Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents

Abstract

Background: Adolescence is a common time for the onset of anorexia nervosa (AN), a condition associated with long-term medical and hormonal consequences.

Objective: The objective was to compare the nutrient intakes of community-dwelling girls with AN with those of healthy adolescents and to describe the associations between specific nutrient intakes and nutritionally dependent hormones.

Design: Nutrient intakes in 39 community-dwelling girls with AN and 39 healthy adolescents aged 12.1-18.7 y were determined by using 4-d food records. Fasting adiponectin, leptin, ghrelin, insulin, and insulin-like growth factor I (IGF-I) concentrations were measured. Indirect calorimetry was used to assess respiratory quotient and resting energy expenditure.

Results: In contrast with the control group, the AN group consumed fewer calories from fats (P < 0.0001) and more from carbohydrates (P = 0.0009) and proteins (P < 0.0001). Intake of individual fat components was lower and of dietary fiber higher in the AN group. No significant between-group differences were observed in dietary intakes of calcium, zinc, and iron; however, total intake was greater in the AN group because of greater supplement use (P = 0.006, 0.02, and 0.01, respectively). The AN group had greater intakes of vitamins A, D, and K and of most of the B vitamins, and significantly more girls with AN met the Dietary Reference Intake for calcium (P = 0.01) and vitamin D (P = 0.02) from supplement use. Fat intake predicted ghrelin, insulin, and IGF-I concentrations; carbohydrate intake predicted adiponectin. Resting energy expenditure was lower (P < 0.0001) and leisure activity levels higher in the AN group.

Conclusions: Despite outpatient follow-up, community-dwelling girls with AN continue to have lower fat and higher fiber intakes than do healthy adolescents, which results in lower calorie intakes. Nutritionally related hormones are associated with specific nutrient intakes.

FIGURE 1

Mean (±SEM) macronutrient intakes in 39 girls with anorexia nervosa (AN) and in 39 healthy control subjects. The girls with AN had a lower absolute intake of fats and a higher intake of fibers than did the control subjects. Compared with the control group, the percentage of energy derived from fats was lower and the percentage of energy derived from carbohydrates and proteins was greater in the AN group. Student’s t test was used to compare the data between groups.

FIGURE 2

Relation between food intake and concentrations of hormones affected by nutrition in adolescent girls with anorexia nervosa (AN) and healthy adolescents. Correlational analysis was used to determine the associations between food intake and nutritionally modulated hormones. Associations of adiponectin with carbohydrate intake and of ghrelin and insulin with fat intake are reported for 20 girls with AN and 21 control subjects; associations of insulin-like growth factor I (IGF-I) with fat intake are reported for 39 girls with AN and 39 control subjects. Adiponectin concentrations correlated positively with carbohydrate intake. A positive association was observed between fat intake and concentrations of insulin and IGF-I, and an inverse association was observed between fat intake and ghrelin concentrations.