Comparisons of bone density and body composition among adolescents with anorexia nervosa and atypical anorexia nervosa

Abstract

Objective: To compare bone mineral density (BMD) and body composition among adolescents: 1) with atypical anorexia nervosa (AAN) versus anorexia nervosa (AN) and 2) those with and without a prior history of overweight. Method: Electronic medical records of patients 9–20 years with AN or AAN who underwent dual-energy x-ray absorptiometry (DXA) scans were retrospectively reviewed and analyzed. Results: A total of 286 adolescents with AN or AAN were included. In linear regression models, AAN was associated with greater Z-scores in whole body bone mineral content (BMC, B=0.88, p<0.001), lumbar spine BMD (B=0.79, p=0.002), femoral neck BMD (B=0.670, p=0.009); fat mass index (FMI, B=1.33, p=0.003), and lean body mass index (LBMI, B=1.10, p<0.001) compared to AN, adjusting for age, sex, and duration of illness. A prior overweight history was associated with greater Z-scores in whole body BMC; lumbar spine BMD, total hip BMD, femoral neck BMD, and LBMI. Discussion: Adolescents with AAN had higher BMD Z-scores than adolescents with AN; adolescents with a prior overweight history had greater BMD Z-scores than adolescents without a prior overweight history. These findings may inform clinical guidelines for the medical management of AAN.

Weight Loss and Illness Severity in Adolescents With Atypical Anorexia Nervosa

“…7 Accordingly, we found elevated ALT in 30% of participants with AN, increasing in proportion to lower weight. ALT was significantly lower in the AAN group but increased with longer duration, suggesting that the relatively higher fat mass documented in AAN 37 is hepatoprotective during early weight loss. Studies should examine whether there are tissue-specific effects of weight loss related to body composition.…”

“…35 Although creatinine must be interpreted with caution in AN, 36 our findings suggest that relative reductions in lean mass are detrimental to nutritional status even if total lean mass remains normal, as shown in AAN. 37 Aminotransferases were of interest as markers of malnutrition; they are elevated in roughly one-third of patients with AN 7 and rise in proportion to lower weight 7,38 and fat mass. 7 Accordingly, we found elevated ALT in 30% of participants with AN, increasing in proportion to lower weight.…”

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“…При этом, сходные с нашими данные были получены Barkaoui A с соавторами [16], в исследовании которых доказана зависимость степени резорбции кости от возраста на примере плотности бедренной кости у женщин и мужчин. О важности гормонального фактора и наличия или отсутствия избыточного веса говорят и исследования [17].…”

Clinician practices assessing hypothalamic–pituitary–gonadal axis suppression in adolescents with an eating disorder

“…In males with eating disorders, a similar process of HPG suppression can occur resulting in lower testosterone levels which may impact sexual function and reproductive health (Wong, Hoermann, & Grossmann, 2019). Bone health issues in males secondary to eating disorders and presumed HPG suppression have been reported, although the pathophysiology in a hormonal milieu that is different than that for female patients, is still being elucidated (De Souza, Koltun, & Williams, 2019; Nagata et al, 2019). Recent literature has called for further research and evidence‐based recommendations for male patients with an eating disorder in order to understand the unique considerations and needs of this subset of patients (Ganson et al, 2019; Hornberger et al, 2020).…”