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Cacciatore C, Cangiano B, Carbone E, Spagnoli S, Cid Ramirez MP, Polli N, Bonomi M, Persani L. Body weight variation is not an independent factor in the determination of functional hypothalamic amenorrhea in anorexia nervosa. J Endocrinol Invest 2024; 47:903-911. [PMID: 37812282 DOI: 10.1007/s40618-023-02207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Functional hypothalamic amenorrhea (FHA) is one of the foremost manifestations in anorexia nervosa (AN), but a subset of patients have menses despite marked weight loss and underweight. The aim of our study was to investigate parameters potentially influencing FHA in AN. DESIGN AND METHODS In this observational retrospective study, we selected 114 female patients with AN who completed a 12 months semi-residential rehabilitation program and a subsequent 12 months outpatient follow-up. We divided our sample into three groups: "Group 0" patients who experienced FHA and recovered their menses, "Group 1" persistent FHA, "Group 2" never experienced FHA, and looked for clinical and hormonal correlations. RESULTS At the enrollment, the BMI was higher in Group 2 than in Group 1 (p = 0.0202), but the last follow-up weight was higher in Group 1 (p < 0.0001) despite persistent amenorrhea. At logistic regression, the higher BMI at which patients experienced amenorrhea was the main prediction factor for persistent FHA. Notwithstanding comparable leptin levels at admission, they improved significantly at discharge only in Groups 0 and 2 (p = 0.0054 and p = 0.0104, respectively). FT3 at admission was significantly higher in Group 2 than in Group 0 (p = 0.0249). CONCLUSIONS FHA does not correlate strictly with body weight variations in AN patients, indicating a multifactorial origin, likely including an individual predisposition. Higher FT3 levels identify patients who continue having menses at extremely low BMI. AN patients with persistent FHA constitute a subgroup in whom estroprogestins should be considered after significant weight recovery to prevent prolonged tissue hypoestrogenism.
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Affiliation(s)
- C Cacciatore
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - B Cangiano
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy
| | - E Carbone
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - S Spagnoli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - M P Cid Ramirez
- Secciòn Endocrinologia y Diabetes, Hospital Clìnico Universidad del Chile, Santiago, Chile
| | - N Polli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - M Bonomi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy
| | - L Persani
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy.
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milan, Italy.
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Graell M, de Andrés P, Sepúlveda AR, Moreno A, Villaseñor Á, Faya M, Martínez‐Cantarero C, Gómez‐Martínez S, Marcos A, Morandé G, Nova E. The adolescent onset anorexia nervosa study (ANABEL): Design and baseline results. Int J Methods Psychiatr Res 2018; 27:e1739. [PMID: 30133037 PMCID: PMC6877151 DOI: 10.1002/mpr.1739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/05/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022] Open
Abstract
The anorexia nervosa adolescent longitudinal biomarker assessment study (ANABEL) is a 2-year longitudinal study. OBJECTIVE Evaluate several clinical, biochemical, immunological, psychological, and family variables and their interactions in adolescent onset eating disorders (EDs) patients and their 2-year clinical and biological outcome. This article illustrates the framework and the methodology behind the research questions, as well as describing general features of the sample. METHODS A longitudinal study of 114 adolescents with EDs seeking treatment was performed. Only adolescents were selected during 4 years (2009-2013). The variables were collected at different times: baseline, 6, 12, 18, and 24 months of the start of treatment. Diagnoses were completed through the semi-structured Kiddie-Schedule for Affective Disorders and Schizophrenia interview. RESULTS At baseline, the mean age was 15.11 (SD = 1.36). The mean ED duration was 10 months (SD = 5.75). The mean body mass index was 16.1 (SD = 1.8). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis at baseline for restrictive anorexia nervosa was 69.6%, 17.4% for purgative anorexia nervosa, and 24.3% for other specified feeding disorder. At 12 months, 19.4% were in partial remission, whereas at 24 months, 13.8% had fully recovered and 29.2% had partially recovered. CONCLUSIONS There was an acceptable physical and psychopathological improvement during the first year of treatment, with recovery being more evident during the first 6 months.
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Affiliation(s)
- Montserrat Graell
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)España
| | - Patricia de Andrés
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | | | - Alba Moreno
- School of PsychologyAutonomous University of MadridMadridSpain
| | - Ángel Villaseñor
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Mar Faya
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Carmen Martínez‐Cantarero
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Sonia Gómez‐Martínez
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
| | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
| | - Gonzalo Morandé
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Esther Nova
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
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Swenne I. Influence of premorbid BMI on clinical characteristics at presentation of adolescent girls with eating disorders. BMC Psychiatry 2016; 16:81. [PMID: 27030047 PMCID: PMC4815196 DOI: 10.1186/s12888-016-0788-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/18/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Considering the prevalence of obesity in society it can be expected that some adolescents with an eating disorder (ED) start weight loss from an overweight and present at a near-normal weight. Presently, the influence of premorbid BMI on clinical characteristics of adolescent girls presenting with an ED has ben studied. METHOD Premorbid growth charts were available for 275 postmenarcheal adolescent girls presenting with an ED (anorexia nervosa = 27, (subthreshold) bulimia nervosa = 9, restrictive EDNOS = 239). Initial assessment included measurement of weight and length, physical examination, blood sampling and administration of the Eating Disorder Examination-Questionnaire youth version (EDE-Q). RESULTS Despite greater weight loss girls with a high premorbid body mass index (BMI) had a higher BMI at presentation compared to those with a lower premorbid BMI. Although not underweight some presented with clinical and laboratory signs of starvation. These signs were related to not only low BMI but also to rapid and large weight loss. Their EDE-Q scores did not differ from those of girls who presented with an underweight. CONCLUSION Girls with a restrictive ED and premorbid overweight may present with a near-normal BMI. They can nevertheless be medically compromised and have eating disturbed cognitions at the level of underweight girls. They should not be regarded as having a less severe ED but merit full assessment and a start of treatment.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University Uppsala, S-75185, Uppsala, Sweden.
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Swenne I. Plasma cholesterol is related to menstrual status in adolescent girls with eating disorders and weight loss. Acta Paediatr 2016; 105:317-23. [PMID: 26540134 DOI: 10.1111/apa.13258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/25/2015] [Accepted: 10/30/2015] [Indexed: 11/27/2022]
Abstract
AIM This study examined the relationship between plasma cholesterol and circulating triiodothyronine and oestradiol in 561 adolescent girls aged 11-17 with eating disorders. METHODS Plasma total cholesterol, high-density lipoprotein cholesterol, serum triodothyronine and oestradiol were measured at assessment, and historical weight data were obtained from growth charts provided by the school health services. Cholesterol levels were related to weight change, menstrual status and serum hormones. RESULTS Plasma total cholesterol levels of >5.0 mmol/L were found in 38% of the 77 girls who were premenarcheal, 32% of the 199 with secondary amenorrhoea and 17% of those who were still menstruating. These cholesterol levels were inversely related to serum oestradiol and triiodothyronine concentrations, but not weight change, in amenorrhoic girls and were positively related to body mass index and inversely related to weight loss and serum triiodothyronine in girls who were still menstruating. CONCLUSION Increased plasma total cholesterol was related to amenorrhoea in adolescent girls with eating disorders and weight loss. Oestrogens appeared to mediate the effect of starvation on cholesterol, most effectively in premenarcheal girls. Re-establishing menstruation is an important goal in the treatment of eating disorders, to avoid dyslipidaemia and the risk of future cardiovascular disease.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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Swenne I, Vessby B. Relationship of Δ(6) -desaturase and Δ(5) -desaturase activities with thyroid hormone status in adolescents with eating disorders and weight loss. Acta Paediatr 2013; 102:416-8. [PMID: 23330919 DOI: 10.1111/apa.12132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/29/2012] [Accepted: 12/11/2012] [Indexed: 11/30/2022]
Abstract
AIM In starvation, there is down-regulation of metabolism and changes in essential fatty acid (FA) status, which could be related to alterations of desaturase activities. Presently, the relationship between thyroid hormones and desaturase activities has been investigated in adolescents with eating disorders and weight loss. METHODS Serum triiodothyronine concentrations and proportions of polyunsaturated FA in plasma phospholipids were analysed in blood samples from 227 adolescents with ED. Δ(6) -desaturase (D6D) activity was calculated as the FA ratio 20:3ω6/18:2ω6 and Δ(5) -desaturase (D5D) activity as the ratio 20:4ω6/20:3ω6. RESULTS Serum triiodothyronine concentrations were related to leanness and ongoing weight loss. The estimated D6D activity was positively correlated with serum triiodothyronine (R(2) = 0.232; p < 0.001). D5D activity exhibited a strong inverse correlation with serum triiodothyronine (R(2) = 0.410; p < 0.001). CONCLUSION Changes in desaturase activities during starvation cannot be explained by inhibition/disinhibition by essential FA only. It is possible that the effects of starvation on these enzyme activities, and hence on essential FA status, are mediated by triiodothyronine.
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Affiliation(s)
- Ingemar Swenne
- Dept of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Bengt Vessby
- Clinical Nutrition and Metabolism; Dept of Health and Caring Sciences; Uppsala University; Uppsala Sweden
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Faust JP, Goldschmidt AB, Anderson KE, Glunz C, Brown M, Loeb KL, Katzman DK, Le Grange D. Resumption of menses in anorexia nervosa during a course of family-based treatment. J Eat Disord 2013; 1:12. [PMID: 24926411 PMCID: PMC4053648 DOI: 10.1186/2050-2974-1-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/12/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The resumption of menses (ROM) is considered an important clinical marker in weight restoration for patients with anorexia nervosa (AN). The purpose of this study was to examine ROM in relation to expected body weight (EBW) and psychosocial markers in adolescents with AN. METHODS We conducted a retrospective chart review at The University of Chicago Eating Disorders Program from September 2001 to September 2011 (N = 225 females with AN). Eighty-four adolescents (Mean age = 15.1, SD = 2.2) with a DSM-IV diagnosis of AN, presenting with secondary amenorrhea were identified. All participants had received a course of outpatient family-based treatment (FBT), i.e., ~20 sessions over 12 months. Weight and menstrual status were tracked at each therapy session throughout treatment. The primary outcome measures were weight (percent of expected for sex, age and height), and ROM. RESULTS Mean percent EBW at baseline was 82.0 (SD = 6.5). ROM was reported by 67.9% of participants (57/84), on average at 94.9 (SD = 9.3) percent EBW, and after having completed an average of 13.5 (SD = 10.7) FBT sessions (~70% of standard FBT). Compared to participants without ROM by treatment completion, those with ROM had significantly higher baseline Eating Disorder Examination Global scores (p = .004) as well as Shape Concern (p < .008) and Restraint (p < .002) subscale scores. No other differences were found. CONCLUSIONS Results suggest that ROM occur at weights close to the reference norms for percent EBW, and that high pre-treatment eating disorder psychopathology is associated with ROM. Future research will be important to better understand these differences and their implications for the treatment of adolescents with AN.
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Affiliation(s)
- Julianne P Faust
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC3077, Chicago, IL, 60637, USA ; Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Andrea B Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC3077, Chicago, IL, 60637, USA
| | - Kristen E Anderson
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC3077, Chicago, IL, 60637, USA
| | - Catherine Glunz
- Department of Pediatrics, The University of Chicago, Chicago, IL, USA
| | - Melanie Brown
- School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Katharine L Loeb
- School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC3077, Chicago, IL, 60637, USA
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Swenne I, Rosling A. No unexpected adverse events and biochemical side effects of olanzapine as adjunct treatment in adolescent girls with eating disorders. J Child Adolesc Psychopharmacol 2011; 21:221-7. [PMID: 21663424 DOI: 10.1089/cap.2009.0098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Olanzapine has been recently tried to relieve anxiety and hyperactivity in adolescents with eating disorders (EDs). Presently, the side effects of the drug have been evaluated. METHOD Forty-seven adolescents with EDs were followed up by repeated blood sampling before, during, and at 3 months after medication with olanzapine. RESULTS Olanzapine medication was discontinued in three patients because of galactorrhea, seizures, and raised liver enzyme activities, respectively. There was a normalization of glucose, insulin, and lipid profiles during treatment, which was related to weight gain and resumption of menstruations but not to medication. Increases in thyroid-stimulating hormone and prolactin were related to olanzapine medication and comedication with selective serotonine reuptake inhibitors. Three months after discontinuing medication, there were no persisting biochemical effects. CONCLUSION The side effects observed were those previously described for olanzapine. Most biochemical changes were related to weight (change) and amenorrhea and not to medication. Placebo-controlled studies are needed to investigate the efficacy of olanzapine in adolescents with EDs.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden.
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Swenne I, Rosling A, Tengblad S, Vessby B. Essential fatty acid status in teenage girls with eating disorders and weight loss. Acta Paediatr 2011; 100:762-7. [PMID: 21362034 DOI: 10.1111/j.1651-2227.2011.02153.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To explore the relationship between essential fatty acids (FA) and weight changes in adolescent girls with eating disorders (ED). METHODS Blood samples were obtained from 220 girls with ED and 39 healthy controls. The girls with ED were 15.3 ± 1.5 years of age and weighed 49.8 ± 8.7 kg (BMI 18.3 ± 2.8 kg/m(2)) after a weight loss of 6.8 ± 6.4 kg. FA were analysed in plasma phospholipids (PPL) and erythrocyte membranes (ERY). RESULTS The proportions of saturated and monounsaturated FA were increased during weight loss, while linoleic acid (18:2ω6) was decreased. The proportions of eicosapentanoic acid (EPA) (20:5ω3) and docosahexanoic acid (DHA) (22:6ω3) in PPL and ERY did not differ from controls. The activity of stearoyl-CoA-desaturase was increased as evidenced by an increased product/precursor ratio and correlated with the rate of weight loss. The activities of delta-6-desaturase and delta-5-desaturase did not differ from controls. The rate of weight loss was inversely correlated with delta-6-desaturase and directly correlated with delta-5-desaturase. CONCLUSION The FA profile indicates low-fat intake, fat mobilization from stores and an increased conversion of essential FA at the delta-5-desaturase step during weight loss in adolescent girls with ED. Normal levels of EPA and DHA were maintained.
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Affiliation(s)
- I Swenne
- Department of Women's and Children's Health, Uppsala University, Sweden.
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Swenne I, Rosling A. Do thyroid hormones mediate the effects of starvation on mood in adolescent girls with eating disorders? Psychoneuroendocrinology 2010; 35:1517-24. [PMID: 20576362 DOI: 10.1016/j.psyneuen.2010.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 05/18/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
In the eating disorders (ED) comorbid depression is common and clinical experience suggests that it is partly related to starvation. Starvation affects thyroid hormone status and thyroid hypofunction is in turn associated with depressed mood. We have therefore investigated the possibility that thyroid hormones and starvation are associated with mood in ED. Two-hundred and thirty-nine adolescent girls were examined at presentation of an ED. Analyses of thyroid hormones, documentation of weight and weight changes, self-reports of depressive symptomatology and clinical diagnoses of ED and depression were used in the analyses. Of the 239 girls 100 were diagnosed with depression. The girls with and without depression did not differ in age, weight, height, body mass index (BMI), weight loss or duration of disease. Plasma free thyroxine concentrations were lower in depressed girls (11.9±1.7 versus 12.8±1.9 pmol/L; p<0.01). Plasma triodothyronine and thyroid-stimulating hormone concentrations did not differ between groups. In a logistic regression analysis the odds ratio for depression was 41.1 (95% confidence interval 4.18-405; p=0.001) for a 10 pmol/L change of plasma free thyroxine after correction for BMI, weight loss, duration of disease, rate of weight loss, plasma triodothyronine and an interaction between BMI and plasma free thyroxine. BMI did not predict depression. Low circulating thyroxine concentrations may provide a link between starvation and depression in adolescent girls with ED.
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Affiliation(s)
- Ingemar Swenne
- Dept. of Women's and Children's Health, Uppsala University Children's Hospital, S-751 85 Uppsala, Sweden.
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