青少年神经性厌食症患者的全身蛋白质不完全恢复。

Incomplete total body protein recovery in adolescent patients with anorexia nervosa.

机构信息

Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

James Fairfax Institute of Pediatric Nutrition, Department of Adolescent and Young Adult Medicine, Westmead Hospital and Centre for Research into Adolescents' Health, and Departments of Psychological and Nuclear Medicine, The Children's Hospital at Westmead, Sydney, Australia.

出版信息

Am J Clin Nutr. 2018 Mar 1;107(3):303-312. doi: 10.1093/ajcn/nqx061.

DOI:10.1093/ajcn/nqx061

PMID:29566191

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.

摘要

背景

青少年的骨骼健康和生长需要足够的全身蛋白质（TBPr）。神经性厌食症（AN）患者的营养再补充应旨在使身体成分正常化，并恢复脂肪量和 TBPr。

目的

我们旨在分析 AN 青少年的蛋白质状况预测因素，包括运动状况，并研究体重增加是否会补充身体蛋白质不足。

方法

我们使用体内中子激活分析，在 103 名 AN 青少年[平均年龄±标准差，15.6±1.4 岁；体重指数（BMI，kg/m2），16.5±1.6]入院重新喂养开始时（T0），56 名患者在 7 个月后作为门诊患者（T1），以及年龄匹配的对照组（C；n=51，15.5±2.1 岁，BMI 20.7±1.9）进行纵向观察性研究，以评估 TBPr。通过双能 X 射线吸收法评估瘦组织和脂肪量。使用接收者操作特征分析，BMI、BMI 标准差评分和瘦组织质量被测试为蛋白质状态的预测因子。

结果

在 T0，AN 的 NI 降低（AN，0.88±0.10 与 C，1.00±0.08，P<0.001）。34%的患者出现蛋白质耗竭。与“不运动者”相比，“运动者”的 NI 更高（0.89±0.11 与 0.85±0.08，P=0.045）。BMI、BMI 标准差评分和瘦组织质量均未显示出作为蛋白质状态预测因子的潜力。尽管体重增加（+6.9±4.5kg）和 BMI 增加（+2.5±1.7），但蛋白质状态并未改善（TBPr T0，8.0±1.1kg；T1，8.1±1.0kg，P=0.495）。在 7 个月时与对照组在年龄（AN，16.5±1.1 岁；C，16.2±1.8 岁）和 BMI（AN，20.5±1.4；C，20.7±1.3）匹配的 AN 亚组中，AN 的蛋白质状态仍未正常化（NI：AN，0.89±0.09 与 C，1.00±0.07，P<0.001）。