Body composition in anorexia nervosa: Meta‐analysis and meta‐regression of cross‐sectional and longitudinal studies

Hübel, Christopher; Yılmaz, Zeynep; Schaumberg, Katherine; Breithaupt, Lauren; Hunjan, Avina; E., Horne,; García‐González, Judit; O’Reilly, Paul; Bulik, Cynthia M.; Breen, Gerome

doi:10.1002/eat.23158

Cited by 36 publications

(43 citation statements)

References 115 publications

(222 reference statements)

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“…Similar patterns are observed in the UK and the Netherlands, where the incidence rate in females is higher than in males, with the peak incidence rate in adolescent girls [16,17]. A meta-analysis of 62 studies published from 1996 to 2019 showed that female AN patients had 50% less body fat mass than their healthy counterparts on average, with fat being stored mainly in the trunk region [18]. Body fat loss has been observed in different age groups.…”

Section: Introductionsupporting

confidence: 58%

Chronic stress and adipose tissue in the anorexic state: endocrine and epigenetic mechanisms

2020

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Although adipose tissue metabolism in obesity has been widely studied, there is limited research on the anorexic state, where the endocrine system is disrupted by reduced adipose tissue mass and there are depot-specific changes in adipocyte type and function. Stress exposure at different stages of life can alter the balance between energy intake and expenditure and thereby contribute to the pathogenesis of anorexia nervosa. This review integrates information from human clinical trials to describe endocrine, genetic and epigenetic aspects of adipose tissue physiology in the anorexic condition. Changes in the hypothalamus-pituitary-thyroid,-adrenal, and-gonadal axes and their relationships to appetite regulation and adipocyte function are discussed. Because of the role of stress in triggering or magnifying anorexia, and the dynamic but also persistent nature of environmentally-induced epigenetic modifications, epigenetics is likely the link between stress and long-term changes in the endocrine system that disrupt homoeostatic food intake and adipose tissue metabolism. Herein, we focus on the adipocyte and changes in its function, including alterations reinforced by endocrine disturbance and dysfunctional adipokine regulation. This information is critical because of the poor understanding of anorexic pathophysiology, due to the lack of suitable research models, and the complexity of genetic and environmental interactions.

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Section: Introductionsupporting

confidence: 58%

Chronic stress and adipose tissue in the anorexic state: endocrine and epigenetic mechanisms

2020

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“…Body composition is significantly altered in AN. Accordingly, lower fat mass and fat free mass were found in patients with AN associated with an extreme physiological state including numerous endocrine and metabolic adaptions 3 , 4 . Furthermore, hematological changes and a respectively increased risk of infection seem to be associated with chronicity of AN, weight loss and the severity of underweight 5 .…”

Section: Introductionmentioning

confidence: 99%

Alterations in B cell subsets correlate with body composition parameters in female adolescents with anorexia nervosa

Freff

Schwarte

Bröker

et al. 2021

Sci Rep

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Anorexia nervosa (AN) is a severe eating disorder and often associated with altered humoral immune responses. However, distinct B cell maturation stages in peripheral blood in adolescents with AN have not been characterized. Treatment effects and the relationship between clinical and B cell parameters are also not fully understood. Here we investigated the phenotype of circulating B cell subsets and the relationship with body composition in adolescents with AN before (T0, n = 24) and after 6 weeks (T1, n = 20) of treatment. Using multi-parameter flow cytometry, we found increased percentages of antigen-experienced B cells and plasmablasts in patients with AN compared to healthy controls (n = 20). In contrast, percentages of CD1d+CD5+ B cells and transitional B cells with immunoregulatory roles were reduced at T0 and T1. These B cell frequencies correlated positively with fat mass, fat mass index (FMI), free fat mass index, and body mass index standard deviation score. In addition, scavenger-like receptor CD5 expression levels were downregulated on transitional B cells and correlated with fat mass and FMI in AN. Our findings that regulatory B cell subgroups were reduced in AN and their strong relationship with body composition parameters point toward an impact of immunoregulatory B cells in the pathogenesis of AN.

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“…The use of BIA allows the monitoring of compartmental weight gain during refeeding. A recent meta-analysis by Hübel et al reported 50% less FM and 5 kg less FFM in AN patients compared to the control group [ 36 ]. Recovery was associated with restored FM primarily stored in the trunk as previously described [ 37 ], while long-term lower levels of FFM were observed compared to the control group.…”

Section: Discussionmentioning

confidence: 99%

Validity of Bioimpedance Equations to Evaluate Fat-Free Mass and Muscle Mass in Severely Malnourished Anorectic Patients

Coëffier

Gaté

Rimbert

et al. 2020

JCM

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Background: Bioelectrical impedance analysis (BIA) is a simple and rapid technique to measure body composition (BC). Validity of BIA in patients with low body mass index (BMI) remains controversial. We assessed the validity of several BIA equations to evaluate fat-free mass (FFM), fat mass (FM) and muscle mass in patients with anorexia nervosa (AN) by using dual X ray absorptiometry (DXA) as reference. Methods: Sixteen BIA equations developed for FFM and appendicular lean mass (ALM) were applied on electrical data measured by BIA in AN patients with BMI <16 kg/m². BIA and DXA were done the same day after overnight fasting. Results were compared with the Bland–Altman method, Pearson correlation and a Lin concordance test. Results: Data from 115 female AN patients (14.6 ± 1.2 kg/m²; 32.3 ± 14.5 years) were included. FM and FFM assessed by DXA were, respectively, 4.2 ± 2.4 kg and 35.5 ± 3.8 kg. The best results were obtained with Sun’s equation: respectively for FM and FFM, Bland Altman bias at 0.548 and 0.706 kg, Pearson correlation r at 0.86 and 0.86 and Lin concordance coefficient at 0.81 and 0.84. However, confidence intervals (CI) at 95% were high (−2.73–3.83 kg for FM; −4.55–3.13 kg for FFM). Other equations also showed high 95% CI. Accuracy was acceptable for Sun and Bedogni equations for FFM (approximately 66%) but very low for FM prediction considering all equations (<15%). Concerning ALM evaluated at 14.88 ± 2.04 kg by DXA, only Scafoglieri and Yoshida equations showed acceptable values: bias (−0.2 and 2.8%), Pearson r (0.89 and 0.86), Lin concordance coefficient (0.82 and 0.82) and accuracy (83.5 and 82.6%). Confidence intervals at 95% were high for both equations (−2.1–2.0 for Scafoglieri equation and −1.6–2.4 for Yoshida equation). Conclusion: In AN patients with BMI < 16 kg/m², no BIA equation tested was adapted to evaluate BC at the individual level.

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Body composition in anorexia nervosa: Meta‐analysis and meta‐regression of cross‐sectional and longitudinal studies

Cited by 36 publications

References 115 publications

Chronic stress and adipose tissue in the anorexic state: endocrine and epigenetic mechanisms

Chronic stress and adipose tissue in the anorexic state: endocrine and epigenetic mechanisms

Alterations in B cell subsets correlate with body composition parameters in female adolescents with anorexia nervosa

Validity of Bioimpedance Equations to Evaluate Fat-Free Mass and Muscle Mass in Severely Malnourished Anorectic Patients

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