Abstract
The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa. Literature searches, study selection, method development and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Twenty studies met the inclusion criteria and were consequently analyzed. The review had five main findings. First, during anorexia nervosa adolescent females lose more central body fat, while adult females more peripheral fat. Second, partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females. Third, after short-term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy age-matched controls. Fourth, central fat distribution is associated with increased insulin resistance, but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults. Fifth, the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration, indicating that preferential central distribution of body fat is a transitory phenomenon. However, a discrepancy in the findings has been noted, especially between adolescents and adults; besides age and gender, these appear to be related to differences in the methodology and time of body composition assessments. The PROSPERO Registry—Anorexia Nervosa and Body Fat Distribution: A Systematic Review (CRD42014008738).
Highlights
Anorexia nervosa is a health problem associated with physical and psychosocial morbidity, and increased risk of mortality [1]
A further 69 papers were excluded because they investigated anorexia nervosa and body composition but not body mass distribution
6 studies were excluded for the following reasons: (I) methodological limitations in assessment of body fat distribution (n = 1); (II) small and heterogeneous sample including both adolescents and adults (n = 1); (III) assessment of endocrine changes rather than body fat distribution (n = 1); (IV) comparison of different devices to assess body fat in a heterogeneous group of females with eating disorders (n = 2); assessment of lean mass distribution rather than fat mass (n = 1) (Figure 1)
Summary
Anorexia nervosa is a health problem associated with physical and psychosocial morbidity, and increased risk of mortality [1]. The core features of anorexia nervosa are restriction of energy intake relative to requirement, which leads to significantly low weight and body fat [4,5,6,7]. The recovery of a normal body weight and body fat are key strategies in the treatment of anorexia nervosa [8,9,10,11,12], a common obstacle is the abdominal protrusion often observed by clinicians and patients during weight restoration [13]. The preferential accumulation of body fat after short-term weight restoration may have negative long-term metabolic consequences, as observed in other conditions (i.e., obesity) [15]. The study of the changes in body fat distribution during the process of weight restoration may have important clinical implications for treatment planners
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