Childhood dietary intake: Comparison between anorexia nervosa and healthy leanness

BACKGROUND: The number of adolescent patients with anorexia nervosa is increasing. In addition, an increase in pre-adolescent patients with premenarchal onset has also been recognized. Detection of the disease in childhood and adolescence, however, is not always easy because the symptoms are not characteristic during this period. This study was performed to investigate detection of anorexia nervosa in children/adolescents by comparing energy and nutrient intake between patients with anorexia nervosa and healthy thin persons. METHODS: The subjects consisted of 13 girls aged 14.4 ± 3.5 years with anorexia nervosa and 320 healthy girls aged 12.4 ± 1.3 years. Dietary intake was evaluated using a validated diet history questionnaire designed for children/adolescents. Daily energy and nutrient intake were expressed as a percentage of the age- and sex-matched reference amount. RESULTS: Healthy lean (body mass index [BMI], <50th percentile) girls with an above-average score for desiring thinness had higher fat and lower cereal intake, and a trend of lower carbohydrate intake. In contrast, patients with anorexia nervosa, compared with thin (BMI <5th percentile) girls, characteristically had significantly lower energy, fat, zinc, vitamin C, and confectionery intake. CONCLUSIONS: Lean girls with an above-average desire for thinness appear to restrict their energy intake by reducing their intake of carbohydrates such as cereals while maintaining a relatively high fat intake. In contrast, girls with anorexia nervosa avoided fat and had a preference for vegetables. This characteristic eating pattern could be a useful clue for detection of anorexia nervosa in thin children and adolescents.