Leptin and body weight regulation in patients with anorexia nervosa before and during weight recovery.
BACKGROUND
Leptin has been considered a starvation hormone, but its role in malnourished patients is unknown.


OBJECTIVE
We aimed to characterize the role of leptin in metabolic adaptation in women with anorexia nervosa (AN).


METHODS
In a cross-sectional study, 57 women with AN [mean (+/-SD) body mass index (kg/m(2)) on admission: 15.2 +/- 1.5] were compared with 49 healthy, normal-weight women (mean body mass index: 22.3 +/- 2.3). Nineteen patients were reinvestigated during weight gain 43 and 84 d after baseline. We measured serum concentrations of leptin, soluble leptin receptor, insulin, ghrelin, and thyroid hormones [thyrotropin, triiodothyronine (T(3)), and thyroxine]; fat mass (FM) and fat-free mass (FFM); resting energy expenditure (REE); energy intake; and eating behavior.


RESULTS
Compared with values in the control women, leptin, T(3), REE, FM, and FFM were lower in the women with AN, but the leptin secretion rate was not significantly different. Leptin correlated with FM (r = 0.83, P < 0.001), T(3) (r = 0.68, P < 0.001), respiratory quotient (r = -0.47, P < 0.001), and REE (r = 0.58, P < 0.001). The association with REE weakened after adjustment for FFM and disappeared after further adjustment for T(3). Hunger and appetite had positive, whereas satiety and restraint had negative, associations with leptin. During weight gain (9.0 +/- 3.3 kg in 84 d), serum leptin and the leptin secretion rate increased. Changes in leptin secretion were associated with energy intake and REE. The initial changes in the leptin secretion rate (ie, the difference between baseline and 43 d) were negatively associated with changes in body weight from 43 to 84 d.


CONCLUSIONS
Leptin contributes to metabolic adaptation in women with AN. The leptin response is associated with weight gain.
Haas
Verena
V
Institut für Humanernährung und Lebensmittelkunde der Christian-Albrechts-Universität zu Kiel, Germany.
Onur
Simone
S
Paul
Thomas
T
Nutzinger
Detlev O
DO
Bosy-Westphal
Anja
A
Hauer
Maren
M
Brabant
Georg
G
Klein
Harald
H
Müller
Manfred J
MJ
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000378:metabolism* / Q000628:therapy; D001481:Basal Metabolism; D015992:Body Mass Index; D001835:Body Weight; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004435:Eating / Q000523:psychology; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D020738:Leptin / Q000097:blood*; D008875:Middle Aged; D009752:Nutritional Status
D020738:Leptin