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Metabolic Consequences in Anorexia Nervosa

  • Daniel Rigaud
  • Marie-Claude Brindisi
Chapter

Abstract

In anorexia nervosa (AN), weight loss and malnutrition trigger a cascade of metabolic, hormonal, and behavioral consequences. A considerable decrease in energy expenditure (EE) is observed during fasting states of the disease, but refeeding and weight gain induce a marked increase in EE, including an increase in resting EE, in diet-induced thermogenesis (DIT), and in EE related to physical activity. There is also a dramatic fall in protein catabolism and in glucose disposal during the fasting stages of the disease. During renutrition, these profiles become normal a long time before normalization of body weight. Malnutrition and slimming diets induce alterations in muscle mass and function, leading to difficulties in refeeding, for example by slowing gastric emptying. As shown in rats, the restrictive diet together with access to physical activity, which is secondary to anorectic thought, is responsible for increasing the cognitive restrictive diet and for increasing mental and physical hyperactivity. Energy and nutrient deficiencies are the consequence of fear of becoming obese, but could also induce, in one-third of cases, binge eating and, thus, purging. Recent studies have provided no evidence that AN is caused by neural, hormonal or metabolic factors and/or damage. But these metabolic and cognitive changes, which are mainly the consequence of the starvation, could explain some symptoms or behavior observed in AN, i.e., those related to the compulsive needs to remain thin and to the fear of being fat.

Keywords

Physical Activity Eating Disorder Anorexia Nervosa Binge Eating Bulimia Nervosa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ACTH

Adrenocorticotropic hormone

AN

Anorexia nervosa

BMI

Body mass index

CETP

Cholesterol ester transfer protein

DIT

Diet-induced thermogenesis

ED

Eating disorder

EE

Energy expenditure

EEPA

Energy expenditure linked to physical activity

EETR

Energy expended for thermoregulation

FFM

Fat free mass

HDL-C

High density lipoprotein cholesterol

IGF1

Insulin like growth factor 1

LDL-C

Low density lipoprotein cholesterol

REE

Resting energy expenditure

TSH

Thyroid stimulating hormone

VLDL-C

Very low density lipoprotein cholesterol

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Endocrinology and NutritionCHU Le Bocage (Dijon University Hospital)Dijon CedexFrance

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