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Childhood Eating and Feeding Disturbances

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 June 2019) | Viewed by 82320

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Prof. Dr. Anja Hilbert

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Integrated Research and Treatment Center AdiposityDiseases, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany
Interests: eating disorders; binge-eating disorder; loss of control eating; avoidant/restrictive food intake disorder; obesity; interventions

Special Issue Information

Dear Colleagues,

Eating and feeding disturbances in childhood are understudied health conditions. They are characterized, to varying degrees, by aberrant eating behaviors, associated cognitive and emotional dysfunctions, and dysregulated body weight, and are accompanied by significant physical and psychosocial comorbidities. Anorexia nervosa, bulimia nervosa, and binge-eating disorder represent the specific eating disorders in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). These disorders may show an early onset, mostly in adolescence. Further feeding or eating disorders have been newly defined in or shifted to the DSM-5 Feeding and Eating Disorders section, including avoidant/restrictive food intake disorder, pica, and rumination disorder. In addition, more forms of non-normative eating behaviors with potential clinical significance in childhood have been investigated, for example, loss of control eating. In general, there is a lack of clinical research on these feeding and eating disturbances, so that their presentation, development, treatment, and prevention in childhood remain largely unclear.

The objective of this Special Issue on “Childhood Feeding and Eating Disturbances” is to aggregate selected clinically relevant research on early childhood feeding disorders, avoidant/restrictive food intake disorder, pica, rumination disorder, and loss of control eating in childhood, as well as on early-onset anorexia nervosa, and binge-eating syndromes. Systematic review articles on these entities, and/or clinical or experimental studies on the assessment, epidemiology, nosology, etiology, treatment, and prevention of these disturbances will be included.

Prof. Dr. Anja Hilbert
Guest Editor

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Keywords

Eating disorders
Feeding disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
Avoidant/restrictive food intake disorder
Pica
Rumination disorder
Loss of control eating
Childhood
Early onset

Published Papers (11 papers)

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Editorial

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5 pages, 199 KiB

Open AccessEditorial

Childhood Eating and Feeding Disturbances

by Anja Hilbert

Nutrients 2020, 12(4), 972; https://doi.org/10.3390/nu12040972 - 01 Apr 2020

Cited by 4 | Viewed by 3763

Abstract

Eating and feeding disturbances are prevalent yet understudied health conditions in youth. They are characterized by aberrant eating behaviors, cognitive and emotional dysfunctions, and dysregulated body weight. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition defines several feeding and eating disorders with a common onset in youth; however, data on their clinical validity at young ages are lacking. Further non-normative eating behaviors exist, but their clinical relevance needs elucidation. This Special Issue compiles state-of-the-art reviews and empirical research on the presentation, development, course, and maintenance of diverse eating and feeding disturbances as a prerequisite for delineating evidence-based interventions for treatment and prevention. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

Research

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10 pages, 248 KiB

Open AccessArticle

Clinical Characteristics of Inpatients with Childhood vs. Adolescent Anorexia Nervosa

by Charlotte Jaite, Katharina Bühren, Brigitte Dahmen, Astrid Dempfle, Katja Becker, Christoph U. Correll, Karin M. Egberts, Stefan Ehrlich, Christian Fleischhaker, Alexander von Gontard, Freia Hahn, David Kolar, Michael Kaess, Tanja Legenbauer, Tobias J. Renner, Ulrike Schulze, Judith Sinzig, Ellen Thomae, Linda Weber, Ida Wessing, Gisela Antony, Johannes Hebebrand, Manuel Föcker and Beate Herpertz-Dahlmann Show full author list Hide full author list

Nutrients 2019, 11(11), 2593; https://doi.org/10.3390/nu11112593 - 28 Oct 2019

Cited by 25 | Viewed by 11066

Abstract

We aimed to compare the clinical data at first presentation to inpatient treatment of children (<14 years) vs. adolescents (≥14 years) with anorexia nervosa (AN), focusing on duration of illness before hospital admission and body mass index (BMI) at admission and discharge, proven predictors of the outcomes of adolescent AN. Clinical data at first admission and at discharge in 289 inpatients with AN (children: n = 72; adolescents: n = 217) from a German multicenter, web-based registry for consecutively enrolled patients with childhood and adolescent AN were analyzed. Inclusion criteria were a maximum age of 18 years, first inpatient treatment due to AN, and a BMI <10th BMI percentile at admission. Compared to adolescents, children with AN had a shorter duration of illness before admission (median: 6.0 months vs. 8.0 months, p = 0.004) and higher BMI percentiles at admission (median: 0.7 vs. 0.2, p = 0.004) as well as at discharge (median: 19.3 vs. 15.1, p = 0.011). Thus, in our study, children with AN exhibited clinical characteristics that have been associated with better outcomes, including higher admission and discharge BMI percentile. Future studies should examine whether these factors are actually associated with positive long-term outcomes in children. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

11 pages, 220 KiB

Open AccessArticle

Is There An Overlap Between Eating Disorders and Neurodevelopmental Disorders in Children with Obesity?

by Elisabet Wentz, Anna Björk and Jovanna Dahlgren

Nutrients 2019, 11(10), 2496; https://doi.org/10.3390/nu11102496 - 17 Oct 2019

Cited by 11 | Viewed by 4496

Abstract

This study aimed at assessing the prevalence of eating disorders (EDs) and ED symptomatology in children with obesity, and at investigating whether EDs occur more often among individuals with a comorbid attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Seventy-six children (37 girls, 39 boys, age 5–16 years) were recruited at an outpatient obesity clinic. The adolescents completed ED instruments including The Eating Disorder Examination Questionnaire (EDE-Q) and The Eating Disorder Inventory for children (EDI-C). The parents of all participants were interviewed regarding the child’s psychiatric morbidity. Diagnoses of ADHD and ASD were collected from medical records. Anthropometric data were compiled. Eight participants (11%) fulfilled the criteria for a probable ED and 16 participants (21%) had ADHD and/or ASD. Two adolescent girls had a probable ED and coexistent ADHD and ASD. No other overlaps between EDs and ADHD/ASD were observed. Loss of control (LOC) eating was present in 26 out of 40 (65%) adolescents, seven of whom had ADHD, ASD or both. LOC eating was not overrepresented among teenagers with ADHD and/or ASD. Weight and shape concerns were on a par with age-matched adolescents with EDs. EDs and ED behavior are more common among children/adolescents with obesity than in the general population. There is no substantial overlap between EDs and ADHD/ASD in adolescents with obesity. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

13 pages, 710 KiB

Open AccessArticle

Interaction Effects of Child Weight Status and Parental Feeding Practices on Children’s Eating Disorder Symptomatology

by Ricarda Schmidt, Andreas Hiemisch, Wieland Kiess and Anja Hilbert

Nutrients 2019, 11(10), 2433; https://doi.org/10.3390/nu11102433 - 12 Oct 2019

Cited by 11 | Viewed by 3477

Abstract

(1) Background: Research on parental feeding practices and non-normative eating behavior including loss of control (LOC) eating and eating disorder psychopathology indicated separate associations of these variables with child weight status, especially in early childhood. This study cross-sectionally examined interaction effects of restriction, monitoring, pressure to eat, and children’s weight status on disordered eating in children aged 8–13 years. (2) Methods: A population-based sample of N = 904 children and their mothers completed the Eating Disorder Examination Questionnaire for Children and the Child Feeding Questionnaire. Child anthropometrics were objectively measured. Hierarchical linear and logistic regression analyses were conducted for cross-sectionally predicting global eating disorder psychopathology and recurrent LOC eating by feeding practices and child weight status for younger (8–10 years) and older (11–13 years) ages. (3) Results: Restriction x Child weight status significantly predicted global eating disorder psychopathology in younger children and recurrent LOC eating in older children. Monitoring x Child weight status significantly predicted eating disorder psychopathology in older children. A higher versus lower child weight status was associated with adverse eating behaviors, particularly in children with mothers reporting high restriction and monitoring. (4) Conclusions: Detrimental associations between higher child weight status and child eating disorder symptomatology held especially true for children whose mothers strongly control child food intake. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

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14 pages, 272 KiB

Open AccessArticle

A Diet High in Processed Foods, Total Carbohydrates and Added Sugars, and Low in Vegetables and Protein Is Characteristic of Youth with Avoidant/Restrictive Food Intake Disorder

by Stephanie G. Harshman, Olivia Wons, Madeline S. Rogers, Alyssa M. Izquierdo, Tara M. Holmes, Reitumetse L. Pulumo, Elisa Asanza, Kamryn T. Eddy, Madhusmita Misra, Nadia Micali, Elizabeth A. Lawson and Jennifer J. Thomas

Nutrients 2019, 11(9), 2013; https://doi.org/10.3390/nu11092013 - 27 Aug 2019

Cited by 35 | Viewed by 8654

Abstract

Avoidant/restrictive food intake disorder (ARFID) is characterized in part by limited dietary variety, but dietary characteristics of this disorder have not yet been systematically studied. Our objective was to examine dietary intake defined by diet variety, macronutrient intake, and micronutrient intake in children and adolescents with full or subthreshold ARFID in comparison to healthy controls. We collected and analyzed four-day food record data for 52 participants with full or subthreshold ARFID, and 52 healthy controls, aged 9–22 years. We examined frequency of commonly reported foods by logistic regression and intake by food groups, macronutrients, and micronutrients between groups with repeated-measures ANOVA. Participants with full or subthreshold ARFID did not report any fruit or vegetable category in their top five most commonly reported food categories, whereas these food groups occupied three of the top five groups for healthy controls. Vegetable and protein intake were significantly lower in full or subthreshold ARFID compared to healthy controls. Intakes of added sugars and total carbohydrates were significantly higher in full or subthreshold ARFID compared to healthy controls. Individuals with full or subthreshold ARFID had lower intake of vitamins K and B12, consistent with limited vegetable and protein intake compared to healthy controls. Our results support the need for diet diversification as part of therapeutic interventions for ARFID to reduce risk for nutrient insufficiencies and related complications. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

12 pages, 450 KiB

Open AccessArticle

Youth with Avoidant/Restrictive Food Intake Disorder: Examining Differences by Age, Weight Status, and Symptom Duration

by Kristina Duncombe Lowe, Timothy L. Barnes, Carolyn Martell, Helene Keery, Sarah Eckhardt, Carol B. Peterson, Julie Lesser and Daniel Le Grange

Nutrients 2019, 11(8), 1955; https://doi.org/10.3390/nu11081955 - 20 Aug 2019

Cited by 40 | Viewed by 7435

Abstract

The primary purpose of this study was to examine differences among youth with avoidant/restrictive food intake disorder (ARFID) by age, weight status, and symptom duration. A secondary goal was to report the frequencies of ARFID using DSM-5 clinical presentations (i.e., fear of aversive consequences, lack of interest in food, sensory sensitivities). Participants (N = 102), ages 8–18 years, were recruited through an eating disorder service within a pediatric hospital. They were evaluated using semi-structured interviews and questionnaires. Patients were assigned to groups according to age, weight status, and symptom duration. Frequencies of clinical presentations, including combinations of DSM-5 categories, were also examined. Our findings suggest that adolescents presented with higher rates of Depression (p = 0.04). Youth with chronic ARFID symptoms presented with significantly lower weight (p = 0.03), and those with acute symptoms rated significantly higher suicidal ideation and/or self- harm (p = 0.02). Half of patients met criteria for more than one ARFID symptom presentation. This study provides preliminary evidence that youth with ARFID differ in clinical presentation depending on age, weight status, and symptom duration, and highlights safety concerns for those with acute symptoms of ARFID. High rates of overlapping symptom presentations might suggest a dimensional approach in the conceptualization of ARFID. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

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17 pages, 1385 KiB

Open AccessArticle

Stability, Continuity, and Bi-Directional Associations of Parental Feeding Practices and Standardized Child Body Mass Index in Children from 2 to 12 Years of Age

by Janina Eichler, Ricarda Schmidt, Tanja Poulain, Andreas Hiemisch, Wieland Kiess and Anja Hilbert

Nutrients 2019, 11(8), 1751; https://doi.org/10.3390/nu11081751 - 30 Jul 2019

Cited by 29 | Viewed by 3688

Abstract

(1) Background: Parental feeding practices are related to child body mass index (BMI, kg/m²) and seem to be a consequence rather than cause of child BMI, but research so far is limited. Stability and continuity of feeding practices, probably explaining changes in food intake and child BMI, remain to be poorly examined. (2) Methods: Feeding practices (i.e., restriction, food as reward, pressure to eat, monitoring) assessed via the Child Feeding Questionnaire, child age, standardized BMI (zBMI), and socio-economic status were measured annually at multiple visits (range 2–8) in a population-based longitudinal cohort study of 1512 parents with their children aged 2 to 12 years. Stability, continuity, and bi-directionality of feeding practices and child zBMI were calculated using correlation coefficients, paired t tests, and cross-lagged panels, respectively. (3) Results: Feeding practices and child zBMI showed moderate to high stability. While continuity was high for restriction, minor temporal changes were observed for other feeding practices and child zBMI. Cross-lags indicated that child zBMI predicted restriction, pressure to eat, and monitoring, while food-rewarding predicted child zBMI only minorly. (4) Conclusions: Parents seem to adapt feeding practices to child zBMI with the exception of food-rewarding. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

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13 pages, 452 KiB

Open AccessArticle

Associations of Weekday and Weekend Sleep with Children’s Reported Eating in the Absence of Hunger

by Sarah LeMay-Russell, Marian Tanofsky-Kraff, Natasha A. Schvey, Nichole R. Kelly, Lisa M. Shank, Sarah J. Mi, Manuela Jaramillo, Sophie Ramirez, Deborah R. Altman, Sarah G. Rubin, Meghan E. Byrne, Natasha L. Burke, Elisabeth K. Davis, Miranda M. Broadney, Sheila M. Brady, Susan Z. Yanovski and Jack A. Yanovski

Nutrients 2019, 11(7), 1658; https://doi.org/10.3390/nu11071658 - 20 Jul 2019

Cited by 29 | Viewed by 4271

Abstract

Insufficient average sleep duration has been inconsistently associated with poor diet and obesity risks in youth. Inconsistencies in findings across studies may be due to a general failure to examine associations in weekday versus weekend sleep. We hypothesized that greater variations in weekday and weekend sleep duration would be associated with more disinhibited eating behaviors, which, in turn, might be involved in the relationship between sleep and weight. We, therefore, examined, among healthy, non-treatment seeking youth, the associations of average weekly, weekend, and weekday sleep duration with eating in the absence of hunger (EAH), a disinhibited eating behavior associated with disordered eating and obesity. Sleep was assessed via actigraphy for 14 days. Participants completed a self-report measure of EAH. Adiposity was measured by dual-energy X-ray absorptiometry. Linear regressions were used to test the associations of sleep duration with EAH and the associations of sleep duration and EAH, with fat mass. Among 123 participants (8–17 years, 52.0% female, and 30.9% with overweight), there was no significant association between average weekly sleep and EAH. Further, there was no significant association among average weekly sleep duration or EAH and fat mass. However, average weekday sleep was negatively associated, and average weekend sleep was positively associated, with EAH (ps < 0.02). Weekend “catch-up” sleep (the difference between weekend and weekday sleep) was positively associated with EAH (p < 0.01). Findings indicate that shorter weekday sleep and greater weekend “catch-up” sleep are associated with EAH, which may place youth at risk for the development of excess weight gain over time. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

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11 pages, 1002 KiB

Open AccessFeature PaperArticle

Altered Processing of Visual Food Stimuli in Adolescents with Loss of Control Eating

by Stefanie C. Biehl, Ulrich Ansorge, Eva Naumann and Jennifer Svaldi

Nutrients 2019, 11(2), 210; https://doi.org/10.3390/nu11020210 - 22 Jan 2019

Cited by 6 | Viewed by 3754

Abstract

Loss of control eating (LOC) constitutes a common eating pathology in childhood and adolescence. Models developed for adult patients stress a biased processing of food-related stimuli as an important maintaining factor. To our knowledge, however, no EEG study to date investigated the processing of visual food stimuli in children or adolescents with LOC. Adolescents with at least one self-reported episode of LOC in the last four weeks and a matched control group completed a modified Go/NoGo task, with a numerical target or non-target stimulus being presented on one side of the screen and an irrelevant high-calorie food or neutral stimulus being presented on the opposite side. Mean P3 amplitudes were analyzed. In Go trials, the LOC group’s mean P3 amplitudes were comparable irrespective of distractor category, while for NoGo trials, mean P3 amplitudes were significantly higher when the distractor was a high-calorie food stimulus. This pattern was reversed in the control group. Results are interpreted in light of Gray’s reinforcement sensitivity theory. They might reflect altered processes of behavioral inhibition in adolescents with LOC upon confrontation with visual food stimuli. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

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Review

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16 pages, 641 KiB

Open AccessReview

Children in Need—Diagnostics, Epidemiology, Treatment and Outcome of Early Onset Anorexia Nervosa

by Beate Herpertz-Dahlmann and Brigitte Dahmen

Nutrients 2019, 11(8), 1932; https://doi.org/10.3390/nu11081932 - 16 Aug 2019

Cited by 50 | Viewed by 17710

Abstract

Knowledge of anorexia nervosa (AN) in childhood is scarce. This review gives a state-of-the-art overview on the definition, classification, epidemiology and etiology of this serious disorder. The typical features of childhood AN in comparison to adolescent AN and avoidant restrictive eating disorder (ARFID) are described. Other important issues discussed in this article are somatic and psychiatric comorbidity, differential diagnoses and medical and psychological assessment of young patients with AN. Special problems in the medical and psychological treatment of AN in children are listed, although very few studies have investigated age-specific treatment strategies. The physical and mental outcomes of childhood AN appear to be worse than those of adolescent AN, although the causes for these outcomes are unclear. There is an urgent need for ongoing intensive research to reduce the consequences of this debilitating disorder of childhood and to help patients recover. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

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24 pages, 1421 KiB

Open AccessReview

Brain and Cognitive Development in Adolescents with Anorexia Nervosa: A Systematic Review of fMRI Studies

by Gaia Olivo, Santino Gaudio and Helgi B. Schiöth

Nutrients 2019, 11(8), 1907; https://doi.org/10.3390/nu11081907 - 15 Aug 2019

Cited by 24 | Viewed by 13231

Abstract

Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to 33%. Moreover, weight recovery does not necessarily reflect cognitive recovery. This issue is of particular interest in adolescence, characterized by progressive changes in brain structure and functional circuitries, and fast cognitive development. We reviewed existing literature on fMRI studies in adolescents diagnosed with AN, following PRISMA guidelines. Eligible studies had to: (1) be written in English; (2) include only adolescent participants; and (3) use block-design fMRI. We propose a pathogenic model based on normal and AN-related neural and cognitive maturation during adolescence. We propose that underweight and delayed puberty—caused by genetic, environmental, and neurobehavioral factors—can affect brain and cognitive development and lead to impaired cognitive flexibility, which in turn sustains the perpetuation of aberrant behaviors in a vicious cycle. Moreover, greater punishment sensitivity causes a shift toward punishment-based learning, leading to greater anxiety and ultimately to excessive reappraisal over emotions. Treatments combining physiological and neurobehavioral rationales must be adopted to improve outcomes and prevent relapses. Full article

(This article belongs to the Special Issue Childhood Eating and Feeding Disturbances)

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