Eating disorders are frequently seen as psychological or societal diseases, but do they have an underlying biological cause? A new study shows that the levels of a brain protein differ between healthy and anorexic women.

Anorexia is a serious and occasionally fatal eating disorder most commonly affecting women. Scientists do not yet understand the physical causes of anorexia, though some studies suggest a link to low levels of a brain protein called BDNF. Now, a study recommended by Cynthia Bulik, a member of Faculty of 1000 Medicine and leading expert in the field of psychiatry and eating disorders, shows that BDNF levels are higher in women who have recovered from anorexia. This suggests that low BDNF levels may be reversible.

Researchers at Chiba University in Japan found that anorexic women had lower levels of BDNF in their blood than healthy women or those who had recovered from anorexia. Women with low BDNF also had the lowest self-image, suffered from anxiety and depression, and performed poorly on certain tests of cognitive ability.

Further study is needed to determine what role BDNF plays in anorexia, and if it can be used to predict the risk of developing it, but Bulik forecasts that “…BDNF may emerge as a useful biomarker of [anorexia] and of recovery from [anorexia].”

1. Nakazato M, Tchanturia K, Schmidt U, Campbell IC, Treasure J, Collier DA, Hashimoto K, Iyo M. Brain-derived neurotrophic factor (BDNF) and set-shifting in currently ill and recovered anorexia nervosa (AN) patients. Psychol Med, 2009 Jun 39(6):1029-35 [link]

source : sciencedaily

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Girls have a better sense of taste than boys. Every third child of school age prefers soft drinks which are not sweet. Children and young people love fish and do not think of themselves as being fussy eaters. Boys have a sweeter tooth than girls. Teenagers taste differently. And finally, schoolchildren in northern Denmark have the best taste buds.

The findings of the world’s largest study so far on the ability of children and young people to taste and what they like have now been published. The study was conducted jointly by Danish Science Communication, food scientists from The Faculty of Life Sciences (LIFE) at University of Copenhagen and 8,900 Danish schoolchildren.

In September, 8,900 schoolchildren from all over Denmark took part in a large-scale experiment conducted by Danish Science Communication and The Faculty of Life Sciences (LIFE) at University of Copenhagen. It is the first time that such a large-scale study has been done on the sense of taste of children and young people and what they like to eat.

One of the reasons why it was possible to include so many children and young people in the study was that the experiment itself was conducted in quite an unorthodox way: It was planned as a ‘mass experiment’ in conjunction with this year’ s natural science festival at Danish primary and secondary schools.

All the participating groups of children were sent a complete kit of taster samples and very detailed instructions, and then conducted the experiment as part of their natural science classes. The various tests were designed to quantify the ability of children and young people to discover and recognise sweet and sour tastes at varying intensities, to establish which sourness or sweetness they prefer, how many taste buds they have and, finally, the children answered a number of questions on their eating habits and fussiness over food.

Both pupils and teachers have taken the experiment very seriously: “What is most surprising is that the results are so clear and of such a high quality,” says Bodil Allesen-Holm, MSc in Food Science and Technology, who is the scientific head of the project and head of the Sensory Laboratory at the Department of Food Science at LIFE. “The trends are very clear in all the answers from the many primary and secondary schools; the pupils and teachers have been very thorough and accurate.”

Industry must do better, and parents could experiment more

According to Bodil Allesen-Holm, the results provide food for thought for both the food industry – and for parents: “It is quite clear that children and young people are very good tasters, and that there are bigger variations between them than most people would expect.

There is, for example, a marked difference between boys and girls, and the ability of children to recognise tastes changes with age. So one could easily develop more varied food products and snacks for children and young people. For example, it is quite clear that children do not necessarily prefer sweet things. According to the findings, healthy snacks could easily be developed for boys with slightly extreme and sour flavours.”

“This experiment has focused on taste alone, while future studies will include more sensory aspects such as smells and appearance to provide a more all-round understanding of Danish children’s preferences,” says Wender Bredie, Professor of Sensory Science at the Department of Food Science at LIFE.

Girls are better at recognising tastes than boys

One of the many findings shows that girls are generally better at recognising tastes than boys. They are better at recognising all concentrations of both sweet and sour tastes. The difference is not dramatic, but it is quite clear. It is also a known fact that women generally have a finer sense of taste than men.

“We also asked the pupils to count ‘taste buds’ or organs of taste on the tongue. However, the experiment showed that boys and girls have largely the same number of taste buds. So it would appear that what makes the difference is the way in which boys and girls process taste impressions,” says Michael Bom Frøst, Associate Professor at the Department of Food Science at LIFE.

According to the figures, boys need an average of approximately 10 per cent more sourness and approximately 20 per cent more sweetness to recognise the taste.

Every third schoolchild would prefer not to eat sweet things

Another sensational finding is that every third schoolchild would prefer non-sugary soft drinks. All the pupils did a blind test in which they were instructed to give scores to ten different variants of the same soft drink – with varying sweetness and sourness.

Surprisingly, as many as 30 per cent of the pupils preferred the variant which contained no sugar at all or very little. “This is new. In other words, soft drinks for children and young people do not always have to contain a lot of sugar,” says Bodil Allesen-Holm.

On the other hand, 48 per cent of the pupils just couldn’t get enough: They gave top marks to the sweetest of the variants. “It may be because many pupils are quite used to drinking a lot of soft drinks and eating a lot of sweets,” says Bodil Allesen-Holm.

Boys like it wild, girls prefer more muted flavours

Funnily enough, girls generally prefer flavours which are not too strong. Boys, on the other hand, tend to like the more extreme flavours. Boys also have a sweeter tooth than girls – most of the boys preferred the super sweet soft drink variety. And most boys also gave top marks to the sourest samples.

Yes, I like fish!

The study shows that when you ask the children about their likes and dislikes, they actually like fish. As many as 70 per cent of the pupils said they like fish. And you can safely give them exciting foods. As many as 59 per cent of pupils do not consider themselves to be fussy eaters, and this applies to both girls and boys.

The world becomes more sour and exciting for teenagers

It would appear that you can safely notch up a gear when it comes to food, drinks and snacks for teenagers. The study showed that their sense of taste changes noticeably: The ability to recognise tastes increases gradually with age, and the greatest shift is seen at 13-14 years when children become markedly more sensitive to sour tastes.

At exactly the same time, their love of very sweet flavours starts waning. And it is here too that many more declare they are not fussy eaters. Past studies have shown that children who like sour things tend not to be nearly as fussy as children who are not mad about sour foods. Those who prefer sour flavours are also more open to tasting new foods.

Pupils in northern Jutland taste champions

Pupils from northern Jutland are better tasters than all other pupils in Denmark. The figures are clear, but the scientists cannot explain why. Firstly, they are clearly better at recognising sour tastes. Where most other children and young people require 0.5g of citric acid per litre to discern the sourness, children in northern Jutland need no more than 0.37g. This is a significant difference.

Children in northern Jutland are also better at recognising sweet tastes, although children from central Jutland and Copenhagen are on a par with them.

source : sciencedaily

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“A feeding problem can be defined as a deficit in any aspect of taking nutritional elements that result in undernutrition, poor growth, or stressful mealtimes for children and their caregivers” (Arvdson & Brodsky, 2002, pg. 570).

Feeding problems in young children appear to be common, although estimates of frequency have varied considerably in the literature. The lack of reliable, consistent diagnostic criteria continues to impede research-based progress in this area (Benoit D. Services and programs proven to be effective in managing young children’s (birth to age 5) eating behaviours and impact on their social and emotional development: Comments on Piazza and Carroll-Hernandez, Ramsay, and Black. In: Tremblay RE, Barr RG, Peters RdeV (eds.) Encyclopedia on Early Childhood Development, 2004;1-4).

Estimates range from 12% to 35% of children as having reportable feeding problems (Kessler, J.W. 1966), (Manikam R & Perman JA. Journal of Clinical Gastroenterology, 2000; 30(1): 34-46), (Palmer, S, & Horn, S. 1978, 107-129) with 1 to 2% of infants and young children having more severe, prolonged difficulty (Dahl, M. Acta Paediatrica Scandinavia, 1987; 76: 872-880). Data from Nova Scotia is in line with these estimates. In a normative sample designed to screen out children with major medical or developmental issues, 21% of parents reported four or more feeding behaviours as problematic for them (Crist, W, Napier-Phillips, A. Journal of Developmental and Behavioral pediatrics, 2001: 22(5): 279-286).

Children with neurological and developmental disabilities are especially prone to having feeding difficulties, with an estimated prevalence of 33% or more within that population (Schwarz SM.  Infants and Young Children. 2003; 16:317-330).

Questions about eating are among the most common concerns that parents raise with their pediatrician (Stickler, GB, Simmons, PS. Clinical Pediatrics, 1995;384-387). Thirty-seven percent of parents are worried about whether their child is eating right and 24% worry that their child does not eat enough.

Determining if a feeding problem exists is easier with physical evidence such as poor growth. Deciding that there is a feeding problem based on stressful mealtimes for children and their caregivers is a judgement call. Here are some things that you might consider in making this judgement. “Because of the wide variety of problems that can arise between parent and child over food, the following only provides common “red flags” and is not an exhaustive list.”

 Long mealtimes. Most family mealtimes last between 15-30 minutes. Mealtimes longer than 30 minutes often indicate feeding difficulties (Crist, W, Napier-Phillips, A. Journal of Developmental and Behavioral pediatrics. 2001; 22(5): 279-286), (Reau NR, Senturia YD, Lebailly SA, Christoffel KK. J Dev Behav Pediat 1996; 17:149-153).

Parents who report that they dread mealtimes. Mealtimes are important social times for families. When parents report that they dread mealtimes, significant difficulties usually exist.

Parents who are very worried that their child is not eating enough, despite evidence of good growth. Pay attention to any discrepancy between how worried a parent is about whether or not a child is getting enough to eat and the child’s actual growth pattern, particularly when such growth is quite good. In such a case, the parent’s worry often reflects significant battles over food.

Parents who report unusual strategies in trying to get their child to eat. Parents should not have to try to get their child to eat. Unusual strategies, such as leaving small bowls of food around the house or chasing their child around the house with a spoon, are good indicators of underlying feeding problems.

 Children who appear to be narrowing their diet over an extended period of time. It is common for toddlers to have food jags — times when they have a few favourite foods. However, these food jags are typically short (i.e. a couple of weeks). If a child’s narrow diet lasts longer than six months, it is probably worthwhile to ask more questions about the situation.

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Copyright © 2009, Picky Eaters Clinic Information Education Network. All rights reserved.

• As a toddler, your child may start to refuse to eat some foods, become a very picky eater or even go on binges where they will only want to eat a certain food.
• As a toddler, your child may start to refuse to eat some foods, become a very picky eater or even go on binges where they will only want to eat a certain food. An important way that children learn to be independent is through establishing independence about feeding. Even though your child may not be eating as well rounded a diet as you would like, as long as your child is growing normally and has a normal energy level, there is probably little to worry about. Remember that early childhood is a period in his development where he is not growing very fast and doesn’t need a lot of calories.

• You should also not prepare more than one meal for your child. If he doesn’t want to eat what was prepared for the rest of the family, then he should not be forced to, but you should also not give him something else to eat. He will not starve after missing a single meal, and providing alternatives to the prepared meal will just cause more problems later.
• Other ways to prevent feeding problems are to not use food as a bribe or reward for desired behaviors, avoid punishing your child for not eating well, limit mealtime conversation to positive and pleasant topics, avoid discussing or commenting on your child’s poor eating habits while at the table, limit eating and drinking to the table or high chair, and limit snacks to two nutritious snacks each day.
• Although your child will probably be hesitant to try new foods, you should still offer small amounts of them once or twice a week (one tablespoon of green beans, for example). Most children will try a new food after being offered it 10-15 times.
• While you should provide three well-balanced meals each day, it is important to keep in mind that most younger children will only eat one or two full meals each day. If you toddler has had a good breakfast and lunch, then it is okay that he doesn’t want to eat much at dinner.

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Copyright © 2009, Picky Eaters Clinic Information Education Network. All rights reserved.

“A feeding problem can be defined as a deficit in any aspect of taking nutritional elements that result in undernutrition, poor growth, or stressful mealtimes for children and their caregivers” (Arvdson & Brodsky, 2002, pg. 570).

Feeding problems in young children appear to be common, although estimates of frequency have varied considerably in the literature. The lack of reliable, consistent diagnostic criteria continues to impede research-based progress in this area (Benoit D. Services and programs proven to be effective in managing young children’s (birth to age 5) eating behaviours and impact on their social and emotional development: Comments on Piazza and Carroll-Hernandez, Ramsay, and Black. In: Tremblay RE, Barr RG, Peters RdeV (eds.) Encyclopedia on Early Childhood Development, 2004;1-4).

Estimates range from 12% to 35% of children as having reportable feeding problems (Kessler, J.W. 1966), (Manikam R & Perman JA. Journal of Clinical Gastroenterology, 2000; 30(1): 34-46), (Palmer, S, & Horn, S. 1978, 107-129) with 1 to 2% of infants and young children having more severe, prolonged difficulty (Dahl, M. Acta Paediatrica Scandinavia, 1987; 76: 872-880). Data from Nova Scotia is in line with these estimates. In a normative sample designed to screen out children with major medical or developmental issues, 21% of parents reported four or more feeding behaviours as problematic for them (Crist, W, Napier-Phillips, A. Journal of Developmental and Behavioral pediatrics, 2001: 22(5): 279-286).

Children with neurological and developmental disabilities are especially prone to having feeding difficulties, with an estimated prevalence of 33% or more within that population (Schwarz SM.  Infants and Young Children. 2003; 16:317-330).

Questions about eating are among the most common concerns that parents raise with their pediatrician (Stickler, GB, Simmons, PS. Clinical Pediatrics, 1995;384-387). Thirty-seven percent of parents are worried about whether their child is eating right and 24% worry that their child does not eat enough.

Determining if a feeding problem exists is easier with physical evidence such as poor growth. Deciding that there is a feeding problem based on stressful mealtimes for children and their caregivers is a judgement call. Here are some things that you might consider in making this judgement. “Because of the wide variety of problems that can arise between parent and child over food, the following only provides common “red flags” and is not an exhaustive list.”

 Long mealtimes. Most family mealtimes last between 15-30 minutes. Mealtimes longer than 30 minutes often indicate feeding difficulties (Crist, W, Napier-Phillips, A. Journal of Developmental and Behavioral pediatrics. 2001; 22(5): 279-286), (Reau NR, Senturia YD, Lebailly SA, Christoffel KK. J Dev Behav Pediat 1996; 17:149-153).

Parents who report that they dread mealtimes. Mealtimes are important social times for families. When parents report that they dread mealtimes, significant difficulties usually exist.

Parents who are very worried that their child is not eating enough, despite evidence of good growth. Pay attention to any discrepancy between how worried a parent is about whether or not a child is getting enough to eat and the child’s actual growth pattern, particularly when such growth is quite good. In such a case, the parent’s worry often reflects significant battles over food.

Parents who report unusual strategies in trying to get their child to eat. Parents should not have to try to get their child to eat. Unusual strategies, such as leaving small bowls of food around the house or chasing their child around the house with a spoon, are good indicators of underlying feeding problems.

 Children who appear to be narrowing their diet over an extended period of time. It is common for toddlers to have food jags — times when they have a few favourite foods. However, these food jags are typically short (i.e. a couple of weeks). If a child’s narrow diet lasts longer than six months, it is probably worthwhile to ask more questions about the situation.

an·o·rex·i·a  (n-rks-) n. 1. Loss of appetite, especially as a result of disease. 2. Anorexia nervosa. [Greek anorexi : an-, without; see a-1 + orexis, appetite (from oregein, to reach out for; see reg- in Indo-European roots).]

The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.

a psychological disorder characterized by fear of becoming fat and refusal to eat [Greek an- without + orexis appetite]

Collins Essential English Dictionary 2nd Edition 2006 © HarperCollins Publishers 2004, 2006

anorexia  (n-rks-) 1. Loss of appetite, especially as a result of disease. 2. Anorexia nervosa.

The American Heritage® Science Dictionary Copyright © 2005 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

dysphagia /dys·pha·gia/ (-fa´jah) difficulty in swallowing.

dys·pha·gia (ds-fj) or dys·pha·gy (dsf-j) n. Difficulty in swallowing or inability to swallow. Also called aglutition, aphagia, odynophagia. dys·phagic (-fjk) adj.

Mentioned in: Achalasia, Esophageal Pouches, Lower Esophageal Ring, Myositis

dysphagia (dis·fāˑ·jē·),

dysphagia (disfā´jē),

difficulty in swallowing.

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

Classifying Complex Pediatric Feeding Disorders

Burklow, Kathleen A.; Phelps, Anne N.; Schultz, Janet R.; McConnell, Keith; Rudolph, Colin

Journal of Pediatric Gastroenterology & Nutrition:

August 1998 – Volume 27 – Issue 2 – pp 143-147

Original Articles

FREE FULLTEXT

Abstract

Background: This study defines the multiple characteristics associated with complex pediatric feeding problems and determines the relative frequency of each classification in a population referred to an interdisciplinary feeding team.

Methods: The written reports from team evaluations on 103 children (64 males, 39 females; age range 4 months to 17 years) were reviewed. Prematurity and/or presence of developmental delay was coded. Identified factors related to current feeding problems were coded according to five categories: structural abnormalities, neurological conditions, behavioral issues, cardiorespiratory problems, metabolic dysfunction.

Cited Here… Interrater reliability for the classification coding was 88%. Thirty-eight percent of the children had a history of prematurity and 74% were reported to have evidence of developmental delay. The following five categories or combinations were coded most frequently: structural-neurological-behavioral(30%), neurological-behavioral (27%), behavioral (12%), structural-behavioral(9%), and structural-neurological (8%). Overall, behavioral issues were coded more often (85%) than neurological conditions (73%), structural abnormalities(57%), cardiorespiratory problems (7%), or metabolic dysfunction (5%).

Conclusions: Data analysis using this classification system revealed that the majority of children in this sample had a behavioral component to their complex feeding problem, regardless of concurrent physical factors. These findings suggest that complex pediatric feeding problems are biobehavioral conditions in which biological and behavioral aspects mutually interact, and both need to be addressed to achieve normal feeding.

REFERENCES

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Feeding Problems in Children: a practical guide.(Review)

Feeding Problems in Children: a practical guide. Edited by Southall A, Schwartz A. (Pp 280, paperback; [pound]19.95.) Abingdon: Radcliffe Medical Press, 1999. ISBN 1 85775 208 2

Given the wide prevalence of feeding problems in children and their potential impact on health, it is important for all health professionals working with children to gain an understanding of feeding difficulties. In several chapters of this book there is a refreshing focus on the role of organic factors in feeding problems, which may highlight the wide range of subtle organic features that can contribute to and exacerbate feeding difficulties in children. The impact of other factors on feeding is also covered–for example, the effect of temperament, appetite, growth, developmental stage, prior experience with foods, and cognitive development, all of which are critical in understanding each child’s feeding difficulty and creating appropriate intervention strategies.

The various theories of feeding difficulties from physiological (oral motor, regulatory, neurological), psychological (behavioural, cognitive behavioural, and psychoanalytical) and cultural perspectives are covered. These are discussed with reference to multidisciplinary teamwork and the development of both hospital and community feeding services. The chapter covering the psychoanalytical perspective sits somewhat oddly within the …

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Clinical Research

Pediatric Assessment Scale for Severe Feeding Problems: Validity and Reliability of a New Scale for Tube-Fed Children

Full Text (PDF)

Nutrition in Clinical Practice, Vol. 19, No. 4, 403-408 (2004)

William Crist, PhD^*, Cindy Dobbelsteyn, MSc, S-LP(C), Anne Marie Brousseau, BScOT^* and Anne Napier-Phillips, BA^*

^* Feeding and Nutrition Clinic, IWK Health Centre, Halifax, Nova Scotia, Canada; and Nova Scotia Hearing and Speech Clinic, Halifax, Nova Scotia, Canada

Correspondence: William Crist, PhD, Feeding and Nutrition Clinic, IWK Health Centre, P.O. Box 3070, Halifax, Nova Scotia, Canada, B3J 3G9. Electronic mail may be sent to william.crist@iwk.nshealth.ca .

Background: This study reports data on the validity and reliability of a new parent report measure, the Pediatric Assessment Scale for Severe Feeding Prob- lems, designed to assess progress in the development of oral eating skills for children who need prolonged tube feeding. Methods: The questionnaire was completed by parents of 3 groups of children. The first group consisted of 17 children who received all of their nutrition by tube feedings, a second group of 30 children who were oral eaters but required supplementation by tube feedings, and a third group of 27 children who were referred for feeding difficulties but were not receiving any tube feed- ing. A subset of parents from each group completed the measure a second time approximately 2 to 4 weeks after completing the initial questionnaire in order to examine the reliability of the measure. Results: The mean scores (scale of 0 to 66) on the measure were 7.3 for completely tube-fed children, 30.0 for partially tube-fed children, and 46.8 for referred, non–tube-fed children. The correlation between first and second administration of the measure was .98. Conclusions: The validity and reliability of the Pediatric Assessment Scale for Severe Feeding Problems appears to be adequate. The new measure should allow clinicians to better rate initial severity of feeding difficul- ties and to track the progress of children as they advance from being totally tube-fed to completely orally fed.

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Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum.
Personal Authors: Yousafzai, A. K., Filteau, S., Wirz, S.
Author Affiliation: Centre for International Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
Editors: No editors
Document Title: British Journal of Nutrition

Abstract:

The aim of the present study was to explore the nature, extent and probable causes of nutritional deficiencies among children with disabilities living in Dharavi, a slum in Mumbai, India. A cross-sectional study was conducted to investigate whether the nutritional status of children with disabilities, aged 2-6 years (n 141), was worse than that of non-disabled sibling controls (n 122) and neighbour controls (n 162). Data on food patterns, anthropometry, micronutrient status and feeding difficulties reported by parents were collected. The mean weight for age of the children with disabilities (-2.44 (SD 1.39) Z scores; n 120) was significantly lower (P<0.05) compared with the sibling (-1.70 (SD 1.20) Z scores; n 109) and neighbour (-1.83 (SD 1.290) Z scores; n 162) control groups. The children with disabilities had significantly lower (P<0.05) mean haemoglobin levels (92 (SD 23) g/l; n 134) compared with siblings (102 (SD 18) g/l; n 103) and neighbours (99 (SD 18) g/l; n 153). Relative risk (RR) analysis indicated that the disabled children with feeding difficulties were significantly more likely (P<0.05) to be malnourished, by the indicator of weight for age (RR 1.1; 95% CI 1.08, 1.20) compared with the disabled children without a feeding difficulty. They were also significantly more likely to be malnourished using the indicators of height for age (RR 1.3; 95% CI 1.19, 1.43) and weight for height (RR 2.4; 95% CI 1.78, 3.23) compared with the disabled children without a feeding difficulty. Feeding difficulties were identified as a risk factor for vulnerability to inadequate nutritional status among children with disabilities.

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