PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France.
Département de Biophysique, Service de Médecine Nucléaire, Hôpital Lapeyronie, CHU de Montpellier, France.
Clin Endocrinol (Oxf). 2018 Jun;88(6):863-872. doi: 10.1111/cen.13610. Epub 2018 Apr 25.
This study compared the profiles of the two types of anorexia nervosa (AN; restrictive: AN-R, and binge eating/purging: AN-BP) in terms of body composition, gynaecological status, disease history and the potential effects on bone metabolism.
Two hundred and eighty-six women with AN (21.8 ± 6.5 years; 204 AN-R and 82 AN-BP) and 130 age-matched controls (CON; 22.6 ± 6.8 years) were enrolled. Areal bone mineral density (aBMD) was determined using DXA and resting energy expenditure (REE) was indirectly assessed using calorimetry. Markers of bone formation (osteocalcin [OC], procollagen type I N-terminal propeptide [PINP] and resorption (type I-C telopeptide breakdown products [CTX]) and leptin were concomitantly evaluated.
Anorexia nervosa patients presented an alteration in aBMD and bone turnover. When compared according to type, AN-BP were older than AN-R and showed less severe undernutrition, lower CTx levels, longer duration of AN, and higher REE levels and aBMD at radius and lumbar spine. After adjustment for age, weight and hormonal contraceptive use, the aBMD and CTx differences disappeared. In both AN groups, aBMD was positively correlated with anthropometric parameters and negatively correlated with durations of AN and amenorrhoea, the bone formation markers (OC and PINP) and the leptin/fat mass ratio. REE was positively correlated with aBMD in AN-R patients only.
This study shows the profiles of AN patients according to AN type. However, the impact of the profile characteristics on bone status, although significant, was minor and disappeared after multiple adjustments. The positive correlation between REE and aBMD reinforces the concept that energy disposal and bone metabolism are strongly interdependent.
本研究比较了两种神经性厌食症（AN；限制型：AN-R 和暴食/清除型：AN-BP）在体成分、妇科状况、疾病史和对骨代谢潜在影响方面的特征。
共纳入 286 名 AN 女性（21.8±6.5 岁；204 名 AN-R 和 82 名 AN-BP）和 130 名年龄匹配的对照者（CON；22.6±6.8 岁）。采用 DXA 测定骨矿物质密度（aBMD），采用热量测定法间接评估静息能量消耗（REE）。同时评估骨形成标志物（骨钙素[OC]、I 型前胶原 N 端前肽[PINP]和骨吸收标志物（I 型胶原 C 端肽分解产物[CTX]）和瘦素。
神经性厌食症患者存在 aBMD 和骨转换的改变。根据类型比较时，AN-BP 比 AN-R 年龄更大，营养不足程度较轻，CTX 水平较低，AN 持续时间较长，REE 水平和桡骨及腰椎 aBMD 较高。校正年龄、体重和激素避孕药使用后，aBMD 和 CTX 差异消失。在两个 AN 组中，aBMD 与人体测量学参数呈正相关，与 AN 持续时间和闭经呈负相关，与骨形成标志物（OC 和 PINP）和瘦素/脂肪量比呈负相关。仅在 AN-R 患者中，REE 与 aBMD 呈正相关。
本研究根据 AN 类型展示了 AN 患者的特征。然而，尽管特征对骨状况的影响显著，但在进行多次调整后，影响较小。REE 与 aBMD 的正相关强化了能量消耗和骨代谢密切相关的概念。
