Kandemir Nurgun, Becker Kendra, Slattery Meghan, Tulsiani Shreya, Singhal Vibha, Thomas Jennifer J, Coniglio Kathryn, Lee Hang, Miller Karen K, Eddy Kamryn T, Klibanski Anne, Misra Madhusmita
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Int J Eat Disord. 2017 Apr;50(4):359-369. doi: 10.1002/eat.22681. Epub 2017 Feb 2.
Clinicians currently use different low-weight cut-offs both to diagnose anorexia nervosa (AN) and to determine AN severity in adolescent girls. The purpose of this study was to evaluate the clinical utility of existing cut-offs and severity criteria by determining which are most strongly associated with risk for low bone mineral density (BMD). Height adjusted BMD Z scores were calculated for 352 females: 262 with AN and 90 healthy controls (controls) (12-20.5 years), using data from the BMD in Childhood Study, for the lumbar spine, whole body less head, and total hip. For most cut-offs used to define low weight (5th or 10th BMI percentile, BMI of 17.5 or 18.5, and 85 or 90% of median BMI), AN had lower BMD Z scores than controls. AN at >85 or >90% expected body weight for height (EBW-Ht) did not differ in BMD Z scores from controls, but differed significantly from AN at ≤85 or ≤90% EBW-Ht. Among AN, any amenorrhea was associated with lower BMD. AN had lower BMD than controls across DSM-5 and The Society for Adolescent Health and Medicine (SAHM) severity categories. The SAHM moderate severity classification was differentiated from the mildly malnourished classification by lower BMD at hip and spine sites. Amenorrhea and %EBW-Ht ≤ 85 or ≤ 90% are markers of severity of bone loss within AN. Among severity categories, BMI Z scores (SAHM) may have the greatest utility in assessing the degree of malnutrition in adolescent girls that corresponds to lower BMD.
目前，临床医生在诊断神经性厌食症（AN）以及确定青春期女孩AN的严重程度时，使用了不同的低体重临界值。本研究的目的是通过确定哪些临界值和严重程度标准与低骨矿物质密度（BMD）风险关联最为密切，来评估现有临界值和严重程度标准的临床实用性。利用儿童期骨密度研究的数据，计算了352名女性（12至20.5岁）的身高调整BMD Z评分：262名患有AN的女性和90名健康对照者，测量部位为腰椎、去头全身和全髋。对于大多数用于定义低体重的临界值（第5或第10百分位BMI、BMI为17.5或18.5，以及中位数BMI的85%或90%），患有AN的女性的BMD Z评分低于对照者。身高预期体重（EBW-Ht）＞85%或＞90%的AN患者的BMD Z评分与对照者无差异，但与EBW-Ht≤85%或≤90%的AN患者有显著差异。在患有AN的女性中，任何闭经都与较低的BMD相关。根据《精神疾病诊断与统计手册》第5版（DSM-5）和青少年健康与医学协会（SAHM）的严重程度分类，AN患者的BMD均低于对照者。SAHM中度严重程度分类与轻度营养不良分类的区别在于髋部和脊柱部位的BMD较低。闭经和EBW-Ht≤85%或≤90%是AN患者骨质流失严重程度的标志。在严重程度分类中，BMI Z评分（SAHM）在评估与较低BMD相对应的青春期女孩营养不良程度方面可能具有最大的实用性。
