Body composition changes in patients with anorexia nervosa after complete weight recovery

Scalfi, Luca; Polito, Angela; Bianchi, Luca; Marra, Maurizio; Caldara, A.; Nicolai, Emanuele; Contaldo, Franco

doi:10.1038/sj.ejcn.1601290

Cited by 60 publications

(50 citation statements)

References 23 publications

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“…This finding reflects the 'catch-up fat' phenomenon (30) and supports previous data on body composition changes in patients with AN (31,32). The increase in FM is associated with an increase in REE.…”

Section: Discussionsupporting

confidence: 90%

l-Tri-iodothyronine is a major determinant of resting energy expenditure in underweight patients with anorexia nervosa and during weight gain

Onur¹,

Haas²,

Bosy‐Westphal³

et al. 2005

eur j endocrinol

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Objective: We aimed to define the effect of L-3,5,3 0 -tri-iodothyronine (T 3 ) on metabolic adaptation in underweight patients with anorexia nervosa (AN) as well as during weight gain. Methods: This involved clinical investigation of 28 underweight patients with AN, who were compared with 49 normal-weight controls. A subgroup of 17 patients was followed during weight gain. Resting energy expenditure was measured by indirect calorimetry. Body composition was measured by anthropometry as well as bioelectrical impedance analysis. Energy intake (EI) was assessed by a 3-day dietary record. Plasma concentrations of thyroid hormones (thyroxine (T 4 ), T 3 and thyrotropin (TSH)) were analyzed by enzyme immunoassays. Results: When compared with normal-weight women, underweight patients with AN had reduced fat mass (FM) (271.3%), fat-free mass (FFM) (2 13.1%), resting energy expenditure (REE) (221.8%), T 3 -(2 33.4%) and T 4 -concentrations (2 19.8%) at unchanged TSH. REE remained reduced after adjustment for FFM (2 24.6%). T 3 showed a close association with REE. This association remained after adjustment of REE for FFM. Treatment of underweight AN patients resulted in a mean weight gain of 8.3 kg. This was mainly explained by an increase in FM with small or no changes in FFM. REE and T 3 also increased (þ9.3% and þ 33.3% respectively) at unchanged TSH and T 4 . There was a highly significant association between weight gain-induced changes in T 3 and changes in adjusted REE (r ¼ 0.78, P , 0.001, based on Pearson's correlation). An increase in plasma T 3 concentrations of 1.8 pmol/l could explain an increase in REE of 0.6 MJ/day (that is, a 32% increase in T 3 was associated with a 13% increase in REE). Conclusions: Our data provide evidence that the low T 3 concentrations add to metabolic adaptation in underweight patients with AN. During weight gain, increases in T 3 are associated with increases in REE, which is independent of FFM. Both results are evidence for a physiologic role of T 3 in modulation of energy expenditure in humans.

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Section: Discussionsupporting

confidence: 90%

l-Tri-iodothyronine is a major determinant of resting energy expenditure in underweight patients with anorexia nervosa and during weight gain

Onur¹,

Haas²,

Bosy‐Westphal³

et al. 2005

eur j endocrinol

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“…Some of our results differed from those of Grinspoon et al 4 Scalfi et al 3 claimed that the proportion of fat in regained weight was related to the body mass increase, but our results did not agree. We therefore sought to explain these differences.…”

Section: Introductioncontrasting

confidence: 99%

“…We did not find the relationship between fat proportion and weight gain claimed by Scalfi et al 3 Examination of their Figure 1 suggests that, although a statistically significant regression was obtained, with P ¼ 0.02, there is considerable scatter and, with only 10 subjects, the apparent relationship could have occurred by chance. Indeed, the omission of one result would leave the regression insignificant.…”

contrasting

confidence: 66%

“…Dual-energy X-ray absorptiometry (DXA) offers a convenient, precise technique for such studies and has been applied in intensive refeeding programs in patients with anorexia nervosa (AN) using a Norland scanner, 1 a Lunar DPA scanner 2 and a Lunar DPX scanner. 3 Such measurements have been extended to subjects experiencing spontaneous weight gain, using a fan-beam Hologic QDR 4500 scanner. 4 Grinspoon et al 4 had included regional soft-tissue measurements and were concerned that the proportion of fat in the trunk increased with increasing weight.…”

Section: Introductionmentioning

confidence: 99%

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Dual-energy X-ray absorptiometry measurements of fat and lean masses in subjects with eating disorders

Tothill

Hannan

2004

Int J Obes

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OBJECTIVE:The main objective was to use a dual-energy X-ray absorptiometer (DXA) to examine the total-body and regional fat and lean composition of soft tissue in subjects with and without eating disorders initially and after weight change. It was necessary also to study the effects of differences of calibration of different models of DXA scanner. DESIGN: A total of 175 women with eating disorders, including anorexia nervosa (AN) and bulimia nervosa, and 43 agematched controls were measured for soft-tissue composition with a pencil-beam Hologic QDR 1000W scanner and results converted to be equivalent to those from a fan-beam Hologic QDR 4500A, using previously determined crosscalibration factors. Some measurements were repeated at 6 and 12 months. RESULTS: The baseline body composition of the patients covered a continuous range of fat proportions. Implausibly low fat proportions in some of the AN subjects were corrected by conversion to 4500 equivalents. The relationship between total lean mass and fat mass could be fitted equally well by a linear or linear/log regression. The relationship between leg and trunk fat was best fitted by a polynomial regression. There were weight changes in either direction in some of the subjects. The fat proportion in the total changed mass was a mean of 55%, higher in the legs and lower in the trunk, but not different between weight gainers and losers or clinical groups. The proportion was dependent on the initial fat proportion. CONCLUSIONS: Relatively small differences in fat/lean calibration of DXA scanners may lead to anomalous results in very anorexic subjects and corrections are necessary in comparing results from different instruments. Concerns expressed about preferential trunk fat accumulation during weight recovery are not well founded. Previous claims of a relationship between fat proportion in regained weight and the amount of the weight gain are not justified.

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“…Whereas many studies have evaluated body composition in anorectic patients (Scalfi et al, 2002;Marra et al, 2005), only a few focused on ballet dancers (Young et al, 1994;Eliakim et al, 2000;Yannakoulia et al, 2000;Matthews et al, 2006) or constitutionally lean patients Germani et al, 2007), the results simply indicating a reduction of body fat. Thus, to the best of our knowledge, body composition has not been properly compared between these three different forms of underweight.…”

Section: Introductionmentioning

confidence: 99%

Bioelectrical impedance phase angle in constitutionally lean females, ballet dancers and patients with anorexia nervosa

et al. 2008

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Background/objective: Several articles have described body composition in anorexia nervosa, whereas little is known about this issue in underweight ballet dancers and constitutionally lean females. The main aim of this study was to assess whether phase angle (a bioimpedance variable related to body cell mass) differs according to the type of underweight in female adolescents and young women. Subjects/methods: Skinfold thicknesses and bioimpedance analysis (whole body and limbs) were evaluated in three groups of underweight patients (30 patients with anorexia nervosa, 10 constitutionally lean individuals and 15 classical dancers) and 30 normal weight controls. Results: There were no differences between the three groups of underweight patients with respect to anthropometric and bioelectrical impedance analysis (BIA) variables with the exception of phase angle. The latter was significantly higher in dancers, lower in anorectic patients and not different in constitutionally lean patients, as compared with controls. Conclusions: Phase angle (assessed by single-frequency BIA) appears to discriminate between different forms of underweight, being an effective marker of qualitative changes in body composition.

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Body composition changes in patients with anorexia nervosa after complete weight recovery

Cited by 60 publications

References 23 publications

l-Tri-iodothyronine is a major determinant of resting energy expenditure in underweight patients with anorexia nervosa and during weight gain

l-Tri-iodothyronine is a major determinant of resting energy expenditure in underweight patients with anorexia nervosa and during weight gain

Dual-energy X-ray absorptiometry measurements of fat and lean masses in subjects with eating disorders

Bioelectrical impedance phase angle in constitutionally lean females, ballet dancers and patients with anorexia nervosa

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