Endocrinologia, Università Cattolica, Rome, Italy.
Clin Endocrinol (Oxf). 2011 Aug;75(2):202-6. doi: 10.1111/j.1365-2265.2011.04046.x.
The aim of treatment in patients affected by anorexia nervosa (AN) is weight recovery. However, during weight gain, anorectic patients' body composition is changed, with an increase in abdominal fat, particularly in the visceral compartment.
We hypothesized that changes in body composition, particularly in abdominal fat, are responsible for the variability in insulin sensitivity (IS) in different stages of AN.
We compared 20 anorectic patients in the acute stage, 19 in the weight-recovery stage and 21 controls. All subjects underwent an oral glucose tolerance test, hyperinsulinaemic euglycaemic clamp and dual energy X-ray absorptiometry to measure body composition.
The percentage of trunk fat was higher in weight recovery than in the acute phase (47·7 ± 8·4%vs 34·6 ± 7·6%; P ≤ 0·01) and in the control group (33·4 ± 7·6; P < 0·01 vs weight recovery). Although the recovery group gained weight, their body mass index (BMI) was not statistically different from that of the acute group (14·4 ± 1·1 vs 13·6 ± 1·8 kg/m(2) ). Insulin sensitivity was lower in the weight-recovery group than the acute group (4·7 ± 1·5 vs 7·8 ± 1·6 mg/kg/min; P < 0·01) and controls (7·7 ± 1·4 mg/kg/min; P < 0·01). A linear negative correlation was found between IS and the percentage of abdominal fat in the weight-recovery and acute groups (r = -0·51; P = 0·04 and r = -0·53; P = 0·04 respectively), while IS did not correlate with BMI.
Although weight-recovery represents the main aim of treatment in AN, refeeding is associated with an increase in abdominal fat which might be responsible of the onset of insulin resistance. As BMI and weight-recovery were associated with impaired IS, they cannot be considered the only aim of treatment of AN.
治疗神经性厌食症（AN）患者的主要目标是体重恢复。然而，在体重增加的过程中，厌食症患者的身体成分会发生变化，腹部脂肪增加，尤其是内脏脂肪。
我们假设身体成分的变化，特别是腹部脂肪的变化，是导致 AN 不同阶段胰岛素敏感性（IS）变化的原因。
我们比较了 20 例处于急性阶段的厌食症患者、19 例处于体重恢复阶段的患者和 21 例对照组。所有受试者均接受口服葡萄糖耐量试验、高胰岛素正葡萄糖钳夹和双能 X 射线吸收法测量身体成分。
体重恢复组的躯干脂肪百分比高于急性组（47.7±8.4%比 34.6±7.6%；P≤0.01）和对照组（33.4±7.6%；P<0.01 比体重恢复组）。尽管恢复组体重增加，但体重指数（BMI）与急性组无统计学差异（14.4±1.1 比 13.6±1.8kg/m2）。体重恢复组的 IS 低于急性组（4.7±1.5 比 7.8±1.6mg/kg/min；P<0.01）和对照组（7.7±1.4mg/kg/min；P<0.01）。在体重恢复组和急性组中，IS 与腹部脂肪百分比呈线性负相关（r=-0.51；P=0.04 和 r=-0.53；P=0.04），而 IS 与 BMI 无相关性。
尽管体重恢复是治疗 AN 的主要目标，但重新喂养会导致腹部脂肪增加，这可能是导致胰岛素抵抗的原因。由于 BMI 和体重恢复与 IS 受损相关，因此它们不能被视为治疗 AN 的唯一目标。
