Achamrah Najate, Coëffier Moïse, Jésus Pierre, Charles Jocelyne, Rimbert Agnès, Déchelotte Pierre, Grigioni Sébastien
Nutrition Unit, Rouen University Hospital, Rouen, France.
Normandie University, UR, INSERM U1073, Rouen, France.
Front Nutr. 2017 Sep 29;4:46. doi: 10.3389/fnut.2017.00046. eCollection 2017.
Low bone mineral density (BMD) is a frequent complication in anorexia nervosa (AN). There are controversial points of views regarding the restoration of bone mineralization after recovery in AN. We aimed to assess changes of BMD at 3 years in patients with AN and to explore the relationships between body composition, physical activity, and BMD. Patients with AN were included from 2009 to 2011 in a first visit (T0) with evaluation of weight, height, body mass index (BMI), body composition [fat mass (FM) and fat-free mass], and BMD. Those who had low BMD, either osteoporosis or osteopenia, were admitted in a second visit (T1) to carry out a new bone densitometry examination and body composition; they were also asked for their physical activity. At T0, our study involved 160 patients. Low BMD was observed in 53.6% of them and significant factors associated with demineralization were lower BMIs (16.5 ± 2.1 vs 17.3 ± 2.3 kg/m, = 0.01) and higher duration of AN (11.4 ± 10.5 vs 6.4 ± 6.5 years, = 0.001). At 3 years follow-up (T1), 42 patients were involved and no significant changes in BMD were observed despite body weight increase (3.8 ± 6.1 kg). Interestingly, FM gain was a significant factor associated with BMD improvement at follow-up (8.0 ± 9.1 vs 3.0 ± 3.5 kg, = 0.02). Our findings suggest that the restoration of normal bone values is not related to the increase of body weight, at least after 3 years. FM seems to play an important role in the pathophysiological mechanism of osteoporosis and osteopenia in AN.
低骨矿物质密度（BMD）是神经性厌食症（AN）常见的并发症。关于AN康复后骨矿化的恢复存在争议性观点。我们旨在评估AN患者3年时BMD的变化，并探讨身体成分、身体活动与BMD之间的关系。2009年至2011年纳入AN患者进行首次就诊（T0），评估体重、身高、体重指数（BMI）、身体成分[脂肪量（FM）和去脂体重]以及BMD。那些患有低BMD（骨质疏松或骨质减少）的患者在第二次就诊（T1）时接受新的骨密度检查和身体成分评估；还询问了他们的身体活动情况。在T0时，我们的研究纳入了160名患者。其中53.6%观察到低BMD，与脱矿相关的显著因素是较低的BMI（16.5±2.1 vs 17.3±2.3kg/m²，P = 0.01）和较长的AN病程（11.4±10.5 vs 6.4±6.5年，P = 0.001）。在3年随访（T1）时，纳入42名患者，尽管体重增加（3.8±6.1kg），但未观察到BMD有显著变化。有趣的是，随访时FM增加是与BMD改善相关的显著因素（8.0±9.1 vs 3.0±3.5kg，P = 0.02）。我们的研究结果表明，至少3年后，正常骨值的恢复与体重增加无关。FM似乎在AN中骨质疏松和骨质减少的病理生理机制中起重要作用。
