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Lopes MP, Robinson L, Stubbs B, Dos Santos Alvarenga M, Araújo Martini L, Campbell IC, Schmidt U. Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis. J Eat Disord 2022; 10:173. [PMID: 36401318 PMCID: PMC9675098 DOI: 10.1186/s40337-022-00694-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lower bone mineral density (BMD) increases the risk of osteoporosis in individuals with eating disorders (EDs), particularly women with anorexia nervosa (AN), making them susceptible to pain and fractures throughout adulthood. In AN, low weight, hypothalamic amenorrhoea, and longer illness duration are established risk factors for low BMD, and in people with other EDs a history of AN seems to be an important risk factor for low BMD. PURPOSE To conduct a systematic review and meta-analysis of BMD in individuals with EDs, including AN, bulimia nervosa (BN), binge-eating disorder (BED) and other specified feeding or eating disorders (OSFED) compared to healthy controls (HC). METHODS Following PRISMA guidelines, electronic databases were reviewed and supplemented with a literature search until 2/2022 of publications measuring BMD (dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with any current ED diagnosis and a HC group. Primary outcomes were spine, hip, femur and total body BMD. Explanatory variables were fat mass, lean mass and ED clinical characteristics (age, illness duration, body mass index (BMI), amenorrhoea occurrence and duration, and oral contraceptives use). RESULTS Forty-three studies were identified (N = 4163 women, mean age 23.4 years, min: 14.0, max: 37.4). No study with individuals with BED met the inclusion criteria. BMD in individuals with AN (total body, spine, hip, and femur), with BN (total body and spine) and with OSFED (spine) was lower than in HC. Meta-regression analyses of women with any ED (AN, BN or OSFED) (N = 2058) showed low BMI, low fat mass, low lean mass and being amenorrhoeic significantly associated with lower total body and spine BMD. In AN, only low fat mass was significantly associated with low total body BMD. CONCLUSION Predictors of low BMD were low BMI, low fat mass, low lean mass and amenorrhoea, but not age or illness duration. In people with EDs, body composition measurement and menstrual status, in addition to BMI, are likely to provide a more accurate assessment of individual risk to low BMD and osteoporosis.
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Affiliation(s)
- Mariana P Lopes
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil. .,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Brendon Stubbs
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Marle Dos Santos Alvarenga
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Ligia Araújo Martini
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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Howard M, Roiser JP, Gilbert SJ, Burgess PW, Dayan P, Serpell L. Short-Term Fasting Selectively Influences Impulsivity in Healthy Individuals. Front Psychol 2020; 11:1644. [PMID: 32765372 PMCID: PMC7381251 DOI: 10.3389/fpsyg.2020.01644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
Previous research has shown that short-term fasting in healthy individuals is associated with changes in risky decision-making. The current experiment was designed to examine the influence of short-term fasting in healthy individuals on four types of impulsivity: reflection impulsivity, risky decision-making, delay aversion, and action inhibition. Participants were tested twice, once when fasted for 20 h, and once when satiated. Participants demonstrated impaired action inhibition when fasted; committing significantly more errors of commission during a food-related Affective Shifting Task. Participants also displayed decreased reflection impulsivity when fasted, opening significantly more boxes during the Information Sampling Task (IST). There were no significant differences in performance between fasted and satiated sessions for risky decision-making or delay aversion. These findings may have implications for understanding eating disorders such as Bulimia Nervosa (BN). Although BN has been characterized as a disorder of poor impulse control, inconsistent findings when comparing individuals with BN and healthy individuals on behavioral measures of impulsivity question this characterization. Since individuals with BN undergo periods of short-term fasting, the inconsistent findings could be due to differences in the levels of satiation of participants. The current results indicate that fasting can selectively influence performance on the IST, a measure of impulsivity previously studied in BN. However, the results from the IST were contrary to the original hypothesis and should be replicated before specific conclusions can be made.
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Affiliation(s)
- Maxine Howard
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jonathan P. Roiser
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Sam J. Gilbert
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Paul W. Burgess
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Peter Dayan
- Gatsby Computational Neuroscience Unit, University College London, London, United Kingdom
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Eating Disorder Service, North East London NHS Foundation Trust, Orchards Health & Family Centre, Essex, United Kingdom
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Frølich J, Winkler LA, Abrahamsen B, Bilenberg N, Hermann AP, Støving RK. Fractures in women with eating disorders-Incidence, predictive factors, and the impact of disease remission: Cohort study with background population controls. Int J Eat Disord 2020; 53:1080-1087. [PMID: 31922277 DOI: 10.1002/eat.23223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/23/2019] [Accepted: 11/30/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Malnutrition and low weight in eating disorders (EDs) are associated with increased fracture risk compared to the general population. In a cohort study, we aimed to determine fracture rates compared to age and gender matched controls (ratio 5:1), assess the impact of disease remission on fracture risk, and establish predictive factors for fractures. METHOD Of note, 803 ED patients referred to specialized ED treatment between 1994 and 2004 were included. In 2016, data on fractures were obtained through the Danish National Registry of Patients. RESULTS Fracture risk was increased in anorexia nervosa (AN; IRR 2.2 [CI 99%: 1.6-3.0]) but not in bulimia nervosa (BN; IRR 1.3, ns) or other specified feeding or eating disorders (OSFED; IRR 1.8, ns). IRR in the AN group were increased for vertebral fractures (IRR 3.8 [CI 99%: 1.4-10.3]), upper arm (IRR 3.0 (CI 99% 1.6-5.5) and hip (IRR 6.6 [CI 99%: 2.6-18.0]). Disease remission in AN is associated to lower fracture risk compared to active disease, but higher fracture risk compared to controls (IRR 1.7 [CI 99%: 1.1-2.7]). In regression analysis, age at debut of disease, nadir BMI and duration of disease before referral to treatment, independently predicted fracture. DISCUSSION We confirm increased fracture risk in AN, and show significant differences in fracture risk between patients in disease remission and patients with active disease. Furthermore, we show that age at debut of disease and duration of disease before referral to treatment is positively correlated to fracture risk, whereas nadir BMI is negatively correlated to fracture risk.
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Affiliation(s)
- Jacob Frølich
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark
- Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Child and Adolescence Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Laura A Winkler
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark
- Department of Child and Adolescence Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
- Nuffield Department of Orthopedics and Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Niels Bilenberg
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Child and Adolescence Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Anne P Hermann
- Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark
| | - René K Støving
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark
- Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Child and Adolescence Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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Robinson L, Aldridge VK, Clark EM, Misra M, Micali N. Bone health in adult women with ED: A longitudinal community-based study. J Psychosom Res 2019; 116:115-122. [PMID: 30577982 PMCID: PMC7105899 DOI: 10.1016/j.jpsychores.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/26/2022]
Abstract
Although Eating Disorders (ED) are known to affect bone health and development, little is known about the longitudinal effect of ED and ED behaviours on bone health in community dwelling adult women. Women (n = 3507) enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) participated in a two-phase prevalence study to assess lifetime ED and ED behaviours (fasting, restrictive eating, vomiting and misuse of medication). Crude and adjusted linear regression methods investigated the association between ED diagnoses and behaviours, and total body, hip, leg and arm bone mineral density (BMD) DXA scans at mean ages of 48 and 52 years. Lifetime occurrence of Anorexia Nervosa (AN) was associated with lower BMD Z-scores for the whole body (mean difference (MD) = -0.28; 95% CI: -0.49, -0.05), hip (MD = -0.45; 95% CI -0.74, -0.16), leg (MD = -0.28; 95% CI -0.52, -0.03) and arm (MD = -0.44; 95% CI -0.68, -0.19) compared to no ED. This effect was mostly accounted for by lowest ever BMI. In post-hoc analyses, Restrictive AN, but not Binge-Purge AN was associated with a lower total body BMD Z-scores (MD = -0.37; 95% CI -0.62, -0.12). Lifetime Fasting and Restrictive Eating were associated with low BMD of the total body, hip, arm and leg in adjusted analyses, all p < 0.05. Both lifetime ED diagnoses and ED behaviours in a large community sample were predictive of low BMD in mid-life. This study confirms that the effects of AN, fasting and restrictive eating, and low BMI on bone health seen in clinical samples also occur in community samples.
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Affiliation(s)
- Lauren Robinson
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, SE5 8AZ, UK; Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK.
| | - Victoria K Aldridge
- Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK; Health and Life Sciences, De Montfort University, Leicester LE1 9BH3, UK
| | - Emma M Clark
- Division of Pediatric Endocrinolgy, Massachusetts General Hospital for Children, Boston, MA 02114, USA
| | - Madhusmita Misra
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Micali
- Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK; Child and Adolescent Psychiatry Division, Department of Child and Adolescent health, Geneva University Hospital, Geneva, Switzerland; Dept. of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, US; Musculoskeletal Research Unit, University of Bristol, Bristol, UK
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5
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Mathisen TF, Rosenvinge JH, Friborg O, Pettersen G, Stensrud T, Hansen BH, Underhaug KE, Teinung E, Vrabel K, Svendsen M, Bratland‐Sanda S, Sundgot‐Borgen J. Body composition and physical fitness in women with bulimia nervosa or binge-eating disorder. Int J Eat Disord 2018; 51:331-342. [PMID: 29473191 PMCID: PMC5947292 DOI: 10.1002/eat.22841] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Knowledge about physical fitness in women with bulimia nervosa (BN) or binge-eating disorder (BED) is sparse. Previous studies have measured physical activity largely through self-report, and physical fitness variables are mainly restricted to body mass index (BMI) and bone mineral density. We expanded the current knowledge in these groups by including a wider range of physical fitness indicators and objective measures of physical activity, assessed the influence of a history of anorexia nervosa (AN), and evaluated predictive variables for physical fitness. METHOD Physical activity, blood pressure, cardiorespiratory fitness (CRF), muscle strength, body composition, and bone mineral density were measured in 156 women with BN or BED, with mean (SD) age 28.4 years (5.7) and BMI 25.3 (4.8) kg m-2 . RESULTS Level of physical activity was higher than normative levels, still <50% met the official physical activity recommendation. Fitness in women with BN were on an average comparable with recommendations or normative levels, while women with BED had lower CRF and higher BMI, VAT, and body fat percentage. We found 10-12% with masked obesity. A history of AN did not predict current physical fitness, still values for current body composition were lower when comparing those with history of AN to those with no such history. DISCUSSION Overall, participants with BN or BED displayed adequate physical fitness; however, a high number had unfavorable CRF and body composition. This finding calls for inclusion of physical fitness in routine clinical examinations and guided physical activity and dietary recommendations in the treatment of BN and BED.
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Affiliation(s)
| | - Jan H. Rosenvinge
- Department of Psychology, Faculty of Health SciencesUiT—The Arctic University of NorwayTromsøNorway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health SciencesUiT—The Arctic University of NorwayTromsøNorway
| | - Gunn Pettersen
- Department of Health and Caring SciencesFaculty of Health Sciences, UiT—The Arctic University of NorwayTromsøNorway
| | - Trine Stensrud
- Department of Sports MedicineNorwegian School of Sport SciencesSognsvegen 220N‐0806 OsloNorway
| | - Bjørge Herman Hansen
- Department of Sports MedicineNorwegian School of Sport SciencesSognsvegen 220N‐0806 OsloNorway
| | - Karoline E. Underhaug
- Department of Sports MedicineNorwegian School of Sport SciencesSognsvegen 220N‐0806 OsloNorway
| | - Elisabeth Teinung
- Department of Sports MedicineNorwegian School of Sport SciencesSognsvegen 220N‐0806 OsloNorway
| | | | - Mette Svendsen
- Department of Endocrinology, Obesity and Preventive MedicineOslo University HospitalOsloNorway
| | - Solfrid Bratland‐Sanda
- Department of Outdoor Studies, Sports and Physical EducationUniversity College of Southeast NorwayNotoddenNorway
| | - Jorunn Sundgot‐Borgen
- Department of Sports MedicineNorwegian School of Sport SciencesSognsvegen 220N‐0806 OsloNorway
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6
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Robinson L, Aldridge V, Clark EM, Misra M, Micali N. A systematic review and meta-analysis of the association between eating disorders and bone density. Osteoporos Int 2016; 27:1953-66. [PMID: 26782684 PMCID: PMC7047470 DOI: 10.1007/s00198-015-3468-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022]
Abstract
This meta-analysis investigates the effect of an eating disorder on bone mineral density in two eating disorder subtypes. Following conflicting findings in previous literature, this study finds that not only anorexia nervosa, but also bulimia nervosa has a detrimental effect on BMD. Key predictors of this relationship are discussed. This systematic review and meta-analysis investigates bone mineral density (BMD) in individuals with anorexia nervosa (AN) and bulimia nervosa (BN) in comparison to healthy controls (HCs). AN has been associated with low BMD and a risk of fractures and mixed results have been obtained for the relationship between BN and BMD. Deciphering the effect these two ED subtypes on BMD will determine the effect of low body weight (a characteristic of AN) versus the effects of periods of restrictive eating and malnutrition which are common to both AN and BN. We conducted a systematic search through the electronic databases MedLine, EMBASE and PsychInfo and the Cochrane Library to investigate and quantify this relationship. We screened 544 articles and included 27 studies in a random-effect meta-analysis and calculated the standardised mean difference (SMD) in BMD between women with a current diagnosis of AN (n = 785) vs HCs (n = 979) and a current diagnosis of BN (n = 187) vs HCs (n = 350). The outcome measures investigated were spinal, hip, femoral neck and whole body BMD measured by DXA or DPA scanning. A meta-regression investigated the effect of factors including age, duration since diagnosis, duration of amenorrhea and BMI on BMD. The mean BMI of participants was 16.65 kg/m(2) (AN), 21.16 kg/m(2) (BN) and 22.06 kg/m(2) (HC). Spine BMD was lowest in AN subjects (SMD, -3.681; 95 % CI, -4.738, -2.625; p < 0.0001), but also lower in BN subjects compared with HCs (SMD, -0.472; 95 % CI, -0.688, -0.255; p < 0.0001). Hip, whole body and femoral neck BMD were reduced to a statistically significant level in AN but not BN groups. The meta-regression was limited by the number of included studies and did not find any significant predictors. This meta-analysis confirms the association between low BMD and AN and presents a strong argument for assessing BMD not only in patients with AN, but also in patients with BN.
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Affiliation(s)
- L Robinson
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - V Aldridge
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - E M Clark
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - M Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - N Micali
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
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7
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Solmi M, Veronese N, Correll CU, Favaro A, Santonastaso P, Caregaro L, Vancampfort D, Luchini C, De Hert M, Stubbs B. Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2016; 133:341-51. [PMID: 26763350 DOI: 10.1111/acps.12556] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs). METHOD Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures. RESULTS Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC. CONCLUSION People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.
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Affiliation(s)
- M Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - N Veronese
- Department of Medicine, Geriatrics Section, University of Padova, Italy
| | - C U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA.,Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - A Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - P Santonastaso
- Department of Neurosciences, University of Padova, Padova, Italy
| | - L Caregaro
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - D Vancampfort
- Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium.,Z.org Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - C Luchini
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - M De Hert
- Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department, Institute of Psychiatry King's College London, London, UK
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8
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Tirabassi G, Boscaro M, Arnaldi G. Harmful effects of functional hypercortisolism: a working hypothesis. Endocrine 2014; 46:370-86. [PMID: 24282037 DOI: 10.1007/s12020-013-0112-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 10/31/2013] [Indexed: 01/15/2023]
Abstract
Functional hypercortisolism (FH) is caused by conditions able to chronically activate hypothalamic-pituitary-adrenal axis and usually occurs in cases of major depression, anorexia nervosa, bulimia nervosa, alcoholism, diabetes mellitus, simple obesity, polycystic ovary syndrome, obstructive sleep apnea syndrome, panic disorder, generalized anxiety disorder, shift work, and end-stage renal disease. Most of these states belong to pseudo-Cushing disease, a condition which is difficult to distinguish from Cushing's syndrome and characterized not only by biochemical findings but also by objective ones that can be attributed to hypercortisolism (e.g., striae rubrae, central obesity, skin atrophy, easy bruising, etc.). This hormonal imbalance, although reversible and generally mild, could mediate some systemic complications, mainly but not only of a metabolic/cardiovascular nature, which are present in these states and are largely the same as those present in Cushing's syndrome. In this review we aim to discuss the evidence suggesting the emerging negative role for FH.
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Affiliation(s)
- Giacomo Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
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9
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Bratland-Sanda S, Martinsen EW, Sundgot-Borgen J. Changes in physical fitness, bone mineral density and body composition during inpatient treatment of underweight and normal weight females with longstanding eating disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:315-30. [PMID: 22470294 PMCID: PMC3315077 DOI: 10.3390/ijerph9010315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/20/2011] [Accepted: 01/16/2012] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine changes in aerobic fitness, muscular strength, bone mineral density (BMD) and body composition during inpatient treatment of underweight and normal weight patients with longstanding eating disorders (ED). Twenty-nine underweight (BMI < 18.5, n = 7) and normal weight (BMI ≥ 18.5, n = 22) inpatients (mean (SD) age: 31.0 (9.0) years, ED duration: 14.9 (8.8) years, duration of treatment: 16.6 (5.5) weeks) completed this prospective naturalistic study. The treatment consisted of nutritional counseling, and 2 × 60 min weekly moderate intensive physical activity in addition to psychotherapy and milieu therapy. Underweight patients aimed to increase body weight with 0.5 kg/week until the weight gain goal was reached. Aerobic fitness, muscular strength, BMD and body composition were measured at admission and discharge. Results showed an increase in mean muscular strength, total body mass, fat mass, and body fat percentage, but not aerobic capacity, among both underweight and normal weight patients. Lumbar spine BMD increased among the underweight patients, no changes were observed in BMD among the normal weight patients. Three out of seven underweight patients were still underweight at discharge, and only three out of nine patients with excessive body fat (i.e., >33%) managed to reduce body fat to normal values during treatment. These results calls for a more individualized treatment approach to achieve a more optimal body composition among both underweight and normal to overweight patients with longstanding ED.
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Affiliation(s)
- Solfrid Bratland-Sanda
- Department of Sport and Outdoor Life Science, Telemark University College, Hallvard Eikas Plass, 3800 Bø i Telemark, Norway
- Research Institute, Modum Bad Psychiatric Center, Badeveien, 3370 Vikersund, Norway
- Author to whom correspondence should be addressed; ; Tel.: +47-35-95-2798; Fax: +47-35-95-2501
| | - Egil W. Martinsen
- Department of Mental Health and Addiction, Oslo University Hospital, Pb 4956 Nydalen, 0424 Oslo, Norway;
- Department of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0315 Oslo, Norway
| | - Jorunn Sundgot-Borgen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Pb 4014 Ullevål Stadion, 0806 Oslo, Norway;
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10
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Misra M. Long-Term Skeletal Effects of Eating Disorders with Onset in Adolescence. Ann N Y Acad Sci 2008; 1135:212-8. [DOI: 10.1196/annals.1429.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Artiga A, Viana J, Maldonado C, Chandler-Laney P, Oswald K, Boggiano M. Body composition and endocrine status of long-term stress-induced binge-eating rats. Physiol Behav 2007; 91:424-31. [PMID: 17498757 PMCID: PMC1989154 DOI: 10.1016/j.physbeh.2007.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Clinical binge eating runs a protracted course. The etiology of binge eating remains perplexing in part because, in humans, it is difficult to isolate and assess the independent and aggregate impact of various contributing variables. Using rats, we found that footshock stress and a history of caloric restriction (S+R), combine synergistically to induce binge eating. Stress and dieting are also strong antecedents and relapse factors in human eating disorders. Here we report further behavioral and physiological parallels to human binge eating. Like the protracted course of human binge eating, young female Sprague-Dawley rats continued to binge eat after 23 restriction/stress cycles (7 months) and this despite experiencing no significant weight loss during the restriction phases. Stress alone reduced adiposity by 35% (p<0.001) but S+R rats had no significant fat loss. An endocrine profile of normal plasma leptin and insulin levels but marked elevation of plasma corticosterone levels was found only in the binge-eating (S+R) rats (p<0.01), also paralleling endocrine profiles reported in clinical binge-eating studies. These behavioral and physiological similarities between this animal model and clinical binge eating increase its utility in understanding binge eating. Importantly, our findings also highlight the stubborn nature of binge eating: once a critical experience with dieting and stress is experienced, little if any further weight loss or food restriction is necessary to sustain it.
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Affiliation(s)
| | | | | | | | | | - M.M. Boggiano
- Correspondence to: Mary M. Boggiano, Ph.D., 415 Campbell Hall, 1300 University Blvd. University of Alabama at Birmingham, Birmingham, AL 35294-1170, , Phone: 205-934-2439, Fax: 205-975-6110
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Abstract
PURPOSE To analyze fracture risk and bone mineral density in patients with eating disorders (anorexia nervosa, bulimia nervosa, and other eating disorders). DESIGN Clinical overview. FINDINGS Bone mineral density is decreased and fracture risk increased in patients with anorexia nervosa. In patients with bulimia nervosa, bone mineral is only marginally decreased and fracture risk marginally increased. In patients with other eating disorders (eating disorders not otherwise specified), bone mineral density is decreased and fracture risk increased. CONCLUSIONS Fracture risk is increased in patients with eating disorders. An eating disorder should be suspected in severely underweight young individuals (primarily girls) presenting with fractures, especially low-energy fractures.
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Affiliation(s)
- Peter Vestergaard
- Department of Endocrinology and Metabolism C, Aarhus Amtssygehus, Aarhus University Hospital, Aarhus, Denmark
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Vestergaard P, Emborg C, Støving RK, Hagen C, Mosekilde L, Brixen K. Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders--a nationwide register study. Int J Eat Disord 2002; 32:301-8. [PMID: 12210644 DOI: 10.1002/eat.10101] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). METHOD Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient was compared with three randomly drawn age- and gender-matched control subjects. RESULTS Fracture risk was increased in AN after diagnosis compared to controls (incidence rate ratio: 1.98, 95% CI: 1.60-2.44), but not before. The increased fracture risk persisted more than 10 years after diagnosis. A significant increase in fracture risk was found before diagnosis in BN (1.31, 95% CI: 1.04-1.64), with a trend towards an increase after diagnosis (1.44, 95% CI: 0.93-2.22). EDNOS patients had a significant increase in fracture risk before (1.39, 95% CI: 1.06-1.81) and after diagnosis (1.77, 95% CI: 1.25-2.51). DISCUSSION The increased fracture risk many years after diagnosis indicates permanent skeletal damage.
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Affiliation(s)
- Peter Vestergaard
- Department of Endocrinology and Metabolism C, Aarhus Amtssygehus, Aarhus University Hospital, Aarhus, Denmark.
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14
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Abstract
We still have much to learn about BMD problems in eating disorders. Much progress has been made in the past 10 years; most clinicians and many patients and their families are now aware of the problem. More research is crucial, however, the authors suggest focusing on three areas: 1. Treatment and prevention: Such studies are difficult to conduct for similar reasons to the difficulties in conducting treatment trials of therapy for AN. First, the relative rarity of the condition makes it difficult to recruit subjects; second, drop-out rates are higher because of ambivalence; and third, the population is heterogeneous both in terms of symptoms and cause. 2. Better understanding of bone turnover in AN. More studies are needed to examine turnover of bone in patients with AN using biochemical markers. In particular, prospective studies are needed to examine the effects of refeeding, weight gain, and treatments such as calcium supplementation. 3. Long-term course of bone density. It would be particularly instructive to examine this in individuals with a short or long history of AN. It would also be useful to study women approaching menopause who had an episode of AN in their teens or early twenties compared with women who were of normal weight during this period.
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Affiliation(s)
- J Treasure
- Eating Disorders Unit, Institute of Psychiatry and South London and Maudsley National Health Service Trust, United Kingdom
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Abstract
PURPOSE To compare whole-body, lumbar, total spine, and pelvis bone mineral density (BMD), body mass index (BMI), body composition, energy expenditure for physical activity, and dietary intake of adolescents, aged 16-22 years. METHODS Three study groups included 25 girls with histories of eating disorderd, 25 girls with no histories of eating diso rders who exercised < or = 7 hours/week, and 15 girls with no history of eating disorders who exercised > 7 hours/week. Bone mineral density was measured by dual-energy x-ray absorptiometry (DEXA), body composition by bioelectric impedance and DEXA, energy expenditure by Personal Activity Computer, nutrient intake by 4-day dietary recalls/records, and BMI by measures of height/weight. General linear models, LSM +/- SEM, Student's t-tests, and correlation analyses were used to determine group differences. RESULTS No significant differences in whole-body, spinal, and pelvis BMD were found among the three groups. Mean body fat (percent) was significantly higher (p =.0001) for the group with histories of eating disorders than other groups. Dietary intakes of adolescents with histories of eating disorders were significantly lower for energy (p =.0001), fat (p =.0001), calcium (p =.0007), vitamin D (p =.0180), and zinc (p =.0057) than those without eating disorder histories who exercised </= 7 hours/week. CONCLUSION Except for body fat (percent), measures of BMD, energy expenditure, and BMI were not significantly different among groups. Our data suggest that with full recovery from eating disorders, teenage girls can achieve normal bone mass and body composition.
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Affiliation(s)
- B R Carruth
- Department of Nutrition, University of Tennessee-Knoxville, Knoxville, TN 37996-1900, USA
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17
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Abstract
OBJECTIVE The objective of this study was to examine potential clinical predictors of bone density in patients with eating disorders. METHOD We studied 137 women with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified (NOS) after admission to the hospital. Clinical data of patients were collected by clinical interview and standardized questionnaires. Bone mineral density of the lumbar spine was measured by dual energy x-ray absorptiometry. RESULTS Lumbar bone density was significantly correlated to present and past minimum weight even after correction for height and age. Other factors did not reach significance. CONCLUSION Normalized present and past weight is the best predictor of lumbar bone density in patients with eating disorders. Factors like reduced caloric intake, binge eating, vomiting, menstrual status, and use of estrogen, laxatives, and nicotine seem to have no independent effect on bone density in this group of patients.
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Affiliation(s)
- G Goebel
- Klinik Roseneck, Center for Behavioral Medicine, Prien, Germany
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18
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Holden RJ, Pakula IS. The role of tumor necrosis factor-alpha in the pathogenesis of anorexia and bulimia nervosa, cancer cachexia and obesity. Med Hypotheses 1996; 47:423-38. [PMID: 8961238 DOI: 10.1016/s0306-9877(96)90153-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this paper a new immunological model of anorexia and bulimia nervosa will be presented in which the inflammatory cytokines are conceived as the fundamental regulators of body metabolism. This conception differs from the conventional view in which the inflammatory cytokines are perceived primarily as peptide molecules utilized by the immune system to control infection, inflammation and tissue or neuronal damage. Given that the inflammatory cytokines are also fundamental regulators of body metabolism, when they become dysregulated they create physiological chaos which results in the development of a number of autoimmune, metabolic and psychiatric disorders. In this proposed immunological model of anorexia and bulimia nervosa, elevated tumor necrosis factor-alpha features as the primary cause of these conditions. Pathophysiological parallels are drawn between anorexia nervosa and cancer cachexia in terms of the causal role the cytokines, neuropeptides and neurotransmitters play in the manifestation of shared symptoms. These shared symptoms include elevated tumour necrosis factor-alpha, down-regulated interleukin-2 and interleukin-4 and depletion of lean body mass. Furthermore, the following neuropeptides are dysregulated in both anorexia nervosa and cancer cachexia: vasoactive intestinal peptide, cholecystokinin, corticotropin-releasing factor, neuropeptide Y, peptide YY and beta-endorphin. In addition, in anorexia and bulimia nervosa, secretion of the neurotransmitter serotonin is inhibited while norepinephrine is enhanced. It will be argued that the causal interplay between the cytokines, neuropeptides and neurotransmitters initiates a cascade of biochemical events which may result in either anorexia or bulimia nervosa, or cancer cachexia. The extent to which these inflammatory cytokines, neuropeptides and neurotransmitters are causally efficacious in the pathogenesis of other autoimmune disorders, such as diabetes mellitus and rheumatoid arthritis, will also be addressed.
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Affiliation(s)
- R J Holden
- Medical Research Unit, University of Wollongong, NSW, Australia
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Luisetto G, Zangari M, Bottega F, Peccolo F, Galuppo P, Nardi A, Ziliotto D. Different rates of forearm bone loss in healthy women with early or late menopause. Osteoporos Int 1995; 5:54-62. [PMID: 7703625 DOI: 10.1007/bf01623659] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to evaluate whether healthy women with early or late menopause have different rates of age- and menopause-related bone loss, and whether premature menopause really represents a risk factor for osteopenia. Healthy women aged from 27 to 84 years (n = 2204), with no history of fractures, were divided into two groups according to their age at menopause (AAM): group A with AAM < or = 43, and group B with AAM > or = 50 years. Bone mineral density (BMD) was measured in the distal non-dominant forearm by single-photon absorptiometry. Group B had a significantly lower average BMD than group A (group A, 0.430 +/- 0.074 g/cm2; group B, 0.419 +/- 0.081; p = 0.003); however, the average age of group A was significantly lower, and weight and height were significantly higher. When women older than 50 years of age were divided into five age-matched subgroups, BMD was significantly lower in women with AAM < or = 43 years up to 60 years; after that age this difference disappeared and, in the oldest subgroups, BMD was significantly lower in group B than in group A. Independent variables such as age, AAM and body mass index (BMI) explain about 30% of the variation of BMD, using a multiple linear regression analysis. In both groups age and BMI weighted more than AAM in determining BMD. When BMD was plotted versus either chronological age or years since menopause, women with late menopause showed a significantly faster bone loss than those with early menopause.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Luisetto
- Department of Endocrinology, University of Padua, Italy
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Ghosh S, Cowen S, Hannan WJ, Ferguson A. Low bone mineral density in Crohn's disease, but not in ulcerative colitis, at diagnosis. Gastroenterology 1994; 107:1031-9. [PMID: 7926456 DOI: 10.1016/0016-5085(94)90227-5] [Citation(s) in RCA: 189] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIMS The pathogenesis of low bone mineral density in patients with inflammatory bowel disease is unclear, and the relevance of secondary osteopenic influences is controversial. Our aim was to study bone mineral density in newly diagnosed patients. METHODS Bone mineral density and biochemical parameters of bone metabolism were measured in 15 patients with Crohn's disease and 15 patients with ulcerative colitis, all of whom were newly diagnosed. Lumbar and forearm bone mineral densities were measured by dual energy x-ray absorptiometry, and Z scores were obtained by comparison with age- and sex-matched normal values. Twenty-three patients had repeat measurements 1 year later, and 20 had received systemic steroids. RESULTS At diagnosis, the mean Z score for patients with Crohn's disease (spine, -1.06 +/- 0.86; forearm, -1.04 +/- 0.86) was significantly lower than that for patients with ulcerative colitis (spine, -0.03 +/- 1.16; forearm, 0.11 +/- 1.24). Inflammatory activity, disease localization, body mass index, smoking habits, sex, physical activity, or biochemical parameters did not account for this difference. Spine and forearm Z scores were significantly correlated. Mean Z scores after 1 year were not significantly different from initial Z scores. CONCLUSIONS At diagnosis, low bone mineralization is a feature of Crohn's disease but not ulcerative colitis. Treatment with corticosteroids did not result in further bone loss in 1 year.
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Affiliation(s)
- S Ghosh
- Gastrointestinal Unit, Western General Hospital, Edinburgh, Scotland
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