title: Evidence of a link between resting energy expenditure and bone remodelling, glucose homeostasis and adipokine variations in adolescent girls with anorexia nervosa.
abstract: Low bone mass is a consequence of anorexia nervosa (AN). This study assessed the effects of energy deficiency on various bone and hormonal parameters. The interrelationships between energy deficiency and bone remodelling, glucose homeostasis and adipokines underscore the importance of preventing energy deficiency to limit demineralisation and hormonal alterations in AN patients.
  
  
  BACKGROUND
  Low areal bone mineral density (aBMD) is a well-known consequence of AN. However, the impact of reduced energy expenditure on bone metabolism is unknown. This study assessed the effects of energy deficiency on bone remodelling and its potential interactions with glucose homeostasis and adipose tissue-derived hormones in AN, a clinical model for reduced energy expenditure.
  
  
  METHODS
  Fifty women with AN and 50 age-matched controls (mean age 18.1 ± 2.7 and 18.0 ± 2.1 years, respectively) were enrolled. aBMD was determined with DXA. Resting energy expenditure (REEm), a marker of energy status, was indirectly assessed by calorimetry. Bone turnover markers, undercarboxylated osteocalcin (ucOC), parameters of glucose homeostasis, adipokines and growth factors were concomitantly evaluated.
  
  
  RESULTS
  AN patients presented low aBMD at all bone sites. REEm, bone formation markers, ucOC, glucose, insulin, HOMA-IR, leptin and IGF-1 were significantly reduced, whereas the bone resorption marker, leptin receptor (sOB-R) and adiponectin were elevated in AN compared with CON. In AN patients, REEm was positively correlated with weight, BMI, whole body (WB) fat mass, WB fat-free soft tissue, markers of bone formation, glucose, insulin, HOMA-IR, leptin and IGF-1 and negatively correlated with the bone resorption marker and sOB-R. Biological parameters, aBMD excepted, appeared more affected by the weight variation in the last 6 months than by the disease duration.
  
  
  CONCLUSIONS
  The strong interrelationships between REEm and bone remodelling, glucose homeostasis and adipokines underscore the importance of preventing energy deficiency to limit short- and long-term bone demineralisation and hormonal alterations in AN patients.
authors.affiliation: Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier 1 (UMI), 34295, Montpellier, France.|Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier, France.
authors.forename: L
authors.initials: L
authors.lastname: Maïmoun
authors.affiliation: Département d'Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHRU Montpellier, UMI, INSERM U1061, 34295, Montpellier, France.
authors.forename: S
authors.initials: S
authors.lastname: Guillaume
authors.affiliation: Department of Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Lefebvre
authors.affiliation: Departement de Biochimie et d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Philibert
authors.affiliation: Unité de Recherche Clinique et Epidémiologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.
authors.forename: H
authors.initials: H
authors.lastname: Bertet
authors.affiliation: Unité de Recherche Clinique et Epidémiologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.|CIC INSERM 1411, Hôpital Saint Eloi, CHRU Montpellier, 34295, Montpellier cedex 5, France.
authors.forename: M-C
authors.initials: MC
authors.lastname: Picot
authors.affiliation: Département de Pédiatrie, Hôpital Caremeau, CHRU Nîmes, 30000, Nîmes, France.
authors.forename: L
authors.initials: L
authors.lastname: Gaspari
authors.affiliation: Departement de Biochimie et d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.|Unité d'Endocrinologie et Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve, 191 avenue Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
authors.forename: F
authors.initials: F
authors.lastname: Paris
authors.affiliation: Département d'Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHRU Montpellier, UMI, INSERM U1061, 34295, Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Seneque
authors.affiliation: Departement de Biochimie et d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Dupuys
authors.affiliation: Département d'Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHRU Montpellier, UMI, INSERM U1061, 34295, Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Courtet
authors.affiliation: Service de Rhumatologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.
authors.forename: E
authors.initials: E
authors.lastname: Thomas
authors.affiliation: Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier 1 (UMI), 34295, Montpellier, France.|Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier, France.
authors.forename: D
authors.initials: D
authors.lastname: Mariano-Goulart
authors.affiliation: Department of Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.
authors.forename: J
authors.initials: J
authors.lastname: Bringer
authors.affiliation: Department of Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France.|CIC INSERM 1411, Hôpital Saint Eloi, CHRU Montpellier, 34295, Montpellier cedex 5, France.|Institut de Génomique Fonctionnelle, CNRS UMR 5203/INSERM U1161/Université Montpellier, Montpellier, France.
authors.forename: E
authors.initials: E
authors.lastname: Renard
authors.affiliation: Unité d'Endocrinologie et Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve, 191 avenue Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France. c-sultan@chu-montpellier.fr.
authors.forename: C
authors.initials: C
authors.lastname: Sultan
mesh_terms: D054392:Adipokines / Q000097:blood*; D000293:Adolescent; D000856:Anorexia Nervosa / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D000886:Anthropometry / Q000379:methods; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D001835:Body Weight / Q000502:physiology; D015519:Bone Density / Q000502:physiology; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D016723:Bone Remodeling / Q000502:physiology*; D016022:Case-Control Studies; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D008598:Menstruation / Q000502:physiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D054392:Adipokines; D015415:Biomarkers; D001786:Blood Glucose; D036341:Intercellular Signaling Peptides and Proteins
keywords: Anorexia nervosa; Bone remodelling; Insulin; Leptin; Resting energy expenditure; Undercarboxylated osteocalcin