title: The consequences of negative energy balance in anorexia syndrome.
abstract: OBJECTIVE
  Using four cases, this study describes common etiological factors and clinical sequelae in anorexia nervosa and athletic anorexia to present a biological explanation for interactions.
  
  
  METHODS
  Four anorectic girls were interviewed regarding their training programs and dietary intake. Bone mineral content, hormonal status, and energy intake were assessed during follow-ups.
  
  
  RESULTS
  All the girls began training before puberty and had a low energy intake for age and height. Amenorrhea, low bone mineral content with stress fractures in three cases, and growth retardation in one case, were present at the follow-up after 6 years. Low amount of body fat and high serum cortisol is indicated and included in the discussion. The etiology is presented in an integrated model in addition to a biological explanation based on a negative energy balance, an acidic condition.
  
  
  CONCLUSIONS
  Energy deficits during puberty can result in the clinical sequela of the anorexia syndrome.
authors.affiliation: Department of Social Medicine, University Hospital, SE-901 85 Umeå, Sweden. lena.haglin@vll.se
authors.forename: Lena
authors.initials: L
authors.lastname: Håglin
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000568:Amenorrhea / Q000209:etiology; D000856:Anorexia Nervosa / Q000150:complications* / Q000178:diet therapy; D015519:Bone Density; D002149:Energy Intake; D005260:Female; D005518:Food Preferences; D015775:Fractures, Stress / Q000209:etiology; D006801:Humans; D012189:Retrospective Studies; D011795:Surveys and Questionnaires