Changes in marrow adipose tissue with short-term changes in weight in premenopausal women with anorexia nervosa

in European Journal of Endocrinology
Correspondence should be addressed to P K Fazeli; Email: pkfazeli@partners.org
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Objective

In anorexia nervosa, a psychiatric disease characterized by self-induced starvation and a model of chronic undernutrition, levels of subcutaneous (SAT) and visceral (VAT) adipose tissue are low, whereas marrow adipose tissue (MAT) levels are elevated compared to normal-weight women. The reason for this paradoxical elevation of an adipose tissue depot in starvation is not known. We sought to understand changes in MAT in response to subacute changes in weight and to compare these changes with those of other fat depots and body composition parameters.

Design and methods

We conducted a 12-month longitudinal study including 46 premenopausal women (n = 26 with anorexia nervosa and n = 20 normal-weight controls) with a mean (s.e.m.) age of 28.2 ± 0.8 years. We measured MAT, SAT, VAT and bone mineral density (BMD) at baseline and after 12 months.

Results

At baseline, SAT (P < 0.0001), VAT (P < 0.02) and BMD of the spine and hip (P ≤ 0.0002) were significantly lower and vertebral and metaphyseal MAT (P ≤ 0.001) significantly higher in anorexia nervosa compared to controls. Weight gain over 12 months was associated with increases not only in SAT and VAT, but also epiphyseal MAT (P < 0.03). Changes in epiphyseal MAT were positively associated with changes in BMD (P < 0.03).

Conclusions

In contrast to the steady state, in which MAT levels are higher in anorexia nervosa and MAT and BMD are inversely associated, short-term weight gain is associated with increases in both MAT and BMD. These longitudinal data demonstrate the dynamic nature of this fat depot and provide further evidence of its possible role in mineral metabolism.

 

     European Society of Endocrinology

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Figures

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    Both body weight and BMI were inversely associated with marrow adipose tissue (MAT) at the L4 vertebra and femoral metaphysis. Association between body weight and MAT at L4 vertebra (rho = −0.47, P = 0.001) (panel A); association between BMI and MAT at L4 vertebra (rho = −0.51, P = 0.0005) (panel B); association between body weight and MAT at the femoral metaphysis (rho = −0.39, P = 0.009) (panel C); association between BMI and MAT at the femoral metaphysis (rho = −0.45, P < 0.003) (panel D). When the subject with the greatest L4 MAT (2.4 lipid/water) was excluded, the associations remained significant (panel A: rho = −0.44, P = 0.003 and panel B: rho = −0.48, P = 0.001). When the subject with the greatest MAT at the femoral metaphysis (17.1 lipid/water) was excluded, the associations remained significant (panel C: rho = −0.47, P < 0.002 and panel D: rho = −0.52, P = 0.0004).

  • View in gallery

    There was a significant positive association between % change in weight and % change in marrow adipose tissue at the femoral epiphysis (rho = 0.51, P < 0.001) over the 12-month study. When we excluded the two subjects who gained more weight (weight gain: 55.1% and 39.4%) than the rest of the subjects, the association remained significant (rho = 0.44, P < 0.01).

  • View in gallery

    % change in marrow adipose tissue at the femoral epiphysis was significantly and positively associated with % change in lateral spine bone mineral density (rho = 0.35, P < 0.03).

  • View in gallery

    % change in marrow adipose tissue at the femoral epiphysis was significantly and positively associated with % change in subcutaneous adipose tissue (rho = 0.48, P = 0.002). When we excluded the two subjects who had higher gains in subcutaneous adipose tissue (790% and 415%) than the rest of the subjects, the association remained significant (rho = 0.39, P < 0.02).

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