Changes of body composition in bulimia nervosa: increased visceral fat and adrenal gland size.
OBJECTIVE
To study the hypothesis that young women suffering from active bulimia nervosa (BN) have more visceral fat and increased adrenal gland volumes (AGV) than healthy controls (HC).


METHODS
Thirteen patients with BN of purging type and 11 healthy age and weight matched women (HC), aged between 19 and 36 years (mean 24 +/- 3 years), with a BMI of 19 to 29 (mean 24 +/- SD 3) were examined. BN was diagnosed by DSM-IV criteria and the severity of illness by the Eating Disorder Inventory (EDI-2). Whole body fat distribution and AGV were determined using a whole body magnetic resonance (MR) scan (T1w) and a 3D-sequence (T1w) at 1.5 Tesla. Salivary cortisol was determined at 9 AM and 4 PM.


RESULTS
BN patients had significantly more visceral adipose tissue (VAT) (HC, 1589.3 +/- 967.6 ml versus 927.2 +/- 428.4 ml, p < .05) and an increased relative AGV (0.068% of body volume versus 0.048% of body volume, p < .05) compared with HC, although waist circumference and BMI did not differ. Although the VAT part in the upper abdomen was increased, especially the VAT of lower abdomen along with the pelvis or any subcutaneous fat compartment was not increased.


CONCLUSIONS
The increase of the VAT volume and the increased AGV in BN women with purging point to chronic high stress levels associated with a hyperactivity of the hypothalamic-pituitary-adrenal axis in these patients. This is the first MR study showing morphological changes in stress associated endocrine organs of young BN patients.
Ludescher
Burkhard
B
Department of Diagnostic Radiology, University Clinic Tuebingen, Tuebingen, Germany. burkhard.ludescher@med.uni-tuebingen.de
Leitlein
Gabriele
G
Schaefer
Jacques-Emmanuel
JE
Vanhoeffen
Stefanie
S
Baar
Sophia
S
Machann
Juergen
J
Claussen
Claus D
CD
Schick
Fritz
F
Eschweiler
Gerhard W
GW
D000311:Adrenal Glands / Q000473:pathology*; D000328:Adult; D000568:Amenorrhea / Q000453:epidemiology; D001823:Body Composition; D015992:Body Mass Index; D002032:Bulimia / Q000473:pathology*; D003276:Contraceptives, Oral; D003480:Cushing Syndrome / Q000473:pathology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D006984:Hypertrophy; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000473:pathology; D010865:Pilot Projects; D012463:Saliva / Q000737:chemistry; D012907:Smoking / Q000453:epidemiology; D055815:Young Adult
D003276:Contraceptives, Oral; D006854:Hydrocortisone