Estour Bruno, Marouani Nesrine, Sigaud Torrance, Lang François, Fakra Eric, Ling Yiin, Diamondé Aurélie, Minnion James S, Galusca Bogdan, Germain Natacha
Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet university, Saint-Etienne, France; Reference Center for Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France.
Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France.
Psychoneuroendocrinology. 2017 Oct;84:94-100. doi: 10.1016/j.psyneuen.2017.06.015. Epub 2017 Jun 23.
Constitutional thinness (CT) is an underweight state characterized by normal menstruations and no change in feeding behaviour. Thinness is the only resemblance between Anorexia Nervosa (AN) and CT. Removal of amenorrhea from the new DSM 5 definition of AN might result in misdiagnosis between these two populations. The objective of this study was to compare CT, AN and Control subjects in terms of biological, anthropometric, and psychological markers in order to better distinguish AN from CT subjects.
Body composition, nutritional markers, pituitary hormones, bone markers and psychological scores were evaluated in three groups of young women: fifty-six CT, forty restrictive-type AN and fifty-four Control subjects. For every marker, a receiver Operator Characteristics (ROC) curve was calculated to evaluate the accuracy of differentiation between AN and CT groups.
For most studied parameters, CT subjects were similar to Controls but dramatically different from AN subjects. DEBQ Restrained Eating subscale score was identified by ROC data analysis as the only psychological parameter tested to successfully differentiate AN from CT. Free-T3 and Leptin were shown to be powerful markers to differentiate AN and CT populations as they were highly specific and sensitive ones.
The exclusive use of psychological testing criteria is not always sufficient to differentiate AN and CT patients. Minimally, additional testing of Free T3 levels, which is cheap and widely accessible for general practitioners, should be completed to avoid misdiagnosis which could result in the implementation of ineffective treatment plans and social stigmatization for CT women.
体质性消瘦（CT）是一种体重过轻的状态，其特征为月经正常且进食行为无变化。消瘦是神经性厌食症（AN）和CT唯一的相似之处。从新版《精神疾病诊断与统计手册》（DSM - 5）对AN的定义中去除闭经可能会导致这两类人群的误诊。本研究的目的是比较CT、AN和对照组受试者在生物学、人体测量学和心理指标方面的差异，以便更好地将AN与CT受试者区分开来。
对三组年轻女性进行了身体成分、营养指标、垂体激素、骨标志物和心理评分的评估：56名CT受试者、40名限制型AN受试者和54名对照受试者。对于每个指标，计算了受试者工作特征（ROC）曲线以评估AN组和CT组之间区分的准确性。
对于大多数研究参数，CT受试者与对照组相似，但与AN受试者有显著差异。通过ROC数据分析，DEBQ抑制性饮食分量表得分被确定为唯一能成功区分AN和CT的心理参数。游离T3和瘦素被证明是区分AN和CT人群的有力标志物，因为它们具有高度的特异性和敏感性。
仅使用心理测试标准并不总是足以区分AN和CT患者。至少，应完成游离T3水平的额外检测，这对全科医生来说成本低廉且易于获得，以避免误诊，误诊可能导致实施无效的治疗方案以及对CT女性的社会污名化。
