Body composition of anorexia nervosa patients assessed by underwater weighing and skinfold-thickness measurements before and after weight gain

Body composition and energy expenditure in anorexia nervosa: preliminary data of outpatients with recovering and active disease

BACKGROUND

In Anorexia Nervosa (AN) recovery, body mass index (BMI) may not reflect body composition. To investigate recovery, bioelectrical impedance (BIA) parameters and energy expenditure were investigated in patients with active and recovering AN, with emphasis on phase angle (PA), a BIA parameter.

METHODS

BMI, PA, indirect BIA parameters (fat free mass, fat mass, total body water, fat free mass index, fat mass index) and resting metabolic rate (RMR) were obtained. Data from subjects distributed to active AN (ANact, n = 9), recovered AN (ANrec, n = 9) and healthy individuals (HI) (n = 16) were compared employing univariate methods and ordinal logistic regression.

RESULTS

In univariate comparison, the BMI would not distinguish recovered individuals; this distinction was observed for the PA (p =  < 0,001). PA showed a good capacity to discriminate, between ANrec and HI (AUC = 0.792; CI = 0.564- 1.000; p = 0.017). In 2 models of ordinal logistic regression PA (OR = 0.123; 95% CI 0.030; 0.503 and OR = 0.091; 95% CI 0.016; 0.528) remained as a significant independent variable, indicating that increases in PA are related to higher probabilities of moving from ANact, to ANrec and to HI group. Bivariate regression indicated the presence of a relationship between PA and (R2 = 0.266, p = 0.002).

CONCLUSIONS

Changes in body composition and energy expenditure were observed in recovered anorexics with normal BMI. PA can play an important role in the assessment of recovering anorexic patients.

Body Composition in Adolescents and Young Adults with Anorexia Nervosa: A Clinical Review

BACKGROUND

Anorexia nervosa is a serious health condition characterized by a significant low body weight and alteration in body composition components.

AIM

In the current paper, we aim to summarize the available literature concerning changes in body fat, lean, and bone masses, during anorexia nervosa and after complete weight restoration.

METHODS

Data were summarized using a narrative approach based on clinical expertise in the interpretation of the available evidence base in the literature.

RESULTS

The available data revealed three main findings. Firstly, anorexia nervosa causes a significant reduction in body fat mass, however it is completely restored after short-term weight normalization but with a central adiposity phenotype that does not seem to negatively influence treatment outcomes and appears to normalize after 1 year of normal weight maintenance. Secondly, anorexia nervosa causes a significant reduction in bone mineral density, but weight restoration is associated first (≈12 months) with stabilization of bone mineral density, followed by improvements (after ≈16 months); and finally, with complete normalization (after ≈30 months) after normal-weight maintenance. Thirdly, during anorexia nervosa loss of lean and skeletal body mass occurring in particular from the extremities rather than the central regions has been consistently reported, especially in patients with a Body Mass Index (BMI) ≤ 16.5 Kg/m2 however short-term weight restoration is associated with complete normalization.

CONCLUSION

Anorexia nervosa adversely affects body composition, however this medical complication seems to be reversible through the main treatment strategy of body weight restoration followed by normal weight maintenance, and this should be openly discussed with patients.

Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers

Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m²), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9-18.9 years) with a diagnosis of AN (n = 404) or atypical AN (n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity.

IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META-ANALYSIS

The resumption of menses (ROM) is an important outcome in anorexia nervosa treatment and is considered as a sign of recovery. Identification of relevant factors in its prediction is important in clinical practice. Therefore we aimed to conduct a systematic review and exploratory meta-analysis of the association between total body fat percentage (%BF) and ROM after weight restoration in adolescents and young adults with anorexia nervosa. The study was conducted by adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 604 articles retrieved, only seven studies comprising a total of 366 adolescent and young adult females with anorexia nervosa met the inclusion criteria and were reviewed, and preliminary results revealed three main findings. Firstly, patients who resumed their menstrual cycle had a significantly higher mean %BF when compared to those who did not, an overall effect confirmed by the meta-analysis (SMD: 3.74, 95% CI: 2.26-5.22). Secondly, %BF was found to be an independent predictor of the ROM in this population and an increase of only one unit of %BF can increase the odds of menstruation by ≈15-20%. Thirdly, despite the paucity of data, a cut-off point of %BF≈21was suggested as the minimum needed for ROM. In conclusion, a higher %BF seems to be associated with the ROM in weight-restored adolescent and young adult females with anorexia nervosa. Its assessment is important in a clinical setting, especially after complete weight restoration. The PROSPERO Registry - A systematic review and meta-analysis of the factors associated with the resumption of the menstrual cycle in females with anorexia nervosa after weight restoration (CRD42019111841).

High-intensity exercise is associated with a better nutritional status in anorexia nervosa

OBJECTIVE

Our aim is to investigate the links between duration and intensity of exercise and the nutritional status in terms of body composition in acute anorexia nervosa (AN) patients.

METHOD

One hundred ninety-one hospitalized women suffering from AN were included. Exercise duration and intensity were assessed using a semistructured questionnaire. Body composition was measured using bioelectrical impedance. Linear multiple regression analyses were carried out using body mass index, fat-free mass index, and fat mass index as dependent variables and including systematically exercise duration, exercise intensity, and other confounding variables described in the literature that were significantly associated with each dependent variable in univariate analysis.

RESULTS

A lower BMI was linked to lower exercise intensity, AN restrictive type, and presence of amenorrhea. A lower FFMI was linked to lower exercise intensity, older age, AN restrictive type, and premenarchal AN. Duration of exercise was not linked to the nutritional status.

CONCLUSIONS

Exercising at higher intensity in AN is associated with a better nutritional status, thus, a better resistance to starvation. The impact of therapeutic physical activity sessions, adapted in terms of exercise intensity and patient's clinical status, should be evaluated during nutrition rehabilitation.

Feasibility and acceptability of the Bod Pod procedure and changes in body composition from admission to discharge in adolescents hospitalized with eating disorders

The feasibility and acceptability of using the Bod Pod procedure to measure changes in body composition in 30 adolescent females admitted to an inpatient eating disorder unit was evaluated using written surveys, Bod Pod measurements obtained at admission and discharge, and medical records review. Participants rated the Bod Pod test as acceptable (100%; 30/30), comfortable (93%, 28/30), and they were willing to repeat the procedure (97%, 29/30). Ten participants did not complete the final Bod Pod: eight were discharged before a second measure could be obtained, one refused the test, and one left against medical advice. Three participants had undetectable readings at admission. Paired t-tests (n = 17) revealed a significant (p < 0.001) mean increase in fat mass (3.7 ± 2 kg), body fat percentage (6.6 ± 3.8%), and lean mass (1.4 ± 1.2 kg) from admission to discharge. The Bod Pod is a feasible and acceptable procedure to measure changes in body composition in adolescent females hospitalized with an eating disorder.

Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome

The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome.

Relationship between affective symptoms and malnutrition severity in severe Anorexia Nervosa

Background

Very few studies have investigated the relationship between malnutrition and psychological symptoms in Anorexia Nervosa (AN). They have used only body weight or body mass index (BMI) for the nutritional assessment and did not always report on medication, or if they did, it was not included in the analysis of results, and they did not include confounding factors such as duration of illness, AN subtype or age. The present study investigates this relationship using indicators other than BMI/weight, among which body composition and biological markers, also considering potential confounders related to depression and anxiety.

Methods

155 AN patients, (DSM-IV) were included consecutively upon admission to inpatient treatment. Depression, anxiety, obsessive behaviours and social functioning were measured using various scales. Nutritional status was measured using BMI, severity of weight loss, body composition, and albumin and prealbumin levels.

Results

No correlation was found between BMI at inclusion, fat-free mass index, fat mass index, and severity of weight loss and any of the psychometric scores. Age and medication are the only factors that affect the psychological scores. None of the psychological scores were explained by the nutritional indicators with the exception of albumin levels which was negatively linked to the LSAS fear score (p = 0.024; beta = −0.225). Only the use of antidepressants explained the variability in BDI scores (p = 0.029; beta = 0.228) and anxiolytic use explained the variability in HADs depression scores (p = 0.037; beta = 0.216).

Conclusion

The present study is a pioneer investigation of various nutritional markers in relation to psychological symptoms in severely malnourished AN patients. The clinical hypothesis that malnutrition partly causes depression and anxiety symptoms in AN in acute phase is not confirmed, and future studies are needed to back up our results.

Can birth weight predict later body composition in anorexia nervosa?

BACKGROUND/OBJECTIVES

The relationship between birth weight and body composition at later stages in life was not studied previously in anorexia nervosa (AN). The aim of the following brief report is to present results concerning the relationship between birth weight and later body composition specifically in AN, and to check if the programming of body composition from birth weight is still detected in severely emaciated AN patients.

SUBJECTS/METHODS

One hundred and fifty-one female AN patients aged between 13 and 44 were recruited from 11 inpatient treatment facilities in France. Birth weight, body weight and height were obtained. Body composition was measured using bioelectrical impedance. Birth weight was significantly correlated to lifetime maximum body mass index (BMI; r=0.211, P=0.009) and significantly correlated to fat-free mass index (r=0.190, P=0.027) but not to fat mass index (FMI).

RESULTS

This report confirms that even in AN when patients are severely emaciated and where fat-free mass (FFM) and fat mass (FM) are low, a link between birth weight and FFM and BMI can still be identified, independently from age.

CONCLUSION

Further studies are needed on larger samples exploring other factors, such as gender, puberty and ethnicity.

Thigh circumference as a useful predictor of body fat in adolescent girls with anorexia nervosa

BACKGROUND/AIM

Girls with anorexia nervosa (AN) demonstrate severe depletion of body fat. The aim of this study was to determine an accurate anthropometric measurement for clinical assessment of fat depletion in girls with AN in connection with body composition measured by dual-energy X-ray absorptiometry (DXA).

METHODS

In 64 female AN patients aged 12.8-23.1 years (mean 16.0 ± 1.8), body mass index (BMI), skinfold thickness (subscapular, abdominal and triceps), mid-upper arm and thigh circumference, fat mass (FM) and lean mass were determined and compared with the data of 71 controls.

RESULTS

Girls with AN had lower anthropometric traits and were fat depleted compared to controls (14.9 ± 7.3 vs. 27.4 ± 6.4% of FM using DXA; all p < 0.001). BMI, thigh circumference and subscapular skinfold thickness demonstrated a very similar predictive value for DXA assessment of body fat. Based on the receiver-operating characteristic curve analysis and the determination of the positive predictive value, thigh circumference appeared the most specific and sensitive anthropometric predictor of fatness discriminating between AN and healthy girls, with the AUC value reaching 0.95 (95% CI = 0.92-0.97). Using a cutoff value of 49.6 cm, accuracy was 90.6%, sensitivity 93% and specificity 88.7%.

CONCLUSIONS

Thigh circumference strongly correlates with DXA-FM and demonstrates a slight clinical advantage over BMI. This simple measurement might also serve as a useful predictor of body fatness in adolescent girls with AN and should therefore be further evaluated in independent cohort studies.

Anorexia nervosa and nutritional assessment: contribution of body composition measurements

The psychiatric condition of patients suffering from anorexia nervosa (AN) is affected by their nutritional status. An optimal assessment of the nutritional status of patients is fundamental in understanding the relationship between malnutrition and the psychological symptoms. The present review evaluates some of the available methods for measuring body composition in patients with AN. We searched literature in Medline using several key terms relevant to the present review in order to identify papers. Only articles in English or French were reviewed. A brief description is provided for each body composition technique, with its applicability in AN as well as its limitation. All methods of measuring body composition are not yet validated and/or feasible in patients with AN. The present review article proposes a practical approach for selecting the most appropriate methods depending on the setting, (i.e. clinical v. research) and the goal of the assessment (initial v. follow-up) in order to have a more personalised treatment for patients suffering from AN.

Monitoring nutritional status accurately and reliably in adolescents with anorexia nervosa

AIM

Accurate assessment of nutritional status is a vital aspect of caring for individuals with anorexia nervosa (AN) and body mass index (BMI) is considered an appropriate and easy to use tool. Because of the intense fear of weight gain, some individuals may attempt to mislead the physician. Mid-upper arm circumference (MUAC) is a simple, objective method of assessing nutritional status. The setting is an eating disorders clinic in a tertiary paediatric hospital in Western Australia. The aim of this study is to evaluate how well MUAC correlates with BMI in adolescents with AN.

METHODS

Prospective observational study to evaluate nutritional status in adolescents with AN.

RESULTS

Fifty-five adolescents aged 12-17 years with AN were assessed between January 1, 2004 and January 1, 2006. MUAC was highly correlated with BMI (r = 0.79, P < 0.001) and individuals with MUAC >or=20 cm rarely required hospitalisation (negative predictive value 93%).

CONCLUSIONS

MUAC reflects nutritional status as defined by BMI in adolescents with AN. Lack of consistency between longitudinal measurements of BMI and MUAC should be viewed suspiciously and prompt a more detailed nutritional assessment.

Body composition in girls and young women with anorexia nervosa: comparison of different equations

OBJECTIVE

The weight percentage of body fat in anorexic adolescents on the basis of four distinct formulas (Siri; Lohman; Westrate and Deurenberg; Heyward and Stolarczyk) is compared.

METHOD

The body composition of 238 anorexia nervosa (AN) patients, divided into four age categories (13-15, 15-17, 17-19, and 19-22 years), was measured by means of densitometry (underwater weighing).

RESULTS

Depending on the formula, the results calculated by the formulas differ significantly in each age category. The Siri formula generally results in the highest mean fat percentage (12.76%-13.39%) whereas the Heyward and Stolarczyck formula shows the lowest figures (8.77%-9.31%). Applying the Lohman and the Heyward and Stolarczyck formulas to the 19-22 years category, results in negative fat percentages.

CONCLUSION

A clinically useful formula is important for the estimation of body composition in specific age categories. We recommend with some restrictions, to apply the Siri formula in AN patients.

Composição corporal em crianças de sete a 10 anos de idade, de alto nível socioeconômico

O objetivo deste estudo foi analisar a composição corporal de crianças de sete a 10 anos de idade, de alto nível socioeconômico. Para tanto, 511 crianças (274 meninos e 237 meninas) foram submetidas a medidas antropométricas de massa corporal, estatura e espessuras de dobras cutâneas tricipital (TR) e subescapular (SE). Com base nessas informações, foram determinados: gordura corporal relativa (% Gordura), massa corporal magra (MCM), distribuição da gordura corporal (DGC) e o somatório da espessura das dobras cutâneas TR e SE (ΣEDC). Anova two-way foi utilizada para as comparações entre os sexos e os diferentes grupos etários, seguida pelo teste post hoc de Scheffé quando P < 0,05. Para a classificação das crianças, de acordo com as categorias de adiposidade corporal, foi utilizada distribuição de freqüência. O teste de comparação entre proporções foi adotado para verificar as diferenças entre os sexos, em cada categoria (P < 0,05). Diferenças significantes entre os sexos (P < 0,05) foram verificadas na dobra TR (meninas > meninos) e na MCM (meninos > meninas). Efeito significante da idade foi identificado em todas as variáveis analisadas, exceto na DGC, com os valores mais elevados sendo encontrados no grupo etário de 10 anos. Um percentual elevado, tanto de meninos quanto de meninas, apresentou índice de adiposidade alto, com superioridade para os meninos (28% vs. 14%, P < 0,01). Por outro lado, um contingente maior de meninas apresentou concentrações de gordura corporal relativa abaixo dos pontos de corte desejáveis (15% vs. 3%, P < 0,01). Os valores de adiposidade corporal encontrados no presente estudo sugerem que um percentual elevado de crianças, de ambos os sexos, já apresenta importantes fatores de risco à saúde, em idades precoces.

How accurate are predictive formulas calculating energy expenditure in adolescent patients with anorexia nervosa?

BACKGROUND & AIMS

To compare resting energy expenditure, measured by indirect calorimetry, to values estimated by different predictive formulas in adolescent patients with anorexia nervosa.

METHODS

We studied 22 female in-patients with a mean age of 14.7 years (SD 1.2). Resting energy expenditure was measured by indirect calorimetry (Deltatrac II MBM-200). We compared measured resting energy expenditure to values estimated by several predictive formulas [Fleisch, Harris-Benedict, FAO, Schofield-HW, Schebendach] using the intraclass correlation coefficient and the Bland-Altman method.

RESULTS

Body mass index increased significantly (P<0.001). Measured resting energy expenditure increased during hospitalization (P<0.05). All formulas overestimated resting energy expenditure with respect to indirect calorimetry except the Schebendach formula. The intraclass correlation between indirect calorimetry and the formulas were poor (0.09-0.20). We observed a poor clinical agreement (Bland-Altman).

CONCLUSIONS

Body mass index and resting energy expenditure increased during hospitalization. The majority of the predictive formulas overestimate resting energy expenditure in adolescent patients with anorexia nervosa. Therefore, indirect calorimetry may be a very useful tool for calculating caloric requirements in these patients.

Dynamic monitoring of restricted eating disorders by indirect calorimetry: a useful cognitive approach

OBJECTIVE

Outpatient treatment in restricted eating disorder: indirect calorimetry during dynamic monitoring.

DESIGN

A retrospective observational study.

SUBJECTS

Twenty seven women affected by restricted eating disorder (essentially anorexia nervosa) with a body mass index [weight (kg)/height (m2)] of 17.29+/-2.47 were studied. The sample was compared as itself control during rehabilitative way.

INTERVENTIONS

Fat mass (FM) and fat free mass (FFM) were determined by anthropometry technique. REE/day and respiratory quotient (RQ,VCO2/VO2) were measured by indirect calorimetry using a Calorimeter Vmax 29n-Sensor Medics-California. Skinfold thickness and circumferences were also measured. Arm muscle area (AMA) and fat area were calculated by formulas reported in Frisancho.

RESULTS

The data indicated a positive correlation between AMA, VO2/ml/min and resting energy expenditure (REE)/day values examined during follow-up of patients. The increase of these parameters indicated a good monitoring index correlated to a FFM recovery during psychonutritional rehabilitation.

CONCLUSION

Indirect calorimetry represents a useful approach for determining REE and prescribing diets in these patients. Moreover, the combined use of anthropometric techniques allows to accurately assess and adjust therapy according to the patient's progress. This study shows that restricted eating disorders are characterized by a recovery of FFM related to improvement of body weight and REE/day. On the contrary, the increase of AFA revealed a recovery of fat-metabolism (corresponding to RQ decrease) and lipid/carbohydrates oxidation improvement, only in the presence, at the same time, of O2 consumption increase.

Medical assessment of adolescent girls with eating disorders: an evaluation of symptoms and signs of starvation

AIM

To investigate the prevalence of symptoms and signs related to starvation at the initial examination of adolescent girls with eating disorders (ED).

METHODS

Two hundred and eleven girls with eating disorders recruited for a multicentre research and evaluation programme of six specialist eating disorder services in Sweden have been studied. The presence or absence of 12 symptoms, reported by the patients, and 16 signs, observed by the examiners, were registered and related to body weight.

RESULTS

Eleven observed signs--loss of subcutaneous fat, loss of muscle mass, loss of muscular force, dry and scaly skin, brittle nails, dry and brittle hair, lanugo hair, resting pulse <60, systolic blood pressure <110, peripheral hypothermia, and peripheral cyanosis--were related to body weight expressed in standard deviation scores (SDS). When the number of observed signs for each patient was calculated, there was a strong relationship with weight. The odds ratio for having more than two signs was 4.35 (95% CI 2.67-7.04; p = 2.8 x 10(-9) for every one-unit change in weight SDS. Of the symptoms reported by the patients, only three were related to weight. When the number of reported symptoms for each patient was calculated, a relationship with weight was not observed.

CONCLUSION

In adolescent girls with ED, physical signs observed at medical examination can be related to weight. However, reported symptoms are poorly related to weight and may be influenced by other factors. The finding emphasizes the importance of medical assessment at presentation of patients with ED.

Índice de massa corporal como indicativo da gordura corporal comparado às dobras cutâneas

FUNDAMENTOS: A gordura corporal está associada com grandes incidências de doenças crônicas degenerativas. Portanto, estimar a gordura com o menor erro possível é fundamental. OBJETIVO: Verificar se o índice de massa corporal (IMC) apresenta consistência perante o somatório das dobras cutâneas do tríceps e da panturrilha (TR + PA) para classificar moças e rapazes acima, abaixo e dentro do padrão (critério de referência) considerado adequado para uma boa saúde. MÉTODOS: A amostra foi composta por 694 moças e 716 rapazes com idades de 10,50 a 17,49 anos. As variáveis foram medidas e analisadas em relação aos critérios de referência apresentados pela AAHPERD (1988). Os resultados foram analisados pelo coeficiente de contingência e índice kappa. RESULTADOS E CONCLUSÃO: Os dados indicaram que somente 48,98% das moças e 57,32% dos rapazes foram classificados concomitantemente pelo IMC e TR + PA. O índice kappa indicou uma fraca concordância entre as três categorias de classificação da gordura corporal (acima, abaixo e dentro do padrão recomendado). Desta forma, conclui-se que o IMC não apresenta consistência para classificar moças e rapazes quanto à gordura corporal.

Improvement of nutritional status as assessed by multifrequency BIA during 15 weeks of refeeding in adolescent girls with anorexia nervosa

In patients with anorexia nervosa (AN), an assessment of changes in body composition and nutritional status is crucial for adequate nutritional management during refeeding therapies. Phase-sensitive multifrequency bioelectrical impedance analysis (BIA) is an inexpensive and noninvasive technique with which to determine nutritional status and body composition. We investigated 21 female adolescents with AN (initial BMI 15.5 +/- 1.1 kg/m(2)) 4 times between wk 3 and 15 of inpatient refeeding and 19 normal-weight, age-matched female controls. From wk 3 to 15, BMI, fat mass, body cell mass (BCM), total body water (TBW), intracellular water (ICW) but not extracellular mass (ECM), and extracellular water (ECW) increased significantly. Reactance (Xc), phase angle (PhA), and the ECM/BCM index as parameters of nutritional status improved significantly in patients and no longer differed from controls in wk 15, although the BMI of patients was significantly lower than those of controls. Changes in the ECM/BCM index were due to accretion of BCM, which was associated with an increase of ICW. Multifrequency phase-sensitive BIA seems to be a promising tool for the assessment of changes in nutritional status and body composition in patients with AN. An individually determined and controlled hyperenergetic diet as part of a multidimensional, interdisciplinary treatment program for eating disorders seems to quickly improve the nutritional status of AN patients.

Nutritional rehabilitation of anorexia nervosa. Goals and dangers

Nutritional rehabilitation of adolescents with anorexia nervosa is both a science and an art. The goals are to promote metabolic recovery; restore a healthy body weight; reverse the medical complications of the disorder and to improve eating behaviors and psychological functioning. Most, but not all of the medical complications are reversible with nutritional rehabilitation. Refeeding patients with anorexia nervosa results in deposition of lean body mass initially, followed by restoration of adipose tissue as treatment goal weight is approached. The major danger of nutritional rehabilitation is the refeeding syndrome, characterized by fluid and electrolyte, cardiac, hematological and neurological complications, the most serious of which is sudden unexpected death. The refeeding syndrome is most likely to occur in those who are severely malnourished. In such patients, this complication can be avoided by slow refeeding with careful monitoring of body weight, heart rate and rhythm and serum electrolytes, especially serum phosphorus. This paper reviews our clinical experience.

Body composition in bulimia nervosa patients compared to healthy females

OBJECTIVE

In contrast to anorexia nervosa there is a lack of research on body composition in bulimia nervosa patients. The aim of the study was to examine the body composition in underweight, normal-weight and overweight bulimia nervosa patients in comparison with healthy sedentary females, to assess the changes in body composition and subcutaneous fat after five months treatment, and to analyze the relation between body composition variables.

DESIGN

The body composition of 138 female bulimia nervosa patients and 188 healthy sedentary females was studied using underwater weighing and skinfold measurements.

RESULTS

A good agreement was found between the results obtained by underwater weighing and skinfold measurements. Normal-weight bulimics and control subjects did not differ significantly in body composition. In comparison with healthy controls, underweight and overweight bulimics showed a lower or higher percentage body fat, respectively. In underweight bulimics the fat mass increased after five months of treatment, whereas it decreased in normal-weight and overweight patients in comparison with control subjects. In bulimics more significant relations between body composition variables were found than in the controls.

CONCLUSION

Body composition of bulimia nervosa patients may show great differences related to their (varying) body weight. Future research should take the patients' body weight into account.

Regional body composition in adolescents with anorexia nervosa and changes with weight recovery

BACKGROUND

Studies of regional fat distribution in adults with anorexia nervosa (AN) have shown decreased extremity fat at baseline and increased trunk fat with weight recovery, resulting in truncal adiposity. Little is known about fat distribution in adolescents with AN, especially with weight recovery.

OBJECTIVE

We sought to determine whether regional fat distribution in adolescents with AN is comparable with that in healthy adolescents and whether weight recovery results in increased trunk fat and truncal adiposity.

DESIGN

In 21 adolescent girls with AN and 21 control subjects matched for age and pubertal stage, we measured body-composition variables with dual-energy X-ray absorptiometry at baseline, 6 mo, and 12 mo. Weight recovery was defined as a > or = 10% increase in body mass index.

RESULTS

At baseline, the girls with AN had a lower percentage of trunk fat than did the control subjects, whereas the percentage of extremity fat was not significantly different between the groups. Weight recovery in 13 subjects with AN resulted in an increased percentage of trunk fat and an increased ratio of trunk fat to extremity fat; however, this ratio did not exceed that of control subjects.

CONCLUSIONS

In adolescents with AN, trunk fat rather than extremity fat is reduced. Weight recovery is associated with increased trunk fat and an increased ratio of trunk fat to extremity fat. In contrast with previous findings in adults, this most likely represents normalization of fat distribution rather than development of truncal adiposity.

Four-year follow-up of body compostion in lung transplant patients

BACKGROUND

Both undernutrition and overnutrition can affect the quality of life and survival of patients with pulmonary disease and lead to quantitative and functional alterations of fat-free mass (FFM). This longitudinal study determines the changes in weight, FFM, and body fat before and up to 4 years after lung transplant (LTR).

METHODS

Height, weight, and body composition measurements (bioelectrical impedance) were obtained in 37 LTR patients. FFM and body fat were measured before and at 1, 3, 6, 9, 12, 18, 24, 36, and 48 months after LTR.

RESULTS

Weight changed by +16.6%, +3.2%, -0.2%, and -3.2% and FFM by +14.0%, +2.5%, -0.3%, and -1.0% during years 1, 2, 3, and 4, respectively. A diagnosis of obliterative bronchiolitis after LTR was associated with loss of body weight, FFM, and body fat, compared with stable weight or gain in weight, FFM, and body fat in obliterative bronchiolitis-negative subjects; 76.2% and 85.7%, and 28% and 38% of men and women, respectively, demonstrated low FFM at 1 month and at 2 years after LTR, respectively. The FFM change was higher (39% of weight) during year 1 than during year 2 (25%) or year 3 (21%).

CONCLUSIONS

After LTR, patients gained weight, FFM, and body fat, and two-thirds reached normal levels of FFM by year 2. A weight increase resulted in an FFM increase. Contrary to studies after heart or liver transplantation, our results suggest that despite posttransplant infections and grafts rejection, LTR permits FFM recovery.

Weight loss and body-composition changes in men and women infected with HIV

BACKGROUND

The nature of body-composition changes in HIV-associated weight loss is unclear.

OBJECTIVE

We examined the relation between the initial percentage of body fat and the composition of weight loss in men and women with HIV infection.

DESIGN

HIV-positive adults were seen at semiannual clinic visits, at which time weight, fat, and fat-free mass were determined. The unit of analysis was the person-interval.

RESULTS

Five hundred fifty-one persons contributed 2266 intervals of data, of which 311 (14%) were intervals in which weight loss was >/= 5% of initial (start of interval) weight. Of these, 208 (67%) intervals met the criteria for analysis (123 from men and 85 from women). Loss of fat-free mass was dependent on the initial percentage of body fat in the men with < 32% body fat. A plot of the initial percentage of body fat compared with loss of fat-free mass (kg) suggested a nonlinear relation over the range of body fat examined. There was no clear relation between the initial percentage of body fat and loss of fat-free mass in the women.

CONCLUSIONS

In men with HIV-associated weight loss, the weight lost as fat-free mass depends on the initial percentage of body fat at low levels of body fat but appears to be independent of initial percentage of body fat at high levels of body fat. In women with HIV-associated weight loss who have normal-to-high body fat stores, loss of fat-free mass is independent of the initial percentage of body fat.

Body composition changes in patients with anorexia nervosa after complete weight recovery

OBJECTIVE

To assess body composition changes occurring in female anorectic patients after complete weight recovery.

DESIGN

Longitudinal study.

SUBJECTS

: Ten female patients with anorexia nervosa (age at baseline: 19.7+/-5.8 y) were studied both when undernourished (body mass index, BMI 14.8+/-1.3 kg/ m(2)) and after the achievement of a BMI >18.5 kg/m(2). The control group comprised 18 well-nourished women (age 20.1+/-4.4 y; BMI 19.0-23.0 kg/ m(2)).

INTERVENTIONS

Fat mass and fat-free mass were determined by dual-energy X-ray absorptiometry. Skinfold thicknesses and circumferences were also measured. Arm muscle area and arm fat area were calculated by standard formulas.

RESULTS

The undernourished patients had lower fat-free mass, fat mass, skinfold thicknesses and circumferences. After refeeding, fat mass represented 25-71% (mean 56%) of the mass regained, this percentage being directly related to the extent of weight gain. The increases in skinfolds and circumferences depended upon the site considered and were correlated to a various extent with those in weight or BMI. Skinfolds at biceps and abdominal sites and the waist-to-hip ratio remained significantly higher, whereas arm muscle circumference was significantly lower, in the refed group than in the control one.

CONCLUSION

The percentage of fat in the weight regained by refed female anorectic patients was directly related to the extent of body mass increase. Refed anorectic patients appear to preferentially regain fat in the abdominal and triceps regions. Abnormalities in skinfolds (at biceps and abdominal sites), arm muscle area and waist-to-hip ratio still persist in refed anorectic patients in comparison to control healthy controls.