Université Clermont Auvergne, CRNH, AME2P, F-63000, Clermont-Ferrand, France.
Eating Disorders, Addictions and Extreme Bodyweight Research Group (TAPE) EA 7423, Jean Monnet University, Saint-Étienne, France.
Rev Endocr Metab Disord. 2021 Dec;22(4):913-971. doi: 10.1007/s11154-021-09650-4. Epub 2021 Apr 30.
A growing interest in constitutional thinness has been observed in the last decades, but the publications however cover various fields of study and report equivocal results. The present work systematically reviewed any clinical trials enrolling participants with constitutional thinness and bibliographic researches were performed between December 2018 and June 2020. From a total of 1 212 records initially identified, 402 records were removed as duplicates, 381 articles were excluded based on titles or abstracts and 390 references were excluded against eligibility criteria. Thirty-nine articles were finally included in the systematic review. The results showed that constitutionally thin people seem to be underweight but not underfat and present a fat-free mass as blunted as anorexic patients, despite being a little less underweight. The meta-analysis confirmed that constitutionally thin people present normal energy intake and revealed a trend toward a higher resting metabolic rate to fat-free mass ratio which suggests a highly metabolic fat-free mass. Contrary to patients with anorexia nervosa, constitutionally thin people present normal levels of insulin-like growth factor 1, estradiol, growth hormone, follicle-stimulating hormone, and luteinizing hormone. An intermediate level of leptin between anorexic and control participants was however observed in constitutional thinness. While all the studies reported normal free triiodothyronine and cortisol levels in constitutionally thin individuals, a higher fasting free triiodothyronine level (p = 0.033) and a lower 24 h mean cortisol level (p = 0.005) were observed for the first time. Present results give robust evidence that constitutionally thin people present an atypical phenotype highly different from anorexia nervosa.
过去几十年来，人们对体质消瘦的兴趣日益浓厚，但这些出版物涵盖了各个研究领域，报告的结果也不一致。本研究系统地综述了纳入体质消瘦参与者的所有临床试验，并于 2018 年 12 月至 2020 年 6 月进行了文献研究。从最初确定的 1212 条记录中，去除了 402 条重复记录，根据标题或摘要排除了 381 篇文章，根据入选标准排除了 390 条参考文献。最终有 39 篇文章被纳入系统综述。结果表明，体质消瘦者似乎体重过轻而非消瘦，且脂肪量与厌食症患者一样减少，尽管体重过轻程度略低。荟萃分析证实，体质消瘦者的能量摄入量正常，并显示出静息代谢率与去脂体重比值升高的趋势，这表明其去脂体重具有高度代谢性。与神经性厌食症患者不同，体质消瘦者的胰岛素样生长因子 1、雌二醇、生长激素、卵泡刺激素和黄体生成素水平正常。然而，在体质消瘦者中观察到瘦素水平处于中间值，介于厌食症患者和对照组之间。虽然所有研究均报告体质消瘦者的游离三碘甲状腺原氨酸和皮质醇水平正常，但首次观察到体质消瘦者的空腹游离三碘甲状腺原氨酸水平较高（p=0.033）和 24 小时平均皮质醇水平较低（p=0.005）。这些结果有力地证明，体质消瘦者表现出一种与神经性厌食症截然不同的非典型表型。
