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Percentage extremity fat, but not percentage trunk fat, is lower in adolescent boys with anorexia nervosa than in healthy adolescents^1,2,3

¹ From the Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA (MM, JC, KKM, and AK); the Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA (MM); the Division of Adolescent Medicine, Hospital for Sick Kids, Toronto, Canada (DKK and SJM); the Wilkins Center for Eating Disorders, Greenwich, CT (DM); and the Harris Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA (DBH)

² Supported by NIH grants R01 DK 062249, K23 RR018851, and M01-RR-01066.

³ Reprints not available. Address correspondence to M Misra, BUL 457, Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail: mmisra{at}partners.org.

Background:Anorexia nervosa (AN) is a condition of severe undernutrition associated with altered regional fat distribution in females. Although primarily a disease of females, AN is increasingly being recognized in males and is associated with hypogonadism. Testosterone is a major regulator of body composition in males, and testosterone administration in adults decreases visceral fat. However, the effect of low testosterone and other hormonal alterations on body composition in boys with AN is not known.

Objective:We hypothesized that testosterone deficiency in boys with AN is associated with higher trunk fat, as opposed to extremity fat, compared with control subjects.

Design:We assessed body composition using dual-energy X-ray absorptiometry and measured fasting testosterone, estradiol, insulin- like growth factor-1, leptin, and active ghrelin concentrations in 15 boys with AN and in 15 control subjects of comparable maturity aged 12–19 y.

Results:Fat and lean mass in AN boys was 69% and 86% of that in control subjects. Percentage extremity fat and extremity lean mass were lower in boys with AN (P = 0.003 and 0.0008); however, percentage trunk fat and the trunk to extremity fat ratio were higher after weight was adjusted for (P = 0.005 and 0.003). Testosterone concentrations were lower in boys with AN, and, on regression modeling, positively predicted percentage extremity lean mass and inversely predicted percentage trunk fat and trunk to extremity fat ratio. Other independent predictors of regional body composition were bone age and weight.

Conclusions:In adolescent boys with AN, higher percentage trunk fat, higher trunk to extremity fat ratio, lower percentage extremity fat, and lower extremity lean mass (adjusted for weight) are related to the hypogonadal state.