Psychosomatic Medicine
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Published online before print January 5, 2009, 10.1097/PSY.0b013e3181904f59
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Psychosomatic Medicine 71:93-97 (2009)
© 2009 American Psychosomatic Society

ORIGINAL ARTICLES

Changes of Body Composition in Bulimia Nervosa: Increased Visceral Fat and Adrenal Gland Size

Burkhard Ludescher, MD, Gabriele Leitlein, MD, Jacques-Emmanuel Schaefer, MD, Stefanie Vanhoeffen, MD, Sophia Baar, MD, Juergen Machann, PhD, Claus D. Claussen, MD, Fritz Schick, MD, PhD and Gerhard W. Eschweiler, MD

From the Department of Diagnostic Radiology, University Clinic Tuebingen, Section on Experimental Radiology (B.L., J.M., C.D.C., F.S.); and Department of Psychiatry and Psychotherapy, University Clinic Tuebingen, Osianderstrasse, Tuebingen, Germany (G.L., J.-E.S., S.V., S.B., G.W.E.).

Address correspondence and reprint requests to Dr. Burkhard Ludescher, Department of Diagnostic Radiology, Section on Experimental Radiology, University Clinic Tuebingen, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen, Germany. E-mail: burkhard.ludescher{at}med.uni-tuebingen.de

Objective: To study the hypothesis that young women suffering from active bulimia nervosa (BN) have more visceral fat and increased adrenal gland volumes (AGV) than healthy controls (HC).

Methods: Thirteen patients with BN of purging type and 11 healthy age and weight matched women (HC), aged between 19 and 36 years (mean 24 ± 3 years), with a BMI of 19 to 29 (mean 24 ± SD 3) were examined. BN was diagnosed by DSM-IV criteria and the severity of illness by the Eating Disorder Inventory (EDI-2). Whole body fat distribution and AGV were determined using a whole body magnetic resonance (MR) scan (T1w) and a 3D-sequence (T1w) at 1.5 Tesla. Salivary cortisol was determined at 9 AM and 4 PM.

Results: BN patients had significantly more visceral adipose tissue (VAT) (HC, 1589.3 ± 967.6 ml versus 927.2 ± 428.4 ml, p < .05) and an increased relative AGV (0.068% of body volume versus 0.048% of body volume, p < .05) compared with HC, although waist circumference and BMI did not differ. Although the VAT part in the upper abdomen was increased, especially the VAT of lower abdomen along with the pelvis or any subcutaneous fat compartment was not increased.

Conclusions: The increase of the VAT volume and the increased AGV in BN women with purging point to chronic high stress levels associated with a hyperactivity of the hypothalamic-pituitary-adrenal axis in these patients. This is the first MR study showing morphological changes in stress associated endocrine organs of young BN patients.

Key Words: adrenal gland • bulimia nervosa • fat distribution

Abbreviations: AGV = adrenal gland volume; BDI = Beck's depression inventory; BMI = body mass index; BN = bulimia nervosa; EDI = eating disorder inventory; GLM = general linear model; HC = healthy controls; HPA axis = hypothalamic-pituitary-adrenal axis; MD = major depression; MR(I) = magnetic resonance (imaging); SCAT = subcutaneous adipose tissue; SSRI = selective serotonin reuptake inhibitor; VAT = visceral adipose tissue.






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