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EPIDEMIOLOGICAL DATA: Anorexia nevrosa is mainly observed in young women in the 15-24 year age range. The incidence is 1 to 2% in the general population of female adolescents. The sex ratio is 9 girls for 1 boy. SYMPTOM TRIAD: Three symptoms predominate in anorexia nevrosa: weight loss, anorexia, amenorrhea. Weight loss results from restrictive eating behavior and not from a loss of appetite. CLINICAL DIAGNOSIS: Diagnosis is clinical and confirmed by an analysis of the underlying psychological conflicts which involve difficulty in accepting the female identity and in assuming self-sufficiency outside the family. The clinician should evaluate the quality of the familial environment, particularly the mother-daughter and father-daughter relationship as well as the social environment (school, friends) which is also needed to apprehend the global situation. Physical examination and laboratory tests are aimed at rapidly eliminating any differential diagnosis and to quantify the weight loss and its rate, and identify any nutritional disorders. ETIOLOGY: Anorexia nevrosa is not a truly structured psychopathological disorder but rather a loss of a stable organization of Self, with a highly vulnerable narcissistic element and precarious neurotic defences. CLINICAL COURSE: The risk of poor outcome is very real, sometimes life threatening. The treatment of choice is to implement analytical management as soon as possible, but outside acute episodes.
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The stated frequency with which 30 Indonesian children with corneal xerophthalmia and age/sex/neighborhood matched controls ordinarily consumed vitamin- and provitamin A-rich foods was compared. Controls were more frequent consumers of eggs (p less than 0.05), fish (p less than 0.05), dark green leafy vegetables (p less than 0.05), carrots (p less than 0.01), and carotene-containing fruits (p less than 0.1). Similar data were collected on 358 children with Bitot's spots and on normal preschool age children in a countrywide survey. Breast-feeding was more common among normals than among cases (p less than 0.001). Normals were also more frequent consumers of mango and papaya during the 2nd and 3rd yr of life (p less than 0.05); and of dark green leafy vegetables and eggs during the 3rd through 6th yr of life (p less than 0.01). In two separate studies, differences in carotene consumption by normals and abnormals were confirmed by differences in their serum carotene levels. Approximately 80% of Indonesian families, with an without xerophthalmic children, consumed dark-green leafy vegetables at least once a day, and 99% at least once a week. Diet therefore appears to be an important factor in the genesis of xerophthalmia in Indonesia despite the availability of suitable provitamin A-rich foods.
Twenty-two consecutive patients with rickets were studied in Benghazi, Libya. All were less than 2 years old. Rickets was associated with traditional cultural habits that limited sunshine exposure of the mothers and their infants, and with breast-feeding. Serum concentrations of the vitamin D metabolites 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D, and other parameters of mineral metabolism were typical of vitamin D deficiency disease, as was the biochemical and clinical response to treatment. Minimum safe serum levels of 25-OHD (20 nmol/L), and the serum levels of vitamin D metabolites in response to vitamin D treatment, were identical to previously obtained results from native Norwegian and Norwegian immigrant children with rickets, suggesting lack of racial differences in response to vitamin D. Fifty percent of the patients had adequate levels of vitamin D metabolites at the time of diagnosis, indicating that they had recently received oral vitamin D or cutaneous exposure to sunshine. Many cases of rickets in the area may, therefore, be spontaneously cured when the children's maturity allows adequate mobility and independence to achieve exposure to sunshine.
Thiamin status of 20 nonpregnant women and 60 pregnant women was assessed. Of the 60 pregnant women, only 49 and 25 were examined for the biochemical thiamin status in the 3rd trimester and postpartum period respectively. Thirty per cent of nonpregnant women and 28 to 39 per cent of pregnant mothers (in either the 2nd trimester, 3rd trimester, or postpartum phase of pregnancy) had a deficient thiamin status with the thiamin pyrophosphate effect (TPP effect) greater than 20 per cent. None of the pregnant subject were deficient in all the three periods. Follow up of the pregnant subjects in the 2nd trimester, 3rd trimester and postpartum period revealed that the deficiency was not necessarily established in the early pregnancy nor was aggravated with the progress of pregnancy. Thiamine intake was over 2/3 of the recommended in all the pregnant subjects and revealed no significant correlation with the biochemical indices. A history of oral contraceptive usage before conception had no significant effect on the incidence of deficiency in the 2nd or 3rd trimester. The occurrence of deficient thiamin status demonstrated an increase with number of previous pregnancies. No correlation was noted between the vitamin B1 status and anthropometric measurements of neonates.
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