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Clinical and physical characteristics of thinness in adolescents: the HELENA study. Eur J Nutr 2023; 62:1731-1742. [PMID: 36802024 DOI: 10.1007/s00394-023-03104-0] [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: 05/31/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE Thinness in adolescence has not been studied as extensively as overweight or obesity. The aim of this study was to assess the prevalence, characteristics, and health impacts of thinness in a European adolescent population. METHODS This study included 2711 adolescents (1479 girls, 1232 boys). Blood pressure, physical fitness, sedentary behaviors, physical activity (PA), and dietary intake were assessed. A medical questionnaire was used to report any associated diseases. A blood sample was collected in a subgroup of the population. Thinness and normal weight were identified using the IOTF scale. Thin adolescents were compared with adolescents of normal weight. RESULTS Two hundred and fourteen adolescents (7.9%) were classified as being thin; the prevalence rates were 8.6% in girls and 7.1% in boys. Systolic blood pressure was significantly lower in adolescents with thinness. The age at the first menstrual cycle was significantly later in thin female adolescents than in those with normal weight. Upper-body muscular strength measured in performance tests and time spent in light PA were significantly lower in thin adolescents. The Diet Quality Index was not significantly lower in thin adolescents, but the percentage of adolescents who skipped breakfast was higher in adolescents with a normal weight (27.7% vs 17.1%). Serum creatinine level and HOMA-insulin resistance were lower and vitamin B12 level was higher in thin adolescents. CONCLUSIONS Thinness affects a notable proportion of European adolescents with no physical adverse health consequences.
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Dopamine D2 receptor overexpression in the nucleus accumbens core induces robust weight loss during scheduled fasting selectively in female mice. Mol Psychiatry 2021; 26:3765-3777. [PMID: 31863019 PMCID: PMC7305037 DOI: 10.1038/s41380-019-0633-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 01/22/2023]
Abstract
Anorexia nervosa (AN) is an eating disorder observed predominantly in women and girls that is characterized by a low body-mass index, hypophagia, and hyperactivity. Activity-based anorexia (ABA), which refers to the weight loss, hypophagia, and hyperactivity exhibited by rodents exposed to both running wheels and scheduled fasting, provides a model for aspects of AN. Increased dopamine D2/D3 receptor binding in the anteroventral striatum has been reported in AN patients. We virally overexpressed D2Rs on nucleus accumbens core (D2R-OENAc) neurons that endogenously express D2Rs, and tested mice of both sexes in the open field test, ABA paradigm, and intraperitoneal glucose tolerance test (IGTT). D2R-OENAc did not alter baseline body weight, but increased locomotor activity in the open field across both sexes. During constant access to food and running wheels, D2R-OENAc mice of both sexes increased food intake and ran more than controls. However, when food was available only 7 h a day, only female D2R-OENAc mice rapidly lost 25% of their initial body weight, reduced food intake, and substantially increased wheel running. Surprisingly, female D2R-OENAc mice also rapidly lost 25% of their initial body weight during scheduled fasting without wheel access and showed no changes in food intake. In contrast, male D2R-OENAc mice maintained body weight during scheduled fasting. D2R-OENAc mice of both sexes also showed glucose intolerance in the IGTT. In conclusion, D2R-OENAc alters glucose metabolism in both sexes but drives robust weight loss only in females during scheduled fasting, implicating metabolic mechanisms in this sexually dimorphic effect.
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Kim YR, Hildebrandt T, Mayer LES. Differential glucose metabolism in weight restored women with anorexia nervosa. Psychoneuroendocrinology 2019; 110:104404. [PMID: 31541915 PMCID: PMC8666139 DOI: 10.1016/j.psyneuen.2019.104404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/21/2019] [Accepted: 08/06/2019] [Indexed: 01/07/2023]
Abstract
Women with anorexia nervosa (AN) develop visceral adiposity associated with insulin resistance after partial weight restoration, but little is known about the glucose homeostasis after full weight restoration. In this investigation, we studied glucose homeostasis in twenty-four women with AN before (AN) and after weight restoration (WR) at a single institution, with both restricting and binge-purge subtypes (>70% binge-purge), compared to gender-, age- and BMI-matched healthy controls (HC). Participants underwent fasting plasma hormone analysis, oral glucose tolerance test (OGTT), and body composition analysis. Glucose homeostasis was assessed by the homeostasis model assessment (HOMA) and OGTT, and parameters were analyzed for association with body composition. We observed that a subset of the WR patients (21%) had metabolically unhealthy HOMA insulin resistance estimates (HOMA-IR), while this was not seen in the control group. Overall mean HOMA-IR between groups were not significantly different. Mean glucose reactivity was higher in the WR group than HC women (p = 0.008, Hedges' g = 0.811), and time-adjusted glucose reactivity in the WR group was inversely associated with visceral adiposity (r = -0.559, p = 0.006), but not with fat mass (r = -273, p = 0.208) or lean mass (r = -0.002, p = 0.994). Our findings suggest that glucose response during the OGTT in women with AN is altered in association with visceral adiposity acutely after full weight restoration, but that they do not develop overt insulin resistance. Glucometabolic profiling could offer novel insights to energy homeostasis acutely after weight restoration.
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Affiliation(s)
- Youngjung R. Kim
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029 USA
| | - Thomas Hildebrandt
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA.
| | - Laurel E. S. Mayer
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY 10032 USA
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Andrisani A, Sabbadin C, Minardi S, Favaro A, Donà G, Bordin L, Ambrosini G, Armanini D. Persistent amenorrhea and decreased DHEAS to cortisol ratio after recovery from anorexia nervosa. Gynecol Endocrinol 2017; 33:311-314. [PMID: 27910716 DOI: 10.1080/09513590.2016.1255881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Persistent amenorrhea is a frequent condition affecting anorexic patients after stable weight recovery. It has been proposed that it could be due to alterations of the hypothalamic-pituitary-gonadal axis linked with persistent hormonal impairments, such as relative hypercortisolemia and hypoleptinemia, and psychological symptoms related to anorexia nervosa (AN). The aim of our study was to evaluate the metabolic and hormonal pattern involved in the persistence of amenorrhea after recovery from AN. Eight weight-recovered anorexic patients with amenorrhea were investigated and matched with 10 healthy eumenorrhoic women, comparable for age and BMI. Data showed basal FSH and LH values similar in both groups and a normal pituitaric response to LHRH administration. Morning serum cortisol was normal but significantly higher in patients, while dehydroepiandrosterone sulfate (DHEAS) to cortisol ratio, leptin and vitamin D were significantly lower in patients than controls. Women with previous AN presented insulin resistance and two patients showed an overall picture consistent with polycystic ovary syndrome (PCOS). In conclusion, long-lasting amenorrhea after recovery from AN is linked with a persistent hypothalamic dysfunction, although other concomitant causes like PCOS and insulin resistance should be considered. Decreased DHEAS to cortisol ratio is a new finding which could be correlated to the persistent hypogonadism.
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Affiliation(s)
- Alessandra Andrisani
- a Department of Women's and Children's Health , University of Padua , Padua , Italy
| | - Chiara Sabbadin
- b Department of Medicine-Endocrinology , University of Padua , Padua , Italy
| | - Silvia Minardi
- b Department of Medicine-Endocrinology , University of Padua , Padua , Italy
| | - Angela Favaro
- c Department of Neurosciences , University of Padua , Padua , Italy , and
| | - Gabriella Donà
- d Department of Molecular Medicine-Biological Chemistry , University of Padua , Padua , Italy
| | - Luciana Bordin
- d Department of Molecular Medicine-Biological Chemistry , University of Padua , Padua , Italy
| | - Guido Ambrosini
- a Department of Women's and Children's Health , University of Padua , Padua , Italy
| | - Decio Armanini
- b Department of Medicine-Endocrinology , University of Padua , Padua , Italy
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Raevuori A, Suokas J, Haukka J, Gissler M, Linna M, Grainger M, Suvisaari J. Highly increased risk of type 2 diabetes in patients with binge eating disorder and bulimia nervosa. Int J Eat Disord 2015; 48:555-62. [PMID: 25060427 DOI: 10.1002/eat.22334] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/02/2014] [Accepted: 07/06/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We aimed to examine the prevalence and incidence of type 2 diabetes (T2D) in a large patient cohort treated for binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa. METHOD Patients (N = 2,342) treated at the Eating Disorder Unit of Helsinki University Central Hospital over the period up to 16 years were compared with matched general population controls (N = 9,368) in three stages: before entering to the treatment for an eating disorder, after the entrance until the end of the study period, and combined any time before, during, and after the treatment. The study population was linked with the oral TSD medication data of 17 years from The Medical Reimbursement Register. Data were analyzed using conditional and Poisson regression models. RESULTS Before entering to the treatment for eating disorders, the risk of T2D was substantially increased in patients compared with controls (OR 6.6, 95% CI 4.0-10.7). At the end of the study period, the lifetime prevalence of T2D was 5.2% among patients, 1.7% among controls (OR 3.4, 95% CI 2.6-4.4), and in male patients, it was significantly higher compared with females. Of those treated for BED, every third had T2D by the end of the study period (OR 12.9, 95% CI 7.4-22.5), whereas the same was true for 4.4% of those with BN (OR 2.4, 95% CI 1.7-3.5). DISCUSSION Our findings provide strong support for the association between T2D and clinically significant binge eating. Disturbed glucose metabolism may contribute to the onset and maintenance of BED and BN.
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Affiliation(s)
- Anu Raevuori
- Department of Public Health, Hjelt Institute, University of Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.,Department of Child Psychiatry, Faculty of Medicine, University of Turku, Finland.,Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suokas
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Helsinki University Central Hospital, Finland
| | - Jari Haukka
- Department of Public Health, Hjelt Institute, University of Helsinki, Finland.,Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Information Department, National Institute for Health and Welfare, Helsinki, Finland.,Nordic School of Public Health, Gothenburg, Sweden
| | - Milla Linna
- Department of Public Health, Hjelt Institute, University of Helsinki, Finland
| | - Marjut Grainger
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Social Psychiatry, Tampere School of Public Health, Finland
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Madden S, Miskovic-Wheatley J, Clarke S, Touyz S, Hay P, Kohn MR. Outcomes of a rapid refeeding protocol in Adolescent Anorexia Nervosa. J Eat Disord 2015; 3:8. [PMID: 25830024 PMCID: PMC4379764 DOI: 10.1186/s40337-015-0047-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/28/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The impact of severe malnutrition and medical instability in adolescent Anorexia Nervosa (AN) on immediate health and long-term development underscores the need for safe and efficient methods of refeeding. Current refeeding guidelines in AN advocate low initial caloric intake with slow increases in energy intake to avoid refeeding syndrome. This study demonstrates the potential for more rapid refeeding to promote initial weight recovery and correct medical instability in adolescent AN. METHODS Seventy-eight adolescents with AN (12-18 years), hospitalised in two specialist paediatric eating disorder units, for medical instability (bradycardia, hypotension, hypothermia, orthostatic instability and/or cardiac arrhythmia) were followed during a 2.5 week admission. Patients were refed using a standardised protocol commencing with 24-72 hours of continuous nasogastric feeds (ceased with daytime medical stability) and routine oral phosphate supplementation, followed by nocturnal feeds and a meal plan of 1200-2400 kcal/day aiming for a total caloric intake of 2400-3000 kcal/day. Along with indicators of medical stability, weight, phosphate and glucose levels were recorded. RESULTS All patients gained weight in week one (M = 2.79 kg, SD = 1.27 kg) and at subsequent measurement points with an average gain of 5.12 kg (SD = 2.96) at 2.5 weeks. No patient developed hypophosphatemia, hypoglycaemia, or stigmata of the refeeding syndrome. CONCLUSIONS The refeeding protocol resulted in immediate weight gain and was well tolerated with no indicators of refeeding syndrome. There were no significant differences in outcomes between the treatment sites, suggesting the protocol is replicable. TRIAL REGISTRATION Australian Clinical Trials Register number: ACTRN012607000009415.
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Affiliation(s)
- Sloane Madden
- Eating Disorder Service, The Sydney Children's Hospitals Network, Westmead Campus, Locked Bag 4001, Westmead, 2145, NSW Australia ; Discipline of Psychiatry, Faculty of Medicine, The University of Sydney, Sydney, Australia ; Westmead Clinical School, The Sydney Children's Hospitals Network, Westmead Campus, Sydney, Australia
| | - Jane Miskovic-Wheatley
- Eating Disorder Service, The Sydney Children's Hospitals Network, Westmead Campus, Locked Bag 4001, Westmead, 2145, NSW Australia ; Westmead Clinical School, The Sydney Children's Hospitals Network, Westmead Campus, Sydney, Australia
| | - Simon Clarke
- Discipline of Paediatrics, Faculty of Medicine, University of Sydney, Sydney, Australia ; Centre for Research into AdolescentS' Health (CRASH), University of Sydney, Sydney, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, University of Western Sydney, Sydney, Australia
| | - Michael R Kohn
- Eating Disorder Service, The Sydney Children's Hospitals Network, Westmead Campus, Locked Bag 4001, Westmead, 2145, NSW Australia ; Westmead Clinical School, The Sydney Children's Hospitals Network, Westmead Campus, Sydney, Australia ; Discipline of Paediatrics, Faculty of Medicine, University of Sydney, Sydney, Australia ; Centre for Research into AdolescentS' Health (CRASH), University of Sydney, Sydney, Australia
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Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition. Curr Opin Pediatr 2011; 23:390-4. [PMID: 21670680 DOI: 10.1097/mop.0b013e3283487591] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This paper reviews recent publications about the physiology associated with adaptation to malnutrition and refeeding (including the refeeding syndrome) and clinical outcomes of refeeding paradigms. RECENT FINDINGS A number of recent reviews and original publications have highlighted important differences from the assumptions underpinning the current refeeding guidelines for patients with anorexia nervosa. The notion of 'starting low and going slow' with the prescription of daily calories seems unlikely to be important in preventing refeeding syndrome. Recent publications suggest this approach does not necessarily add to safety in the refeeding process but rather the contrary. It typically results in weight loss and protracts hospitalization and nutritional recovery. Rather, the composition of macronutrients, in particular avoiding a high proportion of calories from carbohydrates, appears to be more important than the absolute number of calories. The means of initial refeeding appears increasingly important in this process, particularly following descriptions of postprandial hypoglycemia. SUMMARY The study supports a review of the current guidelines. Evidence for the use of continuous feeding strategies with less than 40% of calories from carbohydrates is presented. This approach has important implications for the prevention of the refeeding syndrome as well as the safety and efficiency with which refeeding may occur for children and adolescents with anorexia nervosa in hospital.
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Jauch-Chara K, Schmoller A, Oltmanns KM. Impaired glucose tolerance in healthy men with low body weight. Nutr J 2011; 10:16. [PMID: 21299854 PMCID: PMC3041736 DOI: 10.1186/1475-2891-10-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/07/2011] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Impaired glucose tolerance (IGT) and high body mass index (BMI) are recognized risk factors for type 2 diabetes mellitus (T2DM). However, data suggest that also underweight predisposes people to develop T2DM. Here, we experimentally tested if already moderate underweight is associated with impaired glucose tolerance as compared to normal weight controls. Obese subjects were included as additional reference group. METHOD We included three groups of low weight, normal weight, and obese subjects comprising 15 healthy male participants each. All participants underwent a standardized hyperinsulinemic-euglycemic glucose clamp intervention to determine glucose tolerance. In addition, insulin sensitivity index (ISI) was calculated by established equation. RESULTS ISI values were higher in low and normal weight than in obese subjects (P < 0.010) without any difference between low and normal weight groups (P = 0.303). Comparable to obese participants (P = 0.178), glucose tolerance was found decreased in low weight as compared with normal weight subjects (P = 0.007). Pearson's correlation analysis revealed a positive relationship between glucose tolerance and BMI in low (P = 0.043) and normal weight subjects (P = 0.021), an effect that was found inverse in obese participants (P = 0.028). CONCLUSION Our study demonstrates that not only obese but also healthy people with moderate underweight display glucose intolerance. It is therefore suggested that all deviations from normal BMI may be accompanied by an increased risk of developing T2DM in later life indicating that the maintenance of body weight within the normal range has first priority in the prevention of this disease.
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Affiliation(s)
- Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
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Westling S, Ahrén B, Sunnqvist C, Träskman-Bendz L. Altered glucose tolerance in women with deliberate self-harm. Psychoneuroendocrinology 2009; 34:878-83. [PMID: 19188027 DOI: 10.1016/j.psyneuen.2008.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 12/01/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
Abstract
Disturbances in glucose metabolism are of importance for violent behaviour in men, but studies in women are lacking. We used the 5h-oral glucose tolerance test (OGTT) in this study of 17 female psychiatric patients, selected for violent behaviour directed against themselves (deliberate self-harm) and 17 healthy controls matched for age and BMI. Following OGTT, patients had higher glucose levels at 30 min (p=0.007) and increased glucagon area under the curve (p=0.011). Since a co-morbid eating disorder might affect results, we as a post-hoc analysis subgrouped the patients and found that the increased glucagon levels only were present in patients with an eating disorder. In contrast, those without an eating disorder showed a significantly lower p-glucose nadir (p=0.015) and unaltered glucagon levels compared to controls. There were no significant differences in insulin and C-peptide levels between patients and controls. We conclude that deliberate self-harm in women may be associated with alterations in carbohydrate metabolism in certain groups. Eating disorder is a confounding factor.
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Affiliation(s)
- Sofie Westling
- Department of Clinical Sciences, Psychiatry, Lund University, 221 85 Lund, Sweden.
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Hatch KA, Spangler DL, Backus EM, Balagna JT, Burns KS, Guzman BS, Hubbard MJ, Lindblad SL, Roeder BL, Ryther NE, Seawright MA, Tyau JN, Williams D. Towards a physiologically based diagnosis of anorexia nervosa and bulimia nervosa. Expert Rev Mol Diagn 2007; 7:845-57. [PMID: 18020913 DOI: 10.1586/14737159.7.6.845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diagnosis of anorexia nervosa (AN) and bulimia nervosa (BN), while including such physiological data as weight and the reproductive status of the individual, are primarily based on questionnaires and interviews that rely on self-report of both body-related concerns and eating-related behaviors. While some key components of eating disorders are psychological and thus introspective in nature, reliance on self-report for the assessment of eating-related behaviors and nutritional status lacks the objectivity that a physiologically based measure could provide. The development of a more physiologically informed diagnosis for AN and BN would provide a more objective means of diagnosing these disorders, provide a sound physiological basis for diagnosing subclinical disorders and could also aid in monitoring the effectiveness of treatments for these disorders. Empirically supported, physiologically based methods for diagnosing AN and BN are reviewed herein as well as promising physiological measures that may potentially be used in the diagnosis of AN and BN.
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Affiliation(s)
- Kent A Hatch
- Department of Biology, Brigham Young University, Provo, UT 84602, USA.
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12
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Kinzig KP, Coughlin JW, Redgrave GW, Moran TH, Guarda AS. Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration. Am J Physiol Endocrinol Metab 2007; 292:E1441-6. [PMID: 17264227 DOI: 10.1152/ajpendo.00347.2006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prolonged malnutrition in individuals with anorexia nervosa (AN) has been associated with alterations in endocrine function that may play a sustaining role in the disorder. We hypothesized that abnormalities in endocrine responses to ingestion of a meal in AN are reversible and depend on weight restoration. We measured meal-induced endocrine responses in AN subjects at three time points during hospitalization: before refeeding (n = 13, mean BMI 16.7 kg/m(2)), after 2 wk of refeeding (mean BMI 18.0 kg/m(2)), and in the weight-restored state (mean BMI 20.3 kg/m(2)). Control subjects (n = 13, BMI 19-24.9 kg/m(2)) were tested once. Tests were 2.5-h sessions in which blood was drawn every 15 min before, during, and after a approximately 650-kcal test breakfast. Relative to controls, peak levels of glucose were depressed and peak levels of insulin in response to ingestion of the test meal were delayed, with response patterns in the third trial most similar to controls. Pancreatic polypeptide (PP) levels were increased in AN relative to controls regardless of weight status. The delay in insulin release and elevated PP levels did not correct with short-term refeeding and may contribute to the high relapse rates and maintenance of AN.
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Affiliation(s)
- Kimberly P Kinzig
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana 47907, USA.
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Yasuhara D, Kojima S, Naruo T, Inui A. Relationship between pretreatment laboratory-measured episodes of reactive hypoglycemia and short-term weight restoration in anorexia nervosa: a preliminary study. Psychoneuroendocrinology 2006; 31:452-8. [PMID: 16378696 DOI: 10.1016/j.psyneuen.2005.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 09/15/2005] [Accepted: 11/09/2005] [Indexed: 11/24/2022]
Abstract
Refeeding outcome is difficult to predict in anorexia nervosa (AN). Because reactive hypoglycemia (RH) during an oral glucose tolerance test (OGTT) correlates with rapid increases of energy intake just before the OGTT in AN patients, this study investigated whether pretreatment laboratory-measured RH episodes might be associated with refeeding progress in this disorder. Forty-six female patients with AN (25 restrictors and 21 binge/purgers) and 11 controls underwent an OGTT before treatment. The patients were divided into groups according to the presence of RH. Thereafter, AN patients underwent nutritional rehabilitation, and weight gain and daily energy intake were evaluated. In both AN subtypes, the RH groups showed more daily energy intake and gained more weight compared with the non-RH groups. The present study found a close relationship between pretreatment laboratory-measured RH episodes and refeeding progress, suggesting that pretreatment laboratory-measured RH episodes may be an important predictor of short-term refeeding outcome in AN.
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Affiliation(s)
- Daisuke Yasuhara
- Department of Behavioral Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima-City 890-8520, Japan.
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