Nicholls, Dasha Elizabeth; (2002) The growth and development of children with prepubertal and pubertal eating disorders: Cross sectional and longitudinal finding and their interpretation. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Eating disorders are characterised by grossly disordered or chaotic eating behaviour. Nutritional compromise varies from extreme selectivity to severe malnourishment. During childhood, growth and development can be affected, some studies suggest permanently. Previously patient numbers have been limited, poor reference data used or growth parameters have not been taken into account when drawing conclusions about physical outcome for eating disorders in prepubertal and pubertal children. We studied consecutive cases referred to a specialist eating disorders service for children aged 7 to 16 years. Cross sectional (n=206) and longitudinal (n=126) data included anthropometry, body composition, bone density, and onset or resumption of menses. Findings were compared to normal children through a database designed to calculate age and gender matched scores from reference tables. The findings can be described in four categories. Firstly, in children who were malnourished, stature was significantly lower than age matched norms. Short stature was largely due to reduced spine length, and when adjusted for bone age was no longer evident, suggesting growth delay rather than stunting. Longitudinal data confirmed that ED subjects grew normally when adjusted for developmental stage, and those who had completed growth had a mean height on the 50th centile. Secondly, principal components analysis for anthropometry showed a specific deficit in fat mass in malnourished subjects, although an equivalent relative loss of lean mass was seen when growth parameters are taken into account. Thirdly, methods for adjusting bone density measurements for bone size were compared. Calculating volumetric bone density allows the impact of malnutrition to be evaluated. Finally, pre and postmenarcheal ED subjects were compared with control girls in terms of onset or resumption of menses. Both groups menstruated at weights normally distributed around 0 BMI SDS, but BMI at menses was age dependent.

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