Growth hormone level at admission and its evolution during refeeding are predictive of short-term outcome in restrictive anorexia nervosa

Abstract

The growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis is dramatically altered in patients with anorexia nervosa (AN). The aim of the present study was to investigate whether GH and IGF-1 could be predictors of outcome in patients with a restrictive form of AN. Blood levels of GH, IGF-1, adipocytokines, ghrelin, insulin, glucose, and sex and thyroid hormones were measured in eleven women inpatients with AN and in ten healthy women controls. Three stages were compared during refeeding: admission (T0), when BMI reached 16 kg/m 2 (T1) and at discharge when BMI reached 17·5 kg/m 2 (T2). Clinical status was assessed 6 months after discharge from hospital (T3), and remission was defined by the maintenance of a BMI $ 17·5 kg/m 2 . AN patients in remission (AN-R; n 6) had significantly higher GH levels at admission than those who relapsed (AN-NR; n 5) (P, 0·05). During refeeding (D ¼ T2 2 T0), the AN-R group differed from the AN-NR group only by both GH level decrease (P, 0·05) and BMI increase (P, 0·05). In multiple regression analysis, DGH was associated negatively and significantly and Dleptin and Dbody fat mass levels were associated positively and significantly with BMI at T3 and explained 88 % of its variability (r 2 0·88, P,0·05). The present study suggests that a low GH level at admission and the absence of its decrease after weight recovery could predict short-term relapse in women suffering from a restrictive form of AN.

The metabolic underpinning of eating disorders: A systematic review and meta-analysis of insulin sensitivity

“…Thirteen studies of patients with AN were included in the systematic review, with a total of 572 participants (307 AN cases and 265 controls), all of whom were female (Table 1) (Broglio et al, 2004, Dolezalova et al, 2007, Dostalova et al, 2007, Dostalova et al, 2006, Dostalova et al, 2008, Fazeli et al, 2010, Maimoun et al, 2016, Nogueira et al, 2013, Tagami et al, 2004, Victor et al, 2015, Weinbrenner et al, 2003. All thirteen studies were observational and used a case-control design.…”

“…Eight studies have the appropriate data for the primary meta-analysis (n=340) (Dolezalova et al, 2007, Dostalova et al, 2007, Dostalova et al, 2006, Dostalova et al, 2008, Maimoun et al, 2016, Nogueira et al, 2013, Tagami et al, 2004, Victor et al, 2015…”

“…Mean BMI and age of participants were reported in all studies except one study of AN (Dolezalova et al, 2007). All case-control studies reported matching for controls on age, except for two studies of AN (Broglio et al, 2004, Nogueira et al, 2013 and two studies of BN (Pijl et al, 1995, Yasuhara et al, 2004. However, other important confounding factors such as BMI and waist circumference were…”

The Use of Animal Models to Decipher Physiological and Neurobiological Alterations of Anorexia Nervosa Patients

“…Usually, AN-R patients also showed a nutritionally acquired hepatic resistance to GH with decreased production of IGF-1 and increased GH levels. Such increase is due to (i) a reduction of IGF-1 feedback on pituitary and hypothalamus GH secretion and (ii) high levels of ghrelin, a GH secretagogue ( 16 ). Additionally, osteoporosis, another main complication of AN affecting 20–50% of cases, has been observed and is often irreversible ( 17 , 18 ).…”

Ghrelin-Derived Peptides: A Link between Appetite/Reward, GH Axis, and Psychiatric Disorders?

“…As ghrelin has initially been described as a powerful GH secretagogue and a number of studies have focused on its role as a regulator of the GH/IGF-1 axis ( 1 , 13 , 138 ), the link between ghrelin, GH axis, and psychiatric disorders needs to be questioned. The GH/IGF-1 axis is deregulated in anorexia nervosa and the evolution of GH levels during renutrition is predictive of short-term outcome in AN-R patients ( 139 , 140 ). More specifically, low GH levels at admission and absence of GH reduction after weight recovery could be predictive of short-term relapse.…”