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

European Journal of Clinical Nutrition volume 56, pages 15–20 (2002)Cite this article

Abstract

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/ m2) and after the achievement of a BMI >18.5 kg/m2. The control group comprised 18 well-nourished women (age 20.1±4.4 y; BMI 19.0–23.0 kg/ m2).

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.

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References

  • American Psychiatric Association . 1994 Diagnostic & Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association: Washington, DC

  • Davies CTM, von Dobeln W, Fohlin L, Freyschuss U & Thoren C . 1978 Total body potassium, fat-free weight and maximal aerobic power in children with anorexia nervosa Acta Pediat. Scand. 67: 229–234

    Article  CAS  Google Scholar 

  • Durnin JVGA & Womersley J . 1974 Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged 16 to 72 y Br. J. Nutr. 32: 77–97

    Article  CAS  Google Scholar 

  • Fohlin L . 1977 Body composition, cardiovascular and renal function in adolescent patients with anorexia nervosa Acta Pediat. Scand. 268 Suppl: 7–20

    Google Scholar 

  • Forbes GB, Kreipe RE, Lipinski BA & Hodgman CH . 1984 Body composition changes during recovery from anorexia nervosa: comparison of two dietary regimes Am. J. Clin. Nutr. 40: 1137–1145

    Article  CAS  Google Scholar 

  • Grinspoon S, Thomas L, Miller K, Pitts S, Herzog D & Klibanski A . 2001 Changes in regional fat distribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa Am. J. Clin. Nutr. 73: 865–869

    Article  CAS  Google Scholar 

  • Hannan J, Cowen S, Freeman C, Mackie A & Shapiro CM . 1990 Assessment of body composition in anorexic patients In In Vivo Body Composition Study. Recent Advances, eds S Yasumura, JE Harrison, KG McNeil, AV Woodhead & FA Dilmanian 149–55 Plenum Press: New York

    Google Scholar 

  • Heymsfield SB, McManus C, Smith J, Stevens V & Nixon DW . 1982 Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area Am. J. Clin. Nutr. 36: 680–690.

    Article  CAS  Google Scholar 

  • Henry CJK . 1990 Body mass index and the limits of human survival Eur. J Clin. Nutr. 44: 329–335

    CAS  PubMed  Google Scholar 

  • Iketani T, Kiriike N, Nagata T & Yamagami S . 1999 Altered body fat distribution after recovery of weight in patients with anorexia nervosa Int. J. Eat. Disord. 26: 275–282

    Article  CAS  Google Scholar 

  • Keys A, Brozek J, Henschel A & Taylor HL . 1950 The Biology of Human Starvation. University of Minnesota Press: Minneapolis

  • Krahn DD, Rock C, Dechert RE, Nair KK & Hasse SA . 1993 Changes in resting energy expenditure and body composition in anorexia nervosa patients during refeeding J. Am. Diet. Assoc. 93: 434–438

    Article  CAS  Google Scholar 

  • Lohman TG, Roche AF & Martorell R . 1988 Anthropometric Standardization Reference Manual. Human Kinetics Books: Champaign, IL

  • Mitchell PB & Truswell AS . 1987 Body composition in anorexia nervosa and starvation In Handbook of Eating Disorders, eds PJ Beamount, J Burroughs & RC Casper pp 45–72 Elsevier: New York

    Google Scholar 

  • Nuñez C, Carbajal A & Moreiras O . 1994 Refeeding efficacy on body composition in hospitalized patients with anorexia nervosa Nutr. Res. 14: 1457–1463

    Article  Google Scholar 

  • Orphanidou CI, McCargar LJ, Birmingham CL & Belzberg AS . 1997 Changes in body composition and fat distribution after short-term weight gain in patients with anorexia nervosa Am. J. Clin. Nutr. 65: 1034–1041

    Article  CAS  Google Scholar 

  • Pirke KM, Pahl J, Schweiger U, Munzing W, Lang P & Bull U . 1986 Total body potassium, intracellular potassium and body composition in patients with anorexia nervosa during refeeding Int J. Eat. Disord. 5: 347–354

    Article  Google Scholar 

  • Polito A, Cuzzolaro M, Raguzzini A, Censi L & Ferro-Luzzi A . 1998 Body composition changes in anorexia nervosa Eur. J. Clin. Nutr. 52: 655–662

    Article  CAS  Google Scholar 

  • Probst M, Goris M, Vandereycken W & Van Coppenolle H . 1996 Body composition in female anorexia nervosa patients Br. J. Nutr. 76: 639–647

    Article  CAS  Google Scholar 

  • Probst M, Goris M, Vandereycken W & Van Coppenolle H . 2001 Body composition of anorexia nervosa patients assessed by underwater weighing and skinfold-thickness measurements before and after weight gain Am. J. Clin. Nutr. 73: 190–197

    Article  CAS  Google Scholar 

  • Russel GFM & Mezey AG . 1962 An analysis of weight gain in patients with anorexia nervosa treated with high calorie diets Clin. Sci. 23: 449–461

    Google Scholar 

  • Salisbury JJ, Levine AS, Crow SJ & Mitchell JE . 1995 Refeeding, metabolic rate and weight gain in anorexia nervosa: a review Int. J. Eat. Disord. 17: 337–345

    Article  CAS  Google Scholar 

  • Scalfi L, Di Biase G, Sapio C, Coltorti A & Contaldo F . 1993 Bioimpedance analysis and resting energy expenditure in undernourished and refed anorectic patients Eur. J. Clin. Nutr. 47: 61–67

    CAS  PubMed  Google Scholar 

  • Scalfi L, Marra M, Caldara A, Silvestri E & Contaldo F . 1999 Changes in Bioimpedance analysis after stable refeeding of undernourished anorexic patients Int. J. Obes. Relat. Metab. Disord. 23: 133–137

    Article  CAS  Google Scholar 

  • Standard KL, Wills VG & Waterlow JC . 1959 Indirect indicators of muscle mass in malnourished infants Am. J Clin. Nutr. 33: 2686–2693

    Google Scholar 

  • Trocki O & Shepherd RW . 2000 Change in body mass index does not predict change in body composition in adolescent girls with anorexia nervosa J. Am. Diet. Assoc. 100: 457–460

    Article  CAS  Google Scholar 

  • Vaisman N, Corey M, Rossi MF, Goldeberg E & Pencharz P . 1988 Changes in body composition during refeeding of patients with anorexia nervosa J. Pediatr. 113: 919–924

    Article  CAS  Google Scholar 

  • Waller FG, Wade AJ, Treasure J, Ward A, Leonard T & Powell-Tuck J . 1996 Physical measures of recovery from anorexia nervosa during hospitalised re-feeding Eur. J. Clin. Nutr. 50: 165–170

    CAS  PubMed  Google Scholar 

  • WHO . 1995 Physical status: the use and interpretation of anthropometry Report of a WHO Expert Committee. Technical Report Series no. 854; WHO: Geneva

  • Zamboni M, Armellini F, Turcato E, Todisco P, Gallagher D, Dalle Grave R, Heymsfield S, Bosello O . 1997 Body fat distribution before and after weight gain in anorexia nervosa Int. J. Obes. Relat. Metab. Disord. 21: 33–36

    Article  CAS  Google Scholar 

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Author notes

  1. L Scalfi: Guarantor: L Scalfi.

  2. L Scalfi, A Polito, L Bianchi, M Marra, A Caldara, E Nicolai and F Contaldo: Contributors: LS and FC designed the study and interpreted the results. AP, LB and AC supervised the running of the study and managed the data collection. MM did the statistical analysis and contributed to the interpretation of data. EN performed DXA measurements and contributed to the interpretation of data. All investigators participated in the writing and revision of the paper.

Authors and Affiliations

  1. Department of Food Science, University Federico II, Naples, Italy

    L Scalfi

  2. National Research Institute for Food and Nutrition, Rome, Italy

    A Polito

  3. CDN, Naples, Italy

    L Bianchi & E Nicolai

  4. Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy

    M Marra, A Caldara & F Contaldo

Authors
  1. L Scalfi
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  2. A Polito
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  4. M Marra
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  5. A Caldara
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  6. E Nicolai
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  7. F Contaldo
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Correspondence to L Scalfi.

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Scalfi, L., Polito, A., Bianchi, L. et al. Body composition changes in patients with anorexia nervosa after complete weight recovery. Eur J Clin Nutr 56, 15–20 (2002). https://doi.org/10.1038/sj.ejcn.1601290

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  • DOI: https://doi.org/10.1038/sj.ejcn.1601290

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