Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome
Agüera Z (1,2), Romero X (1), Arcelus J (3), Sánchez I (1), Riesco N (1), Jiménez-Murcia S (1,2,4), González-Gómez J (5), Granero R (2,6), Custal N (1), Montserrat-Gil de Bernabé M (1,7), Tárrega S (6), Baños RM (2,8), Botella C (2,9), de la Torre R (2,10), Fernández-García JC (2,11), Fernández-Real JM (2,12), Frühbeck G (2,13), Gómez-Ambrosi J (2,13), Tinahones FJ (2,11), Crujeiras AB (2,14), Casanueva FF (2,14), Menchón JM (1,4,15), Fernández-Aranda F (1,2,4).
(1) Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
(2) CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.
(3) Loughborough University Centre for Research into Eating Disorders, Loughborough University, Loughborough, United Kingdom.
(4) Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
(5) Marqués de Valdecilla Public Foundation-Research Institute (FMV-IFIMAV), Santander, Spain.
(6) Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona, Barcelona, Spain.
(7) Dietetics and Nutrition Unit, University Hospital of Bellvitge, Barcelona, Spain.
(8) Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.
(9) Department of Basic Psychology, Clinic and Psychobiology, University Jaume I, Castelló, Spain.
(10) Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
(11) Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain.
(12) Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain.
(13) Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain.
(14) Endocrine Division, Complejo Hospitalario U. de Santiago, Santiago de Compostela, Spain.
(15) CIBER de Salud Mental (CIBERSAM), Barcelona, Spain.
The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment.
Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome.
The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices.
Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat.
In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome.
CITATION PLoS One. 2015 Nov 23;10(11):e0143012. doi: 10.1371/journal.pone.0143012. eCollection 2015