Sonja Lackner1, Sabrina Mörkl2, Wolfram Müller3, Alfred Fürhapter-Rieger4, Andreas Oberascher1, Michael Lehofer5, Claudia Bieberger5, Willibald Wonisch6, Omid Amouzadeh-Ghadikolai7, Maximilian Moser8, Harald Mangge9, Sieglinde Zelzer9, Sandra Johanna Holasek1. 1. Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria. 2. Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz, Graz, Austria. 3. Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria. Electronic address: wolfram.mueller@medunigraz.at. 4. Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria. 5. State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria. 6. Department of Physiological Chemistry, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria. 7. Department of Psychiatry, Hospital of the Brothers of St. John of God, Bergstraße, Graz, Austria. 8. Department of Physiology, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria; Human Research Institute, Franz-Pichler-Straße, Weiz, Austria. 9. Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria.
Abstract
BACKGROUND & AIMS: Anorexia nervosa (AN) is a severe psychosomatic disease that seriously affects nutritional status. Therapeutic approaches primarily aim for rapid weight restoration by high caloric diets and activity restriction. This often promotes abdominal body fat gain, which potentially negatively influences the patient's compliance and increases the risk of relapse. This study focused on the evaluation of body weight and subcutaneous adipose tissue (SAT) in AN patients by novel approaches. METHODS: The SAT of AN patients (n = 18, body mass index (BMI) 15.3 ± 1.3 kg/m2) was determined by a highly accurate and reliable ultrasound method. The sum of SAT thicknesses of eight sites (DINCL) was calculated. Individual metabolic profiles were analyzed. The mass index (MI), which considers body proportions, was used in addition to BMI. Additional to the standard laboratory diagnostics, dermal carotenoids measured by resonance Raman spectroscopy, leptin, and oxidative stress indicators were determined. RESULTS: The mean MI was 15.7 ± 1.4 kg/m2. The DINCL considerably differed between individuals with the same BMI. Half of the patients (Group 1) had low DINCL: 1.3-28.4 mm, and Group 2 showed values up to 58.2 mm (corresponding to approximately 6 kg SAT mass). The two group means differed by more than 300% (P < 0.001). Accordingly, leptin levels significantly differed (P < 0.001). Mean SAT thicknesses were significantly higher in Group 2 at all eight sites. The groups also significantly differed in two oxidative stress parameters: total antioxidative capacity, malondialdehyde-modified low density lipoprotein immunoglobulin M (MDA-LDL IgM), and in the carotenoid level. CONCLUSION: Half of the patients had sufficiently high fat mass, despite very low BMI. Consequently, their muscle (and other organ) masses must have been extremely low. Diagnostic criteria and treatment protocols for AN should consider each patient's body composition. In addition to dietary treatments, muscle training at low energy turnover rates may be essential for avoiding unnecessary body fat gain, better treatment results, and long-term recovery.
BACKGROUND & AIMS:Anorexia nervosa (AN) is a severe psychosomatic disease that seriously affects nutritional status. Therapeutic approaches primarily aim for rapid weight restoration by high caloric diets and activity restriction. This often promotes abdominal body fat gain, which potentially negatively influences the patient's compliance and increases the risk of relapse. This study focused on the evaluation of body weight and subcutaneous adipose tissue (SAT) in AN patients by novel approaches. METHODS: The SAT of AN patients (n = 18, body mass index (BMI) 15.3 ± 1.3 kg/m2) was determined by a highly accurate and reliable ultrasound method. The sum of SAT thicknesses of eight sites (DINCL) was calculated. Individual metabolic profiles were analyzed. The mass index (MI), which considers body proportions, was used in addition to BMI. Additional to the standard laboratory diagnostics, dermal carotenoids measured by resonance Raman spectroscopy, leptin, and oxidative stress indicators were determined. RESULTS: The mean MI was 15.7 ± 1.4 kg/m2. The DINCL considerably differed between individuals with the same BMI. Half of the patients (Group 1) had low DINCL: 1.3-28.4 mm, and Group 2 showed values up to 58.2 mm (corresponding to approximately 6 kg SAT mass). The two group means differed by more than 300% (P < 0.001). Accordingly, leptin levels significantly differed (P < 0.001). Mean SAT thicknesses were significantly higher in Group 2 at all eight sites. The groups also significantly differed in two oxidative stress parameters: total antioxidative capacity, malondialdehyde-modified low density lipoprotein immunoglobulin M (MDA-LDL IgM), and in the carotenoid level. CONCLUSION: Half of the patients had sufficiently high fat mass, despite very low BMI. Consequently, their muscle (and other organ) masses must have been extremely low. Diagnostic criteria and treatment protocols for AN should consider each patient's body composition. In addition to dietary treatments, muscle training at low energy turnover rates may be essential for avoiding unnecessary body fat gain, better treatment results, and long-term recovery.
Authors: Wolfram Müller; Alfred Fürhapter-Rieger; Helmut Ahammer; Timothy G Lohman; Nanna L Meyer; Luis B Sardinha; Arthur D Stewart; Ronald J Maughan; Jorunn Sundgot-Borgen; Tom Müller; Margaret Harris; Nuwanee Kirihennedige; Joao P Magalhaes; Xavier Melo; Wolfram Pirstinger; Alba Reguant-Closa; Vanessa Risoul-Salas; Timothy R Ackland Journal: Sports Med Date: 2020-03 Impact factor: 11.136