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Nutrient quality of diets of adolescents with anorexia nervosa
F e b r u a r y 1997
POSTER PRESENTATIONS
NUTRIENT QUALITY OF DIETS OF ADOLESCENTS WITH ANOREXIA NERVOSA Janet Schebendach MA RD, Pamela Reichert MS RD, Neville H. Golden MD, Marc S. Jacobson MD, 1.R. Shenker MD. Department of Pediatrics, Schneider Children's Hospital, Albert Einstein College of Medicine, New Hyde Park, NY. OBJECTIVE: Prior studies report that patients with Anorexia Nervosa (AN) restrict caloric intake by avoiding carbohydrate. Recent clinical experience suggests a shift to fat restriction. A shift from carbohydrate to fat could alter risk for micronutrient deficiencies. We hypothesize that: 1) adolescents with AN primarily restrict dietary fat calories; 2) micronutrients provided by dietary fat will be at greatest risk for deficient intake; 3) nutrient deficiency may differ among younger and older adolescents. DESIGN: Retrospective study. Setting: inpatient adolescent medicine unit at a tertiary care facility. Patients: 30 consecutively admitted white females, mean age 16.3 years, meeting DSMIV criteria for AN. Main Outcome Measure: nutrient analysis performed by Nutritionist-llI software on 24-hr recalls obtained upon admission by a Registered Dietitian. RESULTS: Mean (_#_ SD) intake of 732.5 + 569 Kcal (33.3 + 26 % RDA), with a macronutrient distribution of 69.7 + 17 % carbohydrate, 21.6 + 11% protein, and 11.8 + 13 % fat was reported. Inadequate micronutrient intake (less than 75 % of RDA) was reported for vitamins A, D, E, B6, B 12 and for the minerals Ca, Mg, P, Zn, and Se. Intakes of thiamin, riboflavin, niacin, folate, and vitamin C were adequate. Low cholesterol (39 + 48 mg) and fiber (8.4 + 8 g) intakes were also found. There were no significant differences in macronutrient or micronutrient intakes between younger (age 11-14) and older (age 15-23) adolescents. CONCLUSIONS: Our findings confirm that adolescents with AN consume low fat diets which provided less than half of the current recommendation for percent of fat calories. Deficient intake of fat soluble vitamins and minerals were most apparent. Younger and older adolescents with AN were at significant and similar risk. Nutritional rehabilitation must address the energy deficit as well as dietary fat and micronutrient deficiencies in this population.
DISORDERED EATING, SEXUAL ABUSE AND BODY IMAGE CONCERNS AMONG MEXICAN-AMERICAN FEMALES. Mary K. Sawyer-Morse, M.S., R.D., Dept. of Nutrition, Univ. of the Incarnate Word, San Antonio Elizabeth Edmundson-Drane, Ph.D., Dept. of Kinesiology and Health Education, Univ. of Texas, Austin OBJECTIVE: Epidetmological evidence of the etiology of disordered eating specific to Mexican American females is limited. Our purpose was to investigate intrapersonal and environmental correlates of disordered eating among this group of young women. DESIGN: Measures of disordered eating (EAT-26, bingeing, vonming, laxative use), sexual assault, acculturation, substance use/abuse, and attitudes toward physical appearance s,,~recollected from a stratified sample (n=498) of Mexican American females. Participants were recrmted from 5 colleges in the Southwest USA. Two-thirds of the participants were age 21 or younger. RESULTS: Among this nonclinical sample of young Hispamc women, 27% reported a history of childhood sexual abuse, 31% met the criteria for disordered eating, 6% binge 2-3 times per week, & 6% repotted laxative use 2-3 times per week for weight control. Multivariate analyses indicated that a 3 variable model accounted for 25% of the variance in disordered eating. The degree of acculturation into Anglo mainstream culture, the severity of the victim's emotional response to the sexual abuse, and internalization of a thin ideal body image were significant predictors in the model. CONCLUSIONS: As young Hispanic women adopt and internalize the Anglo (tall, thin) ideal body image, in conjunction with the emotional impact of childhood sexual abuse, their risk for eating disorders matches that for Anglo females, with laxative use a particular concern. Educational and support programs for adolescent disordered eating should ad&ess the potential impact of childhood sexual abuse among Hispanic populations.
151
POSTER PRESENTATIONS
NUTRIENT QUALITY OF DIETS OF ADOLESCENTS WITH ANOREXIA NERVOSA Janet Schebendach MA RD, Pamela Reichert MS RD, Neville H. Golden MD, Marc S. Jacobson MD, 1.R. Shenker MD. Department of Pediatrics, Schneider Children's Hospital, Albert Einstein College of Medicine, New Hyde Park, NY. OBJECTIVE: Prior studies report that patients with Anorexia Nervosa (AN) restrict caloric intake by avoiding carbohydrate. Recent clinical experience suggests a shift to fat restriction. A shift from carbohydrate to fat could alter risk for micronutrient deficiencies. We hypothesize that: 1) adolescents with AN primarily restrict dietary fat calories; 2) micronutrients provided by dietary fat will be at greatest risk for deficient intake; 3) nutrient deficiency may differ among younger and older adolescents. DESIGN: Retrospective study. Setting: inpatient adolescent medicine unit at a tertiary care facility. Patients: 30 consecutively admitted white females, mean age 16.3 years, meeting DSMIV criteria for AN. Main Outcome Measure: nutrient analysis performed by Nutritionist-llI software on 24-hr recalls obtained upon admission by a Registered Dietitian. RESULTS: Mean (_#_ SD) intake of 732.5 + 569 Kcal (33.3 + 26 % RDA), with a macronutrient distribution of 69.7 + 17 % carbohydrate, 21.6 + 11% protein, and 11.8 + 13 % fat was reported. Inadequate micronutrient intake (less than 75 % of RDA) was reported for vitamins A, D, E, B6, B 12 and for the minerals Ca, Mg, P, Zn, and Se. Intakes of thiamin, riboflavin, niacin, folate, and vitamin C were adequate. Low cholesterol (39 + 48 mg) and fiber (8.4 + 8 g) intakes were also found. There were no significant differences in macronutrient or micronutrient intakes between younger (age 11-14) and older (age 15-23) adolescents. CONCLUSIONS: Our findings confirm that adolescents with AN consume low fat diets which provided less than half of the current recommendation for percent of fat calories. Deficient intake of fat soluble vitamins and minerals were most apparent. Younger and older adolescents with AN were at significant and similar risk. Nutritional rehabilitation must address the energy deficit as well as dietary fat and micronutrient deficiencies in this population.
DISORDERED EATING, SEXUAL ABUSE AND BODY IMAGE CONCERNS AMONG MEXICAN-AMERICAN FEMALES. Mary K. Sawyer-Morse, M.S., R.D., Dept. of Nutrition, Univ. of the Incarnate Word, San Antonio Elizabeth Edmundson-Drane, Ph.D., Dept. of Kinesiology and Health Education, Univ. of Texas, Austin OBJECTIVE: Epidetmological evidence of the etiology of disordered eating specific to Mexican American females is limited. Our purpose was to investigate intrapersonal and environmental correlates of disordered eating among this group of young women. DESIGN: Measures of disordered eating (EAT-26, bingeing, vonming, laxative use), sexual assault, acculturation, substance use/abuse, and attitudes toward physical appearance s,,~recollected from a stratified sample (n=498) of Mexican American females. Participants were recrmted from 5 colleges in the Southwest USA. Two-thirds of the participants were age 21 or younger. RESULTS: Among this nonclinical sample of young Hispamc women, 27% reported a history of childhood sexual abuse, 31% met the criteria for disordered eating, 6% binge 2-3 times per week, & 6% repotted laxative use 2-3 times per week for weight control. Multivariate analyses indicated that a 3 variable model accounted for 25% of the variance in disordered eating. The degree of acculturation into Anglo mainstream culture, the severity of the victim's emotional response to the sexual abuse, and internalization of a thin ideal body image were significant predictors in the model. CONCLUSIONS: As young Hispanic women adopt and internalize the Anglo (tall, thin) ideal body image, in conjunction with the emotional impact of childhood sexual abuse, their risk for eating disorders matches that for Anglo females, with laxative use a particular concern. Educational and support programs for adolescent disordered eating should ad&ess the potential impact of childhood sexual abuse among Hispanic populations.
151