Is constitutional thinness really different from anorexia nervosa? A systematic review and meta-analysis

Bailly, Mélina; Boscaro, Audrey; Pereira, Bruno; Féasson, Léonard; Boirie‌, Yves; Germain, Natacha; Galusca, Bogdan; Courteix, Daniel; Torgerson, David; Verney, Julien

doi:10.1007/s11154-021-09650-4

Cited by 12 publications

(25 citation statements)

References 60 publications

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“…Changes in the metabolically active muscle mass (indirectly reflected by FFM variations) and a reduction in thermogenesis due to the FM decrease may be more prominent in the first phases of reduced food intake [43,44]. In patients with AN, FFM and FM variations also affect REE, but FFM is less metabolically active compared with other malnourished individuals [45]. This implies that in individuals with the same weight, REE might be lower in patients with AN than in other undernourished patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study

et al. 2022

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Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REEIC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REEIC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.

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Section: Discussionmentioning

confidence: 99%

Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study

et al. 2022

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“…Se limitaron los resultados a revisiones sistemáticas y meta-análisis usando los filtros correspondientes. Se encontraron 25 citas, de las cuales se seleccionó una revisión sistemática que parecía responder a la pregunta planteada 1 .…”

Section: Estrategia De Búsquedaunclassified

“…La delgadez constitucional es el estado de peso corporal disminuido -habitualmente definido como un IMC menor de 18,5-en el que el balance energético del metabolismo es neutro, es decir, los ingresos calóricos se equiparan con las pérdidas 1 .…”

Section: Algunos Datos Sobre La Delgadez Constitucionalunclassified

“…Si bien el diagnóstico de los trastornos alimentarios se define por criterios clínicos, resulta atractiva la posibilidad de contar con herramientas cuantitativas para descartar su presencia cuando la clínica resulta confusa. En este sentido, de la revisión sistemática de Bailly y col. 1 , se desprenden varias determinaciones que se comportarían de manera diferencial entre las personas con delgadez constitucional y aquellas que presentan anorexia nerviosa, como los dosajes de leptina, T3 libre, factor de crecimiento similar a la insulina 1(IGF-1), estradiol, las hormonas folículoestimulante y luteinizante en ayunas, y el cortisol de 24 horas. Sin embargo, es necesario tener en cuenta las limitaciones importantes del estudio que podrían restringir la extrapolación de sus resultados: la inconsistencia entre los estudios incluidos, el bajo tamaño muestral para muchas variables, y la muy baja tasa de varones incluidos en los estudios primarios (27 de los 39 estudios seleccionados incluyeron exclusivamente mujeres).…”

Section: Conclusiones Y Recomendacionesunclassified

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Los pacientes con delgadez constitucional presentan un fenotipo diferente al de los pacientes con trastornos de la alimentación

Villalon

2021

Evid actual pract ambul

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Los pacientes con delgadez constitucional suelen presentar un peso habitual reducido pero estacionario en el tiempo, con dificultad para aumentarlo incluso luego de someterse a dietas hipercalóricas. A diferencia de otras entidades, no se suelen encontrar trastornos de la alimentación, enfermedades sistémicas, desnutrición o sobre ejercitación. Sin embargo, su presencia suele despertar preocupación y motivar la búsqueda de causas patológicas asociadas, tanto por parte de los pacientes como de los profesionales de la salud. Partiendo de la viñeta clínica de una paciente que presenta estas características, el autor realiza una búsqueda bibliográfica para intentar esclarecer cuán diferentes resultan los pacientes con delgadez constitucional de aquellos que presentan el principal diagnóstico diferencial a tener en cuenta, la anorexia nerviosa.

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“…Yet, based on the data of Orthofer study, it may be calculated at 1.9% (Orthofer et al, 2020). To date, this uncommon phenotype remains poorly investigated with only about 40 clinical trials from 1950 (Bailly et al, 2020c(Bailly et al, , 2021. Based on such a limited number of studies, the absence of health concerns is not, however, robustly demonstrated, particularly according to studies assessing bone tissue (Galusca et al, 2008(Galusca et al, , 2009.…”

Section: Introductionmentioning

confidence: 99%

New Insights on Bone Tissue and Structural Muscle-Bone Unit in Constitutional Thinness

et al. 2022

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While few studies pointed out low bone mineral densities in constitutionally thin women, little is known about potential explanations. The objective was to further explore bone architecture in both women and men with constitutional thinness to investigate their mechanical muscle-bone coupling (or uncoupling). Thirty constitutionally thin people and 31 normal weight controls participated in the study. Body composition, hip structural analysis, and trabecular bone score were assessed by dual-energy X-ray absorptiometry, bone architecture using high-resolution peripheral quantitative computed tomography, and muscle explorations through histological staining on muscle biopsies. Thirty-two out of the 48 indexes relative to density, geometry, texture, and architecture of bones were found significantly lower (p < 0.05) in constitutionally thin individuals compared with controls. This observation was particularly pronounced in constitutionally thin men. Bone microarchitecture was more altered in weight-supporting bone (tibia) than in non-weight-supporting (radius) bone, which might refer to a normal physiological adaptation (Frost’s mechanostat theory). Yet, the heat-maps of correlations analyses showed many alterations of body weight or muscle associations with bone parameters in constitutionally thin individuals contrary to controls. Present results might support the idea of intrinsic disturbances of bone cells independently to the small muscle structure, particularly in men.

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Is constitutional thinness really different from anorexia nervosa? A systematic review and meta-analysis

Cited by 12 publications

References 60 publications

Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study

Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study

Los pacientes con delgadez constitucional presentan un fenotipo diferente al de los pacientes con trastornos de la alimentación

New Insights on Bone Tissue and Structural Muscle-Bone Unit in Constitutional Thinness

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