Adolescent health brief
Percentage Body Fat by Dual-Energy X-Ray Absorptiometry Is Associated With Menstrual Recovery in Adolescents With Anorexia Nervosa

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Abstract

Purpose

To evaluate mediators of resumption of menses (ROM) in adolescents with anorexia nervosa (AN).

Methods

Anthropometrics, body composition by dual-energy X-ray absorptiometry, hormonal studies, and responses to mental health screens were obtained at 6-month intervals for 18 months in 37 adolescents with AN randomized to the placebo arm of a double-blind treatment trial. Outcomes were compared between subjects with menstrual recovery and those without.

Results

Twenty-four subjects (65%) had ROM. Higher percentage body fat was associated with ROM (odds ratio, 1.19; 95% confidence interval, 1.06, 1.33; p < .01), as was body mass index and percent median body weight. Estradiol ≥30 ng/mL alone did not predict menses (p = .08) but was associated with ROM when coupled with percent mean body weight (odds ratio, 2.49; 95% confidence interval, 1.09, 5.65; p = .03). Changes in leptin, cortisol, and mental health were not associated with return of menses.

Conclusions

Percentage body fat may be an additional, useful clinical assessment to follow in caring for adolescents with AN.

Section snippets

Participants

Thirty-seven females, aged 13–27 years, diagnosed with AN by their outpatient medical providers and randomized to the placebo arm of a clinical trial completed the baseline visit; 29 completed the 18-month visit [6]. The Institutional Review Board at Boston Children's Hospital approved the study.

Study assessments

Study visits occurred at baseline, 3, 6, 12, and 18 months. Body composition by dual-energy X-ray absorptiometry (DXA), serum estradiol (high-performance liquid chromatography tandem mass spectrometry,

Results

Few baseline differences existed between subjects with ROM (n = 24, 65%) and those without (n = 13; Table 1). Subjects were primarily Caucasian and older adolescents. Duration of both illness and secondary amenorrhea was similar between groups.

Relationships among BMI, estradiol level, percentage body fat, and percent median body weight (MBW) with ROM are shown in Figure 1. In longitudinal models, higher percentage body fat was associated with ROM (odds ratio [OR], 1.19; 95% confidence interval

Discussion

Weight, menstrual status, and mental health are important considerations when caring for patients with AN. Weight restoration remains a primary treatment aim.

Similar to what Golden et al. [1] demonstrated, weight gain coupled with estradiol ≥30 pg/mL was associated with ROM in the current sample. While estradiol ≥30 pg/mL alone was not significantly associated with ROM in this study, the relationship may have been seen with a larger sample. Our data also suggest that percentage body fat is

Acknowledgments

We thank the dedicated nursing and DXA staff of the Boston Children's Hospital Clinical and Translational Study Unit and our patients and their families.

References (10)

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    More recent studies used DXA, which is frequently considered as the practical gold standard for assessing TBF% [10,11]. In studies that associated body composition changes with ROM in adolescents with AN [20–22], a TBF% of 22.5%, 23.1%, and 22.2%, respectively, were determined as the best cut-off points for menstrual recovery. In a recent relatively large-scale study in adult women with AN, 50% regained their menses at a TBF% of 23% [23].

  • Pubertal Progression in Female Adolescents with Progeria

    2018, Journal of Pediatric and Adolescent Gynecology
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Dr. Amy Divasta and Dr. Catherine M. Gordon are co-senior authors.

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