title: Medical assessment of adolescent girls with eating disorders: an evaluation of symptoms and signs of starvation.
abstract: OBJECTIVE
  To investigate the prevalence of symptoms and signs related to starvation at the initial examination of adolescent girls with eating disorders (ED).
  
  
  METHODS
  Two hundred and eleven girls with eating disorders recruited for a multicentre research and evaluation programme of six specialist eating disorder services in Sweden have been studied. The presence or absence of 12 symptoms, reported by the patients, and 16 signs, observed by the examiners, were registered and related to body weight.
  
  
  RESULTS
  Eleven observed signs--loss of subcutaneous fat, loss of muscle mass, loss of muscular force, dry and scaly skin, brittle nails, dry and brittle hair, lanugo hair, resting pulse <60, systolic blood pressure <110, peripheral hypothermia, and peripheral cyanosis--were related to body weight expressed in standard deviation scores (SDS). When the number of observed signs for each patient was calculated, there was a strong relationship with weight. The odds ratio for having more than two signs was 4.35 (95% CI 2.67-7.04; p = 2.8 x 10(-9) for every one-unit change in weight SDS. Of the symptoms reported by the patients, only three were related to weight. When the number of reported symptoms for each patient was calculated, a relationship with weight was not observed.
  
  
  CONCLUSIONS
  In adolescent girls with ED, physical signs observed at medical examination can be related to weight. However, reported symptoms are poorly related to weight and may be influenced by other factors. The finding emphasizes the importance of medical assessment at presentation of patients with ED.
authors.affiliation: Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden. ingemar.swenne@akademiska.se
authors.forename: Ingemar
authors.initials: I
authors.lastname: Swenne
authors.forename: Ingemar
authors.initials: I
authors.lastname: Engström
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001828:Body Image; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D016001:Confidence Intervals; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D009752:Nutritional Status; D016017:Odds Ratio; D015995:Prevalence; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D013217:Starvation; D013548:Sweden / Q000453:epidemiology; D015431:Weight Loss