Body composition changes in patients with anorexia nervosa after complete weight recovery

Objective: To assess body composition changes occurring in female anorectic patients after complete weight recovery. Design: Longitudinal study. Subjects: Ten female patients with anorexia nervosa (age at baseline: 19.7 +/- 5.8y) were studied both when undernourished (body mass index, BMI 14.8 +/- 1.3kg/ml) and after the achievement of a BMI > 18.5kg/M-2. The control group comprised 18 well-nourished women (age 20.1 +/- 4.4y; BMI 19.0 +/- -23.0kg/M-2). Interventions: Fat mass and fat-free mass were determined by dual-energy X-ray absorptiometry. Skinfold thicknesses and circumferences were also measured. Arm muscle area and arm fat area were calculated by standard formulas. Results: The undernourished patients had lower fat-free mass, fat mass, skinfold thicknesses and circumferences. After refeeding, fat mass represented 25 - 71% (mean 56%) of the mass regained, this percentage being directly related to the extent of weight gain. The increases in skinfolds and circumferences depended upon the site considered and were correlated to a various extent with those in weight or BMI. Skinfolds at biceps and abdominal sites and the waist-to-hip ratio remained significantly higher, whereas arm muscle circumference was significantly lower, in the refed group than in the control one. Conclusion: The percentage of fat in the weight regained by refed female anorectic patients was directly related to the extent of body mass increase. Refed anorectic patients appear to preferentially regain fat in the abdominal and triceps regions. Abnormalities in skinfolds (at biceps and abdominal sites), arm muscle area and waist-to-hip ratio still persist in refed anorectic patients in comparison to control healthy controls.