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Multiple malnutrition diagnostic tools are available in clinical practice, yet, evidence on their validity and reliability is limited. We aim to assess and compare the validity and reliability of the different combinations of indicators of the three most used diagnostic tools with two validated malnutrition screening tools.Nutrition risk screening was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF) and the Nutrition Risk Screening-2002 (NRS-2002). Nutrition assessment was conducted using different combinations of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Concurrent criterion validity and inter-rater reliability of the overall and the different combinations of indicators in the diagnostic tools were evaluated and compared. Sensitivity, specificity, positive predictive value, negative predictive value, and Cohen kappa were calculated to determine tool validity and reliability.The AND/ASPEN (132 [22.8%]) combination and GLIM-1 (133 [23.0%]) (weight loss + compromised food intake) predicted the highest number of malnourished patients and reported a high degree of concurrent criterion validity, agreement, and reliability. On the contrary, overall ESPEN (using any combination) and GLIM-2 (reduced body mass index [BMI] + compromised food intake) reported only moderate criterion validity and low agreement and reliability.Different combinations of diagnostic criteria led to varying validity and reliability, with the lowest validation results rising from the combinations of indicators using BMI as a criterion for malnutrition diagnosis.

Social media (SM) use may have detrimental effects on the physical and mental wellbeing of young adults, including body image dissatisfaction (BID) and changes in dietary behavior. This issue may be of particular concern in pregnant women since adequate dietary behavior is essential during pregnancy for the health of the mother and fetus. The present study aimed to investigate how SM use and posting as well as dependence on technological devices relate to body image and dietary behavior in pregnant women. A descriptive, cross-sectional design was used. A sample of 192 Lebanese pregnant women (29.6 ± 6.2 years old) completed a self-report questionnaire assessing the aforementioned variables. SM usage and posting were both associated with healthy eating behaviors (p = 0.049 and p = 0.03 respectively). On the other hand, SM posting was associated with higher negative body image scores (p = 0.04), postnatal image concerns (p = 0.02), as well as competitiveness with regard to the pregnant body (p = 0.02). Also, dependence on technological devices and internet was associated with higher negative body image scores (p

To improve hospital malnutrition care, assessing actual malnutrition practices and knowledge is essential. Our objectives are to assess malnutrition care practices, evaluate dietitians' malnutrition knowledge, and explore barriers and facilitators to optimal malnutrition care in a LMIC hospitals.This is a national cross-sectional study of mixed-method design. Two questionnaires from the Malnutrition Quality Improvement Initiative were used to assess malnutrition care practices and dietitians' malnutrition knowledge. In-depth interviews were used to investigate barriers and facilitators to optimal malnutrition care.Mean average for malnutrition care practices score was 20.96 out of 30 (N = 56). Factors affecting malnutrition practices were: (1) private/public affiliation of the hospital and (2) presence of a documented malnutrition protocol. Dietitians (N = 62) working at academic hospitals scored 57% for malnutrition knowledge which was higher than the score for those working at non-academic hospitals (44%). Gaps in malnutrition knowledge among hospital staff, shortage in hospital staff, and lack of financial coverage for nutrition therapy were the main barriers identified from eight in-depth interviews.Efforts should be taken by decision makers to facilitate malnutrition care and increase malnutrition awareness among healthcare professionals.

International audience; Background and context: Problematic use of physical activity is frequent in subjects with anorexia nervosa (AN). Although it increases resistance to therapeutic treatment, paradoxically, physical activity in AN can also improve mental and physical health. Based on the literature review we hypothesized that adding an adapted physical activity (APA) program to treatment programs could be more beneficial than a total suppression of physical activities. We designed this open study to evaluate the outcome of AN inpatients after an APA program implementation as well as the perceived effect of APA. Method: Forty-one women with AN (17.2 (±2.5) years old, BMI of 16.86 (±2.0)) were included. An eight-session (1 h30/session/week) standardized APA program was delivered and evaluated by structured questionnaires assessing exercise dependence, perceived physical activity, eating disorder (ED) symptoms, body mass index (BMI), along with an interview before and after the APA program. Results: Twenty-nine women complete the PA program and evaluation. BMI and perceived PA score significantly increased, ED and exercise dependence scores significantly decreased (p

The World Food Programme (WFP) offers yearly health and nutrition summer camps hosting vulnerable Syrian and Lebanese children and aiming at improving physical, mental and social well-being while contributing to better social cohesion. The present study aimed to assess the 2019 WFP summer camps’ effectiveness in reaching the intended outcomes and to provide recommendations for improvement. A multi-method approach using (1) quantitative student pre-/post-surveys (n 443), (2) focus group discussions and (3) key informant interviews and surveys (n 42) was adopted. Mean test results showed improvements in nutrition (4·79 (sd 1·9) v. 5·34 (sd 2·7); t(269) = 4·51, P = 0·000) and life skills knowledge (4·97 (sd 1·9) v. 5·55 (sd 2); t(294) = 4·52, P = 0·000) but no improvement in health knowledge and social cohesion scores. Qualitative data revealed positive changes in social cohesion and an increase in health knowledge. In addition, there was a positive attitude towards the summer camps from students, instructors and administrators specifically regarding the integrated content, snacks and atmosphere of fun and learning. The main weaknesses identified were the short time to prepare for the camps, shortage in instructor training and short camp duration. There were also points of debate regarding sexual and reproductive health-related topics and how they should be delivered. All in all, the camps were shown to be a commendable initiative for incorporating an integrated and holistic approach in the support of education and development among vulnerable children and adolescents.

The genetic aspect of anorexia nervosa (AN) involving specific genes of the central-nervous-system has not yet been clearly understood. The aim of this systematic review is to assess the impact of three candidate genes of the brain: catechol-O-methyltransferase, brain-derived neurotrophic factor (BDNF) and serotonin transporter protein, on the susceptibility to AN and identify whether a clear connection persists between each of the gene-polymorphisms and AN. A total of 21 articles were selected for this review conforming to the PRISMA guidelines. Detailed keyword combinations were implemented within specific databases such as MEDLINE, SCIENCEDIRECT and PUBMED. The catechol-O-methyltransferase gene-polymorphism did not show any change in phenotypic variation between AN and control subjects; but the familial association was rather strong with an over-transmission of the H allele. The latter also correlated with several dimensions of the Temperament and Character Inventory (TCI) scale. A notable relation was indicated between BDNF gene-polymorphism and anorexia-restrictive in terms of phenotypic distribution; the Met66-allele also depicted high association with anorexic behavioral traits. The 5-HTTLPR gene-polymorphism was found to be significantly associated with AN susceptibility with an over-transmission of the S-allele from parents to offspring. The systematic review distinctively emphasized the genetic contribution of the brain-genes on the development of AN. Despite significant study findings, no clear and standardized genetic route was determined to be the cause of AN development. Future research is needed on these specific genes to closely monitor the genetic polymorphisms and their mechanism on AN susceptibility. I, systematic review

In pursuit of equitable access to emergency-related knowledge, the World Health Organization (WHO) translates COVID-19 and other infectious disease courses into multiple languages on its open-access online learning platform OpenWHO.org. Languages spoken by vulnerable or underserved populations in low- and middle-income countries and in outbreak-prone and affected areas are prioritized. Accessing learning in preferred languages enhances uptake and comprehension. In this study, we assess and compare the initial enrollment levels and global reach of these multilingual courses. On average, OpenWHO's 38 COVID-19 courses have each been translated into 4.8 languages. The platform hosts courses in 55 different languages with 10.4 million words translated. The findings identify which available languages were most utilized for COVID-19 learning to inform course production and outreach strategies. Languages were used differently across geographic regions, calling for localized learning offerings. A streamlined multilingual publishing scheme, ensuring quick and effective delivery of diverse languages, is critical to achieving greater equity of access to knowledge. publishedVersion

OpenWHO provides open access, online, free and real time learning responses to health emergencies. Before the pandemic, courses on 18 diseases were provided. The increase to 38 courses in response to COVID-19 have led to a massive increase in the number of new learners. As a result, the COVID-19 pandemic affected learners' trends. This paper presents initial findings of changes perceived in the use and user groups' attendance to the World Health Organization's (WHO) health emergency learning platform OpenWHO. Enrolment statistics were based on data collected in December 2019 and March 2021. A descriptive analysis was conducted to explore changes in the usage pattern of the platform. Several user characteristics shifted between before and during the pandemic. More women, younger and older learners joined the learning during the pandemic. Public health education leaned toward a more equitable reach including previously underrepresented groups.

OpenWHO provides open access, online, free and real time learning responses to health emergencies. Before the pandemic, courses on 18 diseases were provided. The increase to 38 courses in response to COVID-19 have led to a massive increase in the number of new learners. As a result, the COVID-19 pandemic affected learners' trends. This paper presents initial findings of changes perceived in the use and user groups' attendance to the World Health Organization's (WHO) health emergency learning platform OpenWHO. Enrolment statistics were based on data collected in December 2019 and March 2021. A descriptive analysis was conducted to explore changes in the usage pattern of the platform. Several user characteristics shifted between before and during the pandemic. More women, younger and older learners joined the learning during the pandemic. Public health education leaned toward a more equitable reach including previously underrepresented groups. publishedVersion Non

Violence against women (VAW) is a global public health problem associated with considerable health risks, including disordered eating behavior (DEB) and eating disorders (ED). The current study inv...

The interweaving of malnutrition and symptoms of anxiety and depression in anorexia Nervosa (AN) is mentioned without any consensus regarding the course of anxious-depressive symptoms in relation to nutritional status in the course of treatment of patients with AN. The objectives of the current study in a large sample of AN inpatients were to assess the relationships between anxiety and depression symptoms and nutritional status both over the course of inpatient treatment and at discharge. 222 consecutive inpatients with AN (DSM-IV TR) were assessed (entrance and discharge) for duration of illness, psychiatric treatments, sociodemographic data and with psychometric scales for different psychopathological symptoms [depressive (BDI), anxiety and depressive (HAD scale), obsessive–compulsive (MOCI) and social phobia (LSAS fear score)]. Nutritional status was assessed with Body Mass Index (BMI) and body composition by bioelectrical impedance. The Fat free mass index [FFMI = FFM (kg)/height (m2)] was considered for the analysis. Two models were developed where the dependent variables were each psychopathological score at discharge (BDI, HAD anxiety, MOCI, and LSAS fear) in the cross-sectional model, and their variation in the longitudinal model (where a positive score reflected symptom decrease at discharge). A fixed set of predictors, defined on presumed clinical and statistical relevance (FFMI in the cross-sectional model and Variation of FFMI in the longitudinal model), were considered in each model, without any model selection procedure. This is the first study to confirm a positive relationship between the course of eating disorder symptoms and that of anxious-depressive symptoms during inpatient treatment of AN even after adjustment on a vast array of possibly confounding factors.

The aim of this study was to assess the level of food hygiene and food shopping knowledge and practices among residents of Lebanon during the COVID-19 pandemic, and to identify their socio-demographic determinants. A cross-sectional study was conducted through an online questionnaire composed of 13 questions about demographics, and 25 questions related to knowledge and practices in terms of hand maintenance, mask placing, and food shopping. A total of 1337 participants filled the survey. On average, participants scored 73±15 and 67±17% on food hygiene and knowledge and practices, respectively. In terms of best practices by section, they scored 77±22, 51±42, and 65±23% on hand maintenance, mask placing and shopping, respectively. Hand maintenance best practices score was significantly (p

The genetic aspect of anorexia nervosa (AN) involving specific genes of the central-nervous-system has not yet been clearly understood. The aim of this systematic review is to assess the impact of three candidate genes of the brain: catechol-O-methyltransferase, brain-derived neurotrophic factor (BDNF) and serotonin transporter protein, on the susceptibility to AN and identify whether a clear connection persists between each of the gene-polymorphisms and AN.A total of 21 articles were selected for this review conforming to the PRISMA guidelines. Detailed keyword combinations were implemented within specific databases such as MEDLINE, SCIENCEDIRECT and PUBMED.The catechol-O-methyltransferase gene-polymorphism did not show any change in phenotypic variation between AN and control subjects; but the familial association was rather strong with an over-transmission of the H allele. The latter also correlated with several dimensions of the Temperament and Character Inventory (TCI) scale. A notable relation was indicated between BDNF gene-polymorphism and anorexia-restrictive in terms of phenotypic distribution; the Met66-allele also depicted high association with anorexic behavioral traits. The 5-HTTLPR gene-polymorphism was found to be significantly associated with AN susceptibility with an over-transmission of the S-allele from parents to offspring.The systematic review distinctively emphasized the genetic contribution of the brain-genes on the development of AN. Despite significant study findings, no clear and standardized genetic route was determined to be the cause of AN development. Future research is needed on these specific genes to closely monitor the genetic polymorphisms and their mechanism on AN susceptibility.I, systematic review.

OBJECTIVES: To compare initial malnutrition screening performed by nursing staff to that of the dietitians’, pre and post educational intervention To determine the knowledge and practice, of nurses regarding malnutrition METHODS: The study is a quasi-experimental design which included pre and post interventional malnutrition screening and diagnosis, and three multidisciplinary educational interventions, accompanied with pre and post knowledge assessments, for nurses, physicians and pharmacists. Admitted patients were screened for malnutrition using the NRS-2002 or MNA. Patients at risk of malnutrition or malnourished at screening were diagnosis for the latter using ASPEN, ESPEN and GLIM malnutrition diagnostic tools. Nutrition focused physicals examination, functional status and body composition analysis were also conducted. The nurses’ initial screenings of malnutrition (NRS-2002) was recorded for comparison with the dietitians’ screenings. RESULTS: A total of 269 patients were screened prior to the intervention out of which 37 (13.75%) were either at risk of malnutrition or malnourished. Post intervention, 311 patients were screened and 84 (27.01%) were either at risk or malnourished. Hundred and one registered nurses attended the educational session, and a repeated measure ANOVA showed that the nurses’ knowledge significantly improved (P

International audience; Abnormally high levels of physical activity have been documented throughout the literature in patients with eating disorders (ED), especially those diagnosed with anorexia nervosa (AN). Yet no clear definition, conceptualization, or treatment of the problematic use of physical activity (PPA) in ED patients exists. The aim of this review is to propose a new classification of PPA, report the prevalence, triggers, predictors, maintainers and other related factors of PPA in ED patients, in addition to proposing a comprehensive model of the development of PPA in AN. A total of 47 articles, retrieved from Medline and Web of Science, met the inclusion criteria and were included in the analysis. As a result, the new approach of PPA was divided into two groups (group 1 and group 2) according to the dimension (quantitative vs qualitative approach) of physical activity that was evaluated. The prevalence of PPA in ED was reported in 20 out of 47 studies, the comparison of PPA between ED versus controls in 21 articles, and the links between PPA and psychological factors in ED in 26 articles, including depression (16/26), anxiety (13/26), obsessive-compulsiveness (9/26), self-esteem (4/26), addictiveness (1/26), regulation and verbal expression of emotions (1/26) and anhedonia (1/26). The links between PPA and ED symptomatology, PPA and weight, body mass index (BMI) and body composition in ED, PPA and age, onset, illness duration and lifetime activity status in ED, PPA and ED treatment outcome were reported in 18, 15, 7, 5 articles, respectively. All of the factors have been systematically clustered into group 1 and group 2. Results focused more on AN rather than BN due to the limited studies on the latter. Additionally, a model for the development of PPA in AN patients was proposed, encompassing five periods evolving into three clinical stages. Thus, two very opposite components of PPA in AN were suggested: voluntarily PPA increased in AN was viewed as a conscious strategy to maximize weight loss, while involuntarily PPA increased proportionally with weight-loss, indicating that exercise might be under the control of a subconscious biological drive and involuntary cognition.

Background Food consumption and wastage behavior varies across cultures, which warrants investigations in various countries and locations of different income levels. To date, information on the attitudes and behaviors of households in developing countries regarding food waste is scarce. The objective of this study is to assess the household attitudes and behaviors that determine food waste in Lebanon for a better understanding and for tailoring community based interventions. Methods A questionnaire, composed of 3 sections and 27 questions, was developed to assess the attitudes and behaviors towards food waste in Lebanese households. A convenient sample of 1264 households from the five governorates of Lebanon was interviewed in 2016 and 2017. The variable “eat everything prepared” was used as a proxy for food waste. The effect of various socio-demographic and behavioral factors on household food waste generation across urban and rural areas in Lebanon was estimated by means of a Logistic regression, using STATA. Results Socio-demographic variables such as employment, education, number of members in the household and income affected food waste volume. Behaviors such as eating out frequently and buying best offers were shown to increase food wastage. Also, beliefs such as feeling guilty decreased food waste generation. Rural households contributed less to food waste generation compared to urban areas. Conclusion Households contribute significantly to a country's food waste problem through their behavior and beliefs. Our findings showed that various household characteristics and food-related behaviors, attitudes toward recycling and other beliefs affected food waste generation in urban and rural communities of a developing country. Future research is still needed to better understand determinants of food waste at the household level in developing countries.

Evidence on physical activity (PA) indicators for children and youth at a national level is necessary to improve multilevel support for PA behaviors. Lebanon's first Physical Activity Report Card for children and youth (2018) aimed to fill this gap. : In line with the recommended methods of "Global Matrix 3.0," nationally representative data were retrieved from peer-reviewed manuscripts, national surveys, and government reports. In addition to adopting the 10 indicators of "Global Matrix 3.0," publications that discussed weight status were also retained. A grade was assigned for each indicator using a standard rubric: A = 80% to 100%, B = 60% to 79%, C = 40% to 59%, D = 20% to 39%, F =

The prevalence of childhood obesity in Lebanon nearly doubled between 1997 and 2009.1 This shift in population health is extremely alarming, given that obesity is associated with a host of chronic diseases (eg, cardiovascular diseases, diabetes mellitus, cancer)1 representing the primary causes of death and disease burden in 2012.2 Low physical activity (PA) levels and engagement in greater sedentary activities have been used to explain such trends.1 However, little is known about PA indicators among Lebanese children and youth. This led to the development of Lebanon’s first Physical Activity Report Card for Children and Youth (Figure 1).

Background Extensive research has been conducted to investigate the effects of media violence on attitudes, behaviors, and cardiovascular health; however, only few studies have examined its effect on appetite, eating behavior and food preferences. Little attention has been given to understand how movie genre manipulates the physiology and the eating behavior of individuals. The present study aimed at investigating the acute effect of violence content in movies on appetite perception, heart rate and blood pressure, along with food preferences and intake in young individuals. Methods Participants (n = 84) were randomly assigned to either watch a violent movie or a non-violent narrative movie. Measurements including anthropometry, heart rate, blood pressure and grip strength were taken and appetite as well as stress perception were assessed. Subjects were then provided with an individual snack tray containing various items to be consumed ad libitum. Results Post intervention, the experimental group (EG) had a higher consumption of fatty (t (82) = 2.28, p = 0.025, d = 1.52) and salty (t (82) = 2.61, p = 0.01, d = 0.71) food items compared to the control group (CG). Out of the 42 participants in the EG 62% consumed >2 fatty items and 71.4% consumed >2 salty food items. No significant difference in the consumption of sugary items was observed between the two groups. Conclusion Movie violence affects eating behavior and may promote weight gain.

Purpose Breastfeeding rates continue to decrease in Lebanon. Studies addressing the relationship between breastfeeding duration and health outcomes in Middle Eastern countries are scarce. This study is the first in Lebanon to have investigated the determinants of both exclusive and mixed breastfeeding durations and the relationship with health in infants and toddlers. Design and methods Our sample of 1051 toddlers is nationwide and representative of all toddlers enrolled in daycare centers, and aged between 12 and 36 months. Results Median of exclusive breastfeeding duration was 15 days and mean age of formula introduction was 2.03 (±3.22) months. Exclusive breastfeeding was initiated at a mean age of 10.56 (±27.12) hours and half of the toddlers (51.6%) were exposed to formula milk since day one following birth. Determinants of both exclusive and total breastfeeding durations were related to several parents' socio-demographic and behavioral factors. A longer duration of exclusive breastfeeding was associated with a lower frequency of pediatrician visits, antibiotic prescriptions, absence from daycare, and a lower risk of otitis, colic and UTI occurrence, after adjusting for cofounders. Similarly, a longer duration of total breastfeeding was associated with less antibiotic prescriptions and a lower risk of otitis. Conclusions Our study highlights the health benefits of extending exclusive breastfeeding duration. It is urgent to address alarmingly low breastfeeding rates in Lebanon. Policy implementation and enforcement along with raising awareness and creating a supportive environment for breastfeeding mothers should involve the various stakeholders in order to succeed in increasing breastfeeding rates and duration.

Summary Background Multiple clinical guidelines are available to improve and standardize the delivery of nutrition support. However, recommendations are not being universally applied at the bedside due to challenges of resources and barriers of knowledge. Assessing the current level of nutrition support practice is the first step to understand the barriers and ultimately implement potential strategies to increase guideline adherence and promote quality nutrition support in hospitals. There are no published data concerning the practice of nutrition support in Lebanese hospitals. Objectives: The objective of our study is to investigate for the first time the current clinical practice pertinent to nutrition support across Lebanon. Methods A survey was developed by The Nutrition Board of the Lebanese Society of Critical Care Medicine (LSCCM) to determine nutrition support practices in hospitals with an Intensive Care Unit (ICU) across Lebanon. The 28-question survey assesses the delivery of feeding methods such as oral nutrition supplements (ONS), enteral nutrition (EN), and parenteral nutrition (PN). Results Fourty-one hospitals from 116 total completed the survey. The majority of the hospitals (92.6%) do not systematically use a screening system for malnutrition. Seventy six percent of hospitals reported less than 5% of their patients are kept for more than 7 days with no nutrition support. Early EN is used in preference over PN in ICUs, as 72% of hospitals start early EN (within 48 h) in more than 10% of cases while only 30% of hospitals start early PN (within the first week) in more than 10% of cases. Fifty-one percent of the hospitals use ready prepared formula while the rest (49%) use kitchen prepared formula. Conclusions Our study is the first of its kind in Lebanon aiming at describing the current clinical practice in nutrition support at a national level. Working toward the use of a nutritional screening tool on admission and the exclusive use of ready made formula for enteral feeding will have the most significant and immediate impact on improving quality of nutritional care for hospitalized patients. This can be achieved mainly through the education of the concerned staff.

Background The 7-minute workout composed of aerobic and resistance exercises is becoming a very popular workout. It targets individuals with time constrains and low motivation to commit to lengthy and extensive workout programs. The objective of the study is to investigate if the 7-minute workout has a 6 week effect on body weight and composition. Methods The training group (N.=29, age 18-30) did the 7-minute workout 7 days a week during 6 weeks while the control group (N.=29) did not perform the workout. Measurements such as height, weight, body mass index, circumferences (middle upper arm, hip, and waist), blood pressure, heart rate, hand grip, and bioelectrical impedance were collected and recorded at week 1, 3 and 6. Results Mean BMI was 24.4kg/m2 at week 1, 24.01kg/m2 at week 3 (P=0.003). Waist circumference decreased between week 1 and 3 (P=0.003) and week 6 (P=0.01) by 4 cm on average. Hip circumference followed the same trend between week 1 and week 3 (P=-0.001). There was a decrease in fat mass and % fat mass between week 1, 3, and 6 (P=0.001). No changes were noted for mid-upper arm circumference or hand grip. Conclusions The findings of this research show that even a very short duration workout affect the nutritional status in normal weight individuals who did not change any of their eating habits. This implies that even in normal weight individuals who perform the 7-minute workout, improvement through a decrease in waist circumference can be achieved thus leading to a better cardio-protective nutritional status. The 7 minutes workout can be a great solution for people to get started and to plan on continuing exercising, as it is simple and of minimal constraints.

Depressive, anxiety and obsessive symptoms frequently co-occur with anorexia nervosa (AN). The relationship between these clinical manifestations and the biological changes caused by starvation is not well understood. It has been hypothesised that reduced availability of tryptophan (TRP) could reduce serotonin activity and thus trigger these comorbid symptoms. The aim of this study, during re-feeding in individuals with AN, was to analyse covariations across measures of nutritional status, depressive and anxiety symptoms, and peripheral serotonin markers. Depressive and anxiety symptoms, nutritional status and serotonin markers--whole blood serotonin content, plasma TRP and the ratio between TRP and large neutral amino acids--were assessed for 42 AN participants at admission to inpatient treatment and after re-feeding. Biological measures were compared to those obtained in 42 non-eating disordered subjects. For those with AN, psychological, nutritional and biological parameters improved significantly during hospitalisation. Levels of serotonin markers were significantly lower in the AN group compared to the control group, at admission and at discharge. Increase in the TRP/LNAA ratio was correlated with a decrease in depressive symptoms. In addition, there was a positive correlation between serotonin levels and symptoms of both anxiety and depression at discharge. We speculate that enhanced TRP availability during re-feeding, as a result of the increase in the TRP/LNAA ratio, could restore serotonin neurotransmission and lead to a decrease in depressive symptoms. The association between serotonin and anxiety and depressive symptoms would be consistent with numerous observations indicating abnormal functioning of the serotoninergic system in AN.

Objective: To review studies assessing Expressed Emotion among parents/relatives of patients with Anorexia Nervosa and Bulimia Nervosa. Method: A systematic computerized search was performed in Medline complemented by a manual search of the literature for all studies published between 1981 and 2011. A total of 27 papers in English were reviewed for their methods, instruments used and results. Results: Comparisons were not easy due to methodological disparities in assessments. Levels of Expressed Emotion depend concurrently on parental characteristics (parent assessed, social status and psychological distress), patient characteristics (age, social adjustment) and Eating Disorders characteristics (type of Eating Disorders, duration and severity of illness and previous treatment). Expressed Emotion has a predictive value for patient outcome and for compliance with/ and implication in treatment. Levels of Expressed Emotions vary with the parent assessed. The crosscultural aspects of Expressed Emotion in Eating Disorders are not widely documented. Discussion: Both positive and negative aspects of Expressed Emotion are important therapeutic targets and further research on this topic is needed.

Summary Background & aims Body weight changes do not reflect the respective changes of body compartments, namely fat-free mass (FFM) and fat mass (FM). Both bioelectrical Impedance Analysis (BIA) and the Dual X-ray absorptiometry (DXA) measure FFM and FM. This study in underweight patients with anorexia nervosa (AN) aims to compare measurements of FM and FFM done by DXA and BIA using 5 different BIA equations already validated in healthy population and to identify the most suitable BIA equation for AN patients. Methods Fifty female patients with AN (BMI = 14.3 ± 1.49, age = 19.98 ± 5.68 yrs) were included in the study. Body composition was measured by DXA (Delphi W, Hologic, Bedford, MA) and by 50 kHz BIA (FORANA, Helios) using 5 different BIA equations validated in healthy population (Sun, Geneva, Kushner, Deurenberg and Roubenoff equations). Comparison between the DXA and the 5 BIA equations was done using the sum of the squares of differences and Bland–Altman plots. Results The Deurenberg equation gave the best estimates of FFM when compared to the measurements by DXA (FFM dxa = 35.80 kg versus FFM deurenberg = 36.36 kg) and very close estimates of FM (FM dxa = 9.16 kg and FM deurenberg = 9.57 kg) The Kushner equation showed slightly better estimates for FM (FM kushner = 9.0 kg) when compared to the DXA, but not for FFM. Sun equation gave the broadest differences for FM and FFM when compared with DXA. Conclusion The best available BIA equation to calculate the FFM and the FM in patients with AN is the Deurenberg equation. It takes into account the weight, height and age and is applicable in adults and adolescents AN patients with BMI of 12.8–21.0, and for ages between 13.4 and up to 36.9 years.

Background Depression, anxiety and obsessive–compulsive disorder (OCD) frequently co-occur with Anorexia Nervosa (AN). Clinical consensus admits that depressive symptoms and anxiety are the sequelae of malnutrition in AN. This review presents a critical assessment of the literature that looked into the link between depression/anxiety symptoms in relation to malnutrition and their improvement throughout the treatment. Methods We performed a systematic search of literature in Medline and PsychInfo for 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. This search was complemented by a manual search. We also checked the reference lists of the articles we found. Results Seven papers were analyzed and critically reviewed for their methods and results. Results are contradictory and inconsistent at all levels of assessment. Conclusions Evidence based data is very rare. From the 7 reviewed studies, none of them draw the same conclusion. This is mainly due to the large differences in the samples' populations and the studies' protocols. Future studies are needed to focus on the relationship between depression/anxiety symptoms and malnutrition. A more critical nutritional assessment should be undertaken with multiple psychological assessment scales.

The psychiatric condition of patients suffering from anorexia nervosa (AN) is affected by their nutritional status. An optimal assessment of the nutritional status of patients is fundamental in understanding the relationship between malnutrition and the psychological symptoms. The present review evaluates some of the available methods for measuring body composition in patients with AN. We searched literature in Medline using several key terms relevant to the present review in order to identify papers. Only articles in English or French were reviewed. A brief description is provided for each body composition technique, with its applicability in AN as well as its limitation. All methods of measuring body composition are not yet validated and/or feasible in patients with AN. The present review article proposes a practical approach for selecting the most appropriate methods depending on the setting, (i.e. clinicalv.research) and the goal of the assessment (initialv.follow-up) in order to have a more personalised treatment for patients suffering from AN.

Very little is known about media violence and its effect on appetite and eating behavior. The present study aims at investigating the immediate acute effect of violence in movies on mood, stress, appetite perception and food preferences in a real-life setting. A total of 447 subjects (F = 202; M = 239) completed a validated visual analog scale to record their subjective feelings of hunger, satiety and desire to eat immediately at their way out of any of the three types of movies (horror, romance/comedy and drama/action). There was a significant difference between the three movie categories for the tensed feeling (P = 0.003), anxiety (P = 0.021), the sleepy feeling (P = 0.000) and a preference to eat something sweet (P = 0.019). Horror/violence movie types affected the subject by making him feel more stressed and anxious; however, romance made him feel sleepier and less tensed. Movie types did not seem to affect hunger or appetite directly, but rather triggered some food preferences.