Earlier diagnosis in anorexia nervosa: better watch growth charts!
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RESEARCH ARTICLE
Open Access
Earlier diagnosis in anorexia nervosa: better watch growth charts! Morgane Marion1* , Sylvie Lacroix1, Marylène Caquard1, Laurence Dreno2, Pauline Scherdel3, Christèle Gras Le Guen3,4, Emmanuelle Caldagues1 and Elise Launay4
Abstract Background: A better understanding of the healthcare pathway of children and adolescents with anorexia nervosa (AN) may contribute to earlier detection and better disease management. Here we measured and compared the symptomatic time to diagnosis (TTD) (time between the first symptoms, as reported by parents, and the diagnosis) and the auxological TTD (time between the deviation in the weight growth curve and the diagnosis). Methods: We performed a monocentric retrospective study including all patients age 9 years to 16 years who were hospitalized in Nantes University Hospital for AN between 2013 and 2016. We analysed the two TTDs by medical record review and growth curve investigation. TTDs were described by medians and Kaplan-Meier curves. Two profiles of patients were compared according to the kinetics of growth deviation and the occurrence of symptoms. Results: Among the 137 patients included, the median symptomatic and auxological TTDs was 7.0 months (IQR: 4.0–12.0) and 7.2 months (IQR: 2.0–18.0). TTDs were significantly different but clinically similar. For 48% of the patients, a deviation in the growth curve could have been noted at a median of 9.7 months (IQR: 3.0–18.0) before the first symptoms were reported by parents. Those patients showed significantly slower weight loss than did patients with first symptoms reported before growth deviation (weight loss rate 0.41% vs 1.90% per month, p < 0.0001). Conclusions: Careful study of growth curves remains an essential step in detecting eating disorders, possibly allowing for earlier detection of the disease in nearly half of these patients. Keywords: Adolescent, Anorexia nervosa., Eating disorder., Feeding disorder., Time to diagnosis., Early diagnosis., Growth charts.
Plain English summary Our study highlights the need for more meticulous analysis of growth charts to detect anorexia nervosa earlier in children and adolescents. Children and adolescents should be weighed and measured regularly and growth curves should be systematically constructed. Any deviation in the growth pathway (weight loss or stagnation) should be controlled and investigated if confirmed.
* Correspondence: [email protected] 1 CHU de Nantes, Department of adolescent medicine, Pédiatrie générale, 7 quai Moncousu, 44000 Nantes, France Full list of author information is available at the end of the article
Introduction The eating disorder (ED) anorexia nervosa (AN) is more common among girls than boys, with an estimated prevalence of 0.5 to 1% in adolescent girls [1, 2]. AN is responsible for substantial physical and psychological morbidity [1]. The main acute complication of malnutrition is death, but death can also occur over the long term, mainly because of suicide. Among adults, overall mortality with AN is estimated a
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