Excessive physical activity in young girls with restrictive-type anorexia nervosa: its role on cardiac structure and performance
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The aim of this study was to investigate the influence of hyperactivity on left ventricular mass (LVM) in Anorexia Nervosa restricting-type (AN-R) and the correlation between LVM and auxologic parameters/circulating hormones.
Echocardiography was performed in 44 AN-R girls, subgrouped in 24 hyperactive (ANH+) and 20 non-hyperactive (ANH−), and in 20 controls (HC). LVM indexed to Body Surface Area (LVMi) and LVM indexed to height (LVMh) were calculated.
LVMi and LVMh were significantly lower in the AN-R subjects compared to HC. Moreover, both LVMi and LVMh were higher in the ANH+ than in the ANH−. In the HC, LVMi was higher when compared to the ANH− subjects than to the ANH+. Stepwise analysis revealed that in the ANH+ group, fT4 was the only independent predictor of LVMh, while in the ANH− group, height was the only independent predictors of LVMi.
Despite its negative influence on disease severity and outcome, hyperactivity from the standpoint of cardiac function makes the LVM of AN-R young girls more similar to HC.
Level of evidence
Level III, case–control study.
KeywordsAnorexia nervosa restricting-type Adolescents Hyperactivity Echocardiography Left ventricular mass
We would like to thank Dr. Giampiero Igli Baroncelli from the Pediatric Unit I, University of Pisa, Italy, for providing DEXA data.
Compliance with ethical standards
This work was supported by grant from the IRCCS Stella Maris Foundation (Ricerca Corrente, and the “5 × 1000” voluntary contributions, Italian Ministry of Health).
Conflict of interest
All the authors declare that they have no conflict of interest to disclose.
The study conformed to the Declaration of Helsinki and was approved by the IRCCS Stella Maris Institutional Ethical Committee.
An informed consent was obtained from each subject and from a parent or guardian.
- 5.Hebebrand J, Exner C, Hebebrand K, Holtkamp C, Casper RC, Remschmidt H, Herpertz-Dahlmann B, Klingenspor M (2003) Hyperactivity in patients with anorexia nervosa and in semistarved rats: evidence for a pivotal role of hypoleptinemia. Physiol Behav 79:25–37. doi: 10.1016/S0031-9384(03)00102-1 CrossRefPubMedGoogle Scholar
- 8.Bratland-Sanda S, Sundgot-Borgen J, Rø Ø, Rosenvinge JH, Hoffart A, Martinsen EW (2010) Physical activity and exercise dependence during inpatient treatment of longstanding eating disorders: an exploratory study of excessive and non-excessive exercisers. Int J Eat Disord 43:266–273. doi: 10.1002/eat.2076 CrossRefPubMedGoogle Scholar
- 12.Shroff H, Reba L, Thornton LM, Tozzi F, Klump KL, Berrettini WH, Brandt H, Crawford S, Crow S, Fichter MM, Goldman D, Halmi KA, Johnson C, Kaplan AS, Keel P, LaVia M, Mitchell J, Rotondo A, Strober M, Treasure J, Woodside DB, Kaye WH, Bulik CM (2006) Features associated with excessive exercise in women with eating disorders. Int J Eat Disord 39:454–61. doi: 10.1002/eat.20247 CrossRefPubMedGoogle Scholar
- 19.American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (text revised 4th edn). American Psychiatric Association, Washington, DCGoogle Scholar
- 20.Billeci L, Tartarisco G, Brunori E, Crifaci G, Scardigli S, Balocchi R, Pioggia G, Maestro S, Morales MA (2015) The role of wearable sensors and wireless technologies for the assessment of heart rate variability in anorexia nervosa. Eat Weight Disord 20:23–31. doi: 10.1007/s40519-014-0135-2 CrossRefPubMedGoogle Scholar
- 32.Appendix (2007) Normal Hormone Reference Range. In: Gardner D, Shoback D (eds) Greenspan’s basic and clinical endocrinology (LANGE clinical medicine), 9th edn. Mc Graw-Hill Companies, New YorkGoogle Scholar
- 33.Pession A (2015) Manuale di diagnosi e terapia Pediatrica. CEA, BolognaGoogle Scholar
- 34.Wechsler D (2003) Wechsler intelligence scale for children–fourth edition: administrative and scoring manual. The Psychological Corporation, San AntonioGoogle Scholar
- 35.Fichter MM, Herpertz S, Quadflieg N, Herpertz-Dahlmann B (1998) Structured Interview for Anorexic and Bulimic disorders for DSM-IV and ICD-10: updated (third) revision. Int J Eat Disord 24:227–249. doi: 10.1002/(SICI)1098-108X(199811)24:3<227::AID-EAT1>3.0.CO;2-O CrossRefPubMedGoogle Scholar
- 36.Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for disease control and prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60. doi: 10.1542/peds.109.1.45 CrossRefPubMedGoogle Scholar
- 37.Prior BM, Cureton KJ, Modlesky CM, Evans EM, Sloniger MA, Saunders M, Lewis LD (1985) In vivo validation of whole body composition estimates from dual-energy X-ray absorptiometry. J Appl Physiol 83:623e30Google Scholar
- 38.Kohrt WM (1998) Preliminary evidence that DEXA provides an accurate assessment of body composition. J Appl Physiol 84:372e7Google Scholar
- 39.El Ghoch M, Alberti M, Milanese C, Battistini NC, Pellegrini M, Capelli C, Calugi S, Dalle Grave R (2012) Comparison between dual-energy X-ray absorptiometry and skinfolds thickness in assessing body fat in anorexia nervosa before and after weight restoration. Clin Nutr 31:911–916CrossRefGoogle Scholar
- 40.Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography (2005) Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr 18:1440–1463. doi: 10.1016/j.echo.2005.10.005 CrossRefPubMedGoogle Scholar
- 42.de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitii O, Alderman MH (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260. doi: 10.1016/0735-1097(92)90385-Z CrossRefPubMedGoogle Scholar
- 53.Ehrlich S, Burghardt R, Schneider N, Hein J, Weiss D, Pfeiffer E, Lehmkuhl U, Salbach-Andrae H (2009) The role of leptin and cortisol in hyperactivity in patients with acute and weight-recovered anorexia nervosa. Progr Neuropsychopharmacol Biol Psychiatry 33:658–662. doi: 10.1016/j.pnpbp.2009.03.007 CrossRefGoogle Scholar