title: Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders.
abstract: OBJECTIVE
  To investigate the complex relationships between resting energy expenditure (REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders.
  
  
  METHODS
  The study was designed as a cross-sectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence (Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire (EDE-Q). Patients were also evaluated by means of the symptom checklist (SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated.
  
  
  RESULTS
  Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index (BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels (mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating factor for this relationship.
  
  
  CONCLUSIONS
  The data supported a mediation model where cortisol levels mediated the relationship between eating psychopathology (concern about body shape) and REE.
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Castellini
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Castellani
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lelli
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Carolina Lo
authors.initials: CL
authors.lastname: Sauro
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Dini
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lazzeretti
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Bencini
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.affiliation: Giovanni Castellini, Lorenzo Lelli, Lisa Lazzeretti, Lorenza Bencini, Valdo Ricca, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, 50134 Firenze, Italy.
authors.forename: Valdo
authors.initials: V
authors.lastname: Ricca
keywords: Anorexia nervosa; Bulimia nervosa; Cortisol; Psychopathology; Resting energy expenditure