Body fat redistribution after weight gain in women with anorexia nervosa

BACKGROUND: Body image distortions are a core feature of anorexia nervosa (AN). Increasing evidence suggests that the fat distribution immediately after weight restoration in patients with AN differs from the distribution typical of healthy adult women. OBJECTIVE: The purpose of this study was to assess body fat distribution before and shortly after normalization of weight in women with AN. DESIGN: Body composition and fat distribution were assessed by anthropometry, dual-energy X-ray absorptiometry, and whole-body magnetic resonance imaging in 29 women with AN before and after weight normalization and at a single time point in 15 female control subjects. Hormone concentrations were also evaluated in patients and control subjects. RESULTS: During approximately 10.1 +/- 2.9 wk (range: 4-17.3 wk) of treatment, patients with AN gained 12.2 +/- 3.6 kg, and refed weight (54.1 +/- 4.2 kg) did not differ significantly from that of control subjects (54.7 +/- 4.4 kg). Waist-to-hip circumference ratio (P < 0.006), total trunk fat (P < 0.003), visceral adipose tissue (P < 0.006), and intramuscular adipose tissue (P < 0.003) were significantly greater in the weight-recovered patients than in the control subjects. In contrast, after refeeding, total subcutaneous adipose tissue and skeletal muscle mass did not differ significantly between the patients and control subjects. In patients with AN, serum cortisol decreased and serum estradiol increased significantly with refeeding but not to control concentrations. CONCLUSIONS: In women with AN, normalization of weight in the short term is associated with an abnormal distribution of body fat. The implications of these findings for the long-term psychological and physical health of women with AN are unknown.     

Vitamin status in patients with anorexia nervosa and bulimia nervosa

Vitamin status of 24 bulimic and 8 anorectic patients was determined. Intake of vitamins A, E, C, B₁, B₂, B₆, B₁₂, and folic acid is clearly reduced. Save vitamin C contrentration, which is reduced in several patients, all vitamin plasma values lie in the reference range. Great variability in the vitamin plasma concentrations was observed. Four patients had very high, almost toxic, retinol concentrations. The activation of erythrocytic transketolase, glutathione reductase, and aspartate transketolase is enhanced in a few patients. A plausible cause is a lack of vitamin B₁, B₂, and B₆. Five patients have a prolonged prothrombin time, perhaps resulting from a vitamin K deficiency. All these results show that the vitamin status of bulimic and anorectic patients should be controlled regularly in order to prevent severe vitamin deficiencies or intoxications.     

Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa

BACKGROUND: Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States. OBJECTIVE: The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa. DESIGN: Twenty-seven amenorrheic women aged 26.6 +/- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were randomly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements. Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy, eumenorrheic, age-matched (25.4 +/- 0.5 y) control subjects. RESULTS: Twenty of the 27 patients with anorexia aged 27.0 +/- 1.3 y spontaneously gained weight (4.1 +/- 0.9 kg); body mass index (in kg/m(2)) increased from 16.1 +/- 0.3 to 17.5 +/- 0.4. Fat mass and lean mass accounted for 68% and 32% of the gain in total body mass, respectively. With spontaneous weight gain, there was a significant increase in the percentage of trunk fat from 32.4 +/- 1.3% at baseline to 36.5 +/- 1.0% at 9 mo (P = 0.03), which correlated with urinary free cortisol (r = 0.66, P = 0.003). Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain. CONCLUSIONS: In women with anorexia nervosa, spontaneous weight gain is associated with a significant increase in trunk adiposity, and estrogen administration may not protect against the accumulation of central fat with weight gain.     

Caloric requirements for weight gain in anorexia nervosa.

The caloric requirements for weight gain were studied in 29 patients during 35 days of treatment for anorexia nervosa. Associations between the caloric requirements for weight gain and the amount of body weight depletion at the beginning of treatment were analyzed. There was a positive correlation between the percentage standard weight on the 1st day of treatment and the excess calories required to gain a kilogram. This highly significant correlation was possibly due to differences in type to tissue formed and/or an increase in metabolic rate as part of an adaptive response, as the patient nears target weight.     

Brain tissue volume changes following weight gain in adults with anorexia nervosa

Objective:

To measure brain volume deficits among underweight patients with anorexia nervosa (AN) compared to control participants and evaluate the reversibility of these deficits with short‐term weight restoration.

Method:

Brain volume changes in gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were examined in 32 adult women with AN and compared to 21, age and body mass index‐range matched control women.

Results:

Patients with AN had a significant increase in GM (p = .006, η² = 0.14) and WM volume (p = .001, η² = 0.19) following weight restoration. Patients on average had lower levels of GM at low weight (647.63 ± 62.07 ml) compared to controls (679.93 ± 53.31 ml), which increased with weight restoration (662.64 ± 69.71 ml), but did not fully normalize.

Discussion:

This study suggests that underweight adult patients with AN have reduced GM and WM volumes that increase with short‐term weight restoration. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2011; 44:406–411)     

The effects of bone therapy on tibial bone loss in young women with anorexia nervosa

OBJECTIVE: Osteoporosis is recognized as a common medical complication of anorexia nervosa (AN). The purpose of the current study was to investigate the recovery mechanism of osteoporosis in AN and the effect of medical treatment on the skeletal system. METHOD: We conducted a randomized placebo-controlled study of the effects of etidronate and calcium and vitamin D on bone loss in 41 outpatients with the restricting type of AN (AN-R). We measured the tibial speed of sound (SOS) before and after 3 months of treatment. RESULTS: The bone mineral density (BMD) of the tibial SOS change in both the etidronate group and the calcium and vitamin D Group was significantly greater (p < .001) than in the control group. Urine-N-telopeptide cross-links of type I collagen (NTx) before and after treatment decreased significantly (p < .01) in the etidronate group. CONCLUSION: These findings suggest that both etidronate and calcium and vitamin D are equally efficacious for reversing the degree of osteoporosis in patients with AN.     

Aggressive family communication,weight gain,and improved eating attitudes during systemic family therapy for anorexia nervosa

During systemic family therapy with 15 hospitalized anorexics, family communication was evaluated, using a Family Aggression Scale developed by one of the authors. Initially members communicated aggression covertly. This finding may partially explain the common clinical observation that the families of anorexics present a strong facade of togetherness and avoid overt conflict. During therapy members shifted from covert communication of aggression to overt communication of aggression. This shift correlated with improvement in subjects' eating attitudes reflected by their EAT-26 scores. All subjects gained weight. Greater weight gain occurred in subjects whose families had low levels of covert or indirect aggression. A regression analysis showed that 86% of the variance in weight gain was predicted by two leading indicators in the middle phase of treatment. Two other factors accounted for 64% of the variance in EAT scores. The findings of this study suggest that family aggression as measured by the Family Aggression Scale is a significant index of pathology in anorexics' families and is also a clinically meaningful measure of improved conflict resolution during systemic family therapy. © 1995 by John Wiley & Sons, Inc.     

Mood change during weight restoration in patients with anorexia nervosa

OBJECTIVE: Although depression is known to co-occur with anorexia nervosa (AN), there are few clear studies of mood in the context of weight gain treatment without the use of medication. Method: Twenty-one patients admitted consecutively to an inpatient clinical research unit normalized weight to at least 90% of ideal body weight (IBW). Depression was assessed at admission and weight normalization (pre-discharge) with the Beck Depression Inventory (BDI). RESULTS: Multivariate F tests showed BDI scores to be significantly improved across these two time points (BMI: F(2,20) = 166.58, p = 0.000; BDI: F(2,19) = 22.64, p = 0.000). Moreover, improvement in mood was also evident at partial weight restoration (80% IBW). CONCLUSION: Patients with AN undergoing nutritional rehabilitation and psychotherapy on an inpatient unit present with significant depressive symptoms as measured by the BDI, and, with weight restoration, demonstrate statistically significant improvement in mood symptoms without the use of adjunctive medication. Data at partial weight restoration suggest that these results cannot be explained by improved mood related to anticipation of discharge.     

Cardiac function during weight restoration in anorexia nervosa

Fifteen anorexia nervosa patients were evaluated on hospitalization at their lowest weights; 10 were restudied after 25% of their weight deficit had been restored and five at 75% weight restoration. Cardiac function improved with weight gain, but different aspects of cardiac performance varied in their course of recovery. Restoration of normal cardiac rhythm occurred early in weight gain. Left ventricular mass index assessed by echocardiogram increased significantly by 25% weight restoration, while other echocardiographic abnormalities, including mitral valve prolapse, did not change markedly during weight recovery. Overall functional exercise capacity improved, but not until 75% of weight restoration. Consistent with the concept that systolic function lags in recovery, resting left ventricular ejection fraction (LVEF) actually demonstrated a trend to decline by the time 25% of the weight deficit was restored.