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

Ilyas, Athif; Hübel, Christopher; Ståhl, Daniel; Stadler, Marietta; Ismail, Khalida; Breen, Gerome; Treasure, Janet; Kan, Carol

doi:10.1016/j.mce.2018.10.005

Cited by 48 publications

(34 citation statements)

References 37 publications

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“…In females, significant differences were observed in body fat distribution after treatment as body fat is primarily stored in the trunk. This distribution pattern may be due to increased insulin sensitivity observed in AN patients (Ilyas et al, ) potentially similar to observations in healthy individuals after short‐term overfeeding (McLaughlin et al, ). We did not detect meaningful or statistically significant differences in body fat distribution in weight‐restored patients, indicating potential redistribution occurring over longer term follow‐up.…”

Section: Discussionsupporting

confidence: 81%

“…Pretreatment fasting insulin and glucose were reduced in AN patients independent of fat mass, but both concentrations normalized following treatment, suggesting that increased insulin sensitivity (Ilyas et al, ) may be a temporary state in AN. The relationship between AN and insulin sensitivity should be investigated by euglycemic hyperinsulinemic clamp that showed mixed findings in very small samples (Castillo, Scheen, Jandrain, & Lefèbvre, ; Castillo, Scheen, Lefebvre, & Luyckx, ; Dostálová et al, ; Karczewska‐Kupczewska et al, ; Pannacciulli et al, ; Prioletta et al, ; Zuniga‐Guajardo, Garfinkel, & Zinman, ).…”

Section: Discussionmentioning

confidence: 94%

“…Anorexia nervosa (AN) has one of the highest mortality rates of all psychiatric disorders (Chesney, Goodwin, & Fazel, ). Clinical observations show altered body composition (El Ghoch, Calugi, Lamburghini, & Dalle Grave, ; Solmi et al, ) accompanied by elevated cholesterol (Hussain et al, ) and greater insulin sensitivity (Ilyas et al, ). However, conclusions are limited by small sample sizes and consequent mixed findings.…”

Section: Introductionmentioning

confidence: 99%

“…BIA, binge-eating/purging, bioelectrical impedance analysis, body fat percentage, bone, dualenergy X-ray absorptiometry, DXA, estradiol, fat-free mass, insulin, lean mass, long-term followup, restricting, thyroid, weight restoration 1 | INTRODUCTION Anorexia nervosa (AN) has one of the highest mortality rates of all psychiatric disorders (Chesney, Goodwin, & Fazel, 2014). Clinical observations show altered body composition (El Ghoch, Calugi, Lamburghini, & Dalle Grave, 2014;Solmi et al, 2016) accompanied by elevated cholesterol (Hussain et al, 2019) and greater insulin sensitivity (Ilyas et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Body composition in anorexia nervosa: Meta‐analysis and meta‐regression of cross‐sectional and longitudinal studies

Hübel

Yılmaz

Schaumberg

et al. 2019

Intl J Eating Disorders

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Objective Clinically, anorexia nervosa (AN) presents with altered body composition. We quantified these alterations and evaluated their relationships with metabolites and hormones in patients with AN longitudinally. Method In accordance with PRISMA guidelines, we conducted 94 meta‐analyses on 62 samples published during 1996–2019, comparing up to 2,319 pretreatment, posttreatment, and weight‐recovered female patients with AN with up to 1,879 controls. Primary outcomes were fat mass, fat‐free mass, body fat percentage, and their regional distribution. Secondary outcomes were bone mineral density, metabolites, and hormones. Meta‐regressions examined relationships among those measures and moderators. Results Pretreatment female patients with AN evidenced 50% lower fat mass (mean difference [MD]: −8.80 kg, 95% CI: −9.81, −7.79, Q = 1.01 × 10−63) and 4.98 kg (95% CI: −5.85, −4.12, Q = 1.99 × 10−28) lower fat‐free mass, with fat mass preferentially stored in the trunk region during early weight restoration (4.2%, 95% CI: −2.1, −6.2, Q = 2.30 × 10−4). While the majority of traits returned to levels seen in healthy controls after weight restoration, fat‐free mass (MD: −1.27 kg, 95% CI: −1.79, −0.75, Q = 5.49 × 10−6) and bone mineral density (MD: −0.10 kg, 95% CI: −0.18, −0.03, Q = 0.01) remained significantly altered. Discussion Body composition is markedly altered in AN, warranting research into these phenotypes as clinical risk or relapse predictors. Notably, the long‐term altered levels of fat‐free mass and bone mineral density suggest that these parameters should be investigated as potential AN trait markers. ResumenObjetivo Clínicamente, la anorexia nervosa (AN) se presenta con alteraciones en la composición corporal. Cuantificamos estas alteraciones y evaluamos longitudinalmente su relación con metabolitos y hormonas en pacientes con AN. Método De acuerdo con las pautas PRISMA, realizamos 94 meta‐análisis en 62 muestras publicadas entre 1996–2019, comparando hasta 2,319 pacientes mujeres en pre‐tratamiento, post‐tratamiento, y recuperadas en base al peso con hasta 1,879 controles. Las principales medidas fueron masa grasa, masa libre de grasa, porcentaje de grasa corporal y su distribución regional. Las medidas secundarias fueron densidad mineral ósea, metabolitos y hormonas. Las meta‐regresiones examinaron las relaciones entre esas medidas y moderadores. Resultados Las pacientes femeninas con AN pre‐tratamiento mostraron un 50% menos de masa grasa (MD: −8.80 kg, CI 95%: −9.81, −7.79, Q = 1.01 × 10–63) y 4.98 kg (CI 95%: −5.85, −4.12, Q = 1.99 × 10–28) menos de masa libre de grasa, con masa grasa preferentemente almacenada en la región del tronco durante la recuperación temprana del peso (4.2%, CI 95%: −2.1, −6.2, Q = 2.30 × 10–4). Aunque la mayoría de los rasgos regresaron a los niveles vistos en los controles sanos después de la restauración del peso, la masa libre de grasa (MD: −1.27 kg, CI 95%: −1.79, −0.75, Q = 5.49 × 10–6) y la densidad mineral ósea (MD: −0.10 kg, CI 95%: −0.18, −0.03, Q = 0.01) perm...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Body composition in anorexia nervosa: Meta‐analysis and meta‐regression of cross‐sectional and longitudinal studies

Hübel

Yılmaz

Schaumberg

et al. 2019

Intl J Eating Disorders

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“…We measured copeptin concentrations in women suffering from severe AN and in age‐matched normal‐weight women. In addition, we tested whether copeptin concentrations in plasma associate with insulin sensitivity, which is a well‐known co‐feature in this particular disorder (Ilyas et al, ; Stoving et al, ). To the best of our knowledge, this is the first report on copeptin in AN.…”

Section: Introductionmentioning

confidence: 99%

Copeptin in anorexia nervosa

Goetze

Støving

2020

Brain and Behavior

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Objective Antidiuretic hormone (ADH) is involved in the response to stress and in depression and anxiety. However, studies on ADH in anorexia nervosa (AN) show conflicting results. A major reason for this may be methodological challenges due to short half‐life of ADH in circulation and rapid degradation in vitro. To overcome these obstacles, copeptin, the C‐terminal fragment stemming from the ADH precursor, has been increasingly used as a stable clinical measure for ADH. Furthermore, copeptin has been recognized as a biomarker of insulin resistance in obesity. Methods We measured fasting copeptin in plasma from 25 normohydrated, stable women with AN (BMI 13.0 ± 2.0) and 25 age‐matched women. Results No difference in copeptin levels was found (6.8 ± 1.8 vs. 5.5 ± 0.5 pmol/L). Confirmatory, copeptin concentrations were correlated to insulin resistance assessed by the homeostasis model assessment of insulin resistance. Discussion We report for the first time that copeptin level as a marker of ADH activity is not altered in fluid‐ and electrolyte‐stabilized patients with severe AN patients, indicating that ADH may not be crucial in the pathophysiological involvement of psychologic stress in AN.

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