementation than acute inadequacies in nutrient intake. This review compiles the findings reported to date regarding micronutrient deficiencies and supplementation for patients with anorexia and bulimia. Because of the widely varying eating practices from patient to patient and the current lack of data controlling for nutrient self-supplementation, nutrition assessment performed by a nutrition professional via food intake history may be more practical than laboratory tests and more accurate than current food intake for determining potential micronutrient deficiencies(46).
 a.. In the study of  20 female patients with anorexia nervosa (AN) and in 10 lean and 10 normal weight, healthy, female control subjects. Patients with AN had higher activities of L-gamma-glutamyl transferase (gamma-GT) and glutamate pyruvate transaminase (SGPT) and a higher concentration of prealbumin in serum and lower leucocyte and lymphocyte counts in blood. For the other routine clinical chemical parameters no significant differences between the groups were observed. AN patients had higher serum vitamin B12 and retinol levels. No significant differences were found for the status parameters of thiamin, vitamin B6, vitamin C, folate, vitamin E and vitamin D. Contradictory results were obtained for the riboflavin status: AN patients had a lower level of flavin adenine dinucleotide (FAD) in blood and a lower stimulation ratio of the glutathione reductase activity in erythrocytes (alpha-EGR). Patients with AN had higher serum ferritin concentration and lower total iron binding capacity (TIBC). However, haemoglobin (Hb), haematocrit (Ht) and iron saturation were not significantly different. No significant difference was found in the concentration of zinc in plasma. In spite of the poor intake of nutrients and energy, the results obtained did not indicate an inadequate status of vitamins, iron and zinc in patients with AN(47).

b.  Other study of trace metals, vitamins, and other biochemical parameters in 30 female patients hospitalized for anorexia nervosa, showed that Anorexia nervosa patients showed hypogeusia, with the bitter and sour taste most severely affected, however plasma zinc levels did not correlate with taste recognition scores. Patients showed hypercarotenemia (214 +/- 129 microgram/100 ml; P < 0.01) with normal plasma vitamin A and retinol-binding protein levels. Total iron binding capacity was depressed (261 +/- 62 microgram/100 ml; P < 0.001) in contrast to plasma iron, ceruloplasmin and folic acid, which were normal. In nine patients, who were retested before discharge, taste function improved; plasma zinc, copper, and total iron binding capacity levels increased whereas plasma carotene and cholesterol decreased to normal levels. It is concluded that the observed zinc, copper, and iron binding protein deficiencies, and hypogeusia, reflect the self-imposed nutritional restriction of anorexia nervosa patients. Zinc and other micronutrients released from catabolized tissue along with vitamin intake may mitigate against more severe deficiency states in anorexia nervosa(48).
A daily multivitamin is an essential, as it contain numbers of vitamins and trace minerals such as vitamins A, C, E, the B-vitamins,  magnesium, calcium, zinc, phosphorus, copper, and selenium which are essential for the body needed. Other supplement include Omega-3 fatty acids, Coenzyme Q10, 5-hydroxytryptophan (5-HTP), Creatine, Probiotic supplement, etc.
Sources
(42) http://www.ncbi.nlm.nih.gov/pubmed/8540597
(43) http://www.ncbi.nlm.nih.gov/pubmed/19189405 
(44) http://www.ncbi.nlm.nih.gov/pubmed/22398003
(45) http://www.ncbi.nlm.nih.gov/pubmed/19189405
(46) http://www.ncbi.nlm.nih.gov/pubmed/20413694
(47) http://www.ncbi.nlm.nih.gov/pubmed/3074921
(48) http://www.ncbi.nlm.nih.gov/pubmed/7405882

Anorexia nervosa - The Do's and Do not's list

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Preventions
A. The Do's and Do not's list
A.1. Primary prevention 
Dt. Michael Sidiropoulos in the article of Anorexia Nervosa: The physiological consequences of starvation and the need for primary prevention efforts indicated that there are numerous actions that the physician, along with the family, allied health care workers and/or through a broader public health initiative can accomplish in this particular case that will have longstanding implications on the patient's future development and growth and will increase the likelihood of healthy outcomes through primary
prevention(37).
1. Minimizing social pressures
In the study to evaluation the Sociological factors in the development of eating disorders, Dr Nagel KL, andand Dr. Jones KH. at the University of Georgia indicated that professionals in the educational and physical and mental health care fields need to be aware of the influence of social pressures on teenagers' perceptions of body image and appearance. This article reviews the sociocultural, socioeconomic, and sex-related factors which contribute to the development of eating disorders. It is recommended that professionals help adolescents resist societal pressure to conform to unrealistic standards of appearance, and provide guidance on nutrition, realistic body ideals, and achievement of self-esteem, self-efficacy, interpersonal relations and coping skills(38).

2. Minimizing family issues
Dr. Yager J. in the study of the family issues in the pathogenesis of anorexia nervosa, suggested that factors residing in family systems have been implicated in the pathogenesis of anorexia nervosa. In this paper I critically review literature that bears on this issue: the transmission of anorexia nervosa in families; family stress patterns, personality and psychopathological characteristics of parents, parent-child interactions, and whole family systems. Much additional research is needed to accurately determine the precise nature of such factors and the extent to which they actually contribute to the appearance of this syndrome(39).

3. Reducing individual factors
In the study to examine which unique factors (genetic and environmental) increase the risk for developing anorexia nervosa by using a case-control design of discordant sister pairs, Dr. Karwautz A, and the research team at University of London, suggested that he sisters with anorexia nervosa differed from their healthy sisters in terms of personal vulnerability traits and exposure to high parental expectations and sexual abuse. Factors within the dieting risk domain did not differ. However, there was evidence of poor feeding in childhood. No difference in the distribution of genotypes or alleles of the DRD4, COMT, the 5HT2A and 5HT2C receptor genes was detected. These results are preliminary because our calculations indicate that there is insufficient power to detect the expected effect on risk with this sample size(40).

A.2. Secondary prevention
Secondary prevention focuses early detection and intervention as  early detection is often difficult as individuals with eating problems often attempt to conceal their behavior. People such as Parents, peers and siblings, teacher and family doctor are in good position to detect changing attitudes around food,weight, and shape for detecting eating disorder early for effective treatment(41)
 
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Sources
(37) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC483668/
(38) http://www.medicine.mcgill.ca/MJM/issues/v09n01/case_rep/Anorexia%20Nervosa.pdf
(39) http://www.ncbi.nlm.nih.gov/pubmed/1539487
(40) http://www.ncbi.nlm.nih.gov/pubmed/11232918
(41) http://www.nedic.ca/knowthefacts/documents/Preventionofeatingdisorders.pdf 

Eating Disorders: Anorexia nervosa - The Diagnosis

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Diagnosis and tests
The criteria of Anorexia nervosa diagnosed if a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea(33).
After taking the complex physical exam, including detail of absence of period and the examination the symptoms of Anorexia nervosa, such as skin and nails for dryness, hair, etc. If your doctor suspect that you have develop norexia nervosa, he/she may order
1. Hematological and blood coagulation tests
In a study of Red cell and haemoglobin values in 44 women with a typical picutre of anorexia nervosa showed that 20.5% presented a picture of true anaemia. Blood iron was low, sometimes very low, with a mean value of 66 mg 0/0. Clotting parameters: PTT, TT, PT, circulating platelets and TEG were normal. This finding serves to explain the low incidence of haemorrhage and the ready haemostasis noted in this disease, in spite of the considerable food deficit(33).
Other blood tests may be required to check electrolytes and protein as well as functioning of the liver, kidney and thyroid.

2. Urinary steroids
Urinalysis is to measure the levels of dehydroepiandrosterone. The increased level of the stress marker allo-tetrahydrocorticosterone refers to the involvement of stress in these diseases(34).

3. Psychological evaluation
Psychological self-assessment questionnaires are given to test  your thoughts, feelings and eating habits.
Dr. Gordon DP, and the research team in the study of A comparison of the psychological evaluation of adolescents with anorexia nervosa and of adolescents with conduct disorders indicated that Cognitive and projective psychological tests were administered to ten inpatient adolescents with anorexia nervosa and ten inpatient adolescents with conduct disorders. All subjects were selected on the basis of race, sex and overall intelligence. Results indicate that there are high numbers of neuropsychological deficits in both groups, but that neuropsychological deficits are especially numerous in the anorexia group. The two groups showed striking similarities in terms of some psychological functions, but results indicate that some aspects of personality style in the two groups are significantly different. A significant finding was that there were far more suicidal indicators on the Rorschach records of the anorectic group as compared with those found on the records of the conduct disorder group(35).


4. X-rays
X- ray may be taken to check for broken bones, pneumonia. In some cases, dual energy X-ray absorptiometry may be necessary to test for the presented osteopenia and  osteoporosis(36)

5. Electrocardiograms 
Electrocardiograms is necessary to look for heart irregularities. Anorexia nervosa caused demonstrable abnormalities of mitral valve motion and reduced left ventricular mass and filling associated with systolic dysfunction.

6. Etc.
  
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Sources
(33) http://www.ncbi.nlm.nih.gov/pubmed/869704
(34) http://www.ncbi.nlm.nih.gov/pubmed/15560936
(35) http://www.ncbi.nlm.nih.gov/pubmed/6501640
(36) http://www.ncbi.nlm.nih.gov/pubmed/22137016

Eating Disorders: Anorexia nervosa - The Consequences

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
The Consequences
In anorexia nervosa because of malnutrition as a result of self starvation, it can cause abnormal function of the body of that can lead to serious medical consequences:
1. Cardiovascular diseases
In the stidy of 181 women: 140 women with anorexia nervosa (AN) [85 not receiving oral contraceptive pills (OCPs) (AN-E) and 55 receiving oral contraceptive pills (OCPs)(AN+E)] and 41 healthy controls [28 not receiving OCPs (HC-E) and 13 receiving OCPs (HC+E)]. Dr. Lawson EA, and the research team at Harvard Medical School, showed that although hsCRP levels are lower in AN than healthy controls, OCP use puts such women at a greater than 20% chance of having high-sensitivity C-reactive protein (hsCRP), in the high-Cardiovascular (CV)-risk (>3 mg/liter) category. The elevated mean IL-6 in women with AN and high-risk hsCRP levels suggests that increased systemic inflammation may underlie the hsCRP elevation in these patients. Although OCP use in AN was associated with slightly lower mean LDL and higher mean HDL, means were within the normal range, and few patients in any group had high-risk LDL or HDL levels. IGF-I levels appear to be important determinants of hsCRP in healthy young women(24).
Other researchers suggested that anorexia nervosa can slow heart rate and low blood pressure, because of badly underweight.

2. Osteoporosis
Badly underweight can increase the risk of  Osteoporosis, researchers at the  Uniwersytet Medyczny suggested that the consequences of low energy fractures are the main causes of death in women with AN. Hormonal disturbances (e.g. hypoestrogenism, increased levels of ghrelin and Y peptide, changes in leptin and endocannabinoid levels), as well as the mechanisms involved in bone resorption (RANK/RANKL/OPG system), are considered to be of great importance for anorectic bone quality(25).


3. Muscle dysfunction
Protein-energy malnutrition in anorexia nervosa is an under-recognised cause of muscle dysfunction and weakness. In the study to characterise the skeletal myopathy that occurs in patients with severe anorexia nervosa, muscle function and structure. All of the patients showed impaired muscle function on strength and exercise measurement(26).

4. Severe dehydration
In the study to investigate the medical history, dental examination, and saliva tests of 39 patients aged 14 to 42 years, having suffered from AN for periods of 1 to 20 years, showed dental caries, due to excessive carbohydrate consumption, in all subjects, often in a rampant form. In patients with a history of intense vomiting (27 cases) severe lingual-occlusal erosion (perimylolysis) was nearly always present. Buccal erosion, mainly due to high consumption of acid fruits and drinks to relieve thirst caused by dehydration, was more frequent in vomiting than in non-vomiting patients(27). 
5. Fainting, fatigue, and overall weakness
Fainting, fatigue, and overall weakness are expected as patients  body required to conserve energy as protect the body organs due to malnutrition.

6. Lanugo
Lanugo is the growth of fine, downy hair on the face and body of anorexics. It's a sign that the body's natural defenses are at work. Hypertrichosis refers to the amount or length of extra hair that is grown -- to the point of excessive.
At a certain point during the starvation process, some anorexics may start to notice some fine, white hair on their body. People may even call it "fur".
It's usually visible on the face first, but it can appear anywhere on the body, including the back. Extra thick hair is normally found on the legs.
In women and girls with anorexia, the hair tends appear in areas where there is typically very little hair growth, such as the face, chest and back areas(28).


7. Psychiatric health problems
In a register study based on based on socio-economic and health data was conducted for a national cohort of female residents in Sweden born between 1968 and 1977, including 748 in-patients with anorexia nervosa. At follow-up 9-14 years after hospital admission, 8.7% of patients with anorexia nervosa had persistent psychiatric health problems demanding hospital care and 21.4% were dependent on society for their main income; the stratified relative risks were 5.8 (95% CI 4.7-7.6) and 2.6 (2.3-3.0) respectively, compared with the general female population(29).

8.   Psychoactive substance use and suicide
Anorexia nervosa is a mental disorder with high mortality. Dr. Papadopoulos FC, and the research team at the University Hospital, Uppsala, showed that the overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome(30).
9. Reproductive issues  
The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety(31)
 
I would like summarize this section with research from Dt. Miller KK at Massachusetts General Hospital and Harvard Medical School, Boston "Despite significant progress in the field, further research is needed to elucidate the mechanisms underlying the development of anorexia nervosa and its endocrine complications. Such investigations promise to yield important advances in the therapeutic approach to this disease as well as to the understanding of the regulation of endocrine function, skeletal biology, and appetite regulation" (32).Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve 
Optimal Health And Loose Weight

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Sources
(24) http://www.ncbi.nlm.nih.gov/pubmed/17519306
(25) http://www.ncbi.nlm.nih.gov/pubmed/22161979
(26) http://www.ncbi.nlm.nih.gov/pubmed/9650756
(27) http://www.ncbi.nlm.nih.gov/pubmed/14394
(28) http://www.anorexia-reflections.com/lanugo.html#axzz1wVB7hbqL
(29) http://www.ncbi.nlm.nih.gov/pubmed/17077433
(30) http://www.ncbi.nlm.nih.gov/pubmed/19118319
(31) http://www.ncbi.nlm.nih.gov/pubmed/22003362
(32) http://www.ncbi.nlm.nih.gov/pubmed/21976742 


Saturday, 30 November 2013

Eating Disorders: Anorexia nervosa - The Complications

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
The Complications
Anorexia nervosa may cause severe complications in every major organ system in the body  as a result of malnutrition due to self-imposed starvation.
A.1. Dermatologic signs of anorexia nervosa
Some researchers suggested that Dermatologic symptoms are almost always detectable in patients with severe anorexia nervosa (AN) and bulimia nervosa (BN), and awareness of these may help in the early diagnosis of hidden AN or BN. These manifestations include xerosis, lanugo-like body hair, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticularis, interdigital intertrigo, paronychia, generalized pruritus, acquired striae distensae, slower wound healing, prurigo pigmentosa, edema, linear erythema craquele, acral coldness, pellagra, scurvy, and acrodermatitis enteropathica(21). Other suggested that the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell's sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type(22).

A.2. Possible medical complications of anorexia nervosa
In the study of Eating disorders. A review and update, Dr. Haller E. at the University of California, indicated that Patients with eating disorders are usually secretive and often come to the attention of physicians only at the insistence of others. Practitioners also should be alert for medical complications including hypothermia, edema, hypotension, bradycardia, infertility, and osteoporosis in patients with anorexia nervosa and fluid or electrolyte imbalance, hyperamylasemia, gastritis, esophagitis, gastric dilation, edema, dental erosion, swollen parotid glands, and gingivitis in patients with bulimia nervosa. Treatment involves combining individual, behavioral, group, and family therapy with, possibly, psychopharmaceuticals. Primary care professionals are frequently the first to evaluate these patients, and their encouragement and support may help patients accept treatment. The treatment proceeds most smoothly if the primary care physician and psychiatrist work collaboratively with clear and frequent communication(23).
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Sources
(22) http://www.ncbi.nlm.nih.gov/pubmed/20808514
(23) http://www.ncbi.nlm.nih.gov/pubmed/1475950

 

Eating Disorders: Anorexia nervosa - Cause and Risk factors

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Cause and Risk factors
A. Causes
Some researchers suggested that The most commonly mentioned perceived causes were dysfunctional families, weight loss and dieting, and stressful experiences and perceived pressure(12). Others showed that Eating disorders (EDs) manifest as abnormal patterns of eating behavior and weight regulation driven by low self-esteem due to weight preoccupation and perceptions toward body weight and shape and Several lines of evidence indicate that brain-derived neurotrophic factor (BDNF) plays a critical role in regulating eating behaviors and cognitive impairments in the EDs(13).

B. Risk factors
1. Virtue of thin-ideal internalization, body dissatisfaction
Dr. Stice E, and the researchers team at the Oregon Research Institute, in the treatment of Anorexia nervosa showed that there is evidence that selective prevention programs that target young women at elevated risk for eating pathology by virtue of thin-ideal internalization, body dissatisfaction, and negative affect produce significant larger intervention effects than do universal programs offered to unselected populations(14)

2.  Gender
If you are girls and women, you are at higher risk to develop Anorexia nervosa, because of growing social pressures. In a community sample of young adults (n = 1,056) completed a questionnaire that contained the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory, as well as probes for inappropriate compensatory behaviors, excessive exercise, and episodes of binge eating, showed that Women had substantially elevated scores on all of the factors except excessive exercise, for which men had significantly higher scores(15).

3. Gene mutation
Mutation of certain genes can cause increased risk of Anorexia nervosa, but certain gene change have been rule out such as , but some have been confirmed including Allele 13 of the marker D11S911 as it is significantly over represented in the anorexia nervosa population suggesting that a mutation in linkage disequilibrium with this locus may form part of the genetic component of AN. Further work is now required to try to reproduce these data in a second independent cohort and to further characterise this region of the human genome(15). Others found the linkage regions on chromosomes 1, 3, and 4 (anorexia nervosa) and 10p (bulimia nervosa)(16).

4. Family history
If you parent or siblings Anorexia nervosa, you are at increased risk to develop the disease. In the tduy to evaluate 420 first-degree relatives of 14 patients with anorexia nervosa, 55 patients with bulimia, and 20 patients with both disorders, Dr. Hudson JI, and the research team showed that the morbid risk for affective disorder in the families of the eating disorder probands was similar to that found in the families of patients with bipolar disorder; but was significantly greater than that found in the families of patients with schizophrenia or borderline personality disorder. These results add to the growing evidence that anorexia nervosa and bulimia are closely related to affective disorder(17).

5. Loss Weight intentionally
Dr. Müller MJ, and the team of scientists suggested that In regard to clinical practice, dietary approaches to both weight loss and weight gain have to be reconsidered. In underweight patients (e.g., patients with anorexia nervosa), weight gain is supported by biological mechanisms that may or may not be suppressed by hyperalimentation. To overcome weight loss-induced counter-regulation in the overweight, biological signals have to be taken into account. Computational modeling of weight changes based on metabolic flux and its regulation will provide future strategies for clinical nutrition(18).

6. Stress
People who are at stress and anxiety for what ever reason are at higher risk to anorexia nervosa. There is a case of report of athirty-five-year-old woman suffering from anorexia nervosa visited our hospital complaining of severe general weakness. She was diagnosed with stress-induced cardiomyopathy and mural thrombus using a transthoracic echocardiogram(19).

7. Occupations 
Certain occupation such as Athletes, actors and television personalities, dancers, and models are at higher risk of anorexia. In a detailed interview (the Eating Disorder Examination), models reported significantly more symptoms of eating disorders than controls, and a higher prevalence of partial syndromes of eating disorders was found in models than in controls. A body mass index below 18 was found for 34 models (54.5%) as compared with 14 controls (12.7%). Three models (5%) and no controls reported an earlier clinical diagnosis of anorexia nervosa. Further studies will be necessary to establish whether the slight excess of partial syndromes of eating disorders among fashion models was a consequence of the requirement in the profession to maintain a slim figure or if the fashion modeling profession is preferably chosen by girls already oriented towards symptoms of eating disorders, since the pressure to be thin imposed by this profession can be more easily accepted by people predisposed to eating disorders(20).

8. Etc.  
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Use The Revolutionary Findings To Achieve 
Optimal Health And Loose Weight

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Sources
(13) http://www.ncbi.nlm.nih.gov/pubmed/15209840
(14) http://www.ncbi.nlm.nih.gov/pubmed/22614677
(15) http://www.ncbi.nlm.nih.gov/pubmed/1502972
(16) http://www.ncbi.nlm.nih.gov/pubmed/17950174
(17) http://www.ncbi.nlm.nih.gov/pubmed/15785332
(18) http://www.ncbi.nlm.nih.gov/pubmed/16380317
(19) http://www.ncbi.nlm.nih.gov/pubmed/2323585
(20) http://www.ncbi.nlm.nih.gov/pubmed/15282695

Eating Disorders: Anorexia nervosa - Symptoms and Signs

 Eating Disorders are defined as a group of abnormal eating habits associated to a person preoccupation weight, involving either insufficient or excessive food intake.
Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.

II. Symptoms and signs
A. Most common symptoms
1. Weight loss, sometime severe as a result of malnutrition.

2.  Refusal to maintain a normal or minimally above normal body mass index for their age and Dieting despite being thin or dangerously underweight
Dr. Evelyn Attia and B. Timothy Walsh, in the article of Anorexia Nervosa indicated that Anorexia nervosa is a serious mental illness characterized by the maintenance of an inappropriately low body weight, a relentless pursuit of thinness, and distorted cognition about body shape and weight(1).

3. Intense fear of gaining weight and primary or secondary amenorrhea
In the study Eating disorders. A review and update by Haller E. at the University of California indicated  Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea(2).

4. Obsession with calories and fat content of food and and try to avoid eating altogether. They deny hunger and will usually avoid eating around others as well as avoiding situations where food might be present(3).

5. Disturbance to body image the person hold of him/herself
In the study of  Eating disorders. A review and update, Dr E Haller indicated that , Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea(4).


8. Becomes intolerant to cold and frequently complains of being cold due to fat loss as a result of malnutrition(9)

9. Swelling cheek
Swelling cheek is considered Gradual onset of anorexia due to  enlargement of the salivary glands caused by excessive vomiting

10. Abdominal pain and distention
Anorexia nervosa is also associated abdominal and with  a sensation of elevated abdominal pressure and volume. There is a report of a 26-year-old female with anorexia nervosa binge/purge subtype, who presented with abdominal pain and nausea after a binge episode. Abdominal radiography and computed tomography showed a grossly dilated stomach measuring 32 cm × 17.9 cm consistent with acute gastric dilatation. She underwent exploratory laparotomy with gastrotomy and gastric decompression, and recovered uneventfully. Initially, the patient denied the binge episode, as many patients with eating disorders do, but later revealed an extensive history of anorexia nervosa binge/purge subtype. This case stresses the importance of obtaining a thorough history of eating disorders and maintaining a high index of suspicion for acute gastric dilatation in young women who present with abdominal pain and distention(5).

11. Bad breath
The associated of  bad breath and Anorexia nervosa are of the result of from vomiting or starvation-induced ketosis. In the study of Maintaining women's oral health, Dr. McCann AL and Dr. Bonci L. stated that adolescent women are more prone to gingivitis and aphthous ulcers when they begin their menstrual cycles and need advice about cessation of tobacco use, mouth protection during athletic activities, cleaning orthodontic appliances, developing good dietary habits, and avoiding eating disorders(6).

12. Swollen joints
There is a case of anorexia for the past 10 years have never experienced swollen joints, but now that too is becoming a problem and is explained as Electrolyte Imbalances(7)

13.  Lanugo hair

In the study of  Dr. Judith M. E. Walsh and the research team posted in the Journal of General Internal Medicine, indicated that detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair)(8)

14. Etc.

B. Secondary symptoms
1. Leg pain, fatigue and general weakness
Anorexia nervosa is a disease with high prevalence in adolescents and carries the highest mortality of any psychiatric disorder, but there is a case of a 52-year old woman with longstanding anorexia nervosa was hospitalized due to progressive leg pain, weakness, and fatigue accompanied by marked weight loss. On physical examination she was cachectic but in no apparent distress. She had fine lanugo-type hair over her face and arms with an erythematous rash noted on her palms and left lower extremity.(9)

2. Depression and anxiety
Depression, anxiety and obsessive-compulsive disorder (OCD) frequently co-occur with Anorexia Nervosa (AN). In the review of all the studies done to investigate psychological factors in relation to malnutrition in AN using the keywords "Anorexia Nervosa", "depression", "anxiety", "obsessive-compulsive disorder" and "malnutrition". Only articles published between 1980 and 2010 in English or French were reviewed. From the articles on AN and depression, anxiety, and/or OCD, only the ones which investigated on the relation with malnutrition were kept(10).

3. Sleep disorder
Night eating is linked with a reduced consciousness and sleep disorders, mainly somnambulism. Patients never experience hunger, abdominal pain, nausea or hypoglycemia. Night-eating takes place invariant across weekdays, weekend and vacations. Patients consumed high caloric foods and fluids but never alcohol and purging does not occur. Diurnal bulimia is frequently associated with the sleep-related eating disorder(11)

5. Etc.
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Sources
(1) http://ajp.psychiatryonline.org/article.aspx?articleID=99258
(2) http://www.ncbi.nlm.nih.gov/pubmed/1475950
(3) http://drsandie.com/Eating.html
(4) http://www.ncbi.nlm.nih.gov/pubmed/1475950
(5) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966577/
(6) http://www.ncbi.nlm.nih.gov/pubmed/11486666
(7) http://answers.yahoo.com/question/index?qid=20100712185150AAciPvv
(8) http://www.springerlink.com/content/f7m6m410h608g046/
(9) http://www.ncbi.nlm.nih.gov/pubmed/15257758
(10) http://www.ncbi.nlm.nih.gov/pubmed/20920829 
(11) http://www.ncbi.nlm.nih.gov/pubmed/11760692