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Evolution of paediatric eating disorders in Singapore: a historical cohort study
  1. Lisa Wong1,2,
  2. Lee Gan Goh3,4,
  3. Rajeev Ramachandran1,2
  1. 1 Khoo Teck Puat–National University Children’s Medical Institute, National University Health System, Singapore
  2. 2 Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore
  3. 3 Family Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore
  4. 4 Family Medicine, National University Health System, Singapore
  1. Correspondence to Dr Rajeev Ramachandran, Khoo Teck Puat–National University Children’s Medical Institute, National University Health System, 119228, Singapore; rajeev_ramachandran{at}nuhs.edu.sg

Abstract

Objective Most eating disorders (EDs) develop during adolescence, impacting a critical period of development. There is limited research on EDs in children in Singapore or the rest of South-East (SE) Asia.

Design We analysed a hospital-based cohort of paediatric patients (≤18 years) with EDs (n=177) in Singapore between 2011 and 2021. Historical trends, over three decades, were obtained by comparison with two previously published Singapore studies.

Results Of the 177 patients, the majority 158 (89%) were females, with anorexia nervosa (AN) 151 (85%). The mean age at diagnosis was 14.6 (SD 1.8) years. For AN, the mean duration of illness before diagnosis was 8.3 (SD 6.3) months and this has decreased by 8.4 months (95% CI 4.5 to 12.3 months, p=<0.0001) from the 2003 to 2010 cohort, and 17.7 months (95% CI 12.6 to 22.8 months, p=<0.0001) from the 1994 to 2002 cohort. Avoidant/restrictive food intake disorder (ARFID) cases are increasing, and the clinical profile differs from other EDs. Since family-based therapy (FBT) was introduced for patients with AN, the remission rate at 1 year improved from 30% to 79%, and time to remission has decreased from 16 to 7.5 months.

Conclusions AN is the most common ED in paediatric patients in Singapore. Over the past three decades, EDs are being diagnosed earlier. FBT has emerged as the most effective treatment for AN. ARFID is being diagnosed more frequently. Data suggest that EDs are prevalent and increasing among adolescents in SE Asia. Singapore is a good test case for SE Asia, but research and attention to the problem in the region is needed.

  • paediatrics
  • adolescent health

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Footnotes

  • Contributors LW: substantial contributions to the acquisition, analysis and interpretation of data for the work; drafting the work. LGG and RR: substantial contributions to the conception of the work, interpretation of data for the work and revising it critically for important intellectual content. RR is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.