title: Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study. Percent body fat is a risk factor for relapse in anorexia nervosa: a replication study. Does percent body fat predict outcome in anorexia nervosa?
abstract: Background / Objectives : Restrictive Anorexia nervosa ( ANR ) is an eating disorder ( ED ) characterized by a low bone mineral content ( BMC ) and by an alteration in body composition ( reduction and abnormal distribution of fat mass — FM and lean mass — LM ) . The aim of our study was to address whether bone and body composition changes could be influenced by hormonal status and sport in female adolescents with restrictive anorexia nervosa-ANR.Subjects/ Methods : Prospect i ve study on 79 adolescents with ANR su bmi tted to Dual Energy X-Ray Absorptiometry — DXA at baseline-T0  and after 12 months-T12 . Among the 46/79—58.2 % patients that completed the study , we evaluated total and regional FM and LM% , as well as lumbar bone mineral density ( BMD ) and Z-score , linking them to clinical variables : menarche/amenorrhea/hormonal therapy and physical activity . Results : At T0 : body mass index ( BMI ) = 16.4±1.4 kg/m2 with low levels of FM% ( 21.7±5.7 ) low BMC in 12/46—26.0 % ( mean Z-score : −1.21±1.27 , with higher values related to physical activity — P=0.001 ) . At T12 : a significant increase in BMI —P=0.001 , with LM reduction and FM increase ( more evident in the trunk — P<0.001 ) ; regarding bone , no significant changes were observed , though a tendency in terms of improvement associated with resumption of menses . Conclusions : After 1 year , weight recovery was not associated with a reestablishment of bone values ; by contrast , it was associated with an increase and a distortion in FM distribution , more evident in trunk region ( potential and adjunctive risk factor for the relapse of the psychiatric condition ) . The complexity of these clinical findings suggested DXA , a low-dose and low-cost technique , in long-term monitoring of ANR patients BACKGROUND Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States . OBJECTIVE The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa . DESIGN Twenty-seven amenorrheic women aged 26.6 + /- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were r and omly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements .  Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy , eumenorrheic , age-matched ( 25.4 + /- 0.5 y ) control subjects . RESULTS Twenty of the 27 patients with anorexia aged 27.0 + /- 1.3 y spontaneously gained weight ( 4.1 + /- 0.9 kg ) ; body mass index ( in kg/m(2 ) ) increased from 16.1 + /- 0.3 to 17.5 + /- 0.4 . Fat mass and lean mass accounted for 68 % and 32 % of the gain in total body mass , respectively . With spontaneous weight gain , there was a significant increase in the percentage of trunk fat from 32.4 + /- 1.3 % at baseline to 36.5 + /- 1.0 % at 9 mo ( P = 0.03 ) , which correlated with urinary free cortisol ( r = 0.66 , P = 0.003 ) . Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain . CONCLUSIONS In women with anorexia nervosa , spontaneous weight gain is associated with a significant increase in trunk adiposity , and estrogen administration may not protect against the accumulation of central fat with weight gain BACKGROUND Recent clinical guidelines on the health risks of obesity use body mass index ( BMI ; calculated as weight in kilograms divided by the square of height in meters ) and waist circumference , but the waist-hip ratio may provide independent information . METHODS To assess the joint and relative associations of BMI , waist circumference , and waist-hip ratio with multiple disease end points , we conducted a prospect i ve cohort study of 31,702 Iowa women , aged 55 to 69 years and free of cancer , heart disease , and diabetes , assembled by r and om sampling and mail survey in 1986 . Study end points were total and cause-specific mortality and incidence of site-specific cancers and self-reported diabetes , hypertension , and hip fracture over 11 to 12 years . RESULTS The waist-hip ratio was the best anthropometric predictor of total mortality , with the multivariable-adjusted relative risk for quintile 5 vs 1 of 1.2 ( 95 % confidence interval , 1.1 - 1.4 ) , compared with 0.91 ( 95 % confidence interval , 0.8 - 1.0 ) for BMI and 1.1 ( 95 % confidence interval , 1.0 - 1 . 3 ) for waist circumference . The waist-hip ratio was also associated positively with mortality from coronary heart disease , other cardiovascular diseases , cancer , and other causes . The waist-hip ratio was associated less consistently than BMI or waist circumference with cancer incidence . All anthropometric indexes were associated with incidence of diabetes and hypertension . For example , women simultaneously in the highest quintiles of BMI and waist-hip ratio had a relative risk of diabetes of 29 ( 95 % confidence interval , 18 - 46 ) vs. women in the lowest combined quintiles . CONCLUSION The waist-hip ratio offers additional prognostic information beyond BMI and waist circumference BACKGROUND Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa ( AN ) , its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge . OBJECTIVES We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features . DESIGN Body composition was measured by using dual-energy X-ray absorptiometry in 50 female , adult patients with AN before and after complete weight restoration [ body mass index ( BMI ; in kg/m² ) ≥18.5 ] and 100 healthy control subjects matched by age and posttreatment BMI of study group participants . Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory ( BSI-GSI ) , respectively . RESULTS After the achievement of complete weight restoration , patients with AN had higher trunk ( P < 0.001 ) , and roid ( P < 0.001 ) , and gynoid ( P < 0.001 ) fat masses and lower arm ( P < 0.001 ) and leg ( P = 0.001 ) fat masses with respect to control subjects . No relation was shown between body-composition variables and eating disorder psychopathology in the AN group , and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score . CONCLUSION The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions , which does not , however , seem to influence either eating disorder psychopathology or psychological distress scores OBJECTIVE We aim ed to replicate and extend our previous findings of an association between percent body fat in recently weight-restored patients with Anorexia Nervosa ( AN ) and clinical outcome in the year following treatment . METHOD Twenty-two hospitalized , weight-restored women with AN underwent  whole body MRI to determine percent adipose tissue . Following hospital discharge , patients were contacted regularly , and at the end of the year , clinical outcome was determined using modified Morgan-Russell ( MR ) criteria : full , good , fair or poor . Identical to our previous study , outcome was dichotomized into " full , good or fair " and " poor " groups . RESULTS Data from 21 subjects were available for analysis . Percent body fat was significantly lower in the poor outcome group ( 22 % ± 5 % ) compared to the " full , good or fair " outcome group ( 27 % ± 4%)(p < 0.035 ) . To further examine the relationship , we combined data from the current study with data from the 26 subjects on whom we had previously reported . Univariate analysis of variance ( ANOVA ) demonstrated a significant difference in percent adipose tissue across the four MR outcome groups ( F = 3.416 , df = 3 , p<0.03 ) . DISCUSSION Lower percent adipose tissue after short-term weight normalization is associated with poor clinical outcome in the year following inpatient treatment . These findings may be important in the assessment of risk for relapse in patients with AN OBJECTIVE The goal of this study was to investigate the relationship of body composition and neuroendocrine levels with clinical outcome in women with anorexia nervosa in a relapse-prevention trial . METHOD Body composition and fasting cortisol and leptin levels were assessed before r and om assignment in 32 weight-recovered subjects with anorexia nervosa from the New York site of the Fluoxetine to Prevent Relapse in Women With Anorexia Nervosa trial . Clinical outcome at the end of study participation was defined using modified Morgan-Russell criteria ( full , good , fair , poor ) , then dichotomized into treatment " success " or " failure . " RESULTS In a binary logistic regression model examining the effect of percent body fat , body mass index , anorexia nervosa subtype , waist-to-hip ratio , and serum cortisol and leptin levels on treatment outcome , only percent body fat was significantly associated with outcome . CONCLUSIONS In recently weight-restored women with anorexia nervosa , lower percent body fat was associated with poor long-term outcome
target: First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat .
  Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females .
  Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls .
  Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults .
  Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .
background: The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .