Journal Article

Incomplete total body protein recovery in adolescent patients with anorexia nervosa

Verena Haas, Dorothea Kent, Michael R Kohn, Sloane Madden, Simon Clarke, Julie Briody, Felix Fischer, Manfred J Müller and Kevin Gaskin

in The American Journal of Clinical Nutrition

Published on behalf of American Society for Nutrition

Volume 107, issue 3, pages 303-312
Published in print March 2018 | ISSN: 0002-9165
Published online March 2018 | e-ISSN: 1938-3207 | DOI: https://dx.doi.org/10.1093/ajcn/nqx061
Incomplete total body protein recovery in adolescent patients with anorexia nervosa

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  • Medicine and Health
  • Dietetics and Nutrition
  • Biochemistry
  • Food Microbiology
  • Gut Microbiology

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ABSTRACT

Background

Bone health and growth during adolescence require adequate total body protein (TBPr). Renutrition for patients with anorexia nervosa (AN) should aim to normalize body composition and to recover both fat mass and TBPr.

Objective

We intended to analyze predictors of protein status, including exercise status, in adolescents with AN and to investigate whether weight gain would replenish body protein deficits.

Methods

We assessed TBPr in a longitudinal, observational study as height-adjusted nitrogen index (NI) using in vivo neutron activation analysis in 103 adolescents with AN [mean ± SD age, 15.6 ± 1.4 y; body mass index (BMI, in kg/m2), 16.5 ± 1.6] at the commencement of inpatient refeeding (T0), in 56 of these patients 7 mo thereafter as outpatients (T1), and in age-matched controls (C; n = 51, 15.5 ± 2.1 y, BMI 20.7 ± 1.9). Lean tissue and fat mass were assessed by dual-energy X-ray absorptiometry. BMI, BMI standard deviation score, and lean tissue mass were tested as predictors of protein status using receiver operating characteristic analysis.

Results

At T0, NI was decreased in AN (AN, 0.88 ± 0.10 compared with C, 1.00 ± 0.08, P < 0.001). In 34%, the patients showed protein depletion. Patients classified as ``exercisers'' had a higher NI than did ``nonexercisers'' (0.89 ± 0.11 compared with 0.85 ± 0.08, P = 0.045). BMI, BMI standard deviation score, and lean tissue mass did not show potential as predictors of protein status. Despite increases in weight (+6.9 ± 4.5 kg), and BMI (+2.5 ± 1.7), protein status did not improve (TBPr T0, 8.0 ± 1.1 kg; T1, 8.1 ± 1.0 kg, P = 0.495). In an AN subgroup at 7 mo matched with controls in age (AN, 16.5 ± 1.1 y; C, 16.2 ± 1.8 y) and BMI (AN, 20.5 ± 1.4; C, 20.7 ± 1.3), protein status was still not normalized in AN (NI: AN, 0.89 ± 0.09 compared with C, 1.00 ± 0.07, P < 0.001).

Conclusions

Adolescents recovering from AN remained protein depleted at 7 mo after baseline assessment, even though they were weight restored.

Keywords: anorexia nervosa; renutrition exercise; total body protein; muscle mass; bone health

Journal Article.  6414 words.  Illustrated.

Subjects: Medicine and Health ; Dietetics and Nutrition ; Biochemistry ; Food Microbiology ; Gut Microbiology

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