Insulinogenic index at 15 min as a marker of nutritional rehabilitation in anorexia nervosa.
BACKGROUND
Insulin responses to the oral-glucose-tolerance test (OGTT) in anorexia nervosa (AN) are related to body weight and show various patterns. Although weight gain is a key indicator of a successful nutritional program, it is not a sufficiently accurate index for assessing nutritional status, especially in the periods of marked fear of obesity, because patients often manipulate body weight measurements.


OBJECTIVE
The aim of this study was to determine the relation between insulin metabolism during the early phase of the OGTT and progress (weekly weight gain) during nutritional rehabilitation.


METHODS
Forty-eight inpatients with AN (25 AN restricting type and 23 AN bulimic type) underwent the OGTT, with additional blood sampling at 15 min, when energy intake reached 6694 kJ/d (1600 kcal/d). Thirteen healthy volunteers were also studied. To evaluate early-phase insulin metabolism, we calculated the insulinogenic index after 15 (II(15 min)) and 30 min. On the basis of weekly changes in body weight, the AN participants were divided into good (> or =0.5 kg) and poor (<0.5 kg) responders.


RESULTS
Among the AN patients, 48% were poor responders. Analysis of variance showed significant differences in the II(15 min) values (P = 0.0005) and showed that II(15 min) values for good responders were significantly higher than those for the other groups.


CONCLUSIONS
These findings suggest that a lack of progress in weight gain is frequently observed in AN and that II(15 min) values may be a useful marker with which to assess the weekly progress during nutritional rehabilitation.
Yasuhara
Daisuke
D
Department of Psychosomatic Medicine, Kagoshima University Hospital, Kagoshima-City, Japan. yasuhara@m3.kufm.kagoshima-u.ac.jp
Naruo
Tetsuro
T
Nagai
Nobuatsu
N
Tanaka
Muneki
M
Muranaga
Tetsuro
T
Nozoe
Shin-ichi
S
D000328:Adult; D000704:Analysis of Variance; D000856:Anorexia Nervosa / Q000378:metabolism / Q000503:physiopathology* / Q000534:rehabilitation; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D016022:Case-Control Studies; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D009752:Nutritional Status; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin