Abstract
ObjectiveGrowth retardation is an established complication of anorexia nervosa (AN). However, findings concerning final height of AN patients are inconsistent. The aim of this study was to assess these phenomena in female adolescent inpatients with AN.MethodsWe retrospectively studied all 211 female adolescent AN patients hospitalized in an inpatient eating disorders department from 1/1/1987 to 31/12/99. Height and weight were assessed at admission and thereafter routinely during hospitalization and follow-up. Final height was measured in 69 patients 2–10 years after discharge. Pre-morbid height data was available in 29 patients.ResultsPatients’ height standard deviation scores (SDS) on admission (−0.285±1.0) and discharge (−0.271±1.02) were significantly (p<0.001) lower than expected in normal adolescents. Patients admitted at age ≤13 years, or less than 1 year after menarche, were more severely growth-impaired than patients admitted at an older age, (p = 0.03). Final height SDS, available for 69 patients, was −0.258±1.04, significantly lower than expected in a normal population (p = 0.04), and was more severely compromised in patients who were admitted less than 1 year from their menarche. In a subgroup of 29 patients with complete growth data (pre-morbid, admission, discharge, and final adult height), the pre-morbid height SDS was not significantly different from the expected (−0.11±1.1), whereas heights at the other time points were significantly (p = 0.001) lower (−0.56±1.2, −0.52±1.2, and −0.6±1.2, respectively).ConclusionsOur findings suggest that whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.
Highlights
Malnutrition or systemic diseases often result in growth deceleration and stunting
Final ‘‘As expected’’ na na Near FH,TH FH,premorbid height standard deviation scores (SDS) and TH- SDS na Decreased** na na Abberiviations: F = female; M = male; Ctl = control; na = not available; pats = patients; FH = final height; TH = midparental target height. *The mean age of onset in participants with Anorexia nervosa (AN) was 17.963.4 years. **onset before the age of 16, the analysis showed there was a significant effect of both age of onset and lowest body mass index (BMI). doi:10.1371/journal.pone.0045504.t001
Height SDS increased to 20.27161.02, but was still significantly lower than expected in a normal population (p,0.001)
Summary
Malnutrition or systemic diseases often result in growth deceleration and stunting. While nutritional rehabilitation or disease remittance results in accelerated linear growth, [1,2,3], catch-up growth is often incomplete, resulting in compromised final adult height [1,4,5]. Despite the well-described association between nutrition and growth, only few systemized studies assessed the effect of undernutrition during puberty on growth rate and final adult height. The disease provides an attractive model for studying the effect of caloric restriction during adolescence on growth and final height, since in AN patients undernutrition occurs in the absence of other physical illness, and weight rehabilitation is planned and controlled
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