title: Time Course of Leptin in Patients with Anorexia Nervosa during Inpatient Treatment: Longitudinal Relationships to BMI and Psychological Factors.
abstract: BACKGROUND
  Leptin, a hormone secreted by adipose tissue, appears to play a major role in the homeostasis of body weight and psychobiological processes associated with anorexia nervosa (AN). However, there is scarce data on its exact influence on this disorder, in particular data over time.
  
  
  OBJECTIVE
  The present study addresses whether leptin changes during inpatient treatment play a role for treatment outcome and psychological factors in underweight AN patients.
  
  
  METHODS
  In order to understand whether leptin's role differs in relation to AN severity, data were assessed from 11 patients with a very low BMI and a higher chronicity (high severity group; HSS; mean BMI at the beginning of the study = 13.6; mean duration of illness = 5.1 years) vs. nine with less severe symptoms (LSS; mean BMI = 16.2; mean duration of illness = 3.7 years). During the course of treatment, serum leptin concentrations were assessed weekly while weight (BMI) was assessed twice per week. Concomitantly, psychological variables were obtained by means of electronic diaries. Unconditional linear growth models were calculated to evaluate the temporal course of leptin in relation to BMI. For HSS patients, two phases of treatment (BMI < 16 and BMI ≥ 16 kg/m2) were investigated.
  
  
  RESULTS
  Leptin increased significantly with BMI in both groups of patients. For HSS patients, the increase of leptin in the first treatment phase did not predict later increases in BMI. Furthermore, the relationship of leptin and psychological factors was modulated by symptom severity. In HSS patients, higher leptin levels were associated with greater feelings of depression, anxiety, and stress whereas in LSS patients a higher leptin level showed the trend to be associated with lower psychological symptom burden.
  
  
  CONCLUSIONS
  Our results suggest that leptin changes are differently associated with weight gain and psychological symptoms depending on the severity of starvation.
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: Stroe-Kunold
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Buckert
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LVR-Clinics, University Düsseldorf, Düsseldorf, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Friederich
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Wesche
authors.affiliation: Department of Endocrinology and Clinical Chemistry, Medical University Hospital, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kopf
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000097:blood* / Q000150:complications / Q000523:psychology* / Q000628:therapy; D015992:Body Mass Index; D001835:Body Weight; D016022:Case-Control Studies; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D020738:Leptin / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D055815:Young Adult
chemical_list: D020738:Leptin