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Journals / Kıbrıs Türk Psikiyatri ve Psikoloji Dergisi / 2026 / Cilt: 8 Sayı: 3

Are Prognostic Nutrition Index Levels Associated with Prognosis in Adolescents with Anorexia Nervosa?

Anoreksiya Nervosa Hastalığı Olan Ergenlerde Prognostik Nutrisyonel Endeks Düzeyleri Prognoz ile İlişkili midir?

Özge Asena Duygu(Bandırma Training and Research Hospital)0009-0004-4228-6059
Serkan Turan(ULUDAG UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR.)0000-0002-6548-0629
Şafak Eray Çamlı(Bursa Uludağ Üniversitesi)0000-0002-4847-7751
Zeynep Gizem Ergün Özdel(ULUDAG UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR.)0000-0002-6851-7933
Caner Mutlu(ULUDAG UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR.)0000-0001-6507-8042
Pages
244–253
Publication Date
2026-09-09
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Therefore, it was thought that PNI levels may be an indirect prognostic factor for AN in children and adolescents.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:The aim of this study was to investigate the relationship between prognostic nutritional index (PNI) levels and sociodemographic data, disease characteristics, comorbidity, and prognosis in children and adolescents diagnosed with anorexia nervosa (AN).
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Key Findings & Data:The study included 45 patients diagnosed with AN and 42 healthy controls.
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Conclusion & Impact:Therefore, it was thought that PNI levels may be an indirect prognostic factor for AN in children and adolescents.
🔬Design:Survey & Empirical Study
📍Scope:Comprehensive Sample
⚙️Variables:prognostik nütrisyonel endeks · anoreksiya nervoza · intihar amaçlı olmayan kendine zarar verme

Abstract

The aim of this study was to investigate the relationship between prognostic nutritional index (PNI) levels and sociodemographic data, disease characteristics, comorbidity, and prognosis in children and adolescents diagnosed with anorexia nervosa (AN). The study included 45 patients diagnosed with AN and 42 healthy controls. The researcher administered the Sociodemographic Data Form, the Affective Disorders and Schizophrenia Interview Schedule for School-Age Children-Present and Lifetime Version (K-SADS), the General Assessment Scale for Children (CGAS) to both groups, and the Clinical Global Impression-Severity Scale (CGI-SS) to the patient group. Eating Attitude Test (EAT), Eating Disorder Examination Questionnaire (EDE-Q), Self-Reflection and Insight Scale, The Revised Child Anxiety Depression Scale–Child Version (RCADS-CV), Leyton Obsession Inventory-Child Version (LOE-CV), Parental Autonomy Support Scale (PASS), and Shortened Level of Expressed Emotion Scale (SLEES) were completed by participants. In the patient group, PNI levels were significantly lower than in the control group (p<0.05). A negative correlation was found between symptom severity scores and PNI levels (p < 0.05). A positive correlation was found between body mass index (BMI) and PNI levels (p=0.05). PNI levels were significantly lower in those with Major Depressive Disorder (MDD), non-suicidal self-injury (NSSI), and suicide attempts compared to those without (p< 0.05). In children and adolescents diagnosed with AN, PNI levels were not associated with exiting the diagnostic criteria but may be associated with disease severity, BMI, comorbid MDD, NSSI, and suicide attempt. Therefore, it was thought that PNI levels may be an indirect prognostic factor for AN in children and adolescents.

Özet

Bu çalışmada, anoreksiya nervoza (AN) tanısı alan çocuk ve ergenlerde prognostik nutrisyonel endeks (PNI) düzeyleri ile sosyodemografik veriler, hastalık özellikleri, komorbidite ve prognoz arasındaki ilişkinin incelenmesi amaçlanmıştır. Çalışmada AN tanısı alan 45 hasta ve 42 sağlıklı kontrol denek dahil edilmiştir. Araştırmacı, her iki gruba Sosyodemografik Veri Formu, Okul Çağı Çocukları için Duygusal Bozukluklar ve Şizofreni Görüşme Programı - Mevcut ve Yaşam Boyu Versiyonu (K-SADS), Çocuklar için Genel Değerlendirme Ölçeği (CGAS) ve hasta grubuna Klinik Global İzlenim-Şiddet Ölçeği (CGI-SS) uygulamıştır. Yeme Tutumu Testi (EAT), Yeme Bozukluğu Muayene Anketi (EDE-Q), Öz Yansıtma ve İçgörü Ölçeği, Revize Edilmiş Çocuk Anksiyete Depresyon Ölçeği-Çocuk Versiyonu (RCADS-CV), Leyton Obsesyon Envanteri-Çocuk Versiyonu (LOE-CV), Ebeveyn Özerklik Desteği Ölçeği (PASS) ve Kısaltılmış Duygu İfade Düzeyi Ölçeği (SLEES) katılımcılar tarafından doldurulmuştur. Hasta grubunda PNI düzeylerinin kontrol grubuna göre anlamlı olarak daha düşük olduğu saptanmıştır (p<0,05). Semptom şiddeti puanı ile PNI düzeyleri arasında negatif korelasyon saptanmıştır (p < 0,05). Vücut kitle indeksi (BMI) ile PNI düzeyleri arasında pozitif korelasyon bulundu (p=0,05). Majör Depresif Bozukluk (MDB), intihar girişimi olmayan ve intihar girişimi olanlarda PNI düzeyleri, MDB, intihar girişimi olmayanlara göre anlamlı olarak daha düşüktü (p < 0,05). AN tanısı alan çocuk ve ergenlerde PNI düzeyleri tanı kriterlerinden çıkma ile ilişkili bulunmamakla birlikte, hastalık şiddeti, BMI, komorbid MDD, NSSI ve intihar girişimi ile ilişkili olabilir. Bu nedenle, PNI düzeylerinin çocuk ve ergenlerde AN için dolaylı bir prognostik faktör olabileceği düşünülmüştür.

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Cite This Article

Duygu, Ö. A., Turan, S., Çamlı, Ş. E., Özdel, Z. G. E., Mutlu, C. (2026). Are Prognostic Nutrition Index Levels Associated with Prognosis in Adolescents with Anorexia Nervosa?. Kıbrıs Türk Psikiyatri ve Psikoloji Dergisi, Cilt: 8 Sayı: 3, 244–253. https://doi.org/10.35365/ctjpp.26.3.02

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References (49)

  1. Ambwani, S., Cardi, V., Albano, G., Cao, L., Crosby, R. D., Macdonald, P., Schmidt, U., & Treasure, J. (2020). A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of “early stage” versus “severe and enduring” classification. The International Journal of Eating Disorders, 53(8), 1337–1348. https://doi.org/10.1002/EAT.23246
  2. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724–731. https://doi.org/10.1001/ARCHGENPSYCHIATRY.2011.74
  3. Atik EL. (2013). The role of self-reflection and insight in the relationship between high school adolescents' attachment styles and the degree of psychological resilience. [Yayımlanmamış yüksek lisans tezi]. İstanbul Bilim Üniversitesi, Sosyal Bilimler Enstitüsü, İstanbul, Türkiye.
  4. Beaumont. P. He, A.-A. M., T. S. (1988). Relevance of a standard measurement of undernutrition to the diagnosis of anorexia nervosa: The use of Quetelet’s body mass index (BMI). International Journal of Eating Disorders, 7, 399–405. https://doi.org/10.1002/1098-108X(198805)7:3
  5. BERG, C. Z., WHITAKER, A., DAVIES, M., FLAMENT, M. F., & RAPOPORT, J. L. (1988). The survey form of the Leyton Obsessional Inventory-Child Version: norms from an epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 27(6), 759–763. https://doi.org/10.1097/00004583-198811000-00017
  6. Boysan, M., Kadak, M. T., Tarakcioglu, M. C., Sertdurak, Z. S., & Demirel, O. F. (2016). Psychometric properties of Turkish versions of the leyton obsessional inventory-child version (LOI-CV) and obsessive beliefs questionnaire-child version (OBQ-CV). Klinik Psikofarmakoloji Bulteni, 26(4), 382–396. https://doi.org/10.5455/BCP.20151203125902
  7. Bundak, R., Furman, A., Gunoz, H., Darendeliler, F., Bas, F., & Neyzi, O. (2006). Body mass index references for Turkish children. Acta Paediatrica (Oslo, Norway: 1992), 95(2), 194–198. https://doi.org/10.1080/08035250500334738
  8. C. G. Fairburn, S. J. B. (1994). Assessment of eating disorders: interview or self-report questionnaire? The International Journal of Eating Disorders, 16(4), 363–370. https://doi.org/10.1002/1098-108X(199412)16:4
  9. Candeloro, M., Di Nisio, M., Balducci, M., Genova, S., Valeriani, E., Pierdomenico, S. D., & Porreca, E. (2020). Prognostic nutritional index in elderly patients hospitalized for acute heart failure. ESC Heart Failure, 7(5), 2479–2484. https://doi.org/10.1002/EHF2.12812
  10. Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 13(2), 153–160. https://doi.org/10.1002/WPS.20128
  11. Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835–855. https://doi.org/10.1016/S0005-7967(99)00130-8
  12. Crone, C., Fochtmann, L. J., Attia, E., Boland, R., Escobar, J., Fornari, V., Golden, N., Guarda, A., Jackson-Triche, M., Manzo, L., Mascolo, M., Pierce, K., Riddle, M., Seritan, A., Uniacke, B., Zucker, N., Yager, J., Craig, T. J., Hong, S. H., & Medicus, J. (2023). The American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders. The American Journal of Psychiatry, 180(2), 167–171. https://doi.org/10.1176/APPI.AJP.23180001
  13. Demir, T., Karacetin, G., Baghaki, S., & Aydin, Y. (2011). Psychiatric assessment of children with nonsyndromic cleft lip and palate. General Hospital Psychiatry, 33(6), 594–603. https://doi.org/10.1016/j.genhosppsych.2011.06.006
  14. Engelhardt, C., Föcker, M., Bühren, K., Dahmen, B., Becker, K., Weber, L., Correll, C. U., Egberts, K. M., Ehrlich, S., Roessner, V., Fleischhaker, C., von Gontard, A., Hahn, F., Jenetzky, E., Kaess, M., Legenbauer, T., Renner, T. J., Schulze, U. M. E., Sinzig, J., … Hebebrand, J. (2021). Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers. European Child & Adolescent Psychiatry, 30(7), 1081–1094. https://doi.org/10.1007/S00787-020-01595-4
  15. Fairburn, C. G. & W. G. T. (1993). The eating disorder examination. In C. G. and C. Z. Fairburn (Ed.), Binge eating: Nature, assessment, and treatment (Vol. 12, pp. 317–356). NewYork, USA: Guilford Press.
  16. Favaro, A., Tenconi, E., & Santonastaso, P. (2006). Perinatal factors and the risk of developing anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 63(1), 82–88. https://doi.org/10.1001/ARCHPSYC.63.1.82 Franko, D. L., Keshaviah, A., Eddy, K. T., Krishna, M., Davis, M. C., Keel, P. K., & Herzog, D. B. (2013). A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. The American Journal of Psychiatry, 170(8), 917–925. https://doi.org/10.1176/APPI.AJP.2013.12070868
  17. Garner, D. M., & Garfinkel, P. E. (1979). The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychological Medicine, 9(2), 273–279.https://doi.org/10.1017/S0033291700030762
  18. Gormez, V., Kılınçaslan, A., Orengul, A. C., Ebesutani, C., Kaya, I., Ceri, V., Nasıroglu, S., Filiz, M., & Chorpita, B. (2017). Psychometric properties of the Turkish version of the Revised Child Anxiety and Depression Scale – Child Version in a clinical sample. Psychiatry and Clinical Psychopharmacology, 27(1), 84–92. https://doi.org/10.1080/24750573.2017.1297494
  19. Gözükara, İ. Ö. (2019). Ebeveyn Özerklik Desteği Ölçeği’nin Türkçe'ye uyarlama çalışması [Yayımlanmamış yüksek lisans tezi]. İstanbul Arel Üniversitesi, Sosyal Bilimler Enstitüsü, İstanbul, Türkiye.
  20. Grant, A. M., Franklin, J., & Langford, P. (2002). The self-reflection and insight scale: A new measure of private self-consciousness. Social Behavior and Personality, 30(8), 821–836. https://doi.org/10.2224/SBP.2002.30.8.821
  21. Hammer, L. D., Kraemer, H. C., Wilson, D. M., Ritter, P. L., & Dornbusch, S. M. (1991). Standardized percentile curves of body-mass index for children and adolescents. American Journal of Diseases of Children (1960), 145(3), 259–263. https://doi.org/10.1001/ARCHPEDI.1991.02160030027015
  22. Harmancı, H., Akdeniz, S., & Gültekin Ahçı, Z. (2021). Yeme Bozukluklarının Yaygınlığı: Aleksitimi ve Ruhsal Yakınmalarla İlişkisi. Kıbrıs Türk Psikiyatri ve Psikoloji Dergisi, 3(1), 30–36. https://doi.org/10.35365/ctjpp.21.1.02
  23. Harris, E. C., & Barraclough, B. (1998). Excess mortality of mental disorder. The British Journal of Psychiatry: The Journal of Mental Science, 173(JULY), 11–53. https://doi.org/10.1192/BJP.173.1.11
  24. Jagielska, G., & Kacperska, I. (2017). Outcome, comorbidity, and prognosis in anorexia nervosa. Psychiatria Polska, 51(2), 205–218. https://doi.org/10.12740/PP/64580
  25. Karakuş, O. B., Ermiş, Ç., Tunçtürk, M., Yüksel, A. S., Alarslan, S., Sağlam, Y., Görmez, V., & Karaçetin, G. (2022). Identifying clinical and psychological correlates of persistent negative symptoms in early-onset psychotic disorders. Clinical Child Psychology and Psychiatry, 27(4), 1288–1302. https://doi.org/10.1177/13591045221075531
  26. Kayhan, S., Simsek, M., & Kirnap, N. G. (2022). The prognostic nutritional index is associated with the mortality of patients in the intensive care unit. J Surg Med, 6(3), 313–316. https://doi.org/10.28982/josam.1055862
  27. Löwe, B., Zipfel, S., Buchholz, C., Dupont, Y., Reas, D. L., & Herzog, W. (2001). Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychological Medicine, 31(5), 881–890. https://doi.org/10.1017/S003329170100407X
  28. Madge, N., Hewitt, A., Hawton, K., Wilde, E. J. De, Corcoran, P., Fekete, S., Heeringen, K. Van, De Leo, D., & Ystgaard, M. (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 49(6), 667–677. https://doi.org/10.1111/J.1469-7610.2008.01879.X
  29. Mehler, P. S., & Koutsavlis, A. (2021). Anorexia Nervosa, Albumin, and Inflammation. American Journal of Medicine, 134(6), e401. https://doi.org/10.1016/j.amjmed.2020.08.023
  30. Mitchell, J. E., & Peterson, C. B. (2020). Anorexia Nervosa. The New England Journal of Medicine, 382(14), 1343–1351. https://doi.org/10.1056/NEJMCP1803175
  31. Morris, J., & Twaddle, S. (2007). Anorexia nervosa. BMJ (Clinical Research Ed.), 334(7599), 894–898. https://doi.org/10.1136/BMJ.39171.616840.BE
  32. Neale, J., & Hudson, L. D. (2020). Anorexia nervosa in adolescents. British Journal of Hospital Medicine (London, England: 2005), 81(6). https://doi.org/10.12968/HMED.2020.0099
  33. Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (n.d.). The DSM-5: classification and criteria changes. World Psychiatry. 2013 Jun 4;12(2):92–98. https://doi: 10.1002/wps.20050
  34. Savaşır I, E. N. (1989). Yeme Tutum Testi: Anoreksiya Nervoza İndeksi. Türk Psikoloji Dergisi, 7(23), 19–25. https://doi.org/10.31828/tpd1300443319890000m000360
  35. Sertdemir, A. L., Icli, A., Aribas, A., Tatar, S., Akilli, N. B., Alsancak, Y., & Akilli, H. (2021). Prognostic nutritional index and the risk of acute kidney injury in patients with acute coronary syndrome. Revista Da Associação Médica Brasileira (1992), 67(8), 1124–1129. https://doi.org/10.1590/1806-9282.20210460
  36. Shaffer, D., Gould, M. S., Brasic, J., Fisher, P., Aluwahlia, S., & Bird, H. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40(11), 1228–1231. https://doi.org/10.1001/ARCHPSYC.1983.01790100074010 Soenens, B., Vansteenkiste, M., Lens, W., Luyckx, K., Goossens, L., Beyers, W., & Ryan, R. M. (2007). Conceptualizing parental autonomy support: adolescent perceptions of promotion of independence versus promotion of volitional functioning. Developmental Psychology, 43(3), 633–646. https://doi.org/10.1037/0012-1649.43.3.633
  37. Steinhausen, H. C. (2002). The outcome of anorexia nervosa in the 20th century. The American Journal of Psychiatry, 159(8), 1284–1293. https://doi.org/10.1176/APPI.AJP.159.8.1284
  38. T K Bowers, E. E. (1978). Leukopenia in anorexia nervosa. Lack of increased risk of infection. Archives of Internal Medicine, 138(10), 1520–1523. https://doi:10.1001/archinte.1978.03630350050015
  39. Ünal, F., Öktem, F., Çetin Çuhadaroğlu, F., Çengel Kültür, S. E., Akdemir, D., Foto Özdemir, D., Çak, H. T., Ünal, D., Tiraş, K., Aslan, C., Kalayci, B. M., Aydos, B. S., Kütük, F., Taşyürek, E., Karaokur, R., Karabucak, B., Karakök, B., Karaer, Y., & Artik, A. (2019). Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children, present and lifetime version, DSM-5, November 2016, Turkish adaptation (K-SADS-PL-DSM-5-T). Türk Psikiyatri Dergisi, 30(1). https://doi.org/10.5080/u23408
  40. Vincent, J. L., Russell, J. A., Jacob, M., Martin, G., Guidet, B., Wernerman, J., Roca, R. F., McCluskey, S. A., & Gattinoni, L. (2014). Albumin administration in the acutely ill: what is new and where next? Critical Care (London, England), 18(4). https://doi.org/10.1186/CC13991
  41. Vural, P., Siǧirli, D., Eray, Ş., Ercan, I., & Kiliç, E. Z. (2013). The reliability and validity study of the shortened level of the Expressed Emotion Scale in adolescents. Turkiye Klinikleri Journal of Medical Sciences, 33(1), 191–199. https://doi.org/10.5336/MEDSCI.2012-30433
  42. Walsh, K., Blalock, D. V., & Mehler, P. S. (2020). Hematologic findings in a large sample of patients with anorexia nervosa and bulimia nervosa. American Journal of Hematology, 95(4), E98–E101. https://doi.org/10.1002/AJH.25732
  43. William Guy. (1976). ECDEU Assessment Manual for Psychopharmacology. ECDEU Assessment Manual for Psychopharmacology. In Clinical Global Impression (pp. 218–221). Kensington, Maryland, USA: DHEW Publication No. (ADM) 76-338
  44. Yildirim, A., Kucukosmanoglu, M., Koyunsever, N. Y., Cekici, Y., Belibagli, M. C., & Kilic, S. (2021). Combined effects of nutritional status on long-term mortality in patients with non-st segment elevation myocardial infarction undergoing percutaneous coronary intervention. Revista Da Associação Médica Brasileira (1992), 67(2), 235–242. https://doi.org/10.1590/1806-9282.67.02.20200610
  45. Yucel, B., Polat, A., Ikiz, T., Dusgor, B. P., Yavuz, A. E., & Berk, O. S. (2011). The Turkish version of the Eating Disorder Examination Questionnaire: reliability and validity in adolescents. European Eating Disorders Review: The Journal of the Eating Disorders Association, 19(6), 509–511. https://doi.org/10.1002/ERV.1104
  46. Zhang, H., Tao, Y., Wang, Z., Lu, J., & Bhatt, G. C. (2019). Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease. Medicine, 98(34). https://doi.org/10.1097/MD.0000000000016713
  47. Zhang, L., Ma, W., Qiu, Z., Kuang, T., Wang, K., Hu, B., & Wang, W. (2023). Prognostic nutritional index as a prognostic biomarker for gastrointestinal cancer patients treated with immune checkpoint inhibitors. Frontiers in Immunology, 14, 1219929. https://doi.org/10.3389/FIMMU.2023.1219929/FULL
  48. Zipfel, S., Löwe, B., Reas, D. L., Deter, H. C., & Herzog, W. (2000). Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet (London, England), 355(9205), 721–722. https://doi.org/10.1016/S0140-6736(99)05363-5
  49. Neale, J., & Hudson, L. D. (2020). Anorexia nervosa in adolescents. British Journal of Hospital Medicine (London, England: 2005), 81(6). https://doi.org/10.12968/HMED.2020.0099