1
|
Jenkins PE, Proctor K, Snuggs S. Dietary intake of adults with eating disorders: A systematic review and meta-analysis. J Psychiatr Res 2024; 175:393-404. [PMID: 38772131 DOI: 10.1016/j.jpsychires.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Studies have confirmed the link between altered dietary intake and eating disorders (EDs), although no systematic assessment of this research exists. Rigorous synthesis of dietary intake in anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and similar EDs is needed to explore similarities and differences. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we conducted a systematic review and quantitative synthesis of studies of dietary intake. Searches of three electronic databases resulted in thirty-nine included studies. Meta-analyses of subsets of these studies were undertaken to summarise macronutrient intake across AN, BN, and BED. Study quality was assessed using the American Academy of Nutrition and Dietetics Quality Criteria Checklist, with ratings either Positive (k = 27) or Neutral (k = 12). Adults with AN had low energy intake and those with BED reported elevated macronutrient intake. Individuals with BN reported wide variation in energy intake, including some of the highest estimates. Individuals with AN were likely to under-consume key micronutrients, with sodium potentially over-consumed in BN and BED. Vitamin D was under-consumed across all disorders. This meta-analysis highlights important diagnostic differences and synthesises dietary intake in EDs, with particular relevance to risk assessment and treatment.
Collapse
Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom.
| | - Katy Proctor
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
| | - Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
| |
Collapse
|
2
|
Body composition assessment in adult females with anorexia nervosa and bulimia nervosa - a cross-sectional study comparing dual-energy X-ray absorptiometry scan and isotopic dilution of deuterium. J Nutr 2023; 153:1309-1322. [PMID: 36934952 DOI: 10.1016/j.tjnut.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) compromise individuals' nutritional status, affecting among other organs and systems, bone health. OBJECTIVE This study aimed to assess and compare bone mineral density (BMD) from dual-energy x-ray absorptiometry (DXA) scan and deuterium (D2O) dilution of adult females with anorexia nervosa (AN) and bulimia nervosa (BN). METHODS This was a cross-sectional study with 53 female participants (18-49 years) with a diagnosis of AN (N = 25) or BN (N = 28). DXA scan was performed to assess BMD, fat mass, and fat-free mass, and D2O dilution was used to assess total body water (TBW), fat mass, and fat-free mass. Interviews/questionnaires were used to assess symptoms, illness trajectory, and physical activity. T-test, Chi-squared test, Pearson's linear correlation, linear regressions, and Bland-Altman analyses were performed, with a significance level of 5%. RESULTS TBW below the recommended level for adult females (≥ 45%) was more frequent in BN (60%) compared with AN (21%; P = 0.013). FMI (soft tissue only) (t-test P = 0.06), and FFMI (t-test P = 0.08) agreed between DXA scan and D2O dilution. Only FFMI did not show systematic bias of proportion (β:-0.2, P = 0.177). The diagnosis of BN, binge-eating episodes, and physical activity in AN were associated with the differences in the methods' results. FMI was positively associated with BMD in AN, and both FMI and FFMI were positively associated with BMD in BN. CONCLUSION In adult females with EDs, DXA scan and D2O dilution achieved agreement for FMI and FFMI. Changes in fat mass and fat-free mass are important in understanding the mechanisms behind bone loss in EDs. Protocols for body composition assessment in EDs can help to minimize the effect of the ED diagnosis, ED behaviors (i.e., excessive exercise and purging behaviors) and weight on the accuracy of measurements.
Collapse
|
3
|
Lopes MP, Robinson L, Stubbs B, Dos Santos Alvarenga M, Araújo Martini L, Campbell IC, Schmidt U. Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis. J Eat Disord 2022; 10:173. [PMID: 36401318 PMCID: PMC9675098 DOI: 10.1186/s40337-022-00694-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lower bone mineral density (BMD) increases the risk of osteoporosis in individuals with eating disorders (EDs), particularly women with anorexia nervosa (AN), making them susceptible to pain and fractures throughout adulthood. In AN, low weight, hypothalamic amenorrhoea, and longer illness duration are established risk factors for low BMD, and in people with other EDs a history of AN seems to be an important risk factor for low BMD. PURPOSE To conduct a systematic review and meta-analysis of BMD in individuals with EDs, including AN, bulimia nervosa (BN), binge-eating disorder (BED) and other specified feeding or eating disorders (OSFED) compared to healthy controls (HC). METHODS Following PRISMA guidelines, electronic databases were reviewed and supplemented with a literature search until 2/2022 of publications measuring BMD (dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with any current ED diagnosis and a HC group. Primary outcomes were spine, hip, femur and total body BMD. Explanatory variables were fat mass, lean mass and ED clinical characteristics (age, illness duration, body mass index (BMI), amenorrhoea occurrence and duration, and oral contraceptives use). RESULTS Forty-three studies were identified (N = 4163 women, mean age 23.4 years, min: 14.0, max: 37.4). No study with individuals with BED met the inclusion criteria. BMD in individuals with AN (total body, spine, hip, and femur), with BN (total body and spine) and with OSFED (spine) was lower than in HC. Meta-regression analyses of women with any ED (AN, BN or OSFED) (N = 2058) showed low BMI, low fat mass, low lean mass and being amenorrhoeic significantly associated with lower total body and spine BMD. In AN, only low fat mass was significantly associated with low total body BMD. CONCLUSION Predictors of low BMD were low BMI, low fat mass, low lean mass and amenorrhoea, but not age or illness duration. In people with EDs, body composition measurement and menstrual status, in addition to BMI, are likely to provide a more accurate assessment of individual risk to low BMD and osteoporosis.
Collapse
Affiliation(s)
- Mariana P Lopes
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil. .,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Brendon Stubbs
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Marle Dos Santos Alvarenga
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Ligia Araújo Martini
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| |
Collapse
|
4
|
Casper RC. Restlessness and an Increased Urge to Move (Drive for Activity) in Anorexia Nervosa May Strengthen Personal Motivation to Maintain Caloric Restriction and May Augment Body Awareness and Proprioception: A Lesson From Leptin Administration in Anorexia Nervosa. Front Psychol 2022; 13:885274. [PMID: 35959022 PMCID: PMC9359127 DOI: 10.3389/fpsyg.2022.885274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
Anorexia nervosa (AN), a disorder of voluntary food restriction leading to severe weight loss in female adolescents, remains an enigma. In particular, the appropriation of the starved thin body into the self-concept in AN is a process insufficiently researched and still poorly understood. Healthy humans undergoing starvation experience a slowing of movements and avoid voluntary exercise. By contrast, AN tends to be not infrequently associated with voluntary, sometimes excessive and/or compulsive exercise. Such deliberate exercise, not reported in starvation, seems to be facilitated by an increased urge for movement and physical restlessness, particular to AN. The increased urge to move would reflect spontaneous daily activity, the energy expended for everything that is not sleeping, eating, or voluntary exercise. Our hypothesis is that the starvation-induced increased urge to move and restlessness may promote the development of AN. Reversal of the fasting state, by either high caloric food or by leptin administration, would be expected to reduce restlessness and the increased urge to move along with improvement in other symptoms in AN. This review explores the idea that such restless activation in AN, in itself and through accelerating body weight loss, might foster the integration of the starving body into the self-concept by (1) enhancing the person’s sense of self-control and sense of achievement and (2) through invigorating proprioception and through intensifying the perception of the changing body shape. (3) Tentative evidence from studies piloting leptin administration in chronic AN patients which support this hypothesis is reviewed. The findings show that short term administration of high doses of leptin indeed mitigated depressive feelings, inner tension, intrusive thoughts of food, and the increased urge to be physically active, easing the way to recovery, yet had little influence on the patients’ personal commitment to remain at a low weight. Full recovery then requires resolution of the individuals’ personal unresolved psychological conflicts through psychotherapy and frequently needs specialized treatment approaches to address psychiatric co-morbidities. AN might be conceptualized as a hereditary form of starvation resistance, facilitated by the effects of starvation on fitness allowing for an exceptionally intense personal commitment to perpetuate food restriction.
Collapse
|
5
|
Maeda SS, Peters BSE, Martini LA, Antunes HKM, Gonzalez MC, Arantes HP, Prado CM, Pinto CL, de Araújo IM, de Paula FJA, Borges JLC, Albergaria BH, Ushida M, de Souza GC, de Mendonça LMC, do Prado M, de Medeiros Pinheiro M. Official position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry: part I (technical aspects)—general concepts, indications, acquisition, and analysis. Adv Rheumatol 2022; 62:7. [DOI: 10.1186/s42358-022-00241-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To review the technical aspects of body composition assessment by dual-energy X-ray absorptiometry (DXA) and other methods based on the most recent scientific evidence.
Materials and methods
This Official Position is a result of efforts by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and health care professionals with expertise in body composition assessment who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications. In this first part of the Official Position, the authors discuss the different methods and parameters used for body composition assessment, general principles of DXA, and aspects of the acquisition and analysis of DXA scans.
Conclusion
Considering aspects of accuracy, precision, cost, duration, and ability to evaluate all three compartments, DXA is considered the gold-standard method for body composition assessment, particularly for the evaluation of fat mass. In order to ensure reliable, adequate, and reproducible DXA reports, great attention is required regarding quality control procedures, preparation, removal of external artifacts, imaging acquisition, and data analysis and interpretation.
Collapse
|
6
|
Kochavi B, Mendelowitsch S, Enoch-Levy A, Yaroslavsky A, Toledano A, Modan-Moses D, Stein D. Resting energy expenditure in acutely ill and stabilized patients with anorexia nervosa and bulimia nervosa. Int J Eat Disord 2020; 53:1460-1468. [PMID: 32506564 DOI: 10.1002/eat.23301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Determining resting energy expenditure (REE) may be important in the nutritional assessment of adolescents with eating disorders (EDs). Calculated equations assessing REE, developed according to data from healthy people, may under- or overestimate REE in EDs. We have sought to compare the REE measured in clinical settings to that calculated using equations in actively ill adolescents with anorexia nervosa (AN) and bulimia nervosa (BN), and following stabilization of weight and disordered eating. METHODS Thirty-five female adolescents with AN and 25 with BN were assessed at admission to inpatient treatment and at discharge. REE was measured using indirect calorimetry (DELTATRAC Metabolic Monitor). Expected REE was calculated using the Harris-Benedict equation. RESULTS An overestimation of expected versus measured REE was found for both patients with AN and BN, both at admission and discharge. Second, the differences between expected and measured REE were significantly less robust in BN versus AN. Third, REE before renourishing was lower in inpatients with AN versus BN. Fourth, the REE of patients with AN (both measured and expected) increased from admission to discharge, to a greater extent than expected solely from the increase in weight. The difference between admission and discharge expected and measured REE was significant also in patients with BN. DISCUSSION Our findings suggest that predicted and measured REE are different in both AN and BN, and that both expected and measured REE are not useful in the planning of renourishing programs in patients with AN.
Collapse
Affiliation(s)
- Brigitte Kochavi
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shiri Mendelowitsch
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Toledano
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Dalit Modan-Moses
- Pediatric Endocrinology Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Casper RC. Not the Function of Eating, but Spontaneous Activity and Energy Expenditure, Reflected in "Restlessness" and a "Drive for Activity" Appear to Be Dysregulated in Anorexia Nervosa: Treatment Implications. Front Psychol 2018; 9:2303. [PMID: 30532724 PMCID: PMC6265370 DOI: 10.3389/fpsyg.2018.02303] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/05/2018] [Indexed: 02/05/2023] Open
Abstract
Anorexia nervosa (AN) is uncommon as a syndrome, despite widespread dieting or voluntary food restriction, especially among female adolescents. This suggests that restriction of caloric intake might not be the only component driving weight loss in AN. Historical observations and experimental evidence from energy expenditure studies and recordings from movement sensors reviewed in this paper reveal that AN is associated with motor activity levels and with an energy output not significantly different from that in normal-weight healthy age-matched controls. By contrast, other conditions of prolonged caloric under-nutrition are typically associated with loss of energy, slowing of movements and a decrease in self-initiated activity and well-being. Several hypotheses can be inferred from the findings: (a) that long term severe caloric restriction fails in downregulating movements and energy expenditure in AN. (b) Clinically and subjectively observable as mental and physical restlessness and continued motor activity, this restless energy, differing in intensity, seems to serve as the permissive factor for and possibly to drive exercise and hyperactivity in AN. (c) Such restless energy and increased arousal, generated sometime in the course of the weight loss process, appear to enhance the person's self-perception and wellbeing, to heighten proprioception, to intensify body awareness and to improve self-esteem. (d) Restlessness and continued motor activity may constitute a phenotype of AN. The therapeutic value of the concept of an abnormality in the energy regulatory system, likely the result of a host of genetic and epigenetic changes in AN, lies primarily in its heuristic and explanatory power and its potential for disease prevention. Restless energy as a permissive and important component for the development and in the maintenance of AN, does not fundamentally alter treatment, since prolonged food deprivation is the principal causal factor for the development of AN. Re-nutrition within a structured treatment plan, to include individual and family therapy and, if indicated, heat application, remains the most effective symptomatic treatment for AN. Corroboration of the concept of restless activation will require the patient's cooperation and input to identify and capture more precisely the experiences, sensations, and changes that allow the emaciated patient to remain mobile and active.
Collapse
Affiliation(s)
- Regina C. Casper
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
8
|
Casper RC. Restless activation and drive for activity in anorexia nervosa may reflect a disorder of energy homeostasis. Int J Eat Disord 2016; 49:750-2. [PMID: 27315579 PMCID: PMC5094564 DOI: 10.1002/eat.22575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Regina C. Casper
- Department of PsychiatryStanford University School of MedicineStanfordCalifornia94305
| |
Collapse
|
9
|
Robinson L, Aldridge V, Clark EM, Misra M, Micali N. A systematic review and meta-analysis of the association between eating disorders and bone density. Osteoporos Int 2016; 27:1953-66. [PMID: 26782684 PMCID: PMC7047470 DOI: 10.1007/s00198-015-3468-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022]
Abstract
This meta-analysis investigates the effect of an eating disorder on bone mineral density in two eating disorder subtypes. Following conflicting findings in previous literature, this study finds that not only anorexia nervosa, but also bulimia nervosa has a detrimental effect on BMD. Key predictors of this relationship are discussed. This systematic review and meta-analysis investigates bone mineral density (BMD) in individuals with anorexia nervosa (AN) and bulimia nervosa (BN) in comparison to healthy controls (HCs). AN has been associated with low BMD and a risk of fractures and mixed results have been obtained for the relationship between BN and BMD. Deciphering the effect these two ED subtypes on BMD will determine the effect of low body weight (a characteristic of AN) versus the effects of periods of restrictive eating and malnutrition which are common to both AN and BN. We conducted a systematic search through the electronic databases MedLine, EMBASE and PsychInfo and the Cochrane Library to investigate and quantify this relationship. We screened 544 articles and included 27 studies in a random-effect meta-analysis and calculated the standardised mean difference (SMD) in BMD between women with a current diagnosis of AN (n = 785) vs HCs (n = 979) and a current diagnosis of BN (n = 187) vs HCs (n = 350). The outcome measures investigated were spinal, hip, femoral neck and whole body BMD measured by DXA or DPA scanning. A meta-regression investigated the effect of factors including age, duration since diagnosis, duration of amenorrhea and BMI on BMD. The mean BMI of participants was 16.65 kg/m(2) (AN), 21.16 kg/m(2) (BN) and 22.06 kg/m(2) (HC). Spine BMD was lowest in AN subjects (SMD, -3.681; 95 % CI, -4.738, -2.625; p < 0.0001), but also lower in BN subjects compared with HCs (SMD, -0.472; 95 % CI, -0.688, -0.255; p < 0.0001). Hip, whole body and femoral neck BMD were reduced to a statistically significant level in AN but not BN groups. The meta-regression was limited by the number of included studies and did not find any significant predictors. This meta-analysis confirms the association between low BMD and AN and presents a strong argument for assessing BMD not only in patients with AN, but also in patients with BN.
Collapse
Affiliation(s)
- L Robinson
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - V Aldridge
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - E M Clark
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - M Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - N Micali
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
10
|
Solmi M, Veronese N, Correll CU, Favaro A, Santonastaso P, Caregaro L, Vancampfort D, Luchini C, De Hert M, Stubbs B. Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2016; 133:341-351. [PMID: 26763350 DOI: 10.1111/acps.12556] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs). METHOD Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures. RESULTS Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC. CONCLUSION People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.
Collapse
Affiliation(s)
- M Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - N Veronese
- Department of Medicine, Geriatrics Section, University of Padova, Italy
| | - C U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - A Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - P Santonastaso
- Department of Neurosciences, University of Padova, Padova, Italy
| | - L Caregaro
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - D Vancampfort
- Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium
- Z.org Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - C Luchini
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - M De Hert
- Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Health Service and Population Research Department, Institute of Psychiatry King's College London, London, UK
| |
Collapse
|
11
|
Castellini G, Castellani W, Lelli L, Sauro CL, Dini C, Lazzeretti L, Bencini L, Mannucci E, Ricca V. Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders. World J Clin Cases 2014; 2:257-264. [PMID: 25032200 PMCID: PMC4097152 DOI: 10.12998/wjcc.v2.i7.257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/30/2014] [Accepted: 06/18/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the complex relationships between resting energy expenditure (REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders.
METHODS: The study was designed as a cross-sectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence (Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire (EDE-Q). Patients were also evaluated by means of the symptom checklist (SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated.
RESULTS: Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index (BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels (mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating factor for this relationship.
CONCLUSION: The data supported a mediation model where cortisol levels mediated the relationship between eating psychopathology (concern about body shape) and REE.
Collapse
|
12
|
Jésus P, Achamrah N, Grigioni S, Charles J, Rimbert A, Folope V, Petit A, Déchelotte P, Coëffier M. Validity of predictive equations for resting energy expenditure according to the body mass index in a population of 1726 patients followed in a Nutrition Unit. Clin Nutr 2014; 34:529-35. [PMID: 25016971 DOI: 10.1016/j.clnu.2014.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/26/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND & AIMS The resting energy expenditure (REE) predictive formulas are often used in clinical practice to adapt the nutritional intake of patients or to compare to REE measured by indirect calorimetry. We aimed to evaluate which predictive equations was the best alternative to REE measurements according to the BMI. METHODS 28 REE prediction equations were studied in a population of 1726 patients without acute or chronic high-grade inflammatory diseases followed in a Nutrition Unit for malnutrition, eating disorders or obesity. REE was measured by indirect calorimetry for 30 min after a fasting period of 12 h. Some formulas requiring fat mass and free-fat mass, body composition was measured by bioelectrical impedance analysis. The percentage of accurate prediction (±10%/REE measured) and Pearson r correlations were calculated. RESULTS Original Harris & Benedict equation provided 73.0% of accurate predictions in normal BMI group but only 39.3% and 62.4% in patients with BMI < 16 kg m(-2) and BMI ≥ 40 kg m(-2), respectively. In particularly, this equation overestimated the REE in 51.74% of patients with BMI < 16 kg m(-2). Huang equation involving body composition provided the highest percent of accurate prediction, 42.7% and 66.0% in patients with BMI < 16 and >40 kg m(-2), respectively. CONCLUSION Usual predictive equations of REE are not suitable for predicting REE in patients with extreme BMI, in particularly in patients with BMI <16 kg m(-2). Indirect Calorimetry may still be recommended for an accurate assessment of REE in this population until the development of an adapted predictive equation.
Collapse
Affiliation(s)
- Pierre Jésus
- INSERM Unit 1073, Rouen, France; Rouen University, Institute for Innovation and Biomedical Research, Rouen, France; Rouen University Hospital, Nutrition Unit, Rouen, France
| | - Najate Achamrah
- INSERM Unit 1073, Rouen, France; Rouen University, Institute for Innovation and Biomedical Research, Rouen, France; Rouen University Hospital, Nutrition Unit, Rouen, France
| | - Sébastien Grigioni
- INSERM Unit 1073, Rouen, France; Rouen University, Institute for Innovation and Biomedical Research, Rouen, France; Rouen University Hospital, Nutrition Unit, Rouen, France
| | | | - Agnès Rimbert
- Rouen University Hospital, Nutrition Unit, Rouen, France
| | - Vanessa Folope
- INSERM Unit 1073, Rouen, France; Rouen University, Institute for Innovation and Biomedical Research, Rouen, France; Rouen University Hospital, Nutrition Unit, Rouen, France
| | - André Petit
- INSERM Unit 1073, Rouen, France; Rouen University, Institute for Innovation and Biomedical Research, Rouen, France; Rouen University Hospital, Nutrition Unit, Rouen, France
| | - Pierre Déchelotte
- INSERM Unit 1073, Rouen, France; Rouen University, Institute for Innovation and Biomedical Research, Rouen, France; Rouen University Hospital, Nutrition Unit, Rouen, France
| | - Moïse Coëffier
- INSERM Unit 1073, Rouen, France; Rouen University, Institute for Innovation and Biomedical Research, Rouen, France; Rouen University Hospital, Nutrition Unit, Rouen, France.
| |
Collapse
|
13
|
Zipfel S, Mack I, Baur LA, Hebebrand J, Touyz S, Herzog W, Abraham S, Davies PSW, Russell J. Impact of exercise on energy metabolism in anorexia nervosa. J Eat Disord 2013; 1:37. [PMID: 24499685 PMCID: PMC4081773 DOI: 10.1186/2050-2974-1-37] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/27/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Excessive physical activity is one of the most paradoxical features of anorexia nervosa (AN). However, there is individual variation in the degree of physical activity found in AN-patients. As a result, marked differences in energy expenditure may be expected. Furthermore, exercise has a positive impact on a variety of psychological disorders and the psychopathology may be different in AN displaying high exercise levels versus AN displaying low exercise levels. We analyzed the energy metabolism and psychological data in low-level exercise and high-level exercise AN-patients compared with healthy, age matched controls. RESULTS REE was decreased in AN-patients compared with controls but not when adjusted for body surface area or lean body mass. No differences in TDEE between AN- patients and controls were observed. Subgroup analyses showed that the percentage of high-level AN- exercisers was higher compared with controls. This subgroup had increased resting EE, total daily EE and scored higher on depression and the EDI-item "Drive for thinness" compared with low-level AN-exercisers. CONCLUSIONS We identified a significant subgroup of high-level AN-exercisers (66%) with consecutive increased energy requirements. An easy way for clinicians to assess the amount of exercise before and in the course of treatment is a single question in the established Eating Disorder Inventory-SC (EDI-SC).
Collapse
Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine & Psychotherapy, University Medical Hospital Tuebingen, Osianderstr. 5, 72074 Tuebingen, Germany
- Department of Psychological Medicine, University of Sydney, Sydney, Australia
| | - Isabelle Mack
- Department of Psychosomatic Medicine & Psychotherapy, University Medical Hospital Tuebingen, Osianderstr. 5, 72074 Tuebingen, Germany
| | - Louise A Baur
- Department of Paediatrics & Child Health, University of Sydney, Sydney, Australia
| | - Johannes Hebebrand
- Department of Child & Adolescent Psychiatry, Univ. of Essen, Essen, Germany
| | - Stephen Touyz
- Department of Psychological Medicine, University of Sydney, Sydney, Australia
- School of Psychology and Discipline of Psychiatry, University of Sydney, Sydney, Australia
| | - Wolfgang Herzog
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany
| | - Suzanne Abraham
- Department of Obstetrics & Gynaecology, University of Sydney, Sydney, Australia
- Eating Disorders Unit, Northside Clinic, Greenwich NSW 2065, Australia
| | - Peter SW Davies
- Children’s Nutrition Research Centre, School of Medicine, University of Queensland, Brisbane, Australia
| | - Janice Russell
- Department of Psychological Medicine, University of Sydney, Sydney, Australia
- Eating Disorders Unit, Northside Clinic, Greenwich NSW 2065, Australia
| |
Collapse
|
14
|
Bredella MA, Fazeli PK, Freedman LM, Calder G, Lee H, Rosen CJ, Klibanski A. Young women with cold-activated brown adipose tissue have higher bone mineral density and lower Pref-1 than women without brown adipose tissue: a study in women with anorexia nervosa, women recovered from anorexia nervosa, and normal-weight women. J Clin Endocrinol Metab 2012; 97:E584-90. [PMID: 22259053 PMCID: PMC3319179 DOI: 10.1210/jc.2011-2246] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Anorexia nervosa (AN) is associated with depletion of body fat, loss of bone mineral density (BMD), and impaired thermogenesis. Brown adipose tissue (BAT) is lower in obese individuals and decreases during aging. Recent studies have suggested a link between BAT and bone metabolism. OBJECTIVE Our objective was to investigate the presence and quantity of BAT in patients with AN, recovered AN (AN-R), and normal-weight controls and to study the relationship between BAT and BMD and body composition and investigate hormonal predictors of BAT. DESIGN AND SETTING This was a cross-sectional study at a clinical research center. PATIENTS Patients included 15 women: five with AN (mean age 30 ± 6.3 yr), five AN-R, and five healthy nonobese controls of comparable age. MAIN OUTCOME MEASURES Cold-activated BAT was determined by fluorodeoxyglucose-positron emission tomography/computed tomography. BMD of total-body, spine, and hip, fat and lean mass was determined by dual-energy x-ray absorptiometry. Single-slice magnetic resonance imaging at L4 was done for abdominal fat compartments, and preadipocyte factor-1 (Pref-1), T₃, and T₄ were measured. RESULTS Within the AN group, one of five; in the AN-R group, two of five; and in the healthy nonobese control group, four of five subjects were BAT positive. Subjects were divided into groups based on the presence (n = 7) or absence (n = 8) of BAT. Both groups were of comparable age and body mass index. Women with BAT had higher total-body BMD, higher T₃, and lower Pref-1 compared with women without BAT. There was a positive correlation between BAT and BMD that remained significant after controlling for disease status and body mass index. CONCLUSION Young women with AN have low cold-activated BAT, which may be due to impaired BAT thermogenesis. Young women with BAT have higher BMD and lower Pref-1 compared with women without BAT, suggesting that BAT may be involved in the regulation of stem cell differentiation into the bone lineage at the expense of adipogenesis.
Collapse
Affiliation(s)
- Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, Massachusetts 02114, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
El Ghoch M, Alberti M, Capelli C, Calugi S, Dalle Grave R. Resting Energy Expenditure in Anorexia Nervosa: Measured versus Estimated. J Nutr Metab 2011; 2012:652932. [PMID: 21941638 PMCID: PMC3175729 DOI: 10.1155/2012/652932] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 04/07/2011] [Accepted: 07/20/2011] [Indexed: 11/18/2022] Open
Abstract
Introduction. Aim of this study was to compare the resting energy expenditure (REE) measured by the Douglas bag method with the REE estimated with the FitMate method, the Harris-Benedict equation, and the Müller et al. equation for individuals with BMI < 18.5 kg/m(2) in a severe group of underweight patients with anorexia nervosa (AN). Methods. 15 subjects with AN participated in the study. The Douglas bag method and the FitMate method were used to measure REE and the dual energy X-ray absorptiometry to assess body composition after one day of refeeding. Results. FitMate method and the Müller et al. equation gave an accurate REE estimation, while the Harris-Benedict equation overestimated the REE when compared with the Douglas bag method. Conclusion. The data support the use of the FitMate method and the Müller et al. equation, but not the Harris-Benedict equation, to estimate REE in AN patients after short-term refeeding.
Collapse
Affiliation(s)
- Marwan El Ghoch
- Department of Eating Disorder and Obesity, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
| | - Marta Alberti
- Department of Neurological, Neuropsychological, Morphological, and Exercise Sciences, University of Verona, 37131 Verona, Italy
| | - Carlo Capelli
- Department of Neurological, Neuropsychological, Morphological, and Exercise Sciences, University of Verona, 37131 Verona, Italy
| | - Simona Calugi
- Department of Eating Disorder and Obesity, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
| | - Riccardo Dalle Grave
- Department of Eating Disorder and Obesity, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
| |
Collapse
|
16
|
Harris AM, McAlpine DE, Shirbhate R, Manohar CU, Levine JA. Measurement of daily activity in restrictive type anorexia nervosa. Int J Eat Disord 2008; 41:280-3. [PMID: 18004719 PMCID: PMC2705949 DOI: 10.1002/eat.20486] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The assessment of daily activity in patients with restrictive type anorexia nervosa is limited by an absence of accurate and precise technology. We wanted to test a daily activity detecting device named, the physical activity monitoring system (PAMS). METHOD Women participants with restrictive type anorexia nervosa (n = 8, 36 +/- 11 years, 17 +/- 2 kg/m(2)) and healthy women participants (n = 8, 30 +/- 11 years, 27 +/- 7 kg/m(2)) were asked to lie, sit, and stand motionless, and walk at 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mph while wearing PAMS. RESULTS For all restrictive type anorexia nervosa and healthy participants, body posture was correctly detected for all measurements (300/300). There was excellent correlation of an individual's body acceleration with walking velocity and walking energy expenditure (r(2) > .99). CONCLUSION The PAMS technology could serve as a tool for lending insight into the pathophysiology of restrictive type anorexia nervosa; and potentially measuring compliance with activity recommendations for medical professionals treating individuals with restrictive type anorexia nervosa.
Collapse
Affiliation(s)
- Ann M. Harris
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905
| | | | - Rashmi Shirbhate
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905
| | | | - James A. Levine
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905
| |
Collapse
|
17
|
Abstract
AbstractAccurate information about the energy needs of a range of acute and chronic diseases and morbidity is lacking and often complicated by the medication prescribed to treat the condition and also because of the presence of pre-existing malnutrition. Assessing the energy requirements of patients with acute and chronic diseases is more complex than for those in good health. These requirements not only depend on the aggressiveness of the disease and level of inactivity it causes, but also on the treatment, and the presence of prior malnutrition. It used to be generally believed that the energy requirements were increased in a number of diseases. It is now realised that this is not usually the case. Therefore, it is necessary to put these changing ideas into context by considering a wide range of acute and chronic diseases which this paper proposes to do. This paper is almost exclusively restricted to studies that have measured total energy expenditure (TEE) using tracer techniques in both hospital and the community (mostly doubly labelled water and to a lesser extent bicarbonate–urea), and continuous 24–hour indirect calorimetry in artificially ventilated patients in hospital.
Collapse
Affiliation(s)
- Marinos Elia
- Institute of Human Nutrition, University of Southampton, Southampton General Hospital, UK.
| |
Collapse
|
18
|
Abstract
This paper discusses the hypothesis that a 'drive for activity" in the presence of physiological and endocrine changes consistent with starvation is a characteristic symptom of acute anorexia nervosa (AN). This 'drive for movement', along with alertness and lack of fatigue, so unlike the motor slowing and loss of energy observed in simple starvation has been recognized in AN throughout history, but has received little attention in the past fifty years. Clinical reports and experimental evidence suggest that 'restlessness' and a 'drive for activity' vary in intensity, they appears to be starvation-dependent and to wane with food intake. Central nervous system (CNS) systems known to be involved in mediating activity and arousal levels that are altered by the negative energy expenditure in AN are reviewed. Among these, the corticotropin-releasing hormone (CRH) system, the melanocyte stimulating hormone/agouti-related protein (MSH/AGRP) system and the norepinephrine/epinephrine (NE/EPI) and dopamine (DA) system may contribute to the 'drive for activity' and alertness in AN. AN appears to represent a disorder of gene/environment interaction. Future research will reveal whether in individuals predisposed to AN, the 'drive for activity' reflects the reactivation of mechanisms important in food scarcity, controlled by one or more evolutionary conserved genes including those regulating foraging behavior. Recognition of the 'drive for activity' as a diagnostic symptom of AN and its assessment prior to re-nutrition would permit clarification of its role in the etiology of AN.
Collapse
Affiliation(s)
- Regina C Casper
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Room 2365, CA 94305-5723, USA.
| |
Collapse
|
19
|
Afghani A, Barrett-Connor E, Wooten WJ. Resting Energy Expenditure: A Better Marker than BMI for BMD in African-American Women. Med Sci Sports Exerc 2005; 37:1203-10. [PMID: 16015139 DOI: 10.1249/01.mss.0000170080.87526.85] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE African-American women tend to be more overweight and to have lower resting energy expenditures (REE) compared with Caucasian women. Weight is associated with bone mineral density (BMD), but the relation between BMD and REE has not been reported. METHODS Four hundred postmenopausal African-American women aged 45-87 (yr) from San Diego, CA participated in this community-based cross-sectional study. Body composition (fat mass, lean body mass), bone mineral content (BMC) and BMD of the lumbar spine, hip (femoral neck, greater trochanter, intertrochanter), and total body were measured using dual energy x-ray absorptiometry (DXA). REE was calculated using the Harris-Benedict equation; grip strength was measured by isometric dynamometry. RESULTS REE (r range: 0.32-0.79) showed the strongest correlation with spine, total hip, and total body BMC and BMD. In stepwise multiple linear regressions adjusted for age and grip strength, REE explained 15% of the variance in spine BMD, 33% of the variance in total hip, and 32% of the total body BMD variance. REE explained 63% of the total body BMC variance. When body weight replaced REE in the models, weight became the strongest covariate of BMC and BMD but explained 1% less of the variance in spine BMD, 5% less of the variance in total hip BMD, 4% less of the variance in total body BMD, and 3% less of the variances in spine, total hip, and total body BMC than did REE. CONCLUSION In this cohort of African-American women, weight explained less of the BMC and BMD variance than REE. Poor energy economy may contribute to being overweight and may explain the lower rates of osteoporosis observed in African-American women.
Collapse
Affiliation(s)
- Afrooz Afghani
- College of Health Sciences, Touro University International, Cypress, CA 90630, USA.
| | | | | |
Collapse
|
20
|
Marra M, De Filippo E, Signorini A, Silvestri E, Pasanisi F, Contaldo F, Scalfi L. Phase angle is a predictor of basal metabolic rate in female patients with anorexia nervosa. Physiol Meas 2005; 26:S145-52. [PMID: 15798227 DOI: 10.1088/0967-3334/26/2/014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the study was to evaluate the relationship between basal metabolic rate (BMR) and bioelectrical impedance analysis (BIA) in undernourished female patients with anorexia nervosa. Participants were 86 female patients with anorexia nervosa (age 20.8+/-4.7 years; weight 39.3+/-5.2 kg; body mass index 15.4+/-1.6 kg m-2). BMR was measured by indirect calorimetry and single-frequency BIA was determined at 50 kHz on the whole body. The BIA variables considered were resistance, reactance, phase angle and the bioimpedance index (height2/resistance). Fat-free mass was calculated from subcutaneous skin fold thickness. In the study group BMR was 3782+/-661 kJ d-1 while bioimpedance index varied between 27.6 and 49.9 cm2 Omega-1 and phase angle between 2.54 degrees and 6.49 degrees. BMR was significantly correlated with weight, height, body mass index and fat-free mass, and, among BIA variables, with reactance and phase angle. Multiple regression analysis indicated that phase angle was a predictor of BMR not only when solely BIA variables were considered, but also in combination with either weight and age or fat-free mass. In conclusion, phase angle emerged as a strong predictor of BMR in female patients with anorexia nervosa. Nevertheless, further studies are necessary to confirm this finding in other forms of protein energy malnutrition and justify the inclusion of BIA variables in the equations used to predict BMR in the clinical setting.
Collapse
Affiliation(s)
- Maurizio Marra
- Department of Clinical and Experimental Medicine, Federico II University, Napoli, Italy.
| | | | | | | | | | | | | |
Collapse
|
21
|
Albanese CV, Diessel E, Genant HK. Clinical applications of body composition measurements using DXA. J Clin Densitom 2003; 6:75-85. [PMID: 12794229 DOI: 10.1385/jcd:6:2:75] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2002] [Accepted: 01/29/2003] [Indexed: 01/05/2023]
Abstract
Dual-energy X-ray absorptiometry (DXA) scanning was primarily developed for the diagnosis of osteoporosis and was initially applied to studies of the clinically important sites of the lumbar spine, femoral neck, and forearm. The rapid adoption of DXA has led to the development of different, competing generations of equipment. Improvements have been achieved through advances in X-ray generation and detection technology, modification of data acquisition protocols, and implementation of more sophisticated image analysis algorithms. As a result, DXA has been extended to allow the study of the total skeleton and its regional parts, as well as soft-tissue composition measurement. The three major components of the body: fat mass, lean mass, and bone mineral mass, can now be easily measured using a single whole body DXA scan with high precision and low scanning time. The comprehensive view of body composition provided by DXA makes it an attractive technique for a variety of clinical applications such as the prevention of cardiovascular and metabolic diseases, clinical management of different chronic diseases, and monitoring of the impact of treatment regimens on body tissues. In this article we review the contribution DXA has made to the understanding of body composition in clinical studies in adults.
Collapse
Affiliation(s)
- Carlina V Albanese
- Osteoporosis and Bone Pathology Unit of Study, Institute of Radiology, University of Rome La Sapienza, Viale Regina Elena, 326, 00161 Rome, Italy.
| | | | | |
Collapse
|
22
|
de Zwaan M, Aslam Z, Mitchell JE. Research on energy expenditure in individuals with eating disorders: a review. Int J Eat Disord 2002; 32:127-34. [PMID: 12210654 DOI: 10.1002/eat.10074] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD Individual studies are reviewed and their results summarized. RESULTS The most consistent finding is a reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION The ability to measure REE reliably and cost-effectively may aid in the refeeding of patients with AN in whom REE is reduced. Changes in individuals with BN and BED have yet to be consistently identified.
Collapse
Affiliation(s)
- Martina de Zwaan
- The Neuropsychiatric Research Institute, Fargo, North Dakota 58107, USA
| | | | | |
Collapse
|
23
|
de Zwaan M, Aslam Z, Mitchell JE. Research on energy expenditure in individuals with eating disorders: a review. Int J Eat Disord 2002; 31:361-9. [PMID: 11948641 DOI: 10.1002/eat.10047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD Individual studies are reviewed and their results summarized. RESULTS The most consistent finding is evidence of reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION The ability to reliably and cost-effectively measure REE may aid in the refeeding of patients with AN where REE is reduced. Changes in BN and BED subjects have yet to be identified consistently.
Collapse
Affiliation(s)
- Martina de Zwaan
- The Neuropsychiatric Research Institute and the Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota 58107, USA
| | | | | |
Collapse
|
24
|
Kutílek S, Bayer M. Ultrasound parameters of calcaneal bone density in girls with anorexia nervosa. Eat Weight Disord 2001; 6:220-4. [PMID: 11808818 DOI: 10.1007/bf03339746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Osteoporosis is common in patients with anorexia nervosa (AN), but ultrasound has so far been scarcely used to detect it We measured calcaneal broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in 26 AN girls (mean age 15.1+/- 1.5 years) using a Cuba Clinical device (McCue Ultrasonics, UK). Basic anthropometric (body weight, height and body mass index--BMI) and clinical data (mean duration of AN, number of absent cycles, weight loss) were collected. All of the girls reported that they did at least one hour's vigorous exercise a day. BUA was significantly lower (p<0.004) and VOS significantly higher (p<0.0001) in comparison with reference data. Body weight and BMI at the time of the measurements were significantly lower than the reference data (p<0.0001). There were no correlations between body weight or height and BUA or VOS, but there was a slight correlation between BUA and BMI (r=0.4, p<0.05) and a slight inverse correlation between VOS, body weight and BMI (r=-0.48 and r=-0.43, p<0.01). VOS slightly correlated with weight loss (r=0.4, p<0.05), significantly with the weekly number of exercise hours (r=0.48, p<0.01). The duration of AN, the number of missed cycles and the percentage of weight loss did not correlate with BUA, and neither the duration of AN nor the number of missed cycles correlated with VOS. The low BUA value could be attributed to poor nutrition, and substantial physical activity may lead to the increase in VOS. In conclusion, girls with AN have low BUA and high VOS values, neither of which correlate with the duration of AN or the number of missed cycles.
Collapse
Affiliation(s)
- S Kutílek
- Department of Pediatrics, 1st Medical Faculty, Charles University, Prague, Czech Republic.
| | | |
Collapse
|
25
|
Scalfi L, Marra M, De Filippo E, Caso G, Pasanisi F, Contaldo F. The prediction of basal metabolic rate in female patients with anorexia nervosa. Int J Obes (Lond) 2001; 25:359-64. [PMID: 11319633 DOI: 10.1038/sj.ijo.0801547] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2000] [Revised: 08/04/2000] [Accepted: 10/02/2000] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate in female patients with anorexia nervosa the accuracy of a specific predictive formula for basal metabolic rate (BMR) already proposed in the literature and to derive a new disease-specific equation with the same purpose. DESIGN Cross-sectional study. SUBJECTS One-hundred and twenty adolescent girls (<18 y) and young-adult women (18-30 y) with anorexia nervosa. MEASUREMENTS BMR was determined by indirect calorimetry or predicted according to the Schebendach formula, which was specifically derived for anorexia nervosa. RESULTS On average the Schebendach formula performed well in the adolescent group but not in the young-adult group. The range including 95% of the predicted-measured differences was in both cases wider than 2000 kJ/day. In the young-adult patients the accuracy of the prediction was also related to age and body mass index. Weight and age (but not height or body mass index) emerged as predictors of BMR in the sample as a whole, and only weight when the two age groups were considered separately, thus leading to three different equations. The intercepts of these regression lines were very close and not significantly different from zero while their standard error of estimate was 500-550 kJ/day. CONCLUSION The Schebendach formula is not very accurate in estimating the BMR of female anorectic patients. Moreover, in this group the relationship between BMR and weight was altered. The predictive formulas proposed by the present study have a reasonable prediction power.
Collapse
Affiliation(s)
- L Scalfi
- Human Nutrition and Dietetics, Department of Food Science, Federico II University, via Università 100, Portici, Napoli, Italy.
| | | | | | | | | | | |
Collapse
|
26
|
Pagliato E, Corradi E, Gentile MG, Testolin G. Changes in body composition and resting energy expenditure in anorectic patients after a weight gain of fifteen percent. Ann N Y Acad Sci 2000; 904:617-20. [PMID: 10865815 DOI: 10.1111/j.1749-6632.2000.tb06526.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Pagliato
- International Center for the Assessment of Nutritional Status, University of Milan, Italy.
| | | | | | | |
Collapse
|
27
|
Abstract
PURPOSE To compare whole-body, lumbar, total spine, and pelvis bone mineral density (BMD), body mass index (BMI), body composition, energy expenditure for physical activity, and dietary intake of adolescents, aged 16-22 years. METHODS Three study groups included 25 girls with histories of eating disorderd, 25 girls with no histories of eating diso rders who exercised < or = 7 hours/week, and 15 girls with no history of eating disorders who exercised > 7 hours/week. Bone mineral density was measured by dual-energy x-ray absorptiometry (DEXA), body composition by bioelectric impedance and DEXA, energy expenditure by Personal Activity Computer, nutrient intake by 4-day dietary recalls/records, and BMI by measures of height/weight. General linear models, LSM +/- SEM, Student's t-tests, and correlation analyses were used to determine group differences. RESULTS No significant differences in whole-body, spinal, and pelvis BMD were found among the three groups. Mean body fat (percent) was significantly higher (p =.0001) for the group with histories of eating disorders than other groups. Dietary intakes of adolescents with histories of eating disorders were significantly lower for energy (p =.0001), fat (p =.0001), calcium (p =.0007), vitamin D (p =.0180), and zinc (p =.0057) than those without eating disorder histories who exercised </= 7 hours/week. CONCLUSION Except for body fat (percent), measures of BMD, energy expenditure, and BMI were not significantly different among groups. Our data suggest that with full recovery from eating disorders, teenage girls can achieve normal bone mass and body composition.
Collapse
Affiliation(s)
- B R Carruth
- Department of Nutrition, University of Tennessee-Knoxville, Knoxville, TN 37996-1900, USA
| | | |
Collapse
|