Revista nº 811

Ramírez-Sánchez F, et al. | Pediatric eating disorders for 10 years Actual Med. 2020; 105(811): 182- 189 183 Over the last few years there has been a notorious increase in eating disorders (EDs) incidence among pediatric patients, becoming the most frequent chro- nic juvenile diseases. Currently, the diagnosis of EDs is based on criteria of the American Academy of Psychiatry, DSM-V (1), or the criteria selected by the World Health Organization in CIE-10(2), for the pediatric population too. EDs include: anore- xia nervosa (AN), bulimia nervosa (BN), restrictive avoidance disorder of food intake (ARFID), binge ED, unspecified ED (EDNOS), itching and rumina- tion disorders (2). These are psychiatric conditions consistent with ab- normal eating habits, a well-defined alteration of the intake pattern or a behavioral alteration related to weight control, which cannot be explained by other organic or psychiatric causes. The greatest difficulty in diagnosis is related to the clinical variability, due especially to the atypical onset and the incomplete clinical forms of these di- sorders. The clinical manifestations of patients with EDs are multisystemic and may fluctuate according to the stage of the disorder. Besides, the classical profile of these patients is quickly evolving; now there are higher rates of EDs in younger children, male patients, and minority groups (3). One of the main problems is that pediatricians and family doctors are often not specialized in these pathologies, which could result in a delayed diagnosis. In addition, certain complications derived from the disease might turn out to be fatal, meaning all spheres of the patient’s life must be carefully ex- plored through an optimal psychiatric, medical and nutritional evaluation (3-5). In fact, a higher prevalence of morbidity with malnutrition, leading to physical and psychosocial impairment has been associated. Brain functions are affected profoundly, resulting in eating disorders having the highest risk of suicide and mortality rate of all of the juvenile psychiatric conditions (6-8). Commonly, the findings of late adolescents and adults in the spheres of evaluation, clinical signs, and treatments are often extrapolated to pediatric patients. This should be carefully considered since children may have a particular profile with import- ant differences. So, the main goal of this study is to describe the patterns of pediatric patients with EDs to improve the approach of Pediatricians for early-onset EDs and promote protocolized inter- ventions as an essential tool to improve the health of these children. A retrospective, observational and descriptive study was performed on patients with EDs in the Metabolism Unit of a third-level Pediatric Hospital for 10 consecutive years (2010-2019, both included) after the application of an integrated assistance process protocolized by the government (Junta de Andalucía, Spain) based on a multidisciplinary and specialized professionals assistance (9). Children included in the assistance process were those under 14 years of age (In Spain, the pediatric age is con- sidered up to 14 years) with severe restrictive EDs, who had been derived to the Metabolism Unit from the Children’s Mental Health Unit of the Hospital due to their severity or because of their complexity. The diagnosis of EDs and the type (AN, BN, etc.) was made according to DSM-V criteria. The main exclusion criteria were children with behavioral di- sorders that finally were not classified as EDs. Anamnesis and physical examination, including the evaluation of sexual maturity and blood pressure were assessed at baseline and in regular visits. Weight and height were measured using standardized procedures. Body mass index (BMI) and Z-scores for anthropo- metric measures were calculated using the standard growth percentile tables for the Spanish population (10). Electric bioimpedance analysis (BIA) multi- frequencial four-phase was carried out with a Tani- ta BC-418®. Before this evaluation, children were instructed to urinate prior to the evaluation; do not perform moderate or intense physical activity 24 hr before and an overnight fast >12h. This device classi- fies the percentage of body fat as low fat, healthy, high fat and obese, according to healthy levels for sex, age and body stretch. Standard food frequency intake and 24-hour diet recall method questionnaires were made to collect information on food habits. Blood analysis tests were conducted at the laboratory of the hospi- tal using the Architect i2000SR and c16000 automatic analyzer, Abbott Diagnostics w, Abbott Laboratories, according to the manufacturer’s specifications. The psychological study of patients and the detection of the psychiatric comorbidities associated with the disease was conducted in the Children’s Mental Health Unit of the Hospital by a multidisciplinar group. The statistical analysis based on a descriptive analy- sis with measures of central tendency of quantitative variables expressed as means (m) or median, mode and range, and standard deviations (SD). Qualitative variables were expressed as counts (n) and propor- tions (%). The data obtained were processed with the SPSS Statistics version 22. This study was approved by the Hospital’s Institu- tional Ethics committee, following the guidelines established in the Declaration of Helsinki, with an- onymity and special protection of data per the law. INTRODUCTION MATERIALS AND METHODS