Από Χάρη Χατζηγεωργίου παδίατρο
Εκπαιδευτικό και Ερευνητικό Ινστιτούτο « Υγεία του παιδιού» , Κύπρος.
Εισαγωγή: Οι διατροφικές διαταραχές (ΔΔ) περιλαμβάνουν ένα φάσμα καταστάσεων, όπως η ψυχογενής ανορεξία και η ψυχογενής βουλιμία. Δικαίως τυγχάνουν ιδιαίτερης δημόσιας, ιατρικής και ερευνητικής προσοχής εδώ και χρόνια, αφού οδηγούν σε σοβαρά σωματικά, ψυχολογικά και συναισθηματικά προβλήματα, καθώς επίσης και σε ένα υψηλό ποσοστό θνησιμότητας.
Υπόθεση: H κυπριακή κοινωνία έχει υποστεί μεγάλες αλλαγές τα τελευταία χρόνια ως αποτέλεσμα της Τουρκικής εισβολής του 1974, της αστικοποίησης του πληθυσμού, της εισόδου στην ΕΕ και στην παρουσία μεγάλου αριθμού αλλοδαπών που εργάζονται και διαμένουν μόνιμα στην Κύπρο. Ακόμη, η γρήγορη άνοδος του βιοτικού επιπέδου και η τεχνολογία επηρεάζει τον τρόπο ζωής των εφήβων της Κύπρου, ενώ η παρατηρούμενη αύξηση της παχυσαρκίας στην Κύπρο πιθανόν να συμβάλλει και στην αύξηση των ΔΔ. Ενδεικτικά, αναφέρεται πως
EATING DISORTERS AMONG CHILDREN AND ADOLESCENTS OF 10-18 YEARS OF AGE IN CYPRUS
Hadjigeorgiou Charalampos, pediatrician
Child Health Research & Educational Institute, Cyprus
Introduction: Eating disorders (ED) consist of a range of conditions, and include anorexia nervosa and bulimia nervosa. They have received much public, medical and research attention over the years and rightfully so since they lead to serious physical, psychological and emotional problems, as well as having a high mortality rate.
Hypothesis: Cypriot society has been subject to a great many changes over the years as a result of the Turkish invasion in 1974, the urbanization of the population, the entry in to the EU and the influx of a great number of immigrants who work and live permanently in Cyprus. Furthermore, the rapid increase in living standards and technology affects Cypriot adolescents’ ways of living. Indicative of this are reports that hospitalizations for EDs have doubled at the child psychiatric ward of Makarios hospital when the 5 year periods 1992-1997 and 1997-2002 are compared. In addition, the observed increase in obesity in Cyprus possibly contributes to the rise in ED.
Aims: In Cyprus no research data existed concerning ED. The aims of the research are (a) the evaluation of the eating attitudes and behaviours of Cypriot adolescents (b) to identify whether dietary intake differs between adolescents at risk for the development of an ED and those who are not at risk, (c) detect changes in anthropometric measures (weight and height) of Cypriot adolescents during the period 2003-2010 and to determine whether they are related to the psychological characteristics linked to ED and (d) the evaluation of the accuracy of self-report measures of weight and height among Cypriot adolescents.
Participants-Apparatus-Methods: In the years 2003 and 2010 a representative sample of children and adolescents 10-19 years of age in Cyprus were selected. Sample selection was based on area of living with a random selection of departments in chosen schools. The 13% of the sample which refused to participate did not alter the credibility of the sample. In 2003, 1790 children 10-19 years of age took part in the study, 935 of which were female. In 2010, 1128 students 11-19 years of age participated in the study, 731 girls. This thesis utilized specialized questionnaires EAT-26 and EDI-3 which have been used widely to explore ED status. The EAT-26 questionnaire is better suited to reveal tendencies for the development of clinical or subclinical eating disorders whereas the EDI-3 apart from the development of clinical and subclinical eating disorders evaluates different personality and character traits of children. Participants also completed 3-day diet records, of which one day was either a Saturday or Sunday. The diet-records were analyzed by a computer program of the Social Medicine department of the University of Crete. The participants’ weight, height and waist circumference were measured by a physical education teacher.
Results: The first results of 2003 showed a high percentage of children at risk for the development of an ED, with maladaptive eating attitudes and convictions concerning food. Nearly 20% of adolescent boys and almost double, 34% of adolescent girls had high scores on the EAT-26. Practically, this means that in 2003, 465 out of the 1700 students who completed the EAT-26 met criteria for further referral to a qualified professional so that it could be determined whether they meet the diagnostic criteria for an ED. This translates to 27% of the adolescent population. The likelihood of clinical or subclinical anorexia nervosa based on an EAT-26 > 20 score and low body mass index (BMI < 15th percentile) was 0.78% for girls and 0.14% for boys.
Using the EDI-3 Eating Disorder Risk Scale only 1.6% of Cypriot adolescents had scores at the high end of the scale characterizing them with a likely condition, whereas 15.4% had scores in the typical clinical range which is characteristic of adolescents “at risk” for an ED. Amongst Cypriot adolescents 0.8% had scores in the range indicative of a high level of psychopathology and the presence of a clinical eating disorder associated with bulimia. “At risk” adolescents comprised of 30.6% of the sample.
Those students between the ages of 11-18 who took part in the study in 2003 and had high scores on the DT scale which measures the preoccupation with dieting (Drive for thinness) and who simultaneously had low BMI<15th percentile for their age and gender; the percentage likely to have clinical or subclinical anorexia nervosa is 1.19% for girls and 0.65% for boys.
In the Cypriot adolescent population their dissatisfaction towards their bodies (BD) is great, since 2.1% had high scores while 17% appear to be at risk with females having higher scores than males.
The period 2009-2010, during which a new group of adolescents were selected to participate in the follow-up comparison for any likely changes in eating attitudes and behaviours after a period of six years since the start of the study; the results showed the same dietary attitudes and behaviours for both genders. There was however an apparent increase in the number of vulnerable adolescents at risk for the development of bulimia.
In this study it was found that the intake of calories and all other nutrient ingredients with the exception of fibers and vitamins A and C, are significantly higher in adolescent males when compared to females. It was found that the consumption of macronutrients, protein and carbohydrates, were in line with recommended percentages whereas 80% of the adolescents studied consumed below the advised fiber intake. Almost 50% of the adolescents who took part in the study consume below the recommended daily calcium intake. In addition, it was found that 37% of girls have insufficient iron consumption, in comparison to only 3% of boys.
The results indicate that between 2003 and 2010, Cypriot youth have become more overweight as it appears from their increase in BMI whereas a similar increase has been found in pathological dietary habits.
Across all age groups in 2010, waist circumference (WC) has increased significantly in comparison to 2003, a finding that applies for both genders. WC has increased by 3.94cm in girls 10-12 years of age and 3.48cm in boys 10-15 years of age. The greatest increase in WC appears in older adolescent age groups. More specifically WC increased by 8.64cm and 3.98cm in boys and girls respectively, aged 16-18, and only in this age group was an increase in BMI observed. 19.3% of females aged 16-18 had WC above normal limits in 2003 which increased to 57.6% in 2009. 20.7% of males aged 16-18 had WC above normal limits in 2003 which increased to 44.3% in 2009. In addition, in this particular age group (16-18 years), the percentage of adolescents with normal BMI appears to have decreased whereas adolescents with BMIs in the overweight and obese categories have increased by 10% in boys and 10.8% in girls. In the 10-12 age range despite changes in WC, no corresponding increase in BMI was found. In the 13-15age range there was an increase in the percentage of children with normal BMI, while at the same time there was a decrease in the percentage of children in the overweight category.
The majority of overweight and obese girls have pathological scores on the DT scale, as this is the scale relevant for body weight. The percentage of girls with high DT scores was 37.8% in overweight and 55.6% in obese girls. In boys the corresponding figures are 31% for those overweight and 15% for those obese.
In this study it was found that girls underestimate their weight by an average of 0.91 kg and overestimate their height by 1.51 cm. As a result this decreases BMI by 0.74 kg/m2. Boys, even though no statistical significant difference was found, underestimate their weight by an average of 0.28 kg, however statistically significant differences were found with regards to height, which is overestimated by 0.84 cm, making their BMI be decreased by 0.3 kg/m2. The actual figures, as far as adolescents in Cyprus are concerned, 19 overweight and obese girls (4.9%) and 6 overweight and obese boys (3.2%) would have been overlooked and neglected, had this research relied solely on self-report and self-measurement of weight and height. The above Cypriot epidemiological findings so not differ much from those of neighboring countries.
Conclusion: Primary prevention and the adoption of a healthy way of living must become a priority in the education of Cypriot children. Secondary prevention with the early detection of high risk children in the framework of an organized prevention program for EDs and obesity would have a positive impact on adolescents’ health.