Long-term fracture risk among women with anorexia nervosa: a population-based cohort study

OBJECTIVE: To determine if fractures represent an important problem for women with anorexia nervosa who may fail to achieve peak bone mass and may experience premature bone loss from decreased estrogen levels. PATIENTS AND METHODS: In this population-based retrospective cohort study, we identified 208 Rochester, Minn, residents that were first diagnosed as having anorexia nervosa between 1935 and 1989, whose subsequent fractures were documented in contemporary medical records and compared with expected numbers of fractures (standardized incidence ratios [SIRs]). RESULTS: Subjects were followed up for 2689 person-years during which time 45 patients suffered 88 fractures. Fracture risk was increased among the 193 women (SIR, 2.9; 95% confidence interval, 2.0-3.9) as well as the 15 men (SIR, 3.4; 95% confidence interval, 1.1-7.9). The cumulative incidence of any fracture at 40 years after the diagnosis of anorexia nervosa was 57%. Fractures of the hip, spine, and forearm were late complications, occurring on average 38, 25, and 24 years, respectively, after diagnosis. CONCLUSION: Young women with anorexia nervosa are at increased risk of fractures later in life. Greater attention should be paid to the skeletal health of these individuals.     

Incidence of reading disability in a population-based birth cohort, 1976-1982, Rochester, Minn.

OBJECTIVE: To report the incidence of reading disability among school-aged children. SUBJECTS AND METHODS: In this population-based, retrospective birth cohort study, subjects included all 5718 children born between 1976 and 1982 who remained in Rochester, Minn, after the age of 5 years. Based on records from all public and nonpublic schools, medical facilities, and private tutorial services and on results of all individually administered IQ and achievement tests, extensive medical, educational, and socioeconomic information were abstracted. Reading disability was established with use of research criteria based on 4 formulas (2 regression-based discrepancy, 1 non-regression-based discrepancy, and 1 low achievement). RESULTS: Cumulative incidence rates of reading disability varied from 5.3% to 11.8% depending on the formula used. Boys were 2 to 3 times more likely to be affected than girls, regardless of the identification methods applied. CONCLUSIONS: In this population-based birth cohort, reading disability was common among school-aged children and significantly more frequent among boys than girls, regardless of definition.     

神经性厌食症与神经性贪食症女性患者父母教养方式的比较研究

目的 探究神经性厌食症（anorexia nervosa,AN）和神经性贪食症（bulimia nervosa,BN）女性患者父母教养方式的特征,为进食障碍的临床治疗提供参考。方法 回顾性纳入2019年11月-2020年5月四川大学华西医院心理卫生中心的AN和BN患者,并将来自四川大学的女性师生作为正常对照。收集3组受试者的一般情况,并采用父母教养方式评价量表对3组受试者的父母教养方式和行为进行评估。结果 最终AN组纳入受试者30例,BN组纳入受试者44例,健康对照组纳入受试者33例。AN组和BN组病程差异无统计学意义（P>0.05）。3组受试者的年龄、居住地、文化程度、父母离异、父母文化程度及父母职业差异均无统计学意义（P>0.05）。AN组的体质量指数低于BN组和健康对照组（P<0.05）。父母教养方式评价量表得分结果显示,父亲得分方面,3组受试者过分干涉维度得分差异无统计学意义（P>0.05）,AN组偏爱维度得分[（14.60±4.45）vs.(10.18±5.98)vs.(10.36±5.90)分]高于BN组和健康对照组,BN组情感温暖与理解维度得分[（...     

Anorexia nervosa in Rochester, Minnesota: a 45-year study

The incidence of anorexia nervosa during a 45-year period (1935 through 1979) was determined for the population of Rochester, Minnesota, from the epidemiology archives at the Mayo Clinic. The medical records of local residents with the diagnosis of anorexia nervosa were the primary source for case ascertainment, although records of those whose diagnoses might have been shielding anorexia nervosa were also screened. Standard criteria for diagnosis were applied. We identified 140 (128 female and 12 male) residents of the community who fulfilled the diagnostic criteria for anorexia nervosa. No significant long-term trend in rates was ascertained. The overall age- and sex-adjusted incidence rate was 7.3 per 100,000 person-years. The highest age-specific incidence rate (56.7 per 100,000 person-years) occurred in female residents 15 to 19 years old. The prevalence rate on Jan. 1, 1980, for Rochester residents with a history of the disease, age- and sex-adjusted to the 1970 US white population, was 113.1 per 100,000 (203.9 for female and 16.9 for male residents).     

Risk of development of gastric carcinoma in patients with pernicious anemia: a population-based study in Rochester, Minnesota

To determine the long-term risk of the development of gastric cancer among patients with pernicious anemia, we identified the 152 residents of Rochester, Minnesota, who had well-documented pernicious anemia during the 30-year period 1950 through 1979. These patients were subsequently followed up for more than 1,550 person-years of observation. The observed risk of the development of a gastric cancer in this cohort was compared with that expected on the basis of incidence rates of gastric cancer for the local population. We found one case of gastric carcinoma among our 152 patients with pernicious anemia as compared with an expected incidence of 1.02 (relative risk, 1.0; 95% confidence interval, 0.02 through 5.5). We conclude that no strong indication exists for either radiographic or endoscopic surveillance in asymptomatic patients with pernicious anemia.     

Risk factors for diabetic retinopathy: a population-based study in Rochester, Minnesota

Retinopathy is an important sequela of diabetes mellitus, but clinical risk factors for this condition have rarely been assessed in a geographically defined population. In this population-based study, the 1135 Rochester, Minnesota, residents with diabetes mellitus initially diagnosed between 1945 and 1969 (incidence cohort) were followed through their complete medical records in the community to January 1, 1982. Because most of the cases of diabetic retinopathy in Rochester residents developed in patients with non-insulin-dependent diabetes mellitus (NIDDM), risk factors for diabetic retinopathy were examined in this group (N = 1031). A proportional hazards model identified the following risk factors for diabetic retinopathy in NIDDM: elevated initial fasting blood glucose level, marked obesity, and earlier age at onset of diabetes. Stratified analyses indicated that duration of diabetes was also significantly associated with an increased risk of retinopathy. Two secular trends, increasing detection of "mild" NIDDM and decreasing risk of diabetic retinopathy, had a major effect on retinopathy risk assessment. These data also suggest that insulin therapy is not an independent risk factor for diabetic retinopathy.     

神经性厌食症患者的心脏改变

目的：评价神经性厌食症（AN）患者的心脏改变。方法：选择10例AN患者[（18±2）岁]和10名正常对照者[（19±2）岁],进行超声心动图检查。结果：AN患者的左室内径、室间隔、左室后壁、左室质量和左室质量指数较正常对照者明显减小,且在校正身高、收缩压和心率后,左室质量依然有显著差异;主动脉和左房内径无显著差异。AN患者的心率、收缩压、每搏量、心输出量和心脏指数均比正常对照者降低,而射血分数和左室短轴缩短率无显著差异,左室舒张功能亦无显著差异。2例（2/10）AN患者有轻微二尖瓣脱垂（均为前叶）。结论：左室质量降低、二尖瓣脱垂现象在AN患者中较常见。     

Incidence of diabetic retinopathy and blindness: a population-based study in Rochester, Minnesota

Among the 1135 Rochester residents discovered to have diabetes in the period 1945-69, the prevalence of retinopathy was 2.6% at the time of initial diagnosis. Among those free of retinopathy at diagnosis of diabetes, the subsequent incidence of any retinopathy was 17.4 per 1000 person-years and for proliferative retinopathy alone was 1.6 per 1000 person-years, based on 12,000 person-years of follow-up. The incidence rate of retinopathy was almost three times greater among residents with insulin-dependent (IDDM) than with non-insulin-dependent diabetes (NIDDM); however, the actual number of retinopathy cases was over four times greater among the more numerous residents with NIDDM. By 20 yr after diagnosis of diabetes, the cumulative incidence of retinopathy approached 70% among IDDM subjects and was 30% and 36%, respectively, among the obese and nonobese NIDDM residents. The epidemiologic patterns for proliferative retinopathy were qualitatively similar to those for nonproliferative retinopathy. The risk of blindness was greater among those with proliferative than with nonproliferative retinopathy but was substantial even for those without retinopathy. Most blindness was caused by factors other than isolated diabetic retinopathy.     

Seizures in patients with multiple sclerosis seen at Mayo Clinic, Rochester, Minn, 1990-1998

OBJECTIVE: To evaluate seizure type, electroencephalographic findings, and response to antiepileptic drug (AED) treatment in patients with multiple sclerosis (MS) and coexistent seizure activity. PATIENTS AND METHODS: We reviewed the medical records of all patients seen at the Mayo Clinic in Rochester, Minn, with the diagnosis of MS and seizures between 1990 and 1998. RESULTS: During the study period, 5715 patients with MS were identified. Of these 5715 patients, 51 (0.89%) experienced seizure activity. The most common ictal behavior was a generalized tonic-clonic seizure in 35 patients (68.6%). Simple or complex partial seizures occurred in 11 patients (21.6%), and 18 patients (35.3%) had only 1 seizure episode. Focal motor status epilepticus, ie, epilepsia partialis continua, occurred in 3 patients (5.9%) and was associated with cognitive impairment. In 37 patients (72.5%), the initial seizure presentation was after the diagnosis of MS. A seizure resulted in the diagnosis of MS or occurred before the diagnosis of MS but after other symptoms or signs of demyelinating disease in 14 patients (27.4%). Electroencephalography was performed in 43 patients. Electroencephalographic findings included diffuse or localized nonspecific background slowing in 19 patients (44.2%), unilateral or bilateral frontotemporal spike discharges in 9 (20.9%), generalized atypical spike-and-wave or multifocal independent epileptiform alterations in 6 (14.0%), and normal results in 11 (25.6%). Of the 45 patients who received AED therapy, 35 (77.8%) had an excellent response, ie, they were seizure free. Five treated patients (11.1%) had an intractable seizure disorder. CONCLUSION: Most of the patients with MS who experienced seizure activity had a benign and transient disorder that was responsive to AED treatment or required no therapy.     

The prevalence of peripheral neuropathy in patients with anorexia nervosa

A prospective, controlled study was conducted to determine the prevalence of peripheral neuropathy (PN) in patients with anorexia nervosa (AN). Fifty-one patients (49 females, 2 males) between the ages of 12 and 47 (means = 22.5) who met the criteria for AN of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, were randomly selected from an inpatient eating disorders unit during 15 months. Fifty healthy volunteers (41 females, 9 males) between the ages of 17 and 50 (means = 26.5) served as controls. After a neurologic history, all patients were evaluated by physical examination and standardized electrodiagnostic testing. Chi-square contingency testing was used to assess data. Four study group patients (8%) had electrodiagnostic evidence of a sensorimotor PN compared with none in the control group. This is approaching statistical significance (p = 0.13). Three of four patients with AN for at least ten years were among those with PN. The prevalence of subjective symptoms among the study group (65%) as compared to the control group (4%) was of marked significance (p = 5.62 x 10(-10]. In addition, three anorexic patients were found to have an isolated peroneal nerve palsy. We conclude that PN is a notable complication of AN, particularly in long-standing cases. The PN is most likely a product of chronic malnutrition rather than a specific nutrient deficiency. Patients with AN also appear to be at increased risk for developing localized compression neuropathies secondary to subcutaneous tissue loss.     

Haematological changes and infectious complications in anorexia nervosa: a case-control study

To determine the prevalence of haematological abnormalitiesin patients with anorexia nervosa (AN), and assess the relationshipsbetween these changes, the severity of AN and the propensityto infections, we retrospectively studied 67 patients who metthe DSM-III-R diagnostic criteria for AN. We recorded physicalfindings and routine haematological data on admission, and infectiousevents during hospitalization. The patients were compared with67 normal controls matched for age and sex. Mean haemoglobin(Hb) was normal but lower in AN patients than in controls (131± 1 9 vs. 137 + 11 g/l, p=0.03) and the prevalence ofanaemia (Hb<120 g/l) was higher in the AN group (27% vs.1.5%, p<0.0001). Patients had a lower leucocyte count (4.94+ 1.9 vs. 6.78 + 2.4 x10⁹/ l , p< 0.0001), and increasedprevalence of leucopenia ( < 4 x 10 ⁹ cells/l)(36% vs. 1.5%,p<0.0001), neutropenia (<1500x10⁶ cells/l)(17% vs. 0%,p=0.0015)and thrombocytopenia (<150x109 / l ) (10% vs. 0%, p = 0.03).Only 2 patients (3%) had pancytopenia, but 9/17 patients withanaemia (53%) also had leucopenia. There was a slight but significantcorrelation between body-mass index (BMI) and total leucocyte,neutrophil and red blood cell counts. Severe infectious complicationsoccurred in 9% of AN patients vs. 0% in controls (p = 0.01);they were more frequent with neutropenia (relative risk, 15.1:95% Cl, 10–20.2) or low (<12) BMI (relative risk, 11.6:95% Cl, 6.6–16.6) on admission. Compared with controls,AN patients thus had an increased prevalence of anaemia, leucopeniaand thrombocytopenia. The severity of AN, as assessed by BMI,correlated with leucocyte, neutrophil and red blood cell countsbut not with platelet count The risk for subsequently developingsevere infections was significantly increased when low BMI orneutropenia was found on admission.     

Risk factors for cardiovascular disease in patients with anorexia nervosa

BACKGROUND: hypercholesterolemia, hypercortisolemia and low levels of essential fatty acids, oestrogens and antioxidant vitamins are more prevalent in patients with anorexia nervosa (AN) than in the general population. OBJECTIVE: This study aims (1) to compare cardiovascular risk parameters in-patients with AN and controls, and (2) to compare the parameters in-patients on admission and at four month follow up. METHODS: Blood samples and anthropometry were taken from patients with AN on admission (N=30) and matched controls (N=30). Twenty one patients were re-tested after four months of treatment. RESULTS: Total cholesterol, LDL, Apo B and fibrinogen concentrations were elevated in patients on admission compared with controls, while retinol and tocopherol were decreased. Low levels of T3, T4 and estradiol were correlated with increased cholesterol values. After treatment there was a tendency for most of the abnormal markers to normalise. However, HDL levels decreased leaving patients with an undesirable lipid profile. CONCLUSIONS: Cardiovascular disease is not commonly a problem in these patients, however, with age, and without treatment, the cardiovascular risk may increase.     

Treatment of nonfebrile status epilepticus in Rochester, Minn, from 1965 through 1984

OBJECTIVE: To investigate the adequacy and efficacy of antiepileptic drug (AED) treatment of nonfebrile status epilepticus (SE). PATIENTS AND METHODS: We performed a population-based retrospective cohort study to evaluate the medical management of SE. Participants included 184 residents of Rochester, Minn, who experienced a first episode of nonfebrile SE between 1965 and 1984. RESULTS: Of the 184 patients, 133 (72.2%) received appropriate, prompt medical treatment for SE, i.e., intravenous diazepam, phenytoin, or phenobarbital. In 100 patients (75.8%), the dose of the first AED administered was less than that currently recommended. The first treatment was effective in terminating SE in 41 (31.1%) of 132 patients. The adequacy of treatment was highly predictive of drug efficacy (P = .002). The dose of the second AED treatment was inadequate in 52 (80%) of 65 patients treated. CONCLUSION: Based on this retrospective study, the treatment of SE is remarkable for both inadequacy and ineffectiveness. The inappropriate use of therapeutic regimens in the management of SE may be an important cause of ineffective medical treatment.     

Symptom development in bulimia nervosa: a comparison of women with and without a history of anorexia nervosa

Identifying women at risk for developing bulimia nervosa (BN) is an important area of study for psychiatric-mental health nurses. Of those who develop BN, a large proportion of women have been diagnosed earlier with anorexia nervosa (AN). It has been posited that women who are treated for AN are often only partially recovered. Although their weights become clinically acceptable, they often continue to restrict food; this typically leads to a binge eating and purging cycle and the development of BN. A history of AN is viewed as a possible risk factor for the development of BN. This study compared women seeking treatment for BN with a prior history of AN, and those without this history on selected variables. A profile emerged and is described supporting a distinct subgroup with prior AN. Findings from this study have implications for early detection of and extended follow-up care after treatment for AN.