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Adipose tissue distribution after weight restoration and weight maintenance in women with anorexia nervosa^1,2,3

¹ From the Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatric Institute, New York, NY (LESM, DAK, EB, EA, DCS, and BTW); the Body Composition Unit, New York Obesity Research Center, St Luke's-Roosevelt Hospital Center, New York, NY (WS, MP, DG, and JW); the Department of Radiology, Citigroup Biomedical Imaging Center, Weill Cornell Medical College, New York, NY (XM and DCS); Merck and Company, Rahway, NJ (SBH); and the Program for Imaging and Cognitive Sciences (JH) and the Irving Institute for Clinical and Translational Research (HNG), Columbia University Medical Center, New York, NY.

² Supported in part by the following grants: NIH DK66033, NIH DK02749, NIH DK42618, NCRR UL1 RR024156, and a CUMC Irving Scholars Award.

³ Address correspondence and reprint requests to LES Mayer, 1051 Riverside Drive, Unit 98, New York, NY 10032. E-mail: lsm16{at}columbia.edu.

Background: Body image distortions are a core feature of anorexia nervosa (AN). We, and others, previously reported abnormalities in adipose tissue distribution after acute weight restoration in adult women with AN compared with body mass index–matched healthy control women. Whether these abnormalities persist over time remains unknown.

Objectives: We aimed to 1) replicate previous findings that showed preferential central accumulation of adipose tissue in recently weight-restored AN women compared with control subjects, 2) describe the change within patients with longer-term (1-y) weight maintenance, and 3) compare adipose tissue distribution after 1-y maintenance with that of control subjects.

Design: Body composition and adipose tissue distribution were assessed by whole-body magnetic resonance imaging in women with AN shortly after weight normalization (n = 30) and again 1 y after hospital discharge (n = 16) and in 8 female control subjects at 2 time points.

Results: With acute weight restoration, AN patients had significantly greater visceral and intermuscular adipose tissue compared with control women [visceral: 0.75 ± 0.26 compared with 0.51 ± 0.26 kg in AN patients and controls, respectively (P = 0.02); intermuscular: 0.46 ± 0.17 compared with 0.29 ± 0.13 kg in AN patients and controls, respectively (P = 0.01)]. With maintenance of normal weight for 1 y, visceral adipose tissue distribution in AN patients was not different from that in healthy control subjects.

Conclusions: In adult women with AN, normalization of weight in the short term is associated with a distribution of adipose tissue that is consistent with a central adiposity phenotype. This abnormal distribution appears to normalize within a 1-y period of weight maintenance. This research was registered at clinicaltrials.gov as NCT 00271921 and NCT 00368667.