The paradox of marrow adipose tissue in anorexia nervosa

Fazeli, Pouneh K.; Klibanski, Anne

doi:10.1016/j.bone.2018.02.013

Cited by 27 publications

(23 citation statements)

References 69 publications

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“…A new finding from our meta‐analysis is that lower fat mass in females with AN was correlated with significantly low bone mineral content and density across the whole body. We speculate that the hormonal cross‐talk between fat and bone tissue may be influencing this association (El Ghoch et al, ; Hawkes & Mostoufi‐Moab, ), potentially mediated through greater bone marrow adipose tissue observed in AN (Fazeli & Klibanski, ; Suchacki & Cawthorn, ). Whole‐body bone mineral content remained low in weight‐recovered individuals with AN.…”

Section: Discussionmentioning

confidence: 99%

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

Hübel

Yılmaz

Schaumberg

et al. 2019

Intl J Eating Disorders

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Objective Clinically, anorexia nervosa (AN) presents with altered body composition. We quantified these alterations and evaluated their relationships with metabolites and hormones in patients with AN longitudinally. Method In accordance with PRISMA guidelines, we conducted 94 meta‐analyses on 62 samples published during 1996–2019, comparing up to 2,319 pretreatment, posttreatment, and weight‐recovered female patients with AN with up to 1,879 controls. Primary outcomes were fat mass, fat‐free mass, body fat percentage, and their regional distribution. Secondary outcomes were bone mineral density, metabolites, and hormones. Meta‐regressions examined relationships among those measures and moderators. Results Pretreatment female patients with AN evidenced 50% lower fat mass (mean difference [MD]: −8.80 kg, 95% CI: −9.81, −7.79, Q = 1.01 × 10−63) and 4.98 kg (95% CI: −5.85, −4.12, Q = 1.99 × 10−28) lower fat‐free mass, with fat mass preferentially stored in the trunk region during early weight restoration (4.2%, 95% CI: −2.1, −6.2, Q = 2.30 × 10−4). While the majority of traits returned to levels seen in healthy controls after weight restoration, fat‐free mass (MD: −1.27 kg, 95% CI: −1.79, −0.75, Q = 5.49 × 10−6) and bone mineral density (MD: −0.10 kg, 95% CI: −0.18, −0.03, Q = 0.01) remained significantly altered. Discussion Body composition is markedly altered in AN, warranting research into these phenotypes as clinical risk or relapse predictors. Notably, the long‐term altered levels of fat‐free mass and bone mineral density suggest that these parameters should be investigated as potential AN trait markers. ResumenObjetivo Clínicamente, la anorexia nervosa (AN) se presenta con alteraciones en la composición corporal. Cuantificamos estas alteraciones y evaluamos longitudinalmente su relación con metabolitos y hormonas en pacientes con AN. Método De acuerdo con las pautas PRISMA, realizamos 94 meta‐análisis en 62 muestras publicadas entre 1996–2019, comparando hasta 2,319 pacientes mujeres en pre‐tratamiento, post‐tratamiento, y recuperadas en base al peso con hasta 1,879 controles. Las principales medidas fueron masa grasa, masa libre de grasa, porcentaje de grasa corporal y su distribución regional. Las medidas secundarias fueron densidad mineral ósea, metabolitos y hormonas. Las meta‐regresiones examinaron las relaciones entre esas medidas y moderadores. Resultados Las pacientes femeninas con AN pre‐tratamiento mostraron un 50% menos de masa grasa (MD: −8.80 kg, CI 95%: −9.81, −7.79, Q = 1.01 × 10–63) y 4.98 kg (CI 95%: −5.85, −4.12, Q = 1.99 × 10–28) menos de masa libre de grasa, con masa grasa preferentemente almacenada en la región del tronco durante la recuperación temprana del peso (4.2%, CI 95%: −2.1, −6.2, Q = 2.30 × 10–4). Aunque la mayoría de los rasgos regresaron a los niveles vistos en los controles sanos después de la restauración del peso, la masa libre de grasa (MD: −1.27 kg, CI 95%: −1.79, −0.75, Q = 5.49 × 10–6) y la densidad mineral ósea (MD: −0.10 kg, CI 95%: −0.18, −0.03, Q = 0.01) perm...

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Section: Discussionmentioning

confidence: 99%

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

Hübel

Yılmaz

Schaumberg

et al. 2019

Intl J Eating Disorders

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“…Reduced circulating T3 results in decreased resting energy expenditure and adipocyte lipolytic activities [64], which is pivotal in the conservation of energy for vital functions in the AN or fasting state. Cortisol, ghrelin [65] and GH [66] are positively correlated, while leptin [67], IGF-1 [65], and testosterone and oestrogen [68] as well as T3 [69] are negatively correlated with MAT mass. Hence, increased cortisol, ghrelin, and GH, accompanied by reduced leptin, IGF-1, sex steroid hormones, and T3 in AN, are also associated with suboptimal bone health.…”

Section: Endocrine Disruption In Anmentioning

confidence: 93%

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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“…Bone loss occurs early after the initiation of corticosteroid therapy and is correlated to dose and treatment duration [ 29 ]. Fragility fractures have been associated with early mortality and increased morbidity having a significant effect on the quality of life of both patients affected by diabetes [ 30 , 31 , 32 ], anorexia nervosa [ 33 , 34 ], and obesity [ 35 , 36 , 37 ].…”

Section: Bone Pathologies and Clinical Approachmentioning

confidence: 99%

Survey of MRI Usefulness for the Clinical Assessment of Bone Microstructure

Soldati

Rossi

Vicente

et al. 2021

IJMS

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Bone microarchitecture has been shown to provide useful information regarding the evaluation of skeleton quality with an added value to areal bone mineral density, which can be used for the diagnosis of several bone diseases. Bone mineral density estimated from dual-energy x-ray absorptiometry (DXA) has shown to be a limited tool to identify patients’ risk stratification and therapy delivery. Magnetic resonance imaging (MRI) has been proposed as another technique to assess bone quality and fracture risk by evaluating the bone structure and microarchitecture. To date, MRI is the only completely non-invasive and non-ionizing imaging modality that can assess both cortical and trabecular bone in vivo. In this review article, we reported a survey regarding the clinically relevant information MRI could provide for the assessment of the inner trabecular morphology of different bone segments. The last section will be devoted to the upcoming MRI applications (MR spectroscopy and chemical shift encoding MRI, solid state MRI and quantitative susceptibility mapping), which could provide additional biomarkers for the assessment of bone microarchitecture.

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The paradox of marrow adipose tissue in anorexia nervosa

Cited by 27 publications

References 69 publications

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

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

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

Survey of MRI Usefulness for the Clinical Assessment of Bone Microstructure

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