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Insulinogenic index at 15 min as a marker of nutritional rehabilitation in anorexia nervosa^1,2,3

¹ From the Department of Psychosomatic Medicine, Kagoshima University Hospital, Kagoshima-City, Japan.

Background: Insulin responses to the oral-glucose-tolerance test (OGTT) in anorexia nervosa (AN) are related to body weight and show various patterns. Although weight gain is a key indicator of a successful nutritional program, it is not a sufficiently accurate index for assessing nutritional status, especially in the periods of marked fear of obesity, because patients often manipulate body weight measurements.

Objective: The aim of this study was to determine the relation between insulin metabolism during the early phase of the OGTT and progress (weekly weight gain) during nutritional rehabilitation.

Design: Forty-eight inpatients with AN (25 AN restricting type and 23 AN bulimic type) underwent the OGTT, with additional blood sampling at 15 min, when energy intake reached 6694 kJ/d (1600 kcal/d). Thirteen healthy volunteers were also studied. To evaluate early-phase insulin metabolism, we calculated the insulinogenic index after 15 (II_{15 min}) and 30 min. On the basis of weekly changes in body weight, the AN participants were divided into good (0.5 kg) and poor (<0.5 kg) responders.

Results: Among the AN patients, 48% were poor responders. Analysis of variance showed significant differences in the II_{15 min} values (P = 0.0005) and showed that II_{15 min} values for good responders were significantly higher than those for the other groups.

Conclusions: These findings suggest that a lack of progress in weight gain is frequently observed in AN and that II_{15 min} values may be a useful marker with which to assess the weekly progress during nutritional rehabilitation.

Key Words: WORDSAnorexia nervosa • oral-glucose-tolerance test • insulin • glucose • insulinogenic index • nutritional rehabilitation • women

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