IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META ANALYSIS
Main Article Content
Keywords
Anorexia nervosa, Body fat percentage, Dual-energy X-ray absorptiometry, Weight restoration, Menstrual resumption
Abstract
The resumption of menses (ROM) is an important outcome in anorexia nervosa treatment and is considered as a sign of recovery. Identification of relevant factors in its prediction is important in clinical practice. Therefore we aimed to conduct a systematic review and exploratory meta-analysis of the association between total body fat percentage (%BF) and ROM after weight restoration in adolescents and young adults with anorexia nervosa. The study was conducted by adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 604 articles retrieved, only seven studies comprising a total of 366 adolescent and young adult females with anorexia nervosa met the inclusion criteria and were reviewed, and preliminary results revealed three main findings. Firstly, patients who resumed their menstrual cycle had a significantly higher mean %BF when compared to those who did not, an overall effect confirmed by the meta-analysis (SMD: 3.74, 95% CI: 2.26–5.22). Secondly, %BF was found to be an independent predictor of the ROM in this population and an increase of only one unit of %BF can increase the odds of menstruation by ?15–20%. Thirdly, despite the paucity of data, a cut-off point of %BF?21was suggested as the minimum needed for ROM. In conclusion, a higher %BF seems to be associated with the ROM in weight-restored adolescent and young adult females with anorexia nervosa. Its assessment is important in a clinical setting, especially after complete weight restoration. The PROSPERO Registry – A systematic review and meta-analysis of the factors associated with the resumption of the menstrual cycle in females with anorexia nervosa after weight restoration (CRD42019111841).
References
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4. Nakamura Y, Yoshimura Y, Oda T, Kamei K, Iizuka R. [Amenorrhea due to weight loss]. Nihon Sanka Fujinka Gakkai Zasshi. 1984;36:727–35.
5. Stewart DE, Robinson E, Goldbloom DS, Wright C. Infertility and eating disorders. Am J Obstet Gynecol. 1990;163:1196–9. http://dx.doi.org/10.1016/0002-9378(90)90688-4
6. Hoffman ER, Zerwas SC, Bulik CM. Reproductive issues in anorexia nervosa. Expert Rev Obstet Gynecol. 2011;6:403–14. http://dx.doi.org/10.1586/eog.11.31
7. El Ghoch M, Gatti D, Calugi S, Viapiana O, Bazzani PV, Dalle Grave R. The association between weight gain/restoration and bone mineral density in adolescents with anorexia nervosa: A systematic review. Nutrients. 2016;8:1–16. http://dx.doi.org/10.3390/nu8120769
8. Idolazzi L, El Ghoch M, Dalle Grave R, Bazzani PV, Calugi S, Fassio S, et al. Bone metabolism in patients with anorexia nervosa and amenorrhoea. Eat Weight Disord. 2018;23:255–61. http://dx.doi.org/10.1007/s40519-016-0337-x
9. LaBan MM, Wilkins JC, Sackeyfio AH, Taylor RS. Osteoporotic stress fractures in anorexia nervosa: Etiology, diagnosis, and review of four cases. Arch Phys Med Rehabil. 1995;76:884–7. http://dx.doi.org/10.1016/S0003-9993(95)80558-3
10. Murray SB, Quintana DS, Loeb KL, Griffiths S, Le Grange D. Treatment outcomes for anorexia nervosa: A systematic review and meta-analysis of randomized-controlled trials – Corrigendum. Psychol Med. 2019;49:701–704. http://dx.doi.org/10.1017/S0033291718003185
11. Dempfle A, Herpertz-Dahlmann B, Timmesfeld N, Schwarte R, Egberts KM, Pfeiffer E, et al. Predictors of the resumption of menses in adolescent anorexia nervosa. BMC Psychiatry. 2013;13:308. http://dx.doi.org/10.1186/1471-244X-13-308
12. Jacoangeli F, Masala S, Staar Mezzasalma F, Fiori R, Martinetti A, Ficoneri C, et al. Amenorrhea after weight recover in anorexia nervosa: Role of body composition and endocrine abnormalities. Eat Weight Disord. 2006;11:e20–6. http://dx.doi.org/10.1007/BF03327748
13. Katz MG, Vollenhoven B. The reproductive endocrine consequences of anorexia nervosa. BJOG. 2000;107:707–13. http://dx.doi.org/10.1111/j.1471-0528.2000.tb13329.x
14. Golden NH, Lanzkowsky L, Schebendach J, Palestro CJ, Jacobson MS, Shenker IR. The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa. J Pediatr Adolesc Gynecol. 2002;15:135–43. http://dx.doi.org/10.1016/S1083-3188(02)00145-6
15. Bergstrom I, Crisby M, Engstrom AM, Holcke M, Fored M, Jakobsson Kruse P, et al. Women with anorexia nervosa should not be treated with estrogen or birth control pills in a bone-sparing effect. Acta Obstet Gynecol Scand. 2013;92:877–80. http://dx.doi.org/10.1111/aogs.12178
16. El Ghoch M, Alberti M, Capelli C, Calugi S, Dalle Grave R. Resting energy expenditure in anorexia nervosa: Measured versus estimated. J Nutr Metab. 2012;2012:652932. http://dx.doi.org/10.1155/2012/652932
17. El Ghoch M, Calugi S, Lamburghini S, Dalle Grave R. Anorexia nervosa and body fat distribution: A systematic review. Nutrients. 2014;6:3895–912. http://dx.doi.org/10.3390/nu6093895
18. El Ghoch M, Pourhassan M, Milanese C, Muller MJ, Calugi S, Bazzani PV, et al. Changes in lean and skeletal muscle body mass in adult females with anorexia nervosa before and after weight restoration. Clin Nutr. 2017;36:170–8. http://dx.doi.org/10.1016/j.clnu.2015.10.006
19. El Ghoch M, Milanese C, Calugi S, Muller MJ, Pourhassan M, Ruocco A, et al. Regional fat distribution in adolescent and adult females with anorexia nervosa: A longitudinal study. Clin Nutr. 2015;34:1224–32. http://dx.doi.org/10.1016/j.clnu.2014.12.012
20. El Ghoch M, Calugi S, Milanese C, Bazzani PV, Dalle Grave R. Body composition in men with anorexia nervosa: Longitudinal study. Int J Eat Disord. 2017;50:856–60. http://dx.doi.org/10.1002/eat.22721
21. Probst M, Goris M, Vandereycken W, Van Coppenolle H. Body composition of anorexia nervosa patients assessed by underwater weighing and skinfold-thickness measurements before and after weight gain. Am J Clin Nutr. 2001;73:190–7. http://dx.doi.org/10.1093/ajcn/73.2.190
22. Probst M, Goris M, Vandereycken W, Van Coppenolle H. Body composition in female anorexia nervosa patients. Br J Nutr. 1996;76:639–47. http://dx.doi.org/10.1079/BJN19960072
23. Polito A, Cuzzolaro M, Raguzzini A, Censi L, Ferro-Luzzi A. Body composition changes in anorexia nervosa. Eur J Clin Nutr. 1998;52:655–62. http://dx.doi.org/10.1038/sj.ejcn.1600618
24. Scalfi L, Polito A, Bianchi L, Marra M, Caldara A, Nicolai E, et al. Body composition changes in patients with anorexia nervosa after complete weight recovery. Eur J Clin Nutr. 2002;56:15–20. http://dx.doi.org/10.1038/sj.ejcn.1601290
25. Mayer L, Walsh BT, Pierson RN, Jr., Heymsfield SB, Gallagher D, Wang J, et al. Body fat redistribution after weight gain in women with anorexia nervosa. Am J Clin Nutr. 2005;81:1286–91. http://dx.doi.org/10.1093/ajcn/81.6.1286
26. Mayer L. Body composition and anorexia nervosa: Does physiology explain psychology? Am J Clin Nutr. 2001;73:851–2. http://dx.doi.org/10.1093/ajcn/73.5.851
27. Bodell LP, Mayer LE. Percent body fat is a risk factor for relapse in anorexia nervosa: A replication study. Int J Eat Disord. 2011;44:118–23. http://dx.doi.org/10.1002/eat.20801
28. El Ghoch M, Calugi S, Chignola E, Bazzani PV, Dalle Grave R. Body mass index, body fat and risk factor of relapse in anorexia nervosa. Eur J Clin Nutr. 2016;70:194–8. http://dx.doi.org/10.1038/ejcn.2015.164
29. Mayer LE, Roberto CA, Glasofer DR, Etu SF, Gallagher D, Wang J, et al. Does percent body fat predict outcome in anorexia nervosa? Am J Psychiatry. 2007;164:970–2. http://dx.doi.org/10.1176/ajp.2007.164.6.970
30. El Ghoch M, Milanese C, Calugi S, Pellegrini M, Battistini NC, Dalle Grave R. Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: A longitudinal study. Am J Clin Nutr. 2014;99:771–8. http://dx.doi.org/10.3945/ajcn.113.078816
31. Prioletta A, Muscogiuri G, Sorice GP, Lassandro AP, Mezza T, Policola C, et al. In anorexia nervosa, even a small increase in abdominal fat is responsible for the appearance of insulin resistance. Clin Endocrinol (Oxf). 2011;75:202–6. http://dx.doi.org/10.1111/j.1365-2265.2011.04046.x
32. Aguera Z, Romero X, Arcelus J, Sanchez I, Riesco N, Jimenez-Murcia S, et al. Changes in body composition in anorexia nervosa: Predictors of recovery and treatment outcome. PLoS One. 2015;10:e0143012. http://dx.doi.org/10.1371/journal.pone.0143012
33. Winkler LA, Frolich JS, Schulpen M, Stoving RK. Body composition and menstrual status in adults with a history of anorexia nervosa-at what fat percentage is the menstrual cycle restored? Int J Eat Disord. 2017;50:370–7. http://dx.doi.org/10.1002/eat.22600
34. Tinahones FJ, Martinez-Alfaro B, Gonzalo-Marin M, Garcia-Almeida JM, Garrido-Sanchez L, Cardona F. Recovery of menstrual cycle after therapy for anorexia nervosa. Eat Weight Disord. 2005;10:e52–5. http://dx.doi.org/10.1007/BF03327550
35. Golden NH, Jacobson MS, Schebendach J, Solanto MV, Hertz SM, Shenker IR. Resumption of menses in anorexia nervosa. Arch Pediatr Adolesc Med. 1997;151:16–21. http://dx.doi.org/10.1001/archpedi.1997.02170380020003
36. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: A key to evidence-based decisions. ACP J Club. 1995;123:A12–13.
37. Attia E, Roberto CA. Should amenorrhea be a diagnostic criterion for anorexia nervosa? Int J Eat Disord. 2009;42:581–9. http://dx.doi.org/10.1002/eat.20720
38. El Ghoch M, Calugi S, Pellegrini M, Chignola E, Dalle Grave R. Physical activity, body weight, and resumption of menses in anorexia nervosa. Psychiatry Res. 2016;246:507–11. http://dx.doi.org/10.1016/j.psychres.2016.10.043
39. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Ann Intern Med. 2009;151:W65–94. http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00136
40. Davies S. The importance of PROSPERO to the National Institute for Health Research. Syst Rev. 2012;1:5. http://dx.doi.org/10.1186/2046-4053-1-5
41. Age limits and adolescents. Paediatr Child Health. 2003;8:577–8. http://dx.doi.org/10.1093/pch/8.9.577
42. El Ghoch M, Soave F, Calugi S, Dalle Grave R. Eating disorders, physical fitness and sport performance: A systematic review. Nutrients. 2013;5:5140–60. http://dx.doi.org/10.3390/nu5125140
43. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5. http://dx.doi.org/10.1007/s10654-010-9491-z
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Jul 28, 2019
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Traboulsi, S., Itani, L., Tannir, H., Kreidieh, D., Masri, D. E., & Ghoch, M. E. (2019). IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META ANALYSIS. Journal of Population Therapeutics and Clinical Pharmacology, 26(2), e25-e37. https://doi.org/10.15586/jptcp.v26i2.601
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