Anorexia Nervosa (AN) is a sometimes-deadly, psychiatric illness predominantly affecting adolescent girls and young women. Due to a near-delusional fear of gaining weight and becoming fat, a relentless cycle of self-starvation and weight loss ensues. Multiple medical sequelae are associated with the emaciated, low weight state, but they have generally been thought to resolve with normalization of body weight. There is increasing evidence, however, of persistent body fat distribution and hormonal disturbances despite weight recovery. Specifically, there is evidence of an abnormal, predominantly truncal, distribution of body fat with weight gain in women with AN. Increased truncal obesity, specifically increased visceral adipose tissue (VAT), has been associated with Metabolic Syndrome and increased long-term risk of cardiovascular morbidity. The Metabolic Syndrome describes a constellation of disruptions of multiple physiologic systems including: insulin resistance, dyslipidemia, fibrinolytic pathway disruption (increased PAI-1, tPA), and activated inflammatory (increased C-reactive protein, IL-6, and TNF-alpha) and stress (cortisol) responses.
The aim of the proposed study is to explore whether the increased VAT in weight-recovered women with AN is associated with additional markers of Metabolic Syndrome. Secondly, it is to understand whether these changes are transient effects of weight gain, or more permanent. To achieve these goals, 25 women with AN on the inpatient Eating Disorders Unit at the New York State Psychiatric Institute/Columbia University and 25 healthy, female controls matched for age, height and weight to the weight-restored patients will undergo body composition testing (including total body MRI for muscle and fat distribution) and neuroendocrine evaluation (including markers of Metabolic Syndrome). Patients will undergo testing at low weight and after having maintained a weight of at least 90% of Ideal Body Weight (IBW) for 2-4 weeks, and 12 months after weight normalization: It would be a new and important clinical finding, if the hypotheses of this proposed study are borne out - that is, women with AN show increased VAT and associated features of Metabolic Syndrome and these symptoms persist with time and weight maintenance, and might therefore be at increased risk for heart disease.
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