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Glucose Tolerance Predicts Short-term Refeeding Outcome in Females With Anorexia Nervosa

From the Department of Behavioral Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-City, Japan.

Address correspondence and reprint requests to Daisuke Yasuhara, MD, Department of Behavioral Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima-City 890-8520, Japan. E-mail: yasuhara{at}m3.kufm.kagoshima-u.ac.jp

Objective: Little is known about biologic predictors of refeeding outcome in anorexia nervosa (AN). Because nutritional status mirrors glucose metabolism during an oral glucose tolerance test (OGTT) in AN, this study investigated whether pretreatment glucose response patterns during the OGTT might be associated with refeeding progress in patients with AN.

Methods: Sixty-four female patients with anorexia (33 restrictors and 31 binge/purgers) and 13 healthy control subjects underwent an OGTT before nutritional rehabilitation, including desensitization to fear of energy intake of 1000 to 1600 kcal/day. Patients were divided into flat-type responders, impaired glucose tolerance (IGT)-type responders, and normal-type glucose responders. Daily energy intake, weekly weight gain, and the duration of desensitization period were evaluated until the 12th week.

Results: The patients with anorexia consisted of 20 flat-type, 21 IGT-type, and 23 normal- type responders. Normal-type responders required a shorter time to complete the desensitization period than other responders (p = .003 for restrictors, p < .001 for binge/purgers). In terms of refeeding progress, significant group effects for daily energy intake and weekly weight gain were evident in restrictors (p = .006, p = .028, respectively) and binge/purgers (p < .001, p = .003, respectively); normal-type responders showed good refeeding progress compared with other responders in both AN subtypes.

Conclusions: The present study found a close relationship between pretreatment glucose responses, therapeutic progress of desensitization to fear of energy intake, and refeeding progress in both AN subtypes. Our findings suggest that glucose tolerance may be a useful predictor of short-term refeeding outcome in this disorder.

Key Words: anorexia nervosa • fear of energy intake • energy intake • weight gain • oral glucose tolerance test • oral refeeding

Abbreviations: AN = anorexia nervosa; ANOVA = analysis of variance; AUC = insulin area under the curve; BMI = body mass index; DM = diabetes mellitus; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition; FBG = fasting blood glucose concentration; FIRI = fasting serum insulin concentration; HOMA-IR = homeostasis model assessment for insulin resistance; IGT = impaired glucose tolerance; II_15min = insulinogenic index at 15 minutes; OGTT = oral glucose tolerance test.

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