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Hyaluronan (HA) is a high-molecular-weight glycosaminoglycan and widely distributed in all connective tissues and organs with diverse biological functions. HA has been increasingly used as dietary supplements targeted to joint and skin health for humans. We here first report isolation of bacteria from human feces that are capable of degrading HA to lower molecular weight HA oligosaccharides (oligo-HAs). The bacteria were successfully isolated via a selective enrichment method, in which the serially diluted feces of healthy Japanese donors were individually incubated in an enrichment medium containing HA, followed by the isolation of candidate strains from streaked HA-containing agar plates and selection of HA-degrading strains by measuring HA using an ELISA. Subsequent genomic and biochemical assays identified the strains as Bacteroides finegoldii, B. caccae, B. thetaiotaomicron, and Fusobacterium mortiferum. Furthermore, our HPLC analysis revealed that the strains degraded HA to oligo-HAs of various lengths. Subsequent quantitative PCR assay targeting the HA degrading bacteria showed that their distribution in the Japanese donors varied. The evidence suggests that dietary HA is degraded by the human gut microbiota with individual variation to oligo-HAs components, which are more absorbable than HA, thereby exerting its beneficial effects.

Abstract Lactobacillus delbrueckii JCM 1002T grows on highly polymerized inulin-type fructans as its sole carbon source. When it was grown on inulin, a > 10 kb long gene cluster inuABCDEF (Ldb1381-1386) encoding a plausible ABC transporter was suggested to be induced, since a transcriptome analysis revealed that the fourth gene inuD (Ldb1384) was up-regulated most prominently. Although Bacillus subtilis 168 is originally unable to utilize inulin, it became to grow on inulin upon heterologous expression of inuABCDEF. When freshly cultured cells of the recombinant B. subtilis were then densely suspended in buffer containing inulin polymers and incubated, inulin gradually disappeared from the buffer and accumulated in the cells without being degraded, whereas levan-type fructans did not disappear. The results imply that inuABCDEF might encode a novel ABC transporter in L. delbrueckii to “monopolize” inulin polymers selectively, thereby, providing a possible advantage in competition with other concomitant inulin-utilizing bacteria.

There are numerous bacteria reside within the mammalian gastrointestinal tract. Among the intestinal bacteria, Akkermansia, Bacteroides, Bifidobacterium, and Ruminococcus closely interact with the intestinal mucus layer and are, therefore, known as mucosal bacteria. Mucosal bacteria use host or dietary glycans for colonization via adhesion, allowing access to the carbon source that the host’s nutrients provide. Cell wall or membrane proteins, polysaccharides, and extracellular vesicles facilitate these mucosal bacteria-host interactions. Recent studies revealed that the physiological properties of Bacteroides and Bifidobacterium significantly change in the presence of co-existing symbiotic bacteria or markedly differ with the spatial distribution in the mucosal niche. These recently discovered strategic colonization processes are important for understanding the survival of bacteria in the gut. In this review, first, we introduce the experimental models used to study host-bacteria interactions, and then, we highlight the latest discoveries on the colonization properties of mucosal bacteria, focusing on the roles of the cell surface architecture regarding Bacteroides and Bifidobacterium.

The strawberry fruit contains abundant polyphenols, such as anthocyanins, flavan-3-ol, and ellagitannin. Polyphenol enrichment improves the quality of strawberries and leads to a better understanding of the polyphenol induction process. We measured the total polyphenol content of strawberry fruits under different growth conditions, developmental stages, and treatment conditions during pre-harvest and post-harvest periods. High fruit polyphenol content was observed in cold treatment, which was selected for further analysis and optimization. A transcriptome analysis of cold-treated fruits suggested that the candidate components of polyphenols may exist in the phenylpropanoid pathway. Coverage with a porous film bag excluded the effects of drought stress and produced polyphenol-rich strawberry fruits without affecting quality or quantity. The degree of stress was assessed using known stress indicators. A rapid accumulation of abscisic acid was followed by an increase in superoxide dismutase and DPPH (2,2-Diphenyl-1-picrylhydrazyl) activity, suggesting that the strawberry fruits responded to cold stress immediately, reaching the climax at around 6 days, a trend consistent with that of polyphenol content. These findings enhance our understanding of the mechanism of post-harvest polyphenol accumulation and the value of strawberries as a functional food.

Objective: To describe changes in physical activity (PA) and exercise dependence score during treatment of eating disorders (ED), and to explore correlations among changes in PA, exercise motivation, exercise dependence score and ED psychopathology in excessive and non-excessive exercisers. Method: Thirty-eight adult females receiving inpatient treatment for anorexia nervosa, bulimia nervosa or ED not otherwise specified participated in this prospective study. Assessments included accelerometer assessed PA, Exercise Dependence Scale, Reasons for Exercise Inventory, ED Examination, and ED Inventory. Results: Amount of PA was significantly reduced in non-excessive exercisers during treatment, in excessive exercisers there was a trend towards reduced amount of PA from admission to discharge. In excessive exercisers, reduced ED psychopathology was correlated with reduction in exercise dependence score and perceived importance of exercise to regulate negative affects, but not with importance of exercise for weight/appearance. These associations were not found in non-excessive exercisers. Discussion: Excessive exercise is an important issue in longstanding ED, and the excessive exercising patients need help to develop alternative strategies to regulate negative affects. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [ABSTRACT FROM AUTHOR]

Objective To examine self reported versus objectively assessed moderate-to-vigorous physical activity (MVPA), and different reasons for exercise, in patients with longstanding eating disorders (ED) when compared with controls. Method Inpatient females (n = 59, mean 30.1 years) and nonclinical age matched controls (n = 53, mean 31.3 years) accepted participation in this cross sectional study. Instruments included accelerometer ActiGraph, physical activity diary, Reasons for Exercise Inventory, and Eating Disorders Examination interview. Results Self reported and objectively assessed MVPA were higher across all ED diagnoses when compared with controls. The patients' self reported MVPA was lower than the objectively assessed MVPA; no difference was found in controls. Regulation of negative affects, not weight/appearance, was a more important, whereas fitness/health was a less important reason for exercise in patients than controls. Discussion The underreporting of MVPA in some patients with ED may warrant clinical attention. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010; 43:88-92 [ABSTRACT FROM AUTHOR]

OBJECTIVE: The current study aimed to investigate the relation between personality disorders and symptoms of both eating disorders and general psychopathology over time. METHOD: Seventy-four patients, with a mean age of 30 years and admitted to a hospital for treatment of a chronic eating disorder, were assessed using the Eating Disorder Inventory (EDI), the Eating Disorder Examination (EDE), the Symptom Check List-90-Revised (SCL-90-R), and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) at admission, and after 1 and 2 years. RESULTS: At the 2-year follow-up, there was considerable reduction in both personality and symptoms (effect size = 0.83-0.94). Panel modeling using structural equation modeling techniques indicated that symptomatic changes generally preceded changes in the personality disorder. DISCUSSION: Eating disorder symptoms and general symptomatology had direct effects on a dimensional personality disorder index. Thus, personality disorders may be at least partially a consequence of general symptomatology in chronic eating disorders. Symptom improvement appears to precede changes in personality in this sample of patients with chronic eating disorders. 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

ObjectiveThe aims of this prospective study were (1) to report on the 2-year outcome of chronically ill adult eating disorder patients, (2) to investigate whether a specialized inpatient treatment might influence the course of the illness, and (3) to search for prognostic factors.MethodSeventy-two patients were treated in a 4-5-month specialized group treatment programme for chronically ill adults with eating disorders. Sixty-five (90%) with mean age of 30 years were available for the follow-up assessment.ResultsForty-six (71%) patients had improved at the 2-year follow-up and 17 (26%) did not meet diagnostic criteria for an eating disorder. The symptom reductions per time were statistically significantly larger during the inpatient period compared to the waiting-list and follow-up periods. No significant predictors of treatment outcome were found. Patients with avoidant personality disorder had a higher level of distress at all times, but improved at the same rate as the others.ConclusionAt the 2-year follow-up, there were substantial reductions in eating disorder symptoms and general psychiatric symptoms. Most of the improvement occurred during inpatient treatment, which might be an option for chronic eating disorders. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The current study had three objectives: to report the presence of personality disorders (PDs) in adults with longstanding eating disorders (EDs) at admission to inpatient treatment, and at 1 and 2-year follow-up; to compare the frequency of PDs in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS); and to investigate whether recovered patients had lower frequency of PDs. METHOD: Seventy-four patients with a mean age of 30 years and long-lasting EDs were assessed with the Structured Clinical Interview for DSM-IV Axis-II disorders at admission to inpatient treatment, and at 1 and 2-year follow-up. RESULTS: At admission, 57 patients (77%) had one or more PDs, whereas 42 patients (57%) had one or more PDs at 2-year follow-up No statistically significant differences in frequencies of PDs among patients with AN, BN, and EDNOS were found. Recovered patients had a lower frequency of PDs (p < .01). DISCUSSION: At 2-year follow-up, there were substantial reductions in the frequency of PDs in patients with long-lasting EDs. (c) 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

It is generally difficult to specify the sources of infection by which domestic animals may acquire pathogens. Through 16S rRNA gene amplicon sequencing, we compared the composition of microbiota in the saliva, vaginal mucus, and feces of pigs, and in swabs of feeder troughs and water dispensers collected from pig farms in Vietnam. The composition of the microbiota differed between samples in each sample group. Streptococcus, Actinobacillus, Moraxella, and Rothia were the most abundant genera and significantly discriminative in saliva samples, regardless of the plasticity and changeability of the composition of microbiota in saliva. Moreover, species assignment of the genus Streptococcus revealed that Streptococcus suis was exceptional in the salivary microbiota, due to being most abundant among the streptococcal species and sharing estimated proportions of 5.7%-9.4% of the total bacteria in saliva. Thus, pig oral microbiota showed unique characteristics in which the major species was the pig pathogen. On the other hand, β-diversity analysis showed that the microbiota in saliva was distinct from those in the others. From the above results, pig saliva was shown to be the major natural habitat of S. suis, and is suggested to be the most probable source of S. suis infection.

After disinfection of ballast water, it is crucial to detect organisms and determine their vitality to assess the performance of the chosen treatment technique. Ultraviolet (UV) irradiation is a treatment technology commonly used for water disinfection. In this study, the phytoplankter Tetraselmis suecica was UV irradiated and subsequently stained with both 5-carboxyfluorescein diacetate acetoxymethyl ester (CFDA-AM) and SYTOX Blue, staining metabolically active and membrane-permeable cells, respectively. This dual staining protocol can be used to assess samples during type approval of UV-based treatment systems. Non-irradiated and UV-irradiated samples were incubated in darkness, to simulate a ballast water transport, after which the vitality and viability T. suecica were monitored regularly over a period of 15 d. Flow cytometry (FCM) analysis separated the cells into 4 FCM populations (=single cells grouped together based on their fluorescence signals) according to differences in esterase activity and membrane integrity. UV-irradiated samples followed a different staining pattern compared to non-irradiated samples, where 1 specific FCM population of cells expressed esterase activity, but at the same time gave signals for disrupted membranes. This is useful as a sign of future death and is interpreted as an ‘early warning’ FCM population. FCM results were also compared to corresponding plate count results, differentiating vital, viable cells from vital, non-viable cells. We argue that dual staining with SYTOX Blue and CFDA-AM facilitates and improves FCM analysis when evaluating the performance of UV-based water treatment systems.

In this paper, we formulated a mathematical model of the dynamics of Ebola virus infection incorporating effectiveness of drug usage. The infection free and infection persistence equilibrium points were obtained. The control reproduction number was obtained which was used to analyse the local and global stability of the infectionfree equilibrium. Using the method of linearization, the infection-free equilibrium (IFE) state was found to be locally asymptotically stable if Rc < 1 and unstable if Rc > 1. By constructing lyapunov function, the infection-free equilibrium was found to be globally asymptotically unstable if Rc > 1. Numerical simulation of the model was done. It is observed that, as percentage of effectiveness of drug administration increases, the control reproduction number decreases. This suggests that with the help of drugs usage, the immunes system have the ability to suppress the increase of infected cells, as well as virus load which shown that the virus does not maintain an infection in the system. Keywords: Drug Usage; Ebola virus; Global stability; Immune response; Mathematical model

Accumulating evidence suggests that dietary taurine (2-aminoethanesulfonic acid) exerts beneficial anti-inflammatory effects in the large intestine. In this study, we investigated the possible impact of taurine on human colonic microbiota using our single-batch fermentation system (Kobe University Human Intestinal Microbiota Model; KUHIMM). Fecal samples from eight humans were individually cultivated with and without taurine in the KUHIMM. The results showed that taurine remained largely undegraded after 30 h of culturing in the absence of oxygen, although some 83% of the taurine was degraded after 30 h of culturing under aerobic conditions. Diversity in bacterial species in the cultures was analyzed by 16S rRNA gene sequencing, revealing that taurine caused no significant change in the diversity of the microbiota; both operational taxonomic unit and Shannon-Wiener index of the cultures were comparable to those of the respective source fecal samples. In addition, principal coordinate analysis indicated that taurine did not alter the composition of bacterial species, since the 16S rRNA gene profile of bacterial species in the original fecal sample was maintained in each of the cultures with and without taurine. Furthermore, metabolomic analysis revealed that taurine did not affect the composition of short-chain fatty acids produced in the cultures. These results, under these controlled but artificial conditions, suggested that the beneficial anti-inflammatory effects of dietary taurine in the large intestine are independent of the intestinal microbiota. We infer that dietary taurine may act directly in the large intestine to exert anti-inflammatory effects.

An infection age structured mathematical model for tuberculosis disease dynamics is investigated in this paper. The infectious population is structured according to time and age of infection. An explicit formula for the basic reproductive number, R0 of the model is obtained. We showed that the disease-free equilibrium (DFE) state is locally asymptotically stable if R0

We devised a single-batch fermentation system to simulate human colonic microbiota from fecal samples, enabling the complex mixture of microorganisms to achieve densities of up to 1011 cells/mL in 24 h. 16S rRNA gene sequence analysis of bacteria grown in the system revealed that representatives of the major phyla, including Bacteroidetes, Firmicutes, and Actinobacteria, as well as overall species diversity, were consistent with those of the original feces. On the earlier stages of fermentation (up to 9 h), trace mixtures of acetate, lactate, and succinate were detectable; on the later stages (after 24 h), larger amounts of acetate accumulated along with some of propionate and butyrate. These patterns were similar to those observed in the original feces. Thus, this system could serve as a simple model to simulate the diversity as well as the metabolism of human colonic microbiota. Supplementation of the system with several prebiotic oligosaccharides (including fructo-, galacto-, isomalto-, and xylo-oligosaccharides; lactulose; and lactosucrose) resulted in an increased population in genus Bifidobacterium, concomitant with significant increases in acetate production. The results suggested that this fermentation system may be useful for in vitro, pre-clinical evaluation of the effects of prebiotics prior to testing in humans.

Most Escherichia coli O157-serogroup strains are classified as enterohemorrhagic E. coli (EHEC), which is known as an important food-borne pathogen for humans. They usually produce Shiga toxin (Stx) 1 and/or Stx2, and express H7-flagella antigen (or nonmotile). However, O157 strains that do not produce Stxs and express H antigens different from H7 are sometimes isolated from clinical and other sources. Multilocus sequence analysis revealed that these 21 O157:non-H7 strains tested in this study belong to multiple evolutionary lineages different from that of EHEC O157:H7 strains, suggesting a wide distribution of the gene set encoding the O157-antigen biosynthesis in multiple lineages. To gain insight into the gene organization and the sequence similarity of the O157-antigen biosynthesis gene clusters, we conducted genomic comparisons of the chromosomal regions (about 59 kb in each strain) covering the O-antigen gene cluster and its flanking regions between six O157:H7/non-H7 strains. Gene organization of the O157-antigen gene cluster was identical among O157:H7/non-H7 strains, but was divided into two distinct types at the nucleotide sequence level. Interestingly, distribution of the two types did not clearly follow the evolutionary lineages of the strains, suggesting that horizontal gene transfer of both types of O157-antigen gene clusters has occurred independently among E. coli strains. Additionally, detailed sequence comparison revealed that some positions of the repetitive extragenic palindromic (REP) sequences in the regions flanking the O-antigen gene clusters were coincident with possible recombination points. From these results, we conclude that the horizontal transfer of the O157-antigen gene clusters induced the emergence of multiple O157 lineages within E. coli and speculate that REP sequences may involve one of the driving forces for exchange and evolution of O-antigen loci.

Introduction: In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version ( Diabetes Body Project ) of the eating disorder (ED) prevention program the Body Project . The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up., Methods: Young women with T1D aged 16-35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions., Results: Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen's d s ranged from .34 to 1.70)., Conclusion: The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.

Background: Little is known about longer-term adherence to recommended physical activity (PA) and dietary behaviors after metabolic and bariatric surgery (MBS) and whether adherence is associated with weight recurrence., Objectives: To explore (1) changes in and associations between adherence to PA and general dietary recommendations after MBS and (2) whether PA and dietary behaviors interact to predict weight recurrence., Setting: University hospital; public practice., Methods: Participants completed ActiGraph PA monitoring, dietary questionnaire, and weighing 1 and 5 years after surgery. Parametric and non-parametric tests evaluated changes in and associations between adherence to PA and dietary recommendations. Multiple linear regression explored associations of adherence and weight recurrence 5 years post-surgery., Results: A total of 73 participants (66% loss to follow-up, 80.8% females) were included. From 1 to 5 years after surgery, adherence to PA recommendations did not change (23.5% versus 20.5%, P = .824), whereas adherence to dietary recommendations decreased (P = <.001). Adherence to PA recommendations is positively associated with eating fruits and vegetables and limiting intake of sugar and fat at 1 year (P < .05) and negatively associated with choosing meat with less fat at 5 years (P = .018). Adherence to PA and dietary behaviors did not independently contribute or interact to predict weight recurrence., Conclusions: Adherence to recommendations was poor. Dietary adherence decreased from 1 to 5 years post-surgery, whereas PA adherence remained stable. PA adherence was positively associated with adherence to some dietary recommendations at 1 year but not at 5 years. Neither behavioral adherences were associated with weight recurrence. Additional research is needed to understand how to improve adherence and its relationship with other health outcomes after MBS., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood., Method: A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested., Results: We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome DISCUSSION: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential., Public Significance: Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Background: The Eating Disorder Examination-Questionnaire (EDE-Q) is among the most widely used self-report measures of eating disorder (ED) psychopathology. There is a need for brief versions of the EDE-Q that can be used for general assessment and screening purposes. A three-factor 7-item version (EDE-Q7) seems particularly promising but there is a need for more well-powered studies to establish the psychometric properties in both patient and community samples. Moreover, comparing the EDE-Q7 with the full EDE-Q would be beneficial in determining its utility. In the present study, we provide a psychometric comparison between the brief EDE-Q7 and the full EDE-Q in a large sample of both patients and community comparisons., Methods: We pooled available datasets collected in Norway to amass a large female sample comprising both patients (n = 1954, M age  = 28 years) and community comparisons (n = 2430, M age  = 31 years). We investigated the psychometric properties of both versions, including their internal consistency, factor structure, and ability to discriminate between patients and community comparisons., Results: The EDE-Q7 showed similar distributions of scores compared to the full EDE-Q but produced higher scores. Results indicated that the EDE-Q7 have acceptable internal consistency and is adequately able to discriminate between clinical and non-clinical samples. A cut-off threshold of 3.64 was optimal in discriminating between patients and comparisons. We also found support for the three-factor solution for the EDE-Q7, indicating good structural validity. In contrast, we did not find support for the originally proposed four-factor solution of the full EDE-Q., Conclusions: We find that the brief EDE-Q7 performs close to the full EDE-Q in several respects. Our findings indicate that the brief EDE-Q7 may be a viable alternative to the full EDE-Q in situations where response burden is an issue (e.g., epidemiological studies). However, the EDE-Q7 may hold limited value over the full EDE-Q in clinical settings, due to the small number of items and lack of assessment of behavioral features., (© 2023. The Author(s).)

Background: Eating disorders (EDs) are associated with a range of stressful life events, but few have investigated protective factors that may affect these associations. The current study used mixture modelling to describe typologies in life stress exposure and availability of protective resources in individuals with and without eating disorders (EDs)., Methods: A case - control sample (n = 916) completed measures of stressful life events, resilience protective factors, emotion regulation, and symptoms of EDs, depression and anxiety. We conducted latent class analyses to identify subgroups of stress exposure and profile analyses of emotional regulation and resilience. The resulting two latent variables were combined to explore effects on ED status and symptomatology, depression, and anxiety as distal outcome variables., Results: We identified four classes of stressful life events (generally low, some abuse/bullying, sexual/emotional assaults, and high adversity). For protective resources, we identified six profiles that ranged from low to higher levels of protection with variations in social/family resources. The latent protection variable contributed more strongly to the distal outcomes than the latent stress variable, but did not moderate the latent stress and distal outcome variable relationships. Profiles characterized by lower protective resources included higher proportions of individuals with a lifetime ED, and were associated with higher scores on all symptom measures., Conclusions: Intra- and interpersonal protective resources were strongly associated with lifetime EDs and current mental health symptom burden after accounting for stressful event exposure, suggesting protective factors may be useful to target in the clinical treatment of patients with ED., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: This study aimed to evaluate multifamily therapy (MFT) for adolescents with eating disorders (EDs) in a clinical setting, by presenting the outcome of families participating in this treatment at a specialist ED service. MFT was an adjunct to treatment at local mental health services. In particular, the study aimed to present the change in eating disorder symptoms and psychological distress from before to after treatment and at a 6 months follow-up., Methods: Participants were 207 adolescents receiving outpatient MFT (10 or 5 months) at Oslo University Hospital in Norway between 2009 and 2022. Adolescents had heterogeneous ED presentations, with a preponderance of anorexia nervosa (AN) and atypical AN. All participants completed pre- and post-treatment questionnaires [The eating disorder examination questionnaire (EDE-Q) and the strengths and difficulties questionnaire (SDQ)]. 142 adolescents additionally completed the same questionnaires at 6 months follow-up. Weight and height were measured at all time points., Results: Linear mixed model analyses showed that from start of treatment to follow-up, there was a significant increase in BMI percentile (p < 0.001) and a significant decrease in EDE-Q global score (p < 0.001) and SDQ total score (p < 0.001)., Conclusions: The study shows that adolescents with an eating disorder who received adjunct outpatient MFT in a real world clinical setting, experienced reductions in ED symptoms comparable to that found in a randomized controlled trial., Trial Registration: The data used in this study was collected as part of routine clinical procedures for quality assurance and trial registration is therefore not required., (© 2023. The Author(s).)

Objective: To determine the association between continued antidepressant use in pregnancy and postpartum psychiatric visits for eating (ED) or mood/anxiety disorders in women with preexisting ED., Method: Using Danish health registry data (1998-2015), we identified 3529 pregnancies in women with ED prepregnancy: (i) 564 with continued antidepressant use before and during pregnancy; (ii) 778 with discontinued antidepressants before pregnancy; (iii) 2137 unexposed. Outpatient and inpatient postpartum visits for an ED or a mood/anxiety disorder constituted the outcome measures. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) using Cox regression with inverse probability of treatment weighting, and performed stratified analyses by antidepressant prescription filling in the first 3 months postpartum., Results: The weighted cumulative incidence for an ED visit at end of follow-up was 4.5% (continued) and 4.8% (discontinued). We found no association between continued antidepressant and postpartum ED visit, relative to discontinued (HR: 0.89, 95% CI: 0.52-1.52). The HR for postpartum mood/anxiety disorder visit was 1.27 (95% CI: 0.68-2.36) with continued antidepressants versus discontinued but decreased if more than two antidepressant prescriptions were refilled. Continued antidepressant use was associated with a 57% reduced likelihood of a postpartum ED visit versus discontinued use in pregnancies with antidepressant prescription refills in the early postpartum., Conclusion: Among women with preexisting ED, there was no association between continued antidepressant use during pregnancy and the likelihood of postpartum psychiatric visits, relative to discontinued antidepressants before pregnancy. Continuation of treatment into the early postpartum is associated with reduced likelihood of postpartum ED visit., Public Significance: Based on data from the Danish registries, we identified 3529 pregnancies among women with preexisting eating disorders before pregnancy. Women with continued antidepressant treatment both before and during pregnancy did not have a lower probability of having postpartum psychiatric visits for an eating disorder or for mood/anxiety disorders (often coexisting with eating disorders), relative to those who discontinued antidepressants before pregnancy. Further continuation of antidepressant treatment into the early postpartum is associated with improved maternal postpartum outcomes. However, residual confounding by disease severity limits confidence in this conclusion., (© 2022 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: This study aimed to report the presence of categorical and dimensional personality disorders (PD) in adults with longstanding eating disorders (ED) over a period of 17 years and to investigate whether changes in PD predict changes in ED symptoms or vice versa., Methods: In total, 62 of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or ED (n = 14) at baseline were evaluated during hospital treatment and at 1-year, 2-year, 5-year, and 17-year follow-up. PD were assessed using the Structured Clinical Interview for DSM-IV Axis II disorders, and the eating disorder examination (EDE) interview was used to assess ED. Data were analyzed using multilevel modeling., Results: From baseline to the 17-year follow-up, the number of patients with any PD decreased significantly from 74.2% to 24.2%, and the total number of PD diagnoses declined from 80 to 22. Mean EDE score was significantly reduced from 4.2 (SD: 1.1) to 2.0 (SD: 1.6). There was a positive association between ED and PD where the initial level of either disorder was followed by similar levels of the other disorder throughout the entire follow-up period. High baseline levels of borderline PD predicted less decrease in ED symptoms. No significant within-person effects were found., Conclusions: Both ED and PD significantly declined over time. As the severity of either disorder seems to be associated with the other, thorough assessment and treatment that incorporates both the ED psychopathology and the personality disturbances are advisable., Public Significance Statement: While personality disorders were highly prevalent in the sample of patients with longstanding eating disorders, both disorders were significantly reduced at the 17-year follow-up. The disorders are related in the sense that an initial high level of either disorder is associated with a high level of the other over time. A thorough assessment and attention to both illnesses are advisable in therapy., Clinical Trial Identifier: NCT03968705., (© 2022 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Background: Enhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area., Methods: This study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment., Results: A high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered., Conclusions: Patients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate. Trial registration ClinicalTrials.gov. Identifier: NCT02745067. Registered: April 20, 2016. https://clinicaltrials.gov/ct2/showNCT02745067., (© 2022. The Author(s).)

Objective: Burnout is commonly associated with low workplace wellbeing. Patients with eating disorders are frequently referred to as a particularly challenging group to treat. It is therefore important to study healthcare providers´ workplace wellbeing in settings which treat eating disorders. The aims of the current study were to (a) measure burnout among healthcare providers working on specialized eating disorder units in Norway, and (b) explore factors predicting burnout., Methods: 186 participants from 11 specialized eating disorder units in Norway completed an online survey including the Mashlach Burnout Inventory, and eating disorder-specific factors related to burnout, job satisfaction, work environment, emotional dissonance and stress. Multiple regression analysis was used to identify predictors of burnout., Results: Overall, low levels of burnout were found among the participants. Eating disorder-specific factors and emotional dissonance predicted the three central aspects of burnout, namely, emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment., Conclusions: Findings suggest a relatively low level of burnout across age, gender, and professional categories working at specialized eating disorder units, contrary to commonly-held assumptions pertaining to the challenges involved in treating individuals with eating disorders., (© 2021. The Author(s).)

Background: Experiencing stressful life events (SLEs) can negatively impact mental health and increase risk for psychiatric disorders including eating disorders (EDs). Previous research has shown that childhood sexual abuse is associated with some EDs, but less is known about the association between other non-sexual SLEs and EDs., Method: A case-control study of individuals with (n = 495, age mean ± SD = 29.1 ± 9.8 years) and without (n = 395, age = 30.2 ± 11.7) self-reported lifetime history of EDs was conducted to compare history of self-reported SLEs. Participants reported history of sexual (e.g., rape, other sexual assault) and non-sexual (e.g., emotional abuse, assault, bereavement) life events using an adaptation of the Stressful Life Events Screening Questionnaire. Individuals with EDs were divided into ED subtypes along the restricting - binge eating/purging spectrum to examine subtype differences. Logistic regressions were conducted for each SLE and ED subtype to obtain odds ratios (ORs). We report p-values corrected for multiple comparisons., Results: Exposure to any SLE was significantly more common in individuals with EDs than in controls (OR = 2.47, p < .001). Specifically, rape, other sexual assault, and emotional abuse were significantly more common among individuals with a history of binge-eating/purging ED subtypes (ORs = 2.15-3.58, p's < .01) compared with controls. Furthermore, history of life-threatening disease and loss of a close relative/partner/friend were associated with some ED subtypes. The association between SLEs and EDs was stronger for individuals who had experienced multiple SLEs., Conclusion: By investigating a range of different SLEs, we showed that both sexual and non-sexual SLEs were more common in individuals with a history of EDs (binge-eating/purging subtypes) than controls. Results highlight the importance of assessing a variety of past SLEs in risk assessment for different EDs., (© 2021. The Author(s).)

Introduction: Functional networks develop throughout adolescence when anorexia nervosa (AN) normally debuts. In AN, cerebral structural alterations are found in most brain regions and may be related to the observed functional brain changes. Few studies have investigated the functional networks of the brain in adolescent AN patients.. The aim of this explorative study was to investigate multiple functional networks in adolescent AN patients compared to healthy age-matched controls (HC) and the relationship with age, eating disorder symptoms and structural alterations., Methods: Included were 29 female inpatients with restrictive AN, and 27 HC. All participants were between the ages of 12 to 18 years. Independent component analysis (ICA) identified 21 functional networks that were analyzed with multivariate and univariate analyses of components and group affiliation (AN vs HC). Age, age × group interaction and AN symptoms were included as covariates. Follow-up correlational analyses of selected components and structural measures (cortical thickness and subcortical volume) were carried out., Results: Decreased functional connectivity (FC) in AN patients was found in one cortical network, involving mainly the precuneus, and identified as a default mode network (DMN). Cortical thickness in the precuneus was significantly correlated with functional connectivity in this network. Significant group differences were also found in two subcortical networks involving mainly the hippocampus and the amygdala respectively, and a significant interaction effect of age and group was found in both these networks. There were no significant associations between FC and the clinical measures used in the study., Conclusion: The findings from the present study may imply that functional alterations are related to structural alterations in selected regions and that the restricted food intake in AN patients disrupt normal age-related development of functional networks involving the amygdala and hippocampus., (© 2021. The Author(s).)

Objective: This study aimed to develop a virtual diabetes-specific version of the eating disorder (ED) prevention program the Body Project, and to assess feasibility and preliminary efficacy of this program for young females with type 1 diabetes., Method: Young females with type 1 diabetes aged 16-35 years were invited to participate in the study. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks) and completed pretest assessments; 26 participants completed all sessions and posttest assessments (<7 days after last meeting). Primary measures included ED risk factors and symptoms, and secondary outcomes included diabetes-specific constructs previously found to be associated with ED psychopathology (e.g., diabetes distress and illness perceptions)., Results: The ease of recruitment, timely conduct of five groups, moderate drop-out rate and appreciation of the intervention by participants indicated that the Diabetes Body Project is feasible. Meaningful reductions occurred on the primary outcomes (i.e., ED psychopathology, body dissatisfaction, and thin ideal internalization) and on internalization of appearance ideals and appearance pressures at posttest (Cohen's d ranging from .63 to .83, which are medium to large effects). Small to medium effect sizes were found for diabetes illness perceptions and distress (.41 and .48, respectively)., Discussion: The virtual Diabetes Body Project is a promising and much-needed intervention, worthy of more rigorous evaluation. A randomized controlled trial is warranted to determine its effectiveness compared with a control condition., (© 2021 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Childhood bullying is associated with a range of adverse mental health outcomes, and here we investigated the association between bullying exposure and eating disorders (EDs)., Method: In this case-control study, we compared bullying history in individuals with EDs with community controls. Participants (n = 890, mean age = 29.50 ± 10.60) completed an online self-report battery assessing bullying history and lifetime history of bulimia nervosa (BN), binge-eating disorder (BED), and anorexia nervosa (binge-eating/purging (AN-BP) or restrictive (AN-R) subtype). Logistic regressions were performed to estimate odds ratios (ORs)., Results: In the combined ED sample, individuals with a history of any ED were significantly more likely than controls to have experienced bullying victimization during childhood or adolescence (ORs = 1.99-3.30), particularly verbal, indirect, and digital bullying. Bullying prior to ED onset was also significantly more common than bullying within the same time frame for controls (ORs = 1.75-2.16). Further analysis showed that these effects were due to individuals with BN or BED reporting significantly more lifetime (p < .001) and premorbid bullying (p = .002) than controls, while individuals in the other diagnostic subgroups did not differ significantly from controls., Discussion: Our results confirm an association between bullying and binge-eating/purging ED subtypes. Prospective studies are needed to establish bullying as a risk factor for EDs., (© 2021 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

This study investigated former patients' experiences with family-based inpatient treatment. Interviews of thirty-seven patients diagnosed with anorexia nervosa during the admissions were conducted to examine their post-treatment perspectives. The accounts were analyzed by utilizing an inductive thematic analytic approach. The analysis yielded 4 main themes, constituted by in all 8 subthemes. The main themes were; 1) Enabling new ways of understanding and relating , 2) Enhancing or maintaining negative power dynamics , 3) Vulnerable transitions, and 4) Sibling relationships and different ways of involvement . With its "insider focus," this study contributes to knowledge on how family-based inpatient treatment is perceived from a user perspective. The current study has value for both advancing the development of family-based inpatient treatment, and by adding patient perspectives to the ongoing effort of providing family-based approaches at higher levels of care.

Objective: Although studies with short and intermediate observation time suggest favorable outcomes in regard to eating disorders (ED), there is limited knowledge on long-term outcomes. The present study aimed to investigate the 5- and 17-year outcome of adult patients with longstanding ED who were previously admitted to an inpatient ED unit. ED diagnoses and recovery, comorbid and general psychopathology, along with psychosocial functioning and quality of life were evaluated., Method: Sixty-two of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or eating disorders (n = 14) at admission were evaluated. The mean age at the 17-year follow-up point was 46.2 (SD 7.5). The Eating Disorder Examination (EDE) was used to assess recovery. The Mini International Neuropsychiatric Interview (M.I.N.I.) and self-report instruments provided additional information., Results: There was a significant reduction in patients fulfilling criteria for an ED from the 5-year to the 17-year follow-up, meanwhile recovery rates were stable. A total of 29% of the patients were fully recovered and 21% were partially recovered while the remaining 50% had not recovered. No significant changes were found in any self-report measures and more than 70% had a comorbid disorder at both assessments., Discussion: The findings illustrate the protracted nature of ED for adults with longstanding ED. A long illness duration prior to treatment is unfortunate and early detection and treatment is advisable., (© 2021 Wiley Periodicals LLC.)

Background: Patients with Anorexia Nervosa (AN) often experience the transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) as challenging. This period tends to have a negative influence on the continuity of care for the adolescents and represents a demanding and difficult period for the parents. To our knowledge, no previous study has explored the parents' experience with the transition from CAMHS to AMHS. Therefore, this qualitative study examines how parents experience the transition process from CAMHS to AMHS., Methods: In collaboration with a service user with carer experience, qualitative interviews were conducted with 10 parents who had experienced the transition from CAMHS to AMHS, some from outpatient care and others from both in- and outpatient mental care units in Norway. All had some experience with specialized eating disorder units. The interviews were analyzed with a Systematic Text Condensation (STC) approach. Service users' perspectives were involved in all steps of the research process., Results: Six categories represent the parents' experiences of the transition: (1) the discharge when the child turns 18 years old is sudden; (2) the lack of continuity is often followed by deterioration and relapses in the patient; (3) the lack of involvement and information causes distress; (4) knowledge - an important factor for developing a trusting relationship between parents` and clinicians`; (5) parents have overwhelming multifaceted responsibilities; and (6) parents need professional support., Conclusion: Improving the transition by including parents and adolescents and preparing them for the transition period could ease parental caregiving distress and improve adolescents' compliance with treatment. Clinicians should increase their focus on the important role of parents in the transition process. The system should implement routines and guidelines to offer caregivers support and guidance during the transition process.

This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes ( n  = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females ( β  = 0.40, p  < 0.001 and β  = -0.22, p  < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c ( β  = 0.37, p  < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.

Severe obesity has been associated with reduced performance on tests of verbal memory in bariatric surgery candidates. There is also some evidence that bariatric surgery leads to improved verbal memory, yet these findings need further elucidation. Little is known regarding postoperative memory changes in the visual domain and how patients subjectively experience their everyday memory after surgery. The aim of the current study was to repeat and extend prior findings on postoperative memory by investigating visual, verbal, and self-reported everyday memory following surgery, and to examine whether weight loss and somatic comorbidity predict memory performance. The study was a prospective, observational study in which participants ( n = 48) underwent cognitive testing at baseline, 1 and 2 years after bariatric surgery. Repeated measures analyses of variance revealed significantly poorer visual and verbal memory performance at the 1-year follow-up, with performance subsequently returning to baseline levels after 2 years. Verbal learning and self-reported everyday memory did not show significant postoperative changes. Memory performance at 1 year was not significantly predicted by weight loss, changes in C-reactive protein levels or postoperative somatic comorbidity (Type 2 diabetes, sleep apnea, and hypertension). The study demonstrated poorer visual and verbal memory performance at 1-year follow-up that returned to baseline levels after 2 years. These findings are in contrast to most previous studies and require further replication, however, the results indicate that postoperative memory improvements following bariatric surgery are not universal. Findings suggest that treatment providers should also be aware of patients potentially having poorer memory at 1 year following surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Walø-Syversen, Kvalem, Kristinsson, Eribe, Rø, Brunborg and Dahlgren.)

Background: Family-based outpatient treatment is usually recommended as the treatment of choice when a child develops anorexia nervosa. However, some young persons will inevitably require higher levels of care. Qualitative research on family perspectives may help inform strategies to adapt family-based practices into intensified treatment settings. Our overarching aim was to investigate family members' perspectives following a family-based inpatient treatment program for adolescent anorexia nervosa and to discuss clinical implications for treatment providers., Methods: A subsample of eight families taking part in a naturalistic outcome study at a specialized eating disorder unit participated in the study (8 patients, 14 parents, and 10 siblings). The thematic analyses were inductive, predominantly descriptive, and guided by a multi-perspective framework., Results: Five main themes were identified: 1: Expectations and evaluation of needs. Entering treatment from different vantage points, 2: Interactions with peers during the admission as highly beneficial or problematic, 3: Perspectives on staff expertise and the eating disorder unit's structure, 4: Influencing within family relationships in different ways, and 5: Being admitted is at best only half the job: reflections on leaving the eating disorder unit., Conclusions: Our study offers insight into how former inpatients and their family members experienced an inpatient treatment program designed to align treatment with the central elements of an outpatient family-based treatment approach for adolescent anorexia nervosa. Overall, the findings support emerging research underlining the necessity of strengthening the family-based treatment approach within intensified treatment settings. Moreover, the results emphasized the need for more knowledge on how to optimize inpatient treatment as well as the importance of providing smooth transitions between care settings.

Background: Internationally, the Patient Health Questionnaire-9 (PHQ-9) is commonly used to assess the frequency and severity of depressive symptoms. However, psychometric properties of the Norwegian version of the PHQ-9 have only been assessed in adolescents. We present normative data for women and an evaluation of the psychometric properties (internal consistency, convergent validity, and factor structure) of the Norwegian PHQ-9 among women with and without eating disorders (ED)., Methods: In this case-control study, a total of 793 females aged 18-78 years (mean 30.39; SD 9.83) completed an online self-report assessment. Measures included the ED100K and Eating Disorder Examination Questionnaire (EDE-Q) to assess ED psychopathology, and the Generalized Anxiety Disorder (GAD) scale and Difficulties in Emotion Regulation Scale Short Form (DERS-SF) to assess symptoms of anxiety and emotion regulation deficits. Participants were categorized into three groups, i.e., previous ED (19.7%, n = 148), current ED (36.3%, n = 272), and no history of ED (44.0%, n = 330), based on self-reported scores on the ED 100 K and the EDE-Q., Results: Mean PHQ-9 total score for those with a previous history of ED was 10.67 (SD 6.33), for those with a current ED 16.61 (SD 5.84), and for those with no lifetime history of ED 6.83 (SD 5.58). Excellent internal consistency was demonstrated by Cronbach's alpha's for individuals with a previous ED (.88), for individuals with a current ED (.86), and for individuals with no history of ED (.88). Acceptable convergent validity was indicated based on significant correlations between the PHQ-9 and GAD-7 and DERS-SF. Confirmatory Factor Analyses revealed a mediocre fit for a one-factor structure of the PHQ-9, regardless of diagnostic status., Conclusions: The psychometric properties of the Norwegian version of the PHQ-9 are acceptable across females with and without ED, and the PHQ-9 can be recommended for use in clinical ED settings and for people without mental disorders.

Objective: Executive function (EF) and, in particular, inhibitory control have been associated with weight loss (WL) in behavioural WL treatment for obesity. Few studies have focused on the relationship between preoperative inhibitory control and post-operative WL following bariatric surgery, and the potential mediating role of maladaptive eating behaviours is unclear. The aim of this study was to investigate preoperative executive function as a predictor of WL at 1 year following bariatric surgery. Additionally, we aimed to explore the mediating role of postoperative compulsive grazing in the relationship between inhibitory control and WL., Method: A prospective observational study in which participants completed neuropsychological testing 30 days before and 1 year following surgery (n = 61/80; 76% follow-up). Participants were 80% female, with an average age of 41 years. Approximately 54% underwent gastric bypass, 26% gastric sleeve and 20% had one anastomosis gastric bypass. Regression analyses were employed to examine the relationship between preoperative EF and percentage total weight loss (%TWL), and structural equation modelling was used to examine compulsive grazing as a mediator., Results: After adjusting for control variables, preoperative inhibitory control explained 8% of the variance in %TWL (p ≤ 0.05). Preoperative working memory was not significantly associated with %TWL. Postoperative compulsive grazing was significantly associated with %TWL (p ≤ 0.05), but did not mediate the association between preoperative inhibitory control and %TWL., Conclusion: The results suggest that preoperative inhibitory control performance is a relevant predictor of postoperative WL and that compulsive grazing is a maladaptive eating behaviour that warrants clinical attention after surgery., (© 2020 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Accumulating evidence shows that patients with anorexia nervosa (AN) have globally reduced brain mass, including lower cortical volume and thickness, which largely normalizes following weight restoration. The underlying mechanisms for these processes are unknown, and how age and severity of emaciation are associated with brain morphology in AN is poorly understood. We investigated associations of age, body mass index (BMI) and biochemical parameters with brain morphology among patients in treatment., Method: We included 85 patients (94% female) aged 12-48 (mean = 23) years with quality controlled magnetic resonance imaging (MRI) data. T1-weighted MRI images, clinical characteristics and biochemical parameters were retrospectively collected from hospital records. Brain morphology was measured using FreeSurfer, and associations investigated using regression models and correlations., Results: Controlling for BMI, age showed significant associations with brain morphology generally concordant with typical brain developmental patterns. Controlling for age, BMI showed significant positive associations with cortical volume and thickness. There were no significant interaction effects between age and BMI. None of the biochemical parameters correlated significantly with brain morphology., Conclusion: Our findings suggest the presence of typical neurodevelopmental patterns in AN. Importantly, we showed that severity of emaciation is related to brain morphology reductions, underscoring the importance of weight restoration., (© 2020 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Reduction in cerebral volume is often found in underweight patients with anorexia nervosa (AN), but few studies have investigated other morphological measures. Cortical thickness (CTh) and surface area (CSA), often used to produce the measure of cortical volume, are developmentally distinct measures that may be differentially affected in AN, particularly in the developing brain. In the present study, we investigated CTh and CSA both separately and jointly to gain further insight into structural alterations in adolescent AN patients., Method: Thirty female AN inpatients 12-18 years of age, and 27 age-matched healthy controls (HC) underwent structural magnetic resonance imaging. Group differences in CTh and CSA were investigated separately and jointly with a permutation-based nonparametric combination method (NPC) which may be more sensitive in detecting group differences compared to traditional volumetric methods., Results: Results showed significant reduction in in both CTh and CSA in several cortical regions in AN compared to HC and the reduction was related to BMI. Different results for the two morphological measures were found in a small number of cortical regions. The joint NPC analyses showed significant group differences across most of the cortical mantle., Discussion: Results from this study give novel insight to areal reduction in adolescent AN patients and indicate that both CTh and CSA reduction is related to BMI. The study is the first to use the NPC method to reveal large structural alterations covering most of the brain in adolescent AN., (© 2020 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Background: Patients with eating disorders may experience a severe and enduring course of illness. Treatment outcome for patients provided with inpatient treatment is reported as poor. Research to date has not provided consistent results for predictors of treatment outcome. The aims of the study were to investigate rates of remission at follow-up after inpatient treatment, symptom change from admission to follow-up, and predictors of treatment outcome., Methods: The follow-up sample consisted of 150 female adult former patients (69.4% of all eligible female patients) with eating disorders. Mean age at admission was 21.7 (SD = 4.9) years. Diagnostic distribution: 66% (n = 99) anorexia nervosa, 21.3% (n = 32) bulimia nervosa and 12.7% (n = 19) other specified feeding or eating disorder, including binge eating. Data were collected at admission, discharge and follow-up (mean 2.7 (SD = 1.9) years). Definition of remission was based on the EDE-Q Global score, body mass index and binge/purge behavior. Paired T-tests were performed to investigate change over time. Univariate and multivariate logistic regressions were estimated to investigate predictors of remission., Results: At follow-up, 35.2% of the participants were classified as in remission. Significant symptom reduction (in all patients) (p <  0.001) and significant increase in body mass index (BMI) (in underweight participants at admission) (p <  0.001) was found. Increased BMI (p <  0.05), the level of core eating disorder symptoms at admission (p <  0.01) and reduced core eating disorder symptoms (p <  0.01) during inpatient treatment were found significant predictors of outcome in the multivariate model., Conclusions: All participants had an eating disorder requiring inpatient treatment. Approximately one-third of all participants could be classified as in remission at follow-up. However, most participants experienced significant symptom improvement during inpatient treatment and the improvements were sustained at follow-up. Increased probability of remission at follow-up was indicated by lower core ED symptoms at admission for all patients, raised BMI during admission for patients with AN, and reduced core ED symptoms during inpatient treatment for all patients. This finding contributes important information and highlights the importance of targeting these core symptoms in transdiagnostic treatment programs.