Premorbid Weight Research Articles

Weight gain and reproductive function: ultrasonographic and endocrine features in anorexia nervosa.

Pelvic ultrasonographic measurements and reproductive hormone levels in 36 patients with anorexia nervosa were followed as they gained weight during inpatient treatment. In 24 patients who were severely malnourished (69% of premorbid weight) the ovaries were small and amorphous and the levels of LH, FSH and oestradiol were very low. Weight gain led to the appearance of multifollicular ovaries when levels of LH and oestradiol remained low but FSH levels had increased resulting in an LH:FSH ratio of less than 1. The emergence of a dominant follicle in 19 patients after weight gain (to 97% of premorbid weight) was accompanied by an increase in uterine area and associated with increased levels of LH and oestradiol and an LH:FSH ratio greater than 2. Among these patients with a dominant follicle at peak weight, 11 menstruated within a month of discharge. The weight at which normal ovarian morphology returned was related to premorbid weight (P less than 0.002) whereas body mass index (BMI) was poorly related. Our findings suggest that pelvic ultrasonography is probably the best indicator of the weight required for full endocrine recovery and offers advantages over sequential hormonal measurements, and is valuable in the management of patients with anorexia nervosa.

Tumor necrosis factor not detectable in patients with clinical cancer cachexia.

Tumor necrosis factor (TNF) has been implicated in the pathogenesis of cachexia in neoplastic and infectious diseases. To assess the relationship between TNF and weight loss among cancer patients, we assayed TNF levels in serum from 19 patients who had lost 8%-40% of premorbid weight. The weight loss experienced by these patients was not attributable to anticancer therapy, gastrointestinal disorders, or other medical problems. TNF was measured using a quantitative sandwich enzyme-linked immunosorbent assay that is sensitive to human TNF in serum at concentrations greater than or equal to 40 pg/mL. No TNF was detected in serum samples from the 19 patients studied.

The ultrasonographic features in anorexia nervosa and bulimia nervosa: A simplified method of monitoring hormonal states during weight gain

Ovarian volume and the diameter of the intra-ovarian follicles correlated with the percentage of premorbid weight in 36 patients with anorexia nervosa who had repeated pelvic ultrasound scans during weight gain. Oestradiol levels increased when the follicles became dominant and were greater than 1 cm in diameter; and uterine growth increased linearly with plasma oestradiol. Pelvic ultrasonography can thus be used as a simple, rapid, bioassay to determine hypothalamic-pituitary-ovarian function in patients with anorexia nervosa and provides a useful guide to the degree of weight restoration required to enable menstrual function to cover. The outcome of anorexia nervosa may be related to the degree to which the biological consequences of starvation which perpetuate the disorder are overcome. The menstrual abnormalities in bulimia nervosa are associated with pelvic ultrasound findings such as small multifollicular ovaries and small uterine areas which also occur in anorexia nervosa and simple weight loss amenorrhoea. This suggests that weight loss or the nutritional disturbance in bulimia nervosa may underlie the menstrual irregularities which commonly occur in this condition.

Caloric intake necessary for weight maintenance in anorexia nervosa: nonbulimics require greater caloric intake than bulimics

In the past decade, patients with anorexia nervosa have been subdivided by the presence or absence of bingeing-and-purging behavior. Psychologic, physiologic, and premorbid weight differences have also been discovered between these subgroups. We now report that nonbulimic anorectics required 30–50% more caloric intake than bulimic anorectics to maintain a stable weight. This difference in caloric intake was independent of phase of illness; it was present at low weight and at intervals after weight restoration. Subjects were closely supervised on an inpatient hospital ward so that they could not binge or purge. Motor activity did not appear to explain these alterations in caloric requirements. Such differences in caloric intake could be trait related or a consequence of many years of starving or bingeing behavior. These findings are clinically relevant for advising eating disorder patients of caloric requirements necessary to maintain a normal weight.

Weight maintenance in pediatric burned patients

Weight change, defined as the difference between the preadmission and discharge weights, has often been used as an indicator of the adequacy of nutrition support. Weight change has been found to be uninterpretable in burned patients because excision and grafting contribute to weight loss but do not reflect systemic physiology. Also, normal growth during hospitalization contributes to weight gain but is not included in traditional methods of assessing weight change of children. We examined weight change corrected for escharectomies and growth in 42 adult and pediatric burned patients. Thirty-five of the patients had weight loss within 10% of their premorbid weight. Moreover, weight loss was correlated with three observable patient characteristics: age, percent initial burn size, and preburn weight. It was concluded that the dietary regimen of providing twice the predicted basal metabolic rate in terms of calories, based on ideal body weight, was adequate to prevent significant weight loss in most patients but that further refinement is necessary to improve individual reliability. Furthermore, significant weight losses may not affect morbidity/mortality as previously thought.

Domiciliary initiation of insulin therapy by community nurses

AbstractOver a four‐year period, 45 patients commenced insulin therapy and received education in diabetic self‐care in their own homes, under the supervision of community nurses. No major problems were encountered and none required admission to hospital. Consistently good blood sugar control and weight‐gain back to premorbid or ideal body weight was achieved on average in approximately one and three months respectively. A questionnaire revealed that patients had initial reservations but, after going through the procedure, a majority stated a preference for domiciliary over hospital management. A small number of elderly, isolated or very nervous individuals would have been more suited to in‐patient care.

Cranial CT scans in eating disorder patients and controls

Computed tomography (CT) scans of 21 patients with eating disorders were compared with those of 14 nonpsychotic controls. Of 14 patients with anorexia nervosa, 8 had cerebral ventricular enlargement, and 4 of these also had cortical sulcal atrophy, both by global assessment as compared with none of the controls. Ventricular brain ratio (VBR) and third ventricular measurements were also significantly increased in anorectics in comparison with 5 bulimic patients or controls. CT abnormalities were significantly correlated with rate of and degree of weight loss from premorbid weight but not with loss from estimated minimal healthy weight. Of any clinical features of anorexia, only hypothermia correlated with CT scan abnormality. Review of other reports of CT abnormalities in anorectics and implications for further investigation are discussed.

Changes in muscle and plasma amino acid metabolism in severe malnutrition — The influence of total parenteral nutrition

The concentrations of free amino acids in muscle and plasma were determined in nine female patients with severe anorexia nervosa before and after 3 to 5 weeks of total parenteral nutrition (TPN). The patients had lost 25 to 42% of their pre-morbid weight. During TPN their weight gain was around 2.5 kg/week. Initially total non-essential amino acids (NEAA) in muscle were decreased 30% compared to controls. The major part of this depletion was due to a 40% reduction in glutamine. After TPN the level of glutamine normalized. Alanine, being normal before TPN, decreased after TPN. Proline and several other non-essential amino acids in muscle were decreased before and after TPN. Total essential amino acids (EAA) in muscle were initially normal and were not significantly affected by TPN. Total NEAA in plasma were decreased at admission and normalized after TPN. Total EAA in plasma, however, were normal both before and after TPN. This study demonstrates that severely malnourished patients with anorexia nervosa have changes in amino acid patterns in both muscle and plasma. These changes were largely, though not completely, reversed after 3 to 5 weeks of TPN.

Emotionality and the course of collagen arthritis in the rat.

43 female Sprague-Dawley rats were tested for emotionality using standard open-field procedures. The subjects were then injected with emulsified collagen-II. 31 responded with arthritic activity, clearly evidencing edema and erythema in from one to all 4 limbs. Duration of active response varied from 29 to 59 days. For the arthritic rats, severity of disease (combining duration and number of limbs by standard scores) correlated with both premorbid emotionality (where the partial r, controlling for preweight, was .47, with p < .01), and premorbid weight (where the partial r, controlling for pre-emotionality, was .38, with p < .05). The results encourage further study of premorbid behavioral tendencies as predictors of variations in arthritic responsivity.

Long-term weight regulation in treated hyperthyroid and hypothyroid subjects

Body weight regulation after treatment was studied in 87 hyperthyroid and 18 hypothyroid subjects. Mean body weight was 83.9 percent of the premorbid weight at the time of initial treatment for hyperthyroidism and 102.5 percent at 96 months following treatment. Mean (± SD) post-treatment weight difference from baseline was 3.4 ± 18.6 pounds at 96 months (n = 44). Early weight gain was greatest in subjects in whom thyroxine values normalized quickly. Hyperthyroid subjects from whom a body mass index could be calculated (n = 45) were divided into two groups. The obese group had a greater mean weight loss (35.2 ± 15.0 pounds versus 21.2 ± 9.9 pounds, p < 0.001) and a lower weight (percent of baseline weight) at the time of treatment for hyperthyroidism (81.6 ± 7.7 percent versus 86.0 ± 5.1 percent, p < 0.05). Subjects with thyroxine levels of 20 μg/dl or more had higher premorbid body weights and greater weight loss from baseline than subjects with thyroxine values below 20 μg/dl. Hypothyroid subjects showed a small decline in mean body weight over the first six months of treatment but returned to pretreatment weight by 24 months. In the absence of significant metabolic derangement, body weight is regulated within narrow limits over many years. Effective treatment of hyperthyroidism is accompanied by weight gain.

Muscle metabolic changes in severe malnutrition — Effect of total parenteral nutrition

Severe malnutrition with extreme loss of muscle mass and body fat can be seen in anorexia nervosa. Seven otherwise healthy girls with anorexia nervosa with a weight loss of 25–40% of their premorbid weight were studied. Because of their critical condition and unsuccessful refeeding, total parenteral nutrition (TPN for 3–5 weeks) was indicated. The TPN was administered via a tunnelated silicon catheter. Their weight gain was about 2.5 kg/week. Muscle biopsies were taken from the quadriceps femoris muscle at admission and after TPN for analysis of energy substrates and electrolytes. Initially ATP, phosphocreatine, glycogen, magnesium and potassium were decreased compared to controls. The values returned to normal with 3–5 weeks of TPN. Total muscle water was increased at admission and was not significantly affected by the TPN. No serious complications were observed during the nutritional treatement. These findings emphasized the importance of nutritional supply to patients with severe anorexia nervosa who do not have any known disturbances in the metabolic pathways of the cell.

Reversal of diabetes by allogenic islet transplantation without immunosuppression.

Streptozotocin-induced diabetes is temporarily reversed following the allo-transplantation of BALB/c (H-2d) islet tissue to normal CBA (H-2k) recipients, but by 2-4 week post-transplantation these animals return to their initial diabetic condition. Organ culture of allogeneic islet tissue in 95% O2 and 5% CO2 for 7 days prior to transplantation reduces the immunogenicity of the tissue, and cultured allografts give prolonged (greater than 110 days) reversal of diabetes in normal allogeneic recipients. The non-fasting blood sugar level remains in or very close to the normal range, urine glucose output is one to two orders of magnitude less than that of diabetic control animals and allografted animals regain their pre-morbid body weight within 60 days of transplantation. Surgical removal of the allograft results in a rapid return of the animal to the initial diabetic condition.

Exercise performance and body dimensions in anorexia nervosa before and after rehabilitation.

The boys and five girls (mean age 15.0 y.) with anorexia nervosa (AN) were studied before and after a treatment which restored their body weight to normal. Before treatment the patients' average weight loss was 25% of their premorbid weight. The function and dimensions of the oxygen transport system were determined with heart (HV) and blood (BV) volumes, lean body mass (LBM) and exercise tests on a bicycle ergometer with determination of maximal aerobic power (VO2 max). Before treatment, the patients had bradycardia and hypotension. HV and BV decreased in proportion to the loss of body weight. During maximal exercise, attainable oxygen uptake and heart rate were low. VO2 max decreased out of proportion to the circulatory and body dimensions. After treatment, HV and BV increased in proportion to the rise in body weight. LBM increased significantly in all patients. Heart rates at rest and during exercise were within the range of normal and VO2 max increased. It is concluded that the circulatory system is highly adaptive to the low caloric intake in AN and is totally normalized after weight gain.

Observations of gonadotrophic and ovarian hormone activity during recovery from anorexia nervosa.

Summary Serum gonadotrophins and gonadal steroids were measured in six unmarried female patients with anorexia nervosa before and during treatment by feeding and psychotherapy, which led to restoration of weight to matched population mean levels. In three patients whose premorbid weight was normal, hormonal levels during treatment were initially low, but as weight was regained gonadotrophic levels increased and one patient showed cyclical activity. In three other patients who were premorbidly obese gonodotrophic levels did not appear to increase over the period of investigation. With the exception of one patient whose menstrual cycles were resumed during the period of investigation, gonadal steroid levels in general appeared to remain low although, subsequently, regular monthly menstrual bleeding occurred in some of these patients.

Relation between aspects of nutritional disturbance and menstrual activity in primary anorexia nervosa.

A significantly high number of patients with anorexia nervosa are overweight immediately before the onset of the condition. This premorbid weight may be a feature of their constitution but is sometimes a more transitory phenomenon. Menstruation ceases early in the condition but usually within the context of significant weight loss. However, the subsequent amenorrhoea, related to factors that presumably may not begin to operate until several weeks later, may be a symptom which first draws attention to the condition.Treatment included the restitution of body weight to the matched population mean weight for each patient. This may be important, as the mean weight at which menstrual activity returned was not significantly different from the matched population mean weight. A further treatment aim, so far as nutrition was concerned. was restoration of regular and reasonable feeding behaviour, including adequate carbohydrate ingestion. It is suggested that these findings support the view that the nutritional disturbance in anorexia nervosa is an important factor affecting menstrual activity.