Changes in body composition and fat distribution after short-term weight gain in patients with anorexia nervosa

Objective: To assess the body composition changes in anorexia nervosa and after medium term recovery. Design: A descriptive study. Setting: Rome, Italy. Subjects: Twenty women affected by anorexia nervosa (AN) with a BMI [weight (kg)aheight (m 2 )] below 17 kgam 2 and weight-stable for at least three months, were compared with 10 well nourished control women (CO) and nine rehabilitated subjects (R-AN), who had a BMI above 18.5 kgam 2 stable for at least the last six months. Interventions: Body fat was assessed by underwater weighing, muscle mass by urinary creatinine, total body water (TBW) by impedance parameters (50 kHz and 800 mA), skeletal mass by anthropometry and radius bone mineral density by dual photon absorptiometry in ultra-distal (UD-BMD) and medio-distal (MD-BMD) sites. Results: The AN group, as compared to the control group, had a signi®cantly lower weight, body mass index (BMI kgam 2 ) and percent body fat (P`0.0000). Creatinine urinary excretion was lowest in absolute term and when expressed as creatinine height index or per kg fat free mass (FFM) (P`0.0000); muscle mass per kg body weight was 13% lower (P`0.01). Ultra distal bone mineral density (UD-BMD) was 6% lower (not signi®cant). TBW as percent of body weight was signi®cant higher (P`0.001): however TBWaFFM % was not statistically different with large inter-individual variability. An altered distribution of extra and intra-cellular water was suggested by the phase angle (AN: 4.4 AE 0.8 ; CO: 6.1 AE 0.4 ; (P`0.0000). In rehabilitated anorexic patients (R-AN) the fat mass represented 53% of the weight gain. Their creatinine excretion remained still below the mean value of the controls (P`0.001). The impedance parameters were not signi®cantly different between the R-AN and the CO groups, however, the phase angle of the R-AN (5.0 AE 0.7 ) remained lower than in the CO group, indicating that the water distribution was still altered. Conclusions: This study shows that AN is a condition of reduced body fat as well as of muscle mass, with a slightly reduced bone mass. In the course of rehabilitation, most of the weight regained is represented by fat, while the muscle mass appears to lag behind, at least in the medium term.

Section: Discussionmentioning

confidence: 99%

Body composition changes in anorexia nervosa

Polito¹,

Cuzzolaro

Raguzzini³

et al. 1998

“…Several investigators have evaluated body composition in anorectic patients (Fohlin, 1977;Hannan et al, 1990;Krahn et al, 1993;Scalfi et al, 1993;Nuñiez et al, 1994;Probst et al, 1996;Orphanidou et al, 1997;Polito et al, 1998): a decrease of both fat-free mass (FFM) and fat mass (FM) has always been reported, with lean tissues accounting for a variable percentage of the reduction in body mass. With respect to refed patients, changes in FFM and FM (Orphanidou et al, 1997;Probst et al, 2001), body potassium (Pirke et al, 1986), total body water and its intracellular=extracellular distribution (Vaisman et al, 1988), as well as in bioimpedance analysis (Polito et al, 1998;Scalfi et al, 1999), have been observed after weight recovery.…”

Section: Introductionmentioning

confidence: 99%

“…With respect to refed patients, changes in FFM and FM (Orphanidou et al, 1997;Probst et al, 2001), body potassium (Pirke et al, 1986), total body water and its intracellular=extracellular distribution (Vaisman et al, 1988), as well as in bioimpedance analysis (Polito et al, 1998;Scalfi et al, 1999), have been observed after weight recovery. The studies available in the literature also indicate that FM represents 21 -77% of the weight gained (Russell & Mezey, 1962;Forbes et al, 1984;Pirke et al, 1986;Mitchell & Truswell, 1987;Vaisman et al, 1988;Krahn et al, 1993;Waller et al, 1996;Orphanidou et al, 1997;Polito et al, 1998;Probst et al, 2001;Grinspoon et al, 2001), while the number of calories needed to put down body mass seems to increase during refeeding (Salisbury et al, 1995). Nevertheless, despite the widespread use of anthropometric techniques for the assessment of nutritional status, only a few studies have so far examined the changes in skinfolds and circumferences which occur during weight recovery (Forbes et al, 1984;Nuñez et al, 1994;Orphanidou et al, 1997;Polito et al, 1998;Probst et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…The studies available in the literature also indicate that FM represents 21 -77% of the weight gained (Russell & Mezey, 1962;Forbes et al, 1984;Pirke et al, 1986;Mitchell & Truswell, 1987;Vaisman et al, 1988;Krahn et al, 1993;Waller et al, 1996;Orphanidou et al, 1997;Polito et al, 1998;Probst et al, 2001;Grinspoon et al, 2001), while the number of calories needed to put down body mass seems to increase during refeeding (Salisbury et al, 1995). Nevertheless, despite the widespread use of anthropometric techniques for the assessment of nutritional status, only a few studies have so far examined the changes in skinfolds and circumferences which occur during weight recovery (Forbes et al, 1984;Nuñez et al, 1994;Orphanidou et al, 1997;Polito et al, 1998;Probst et al, 2001). In particular, the issue has recently been evaluated by Orphanidou et al, (1997) and Probst et al, (2001) in a more systematic way.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Scalfi¹,

Polito

Bianchi

et al. 2002

Objective: To assess body composition changes occurring in female anorectic patients after complete weight recovery. Design: Longitudinal study. Subjects: Ten female patients with anorexia nervosa (age at baseline: 19.7 AE 5.8 y) were studied both when undernourished (body mass index, BMI 14.8 AE Interventions: Fat mass and fat-free mass were determined by dual-energy X-ray absorptiometry. Skinfold thicknesses and circumferences were also measured. Arm muscle area and arm fat area were calculated by standard formulas. Results: The undernourished patients had lower fat-free mass, fat mass, skinfold thicknesses and circumferences. After refeeding, fat mass represented 25 -71% (mean 56%) of the mass regained, this percentage being directly related to the extent of weight gain. The increases in skinfolds and circumferences depended upon the site considered and were correlated to a various extent with those in weight or BMI. Skinfolds at biceps and abdominal sites and the waist-to-hip ratio remained significantly higher, whereas arm muscle circumference was significantly lower, in the refed group than in the control one. Conclusion: The percentage of fat in the weight regained by refed female anorectic patients was directly related to the extent of body mass increase. Refed anorectic patients appear to preferentially regain fat in the abdominal and triceps regions. Abnormalities in skinfolds (at biceps and abdominal sites), arm muscle area and waist-to-hip ratio still persist in refed anorectic patients in comparison to control healthy controls.

“…Premenarcheal AN, although rare, is well recognised (Gowers et al, 1991;Jacobs & Isaacs, 1986;Bryant-Waugh, 2000). The majority of studies to date looking at body composition in eating disorders have been on postmenarcheal adolescents or adult patients (Vaisman et al, 1988;Mazess et al, 1990;Orphanidou et al, 1997;Trocki & Shepherd, 2000). The physical impact of malnutrition in pre-and peri-pubertal children with eating disorders has been little investigated, the largest series being a retrospective study of 20 adults whose AN was of premenarcheal onset (Russell, 1985).…”

Section: Introductionmentioning

confidence: 99%

Body composition in early onset eating disorders

Nicholls¹,

Wells²,

Singhal³

et al. 2002

Background: Body mass index (BMI) or equivalent weight for height indices are the most widely used measures of body composition in early onset and adolescent eating disorders. Although of value as screening instruments the limitation in disease states is their inability to discriminate fat and fat-free components of body weight. Objective: To compare height-adjusted fat and fat-free components of body composition in children and young adolescents with different types of eating disorders with those of age matched reference children. Design: Weight, height, triceps and subscapular skinfold thickness were measured in 172 children (aged 7 -16 y) with eating disorders receiving specialist treatment. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated using Slaughter's and Deurenberg's equations and normalisation for height. Using data from 157 normal children, representative of the UK 1990 growth reference data, reference curves for FMI and FFMI AE 2 s.d. were derived. Results for patient groups were superimposed on these reference curves.Results: FMI and FFMI were both reduced in eating disorders associated with malnutrition, including anorexia nervosa (AN). AN subjects did not differ from other subjects with comparable degrees of malnutrition. Children with eating disorders of normal weight, such as bulimia nervosa and selective eating, did not differ significantly from reference children in their relative FM and FFM. Conclusions: FM and FFM merit independent consideration in disorders of malnutrition in children, rather than expressing data as percentage body fat or percentage BMI. The implications of loss of FFM on growth and development merit further investigation.