nutrition in eating disorders and bone health

what eating disorder is characterized by persistent energy restriction, intense fear of gaining weight, and disturbance in self perceived weight?

anorexia nervosa

what are the 2 diagnostic subtypes of anorexia nervosa?

restrictive eating only (AN-R)

restrictive eating w binge eating or purging (AN-BP)

how is the severity of anorexia categorized?

by BMI

what does starvation lead to?

protein and fat breakdown

loss of cellular volume

atrophy of vital organs

what are physical characteristics of someone with anorexia nervosa?

appears underweight

lanugo

dry skin and hair

cold intolerance

cyanosis

edema

amenorrhea

what cardio complications are associated with anorexia nervosa?

bradycardia

orthostatic hypotension

arrhythmias

pericardial effusion

what nutrient deficiencies may be seen in anorexia nervosa?

thiamine

phosphorus

magnesium

is anorexia nervosa reversible?

it can be w nutritional rehab and weight restoration

what are GI complications associated with anorexia nervosa?

delayed gastric emptying

decreased small bowel motility

constipation

what bone complication is associated with anorexia nervosa?

osteopenia

what are renal complications associated with anorexia nervosa?

renal insufficiency

increased urine output

proteinuria

hematuria

what are hematologic complications associated with anorexia nervosa?

anemia

leukopenia

thrombocytopenia

what would you see on labs for anorexia nervosa?

normal albumin

low prealbumin

hypophosphatemia

hypoglycemia

high cholesterol (LDL and HDL)

what eating disorder is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors in an effort to prevent weight gain?

bulimia nervosa

what is an episode of uncontrollable eating of an excessive amount of food in a discrete period of time?

binge consumption

what is included in inappropriate compensatory behaviors involved in bulimia nervosa?

self induced vomiting

misuse of laxative

diuretics

fasting

excessive exercise

what are physical characteristics of bulimia nervosa?

usually of normal weight

secretive behavior

Russell's sign on hand

parotid gland enlargement

erosion of dental enamel w increased caries

what are GI complications associated with bulimia nervosa?

sore throat

dysphagia

reflux

esophagitis

subconjunctival hemorrhage

mallory-weiss tears

gastric dilation or rupture

diarrhea from laxatives, then rebound constipation

what do you see on labs for bulimia nervosa?

acid base imbalance

Hypokalemia, hypochloremic metabolic alkalosis- vomiting and abuse of diuretics

Hypokalemia and hyperchloremia metabolic acidosis - abuse of laxatives

menstrual irregularity

which lab value indicates purging/vomiting and use of diuretics?

increased serum bicarb

hypokalemia and HYPOchloremic metabolic alkalosis

which lab value indicates abuse of laxatives?

decreased serum bicarb

hypokalemia and hyperchloremic metabolic acidosis

what is characterized by recurrent episodes of binge eating w/o inappropriate compensatory measures such as purging?

binge eating disorder

what is the severity of binge eating disorder based on?

frequency of binge episodes

what is the treatment for eating disorders?

family/cognitive behavioral therapy - first line < 19 yo

multidisciplinary approach

what are long term goals for treatment of eating disorders?

help pt understand importance of rehab

help pt change behaviors and attitudes

address psychologic conflicts that contribute to disorder

what is the treatment for anorexia nervosa?

refeeding (start low and go slow)

aim for weight gain of 2-3 lbs per week

what is refeeding syndrome marked by?

hypophosphatemia

hypokalemia

hypomagnesemia

seizures

rhabdomyolysis

what is the treatment for bulimia nervosa?

weight maintenance diet of 2200-2400 kcal/day

establish regular eating pattern

change beliefs about shape/weight

prevent relapse by reminding pt not to restrict calories

what are common characteristics of both anorexia and bulimia?

food aversions

may label foods as good or bad

strange/anxious mealtime behaviors

which condition must be associated with low body weight?

anorexia nervosa

3 multiple choice options

which condition is most associated with russell sign?

bulimia nervosa

3 multiple choice options

what are shafts of long bones primarily composed of?

cortical bone

what is the composition of bone that is not cortical?

trabecular/cancellous

which bone cells are responsible for the formation or production of bone tissue?

osteoblasts

which bone cells govern the resorption or breakdown of bone?

osteoclasts

which bone cells are inactive and derived from osteoblasts?

osteocytes and bone lining cells

what forms the first temporary skeleton and is found in adults to act as flexible supporting structure?

cartilage

bone tissue serves as a reservoir for what?

calcium and other minerals

what is the process of maintaining a constant serum calcium concentration?

calcium homeostasis

what is serum calcium concentration regulated by?

PTH and vit D

what is the relationship of Ca and PTH?

inverse

what is the relationship of Ca and Vit D?

vit D helps the body absorb calcium from the intestines

what is the growth of the skeleton?

bone modeling

when do long bones stop growing?

18 yo - women

20 yo - men

when is peak bone mass reached?

by age 30

what is peak bone mass related to?

nutrient intake

physical activity

genetics

when does bone mineral density start decreasing?

age 50

what accelerates bone loss in women?

menopause

what injury is associated with osteoporosis in post menopausal women?

hip fractures

which osteoporosis type is a result of natural aging and usually occurs 10-15 yrs after menopause for women or at age 65-80 for men?

primary

which osteoporosis type results when an identifiable drug or disease process causes loss of bone tissue?

secondary

what measures bone mass on the basis of tissue absorption of photons produced by x ray tubes?

dual energy x ray absorptiometry (DEXA scan)

what are the bone mineral density scores for osteopenia?

1-2.5 standard deviations below the mean

what are the bone mineral density scores for osteoporosis?

2.5 standard deviations below the mean

who should be screened for osteoporosis? what grade recommendation is this?

women > 65 yo or < 65 if at increased risk

grade B

how can we prevent osteoporosis?

adequate calcium, vit D, and vit K intake

weight training exercise 3-5x per week

hormone replacement therapy

which vitamin modifies matrix proteins including osteocalcin?

vit K

who should take calcium supplements?

taking steroids

low bone mass

post menopausal women

lactose intolerant

what is the most common calcium supplement?

calcium carbonate

what is the treatment for osteoporosis?

bisphosphonate treatment

calcium 1000-1200 mg/day

vit D 800-1000 IU/day

exercise (posture, balance, resistance and weight training)

what is the action of bisphosphonate treatment?

reduces osteoclasts bone degradative activities

Screening for osteoporosis in women > 65 is consistent with what grade per USPSTF recommendations?

B

3 multiple choice options