Lower leptin level at discharge in acute anorexia nervosa is associated with early weight‐loss

Abstract

Objective Predictive values of acute phase metabolic abnormalities of anorexia nervosa (AN) have seldom been studied. As early postrestoration weight loss is associated with poor outcome, discharge biologic parameters were assessed to detect an association with 2‐month follow‐up weight loss as a proxy to poor outcome. Method Fasting plasma levels of leptin, acyl‐ghrelin, obestatin, PYY, oxytocin and BDNF were measured in 26 inpatients, at inclusion, at discharge and 2 months later. A body mass index less than 18 2‐month postdischarge was considered a poor outcome. Results Nineteen patients (73%) had a fair outcome and seven (27%) had a poor one with a mean loss of 0.69 versus 4.54 kg, respectively. Only discharge leptin levels were significantly higher in fair versus poor outcome patients (14.1 vs. 7.0 ng/ml, p = 0.006). The logistic regression model using discharge leptin, acyl‐ghrelin, obestatin, oxytocin, PYY and BDNF levels as predictors of outcome disclosed a nearly significant effect of leptin (p < 0.10). Receiver operating characteristic analysis showed 11.9 ng/ml was the best value of threshold. Neither clinical variables differed according to outcome. Conclusion Leptin level may be a biomarker of early weight relapse after acute inpatient treatment of AN. Its clinical usefulness in monitoring care in AN should further be determined.

BMI at Discharge from Treatment Predicts Relapse in Anorexia Nervosa: A Systematic Scoping Review

“…Twelve of the nineteen studies presented relapse rates for different time periods, ranging from 2 months [ 26 ] up to 26 months [ 16 ]. The studies had different designs and purposes.…”

“…The studies had different designs and purposes. One study presented relapse rates of 27% at 2 months [ 26 ], some reported 21–31% at 6 months [ 27 , 28 ], while other studies found relapse rates in the range of 30–72% at 12 months [ 16 , 24 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Half of the studies reported a relapse rate of approximately 50% at 12 months (M ± SD: 47.4 ± 19.2%).…”

“…Of the 19 studies included in this review, 8 excluded patients with a BMI below 18.5 kg/m 2 at discharge [ 12 , 16 , 30 , 32 , 33 , 37 , 38 , 39 ]. Another eight studies had not excluded patients with BMI below 18.5 kg/m 2 , but the variability of BMI at discharge indicated that potentially a minor subgroup of these patients was not in complete remission [ 23 , 25 , 26 , 31 , 34 , 35 , 36 , 40 ]. In addition, three of the studies may have included a significant minority of unremitted patients, but the design of the study could still allow for relevant data on outcome prediction [ 24 , 27 , 28 ].…”

“…Three studies investigated levels of leptin at discharge, and two high-quality studies found it to be a predictor of relapse [ 26 , 33 ], while one moderate quality study did not [ 25 ].…”

“…Two other findings from this review, albeit of low level of evidence, that low body fat percentage was a predictor of relapse [ 30 , 33 , 38 ] and that low leptin levels at discharge predicted risk of relapse [ 25 , 26 , 33 ], both harmonize with the finding that low BMI is a predictor of relapse, together with supporting that achieving a sufficiently high BMI also implies that the body fat percentage has increased and thereby leptin levels, at the end of treatment is a treatment goal that creates the most optimal protection against relapse.…”