Body composition changes in female adolescents with anorexia nervosa

Background: Body weight provides limited information about nutritional status of patients with anorexia nervosa(AN). Objectives: Our objectives were to determine body composition(BC) changes, to find clinical predictors and endocrine correlates of total body protein(TBPr) depletion, and to compare results on fat mass(FM) obtained with anthropometry(skinfold measurements) and dual-energy X-ray absorptiometry(DXA) in patients with AN. Design: Body weight, body mass index(BMI; in kg/m²), BC(with DXA and skinfold measurements), and TBPr[with in vivo neutron activation analysis(IVNAA)] was assessed in 50 AN patients(15.2 y) and 40 healthy sex- and age-matched controls. In 47 AN patients and 22 controls, hormone concentrations were measured. Results: In AN patients, body weight(44.4 ± 5.5 kg), BMI(16.7 ± 1.6), and FM_DXA(7.0 ± 3.4 kg) were lower than in controls. Lean tissue mass by DXA(LTM_DXA) was similar in AN patients and controls(35.7 ± 4.3 compared with 35.8 ± 4.5 kg), but TBPr was 87% of that of controls(8.1 ± 1.0 compared with 9.2 ± 1.2 kg; P < 0.001). Cortisol was high, testosterone was unchanged, and estradiol and insulin-like growth factor I were low. Severe protein depletion measured by IVNAA seen in 17 AN patients could not be identified with simpler methods. All except 1 of 26 AN patients with a BMI > 16.5 had normal TBPr. The difference in individual percentage of body fat measured with DXA and skinfold measurements came up to 9%. Conclusion: The severe protein depletion in 34% of AN patients was not accurately identified by LTM_DXA or simpler methods, but a BMI > 16.5 indicated normal TBPr. Future studies need to compare DXA and skinfold measurements with a reference technique to assess FM in AN patients. Am J Clin Nutr 2009;89:1005-10.