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Body composition in early onset eating disorders

Abstract

Background: Body mass index (BMI) or equivalent weight for height indices are the most widely used measures of body composition in early onset and adolescent eating disorders. Although of value as screening instruments the limitation in disease states is their inability to discriminate fat and fat-free components of body weight.

Objective: To compare height-adjusted fat and fat-free components of body composition in children and young adolescents with different types of eating disorders with those of age matched reference children.

Design: Weight, height, triceps and subscapular skinfold thickness were measured in 172 children (aged 7–16 y) with eating disorders receiving specialist treatment. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated using Slaughter's and Deurenberg's equations and normalisation for height. Using data from 157 normal children, representative of the UK 1990 growth reference data, reference curves for FMI and FFMI±2 s.d. were derived. Results for patient groups were superimposed on these reference curves.

Results: FMI and FFMI were both reduced in eating disorders associated with malnutrition, including anorexia nervosa (AN). AN subjects did not differ from other subjects with comparable degrees of malnutrition. Children with eating disorders of normal weight, such as bulimia nervosa and selective eating, did not differ significantly from reference children in their relative FM and FFM.

Conclusions: FM and FFM merit independent consideration in disorders of malnutrition in children, rather than expressing data as percentage body fat or percentage BMI. The implications of loss of FFM on growth and development merit further investigation.

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References

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

  • Bachrach LK, Guido D, Katzman D, Litt IF, Marcus R . 1990 Decreased bone density in adolescent girls with anorexia nervosa Pediatrics 86: 440–447

    CAS  PubMed  Google Scholar 

  • Beaumont PJ, George GC, Pimstone BL, Vinik AI . 1976 Body weight and the pituitary response to hypothalamic releasing hormones in patients with anorexia nervosa J. Clin. Endocrinol. Metab. 43: 487–496

    Article  Google Scholar 

  • Birmingham CL, Jones PJ, Orphanidou C, Bakan R, Cleator IG, Goldner EM, Phang PT . 1996 The reliability of bioelectrical impedance analysis for measuring changes in the body composition of patients with anorexia nervosa Int. J. Eat. Disord. 19: 311–315

    Article  CAS  Google Scholar 

  • Brooks ER, Ogden BW, Cavalier DS . 1998 Compromised bone density 11.4 years after diagnosis of anorexia nervosa J. Womens Health 7: 567–574

    Article  CAS  Google Scholar 

  • Bryant-Waugh R . 2000 Overview of the eating disorders In: Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence 2nd edn, ed. B Lask & R Bryant-Waugh pp 27–40 Hove: Psychology Press

    Google Scholar 

  • Cole TJ, Freeman JV, Preece MA . 1995 Body mass index reference curves for the UK, 1990 Arch. Dis. Child. 73: 25–29

    Article  CAS  Google Scholar 

  • Cooke RA, Chambers JB, Singh R, Rodd GJ, Smeeton NC, Treasure J, Treasure T . 1994 QT interval in anorexia nervosa Br. Heart J. 72: 69–73

    Article  CAS  Google Scholar 

  • Deurenberg P, Pieters JJ, Hautvast JG . 1990 The assessment of the body fat percentage by skinfold thickness measurements in childhood and young adolescence Br. J. Nutr. 63: 293–303

    Article  CAS  Google Scholar 

  • Falk JR, Halmi KA . 1982 Amenorrhea in anorexia nervosa: examination of the critical body weight hypothesis Biol. Psychiat. 17: 799–806

    CAS  PubMed  Google Scholar 

  • Frisch RE . 1984 Body fat, puberty and fertility Biol. Rev. Camb. Phil. Soc. 59: 161–188

    Article  CAS  Google Scholar 

  • Gowers SG, Crisp AH, Joughin N, Bhat A . 1991 Premenarcheal anorexia nervosa J. Child Psychol. Psychiat. 32: 515–524

    Article  CAS  Google Scholar 

  • Grinspoon S, Miller K, Coyle C, Krempin J, Armstrong C, Pitts S, Herzog D, Klibanski A . 1999 Severity of osteopenia in estrogen-deficient women with anorexia nervosa and hypothalamic amenorrhea J. Clin. Endocrinol. Metab. 84: 2049–2055

    CAS  PubMed  Google Scholar 

  • Hannan WJ, Wrate RM, Cowen S, Freeman CP . 1995 Body mass index as an estimate of body fat Int. J. Eat. Disord. 18: 91–97

    Article  CAS  Google Scholar 

  • Higgs JF, Goodyer IM, Birch J . 1989 Anorexia nervosa and food avoidance emotional disorder Arch. Dis. Child. 64: 346–351

    Article  CAS  Google Scholar 

  • Hindler CG, Crisp AH, McGuigan S, Joughin N . 1994 Anorexia nervosa: change over time in age of onset, presentation and duration of illness Psychol. Med. 24: 719–729

    Article  CAS  Google Scholar 

  • Hotta M, Shibasaki T, Sato K, Demira H . 1998 The importance of body weight history in the occurrence and recovery of osteoporosis in patients with anorexia nervosa: evaluation by dual X-ray absorptiometry and bone metabolic markers Eur. J. Endocrinol 139: 276–283

    Article  CAS  Google Scholar 

  • Jacobs BE, Isaacs S . 1986 Pre-pubertal anorexia nervosa: a retrospective controlled study J. Child Psychol. Psychiat. 27: 237–250

    Article  CAS  Google Scholar 

  • James WP, Ferro LA, Waterlow JC . 1988 Definition of chronic energy deficiency in adults. Report of a working party of the International Dietary Energy Consultative Group Eur. J. Clin. Nutr. 42: 969–981

    CAS  PubMed  Google Scholar 

  • Janz KF, Nielsen DH, Cassady SL, Cook JS, Wu YT, Hansen JR . 1993 Cross-validation of the Slaughter skinfold equations for children and adolescents Med. Sci. Sports Exerc. 25: 1070–1076

    Article  CAS  Google Scholar 

  • Jeuniewic N, Brown GM, Garfinkel PE, Moldofsky H . 1978 Hypothalamic function as related to body weight and body fat in anorexia nervosa Psychosom. Med. 40: 187–198

    Article  CAS  Google Scholar 

  • Kohmura H, Miyake A, Aono T, Tanizawa O . 1986 Recovery of reproductive function in patients with anorexia nervosa: a 10-year follow-up study Eur. J. Obstet. Gynecol. Reprod. Biol. 22: 293–296

    Article  CAS  Google Scholar 

  • Lucas AR, Beard CM, O'Fallon WM, Kurland LT . 1991 Fifty year trends in the incidence of anorexia nervosa in Rochester, Minnesota: a population-based study Am. J. Psychiat. 148: 917–922

    Article  CAS  Google Scholar 

  • Mazess RB, Barden HS, Ohlrich ES . 1990 Skeletal and body-composition effects of anorexia nervosa Am. J. Clin. Nutr. 52: 438–441

    Article  CAS  Google Scholar 

  • Nicholls D, Chater R, Lask B . 2000 Children into DSM IV don't go: a comparison of classification systems for eating disorders in childhood and early adolescence Int. J. Eat. Disord. 28: 317–324

    Article  CAS  Google Scholar 

  • Nicholls D, Christie D, Randall L, Lask B . 2001 Selective eating: symptom, disorder or normal variant? Clin. Child Psychol. Psychiat. 6: 257–270

    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 

  • 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 

  • Prentice AM . 1998 Body mass index standards for children. Are useful for clinicians but not yet for epidemiologists [editorial.] Br. Med. J. 317: 1401–1402

    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 

  • Reilly JJ, Wilson J, Durnin JV . 1995 Determination of body composition from skinfold thickness: a validation study Arch. Dis. Child. 73: 305–310

    Article  CAS  Google Scholar 

  • Russell GFM . 1985 Pre-menarchal anorexia nervosa and its sequelae J. Psychiat. Res. 19: 363–369

    Article  CAS  Google Scholar 

  • Schneider P, Biko J, Schlamp D, Trott GE, Badura F, Warnke A, Reiners C . 1998 Comparison of total and regional body composition in adolescent patients with anorexia nervosa and pair-matched controls Eat. Weight Disord. 3: 179–187

    Article  CAS  Google Scholar 

  • Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van LM, Bemben DA . 1988 Skinfold equations for estimation of body fatness in children and youth Hum. Biol. 60: 709–723

    CAS  PubMed  Google Scholar 

  • Sobanski E, Hiltmann WD, Blanz B, Klein M, Schmidt MH . 1997 Pelvic ultrasound scanning of the ovaries in adolescent anorectic patients at low weight and after weight recovery Eur. Child Adolesc. Psychiat. 6: 207–211

    Article  CAS  Google Scholar 

  • Swenne I, Larsson PT . 1999 Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QT(c) interval prolongation and dispersion Acta Paediat. 88: 309

    Article  Google Scholar 

  • Treasure J, Fogelman I, Russell GF . 1986 Osteopaenia of the lumbar spine and femoral neck in anorexia nervosa Scott. Med. J. 31: 206–207

    CAS  PubMed  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 

  • Ulijaszek SJ, Lourie JA . 1997 Anthropometry in health assessment: the importance of measurement error Coll. Anthropol. 21: 429–438

    CAS  Google Scholar 

  • Vaisman N, Corey M, Ossi M, Goldberg E, Pencharz P . 1988 Changes in body composition during refeeding of patients with anorexia nervosa J. Pediatr. 113: 925–929

    Article  CAS  Google Scholar 

  • Van Itallie TB, Yang MU, Heymsfield SB, Funk RC, Boileau RA . 1990 Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutrition status Am. J. Clin. Nutr. 52: 953–959

    Article  CAS  Google Scholar 

  • Warner JT, Cowan FJ, Dunstan FD, Gregory JW . 1997 The validity of body mass index for the assessment of adiposity in children with disease states Ann. Hum. Biol. 24: 209–215

    Article  CAS  Google Scholar 

  • Wells JC . 2000 A Hattori chart analysis of body mass index in infants and children Int. J. Obes. Relat. Metab. Disord. 24: 325–329

    Article  CAS  Google Scholar 

  • Wells JCK . 2001 A critique of the expression of paediatric body composition data Arch. Dis. Child. 85: 67–72

    Article  CAS  Google Scholar 

  • Wells JC, Fuller NJ, Dewit O, Fewtrell MS, Elia M, Cole TJ . 1999 Four-component model of body composition in children: density and hydration of fat-free mass and comparison with simpler models Am. J. Clin. Nutr. 69: 904–912

    Article  CAS  Google Scholar 

  • Weststrate JA, Deurenberg P . 1989 Body composition in children: proposal for a method for calculating body fat percentage from total body density or skinfold-thickness measurements (Published errata appear in Am. J. Clin. Nutr. (1991) 54, 428 and 590.) Am. J. Clin. Nutr. 50: 1104–1115

    Article  CAS  Google Scholar 

  • Zamboni M, Armellini F, Turcato E, Todisco P, Gallagher D, Dalle GR, Haymsfield 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 

Download references

Acknowledgements

The work of Dasha Nicholls is supported by the Child Growth Foundation, UK.

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Nicholls, D., Wells, J., Singhal, A. et al. Body composition in early onset eating disorders. Eur J Clin Nutr 56, 857–865 (2002). https://doi.org/10.1038/sj.ejcn.1601403

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